Test 3

Question 1

When describing the global framework, which of the following would the community health nurse be least likely to include?
A) Population
B) Provider
C) Procedure
D) Physician

Answer 1

Ans: D
Feedback:
The global framework is bounded by a context and includes three parts, the three Ps. These are the population, the provider, and the procedure. A physician would be included as a provider.

Question 2

When applying the Universal Imperatives of Care, which of the following would be the priority?
A) Mortality
B) Daily functioning
C) Decision-making
D) Cost

Answer 2

Ans: A
Feedback:
The Universal Imperatives of Care include mortality, morbidity, daily functioning, decision-making, and cost. This paradigm underscores the notion of first things first. That is, one must be alive and well before interventions focus on functioning or decision-making.

Question 3

A nursing student is considering a career in international community health nursing.
Which of the following statements is accurate regarding the context of international community health nursing? Select all that apply.
A) Global community health care is complex and is affected by multiple factors relating to geography, history, politics, culture, religion,
and economy.
B) The types of services that can be provided include a range from providing clinical services to policy making at an international
level.
C) People’s conceptions of health, wellness, and illness are static from culture to culture.
D) By looking through a computer window, the student is able to see almost anywhere, connect to about any person, and access
information about almost any concept.
E) The ways in which people view nurses and other health care providers are affected by
their attitudes toward women, their culture,
and belief systems.

Answer 3

Ans: A, B, D, E
Feedback:
The following statements are true: Global community health care is complex and is
affected by multiple factors relating to geography, history, politics, culture, religion, and economy; The types of services that can be provided range from providing clinical services to policy making at an international level. By looking through a computer window, the student is able to see almost anywhere, connect to about any person, and access information about almost any concept. The ways in which people view nurses and other health care providers are affected by their attitudes toward women, their culture, and their belief systems. The statement that people’s conceptions of health are static from culture to culture is false. Indeed, people’s conceptions of health, wellness, and illness vary from culture to culture.

Question 4

A community health nurse is preparing a presentation for a community group about
tuberculosis (TB) and its current epidemic status. Which of the following would the nurse
include in the presentation about this
disease?
A) TB kills about 1.7 million people each year.
B) All persons who are infected by the causative organism become ill and can spread the causative organism to others throughout the remainder of their lifetime.
C) Three-fourths of the world’s population is thought to be currently infected by the
causative organism.
D) The highest number of deaths is in Eastern
Europe.

Answer 4

Ans: A
Feedback:
TB kills approximately 1.7 million people each year. Only 5 to 10 of those infected become ill or can spread the causative organism to others within their lifetime. One-third of the world’s population is thought to be currently infected by the causative organism (Tubercle bacillus). The highest number of deaths occur in Africa.

Question 5

A community health nurse has identified noise as an environmental hazard. Using the
Blumenthal classification, the nurse would
identify this as which of the following classes?
A) Infectious agents
B) Asphyxiates
C) Poison
D) Physical agents

Answer 5

Ans: D
Feedback:
The Blumenthal classification lists classes of environmental hazards. They include infectious agents (e.g., bacteria and viruses), respiratory fibrotic agents (e.g., coal dust), asphyxiates (e.g., carbon monoxide), poison (e.g., pesticides), physical agents (e.g., noise),
psychological agents (stressful synergisms such as crowding combined with noise), mutagens (e.g., dioxin), teratogens (e.g., cadmium), and carcinogens (e.g., cigarette
smoke).

Question 6

Which one of the following factors has resulted in the Era of Chronic Long-Term Health Conditions?
A) Decreased usage of tobacco by young populations
B) Despite programs of control, many infectious diseases persist, with many people surviving to experience chronic, long-term conditions secondary to the infectious disease.
C) Shorter life expectancies due to chronic
diseases
D) Death from infectious diseases results in a
decrease in degenerative diseases.

Answer 6

Ans: B
Feedback:
Despite the programs of control, many infectious diseases persist. However, populations now survive and also experience chronic, long-term conditions. These conditions affect mortality and morbidity, daily functioning, decision-making, and cost. Thus, the longevity that has resulted from meeting the challenges of the Era of Infectious Diseases compounds the more recent emergence of chronic diseases in many countries. The emergence of multidrug-resistant diseases, continued persistence of infectious disease, and urbanization with deforestation have resulted in new and emerging infectious diseases and conditions.

Question 7

When reviewing statistics about illnesses worldwide, which of the following would the
nurse identified as the most common and a leading cause of mortality?
A) Tuberculosis
B) Smallpox
C) Acute respiratory tract infection
D) Infectious diarrheal disease

Answer 7

Ans: C
Feedback:
The most common illness in the world and a leading cause of mortality is acute respiratory tract infection (ARI). Three million deaths annually are attributed to ARI among
children younger than 5 years of age, usually from pneumonia. Tuberculosis is considered
epidemic today. Smallpox has been eradicated. Infectious diarrheal disease has been reduced due to oral rehydration therapy and improvements in water and sanitation.

Question 8

help achieve a reduction in the number of measles deaths worldwide?
A) Integrated Management of Childhood Illness (MCI)
B) Global Alliance for Vaccine and Immunization
C) Oral rehydration therapy
D) Geographical information systems

Answer 8

Ans: A
Feedback:
The MCI is the intervention considered to have the greatest impact on reducing measles.
It provides wide immunization coverage, rapid referral of serious cases, prompt recognition of secondary conditions, and improved nutrition and vitamin A supplementation. The Global Alliance for Vaccine and Immunization is an interagency initiative that seeks to protect every child against vaccine-preventable diseases. This initiative addresses all of these types of diseases. Oral rehydration therapy has been used to reduce mortality associated with diarrheal diseases. Geographical information systems is not a program but a means to monitor diseases.

Question 9

Which one of the following statements about
Is poliomyelitis the most accurate?
A) Polio is not endemic in any countries at
present.
B) Polio has been eliminated worldwide.
C) Rotary International has contributed no funds but many hours of manpower to eradicate polio.
D) Polio has been eliminated from the Western hemisphere.

Answer 9

Ans: D
Feedback:Polio has been eliminated from the Western Hemisphere. It is now almost eliminated worldwide. Polio is endemic in Afghanistan, India, Pakistan, and Nigeria. Rotary International has contributed over $900
million dollars to help eradicate this disease.

Question 10

A community health nurse is reading a journal article about global health and communicable diseases. The article states that elimination is the goal. The nurse interprets this to mean which of the following?
A) There are no further cases of the disease
anywhere.
B) No further preventive efforts are necessary.
C) The disease is no longer a public health threat.
D) The disease has been interrupted in a
geographic area.

Answer 10

Ans: D
Feedback:
The term elimination is used when a disease has been interrupted in a defined geographic
area. In 1991, WHO defined elimination as a reduction of prevalence to less than one case per 1 million population in a given area.
Eradication means interruption of person-to-person transmission and limitation of the reservoir of infection so that no further preventive efforts are required; it indicates a status whereby no further cases of a disease occur anywhere. The term control indicates that a specific disease has ceased to be a
public health threat.

Question 11

A community health nurse instructs a local community group on how to prepare homemade oral rehydration solution. Which of the following ingredients would the nurse include?
A) Sea water
B) Table salt
C) Baking soda
D) Crushed bananas

Answer 11

Ans: B
Feedback:
Oral rehydration solution consists of 1 L of safe water, to which is added half a teaspoon of salt and four large spoons of sugar. In addition, bananas or green coconut water are encouraged to compensate for the
loss of potassium.

Question 12

Communicable disease is a global health concern with the primary goal of eradicating communicable diseases worldwide.
Achievement of this goal would involve
A) interrupting disease in a limited, defined
geographic area.
B) reducing the incidence and/or prevalence of communicable diseases.
C) establishing primary health care services for all people on the globe.
D) interrupting transmission and reservoir of
infection to prevent further cases.

Answer 12

Ans: D
Feedback:
Eradication is an ambitious and expensive goal and has occurred with smallpox in 1977
and is under way with other diseases such as poliomyelitis, guinea worm, leprosy, and measles so that many diseases can be eradicated early in the 21st century. One major means of eradicating communicable diseases is to interrupt the transmission and reservoir, thereby preventing the development of new cases. Interrupting disease in a limited area may be a starting point, but more widespread involvement is needed. Reducing the incidence or prevalence would provide indications about the effects of attempting to eradicate the disease. Establishing primary health care services is the goal of Alma-Ata Health for All.

Question 13

Is immunization true?
A) The World Health Organization estimates that a billion more lives could be saved each year with immunizations.
B) Vaccines are one of the most cost-effective
interventions found in public health.
C) Half of the world’s children are being reached with essential vaccines.
D) In the United States, toddlers are thoroughly vaccinated.

Answer 13

Ans: B
Feedback:
Vaccines are one of the most cost-effective interventions found in public health. The World Health Organization estimates that 3 million more lives could be saved each year with immunizations. Three-fourths of the world’s children are being reached with essential vaccines. In the United States, only 10% of toddlers are protected against measles, mumps, and rubella via vaccinations.

Question 14

A community health nurse is working with an international agency in Australia. The nurse would most likely encounter which type of health care system?
A) Entrepreneurial
B) Welfare-oriented
C) Comprehensive
D) Socialist

Answer 14

Ans: B
Feedback:
Australia subscribes to a welfare-oriented health care system in which statutory programs drive these systems to support the cost of health care for all, or almost all, of the population through their <national health insurance. An Entrepreneurial Health Care System, found in the United States, is one in which the country’s health care system is based, in part, on its political economy. A Comprehensive Health Care System is a step away from the welfare-oriented type
in that substantial modifications exist in delivery and financing that result in universal
entitlements. These systems are found in Scandinavian countries, Great Britain, and New Zealand. Socialist health care systems came about through social revolutions that abolished free-market economies and replaced them with socialism, where the health care system is also socialized. They are found in countries such as Russia, Eastern Europe, Albania, Bulgaria, Czechoslovakia, East Germany, Hungary, Poland, Romania, Yugoslavia, and China.

Question 15

Which of the following are factors that influence populations’ perceptions of health and health status and their receptivity to community health nursing programs? Select all that apply.
A) Their perceptions of healthy food
B) Their attitudes toward women
C) Their culture
D) Their belief systems
E) Their geographic location

Answer 15

Ans: B, C, and D
Feedback:
The factors that influence populations’ perceptions of health and health status and their receptivity to community health nursing programs include their attitudes toward women, their culture, and their belief systems. Their perceptions of healthy food or their geographic location would not have a direct bearing on their perception of health, health status or receptivity to community
health nursing programs.

Question 16

A community health nurse is preparing to work in a country in which women are viewed
as weak and ineffectual. Which of the following would the nurse need to do first?
A) Determine his or her own position and beliefs about this view
B) Develop a basic plan to change the view of
women
C) Become aware of possible areas that might
impact care
D) Avoid situations involving the care of women

Answer 16

Ans: A
Feedback:
Community health nurses first need to determine their own position on this issue and
come to terms with it, realizing that it may impact their care. Once aware, the nurses can then prepare appropriately for situations in which their care may be affected. It would be
inappropriate and probably impossible to attempt to change the view or avoid situations
involving the care of women.

Question 17

Which of the following statements about the personal and professional perceptions that nurses have of providing community health nursing interventions within an international context is most accurate?
A) Community health nurses are not susceptible to preconceived perceptions and biases.
B) It is not necessary for community health
nurses to face their own beliefs.
C) Community health nurses are universally opposed to female circumcision, the use of
non-licensed personnel to carry out medical treatments, and the use of Western interventions used simultaneously with other methods of treatment.
D) It is critical for community health nurses to face their own beliefs when confronting
female circumcision, the use of non-licensed personnel to carry out medical treatments, and the use of Western interventions used simultaneously with other methods of
treatment.

Answer 17

Ans: D
Feedback:
It is critical for community health nurses to face their own beliefs when confronting
female circumcision, the use of non-licensed personnel to carry out medical treatments, and the use of Western interventions used simultaneously with other methods of treatment. Community health nurses are as susceptible as any other group of people to preconceived perceptions and
biases. Community health nurses may not be universally opposed to female circumcision, the use of non licensed personnel to carry out medical treatments, and the use of Western interventions used simultaneously with other
methods of treatment.

Question 18

Community health nurses need to be knowledgeable about the World Health Organization.
Organization because its mission reflects which of the following?
A) Collaboration in health development to free
the world from poverty
B) Service as an independent agency providing economic and humanitarian assistance overseas
C) Representation of global interests and
concerns of the nursing profession
D) Global health promotion by supporting development efforts of governments,
organizations, and universities throughout the
world

Answer 18

Ans: D
Feedback:
WHO’s mission reflects global health promotion by supporting the development efforts of governments, organizations, and universities throughout the world. Collaboration to free the world from poverty reflects the mission of the World Bank. Service as an independent agency for economic and humanitarian assistance describes the
mission of the United States Agency for International Development (USAID). Representation of global interests and concerns of nurses describes the mission
of the International Council of Nurses (ICN).

Question 19

An instructor in community health nursing teaches a group of students about the role of
the World Health Organization and global health, reviewing the importance of the Declaration of Alma-Ata. The instructor determines that the students have grasped its importance when they describe it as which of the following?
A) The beginning of the Carter Center’s work in disease prevention and agriculture
B) A formal document written by 134 nations in 1978 to achieve health for all
C) Participatory development activities, working in partnership with voluntary organizations
D) Alliance building and communicating best
practices for global health development

Answer 19

Ans: B
Feedback:
The declaration represents the work of 134 nations during a WHO/UNICEF conference
in 1978 to achieve primary health care for all. The Carter Center was founded in 1986 and is not related to the work at Alma-Ata.
Participatory development activities describe the work of the United States Agency for
International Development (USAID). Alliance building and communicating best practices
describe the Global Health Council, which is a leading private, voluntary, American nongovernmental organization.

Question 20

Which of the following statements about the International Council of Nurses (ICN) are
accurate? Select all that apply.
A) ICN represents the global interests and
concerns of the nursing profession.
B) The mission of ICN is to maintain the role of
nursing in health care through its global voice.
C) ICN has, as members, nursing organizations from 130 countries representing 13 million
nurses.
D) ICN is a governmental organization.
E) ICN employs regional nursing advisors.

Answer 20

Ans: A, B, C
Feedback:
The following statements about ICN are accurate: ICN represents the global interests and concerns of the nursing profession; the mission of ICN is to maintain the role of nursing in health care through its global voice; and ICN has, as members, nursing organizations from 130 countries representing 13 million nurses. ICN is a nongovernmental organization. Regional nursing advisors are employed at the international level of the World Health Organization.

Question 21

After teaching a class of community health nursing students about the World Health Organization, the instructor determines that the teaching was successful when the class identifies which of the following as the highest governing body?
A) World Health Assembly
B) WHO Collaborating Centers
C) The European Union
D) U.S. Agency for International Development

Answer 21

Ans: A
Feedback:
The World Health Assembly is the highest governing body within the WHO. WHO Collaborating Centers are networks of centers focusing on specific areas of expertise and carrying out the work of the member countries in these areas. The European Union is an organization that provides funding for many projects, including health. The U.S. Agency for International Development is an independent bilateral agency of the executive branch that works to enhance long-term and equitable economic growth.

Question 22

A group of students are reviewing for an examination on nongovernmental organizations that provide global interventions. The students demonstrate the need for additional study when they identify which of the following as an example?
A) Global Health Council
B) CARE
C) Carter Center
D) World Bank

Answer 22

Ans: D
Feedback:
The World Bank is an agency that focuses on economic development. It partners with countries, WHO, and other organizations. It is not a non-governmental organization. Examples of nongovernmental organizations include Global Health Council, The Center for
International Health and Cooperation,
CARE, and the Carter Center.

Question 23

Which organization would be most appropriate for the community health nurse to contact for assistance when dealing with countries shattered by war and ethnic
violence?
A) Center for International Humanitarian
Cooperation
B) CARE
C) Global Health Council
D) International Council of Nurses

Answer 23

Ans: A
Feedback:
The Center for International Humanitarian Cooperation (CIHC), founded in 1992,
promotes healing and peace in countries shattered by war, regional conflicts, and ethnic violence. CARE intervenes by responding to famines and disasters worldwide with emergency food, supplies, and rehabilitative efforts. The GHC advocates for needed policies and resources, builds networks and alliances among those working to improve health, and shares innovative ideas, knowledge, and best practices in health. The ICN represents the global interests and concerns of the nursing profession.

Question 24

Which of the following statements about the
Is the World Health Organization accurate?
A) The World Health Organization does not provide technical support for interventions or
provide assistance in developing nursing
knowledge and skills.
B) The World Health Organization can help a member state determine the drugs that are
essential and will assist in developing health
policy, project plans, and programs.
C) The World Health Organization provides medicines and other tangible resources to its
member states.
D) The World Health Organization focuses on professional issues to support the
development of particular health-related
practitioners, such as nurses.

Answer 24

Ans: B
Feedback:
The World Health Organization can help a member state determine the drugs that are
essential and will assist in developing health policy, project plans, and programs. The World Health Organization does focus on providing technical support related to the interventions and provides assistance in developing nursing knowledge and skills. The World Health Organization does not provide medicines and other tangible resources to its member states but does help member states determine the drugs that are essential and assist in developing health policy, project
plans, and programs.

Question 25

Which of the following statements regarding WHO Collaborating Centers is most accurate? A) One or two Regional Nursing Advisors carry out the work of a region that might be home to thousands of nursing personnel. B) The World Health Organization Collaborating Centers in Nursing and other fields focus on specific areas of expertise and carry out the work of the member countries in these areas. C) It is referred to as a philosophy, a movement, a way of thinking, a setting for health services, or a set of principles. D) It focuses on professional issues to support the development of particular health-related practitioners.

Answer 25

Ans: B Feedback: The World Health Organization Collaborating Centers in Nursing and other fields focus on specific areas of expertise and carry out the work of the member countries in these areas. Regional Nursing Advisors work in collaboration with WHO Collaborating Centers to accomplish the work within each region. Primary Health Care refers to a philosophy, a movement, a way of thinking, a setting for health services, or a set of principles.

