And health and concepts describing the view health

Chapter 18: Violence and Abuse
1. A community health nurse is reviewing the medical records of several families in the community who have experienced varying crises. The nurse identifies which as developmental crises? Select all that apply.

A) A windstorm that damaged 18 homes in a community
B) Grandpa Jones dying at age 82 years
C) A couple getting engaged
D) The Smiths getting a divorce
E) The Jones experiencing a home invasion
F) Seven people dying in an automobile crash
Ans: B, C, 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 grandparent or parent is a developmental expectation. However, the actual event may occur suddenly. Experiencing damage from a windstorm, a home invasion, and an automobile crash are situational crises.

D) Situational crises often occur without warning.

E) Situational crises occur to people because of where they are in time and space.

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.

D) Family violence is decreasing in industrialized countries in the world as a result of more public awareness.

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 the urbanized areas where exposure to crime is more prevalent. Family violence is decreasing in industrialized countries in the world as a result of more public awareness.

7. Which would lead a 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.

F) 14-year-old Jennifer watches her neighbor’s 2-year-old child every Saturday.

Ans: A, C, 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.

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 elimination of the loving reconciliation phase. 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.

9. When discussing elder abuse with a senior citizen group, which would the community health nurse include?

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

10. A nurse is interviewing a teenage who has come to the school nurse office after telling a teacher “I am scared of my parents.” The nurse begins to ask questions and finds out that the teenage and parents had a fight last night related to the peer group the teenager has chosen to socialize with. The parents told the teenager that they did not like the peer group and took away his or her cellular device. Which part of the situation depicts protective factors of violence?

Relationships with adults are considered protective factors, and the teenager did not detail any relationships. Other protective factors include access to services for mental health and substance abuse, which were also not indicated in the teenager’s description.

Chapter 19: Maternal–Child Health
1. A community health nurse is conducting an in-service program for a group of maternal and child health nurses. When describing the critical population health indicators affecting this population globally and nationally, the nurse would include which components? Select all that apply.

A) Classroom lectures
B) Informal group discussions
C) Creative craft sessions
D) Small group games
E) Interactive computer activities
Ans: B, C, D, E
Feedback: Adolescents are more often concerned with present needs and respond better to relaxed, informal group approaches to education that involve topics of their choosing and do not resemble the school setting. Pregnancy diaries, creative activities (crafts, drawing, making snacks), small group activities and games, videos with discussions, social media and computer-assisted interventions,

and visits to local community resources (hospital delivery rooms, social services, lactation counselors) are more appealing than classroom lectures.

B) Waning of pertussis immunity with age necessitating immunization of adults who would be around infants.

C) Increased immunity when varicella vaccine given in two doses has been found to increase immunity.

2. 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 probably will need to give the child medication to help the child in school.”
B) “We need to keep the child 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.”
Ans: B
Feedback: While a number of parents feel that sugar and 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.

D) Poverty is one health problem that does not affect learning and achievement in school-age children.

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

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.”
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.

3. Which statement 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.

4. The community health nurse is developing an education session targeting young adult women regarding sexual health. For this population group, the nurse would be sure to integrate specific information regarding which most common bacterial sexually transmitted infection (STI) during the education session?

A) Herpes
B) Chlamydia
C) Syphilis
D) HIV
Ans: B
Feedback: Sexual health and STIs are important health concerns for young women. The two most common STIs affecting women are Chlamydia and gonorrhea. While it is important to include information about herpes, syphilis, and HIV as well, the nurse should target the most common affecting this age group.

C) ageism.

D) insight.

C) They maintain the maximum degree of physical, mental, and social vigor.

D) They are likely to be dependent on others.

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.

5. A community health nurse meets with a group of adults at the local senior center. They range in age from 50 to 75 years. The nurse would recommend colonoscopy screening at which frequency?

A) Every year
B) Every 2 years
C) Every 5 years
D) Every 10 years
Ans: D
Feedback: Currently, colonoscopy screenings should be administered every 10 years.

A) Arthritis
B) Hypertension
C) Emphysema
D) Peripheral vascular disease
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.

8. Which statement about elder abuse is most accurate?

Ans: A
Feedback: Elder abuse is a problem that is underrecognized and underreported. It is more common for older women to be abused rather than older 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.

