NUR 442 Exam 3 Ch 16-17, Ch 21-27

1. When describing the global framework, which of the following would the community health nurse be least likely to include?
A) Population
B) Provider
C) Procedure
D) Physician
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Terms in this set (206)
3. A nursing student is considering a career in international community health nursing.
Which of the following statements are accurate regarding the context of international community
health nursing? Select all that apply.
A) Global community health care is complex and is affected by multiple factors relating to
geography, history, politics, culture, religion,
and economy.
B) The types of services that can be provided include a range from providing clinical
services to policy making at an international level.
C) People's conception of health, wellness, and
illness are static from culture to culture.
D) By looking through a computer window, the student is able to see almost anyplace,
connect to about any person, and access information about almost any concept.
E) The ways in which people view nurses and other health care providers are affected by
their attitudes toward women, their culture,
and belief systems.
Ans: A, B, D, E
Feedback:
The following statements are true: Global community health care is complex and is
affected by multiple factors relating to geography, history, politics, culture, religion, and
economy; The types of services that can be provided include a range from providing clinical
services to policy making at an international level; By looking through a computer window, the
student is able to see almost anyplace, connect to about any person, and access information about
almost any concept; The ways in which people view nurses and other health care providers are
affected by their attitudes toward women, their culture, and belief systems. The statement that
people's conceptions of health are static from culture to culture is false.
Indeed, people's conceptions of health, wellness, and illness vary from culture to culture.
4. A community health nurse is preparing a presentation for a community group about
tuberculosis (TB) and its current epidemic status. Which of the following would the nurse
include in the presentation about this disease?
A) TB kills about 1.7 million people each year.
B) All persons who are infected by the causative organism become ill and can spread the
causative organism to others throughout the
remainder of their lifetime.
C) Three fourths of the world's population is thought to be currently infected by the
causative organism.
D) The highest number of deaths is in Eastern
Europe.
Ans: A
Feedback:
TB kills approximately 1.7 million people each year. Only 5 to 10 of those infected
become ill or can spread the causative organism to others within their lifetime. One third of the
world's population is thought to be currently infected by the causative organism (tubercle
bacillus). The highest number of deaths occur in Africa.
6. Which one of the following factors has resulted in the Era of Chronic Long-Term
Health Conditions?
A) Decreased usage of tobacco by young
populations
B) Despite programs of control, many infectious diseases persist with many people surviving
to experience chronic, long-term conditions
secondary to the infectious disease.
C) Shorter life expectancies due to chronic
diseases
D) Death from infectious diseases results in a
decrease in degenerative diseases.
Ans: B
Feedback:
Despite the programs of control, many infectious diseases persist. However, populations
now survive and also experience chronic, long-term conditions. These conditions affect mortality
and morbidity, daily functioning, decision making, and cost. Thus, the longevity that has resulted
from meeting the challenges of the Era of Infectious Diseases compounds the more recent
emergence of chronic diseases in the many countries. The emergence of multidrug resistant
diseases, continued persistence of infectious disease, and urbanization with deforestation have
resulted in new and
emerging infectious diseases and conditions.
Ans: C
Feedback:
The most common illness in the world and a leading cause of mortality is acute
respiratory tract infection (ARI). Three million deaths annually are attributed to ARI among
children younger than 5 years of age, usually from pneumonia. Tuberculosis is considered
epidemic today. Smallpox has been eradicated. Infectious diarrheal disease has been reduced due
to oral rehydration therapy and improvements in water and sanitation.
Ans: A
Feedback:
The MCI is the intervention considered to have the greatest impact in reducing measles.
It provides wide immunization coverage, rapid referral of serious cases, prompt recognition of
secondary conditions, and improved nutrition and vitamin A supplementation. The Global
Alliance for Vaccine and Immunization is an interagency initiative that seeks to protect every
child against vaccine-preventable diseases. This initiative addresses all of these types of diseases.
Oral rehydration therapy has been used to reduce mortality associated with diarrheal diseases.
Geographical information systems is not a program but a means to monitor diseases.
9. Which one of the following statements about
poliomyelitis is the most accurate?
A) Polio is not endemic in any countries at
present.
B) Polio has been eliminated worldwide.
C) Rotary International has contributed no funds but many hours of manpower to eradicate
polio.
D) Polio has been eliminated from the Western
hemisphere.
10. A community health nurse is reading a journal article about global health and
communicable diseases. The article states that elimination is the goal. The nurse interprets this to
mean
which of the following?
A) There are no further cases of the disease
anywhere.
B) No further preventive efforts are necessary.
C) The disease is no longer a public health threat.
D) The disease has been interrupted in a
geographic area.
Ans: D
Feedback:
The term elimination is used when a disease has been interrupted in a defined geographic
area. In 1991, WHO defined elimination as a reduction of prevalence to less than one case per 1
million population in a given area.
Eradication means interruption of person-to- person transmission and limitation of the reservoir
of infection so that no further preventive efforts are required; it indicates a status whereby no
further cases of a disease occur anywhere. The term control indicates that a specific disease has
ceased to be a
public health threat.
11. A community health nurse instructs a local community group on how to prepare homemade oral rehydration solution. Which of the following ingredients would the nurse include? A) Sea water B) Table salt C) Baking soda D) Crushed bananasAns: B Feedback: Oral rehydration solution consists of 1 L of safe water to which is added half small teaspoon of salt, and four large spoons of sugar. In addition, bananas or green coconut water are encouraged to compensate for the loss of potassium.12. Communicable disease is a global health concern with a primary goal of eradicating communicable diseases worldwide. Achievement of this goal would involve A) interrupting disease in a limited, defined geographic area. B) reducing the incidence and/or prevalence of communicable diseases. C) establishing primary health care services for all people on the globe. D) interrupting transmission and reservoir of infection to prevent further cases.Ans: D Feedback: Eradication is an ambitious and expensive goal and has occurred with smallpox in 1977 and is under way with other diseases such as poliomyelitis, guinea worm, leprosy, and measles so that many diseases can be eradicated early in the 21st century. One major means of eradicating communicable diseases is to interrupt the transmission and reservoir, thereby preventing the development of new cases. Interrupting disease in a limited area may be a starting point, but more widespread involvement is needed. Reducing the incidence or prevalence would provide indications about the effects of attempting to eradicate the disease. Establishing primary health care services is the goal of Alma-Ata "health for all."13. immunization is true? A) The World Health Organization estimates that a billion more lives could be saved each year with immunizations. B) Vaccines are one of the most cost-effective interventions found in public health. C) Half of the world's children are being reached with essential vaccines. D) In the United States, toddlers are thoroughly vaccinated.Ans: B Feedback: Vaccines are one of the most cost-effective interventions found in public health. The World Health Organization estimates that 3 million more lives could be saved each year with immunizations. Three fourths of the world's children are being reached with essential vaccines. In the United States, only 10% of toddlers are protected against measles, mumps, and rubella via vaccinations.14. A community health nurse is working with an international agency in Australia. The nurse would most likely encounter which type of health care system? A) Entrepreneurial B) Welfare-oriented C) Comprehensive D) SocialistAns: B Feedback: Australia subscribes to a welfare-oriented health care system in which statutory programs drive these systems to support the cost of health care for all, or almost all, of the population through their "national health insurance." An Entrepreneurial Health Care System, found in the United States, is one in which the country's health care system is based, in part, on its political economy. A Comprehensive Health Care System is a step away from the welfare-oriented type in that substantial modifications exist in delivery and financing that result in universal entitlements. These systems are found in Scandinavian countries, Great Britain, and New Zealand. Socialist Health Care Systems came about through social revolutions that abolished free- market economies and replaced them with socialism where the health care system is also socialized. They are found in countries such as Russia, Eastern Europe, Albania, Bulgaria, Czechoslovakia, East Germany, Hungary, Poland, Romania, Yugoslavia, and China.15. Which of the following are factors that influence populations' perceptions of health and health status and their receptivity to community health nursing programs? Select all that apply. A) Their perceptions of healthy food B) Their attitudes toward women C) Their culture D) Their belief systems E) Their geographic locationAns: B, C, D Feedback: The factors that influence populations' perceptions of health and health status and their receptivity to community health nursing programs include their attitudes toward women, their culture, and their belief systems. Their perceptions of healthy food or their geographic location would not have a direct bearing on their perception of health and health status or receptivity to community health nursing programs.16. A community health nurse is preparing to work in a country in which women are viewed as weak and ineffectual. Which of the following would the nurse need to do first? A) Determine his or her own position and beliefs about this view B) Develop a basic plan to change the view of women C) Become aware of possible areas that might impact care D) Avoid situations involving the care of womenAns: A Feedback: Community health nurses first, need to determine their own position on this issue and come to terms with it, realizing that it may impact their care. Once aware, the nurses can then prepare appropriately for situations in which their care may be affected. It would be inappropriate and probably impossible to attempt to change the view or avoid situations involving the care of women.17. Which of the following statements about the personal and professional perceptions that nurses bring to providing community health nursing interventions within an international context is most accurate? A) Community health nurses are not susceptible to preconceived perceptions and biases. B) It is not necessary for community health nurses to face their own beliefs. C) Community health nurses are universally opposed to female circumcision, the use of nonlicensed personnel to carry out medical treatments, and the use of Western interventions used simultaneously with other methods of treatment. D) It is critical for community health nurses to face their own beliefs when confronting female circumcision, the use of nonlicensed personnel to carry out medical treatments, and the use of Western interventions used simultaneously with other methods of treatment.Ans: D Feedback: It is critical for community health nurses to face their own beliefs when confronting female circumcision, the use of nonlicensed personnel to carry out medical treatments, and the use of Western interventions used simultaneously with other methods of treatment. Community health nurses are as susceptible as any other group of people to preconceived perceptions and biases. Community health nurses may not be universally opposed to female circumcision, the use of nonlicensed personnel to carry out medical treatments, and the use of Western interventions used simultaneously with other methods of treatment.18. Community health nurses need to be knowledgeable about the World Health Organization because its mission reflects which of the following? A) Collaboration in health development to free the world from poverty B) Service as an independent agency providing economic and humanitarian assistance overseas C) Representation of the global interests and concerns of the nursing profession D) Global health promotion by supporting development efforts of governments, organizations, and universities throughout the worldAns: D Feedback: WHO's mission reflects global health promotion by supporting development efforts of governments, organizations, and universities throughout the world. Collaboration to free the world from poverty reflects the mission of the World Bank. Service as an independent agency for economic and humanitarian assistance describes the mission of the United States Agency for International Development (USAID). Representation of global interests and concerns of nurses describes the mission of the International Council of Nurses (ICN).19. An instructor in community health nursing teaches a group of students about the role of the World Health Organization and global health, reviewing the importance of the Declaration of Alma-Ata. The instructor determines that the students have grasped the importance when they describe it as which of the following? A) The beginning of the Carter Center's work in disease prevention and agriculture B) A formal document written by 134 nations in 1978 to achieve "health for all" C) Participatory development activities, working in partnership with voluntary organizations D) Alliance building and communicating best practices for global health developmentAns: B Feedback: The declaration represents the work of 134 nations during a WHO/UNICEF conference in 1978 to achieve primary health care for all. The Carter Center was founded in 1986 and is not related to the work at Alma-Ata. Participatory development activities describe the work of the United States Agency for International Development (USAID). Alliance building and communicating best practices describe the Global Health Council, which is a leading private, voluntary, American nongovernmental organization.20. Which of the following statements about the International Council of Nurses (ICN) are accurate? Select all that apply. A) ICN represents the global interests and concerns of the nursing profession. B) The mission of ICN is to maintain the role of nursing in health care through its global voice. C) ICN has, as members, nursing organizations from 130 countries representing 13 million nurses. D) ICN is a governmental organization. E) ICN employs Regional Nursing Advisors.Ans: A, B, C Feedback: The following statements about ICN are accurate: ICN represents the global interests and concerns of the nursing profession; the mission of ICN is to maintain the role of nursing in health care through its global voice; and ICN has, as members, nursing organizations from 130 countries representing 13 million nurses. ICN is a nongovernmental organization. Regional Nursing Advisors are employed at the international level of the World Health Organization.21. After teaching a class of community health nursing students about the World Health Organization, the instructor determines that the teaching was successful when the class identifies which of the following as the highest governing body? A) World Health Assembly B) WHO Collaborating Centers C) The European Union D) U.S. Agency for International DevelopmentAns: A Feedback: The World Health Assembly is the highest governing body within WHO. WHO Collaborating Centers are networks of centers focusing on specific areas of expertise and carry out the work of the member countries in these areas. The European Union is an organization that provides funding for many projects including health. The U.S. Agency for International Development is an independent bilateral agency of the executive branch that works to enhance long-term and equitable economic growth.22. A group of students are reviewing for an examination on nongovernmental organizations that provide global interventions. The students demonstrate the need for additional study when they identify which of the following as an example? A) Global Health Council B) CARE C) Carter Center D) World BankAns: D Feedback: The World Bank is an agency that focuses on economic development. It partners with countries, WHO, and other organizations. It is not a nongovernmental organization. Examples of nongovernmental organizations include Global Health Council, The Center for International Health and Cooperation, CARE, and the Carter Center.23. Which organization would be most appropriate for the community health nurse to contact for assistance when dealing with countries shattered by war and ethnic violence? A) Center for International Humanitarian Cooperation B) CARE C) Global Health Council D) International Council of NursesAns: A Feedback: The Center for International Humanitarian Cooperation (CIHC), founded in 1992, promotes healing and peace in countries shattered by war, regional conflicts, and ethnic violence. CARE intervenes by responding to famines and disasters worldwide with emergency food, supplies, and rehabilitative efforts. The GHC advocates for needed policies and resources, builds networks and alliances among those working to improve health, and shares innovative ideas, knowledge, and best practices in health. The ICN represents the global interests and concerns of the nursing profession.24. Which of the following statements about the World Health Organization is accurate? A) The World Health Organization does not provide technical support for interventions or provide assistance developing nursing knowledge and skills. B) The World Health Organization can help a member state determine the drugs that are essential and will assist in developing health policy, project plans, and programs. C) The World Health Organization provides medicines and other tangible resources to its member states. D) The World Health Organization focuses on professional issues to support the development of particular health-related practitioners, such as nurses.Ans: B Feedback: The World Health Organization can help a member state determine the drugs that are essential and will assist in developing health policy, project plans, and programs. The World Health Organization does focus on providing technical support related to the interventions and provides assistance developing nursing knowledge and skills. The World Health Organization does not provide medicines and other tangible resources to its member states but does help member states determine the drugs that are essential and assist in developing health policy, project plans, and programs.25. Which of the following statements regarding WHO Collaborating Centers is most accurate? A) One or two Regional Nursing Advisors carry out the work of a region that might be the home to thousands of nursing personnel. B) The World Health Organization Collaborating Centers in Nursing and other fields focus on specific areas of expertise and carry out the work of the member countries in these areas. C) It is referred to a philosophy, a movement, a way of thinking, a setting for health services, or a set of principles. D) It focuses on professional issues to support the development