4 - Perspectives in Global Health Care

Question 1

A nurse is caring for a client who has been diagnosed with tuberculosis (TB). Which of the following medications would the nurse most likely administer?

a. ) Isoniazid
b. ) Nevirapine
c. ) Amodiaquine
d. ) Bacille Calmette-Guérin (BCG)

Answer 1

a.) Isoniazid

Isoniazid is one of several chemotherapeutic medications used to treat TB. Nevirapine is used to decrease the likelihood of maternal transmission of HIV-AIDS. Amodiaquine is one of several medications used to treat malaria. BCG is a vaccine that has been promoted as effective in inducing active immunity against TB.

Question 2

A nurse is working in a lesser-developed country and is caring for the women in the local community. Which of the following would be an important consideration for the nurse?

a. ) They are at risk for a vitamin D deficiency.
b. ) They are likely to have one child.
c. ) They are at risk for death during pregnancy and childbirth.
d. ) They are viewed as the leader of the family unit.

Answer 2

c.) They are at risk for death during pregnancy and childbirth.

Most deaths to women worldwide are related to pregnancy and childbirth. Most of these deaths occur in lesser-developed countries. Common nutritional deficiencies in this population are zinc, iodine, vitamin A, folic acid, and calcium. One of the reasons this problem exists is because women are not seen as valued members of society. In developing nations there is a significant incidence of lack of prenatal care during pregnancy and high fertility rates, often due to a lack of access to contraception and other family planning and reproductive health services, as well as cultural belief systems that increase the lifetime risk of maternal death.

Question 3

The intergovernmental organization that focuses its efforts on assisting countries in Latin America is the:

a. ) Pan American Health Organization.
b. ) World Bank.
c. ) World Health Organization (WHO).
d. ) United Nations Children’s Fund.

Answer 3

a.) Pan American Health Organization.

The Pan American Health Organization serves as a regional field office in Latin America for the WHO. The World Bank’s major aim is to lend money to the lesser-developed countries so that they might use it to improve the health status of their people. The WHO addresses the wide scope and nature of the world’s health problems. The United Nations Children’s Fund is an advocate for the health needs of women and children under the age of 5.

Question 4

A nurse is working to improve the health status of a population in a lesser-developed country. Which of the following interventions would the nurse most likely support?

a. ) Decrease the number of people who need outside resources
b. ) Increase the number of children who can attend school
c. ) Increase the monetary resources that can be used to treat disease and illness
d. ) Improve the ability to pay debt to more developed countries

Answer 4

b.) Increase the number of children who can attend school

Health status improvement in children can lead to better education that eventually helps the country’s economic growth. Because children are educated, there is more economic growth. This allows for additional monetary resources to be spent on economic development rather than on treatment of illness and disease.

Question 5

A nurse plans to contact a multilateral organization. Which of the following would the nurse most likely contact?

a. ) United Nations (UN)
b. ) United States Agency for International Development (USAID)
c. ) Project Hope
d. ) Catholic Relief Services

Answer 5

a.) United Nations (UN)

A multilateral organization is one that receives funding from multiple governments and nongovernmental sources, which describes the UN. Project Hope and Catholic Relief Services are private voluntary organizations. USAID is funded by one country, the United States.

Question 6

A community health nurse is utilizing the health care system in the United Kingdom. Which of the following expectations should the nurse have?

a. ) An equal employer-citizen share in cost of health care
b. ) Ownership and operation of the system by the government
c. ) Nurse practitioners as the primary providers of care in the system
d. ) Primary care provided in hospitals

Answer 6

b.) Ownership and operation of the system by the government

The United Kingdom has a tax-supported health system that is owned and operated by the government. Services are available to all without cost or for a small fee. Physicians are the primary providers in this system; nurses and allied health professionals are also recognized and used. Services are made available through hospitals, private physicians and allied health professional clinics, health outreach programs such as hospice, boroughs, and environmental health services.

Question 7

Multilateral organizations:

a. ) receive funding from multiple sources.
b. ) control the spread of disease.
c. ) feed the people of the world.
d. ) use nurses as their main source of information.

