21 terms

Chapter 4 Health and the Global Environment

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1. Which example best illustrates the World Health Organization's definition of health?

A) 72-year-old woman with well-managed diabetes who walks 2 miles every day and takes classes at the local community college
B) 20-year-old man with no significant history of disease who smokes, works a stressful job, and is sedentary
C) 50-year-old woman with no health complaints who is alcoholic, lives alone with little social contact, and is obese
D) 98-year-old man with dementia who resides in an assisted living facility
Ans: A
Feedback: The World Health Organization defines health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." Although the 72-year-old woman has diabetes, she is managing it well, is physically active, and is effectively developing her mental and social well-being. The 20-year-old man and 50-year-old woman, although they have no known health concerns, do not have healthy lifestyles. The 98-year-old man has a mental condition and there are no indicators of physical or social well-being.
2. The nurse collects specific data related to risk factors, health indicators, and health outcomes that determine the burden of disease. Which data would the measure known as HALE yield about health indicators and outcomes?

A) Average number of years a newborn is expected to live if current mortality rates continue to apply
B) Average number of years that a person can expect to live in "full health" by taking into account years lived in less than full health due to disease and/or injury
C) Quantifying the burden of disease to a healthy life on the basis of the loss of years related to the burden of disease. The gap in years reflects the current state of health compared with an optimum state of health of a nation.
D) Quantifying the burden of acute illness to a healthy life on the basis of the loss of years related to the burden of acute illness. The gap in years reflects the current state of health compared with an optimum state of health of a nation.
Ans: B
Feedback: Health-adjusted life expectancy at birth (HALE) is the average number of years that a person can expect to live in "full health" by taking into account years lived in less than full health due to disease and/or injury. Life expectancy at birth is the average number of years a newborn is expected to live if current mortality rates continue to apply. Disability-adjusted life years (DALY) is a measure that quantifies the burden of disease to a healthy life on the basis of the loss of years related to the burden of disease. The gap in years reflects the current state of health compared with an optimum state of health of a nation. Acute illness is not a factor in determining health indicators.
3. The nurse prepares a presentation about the World Health Organization's World Health Statistics Report for 2013. Which trend is mentioned in this report?

A) Children in low-income countries are 2 times more likely to die before reaching the age of 5 years than children in high-income countries.
B) Every day 800 women die due to complications of pregnancy and childbirth.
C) Zimbabwe now has a higher life expectancy than 7 out of 10 countries in Eastern Europe.
D) Almost 5% of the world's adult population has diabetes.
Ans: B
Feedback: The report includes the following statistics. Every day, about 800 women die due to complications of pregnancy and childbirth. Children in low-income countries are 16 times more likely (not 2 times more likely) to die before reaching the age of 5 years than children in high-income countries. China, not Zimbabwe, now has a higher life expectancy at birth than 7 out of 10 countries in Eastern Europe. Almost 10%, not 5%, of the world's adult population has diabetes, measured by elevated fasting blood glucose (≥126 mg/dL).
4. Which risk factor for poor health is associated with low- and middle-income countries? (Select all that apply.)

A) Burning of wood and dung for cooking and heat
B) Low status of women
C) Sedentary lifestyle
D) Not wrapping an infant immediately after birth
E) Overconsumption of fatty foods
Ans: A, B, D
Feedback: Low- and middle-income countries have an increased burden of the risk factor of poverty. Extreme poverty—the inability to meet the basic needs of adequate nutrition, safe drinking water, basic education, and primary health services and the lack of a livelihood that can generate the means to secure these basic needs—is the driving force behind increased mortality. The continuous smoke from the burning of air-polluting solid fuels affects the population's health and in turn affects economic prospects. The continued low status of women, despite years of policy development, increases the risk of disease and disability. Interventions to improve neonatal care at birth in lower-income countries include drying the infant off and wrapping immediately after birth. A sedentary lifestyle and overconsumption of fatty foods are not risk factors associated with low- and middle-income countries but with higher-income countries.
5. The nurse is assigned to prepare the yearly goals for the community health agency in a developing nation. Which goals, on the basis of the United Nations' Millennium Development Goals for improving global health, should the nurse include? (Select all that apply.)