of particular health-related practitioners.Ans: B Feedback: The World Health Organization Collaborating Centers in Nursing and other fields focus on specific areas of expertise and carry out the work of the member countries in these areas. Regional Nursing Advisors work in collaboration with WHO Collaborating Centers to accomplish the work within each region. Primary Health Care is referred to a philosophy, a movement, a way of thinking, a setting for health services, or a set of principles.1. A community health nurse is working with people who experienced a tornado and have been forced to leave their homes to escape the effects of a disaster. The nurse would identify these people as which of the following? A) Indirect victims B) Refugees C) Displaced persons D) CasualtiesAns: C Feedback: Displaced persons are those who have been forced to leave their homes to escape the effects of a disaster. Indirect victims are the relatives and friends of direct victims. Refugees are direct victims who are forced to leave their homeland, usually due to war, religious persecution, or political turmoil. A casualty is a human being who is injured or killed by or as a direct result of an accident.2. A community health nurse working as a part of a disaster response team is told that the disaster is classified as a multiple-casualty incident. The nurse would interpret this to mean which of the following? A) There is more than 1 but less than 10 casualties. B) The number of casualties is between 2 and 100. C) Casualties number over 100. D) There are too many casualties to count.Ans: B Feedback: If casualties number more than two people but fewer than 100, the disaster is characterized as a multiple-casualty incident. A mass- casualty incident involves100 or more casualties.3. A community health nurse is part of a disaster response team that is first to respond to an earthquake. The team evaluates the level of destruction and devastation, identifying this as which of the following? A) Intensity B) Scope C) Casualty D) Range of effectAns: A Feedback: The intensity of a disaster is the level of destruction and devastation it causes. The scope of a disaster is the range of its effect, either geographically or in terms of the number of victims. Casualty refers to the human being(s) injured or killed by or as a direct result of an accident.4. Which of the following examples of disasters are natural disasters? Select all that apply. A) The Earthquake and tsunami in Japan in 2011 B) The 2008 shootings at Virginia Tech C) The terrorist attacks on the United States on September 11, 2001 D) Wildfires that affected California in October 2007 E) The oil spill in the gulf coast in 2010 that threatened hundreds of species of wildlifeAns: A, D Feedback: Examples of natural disasters include the earthquake and tsunami in Japan in 2011 and wildfires that affected California in October 2007. The following disasters are man-made: the 2008 shootings at Virginia Tech; the terrorist attacks on the United States on September 11, 2001; and the oil spill in the gulf coast in 2010 that threatened hundreds of species of wildlife.5. After teaching a class about the factors that contribute to disasters, the instructor determines that the teaching was successful when the students identify which of the following as the agent? A) Population's age B) Radiation C) Level of preparedness D) Flood-prone locationAns: B Feedback: The agent is the natural or technologic element that causes the disaster. For example, the high winds of a hurricane and the lava of an erupting volcano are agents, as are radiation, industrial chemicals, biologic agents, and bombs. The population's age is an example of host factor. The level of preparedness and flood-prone location are examples of environmental factors.6. Which of the following federal agencies would a community health nurse expect to be contacted to assist with a disaster in the United States? A) American Red Cross B) Federal Emergency Management Agency (FEMA) C) WHO's Emergency Relief Operations D) Pan American Health OrganizationAns: B Feedback: The Federal Emergency Management Agency (FEMA) is the federal agency responsible for assessing and responding to disaster events in the United States. The American Red Cross is authorized to provide disaster assistance free of charge across the country through its more than 1 million volunteers. It is not supported by the federal government. The World Health Organization's Emergency Relief Operations provide disaster assistance internationally, and the Pan American Health Organization works to coordinate relief efforts in Latin America and the Caribbean.7. The nurse is using the epidemiological triad to explain the factors contributing the disaster. Which one of the following statements about the environment factors that contribute to disasters is most accurate? A) The environment is the natural or technologic element that causes the disaster. B) The environment is the human being who experiences the disaster. C) Factors that could potentially contribute to or mitigate a disaster are environmental. D) Examples of environmental factors that cause a disaster are high winds of a hurricane and the lava of an erupting volcano.Ans: C Feedback: Factors that could potentially contribute to or mitigate a disaster are environmental. The agent factor is the natural or technologic element that causes the disaster, for example the high winds of a hurricane and the lava of an erupting volcano. The host is the human being who experiences the disaster.8. A community health nurse is working with a community that is involved with identifying risk factors for program development in case of a disaster. This community is in which phase of disaster management? A) Prevention B) Preparedness C) Response D) RecoveryAns: A Feedback: During the prevention phase, no disaster is expected or anticipated. The task during this phase is to identify community risk factors and to develop and implement programs to prevent disasters from occurring. Disaster preparedness involves improving community and individual reaction and responses so that the effects of a disaster are minimized. The response phase begins immediately after the onset of the disastrous event. During the recovery phase, the community takes actions to repair, rebuild, or relocate damaged homes and businesses and restore health and economic vitality to the community.9. A community health nurse is working with a community that is involved with improving community and individual reaction and responses, so that the effects of a disaster are minimized. This community is in which phase of disaster management? A) Prevention B) Preparedness C) Response D) RecoveryAns: B Feedback: Disaster preparedness involves improving community and individual reaction and responses so that the effects of a disaster are minimized. During the prevention phase, no disaster is expected or anticipated. The task during this phase is to identify community risk factors and to develop and implement programs to prevent disasters from occurring. The response phase begins immediately after the onset of the disastrous event. During the recovery phase, the community takes actions to repair, rebuild, or relocate damaged homes and businesses and restore health and economic vitality to the community.10. When would the nurse expect the response phase of a disaster to occur? A) When no disaster is expected or anticipated B) Immediately after the onset of the disastrous event C) Long-term phase occurring after the disastrous event D) Prior to the disastrous eventAns: B Feedback: The response phase of disaster occurs immediately after the onset of the disastrous event. During the prevention phase no disaster is expected or anticipated. Long-term phase occurring after the disastrous event is the recovery phase. Prior to the disastrous event is the preparedness phase.11. Which of the following statements about disaster planning is most accurate? A) Disaster planning is essential for a community, business, or hospital. B) A disaster plan must be lengthy and detailed. C) A disaster plan should be created by the person responsible for the emergency management of the community. D) It is assumed that all professionals have addressed their personal preparation.Ans: A Feedback: Disaster planning is essential for a community, business, or hospital. A disaster plan need not be lengthy. A disaster plan should be created by all involved, including community leaders, health and safety professionals, and lay people. All nurses should address their own personal preparedness to respond in a disaster, but this may not be assumed.12. Which of the following are necessary components of a nurse's personal preparedness? Select all that apply. A) Workplace and community disaster plans have been reviewed by the nurse. B) An individual disaster plan for the nurse's own family has been developed. C) The nurse participated in disaster drills at the workplace and had a family disaster drill to practice what actions to take in the event of a disaster. D) It is not necessary for the nurse to bring copies of their nursing license and driver's license. E) In the case of an actual disaster, the nurse will be able to use equipment made available to them.Ans: A, B, C Feedback: To be personally prepared, a nurse should have read and understood workplace and community disaster plans, should have developed a disaster plan for his or her own family, and should have participated in disaster drills. Nurses preparing to work in disaster areas should bring copies of their nursing license and driver's license and bring basic equipment.13. As part of secondary prevention, the community health nurse engages in crisis intervention to achieve which of the following? A) Reestablish equilibrium to the lives of those involved B) Prevent the crisis altogether C) Involve as many people as possible in the resolution D) Triage clients during the recovery phase of the crisisAns: A Feedback: The stated goal of crisis intervention is to reestablish equilibrium. Prevention is the best approach, but some crises, such as natural disasters, cannot be prevented. They can, however, be prepared for to decrease the negative effects of the crisis as much as possible. It is important to have an adequate number of people needed to come to resolution. However, too many people involved in resolution may cause additional confusion, chaos, and unnecessary delays. Triage decisions need to be made during the response phase of the disaster or crisis and not deferred until the recovery phase. Triage is an ongoing process throughout the response phase.14. A community health nurse is engaged in primary prevention activities related to disasters. Which of the following would be examples of appropriate activities? Select all that apply. A) Providing anticipatory guidance B) Practicing an escape plan C) Providing emergency assistance D) Planning disaster drills E) Providing immediate response F) Reducing the degree of disabilityAns: A, B, D Feedback: Anticipatory guidance, practicing escape plans, and planning disaster drills all constitute primary prevention activities. Providing emergency assistance and immediate response reflect secondary prevention activities. Reducing the degree of disability or damage resulting from the disaster reflects tertiary level prevention activities.15. When describing primary prevention activities that would occur in the preparedness phase of a terrorist attack involving biologic weapons like smallpox or anthrax to a local community group, which of the following would the nurse include? A) Investigating outbreaks to determine source B) Administering vaccines C) Screening suspected cases D) Treating persons who have been infectedAns: B Feedback: Primary prevention activities that would occur in the preparedness phase of a terrorist attack involving biologic weapons like smallpox or anthrax would include administering vaccines. Investigating outbreaks to determine the source, screening suspected cases, and treating persons who have been infected would be secondary prevention activities.16. A community health nurse is assisting the local community in preparing a disaster plan. Which of the following would the nurse expect to be addressed? Select all that apply. A) Chain of command B) Routes for transportation C) Triage D) Basic equipment E) Copies of licensesAns: A, B, C Feedback: A disaster plan should address the chain of command, routes and modes of transportation, and triage methods. Basic equipment and licenses are items that a nurse should bring along when preparing to work in a disaster area.17. A community health nurse is responding to a disaster. Which of the following would most likely be the least appropriate area for the nurse to be located? A) The disaster site B) Triage C) Victim treatment area D) Local hospitalsAns: A Feedback: Usually, the immediate disaster site is not the best place for the disaster nurse, who can be far more effective in triage and treatment of victims. One of the lessons of the World Trade Center bombing was that the greatest need for medical professionals was at the local hospitals, not at the disaster site.18. When performing triage during a disaster, which color would indicate that the victim is in urgent need of care? A) Red B) Yellow C) Green D) BlackAns: A Feedback: During triage, red indicates that the victim has injuries or medical problems that will likely lead to death if no treated immediately. Yellow indicates that the person has injuries that require medical attention but time to treatment is not yet critical. Green indicates that the victim has minor injuries or are presenting with minimal signs of illness. Black indicates that the victim is dead or has suffered mortal wounds.19. A community health nurse responding to a disaster is involved with caring for the bodies of the casualties who have died. Which of the following would be an appropriate method for documentation? A) Making a note on the triage tag B) Using a toe tag for identification C) Placing the name on a casualty list D) Recording the name on the victim's bodyAns: B Feedback: Toe tags make documentation visible and accessible and are the most appropriate means for documentation. Making a note on the triage tag, placing the name on a casualty list and recording the name on the victim's body are inappropriate.20. Which time after the disaster would be the ideal time for this to occur? A) Within 18 hours B) 1 to 3 days C) 4 to 6 days D) 7 to 10 daysAns: B Feedback: The ideal time for CISD is between 24 and 72 hours after the disaster event.21. When providing secondary prevention activities for individuals experiencing psychological consequences of a disaster, which of the following would the nurse do as a generic approach? A) Providing situational support for stress relief B) Conveying warmth and concern for the client C) Teaching about expected emotional reactions D) Reunifying family members who were separatedAns: C Feedback: The generic approach is designed to reach high-risk individuals and large groups who have experienced the same disaster, teaching them about the expected emotional reactions to the type of disaster they have experienced and promoting adaptive responses. Environmental manipulation results in the change of a person's physical or interpersonal situation, providing situational support to relieve stress. An example of environmental manipulation is when a community health nurse coordinates the reunification of family members separated by the disaster. General support is defined as the caring, warmth, and concern the community health nurse conveys to the client as she or he delivers services.22. A community health nurse suspects that a client who was a victim of a disaster 3 months ago is experiencing post-traumatic stress disorder. Which of the following would the nurse expect to find? Select all that apply. A) Diminished startle response B) Hypervigilance C) Feelings of detachment D) Flashbacks E) Full range of affectAns: B, C, D Feedback: Signs and symptoms of post-traumatic stress disorder include increased startle response, hypervigilance, feelings of detachment, flashbacks, and restricted affect.23. A group of ten people from the commune in the hills come into town dressed in robes and have their faces covered. They have weapons hidden in their clothing and begin entering the three banks in town to rob them. These actions can be classified as which of the following? A) Natural disaster B) Terrorism C) Casualty D) Adventitious crisisAns: B Feedback: The actions resemble terrorism, the unlawful use of force and violence against persons or property to intimidate or coerce a government, the civilian population or any segment thereof in furtherance of political or social objectives. The actions are not a natural disaster. Casualty refers to the person who is injured or killed by or as a direct result of an accident. An adventitious crisis is an event that is out of the ordinary in magnitude and personal experience.24. After teaching a group of students about agents associated with chemical warfare, the instructor determines that additional teaching is needed when the students identify which as an example? A) Explosives B) Nerve agents C) Anthrax D) Jet fuelAns: C Feedback: Anthrax is considered a bioweapon. Explosives, nerve agents, and jet fuel are considered agents of chemical warfare.25. Which of the following would be most appropriate for community health nurses to encourage when helping communities cope with the anxiety associated with terrorism? A) Maintaining high levels of alertness and fear B) Spending time with children and young people C) Spending more time indoors D) Keeping a fear journalAns: B Feedback: Most young people carry a charge of positive energy that is infectious. Maintaining high levels of alertness and fear are not healthy. Instead individuals should be a little afraid because a certain level of fear is healthy if the person learns to use it as positive energy. Spending more time outdoors is helpful remedy. Individuals should keep a courage journal; fear immobilizes and courage takes action.26. A community health nurse is preparing a presentation for a community group about possible agents of terrorism. Which of the following would the nurse include as an example of a bioweapon? Select all that apply. A) Mustard gas B) Sarin C) VX gas D) Nerve agents E) BombsAns: A, B, C Feedback: Bioweapons include mustard gas, sarin, VX gas, and anthrax. Nerve agents and bombs are examples of chemical warfare agents.1. A community health nurse is working with other professionals to develop preventive programs to address the leading cause of death in men and women. Which of the following would be appropriate? A) Risk reduction for heart disease B) Cancer screening C) Safety education D) Flu vaccine immunizationAns: A Feedback: The leading cause of death for men and women is heart disease. Therefore, risk reduction for heart disease would be most appropriate. Cancer screening, safety education, and flu vaccine immunization would be appropriate for cancer, the second leading cause of death; unintentional injuries, the third leading cause of death in men; and influenza and pneumonia, the eighth leading cause of death in men and women respectively.2. of the following would the community health nurse identify as a key aspect for this community's ability to follow through with the teaching? A) Life expectancy B) Health disparity C) Health literacy D) Financial abilityAns: C Feedback: Health literacy is a critical aspect of managing health problems and a key to being able to read and understand health information so that individuals can follow through and make appropriate health decisions. Low health literacy also contributes to health disparities, a difference in health status due to sex, race, or ethnicity. Life expectancy is the average number of years an individual member is projected to live. It is a standard measurement unrelated to the ability to follow through with teaching. Financial ability may impact a person's ability to obtain needed services, but it is not a key aspect.3. When assessing a population for health disparities, which of the following would the nurse least likely evaluate? A) Race B) Education C) Age D) Sexual orientationAns: C Feedback: A health disparity is defined as a difference in health status that occurs by sex, race or ethnicity, education or income, disability, geographic location, or sexual orientation. Age would