Question 26

A community health nurse is working with people who experienced a tornado and have been forced to leave their homes to escape the effects of a disaster. The nurse would identify these people as which of the following? A) Indirect victims B) Refugees C) Displaced persons D) Casualties

Answer 26

Ans: C Feedback: Displaced people are those who have been forced to leave their homes to escape the effects of a disaster. Indirect victims are the relatives and friends of direct victims. Refugees are direct victims who are forced to leave their homeland, usually due to war, religious persecution, or political turmoil. A casualty is a human being who is injured or killed by or as a direct result of an accident.

Question 27

A community health nurse working as a part of a disaster response team is told that the disaster is classified as a multiple-casualty incident. The nurse would interpret this to mean which of the following? A) There is more than 1 but less than 10 casualties. B) The number of casualties is between 2 and 100. C) Casualties number over 100. D) There are too many casualties to count.

Answer 27

Ans: B Feedback: If casualties number more than two people but fewer than 100, the disaster is characterized as a multiple-casualty incident. A mass- casualty incident involves100 or more casualties.

Question 28

A community health nurse is part of a disaster response team that is first to respond to an earthquake. The team evaluates the level of destruction and devastation, identifying as which of the following? A) Intensity B) Scope C) Casualty D) Range of effect

Answer 28

Ans: A Feedback: The intensity of a disaster is determined by the level of destruction and devastation it causes. The scope of a disaster is the range of its effect, either geographically or in terms of the number of victims. Casualty refers to the human being(s) injured or killed by or as a direct result of an accident.

Question 29

Which of the following examples of disasters are natural disasters? Select all that apply. A) The Earthquake and tsunami in Japan in 2011 B) The 2008 shootings at Virginia Tech C) The terrorist attacks on the United States on September 11, 2001 D) Wildfires that affected California in October 2007 E) The oil spill in the gulf coast in 2010 that threatened hundreds of species of wildlife

Answer 29

Ans: A, D Feedback: Examples of natural disasters include the earthquake and tsunami in Japan in 2011 and wildfires that affected California in October 2007. The following disasters are man-made: the 2008 shootings at Virginia Tech; the terrorist attacks on the United States on September 11, 2001; and the oil spill in the gulf coast in 2010 that threatened hundreds of species of wildlife.

Question 30

After teaching a class about the factors that contribute to disasters, the instructor determines that the teaching was successful when the students identify which of the following as the agent? A) Population's age B) Radiation C) Level of preparedness D) Flood-prone location

Answer 30

Ans: B Feedback: The agent is the natural or technological element that causes the disaster. For example, the high winds of a hurricane and the lava of an erupting volcano are agents, as are radiation, industrial chemicals, biologic agents, and bombs. The population's age is an example of a host factor. The level of preparedness and flood-prone location are examples of environmental factors.

Question 31

Which of the following federal agencies would a community health nurse expect to be contacted to assist with a disaster in the United States? A) American Red Cross B) Federal Emergency Management Agency (FEMA) C) WHO's Emergency Relief Operations D) Pan American Health Organization

Answer 31

Ans: B Feedback: The Federal Emergency Management Agency (FEMA) is the federal agency responsible for assessing and responding to disaster events in the United States. The American Red Cross is authorized to provide disaster assistance free of charge across the country through its more than 1 million volunteers. It is not supported by the federal government. The World Health Organization's Emergency Relief Operations provide disaster assistance internationally, and the Pan American Health Organization works to coordinate relief efforts in Latin America and the Caribbean.

Question 32

The nurse is using the epidemiological triad to explain the factors contributing the disaster. Which one of the following statements about the environmental factors that contribute to disasters is most accurate? A) The environment is the natural or technological element that causes the disaster. B) The environment is the human being who experience the disaster. C) Factors that could potentially contribute to or mitigate a disaster are environmental. D) Examples of environmental factors that cause a disaster are the high winds of a hurricane and the lava of an erupting volcano.

Answer 32

Ans: C Feedback: Factors that could potentially contribute to or mitigate a disaster are environmental. The agent factor is the natural or technological element that causes the disaster, for example, the high winds of a hurricane and the lava of an erupting volcano. The host is a human being who experiences the disaster.

Question 33

A community health nurse is working with a community that is involved with identifying risk factors for program development in case of a disaster. This community is in which phase of disaster management? A) Prevention B) Preparedness C) Response D) Recovery

Answer 33

Ans: A Feedback: During the prevention phase, no disaster is expected or anticipated. The task during this phase is to identify community risk factors and develop and implement programs to prevent disasters from occurring. Disaster preparedness involves improving community and individual reactions and responses so that the effects of a disaster are minimized. The response phase begins immediately after the onset of the disastrous event. During the recovery phase, the community takes actions to repair, rebuild, or relocate damaged homes and businesses and restore health and economic vitality to the community.

Question 34

A community health nurse is working with a community that is involved with improving community and individual reactions and responses so that the effects of a disaster are minimized. This community is in which phase of disaster management? A) Prevention B) Preparedness C) Response D) Recovery

Answer 34

Ans: B Feedback: Disaster preparedness involves improving community and individual reaction and responses so that the effects of a disaster are minimized. During the prevention phase, no disaster is expected or anticipated. The task during this phase is to identify community risk factors and to develop and implement programs to prevent disasters from occurring. The response phase begins immediately after the onset of the disastrous event. During the recovery phase, the community takes actions to repair, rebuild, or relocate damaged homes and businesses and restore health and economic vitality to the community.

Question 35

When would the nurse expect the response phase of a disaster to occur? A) When no disaster is expected or anticipated B) Immediately after the onset of the disastrous event C) Long-term phase occurring after the disastrous event D) Prior to the disastrous event

Answer 35

Ans: B Feedback: The response phase of a disaster occurs immediately after the onset of the disastrous event. During the prevention phase no disaster is expected or anticipated. The long-term phase occurring after the disastrous event is the recovery phase. Prior to the disastrous event is the preparedness phase.

Question 36

Which of the following statements about disaster planning is most accurate? A) Disaster planning is essential for a community, business, or hospital. B) A disaster plan must be lengthy and detailed. C) A disaster plan should be created by the person responsible for the emergency management of the community. D) It is assumed that all professionals have addressed their personal preparation.

Answer 36

Ans: A Feedback: Disaster planning is essential for a community, business, or hospital. A disaster plan need not be lengthy. A disaster plan should be created by all involved, including community leaders, health and safety professionals, and laypeople. All nurses should address their own personal preparedness to respond in a disaster, but this may not be assumed.

Question 37

Which of the following are necessary components of a nurse's personal preparedness? Select all that apply. A) Workplace and community disaster plans have been reviewed by the nurse. B) An individual disaster plan for the nurse's own family has been developed. C) The nurse participated in disaster drills at the workplace and had a family disaster drill to practice what actions to take in the event of a disaster. D) It is not necessary for the nurse to bring copies of their nursing license and driver's license. E) In the case of an actual disaster, the nurse will be able to use equipment made available to them.

Answer 37

Ans: A, B, C Feedback: To be personally prepared, a nurse should have read and understood workplace and community disaster plans, should have developed a disaster plan for his or her own family, and should have participated in disaster drills. Nurses preparing to work in disaster areas should bring copies of their nursing license and driver's license and bring basic equipment.

Question 38

As part of secondary prevention, the community health nurse engages in crisis intervention to achieve which of the following? A) Reestablish equilibrium to the lives of those involved B) Prevent the crisis altogether C) Involve as many people as possible in the resolution D) Triage clients during the recovery phase of the crisis

Answer 38

Ans: A Feedback: The stated goal of crisis intervention is to reestablish equilibrium. Prevention is the best approach, but some crises, such as natural disasters, cannot be prevented. They can, however, be prepared to decrease the negative effects of the crisis as much as possible. It is important to have an adequate number of people to come to a resolution. However, too many people involved in the resolution may cause additional confusion, chaos, and unnecessary delays. Triage decisions need to be made during the response phase of the disaster or crisis, not deferred until the recovery phase. Triage is an ongoing process throughout the response phase.

Question 39

A community health nurse is engaged in primary prevention activities related to disasters. Which of the following would be examples of appropriate activities? Select all that apply. A) Providing anticipatory guidance B) Practicing an escape plan C) Providing emergency assistance D) Planning disaster drills E) Providing immediate response F) Reducing the degree of disability

Answer 39

Ans: A, B, D Feedback: Anticipatory guidance, practicing escape plans, and planning disaster drills all constitute primary prevention activities. Providing emergency assistance and immediate response reflect secondary prevention activities. Reducing the degree of disability or damage resulting from the disaster reflects tertiary-level prevention activities.

Question 40

When describing primary prevention activities that would occur in the preparedness phase of a terrorist attack involving biologic weapons like smallpox or anthrax to a local community group, which of the following would the nurse include? A) Investigating outbreaks to determine source B) Administering vaccines C) Screening suspected cases D) Treating people who have been infected

Answer 40

Ans: B Feedback: Primary prevention activities that would occur in the preparedness phase of a terrorist attack involving biologic weapons like smallpox or anthrax would include administering vaccines. Investigating outbreaks to determine the source, screening suspected cases, and treating people who have been infected would be secondary prevention activities.

Question 41

A community health nurse is assisting the local community in preparing a disaster plan. Which of the following would the nurse expect to be addressed? Select all that apply. A) Chain of command B) Routes for transportation C) Triage D) Basic equipment E) Copies of licenses

Answer 41

Ans: A, B, C Feedback: A disaster plan should address the chain of command, routes and modes of transportation, and triage methods. Basic equipment and licenses are items that a nurse should bring along when preparing to work in a disaster area.

Question 42

A community health nurse is responding to a disaster. Which of the following would most likely be the least appropriate area for the nurse to be located? A) The disaster site B) Triage C) Victim treatment area D) Local hospitals

Answer 42

Ans: A Feedback: Usually, the immediate disaster site is not the best place for the disaster nurse, who can be far more effective in the triage and treatment of victims. One of the lessons of the World Trade Center bombing was that the greatest need for medical professionals was at the local hospitals, not at the disaster site.

Question 43

When performing triage during a disaster, which color would indicate that the victim is in urgent need of care? A) Red B) Yellow C) Green D) Black

Answer 43

Ans: A Feedback: During triage, red indicates that the victim has injuries or medical problems that will likely lead to death if not treated immediately. Yellow indicates that the person has injuries that require medical attention, but time for treatment is not yet critical. Green indicates that the victim has minor injuries or is presenting with minimal signs of illness. Black indicates that the victim is dead or has suffered mortal wounds.

Question 44

A community health nurse responding to a disaster is involved with caring for the bodies of the casualties who have died. Which of the following would be an appropriate method for documentation? A) Making a note on the triage tag B) Using a toe tag for identification C) Placing the name on a casualty list D) Recording the name on the victim's body

Answer 44

Ans: B Feedback: Toe tags make documentation visible and accessible and are the most appropriate means for documentation. Making a note on the triage tag, placing the name on a casualty list and recording the name on the victim's body are inappropriate.

Question 45

Which time after the disaster would be the ideal time for this to occur? A) Within 18 hours B) 1 to 3 days C) 4 to 6 days D) 7 to 10 days

Answer 45

Ans: B Feedback: The ideal time for CISD is between 24 and 72 hours after the disaster event.

Question 46

When providing secondary prevention activities for individuals experiencing psychological consequences of a disaster, which of the following would the nurse do as a generic approach? A) Providing situational support for stress relief B) Conveying warmth and concern for the client C) Teaching about expected emotional reactions D) reunifying family members who were separated.

Answer 46

Ans: C Feedback: The generic approach is designed to reach high-risk individuals and large groups who have experienced the same disaster, teaching them about the expected emotional reactions to the type of disaster they have experienced and promoting adaptive responses. Environmental manipulation results in a change in a person's physical or interpersonal situation, providing situational support to relieve stress. An example of environmental manipulation is when a community health nurse coordinates the reunification of family members separated by the disaster. General support is defined as the caring, warmth, and concern the community health nurse conveys to the client as she or he delivers services.

Question 47

A community health nurse suspects that a client who was a victim of a disaster three months ago is experiencing post-traumatic stress disorder. Which of the following would the nurse expect to find? Select all that apply. A) Diminished startle response B) Hypervigilance C) Feelings of detachment D) Flashbacks E) Full range of affect

Answer 47

Ans: B, C, D Feedback: Signs and symptoms of post-traumatic stress disorder include increased startle response, hypervigilance, feelings of detachment, flashbacks, and restricted affect.

Question 48

A group of ten people from the commune in the hills come into town dressed in robes and have their faces covered. They have weapons hidden in their clothing and begin entering the three banks in town to rob them. These actions can be classified as either of the following? A) Natural disaster B) Terrorism C) Casualty D) Adventitious crisis

Answer 48

Ans: B Feedback: The actions resemble terrorism, the unlawful use of force and violence against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof in furtherance of political or social objectives. The actions are not a natural disaster. Casualty refers to the person who is injured or killed by or as a direct result of an accident. An adventitious crisis is an event that is out of the ordinary in magnitude and personal experience.

Question 49

After teaching a group of students about agents associated with chemical warfare, the instructor determines that additional teaching is needed when the students identify which as an example? A) Explosives B) Nerve agents C) Anthrax D) Jet fuel

Answer 49

Ans: C Feedback: Anthrax is considered a bioweapon. Explosives, nerve agents, and jet fuel are considered agents of chemical warfare.

Question 50

Which of the following would be most appropriate for community health nurses to encourage when helping communities cope with the anxiety associated with terrorism? A) Maintaining high levels of alertness and fear B) Spending time with children and young people C) Spending more time indoors D) Keeping a fear journal

Answer 50

Ans: B Feedback: Most young people carry a charge of positive energy that is infectious. Maintaining high levels of alertness and fear is not healthy. Instead, individuals should be a little afraid, because a certain level of fear is healthy if the person learns to use it as positive energy. Spending more time outdoors is a helpful remedy. Individuals should keep a courage journal; fear immobilizes and courage takes action.

Question 51

A community health nurse is preparing a presentation for a community group about possible agents of terrorism. Which of the following would the nurse include as an example of a bioweapon? Select all that apply. A) Mustard gas B) Sarin C) VX gas D) Nerve agents E) Bombs

Answer 51

Ans: A, B, C Feedback: Bioweapons include mustard gas, sarin, VX gas, and anthrax. Nerve agents and bombs are examples of chemical warfare agents.

Question 52

A community health nurse is reviewing the medical records of several families in the community who have experienced varying crises. The nurse identifies which of the following as developmental crises? Select all that apply. A) A windstorm that damaged 20 homes in a community B) Grandpa Jones dying at age 82 C) A couple getting engaged D) The Smiths getting a divorce E) The Jones experiencing a home invasion F) Seven people died in an automobile crash

Answer 52

Ans: B, C, and D Feedback: Developmental crises are periods of disruption that occur at transition points during normal growth and development. Developmental crises, as a rule, do not occur suddenly. They are more evolutionary than revolutionary. Even the advancing age, illness, or death of a A grandparent or parent is a developmental expectation. However, the actual event may occur suddenly. Experiencing damage from a windstorm, a home invasion, or an automobile crash is a situational crisis.

Question 53

A community health nurse is preparing a presentation for a community center group about crisis. Which of the following concepts about situational crises should be included in the presentation? Select all that apply. A situational crisis is a stressful, disrupting event arising from external circumstances that occur suddenly to a person, group, aggregate, or community. B) Situational crises can be predicted, expected, and planned. C) Situational crises are never positive. D) Situational crises often occur without warning. E) Situational crises occur to people because of where they are in time and space.

Answer 53

Ans: A, D, E Feedback: A situational crisis is a stressful, disrupting event arising from external circumstances that occur suddenly to a person, group, aggregate, or community. Situational crises often occur without warning. Situational crises occur for people because of where they are in time and space. Situational crises cannot be predicted, expected, or planned. Some situational crises arise from positive events such as significant job promotion or sudden acquisition of great wealth because the change makes increased demands on individuals who must make major life adjustments.

Question 54

Which one of the following statements about Which primary prevention method for family violence is most accurate? A) The cycle of violence within the family cannot be interrupted. B) Persons who have been victims of family violence will repeat the behavior with others. C) Primary prevention includes planned activities undertaken by the nurse to prevent an unwanted event from occurring. D) It is not possible for the community health nurse to foster healthful practices that will counteract unhealthful influences.

Answer 54

Ans: C Feedback: Primary prevention includes planned activities undertaken by the nurse to prevent an unwanted event from occurring. The cycle of violence within the family can be interrupted, and people who have been victims of family violence can learn to use more appropriate coping strategies. It is possible for the community health nurse to foster healthy practices that will counteract unhealthful influences.

Question 55

The nursing student reads the textbook in preparation for a class meeting about primary, secondary, and tertiary prevention related to families in crisis. The student determines which one of the following statements is most accurate regarding the levels of prevention? A) Often, people in crisis are temporarily helpless and unable to cope on their own but are receptive to outside influence. B) Secondary prevention interventions include taking action to prevent the unwanted event from occurring. C) Tertiary prevention focuses on moving past the crisis and returning to the precrisis state. D) Primary prevention is the least effective level of intervention in terms of promoting the client's health and containing costs.

Answer 55

Ans: A Feedback: Often, people in crisis are temporarily helpless and unable to cope on their own, but understand the need for outside help and are receptive to other people's suggestions. Primary prevention, not secondary prevention, involves actions that help to prevent an unwanted event from occurring. Tertiary prevention focuses on moving past the crisis, although returning to the precrisis state may not be possible. Primary prevention is the most effective level of intervention in terms of promoting client's health and containing costs.

Question 56

After teaching a class about family and domestic violence directed toward children as a community health problem, which of the following, if stated by the class, indicates to the instructor that the teaching was effective? A) Family violence is new and occurs as a result of our fast-paced technological society. B) Family violence has occurred in most countries for centuries, as children have been thought of as the property of their parents. C) Family violence occurs mostly in the urbanized areas of the United States, where exposure to crime is more prevalent. D) Family violence is decreasing in industrialized countries in the world as a result of more public awareness.