A) Initiate an afterschool sports program at every school in the nation to increase physical activity among children.
B) Distribute a mosquito bed net to every home in the nation.
C) Provide 1 million free allergy shots to people at highest risk.
D) Increase the number of girls who attend primary schools by 100%.
E) Provide training on prevention of postpartum hemorrhage to all healthcare workers.
Ans: B, D, E
Feedback: The United Nations Millennium Development Goals and Targets include the following: eradicate extreme hunger and poverty; achieve universal primary education; promote gender equality and empower women; reduce child mortality; improve maternal health; halt and reverse the spread of HIV/AIDS, malaria, and other diseases; ensure environmental sustainability; and develop a global partnership for development. Increasing physical activity among children and allergy prevention are not among the United Nations' Millennium Development Goals for improving global health.
6. The community health nurse works in a low-income country. The nurse's primary concern is to decrease the incidence of malaria. Which intervention should the nurse pursue?

A) Fuel alternatives to burning wood and dung
B) Sanitized drinking water
C) Education regarding contraception use
D) Distribution of and education on the daily use of insecticide-treated bed nets
Ans: D
Feedback: Educating families on the daily use of insecticide-treated bed nets in regions where malaria is highly endemic would be the appropriate intervention, as malaria is spread predominantly by mosquitoes. Malaria is not related to burning wood or dung, water quality, or sexual intercourse.
7. Which key factors contribute to the rise of noncommunicable diseases in low- and middle-income countries? (Select all that apply.)

A) Tobacco use
B) Insufficient physical activity
C) Unclean water
D) High blood pressure
E) Lack of contraceptive use
Ans: A, B, D
Feedback: Key factors in the rise of noncommunicable diseases include the following: tobacco use, insufficient physical activity, harmful use of alcohol, unhealthy diet, high blood pressure, overweight and obesity, high cholesterol, and cancer-associated infections. Unclean water and lack of contraceptive use are risk factors for communicable diseases, such as Legionnaires' disease and HIV, respectively.
8. The parish community health nurse is assigned to prepare the goals for a 6-month mission trip to a developing nation. Which challenge to the Millennium Development Goals should the nurse consider?

A) Child mortality has increased 21% since 1990.
B) The percentage of people living on less than $0.25 a day rose from 22% in 1990 to 47% in 2010.
C) The number of children out of school worldwide increased from 57 million to 102 million.
D) 870 million people still do not consume enough food to meet their nutritional energy requirements.
Ans: D
Feedback: 870 million people still do not consume enough food to meet their nutritional energy requirements. Child mortality has dropped 41% since 1990, not increased 21%. Extreme poverty is falling in every region. The percentage of people living on less than $.25 a day fell from 47% in 1990 to 22% in 2010. The number of children out of school worldwide decreased from 102 million to 57 million.
9. Which is the focus of Smith's eudaimonistic model?

A) Elimination of disease or symptoms
B) A fit between people and social roles
C) Adaptation to the environment
D) Actualization or realization of human potential
Ans: D
Feedback: The focus of the eudaimonistic model is the actualization or realization of human potential. The focus of the clinical model is elimination of disease or symptoms. The focus of the role performance model is a fit between people and social roles. The focus of the adaptive model is adaptation to the environment.
10. Which exemplify determinants of health? (Select all that apply.)

A) Living in a community with clean, fluoridated water
B) Having a death rate of 500 per 100,000 population
C) Living in neighborhood with a high crime rate
D) Smoking two packs of cigarettes per day
E) Having an infant mortality rate of 95 deaths per 1,000 live births
Ans: A, C, D
Feedback: Determinants of health are factors that affect outcomes of health status, such as physical environment (living in a community with clean, fluoridated water), social environment (living in a neighborhood with a high crime rate), health behaviors (smoking two packs of cigarettes per day), and individual health, as well as broader factors such as access to health services and overall health policies and interventions. Mortality rates are indicators of health, not determinants of health.
11. The nurse works to identify epidemiologic transitions in the community. Which exemplifies an epidemiologic transition?

