exam 2

Question 1

(ON_SLIDES)
refers to the differences among people, especially those related to values, attitudes, beliefs, norms, behaviors, customs and ways of living, what is this called?

Answer 1

Cultural diversity

Question 2

(ON-SLIDES)
a formal area of study and practice focused on a comparative analysis of different cultures and
subcultures in the world with respect to cultural care, health and illness beliefs, values, and practices with the goal of using this knowledge to provide culture-specific and culture-universal nursing care to people, coined by Leininger is what type of nursing?

a. culture-specific care
b. transcultural nursing
c. culture-universal care
d. cultural diversity

Answer 2

b. transcultural nursing

Question 3

(ON SLIDES)
particularistic values, beliefs and patterning of behaviors, that tend to be special, local, or unique to a designated culture and which do not tend to be shared with members of other cultures is what type of care?

Answer 3

culture-specific care

Question 4

(ON-SLIDES)
commonalities of values, norms of behaviors, and life patterns that are similarly held among cultures about human behavior and lifestyles and form the bases for formulating theories for developing cross-cultural laws of human behavior is what type of care?

Answer 4

Culture-universal care

Question 5

(ON-SLIDES)

culture is?

Answer 5

a set of knowledge, beliefs, morals, law, art, customs and tradition
-refers to a complex whole

Question 6

(ON-SLIDES)
A group of teens develops their own method of texting in a language that they feel is all their own. The change is subtle, but the meanings and the feelings associated with the text are known only to a select few. This behavior is an example of:

A)Culture
B)Cultural competence
C)Cultural safety
D)Ethnocentrism

Answer 6

A (Culture)

Question 7

The nurse is caring for a client who refuses the food as served. He states that the food is foreign to him and will make him ill. All food must be blessed. The personal care attendant is upset by this behavior and states that the client should eat the food anyway. The client’s behavior is most likely a result of:

A)Psychosocial deficit
B)Cultural belief
C)Allergies
D)Hygiene

Answer 7

B (cultural belief)
rationale:
Culture is how people approach the world. Culture includes language, religion, occupation, economics, art, politics, and philosophy, along with diet. The fact that the client says that the food must be “blessed” indicates a religious belief that is part of his culture. There is no evidence of a psychosocial deficit in this client, or of allergies or hygiene concerns

Question 8

The nurse is present when a mother begins cupping her child. She states that it will help to heal the child’s respiratory tract infection. The nurse understands that the cultural belief that cupping will aid in the healing process is a:

A)Shared instinct
B)Learned behavior
C)Private idiosyncrasy
D)Genetically programmed idea

Answer 8

B (learned behavior)
rationale:
Usually culture is first “learned” from parents and siblings and then from peers, teachers, neighbors, books, television, and other media. Thus, it is not innate instinct, a private idiosyncrasy, or a genetically programmed idea.

Question 9

A Mexican-American client arrives at the emergency department. He reports abdominal pain and has been vomiting for 5 days. The nurse notes that he is exhibiting symptoms of dehydration, and his vital signs and labs confirm this. The nurse asks the client why he waited so long to seek medical care. He states that he is being treated by the Curandero and wishes to continue while in the hospital. The nurse recognizes the different cultural assumptions regarding care. This situation is an example of:

A)Cross-cultural nursing
B)Ethnocentrism
C)Cultural safety
D)Transcultural bias

Answer 9

A (cross-cultural nursing)
rationale:
Cross-cultural nursing is any nursing work in which the nurse and the client have different cultures. Ethnocentrism is the assumption that others believe and behave as the dominant culture does, or the belief that the dominant culture is superior to others. Cultural safety is the practice of providing culturally appropriate health services to disadvantaged groups while stressing dignity and avoiding institutional racism, assimilation (forcing people to adopt a dominant culture), and repressive practices. There is no evidence of bias in this scenario

Question 10

The nurse conducts a well-child clinic in your community. The client population is culturally diverse, and, although the clinic is busy, it runs smoothly because it has an interpreter. In addition to the interpreter, it is important that the nurses treat each client that reflects his or her individual cultural needs. This is cultural:

A)Bias
B)Artwork
C)Competence
D)Beliefs

Answer 10

C (competence)
rationale:
In nursing, cultural competence means considering cultural aspects of health, illness, and treatment for each client or community, as well as doing so at each stage of the nursing process. The nurse should not display cultural bias or favoritism to any specific culture. The nurse does not need to display the beliefs of other cultures, just respect, and understanding of them. The nurse does not need to display cultural artwork.

Question 11

A nurse, new to the community health agency, works in a culturally diverse area of the community. The nurse is responsible for providing holistic care to clients and to be culturally competent. The health agency requires the nurse to demonstrate which competency to exhibit cultural competence? (Select all that apply.)

A)Value diversity
B)Adopt the client's cultural values
C)Acquire cultural knowledge
D)Adapt to diversity
E)Speak the language of the client

Answer 11

A,C,D (value diversity, acquire cultural knowledge, adapt to diversity)
rationale:
For community and public health agencies to be culturally competent, they must do the following: have a defined set of values and principles and demonstrate behaviors, attitudes, policies, and structures that enable them to work effectively cross-culturally; have the capacity to (1) value diversity, (2) conduct self-assessment, (3) manage the dynamics of difference, (4) acquire and institutionalize cultural knowledge, and (5) adapt to diversity and the cultural contexts of the communities they serve; and incorporate this capacity in all aspects of policy making, administration, practice, and service delivery, as well as systematically involve consumers, key stakeholders, and communities.

Question 12

The nurse is called to make an unscheduled visit to a new client in her home. The purpose of the visit is to admit the client and treat an abdominal wound. The nurse discovers that the client is from a culture unfamiliar to her. In this situation, the nurse should demonstrate cultural competence and awareness by: (Select all that apply.)

A)Being open to the client’s ideas and way of life
B)Obtaining objective data when caring for the client
C)Exhibiting respect and patience
D)Being aware of your own culture
E)Assuming that you have enough knowledge to get by

Answer 12

A,C,D ( being open to the client’s ideas and way of life, exhibiting respect and patience, being aware of your own culture)
rationale:
Although the nurse will not be fluent in all cultures at all times, certain principles will make him or her a more culturally competent nurse: openness to others’ ideas and ways of life, respect, curiosity, patience, and self-awareness of one’s own culture and culturally mediated ideas, as well as the humility to know that one can always learn more about a certain client’s culture and that person as an individual. Obtaining objective data about the client will not help the nurse demonstrate cultural competence and awareness. The nurse should not assume that he or she has enough knowledge but should be willing to learn more.

Question 13

(LEARNED IN CLASS)

During a conference after rounds, a nurse states, “They are in the United States now; you would think that they would act like us.” This nurse is exhibiting:

A)Cultural humility
B)Ethnocentrism
C)Cultural competence
D)Cross-cultural nursing

Answer 13

B (ethnocentrism)
rationale:
Ethnocentrism refers to the tendency of people to view their way of doing things and their culture as superior to the cultures and ways of others. Cultural humility requires community health nurses to continually self-evaluate and critique their own cultural assumptions and advocate for their clients in a non paternalistic way. In nursing, cultural competence means considering cultural aspects of health, illness, and treatment for each client or community, as well as doing so at each stage of the nursing process. Cross-cultural nursing is any nursing work in which the nurse and client have different cultures.

Question 14

During an ice storm, people in one neighborhood banded together and shared the home of a neighbor who still had power and heat. Other neighbors provided food, water, and bedding. In another neighborhood, the neighbors did not know one another and weathered the storm alone. Both neighborhoods are part of the same community. What characteristic did the people in the first neighborhood share that made them a subculture that those in the second neighborhood lacked?

A)Belief in the value of the cooperation
B)Religion
C)Socioeconomic status
D)Geography

Answer 14

A (belief in the value of the cooperation)
rationale:
A subculture may be large or small, clustered together or scattered, but its members share some cultural facets such as experience, belief, language (or lingo), practices, and values. The only common characteristic that the neighbors in the first neighborhood had with each other that the neighbors in the second neighborhood lacked was a belief in the value of cooperating with one another during the storm. There is no indication that they were of the same religion or socioeconomic status. People in both neighborhoods have geography as a common characteristic.

Question 15

The nurse enters a client’s home to provide care to a wound and teach the client’s wife how to care for the wound. The nurse is comfortable with the client’s culture and the fact that it is matriarchal in nature. As teaching begins, the husband interrupts and states that the woman does not change bandages according to his culture. He asks if the nurse is familiar with his culture and then says that all members of his neighborhood follow its principles. The nurse should suspect that the client is a member of:

A)A cult
B)An orthodox religious group
C)A subculture
D)An occupation

Answer 15

C (subculture)
rationale:
Just as any group of people from a certain place may share a culture, any group of people who share a certain characteristic can share a smaller culture, or subculture. In this situation, although the nurse is familiar with the culture of the client and her husband, it is apparent that they also belong to a subculture that the nurse is unfamiliar with. There is no indication that the client and her husband are members of a cult, orthodox religious group, or certain occupations, all of which are types of subcultures.

Question 16

To demonstrate true cultural sensitivity and awareness, the nurse must:

A)Travel to other countries on the occasion
B)Become bilingual
C)Be competent in his or her own cultural heritage
D)Know the practices of all major cultures in one’s region of the country

Answer 16

C ( being competent in his or her own cultural heritage)
rationale:
The first imperative of cultural competence is to be competent in one’s own cultural heritage. International travel, being bilingual and knowing practices of major cultures are all helpful, but not as important as being competent in one’s own cultural heritage.

Question 17

A client, diagnosed with hypertension, is prescribed a no-added-salt, low-fat diet. He agrees and repeats the teaching principles. At the next visit, the nurse notices salted meat on the counter and the client shows the nurse his food diary. The diet in the past week does not reflect the physician’s orders. What cultural component may have contributed to the noncompliance with the diet order?

A)Diet may be too lean
B)The wife cooks according to the husband’s preferences
C)Diet may not meet the cultural criteria for food choices
D)Food tastes bland and unappetizing

Answer 17

C (diet may not meet the cultural criteria for food choices)
rationale: What and how people eat varies tremendously among cultures, the understanding of which is crucial to good nursing care. A nurse educating a client who is newly diagnosed with diabetes or hyperlipidemia about dietary restrictions will be much more effective if he or she chooses examples that resonate with that particular client. Although the diet could be too lean or bland and unappetizing or the wife might cook according to the husband’s preferences, these are not cultural components.

Question 18

what are the universal features of all cultures, what they believe is called?

Answer 18

values

Question 19

what are the rules by which human behavior is governed and result from the cultural values held by the group?

Answer 19

norms

Question 20

Every culture that has what is shared by the majority?

Answer 20

dominant value

Question 21

what are groups in a culture that share different values than the majority called?

Answer 21

sub-culture

Question 22

what are the organizational elements (components) of culture?

Answer 22

• child-rearing practices
• family-basic social unit in a culture
• religious practices
• space
• communication

Question 23

What does culture influence?

Answer 23

How a person perceives and evaluates the world, and behaves in that world

Question 24

Culture is influenced by what?

Answer 24

Education, income, and other shared socioeconomic factors

Question 25

(on-slide) The ability of nurses to recognize their own cultural abilities and perspectives and how this influences your interaction with the client is for a nurse to have?