Answer 56

Ans: B Feedback: The history of family and domestic violence is long. For centuries, children were thought of as the property of their parents, and any treatment doled out by the parents was their prerogative. It is only fairly recently in history (early 1900s) that groups have become concerned and begun to do something about family violence. Family violence is brought to the attention of officials more frequently today than in yesteryear, especially in urban areas where more people live, but it occurs throughout the world in urban, rural, and remote areas with no signs of decreasing. Family violence in the United States occurs mostly in urbanized areas, where exposure to crime is more prevalent. Family violence is decreasing in industrialized countries around the world as a result of increased public awareness.

Question 57

After teaching a group of students about abuse and families, the instructor determines that the students have an understanding of this issue when they state which of the following? A) Less than 10% of women worldwide reported being physically abused by an intimate partner at some point in their lives. B) A woman's risk of intimate partner violence decreases during pregnancy but increases once the baby is born. C) Intimate partner violence is a leading cause of morbidity and mortality in women worldwide. D) Intimate partner violence is a private matter and not a public health issue

Answer 57

Ans: C Feedback: Intimate partner violence is a leading cause of morbidity and mortality in women worldwide and is a public health issue. It is estimated that between 10% and 52% of women report being physically abused by an intimate partner at some point in their lives worldwide. A woman's risk of intimate partner violence increases during pregnancy, with 44% to 48% of all women being abused at least once during the pregnancy.

Question 58

In preparation for an examination on the history of family violence, a group of students reviews the various laws enacted for protection. The students demonstrate understanding when they identify which of the following was one of the earliest laws enacted? A) Child Abuse Prevention and Treatment Act B) Family Violence Prevention and Services Act C) Keeping Children and Families Safe Act D) Child Abuse Prevention and Treatment and Adoption Reform Act

Answer 58

Ans: D Feedback: In 1974, the Child Abuse Prevention and Treatment Act was passed, becoming Public Law 93-247 (PL 93-247). The Child Abuse Prevention and Treatment and Adoption Reform Act of 1978 was followed by the Family Violence Prevention and Services Act of 1984. Later, all three acts were consolidated into the Child Abuse Prevention, Adoption, and Family Services Act of 1988 (Public Law 100-294), and most recently, the Act was amended and reauthorized as the Keeping Children and Families Safe Act.

Question 59

A community health nurse suspects Munchausen syndrome by proxy when a child A) experiences seizures only when a parent is present, not if a third party is present. B) has stunted growth and shortened limbs that have been noticeable since birth. C) has a noticeable limp when wearing shoes but not in bare feet. D) has periods of acting out and misbehaving, especially when there is company.

Answer 59

Ans: A Feedback: Experiencing seizures only when a parent is present would be a red flag for this syndrome if it were occurring in a child. Stunted growth, limping, or acting out are not associated with Munchausen syndrome by proxy.

Question 60

Which of the following would lead to community health nurse to suspect possible child neglect? Select all that apply. A) 15-year-old Lucy misses school once a week to watch her baby sister while Mom works. B) 6-year-old Sam plays in the yard with a sweater on when it is 60 degrees outside. C) Twins, Bobby and Billy, arrive at school in dirty and smelly clothing most school days. D) 11-year-old Samantha comes to school without lunch or lunch money each day. E) 9-year-old Tommy misses school two or three times a month due to asthma attacks. F) 14-year-old Jennifer watches her neighbor's 2 year-old every Saturday.

Answer 60

Ans: A, C, and D Feedback: Educational neglect involves Lucy missing school to watch her baby sister, and general neglect is evident for the twins and Samantha. Sam may be appropriately dressed based on how hard and long he is playing he may be comfortable. Although Tommy is missing a number of days of school, he has a legitimate excuse. Fourteen is an appropriate and legal age to babysit.

Question 61

Which of the following would the community health nurse identify as an act of sexual exploitation of a child? A) Child pornography B) Child molestation C) Fondling of child's genitals D) Vaginal penetration with an object

Answer 61

Ans: A Feedback: Sexual exploitation of children includes conduct or activities related to pornography that depict minors in sexually explicit situations and the promotion of prostitution by minors. Sexual assault includes rape, gang rape, incest, sodomy, lewd, or lascivious acts with a child younger than 14 years of age (in most states), oral copulation, fondling of the child's genitals, penetration of the genital or anal opening by a foreign object, and child molestation.

Question 62

A community health nurse assesses a child during a home visit. Which of the following would lead the nurse to suspect that the child is a victim of sexual abuse? A) Bruising of the arms and back B) Evidence of numerous dental caries C) Complaints of pain on urination D) Burns on the hands and feet

Answer 62

Ans: C Feedback: A sign of sexual abuse would be complaints of pain on urination or defecation. Bruising on the arms and back and burns on the hands and feet would suggest physical abuse. Numerous dental caries may suggest neglect.

Question 63

A group of families are attending a local community group for a class on Internet safety and children. Which of the following statements by the group indicates effective teaching? A) It's not so much the time they spend but the sites they use. B) We'll move the computer to the family room so we can easily observe the child's internet use. C) We'll set the Internet browser feature to medium. D) The firewall program that we have from 2 years ago should still be good.

Answer 63

Ans: B Feedback: To promote Internet safety with children, the computer should be placed in a high-traffic area. area in the home so that others can easily observe what is going on. Parents need to monitor the time as well as the sites that the child uses. The Internet security browser should be set to high. With the advances in technology, a firewall program that is 2 years old may not be adequate to protect the child. However, it would be better than no firewall program at all.

Question 64

While visiting a family in their home, a community health nurse hears a parent screaming who says, Everything you do is wrong. Can't you do anything right ever? The nurse suspects which of the following? A) Neglect B) Emotional abuse C) Sexual abuse D) Physical abuse

Answer 64

Ans: B Feedback: Emotional abuse involves psychological mistreatment or neglect and may involve verbal abuse, such as statements like Everything you do is wrong. Can't you do anything right? Neglect occurs when physical, emotional, medical, and educational resources necessary for healthy growth and development are withheld or unavailable. Sexual abuse involves acts of sexual assault or sexual exploitation of a minor. Physical abuse is intentional harm that results in pain, physical injury, or death.

Question 65

When describing the cycle of violence to a group of students, the instructor includes which of the following as occurring as the cycle continues? A) Frequency of the cycle slows B) Tension-building occurs less often C) Loving reconciliation lasts longer D) Acute battering occurs more often

Answer 65

Ans: D Feedback: As the cycle of violence continues, the frequency of the cycle increases, with the tension-building phase and the acute battering incident occurring more often and the loving reconciliation phase eliminated. Without intervention, this shorter, more violent cycle becomes increasingly risk-filled, for outcomes that may lead to injury or maiming of a partner, incarceration, or death of a partner.

Question 66

Which of the following would a community health nurse expect to assess in a perpetrator of intimate partner violence? A) Occasional marijuana use B) High academic achievement C) Belief in male dominance D) Desire for complacency

Answer 66

Ans: C Feedback: Characteristics of perpetrators of intimate partner violence include a belief in strict gender roles, such as male dominance, heavy alcohol and drug use, low academic achievement, and desire for power and control in relationships.

Question 67

When discussing elder abuse with a senior citizen group, which of the following would community health include? A) Older men experienced abuse at a higher rate than elderly women. B) Types of elder abuse include physical abuse, emotional abuse, neglect, and exploitation. C) The majority of cases of elder abuse are perpetrated by persons unknown to the victim. D) Elders with dementia are less likely to be abused since they have less social interactions.

Answer 67

Ans: B Feedback: Types of elder abuse include physical abuse, emotional abuse, neglect, and exploitation. Older women experienced abuse at a higher rate than elderly men. The perpetrators of elder abuse may be either known or unknown to the elder. Some elders are especially vulnerable to elder abuse.

Question 68

A community health nurse is designated as a mandated reporter. Which of the following best describes this designation? A) The nurse must witness abuse and neglect before being mandated to report. B) The nurse commands that battered women report the abuse. C) The supervising community health nurse is responsible for reporting only known cases of elder abuse. D) The nurse must report any case of known or suspected abuse and neglect in children or elders.

Answer 68

Ans: D Feedback: The abuse or neglect simply needs to be suspected in order for the nurse to report. In most states, the nurse can receive a jail sentence and a fine for not reporting suspected abuse. Reporters may never witness the actual abusive event, but they can often see the resulting damage. Each nurse follows through with reporting abuse and neglect cases she or he suspects according to the community's laws.

Question 69

A community health nurse is providing a community education program about suicide. Which of the following would the nurse include as a common method used by women? A) Hanging B) Firearms C) Vehicle crash D) Overdose

Answer 69

Ans: D Feedback: Women usually choose less violent methods, such as overdosing on medications. Men choose more violent forms of suicide, such as hanging, use of firearms, or vehicle crashes.

Question 70

Which of the following would be least appropriate for a community health nurse to include in a plan of care at the secondary prevention level for families who may need to respond in a case of crisis in the future? A) Teaching social problem-solving skills B) Helping women develop assertiveness skills C) Providing parenting classes D) Helping to reestablish a sense of safety

Answer 70

Ans: D Feedback: Helping to reestablish a sense of safety would be appropriate at the secondary level of prevention. Teaching social problem-solving skills, helping women develop assertiveness skills, and providing parenting classes are appropriate primary prevention level activities.

Question 71

When assessing a family in crisis, which of the following would the community health nurse need to do first? A) Assess the nature of the crisis B) Determine client's perception C) Define available supports D) Assess coping abilities

Answer 71

Ans: A Feedback: Initially, the nurse must assess the nature of the crisis and the client's response to it. Next, the nurse focuses on the clients' perceptions of the event. Then the nurse determines who is available for support for the individual or family. Finally, the nurse assesses the client's coping abilities.

Question 72

A community health nurse is developing a plan of care for families in crisis. Which of the following would be most appropriate for the nurse to include? A) Encourage clients to suppress feelings to minimize pain B) Avoid correcting distorted facts to reduce stress C) Allow clients to blame others for the crisis D) Help clients confront crisis

Answer 72

Ans: D Feedback: In a crisis, the community health nurse encourages clients to accept help by acknowledging the problem. The nurse should encourage clients to express their feelings openly, assist them in finding facts (distortions create additional tension that may lead to maladaptive responses), and avoid blaming others to promote responsibility for problem solving.

Question 73

Critical population health indicators that affect childbearing women, infants, toddlers, and Preschool populations globally and in the United States include which of the following? Select all that apply. A) Maternal mortality rate B) Infant mortality rate C) HIV/AIDS D) Crude mortality rate E) Fetal alcohol syndrome

Answer 73

Ans: A, B, C, E Feedback: Critical population health indicators that affect childbearing women, infants, toddlers, and Preschool populations globally and in the United States include the maternal mortality rate, infant mortality rate, HIV/AIDS, and fetal alcohol syndrome. The crude mortality rate does not apply specifically to childbearing women infant, toddler, and preschool populations.

Question 74

Which one of the following statements about low-birth-weight and very-low-birth-weight babies is most accurate? A) Low birth weight is more common in Whites and Hispanics than in African Americans. B) Birth weight is one of the most important predictors of infant mortality. C) The incidence of low-birth-weight in the United States is decreasing in relation to the increase in multiple births. D) Recent trends in very-low-birth-weight babies show that they continue to have morbidity with significant increases in survival.

Answer 74

Ans: B Feedback: Birth weight is one of the most important predictors of infant mortality. Low birth weight is more common in African Americans than in whites and Hispanics. The overall incidence of low birth weight is increasing slightly, which can be explained by increased multiple births. Recent trends in very-low-birth-weight babies show that they continue to have morbidity with no significant increases in survival.

Question 75

A community health nurse is developing a program that would encourage mothers to use breast-feeding exclusively for their babies' nutrition for the first 6 months. The nurse bases this program on the understanding about which of the following? A) Exclusive breast-feeding promotes better growth and development. B) Its lower cost provides more money for other needed items. C) Infant mortality would significantly decrease. D) It would aid in decreasing maternal mortality rates.

Answer 75

Ans: C Feedback: Approximately 1.3 million infants would survive annually if mothers were able to exclusively breast-feed their infants for 6 months. The lack of breast-feeding is related to decreased survival and increased morbidity from infections, lower intelligence test scores, increased cardiac risk factors, and inadequate nutrition. The superiority of breast milk and lower costs would not be factors in developing a community health program for breast-feeding. Exclusive breast-feeding is not associated with decreasing maternal mortality rates.

Question 76

A community health nurse is integrating the Healthy People 2010 goals into suggested programs for a local community. Which of the following goals would the nurse identify as having been met? A) Reduction in low-birth-weight infants B) Reduction in total preterm births C) Increase in the number of infants put to sleep on their backs D) Increased proportion of mothers breast- feeding at 6 months

Answer 76

Ans: C Feedback: After years of working toward improving maternal and child health, the United States has made limited progress. One objective, however, has been met: 70% of infants are now being put to sleep on their backs (up from 35% baseline), largely due to public health educational efforts and reminders. Objectives for LBW, VLBW, and preterm births all moved away from their Healthy People 2010 targets. Breast-feeding is beneficial to both mother and infant, and in 2005, almost 73% of infants were breast-fed for some period of time. However, the goal has not been met.

Question 77

Which Healthy People 2020 goal has been established has been met? A) The number of infants being put to sleep on their backs and the rate for sudden infant death syndrome B) Improving the proportion of infants who are breast-fed C) Reduce the rate of fetal and infant deaths D) Reduce the occurrence of fetal alcohol syndrome

Answer 77

Ans: A Feedback: After years of working toward improving maternal and child health, the United States has made limited progress. One objective, however, has been met: 70% of infants are now being put to sleep on their backs, up from a 35% baseline. The rate of sudden infant death syndrome (SIDS) has dropped by over 50% since 1994. The proportion of infants who are breast-fed is reducing the rate of fetal and infant deaths and occurrences of fetal alcohol syndrome have not been met.

Question 78

A community health nurse is providing a class for pregnant women about the dangers of alcohol consumption during pregnancy. Which of the following would the nurse include as an effect on the newborn? Select all that apply. A) Intellectual impairment B) Low-birth-weight C) Leukemia D) Respiratory distress E) Altered growth and development F) Childhood cancers

Answer 78

Ans: A, B, E Feedback: The health of infants can be dramatically affected by maternal consumption of alcohol. The pregnancy itself can be threatened. However, the most devastating consequence of alcohol consumption during pregnancy are fetal alcohol spectrum disorders (FASD) and fetal alcohol syndrome (FAS), both of which compromise the intellectual functioning, birth weight, and altered growth and development of the infant or child. Respiratory distress, leukemia, and other childhood cancers are not associated with maternal alcohol consumption.

Question 79

A community health nurse is working with a group of pregnant women in the community to reduce lifestyle risk factors associated with low-birth-weight newborns and infant mortality. Which of the following would the nurse address? A) Multiparity B) College-level education C) Environmental toxins D) Single-gestational pregnancy

Answer 79

Ans: C Feedback: Environmental toxins are lifestyle risk factors associated with low-birth-weight newborns and infant mortality. Other risk factors include primiparity, low educational level, and multiple gestations, among others.

Question 80

A community health nurse visits a local women's health center to provide education about the effects of smoking during pregnancy. After teaching the class, the nurse determines that the women have understood the teaching when they identify which of the following as a possible maternal or infant effect:? A) Low-birth-weight newborns B) Newborn feeding problems C) Genetic malformations D) Developmental delays

Answer 80

Ans: A Feedback: One of the strongest predictors of both LBW and preterm birth is maternal smoking. Other studies have shown that there is a greater incidence of stillbirths, spontaneous abortions, and perinatal mortality in pregnancies in which women smoke. Smoking during pregnancy is not associated with genetic malformations, developmental delays, or feeding problems.

Question 81

A local community health center is providing classes to childbearing families about the effects of alcohol use during pregnancy. During one of the classes, a community health nurse describes fetal alcohol spectrum disorder (FASD). Which of the following would the nurse include as a common finding in the newborn? A) Large for gestational age B) Facial abnormalities C) Hypoactive behavior D) Enhanced intellectual development

Answer 81

Ans: B Feedback: A newborn with FASD typically exhibits facial abnormalities and is small for gestational age. age, demonstrates hyperactivity and intellectual impairment.

Question 82

While providing preconception counseling to a group of women, the community health nurse emphasizes the need for adequate weight gain during pregnancy based on the understanding of which of the following? A) Maternal nutritional habits do not affect later life. B) Inadequate weight gain increases the woman's risk for cesarean birth. C) Prolonged labor can occur with too little or too much weight gain. D) Adequate weight gain is positively correlated with normal birth weight.

Answer 82

Ans: D Feedback: Research has demonstrated a positive correlation between weight gain during pregnancy and normal birth weight in babies. Inadequate weight gain is related to LBW, premature births, and perinatal mortality. Gaining large amounts of weight can also cause problems at birth, including increased numbers of cesarean deliveries and large-for-gestational-age babies, along with the mother's retention of excessive weight. Maternal nutritional habits set gene switches that affect later life.

Question 83

After teaching a group of pregnant women about the need for proper oral health during pregnancy, which of the following statements by the group indicates the need for additional teaching? A) We should continue seeing the dentist, like We always do. B) Chewing sugar-free gum is okay, even with the pregnancy. C) If we need dental work, we can postpone it until after the birth. D) Flossing and brushing are just as important now as before.

Answer 83

Ans: C Feedback: Postponing dental work is inappropriate. Dental health procedures have generally been found to be effective and safe for pregnant women, especially during the second trimester. Statements about the importance of regular dental health checkups and proper dental hygiene, along with referrals for dental treatment when needed, indicate effective teaching. Sugar-free gums that contain xylitol and chlorhexidine may be helpful in reducing the maternal-child transmission of caries-causing bacteria.