A) High fertility and high mortality, resulting in slow population growth
B) Improvement in hygiene and nutrition, leading to a decreased burden of infectious disease
C) High and fluctuating mortality, due to poor health, epidemics, and famine
D) Mortality declines and, later, fertility declines
Ans: C
Feedback: An example of an epidemiologic transition is high and fluctuating mortality, due to poor health, epidemics, and famine. Demographic transitions may progress from low to high levels and include the following: high fertility and high mortality, resulting in slow population growth; improvement in hygiene and nutrition, leading to a decreased burden of infectious disease; mortality declines and, later, fertility declines.
12. Which risk factor is associated with overall health?

A) Allergy
B) Traumatic injury
C) Air pollution
D) Down syndrome
Ans: C
Feedback: Risk factor categories found to be associated with overall health include childhood and maternal undernutrition; other nutrition-related risk factors and inactivity; additive substances; sexual and reproductive health; and environmental risks (such as air pollution). Allergy, traumatic injury, and Down syndrome are not risk factors for overall health.
13. The nurse recently learned that more than 100 infants and children in the community have received vaccinations at the health clinic in the past month. These data are an example of which health indicator?

A) Morbidity and mortality
B) Risk factors
C) Health service coverage
D) Health system resources
Ans: C
Feedback: According to the World Health Organization statistical information system, health indicators may be placed into four categories: morbidity and mortality, risk factors, health service coverage, and health system resources. Health service coverage data identify uptake of specific services known to improve or promote health and well-being, such as reproductive health services, infant and child health and immunization, HIV, and tuberculosis care. Morbidity and mortality are measured by life expectancy at birth and health-adjusted life expectancy at birth. Risk factors focus on nutrition and health behaviors and environmental factors such as clean drinking water and burning of solid fuels. Health system resources focus on the capacity and supply of healthcare providers.
14. A community health nurse visits a village in Chad. The nurse has just finished assessing a 10-year-old girl who reports always being hungry. She lives in a home with her mother and father, who both work. She says she's never been to a healthcare provider before. Which level of poverty should the nurse most suspect in this girl and her family?

A) Middle
B) Moderate
C) Relative
D) Extreme
Ans: D
Feedback: Unlike the moderately and relatively poor, the extremely poor cannot access healthcare and are chronically hungry. "Middle" is not a level of poverty.
15. The community health nurse manager works to identify how to manage the local health workforce shortage effectively. Using knowledge of the World Health Organization's (WHO) recommendations, which suggestion should the nurse manager give to the agency?

A) Increase the agency's investment in the education and training of new healthcare workers
B) Offer incentives to attract workers to thriving urban areas
C) Attract men to the health professions
D) Provide cures for common health problems to reduce demand for health services
Ans: A
Feedback: WHO considers the following as important requirements for the effective management of health workforce shortages: increased investment in education and training; career incentives to attract health workers to rural and disadvantaged areas; attracting women to health professions and addressing retirement; and health promotion and prevention strategies to reduce demand for health services.
16. The nurse manager at a healthcare facility in a developing nation regularly loses nurses to positions in developed nations. According to the World Health Organization, which action would be appropriate for the nurse manger to take to address this problem?

A) Lobby for local legislation that prevents migration of healthcare workers.
B) Encourage the facility to build workforce capacity within the country.
C) Institute HIV prevention measures and treatment for health workers.
D) Treat expatriate workers with the same dignity and respect as all healthcare workers.
Ans: C
Feedback: HIV protection and treatment, as well as plans for emergency preparedness, are paramount if workers are to feel safe in their environments. Migration is a human right, so lobbying for antimigration legislation would not be appropriate. Because the facility is losing its native healthcare workers, not gaining expatriate workers from other nations, encouraging the facility to build workforce capacity in the nurse's own country, and treating expatriate workers with dignity would not address the problem.
17. In a healthcare facility, a client is regarded as being healthy if he or she has no diagnosed diseases and is free of any symptoms. Which model of health is in place at this facility?

