Public Health Test #3

Term
1 / 54
1. Which infection continues to increase in the United States?
a. Measles
b. Pertussis
c. Hepatitis A, B, and C
d. Sexually transmitted diseases (STDs)
Click the card to flip 👆
Terms in this set (54)
1. Which infection continues to increase in the United States?
a. Measles
b. Pertussis
c. Hepatitis A, B, and C
d. Sexually transmitted diseases (STDs)
ANS: D
Treatable STDs, such as gonorrhea, chlamydia, and syphilis, are still occurring at significant rates. Gonorrhea had plateaued or declined until 2009 but increased steadily since that time. Chlamydia, the most commonly reported bacterial disease in the United States, reached 1,441,789 cases in 2014, although some of this increase is thought to be the result of improved screening for the infection,
DIF: Cognitive Level: Remember (Knowledge)
2. Which best describes what is happening with infectious diseases in the United States?
a. There is a continuing decrease in vector-borne infections.
b. There is a continuing increase in food-borne and waterborne infections.
c. Many airborne diseases are being spread by bioterrorists.
d. The rate of infection varies extensively by income and ethnic groups.
ANS: D
Probably one of the most profound failures in infectious disease control in the United States and elsewhere is that the successes are not equally distributed in the general population. Infectious diseases continue to be differentially distributed by income and ethnic groups, and the poor and minorities continue to experience the greater burden. There continues to be an increase in vector-borne infections, but there has been a decrease in food-borne and waterborne infections. There is concern that deadly pathogens will be weaponized by terrorists.
DIF: Cognitive Level: Understand (Comprehension)
Which statement is true concerning tuberculosis (TB) infections in the United States?
a. Subclinical cases of TB can occur in patients who fight off the infection and thus
are not a danger to themselves or others.
b. TB can be cured by a 6-month period of treatment with INH.
c. TB can only be caused by the Mycobacterium bovis bacillus.
d. Under certain conditions, susceptible hosts may be infected by the TB bacillus.
ANS: D
The principle of multicausation emphasizes that an infectious agent alone is not sufficient to cause disease; the agent must be transmitted within a conducive environment to a susceptible host. Mycobacterium tuberculosis kills cells. M. tuberculosis has low infectivity, low pathogenicity, but high virulence if untreated.
DIF: Cognitive Level: Understand (Comprehension)
One child in a kindergarten room had a slight fever and did not eat lunch. Otherwise, the child seemed OK. Three days later, several children were absent from kindergarten. Which best describes what happened?
a. Another nursery school was offering the same child care at a much lower price.
b. Infectious diseases can be contagious before any diagnostic symptoms occur.
c. No way to tell; there are many reasons why parents keep children home.
d. Parents chose to protect their children from the child with a fever, so they kept
their children home for a few days.
ANS: B
Frequently, the communicable period begins before symptoms are present. The communicable period, or communicability, follows latency and begins with shedding of the agent. The incubation period is the time from invasion to the time when disease symptoms first appear. Thus, even if parents kept their children away from the child with the fever, this could possibly be ineffective because their children may have already been exposed before the child exhibited symptoms. It is unlikely that the children suddenly changed schools. Although, there may be many reasons why parents keep their children home from school, in this situation there is a specific reason that can be identified.
DIF: Cognitive Level: Apply (Application)
Which best describes why clinical areas are so careful to ensure sanitization of surfaces and equipment between each patient?
a. To avoid direct patient-to-patient transmission of infection
b. To provide a clean environment for clients and staff
c. To decrease transmission by fomites
d. To decrease transmission by vectors
ANS: C
Indirect transmission is the spread of infection through a vehicle of transmission outside the
host. These may be contaminated fomites or vectors. Fomites can be any inanimate object, material, or substance that acts as a transport agent for a microbe (e.g., water, a telephone, or a contaminated tissue).DIF: Cognitive Level: Understand (Comprehension)
Which is the first step in preventing further spread of a particular sexually transmitted disease (STD)?
a. Have a citywide free screening program in all high schools and colleges
b. Provide public education about safe sex from abstinence to monogamous
relationships
c. Require all public facilities to sanitize all restrooms with a stronger, more effective
agent
d. Treat each infected person with the appropriate pharmaceutical agent
ANS: D
Antiinfective drugs, such as antibiotics, antivirals, antiretrovirals, and antimalarials, play important roles in controlling infectious diseases. Not only do they permit recovery of the infected person, but they also play a major role in preventing transmission of the pathogens to another. The first step in preventing transmission of tuberculosis and syphilis is to treat the infected person with antibiotics. Because the question asks about further spread, infection in a person has been diagnosed, so education is needed, but it is too late for that person. Adults not in school also are infected with STDs. A stronger, more effective sanitizing agent would not be the most effective strategy to prevent spread of STDs.
DIF: Cognitive Level: Understand (Comprehension)
A patient walks into a community clinic complaining of severe intestinal cramps and diarrhea.