Question 84

What are the roles that public and community health nurses need to enact in order to maximize the outcome for pregnant adolescents? Select all that apply. A) Clinician B) Educator C) Counselor D) Provider of referrals E) Friend

Answer 84

Ans: A, B, C, D Feedback: Roles that public and community health nurses need to enact in order to maximize the outcome for pregnant adolescents include clinician, educator, counselor, and provider of referrals. It is not appropriate for the nurse to enact the role of friend with pregnant adolescent clients or any other client.

Question 85

follow up. Which of the following would be appropriate to include when teaching the woman about controlling her blood pressure at this time? A) Ensuring rest periods with legs elevated B) Limiting her daily intake of fluid C) Restricting intake of fresh fruits D) Encouraging additional weight gain

Answer 85

Ans: A Feedback: Various methods are employed to attempt to prevent and control hypertension during pregnancy, namely, a diet rich in fresh fruits and vegetables, adequate fluid intake, weight gain limitations, rest, and regular exercise. These remain the most common preventive suggestions that community health nurses, in collaboration with the clients' primary health care providers can give to their pregnant clients. A calm environment, along with periods of rest with the pregnant woman either elevating her feet or reclining in a left-side-lying position is also recommended.

Question 86

During a home postpartum visit, a community health nurse suspects that the woman is experiencing depression. Which of the following responses would be most appropriate? A) You should try drinking more caffeine to help you be less tired. B) Don't worry. Good mothers don't hurt their babies. C) Try napping when the baby is napping. D) You should be able to achieve perfection with housekeeping tasks while you are still on maternity leave.=

Answer 86

Ans: C Feedback: Getting adequate sleep is important, because sleep deprivation exacerbates psychiatric symptoms. Napping when the baby naps, resting when possible throughout the day, and going to bed early (albeit with the knowledge that sleep may be interrupted two or more times to feed the infant) will provide more hours of rest and sleep. Caffeine can lead to sleep disturbance, and alcohol is a depressant that has been implicated in depression. The elimination of both is a simple yet helpful suggestion. The statement about telling the woman not worry discounts her feelings. In addition, it also may increase her anxiety because she may be worried about hurting the baby. The statement about ability to achieve perfection with housekeeping tasks while on maternity leave is counterproductive as it has been recently identified perfectionism increases the risk for postpartum depression.

Question 87

After teaching a group of students about various community nutritional programs, the instructor determines that the teaching has been successful when the students identify which of the following as a result of the WIC program? A) Increased expenditures for health care B) Decreased rates of large for gestational age babies C) Reduced rates of infant iron deficiency anemia D) Drop in breast-feeding rates

Answer 87

Ans: C Feedback: In addition to supporting women and young children with nutritious foods and achieving the initial goals of decreasing the rates of preterm and LBW babies, increasing the length of pregnancy, and reducing the incidence of infant and child iron deficiency anemia, WIC also increases breast-feeding rates and improves pregnant women's nutritional status.

Question 88

A group of nursing students are studying for a test on child health statistics. The students demonstrate that they are prepared for the test when they identify which of the following is a major cause of death in the 1- to 4-year-old population. A) Pneumonia B) Poverty C) Unintentional injuries and homicide D) Heart disease

Answer 88

Ans: C Feedback: Unintentional injuries and homicide cause most of the deaths in the 1- to 4-year-old population: motor vehicle crashes, falls, drowning, fires, and burns. Pneumonia is not a major cause of death among children. Poverty contributes to morbidity and mortality but is not a cause of death in and of itself. Heart disease is the fourth leading cause of death among young children.

Question 89

A community health nurse is developing a plan to address the nutritional needs of infants. toddlers, and preschoolers. Which of the following would the nurse need to incorporate as a major issue associated with nutritional problems? A) Life in the culture of poverty B) Overfeeding of an infant C) Cultural food preferences D) Rapid growth spurts

Answer 89

Ans: B Feedback: Overfeeding an infant can lead to childhood obesity and become a risk factor for heart disease. disease, hypertension, and diabetes. Many parents overfeed infants and toddlers and allow preschool-aged children to make inappropriate food choices, which can lead to a lifetime of nutritional problems. Poverty may limit food choices and selection of inappropriate foods. However, poverty itself does not cause nutritional problems. Although there are major differences, in food preferences and eating practices among different cultural groups, they do not account for

Question 90

A community health nurse implements a teaching program for new parents about ways to reduce infant mortality. Which suggestion would the nurse include as most important? A) Never leave the infant alone on a dressing table or couch. B) Check the temperature of the bath water before bathing. C) Stay within an arm's length when the baby is in the tub. D) Put the infant to sleep on his or her back.

Answer 90

Ans: D Feedback: Suffocation is the leading cause of death in infants. Therefore, the suggestion to put the baby to sleep on the back is a major preventive measure and the most important. Never leaving the infant alone would reduce the risk of falls, a leading case of nonfatal injuries for infants. Checking bath water temperature is appropriate to prevent burns. Staying within an arm's length while bathing is a suggestion to prevent drowning.

Question 91

A community health nurse is involved in a screening program for lead exposure. The nurse would target this program primarily at which age group? A) Birth to 1-year-olds B) 18- to 3-year-olds C) 3- to 5-year-olds D) 5- to 7-year-olds

Answer 91

Ans: B Feedback: The critical age of lead exposure (or peak level) is thought to be between 18 and 36 months. Levels generally begin to decline after age 3.

Question 92

Which of the following issues motivated the increased doses of certain vaccines and reformulated vaccines? at the start of the 21st century? Select all that apply. A) Increased virulence of the vaccine-preventable disease-causative organisms B) Pertussis immunity was found to wane with age, so the vaccine was reformulated for cocoon infants by immunizing the adults around them to prevent infant exposure. C) Varicella vaccine given in two doses has been found to increase immunity. D) Measles outbreaks were identified in populations where parents had refused MMR vaccination for their children and received personal belief exemptions.

Answer 92

Ans: B, C, and D Feedback: The following issues motivated the increased doses of certain vaccines and reformulated vaccines at the start of the 21st century:. Pertussis immunity was found to wane with age so the vaccine was reformulated to cocoon infants by immunizing the adults around them to prevent exposure of infants; varicella vaccine given in two doses has been found to increase immunity; and measles outbreaks were identified in populations where parents had refused MMR vaccination for their children and received personal belief exemptions. There is no evidence that the vaccine prevents disease; organisms have increased virulence.

Question 93

A community health nurse is making a family home visit. The family consists of the mother, father, 1-year-old, and 4-year-old. The mother states that the 4-year-old who is in preschool had a cold last week, and now the 1-year-old has it. She asks the nurse if she can use the over-the-counter cold medication that she gave to the 4-year-old for the 1-year-old. Which response would be most appropriate? A) It shouldn't be a problem if you use that same medication for the 1-year-old. B) I don't know if the medicine will work, but you can try it and see. C) That type of medicine should not be used in children under age 2. D) You should use a smaller dose but watch if it makes him irritable.

Answer 93

Ans: C Feedback: Community health nurses need to emphasize that over-the-counter cough and cold medications should not be used for children under the age 2. The Food and Drug Administration (FDA) deemed them unsafe and ineffective and most manufacturers took them off the market in the fall of 2007 in response to emergency room visits and deaths linked to their toxic effects. Therefore, the nurse would tell the mother not to use the medicine since the child is only 1 year-old.

Question 94

A community health nurse is working with a group of parents who have infants and toddlers. Which of the following would the nurse include in a teaching plan for this group about reducing dental caries? A) Serving sugary foods at mealtimes and not snacks B) Providing juice in a sippy cup between meals C) Allowing the older infant to fall asleep with a bottle D) Permitting snacking throughout the day

Answer 94

Ans: A Feedback: It is recommended that sugary foods be eaten at mealtimes and not as snacks, and that regular snack times be established. Between meals, drinks should consist of water or milk. Juice should be given only with meals. Allowing infants to fall asleep with a bottle can lead to baby bottle tooth decay or nursing caries.

Question 95

Which of the following would be appropriate as secondary prevention-level activities focusing on child abuse and neglect? A) Prenatal parent preparation classes B) Public service announcements for positive parenting C) Education to improve family functioning skills D) Respite care for families with special needs children

Answer 95

Ans: D Feedback: Providing respite care for families with children with special needs is an example of a secondary prevention action. Prenatal parent preparation classes, public service announcements, and education to improve family functioning skills are examples of primary prevention-level activities.

Question 96

As one aspect of ensuring adequate brain development in a child, a community health nurse would encourage the intake of which during the first 2 years of life? A) Vitamins B) Fats C) Protein D) Carbohydrates

Answer 96

Ans: B Feedback: During the first 2 years, when rapid myelination is taking place, 50% of total calories should come from fat, but after age 2, the choice of 1% or 2% milk should be the norm. A well-balanced diet including an adequate intake of vitamins, protein, and carbohydrates is needed for overall growth and development

Question 97

When providing safety education for parents of school-age children, the community health nurse would focus interventions on which of the following as the priority? A) Motor vehicle safety B) Water safety C) Fire safety D) Poisoning prevention

Answer 97

Ans: A Feedback: For the 1- to 9-year-old age group, motor vehicle/traffic injury, drowning, and fire/burn injuries were the top three causes of injury death. For the 10- to 19-year-old age group, motor vehicle/traffic injuries, drowning, and poisoning are the three leading causes of injury death. Thus the priority would be to focus interventions on motor vehicle safety. Although water and fire safety and poisoning prevention would be important, motor vehicle safety would be most important.

Question 98

A community health nurse is presenting a program to a local elementary parent teacher association on the topic of pediculosis. The nurse determines that the group needs additional teaching when they identify which of the following is a likely mode of transmission:? A) Coming into contact with an animal B) Combing hair with another's comb C) Using the towel of an infected child D) Sleeping in a friend's bed who had lice

Answer 98

Ans: A Feedback: Head lice are most often transmitted by direct contact (head-to-head) or may be passed from infected to uninfected children through shared items such as combs and brushes, hats, scarves, sheets, and towels (called fomites). Contrary to some popular myths, lice do not fly or jump, and they cannot be contracted from animals they live only on humans.

Question 99

A community health nurse who is participating in a nutritional screening program with School-age children measure their body mass index (BMI). The majority of children fall within the 45th to 65th percentile for their age. The nurse would classify these children as which of the following? A) Underweight B) Healthy weight C) At-risk for overweight D) Overweight

Answer 99

Ans: B Feedback: A BMI between the 5th and 95th percentile for age is considered healthy weight. Underweight refers to a BMI below the 5th percentile. At-risk for overweight refers to children with a BMI between the 85th and 94th percentile. Overweight refers to children with a BMI equal to or greater than the 95th percentile.

Question 100

Which of the following measures would be most appropriate for community health? nurse to include when developing programs to address childhood obesity? A) Encouraging television watching for about 3 hours per day B) Suggesting that families eat fewer meals together at home C) Urging participation in physical activity for 30 minutes per day D) Limiting the intake of unsaturated oils in cooking

Answer 100

Ans: C Feedback: Research has demonstrated an association between poor eating habits and physical inactivity. Low levels of physical activity and more than 2 hours of watching television per day were found to be predictors of overweight status in a large longitudinal study of children. Therefore, interventions should focus on increasing levels of physical activity and encouraging limited television for school-age children, encouraging families to eat more meals together at home, advocating for increased physical education in the school setting, and for more safe recreational opportunities in all neighborhoods. In addition, healthy eating habits, such as using Unsaturated oils in cooking need to be stressed.

Question 101

Which of the following programs would be least effective to institute for a community of school-age children who are experiencing dental caries? A) Ensuring that the drinking water is fluoridated B) Having the school to institute a fluoride rinse program C) Encouraging the parents to get their children's teeth sealed D) Advising parents to encourage the children to brush once daily

Answer 101

Ans: D Feedback: Regular brushing and flossing is important for dental hygiene. However, once daily is not enough. Fluoridated drinking water, school- based fluoride rinse or gel, and dental sealant programs are cost-effective, proven methods of reducing dental caries in school-age children.

Question 102

Which of the following would a community health nurse expect to assess in the adolescent population with an eating disorder? A) High levels of peer support B) Clear sense of self C) Feelings of being in control D) Distorted body image

Answer 102

Ans: D Feedback: Adolescents with eating disorders typically have a disturbed body image, low levels of peer support, a distorted self-concept, and low self-esteem. In addition, they have issues with control, such that they use eating as a means of for control.

Question 103

A community health nurse is teaching a group of parents about attention deficit hyperactivity disorder. Which statement by the parents would indicate the need for additional teaching? A) We will probably need to give him medication to help him in school. B) We need to keep him away from foods that have additives in them. C) This condition is most likely due to problems with genes and nerve receptors. D) We'll be alert to the possibility of more injuries and accidents.

Answer 103

Ans: B Feedback: While a number of parents feel that sugar, food coloring or additives may worsen ADHD symptoms in their children, research shows no behavioral or learning differences in double-blind studies with sugar and sugar substitutes. Medications are commonly used, with the primary goal of improving academics. New research is focusing on inherited tendencies for problems with dopamine receptors and transporter genes, supporting a neurologic basis for the condition. Children with ADHD are more prone to accidents and injuries.

Question 104

local community agencies to provide services for children and adolescents with disabilities. Based on the nurse's knowledge of the most common disabilities affecting this group, the nurse would advocate for which of the following to address the largest group? A) Special education services B) Speech therapy services C) Mental health services D) Mental retardation services

Answer 104

Ans: A Feedback: In descending order, the most common disabilities found in school-age children and adolescents have learning disorders; speech or language impairment; mental retardation; serious emotional disturbances and other disabilities, such as autism; deafblindness, and orthopedic problems; traumatic brain injury; and other health impairments, such as asthma, diabetes, and epilepsy. Thus, advocating for special education services would address the most common disability, learning disorders.

Question 105

Which of the following statements about children's health status and academic achievement are most accurate? A) All health problems that can affect learning and achievement in school-age children are preventable. B) Physical and emotional health can affect academic achievement in children and adolescents. C) Only behavioral health problems can affect learning and achievement in school-age children. D) Poverty is one health problem that does not affect learning and achievement in school-age children.

Answer 105

Ans: B Feedback: Physical and emotional health can affect academic achievement in children and adolescents. Not all health problems that can affect learning and achievement in school-age children are preventable. Behavioral health problems can affect learning and achievement in school-age children, but other types of health problems can also affect learning and achievement in school-age children. Poverty is a health problem that also affects learning and achievement in school-age children.

Question 106

A community health nurse is providing immunizations to school-age children at a local health department. At what age would the nurse expect to administer the first dose of human papilloma virus (HPV) vaccine? A) 9 B) 11 C) 13 D) 15

Answer 106

Ans: B Feedback: The current recommendation is to administer the first dose of the HPV vaccine at age 11. However, the earliest age at which the vaccine can be given is age 9. The HPV vaccine is administered to females at age 13 to 18 if they have not been previously vaccinated.

Question 107

A community health nurse is speaking to a group of parents of incoming college freshmen students who will be living in the dormitories. The focus of the program is on the college health program, health issues, and immunizations. Which immunization would the nurse most strongly encourage the students to receive if they have not received it previously? A) Varicella virus vaccine B) Human papilloma virus vaccine C) Meningococcal vaccine D) Influenza vaccine

Answer 107

Ans: C Feedback: The meningococcal vaccine is a catch-up vaccine that is recommended for all previously unvaccinated college freshmen living in dormitories. Adolescents who have not had chickenpox and have not received prior vaccinations should receive the varicella vaccines. The HPV vaccine is given to females only. The influenza vaccine should be given only those who are considered high risk.

Question 108

When preparing a program to address violence among school-age children and adolescents, the community health nurse integrates knowledge of which of the following? A) Teen females commit homicide more frequently than teen males. B) Homicide is the second highest cause of death for all adolescents. C) Adolescents account for less than one half of all firearm injuries treated. D) Serious youth violence is unrelated to drugs and guns.

Answer 108

Ans: B Feedback: Homicide is the second leading cause of death for adolescents (ages 10 to 24) and is more common in males than females. Adolescents between the ages of 15 and 19 years account for almost 85% of all firearm injuries treated in emergency departments or hospitals. Serious youth violence is part of a constellation of risk-taking behaviors that also includes precocious sex, drugs, and guns.

Question 109

When working with community groups to develop appropriate programs for adolescents health promotion, the nurse integrates knowledge of the Healthy People 2020 objectives, keeping in mind that many of the Objectives address which of the following? A) Self-esteem improvement B) Risk-taking behaviors C) Control of disease D) Behavioral issues

Answer 109

Ans: B Feedback: Healthy People 2020 objectives are geared to improving the health of all Americans. Twenty-one specific objectives have been ranked as critical for this population. The objectives focus on issues involving mortality and morbidity in this age group that stem primarily from risk-taking behaviors. Many of the objectives relate to reduction in alcohol-related unintentional injuries, declines in violent behaviors, suicide and mental health issues, as well as more responsible reproductive health behaviors.

Question 109

When working with school districts, which of the following would affect community health? nurse encourages the most effective school-based approach to solving the problem of teenage suicide? A) Suicide prevention programs with direct interventions B) Teachers assessing suicide risk among students C) Promotion of stronger parental control of teens D) Punitive treatment of teens by the school administration

Answer 109

Ans: A Feedback: Programs and interventions by counselors and school nurses that are focused on determining adolescent suicide intentions are the most effective approaches. Teachers do not feel comfortable or prepared to assess suicide risk, and this alone will not prevent teen suicide. Peer pressure is strong, and parent concerns are not as important to the teen. Teens are seeking Independence and stronger parental control are not effective methods of reducing teen suicide. This approach is inappropriate for any school-age child or teen.

Question 110

A community health nurse is working with local schools to help address teen pregnancy. The nurse would focus interventions on which of the following? A) Better use of contraceptives B) Decreased sexual activity C) Improved parenting skills D) Proper nutritional habits

Answer 110

Ans: B Feedback: Although contraceptives, parenting skills, and nutrition may be areas of focus for teen pregnancy, research has shown that the downward trend for teen pregnancy rates has been attributed largely to better contraceptive use rather than less sexual activity. Therefore, interventions should focus on the area of decreasing sexual activity.

