Community - Week 10 (Ch 5 21 22 24 25) - Evolve Questions

Question 1

It is important that nurses understand the nontraditional healing practices of their clients because:
A. folk practices are usually ineffective.
B. nurses can refer clients to the appropriate local folk healers.
C. safe, effective nontraditional healing methods can be blended with Western medicine.
D. the nurse must understand them to help the client give them up.

Answer 1

C. safe, effective nontraditional healing methods can be blended with Western medicine.

Nurses need to understand the nontraditional healing practices that their clients use. Many of these treatments have proven effective and can be blended with traditional Western medicine. The key is to know what practices are being used so that the blending can be knowledgeably done.
DIF: Cognitive Level: Application
REF: Page 71

Question 2

A nurse demonstrates cultural competence by using statements such as:
A. “I know how you feel.”
B. “Tell me about your health care beliefs.”
C. “Let me show you the way you should do this.”
D. “You can do things in a more modern way now.”

Answer 2

B. “Tell me about your health care beliefs.”

Cultural competence includes acknowledging the fundamental differences in the ways clients and families respond to illness and treatment from one’s own response or a more generalizable Western health care response. Culturally competent nursing care is grounded in the following four principles:
1. Care is designed for the specific client.
2. Care is based on the uniqueness of the person’s culture and includes cultural norms and values. (“Tell me about your health care beliefs.”)
3. Care includes self-empowerment strategies to facilitate client decision making in health behavior.
4. Care is provided with sensitivity and is based on the cultural uniqueness of clients.
DIF: Cognitive Level: Application
REF: Page 74

Question 3

A nurse exclaims proudly to other nurses at the agency, "The care I provide is the same for everyone. I treat everyone the same." In fact, this nurse is demonstrating what inhibitor to developing cultural competence?
A. Cultural blindness
B. Cultural competence
C. Cultural conflict
D. Culture shock

Answer 3

A. Cultural blindness

Cultural blindness is the tendency to ignore all differences among cultures and to act as though the differences do not exist and to treat all people the same when, in truth, each person is different. Cultural competence in nurses is a combination of culturally congruent behaviors, practice attitudes, and policies that allow nurses to work effectively in cross-cultural situations. Cultural conflict is a perceived threat that may arise from a misunderstanding of expectations between clients and nurses when either group is not aware of cultural differences. Cultural shock is the feeling of helplessness, discomfort, and disorientation experienced by an individual attempting to understand or effectively adapt to another cultural group that differs in practices, values, and beliefs.
DIF: Cognitive Level: Knowledge
REF: Page 79

Question 4

A nurse who speaks only English has just gotten a new client for an intake interview. The client is a refugee who has very limited English proficiency (LEP). The nurse should:
A. get an interpreter.
B. see whether another nurse, more comfortable with refugees, will work with the client.
C. see what helpful information is on the Internet.
D. try to communicate with hand gestures.

Answer 4

A. get an interpreter.

When nurses do not speak or understand the language, they should obtain an interpreter. The amount of accommodation that an agency must provide is guided by the proportion of people using the service overall as compared with those who need special assistance. Depending on the volume of clients who cannot speak English, agencies may be required to have all of their written materials translated and regularly use interpreters or have only portions of the materials translated. Health care agencies are responsible for effectively communicating with their clients. When an interpreter is not available to translate, the client may view this behavior as unacceptable and bring legal action against the agency.
DIF: Cognitive Level: Application
REF: Pages 82-83

Question 5

Nurses in community health who understand the basis of their own behaviors and how those behaviors help or hinder the delivery of competent care to persons from cultures other than their own are demonstrating the cultural competence development process construct of:
A. cultural awareness.
B. cultural desire.
C. cultural encounter.
D. cultural skill.

Answer 5

A. cultural awareness.

The five constructs that explain the process of developing cultural competence are cultural awareness, cultural knowledge, cultural skill, cultural encounter, and cultural desire. Cultural awareness is self-examination and in-depth exploration of one’s own beliefs and values as they influence behavior. Nurses who are receptive to learning about cultural dimensions understand the basis of their own behaviors and how they help or hinder the delivery of competent care, and nurses who recognize that health is expressed differently across cultures have developed cultural awareness. Cultural desire refers to the nurse’s intrinsic motivation to provide culturally competent care. Cultural encounter is the process that permits nurses to seek opportunities to engage in cross-cultural interactions. Cultural skill refers to the effective integration of cultural awareness and cultural knowledge to obtain relevant cultural data and meet the needs of culturally diverse clients.
DIF: Cognitive Level: Knowledge
REF: Page 75

Question 6

A nurse in community health seeks to determine whether the visit with an older adult Asian woman is successful. The nurse has not encountered many clients from this culture. An effective way to judge whether a cultural encounter has been effective would include the nurse’s sense that the visit was successful, the nurse and client experience little or no stress, and:
A. the client says “thank you.”
B. the client nods frequently.
C. the client’s family does not complain.
D. tasks are done efficiently.