Which action can be taken to protect the staff at the clinic?
a. Refuse to see anyone that sick as clinics have a different mission than secondary
and tertiary care of the obviously ill
b. Send the patient immediately to the closest hospital emergency department
c. Treat the patient with broad-spectrum antibiotics and lots of fluids
d. Use universal precautions with all patients regardless of the situation
ANS: D
The Centers for Disease Control and Prevention (CDC) developed a set of guidelines, called universal precautions, to prevent transmission of diseases found in blood and other body fluids. These guidelines were developed because infected people may be asymptomatic and have no knowledge of their conditions; therefore, health care workers must assume that all patients are infectious and protect themselves, other health care workers, and other patients. Refusing to treat the patient, sending the patient to an emergency department, or treating the patient with antibiotics and fluids would not be appropriate measures to protect the staff.
DIF: Cognitive Level: Apply (Application)
A school had tried very hard to uphold the requirement for all children to be vaccinated. However, state law allowed parents to exempt their child if they had a religious reason for refusal. Two children have been diagnosed with chickenpox. Which will be the most likely result?
a. Adults as well as children in the neighborhood will get chickenpox.
b. All the children who played with the two sick children will probably get chickenpox.
c. All the unimmunized children will probably come down with chickenpox.
d. Few children will get chickenpox because of herd immunity.
ANS: D
Herd immunity is a state in which those not immune to an infectious agent will be protected if a certain proportion (generally considered to be 80%) of the population has been vaccinated or is otherwise immune. Because most children in the school are immune, it will be difficult for the chickenpox to spread.DIF: Cognitive Level: Apply (Application)
Which statement best explains how infectious diseases are different from any other health problem?
a. Infectious diseases are easier to treat by using pharmaceuticals.
b. Infectious diseases are more prevalent now than in the past.
c. Infectious diseases are acute illnesses that catch clients unprepared.
d. Infectious diseases have the potential to spread, creating a community emergency.
ANS: D
Because of their potential to spread and cause communitywide or worldwide emergencies, infectious diseases require organized, public efforts for their prevention and control. Most human diseases (e.g., cancer or diabetes) can be classified as personal health problems. Individuals with a personal health problem can be treated by the health care system one person at a time. By contrast, infectious diseases are categorized as public or community
DIF: Cognitive Level: Understand (Comprehension)
19. Which would be one of the first steps in attempting to control a disease?
a. Create an appropriate screening test for widespread use
b. Define what the disease looks like in confirmed or probable cases
c. Determine the disease's portal of entry and portal of exit
d. Measure the extent of its spread geographically
ANS: B
Standardized definitions of diseases are necessary for public health monitoring and surveillance across all levels of government. Diseases are defined and classified according to confirmed cases, probable cases, laboratory-confirmed cases, clinically compatible cases, epidemiologically linked cases, genetic typing, and clinical case definition. Once defined, disease occurrence can be compared across time, populations, and geographic areas, and appropriate control efforts can be implemented.
DIF: Cognitive Level: Understand (Comprehension)
Which preventable health problem is the cause of more deaths, illnesses, and disabilities than any other? a. Use of tobacco b. Obesity c. Sexually transmitted diseases (STDs) d. Substance abuseANS: D Perhaps no other health-related condition has as many far-reaching consequences in contemporary Western society as substance abuse. These consequences include a wide range of social, psychological, physical, economic, and political problems. Drug abuse and addiction have negative consequences for individuals, families, and communities. Estimates of the total overall costs of substance abuse in the United States, including productivity and health- and crime-related costs exceed $700 billion annually. This includes approximately $193 billion for illicit drugs, $295 billion for tobacco, and $224 billion for alcohol. These numbers in dollars do not describe the extent of public health and safety implications. DIF: Cognitive Level: Remember (Knowledge)3. Which mood-altering substances are considered acceptable to use by current Western society? a. Alcohol b. Amphetamines c. Barbiturates d. NicotineANS: A In general, alcohol use has gained more social acceptance than other drug use. Because of the known harmful effects of tobacco, it is not acceptable to use tobacco products, which contain nicotine. The use of amphetamines and barbiturates are not acceptable in Western society. DIF: Cognitive Level: Remember (Knowledge). Which is the most commonly used illegal mood-altering substance? a. Cocaine or crack ecstasy b. Heroin c. Marijuana d. Methamphetamine or speedANS: C Marijuana was the most commonly used illicit drug. In 2015, there were 22.2 million current users. The proportion of people aged 12 or older who were current marijuana users in 2015 was similar in proportion to 2N014R, than the percentages from 2012 to 2013. DIF: Cognitive Level: Remember (Knowledge)Which best explains why experts are now distinguishing between use and misuse? a. It is easier to discuss use than to accuse persons of being drug addicts. b. Expansion of drug treatment programs has prevented some people from becoming totally addicted. c. Persons using prescription drugs are "users," not "misusers." d. Some persons may use drugs and not become dependent on them.ANS: D Research has revealed that problems associated with substance use may or may not relate to classically or clinically defined dependence or addiction. Many are turning to recovery before they have developed physiological dependence. Thus, many in the field have begun to differentiate between use and misuse (misuse being interchangeable with abuse), and these terms now appear in the literature. Drug treatment programs are far fewer than the need. DIF: Cognitive