Question 111

Which of the following would the community health nurse most commonly need to address when planning programs for children with chronic illness? A) Asthma control B) Autism education C) Diabetes regimens D) Seizure control

Answer 111

Ans: A Feedback: Although autism education, diabetic regimens, and seizure control are common issues related to chronic disease in children, asthma is the most common chronic disease. Thus asthma control would be a priority.

Question 111

A community health nurse is working with a group of school nurses to develop interventions for a 10-year-old girl exhibiting signs and symptoms of school refusal. Which of the following would be most appropriate? A) Limiting parent involvement in the school B) Exposing the child rapidly to the classroom C) Keeping the child at home for a while D) Providing relaxation training

Answer 111

Ans: D Feedback: The most effective interventions for school refusal include early return to school with parental involvement in school, systematic desensitization (gradual exposure to the classroom), relaxation training, and counseling.

Question 112

A community health nurse is working with the local health department on screening for sexually transmitted infections. Which of the following would the nurse identify as the most common? A) Syphilis B) Gonorrhea C) Chlamydia D) Herpes simplex virus

Answer 112

Ans: C Feedback: Chlamydia is the most common STI in adolescents and should be a major focus of the screening. Syphilis, gonorrhea, and herpes simplex virus also are common among adolescents but less than Chlamydia.

Question 113

When preparing a program about substance abuse prevention for adolescents, the community health nurse would focus on which substance as the most frequently used? A) Marijuana B) Alcohol C) Ecstasy D) Ketamine

Answer 113

Ans: B Feedback: Alcohol is the most frequently used substance for adolescents in the United States. Marijuana is the most commonly used drug among 14- to 17-year-olds. Ecstasy and ketamine are other drugs used by adolescents and young adults.

Question 113

A community health nurse is engaged in a community-wide program to promote nutrition in adolescents. Which of the following would lead the nurse to target the program to adolescent girls? A) Girls eat larger quantities of food than boys. B) They are more physically active than boys. C) They have a tendency to diet inappropriately. D) They are more conscious about food nutrients.

Answer 113

Ans: C Feedback: Girls are more at risk for problems with nutrition for several reasons: They tend to diet inappropriately, to have more finicky eating habits, and to be less physically active than teenage boys. Boys typically eat large quantities of food, which increases the likelihood of obtaining adequate nutrients, and they also tend to be more physically active than girls.

Question 114

A community health nurse is implementing a family planning program near a local inner city's schools. The nurse is engaging, which type of health service? A) Preventive program B) Health protection C) Health promotion D) Injury prevention

Answer 114

Ans: A Feedback: A family planning program is an example of a preventive program that provides birth control information and counseling. Health protection programs focus on safety including injury prevention. Health promotion programs focus on areas such as nutrition and weight control, and drug abuse education.

Question 114

A community health nurse is working with other professionals to develop preventive programs to address the leading cause of death in men and women. Which of the following would be appropriate? A) Risk reduction for heart disease B) Cancer screening C) Safety education D) Flu vaccine immunization

Answer 114

Ans: A Feedback: The leading cause of death for men and women is heart disease. Therefore, risk reduction for heart disease would be most appropriate. Cancer screening, safety education, and flu vaccine immunization would be appropriate for cancer, the second leading cause of death; unintentional injuries, the third leading cause of death in men; and influenza and pneumonia, the eighth leading cause of death in men and women respectively.

Question 115

of the following would the community health nurse identify as a key aspect for this community's ability to follow through with the teaching? A) Life expectancy B) Health disparity C) Health literacy D) Financial ability

Answer 115

Ans: C Feedback: Health literacy is a critical aspect of managing health problems and a key to being able to read and understand health information so that individuals can follow through and make appropriate health decisions. Low health literacy also contributes to health disparities, a difference in health status due to sex, race, or ethnicity. Life expectancy is the average number of years an individual member is projected to live. It is a standard measurement unrelated to the ability to follow through with teaching. Financial ability may impact a person's ability to obtain needed services, but it is not a key aspect.

Question 116

When assessing a population for health disparities, which of the following would the nurse least likely evaluate? A) Race B) Education C) Age D) Sexual orientation

Answer 116

Ans: C Feedback: A health disparity is defined as a difference in health status that occurs by sex, race or ethnicity, education or income, disability, geographic location, or sexual orientation. Age would not be used to assess health disparity.

Question 117

Which one of the following statements about which life expectancy is most accurate? A) The life expectancy for White women is 4 years greater than for black women. B) The life expectancy for Black men is 6 years greater than for white men. C) In the United States, life expectancy continues to decline. D) There is a gap in life expectancy between women and men of more than 6 years.

Answer 117

Ans: A Feedback: The life expectancy for White women is 4 years greater than for Black women. The life expectancy for White men is 6 years greater than for Black men. In the United States, life expectancy continues to increase consistently over time. The gap in life expectancy between women and men was 5.0 years in 2007.

Question 117

A community health nurse is working with a grant funded project to address stroke prevention nationwide. After reviewing statistics related to stroke, which would the nurse identify as having the greatest need for this type of program? A) North central B) Southeast C) Southwest D) Pacific northwest

Answer 117

Ans: B Feedback: The nurse would identify the southeast as the area of greatest need because here. Known as the stroke belt, stroke death rates for both Blacks and Whites are higher than in any other part of the country.

Question 118

The nurse educator is aware that the nursing student has a grasp of the major health problems of adults when the nursing student Which one of the following statements is true? A) Morbidity and mortality among adults not vary much by age, gender, and race or ethnicity. B) The six leading causes of death in adults include suicide, Alzheimer's disease, and homicide. C) Diseases of the heart and cerebrovascular diseases are the first and third causes of death in adults. D) Malignant neoplasms, chronic lower respiratory diseases, unintentional injuries, and diabetes mellitus are not among the six leading causes of death in adults.

Answer 118

Ans: C Feedback: The following statement is true:

Question 119

The following is a list of the top five causes of unintentional injuries accounting for the majority of adults deaths due to injury. Order these in their proper sequence from first to fifth. A) Fire arms B) Suffocation C) Motor vehicle crashes D) Poisoning E) Falls

Answer 119

Ans: C, A, D, E, B Feedback: The top five causes of unintentional injuries include motor vehicle crashes, fire arms, poisoning, falls, and suffocation. Together, these causes account for approximately 80% of all injury deaths.

Question 120

A community health nurse is preparing a presentation about drug use and abuse for a group of adults. Which of the following would the nurse include as the one of the fastest growing forms of drug abuse? A) Cocaine B) Alcohol C) Prescription drugs D) Heroin

Answer 120

Ans: C Feedback: Illegal use of prescription drugs is one of the fastest growing forms of drug abuse, and it is becoming a major public health concern. The primary illicit drugs used in the United States, such as cocaine and heroin, have and continue to be a public health problem. Alcohol abuse also is a public health problem and is considered the third leading lifestyle-related cause of death for people living in the United States

Question 121

After teaching a group of students about the major types of cancer affecting men and women, the instructor determines that the teaching was successful when the students identify which of the following as the number one cause of cancer deaths among adults? A) Colon B) Pancreatic C) Esophageal D) Lung

Answer 121

Ans: D Feedback: Lung and bronchial cancers are the number one cause of cancer deaths among adults. Colon and rectal cancers are the third most common cancers in adults. Pancreatic and esophageal cancers are less common causes of cancer death.

Question 122

A patient comes to the community health clinic with complaints of changes in urination. Which of the following would lead the community health nurse to suspect that the patient has benign prostatic hypertrophy (BPH)? A) Nighttime frequency B) Dysuria C) Hematuria D) Flank pain

Answer 122

Ans: A Feedback: The symptoms of BPH vary, but the most common ones involve changes or problems with urination, such as hesitant, interrupted, or weak urinary stream; urgency or leaking of urine; and more frequent urination, especially at night. Dysuria may indicate a urinary tract infection. Hematuria could suggest a variety of problems, such as infection calculi, or cancer. Flank pain may indicate conditions such as pyelonephritis or renal calculi.

Question 123

When developing community health programs target to adult men, which of the following would the nurse need to integrate into the plan? A) Improved quality of education programs available for men B) Increased access of health services by men as compared to women C) Limited male-gender specific research D) Increased awareness of men's health issues

Answer 123

Ans: C Feedback: The current state of men's health involves a lack of quality health education programs for men, health care services that are only accessed half as much by men when compared to women, and a lack of male gender-specific research. In addition, awareness of men's health issues is lacking. Currently, there is no Office on Men's Health in the U.S. Department of Health and Human Services; legislation to establish such an office has been introduced; however, the bill did not progress out of the congressional subcommittee on health and has not been reintroduced.

Question 124

A community health nurse is reviewing research related to women's health. Which of the following would the nurse use to obtain information about postmenopausal women's health? A) The Women's Health Study B) The Women's Health Initiative C) The Nurses' Health Study I D) The Nurses' Health Study II

Answer 124

Ans: B Feedback: The nurse would use The Women's Health Initiative. This study was a major 15-year research program addressing the most common causes of death, disability, and poor quality of life in postmenopausal women4 CVD, cancer, and osteoporosis. The Women's Health Study evaluated the effects of vitamin E and low-dose aspirin therapy in primary prevention of CVD and cancer in apparently healthy women. The Nurses' Health Study I investigated the potential long-term consequences of the use of oral contraceptives. The Nurses' Health Study II studied oral contraceptives, diet, and lifestyle risk factors in a population younger than the original Nurses' Health Study cohort.

Question 125

While working in a community health clinic, a community health nurse interviews a 24- year-old client. Which of the following would lead the nurse to suspect that the client is binge eating? A) Significant weight loss from dieting last year B) Participation in excessive exercise C) Exaggerated concern about body shape D) Severe emaciation

Answer 125

Ans: A Feedback: Binge eating is an eating disorder that is characterized by repeated episodes of uncontrolled eating. It usually starts following significant weight loss from dieting. Typically, individuals with this disorder eat quickly, eat until they are uncomfortably full, eat when they are not hungry, eat large amounts of food alone, have difficulty expressing their feelings, have difficulty controlling impulses and stress, and feel depressed about overeating. Participation in excessive exercise and an exaggerated concern about body shape is usually associated with bulimia. Severe emaciation is associated with anorexia.

Question 125

Which of the following statements by a women's group indicates that they have understood the teaching about heart disease and women? A) More women die of breast cancer than heart disease.= B) Women experience similar symptoms as men.= C) Hormone replacement therapy protects the heart D) Heart disease is the number one killer of women.=

Answer 125

Ans: D Feedback: Heart disease is the number one killer of women. One in 2.6 female deaths is from cardiovascular disease, compared to 1 in 30 from breast cancer. Women have atypical symptoms or less acute chest pain than men, often leading them to delay care. Hormone therapy does not reduce coronary events.

Question 126

Which one of the following statements about coronary heart disease and stroke are most accurate? A) Cardiovascular disease kills more women than men. B) Stroke kills more men than women. C) White persons are more likely to have their first stroke earlier than Black persons. D) Risk factors for cardiovascular disease are not known.

Answer 126

Ans: A Feedback: Cardiovascular disease kills more women than men. Stroke kills more women than men. Black persons are more likely to have their first stroke earlier than White persons. Risk factors for cardiovascular disease are known. Some are controllable such as lifestyle, and some are uncontrollable such as heredity.

Question 127

A community health nurse working in a local women's health clinic is planning a teaching session for a group of women about menopause. Which of the following would the nurse include in the session? A) Menopause involves very noticeable and characteristic symptoms. B) The symptoms are usually temporary lasting for a month or two. C) It can occur as early as age 30 but more commonly ages 45 to 55 years. D) Going 6 months without a period signals menopause.

Answer 127

Ans: C Feedback: Menopause is a time that marks the permanent cessation of menstrual activity. It usually occurs between the ages of 45 and 55 years. However, it can occur as early as age 30. Symptoms of menopause vary among women and last from months to years. They range from hardly noticeable in some women to very severe in others. Natural menopause is when a woman has not had a period in 12 months (no other apparent causes).

Question 128

During a home visit to a family, a community health nurse encourages the mother, aged 42, and grandmother, aged 67, to have a clinical breast exam at which frequency? A) Monthly B) Yearly C) Every 2 years D) Every 3 years

Answer 128

Ans: B Feedback: Clinical breast exams, performed by a health care provider should be done every year for each of these women. They should also perform breast self-exam every month. The mother at her current age should have a physical examination every 2 years. Both the mother and grandmother should have a pelvic exam and Pap smear done every 3 years after three consecutive negative Pap smears.

Question 129

As part of a health screening program, a community health nurse determines that a client is infected with the human papilloma virus (HPV). The community health nurse encourages the client to do which of the following? A) Get a mammogram immediately B) Have her blood glucose level checked C) Undergo testing for a breast cancer gene D) Have a pelvic examination and Pap smear

Answer 129

Ans: D Feedback: Infection with certain types of human papilloma virus is associated with an increase risk for developing cervical cancer. Pap smears have improved early detection and prevention of cervical cancer dramatically. HPV infection is not associated with breast cancer, so there is no need for a mammography or testing for a breast cancer gene. HPV is not associated with diabetes so blood glucose testing is not indicated.

Question 130

A nurse is instructing the adult male members of a family on how to perform testicular self examination. Which of the following would the nurse include? A) Performing the examination every 3 months B) Completing the exam right after a hot shower C) Examining both testicles at the same time D) Reporting a slight difference in size of one testicle

Answer 130

Ans: B Feedback: A testicular self-examination should be performed monthly right after a hot shower or bath. One testicle is examined at a time. One testicle, usually the right one, is normally slightly larger than the other.

Question 131

Which one of the following statements best describes the role of the community health nurse in promoting the health of adult men 35 to 65 years of age? A) Anticipatory guidance to men approaching each stage and help them with ways to manage life more effectively. B) Men of this age do not need to enhance their self-care skills. C) A positive attitude toward aging is not helpful to men at this time in their lives. D) Men of this age should exercise sporadically.

Answer 131

Ans: C Feedback: The community health nurse can provide anticipatory guidance to men approaching this stage and help them with ways to manage life more successfully. Successful navigating this stage of life can be fulfilling but may require a man to enhance his self-care skills. This includes having a positive attitude toward aging, one that examines the benefits of maturity, finds a balance between work and home, and maintains a healthy lifestyle by eating balanced meals and obtaining regular exercise.

Question 132

When developing a plan of care for a group of male patients experiencing erectile dysfunction, which of the following would the nurse expect to institute first? A) Lifestyle changes B) Adjustments to current medications C) Psychotherapy D) Behavior modification

Answer 132

Ans: A Feedback: Treatment for ED usually proceeds from least to most invasive. For some men, making a few healthy lifestyle changes may solve the problem. Smoking cessation, weight loss, and increased physical activity may help some men regain sexual function. Cutting back on any drugs with harmful side effects is considered next. For example, drugs for high blood pressure

Question 133

Which of the following would a community health nurse recommend adult men and women over the age of 50 receive yearly? A) Electrocardiogram B) Tetanus booster C) Flexible endoscopy D) Hemoccult stool testing

Answer 133

Ans: D Feedback: Men and women over the age of 50 should receive yearly physical exams and hemoccult stool testing, electrocardiograms every 3 years, tetanus booster every 10 years, and flexible endoscopy every 3 to 4 years.

Question 134

A community health nurse, who is working with a program to foster early detection of prostate cancer, recommends prostate-specific antigen testing and a digital rectal exam for men with average risk starting at which age? A) 40 years B) 45 years C) 50 years D) 55 years

Answer 134

Ans: C Feedback: The American Cancer Society recommends that screening of men who are at average risk should begin at age 50 years and should include a blood test to assess PSA levels and a digital rectal examination.

Question 135

When describing the changes occurring in the older adult population globally, which of the following would be most accurate? A) The over-80 age group is the fastest growing segment of the group. B) Males have a longer projected life expectancy when compared with females. C) Most countries have adequate numbers of social programs for older adults. D) Adults over age 65 are expected to account for about 25% of the population by 2050.

Answer 135

Ans: A Feedback: In most of the world, the population of those over 80 years of age is growing faster than any other population age group. A higher life expectancy at birth for females compared with males is almost universal. Many countries have few or no social programs available for older adults. By the year 2050, one tenth of the population is expected to be over the age of 65 years.

Question 136

A community health nurse is working with an older adult population ranging in age from 75 to 85 years. The nurse correctly classifies this group as which of the following? A) Young-old B) Old-old C) Oldest-old D) Elite-old

Answer 136

Ans: B Feedback: Those between the ages of 65 and 75 are classified as

Question 137

While working with another group of community health nurses, a nurse overhears one of the nurses saying,

Answer 137

Ans: C Feedback: The one nurse's statement reflects stereotyping and a negative image of an older adult. This is called ageism. It may be due to negative personal experiences, myths, or a general lack of information. It is not reflective of prejudice or bias. Insight would reflect an understanding of the older adult, which this statement does not do.

Question 138

Which of the following statements are common misconceptions about older adults? Select all that apply. A) It is normal for older adults to become more confused and childlike, forgetful, and lose contact with reality as they age. They become senile. B) As older adults age, they become more different and less alike than other older adults. C) Older people are very capable of learning new things. D) As age increases, older adults withdraw, become inactive and cease being productive.

Answer 138

Ans: A, D Feedback: Misconceptions or myths about older adults include the following: It is normal for older adults to become more confused and childlike, forgetful, and lose contact with reality as they age. They become senile. As age increases, older adults withdraw, become inactive, and cease being productive. As older adults age, they lose their individual differences and become progressively more alike; older adults are forgetful, unable to learn new things, and set in their old ways of doing things.

Question 139

Which of the following are characteristics of healthy older adults? A) They are able to perform functional activities of daily living. B) They are able to adapt, to continue to handle stress, and to be active in life and living. C) They maintain the maximum degree of physical, mental, and social vigor. D) They are likely to be dependent on others. E) They reside in institutions.