Answer 6

D. tasks are done efficiently.

Having cultural competence is not the same thing as being an expert on the culture of a group that is different from one’s own. Nurses can develop cultural competence by reading about, taking courses on, and discussing different cultures within multicultural settings. A successful encounter may be judged on the basis of the following four aspects:
1. The nurse feels successful about the relationship with the client.
2. The client feels that interactions are warm, cordial, respectful, and cooperative.
3. Tasks are done efficiently.
4. The nurse and client experience little or no stress.
DIF: Cognitive Level: Application
REF: Page 77

Question 7

In caring for a young adult from West Africa, the community nurse is introduced to another individual who is referred to as “auntie.” A culturally competent nurse who is aware of the basic organizing factor of culture related to social organization would:
A. assess the competence of the “auntie” to care for the young adult.
B. assume that the “auntie” is related to one of the young adult’s parents.
C. declare that the young adult is capable of making personal health decisions.
D. find out who is considered to be a member of the family.

Answer 7

D. find out who is considered to be a member of the family.

Social organization is one of the basic organizing factors related to cultures. It refers to the way in which a cultural group structures itself around family to carry out roles and functions. In some cultures, family may include people who are not actually related to one another. The nurse should find out who is considered to be in the family, who the key decision makers are, and if the needs of the family supersede those of the individuals in the family. Nurses should advocate for the individual, so that when families make decisions, the individual’s needs are also considered.
DIF: Cognitive Level: Application
REF: Page 83

Question 8

A Public Health Service nurse working for the Indian Health Service is working with a client diagnosed with cancer. The client uses sweat lodges to "cure the disease." The nurse understands that within the culture, disease is often perceived as disharmony with other forces, and clients may look to hot or cold treatments to resolve or cure a cancerous condition. The nurse is integrating her knowledge of the cultural organizing factor of:
A. biological variations.
B. communication.
C. environmental control.
D. space.

Answer 8

C. environmental control.

Environmental control refers to the relationships between humans and nature. Cultures that view a human harmony with nature may perceive illness as a disharmony with other forces and believe that medicine can only relieve the symptoms rather than cure the disease. They would use the mind-body-spirit connection to heal from within. Such cultures look to naturalistic solutions such as herbs, hot and cold treatments, or acupuncture to resolve or cure a cancerous condition. Biological variations are the physical, biological, and physiological differences that exist and distinguish one racial group from another. Communication and space are not cultural factors associated with this scenario.
DIF: Cognitive Level: Application
REF: Pages 83-84

Question 9

A community-based hospice nurse has an Asian male client with terminal stage cancer. The client complains that he is in continuous pain and receives no relief from the codeine prescribed by his primary care practitioner (PCP). The nurse contacts the client's PCP to discuss replacing the prescription of codeine with another pain-reducing non-codeine-based drug. The nurse is demonstrating knowledge of the cultural organizing factor of:
A. biological variance.
B. communication.
C. space.
D. time perception.

Answer 9

A. biological variance.

Biological variations are the physical, biological, and physiological differences that exist and distinguish one racial group from another. They occur in areas of growth and development, skin color, enzymatic differences, and susceptibility to disease. Research findings suggest that sensitivity to codeine varies with ethnic background, and that Asian men experience significantly weaker effects from the drug than do European men. Asian men are missing an enzyme called CYP2D6 that allows the body to metabolize codeine into morphine, which is responsible for the pain relief provided by codeine. When an individual is missing the enzyme, no amount of codeine will lessen the pain, and other pain-reducing chemicals should be explored. The cultural organizing factors associated with communication, space and time perception are not related to this situation.
DIF: Cognitive Level: Application
REF: Page 84

Question 10

A nurse overhears the doctor saying, “Let’s not give him codeine; he is Asian.” The nurse reflects on the comment and determines that the: (select all that apply)
A. doctor is culturally competent.
B. doctor is prejudiced.
C. doctor should have called an interpreter.
D. doctor’s ability to assess pain based on culture may be limited.
E. doctor is planning care based on racial enzymatic differences.

Answer 10

A. doctor is culturally competent.
E. doctor is planning care based on racial enzymatic differences.

Biological variations distinguish one racial group from another. They occur in areas of growth and development, skin color, enzymatic differences, and susceptibility to disease. Research findings suggest that sensitivity to codeine varies with ethnic background. Asian men experience significantly weaker effects from drug use than do European men. Asian men are missing an enzyme called CYP2D6 that allows the body to metabolize codeine into morphine, which is responsible for the pain relief provided by codeine. When an individual is missing the enzyme, no amount of codeine will lessen the pain, and other pain-reducing medicines should be explored.
DIF: Cognitive Level: Application
REF: Page 84

Question 11

A city uses the local media (radio, television, and newspapers) to post ratings of air quality on days when the air quality is poor. This notification is directed toward older adults, very young members of the community, and those with chronic breathing problems. These groups are an example of:
A. disenfranchised populations.
B. disadvantaged populations.
C. vulnerability.
D. vulnerable populations.

Answer 11

D. vulnerable populations.

Vulnerable populations are those groups who have an increased risk to develop adverse outcomes. A vulnerable population group is a subgroup of the population, more likely to develop health problems as a result of exposure to risk or to have worse outcomes from a health problem than is the rest of the population. The risks are often cumulative risks from environmental hazards, personal behavior, or biological or genetic makeup.
DIF: Cognitive Level: Application
REF: Page 375

Question 12

A poor, older Native Alaskan woman lives in a small, remote village near the Canadian border. She has been diagnosed with hypertension and diabetes but rarely makes it to the regional clinic in a distant town for checkups. This woman is most at risk for:
A. disenfranchisement.
B. health disparities.
C. loss of independence.
D. resilience.