Level: Understand (Comprehension)When does disaster management begin? a. Before a disaster occurs b. Immediately after the disaster c. Throughout the disaster period d. When the disaster beginsANS: A When one is aware of the types and characteristics of disasters, the question then becomes: What can be done to prevent, prepare for, respond to, and recover from disasters? Disaster management requires an interdisciplinary, collaborative team effort and involves a network of agencies and individuals to develop a disaster plan that covers the multiple elements necessary for an effective plan. Communities can respond more quickly, more effectively, and with less confusion if the efforts needed in the event of a disaster have been anticipated and plans for meeting them have been identified. The results of planning are that more lives are saved and less property is damaged. Planning ensures that resources are available and that roles and responsibilities of all personnel and agencies, both official and unofficial, are delineated.Which agency should develop a community disaster plan, have emergency drills to test the plan, and determine the proper response? a. Federal Emergency Management Agency (FEMA) b. Office of Emergency Management c. State Disaster Office d. The National Disaster Relief AgencyANS: B The local Office of Emergency Management involves representatives from all official and unofficial agencies in developing the community disaster plan; developing scenarios to test the plan through drills; and assessing the scope, intensity, and number of casualties (once an incident has occurred) to initiate the proper response. The mission of the FEMA is to support citizens and first responders to ensure that, as a nation, everyone works together to build, sustain, and improve the capacity to prepare for, protect against, respond to, recover from, and mitigate all hazards. There is no specific government agency called the State Disaster Office or the National Disaster Relief Agency. DIF: Cognitive Level: Remember (Knowledge)10. When would the National Guard become involved in a disaster? a. When the Federal Emergency Management Agency requests such assistance b. When the local government requests help keeping order in the community c. When the president has declared the area a national disaster d. When the state has been asked to help an overwhelmed communityANS: D When a disaster overwhelms the local community's resources, then the state's department or office of emergency management is called for assistance. Before an event, state officials provide technical support for prevention, preparedness, response, and recovery. State officials are on scene at disaster events to facilitate coordination of state resources and to disseminate information. In some cases, the National Guard may be called in to aid the community. DIF: Cognitive Level: Understand (Comprehension)Which best describes the mission of the U.S. Department of Homeland Security (DHS)? a. To consolidate all existing agencies, groups, and organizations into a single department b. To distribute federal financial aid to disaster-stricken areas c. To enable appropriate response to assist a state having a disaster d. To prevent terrorism and ensure resilience to disastersANS: D There are five homeland security missions: prevent terrorism and enhance security, secure and manage U.S. borders, enforce and administer immigration laws, safeguard and secure cyberspace, and ensure resilience to disasters. This agency was created to realign the existing agencies, groups, and organizations into a single department, focusing on protecting the American people and their homeland, but this is not the mission of the agency. The Federal Emergency Management Agency distributes federal financial aid to disaster-stricken areas and is responsible to enable the appropriate response to assist a state having a disaster. DIF: Cognitive Level: Understand (Comprehension)Which best describes how a community will know whether its disaster plan is adequate? a. After a disaster occurs and reports of deaths and injuries are fairly accurate b. By following practice drills involving various feasible scenarios as an initial step of planning c. When federal experts have reviewed and approved the plan d. When state officials have reviewed and approved the planANS: B For a plan to be effective, it must be tested by having different disaster scenario drills. The more times realistic scenarios are created to test the plan in actual practice sessions, and not just tabletop or paper drills, the more problems with the plan will be identified and solutions for those problems can be found. Without practice drills, plans may have many unrecognized faults and, as a result, many more individuals may be harmed and communities damaged when an actual disaster occurs. DIF: Cognitive Level: Understand (Comprehension)17. A man walked to the staging area after an earthquake crying that he was hurt. A triage nurse noted he had cuts, abrasions, and an open (bone was seen) fractured arm. Which action should be taken next? a. Put a green tag on his shirt and he can get in line to wait his turn for medical treatment b. Put a yellow tag on his shirt and then await transport to a medical facility c. Put a black tag on his shirt and give him a chair to rest in until something can be done d. Put a green tag on his shirt and ask him to use his good arm to help others make it to the staging areaANS: B Green on the triage tag is for the walking wounded or those with minor injuries (e.g., cuts and abrasions) who can wait several hours before they receive treatment; yellow is for those with systemic but not yet life-threatening complications, who can wait 45 to 60 minutes (e.g., simple fractures); red is considered top priority or immediate and is for those with life-threatening conditions but who can be stabilized and have a high probability of survival (e.g., amputations); and black is for the deceased or for those whose injuries are so extensive that nothing can be done to save them (e.g., multiple severe injuries). DIF: Cognitive Level: Apply (Application)18. Which step should the nurse take first when triaging a victim of a disaster? a. Assess mental status b. Assess perfusion c. Assess respirations d. Assess blood pressureANS: C To assess an individual within the 1-minute guideline, the START system uses three characteristics. First, respirations are checked; then perfusion by pinching the nail bed and observing the