Answer 139

Ans: A Feedback: Healthy older adults' ability to function is a key indicator of health and wellness and is an important factor in understanding healthy aging. They are able to adapt, to continue to handle stress, and to be active in life and living. They maintain the maximum degree of physical, mental, and social vigor. The vast majority of older adults, even those with chronic diseases or other disabilities, are living outside institutions and are relatively independent.

Question 140

The nurse educator is aware that the nursing student has a grasp of the primary prevention needs of older adults when the nursing student makes which of the following comments? A) It is unnecessary for older adults to receive immunizations. B) All older adults must restrict their sodium intake. C) Older adults don't need to drink as much fluid as they are often less thirsty. D) The oral health of older adults is often neglected, so it is important that they see a dentist regularly.

Answer 140

Ans: D Feedback: The oral health of older adults is often neglected, and so it is important that they see a dentist regularly. It is necessary for older adults to receive immunizations. Neither of these statements is true. All older adults must restrict their sodium intake and older adults don't need to drink as much fluid as they are often less thirsty.

Question 141

When visiting a local senior center, a community health nurse engages several of the older adults in a discussion about immunizations. Which statement best reflects the importance of older adult immunization? A) We're at greater risk of dying from the flu or pneumonia. B) You don't get the flu from the flu shot. C) The doctor told us that we should get it. D) Many of us get the shot here at the center for free.

Answer 141

Ans: C Feedback: Older adults are at risk of not only contracting influenza or pneumonia but of dying from them, underscoring the importance of obtaining the immunizations. The statement about not getting the flu from the shot addresses one of the common reasons for not getting it: the belief that the flu shot will give them the flu. The statement about the doctor telling them to get it indirectly reflects another reason for not getting it: a lack of knowledge about the need. The statement about getting the shot for free suggests that finances may be a barrier to obtaining the shot, but not why it is important.

Question 142

A community health nurse is teaching a group of older adults at a senior center about strategies for successful aging. Which of the following would the nurse include? A) Limit drinking alcohol to once or twice a month B) Avoid eating too many fruits and vegetables C) Keep in touch with friends and family D) Get up early in the morning

Answer 142

Ans: C Feedback: Strategies for successful aging include maintaining contacts with family and friends and staying active through work, recreation, and the community. Moderation in drinking is key. The older adult should eat a healthy diet of fruits, whole grains, vegetables, and lean meat. They also should get as much sleep and rest as needed. Getting up early in the morning may or may not be appropriate.

Question 143

An older adult interested in nutrition asks the community health nurse about the number of calories that he or she should eat every day. Which of the following would be most appropriate? A) 800 to 1,200 calories B) 1,200 to 1,600 calories C) 1,600 to 2,000 calories D) 2,000 to 2,400 calories

Answer 143

Ans: B Feedback: It is generally believed that older people need to maintain their optimal weight by eating a diet that is low in fats, moderate in carbohydrates, and high in proteins with a daily calorie count of 1,200 to 1,600.

Question 144

An older adult comes to the community health center for a checkup. During the visit, he or she mentions that he or she is somewhat constipated. Which of the following suggestions would be most appropriate? A) Use a laxative about once or twice a week B) Increase your intake of fresh fruits and vegetables C) Drink about four 8-oz. glasses of fluid each day D) Walk around the block once a week

Answer 144

Ans: B Feedback: Older adults should add more fiber and bulk to their diet with fresh fruits and vegetables instead of relying on the habitual use of laxatives. Also, inadequate fluid intake can contribute to bowel and bladder problems. Consuming a diet that includes eight or more 8-oz. glasses of fluid (water, juices, tea) each day assists the gastrointestinal and genitourinary systems in their functions. Increased physical activity and exercise, such as a daily walk, help keep an older adult's bowel patterns regular.

Question 145

A community health nurse meets with a group of adults at the local senior center. They range in age from 65 to 70 years. The nurse would recommend vision screening, at which frequency? A) Every year B) Every 2 years C) Every 5 years D) Every 10 years

Answer 145

Ans: B Feedback: Currently, vision screening is recommended every 2 years for adults aged 65 years and older. Blood pressure screening should occur yearly, and total cholesterol evaluation should occur every 5 years. Tetanus and diphtheria immunizations should be administered every 10 years.

Question 146

A community health nurse is assessing an older adult's ability to perform activities such as shopping, doing the laundry, using the telephone, and handling finances. Which assessment tool would be most appropriate for the nurse to use? A) Barthel Index B) Instrumental Activities of Daily Living Scale C) Katz Index of Activities of Daily Living D) Modified Rankin Scale

Answer 146

Ans: B Feedback: The Instrumental Activities of Daily Living Scale looks at an older adult's ability to perform such activities as using the telephone, shopping, doing laundry, and handling finances. The Barthel Index assesses functional independence and is often used to determine levels of disability or dependence of stroke victims in respect to ADLs. The Modified Rankin Scale (MRS) is another common tool used for this purpose. The Katz Index of Activities of Daily Living is based on an evaluation of the functional independence or dependence of clients with respect to bathing, dressing, toileting, and related tasks.

Question 147

A community health nurse is preparing a teaching program that addresses chronic diseases common among older adults. Which of the following would be most appropriate to include? A) Forty percent of older adults are diagnosed with diabetes. B) Weight-bearing exercises are related to increased cases of osteoporosis. C) Postural hypotension can be related to falls in elders. D) Older White men have the highest rates of hypertension.

Answer 147

Ans: C Feedback: Older adults need to have sufficient cerebral circulation to avoid dizziness. Dizziness can lead to falling. A normal to high-normal blood pressure for the elder should be maintained. Based on the most current statistics, 15.1% of men and 13.0% of women report having diabetes. Weight-bearing exercises are a way to prevent osteoporosis. Older African American men have the highest rates of hypertension.

Question 148

After teaching a group of older adult women about preventing osteoporosis, which of the following if stated by the group indicates the need for additional teaching? A) We should eat foods that are high in calcium and vitamin D. B) We need to get bone density screenings regularly.= C) We should avoid activities that involve weight bearing.= D) We need to make sure that maintain a healthy weight.=

Answer 148

Ans: C Feedback: Weight-bearing activities are encouraged to promote strong bones. In addition, individuals should be encouraged to eat diets that are rich in vitamin D and calcium, and include calcium supplements as needed. Not smoking, maintaining a healthy weight, and receiving ongoing bone density screenings are positive health behaviors that can contribute to strong bones throughout life.

Question 149

After teaching a group of students about the most common health problems affecting older adults in the community, which of the following if identified by the students would alert the instructor to the need for additional teaching? A) Arthritis B) Hypertension C) Emphysema D) Peripheral vascular disease

Answer 149

Ans: C Feedback: Emphysema is not considered a common health problem of older adults. The most common health problems of older people in the community are arthritis, reduced vision, hearing loss, heart disease, peripheral vascular disease, and hypertension.

Question 150

When describing elder abuse to the families of older adults who are attending a local community presentation, which of the following would the community health nurse identify most commonly as the perpetrator? A) Elder's adult child B) Elder's partner C) Elder's neighbor D) Elder's grandchild

Answer 150

Ans: B Feedback: The most common perpetrators of elder abuse are spouses or partners of elders. The next most frequent abuser is the adult child of the elder. Although it may be possible that the perpetrator is the elder's neighbor or grandchild, this situation would be quite rare.

Question 151

Which one of the following statements about elder abuse is most accurate? A) Elder abuse is a problem that is under recognized and underreported. B) It is more common for elderly men to be abused rather than elderly women. C) If there is long-term domestic violence in an elderly couple, it is not considered elder abuse for the perpetrator to continue to abuse the victim. D) Self-neglect is not considered to be a form of mistreatment.

Answer 151

Ans: A Feedback: Elder abuse is a problem that is under recognized and underreported. It is more common for elderly women to be abused rather than elderly men. The most common perpetrators of elder abuse are spouses or partners of elders, often in a relationship with long-term domestic violence. In some states, self-neglect is also considered a form of mistreatment.

Question 152

Which of the following comprise the primary criteria for effective programs for older adults? A) Coordination B) Accessibility C) Comprehensive D) Complex E) Quality

Answer 152

Ans: A, B, C, E Feedback: The primary criteria for effective programs for older adults include coordination, accessibility, comprehensive, and quality.

Question 153

Which of the following are included in a comprehensive set of services? Select all that apply. A) Adequate financial support B) Health education C) Encouragement to spend much time alone D) Adult day care programs E) Access to high-quality health care services F) In-home services

Answer 153

Ans: A, B, D, E, F Feedback: A comprehensive set of services for senior citizens should include the following: adequate financial support, adult day care programs, access to high quality health care services, health education, in-home services, recreation and activity programs that promote socialization (not encouragement to spend much time alone), and specialized transportation services.

Question 154

A community health nurse is making a home visit to a family who is providing care to an older adult member with Alzheimer's disease for the past 6 months. During the visit, which of the following would be most important for the nurse to assess? A) Cognitive status B) Medication regimen C) Personality changes D) Caregiver's status

Answer 154

Ans: D Feedback: Although assessment of the various aspects of the patient's status is important, that of the caregiver is even more important. Often, the person with AD is cared for at home until very late in the disease course. The intense care given to these clients can be a constant drain on the emotional and physical reserves of their families. The stress of providing care puts the caregiver's health at risk, as well.

Question 155

A group of community health nurses who work in continuing care retirement centers are asked to talk to a group of seniors about what they do. Which of the following would the nurses identify as unique for this setting? A) Accept clients who primarily need skilled nursing services B) Are similar to board and care homes C) Are respite centers for family members of older adults D) Provide a variety of housing and care options that elders need as they age

Answer 155

Ans: D Feedback: Continuing care retirement centers are comprehensive centers and have become the last place an older adult needs to live, meeting independent to dependent needs, including skilled nursing and Alzheimer's disease services. They can age in place without moving to another location as their needs increase. They accept residents at all stages of need, from totally independent living to assisted living to skilled nursing care. In some settings, residents cannot enter the residence at the skilled nursing level. These beds are filled by residents with increasing needs as they move from independent living, to assisted living, to skilled nursing care. Skilled nursing facilities provide skilled nursing care along with personal care that is considered nonskilled. Board and care or personal care homes offer 24 hours basic custodial care but provide no skilled nursing services. Respite care centers provide time off for caregivers. It can take place in an adult day center, home, or residential setting.

Question 156

Which one of the following statements is most accurate when differentiating hospice from palliative care? A) Both palliative care and hospice focus on cure; however, hospice focuses on terminal illnesses, and palliative care focuses on diseases that are more chronic in nature. B) Palliative care consists of comfort and symptom management and is often a part of hospice care. C) Hospice is more of a specific place than a concept of care, whereas palliative care is more of a concept of care. D) Hospice is intended for people who have a projected life expectancy of 6 months or more, and palliative care is intended for people who are actively dying.

Answer 156

Ans: B Feedback: Palliative care consists of comfort and symptom management and is often part of hospice care. Neither palliative care nor hospice focuses on cure. Hospice does focus on care of people who are known to be at end of life, and palliative care can be provided to people who have chronic ongoing health conditions even when death is not imminent. Hospice is more of a concept of care than a specific place. Palliative care should be a major focus of care throughout the aging process, regardless of whether death is imminent within 6 months.

Question 157

When working with the older adult population in the community, which of the following would be most important for the community health nurse to do? A) Develop case management programs to channel clients to appropriate services B) Place the older adult in skilled nursing facilities for the best care available C) Raise funds to support the needs of the older adults in the community D) Emphasize tertiary prevention at this stage in the lives of the older adult

Answer 157

Ans: A Feedback: Services for the older adult should be proactive. Nurses should design interventions that maximize nursing resources and provide the greatest benefit to elderly clients. Skilled nursing facilities are for people with skilled needs, not for older adults managing chronic diseases independently. One's own home is most often the best place for elders and where they want to be. This is not something that is always needed or possible for a community health nurse to become involved in. Nurses can identify the needs for additional funding, advocate for more funding, and facilitate a community group's efforts to raise funds. This is how a nurse can best serve the elderly and support their needs rather than by actually raising the funds. Prevention should be proactive and focus on primary prevention regardless of the client's age.

Question 158

Which of the following would a community health nurse use to define vulnerable populations? A) Those persons with higher mortality rates B) Individuals with lower life expectancy C) Those with increased risk for adverse health outcomes D) Individuals with chronic illness

Answer 158

Ans: C Feedback: Vulnerable populations are groups who have a heightened risk for adverse health outcomes. They may include various populations such as those with higher mortality rates, lower life expectancies, or chronic illnesses. However, presence of just one of these does not necessarily indicate that the population is vulnerable.

Question 159

When assessing vulnerable populations, a community health nurse uses a popular model that contains three related concepts. Which of the following would the nurse include? Select all that apply. A) Resource availability B) Relative risk C) Health status D) Housing E) Education

Answer 159

Ans: A, B, C Feedback: A popular conceptual framework of vulnerability contains three related concepts: resource availability, relative risk, and health status. Housing and education are not one of the three related concepts in this popular model.

Question 160

A community health nurse is applying the Behavioral Model for Vulnerable Populations when evaluating a local community. Which of the following would the nurse include as an enabling factor? A) Insurance B) Acculturation C) Knowledge of disease D) Marital status

Answer 160

Ans: A Feedback: Enabling factors include personal and family resources, as well as community resources (e.g., income, insurance, social support, region, health services resources, public benefits, transportation, telephone, crime rates, social services resources). Acculturation, knowledge of disease, and marital status are examples of predisposing factors.

Question 161

population for socioeconomic resources. Which of the following would the nurse address? A) Quality of care provided B) Access to health care services C) Educational opportunities D) Adequacy of health care providers

Answer 161

Ans: C Feedback: Socioeconomic resources include such things as human capital (e.g., jobs, income, housing, education), social connectedness or integration (e.g., social networks or ties, social support or the lack of it characterized by marginalization), and social status (e.g., position, power, role). Environmental resources deal mostly with access to health care and the quality of that care, including the adequacy of health care providers.

Question 162

When assessing a population's vulnerability, which of the following would the community health nurse identify as a predisposing factor? A) Social support networks B) Crime rates C) Transportation D) Living conditions

Answer 162

Ans: D Feedback: Predisposing factors include demographic variables (e.g., gender, age, marital status), social variables (e.g., education, employment, ethnicity, social networks), and health beliefs (e.g., values and attitudes toward health and health care services, knowledge of disease). Social structures (e.g., acculturation and immigration), sexual orientation, and childhood characteristics (e.g., mobility, living conditions, history of substance abuse, criminal behavior, victimization, or mental illness) are also considered as predisposing factors. Enabling factors include personal and family resources, as well as community resources (e.g., income, insurance, social support, region, health services resources, public benefits, transportation, telephone, crime rates, social services resources).

Question 163

When assessing a vulnerable population's relative risk, which of the following would the community health nurse identify most likely as contributing to this risk? A) Well-balanced diet B) Up-to-date immunizations C) Enabling factors D) Exposure to abuse

Answer 163

Ans: D Feedback: Relative risk refers to exposure to risk factors identified by a substantial body of research as lifestyle, behaviors, and choices (e.g., diet, exercise, use of tobacco, alcohol and other drugs, sexual behaviors), use of health screening services (e.g., immunizations, health promotion, use of seat belts), and stressful events (e.g., crime, violence, abuse, firearm use). A well-balanced diet, up-to-date immunizations, and use of seat belts would reduce one's risk whereas exposure to abuse may increase the risk. Enabling factors relate to the Behavioral Model for Vulnerable Populations and not to the relative risk.

Question 164

When describing the causes of vulnerability to a group of students, which of the following would the instructor include? A) Vulnerable populations are fairly similar across the nation and globally. B) Statistics about vulnerable populations are highly accurate. C) The most important causative factor is race or ethnicity. D) Many of the factors and conditions suggest vulnerability overlap.

Answer 164

Ans: D Feedback: Many of the factors and conditions contribute to vulnerability overlap, making it difficult to obtain accurate data and statistics for each group or category. Although there are some similarities and consistencies in terms of vulnerable populations, the factors vary. They also are interactive, making it difficult to determine which factor or cause is considered most important.

Question 165

Which one of the following statements about relative risk is most accurate? A) Lifestyle, behaviors, and choices do not relate to relative risk. B) Relative risk refers to exposure to risk factors identified from a substantial body of research. C) Relative risk means that if a risk exists, the illness or adverse event will occur. D) Any factor that is likely to cause increased risk is considered relative risk.

Answer 165

Ans: B Feedback: Relative risk refers to exposure to risk factors identified from a substantial body of research. Lifestyle, behaviors, and choices are risk factors. Relative risk is not an absolute cause and effect that if a risk exists, the illness or adverse event will occur. Only factors that are identified by a substantial body of research are considered relative risk.

Question 166

A community health nurse is describing social capital and its impact on populations to a group of local community leaders. Which of the following would the nurse suggest as a way to improve the social capital of the community? A) Better job training B) Improved educational programs C) Expanded employment opportunities D) More community organizations

Answer 166

Ans: D Feedback: Social capital consists of marital status, family structure, social ties and networks, and membership in voluntary organizations, such as a church or clubs. Thus suggesting more community organizations would address social capital. Better job training, improved education, and expanded employment opportunities are examples of human capital, investments in individuals' capabilities and skills (e.g., education, job training) that comprise jobs, income, housing, and education.

Question 167

Which one of the following statements is true regarding social capital? A) Social capital includes investments in individuals' capabilities and skills. B) Social capital includes marital status and family structure. C) Social capital includes jobs, income, housing, and education. D) Examples of social capital are education and job training.

Answer 167

Ans: B Feedback: Social capital consists of marital status, family structure, social ties and networks, and memberships in voluntary organizations. Human capital is linked to investments in individuals' capabilities in skills (e.g., education, job training) and comprises jobs, income, housing, and education.