Answer 25

cultural competence

Question 26

What are the foundations to competent care?

Answer 26

Self-awareness (any healthcare worker must have this) | Humility

Question 27

Culturally competent nursing requires that the nurse understands...

Answer 27

- Their own cultural perspective (self-awareness) - The culture of institutions that influence the health and well-being of communities - Lifestyle, value systems, and health/illness behaviors of diverse people

Question 28

What are the four principles to culturally competent care?

Answer 28

Care is: - Specific to the client - Unique to their norms/values - Includes self-empowerment strategies to facilitate client decision making in health behaviors - Provided with sensitivity

Question 29

(ON-SLIDES) | What are the BARRIERS of developing cultural competence?

Answer 29

``` Stereotyping Prejudice Racism Ethnocentrism Cultural Blindness Cultural Imposition Cultural Conflict Cultural Shock ```

Question 30

Leininger's Theory of Cultural Care (Sunrise model)

Answer 30

Helps us think about cultures in a respectful way and shows us how to use knowledge to provide to provide culturally competent care

Question 31

(ON SLIDES) Race relates to a persons?

Answer 31

physical characteristics

Question 32

(ON SLIDES) | race, religion, and national origin are part of?

Answer 32

ethnicity

Question 33

(ON SLIDES)) the nurse can support the use of cultural practices in health care when the practice does not have a harmful effect is called what type of accommodation?

Answer 33

cultural accommodation

Question 34

is a form of prejudice where individuals feel they have power over a group based on skin color or other physical characteristics?

Answer 34

racism

Question 35

is an emotional reaction of beliefs about a group. An individual is pre-judged to have negative traits?

Answer 35

prejudice

Question 36

Is assigning particular beliefs about an individual or group without recognizing individual differences called what?

Answer 36

stereotyping

Question 37

Is a belief that ones own culture determines the standards by which everyone should be judged?

Answer 37

Ethnocentrism

Question 38

what is it called when a person does not see differences between their culture and others?

Answer 38

Cultural blindness

Question 39

a person imposes their cultural beliefs on a person of another culture is called?

Answer 39

Cultural imposition

Question 40

(IMPORTANT) What is the role of the nurse in a comprehensive cultural assessment of the culture include?

Answer 40

- Values, beliefs and attitudes regarding health, illness, birth, death and health care providers - Nutritional assessment - Socioeconomic assessment - Developmental considerations-child-bearing and child-rearing practices, care of older adults

Question 41

What are resources (FEDERAL) for minority health?

Answer 41

1. US Department of Health and Human Services - Office of Minority Health-coordinates federal efforts to improve the health status of racial and ethnic minorities 2. -Indian Health Services provides health services to Native Americans and Alaska Natives. Works with this population to establish goals. Tribes actively involved with health care services

Question 42

What are the four characteristics of a culture?

Answer 42

1. they are learned from birth 2. shared by all members of the cultural group 3. adapted to specific conditions related to the environment, technical factors and available resources 4. Culture is dynamic

Question 43

Who is considered the first epidemiologist? A)Hippocrates of Cos B)Aretaeus the Cappadocian C)Claudius Galen D)Susruta

Answer 43

A (hippocrates of Cos) rationale: Hippocrates of Cos was the first to record the relationship of the external environment to the health of individuals and is considered the first epidemiologist. Aretaeus the Cappadocian described pulmonary tuberculosis in detail. Claudius Galen described the four humors, introduced many drugs derived from plants, and was the first to describe smallpox. Susruta was a Brahmin physician who associated malaria with the mosquito.

Question 44

Which occurs in the epidemiologic process that is similar to the diagnosis phase of the nursing process? A)Data are gathered from reliable sources B)Healthcare needs and assets are identified C)Goals and objectives for care are established D)A tentative hypothesis is formulated

Answer 44

D (a tentative hypothesis is formulated) rationale: During the diagnosis phase of the epidemiologic process, a tentative hypothesis is formulated. During the assessment phase of the epidemiologic process, data are gathered from reliable sources. During the diagnosis phase of the nursing process, healthcare needs and assets are identified and goals and objectives for care are established.

Question 45

Which most accurately describes how disease patterns have changed from 1900 to the present? A)Morbidity and mortality from infectious diseases have increased. B)Morbidity and mortality from unintentional injuries have decreased. C)Morbidity and mortality from chronic degenerative conditions have decreased. D)Morbidity and mortality from noninfectious diseases have increased.

Answer 45

D (morbidity and mortality from noninfectious diseases have increased) rationale: Primarily as a result of improved public health practices in the early 20th century, life expectancy in the United States, the United Kingdom, and European countries, as well as in other developed countries, rose. With it, a change in the patterns of disease occurred. No longer are infectious diseases the leading causes of death; the morbidity and mortality from noninfectious diseases and chronic degenerative conditions have increased

Question 46

The community health nurse knows that early attempts to understand illness and disease-focused on the study of the experiences of individual people. Using this knowledge, how would the nurse define epidemiology to a group of nursing students? A)An outbreak that occurs when there is an increased incidence of a disease beyond that which is normally found in the population B)Model based on the belief that health status is determined by the interaction of the characteristics of the host, agent, and environment C)Study of the distribution and determinants of states of health and illness in human populations D)Epidemiologic model that strongly emphasizes the concept of multiple causations while de-emphasizing the role of agents in explaining illness

Answer 46

C (Study of the distribution and determinants of states of health and illness in human populations) rationale: Epidemiology is the study of the distribution and determinants of states of health and illness in human populations. An epidemic is an outbreak that occurs when there is an increased incidence of a disease beyond that which is normally found in the population. The epidemiologic triad is a model based on the belief that health status is determined by the interaction of the characteristics of the host, agent, and environment. The web of causation is an epidemiologic model that strongly emphasizes the concept of multiple causations while de-emphasizing the role of agents in explaining illness.

Question 47

Which most accurately defines “rate”? A)Course of a disease or condition from the onset to resolution B)Primary measurement used to describe either the occurrence or the existence of a specific state of health or illness C)Probability or likelihood that a disease or illness will occur in a group of people who presently do not have the problem D)Characteristic or event that has been shown to increase the probability that a specific disease or illness will develop

Answer 47

B (Primary measurement used to describe either the occurrence or the existence of a specific state of health or illness) Rate is the primary measurement used to describe either the occurrence or the existence of a specific state of health or illness. Natural history is the course of a disease or condition from the onset to resolution. Risk is the probability or likelihood that a disease or illness will occur in a group of people who presently do not have the problem. A risk factor is a characteristic or event that has been shown to increase the probability that a specific disease or illness will develop.

Question 48

In researching cases of West Nile virus in the community, the nurse explores how the interactions among people infected with this virus, mosquitoes, and the environment they share contribute to outbreaks of this disease. Which epidemiologic model is used in this case? A)Epidemiologic triad B)Wheel of causation C)Web of causation D)Natural history

Answer 48

A (Epidemiologic triad) rationale: The epidemiologic triad is the classic model based on the belief that health status is determined by the interaction of the characteristics of the host, agent, and environment, not by any single factor. The wheel of causation de-emphasizes the agent as the sole cause of disease while emphasizing the interplay of physical, biological, and social environments. The web of causation is an epidemiologic model that strongly emphasizes the concept of multiple causation while de-emphasizing the role of agents in explaining illness. Natural history is the course of a disease or condition from the onset to resolution.

Question 49

The nurse explores all of the possible factors that contribute to coronary artery disease in the community as links in multiple interrelated chains. Which epidemiologic models is the nurse using? A)Epidemiologic triad B)Wheel of causation C)Web of causation D)Natural history

Answer 49

C (Web of causation) rationale: The web of causation is an epidemiologic model that strongly emphasizes the concept of multiple causation while de-emphasizing the role of agents in explaining illness. The epidemiologic triad is the classic model based on the belief that health status is determined by the interaction of the characteristics of the host, agent, and environment, not by any single factor. The wheel of causation de-emphasizes the agent as the sole cause of disease while emphasizing the interplay of physical, biological, and social environments. Natural history is the course of a disease or condition from the onset to resolution.

Question 50

Which occurs in the epidemiologic process that is similar to the implementation phase of the nursing process? A)Data are gathered from reliable sources B)Actions are initiated to carry out the plan C)Actions are evaluated and report prepared D)Further research is conducted if necessary

Answer 50

B (Actions are initiated to carry out the plan) rationale: During the implementation phase of the epidemiologic process, actions are initiated to implement the plan. During the assessment phase of the epidemiologic process, data are gathered from reliable sources. During the evaluation phase of the epidemiologic process, actions are evaluated, a report is prepared, and further research is conducted if necessary.

Question 51

Which best describes a risk factor? A)Course of a disease or condition from the onset to resolution B)Primary measurement used to describe either the occurrence or the existence of a specific state of health or illness C)Probability or likelihood that a disease or illness will occur in a group of people who presently do not have the problem D)Characteristic or event that has been shown to increase the probability that a specific disease or illness will develop

Answer 51

D (Characteristic or event that has been shown to increase the probability that a specific disease or illness will develop) rationale: A risk factor is a characteristic or event that has been shown to increase the probability that a specific disease or illness will develop. An outbreak is a course of a disease or condition from the onset to resolution. Rate is a primary measurement used to describe either the occurrence or the existence of a specific state of health or illness. Risk is the probability or likelihood that a disease or illness will occur in a group of people who presently do not have the problem.

Question 52

In researching an outbreak of malaria in the developing nation where the nurse currently works, the nurse decides to not focus on the role of mosquitoes in transmitting the disease but on how the physical environment of the community, biological aspects of the community, and social customs interact to affect the prevalence of this disease. Which epidemiological model is the nurse using? A)Epidemiologic triad B)Wheel of causation C)Web of causation D)Natural history

Answer 52

B ( wheel of causation) rationale: The wheel of causation de-emphasizes the agent as the sole cause of disease while emphasizing the interplay of physical, biological, and social environments. The epidemiologic triad is the classic model based on the belief that health status is determined by the interaction of the characteristics of the host, agent, and environment, not by any single factor. The web of causation is an epidemiologic model that strongly emphasizes the concept of multiple causation while de-emphasizing the role of agents in explaining illness. Natural history is the course of a disease or condition from the onset to resolution.

Question 53

epidemiology covers?

Answer 53

- Infectious and chronic disease - Mental health - Accidents and injuries - Occupational and environmental exposures

Question 54

The study of the distribution and determination of health and disease in human populations. The principle science of public health. Used to promote health and reduce risks?

Answer 54

Epidemiology

Question 55

Person-Place-Time Model

Answer 55

- Person: “Who” factors such as demographic characteristics and health and disease statistics - Place: “Where” factors such as geographic location, climate and environmental conditions, and political and social environment - Time: “When” factors such as time of day, week, or month and secular trends over months and years

Question 56

Epidemiological triad (triangle) consists of?

Answer 56

Host, environment, and agent * not for chronic diseases - alterations in any of these disrupts the communicable disease process

Question 57

Host factors of the epidemiological triad are? Intrinsic Factors (Susceptibility, or Response to Agent)

Answer 57

Influence exposure, susceptibility, or response to agent include: Genetics - Age - Gender- male or female - Ethnic group- certain conditions are more prevalent in specific ethnic groups - Physiological state- rest, exercise - Prior immunological experience- have you been vaccinated and it relates to your immune system (active or passive) - Preexisting disease- having other chronic diseases that put them at risk further - Human behavior- drinking, drugs, unsafe sex, poor diet, poor exercise

Question 58

Agent of Disease (Etiologic Factors)?

Answer 58

- Nutritive elements (excesses, deficiencies) - Chemical agents (Poisons, allergens) - Physical agents (Ionizing radiation, mechanical) - Infectious agents (metazoa, protozoa, bacteria, fungi, rickettsia, viruses)

Question 59