reaction; and, last, mental status is checked by asking the individual a question. Assessing blood pressure is not part of the 1-minute guideline. DIF: Cognitive Level: Understand (Comprehension)3. Which are the responsibilities of the Centers for Disease Control and Prevention (CDC) in relation to disasters? (Select all that apply.) a. Contacting family members with up-to-date information regarding victims and their condition b. Coordinating local services to prevent duplication and fragmentation c. Delivering first aid and arranging for prescription medications that were lost to be replaced d. Detecting disease outbreaks, their cause, and risk factors, and implementing interventions for control e. Ensuring that drinking water, food, shelter, and medical care are available to victims f. Setting up safe and comfortable disaster shelters (emergency housing) for familiesANS: D, E After the rescue of survivors has been accomplished, the Department of Health and Human Services (HHS), the CDC—which is responsible to the HHS—steps in to ensure that clean drinking water, food, shelter, and medical care are available for those affected. Preparedness includes vigilance and reporting of suspicious illnesses (e.g., signs and symptoms of biological agents, food-borne diseases, and communicable diseases) in the community by physicians and nurses in local health care facilities or private offices and clinics. Public health officials then have the responsibility of detecting outbreaks, determining the cause of illness, identifying the risk factors for the population, implementing interventions to control the outbreak, and informing the public of the health risks and preventive measures that need to be taken. Many of the other choices are actually services offered by the American Red Cross. DIF: Cognitive Level: Understand (Comprehension)8. An occupational health nurse (OHN) reminds employees to put on their safety glasses and use other personal protective equipment. Which level of prevention is being implemented? a. Primary b. Secondary c. Tertiary d. Health promotionANS: A The OHN uses a variety of primary prevention methods, with one-on-one interaction as an important strategy for evaluating risk reduction behavior for individuals. Understanding appropriate engineering and administrative controls and personal protective equipment specific to preventing workplace health hazard exposures is one of the responsibilities of the OHN. Secondary prevention strategies are aimed at early diagnosis, early treatment interventions, and attempts to limit disability. On a tertiary level, the OHN plays a key role in the rehabilitation and restoration of the worker to an optimal level of functioning. Health promotion is not a level of prevention. DIF: Cognitive Level: Apply (Application)Which best describes what the Occupational Safety and Health Act of 1970 requires? a. All employees are eligible for a free health examination before beginning employment. b. Employers are required to make suggestions on standards for improving worker safety. c. Employers have the right to request an Occupational Safety and Health Administration (OSHA) inspection for ways to improve worksite safety. d. Employers must keep the worksite free from recognized hazards.ANS: D OSHA promulgates occupational health and safety standards, which are published in the Code of Federal Regulations and updated on a regular basis. Having access to the most recent publication of these standards is a crucial responsibility of the occupational health nurse (OHN). The OHN must be knowledgeable of Title 29 of the Code and other sections that apply to specific hazards in the workplace. DIF: Cognitive Level: Remember (Knowledge)On which level of care do most faith community nurses (FCNs) focus? a. Hospice care b. Primary c. Secondary d. tertiaryANS: B The FCN practice focuses on health promotion and wellness, which is primary intervention. It holds the spiritual dimension central to health and healing within the context of the faith community. DIF: Cognitive Level: Understand (Comprehension)Which were among the first school nurse services offered? Select all that apply. A. Inspecting children B. Educating families C. Ensuring follow-up treatment D. Monitoring communicable diseases E. Screening for required immunizationsA. Inspecting children B. Educating families C. Ensuring follow-up treatmentWhich of the following best describes why the numbers of children seen by the school health nurse is increasing? a. Higher expectations for performance by parents and school administrators b. Increasing school enrollments c. Lack of another source of regular health care d. Overcrowding within the communityANS: C Increasing numbers of children are being seen in the school setting because they lack a source of regular medical care. DIF: Cognitive Level: Understand (Comprehension) REF: p. 584Which of the following health problems continues to increase in school-aged and adolescent children? a. Contagious diseases b. Obesity and related problems (diabetes) c. Sexually transmitted diseases (STDs) d. Stomach flu (viral gastroenteritis)ANS: B Obesity is the fastest rising public health concern in the nation and may overtake tobacco use as the single leading preventable cause of death. The obesity rate has more than doubled in children and tripled in adolescents over the past three decades. More than one third of children and adolescents are considered overweight or obese. Vaccine-preventable deaths (VPD) related to contagious diseases are at or near record-low levels. According to the Centers for Disease Control and Prevention, many communicable diseases have been reduced by greater than 99% as a result of immunizations. STDs and stomach flu have not been increasing in school-aged and adolescent children.DIF: Cognitive Level: Remember (Knowledge) REF: p. 593Everyone in a high school was very upset over the fact that one of the students had shot and killed another student. The nurse decided this was an appropriate time to establish a program to help prevent violence. Which of the following groups of students should receive the program first? a. Elementary school grades 4, 5, and 6 b. Grades 7, 8, and 9 c. High school grades 10, 11, and 12 d. The students who knew the victim and his assailantANS: A Violence prevention programs should begin in elementary schools. Children who exhibit aggressive behavior in elementary school are more likely to exhibit antisocial and violent behavior as adolescents and adults. Programs