Answer 7

a.) receive funding from multiple sources.

Multilateral organizations are those that receive funding from multiple government and nongovernment sources. The other items are specific to the agencies listed, but do not include all of the organizations.

Question 8

A nurse is working with a religious organization to provide food to starving people in a lesser-developed country. Which of the following organizations is the nurse most likely working with?

a. ) International Red Cross
b. ) Church World Service
c. ) Maryknoll Missionaries
d. ) Catholic Relief Services

Answer 8

d.) Catholic Relief Services

Catholic Relief Services alleviates suffering and provides assistance to people in need affected by war, starvation, famine, drought, and national disasters without regard to race, religion, or nationality. The Red Cross is not a religious organization, and the Church World Service and Maryknoll Missionaries do other things besides providing food.

Question 9

An example of a successful campaign against which of the following communicable diseases was carried out during the 1960s and 1970s?

a. ) Tetanus
b. ) Measles
c. ) Pertussis
d. ) Smallpox

Answer 9

d.) Smallpox

Smallpox was virtually eliminated throughout the world as a result of immunization. Tetanus, measles, and pertussis all continue to exist throughout the world.

Question 10

A nurse is working to manage the public health aspects of a bioterrorist event. Which of the following does the nurse need to understand? (Select all that apply.)

a. ) Medical management and public health measures
b. ) The names and descriptions of the agent/disease
c. ) The chemical features of the pathogens
d. ) How to address mental health concerns
e. ) The amount of risk that each type of event will have for the public

Answer 10

a.) Medical management and public health measures

b.) The names and descriptions of the agent/disease

d.) How to address mental health concerns

Nurses need to understand the names of the pathogens and the disease they cause, the medical management and public health measures (so that accurate information can be disseminated), and how to help people cope with their feelings. The chemical features of the pathogens and the amount of risk that each type of event will have for the public would not be part of the nurses’ role when managing the public health aspects of a bioterrorist event.

Question 11

A nurse is employed by an agency that addresses global health needs. Which of the following roles is the nurse most likely to provide? (Select all that apply.)

a. ) Medications and vaccines for worldwide use
b. ) Direct patient care for members of the community
c. ) Knowledge and skill in countries where nursing is an organized profession
d. ) Consultation to auxiliary personnel
e. ) Facilitation of education and health promotion within the community

Answer 11

b.) Direct patient care for members of the community

c.) Knowledge and skill in countries where nursing is an organized profession

d.) Consultation to auxiliary personnel

e.) Facilitation of education and health promotion within the community

Nurses perform many roles related to global health, including providing direct patient care, facilitating education and health promotional needs of the community, providing knowledge and skill in countries where nursing is an organized profession, and providing consultation to auxiliary personnel. Providing medications and vaccines for worldwide use would not be part of the role of the nurse in relation to global health.

Question 12

A community health nurse is investigating international diseases. Which of the following would the nurse track by using the global burden of disease (GBD)?

a. ) The number of cases of HIV/AIDS in a country
b. ) Losses from premature death and losses of healthy life that result from disability
c. ) The economic impact of disability on lesser-developed countries
d. ) The rate of disability in industrialized nations

Answer 12

b.) Losses from premature death and losses of healthy life that result from disability

The GBD combines losses from premature death and losses of healthy life that result from disability. The GBD represents units of disability-adjusted life-years (DALYs). This statistic is not specific to a particular disease or a particular developmental stage of a country.

Question 13

The health priorities in HEALTH21 are based on the concept of:

a. ) eradication of communicable disease worldwide.
b. ) social justice and solidarity with an emphasis on the responsibility for health.
c. ) world trade and knowledge sharing about health concerns.
d. ) provisions for the creation of the United Nations Children’s Fund (UNICEF).

Answer 13

b.) social justice and solidarity with an emphasis on the responsibility for health.