``` Environmental Factors (Influence Existence of the Agent, Exposure, or Susceptibility to Agent) in the triad? (Extrinsic factors) ```

Answer 59

influence existence of the agent, exposure, or susceptibility to agent. This includes...1. Physical environment-climate, noise, radiation 2. Biological environment-population density, food, water, flora, fauna 3. Socioeconomic environment-occupations, exposure to chemicals , economic environment, urbanization

Question 60

Descriptive epidemiology

Answer 60

- Study of the amount and distribution of disease - Used by public health professionals - Identified patterns frequently indicate possible causes of disease

Question 61

Analytic Epidemiology

Answer 61

- Examine complex relationships among the many determinants of disease - Investigation of the causes of disease, or etiology

Question 62

Wheel Model of Human-Environment Interaction

Answer 62

In the middle: Host (human); this is the genetic core | -Surrounding that in the wheel is Biological environment, social environment, and physical environment

Question 63

Web of Causation

Answer 63

many different things lead up to the final outcome - ex:illustrates the complexity of relationships among causal variables for heart disease - these factors can be modified which will alter the final outcome

Question 64

What are rates?

Answer 64

arithmetic expressions that help practitioners consider a count of an event relative to the size of the population from which it is extracted -calculating rates--> measures the frequency

Question 65

Epidemiologic Process

Answer 65

1. Define a case-who, where and when 2. Calculate rates-measures frequency 3. Establish causality-why and how 4. Screening-reliability of methods-must have referrals & follow-up. Yield of screening= number of true positive relative to all positive results. 5. The surveillance-continuous process to identify trends in disease and risks

Question 66

What are 2 types of Observational Methods-No interventions or treatment is used?

Answer 66

1. Descriptive Epidemiology Information is collected to characterize a health problem. Provides the foundation for the development of hypotheses testing. 2. Analytic Epidemiology Investigates the causes of disease by determining why a disease rate is lower in one population group than in another. Comparisons between groups are made to determine the role of risk factors causing a disease or health problem. Examine causality.

Question 67

What type of studies are these? 1. Cross-Sectional Studies-Prevalence Studies-collect data by questionnaire or interview of a cross section of the population with a disease or risk factor. Behavior Risk Factor Survey (just to collect the data) 2. Retrospective/Case Control Study-goes back in time. One group has disease, other group does not have the disease. Groups compared for risk factors. (medical records could be lost, subject recall may be a problem) 3. Prospective Studies-Longitudinal Studies-follows disease free people over long period-examines causality. (cause and effect) -this is the best techniques going forward in time

Answer 67

Observational studies

Question 68

What type of studies are these? 1. True experiments have an experimental and control group. 2. Subjects are randomly assigned to the experimental group or control group. 3. The experimental group receives a treatment and the control group does not receive a treatment. 4. Mainly used to test medications or other treatments.

Answer 68

Interventional-Experimental studies

Question 69

The public health nurse is preparing to participate in a descriptive epidemiology study. Which statement best describes descriptive epidemiology? a. The study seeks to answer questions about the cure for a disease b. The study seeks to answer questions about the distribution of disease in a population c. The study seeks to answer questions about the cause of a disease

Answer 69

b | The study seeks to answer questions about the distribution of disease in a population

Question 70

What do incidence rates describe?

Answer 70

the occurrence of new cases of a disease or condition in a community over a period of time relative to the size of the population at risk for that disease or condition during that same time period.describe the occurrence of new cases of a disease or condition in a community over a period of time relative to the size of the population at risk for that disease or condition during that same period of time. Only new cases that occur in the designated time are counted. Researcher needs to determine the time of onset.

Question 71

What do attack rates document?

Answer 71

the number of new cases of a disease in those exposed to the disease (ex. food poisoning; denominator is the number of people exposed to a suspect food, and the numerator is the number of people who were exposed and became ill. -Usually specific to an exposure, e.g. food poisoning or a communicable disease

Question 72

Prevalence

Answer 72

the number of all cases of a specific disease or condition in a population at a given point in time. Cases include old and new cases that develops within the same time period. Prevalence rates are higher with chronic diseases because cases remain in populations for long periods of time * new or old cases the population ( all cases) regards to chronic disease, COPD, HTN, heart disease--> only time you come out of it is when you die

Question 73

Mortality rate

Answer 73

-measure of death rates

Question 74

Establishing Causality includes: (select all that apply) a. Strength of association-rates of morbidity and mortality must be higher in the exposed group than in the non-exposed group. b. Dose-response relationship-an increased exposure to the risk factor causes a concomitant increase in disease rate. c. Temporally correct relationship-exposure to the causal factor must occur before the disease d. Biological plausibility-data must explain the relationship e.g.cigarette smoking increases the risk of lung cancer e. Consistency with other studies-various studies in other populations must show similar results.

Answer 74

a, b, c, d, e

Question 75

Classification of infectious diseases include which of the following (select all that apply): a. endemic-occurrence of an infectious disease at a consistent, expected level in a geographic area, e.g. influenza b. outbreak-unexpected occurrence of an infectious disease in a limited geographic area, during a limited period of time c. pandemic-a steady occurrence of disease over a large geographic area e.g. worldwide d. epidemic-unexpected increase of an infectious disease in a geographic area over an extended period of time

Answer 75

a, b, c, d

Question 76

unexpected increase of an infectious disease in a geographic area over an extended period of time is called?

Answer 76

epidemic

Question 77

a steady occurrence of disease over a large geographic area e.g. worldwide is called?

Answer 77

pandemic

Question 78

occurrence of an infectious disease at a consistent, expected level in a geographic area, e.g. influenza is called?

Answer 78

endemic

Question 79

Those who survive a chronic disease without cure remain in the:

Answer 79

prevalence pot which is The relationship between incidence and prevalence

Question 80

risk refers to the?

Answer 80

the probability of an adverse event

Question 81

Primary prevention:

Answer 81

when interventions occur before disease development | -Includes health promotion and specific prevention

Question 82

secondary prevention

Answer 82

occurs after pathogenesis; screening and physical examinations that are aimed at early diagnosis

Question 83

tertiary prevention

Answer 83

focuses on limitation of disability and the rehabilitation of those with irreversible diseases such as diabetes and spinal cord injury

Question 84

Why is it important to identify causality of disease?

Answer 84

to encourage the most effective prevention activities and develop treatment modalities

Question 85

What are cross-sectional studies also called?

Answer 85

Prevalence or correlational studies

Question 86

Why are observational studies used?

Answer 86

- Descriptive purposes - Etiology of disease - No manipulation by investigator

Question 87

Why is it impossible for a cross-sectional study to make causal inferences?

Answer 87

because the study cannot establish the temporal sequence of events (i.e., the cause preceded the effect)

Question 88

The nurse works with a female client who recently developed an infection of Staphylococcus aureus while in the hospital. In this case, S. aureus is which component in the chain of infection? A)Host B)Environmental reservoir C)Agent D)Portal

Answer 88

C (agent) rationale: The agent, or the microbe that causes the disease, is the “what” of the epidemiologic triangle. The host, or the organism that is harboring the infectious agent, is the “who” of the triangle. The environment, which includes those external factors that cause or allow disease transmission, is the “where” of the triangle. Other necessary elements include a portal of exit from the host, environmental reservoirs, transmission, and a portal of entry to a new host.

Question 89

A student nurse asks if an infectious disease is the same thing as a communicable disease. The nurse explains that an infectious disease is not necessarily a communicable disease. Which must a communicable disease have that an infectious disease does not have to have? (Select all that apply.) A)Pathogenic microorganism B)Portal of exit from the infected person C)Means of transmission D)Portal of entry to a susceptible host E)Organism that harbors the infectious agent

Answer 89

B,c,d rationale: An infectious disease in a human host is one caused by the growth of pathogenic microorganisms in the body. For a disease to be communicable, or contagious, there must be a portal of exit from the infected person (or animal), a means of transmission, and a portal of entry to a susceptible host. Thus, an infectious disease need not be contagious, or communicable.

Question 90

Infectious agents are biological agents capable of producing an infection or infectious disease. Which are considered biological agents? (Select all that apply.) ``` A)Fungi B)Fomites C)Bacteria D)Viruses E)Helminths ```

Answer 90

A,C,D,E rationale: Infectious agents are biological agents capable of producing an infection or infectious disease and include bacteria, viruses, rickettsiae, fungi, protozoa, and helminths. Fomites are any substance that adheres to and transmits infectious materials. An infectious disease need not be contagious or communicable.

Question 91

In infectious disease epidemiology, just the presence of an infectious agent is not sufficient to produce an infectious disease. Which host factors determine whether a person is at risk for an infection or an infectious disease? (Select all that apply.) ``` A)Age B)Sex C)Occupation D)Physical and emotional health E)Immune status ```

Answer 91

A,B,D,E rationale: There are several host factors that determine whether a person is at risk for an infection or an infectious disease. These include age, sex, race, physical and emotional health, and immune status. Occupation is not a host factor

Question 92

When an infectious agent enters the host and begins to multiply, an infection occurs. The time between exposure to an infectious agent and the manifestation of symptoms in the host is known as: A)Carrier time B)Colonization C)Incubation period D)Latent period

Answer 92

C (incubation period) rationale: The time between exposure to an infectious agent and the manifestation of symptoms in the host is called the incubation period. Asymptomatic people are carriers of a virus and can transmit the virus to others through percutaneous inoculation, exposure to mucous membranes, and sexual contact. When an infectious agent is present and there are no clinical signs of disease, colonization with the infectious agent is said to have occurred, and the infected person is capable of transmitting the agent.

Question 93

The latent period is the stage of a disease during which symptoms are?

Answer 93

hidden

Question 94

A client with tuberculosis sneezes in the waiting room and infects several other clients who are sitting on the other side of the room. Which mechanism of transmission is involved in this case? A)Airborne B)Droplet C)Direct contact D)Indirect contact

Answer 94

A (airborne) rationale: Airborne transmission occurs when microorganisms are carried in the air in small particles, called droplet nuclei, at distances that exceed a few feet. Droplet transmission theoretically is a form of contact transmission; the mechanism of transfer of the pathogen to the host is quite distinct from either direct or indirect transmission. Therefore, droplet transmission is considered a separate route of transmission. Droplets

Question 95

Direct contact occurs through?

Answer 95

direct body surface–to–body surface contact and physical transfer of microorganisms between a susceptible host and an infected or colonized person (or animal).

Question 96

what type of contact involves contact of a susceptible host with a contaminated intermediate inanimate object, called a vehicle, such as a contaminated surgical instrument, needle, toy, soiled clothing, or bed linen?