9. Which are included in a comprehensive set of services? Select all that apply.

11. Which statement 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.

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.

Chapter 23: Working With Vulnerable People
1. Which statement about relative risk is most accurate?

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.

2. 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?

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 examinations 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.

3. A community health nurse is working to empower clients of a vulnerable population. Which client behavior indicates that the nurse is achieving this goal?

D) unequal.

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. If it were a direct relationship, a change with one variable will likely show a corresponding change in the other. This type of relationship can also be referred to as a positive relationship because this corresponding change in the other variable is typically in the same direction. In an unequal relationship, distribution is not equal.

D) The socioeconomic gradient of health is universal.

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.

E) Health-damaging behaviors that are chosen by an individual despite health education and counseling efforts.

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., older adults, women, children, rural residents, disabled) and across clinical conditions. Clients 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.

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.

3. A community health nurse notices that a client with a disability has not undergone breast cancer screening for quite a few years due to a lack of accessible equipment and personnel at the local clinic. The nurse works with the clinic to obtain appropriate equipment to facilitate screening as well as ensuring that adequate personnel are available to help with the screening. The nurse is assuming which role?

C) The built environment refers to the naturally occurring features of the planet.

D) Access implies that universal design is in place.

A) Treatment of AIDS
B) Heart healthy diet
C) Increased activity levels
D) Water sanitation
E) Smoking cessation
Ans: B, C, E
Feedback: The WHR 2002 (WHO, 2002b) emphasized that health care providers worldwide should broaden their clinical and population health practices, rather than continue a narrow focus on acute illness. Changes in lifestyles and behaviors that have key impacts on increasing healthy years of life should be emphasized. The 10 leading health risks identified by the WHO are as follows: (1) air pollution and climate change, (2) noncommunicable diseases, (3) global influenza pandemic, (4) fragile and vulnerable settings, (5) antimicrobial resistance, (6) Ebola and other high-threat pathogens, (7) weak primary health care, (8) vaccine hesitancy, (9) dengue, and (10) HIV (WHO, 2019b). Across the globe, these 10 health risks contribute to more than one third of all deaths and a significant proportion of disability. Half of these risk factors—tobacco and alcohol consumption, high blood pressure, high cholesterol, and obesity—are directly related to lifestyle and behavioral choices. Thus, programs such as heart healthy diet, increased activity levels, and smoking cessation would be the priority focus areas.

7. A community health nurse is reviewing information about Healthy People 2030. Which areas would the nurse most likely find as needed public health action? Select all that apply.

A) Hearing
B) Vision
C) Cognitive
D) Ambulatory
E) Self-care
F) Independent living
Ans: A, B
Feedback: Disability status is determined by difficulties in these six areas: hearing, vision, cognitive, ambulatory, self-care, and independent living; children aged 5 to 14 years can have difficulty in hearing, vision, ambulatory, and self-care; and children <5 years can have difficulties in hearing and vision (American Community Survey, 2015). Among young adults, cognitive disabilities were the most common, whereas mobility disabilities were more prevalent in those over the age of 45 (Okoro et al., 2018).

10. A nurse is caring for an older female who recently loss sight in her left eye due to cancer. She is planning on visiting her daughter in a few months and expresses concern about flying and getting around the airport. Which law should the nurse explain to the client?

Ans: A
Feedback: C/PHNs should be aware of the prevalence of drug use in the community. Commonly used substances include alcohol, marijuana, cocaine and crack, heroin, hallucinogens, inhalants, methamphetamine, prescription drugs such as opioids, and tobacco. Neither gender is more at risk for substance abuse. Not all instances of substance abuse are accompanied by mental illness. A single screening tool would be used to determine substance abuse.

2. A community health nurse is discussing alcohol use disorders and is explaining what is meant by a standard drink. Which would the nurse include as examples? Select all that apply.

4. Healthy People 2030 objectives focus on tobacco, alcohol, and illicit drug use education. Identify the 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
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) understanding the consequences of substance use. Identifying the impact of substance use on the environment is not one of the steps. There are differences in prevention programs—if 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 SUDs are noted in American Indians with increased rates of fetal alcohol syndrome and increased prevalence in prison and jail populations.

D) Reducing substance abuse and addressing mental health needs are not priority with Healthy People 2030.

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.