HEALTH21 is not a single, finite goal but a strategic process that can lead to progressive improvement in the health of people. In essence, it is a call for social justice and solidarity with an emphasis on individual, family, and community responsibility for health. The concepts of eradication of communicable disease worldwide, world trade and knowledge sharing about health concerns, and provisions for the creation of UNICEF are not part of these health priorities.

Question 14

The key to achieving the goals of Health for All in the 21st Century (HEALTH21) is the worldwide:

a. ) cure of communicable disease.
b. ) technological development of all nations.
c. ) availability of health care insurance.
d. ) implementation of primary health care.

Answer 14

d.) implementation of primary health care.

The major key to attaining Health for All by the Year 2000 was the worldwide implementation of primary health care; this has extended into the next century with the document HEALTH21. The World Health Assembly in 1977 stated that all citizens of the world should enjoy a level of health that would permit them to lead a socially and economically productive life. Curing communicable disease, technological developments of all nations, and availability of health care insurance are not part of the key strategies to achieve the goals of HEALTH21.

Question 15

Population health is an approach and perspective that focuses on:

a. ) control of the spread of the HIV virus worldwide.
b. ) the broad range of factors and conditions that influence health.
c. ) community-based care for all citizens.
d. ) prevention and diagnosis of disease worldwide.

Answer 15

b.) the broad range of factors and conditions that influence health.

Population health is a holistic approach that considers the total health system. The focus of population health is broader than only considering spread of the HIV virus. Population health considers more than the community-based care in the community. Population health examines spread of disease on a smaller scale.

Question 16

A nurse is caring for a client with TB. Which of the following statements would the nurse recognize as being true?

a. ) Meningitis is the leading cause of death from TB.
b. ) Chemotherapy, if made widely available, could eradicate the disease.
c. ) Many TB cases are associated with HIV.
d. ) The TB bacillus is difficult to isolate.

Answer 16

c.) Many TB cases are associated with HIV.

The rise in HIV has led to an increase in TB because the disease depresses the immune system. Chemotherapy is not always effective, especially in the new drug-resistant strains. Meningitis is not a leading cause of death from TB. TB is becoming more difficult to treat because of the new drug-resistant strains, but the TB bacillus is not difficult to isolate.

Question 17

Which is a disease that was once isolated and rare but is now widespread throughout the world?

a. ) Acquired immunodeficiency syndrome (AIDS)
b. ) Smallpox
c. ) Malaria
d. ) Measles

Answer 17

a.) Acquired immunodeficiency syndrome (AIDS)

Smallpox has been eradicated; malaria and measles were not isolated and rare throughout the world. AIDS was once isolated and rare, but is now worldwide.

Question 18

A nurse is organizing a fundraiser for a philanthropic organization. Which of the following organizations is the nurse most likely working with?

a. ) International Red Cross
b. ) Carnegie Foundation
c. ) Nestlé
d. ) Johnson & Johnson

Answer 18

b.) Carnegie Foundation

The Carnegie Foundation is a philanthropic organization, receiving funding from private endowment funds. The Red Cross is a nongovernmental agency, and Nestlé and Johnson & Johnson are private voluntary organizations.

Question 19

Which is referred to as a lesser-developed country?

a. ) France
b. ) Japan
c. ) Indonesia
d. ) Sweden

Answer 19

c.) Indonesia

A country that is not yet stable with respect to its economy and technological development is lesser developed, which describes Indonesia. France, Japan, and Sweden are considered developed countries.

Question 20

Which of these statements is true about the DALYs in lesser-developed countries?

a. ) Children are at great risk for an early death.
b. ) Diarrheal disease and respiratory infections are rampant despite technology.
c. ) Injuries account for most disability.
d. ) Birth control methods are often lacking.

Answer 20

a.) Children are at great risk for an early death.

Approximately 2.5 million neonatal deaths occurred in 2011 and over 20 million children under age 5 died during the same year in lesser-developed countries. Children are at great risk for an early death in these lesser-developed nations. If these children could face the same risks as those in developed nations, the deaths would decrease by 90%. Noncommunicable diseases such as respiratory, cardiac, musculoskeletal, and other conditions are problems in all countries.