Answer 96

indirect contact

Question 97

are generated from the source person primarily during coughing, sneezing, or talking and are propelled a short distance (<3 feet) through the air and deposited on the conjunctivae, nasal mucosa, or mouth of another person. ?

Answer 97

droplets

Question 98

The student-nurse discusses transmission that involves contact of a susceptible host with a vehicle. Based on the chain of infection links, which exemplifies a vehicle? A)Animals B)Insects C)Reptiles D)Water

Answer 98

D (water) rationale: Indirect contact involves contact of a susceptible host with a contaminated intermediate inanimate object, called a vehicle, such as a contaminated surgical instrument, needle, toy, soiled clothing, or bed linen. Vehicles also include food, water, and contaminated hands that are not washed. Indirect contact also includes vector transmission. Vectors are animal or insect carriers of infectious agents.

Question 99

Chloroquine-resistant malaria occurs in most of Africa, the Middle East, and Asia and all of the South Pacific islands. This type of disease occurrence is known as: A)Endemic B)Epidemic C)Pandemic D)Outbreak

Answer 99

A (endemic) ( a normal occurence) rationale: An endemic disease, infection, or infectious agent occurs when it becomes prevalent within a population or geographic area. The use of “outbreak” in this text is synonymous with epidemic.

Question 100

is an epidemic that generally spreads worldwide?

Answer 100

pandemic

Question 101

refers to a significant increase in an infection or infectious disease beyond the expected (endemic) level in a certain population and/or geographic area?

Answer 101

epidemic or outbreak

Question 102

Person, place, and time characterize the description of an epidemiologic problem. Using knowledge of outbreak investigations, which occurs with propagated outbreaks? A)Same person or vehicle as the reservoir or means of transmission B)Infection transmitted from person to person over a short period of time C)Generating secondary infections with intervals between peaks that approximate the usual incubation period for the infection D)Generating tertiary infections following exposure to a primary case

Answer 102

C (generating secondary infections) rationale: A propagated outbreak is one where the infection is transmitted from person to person over a longer period of time than with a common source outbreak, and it can generate secondary infections with intervals between peaks that approximate the usual incubation period for the infection. A common source outbreak is one that has the same origin. Secondary infections are those that occur within the accepted incubation period following exposure to a primary case.

Question 103

Several levels of public health surveillance are necessary to protect the nation's health. At what level are healthcare providers and health facilities required to report certain infectious diseases? A)Local B)State C)Federal D)International

Answer 103

B (state) rationale: Local reporting mechanisms are community specific. At the state level, healthcare providers and health facilities are required to report certain infectious diseases to state health departments. At the federal level, the Department of Health and Human Services (DHHS) is the US public health infrastructure that develops policies to protect the nation's health. The Centers for Disease Control and Prevention (CDC) also is a partner with the World Health Organization (WHO) through the Global Outbreak Alert and Response Network and the WHO Surveillance and Response system, which provide international epidemic alerts and responses

Question 104

Which agency has an electronic surveillance system for the early notification of community-based epidemics? A)Department of Health and Human Services B)Centers for Disease Control and Prevention C)World Health Organization D)Department of Defense

Answer 104

D (department of defense) rationale: The Department of Defense (DoD) has an electronic surveillance system for the early notification of community-based epidemics (ESSENCE), which has been in operation since 2001 to detect infectious disease outbreaks. At the federal level, the Department of Health and Human Services (DHHS) is the U.S. public health infrastructure that develops policies to protect the nation's health. The Centers for Disease Control and Prevention (CDC) is a major DHHS agency that protects the nation's health by developing guidelines that promote health and quality of life by preventing and controlling disease, injury, and disability. The CDC is also a partner with the World Health Organization (WHO) through the Global Outbreak Alert and Response Network and the WHO Surveillance and Response system, which provide international epidemic alerts and responses.

Question 105

refer to the pathophysiological responses of the host to the infectious agent, manifesting as an illness . Infection is the entry & multiplication of an agent in the host is?

Answer 105

infectious disease and comunicable disease

Question 106

emphasizes that an infectious agent alone is not sufficient to cause disease—the agent must be transmitted in the environment to a susceptible host is called?

Answer 106

multicausation

Question 107

What are the stages/periods of infection (LCIA)?

Answer 107

latent, communicable, incubation, active illness

Question 108

Which stage/period of infection is when replication before shedding occurs?

Answer 108

Latent period (infectious period, your invaded) , fatigue and weakness

Question 109

What stage or period is when the illness begins with the shedding of the virus?

Answer 109

Communicable period (coughing sneezing agent)

Question 110

What is the name of the stage/period that is the time between invasions and symptoms and may overlap with the communicable period?

Answer 110

incubation period (times change)

Question 111

carriers of illness are referred to as?

Answer 111

the person that has the infectious agent and can transfer to others without the symptoms ex: typhoid and COVID(they never get sick and they are considered the super spreaders)

Question 112

an unexpected occurrence of an infectious disease in a limited area during a limited time is called?

Answer 112

an outbreak

Question 113

What are factors in the Chain of Transmission?

Answer 113

1. Infectious agents 2. Reservoirs (humans, animals, vectors, water, soil, insects) --> where is it lets eliminate it 3. Portals of exit and entry (mucous membranes, skin, cuts)--> you want to cover the areas 4. Modes of transmission (direct or indirect) Direct, indirect, fecal-oral, airborne 5. Host susceptibility –immune system, immunization status, personal behaviors

Question 114

Breaking the chain of transmission

Answer 114

``` Controlling the agent Eradicating the nonhuman reservoir Controlling the human reservoir Controlling the portals of exit and entry Improving host resistance and immunity ```

Question 115

Public Health Control of Infectious Diseases

Answer 115

1. Control -->The reduction of incidence or prevalence of a given disease to a locally acceptable level as a result of deliberate efforts 2.Elimination-->Controlling a disease within a specified geographical area and reducing the prevalence and incidence to near zero *The result of deliberate efforts, but continued intervention measures are required 3. Eradication--> Reducing the worldwide incidence of a disease to zero as a function of deliberate efforts No need for further control measures Only possible under certain conditions *Smallpox was eradicated in 1977, and the virus now exists only in storage in laboratories.

Question 116

Live or attenuated vaccines

Answer 116

small amount of antigen to stimulate the immune system e.g. MMR-active immunity

Question 117

Inactivated vaccine examples

Answer 117

flu, hep A, typhoid (get every year)

Question 118

passive immunity

Answer 118

immunoglobulins, natural immunity (provides antibodies and help get you through the period you get sick) -protects you and is inactive

Question 119

Herd immunity

Answer 119

if a certain percentage of the population is vaccinated then there will be herd immunity to others that are not vaccinated due to the majority of the population that are vaccinated

Question 120

vaccine failure types?

Answer 120

1. Primary-vaccine does not stimulate immune system and to produce antibodies--> vaccine not stored under proper condition 2. Secondary-decreasing strength of immunity after initial response (you would get titer done to see if you are immune)

Question 121

Key things to remember with immunizations?

Answer 121

1. Cold chain 2. Vaccine spacing- how far apart 3. Routes of administration- IM is preferred 4. Hypersensitivity and contraindications- give vaccine statement prior and includes the preservatives in them - Flu vaccine-- people with an egg sensitivity contraindicated - Pregnant women- do not get MMR - people on chemo- do not get live vaccine 5. Documentation- will include who gave it, Lot #, how it is given, manufacturer 6. Vaccine safety and reporting-Vaccine Adverse Event Reporting System, National Vaccine Injury Compensation Program (report to the FDA and CDC, but 1st report it to the place that gave it) and if it is severe it will be investigated 7. V-SAFE-App to report adverse reaction to COVID-19 vaccine. Installed on smart phone after 1st dose 8. Vaccine needs for special groups --> most at risk and with chronic diseases

Question 122

Healthy People 2020 major objectives are:

Answer 122

- Immunization & Infectious Disease - Sexually Transmitted Diseases - HIV

Question 123

What level of prevention does these: - Control the agent - Eradicate the nonhuman reservoir - Control the human reservoir - Control the portals of exit and entry (masks, PPE, handwashing) - Improve host resistance and immunity - education on medication that needs to be taken

Answer 123

primary prevention-->Activities targeted at intervening before the agent enters the host and causes pathological changes

Question 124

What level of prevention covers: - Report infectious diseases ( every state has this) - Investigate contacts - Notify partners - Find new cases - Isolate cases

Answer 124

secondary prevention -->Targeted at detecting disease at the earliest possible time to begin treatment, stop progression, and initiate primary prevention activities to protect others in the community.

Question 125

What level of prevention includes: - Ensure person takes antibiotics and antivirals effectively - Ensure that caregivers know how to protect themselves and the environment

Answer 125

tertiary prevention -->Limits the progression of disability.

Question 126

Acquired Immunity

Answer 126

Previous exposure or illness from agent or vaccination; | vaccination= artificial immunity

Question 127

Active humoral immunity

Answer 127

B-Lymphocyte response resulting in immunity that lasts for several years with diseases such as tetanus or a lifetime with diseases such as measles or mumps.

Question 128

Passive Immunity

Answer 128

transplacental transfer of mother's immunity to unborn child or immunity passed on from someone else

Question 129

Types of Food-Borne Diseases

Answer 129

Campylobacteriosis Listeriosis Salmonellosis Ecoli

Question 130

Vector-Borne disease types

Answer 130

-some form of living organism, usually an animal or an arthropod. -"animal, particularly an insect, that transmits a disease-producing organism from a host to a non-infected animal" Examples: lymes disease malaria west nile virus

Question 131

Types of zoonosis disease (animal disease that is transmitted to humans)

Answer 131

Hantavirus Avian Flu Rabies

Question 132

Types of parasitic diseases

Answer 132

Helminths (pinworm, roundworm, tapworm) | protozoans (giardiasis, crypto)

Question 133

3 Key factors in the control of communicable disease

Answer 133

1. The removal, elimination, or containment of the cause or source of infection. 2. The disruption and blockage of the chain of disease transmission. 3. The protection of the susceptible population from infection and disease.

Question 134

Healthcare-Associated Infections

Answer 134

Also known as nosocomial infections, are acquired by patients while being treated for other conditions in a healthcare setting.

Question 135

Bioterrorism 3 categories

Answer 135

Category A: Highest risk easily spread or transmitted from person to person and result in high death rates. Category B: Moderately east to spread, result in moderate illness and low death rates. Category C: Easily available, easily produced and spread, and have the potential for high morbidity and mortality rates and major public impact.

Question 136

Goals of Health Education. Health education enables the client to:

Answer 136

- Attain optimal health - Prevent health problems - Identify and treat health problems early - Minimize disability - Outcome of health education-behavioral changes in the client

Question 137

What type of theory does all of this: - Helps an individual develop his/her potential in a self-directed and holistic manner. - Describes the influence that feelings, emotions and personal relationships have on behavior. Encourages self-expression. - Person needs to be aware of their values. - Educator would help learners develop the program.

Answer 137

humanistic theory | Utilizes influential effects of feelings, emotions, relationships on behavior

Question 138

What is the theory that is the: - Belief is that by changing thought patterns and providing information, the learner’s behavior will change. - Increases a person’s knowledge by increasing the person’s ability to think, learn and solve problems

Answer 138

Cognitive theory (Rudimentary cognition is required Changes behavior by providing information & changing thought patterns)

Question 139

Social learning theory

Answer 139

Learning is enhanced through the concepts of efficacy, outcome expectations and incentives. Educator can use this theory to change behaviors by enabling person to change either their expectations about a value or their ability to achieve the desired outcome. * Learning is based on behavior. Combines cognitive theory with behaviorism e.g. stimulus-response conditioning. -"monkey see monkey do" Behavior is a function of expectations and beliefs: Considers self-efficacy - Confidence - Knowledge and skill

Question 140

WHAT IS THE THEORY THAT INCLUDES: - Learning occurs with the developmental stages from infancy to old age. - Readiness to learn depends on each person’s developmental stage. Learning occurs differently in each developmental period.

Answer 140

developmental theory

Question 141

What 3 levels of learning ?

Answer 141

Cognitive, affective, psychomotor

Question 142

Cognitive Domain

Answer 142

``` Levels of cognition: -Knowledge-recall information -Comprehension-understand information -Application-use information -Analysis-break information into separate parts -Synthesis-put parts back together to understand the total message -Need to assess the cognitive ability of the learner EXAMPLES: Recall/Memory Comprehension Application Analysis Synthesis Evaluation ```

Question 143

Affective domain

Answer 143

- Learning focused on changing person’s attitudes, beliefs and values. - Learner adapts behaviors of a new value system. - People need support to make changes and reinforce new behaviors. Individual support or support groups.