not be used to assess health disparity.4. Which one of the following statements about life expectancy is most accurate? A) The life expectancy for White women is 4 years greater than for Black women. B) The life expectancy for Black men is 6 years greater than for White men. C) In the United States, life expectancy continues to decline. D) There is a gap in life expectancy between women and men of more than 6 years.Ans: A Feedback: The life expectancy for White women is 4 years greater than for Black women. The life expectancy for White men is 6 years greater than for Black men. In the United States, life expectancy continues to increase consistently over time. The gap in life expectancy between women and men was 5.0 years in 2007.5. A community health nurse is working with a grant funded project to address stroke prevention nationwide. After reviewing statistics related to stroke, which would the nurse identify as having the greatest need for this type of program? A) North central B) Southeast C) Southwest D) Pacific northwestAns: B Feedback: The nurse would identify the southeast as the area of greatest need because here. Known as the stroke belt, stroke death rates for both Blacks and Whites are higher than in any other part of the country.6. The nurse educator is aware that the nursing student has a grasp of the major health problems of adults when the nursing student makes which one of the following statements? A) "Morbidity and mortality among adults does not vary much by age, gender, and race/ ethnicity." B) "The six leading causes of death in adults include suicide, Alzheimer's disease, and homicide." C) "Diseases of the heart and cerebrovascular diseases are the first and third causes of death in adults." D) "Malignant neoplasms, chronic lower respiratory diseases, unintentional injuries, and diabetes mellitus are not among the six leading causes of death in adults."Ans: C Feedback: The following statement is true: "Diseases of the heart and cerebrovascular diseases are the first and third causes of death in adults." Morbidity and mortality among adults varies substantially by age, gender, and race/ ethnicity. Malignant neoplasms, chronic lower respiratory diseases, unintentional injuries, and diabetes mellitus are among the six leading causes of death in adults. Causes of death in adults that are not among the six leading causes of death include suicide, Alzheimer's disease, and homicide.7. The following is a list of the top five causes of unintentional injuries accounting for the majority of adults deaths due to injury. Order these in their proper sequence from first to fifth. A) Fire arms B) Suffocation C) Motor vehicle crashes D) Poisoning E) FallsAns: C, A, D, E, B Feedback: The top five causes of unintentional injuries include motor vehicle crashes, fire arms, poisoning, falls, and suffocation. Together, these causes account for approximately 80% of all injury deaths.8. A community health nurse is preparing a presentation about drug use and abuse for a group of adults. Which of the following would the nurse include as the one of the fastest growing forms of drug abuse? A) Cocaine B) Alcohol C) Prescription drugs D) HeroinAns: C Feedback: Illegal use of prescription drugs is one of the fastest growing forms of drug abuse, and it is becoming a major public health concern. The primary illicit drugs used in the United States, such as cocaine and heroin, have and continue to be a public health problem. Alcohol abuse also is a public health problem and is considered the third leading lifestyle-related cause of death for people living in the United States.9. After teaching a group of students about the major types of cancer affecting men and women, the instructor determines that the teaching was successful when the students identify which of the following as the number one cause of cancer deaths among adults? A) Colon B) Pancreatic C) Esophageal D) LungAns: D Feedback: Lung and bronchus cancers are the number one cause of cancer deaths among adults. Colon and rectal cancers are the third most common cancers in adults. Pancreatic and esophageal cancers are less common causes of cancer death.10. A patient comes to the community health clinic with complaints of changes in urination. Which of the following would lead the community health nurse to suspect that the patient has benign prostatic hypertrophy (BPH)? A) Nighttime frequency B) Dysuria C) Hematuria D) Flank painAns: A Feedback: The symptoms of BPH vary, but the most common ones involve changes or problems with urination, such as hesitant, interrupted, or weak urinary stream; urgency or leaking of urine; and more frequent urination, especially at night. Dysuria may indicate a urinary tract infection. Hematuria could suggest a variety of problems, such as infection calculi, or cancer. Flank pain may indicate conditions such as pyelonephritis or renal calculi.11. When developing community health programs target to adult men, which of the following would the nurse need to integrate into the plan? A) Improved quality of education programs available for men B) Increased access of health services by men as compared to women C) Limited male-gender specific research D) Increased awareness of men's health issuesAns: C Feedback: The current state of men's health involves a lack of quality health education programs for men, health care services that are only accessed half as much by men when compared to women, and a lack of male gender-specific research. In addition, awareness of men's health issues is lacking. Currently, there is no Office on Men's Health in the U.S. Department of Health and Human Services; legislation to establish such an office has been introduced; however, the bill did not progress out of the congressional subcommittee on health and has not been reintroduced.12. A community health nurse is reviewing research related to women's health. Which of the following would the nurse use to obtain information about postmenopausal women's health? A) The Women's Health Study B) The Women's Health Initiative C) The Nurses' Health Study I D) The Nurses' Health Study IIAns: B Feedback: The nurse would use The Women's Health Initiative. This study was a major 15-year research program addressing the most common causes of death, disability, and poor quality of life in postmenopausal women— CVD, cancer, and osteoporosis. The Women's Health Study evaluated the effects of vitamin E and low-dose aspirin therapy in primary prevention of CVD and cancer in apparently healthy women. The Nurses' Health Study I investigated the potential long-term consequences of the use of oral contraceptives. The Nurses' Health Study II studied oral contraceptives, diet, and lifestyle risk factors in a population younger than the original Nurses' Health Study cohort.13. While working in a community health clinic, a community health nurse interviews a 24- year-old client. Which of the following would lead the nurse to suspect that the client is binge eating? A) Significant weight loss from dieting last year B) Participation in excessive exercise C) Exaggerated concern about body shape D) Severe emaciationAns: A Feedback: Binge eating is an eating disorder that is characterized by repeated episodes of uncontrolled eating. It usually starts following significant weight loss from dieting. Typically, individuals with this disorder eat quickly, eat until they are uncomfortably full, eat when they are not hungry, eat large amounts of food alone, have difficulty expressing their feelings, have difficulty controlling impulses and stress, and feel depressed about overeating. Participation in excessive exercise and an exaggerated concern about body shape is usually associated with bulimia. Severe emaciation is associated with anorexia.14. Which of the following statements by a women's group indicates that they have understood the teaching about heart disease and women? A) "More women die of breast cancer than heart disease." B) "Women experience similar symptoms as men." C) "Hormone replacement therapy protects the heart." D) "Heart disease is the number one killer of women."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.15. Which one of the following statements about coronary heart disease and stroke are most accurate? A) Cardiovascular disease kills more women than men. B) Stroke kills more men than women. C) White persons are more likely to have their first stroke earlier than Black persons. D) Risk factors for cardiovascular disease are not known.Ans: A Feedback: Cardiovascular disease kills more women than men. Stroke kills more women than men. Black persons are more likely to have their first stroke earlier than White persons. Risk factors for cardiovascular disease are known. Some are controllable such as lifestyle, and some are uncontrollable such as heredity.16. A community health nurse working in a local women's health clinic is planning a teaching session for a group of women about menopause. Which of the following would the nurse include in the session? A) Menopause involves very noticeable and characteristic symptoms. B) The symptoms are usually temporary lasting for a month or two. C) It can occur as early as age 30 but more commonly ages 45 to 55 years. D) Going 6 months without a period signals menopause.Ans: C Feedback: Menopause is a time that marks the permanent cessation of menstrual activity. It usually occurs between the ages of 45 and 55 years. However, it can occur as early as age 30. Symptoms of menopause vary among women and last from months to years. They range from hardly noticeable in some women to very severe in others. Natural menopause is when a woman has not had a period in 12 months (no other apparent causes).17. During a home visit to a family, a community health nurse encourages the mother, aged 42, and grandmother, aged 67, to have a clinical breast exam at which frequency? A) Monthly B) Yearly C) Every 2 years D) Every 3 yearsAns: B Feedback: Clinical breast exams, performed by a health care provider should be done every year for each of these women. They should also perform breast self-exam every month. The mother at her current age should have a physical examination every 2 years. Both the mother and grandmother should have a pelvic exam and Pap smear done every 3 years after three consecutive negative Pap smears.18. As part of a health screening program, a community health nurse determines that a client is infected with the human papilloma virus (HPV). The community health nurse encourages the client to do which of the following? A) Get a mammogram immediately B) Have her blood glucose level checked C) Undergo testing for a breast cancer gene D) Have a pelvic examination and Pap smearAns: D Feedback: Infection with certain types of human papilloma virus is associated with an increase risk for developing cervical cancer. Pap smears have improved early detection and prevention of cervical cancer dramatically. HPV infection is not associated with breast cancer, so there is no need for a mammography or testing for a breast cancer gene. HPV is not associated with diabetes so blood glucose testing is not indicated.19. A nurse is instructing the adult male members of a family on how to perform testicular self examination. Which of the following would the nurse include? A) Performing the examination every 3 months B) Completing the exam right after a hot shower C) Examining both testicles at the same time D) Reporting a slight difference in size of one testicleAns: B Feedback: A testicular self-examination should be performed monthly right after a hot shower or bath. One testicle is examined at a time. One testicle, usually the right one, is normally slightly larger than the other.20. Which one of the following statements best describes the role of the community health nurse in promoting the health of adult men 35 to 65 years of age? A) Anticipatory guidance to men approaching each stage and help them with ways to manage life more effectively. B) Men of this age do not need to enhance their self-care skills. C) A positive attitude toward aging is not helpful to men at this time in their lives. D) Men of this age should exercise sporadically.Ans: C Feedback: The community health nurse can provide anticipatory guidance to men approaching this stage and help them with ways to manage life more successfully. Successful navigating this stage of life can be fulfilling but may require a man to enhance his self-care skills. This includes having a positive attitude toward aging, one that examines the benefits of maturity, finds a balance between work and home, and maintains a healthy lifestyle by eating balanced meals and obtaining regular exercise.21. When developing a plan of care for a group of male patients experiencing erectile dysfunction, which of the following would the nurse expect to institute first? A) Lifestyle changes B) Adjustments to current medications C) Psychotherapy D) Behavior modificationAns: A Feedback: Treatment for ED usually proceeds from least to most invasive. For some men, making a few healthy lifestyle changes may solve the problem. Smoking cessation, weight loss, and increased physical activity may help some men regain sexual function. Cutting back on any drugs with harmful side effects is considered next. For example, drugs for high blood pressure work in different ways. If a particular drug is causing problems with erection, a different class of blood pressure medicine might work just as well. Medications, psychotherapy and behavior modifications would follow.22. Which of the following would a community health nurse recommend adult men and women over the age of 50 receive yearly? A) Electrocardiogram B) Tetanus booster C) Flexible endoscopy D) Hemoccult stool testingAns: D Feedback: Men and women over the age of 50 should receive yearly physical exams and hemoccult stool testing, electrocardiograms every 3 years, tetanus booster every 10 years, and flexible endoscopy every 3 to 4 years.23. A community health nurse, who is working with a program to foster early detection of prostate cancer, recommends prostate-specific antigen testing and a digital rectal exam for men with average risk starting at which age? A) 40 years B) 45 years C) 50 years D) 55 yearsAns: C Feedback: The American Cancer Society recommends that screening of men who are at average risk should begin at age 50 years and should include a blood test to assess PSA levels and a digital rectal examination.1. When describing the changes occurring in the older adult population globally, which of the following would be most accurate? A) The over-80 years age group is the fastest growing segment of the group. B) Males have a longer projected life expectancy when compared with females. C) Most countries have adequate numbers of social programs for older adults. D) Adults over age 65 are expected to account for about 25% of the population by 2050.Ans: A Feedback: In most of the world, the population of those over 80 years of age is growing faster than any other population age group. A higher life expectancy at birth for females compared with males is almost universal. Many countries have few or no social programs available for older adults. By the year 2050, one tenth of the population is expected to be over the age of 65 years.2. A community health nurse is working with an older adult population ranging in age from 75 to 85 years. The nurse correctly classifies this group as which of the following? A) Young-old B) Old-old C) Oldest-old D) Elite-oldAns: B Feedback: Those between the ages of 65 and 75 are classified as "young-old," while those between 75 and 85 are labeled "old-old." The number of people living into "older" old age (75 years and older) is increasing. Forty percent of elderly people in the United States are among the "oldestold" (85 to 100 years), while more than 200,000 are among the eliteold, or centenarians.3. While working with another group of community health nurses, a nurse overhears one of the nurses saying, "That older man should just retire. He's 70 years old. How productive can he be?" The nurse interprets this statement as reflecting which of the following? A) Prejudice B) Bias C) Ageism D) InsightAns: C Feedback: The one nurse's statement reflects stereotyping and a negative image of an older adult. This is called ageism. It may be due to negative personal experiences, myths, or a general lack of information. It is not reflective of prejudice or bias. Insight would reflect an understanding of the older adult, which this statement does not do.4. Which of the following statements are common misconceptions about older adults? Select all that apply. A) It is normal for older adults to become more confused and childlike, forgetful, and lose contact with reality as they age. They become "senile." B) As older adults age, they become more different and less alike other older adults. C) Older people are very capable of learning new things. D) As age increases, older adults withdraw, become inactive, and cease being productive.Ans: A, D Feedback: The misconceptions or myths about older adults include the following: It is normal for older adults to become more confused and childlike, forgetful, and lose contact with reality as they age. They become "senile"; As age increases, older adults withdraw, become inactive, and cease being productive; As older adults age, they lose their individual differences and become progressively more alike; older adults are forgetful, unable to learn new things, and set in their old ways of doing things.5. Which of the following are characteristics of healthy older adults? A) They are able to perform functional activities of daily living. B) They are able to adapt, to continue to handle stress, and to be active in life and living. C) They maintain the maximum degree of physical, mental, and social vigor. D) They are likely to be dependent on others. E) They reside in institutions.Ans: A Feedback: Healthy older adults' ability to function is a key indicator of health and wellness and is an important factor in understanding healthy aging. They are able to adapt, to continue to handle stress, and to be active in life and living. They maintain the maximum degree of physical, mental, and social vigor. The vast majority of older adults, even those with chronic diseases or other disabilities, are living outside institutions and are relatively independent.6. The nurse educator is aware that the nursing student has a grasp of the primary prevention needs of older adults when the nursing student makes which of the following comments? A) It is unnecessary for older adults to receive immunizations. B) All older adults must restrict their sodium intake. C) Older adults don't need to drink as much fluid as they are often less thirsty. D) The oral health of older adults is often neglected and so it is important that they see a dentist regularly.Ans: D Feedback: The oral health of older adults is often neglected, and so it is important that they see a dentist regularly. It is necessary for older adults to receive immunizations. Neither of these statements is true: All older adults must restrict their sodium intake and older adults don't need to drink as much fluid as they are often less thirsty.7. When visiting a local senior center, a community health nurse engages several of the older adults in a discussion about immunizations. Which statement best reflects the importance of older adult immunization? A) "We're at greater risk of dying from the flu or pneumonia." B) "You don't get the flu from the flu shot." C) "The doctor told us that we should get it." D) "Many of us get the shot here at the center for free."Ans: C Feedback: Older adults are at risk of not only contracting influenza or pneumonia but of dying from them, underscoring the importance of obtaining the immunizations. The statement about not getting the flu from the shot addresses one of the common reasons for not getting it, the belief that the flu shot will give them the flu. The statement about the doctor telling them to get it indirectly reflects another reason for not getting it, lack of knowledge about the need. The statement about getting the shot for free suggests that finances may be a barrier to obtaining the shot but not why it is important.8. A community health nurse is teaching a group of older adults at a senior center about strategies for successful aging. Which of the following would the nurse include? A) "Limit drinking alcohol to once or twice a month" B) "Avoid eating too many fruits and vegetables" C) "Keep