Answer 12

B. health disparities.

Vulnerable populations often are more likely than the general population to suffer from health disparities (i.e., wide variations in health services and health status among certain population groups). The less than adequate care experienced by these groups can be defined by age, gender, race or ethnicity, education or income, disability, geography, or sexual orientation. Disenfranchisement refers to a feeling of separation from mainstream society. The person does not seem to have an emotional connection with any group in particular or with the larger society.
DIF: Cognitive Level: Application
REF: Pages 375-376

Question 13

A young adult with a history of prior parental abuse recently has been diagnosed with a stress-related illness. The individual works at a local convenience store, earning a little more than the federal poverty level, but receives no health benefits. This individual is predisposed to the development of:
A. poverty.
B. resilience.
C. risk.
D. vulnerability.

Answer 13

D. vulnerability.

Vulnerability results from the combined effects of limited resources. Limitations in physical resources, environmental resources, personal resources (or human capital), and biopsychosocial resources (e.g., the presence of illness, genetic predispositions) combine to cause vulnerability. Poverty, limited social support, and working in a hazardous environment are examples of limitations in physical and environmental resources.
DIF: Cognitive Level: Application
REF: Page 376

Question 14

A nurse participates with a community planning board addressing housing strategies and future community needs. The nurse is aware that the community has a population of homeless families served by local churches. The nurse is also aware that this agricultural community relies on migrant workers during seasonal harvesting of local produce. The nurse is concerned that these disenfranchised populations may be:
A. complicated to address.
B. costly to serve.
C. invisible to the community.
D. resilient to the community.

Answer 14

C. invisible to the community.

Disenfranchisement refers to a feeling of separation from mainstream society. Groups such as the poor, the homeless, and migrant workers are “invisible” to society as a whole and forgotten in health and social planning. Vulnerable populations are at risk for disenfranchisement because their social supports are generally weak, as are their links with formal community organizations.
DIF: Cognitive Level: Application
REF: Page 376

Question 15

A nurse volunteering at the free clinic in her community informs a client seeking treatment for hypertension that the family’s children may qualify for enrollment in the State Children’s Health Insurance Program (SCHIP). The nurse’s intervention can reduce health disparities for these vulnerable children by making a referral to a program that provides:
A. direct financial subsidies for children.
B. funds to insure currently uninsured children.
C. outreach efforts to enroll eligible children in Medicaid.
D. prospective payments for child services.

Answer 15

B. funds to insure currently uninsured children.

Title XXI of the Social Security Act provides for the State Children’s Health Insurance Program (SCHIP) to provide funds to insure currently uninsured children. The SCHIP program is jointly funded by the Federal and State governments and administered by the states. Using broad Federal guidelines, each state designs its own program, determines who is eligible for benefits, sets the payment levels, and decides upon the administrative and operating procedures. The program is subject to change when states undergo budget reductions
DIF: Cognitive Level: Application
REF: Page 379

Question 16

Vulnerable populations may be exposed to more than one hazard at a time. This is known as:
A. cumulative risk.
B. disenfranchised populations.
C. resilience.
D. underserved populations.

Answer 16

A. cumulative risk.

Vulnerable populations often experience multiple cumulative risks, and they are particularly sensitive to the effects of those risks. Risks come from environmental hazards (e.g., lead exposure from lead-based paint from peeling walls or that which has been used in toy manufacturing or melamine added to milk supplies), social hazards (e.g., crime, violence), personal behavior (e.g., diet, exercise habits, smoking), or biological or genetic makeup (e.g., congenital addiction, compromised immune status).
DIF: Cognitive Level: Knowledge
REF: Page 375

Question 17

The most critical strategy that can be used by nurses in community health to improve the health status of migrant workers that spend only a few months in a geographic location is to:
A. conduct a comprehensive assessment and formulate a plan for treatment.
B. establish a long-term trust relationship to prevent disappointment.
C. schedule appointments for appropriate immunizations for the children.
D. use every opportunity to teach about preventive health care.

Answer 17

D. use every opportunity to teach about preventive health care.

Focus on prevention. Use every opportunity to teach about preventive health care. A single client visit may focus on an acute health problem such as influenza, but it may also include health education about diet and exercise, counseling for smoking cessation, and a follow-up appointment for immunizations once the influenza is over. The shift away from hospital-based care includes a renewed commitment to the public health services that vulnerable populations need to prevent illness and promote health, such as reductions of environmental hazards and violence and assurance of safe food and water.
DIF: Cognitive Level: Comprehension
REF: Page 384

Question 18

A nurse in community health directly contacts a mammography clinic to arrange an appointment for a female migrant worker with limited English language abilities. The nurse communicates with the client through an interpreter to ensure that the client's appointment is scheduled to meet her needs and that the client understands the procedure to be performed. This strategy used with vulnerable populations can best be described as:
A. advocacy.
B. culturally competent care.
C. partnership.
D. social justice.