Question 144

psychomotor domain

Answer 144

- Includes performance of skills-requires neuromuscular coordination - Need to allow time for practice of a new skill - Nurse needs to assess client’s intellectual and physical ability to perform a skill

Question 145

Characteristics that impact learning

Answer 145

Adults must know why they need to learn Adults want to be self-directed Readiness to learn Orientation to learning Life experience-connect previous experience to present learning Motivation-assess for barriers to motivation

Question 146

Concepts of Community Organization and Education

Answer 146

Empowerment/problem solving skills Community competence/achieve goals through collaboration Issue selection/problems meaningful & attainable to the community. Let community members define learning needs Encourage active participation of group

Question 147

Nurse’s Role in Health Education

Answer 147

Establish therapeutic relationship with group-begins with establishing trust Enhance communication-establish a positive learning environment Become culturally competent-using experts in a culture is highly effective

Question 148

Framework for Developing Health Communications

Answer 148

Planning and Strategy Development-identify goals, design program to meet groups needs and plan method of evaluation. Priority for effective programs Developing and Pre-Testing Concepts, Messages and Materials Implementing the Program Assessing Effectiveness & Making RevisionsWork with *target group when planning-get group involved in development of program.

Question 149

Characteristics of An Effective Educator

Answer 149

Send a clear message Select the appropriate learning format Create the best learning environment-present information from simple to complex Inform the learner of the objectives Stimulate recall of previous learning-connect to new knowledge Elicit and assess performance Assist in the transfer of knowledge

Question 150

BARRIERS TO LEARNING

Answer 150

Literacy=ability to read and write at a fifth grade level in any language Assess patient’s age, language and resources e.g. use of technology Ask questions to verify understanding Use plain language at the 6th grade level Use visual aids as appropriate Organize teaching into smaller units Motivation-Educators Role -Explain how instruction relates to learner’s goals Build confidence -Create positive expectations for success

Question 151

Identify the learning theory in the following: Members of a senior citizen group want to develop a health promotion program. The public health nurse agrees to facilitate the group discussion and guide the group as they develop their program

Answer 151

humanistic | -helps an individual develop his or her potential in a self-directing and holistic manner.

Question 152

IDENTIFY THE LEARNING THEORY USED The public health nurse is teaching a group of women to perform monthly breast self-exams. She provides verbal instruction and uses a video and model to demonstrate the technique. Each women is given a handout to take home that visually demonstrates the correct procedure.

Answer 152

cognitive -recognizes the brain's ability to think, feel, learn, and solve problems; theorists in this area train the brain to maximize these functions.

Question 153

IDENTIFY THE LEARNING THEORY USED The nurse is helping a group of obese women lose weight. She instructs the group on selection of healthy foods and exercise. Scientific data regarding balanced nutrition and the positive effects of exercise are presented to help the group develop the expectation that decreased food intake and exercise will result in weight loss.

Answer 153

social learning - is based on behavior explaining and enhancing learning through the concepts of efficacy, outcome expectation, and incentives.

Question 154

IDENTIFY THE LEARNING THEORY USED The nurse is instructing a group of parents with toddlers about home safety. They are provided with methods that can be used to teach the child according to their stage of development and readiness to learn

Answer 154

developmental

Question 155

How can nurses best help expand availability of health education programs? a. Being entrepreneurs and asking patients to pay what they think the educational program was worth b. Suggesting to their friends and neighbors that they lobby local health organizations to provide such health education programs c. Teaching health education programs as unpaid volunteers in the community d. Working politically to influence public policy regarding funding health education programs

Answer 155

D Although nurses can volunteer, join other people in requesting health education programs, or teach such programs as nurse entrepreneurs, the best way to expand the availability of such programs is to influence public policy regarding development and funding of health education programs. Although it is not clearly stated in Chapter 20 (all the answers are recommended in the text), the book as a whole emphasizes the importance of political action for more extensive influence.

Question 156

What strategies will a nurse include when planning an educational program for adults that ensures student learning? a. Individual one-on-one tutorials to ensure maximum understanding b. Large group lectures with handouts of main points along with culturally appropriate pictures c. Small peer group discussions on how to apply the new knowledge with prompt feedback d. Use of multimedia technologies such as videotapes and PowerPoint presentations

Answer 156

C Small group discussions help adults become actively involved, often with repetition of the information as they discuss how to apply the knowledge. Individual one-on-one tutorials are extremely expensive. Large group lectures, even with handouts and pictures, still are only effective for low-level cognitive learning, not application. Table 20-1 emphasizes that adults want application of the facts and real-life context.

Question 157

In what way is the Predisposing, Reinforcing, Enabling, Causes in Educational Diagnosis, and Evaluation (PRECEDE) model helpful when health education programs are implemented? a. It addresses the learning needs of ill individuals. b. It begins with examining an aggregate's general concerns and quality of life. c. It emphasizes the learning needs of families who have an ill member. d. It focuses primarily on environmental resources

Answer 157

B The PRECEDE model begins with the presence or absence of health problems that are linked to quality-of-life issues, with the question "What are the general concerns of the population?" Such assessment helps ensure that the intervention is based on diagnosis of the community's need.

Question 158

Which of the following factors most influences a client's ability to learn from a health education program? a. Client's belief that the information will be useful or enjoyable b. Handouts given to the client c. Nurse's ability to teach d. Setting in which the educational program is given

Answer 158

A Learning depends primarily on emotional readiness, which is reinforced primarily by internal motivation. The learner must be willing to put forth the effort needed to learn. Internal motivation is self-directive and long lasting and is based on the belief that the client's action will be useful or enjoyable.

Question 159

A nurse is teaching a client how to perform her own insulin injections. Which of the following should the nurse assess first to determine the client's experiential readiness to learn? a. Culture and ethnic background b. Educational ability c. Family structure d. Home environment

Answer 159

B The client's ability to learn can most easily be assessed by determining the client's educational level. Direct questioning related to years of formal education is useful but does not always provide complete and accurate information. Reading ability and learning disabilities should also be considered.

Question 160

Behavioral objectives should be a. Comprehensive and complete. b. Observable, measurable, and clearly communicated. c. Specific and detailed. d. Written on the teaching plan.

Answer 160

B Although all of the responses are consistent with careful planning, the plan will not be workable unless the objectives are measurable and the nurse is able to observe changes in learning, attitudes, or behavior. Because the objectives convey intent to other people, such as external evaluators, they must also be communicable. If clearly stated, the objectives can also be used for evaluation purposes.

Question 161

The nurse distributed written materials with culturally appropriate pictures to the small groups in the audience and began to lecture on the important content before the planned discussion period. However, no one was listening. What should the nurse have done differently? a. Created a more interesting and entertaining lecture b. Withheld the written materials until after the lecture c. Let the audience discuss the material as a whole, not in small groups d. Skipped the lecture and went directly to the discussion period

Answer 161

B Wait to make group assignments and to give handouts for group activity until after you have given the final instructions; otherwise, people will be reading instead of listening to you.

Question 162

A community/public health nurse is planning an educational program about healthy choices to prevent heart disease. Which of the following variables will be the primary influence as the nurse selects content for the program? a. Employing agency's preferences b. Needs of the high-risk target group c. Third-party payers' probable coverage of the educational program d. What the nurse feels most comfortable and skilled in teaching

Answer 162

B The nurse certainly must function within the constraints of the health care system, including policies of the employing agency and third-party payers; in a specific planned program, however, the actual content depends on the learning needs of the target group, as determined by a needs assessment.

Question 163

When teaching an educational program to an adult audience, which of the following actions should a nurse take to best meet their educational needs? a. Providing a specific, detailed explanation of each component of the program b. Using various methods of instruction, including lecture, discussion, and visual aids c. Providing an opportunity for participants to express their feelings about the program d. Using a PowerPoint presentation so that the audience can visualize the material

Answer 163

B To best meet the needs of the audience, it is important to use different teaching methods so that each member of the audience can learn by his or her preferred method, whether that is hearing, reading, discussing, or another activity. Thus, the use of only a PowerPoint presentation may not meet the needs of all the members of the audience. In addition, it is helpful to include all three domains of learning, which is usually necessary to incorporate a new health behavior into the learner's life. The best choices include opportunities for learning the material by preferred learning style, expressing feelings, and applying material, which represent the cognitive, affective, and psychomotor aspects.

Question 164

Which comment to the nurse best demonstrates a successful health education program? a. "I'm going to take a 30-minute walk each day." b. "I certainly enjoyed the program, and thank you for the freebies." c. "You gave me so much new information; thank you so much." d. "Wow! I learned many things that I can use in my daily activities."

Answer 164

A The overall goal is to teach a health-promoting activity that can be incorporated into the learner's lifestyle. Assessment of learner outcomes has traditionally been based on achievement of the behavioral objectives. If the objectives are properly written, each objective is measurable. Planning to take a daily walk demonstrates intention to incorporate the program content into personal lifestyle.

Question 165

Which of the following activities would be important for the nurse to complete when planning an educational program? a. Avoid rehearsing the content or it will sound too practiced. b. Come early to set up the audiovisual materials. c. Remind all possible participants that early registration is required. d. Try to get as many free handouts and freebies as possible.

Answer 165

B The nurse should visit the site to ensure the cleanliness, temperature, and lighting of the area; arrive early to set up the audiovisual materials; and bring extra supplies such as projector bulb and extension cord. Last-minute attendees should be welcomed. In addition, the nurse should practice the material until it is known forwards and backwards.