A) Clinical model
B) Role performance model
C) Adaptive model
D) Eudaimonistic model
Ans: A
Feedback: The clinical model of health focuses on the elimination of disease or symptoms. For example, some people feel that they are well when they have no symptoms or diagnosed diseases and would not classify themselves as sick otherwise. The role performance model holds that health involves a fit between people and social roles. In the adaptive model, health involves adaptation to the environment. The eudaimonistic model of health holds that health is the actualization or realization of human potential.
18. A client reluctantly came to the clinic only after his daughter insisted that he do so. The nurse finds that he has type 2 diabetes. When the nurse explains that he has a serious condition, the client brushes it off and says, "I can still work and provide for my family. I'm not sick." Which model of health has this client adopted?

A) Clinical model
B) Role performance model
C) Adaptive model
D) Eudaimonistic model
Ans: B
Feedback: The role performance model holds that health involves a fit between people and social roles. For example, some people, even if they have symptoms of disease, would classify themselves as unhealthy only if they could not fulfill their roles in life, such as mother or worker. The clinical model of health focuses on the elimination of disease or symptoms. In the adaptive model, health involves adaptation to the environment. The eudaimonistic model of health holds that health is the actualization or realization of human potential.
19. The nurse works to identify epidemiologic transitions in the community. Which is an example of a demographic transition?

A) High fertility and high mortality, resulting in slow population growth
B) Progressive declines in mortality, as epidemics become less frequent
C) High and fluctuating mortality, due to poor health, epidemics, and famine
D) Further declines in mortality, increasing life expectancy, and predominance of noncommunicable diseases
Ans: A
Feedback: Demographic transitions may progress from low to high levels and include the following: high fertility and high mortality, resulting in slow population growth; improvement in hygiene and nutrition, leading to a decreased burden of infectious disease; declines in mortality and, later, declines in fertility. Epidemiologic transitions include the following: high and fluctuating mortality, due to poor health, epidemics, and famine; progressive declines in mortality, as epidemics become less frequent; and further declines in mortality, increasing life expectancy, and predominance of noncommunicable diseases.
20. The nurse is migrating from a developing nation to a developed nation. This migration ultimately benefits the nurse's home country if the nurse: (Select all that apply.)

A) Returns to the home country with advanced practice skills
B) Returns to the home country and teach others what was learned
C) Shares with the new coworkers nursing practices unique to the nurse's home country
D) Earn more money in the position in the new country
E)Is safer from exposure to HIV in the new country
Ans: A, B
Feedback: Workers who migrate gain new skills in the receiving countries and can return to their native countries revitalized with education and new outlooks on solving the problems—in other words, "brain gain." Those who leave may also come back with the skills to educate other workers. For example, nurses may return with advanced practice nursing skills and become educators in their respective countries. Sharing nursing practices with coworkers in the new job might benefit them and their clients but would not benefit the home country. Earning more money and being safer from exposure to HIV would benefit the nurse, but not the nurse's home country.
21. The community health nurse in a low-income country is working to decrease the incidence of diarrheal illnesses. Which intervention would most likely best address this problem?

A) Providing fuel alternatives to burning wood and dung
B) Providing sanitized drinking water
C) Education regarding contraception use
D)Distribution of and education on the daily use of insecticide-treated bed nets
Ans: B
Feedback: Unclean water remains a major problem in reducing diarrheal illness and waterborne and water-related illnesses and their health consequences. Educating families on the daily use of insecticide-treated bed nets would address malaria, as malaria is spread predominantly by mosquitoes, but there is no indication that malaria is the culprit here. Diarrheal illnesses are not directly related to burning wood or dung or to sexual intercourse.