Question 168

Which of the following would a community health nurse include when describing the differential vulnerability hypothesis? A) Exposure to risk factors affects the population's social and human capital. B) Everyone is at risk because of stressful events occurring in life. C) A risk for a negative outcome increases with lower education and income levels. D) Certain groups are impacted by stressful events more than others.

Answer 168

Ans: D Feedback: The differential vulnerability hypothesis states that everyone is subjected to stressful events, but that these events hurt some people more than others, thus they are vulnerable populations. Although everyone experiences stresses, not everyone is vulnerable. Deficits or problems in social and human capital can increase the population's risk. Lower education and income are associated with a higher relative risk, but these alone do not describe the hypothesis.

Question 169

After teaching a group of students about factors associated with vulnerable populations, the instructor determines the need for additional teaching when the students identify which as a factor? A) Homelessness B) Acute illness C) Income D) Immigrant status

Answer 169

Ans: B Feedback: Factors associated with vulnerable populations include income and education, age and gender, race and ethnicity, homelessness, chronic illness and disability, and immigration among others. Chronic, not acute, illness is considered as a factor.

Question 170

A community health nurse is part of a group working with local and state legislators to expand health insurance coverage for those with inadequate or no insurance. Which outcome would the nurse hope to achieve if the group is successful? A) Increase use of early screenings B) Increase emergency room visits C) Increase episodic care D) Increase disparities in care

Answer 170

Ans: A Feedback: Having inadequate or no health insurance leads to poor health outcomes due to lack of early screening and preventive measures, including regular physical exams and immunizations, delays in getting treatment, and use of emergency rooms for worsening conditions with no continuity of care, all as efforts to save money. Expanding health insurance hopefully would promote increased use of early screenings, decreased emergency room visits, more continuity of care, and better health outcomes all around with less disparities.

Question 171

Which of the following would be most important for a community health nurse to do first when working with vulnerable populations? A) Helping them to make choices B) Guiding them to think things through C) Getting them to interact with the nurse D) Providing honest feedback

Answer 171

Ans: C Feedback: When working with vulnerable populations, the first step is to open the door and interact with the clients, engaging them, and developing rapport. Once this is accomplished, the community health nurse can then help them in making choices, guide them to think through all the issues and consequences, and provide honest feedback.

Question 172

A community health nurse is working to empower clients of a vulnerable population. Which of the following client behaviors indicates that the nurse is achieving this goal? A) Collaboration with their health care providers B) Demonstration of a reactive focus C) Hesitancy in the use of resources D) Viewing of situations as nonchangeable

Answer 172

Ans: A Feedback: Empowerment would be manifested by the clients engaging in collaboration with their health care providers, becoming more proactive than reactive, being better able to seek and use services, and being realistic about barriers with a view for ways to change things for the better.

Question 173

Which of the following would be least helpful to a novice community health nurse working with vulnerable populations who is feeling overwhelmed and somewhat guilty about his or her personal situation as compared to his or her clients? A) Setting up an community agency clothing drive collection B) Working for changes in community attitudes C) Sending a personal donation to an agency in the area D) Remaining grounded

Answer 173

Ans: C Feedback: Working with disadvantaged populations can be challenging and exhausting. Often a novice community health nurse may feel overwhelmed and suffer compassion fatigue and guilt about ones one life. To be effective, it is often helpful to donate money or items on a group level such as an agency clothing drive rather than an individual level and to work for substantial changes in community attitudes. In addition, the nurse needs to remain grounded in order to continue to have the necessary energy and compassion.

Question 174

A community health nurse working with a group of vulnerable clients is focusing on empowering them. Which of the following would be most effective? A) Keeping the clients to a firm schedule of visits B) Viewing the clients as active partners in the process C) Having the clients cut through bureaucratic red tape D) Focusing on the clients' limitations

Answer 174

Ans: B Feedback: Activities that are most effective in promoting empowerment include viewing the clients as active partners (shows mutual respect and helps build a trusting relationship), being flexible in dealing with the clients (demonstrates a client-centered approach), cutting through the bureaucratic red tape (demonstrates advocacy), and focusing on the clients' strengths rather than limitations (helps to build client capacity).

Question 175

A community health nurse is preparing a presentation for a group of local community nurses about measures to help decrease health disparities. Which of the following would be the least effective suggestion? A) Avoiding political involvement in issues B) Working with schools to reduce dropout rate C) Organizing task forces to raise community awareness D) Holding community meetings to identify needs

Answer 175

Ans: A Feedback: To help decrease health disparities, political advocacy is necessary to influence health policy. In addition, working with schools to reduce the dropout rate helps to address the connection between education and outcomes. Organizing task forces, raising community awareness, and community input for need identification are all effective methods to address vulnerable populations and health disparities.

Question 176

After teaching a group of students about the socioeconomic gradient in health, the instructor determines that the students understand the concept when they state that the relationship between social class and health is which of the following? A) Direct B) Inverse C) Positive D) Unequal

Answer 176

Ans: B Feedback: The socioeconomic gradient refers to the inverse relationship between social class or income and health, such that the lower the social class or income, the higher the rates of disease.

Question 177

Which one of the following statements is true regarding the socioeconomic gradient of health? A) The behavior of smoking is lowest among those who have low income and low educational levels. B) The socioeconomic gradient of health has been found in populations around the world. C) All persons who have a low socioeconomic status will develop particular health problems. D) The socioeconomic gradient of health is universal.

Answer 177

Ans: B Feedback: The socioeconomic gradient of health has been found in populations around the world, although not always unfailingly. The behavior of smoking is highest among those who have low income and low educational levels. Not all persons who have low socioeconomic status will develop particular health problems.

Question 178

Which of the following are types of health disparities that are due to inequities that can be corrected? Select all that apply. A) Patients feel that they are unable to trust the information given to them and may not follow it as explained. B) Limited access to appropriate level of care C) Poor access to quality care D) Overt discrimination E) Health-damaging behaviors that are chosen by an individual despite health education and counseling efforts

Answer 178

Ans: A, B, C, D Feedback: Health disparities may be unavoidable, such as health-damaging behaviors that are chosen by an individual despite health education and counseling efforts, but most are thought to be due to inequities than can be corrected. Reported disparities exist in the areas of quality of health care, access to care, levels and types of care, and care settings; they exist within subpopulations (e.g., elderly, women, children, rural residents, disabled) and across clinical conditions. Patients can also react to providers in a way that promotes disparities; they may not trust the information given to them and may not follow it as explained, leading to inadequate care.

Question 179

Which of the following vulnerable populations have been subjected to perceived poor quality of care and access to care? Select all that apply. A) HIV-infected persons B) Persons who use illicit drugs C) People of non-White race/ethnicity D) People of White race/ethnicity E) Homeless persons

Answer 179

Ans: A, B, C, E Feedback: Higher perceived discrimination was associated with HIV infection, homelessness, drug use, and race/ethnicity, emphasizing the perceived poor quality of care and difficulties with access to care.

Question 180

develop effective plans to meet the needs of people with disabilities, the community health nurse reviews the statistics involving individuals with disabilities. Which of the following would the nurse identify as accurately reflecting the number of persons with ongoing disability? A) 10 million people less than 5% of the US population B) 27 million people about 10% of the US population C) 36 million people about 12% of the US population D) 150 million people4almost 50% of the US population

Answer 180

Ans: C Feedback: An estimated 36 million people or 12% of the population is living with some ongoing level of disability. The other statistics of 10 million, 27 million, and 150 million are inaccurate.

Question 181

When explaining the concept of disability to a local community group, which of the following descriptions would be most appropriate for the nurse to include? A) A disability is a condition someone has, not something one is. B) The plan of care for two people with the same disability would be the same. C) A disability refers to a person's inability to do something. D) Handicap and disability are two terms that go hand in hand.

Answer 181

Ans: A Feedback: Long-held negative views of disabilities are being replaced with new and more positive approaches that view individuals and their challenges from a more holistic standpoint. Thus, a disability is something that a person has, not something one is. Even persons with the same disability but their plan of care can be quite different. Earlier terminology equated disability with an inability or incapacity or handicap that presents a more negative view of the condition.

Question 182

In Healthy People 2020, what is the emphasis of the categories of objectives that relate to the goal of Disability and Health to promote the health and well-being of people with disabilities? A) A growing emphasis on a holistic approach that recognizes life satisfaction is just as important to health and well-being as preventative services B) A growing realization that healthy-life years for persons with disabilities do not equate to decreased health costs at local, state, and national levels, unlike they do for persons without disabilities C) Focus on personal responsibility for healthy lifestyle by persons with disabilities D) Concept that persons with disabilities are always dependent on others

Answer 182

Ans: A Feedback: In Healthy People 2020, the emphasis of the categories of objectives that relate to the goal of

Question 183

Which of the following are the three areas that Healthy People identified for public health action for the year 2020 using the International Classification of Functioning, Disability, and Health? Select all that apply. A) Improve the conditions of life for persons with disabilities B) Address the inequitable distribution of resources among people with disabilities and those without disabilities C) Expand the knowledge base and raise awareness about determinants of health for people with disabilities D) Ensure the health of people with disabilities by influencing many social and physical factors E) Public health activities need to focus only on preventing disability

Answer 183

Ans: A, B, C Feedback: The three areas that Healthy People has identified for public health action for the year 2020 using the International Classification of Functioning, Disability, and Health include improve the conditions of life for persons with disabilities; address the inequitable distribution of resources among people with disabilities and those without disabilities; and expand the knowledge base and raise awareness about determinants of health for people with disabilities. The plan to ensure the health of people with disabilities by influencing many social and physical factors is too broad. Public health activities need to focus only on preventing disability is a misconception.

Question 184

The community health nurse is invited to speak to a group of students about clients with disabilities. As part of the class, the nurse intends to describe The International Classification of Functioning, Disabilities, and Health (ICF) and its attempts at standardized language. Which of the following would the nurse include as terminology that was standardized? Select all that apply. A) Disability impairment issues B) Body functions C) Handicapping conditions D) Activities E) Environmental factors F) Personal Factors

Answer 184

Ans: B, D, E, F Feedback: The ICF included definitions for body functions and structures, activities, and environmental and personal factors. Terms such as disability, impairment, and handicap have been removed from the definition and replaced with functioning, which is more holistic and positive.

Question 185

After teaching a group of students about leading health risks, the instructor determines that the teaching was successful when the students identify which of the following as the #1 leading health risk? A) Unsafe sex B) High blood pressure C) Underweight D) Tobacco consumption

Answer 185

Ans: C Feedback: The ten leading health risks are (1) underweight; (2) unsafe sex; (3) high blood pressure; (4) tobacco consumption; (5) alcohol consumption; (6) unsafe water, sanitation, and hygiene; (7) iron deficiency; (8) indoor smoke from solid fuels; (9) high cholesterol; and (10) obesity.

Question 186

A community health nurse is preparing for a presentation on disabilities and is planning to include information about Healthy People 2020 goals. When addressing these goals, the nurse identifies differences from the goals addressed by Healthy People 2000. Which of the following would the nurse identify as different? Select all that apply. A) Rather than individuals with disabilities and/ or chronic illnesses being defined by their limiting conditions, they are viewed as having the potential to meet and exceed health promotion and disease prevention goals set for the nation's population as a whole. B) The approach to disability now emphasizes the principles of health promotion and disease prevention for those currently experiencing disabilities and/or chronic illness. C) The goals for Healthy People 2000 have an entire section on disability and secondary conditions. D) A growing realization that healthy life-years for persons with disabilities equate to decreased health costs at local, state, and national levels, just as they do for persons without disabilities.

Answer 186

Ans: A, B, D Feedback: A comparison among Healthy People plans over the last decades underscores the emergence of new approaches to identifying priority areas and planning to improve the health of individuals with disabilities and chronic illness. In Healthy People 2000, only one priority was devoted to disability and chronic illness. Over the past two decades, interest in disability has accelerated. Areas that are focused on with Healthy People 2020 include rather than individuals with disabilities and/or chronic illnesses being defined by their limiting conditions, they are viewed as having the potential to meet and exceed health promotion and disease prevention goals set for the nation's population as a whole; the approach to disability now emphasizes the principles of health promotion and disease prevention for those currently experiencing disabilities and/ or chronic illness; and a growing realization that healthy life-years for persons with disabilities equate to decreased health costs at local, state, and national levels, just as they do for persons without disabilities.

Question 187

A community health nurse is compiling a list of organizations that serve the needs of persons with disabilities. Which of the following would the nurse categorize as a federal agency? A) National Organization on Disability B) National Council on Disability C) National Association of the Deaf D) American Foundation for the Blind

Answer 187

Ans: B Feedback: The National Council on Disability is an independent federal agency. The National Organization on Disability, National Association of the Deaf, and American Foundation for the Blind are private organizations.

Question 188

Which of the following is a major difference between Healthy People 2010 and Healthy People 2020 with respect to people with disabilities? A) Healthy People 2010 emphasized the disparities that people with disabilities experience. B) The emphasis on

Answer 188

Ans: B Feedback: The emphasis on

Question 189

An instructor is reviewing the principles that resulted from the 2011 reassessment of global progress on addressing disability with a class. Which of the following would the nurse include? A) The government must focus solely on seeking improvement in the lives of individuals and families living with disabilities. B) Government must play the only role in addressing disability. C) It is unimportant for service providers, academic institutions, the private sector, communities, and people with disabilities and their families to address disabilities. D) The importance of all persons, including those with disabilities, participating in their country's development.

Answer 189

Ans: D Feedback: In 2011, the World Health Organization and the World Bank reassessed global progress on addressing disability in light of the 2006 Convention on the Rights of Persons with Disabilities. It was determined that not only must governments seek improvements in the lives of individuals and families living with disability, but every citizen needs to participate in their country's development. Government at every level may play a most significant role, but there are important roles for service providers, academic institutions, the private sector, communities, and especially people with disabilities and their families.

Question 190

When describing the importance of the World Health Report to a group of students, the instructor would emphasize which of the following? A) It challenged the world community to focus more attention on unhealthy behaviors that lead ultimately to chronic disease, disability, and early mortality. B) Lifestyle choices are not one of the key contributors to morbidity and mortality levels in either affluent or poor countries. C) Infectious disease is the major threat. D) Malnutrition is the only threat.

Answer 190

Ans: A Feedback: The World Health Report challenged the world community to focus more attention on unhealthy behaviors that ultimately lead to chronic disease, disability, and early mortality. It recognized that although infectious disease and malnutrition require ongoing vigilance because they continue to plague many parts of the world, they are not the only threats. Lifestyle choices are also one of the key contributors to morbidity and mortality levels in both affluent and poor countries.

Question 191

After teaching a class about the International Classification of Functioning, Disability, and Health (ICF), the instructor determines that the teaching was successful when the students identify which of the following as a personal factor? A) Problems with ambulation B) Working C) Coping styles D) Amputation

Answer 191

Ans: C Feedback: Personal factors are the features of an individual's background, life, and living that are not part of a health condition or health status, such as gender, race, age, other health conditions, fitness, lifestyle habits, upbringing, coping styles, social background, education, profession, past and current experience, overall behavior pattern and character style, individual psychological assets, and other characteristics. Problems with ambulation would be considered an activity limitation. Working would be an activity. Amputation would be an impairment.

Question 192

A community health nurse is planning to apply the International Classification of Functioning, Disability, and Health to clinical care in the community. The nurse could use this document as a basis for which of the following? A) Curriculum design B) Needs assessment C) Quality of life measures D) Policy design

Answer 192

Ans: B Feedback: In clinical care, the ICF document would be helpful with a needs assessment. Using the ICF document for curriculum design would reflect education; using it for quality of life measures would reflect research; using it for policy design would reflect social policy.

Question 193

A community health nurse is working with a group of visually impaired individuals and is developing a program to promote self- confidence and self-respect. Which of the following organizations would be a valuable resource for the nurse? A) American Foundation for the Blind B) American Council of the Blind C) Guide Dogs for the Blind D) National Federation of the Blind

Answer 193

Ans: D Feedback: The nurse would contact the National Federation of the Blind whose focus is on helping blind individuals achieve self- confidence and self-respect. The American Foundation for the Blind advocates for the visually impaired through increased state and federal funding. The American Council of the Blind provides services such as information and referral, scholarship assistance, public education, and industry consultation, governmental monitoring, consultation, and advocacy. The Guide Dogs for the Blind makes guide dogs available for the visually impaired.

Question 194

A community health nurse is making a home visit to a family. The family has a son with a disability who requires a motorized wheelchair. The family asks for the nurse's assistance. Which response by the nurse would be most appropriate? A) His disability should automatically cover the cost of the chair. B) We'll need to check with the insurance company about coverage.= C) You'll probably be able to get it if you pay for half the cost.= D) You might be able to get a regular wheelchair, but a motorized one is impossible.=

Answer 194

Ans: B Feedback: One major obstacle for families with a disabled or chronically ill member may be obtaining needed assistive devices and technology. Just because the technology exists does not mean that it can be obtained. Often the insurance carrier, whether private or governmental, sets limits on which products can be obtained or which brands are acceptable. Thus the nurse working with the family would need to check with the insurance company first and determine what if anything is covered and then determine how to go about obtaining what the son needs.

Question 195

A community health nurse is developing a plan of care for a family who is providing round-the-clock care in their home for a daughter who is chronically ill. Which of the following would be most important for the nurse to integrate into the plan? A) Insurance limitations B) Skill teaching C) Flexible visiting D) Respite care

Answer 195

Ans: D Feedback: Respite care is another area of great importance for families of the disabled and the chronically ill. It can be emotionally draining to meet the daily needs of a member who cannot perform self-care. This often leads to caregiver fatigue and increased stress. It is also important to recognize the effect of the situation on noncaregivers in the family, particularly nondisabled siblings of a disabled child. Respite care offers some needed relief to the family and allows for uninterrupted attention to the nondisabled children. Whatever the source, some type of respite care is often vital to the family's health and should be a priority in the overall treatment plan of the family. Although insurance considerations, teaching, and flexible visiting would be issues to be addressed, respite care is a priority.