Answer 18

A. advocacy.

Advocacy refers to those actions one undertakes on behalf of another. Nurses may function as advocates for vulnerable populations by working for the passage and implementation of policies that lead to improved public health services for these populations.
DIF: Cognitive Level: Application
REF: Page 380

Question 19

Health education is often used as a strategy in working with vulnerable populations. The benefits of health education can be greatly affected by:
A. dependency cycle.
B. health literacy.
C. income level.
D. race and ethnicity.

Answer 19

B. health literacy.

A new concern for public nurses and nurses in community health is whether the populations with whom they work have adequate health literacy to benefit from health education. It may be necessary to collaborate with an educator, an interpreter, or an expert in health communications to design messages that vulnerable individuals and groups can understand and use.
DIF: Cognitive Level: Knowledge
REF: Page 381-382

Question 20

Which of the following are factors that may contribute to vulnerability? (Select all that apply.)
A. Exercise habits
B. Crime
C. Peeling lead paint
D. Social isolation
E. Illiteracy

Answer 20

All choices.
A. Exercise habits
B. Crime
C. Peeling lead paint
D. Social isolation
E. Illiteracy

Vulnerability results from the combined effects of limited resources. Limitations in physical resources, environmental resources, personal resources (or human capital), and biopsychosocial resources (e.g., the presence of illness, genetic predispositions) combine to cause vulnerability. Poverty, limited social support, and working in a hazardous environment are examples of limitations in physical and environmental resources. People with preexisting illnesses, such as those with communicable or infectious diseases or those with chronic illnesses such as cancer, heart disease, or chronic airway disease, have less physical ability to cope with stress than those without such physical problems
DIF: Cognitive Level: Knowledge
REF: Pages 375, 376

Question 21

When determining whether a geographic area is rural or urban, the nurse should recognize that:
A. rural and urban areas, by relative nature, occur on a continuum.
B. rural regions have fewer than six persons per square mile.
C. rural residents feel isolated.
D. rural areas are recreational, retirement, or resort communities.

Answer 21

A. rural and urban areas, by relative nature, occur on a continuum.

Rural and urban residencies are not opposing lifestyles. Rather, they are a rural-urban continuum ranging from living on a remote farm, to a village or small town, to a larger town or city, to a large metropolitan area with a core inner city.
DIF: Cognitive Level: Knowledge
REF: Page 390

Question 22

A nurse in community health is working in a rural setting. In planning for programs to address the population’s needs, the nurse should be aware that, in general, rural populations:
A. engage in physical activity during leisure time.
B. engage in preventive behaviors.
C. perceive their overall health as less favorable.
D. use seat belts.

Answer 22

C. perceive their overall health as less favorable.

In general, people in rural areas have a poorer perception of their overall health and functional status than do urban residents. Rural residents older than 18 years assess their health status less favorably than do urban residents. Studies show that rural adults are less likely to engage in preventive behavior, which increases their exposure to risk.
DIF: Cognitive Level: Knowledge
REF: Page 392

Question 23

When using the health measure of death rates for working-age adults, the nurse could expect to find the highest rates in which areas?
A. Large metropolitan areas
B. Most rural and highly populated urban areas
C. Most rural and suburban areas
D. Small suburban and all urban areas

Answer 23

B. Most rural and highly populated urban areas

Death rates for working-age adults are higher in the most rural and the most highly populated urban areas. The highest death rates for children and young adults occur in the most rural counties. Residents of rural areas have the highest death rates resulting from unintentional injuries in general and motor vehicle injuries in particular.
DIF: Cognitive Level: Knowledge
REF: Page 392

Question 24

Within a state, counties designated as Health Professional Shortage Areas (HPSAs) tend to have a high proportion of racial minorities and fewer specialists. This factor may explain conflicting data within a state related to:
A. adult immunization rates.
B. chronic respiratory illness rates.
C. maternal/infant morbidity rates.
D. obesity rates.

Answer 24

C. maternal/infant morbidity rates.

HPSAs tend to have a high proportion of racial minorities and fewer specialists, such as pediatricians, obstetricians, and gynecologists, available to provide care to at-risk populations. There are extreme variations in pregnancy outcomes from one part of the country to another, and even within states.
DIF: Cognitive Level: Knowledge
REF: Page 393

Question 25

A nurse in community health located in Virginia is conducting an assessment on a Hispanic worker currently working in a local apple orchard for the season. The nurse determines that the worker originates from Florida and is living in temporary housing with other orchard workers. Based on this information, the nurse should integrate the special needs of what vulnerable population?
A. Migrant farmworkers
B. Seasonal farmworkers
C. Underinsured
D. Undocumented aliens

Answer 25

A. Migrant farmworkers

A migrant farmworker is a person whose principal employment is in agriculture on a seasonal basis, who has been employed within the last 24 months, and who establishes for the purpose of such employment a temporary abode. Seasonal farmworkers work cyclically in agriculture but do not migrate. The majority of migrant and seasonal farmworkers are foreign born and predominantly Mexican (75%), coming primarily from the west central states and more recently the states of southern Mexico.
DIF: Cognitive Level: Knowledge
REF: Page 396

Question 26

The local hospital emergency department has recently experienced an increase in gastroenteritis cases among migrant farmworkers. The local health department is informed of this rise in cases and schedules a case mapping of local:
A. bars frequented by migrant workers.
B. farm fields employing migrant workers.
C. housing for migrant workers.
D. restaurants frequented by migrant workers.