D) Study data regarding opioid addictions.

Ans: D
Feedback: While all of these are important roles to the community health nurse, studying the data is the first step and vital to the roles. The nurse can identify incidence and prevalence of opioid addictions by examining the causes and risk factors associated with the disorders, then identifying and addressing the needs of people with substance use disorders. As an advocate, the nurse can reduce barriers to treatment and improve services but not advocate for changes to prescribing opioids. This work requires the nurse to be politically active. As an educator, the nurse can provide information to the client and to the community.

2. Which are reasons why it is difficult to estimate the number of persons who are homeless? Select all that apply.

A) It is difficult to estimate the number of people who are homeless, since homelessness is a temporary condition.

Ans: A, B, C, D
Feedback: The following are reasons: It is difficult to estimate the number of people who are homeless, since homelessness is a temporary condition. It is difficult to locate and account for people who are homeless. Some people are unable to access shelters where they would be counted as homeless because the shelter is already overcrowded and there is limited capacity. In rural areas, there are fewer housing options and resources for the homeless, and as a result, people may be forced to live temporarily with friends or family. It is true that homelessness is increasing due to poverty and the growing shortage of affordable rental housing, but this is not a reason why it is difficult to estimate the number of people who are homeless.

3. Which are reasons for the increase in poverty rates over recent years? Select all that apply.

C) Homeless adolescents may have difficulty accessing emergency shelter because of shelter policies that prohibit older youth from the facility.

D) It is not uncommon for homeless youth to be arrested for running away, breaking curfews, or being without supervision.

A) Adequate numbers and types of providers
B) Unpredictable and hazardous weather conditions
C) Lack of transportation
D) Physical distance between the residence and the location of health care services
E) Less high-tech health care equipment and services available
Ans: B, C, D, E
Feedback: The barriers to access to health care that may be experienced by rural clients include unpredictable and hazardous weather conditions, lack of transportation, physical distance between the residence and the location of health care services, and less high-tech health care equipment and services available. There are often not adequate numbers and types of providers of health care in rural areas.

2. A community health nurse is planning to switch employment and work at a clinic that provides services to migrant workers and their families. When preparing to work with this population, which information about this population would the nurse need to keep in mind?

Ans: C
Feedback: Migrant workers often work 6 days a week from sunrise to sunset. They are often paid unfairly and treated unjustly. The entire family is often involved in performing the migrant work. Their earning power is variable depending on the variables of weather and crop conditions

3. When assessing a group of migrant farmworkers, the community health nurse notes that the group leaves their home base for part of the year to travel to the same place along a route during the agricultural season, usually returning on yearly basis. The community health nurse identifies this as which of the following?

A) Many are undocumented aliens living in fear of deportation.

B) They are often deprived of safe working conditions.

6. A community health nurse works to offer increased health care services to meet the needs of a local migrant population. Which ideas would be most effective for the nurse to implement with this population? Select all that apply.

A) Providing a mobile van clinic that comes to the farms during the day
B) Offering a clinic at the migrant camp from 7 to 10 pm
C) Asking local doctors to stay open until 6 pm during the summer
D) Offering school-based health services for the children
E) Providing a breakfast program for the children at school
Ans: A, B, D, E
Feedback: The van at the work site, services for children in school including a breakfast program, and a late evening clinic at the camp would help the greatest number of migrant family members. Migrant workers are in the fields until dark. In the summer, that may be 9 pm; thus, a physician who stays open until 6 pmwill not be effective.

9. A public health nurse is conducting a program on social justice and public health for a group of community health nurses. After teaching the group about this topic, the nurse determines that the program was successful when the group identifies which concept as a component?

A) Decreased burden borne by all
B) Increased benefits obtained for all
C) Narrow isolated view of health
D) Impartiality as the goal
Ans: D
Feedback: Social justice occurs when a society provides for the overall health and well-being of all people by treating people fairly. It involves an equal societal bearing of burdens and reaping of benefits, and it is a widely held view that social justice is the foundation of public health nursing. Community health nurses who practice social justice have broad and holistic views of health; they have strong convictions that health care is a basic human right and that improving the health of communities is an example of social justice. Social justice ensures the distribution of resources that benefits marginalized populations and holds in check the self-interest of more privileged populations. Impartiality is the goal.