Question 196

When developing programs to assist individuals with disability and chronic illness, which of the following would be most important? A) Narrow focus B) Holistic practice C) Orientation to the present D) Episodic care

Answer 196

Ans: B Feedback: The role of the community health nurse with respect to disabilities and chronic illness requires a holistic practice and broad focus. Strong and sustained efforts are needed to achieve results. The community health nurse addresses current needs and plans for the future

Question 197

A community health nurse is providing information handouts that describe the need for annual gynecologic exams to local health clinics that provide care for individuals with disabilities. The nurse is fulfilling which role? A) Advocate B) Coordinator C) Researcher D) Educator

Answer 197

Ans: D Feedback: Providing information handouts is a method for teaching. Therefore, the nurse is assuming the role of an educator at the community level. In the advocate role, the nurse would assist in arranging for the population to receive the appropriate screening, ensuring that any special modifications or adaptations would be available. In the coordinator role, the nurse might arrange for screening to be performed during a routine visit made by a client to a facility or make arrangements for transporting the clients to a facility for the screening. In the researcher role, the nurse might contact other community health nurses about their experience in ensuring screening for this population to discover if they have similar needs or problems.

Question 198

A community health nurse is reviewing the effects of the Americans with Disabilities Act of 1990. Which of the following would the nurse identify as a major result of this legislation? A) Employers with five or more employees must abide by the American with Disabilities Act. B) Architectural barriers must be removed from pathways so that they are accessible by wheelchair. C) The disabled are eligible to receive telephone services in their home at no cost to them. D) Individuals with disabilities who wish to vote must be provided transportation to polling places to vote.

Answer 198

Ans: B Feedback: A major accomplishment of this law was the removal of architectural barriers; curbs, stairs, handicap toilets, etc. so that the disabled in wheelchairs can freely move about. Employers with 15 or more employees must follow this law. Adapted telephone services are provided for those who are hearing or physically impaired, but the telephone service is not free. Polling places must be accessible to the disabled and absentee ballots and voter registration can be done from home.

Question 199

When reviewing the concept of universal design with a group of community developers, the community health nurse recognizes that the emphasis is on which of the following as the underlying theme? A) Disability needs B) Adaptation C) Access D) Safety

Answer 199

Ans: C Feedback: The underlying theme of universal design is ensuring access. Universal design is the design of products and environments to be usable by all people, including those with disability needs as well as chronic illness. The concept incorporated issues of adaptive design and safety measures such as reinforcement in bathroom walls to allow for installation of grab bars, but the key issue is accessibility.

Question 200

Which one of the following statements about the benefits of universal design for all persons is the most accurate? A) It is the right thing to do to allow access to the built environment for all persons including persons with disabilities. B) A healthier population may be achieved with attention to the environmental barriers that impede healthy lifestyles for all persons, including those with chronic or disabling conditions. C) The built environment refers to the naturally occurring features of the planet. D) Access implies universal design.

Answer 200

Ans: B Feedback: A healthier population may be achieved with attention to the environmental barriers that impede healthy lifestyles for all persons, including those with chronic or disabling conditions. Universal design is the right thing to do for persons with disabilities but is not the most accurate or best reason to ensure universal design. The built environment refers to the physical parts of where we live and work (e.g., homes, buildings, streets, open spaces, and infrastructure). Universal design incorporates access, but access does not necessarily imply universal design.

Question 201

A community health nurse is meeting with a group of individuals who have been diagnosed with a serious mental illness. The nurse interprets this to mean which of the following? A) The clients have impaired level of functioning and quality of life. B) The clients' disorder is chronic and persistent. C) The clients have issues of impaired control and dependency. D) The clients have a significant behavior syndrome with present distress.

Answer 201

Ans: A Feedback: Serious mental illness (SMI) is mental illness that has compromised both the client's level of function and his or her quality of life. Serious and persistent mental illness (SPMI) is the preferred term for serious mental illness of a chronic nature. Impaired control and dependency are components of addiction. A significant behavior syndrome with present distress characterizes a mental illness.

Question 202

When developing appropriate programs for adult mental health promotion, the nurse incorporates knowledge about the most prevalent mental disorders. Which of the following would the nurse identify as the most prevalent? A) Major depression B) Bipolar disorder C) Anxiety disorders D) Schizophrenia

Answer 202

Ans: C Feedback: For American adults, the most prevalent mental disorders are anxiety disorders, followed by mood disorders, especially major depression and bipolar disorders. Schizophrenia, which affects approximately the same number of adults as bipolar disorder, is problematic because it is so persistently disabling

Question 203

After teaching a group of women in the community about common mental health disorders affecting them, the community health nurse determines that the teaching has been effective when the group identifies which one of the following? A) Anxiety disorders and mood disorders occur twice as frequently in men as in women. B) Women of color, women on welfare, poor women, and uneducated women are more likely to experience depression than women in the general population. C) The three main types of eating disorders affect more men than women. D) The three main types of eating disorders include undereating due to food unavailability.

Answer 203

Ans: B Feedback: Women of color, women on welfare, poor women, and uneducated women are more likely to experience depression than women in the general population. Anxiety disorders and mood disorders occur twice as frequently in women as in men. The three main types of eating disorders affect more women than men. The three main types of eating disorders (anorexia, bulimia nervosa, and binge eating) also affect more women than men.

Question 204

A community health nurse is part of community discussion group on alcohol. The nurse recommends that adult males should have less than A) 6 standard drinks weekly. B) 8 standard drinks weekly. C) 10 standard drinks weekly. D) 14 standard drinks weekly.

Answer 204

Ans: D Feedback: For the general male adult population, the recommended drinking limits are fewer than five standard drinks daily or 14 weekly. For the general female adult population, the recommended drinking limits are fewer than four standard drinks daily or eight weekly, and forpeople age 65 and older, recommended drinking limits are no more that one standard drink daily or seven standard drinks weekly.

Question 205

When determining a target population for education about alcohol use, which age group would the community health nurse most likely plan to address? A) 18- to 25-year-olds B) 30- to 40-year-olds C) 45- to 55-year-olds D) 65 years of age and older

Answer 205

Ans: A Feedback: Trends in alcohol use in the United States differ across subsets of the population. Young adults (age 18 to 25) have the highest incidence of problem drinking. Thus the community health nurse would most likely address this age group.

Question 206

After teaching a class about commonly used illicit substances, the instructor determines that the teaching was successful when the class identifies which of the following as the most frequently reported illicit drug? A) Heroin B) Methamphetamine C) Marijuana D) Cocaine

Answer 206

Ans: C Feedback: Although heroin, methamphetamine, and cocaine are frequently used illicit drugs, marijuana is the most frequently reported illicit drug.

Question 207

A community health nurse is discussing alcohol use disorders and is explaining what is meant by a standard drink. Which of the following would the nurse include as an example? Select all that apply. A) Two 12-oz. cans of beer B) 5-oz. glass of wine C) 1.5 oz. of an 80-proof spirit D) 3 oz. of a cordial E) Two bottles of wine cooler

Answer 207

Ans: B, C, D Feedback: A standard drink contains about 14 g of alcohol (0.6 fluid ounces or 1.2 tablespoons), which is equivalent to one 12-oz. bottle of beer or wine cooler; 8 to 9 oz. of malt liquor; one 5- oz. glass of table wine; 3 to 4 oz. of fortified wine, 2 to 3 oz. of cordial, liqueur, or aperitif; 1.5 oz. of brandy; or 1.5 oz. of 80- proof distilled spirits.

Question 208

When assessing a group of individuals for factors related to an increased risk for alcohol use disorders, which of the following would the nurse expect to find? Select all that apply. A) Academic engagement/achievement B) Antisocial peer affiliations C) Decreased impulsivity D) Positive mother3child/father3child relationships E) Stressful life events

Answer 208

Ans: A, B, E Feedback: Individual factors associated with the development of AUDs include problems with academic engagement/achievement, antisocial peer affiliations, problems in the mother3 child/father3child relationship, and other stressful life events.

Question 209

Which one of the following statements regarding the etiology of substance use disorders is most accurate? A) It is believed that nurture has substantially more influence on the development of substance use disorders than nature. B) With the mapping of the human genome, hope has decreased that the genes related to substance use disorders could be identified. C) Alcohol dependence is thought to be a multigenomic disorder influenced by the environment (gene3environment interaction). D) Only genetic heritability is involved in the etiology and course of substance use disorders.

Answer 209

Ans: C Feedback: Alcohol dependence is thought to be a multigenomic disorder influenced by the environment (gene3environment interaction). It is believed that genetics is a risk factor in the range of 50% to 50%. With the mapping of the human genome, hope has increased that the genes related to substance use disorders could be identified. In addition to genetic heritability, both personal and environmental factors are involved comparably in the etiology and course of substance use disorders.

Question 210

The community health nurse is using effect theory to design a prevention program for behavioral health. Which of the following would be the most likely place for the nurse to start? A) Identifying antecedent factors leading to the problem B) Identifying the specific health problem C) Determining the desired health problem impact D) Specifying the health problem outcome

Answer 210

Ans: B Feedback: When using effect theory to design a prevention program for behavioral health, a good place to start is to identify the specific health problem and then the desired health problem impact and health problem outcome. As the program is developed, the community health nurse starts by identifying the antecedent factors that lead to behavioral health problems. This provides a clear rationale for why the intervention should provide the desired impact.

Question 211

A community health nurse is providing an in- service program to the agency staff about effect theory, which will be used to develop behavioral intervention programs. The nurse determines that the staff needs additional teaching when they identify which of the following as a component of the theory? A) Determinant theory B) Intervention theory C) Impact theory D) Process theory

Answer 211

Ans: D Feedback: Process theory is a theoretical framework used in community/public health science. It is not a component of effect theory. Effect theory has four components: determinant theory, intervention theory, impact theory, and outcome theory.

Question 212

A community health nurse is applying the Institute of Medicine model based on Gordon's Classification of Disease Prevention model to address prevention of alcohol use during pregnancy and prevention of fetal alcohol syndrome. Which of the following populations would the nurse target indicated prevention strategies? A) Local women in the community of childbearing age B) Women of childbearing age living in a city C) Women of childbearing age considered at risk D) Pregnant women who have a child with fetal alcohol syndrome

Answer 212

Ans: D Feedback: Indicated prevention strategies would be designed to prevent the use of alcohol in pregnant women who had screened positive for alcohol use during pregnancy or already had a child diagnosed with FAS or FASD. Universal prevention strategies would address the entire population of women of childbearing age (national, local community, school, neighborhood), with messages and programs aimed at preventing the use of alcohol if pregnancy is a possibility. Selective prevention strategies would target subsets of women of childbearing age who are deemed to be at risk for alcohol use by virtue of their membership in a particular population segment.

Question 213

A community implements a plan to enforce the underage drinking law. The community health nurse interprets this action as reflecting which public health model? A) Primary prevention B) Behavioral prevention C) Environmental prevention D) Clinical prevention

Answer 213

Ans: C Feedback: Environmental prevention relies on a societal commitment for the implementation of the interventions and aims to alter the environment by reducing risk (e.g., community-wide decrease in availability of the substance; underage drinking law enforcement). Primary prevention is conducted when no disease is present in the target population with the primary goal being prevention of disease development. Behavioral prevention includes a broad array of strategies aimed at changing lifestyles (e.g., exercise, smoking cessation, balanced nutrition). The goal of the intervention is to change behaviors that put the person at risk for developing the disease or to prevent consequences of the disease. Clinical prevention is based on the medical model for preventive services. It relies on one-to-one, provider-to-patient interaction and occurs within the traditional health care delivery system.

Question 214

Which of the following statements about the National Alliance on Mental Illness (NAMI) is most accurate? A) NAMI focuses on the needs of the people who actually have mental illness. B) NAMI is committed to enhance the care of those with mental illness and improve the quality of life of those who are affected. C) The NAMI Web site contains some information that is intended to be used exclusively by care providers. D) All services of NAMI are provided at the main headquarters.

Answer 214

Ans: B Feedback: NAMI is committed to enhance the care of those with mental illness and improve the quality of life of those who are affected. NAMI focuses on the needs of the families, peers, and consumers of Mental Health services. The NAMI Web site contains extensive information that can be utilized by both consumer and care providers. NAMI is a nationwide organization with chapters in each state and county.

Question 215

Which one of the following statements about nonprofit organizations that serve those with mental health issues is most accurate? A) They are all associated with the government. B) A for-profit organization that promotes mental health is Mental Health America, which was established in 1909. C) The organization National Mental Health Association is a scam. D) They focus on advocacy, education, service, and funding research endeavors.

Answer 215

Ans: D Feedback: Nonprofit organizations focus on advocacy, education, service, and funding research endeavors. They are not all associated with the government. Mental Health America was formerly known as National Mental Health Association, which is a leading nonprofit organization that promotes mental health.

Question 216

Healthy People 2020 objectives focus on tobacco, alcohol, and illicit drug use education. Which of the following are steps in the process to providing this education? Select all that apply. A) Identifying the impact of substance use on the environment B) Identifying trends of substance use to develop a prevention program C) Understanding the consequences of substance use that affect a community as a whole D) Differentiating between legal and illegal substance use E) There are no differences in prevention programs for different populations

Answer 216

Ans: B, C, D Feedback: The three steps in the process for providing tobacco, alcohol, and illicit drug use education are in order (1) identifying trends, (2) differentiating legal versus illegal use, and (3) consequences of use. Identifying the impact of substance use on the environment is not one of the steps. There are differences in prevention programs4if the target population is young adults, the prevention of binge drinking might be a top concern; if homeless adults, the focus will be on chronic alcohol, cocaine, and heroin use; cultural and ethnic differences in alcohol and

Question 217

A community health nurse is involved in a screening program for alcohol use with an ethnically diverse population. Which of the following would be the best instrument to use? A) Alcohol Use Disorders Identification Test (AUDIT) B) CAGE questionnaire C) Michigan Alcoholism Screening Test (MAST) D) Drug Abuse Screening Test (DAST)

Answer 217

Ans: A Feedback: For alcohol use, the screening instrument recommended by the NIAAA is the AUDIT. WHO developed this instrument for use across populations, and it has established high reliability and validity across ethnic groups. Other tests that can be used include the CAGE questionnaire and MAST. The DAST would be appropriate to screen for drug use.

Question 218

Which of the following would the community health nurse identify as a major limitation for using biological markers for screening for substance use? A) Sensitivity of the test B) Cost of the test C) Factors influencing the test D) Ease of obtaining a specimen

Answer 218

Ans: B Feedback: Biological screening tests are rarely used in a community-based screening program due to the cost and the problems with obtaining biological specimens. In addition, numerous factors can influence sensitivity and specificity of biological markers, including other metabolic disorders or other diseases, medication use, and reliability of the method.

Question 219

Which of the following statements about Healthy People 2020 and reducing substance use and addressing mental health needs is most accurate? Select all that apply. A) After a diagnosis is established, the nurse can decide on an intervention that can address the specific public health issue identified in the diagnosis using the Healthy People 2020 objectives. B) It could be considered a priority as two of the top ten health indicators relate to substance use and mental health. C) Target benchmarks and data derivation for each objective can be used to guide program development. D) Reducing substance abuse and addressing mental health needs are not priority with Healthy People 2020. E) The goals are to improve mental health through prevention and to reduce substance abuse to protect the health, safety, and quality of life for all, especially children.

Question 220

Which of the following would a community health nurse address as a means for enhancing the life of the public? A) Proper nutrition B) Healthy sleep patterns C) Use of community supports D) Creative outlets

Answer 220

Ans: D Feedback: Life-enhancing activities to enhance public well-being include meaningful work, whether through or outside of employment, creative outlets, interpersonal relationships, recreational activities, and opportunities for spiritual and intellectual growth. Proper nutrition, healthy sleep patterns, and use of community supports are life-sustaining activities.

Question 221

A community health nurse has completed a community assessment. Which of the following would be next? A) Decide on an intervention B) Locate an appropriate the specific focus area in Healthy People 2020 C) Establish a community diagnosis D) Determine the level of prevention

Answer 221

Ans: C Feedback: After completing a community assessment, the nurse then establishes a community diagnosis. Once this is done, the next step is to decide on an intervention that can address the specific public health issue identified in the diagnosis. A good starting point in the development of community/public health intervention is to begin with the Healthy People 2020 objectives, locating the specific focus area that matches the community diagnosis. Once the nurse identifies the focus of the intervention, the next step is to determine the level of prevention.

Question 222

A community health nurse is working with a political group to lobby for changes in funding for a mental health promotion program. The nurse is functioning in which role? A) Educator B) Collaborator C) Advocate D) Case manager

Answer 222

Ans: C Feedback: The advocacy role requires being politically involved by serving on decision-making boards and committees, lobbying for legislative changes, and helping to influence mental health policy development that will better serve this population. In the educator role, the community mental health nurse teaches clients individually and in groups about their mental health conditions, their treatment protocols, ways to function more independently in the community, prevention and health-promoting strategies, and much more. In the collaborator role, the nurse works with others, pooling the groups professional expertise to enhance the quality and effectiveness of services. In the case manager role, the nurse is involved with screening, assessment, care planning, arranging for service delivery, monitoring, reassessment, evaluation, and discharge, often within the context of a community mental health center (CMHC). Case management helps the person with an SMI to access services and live as independently as possible.

Question 223

Which one of the following are the primary roles that the community health nurse must use to understand and serve populations with mental illness? A) Advocate B) Educator C) Case manager D) Consumer of epidemiologic data

Answer 223

Ans: D Feedback: The access and use of epidemiologic data to understand and serve populations with mental illness are primary.

Question 224

Which of the following are involved in accessing and using epidemiologic data to understand and serve populations with mental illness? Select all that apply. A) Identifying the incidence and prevalence of mental disorders B) Understanding that all data are accurate C) Examining the causes and risk factors associated with mental illness D) Identifying the needs of people with mental disorders

Answer 224

Ans: A, C, D Feedback: This means identifying the incidence and prevalence of mental disorders, examining the causes and risk factors associated with mental illness, and identifying the needs of populations with mental illness. However, not all data are accurate.

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