in touch with friends and family" D) "Get up early in the morning"Ans: C Feedback: Strategies for successful aging include maintaining contacts with family and friends and staying active through work, recreation, and the community. Moderation in drinking is key. The older adult should eat a healthy diet of fruits, whole grains, vegetables, and lean meat. They also should get as much sleep and rest as needed. Getting up early in the morning may or may not be appropriate.9. An older adult interested in nutrition asks the community health nurse about the number of calories that he or she should eat every day. Which of the following would be most appropriate? A) 800 to 1,200 calories B) 1,200 to 1,600 calories C) 1,600 to 2,000 calories D) 2,000 to 2,400 caloriesAns: B Feedback: It is generally believed that older people need to maintain their optimal weight by eating a diet that is low in fats, moderate in carbohydrates, and high in proteins with a daily calorie count of 1,200 to 1,600.10. An older adult comes to the community health center for a checkup. During the visit, he or she mentions that he or she is somewhat constipated. Which of the following suggestions would be most appropriate? A) Use a laxative about once or twice a week B) Increase your intake of fresh fruits and vegetables C) Drink about four 8-oz. glasses of fluid each day D) Walk around the block once a weekAns: B Feedback: Older adults should add more fiber and bulk to their diet with fresh fruits and vegetables instead of relying on the habitual use of laxatives. Also inadequate fluid intake can contribute to bowel and bladder problems. Consuming a diet that includes eight or more 8-oz. glasses of fluid (water, juices, tea) each day assists the gastrointestinal and genitourinary system in their functions. Increased physical activity and exercise, such as a daily walk, help keep an older adult's bowel patterns regular.11. A community health nurse meets with a group of adults at the local senior center. They range in age from 65 to 70 years. The nurse would recommend vision screening at which frequency? A) Every year B) Every 2 years C) Every 5 years D) Every 10 yearsAns: B Feedback: Currently, vision screening is recommended every 2 years for adults aged 65 years and older. Blood pressure screening should occur yearly, and total cholesterol evaluation should occur every 5 years. Tetanus and diphtheria immunizations should be administered every 10 years.12. A community health nurse is assessing an older adult's ability to perform activities such as shopping, doing the laundry, using the telephone, and handling finances. Which assessment tool would be most appropriate for the nurse to use? A) Barthel Index B) Instrumental Activities of Daily Living Scale C) Katz Index of Activities of Daily Living D) Modified Rankin ScaleAns: B Feedback: The Instrumental Activities of Daily Living Scale looks at an older adult's ability to perform such activities as using the telephone, shopping, doing laundry, and handling finances. The Barthel Index assesses functional independence and is often used to determine levels of disability or dependence of stroke victims in respect to ADLs. The Modified Rankin Scale (MRS) is another common tool used for this purpose. The Katz Index of Activities of Daily Living is based on an evaluation of the functional independence or dependence of clients with respect to bathing, dressing, toileting, and related tasks.13. A community health nurse is preparing a teaching program that addresses chronic diseases common among older adults. Which of the following would be most appropriate to include? A) Forty percent of older adults are diagnosed with diabetes. B) Weight-bearing exercises are related to increased cases of osteoporosis. C) Postural hypotension can be related to falls in elders. D) Older White men have the highest rates of hypertension.Ans: C Feedback: Older adults need to have sufficient cerebral circulation to avoid dizziness. Dizziness can lead to falling. A normal to high-normal blood pressure for the elder should be maintained. Based on the most current statistics, 15.1% of men and 13.0% of women report having diabetes. Weight-bearing exercises are a way to prevent osteoporosis. Older African American men have the highest rates of hypertension.14. After teaching a group of older adult women about preventing osteoporosis, which of the following if stated by the group indicates the need for additional teaching? A) "We should eat foods that are high in calcium and vitamin D." B) "We need to get bone density screenings regularly." C) "We should avoid activities that involve weight bearing." D) "We need to make sure that maintain a healthy weight."Ans: C Feedback: Weight-bearing activities are encouraged to promote strong bones. In addition, individuals should be encouraged to eat diets that are rich in vitamin D and calcium, and include calcium supplements as needed. Not smoking, maintaining a healthy weight, and receiving ongoing bone density screenings are positive health behaviors that can contribute to strong bones throughout life.15. After teaching a group of students about the most common health problems affecting older adults in the community, which of the following if identified by the students would alert the instructor to the need for additional teaching? A) Arthritis B) Hypertension C) Emphysema D) Peripheral vascular diseaseAns: 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.16. When describing elder abuse to the families of older adults who are attending a local community presentation, which of the following would the community health nurse identify most commonly as the perpetrator? A) Elder's adult child B) Elder's partner C) Elder's neighbor D) Elder's grandchildAns: B Feedback: The most common perpetrators of elder abuse are spouses or partners of elders. The next most frequent abuser is the adult child of the elder. Although it may be possible that the perpetrator is the elder's neighbor or grandchild, this situation would be quite rare.17. Which one of the following statements about elder abuse is most accurate? A) Elder abuse is a problem that is under recognized and underreported. B) It is more common for elderly men to be abused rather than elderly women. C) If there is long-term domestic violence in an elderly couple, it is not considered elder abuse for the perpetrator to continue to abuse the victim. D) Self-neglect is not considered to be a form of mistreatment.Ans: A Feedback: Elder abuse is a problem that is under recognized and underreported. It is more common for elderly women to be abused rather than elderly men. The most common perpetrators of elder abuse are spouses or partners of elders, often in a relationship with long-term domestic violence. In some states, self-neglect is also considered a form of mistreatment.18. Which of the following comprise the primary criteria for effective programs for older adults? A) Coordination B) Accessibility C) Comprehensive D) Complex E) QualityAns: A, B, C, E Feedback: The primary criteria for effective programs for older adults include coordination, accessibility, comprehensive, and quality.19. Which of the following are included in a comprehensive set of services? Select all that apply. A) Adequate financial support B) Health education C) Encouragement to spend much time alone D) Adult day care programs E) Access to high quality health care services F) In-home servicesAns: A, B, D, E, F Feedback: A comprehensive set of services for senior citizens should include the following: adequate financial support, adult day care programs, access to high quality health care services, health education, in-home services, recreation and activity programs that promote socialization (not encouragement to spend much time alone), and specialized transportation services.20. A community health nurse is making a home visit to a family who is providing care to an older adult member with Alzheimer's disease for the past 6 months. During the visit, which of the following would be most important for the nurse to assess? A) Cognitive status B) Medication regimen C) Personality changes D) Caregiver's statusAns: D Feedback: Although assessment of the various aspects of the patient's status is important, that of the caregiver is even more important. Often, the person with AD is cared for at home until very late in the disease course. The intense care given to these clients can be a constant drain on the emotional and physical reserves of their families. The stress of providing care puts the caregiver's health at risk, as well.21. A group of community health nurses who work in continuing care retirement centers are asked to talk to a group of seniors about what they do. Which of the following would the nurses identify as unique for this setting? A) Accept clients who primarily need skilled nursing services B) Are similar to board and care homes C) Are respite centers for family members of older adults D) Provide a variety of housing and care options that elders need as they ageAns: D Feedback: Continuing care retirement centers are comprehensive centers and have become the last place an older adult needs to live, meeting independent to dependent needs, including skilled nursing and Alzheimer's disease services. They can age in place without moving to another location as their needs increase. They accept residents at all stages of need, from totally independent living to assisted living to skilled nursing care. In some settings, residents cannot enter the residence at the skilled nursing level. These beds are filled by residents with increasing needs as they move from independent living, to assisted living, to skilled nursing care. Skilled nursing facilities provide skilled nursing care along with personal care that is considered nonskilled. Board and care or personal care homes offer 24 hours basic custodial care but provide no skilled nursing services. Respite care centers provide time off for caregivers. It can take place in an adult day center, home, or residential setting.22. Which of the following care options would be most appropriate for an older adult who experiences confusion, requires daily insulin injections and blood glucose monitoring, and needs assistance with bathing, dressing, and feeding? A) Personal care home B) Respite care C) Intermediate care facility D) Skilled nursing facilityAns: D Feedback: Based on the situation, a skilled nursing facility would be most appropriate. A skilled nursing facility provides skilled nursing care, such as injections and blood glucose monitoring, along with personal care that is considered nonskilled such as bathing, dressing, and feeding. A personal care home offers 24 hours basic custodial care but no skilled services. Respite care provides time off for caregivers and can take place in a variety of settings. An intermediate care facility provides health care, but the amount and type of skilled care is less than that provided in skilled nursing facilities.23. Which one of the following statements is most accurate when differentiating hospice from palliative care? A) Both palliative care and hospice focus on cure; however, hospice focuses on terminal illnesses, and palliative care focuses on diseases that are more chronic in nature. B) Palliative care consists of comfort and symptom management and is often a part of hospice care. C) Hospice is more of a specific place than a concept of care, whereas palliative care is more of a concept of care. D) Hospice is intended for people who have a projected life expectancy of 6 months or more, and palliative care is intended for people who are actively dying.Ans: B Feedback: Palliative care consists of comfort and symptom management and is often part of hospice care. Neither palliative care nor hospice focuses on cure. Hospice does focus on care of people who are known to be at end of life, and palliative care can be provided to people who have chronic ongoing health conditions even when death is not imminent. Hospice is more of a concept of care than a specific place. Palliative care should be a major focus of care throughout the aging process, regardless of whether death is imminent within 6 months.24. When working with the older adult population in the community, which of the following would be most important for the community health nurse to do? A) Develop case management programs to channel clients to appropriate services B) Place the older adult in skilled nursing facilities for the best care available C) Raise funds to support the needs of the older adults in the community D) Emphasize tertiary prevention at this stage in the lives of the older adultAns: A Feedback: Services for the older adult should be proactive. Nurses should design interventions that maximize nursing resources and provide the greatest benefit to elderly clients. Skilled nursing facilities are for people with skilled needs, not for older adults managing chronic diseases independently. One's own home is most often the best place for elders and where they want to be. This is not something that is always needed or possible for a community health nurse to become involved in. Nurses can identify the needs for additional funding, advocate for more funding, and facilitate a community group's efforts to raise funds. This is how a nurse can best serve the elderly and support their needs rather than by actually raising the funds. Prevention should be proactive and focus on primary prevention regardless of the client's age.1. Which of the following would a community health nurse use to define vulnerable populations? A) Those persons with higher mortality rates B) Individuals with lower life expectancy C) Those with increased risk for adverse health outcomes D) Individuals with chronic illnessAns: C Feedback: Vulnerable populations are groups who have a heightened risk for adverse health outcomes. They may include various populations such as those with higher mortality rates, lower life expectancies, or chronic illnesses. However, presence of just one of these does not necessarily indicate that the population is vulnerable.2. When assessing vulnerable populations, a community health nurse uses a popular model that contains three related concepts. Which of the following would the nurse include? Select all that apply. A) Resource availability B) Relative risk C) Health status D) Housing E) EducationAns: A, B, C Feedback: A popular conceptual framework of vulnerability contains three related concepts: resource availability, relative risk, and health status. Housing and education are not one of the three related concepts in this popular model.3. A community health nurse is applying the Behavioral Model for Vulnerable Populations when evaluating a local community. Which of the following would the nurse include as an enabling factor? A) Insurance B) Acculturation C) Knowledge of disease D) Marital statusAns: A Feedback: Enabling factors include personal and family resources, as well as community resources (e.g., income, insurance, social support, region, health services resources, public benefits, transportation, telephone, crime rates, social services resources). Acculturation, knowledge of disease, and marital status are examples of predisposing factors.4. population for socioeconomic resources. Which of the following would the nurse address? A) Quality of care provided B) Access to health care services C) Educational opportunities D) Adequacy of health care providersAns: C Feedback: Socioeconomic resources include such things as human capital (e.g., jobs, income, housing, education), social connectedness or integration (e.g., social networks or ties, social support or the lack of it characterized by marginalization), and social status (e.g., position, power, role). Environmental resources deal mostly with access to health care and the quality of that care, including the adequacy of health care providers.5. When assessing a population's vulnerability, which of the following would the community health nurse identify as a predisposing factor? A) Social support networks B) Crime rates C) Transportation D) Living conditionsAns: D Feedback: Predisposing factors include demographic variables (e.g., gender, age, marital status), social variables (e.g., education, employment, ethnicity, social networks), and health beliefs (e.g., values and attitudes toward health and health care services, knowledge of disease). Social structures (e.g., acculturation and immigration), sexual orientation, and childhood characteristics (e.g., mobility, living conditions, history of substance abuse, criminal behavior, victimization, or mental illness) are also considered as predisposing factors. Enabling factors include personal and family resources, as well as community resources (e.g., income, insurance, social support, region, health services resources, public benefits, transportation, telephone, crime rates, social services resources).6. When assessing a vulnerable population's relative risk, which of the following would the community health nurse identify most likely as contributing to this risk? A) Well-balanced diet B) Up-to-date immunizations C) Enabling factors D) Exposure to abuseAns: D Feedback: Relative risk refers to exposure to risk factors identified by a substantial body of research as lifestyle, behaviors, and choices (e.g., diet, exercise, use of tobacco, alcohol and other drugs, sexual behaviors), use of health screening services (e.g., immunizations, health promotion, use of seat belts), and stressful events (e.g., crime, violence, abuse, firearm use). A well-balanced diet, up-to-date immunizations, and use of seat belts would reduce one's risk whereas exposure to abuse may increase the risk. Enabling factors relate to the Behavioral Model for Vulnerable Populations and not to the relative risk.7. When describing the causes of vulnerability to a group of students, which of the following would the instructor include? A) Vulnerable populations are fairly similar across the nation and globally. B) Statistics about vulnerable populations are highly accurate. C) The most important causative factor is race or ethnicity. D) Many of the factors and conditions suggest vulnerability overlap.Ans: D Feedback: Many of the factors and conditions contribute to vulnerability overlap, making it difficult to obtain accurate data and statistics for each group or category. Although there are some similarities and consistencies in terms of vulnerable populations, the factors vary. They also are interactive, making it difficult to determine which factor or cause is considered most important.8. Which one of the following statements about relative risk is most accurate? A) Lifestyle, behaviors, and choices do not relate to relative risk. B) Relative risk refers to exposure to risk factors identified from a substantial body of research. C) Relative risk means that if a risk exists, the illness or adverse event will occur. D) Any factor that is likely to cause increased risk is considered relative risk.