should teach stress management, conflict and anger resolution, and personal and self-esteem development. This program would be offered too late for children in grades 7 through 12, and should be offered to a larger audience than only those who knew the victim and assailant. Thus, the priority population would be the elementary school children.DIF: Cognitive Level: Apply (Application) REF: p. 595Which of the following screenings are typically administered in the school setting? (Select all that apply.) a. Blood pressure b. Chest x-ray c. Cholesterol and blood glucose d. Height and weight e. Scoliosis f. Visual and hearing acuityANS: A, D, E, F Height, weight, vision, and hearing screenings are provided at most schools. Scoliosis or postural screening should be done to identify spinal deviations and intervene early to prevent related secondary problems. The detection of high blood pressure during childhood is important in identifying children who have hypertension and who will benefit from early intervention and follow-up. Screenings in schools must be relatively fast, easy, and noninvasive. Blood work is invasive and cannot be done without parental consent. It is also expensive because test strips must be purchased. Due to the equipment needed, it is not typical that chest x-rays or cholesterol and blood glucose screenings are administered in the school setting.DIF: Cognitive Level: Understand (Comprehension) REF: p. 590Although it was uncomfortable, a home health nurse finally learned to discuss finances with the client and family on the very first visit. Visits had to be reimbursed. Now that she is working for a different agency, funding was no longer such a concern. Which offers the best explanation for this change? a. Because the nurse was an unpaid volunteer professional, visits made by that nurse had no cost to the agency. b. Only clients of high socioeconomic class were admitted for care, so the agency was always immediately reimbursed for care rendered. c. Taxpayers fund official (i.e., public) home health agencies for care not reimbursed by third parties. d. The new agency has a large foundation that funds its activities from investment profits.ANS: C Taxpayers fund official (i.e., public) home health agencies, but they also receive reimbursement from third-party payers such as Medicare, Medicaid, and private insurance companies. This additional taxpayer funding eliminates the stressor as to who will be paying for the nursing visits for both the client and the home health agency. The nurse is not working as an unpaid professional volunteer for this agency. The clients served by the official agency are not likely of a high socioeconomic class and the agency most likely does not have a large foundation to assist with paying for services that are provided. DIF: Cognitive Level: Apply (Application)Which best explains the purpose of the Outcome and Assessment Information Set (OASIS)? a. To analyze the cost-effectiveness of health agencies b. To evaluate and improve clinical performance quality c. To measure and publicize hospital data on outcomes such as death rates d. To survey patient satisfaction with care received from health agenciesANS: B OASIS is a data set that measures outcomes of adult home care patients to monitor outcome-based quality improvement. These items are used to monitor outcomes, plan patient care, provide reports on patient characteristics for each agency, and evaluate and improve clinical performance. The use of OASIS is mandatory for all Medicare and Medicaid patients receiving skilled care. The primary purpose of OASIS is not to analyze the cost-effectiveness of health agencies. This data set does not publicize hospital data or survey patient satisfaction of care from the health agencies. DIF: Cognitive Level: Understand (Comprehension)Which is the most important task to be accomplished during the initial home visit? a. Assess the client and the family b. Discuss social topics c. Educate the client and the family regarding the health problem d. Establish rapport and trustANS: D Many clients in need of nursing visits do not trust the health care system and are uncomfortable with the representative from an agency visiting their home. The nurse must build a trust relationship early in the visit or the client will not allow additional visits. Beginning with social topics is often a helpful tool to help establish trust and rapport. After rapport and trust have been established, the nurse can assess the client and family and provide education. Discussion of social topics would not be the primary task to accomplish during any nurse-client interaction. DIF: Cognitive Level: Understand (Comprehension)A forensic nurse is responsible for conducting a thorough examination, including a history, performing a physical assessment, and collecting forensic evidence on a female client following a rape. In which of the following subspecialties of forensic nursing is this nurse practicing? a. Sexual assault nurse examiner (SANE) b. Nurse coroner c. Legal nurse consultant d. Forensic nurse death investigatorANS: A A SANE is a specially trained registered nurse who applies the nursing process during forensic examinations to victims or perpetrators of sexual assault. The SANE collects forensic evidence related to a reported crime and frequently testifies as an expert witness at subsequent trials. If the client is medically stable, the SANE is responsible for conducting a thorough examination, including obtaining a history, performing the physical assessment, and collecting forensic evidence. The nurse coroner would be responsible for ensuring that appropriate measures were taken to perform death investigations and certify death certificates. Legal nurse consultants provide assistance within the legal system using specialized nursing knowledge and expertise when interactions of law and health issues arise. The forensic nurse death investigator evaluates the death scene from a holistic nursing perspective and might interpret the scene differently.DIF: Cognitive Level: Understand (Comprehension) REF: p. 620A client needed a great deal of care. During a morning visit, the nurse shared information with the client's caregiver and demonstrated technical procedures. Which is most important for the nurse to assess? a. Client response to the procedures b. How the client thought the goals were being achieved c. If the client and the caregiver retained all the information the nurse gave d. The skill and comfort level