Answer 26

C. housing for migrant workers.

Housing conditions greatly vary among states and localities. When housing costs are high, 50 farmworkers may live in one house, or three families may share one trailer. Some may live in cars or tents if necessary. Housing may lack individual sanitation, bathing, or laundry facilities. Poor-quality and crowded housing can contribute to such health problems as tuberculosis (TB), gastroenteritis, and hepatitis.
DIF: Cognitive Level: Knowledge
REF: Page 398

Question 27

An undocumented migrant farmworker has been diagnosed with tuberculosis (TB). The local health department initiates treatment by dispensing the first month's supply of medication and educates the client on the need to continue treatment for 6 to 12 months. A major challenge that the client may face related to ongoing treatment for TB is:
A. affordable care.
B. discrimination.
C. fragmented services.
D. language barriers.

Answer 27

C. fragmented services.

Although migrant workers move from job to job, their health care records typically do not go with them. This leads to fragmented services in such areas as TB treatment, chronic illness management, and immunization. When migrant farmworkers move, they must independently seek out new health services to continue their medications. Also, people with TB may forfeit treatment because they are afraid of immigration authorities.
DIF: Cognitive Level: Comprehension
REF: Page 399

Question 28

A school nurse is asked to assess a 13-year-old child because of excessive drowsiness and inattention in class. The nurse determines that this is a child of migrant workers on a local produce farm. Based on the nurse's knowledge of migrant worker families, the nurse should first explore the child's potential involvement in:
A. delinquent behavior.
B. drug use.
C. field work.
D. Migrant Education Program.

Answer 28

C. field work.

Children of migrant farmworkers may need to work for the family’s economic survival. Federal law does not protect children from overworking or from the time of day they work outside of school. Therefore children may work until late in the evening or very early in the morning every day of the week. These children may experience constant fatigue and are set up for failure in school.
DIF: Cognitive Level: Application
REF: Pages 399-400

Question 29

A district health nurse is assigned to two rural counties in the state. To achieve the best outcomes possible in reducing the health disparities for the large number of frail older clients in the two counties, the nurse should consider using what community-oriented nursing skill?
A. Assessment
B. Case management
C. Geriatrics
D. Tertiary prevention

Answer 29

B. Case management

Nurses working in rural areas, including those working with migrant farmworkers, have opportunities to use many skills of nursing in community health. One of the first and most important is that of prevention. Given the barriers to receiving health care in rural areas, the ideal situation is to prevent health disruptions whenever possible. Case management and community-oriented primary health care are two effective models to address some of those deficits and resolve rural health disparities.
DIF: Cognitive Level: Application
REF: Page 403

Question 30

Rural residents appear to have a more persistent, endemic level of depression. The factors that may contribute to this level of depression may be related to which of the following? (Select all that apply.)
A. Crisis intervention
B. Gaps in continuum of mental health services
C. Sufficient number of mental health services
D. Tolerance for destructive coping behaviors
E. Trust in the health care professionals

Answer 30

B. Gaps in continuum of mental health services
D. Tolerance for destructive coping behaviors

There appears to be a more persistent, endemic level of depression among rural residents. Factors that relate to this level of depression are high rate of poverty, economic difficulties, economic recession, geographic isolation, insufficient number of mental health professionals, delays in seeking treatment, tolerance of destructive coping behaviors, lack of trust in mental health professionals, and gaps in the continuum of mental health services.
DIF: Cognitive Level: Knowledge
REF: Page 394

Question 31

For a nurse to develop a therapeutic attitude toward the treatment of alcohol, tobacco, and other drug (ATOD) problems in the community, the nurse must realize drug addiction can be successfully treated, anyone may develop drug dependence, and:
A. any drug can be abused.
B. illegal drugs are the category of abused drugs.
C. prescription drugs rarely cause dependence.
D. over-the-counter (OTC) drugs are “good drugs.”

Answer 31

A. any drug can be abused.

A health care approach to ATOD problems is the harm reduction model. This is a new public health model that nurses can use to treat individuals, families, and communities. To develop a therapeutic attitude, the nurse must realize that any drug can be abused, anyone may develop drug dependence, and drug addiction can be successfully treated.
DIF: Cognitive Level: Knowledge
REF: Page 434

Question 32

A long-distance truck driver being assessed by a nurse in a community-based clinic states, "I smoke 3 packs of cigarettes a day. I use coffee and diet pills from the drug store to stay awake on the road. That makes it difficult to sleep when I do pull over, so I use a prescription sleeping pill from my doctor to sleep for 4 hours. It's giving me palpitations." The nurse's assessment should include a diagnosis of:
A. drug abuse.
B. drug addiction.
C. substance abuse.
D. adverse drug reaction.