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.9. A community health nurse is describing social capital and its impact on populations to a group of local community leaders. Which of the following would the nurse suggest as a way to improve the social capital of the community? A) Better job training B) Improved educational programs C) Expanded employment opportunities D) More community organizationsAns: D Feedback: Social capital consists of marital status, family structure, social ties and networks, and membership in voluntary organizations, such as a church or clubs. Thus suggesting more community organizations would address social capital. Better job training, improved education, and expanded employment opportunities are examples of human capital, investments in individuals' capabilities and skills (e.g., education, job training) that comprise jobs, income, housing, and education.10. Which one of the following statements is true regarding social capital? A) Social capital includes investments in individuals' capabilities and skills. B) Social capital includes marital status and family structure. C) Social capital includes jobs, income, housing, and education. D) Examples of social capital are education and job training.Ans: B Feedback: Social capital consists of marital status, family structure, social ties and networks, and memberships in voluntary organizations. Human capital is linked to investments in individuals' capabilities in skills (e.g., education, job training) and comprises jobs, income, housing, and education.11. Which of the following would a community health nurse include when describing the differential vulnerability hypothesis? A) Exposure to risk factors affects the population's social and human capital. B) Everyone is at risk because of stressful events occurring in life. C) A risk for a negative outcome increases with lower education and income levels. D) Certain groups are impacted by stressful events more than others.Ans: D Feedback: The differential vulnerability hypothesis states that everyone is subjected to stressful events, but that these events hurt some people more than others, thus they are vulnerable populations. Although everyone experiences stresses, not everyone is vulnerable. Deficits or problems in social and human capital can increase the population's risk. Lower education and income are associated with a higher relative risk, but these alone do not describe the hypothesis.12. After teaching a group of students about factors associated with vulnerable populations, the instructor determines the need for additional teaching when the students identify which as a factor? A) Homelessness B) Acute illness C) Income D) Immigrant statusAns: B Feedback: Factors associated with vulnerable populations include income and education, age and gender, race and ethnicity, homelessness, chronic illness and disability, and immigration among others. Chronic, not acute, illness is considered as a factor.13. A community health nurse is part of a group working with local and state legislators to expand health insurance coverage for those with inadequate or no insurance. Which outcome would the nurse hope to achieve if the group is successful? A) Increase use of early screenings B) Increase emergency room visits C) Increase episodic care D) Increase disparities in careAns: A Feedback: Having inadequate or no health insurance leads to poor health outcomes due to lack of early screening and preventive measures, including regular physical exams and immunizations, delays in getting treatment, and use of emergency rooms for worsening conditions with no continuity of care, all as efforts to save money. Expanding health insurance hopefully would promote increased use of early screenings, decreased emergency room visits, more continuity of care, and better health outcomes all around with less disparities.14. Which of the following would be most important for a community health nurse to do first when working with vulnerable populations? A) Helping them to make choices B) Guiding them to think things through C) Getting them to interact with the nurse D) Providing honest feedbackAns: C Feedback: When working with vulnerable populations, the first step is to open the door and interact with the clients, engaging them, and developing rapport. Once this is accomplished, the community health nurse can then help them in making choices, guide them to think through all the issues and consequences, and provide honest feedback.15. A community health nurse is working to empower clients of a vulnerable population. Which of the following client behaviors indicates that the nurse is achieving this goal? A) Collaboration with their health care providers B) Demonstration of a reactive focus C) Hesitancy in the use of resources D) Viewing of situations as nonchangeableAns: A Feedback: Empowerment would be manifested by the clients engaging in collaboration with their health care providers, becoming more proactive than reactive, being better able to seek and use services, and being realistic about barriers with a view for ways to change things for the better.16. Which of the following would be least helpful to a novice community health nurse working with vulnerable populations who is feeling overwhelmed and somewhat guilty about his or her personal situation as compared to his or her clients? A) Setting up an community agency clothing drive collection B) Working for changes in community attitudes C) Sending a personal donation to an agency in the area D) Remaining groundedAns: C Feedback: Working with disadvantaged populations can be challenging and exhausting. Often a novice community health nurse may feel overwhelmed and suffer compassion fatigue and guilt about ones one life. To be effective, it is often helpful to donate money or items on a group level such as an agency clothing drive rather than an individual level and to work for substantial changes in community attitudes. In addition, the nurse needs to remain grounded in order to continue to have the necessary energy and compassion.17. A community health nurse working with a group of vulnerable clients is focusing on empowering them. Which of the following would be most effective? A) Keeping the clients to a firm schedule of visits B) Viewing the clients as active partners in the process C) Having the clients cut through bureaucratic red tape D) Focusing on the clients' limitationsAns: B Feedback: Activities that are most effective in promoting empowerment include viewing the clients as active partners (shows mutual respect and helps build a trusting relationship), being flexible in dealing with the clients (demonstrates a client-centered approach), cutting through the bureaucratic red tape (demonstrates advocacy), and focusing on the clients' strengths rather than limitations (helps to build client capacity).18. A community health nurse is preparing a presentation for a group of local community nurses about measures to help decrease health disparities. Which of the following would be the least effective suggestion? A) Avoiding political involvement in issues B) Working with schools to reduce the dropout rate C) Organizing task forces to raise community awareness D) Holding community meetings to identify needsAns: A Feedback: To help decrease health disparities, political advocacy is necessary to influence health policy. In addition, working with schools to reduce the dropout rate helps to address the connection between education and outcomes. Organizing task forces, raising community awareness, and community input for need identification are all effective methods to address vulnerable populations and health disparities.19. After teaching a group of students about the socioeconomic gradient in health, the instructor determines that the students understand the concept when they state that the relationship between social class and health is which of the following? A) Direct B) Inverse C) Positive D) UnequalAns: 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.20. Which one of the following statements is true regarding the socioeconomic gradient of health? A) The behavior of smoking is lowest among those who have low income and low educational levels. B) The socioeconomic gradient of health has been found in populations around the world. C) All persons who have a low socioeconomic status will develop particular health problems. D) The socioeconomic gradient of health is universal.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.21. Which of the following are types of health disparities that are due to inequities that can be corrected? Select all that apply. A) Patients feel that they are unable to trust the information given to them and may not follow it as explained. B) Limited access to appropriate level of care C) Poor access to quality care D) Overt discrimination E) Health-damaging behaviors that are chosen by an individual despite health education and counseling effortsAns: A, B, C, D Feedback: Health disparities may be unavoidable, such as health-damaging behaviors that are chosen by an individual despite health education and counseling efforts, but most are thought to be due to inequities than can be corrected. Reported disparities exist in the areas of quality of health care, access to care, levels and types of care, and care settings; they exist within subpopulations (e.g., elderly, women, children, rural residents, disabled) and across clinical conditions. Patients can also react to providers in a way that promotes disparities; they may not trust the information given to them and may not follow it as explained, leading to inadequate care.22. Which of the following vulnerable populations have been subjected to perceived poor quality of care and access to care? Select all that apply. A) HIV-infected persons B) Persons who use illicit drugs C) People of non-White race/ethnicity D) People of White race/ethnicity E) Homeless personsAns: A, B, C, E Feedback: Higher perceived discrimination was associated with HIV infection, homelessness, drug use, and race/ethnicity, emphasizing the perceived poor quality of care and difficulties with access to care.1. develop effective plans to meet the needs of people with disabilities, the community health nurse reviews the statistics involving individuals with disabilities. Which of the following would the nurse identify as accurately reflecting the number of persons with ongoing disability? A) 10 million people—less than 5% of the US population B) 27 million people—about 10% of the US population C) 36 million people—about 12% of the US population D) 150 million people—almost 50% of the US populationAns: C Feedback: An estimated 36 million people or 12% of the population is living with some ongoing level of disability. The other statistics of 10 million, 27 million, and 150 million are inaccurate.2. When explaining the concept of disability to a local community group, which of the following descriptions would be most appropriate for the nurse to include? A) A disability is a condition someone has, not something one is. B) The plan of care for two persons with the same disability would be the same. C) A disability refers to a person's inability to do something. D) Handicap and disability are two terms that go hand in hand.Ans: A Feedback: Long-held negative views of disabilities are being replaced with new and more positive approaches that view individuals and their challenges from a more holistic standpoint. Thus, a disability is something that a person has, not something one is. Even persons with the same disability but their plan of care can be quite different. Earlier terminology equated disability with an inability or incapacity or handicap that presents a more negative view of the condition.3. In Healthy People 2020, what is the emphasis of the categories of objectives that relate to the goal of "Disability and Health to promote the health and well-being of people with disabilities?" A) A growing emphasis on a holistic approach that recognizes life satisfaction is just as important to health and well-being as preventative services B) A growing realization that healthy-life years for persons with disabilities do not equate to decreased health costs at local, state, and national levels, unlike they do for persons without disabilities C) Focus on personal responsibility for healthy lifestyle by persons with disabilities D) Concept that persons with disabilities are always dependent on othersAns: A Feedback: In Healthy People 2020, the emphasis of the categories of objectives that relate to the goal of "Disability and Health to promote the health and well-being of people with disabilities" is a growing emphasis on a holistic approach that recognizes life satisfaction is just as important to health and well-being as preventative services. It also indicates a growing realization that healthy life years for persons with disabilities equate to decreased costs at local, state, and national levels, just as they do for persons without disabilities. There is not a focus on personal responsibility for healthy lifestyle by persons with disabilities or a concept that persons with disabilities are always dependent on others.4. Which of the following are the three areas has Healthy People identified for public health action for the year 2020 using the International Classification of Functioning, Disability, and Health? Select all that apply. A) Improve the conditions of life for persons with disabilities B) Address the inequitable distribution of resources among people with disabilities and those without disabilities C) Expand the knowledge base and raise awareness about determinants of health for people with disabilities D) Ensure the health of people with disabilities by influencing many social and physical factors E) Public health activities need to focus only on preventing disabilityAns: A, B, C Feedback: The three areas that Healthy People has identified for public health action for the year 2020 using the International Classification of Functioning, Disability, and Health include improve the conditions of life for persons with disabilities; address the inequitable distribution of resources among people with disabilities and those without disabilities; and expand the knowledge base and raise awareness about determinants of health for people with disabilities. The plan to ensure the health of people with disabilities by influencing many social and physical factors is too broad. Public health activities need to focus only on preventing disability is a misconception.5. The community health nurse is invited to speak to a group of students about clients with disabilities. As part of the class, the nurse intends to describe The International Classification of Functioning, Disabilities, and Health (ICF) and its attempts at standardized language. Which of the following would the nurse include as terminology that was standardized? Select all that apply. A) Disability impairment issues B) Body functions C) Handicapping conditions D) Activities E) Environmental factors F) Personal FactorsAns: 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.6. After teaching a group of students about leading health risks, the instructor determines that the teaching was successful when the students identify which of the following as the #1 leading health risk? A) Unsafe sex B) High blood pressure C) Underweight D) Tobacco consumptionAns: C Feedback: The ten leading health risks are (1) underweight; (2) unsafe sex; (3) high blood pressure; (4) tobacco consumption; (5) alcohol consumption; (6) unsafe water, sanitation, and hygiene; (7) iron deficiency; (8) indoor smoke from solid fuels; (9) high cholesterol; and (10) obesity.7. A community health nurse is preparing for a presentation on disabilities and is planning to include information about Healthy People 2020 goals. When addressing these goals, the nurse identifies differences from the goals addressed by Healthy People 2000. Which of the following would the nurse identify as different? Select all that apply. A) Rather than individuals with disabilities and/ or chronic illnesses being defined by their limiting conditions, they are viewed as having the potential to meet and exceed health promotion and disease prevention goals set for the nation's population as a whole. B) The approach to disability now emphasizes the principles of health promotion and disease prevention for those currently experiencing disabilities and/or chronic illness. C) The goals for Healthy People 2000 have an entire section on disability and secondary conditions. D) A growing realization that healthy life-years for persons with disabilities equate to decreased health costs at local, state, and national levels, just as they do for persons without disabilities.Ans: A, B, D Feedback: A comparison among Healthy People plans over the last decades underscores the emergence of new approaches to identifying priority areas and planning to improve the health of individuals with disabilities and chronic illness. In Healthy People 2000, only one priority was devoted to disability and chronic illness. Over the past two decades, interest in disability has accelerated. Areas that are focused on with Healthy People 2020 include rather than individuals with disabilities and/or chronic illnesses being defined by their limiting conditions, they are viewed as having the potential to meet and exceed health promotion and disease prevention goals set for the nation's population as a whole; the approach to disability now emphasizes the principles of health promotion and disease prevention for those currently experiencing disabilities and/ or chronic illness; and a growing realization that healthy life-years for persons with disabilities equate to decreased health costs at local, state, and national levels, just as they do for persons without disabilities.8. A community health nurse is compiling a list of organizations that serve the needs of persons with disabilities. Which of the following would the nurse categorize as a federal agency? A) National Organization on Disability B) National Council on Disability C) National Association of the Deaf D) American Foundation for the BlindAns: B Feedback: The National Council on Disability is an independent federal agency. The National Organization on Disability, National Association of the Deaf, and American Foundation for the Blind are private organizations.9. Which of the following is a major difference between Healthy People 2010 and Healthy People 2020 with respect to people with disabilities? A) Healthy People 2010 emphasized the disparities that persons with disabilities experience. B) The emphasis on "secondary conditions" in Healthy People 2010 has been replaced in Healthy People 2020 with a concern for health disparities for people with disabilities. C) People with disabilities do not experience health disparities any more than people in the general population. D) Healthy People 2020 continues to emphasize secondary conditions.Ans: B Feedback: The emphasis on "secondary conditions" in Healthy People 2010 has been replaced in Healthy People 2020 with a concern for health disparities for people with disabilities. Key to addressing the barriers is for people with disabilities to "(1) be included in public health activities; (2) receive well-timed interventions and services; (3) interact with their environment without barriers; and (4) participate in everyday life activities. Without these opportunities, people with disabilities will continue to experience health disparities, compared to the general population."10. An instructor is reviewing the principles that resulted from the 2011 reassessment of global progress on addressing disability with a class. Which of the following would the nurse include? A) The government must focus solely on seeking improvement in the lives of individuals and families living with disability. B) Government must play the only role in addressing disability. C) It is unimportant for service providers, academic institutions, the private sector, communities, and people with disabilities and their families to address disability. D) The importance of all persons, including those with disabilities to participate in their country's development.Ans: D Feedback: In 2011, the World Health Organization and the World Bank reassessed global progress on addressing disability in light of the 2006 Convention on the Rights of Persons with Disabilities. It was determined that not only must governments seek improvements in the lives of individuals and families living with disability, but every citizen needs to participate in their country's development. Government at every level may play a most significant role, but there are important roles for service providers, academic institutions, the private sector, communities, and especially people with disabilities and their families.11. When describing the importance of the World Health Report to a group of students, the instructor would emphasize which of the following? A) It challenged the world community to focus more attention on unhealthy behaviors that lead ultimately to chronic disease, disability, and early mortality. B) Lifestyle choices are not one of the key contributors to morbidity and mortality levels in either affluent or poor countries. C) Infectious disease is the major threat. D) Malnutrition is the only threat.Ans: A Feedback: The World Health Report challenged the world community to focus more attention on unhealthy behaviors that lead ultimately to chronic disease, disability, and early mortality. It recognized that although infectious disease and malnutrition require ongoing vigilance because they continue to plague many parts of the world, they are not the only threat. Lifestyle choices are also one of the key contributors to morbidity and mortality levels in both affluent and poor countries.12. After teaching a class about the International Classification of Functioning, Disability, and Health (ICF), the instructor determines