of the client's caregiverANS: D The home health nurse spends much of the visit assessing the skills of the caregiver. The home health nurse instructs the caregiver in the correct procedures for providing care and in recognizing the signs and symptoms of problems that must be reported to the health care provider. The goal of the home health nurse's instruction is to provide the caregiver with the skills necessary to care for the patient successfully in the home without intervention of the nurse. Information not retained can be repeated. DIF: Cognitive Level: Apply (Application)23. A client was admitted to home care and was dismayed to find the nurse discussing such uncomfortable topics as advance directives, living will, and durable power of attorney. Which is the most appropriate response by the nurse? a. "Don't be concerned; this is just routine." b. "I'm sorry, but the state law says I have to ask you to fill out these forms." c. "You get to make decisions about your care, but if, for any reason, you can't do this, these forms will tell us what you want us to do." d. "Your physician asked us to discuss these with you."ANS: C Medicare-certified health care agencies must ask patients about advance directives and provide patients with the advance directive form if the patient is interested in completing the document.DIF: Cognitive Level: Apply (Application)4. Which best explains why home health care agencies that are part of national chains are doing better in the competitive marketplace than individually owned agencies? a. There is better media coverage and a nationally known "name" recognized by prospective clients. b. They are able to offer lower quality care using less well-prepared caregivers to ensure maximum profit. c. The chief executive officer usually has extensive experience and makes wise decisions. d. There are lower administrative costs and easier negotiating when buying in bulk.ANS: D Agencies within chains have a financial advantage over single agencies. The chains have lower administrative costs because a larger single corporate structure provides many services. For example, a multiagency corporation has greater purchasing power for supplies and equipment because they purchase a larger volume. A single corporate office can provide administrative services such as payroll and employee benefits for all chain employees, thereby reducing duplication of these services. It is unlikely that they are doing better because they receive better media coverage, offer less quality care, or have a more experienced chief executive officer. DIF: Cognitive Level: Understand (Comprehension)5. Which is required for an agency to receive reimbursement for care given from Medicare? a. Application for recognition including signing a contract with the federal government b. Application for reimbursement from Medicare using the appropriate federal forms c. Demonstrating meeting federal quality standards for Medicare-covered services d. Providing specialty care such as physical therapyANS: C Certified home health agencies meet federal standards; therefore they are able to receive Medicare payments for services provided to eligible individuals. Not all home health agencies are certified. DIF: Cognitive Level: Understand (Comprehension)22. A hospice patient is taking rather strong narcotics with good pain control, but today the patient's family tells the nurse that the client does not want to become addicted. Which is the best response by the nurse? a. "But you're dying, what difference will it make if you become addicted?" b. "You can try not to take so much so frequently if you are concerned." c. "You may develop tolerance but you can't be addicted when you're using the medication for pain control." d. "You need strong narcotics to control your pain; we want to keep you comfortable." e. "We'll keep you comfortable using some nonnarcotic drugs if that is what you prefer."ANS: C The key to successful pain control for the terminally ill is to convince patients to take their medications on a regular basis. Many patients, especially the elderly, are afraid of becoming "junkies" or "druggies" and want to delay using pain medication until they "get really bad." Many people believe that using these medications signals "the end of the line," and they are amazed to learn that patients do well while receiving this drug for months, even years, before death occurs. Almost every family must learn that addiction is not the same as tolerance and that their physicians will not "cut off their supply if they take too much." DIF: Cognitive Level: Apply (Application)6. Which 66-year-old client who needs skilled nursing care would be eligible for home health care reimbursement by Medicare? a. A client who always worked for the state and enjoys going to the neighborhood coffee shop on a daily basis b. A client who needs his wounds cared for every day, including weekends, and needs the nurse to visit at 8 AM every day c. A client who is a loner and has no one to assist him except for the home care agency d. A client who is homebound and has a very strong support system e. A client who is an illegal immigrant who has lived in the United States for 25 years but begged the nurse not to tellANS: D Medicare pays for short-term, skilled health care on a part-time or intermittent-care basis for persons aged 65 years or older who are eligible under Title XVIII of the Social Security Act. If family and caregiver support is available in the home to care for the patient between nurse visits, the patient is eligible. DIF: Cognitive Level: ApplyN(Application)Which should be included when the nurse writes a proposed treatment plan for a home health client? a. Outline of specific client goals with measurable outcomes b. Specific nursing interventions to treat identified client problems c. Type of services needed and frequency of visits by each discipline d. Typical nursing care plan information from assessment to evaluationANS: C There are differences between the treatment plan and the nursing care plan. The plan of treatment includes the type of home health services received, the projected frequency of visits by each discipline, and the necessary interventions. The nursing care plan addresses specific nursing interventions designed to treat the patient's actual or potential problems and includes identified goals with measurable outcomes. DIF: Cognitive Level: Understand (Comprehension)3. In which ways is a hospice nurse different from any other nurse who provides