Answer 32

C. substance abuse.

Substance abuse is the use of any substance that threatens a person’s health or impairs social or economic functioning. This definition is more objective and universal than the government’s definition of drug abuse, which is the use of a drug without a prescription or any use of an illegal drug. Drug addiction is a pattern of abuse characterized by an overwhelming preoccupation with the use (compulsive use) of a drug and securing its supply and a high tendency to relapse if the drug is removed. Adverse drug reactions are associated with side effects.
DIF: Cognitive Level: Application
REF: Page 435

Question 33

The nurse is evaluating a new home health client for ongoing management at home following back surgery for a traumatic injury. The client has been receiving a morphine-based drug for long-term pain management over the past 6 months. The nurse's assessment should include a plan for addressing the client's:
A. drug dependence.
B. drug addiction.
C. substance abuse.
D. opiate addiction.

Answer 33

A. drug dependence.

Drug dependence is a state of neuroadaptation caused by the chronic, regular administration of a drug. This is a physiological change in the central nervous system; therefore the drug must be continued to prevent withdrawal symptoms. The morphine should be gradually tapered rather than abruptly stopped to prevent withdrawal symptoms.
DIF: Cognitive Level: Application
REF: Page 435

Question 34

An eighth-grader is brought to the emergency department by a parent for unusual skin blistering and discoloration around the nose and lips. The parent states that the child will not say what caused the injury. The nurse should consider the possible use of:
A. crystallized methamphetamine.
B. inhalants.
C. MDMA (Ecstasy).
D. PCP (phencyclidine).

Answer 34

B. inhalants.

Inhalants are often among the first drugs that young children use. The primary abusers of most inhalants are adolescents who are 12 to 17 years of age. Use often ends in late adolescence. The 2008 National Survey on Drug Use and Health found that 729,000 persons age 12 or older had used inhalants for the first time in the past 12 months and 70% of them were under the age of 18. Depending on the dose, the user may feel a slight stimulation, less inhibition, or even lose consciousness. There is a link between school performance and use of an inhalant. Other signs include paint or stains on clothes or the body; spots or sores around the mouth; red or runny eyes or nose; chemical breath odor; a drunk, dazed, or dizzy appearance; nausea and loss of appetite; and finally anxiety, excitability, and irritability.
DIF: Cognitive Level: Application
REF: Page 440

Question 35

The harm reduction approach to substance abuse focuses on health promotion and disease prevention. A primary prevention strategy that can be used by the nurse to address substance abuse under this approach is to:
A. assess for recreational drug use.
B. destroy the myth of good drugs versus bad drugs.
C. encourage children to “just say no.”
D. refer to an addiction treatment program.

Answer 35

B. destroy the myth of good drugs versus bad drugs.

Rationale: Nurses are experts in medication administration and understand the potential dangers of indiscriminate drug use and the inherent inability of drugs to cure problems. Nurses can influence the health of clients by destroying the “good drugs versus bad drugs”myth. This means (1) teaching clients that no drug is completely safe and that any drug can be abused and (2) helping persons learn how to make informed decisions about their drug use to minimize potential harm.
DIF: Cognitive Level: Application
REF: Page 441

Question 36

A client is back for his follow-up appointment and says to the nurse, "I know. I know. I drink too much, but the job is so stressful that I need to find a way to unwind at the end of the day. You would too!" The nurse should recognize that this is a primary symptom of addiction known as:
A. denial.
B. social drug use patterns.
C. setting variable.
D. coping.

Answer 36

A. denial.

The role of the nurse in secondary prevention is to accurately assess the client to identify substance abuse and plan appropriate interventions. A progression in drug-use patterns and related problems warns about the possibility of addiction. Denial is a primary symptom of addiction and can be demonstrated by the following: lying about use; minimizing use patterns; blaming or rationalizing; intellectualizing; changing the subject; using anger or humor; and “going with the flow” (agreeing that a problem exists, stating behavior will change, but not demonstrating any behavior change).
DIF: Cognitive Level: Application
REF: Page 443

Question 37

Methadone maintenance for heroin addiction is a harm reduction strategy because it reduces deviant behavior and introduces addicted persons to the health care system. What is a disadvantage to the use of Methadone?
A. Methadone is inexpensive.
B. Methadone carries a risk of overdose.
C. Methadone prevents relapse.
D. Methadone is long acting and effective orally.

Answer 37

B. Methadone carries a risk of overdose.

Methadone maintenance is a harm reduction intervention because it reduces deviant behavior (needle-sharing practices) and introduces addicted persons to the health care system. Methadone, when administered in moderate or high daily doses, produces a cross-tolerance to other narcotics, thereby blocking their effects and decreasing the craving for heroin. The advantages of methadone are that it is long-acting, effective orally, and inexpensive with few known side effects. However, there is a risk of overdose with the use of Methadone.
DIF: Cognitive Level: Knowledge
REF: Page 447

Question 38

Indiscriminate use of "good drugs" has caused more health problems from adverse reactions, drug interactions, dependence, addiction, and overdoses than has the use of "bad drugs." The high-risk population group that most experiences the negative consequences identified above is:
A. adolescents.
B. injection drug users.
C. older adults.
D. pregnant women.

