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Chapter 23- Poverty, Homelessness, Mental Illness, and Teen Pregnancy
Terms in this set (24)
1. A student nurse was seriously shocked when late one night the she saw a former high school friend going through a trash bin outside a fast-food restaurant and pulling out half-eaten food. What is a likely explanation for a healthy young adult engaging in such behavior?
a. He ate his meal but wanted more and had no more money.
b. He had full-time employment, but with such a low salary it was inadequate to meet basic expenses.
c. A friend had thrown his meal away, and he thought he could find his friend's untouched food.
d. He was doing this to fulfill obligation of fraternity initiation at the college.
The causes of poverty are complex and include decreased earnings, increased unemployment rates, and inadequate education and job skills.
: Cognitive Level: Knowledge REF: p. 422
2. A school nurse was caring for an 8-year-old child who had been hurt on the school playground. During the nurse's assessment, the child admitted that her mother was working but didn't make much money so the girl and her mother were living in their car. Based on this information, what might the nurse suspect?
a. The child is accident-prone and clumsy.
b. The child is being bullied and pushed around by other children.
c. The child may be a member of the 5H club.
d. The child tripped, so perhaps she needs vision screening.
Many American children are members of the "5H" club—they are hungry, homeless, hugless, hopeless, and without health care.
: Cognitive Level: Application REF: p. 423
3. A school nurse was talking to the teacher of an 8-year-old child who was living with her mother in their car. What might lead the nurse to talk to the teacher about the child?
a. Concern that other children are mistreating the child
b. Concern over developmental delays
c. Concern that the child is given adequate food during lunch
d. Concern that the child may need to sit in the front in order to be able to see well
Poverty increases the likelihood of chronic disease, injuries, traumatic death, developmental delays, poor nutrition, inadequate immunization levels, iron deficiency anemia, and elevated blood lead levels. Poverty-stricken children may be hungry and fatigued and have dizziness, irritability, headaches, ear infections, frequent colds, weight loss, inability to concentrate, and increased school absenteeism. Homeless children also experience higher rates of school absenteeism, academic failure, and emotional and behavioral maladjustments. The stress of homelessness can be seen in withdrawal, depression, anxiety, aggression, regression, and self-mutilation. Homeless children may have delayed communication, more mental health problems, and histories of abuse.
: Cognitive Level: Application REF: p. 423 (Box 23-1)
4. What is the most rapidly growing group of homeless?
a. Adolescents (runaways and "throw-aways")
b. Families with children
c. Persons in crisis
d. Single men
Families with children are the fastest-growing segment of the homeless population.
: Cognitive Level: Knowledge REF: p. 423
5. Which finding in a young single pregnant woman would cause you the most concern?
a. Elevated blood pressure
b. First prenatal visit at 5 months' gestation
c. Persistent homelessness
d. Positive STD test
All these assessment findings are of concern and need attention. However, pregnant homeless women present several challenges. They have higher rates of sexually transmitted diseases, higher incidences of addiction to drugs and alcohol, poorer nutritional status, and higher incidences of poor birth outcomes. Thus being homeless is the most dangerous sign of those listed.
: Cognitive Level: Knowledge REF: p. 425
6. Why is health care of the homeless so expensive to the community?
a. Health conditions of the homeless require increased preventive services.
b. Homeless clients typically make more clinic visits for multiple health problems.
c. Homeless people spread contagious diseases to those they pass on the street.
d. Most care to homeless people takes place in hospital emergency departments.
Homeless persons have the same problems accessing care as do others in poverty (e.g., lack of money, lack of insurance, lack of transportation). Therefore health care of homeless persons is usually crisis oriented and sought in emergency departments, where the cost of service is high but is not refused as it often is in clinics.
: Cognitive Level: Knowledge REF: p. 425
7. What action by the nurse can best ensure long-term positive health outcomes of poor pregnant teens and their children?
a. Assisting teen mothers to learn about their body changes during pregnancy
b. Developing programs that allow teen mothers to complete their education
c. Offering courses in proper care of babies and how to be a parent
d. Monitoring pregnant teens to detect early problems with pregnancy
Single motherhood is increasing. A direct correlation exists between lack of education and poverty. Similarly, a direct correlation exists between poverty and poor health outcomes. Poor teens are nearly three times more likely to drop out of school as their nonpoor counterparts. When programs that assist the mother to complete her education are instituted, chances are increased for a better future, which improves health care over the long term across the life span. It is important to keep the pregnant adolescent in school during the pregnancy and have her return as soon as possible after the birth.
: Cognitive Level: Synthesis REF: p. 427
8. A school health nurse presents a program on preventing teen pregnancy to a group of parents. Following the presentation, what comment by a parent would cause concern?
a. "I do not know if my son is sexually active; however, I have decided I'm going to talk to him about it."
b. "My daughter is too intelligent to get involved with boys, even if her friends do sleep around."
c. "My daughter and I have often discussed sexuality, and when she's ready, I'll pay for her birth control pills.
d. "I have spoken to my son about birth control. He says he's not ready to be a father and support a baby. He wants to go to college."