care to a client in the context of their family and home environment? (Select all that apply.) a. Hospice nurses approach care in a holistic fashion. b. Hospice nurses continue to support the family after the client has died. c. Hospice nurses focus more on care and comfort than cure and control. d. Hospice nurses are expert in both physical and psychosocial care. e. Hospice nurses are more skilled at pharmaceutical pain management. f. Some hospice nurses see patients at home and others in institutions.ANS: B, C Nurses who work with the terminally ill seek to enhance the patient's quality of life by focusing on relieving suffering throughout the illness, supporting the patient and family through the dying process, and providing grief support to the family after the patient has died. When the patient becomes terminally ill, the focus shifts from cure to comfort care. Hospice and palliative nursing care is provided in a variety of settings including hospitals, nursing homes, residential homes, and palliative care clinics. Ideally, all nurses approach care holistically and are expert in pain management and both physical and psychosocial care. DIF: Cognitive Level: Understand (Comprehension)14. A prisoner was bleeding where another inmate had attacked him with a fork. Which would be the correctional nurse's first and most crucial responsibility? a. Perform a complete physical assessment, specifically looking for internal injuries b. Maintain an escape route to help ensure personal safety c. Report the incident to administration, indicating who was responsible for injuring the inmate d. Stop the bleeding, apply an antibiotic, and bandage the woundANS: B Unlike any other care setting, clients are inmates, and care is negotiated and provided with recognition of safety and security issues for the nurse. The nurse must maintain an escape route, should a situation of personal violence be imminent. If the nurse is able to maintain an escape route, the nurse would then be able to complete a physical assessment, stop the bleeding, and then report the incident to administration. DIF: Cognitive Level: Understand (Comprehension)A 14-year-old was found guilty of beating and raping a 73-year-old neighbor. The prosecutor had successfully argued for the child to be tried as an adult. The jury is considering a long adult prison term. Which would the nurse most likely suggest when called on as an expert witness? a. The child must be mentally ill to have done such a thing and should be in a mental hospital. b. The child should be in a juvenile facility to avoid the high risk of sexual assaults, beatings, and suicide in adult prison. c. The child should be given a long adult prison sentence to protect society from such a predator. d. The child must be given an opportunity to complete high school while incarcerated in the adult prison.ANS: B Adult correctional facilities are not generally equipped to deal with the challenges of adolescent development. Adolescents in an adult correctional facility are the highest at risk than any other group. Juveniles in adult correctional facilities are 36 times more likely than the adult population to commit suicide. Thus, it is in the best interest of the adolescent to be placed in a juvenile facility. The placement of an adult prison or mental hospital would not be in the best interest of this child. DIF: Cognitive Level: Apply (Application)13. Which describes a responsibility of the forensic psychiatric nurse? a. Assisting with the deposition b. Collecting evidence to be used in future legal proceedings c. Judging intent or diminished capacity of the client during the incident d. Preparing to testify in courtANS: C Forensic psychiatric nurses collect evidence by determining intent or diminished capacity in the client's thinking at the time of the incident. To do this, they often spend several hours interviewing and observing the client, carefully documenting conversations and observations. DIF: Cognitive Level: Understand (Comprehension)An emergency department nurse was not sure whether there was enough evidence one way or the other to suspect child abuse with a child client, because there was not much evidence of physical harm. The forensic nurse agreed to see the child. Which would be the forensic nurse's primary focus? a. Ask the child whether the family has any secrets b. Assess for old injuries or injuries in the process of healing c. Observe the child's appearance and behavior and how the child interacted with other children and adults d. Question the parents concerning the child and any discipline problemsANS: C The nurse obtains a thorough history and assessment, focusing on several facets of abuse and neglect. These include child-parent interaction, the child's appearance and behavior, child-child interaction, and the environment. DIF: Cognitive Level: Apply (Application)9. The female nurse was called to the emergency department (ED) to help with a woman who had been beaten and raped. Which are the nurse's responsibilities as a forensic nurse? a. Discuss with police officers what is known and what needs to be known to close the case b. Initiate the proper collection, preservation, and chain of custody of evidence with appropriate documentation c. Serve as chaperone while the physician completes the physical examination d. Be empathetic and supportive to the victimANS: B It is imperative that ED registered nurses identify forensic cases and initiate the proper collection, preservation, and chain of custody of evidence and provide accurate documentation for this unique population. This collection of evidence plays an important role in the investigation of crimes and can have a major impact on legal decisions. Accurate collection of evidence is the primary responsibility of the nurse and needs to be completed before any additional action is taken. The recognition, collection, and documentation collected within the emergency department may play an important role in the investigation of crimes and can have a major impact on legal decisions. It is important for the nurse to collect the necessary evidence whereas it is the responsibility of the legal system to prosecute and close the case. The primary role of the female forensic nurse would not be to serve as a chaperone to the physician or provide support to the victim. DIF: Cognitive Level: Apply (Application)If a forensic nurse was employed in the most widely recognized subspecialty in forensic nursing, which would be the nurse's primary