that the teaching was successful when the students identify which of the following as a personal factor? A) Problems with ambulation B) Working C) Coping styles D) AmputationAns: C Feedback: Personal factors are the features of an individual's background, life, and living that are not part of a health condition or health status, such as gender, race, age, other health conditions, fitness, lifestyle habits, upbringing, coping styles, social background, education, profession, past and current experience, overall behavior pattern and character style, individual psychological assets, and other characteristics. Problems with ambulation would be considered an activity limitation. Working would be an activity. Amputation would be an impairment.13. A community health nurse is planning to apply the International Classification of Functioning, Disability, and Health to clinical care in the community. The nurse could use this document as a basis for which of the following? A) Curriculum design B) Needs assessment C) Quality of life measures D) Policy designAns: B Feedback: In clinical care, the ICF document would be helpful with a needs assessment. Using the ICF document for curriculum design would reflect education; using it for quality of life measures would reflect research; using it for policy design would reflect social policy.14. A community health nurse is working with a group of visually impaired individuals and is developing a program to promote self- confidence and self-respect. Which of the following organizations would be a valuable resource for the nurse? A) American Foundation for the Blind B) American Council of the Blind C) Guide Dogs for the Blind D) National Federation of the BlindAns: D Feedback: The nurse would contact the National Federation of the Blind whose focus is on helping blind individuals achieve self- confidence and self-respect. The American Foundation for the Blind advocates for the visually impaired through increased state and federal funding. The American Council of the Blind provides services such as information and referral, scholarship assistance, public education, and industry consultation, governmental monitoring, consultation, and advocacy. The Guide Dogs for the Blind makes guide dogs available for the visually impaired.15. A community health nurse is making a home visit to a family. The family has a son with a disability who requires a motorized wheelchair. The family asks for the nurse's assistance. Which response by the nurse would be most appropriate? A) "His disability should automatically cover the cost of the chair." B) "We'll need to check with the insurance company about coverage." C) "You'll probably be able to get it if you pay for half the cost." D) "You might be able to get a regular wheelchair, but a motorized one is impossible."Ans: B Feedback: One major obstacle for families with a disabled or chronically ill member may be obtaining needed assistive devices and technology. Just because the technology exists does not mean that it can be obtained. Often the insurance carrier, whether private or governmental, sets limits on which products can be obtained or which brands are acceptable. Thus the nurse working with the family would need to check with the insurance company first and determine what if anything is covered and then determine how to go about obtaining what the son needs.16. A community health nurse is developing a plan of care for a family who is providing round-the-clock care in their home for a daughter who is chronically ill. Which of the following would be most important for the nurse to integrate into the plan? A) Insurance limitations B) Skill teaching C) Flexible visiting D) Respite careAns: D Feedback: Respite care is another area of great importance for families of the disabled and the chronically ill. It can be emotionally draining to meet the daily needs of a member who cannot perform self-care. This often leads to caregiver fatigue and increased stress. It is also important to recognize the effect of the situation on noncaregivers in the family, particularly nondisabled siblings of a disabled child. Respite care offers some needed relief to the family and allows for uninterrupted attention to the nondisabled children. Whatever the source, some type of respite care is often vital to the family's health and should be a priority in the overall treatment plan of the family. Although insurance considerations, teaching, and flexible visiting would be issues to be addressed, respite care is a priority.17. When developing programs to assist individuals with disability and chronic illness, which of the following would be most important? A) Narrow focus B) Holistic practice C) Orientation to the present D) Episodic careAns: B Feedback: The role of the community health nurse with respect to disabilities and chronic illness requires a holistic practice and broad focus. Strong and sustained efforts are needed to achieve results. The community health nurse addresses current needs and plans for the future.18. A community health nurse is providing information handouts that describe the need for annual gynecologic exams to local health clinics that provide care for individuals with disabilities. The nurse is fulfilling which role? A) Advocate B) Coordinator C) Researcher D) EducatorAns: D Feedback: Providing information handouts is a method for teaching. Therefore, the nurse is assuming the role of an educator at the community level. In the advocate role, the nurse would assist in arranging for the population to receive the appropriate screening, ensuring that any special modifications or adaptations would be available. In the coordinator role, the nurse might arrange for screening to be performed during a routine visit made by a client to a facility or make arrangements for transporting the clients to a facility for the screening. In the researcher role, the nurse might contact other community health nurses about their experience in ensuring screening for this population to discover if they have similar needs or problems.19. A community health nurse is reviewing the effects of the Americans with Disabilities Act of 1990. Which of the following would the nurse identify as a major result of this legislation? A) Employers with five or more employees must abide by the American with Disabilities Act. B) Architectural barriers must be removed from pathways so that they are accessible by wheelchair. C) The disabled are eligible to receive telephone services in their home at no cost to them. D) Individuals with disabilities who wish to vote must be provided transportation to polling places to vote.Ans: B Feedback: A major accomplishment of this law was the removal of architectural barriers; curbs, stairs, handicap toilets, etc. so that the disabled in wheelchairs can freely move about. Employers with 15 or more employees must follow this law. Adapted telephone services are provided for those who are hearing or physically impaired, but the telephone service is not free. Polling places must be accessible to the disabled and absentee ballots and voter registration can be done from home.20. When reviewing the concept of universal design with a group of community developers, the community health nurse recognizes that the emphasis is on which of the following as the underlying theme? A) Disability needs B) Adaptation C) Access D) SafetyAns: C Feedback: The underlying theme of universal design is ensuring access. Universal design is the design of products and environments to be usable by all people, including those with disability needs as well as chronic illness. The concept incorporated issues of adaptive design and safety measures such as reinforcement in bathroom walls to allow for installation of grab bars, but the key issue is accessibility.21. Which one of the following statements about the benefits of universal design for all persons is the most accurate? A) It is the right thing to do to allow access to the built environment for all persons including persons with disabilities. B) A healthier population may be achieved with attention to the environmental barriers that impede healthy lifestyles for all persons, including those with chronic or disabling conditions. C) The built environment refers to the naturally occurring features of the planet. D) Access implies universal design.Ans: B Feedback: A healthier population may be achieved with attention to the environmental barriers that impede healthy lifestyles for all persons, including those with chronic or disabling conditions. Universal design is the right thing to do for persons with disabilities but is not the most accurate or best reason to ensure universal design. The built environment refers to the physical parts of where we live and work (e.g., homes, buildings, streets, open spaces, and infrastructure). Universal design incorporates access, but access does not necessarily imply universal design.1. A community health nurse is meeting with a group of individuals who have been diagnosed with a serious mental illness. The nurse interprets this to mean which of the following? A) The clients have impaired level of functioning and quality of life. B) The clients' disorder is chronic and persistent. C) The clients have issues of impaired control and dependency. D) The clients have a significant behavior syndrome with present distress.Ans: A Feedback: Serious mental illness (SMI) is mental illness that has compromised both the client's level of function and his or her quality of life. Serious and persistent mental illness (SPMI) is the preferred term for serious mental illness of a chronic nature. Impaired control and dependency are components of addiction. A significant behavior syndrome with present distress characterizes a mental illness.2. When developing appropriate programs for adult mental health promotion, the nurse incorporates knowledge about the most prevalent mental disorders. Which of the following would the nurse identify as the most prevalent? A) Major depression B) Bipolar disorder C) Anxiety disorders D) Schizophrenia` Ans: C Feedback: For American adults, the most prevalent mental disorders are anxiety disorders, followed by mood disorders, especially major depression and bipolar disorders. Schizophrenia, which affects approximately the same number of adults as bipolar disorder, is problematic because it is so persistently disabling.3. After teaching a group of women in the community about common mental health disorders affecting them, the community health nurse determines that the teaching has been effective when the group identifies which one of the following? A) Anxiety disorders and mood disorders occur twice as frequently in men as in women. B) Women of color, women on welfare, poor women, and uneducated women are more likely to experience depression than women in the general population. C) The three main types of eating disorders affect more men than women. D) The three main types of eating disorders include undereating due to food unavailability.Ans: B Feedback: Women of color, women on welfare, poor women, and uneducated women are more likely to experience depression than women in the general population. Anxiety disorders and mood disorders occur twice as frequently in women as in men. The three main types of eating disorders affect more women than men. The three main types of eating disorders (anorexia, bulimia nervosa, and binge eating) also affect more women than men.4. A community health nurse is part of community discussion group on alcohol. The nurse recommends that adult males should have less than A) 6 standard drinks weekly. B) 8 standard drinks weekly. C) 10 standard drinks weekly. D) 14 standard drinks weekly.Ans: D Feedback: For the general male adult population, the recommended drinking limits are fewer than five standard drinks daily or 14 weekly. For the general female adult population, the recommended drinking limits are fewer than four standard drinks daily or eight weekly, and for people age 65 and older, recommended drinking limits are no more that one standard drink daily or seven standard drinks weekly.5. When determining a target population for education about alcohol use, which age group would the community health nurse most likely plan to address? A) 18- to 25-year-olds B) 30- to 40-year-olds C) 45- to 55-year-olds D) 65 years of age and olderAns: A Feedback: Trends in alcohol use in the United States differ across subsets of the population. Young adults (age 18 to 25) have the highest incidence of problem drinking. Thus the community health nurse would most likely address this age group.6. After teaching a class about commonly used illicit substances, the instructor determines that the teaching was successful when the class identifies which of the following as the most frequently reported illicit drug? A) Heroin B) Methamphetamine C) Marijuana D) CocaineAns: C Feedback: Although heroin, methamphetamine, and cocaine are frequently used illicit drugs, marijuana is the most frequently reported illicit drug.7. A community health nurse is discussing alcohol use disorders and is explaining what is meant by a standard drink. Which of the following would the nurse include as an example? Select all that apply. A) Two 12-oz. cans of beer B) 5-oz. glass of wine C) 1.5 oz. of an 80-proof spirit D) 3 oz. of a cordial E) Two bottles of wine coolerAns: B, C, D Feedback: A standard drink contains about 14 g of alcohol (0.6 fluid ounces or 1.2 tablespoons), which is equivalent to one 12-oz. bottle of beer or wine cooler; 8 to 9 oz. of malt liquor; one 5- oz. glass of table wine; 3 to 4 oz. of fortified wine, 2 to 3 oz. of cordial, liqueur, or aperitif; 1.5 oz. of brandy; or 1.5 oz. of 80- proof distilled spirits.8. When assessing a group of individuals for factors related to an increased risk for alcohol use disorders, which of the following would the nurse expect to find? Select all that apply. A) Academic engagement/achievement B) Antisocial peer affiliations C) Decreased impulsivity D) Positive mother-child/father-child relationships E) Stressful life eventsAns: A, B, E Feedback: Individual factors associated with the development of AUDs include problems with academic engagement/achievement, antisocial peer affiliations, problems in the mother- child/father-child relationship, and other stressful life events.9. Which one of the following statements regarding the etiology of substance use disorders is most accurate? A) It is believed that nurture has substantially more influence on the development of substance use disorders than nature. B) With the mapping of the human genome, hope has decreased that the genes related to substance use disorders could be identified. C) Alcohol dependence is thought to be a multigenomic disorder influenced by the environment (gene-environment interaction). D) Only genetic heritability is involved in the etiology and course of substance use disorders.Ans: C Feedback: Alcohol dependence is thought to be a multigenomic disorder influenced by the environment (gene-environment interaction). It is believed that genetics is a risk factor in the range of 50% to 50%. With the mapping of the human genome, hope has increased that the genes related to substance use disorders could be identified. In addition to genetic heritability, both personal and environmental factors are involved comparably in the etiology and course of substance use disorders.10. The community health nurse is using effect theory to design a prevention program for behavioral health. Which of the following would be the most likely place for the nurse to start? A) Identifying antecedent factors leading to the problem B) Identifying the specific health problem C) Determining the desired health problem impact D) Specifying the health problem outcomeAns: B Feedback: When using effect theory to design a prevention program for behavioral health, a good place to start is to identify the specific health problem and then the desired health problem impact and health problem outcome. As the program is developed, the community health nurse starts by identifying the antecedent factors that lead to behavioral health problems. This provides a clear rationale for why the intervention should provide the desired impact.11. A community health nurse is providing an in- service program to the agency staff about effect theory, which will be used to develop behavioral intervention programs. The nurse determines that the staff needs additional teaching when they identify which of the following as a component of the theory? A) Determinant theory B) Intervention theory C) Impact theory D) Process theoryAns: D Feedback: Process theory is a theoretical framework used in community/public health science. It is not a component of effect theory. Effect theory has four components: determinant theory, intervention theory, impact theory, and outcome theory.12. A community health nurse is applying the Institute of Medicine model based on Gordon's Classification of Disease Prevention model to address prevention of alcohol use during pregnancy and prevention of fetal alcohol syndrome. Which of the following populations would the nurse target indicated prevention strategies? A) Local women in the community of childbearing age B) Women of childbearing age living in a city C) Women of childbearing age considered at risk D) Pregnant women who have a child with fetal alcohol syndromeAns: D Feedback: Indicated prevention strategies would be designed to prevent the use of alcohol in pregnant women who had screened positive for alcohol use during pregnancy or already had a child diagnosed with FAS or FASD. Universal prevention strategies would address the entire population of women of childbearing age (national, local community, school, neighborhood), with messages and programs aimed at preventing the use of alcohol if pregnancy is a possibility. Selective prevention strategies would target subsets of women of childbearing age who are deemed to be at risk for alcohol use by virtue of their membership in a particular population segment.13. A community implements a plan to enforce the underage drinking law. The community health nurse interprets this action as reflecting which public health model? A) Primary prevention B) Behavioral prevention C) Environmental prevention D) Clinical preventionAns: C Feedback: Environmental prevention relies on a societal commitment for the implementation of the interventions and aims to alter the environment by reducing risk (e.g., community-wide decrease in availability of the substance; underage drinking law enforcement). Primary prevention is conducted when no disease is present in the target population with the primary goal being prevention of disease development. Behavioral prevention includes a broad array of strategies aimed at changing lifestyles (e.g., exercise, smoking cessation, balanced nutrition). The goal of the intervention is to change behaviors that put the person at risk for developing the disease or to prevent consequences of the disease. Clinical prevention is based on the medical model for preventive services. It relies on one-to-one, provider-to-patient interaction and occurs within the traditional health care delivery system.14. Which of the following statements about the National Alliance on Mental Illness (NAMI) is most accurate? A) NAMI focuses on the needs of the people who actually have mental illness. B) NAMI is committed to enhance the care of those with mental illness and improve the quality of life of those who are affected. C) The NAMI Web site contains some information that is intended to be used exclusively by care providers. D) All services of NAMI are provided at the main headquarters.Ans: B Feedback: NAMI is committed to enhance the care of those with mental illness and improve the quality of life of those who are affected. NAMI focuses on the needs of the families, peers, and consumers of Mental Health services. The NAMI Web site contains extensive information that can be utilized by both consumer and care providers. NAMI is a nationwide organization with chapters in each state and county.15. Which one of the following statements about nonprofit organizations that serve those With mental health issues is most accurate? A) They are all associated with the government. B) A for-profit organization that promotes mental health is Mental Health America, which was established in 1909. C) The organization National Mental Health Association is a scam. D) They focus on advocacy, education, service, and funding