Question 21

A nurse has promoted the introduction of health care technology into lesser-developed countries, but this has led to less-than-satisfactory results. Which of the following best describes why this has happened?

a. ) People do not want to use newer technology.
b. ) The cost is so high that they cannot afford to use new technology.
c. ) The community may not be ready for this technology.
d. ) Technology is too complex for people in lesser-developed countries.

Answer 21

c.) The community may not be ready for this technology.

It is not generally a lack of desire that is a barrier to use of the new technological systems, but the lack of knowledge about them. It is essential to conduct needs assessments to learn what a community has, what a community wants, and what it can sustain. Well-intended projects have failed because the most basic needs were not met, nor was recognition given to what resources and services the country could sustain.

Question 22

A nurse is analyzing one of the components of a unit of DALYs. From which of the following individuals would the nurse be able to calculate this measurement?

a. ) A woman who lives to be 100 years old
b. ) A woman who contracts HIV after working as a prostitute
c. ) A father with five children who dies at the age of 50 from malaria
d. ) A woman who gives birth to a premature infant

Answer 22

c.) A father with five children who dies at the age of 50 from malaria

A male who dies from malaria at age 50 would represent 30 DALYs. Measurement is based on the potential limit for life, which has been set at 82.5 years for women and 80 years for men. In order to calculate this statistic, the nurse must know the client’s age and the potential limit for life.

Question 23

A government agency is planning a project in hopes of receiving funding from the World Bank. Which of the following projects would most likely receive this funding?

a. ) Development of a sanitation system
b. ) Improvement of roads and bridges
c. ) Creation of a national health insurance plan
d. ) Recovery efforts following a hurricane

Answer 23

a.) Development of a sanitation system

The World Bank lends money to lesser-developed countries so that they might use it to improve the health status of their people. Projects include control and eradication of disease, providing safe drinking water and affordable housing, developing sanitation systems, and encouraging family planning and childhood immunizations. Improvement of roads and bridges, creation of a national health insurance plan, and recovery efforts following a hurricane would not be projects where World Bank funds would be used.

Question 24

A nurse is concerned about an event of bioterrorism. Which of the following would the nurse most likely be referring to?

a. ) Outbreak of smallpox
b. ) Bombed historic buildings
c. ) Explosion of land mines
d. ) Threats of war

Answer 24

a.) Outbreak of smallpox

Bioterrorism is a term used to describe the deliberate release of viruses, bacteria, or other germs (agents) used to cause illness or death in people, animals, or plants. Bombing historical buildings, explosion of land mines, and threats of war may be part of terrorist attacks, but do not include the component of bioterrorism.

Question 25

The government is preparing for a bioterrorism event. Which of the following would be the best strategy to use?

a. ) Threaten lesser-developed countries so they don’t develop biological weapons
b. ) Ban biological weapons worldwide
c. ) Effectively detect pathogens and manage services
d. ) Develop antidotes for biological agents

Answer 25

c.) Effectively detect pathogens and manage services

Health care professionals and public health officials need to be able to effectively detect pathogens, manage services, and communicate during a bioterrorism threat. Any country can develop biological weapons that can be used for bioterrorism, not only lesser-developed countries. By effectively detecting pathogens, one is able to know what antidotes need to be developed.

Question 26

Which of the following do the Millennium Development Goals address? (Select all that apply.)

a. ) Reduction of child mortality
b. ) Eradication of communicable diseases
c. ) Promotion of gender equality and empowerment of women
d. ) Achievement of universal health care access
e. ) Promotion of specialty practice by physicians

Answer 26

a.) Reduction of child mortality

c.) Promotion of gender equality and empowerment of women

The Millennium Development Goals address reduction of child mortality and promotion of gender equality and empower women. Other goals include eradicating extreme poverty and hunger; achieving universal primary education; improving maternal health; combating HIV/AIDS, malaria, and other diseases; ensuring environmental sustainability; and developing a global partnership for development. Eradication of communicable diseases, achievement of universal health care access, and promotion of specialty practice by physicians are not part of the Millennium Development Goals.