tasks? a. Be employed by insurance companies to review and interpret medical records b. Complete the death certificate, including causes of death c. Do a history and physical assessment and collect evidence d. Review the crime scene for insights with police officersANS: C Sexual assault forensic examiner(SANE) is the most widely recognized subspecialty in forensic nursing. The SANE assesses and documents detailed examination findings, collects forensic evidence related to a reported crime, and frequently testifies as an expert witness at subsequent trials. DIF: Cognitive Level: Understand (Comprehension)Which U.S. agency is responsible for overseeing the actions of protecting against, responding to, recovering from, and preventing the effects of disaster? a. American Red Cross (ARC) b. The Department of Homeland Security (DHS) c. Federal Emergency Management Agency (FEMA) d. The National Incident Management System (NIMS)ANS: D Because of the recognition of the need to be prepared, programs have been created to address the national, state, and local management of disasters. President George W. Bush established the NIMS in 2004. The NIMS provides a systematic, proactive approach for all levels of government and nongovernmental agencies to work seamlessly to prevent, protect against, respond to, recover from, and prevent the effects of disasters (Federal Emergency Management Agency, 2017a). The ARC is not a governmental agency. It is chartered by Congress to provide disaster relief. It works in partnership with FEMA, DHS, the Centers for Disease Control and Prevention, and other local, state, and federal agencies to provide and manage needed services. The DHS was established to realign the existing agencies, groups, and organizations into a single department, focusing on protecting the American people and their homeland. The mission of the FEMA is to support citizens and first responders to ensure that, as a nation, everyone works together to build, sustain, and improve the capacity to prepare for, protect against, respond to, recover from, and mitigate all hazards. DIF: Cognitive Level: Remember (Knowledge)Who is responsible for ensuring the safety and welfare of communities? a. Federal government b. Federal Emergency Management Agency c. Local government d. State governmentANS: C The local government is responsible for the safety and welfare of its citizens. Emergencies and disaster incidents are handled at the lowest possible organizational and jurisdictional level. DIF: Cognitive Level: Remember (Knowledge)13. Which statement best describes how the American Red Cross (ARC) is different from the Federal Emergency Management Agency (FEMA) or the National Incident Management System? a. Funding includes only voluntary contributions. b. It emphasizes being prepared for emergencies, not just reacting to them. c. It has only volunteers as staff. d. It is a nongovernmental volunteer agency.ANS: D The ARC is not a governmental agency. The ARC, however, is chartered by Congress to provide disaster relief. It works in partnership with FEMA, the Department of Health and Human Services, the Centers for Disease Control and Prevention, and other federal agencies to provide and manage needed services. The ARC receives federal money as well as voluntary contributions. The ARC has both paid and volunteer staff. All of these agencies focus on preparation for disasters (not emergencies) as well as reacting after they occur. DIF: Cognitive Level: Understand (Comprehension)32. Which behavior is a warning that a person is no longer just using a drug's recreationally but is abusing drugs and becoming addicted? a. The person decides to try a new drug, claiming to be curious. b. The person is using the drug more frequently than before. c. The person joins a friend in using drugs in a social situation. d. The person is less able to control frequency and amount of indulging.ANS: D A major step from initiation to continued use to abuse is the stage of transition. Transition is seen when there is a change in total consumption, frequency, and occasions of use. Drug use is now more than just social use, with the person beginning to lose control. DIF: Cognitive Level: Understand (Comprehension). A female client develops a fungal vaginal infection after being treated with antibiotics for strep throat. Which component of the epidemiological triangle is primarily responsible? a. Agent b. Environment c. Host d. Interaction of agent and environmentANS: C Infectious diseases are the result of interaction among the human host, an infectious agent, and the environment, which surrounds the human host and where transmission is occurring. This interaction is pictured in the epidemiological triad of agent, host, and environment also discussed in Chapter 5. The antibiotic therapy eliminated a specific pathological agent, but it also may alter the balance of normally occurring organisms in the woman's body, which caused a change in the vaginal environment, allowing normally present fungi to proliferate, resulting in a yeast infection. DIF: Cognitive Level: Analyze (Analysis)A nurse is planning primary prevention activities related to the emergence of tuberculosis (TB) in the local community. Which activity would the nurse implement? a. Offer screening tests for TB in the community b. Discuss the referral process with community members diagnosed with TB c. Educate community members about TB infection and transmission d. Monitor medication compliance for community members diagnosed with TBANS: C Primary prevention of communicable diseases involves measures to prevent transmission of an infectious agent and to prevent pathology in the person exposed to an infection. Community education is part of primary prevention. Secondary prevention consists of activities to detect infections early and effectively treat persons who are infected. These actions prevent not only progression of the infectious disease but also transmission of the pathogen to others. Reporting infectious diseases, investigating contacts, notifying partners, finding new cases, and isolating infected people also are examples of secondary prevention. Tertiary prevention includes activities involved in caring for persons with an infectious disease to ensure that they are cured or that their quality of life is maintained. Perhaps the most important part of the treatment process is to ensure that people take their antimicrobial agents completely and effectively. DIF: Cognitive Level: Apply (Application)