research endeavors.Ans: D Feedback: Nonprofit organizations focus on advocacy, education, service, and funding research endeavors. They are not all associated with the government. Mental Health America was formerly known as National Mental Health Association, which is a leading nonprofit organization that promotes mental health.16. Healthy People 2020 objectives focus on tobacco, alcohol, and illicit drug use education. Which of the following are steps in the process to providing this education? Select all that apply. A) Identifying the impact of substance use on the environment B) Identifying trends of substance use to develop a prevention program C) Understanding the consequences of substance use that affect a community as a whole D) Differentiating between legal and illegal substance use E) There are no differences in prevention programs for different populationsAns: B, C, D Feedback: The three steps in the process for providing tobacco, alcohol, and illicit drug use education are in order (1) identifying trends, (2) differentiating legal versus illegal use, and (3) consequences of use. Identifying the impact of substance use on the environment is not one of the steps. There are differences in prevention 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.17. A community health nurse is involved in a screening program for alcohol use with an ethnically diverse population. Which of the following would be the best instrument to use? A) Alcohol Use Disorders Identification Test (AUDIT) B) CAGE questionnaire C) Michigan Alcoholism Screening Test (MAST) D) Drug Abuse Screening Test (DAST)Ans: A Feedback: For alcohol use, the screening instrument recommended by the NIAAA is the AUDIT. WHO developed this instrument for use across populations, and it has established high reliability and validity across ethnic groups. Other tests that can be used include the CAGE questionnaire and MAST. The DAST would be appropriate to screen for drug use.18. Which of the following would the community health nurse identify as a major limitation for using biological markers for screening for substance use? A) Sensitivity of the test B) Cost of the test C) Factors influencing the test D) Ease of obtaining a specimenAns: B Feedback: Biological screening tests are rarely used in a community-based screening program due to the cost and the problems with obtaining biological specimens. In addition, numerous factors can influence sensitivity and specificity of biological markers, including other metabolic disorders or other diseases, medication use, and reliability of the method.19. Which of the following statements about Healthy People 2020 and reducing substance use and addressing mental health needs is most accurate? Select all that apply. A) After a diagnosis is established, the nurse can decide on an intervention that can address the specific public health issue identified in the diagnosis using the Healthy People 2020 objectives. B) It could be considered a priority as two of the top ten health indicators relate to substance use and mental health. C) Target benchmarks and data derivation for each objective can be used to guide program development. D) Reducing substance abuse and addressing mental health needs are not priority with Healthy People 2020. E) The goals are to improve mental health through prevention and to reduce substance abuse to protect the health, safety, and quality of life for all, especially children.Ans: A, B, C, E Feedback: Reducing substance abuse and addressing mental health needs is a priority with Healthy People 2020.20. Which of the following would a community health nurse address as a means for enhancing the life of the public? A) Proper nutrition B) Healthy sleep patterns C) Use of community supports D) Creative outletsAns: D Feedback: Life-enhancing activities to enhance public well-being include meaningful work, whether through or outside of employment, creative outlets, interpersonal relationships, recreational activities, and opportunities for spiritual and intellectual growth. Proper nutrition, healthy sleep patterns, and use of community supports are life-sustaining activities.21. A community health nurse has completed a community assessment. Which of the following would be next? A) Decide on an intervention B) Locate an appropriate the specific focus area in Healthy People 2020 C) Establish a community diagnosis D) Determine the level of preventionAns: C Feedback: After completing a community assessment, the nurse then establishes a community diagnosis. Once this is done, the next step is to decide on an intervention that can address the specific public health issue identified in the diagnosis. A good starting point in the development of community/public health intervention is to begin with the Healthy People 2020 objectives, locating the specific focus area that matches the community diagnosis. Once the nurse identifies the focus of the intervention, the next step is to determine the level of prevention.22. A community health nurse is working with a political group to lobby for changes in funding for a mental health promotion program. The nurse is functioning in which role? A) Educator B) Collaborator C) Advocate D) Case managerAns: C Feedback: The advocacy role requires being politically involved by serving on decision-making boards and committees, lobbying for legislative changes, and helping to influence mental health policy development that will better serve this population. In the educator role, the community mental health nurse teaches clients individually and in groups about their mental health conditions, their treatment protocols, ways to function more independently in the community, prevention and health-promoting strategies, and much more. In the collaborator role, the nurse works with others, pooling the groups professional expertise to enhance the quality and effectiveness of services. In the case manager role, the nurse is involved with screening, assessment, care planning, arranging for service delivery, monitoring, reassessment, evaluation, and discharge, often within the context of a community mental health center (CMHC). Case management helps the person with an SMI to access services and live as independently as possible.23. Which one of the following are the primary roles that the community health nurse must use to understand and serve populations with mental illness? A) Advocate B) Educator C) Case manager D) Consumer of epidemiologic dataAns: D Feedback: The access and use of epidemiologic data to understand and serve populations with mental illness are primary.24. Which of the following are involved in accessing and using epidemiologic data to understand and serve populations with mental illness? Select all that apply. A) Identifying the incidence and prevalence of mental disorders B) Understanding that all data are accurate C) Examining the causes and risk factors associated with mental illness D) Identifying the needs of people with mental disordersAns: A, C, D Feedback: This means identifying the incidence and prevalence of mental disorders, examining the causes and risk factors associated with mental illness, and identifying the needs of populations with mental illness. However, not all data are accurate.1. An instructor reviews the definition of homelessness according to the McKinney Vento Homeless Assistance Act with a group of community health nursing students. The instructor determines that the students need clarification when they include which of the following as homeless? A) Someone living in a public shelter B) Someone living in a park C) Someone who is incarcerated D) Someone who lives in his or her carAns: C Feedback: The McKinney-Vento Homeless Assistance Act (Title 42 of the U.S. Code) defines a person as homeless who lacks a fixed, regular, adequate night time residence including supervised public or private shelters that provide temporary accommodations, institutional settings providing temporary shelter, or public or private places that are not designed for or used as a regular sleeping accommodation for human beings (i.e., cars, parks, camp grounds). Incarcerated individuals, however, are not considered homeless under this definition.2. When addressing homeless children and youth, which of the following situations are also considered homeless according to the education subtitle of the McKinney-Vento Homeless Assistance Act? Select all that apply. A) Children who share housing with others due to economic hardship or loss of housing B) Children who are abandoned in hospitals C) Children who are awaiting placement in foster care D) Children who are living in motels, trailer parks, or camping grounds E) Children who are living apart from one or more of their parentsAns: A, B, C, D Feedback: The education subtitle of the McKinney- Vento Homeless Assistance Act expands on the definition of homelessness when addressing homeless children and youth. The act includes as homeless those children who share housing with others due to economic hardship or loss of housing, are abandoned in hospitals, are awaiting placement in foster care, or are living in motels, trailer parks, or camping grounds. Children who are living apart from one or more of their parents may not be homeless.3. Which of the following would likely provide the best estimate of the number of persons who are homeless? A) Counting the number of homeless people on a particular day B) Counting the persons who are homeless in a given week C) Counting the number of persons who are homeless at a specific time on a specific date D) The number of people who have been homeless over the course of a yearAns: D Feedback: Rather than trying to count the number of homeless people on a given day or week (point in time counts), it may be more prudent to measure the number of people who have been homeless over a longer timeframe such as over the course of a year (period prevalence counts).4. Which of the following 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. B) It is difficult to locate and account for people who are homeless. C) 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. D) 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. E) Homelessness is increasing due to poverty and the growing shortage of affordable rental housing.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.5. After reviewing statistics on homelessness, which of the following would a community health nurse identify as the fastest growing segment of the homeless population? A) Children under age 18 years B) Families headed by a female single parent C) Families headed by a male single parent D) Families with childrenAns: D Feedback: Families with children are the fastest growing segment of the homeless population based on statistics, accounting for approximately 34% of the homeless population. Single female parents account for most of the homeless families. However, because many two-parent families and families headed by single fathers are becoming homeless because of the recession, and most homeless provider organizations serving families are geared to serving single women with children, it can be harder for intact families and families headed by men to access shelter.6. Which of the following are subpopulations that are more likely to be sheltered homeless in urban areas? Select all that apply A) Adult males B) African Americans C) Veterans D) Disabled E) Migrant workersAns: A, B, C, D Feedback: When compared to their housed counterparts nationwide, the sheltered homeless are more likely to be adult males, African Americans, veterans, unaccompanied, and disabled. In rural areas, the homeless are more likely to be White, Native American, or migrant workers.7. Which of the following are reasons for the increase in poverty rates over recent years? Select all that apply. A) Declining wages B) Decline in public assistance C) Loss of jobs that offer security and carry benefits D) A decline in manufacturing jobs in favor of lower paying service jobs E) Globalization and outsourcing F) HomelessnessAns: A, B, C, D, E Feedback: The increase in poverty rates over recent years may be attributed to declining wages, loss of jobs that offer security and carry benefits, and increase in temporary and part- time employment, erosion of the true value of the minimum wage, a decline in manufacturing jobs in favor of lower paying service jobs, globalization and outsourcing, and a decline in public service. As wages drop, the potential to secure adequate housing wanes. This does not mean that homelessness is a cause of poverty. Actually, it is poverty that is known to cause homelessness.8. Which one of the following statements regarding mental illness and homelessness is most accurate? A) 75% of the sheltered homeless report a severe mental illness. B) Deinstitutionalization or being released from institutions into the community contributes to the number of persons who have a severe mental illness who are homeless. C) Mental illness only contributes to homelessness because poor mental health adversely affects an individual's ability to make sound judgments, solve problems, and make wise decisions. D) Mental illness and substance abuse are not often comorbid conditions that contribute to homelessness.Ans: B Feedback: Deinstitutionalization or being released from institutions into the community contributes to the number of severely mentally ill persons represented in the homeless population. Twenty-five percent of the sheltered homeless report a severe mental illness. Mental illness contributes to homelessness because poor mental health adversely affects an individual's ability to make sound judgments, solve problems, and make wise decisions. Mental illness and substance abuse are often comorbid conditions, which, coupled with poor physical health, make it especially difficult to secure employment and safe, affordable housing.9. Which of the following would a community health nurse expect to assess in the population of homeless men? A) Marital status B) Substance abuse C) Permanent employment D) Frequent use of sheltersAns: B Feedback: The majority of homeless men are single adults. Homeless men are more likely to be employed than their homeless female counterparts; yet, they usually hold temporary, low wage jobs that offer little security. They are also more likely than homeless women to have uncontrolled substance abuse issues. This makes it more difficult for them to access shelters, which tend to require abstinence for admission10. A community health nurse is preparing a program for a local community group about homelessness. A portion of the program will address homeless men. Which of the following would the nurse include? A) Homeless men are not looked down upon less than other groups. B) Homeless men are usually eligible for social services. C) Homeless men are perceived as blameless for their situation. D) Single, low-income men only qualify for medical assistance if disabled.Ans: D Feedback: Single, low-income men only get medical assistance if they are disabled. Homeless men are more likely to be treated with disdain than other homeless subgroups. Some people perceive homeless men as largely to blame for their plight, believing that they are able bodied and should be able to work. Moreover, homeless men may suffer from disabilities that are not severe enough to warrant eligibility for health and social services. Often health and social programs give priority to women and children.11. The nurse educator knows the nursing student understands the effect of homelessness on the health of children when the nursing student identifies which of the following? A) "Homeless children are four times more likely to become ill." B) "While approximately 87% of homeless children are enrolled in school, only about 77% attend regularly." C) "Fewer than 25% of homeless children graduate from high school." D) "Homeless children are twice as likely as their housed counterparts to repeat a grade in school."Ans: A Feedback: Only one of these statements that directly relates to the effect of homelessness on the health of children is, "Homeless children are four times more likely to become ill."12. For which reason are homeless youth at higher risk for HIV, hepatitis, and sexually transmitted infections? A) They are not likely to receive treatment for HIV, hepatitis, and sexually transmitted infections. B) They lack education or job training skills and may resort to prostitution or survival sex, which increases their risk for HIV, hepatitis, and sexually transmitted infections. 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.Ans: B Feedback: The reason that homeless youth are at higher risk for HIV, hepatitis, and sexually transmitted infections is that they lack education or job training skills and may resort to prostitution or survival sex. The following factors do not increase the risk for HIV, hepatitis, and sexually transmitted infections: They are not likely to receive treatment for HIV, hepatitis, and sexually transmitted infection; they may have difficulty accessing emergency shelter because of shelter policies that prohibit older youth from the facility; and it is not uncommon for homeless youth to be arrested for running away, breaking curfews, or being without supervision.13. Which one of the following statements about mental health issues and homeless young people is most accurate? A) 87% of homeless children has suffered emotional disturbances due to the effects of traumatic stress and violence. B) Homeless youth suffer disproportionately from anxiety, depression, conduct disorders, posttraumatic stress, and low self-esteem. C) It is not common for homeless youths to be arrested for running away, breaking curfews, or being without supervision. D) Homeless youth are persons under age 18 who lack parental, foster, or institutional care.Ans: B Feedback: Homeless youth suffer disproportionately from anxiety, depression, conduct disorders, posttraumatic stress, and low self-esteem. One in six homeless children has suffered emotional disturbances due to the effects of traumatic stress and violence. It is not uncommon for homeless youth to be arrested for running away, breaking curfews, or being without supervision. Homeless youth are persons under age 18 who lack parental, foster, or institutional care, but this is not necessarily related to mental health issues.14. The community health nurse is explaining the reasons for health problems in the homeless population. Which of the following would the nurse identify as the most likely reason? A) Issues related to storage of medications B) Lack of transportation to keep appointments C) Time and energy focus on survival needs D) Limited access to health care servicesAns: C Feedback: Although issues related to medication storage, lack of transportation, and limited access to health care play a role, many homeless people expend their time and energy trying to meet basic survival needs such that health care takes a backseat to finding food, clothing, or shelter.15. community-based organization to develop programs to provide quality accessible health care to the homeless population. Which of the following would be the most appropriate source from which to seek funding for this program? A) Projects for Assistance in Transition from Homelessness (PATH) B) Health Care for the Homeless (HCH) C) The Interagency Council on Homelessness D) U.S. Department of Housing and Urban DevelopmentAns: B Feedback: The HCH program (a provision of the McKinney Act) awards grants to communitybased organizations that seek to provide quality, accessible health care to the homeless and would be the most appropriate source for funding. PATH is a grant program created under the McKinney Act to support the delivery of services to persons with severe mental illnesses, including those who are homeless or at risk of becoming homeless. The Interagency Council on Homelessness coordinates the federal response to homelessness and creates a national partnership with public and private sectors to reduce and end homelessness in the United States. HUD provides funding for supportive housing for low-income families, as well as low-income individuals with disabilities, and low-income elderly.16. After teaching a group of community health students about public and private sector programs and initiatives aimed at combating homelessness, the instructor determines that they need additional teaching when they identify which of the following as a private sector organization? A) National Coalition