Question 27

A nurse is working with colonias. Which of the following considerations should be made by the nurse?

a. ) They have developed roads, transportation, and electrical services.
b. ) They are frequently driven off, only to return to the same area.
c. ) Their settlements have led to an increase in several disease conditions.
d. ) Their contributions have improved the local economy.

Answer 27

c.) Their settlements have led to an increase in several disease conditions.

Many immigrants have settled on unincorporated land, known as colonias, outside the major metropolitan areas in California, Arizona, New Mexico, and Texas. These colonies may not have developed roads, transportation, water, or electrical services. Conditions in these settlements have led to an increase in disease conditions such as amebiasis, respiratory, and diarrheal diseases. Environmental health hazards in the colonias are associated with poverty, poor sanitation, and overcrowded conditions.

Question 28

A nurse is providing education for a client who is living in an area of the world where malaria is endemic. Which of the following interventions would be appropriate to include?

a. ) Receive a dose of intravenous (IV) quinine
b. ) Avoid direct contact with individuals who have malaria
c. ) Use insecticide-treated bed nets
d. ) Apply dichlorodiphenyltrichloroethane (DDT) spray

Answer 28

c.) Use insecticide-treated bed nets

An effective antimalarial intervention is the use of insecticide-treated bed nets. Malaria is contracted by being bit by an infected mosquito; it cannot be passed by direct person-to- person contact. IV quinine is the drug of choice for treating malaria, not preventing it. Some mosquitoes are resistant to DDT, so this may not be effective.

Question 29

A nurse is examining the income levels and social networks of individuals in a community. Which of the following is the nurse investigating?

a. ) Culture
b. ) Development
c. ) Community
d. ) Determinants

Answer 29

d.) Determinants

Determinants are conditions and factors that are important considerations in population health.

Culture refers to the beliefs and customs of a certain group.

Development refers to something that is being created.

Community is a group of people living in the same geographic location.

Question 30

A nurse is advocating for increased funding for an international agency. Which of the following best describes how these funds will likely be used?

a. ) Development and installation of technology
b. ) Food relief, worker training, and disaster relief
c. ) Support of dictatorships and corrupt governments
d. ) Funding of local private organizations

Answer 30

b.) Food relief, worker training, and disaster relief

Many international organizations have an ongoing interest in global health. Despite the presence of these well-meaning organizations, it is estimated that the lesser-developed countries still bear most of the cost for their own health care and that contributions from major international organizations actually provide for less than 5% of needed costs. Recent reports indicate that the majority of funds raised by international organizations are used for food relief, worker training, and disaster relief.

Question 31

Which of the following diseases is the leading killer of people with HIV?

a. ) AIDS
b. ) Malaria
c. ) Hepatitis
d. ) TB

Answer 31

d.) TB

TB is the leading killer of people with HIV, and up to 80% of TB clients are HIV positive in countries with a high prevalence of HIV. AIDS, malaria, and hepatitis are not the leading killer of people with HIV.

Question 32

A nurse is assessing a refugee who fled the genocide in Darfur. Which of the following disease/disorder should the nurse anticipate finding?

a. ) TB
b. ) Post-traumatic stress disorder (PTSD)
c. ) Chronic obstructive pulmonary disorder (COPD)
d. ) Malnutrition

Answer 32

b.) Post-traumatic stress disorder (PTSD)

The biopsychological changes seen following genocide include physical stress reactions (cardiovascular, neurological) and mental stress responses, especially PTSD and depression. The biopsychosocial changes are the major concern over any physical illnesses that may be present.

Question 33

Which health problem is in need of control in developed countries?

a. ) Hepatitis
b. ) Malaria
c. ) Polio
d. ) Smallpox

Answer 33

a.) Hepatitis

Current health concerns in more developed countries are hepatitis, infectious diseases, and new viral strains such as hantavirus, SARS (severe acute respiratory syndrome), H1N1, and avian flu. Malaria, polio, and smallpox are more commonly found in lesser-developed countries.