Question 166

Characteristics of Adult Learner (6)

Answer 166

1) Need to know 2) Concept of self 3) Readiness to learn 4) Orientation to learning 5) Experience 6) Motivation

Question 167

A client meeting with a community health nurse inquires about diabetes education classes. The client's health records reveal the diagnosis of diabetes was made a little over 1 year ago. The client reports partial compliance with diet, gradual improvement in her exercise program, and a 15-pound weight loss. The client reports that she takes her medication as prescribed but rarely monitors her blood glucose level. Which statement best reflects the impact of initial diabetes education on this client? A. Learning occurred, but additional support and education are needed. B. It is apparent that the diabetic education was totally inadequate. C. It is not possible to draw any conclusions about the education. D. The education did not work because this client is noncompliant.

Answer 167

A. Learning occurred, but additional support and education are needed. The client exhibits learning by striving over the past year to comply with the prescribed diet, improve her exercise program, lose weight, and take the prescribed medications. Learning is described as enduring change that involves modification of insights, behaviors, perceptions, or motivations. The client perceives that additional support and health education will improve her diabetes

Question 168

The community health nurse is working with a client who has recently been diagnosed with diabetes. The physician has prescribed a diet and recommended adding an exercise regimen. Assessment reveals the client has been smoking two packs of cigarettes per day for approximately 30 years. Which statement most accurately reflects the appropriate approach for establishing health education priorities for this client? A. The nurse must assist the client to recognize that smoking cessation should be the highest priority. B. The nurse and client must partner in establishing health education priorities for the client. C. The client does not have his priorities in order and must be informed by the nurse as to the most important priority. D. The nurse should not discuss smoking cessation because this is not the client's most important health issue.

Answer 168

B. The nurse and client must partner in establishing health education priorities for the client. Lasting health behavior change depends on learner participation in determining health education needs and priorities. The nurse and patient should partner together to establish health education needs and priorities. The other options do not give the client the opportunity to establish his health education

Question 169

The nurse is meeting with a client who has been referred for assistance with smoking cessation. During their first meeting, the client states he is very doubtful about his ability to stop smoking. In the health belief model, the client's belief that actions can be performed to achieve the desired outcome is referred to by which of the following terms? A. Self-efficacy B. Perceived susceptibility C. Perceived benefits D. Cues to action

Answer 169

A (self- efficacy) One component of the health belief model is self-efficacy. Self-efficacy refers to the degree to which the client believes in his or her ability to be successful in taking the necessary actions to accomplish the desired outcome. Other components of the health belief model include perceived susceptibility, perceived severity, perceived benefits, perceived barriers, demographics, and cues to action

Question 170

Learner assessment is an important aspect of health education. The assessment performed by the community health nurse includes questions about the client's age, family roles, social roles, and various responsibilities. Which of the following is the most important reason for obtaining this information? A. The nurse will need this information to plan the meetings with the client. B. The information will help the nurse to understand the client's desired outcomes. C. The client's developmental stage and roles have an impact on readiness to learn. D. The information is necessary to understand how much time the client will have.

Answer 170

C. The client's developmental stage and roles have an impact on readiness to learn. The client's social roles and the tasks associated with the client's developmental stage must be considered because they will have an important influence on the client's learning experience. Gathering information to plan and time the meetings and understand the desired outcomes is necessary, but the most important reason to obtain the information is to understand the client's readiness to learn

Question 171

A community health nurse is asked to review a draft of a brochure developed for distribution to clients. The nurse finds the brochure generally well designed but suggests replacing several words with simpler words that have fewer syllables and are more commonly used. What is the best explanation for the nurse's recommendation? A. The nurse assumes the clients are uneducated because they have low income. B. The nurse knows that English may not be the primary language of many clients. C. The nurse is assuming that most of the client's will read at a third-grade level. D. The nurse knows that more difficult words will pose a barrier to some clients.

Answer 171

D. The nurse knows that more difficult words will pose a barrier to some clients. Materials written at a simpler level can be effective learning tools for clients who read at different levels. The nurse should not make assumptions about the client's education. Simplifying the words would not necessarily assist non-English-speaking clients

Question 172

Knowledge of various learning theories is important for community health nurses involved in health education. Enhancing self-confidence and self-efficacy are important aspects of which learning theory? A. Cognitive learning theory B. Humanistic learning theory C. Behavioral learning theory D. Social learning theory

Answer 172

D. Social learning theory Social learning theory's premise is based on behavior explaining and enhancing learning through the concepts of efficacy, outcome expectation, and incentives. Humanistic theories help individuals develop their potential in self-directing and holistic manners. Although social learning theory is largely a cognitive theory, it also includes elements of behaviorism

Question 173

is gaining knowledge & skills that results in measurable change that occurs over time is called?

Answer 173

Learning

Question 174

Primary prevention teaching topics are:

Answer 174

Safety, nutrition, dental hygiene, basic first aid, vaccine preventable illnesses, personal hygiene, sleep hygiene

Question 175

secondary prevention teaching topics are:

Answer 175

performing SBE (simulation-based education) , cancer screenings

Question 176

tertiary prevention teaching topics are:

Answer 176

use the word managing in the title insert a chronic illness and make topic specific to your population

Question 177

the educational process (5):

Answer 177

1. Identify educational needs 2. Establish educational goals and objectives 3. Select appropriate educational methods 4. Implement the educational plan 5. Evaluate the educational process

Question 178

steps in the teacher-learner process:

Answer 178

1. Assessment of learner's characteristics and needs 2. Develop expected learning outcomes 3. Develop teaching plan (Content/strategies) 4. Implement teaching plan 5. Evaluate (Achievement of learning outcome and Teaching process)

Question 179

Nurses assessment of learner:

Answer 179

``` Age, developmental stage, level of education Health beliefs Motivation, readiness to learn Health risks Current knowledge and skills Barriers and facilitators to learning ```

Question 180

3 educational issues:

Answer 180

1. Population considerations - Populations based on age - Populations based on culture 2. Barriers to Learning - Educator-related barriers - Learner-related barriers 3. Technological Issues - Computer games and programs - Internet and the World Wide Web

Question 181

Examples of cognitive educational theories:

Answer 181

Seat belts save lives Cigarettes cause cancer Walking is beneficial to overall health New USDA's My Plate

Question 182

Behavioral theory

Answer 182

- Changes behavior using feedback and reinforcement | - educator has control over rewards and consequences

Question 183

Examples of behavioral educational theories:

Answer 183

Walking- pedometers, most steps wins Quit smoking, use money saved/year for vacation. Click it or ticket

Question 184

Examples of educational developmental theories:

Answer 184

walking In elderly: focus is on falls prevention and walking Safety In toddlers: focus on stair and climbing/ poison safety Dental hygiene kids- how to brush, when and why old- importance of still brushing w/ w/o teeth smoking: kids- prevention old-stop smoking

Question 185

Examples of educational humanistic theories:

Answer 185

Walking: "mrs. smith have you tried walking with your husband?" seat belts: pt uses seat belt bc her 4 year old grand kid always reminds her smoking: "mrs. brown have you considered the effects of second hand smoke on your baby?"

Question 186

Examples of social learner educational theories:

Answer 186

combines (self-efficacy) more than belief in ability to do "Just Say No" EX. MY co worker quit a 3 pack a day 20 year habit so I can do it too

Question 187

Cognitive domain of learning example:

Answer 187

EX. Hand washing: What supplies do I need (recall)? Explain the order of the supplies used for hand washing (Comprehension)? When should I wash my hands( application)? Why is it important for me turn the facet off with a paper towel (analysis)? What would happen if I use my clean hands (analysis)? Explain to me how to properly wash hands (synthesis.) Show me how to properly wash your hands (evaluation).

Question 188

Affective domain of learning example:

Answer 188

EX. this is your brain on drugs (fried egg). have people samples a low salt food item/healthy snack & enjoys.

Question 189

Cognitive (knowledge) domain of learning example:

Answer 189

EX. Hand washing: What supplies do I need (recall)? Explain the order of the supplies used for hand washing (Comprehension)? When should I wash my hands( application)? Why is it important for me turn the facet off with a paper towel (analysis)? What would happen if I use my clean hands (analysis)? Explain to me how to properly wash hands (synthesis.) Show me how to properly wash your hands (evaluation). - memorizing - reasoning - thinking and problem solving

Question 190

The affective (attitude) domain of learning example:

Answer 190

learners attitudes and feelings that are a result of the learning process examples: - appreciation - motivation - adopting - emotional growth - interpersonal development

Question 191

The psychomotor (skills and doing) domain of learning example:

Answer 191

EX. allow kids to make a healthy snack during a nutrition presentation make ants on a log, granola and yogurt (the doing) -this requires the skills are acquired and integrated using mental and muscular activity example: typing playing

Question 192

Which is the most accurate definition of an exposure pathway? A)The total amount of a contaminant that comes in direct contact with the body B)Factor that determines a person's level of exposure to a contaminant C)Method by which people are exposed to an environmental contaminant D)Process to determine whether exposure to an environmental contaminant has occurred

Answer 192

C (method by which people are exposed to environmental contaminants) rationale: An exposure pathway is the method by which people are exposed to an environmental contaminant that originates from a specific source. Exposure is a measure of the total amount of a contaminant that comes in direct contact with the body. An exposure estimate is a method of determining a person's level of exposure to a contaminant on the basis of associated factors. An exposure history is a process to help determine whether an individual has been exposed to environmental contaminants.

Question 193

``` The nurse visits the home of client in a low-income community and notices that paint is flaking off the walls and forming a dust in the corners of some rooms. The nurse asks the client when the house was built, and she responds that it was built in 1959. Which contaminant should the nurse expect to find in this home? A)Lead B)Radon C)Asbestos D)Pesticide ```

Answer 193

A (lead) rationale: Contaminants in the environment, such as asbestos, lead, or radon, influence human health. For example, lead was used in paint until the 1970s and is often found in houses built earlier. As the old paint breaks down, lead can be found in dust and old paint chips in homes. In communities with older, deteriorating housing, children can be exposed to lead. In many cases, such housing is found in poorer communities. There are no indications of the other contaminants being present.

Question 194

Several important pieces of legislation have helped highlight the importance of environmental health and environmental protection. Which best describes Superfund? A)National program to control the damaging effects of air pollution B)Program that protects and enhances the quality of the nation's air by regulating stationary and mobile sources of air emissions C)Environmental program established to address abandoned hazardous waste sites D)Comprehensive framework of standards, technical tools, and financial assistance to address the many causes of pollution and poor water quality

Answer 194

C (Environmental program established to address abandoned hazardous waste sites) rationale: Superfund is the name given to the environmental program established to address abandoned hazardous waste sites. The Clean Water Act focuses on improving the quality of the nation's waters. It provides a comprehensive framework of standards, technical tools, and financial assistance to address the many causes of pollution and poor water quality, including municipal and industrial wastewater discharges, polluted runoff from urban and rural areas, and habitat destruction. The Clean Air Act is a national program to control the damaging effects of air pollution. It protects and enhances the quality of the nation's air by regulating stationary and mobile sources of air emissions.