Answer 38

C. older adults.

Older adults consume more prescribed and OTC medications than does any other age group. Problems with alcohol consumption, including interactions with prescribed and OTC drugs, far outnumber any other substance-abuse problem among older adults. Factors such as slowed metabolic turnover of drugs, age-related organ changes, enhanced drug sensitivities, a tendency to use drugs over longer periods, and a more frequent use of multiple drugs contribute to greater negative consequences from drug use among older adults.
DIF: Cognitive Level: Comprehension
REF: Pages 444-445

Question 39

A nurse in community health is following an older woman who complains frequently of migraine headaches, backaches, and GI disturbances. During a recent visit, the woman states that her adult son now lives with her. He was recently let go from his job. He enjoys hanging out with his old buddies. When he feels better he will look for a new job. Despite the added burden she really enjoys having her son around again. The nurse should explore this further to determine whether the family is:
A. abusive.
B. codependent.
C. coping.
D. estranged.

Answer 39

B. codependent.

Drug addiction is often a family disease. People in close relationship with the addict often develop unhealthy coping mechanisms to continue the relationship. This is known as codependency, a stress-induced preoccupation with the addicted person’s life, leading to extreme and excessive concern with the addict. Codependents try to meet the addict’s needs at the expense of their own. Codependency may underlie medical complaints and emotional stress seen by health care providers such as ulcers, skin disorders, migraine headaches, chronic colds, and backaches.
DIF: Cognitive Level: Application
REF: Page 446

Question 40

Marijuana (Cannabis sativa or C. indica) is the most widely used illicit drug in the United States. The nurse should be aware that marijuana has which of the following characteristics? (Select all that apply.)
A. Decreases appetite
B. May lead to tolerance
C. Is highly toxic
D. Has little quality control
E. Is a safe therapeutic agent

Answer 40

B. May lead to tolerance
D. Has little quality control
E. Is a safe therapeutic agent

Compared with the other psychoactive drugs, marijuana has little toxicity and is one of the safest therapeutic agents known. However, because of its illegal status, there is little quality control, and a user may consume contaminated marijuana that may cause problems. Tolerance can develop, as well as physical dependence; however, withdrawal is benign.
DIF: Cognitive Level: Knowledge
REF: Page 439

Question 41

Violence is a major public health problem in our communities that causes premature mortality and lifelong disability. Violence-related morbidity is a significant factor in:
A. community deterioration.
B. health care costs.
C. juvenile delinquency.
D. population density.

Answer 41

B. health care costs.

Violence is a public health problem that has both emotional and physical effects. Violence is the major cause of premature mortality and lifelong disability, and violence-related morbidity is a significant factor in health care costs. Violent behavior is predictable, and therefore it is preventable, especially with community action.
DIF: Cognitive Level: Application
REF: Pages 453-454

Question 42

A large industrial plant has recently laid off a significant portion of its workforce because of scalebacks in production. The occupational health nurse proposes education sessions with the remaining employees about effective strategies for managing stress during economic downturns. This suggestion to management is based on the nurse's understanding that increases in aggression and violence at home and work may be triggered by:
A. competition.
B. unemployment.
C. survivor guilt.
D. work-related stress.

Answer 42

D. work-related stress.

Productive and paid work is an expectation in mainstream American society. Work can be fulfilling and contribute to a sense of well-being; it can also be frustrating and unfulfilling, contributing to stress that may lead to aggression and violence. Some people are frustrated by jobs that are repetitive, boring, and lack stimulation.
DIF: Cognitive Level: Application
REF: Pages 454-455

Question 43

A nurse in community health is working with a parent whose spouse has been called up for active duty in the military reserve. The family is experiencing financial strain due to decreased income. The extended family lives at a distance. The parent is struggling to manage the family in the spouse's absence. The family consists of four children (three preschool and one preteen). In this situation, it would be important for the nurse to further explore the potential for:
A. child abuse.
B. depression.
C. intimate partner abuse.
D. parent's resentment of the preteen.

Answer 43

A. child abuse.

To help abusive families, nurses need to understand that the factors that characterize people who become involved in family violence include upbringing, living conditions, and increased stress. Of these factors, the one most predictably present is previous exposure to some form of violence. As children, abusers were often beaten or saw siblings or parents beaten. They learned that violence is a way to manage conflict. Both men and women who witnessed abuse as children were more likely to abuse their children. Financial solvency and support tended to decrease the incidence of child abuse.
DIF: Cognitive Level: Application
REF: Pages 460-461

Question 44

A nurse in community health conducting a home visit notices a 4-year-old girl sitting on a stool in an adjoining room. The girl is quiet and withdrawn, rarely makes eye contact, and does not leave the room. The nurse proceeds to ask about the child and attempts to engage the child in conversation. The nurse is assessing for what indicators of child abuse?
A. Emotional abuse
B. Emotional neglect
C. Physical abuse
D. Physical neglect

Answer 44

B. Emotional neglect

Neglect is more difficult to assess than is abuse. Emotional neglect is the omission of basic nurturing, acceptance, and caring essential for healthy personal development. These children are largely ignored or in many cases treated as a nonperson. It is difficult for a neglected child to feel a great deal of self-worth because the parents have not demonstrated that they value the child. Astute observations of children, their homes, and the way they relate to their caregivers can provide clues of neglect.
DIF: Cognitive Level: Application
REF: Page 464

Question 45

A father brings his stepdaughter to the family clinic for an immunization update before the new school year. The nurse notices the interaction between the young girl and her stepfather. The child appears tense and cautious and wraps her arms around herself in a protective manner. The child startles when touched by the stepfather and pulls away. The stepfather is overheard saying, "I'll leave you here if you don't behave and act nice." In this scenario, it would be important for the nurse to explore in her assessment the possibility of:
A. child neglect.
B. family secrets.
C. father-daughter incest.
D. impaired family functioning.