12. A community health nurse is trying to decide where to work, an urban or rural setting. Which factors would the nurse identify as characteristic of an urban setting? Select all that apply.

A) Higher salaries
B) Greater advancement opportunities
C) Limited access for additional education
D) Limited resources
E) Physical isolation
Ans: A, B
Feedback: Nurses working in urban settings typically have higher salaries and more opportunities for advancement or additional education. Limited resources and physical isolation are more often noted with rural nursing.

D) The majority receive low hourly pay.

E) Most if not all, do not have safe working conditions.

B) There is a lower poverty rate in urban communities.

C) The median household income is greater in the rural communities.

Chapter 28: Public Settings
1. A public health nurse is participating as a member of a job fair in a local community. One of the attendees asks the nurse how public health nursing differs from nursing in general. When describing the differences, which characteristics would the nurse include as reflecting public health nursing? Select all that apply.

A) Acute care services
B) Focus on the greater good
C) Seek out of clients in need
D) Community commitment
E) Health restoration
Ans: B, C, D
Feedback: Public health nurses focus on the greater good, seek out of clients in need, and are committed to the community. Public health nursing is grounded in social justice and focuses on health promotion and disease prevention. Public health nursing does not usually include acute care services or health restoration.

D) Nurses who work in public health do not use the nursing process as a foundation for their work.

Ans: B
Feedback: In hospital nursing, nurses must address the issues that come to them. Whereas in public health nursing, it is necessary for the nurse to actively seek out and identify potential problems and situations. The priorities vary for both public health nursing and other types of nursing and certainly within different communities that a public health nurse practices. Nurses who work in public health must collaborate as must nurses who work in the hospital. However, the types of people and agencies that a public health nurse must collaborate with vary from the types of people and agencies that a hospital nurse must collaborate with. Nurses who work in public health use the nursing process as a foundation for their work, just as nurses who work in hospitals do. In public health nursing, the community is the client, but the nursing process may also be applied to individuals and families.

A) “I provide care to children with special health needs.”
B) “I work to prevent illness among the school community.”
C) “I conduct health screenings.”
D) “I assess acute health problems.”
Ans: B
Feedback: The primary responsibilities of the school nurse are to prevent illness and to promote and maintain the health of the school community. The school nurse serves not only individuals, families, and groups within the context of school health but also the school as an organization and its membership (students and staff) as aggregates. Caring for children with special health needs, performing health screenings, and assessing acute health problems are aspects associated with the primary responsibilities of preventing illness and promoting and maintaining the health of the school community.

5. A school nurse is reviewing the population of school-age children for chronic conditions. Which conditions would the school nurse expect to find most often? Select all that apply.

C) These specialties are paid very well because their setting is supported through public funds.

D) Public health nurses influence the health of vulnerable populations more than the other specialties.

A) Diabetes
B) Hearing impairment

C) Asthma
D) Intellectual disability
E) Traumatic brain injury
Ans: B, D, E
Feedback: Disabilities eligible for IEPs include hearing impairment, intellectual disability, and traumatic brain injury. Conditions such as diabetes and asthma would require an individualized health plan.

2 Which are the main categories of occupational health nursing practice? Select all that apply.

A) Safety
B) Compliance
C) Health promotion
D) Care
E) Referrals
Ans: B, C, D
Feedback: Occupational health nursing practice can be divided into three main categories: compliance, care, and health promotion.

Feedback: Lillian Wald contributed to the profession of public health nursing by demonstrating the effectiveness of placing school nurses in public schools to reduce absenteeism and improve follow-up of problems identified in school children, convincing the Metropolitan Life Company that nurse intervention could reduce death rates, and founding the National Organization for Public Health Nursing (NOPHN). Margaret Sanger was responsible for promoting the use of birth control. Mary Breckenridge was responsible for creating the Frontier Nursing Service in Kentucky.

2. Nightingale’s work is fundamental to nursing today. Which are essential elements learned in those early years and still essential to optimal health and healing in today’s community health nursing? Select all that apply.

A) Chronic skin ulcer
B) COPD
C) Heart failure
D) Terminal cancer
E) Diabetes
Ans: A, C, E
Feedback: The most common diagnoses managed at home are diabetes, chronic skin ulcer, essential hypertension, heart failure, and osteoarthritis.