Question 195

Which is the most accurate definition of a risk assessment? A)Assessment of the adverse effects of chemical, physical, or biological agents on people, animals, and the environment B)Process to help determine whether an individual has been exposed to environmental contaminants C)Assessment of factors that determine a person's level of exposure to an environmental contaminant D)Determination of the likelihood of adverse effects in a group exposed to an environmental contaminant

Answer 195

D (Determination of the likelihood of adverse effects in a group exposed to an environmental contaminant) rationale: Risk assessment is the process to determine the likelihood or probability that adverse effects such as illness or disease will occur in a group of people because of an exposure to an environmental contaminant. Toxicology is the study of the adverse effects of chemical, physical, or biological agents on people, animals, and the environment. Exposure history is the process to help determine whether an individual has been exposed to environmental contaminants. Exposure estimate is assessment of factors that determine a person's level of exposure to a contaminant.

Question 196

There are different methods for conducting risk assessment for environmental contaminants. Which formula determines the amount of risk? C (A)Hazard = exposure × risk B)Exposure = risk × hazard C)Risk = contaminant presence × exposure D)Risk = hazard × exposure

Answer 196

D ( risk=hazard x exposure) rationale: A key concept for assessing risk is that the amount of risk equals the hazard times the exposure (risk = hazard × exposure). The presence of a hazard alone does not determine the amount of risk the hazard poses.

Question 197

Which exemplify environmental media and transport mechanisms within an exposure pathway? (Select all that apply.) ``` A)Mercury B)Groundwater C)Pond D)Air E)Subsurface soil ```

Answer 197

B,C,D,E (groundwater, pond, air, subsurface soil) rationale: Environmental media include groundwater, surface water (lakes, ponds, and rivers), air, surface soil, subsurface soil, sediment, and biota (plants and animals). The environmental medium that the contaminant is in helps determine who is exposed and how they are exposed. Mercury is an example of a contaminant, or source of contamination.

Question 198

The nurse applies the nursing process to a case in which a client has been exposed to an environmental contaminant. The nurse considers the question, “Has the exposure pathway been interrupted?” This question would be considered during which phase of the nursing process to examine the impact of the environment on human health? A)Assessment B)Planning C)Intervention D)Evaluation

Answer 198

D (evaluation) rationale: An evaluation, not assessment or planning, is performed for any intervention to decide whether the intervention has achieved its goals and whether improvements or changes need to be made.

Question 199

Which most accurately describes environmental epidemiology? A)Focuses on the amount of a contaminant that is absorbed into the body B)Involves monitoring the results of medical tests to determine whether a person has been exposed to a contaminant C)Focuses on the incidence and prevalence of disease or illness in a population from exposures in their environments D)Involves monitoring the number of adverse effects of chemical, physical, or biological agents on people, animals, and the environment

Answer 199

c (Focuses on the incidence and prevalence of disease or illness in a population from exposures in their environments) rationale: Environmental epidemiology is a field of public health science that focuses on the incidence and prevalence of disease or illness in a population from exposures in their environments. Bioavailability is the amount of a contaminant that is absorbed into the body. Biomonitoring is the process of using medical tests such as blood or urine collection to determine whether a person has been exposed to a contaminant and how much exposure he or she has received. Toxicology is the study of the adverse effects of chemical, physical, or biological agents on people, animals, and the environment.

Question 200

Children may be more vulnerable to environmental exposures than adults. There are several factors that increase children's vulnerability. Which factors should be considered with children? (Select all that apply.) A)Their body systems are still rapidly developing. B)They eat less, drink less, and breathe more in proportion to their body size than do adults. C)Their bodies may be less able to break down and excrete contaminants. D)Their behaviors can expose them to more contaminants. E)Their breathing zone is further from the ground.

Answer 200

A,C,D rationale: Children may be more vulnerable to environmental exposures than are adults. Several factors increase children's vulnerability, including the following. Children's body systems are still rapidly developing. Children eat more, drink more, and breathe more (not less) in proportion to their body size than adults. Children's breathing zone is closer to (not further from) the ground than adults'. Children's bodies may be less able to break down and excrete contaminants. Children's behaviors can expose them to more contaminants.

Question 201

What is in the environment that can affect it? (Select all that apply) a. the physical environment b. the social environment c. the cultural environment d. the economic and political environment

Answer 201

a,b,c,d physical environment - where we live, what is in it social environment- resources, relationships where we live, educational cultural environment economic and political environment- affect resources and policies

Question 202

Healthy people 2020 and environmental health and priorities include:

Answer 202

Air quality-estimated that 50,000 deaths/year are due to poor air quality Safe drinking water Reduction of water-borne disease Quality of water used for fishing Decreased pesticide exposure--> rural areas and contribute to cancer Decreased indoor pollution--> dust-leads to asthma, respiratory problems

Question 203

Agent-chemical mixtures Host-various people in a community Environment-air, water, soil, food, temperature, wind and humidity A harmful agent needs to come in contact with a susceptible host in the right environment. Disease can be prevented by interrupting the triangle on any of the three sides. What is this called ?

Answer 203

Epidemiological triangle

Question 204

Areas of environmental health:living patterns

Answer 204

-Relationship among people and their environment -Reflect a person’s lifestyle choices-second hand smoke , crime, drugs -People living near hazardous facilities-environmental racism Lower economic status= poor housing, high crime rates, and environmental hazards

Question 205

Major contributors to air pollution

Answer 205

Cars-most significant contributor Fossil fuels-diesel, industrial boilers and power plants, mercury released into air Health Risks associated with poor air quality-asthma, bronchitis, lung cancer Greenhouse effect-loss of vegetation releases stored CO2 which traps heat and increases earth’s surface heat. Causes sea levels to rise and more severe weather patterns

Question 206

water quality: sources of water pollution

Answer 206

1. Contamination-waste, chemicals, lead, mercury 2. Septic or sewage systems 3. Run off from construction sites 4. Agriculture-pesticides, fertilizers (end up in water systems) 5. Pollution can be a well defined point source or a large non-point source e.g. air to water transfer of mercury * EPA has regulations for this

Question 207

HOUSING: Major environmental problems:

Answer 207

Refers to the availability, safety, structural strength location and cleanliness - Increased indoor allergen levels-mold, dust, carbon monoxide, pets and pests - Radon poisoning-radioactive decay of granite & black slate. Colorless, odorless gas seeps into home via cracks in the foundation. Major cause of lung cancer - Fire hazards (hoarders, exposed wiring, smokers) - Lack of access for the disabled - Overcrowding (a lot of people over dwelling in a small house) - Inadequate heating or cooling- too hot or too cold

Question 208

types of allergens in house

Answer 208

``` dust mold carbon monoxide pets (dander) pests (mice, roaches, bed bugs) ```

Question 209

Radon poisoning

Answer 209

-colorless -odorless--> seeps into homes through cracks in the foundation -major cause of lung cancer -inspection needed -fill cracks get detectors

Question 210

EFFECTS OF POOR HOUSING

Answer 210

1) Spread of communicable disease 2) Poor air quality-dust, mold, smoke, lead, carbon monoxide, radon 3) Sick building syndrome-buildings or home causes symptoms e.g. headache, fatigue, allergies from poor ventilation. Symptoms subside when out of home or building.

Question 211

``` Food quality (refers to availability, cost, safety and the health of animal and plant sources) some problems are: ```

Answer 211

- Chemicals/additives - Salmonella and e-coli contamination - Parasite contamination - Hepatitis A - Unsafe handling, storage & transport of foods (trucks come from other places, refrigeration could not be working, food contaminants, food expirations, food coming from other countries and they have different regulations)

Question 212

Environmental Problems Related to Waste Management | are:

Answer 212

- Use of non-biodegradable plastics - Inefficient recycling programs - Unlicensed waste dumps - Inadequate sewage systems - Industrial dumping of toxic waste - Lack of enforcement of environmental protection legislation

Question 213

HEALTH RISKS ASSOCIATED WITH WASTE MANAGEMENT

Answer 213

1) Methane gas accumulation- from decomposing organic waste can cause fires and explosions. Gas moves through soil. 2) Radiation risks-can cause increased rates of cancer, immune damage, birth defects

Question 214

EPA Superfund- 1980 | it was created for:

Answer 214

Build and renovate water treatment plants Develop energy source alternatives to fossil fuels Promote recycling Clean up toxic waste sites 2019-1303 superfund sites in US. Number 1 NJ 114 of the most toxic sites, number 2 California 97 sites and number 3 Pennsylvania 95 sites

Question 215

EPA stands for:

Answer 215

Environmental protection agency

Question 216

EPA Process Used to Control Pollution is:

Answer 216

1. Permitting (need from federal government) - places limits on industrial waste emitted into air and water. - Establishes a maximum contaminant level of a substance. - Level based on health risks - Emit limit is they tell you can only produce a certain amount of waste 2. Monitoring (will happen unannounced) - inspections to ensure safety - industries need to keep good records of waste 3. Compliance - ensure requirements of permit are met - if you don't comply you will be shut down and the government will come in and take over (superfund site) 4. Enforcement 5. Clean up and remediation (the place can be financially responsible) * Right to know-laws give people right to know about hazards in their environment (see on site)

Question 217

THE PUBLIC HEALTH NURSE’S RESPONSIBILITIESAssessment-Quick assessment of person’s history of exposure to hazardous substances: IPREPARE (what does it stand for)?

Answer 217

I-investigate potential exposures P-present work R-residence E-environmental concerns- your neighborhood P-past work- people over around a lot and have different exposures A-activities- hobbies, hunting, fishing, gardening, fertilizers R-referrals and resources- look up what they were exposed too E-educate- educate them *contact the EPA for consult