for the Homeless B) National Alliance to End Homelessness C) National Resource Center on Homelessness and Mental Illness D) National Low Income Housing CoalitionAns: C Feedback: The National Resource Center on Homelessness and Mental Illness is a federally sponsored public program for addressing the needs of the homeless. The National Coalition for the Homeless, the National Alliance to End Homelessness, and the National Low Income Housing Coalition are private sector resources.17. A community health nurse who will be working with a homeless population is planning care. Which of the following would the nurse need to do first? A) Develop trust with the population B) Clarify personal values and beliefs C) Focus on the issue of homelessness D) Visit the local shelter where the clients areAns: B Feedback: When working with the homeless population, it is crucial that the nurse clarify personal beliefs and values about poverty, homelessness, addictions, and mental disorders to ensure nonjudgmental care. Trust too is essential, but this would need to occur after the nurse has clarified his or her values and beliefs. Biases or judgments on the nurse's part would undermine the development of trust. The nurse needs to use a comprehensive, holistic approach or focus, not just focus on the population's homelessness. Visiting the local shelter may be helpful to gather information about what the nurse might expect, but it isn't the first thing the nurse would do.18. women who are victims of intimate partner violence, the nurse develops interventions aimed at the primary level of prevention. Which of the following would be most appropriate for the nurse to include? A) Assisting them to locate a safe shelter B) Providing immunizations C) Screening for sexually transmitted infections D) Teaching about basic hygiene measuresAns: A Feedback: For women who are victims of intimate partner violence, counseling and helping them locate a safe shelter can assist in preventing homelessness. Providing immunizations and teaching about basic hygiene may be appropriate, but these would not priorities at this time. Screening for sexually transmitted disease would be a secondary level of prevention activity.19. A community health nurse is working with a group of homeless clients with substance abuse problems. Which of the following would be appropriate for the nurse to do at the tertiary level of prevention? A) Conduct mass screening for common communicable diseases B) Institute a mobile van to assist in early diagnosis of common illnesses C) Advocate for counseling programs to address high risk behaviors and abuse D) Assist in ensuring participation in substance abuse rehabilitation programsAns: D Feedback: Tertiary prevention level activities include treatment of complications of advanced disease, providing rehabilitative care, such as participation in a substance abuse rehabilitation program, and offering counseling and support. Conducting mass screenings for common communicable diseases associated with substance abuse and a mobile van program to assist in early diagnosis are secondary prevention level activities. Advocating for counseling programs to address risk behaviors and abuse would be a primary prevention level activity.1. When describing the term "frontier area," which of the following would the nurse include as the most common description? A) A population density of fewer than 1,000 people per square mile B) Population density of 1,000 people or more per square mile C) Fewer than 10,000 residents in the community D) Fewer than six people per square mileAns: D Feedback: Fewer than six people per square mile is one of the most common descriptions of a "frontier area." Fewer than 10,000 residents or population density of less than 1,000 people per square mile is the definition of "rural." A population density of 1,000 or more people per square mile refers to an urbanized area or urban cluster.2. The nurse educator is aware that the nursing student needs further instruction on the terminology related to rural, frontier, migrant, and urban issues when the nursing students identifies which of the following? A) A rural area has six or fewer persons per square mile. B) There are many factors that are considered when determining if a community is rural or frontier other than population density. C) Urban areas are much more densely populated than urban areas. D) An urban area consists of at least 2,500 people per square mile with at least 1,500 of those who reside outside institutional group quarters.Ans: A Feedback: If a nursing student would identify that a rural area has six or fewer persons per square mile, the student would need further instruction as it is a frontier area that has six or fewer persons per square mile. There are many factors that are considered when determining if a community is rural or frontier other than population density. Urban areas are much more densely populated than rural areas. Urban areas consist of at least 2,500 people per square mile with at least 1,500 of them living outside institutional group quarters.3. When attempting to describe the characteristics of a typical rural population to a group of community health nurses, which of the following would the nurse include? A) Older, White, with a lower income and less formal education B) Young minorities with a lower income and less formal education C) Wealthier, more highly educated, older White Americans D) A reflection of the population as a wholeAns: A Feedback: Population characteristics include older adults as the largest segment of the population, majority as White, with lower educational attainment, and, on the average, a lower income.4. Which of the following reasons is most likely to force a rural hospital to close? A) Rural hospitals have a high risk for financial problems and closures. B) Rural hospitals do not have access to high tech equipment and services. C) Rural hospitals are able to attract many specialty physicians. D) Many rural residents depend heavily on public health department services.Ans: A Feedback: Rural hospitals have a high risk for financial problems and closures. Rural hospitals usually have less high-tech health care equipment and services, but this does not directly influence closure of the hospital. Rural hospitals are usually not able to attract many specialty physicians, and indeed physician and nurse and pharmacist shortages in rural areas make it difficult to operate a hospital. Many rural residents depend heavily on public health department services, but this is more likely an effect of lack of access to acute care services than a cause of lack of access to acute care services.5. Which of the following are barriers to access to health care that may be experienced by rural clients? Select all that apply. 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 availableAns: 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.6. Which one of the following statements about migrant workers and their families most accurately describes their lifestyle? A) They are usually paid fairly and treated justly by their employers. B) Often the men are the only ones who perform the migrant work. C) They often work 6 days a week from sunrise to sunset. D) Their earning power is dependent only upon their skill level.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.7. 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) Restricted circuit migration B) Point-to-point migration C) Nomadic migration D) Migrant stream migrationAns: B Feedback: Point-to-point migration entails leaving a home base for part of the year to travel to the same place or series of places along a route during the agricultural season, usually returning on a yearly basis. In a restricted circuit, many people travel throughout a season within a small geographic area, following the crops. Nomadic migration involves traveling away from home for several years, working from farm to farm and crop to crop, relying on word of mouth about job opportunities. Migrant stream migration involves following the harvest seasons of agricultural crops, moving from place to place, usually along predetermined routes (migrant streams).8. A community health nurse is working to improve the health children of migrant families. Which of the following issues would be of least importance for the nurse to address? A) Adolescent substance abuse B) Exposure to domestic violence C) Mental health problems D) Participation in choresAns: D Feedback: Many migrant children are called upon by their families to stay home from school to work, care for younger children, or attend to other household chores, thus affecting the child's academic performance. However, chores and helping the family are necessary to the family's survival and as such would be something the nurse would focus on at a later time. Issues such as adolescent substance abuse, domestic violence, and mental health problems are common and would need to be addressed early on.9. Which of the following have a direct and negative influence on the vulnerability of migrant workers? Select all that apply. A) Many are undocumented aliens and live in fear of deportation. B) They are often deprived of safe working conditions. C) Their children are deprived of a quality education. D) They often lack adequate sanitation and housing. E) They often have poor nutrition because of poverty.Ans: A, B, D, E Feedback: Factors that have a direct and negative influence on the vulnerability of migrant workers include many are undocumented aliens and live in fear of deportation; lack of safe working conditions; lack of adequate sanitation and housing; and poor nutrition because of poverty. That their children are deprived of a quality education is also significant, but it is not a direct influence on the vulnerability to health concerns of the migrant workers themselves.10. A community health nurse is working to develop programs to address the health status of migrant families. Which of the following would the nurse need to keep in mind when planning these programs? Select all that apply. A) A greater mortality from injuries, TB, respiratory diseases, and cerebrovascular diseases B) A dramatic increase in use of immunizations for migrant children C) An infant mortality rate that is 25% to 30% higher than for other infants in the United States D) Health needs compromised by limited access to health care and high mobility E) A much lower life expectancy than that of the general populationAns: A, C, D, E Feedback: The life expectancy of a migrant worker is much lower than the general population, with proportionally increased mortality from "injuries, tuberculosis, mental disorders, cerebrovascular disease, respiratory diseases, ulcers, hypertension, and cirrhosis." The migrant infant mortality rate is 25% to 30% higher than the national average. Migrant children are delayed for immunizations. Migrant families have numerous health needs, but they often face many obstacles to accessing health care including their frequent movement from place to place.11. A local community has a significant population of migrant workers. In response, a community health nurse plans to prevent a program to the local community about this population. As part of the program the nurse plans to include information about Cesar Chavez, describing him as which of the following? A) A Mexican president who worked to keep people from crossing the border illegally B) A well-known actor who advocates for increasing the number of Latinos in Hollywood C) The senator who wrote the Children's Health Insurance Program (CHIP) bill D) Founder of the United Farm Workers who spent his life fighting for social justiceAns: D Feedback: Cesar Chavez founded the United Farm Workers (UFW), the first union in agricultural labor history that successfully organized migrant farmworkers. Chavez fought for social justice and is an example of a migrant hero. He was not a senator, well-known actor, or Mexican president.12. When providing care for migrant workers, which of the following would be most appropriate for the community health nurse to do? A) Maintain existing services B) Use standard methods of health care delivery C) Employ information tracking systems D) Use professionals for community outreachAns: C Feedback: Employing information tracking systems is necessary due to the mobility of this population and the need for continuity of care. The nurse should improve the existing services, use unique methods of health care delivery to reach this population, and use lay personnel for community outreach.13. A community health nurse works to offer increased health care services to meet the needs of a local migrant population. Which of the following ideas will work well for 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 schoolAns: A, B, D, E Feedback: The van at the work site, services for children in school including a breakfast program, 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 PM will not help.14. When dealing with urban populations, which of the following issues would a community health nurse most likely face? Select all that apply. A) Health disparities in the population B) Lower levels of homelessness C) Increased cases of asthma D) High levels of poverty E) Major transportation issuesAns: A, C, D Feedback: Health disparities are very evident in the populated urban setting. There are increased levels of asthma and higher levels of poverty. Homelessness is more evident, yet transportation issues are not as great as in suburban or rural areas.15. After teaching a group of community health nursing students about urban sprawl and its effects, the instructor determines that additional teaching is needed when the students identify which of the following as an effect? A) Water pollution B) Heat islands C) Less exposure to pesticides D) Decreased air qualityAns: C Feedback: Encroachment of housing areas into natural habitats or farmlands can lead to wider human exposure to pesticides, herbicides, and other things such as mosquito-borne illnesses. Urban encroachment into agricultural areas creates problems with air and water pollution, access to health care, and heat islands. 16. Which of the following are livability principles that have been identified by the Partnership for Sustainability Communities? Select all that apply. A) Diminish economic competitiveness B) Disassemble existing communities C) Coordinate and leverage federal policies and investment D) Provide more transportation choices E) Promote equitable, affordable housing ` Ans: C, D, E Feedback: The six livability principles include (1) provide more transportation choices, (2) promote equitable, affordable housing, (3) enhance economic competitiveness, (4) support existing communities, (5) coordinate and leverage federal policies and investment, and (6) value communities and neighborhoods.17. concept of social justice, which of the following if stated by the group as a component indicates effective teaching? A) Decreased burden borne by all B) Increased benefits obtained for all C) Narrow isolated view of health D) Diversity viewed as a strengthAns: D Feedback: Social justice occurs when a society provides for the health needs and health care issues of all people by treating people fairly, regardless of where they live or who they are. It deals with concepts of inclusion, participation, empowerment, and the recognition that diversity is a strength. Social justice involves an equal bearing of the burdens and equal reaping of the benefits. Community health nurses who practice social justice have broad and holistic views of health.18. A community health nurse working with urban populations integrates the concept of social justice into practice by demonstrating which of the following? A) Impartiality B) Paternalism C) Self-interest D) InflexibilityAns: A Feedback: Social justice requires impartiality, that is, ensuring that interventions are just and the outcome is fair when viewed by an uninvolved outsider. Paternalism reflects an individual focus rather than the population focus of social justice. Self-interest and inflexibility would interfere with impartiality and, subsequently, social justice.19. is describing how rural community health nursing compares with community health nursing in urban and suburban areas. Which of the following would the nurse include about rural community health nurses? A) Salaries comparable with the other two areas B) More difficulty in initiating planned change C) Nurses viewed as active, highly respected community members D) Less physical isolation from professional opportunitiesAns: C Feedback: Rural community health nurses are active members of their community and are highly respected professionals. Salaries typically are lower than that of urban nurses in comparable positions. However, because the system of health care is smaller, it can be easier to understand the system and initiate planned change. Rural community health nurses may experience the challenge of physical isolation from personal and professional opportunities associated with urban areas. Traveling to cities for basic and continuing education can be a barrier. In addition, rural nurses may feel isolated in clinical practice because of the scarcity of professional colleagues.20. A community health nurse implements the use of promotoras to promote health in migrant communities. Which of the following best describes a promotora? A) Nonprofessional community outreach worker B) Trained childbirth assistant C) Retired nurses knowledgeable of the area D) Language translatorsAns: A Feedback: The use of promotoras—lay community outreach workers—or doulas—usually trained childbirth assistants—have promoted health in migrant communities. Promotoras are not retired nurses or language translators.21. Which of the following activities best exemplifies a community health nurse forging a relationship? A) Dealing with sensitive subjects B) Introducing one's self as a community health nurse C) Listening to more than just what is said D) Being aware of the long term commitment to the clientAns: B Feedback: In forging a relationship, CHNs begin with creating a "perception of presence" by identifying themselves as a public health nurse and passing out their card with the instruction to the client to call upon them when needed. Acting as a resource involves dealing with "sensitive subjects" and requires "honesty, asking direct questions, and ignoring rude behavior." Detecting and asking the next question "means listening to more than what is said." When a client is truly heard and all information is on the table, making an informed judgment is then possible. Sense of time includes the awareness of the long-term commitment of the community health nurse to the client and the belief that results can occur, despite the lack of progress or even regression on the part of some clients.22. After teaching a class on urban health to a group of community health nursing, the instructor determines that the teaching was successful when the students describe it as which of the following? A) Providing care to those individuals who are living in ghettos B) Addressing the needs of immigrants living in large cities C) Considering effects of environment on the health of large cities D) Ensuring the appropriate planning of attractive and equitable placesAns: C Feedback: Urban health considers those characteristics of the environment as they relate to the health of the population living within large cities. Individuals living in ghettos and immigrants living in large cities are but two segments of the urban population. Urban planning works to improve the welfare of individuals and communities by creating more healthful, efficient, attractive, and equitable places.23. A rural community health nurse is acting in the role of a mentor. Which of the following activities would the nurse most likely be doing? A) Providing childbirth classes B) Contacting a specialist for a client C) Collecting immunization data for program development D) Orienting a new rural health nurse to the communityAns: D Feedback: In the role of a mentor, the rural community health nurse would engage in guiding new community health nurses, nursing students, and other nurses new to the rural community. Childbirth classes would be characteristic of the educator role. Contacting a specialist for a client reflects the nurse's role as a referral agent. Collecting immunization data for program development reflects the nurse's role as a change agent/researcher.