Answer 45

C. father-daughter incest.

Incest occurs in all races, religious groups, and socioeconomic classes. A typical pattern is as follows: The daughter involved in the parental incest is usually 9 years of age at the onset and is often the oldest or only daughter. The father seldom uses force. He is more likely to use threats, bribes, intimidations, or misrepresentation of moral standards. These children may have difficulty in social situations and demonstrate avoidance behaviors. They may also attempt to cover or protect their bodies. Therefore the nurse must be aware of these indicators in order to conduct an appropriate assessment and plan appropriate interventions.
DIF: Cognitive Level: Application
REF: Page 465

Question 46

All adults should be assessed for violence in their primary intimate relationships. The abuse of female partners has the most serious community health ramifications because of the greater prevalence, the more serious long-term emotional and physical consequences, and the greater potential for:
A. fleeing to a shelter.
B. homicide.
C. possessive behavior.
D. spontaneous abortion.

Answer 46

B. homicide.

The abuse of female partners has the most serious community health ramifications because of the greater prevalence, the greater potential for homicide, the effects on the children in the household, and the more serious long-term emotional and physical consequences. As a woman tries to leave the abusive relationship, the risk for homicide increases, creating a catch-22 scenario. A nurse encountering evidence of severe abuse needs to consider the safety of the woman and her children as the priority.
DIF: Cognitive Level: Application
REF: Page 465

Question 47

The nurse at the adult day care center notices bruises on the wrists of a 90-year-old client. Besides the physical assessment of the client, the nurse should:
A. confront the daughter when she arrives to pick the father up.
B. discuss the findings with the caregivers to determine the cause of the injuries.
C. educate the staff about indications of elder abuse.
D. make a referral to the primary care provider for follow-up.

Answer 47

B. discuss the findings with the caregivers to determine the cause of the injuries.

Rough handling by caregivers can lead to bruises and bleeding into body tissues because of the fragility of older adult clients’ skin and vascular systems. It is often difficult to determine whether the injuries of older adults result from abuse, falls, or other natural causes. Careful assessment through both observation and discussion can help determine the cause of injuries so that proper plans for interventions can be made.
DIF: Cognitive Level: Knowledge
REF: Page 467

Question 48

In giving care to the survivors of violence, the nurse should demonstrate respect and caring for all family members, insist that safety is the first priority, and demonstrate intolerance for violent behavior. Additionally, the nurse should be:
A. absolutely honest about what will be reported and what the family can expect.
B. authoritarian in approaching the problem.
C. cautious in reporting unconfirmed reports of violence.
D. sincere in concern for the victims.

Answer 48

A. absolutely honest about what will be reported and what the family can expect.

The principles of giving care to families who have experienced violence include the following: intolerance of the violence, respect and caring for all family members, safety as the first priority, absolute honesty, and empowerment. The nurse must use a nurse-family partnership rather than a paternalistic or authoritarian approach.
DIF: Cognitive Level: Knowledge
REF: Pages 470-471

Question 49

A nurse new to the community evaluates the resources available to a father that has sought help with his escalating abuse and threats of violence to his family. After making the referral, the nurse approaches the local newspaper about running a series on the nature and extent of human abuse in the community. This strategy would:
A. advocate for government programs to treat survivors.
B. demonstrate the provider’s commitment to address the need for services.
C. increase awareness of community resources to address violence and abuse.
D. increase the number of individuals identified as perpetrators.

Answer 49

C. increase awareness of community resources to address violence and abuse.

Referral is an important component of tertiary prevention. Nurses should know about available community resources for abuse victims and perpetrators. If attitudes and resources are inadequate, it is often helpful to work with local radio and television stations and newspapers to provide information about the nature and extent of human abuse as a community health problem. People often do not seek services early in an abusive situation because they simply do not know what is available to them.
DIF: Cognitive Level: Application
REF: Page 471

Question 50

The community health nurse performs an assessment of violence by observing which of the following community characteristics? (Select all that apply.)
A. Presence of social support networks
B. Crime rates
C. Levels of unemployment
D. Presence of physical disabilities in individuals
E. Presence of family violence

Answer 50

B. Crime rates
C. Levels of unemployment

Identification of risk factors is an important part of primary prevention used by nurses who work with clients in a variety of settings. Although abuse cannot be predicted with certainty, several factors influence the onset and support the continuation of abusive patterns. Assessing for violence in a community context is completed by observing community characteristics inclusive of crime rates, unemployment levels, lack of neighborhood resource and support systems, and a lack of community cohesiveness. Individual factors include the presence of physical disability and familial factors are those related to violence and other family factors.
DIF: Cognitive Level: Comprehension
REF: Page 470 (Box 25-3)