Teens are often ignorant concerning sexuality and pregnancy and often very embarrassed to discuss such topics. Further, they often believe myths such as they cannot get pregnant the first time they have sex. The earlier their sexual debut, the less likely a birth control method will be used, because younger teens have less knowledge. Teens are more likely to be sexually active if their friends are sexually active. Teens who are knowledgeable and want to be responsible often find it difficult to access birth control. Confidential reproductive health care services may be available for teens, but problems are still associated with transportation, school absences, and costs of care. Parents who do not talk about sexuality with their teens may find them more at risk for sexual permissiveness and pregnancy.
: Cognitive Level: Application REF: p. 427
9. What is the most important principle to keep in mind when caring for the pregnant teen?
a. All teen pregnancies are considered high-risk.
b. Limited self-care knowledge can lead to pregnancy complications.
c. Pregnant teens are likely to receive prenatal care late in the pregnancy.
d. Pregnant teens may have limited financial resources to pay for care.
All of these statements are true; thus it is crucial to consider all pregnant teenagers as high-risk obstetric clients. A number of problems (e.g., poverty, late entry into prenatal care, and limited self-care knowledge) can lead to complications of pregnancy, so it is important to treat every teen pregnancy as a special high-risk pregnancy.
: Cognitive Level: Knowledge REF: p. 430
10. The nurse was making a postpartum visit to a teenage mother and her month-old infant. What assessment would be most important?
a. Assessing for mother's ability to fulfill her own growth and development tasks
b. Assessing for mother's knowledge about normal infant growth and development
c. Assessing how much the teenager mother's own mother is helping her cope with child care
d. Assessing whether the baby's father is being helpful to the mother
Although the nurse might assess for any and all of these options, the primary goal would be to assess how much the mother knows and understands about the needs of infants and their development. Such knowledge helps avoid unrealistic expectations and frustrations, which could lead to child abuse.
: Cognitive Level: Application REF: p. 432
11. A mother and her son are in the emergency department. The mother is extremely upset. Earlier, the son had become so angry that he put his hand through a glass window and had to have stitches. The physician suggested a psychiatric consult. Now the mom asks, "Do you think my son is crazy?" Which is the most appropriate response?
a. "Absolutely not. But a psychiatrist can help your son realize more appropriate ways of displaying anger."
b. "Have you had other reasons to think your son is crazy? Perhaps the psychiatrist can reassure you that your son is just an adolescent coping with hormones."
c. "Your son is having problems coping with anger. And naturally you're upset. Let the psychiatrist determine whether your son is crazy or not."
d. "Your son is having problems with behavior, which is distressing all of you. A psychiatrist may be able to help your son cope with life in a more acceptable way."
Mental health is defined as being able to engage in productive activities and fulfilling relationships with other people, to adapt to change, and to cope with adversity. Mental disorders are conditions characterized by alterations in thinking, mood, or behavior, resulting in distress and/or impaired functioning. Most persons do not get so angry that they become self-destructive (e.g., putting their hand through a glass window and requiring medical attention). The nurse can help the mother accept appropriate assessment and intervention by using positive language and giving hope. With more time the nurse can help the mother deal with feelings of having a "crazy" family member and the effects of such behavior on the whole family.
: Cognitive Level: Synthesis REF: p. 433
12. Excluding war, what is the leading cause of disability for Americans 15 to 44 years of age?
c. Major depressive disorder
d. Workplace injuries
Major depressive disorder is the leading cause of disability in Americans between the ages of 15 and 44 years.
: Cognitive Level: Knowledge REF: p. 433
13. Which group is most at risk for suicide?
a. Adolescents under age 20
b. Men over age 85
c. Females 25 to 45 years of age
d. Women over age 65
Men over age 85 are in the highest risk category for suicide.
: Cognitive Level: Knowledge REF: pp. 436-437
14. What can the nurse do to decrease the risk for depression in older adults?
a. Encourage moving to a nursing home where others of the same age reside.
b. Monitor for signs and symptoms of depression.
c. Organize an exercise and health promotion program at the local senior citizen center.
d. Teach older clients to focus on their strengths rather than their weaknesses.
The depression rate among older adults is half that of younger people, but the presence of a physical or chronic illness increases rates of depression. Depression rates for older adults in nursing homes range from 15% to 25%; thus encouraging older adults to move to nursing homes would certainly not decrease their risk for depression. Healthy aging activities such as physical activity and establishing social networks improve the mental health of older adults. Older adults underuse the mental health system and are more likely to be seen in primary care or to be recipients of care in institutions. The nurse can reach them by organizing health promotion programs through senior centers or other community-based settings. Telling clients to focus on strengths instead of weaknesses is not helpful—this advice can sound flippant and patronizing if (1) the weaknesses are profound and (2) tools are not given to assist in coping. Monitoring for signs of depression is not an effective approach because this—like most programs currently available for adults, families, and caregivers with health problems—focuses on identifying rather than preventing problems.
: Cognitive Level: Synthesis REF: p. 437
15. The nurse who works at a homeless clinic wants to improve healing of chronic wounds in clients living on the streets. What would be the best action to take to improve client outcomes?
a. Providing antibiotics to all homeless persons with chronic, nonhealing wounds
b. Offering daily access to a room with soap, water, and bandages
c. Handing out free bandaging supplies following each clinic visit
d. Performing regular monitoring of the client's wound condition
Health problems faced by the homeless often are related directly to poor access to preventive health care services. Proper wound care relies on cleanliness; however, those living on the streets do not typically have ready access to soap and water. The nurse can help by designating a wound room, in which clients can safely carry out wound care activities taught during clinic visits.
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