Question 218

``` The nurse asks a client, “Do you wear the clothes you wear at work to home?” This is an example of which subject on the exposure history? A)Present work B)Past work C)Home/residence D)Concerns ```

Answer 218

A ( present work)

Question 219

SPECIFIC ASSESSMENT OF AN INDIVIDUAL’S EXPOSURE includes:

Answer 219

1. what have they been exposed too? 2. Access toxicology data of the specific chemical. Is chemical related to health problems? 3. . Determine how the chemical has been released into the environment 4. Determine how much of the chemical might have entered the body (did they eat it, inhale it, touch it) 5. Predict the potential harm based on the estimated exposure

Question 220

VULNERABLE POPULATIONS | Children-Health Problems Associated With Environmental Factors

Answer 220

A. Autism-prevalence has increased more than any other medical condition B. Cancer-leukemia and CNS tumors C. Asthma in children

Question 221

Infants' body characteristics that put them at risk?

Answer 221

- premature immune system (not fully formed) - trachea is more narrow - blood brain barrier is not mature - increased rr

Question 222

ENVIRONMENTAL RISKS DURING PREGNANCY

Answer 222

Highest risks are exposure of the fetus to radiation, lead and mercury - Exposure to mercury during the last trimester may cause abnormal brain development in the fetus. - Pregnant woman should avoid shellfish, tile fish, shark, swordfish and mackerel during pregnancy.

Question 223

THE NURSE’S ROLE when dealing with environmental issues

Answer 223

A. Advocate for change-need changes in social, economic and political structures to improve the environment. - Use the objectives of Healthy People 2020 as a guide for change. - Involve community in identifying and solving environmental problems. - Form coalitions with existing organizations - Research * get community involved

Question 224

What is the specialty practice in nursing that focuses on the promotion, prevention, and restoration of health within the context of a safe and healthy work environment called? it also contains all 3 levels of prevention!

Answer 224

Occupational health nursing

Question 225

Occupational health nursing is what type of practice?

Answer 225

Multidisciplinary practice contains: - Nursing and medical science - toxicology--> effects of chemicals on health - industrial hygiene--> identify hazards and use control measures to protect workers - safety--> ergonomics to minimize work-related injuries - business and economic theories- planning and cost-effectiveness - social and behavioral sciences--> services for personal problems: alcohol, drugs, mental health - environmental health - legal and ethical issues

Question 226

Regarding Occupational health What are some of the Healthy people 2020 Goals:

Answer 226

decrease in: - work-related injury/death - assault and homicides - lead and other chemical exposure - skin diseases and eye injuries - stress - needle stick injury and hep B - hearing loss

Question 227

WORK-RELATED AND ENVIRONMENTAL HAZARDS | what are some of the types?

Answer 227

1. Chemical-medications, solutions, gases 2. Enviromechanical-poor equipment, slippery floors-major problem=back & neck injuries 3. Physical agents-radiation, extreme temperatures, electricity, noise 4. Psychosocial-situations that cause stress or interpersonal problems 5. Biological-infections, blood & body fluids

Question 228

EPIDEMIOLOGIC MODEL FOR OCCUPATIONAL HEALTH HOST--> all workers considered at risk. Factors associated with increased risk are? (Select all that apply) a. age b. gender/women of childbearing age c. health status d. the workplace

Answer 228

all are correct and considered risk factors at work a. age (at risk at any age) but older people can have more injuries due to hearing loss, loss of vision, decreased reaction time b. gender/pregnancy (high risk) c. health status (do you have chronic conditions, do you have musculoskeletal problems- knee/back/muscles) d. the workplace- things in the workplace that can affect you Non-modifiable risk factors: age, gender, ethnicity, chronic diseases (can be minimized but never erased) modifiable: lifestyle, work practice and to some degree health status

Question 229

EPIDEMIOLOGIC MODEL FOR OCCUPATIONAL HEALTH AGENTS- name some

Answer 229

1. Biological/Infectious- bacteria, viruses, fungi, protozoa, helminths (microorganisms produce toxins), the transmission of resistant infectious agents, biologic hazards NURSES, Healthcare workers, cleaners, maintenance and security--> exposed to linens, trash, contaminated equipment which may result in illness 2. Enviromechanical factors (chemical agents)- coal dust, fumes, radiation exposure, gases 3. Physical agents- sources of energy that may lead to injury or illness Ex: vibration in tools leads to vasoconstriction of arteries in fingers and toes (raynauds phenomenon); radiation, temperature extremes, noise, lighting, falls, and unsafe equipment SOLUTION--> monitoring the exposure to agents and proper use of PPE, hearing protection, eye guard in the industry 4. Psychosocial factors- include all organizational and interpersonal relationships in the workplace that may affect the health of the workers Examples: stress from overworking, unfairness in the workplace, time pressure, exposure to infectious diseases, needlestick injuries, and understaffing, workplace violence SOLUTION--> to identify the issues and address them head on

Question 230

OSHA stands for:

Answer 230

Occupational safety and health administration their mission is to: -prevent workplace injuries, illnesses, and fatalities by setting federal standards regulating workers' exposures to potentially toxic substances.

Question 231

EPIDEMIOLOGIC MODEL FOR OCCUPATIONAL HEALTH HostAGENTEnvironment ENVIRONMENTal factors in the workplace?

Answer 231

Environment influences the occurrence of host-agent interactions - Water (lead in the water, high chemicals/toxins) - Air quality/temperature/ventilation (pollution) (unintentional exposure-car fumes affecting patients that are close to the roadway) - Levels of stress - Noise - economic and political decisions--> factors such as adequate housing, literacy, crowding, culture, customs, and availability and accessibility of healthcare services are issues to be addressed - social problems--> drug and alcohol abuse, infectious disease and poverty can have an effect on the workplace productivity

Question 232

Levels of prevention in occupational health nursing?

Answer 232

1. Primary-involves health promotion and disease/injury prevention. Education. Perform walk-throughs to identify hazards 2. Secondary-goal is early diagnosis and treatment. Provide care for illness or injury to limit disability, screening, counseling 3. Tertiary-goal is to return the worker to the highest level of functioning following an illness or injury. Case management

Question 233

The occupational health nurse finds several workers in a factory complaining of hearing loss and heat exhaustion. These are most likely caused by: A. Chemical hazards B. Physical hazards C. Enviromechanical hazards D. Biological hazards

Answer 233

B physical hazards

Question 234

Work-related health problems such as back problems are most likely to be caused by: A. Biological hazards B. Chemical hazards C. Physical hazards D. Enviromechanical hazards

Answer 234

D. Enviromechanical hazards

Question 235

A nurse in a large auto plant believes that lack of protective equipment violates federal standards. Management does not share the concern. The nurse should contact: A. Civil Rights Commission B. Environmental Protection Agency C. Occupational Safety and Health Administration

Answer 235

C. Occupational Safety and Health Administration

Question 236

ROLES OF THE OCCUPATIONAL HEALTH NURSE Clinician role involves

Answer 236

The occupational health nurse acts as a clinician whose primary responsibilities are to prevent work and non-work related health problems and to restore as well as maintain the health of workers includes: 1. assessments of hazards, surveillance of the workers and workplace, investigations of illness, and monitoring events that lead to an injury are fundamental to achieving this goal A. WORKER ASSESSMENT -Clinical-physical assessments, provide interventions for injury etc. maintain records, take an occupational health history, referrals B. Workplace Assessment -assessing the workplace and should be comprehensive and include employees and to identify hazards (fire prevention plans, alarms and detective devices, exits, occupancy and building diagrams, procedures/processing /shipping receiving, power tools, worker training procedures, hazardous materials, emergency action plans, PPE policies and procedures of when to use, electricity/lighting, heating/ventilation, airconditioning, fall prevention program

Question 237

ROLES OF THE OCCUPATIONAL HEALTH NURSE Case-Manager role involves

Answer 237

coordination and management of services for ill or injured workers, including various aspects related to group health, workers compensation, and regulations pertaining to the FMLA (family medical leave act), GOAL--> to do everything that can be done to prevent accidents and minimize illness - they track each incident that relates to employee health and safety, beginning immediately after the onset of an illness or injury and continuing through rehab and return to work. - Involves WORKPLACE ACCOMMODATION in order to return to work accommodation the worker based on their injuries or abilities after rehab (tertiary level) - Contains Root Cause Analysis (want to know what happened, why it happened, and what can be done to prevent a reoccurrence

Question 238

ROLES OF THE OCCUPATIONAL HEALTH NURSE Counselor/consultant

Answer 238

acts as an advisor in selecting, developing, implementing, and evaluating occupational health and safety services within both organizations and communities - as a clinician and consultant, it is the role of the OHN to investigate all possible material and chemical exposures that could lead to an adverse reaction in the workers - MSDS (material safety data sheets) provides information to employers from the manufacturer or producer of substances - COUNSEL groups on psychosocial needs, wellness, health promotion concerns, substance abuse, and work-related issues.

Question 239

ROLES OF THE OCCUPATIONAL HEALTH NURSE Health promotion and disease prevention specialist

Answer 239

-the objective is to create an environment for the worker that provides a sense of balance among work, family, personal health, and psychosocial concerns assess worker’s needs/problems, plan, implement and evaluate health programs -participates in the development and management of a multidimensional, broad-range health promotion program that supports the business objectives of the organization -health promotion and prevention is a function the the OHN performs along the continuum of the worker population

Question 240

ROLES OF THE OCCUPATIONAL HEALTH NURSE Occupational safety

Answer 240

develop and implement a training program for workers

Question 241

ROLES OF THE OCCUPATIONAL HEALTH NURSE researcher

Answer 241

identify researchable problems, collect and analyze data, identify trends

Question 242

ROLES OF THE OCCUPATIONAL HEALTH NURSE Professioanlism

Answer 242

attend continuing education programs, maintain currency in practice

Question 243

ROLES OF THE OCCUPATIONAL HEALTH NURSE Management

Answer 243

prepare budgets, business planning, quality assurance, manage workman’s compensation, coordinate site disaster planning

Question 244

FEDERAL LEGISLATION & OCCUPATIONAL HEALTH Mine Safety and Health Act (1968)

Answer 244

first legislation that required prevention programs for workers

Question 245

FEDERAL LEGISLATION & OCCUPATIONAL HEALTH Occupational Safety Health Act (1970)

Answer 245

provides for federal occupational safety and health standards. Provides for the establishment of state occupational safety administrations. Agencies-Occupational Health and Safety Administration and National Institute For Occupational Safety and Health (under CDC-research oriented). OSHA--> enforce that rules and regulations are being followed in a workplace, can come in and make sure at any time

Question 246

FEDERAL LEGISLATION & OCCUPATIONAL HEALTH OSHA developed "the right to know" what is it?

Answer 246

All worksites need to have Safety Data Sheets (MSDS) | -workers have the right to know what they could be exposed to

Question 247

FEDERAL LEGISLATION Workers Compensation Act (state funded)

Answer 247

state-mandated and state-funded. | -Provides income and health care to workers who have work-related injuries, temporary or permanent disability or death.

Question 248

FEDERAL LEGISLATION Americans With Disabilities Act(1990)

Answer 248

Prohibits discrimination on the basis of a disability. Includes employers with 15 or more employees. -A person must meet the requirements for the position.

Question 249

ROLES OF THE OCCUPATIONAL HEALTH NURSE Legal and Ethical

Answer 249

practice within the state’s nurse practice act, have knowledge of occupational health and safety issues, maintain confidentiality

Question 250

DISASTER PLANNING SUPERFUND and reauthorization Act

Answer 250

requires that written disaster plans be shared with key resources in the community Goals for disaster plans 1. prevent or minimize injuries and deaths of workers and residents 2. minimize property damage 3. provide triage. *ex: fire drills-there needs to be a fire plan and practice drills and they needed to be current

Question 251

Nurses role in disaster planning

Answer 251

1. Coordinate and implement the plan 2. Provide communication with key people to keep the plan current 3. Plan drills and educate employees about the plan 4. Assess equipment and services needed during a disaster 5. After a disaster, identify ongoing disaster-related health needs, collect data, assess cause of disaster and plan prevention measures

Question 252

Providing appropriate care is what level of prevention?

Answer 252

secondary | - if you don't provide the care you can get a lawsuit against you

Question 253

The occupational and environmental health nurse faces many different practice issues every day and can function comfortably in roles as a clinician, coordinator, and case manager following company procedures, using assessment checklists and clinical protocols to provide treatment. At which American Association of Occupational Health Nurses (AAOHN) competency level in occupational and environmental health nursing is this nurse functioning? A) Advanced beginner B)Competent C)Proficient D)Expert

Answer 253

B (competent) Benner identified five stages of competency in clinical nursing practice: novice, advanced beginner, competent, proficient, and expert. Within each stage are levels of achievement that are expressed in measurable behavioral objectives. AAOHN has cross-referenced and stated behavioral objectives for the OHN in three of these stages: competent, proficient, and expert. The competent nurse is one who is confident and a master, with an ability to cope with specific situations. There is less of a need to rely on the judgment of peers and other professionals.

Question 254

The occupational and environmental health nurse provides leadership in developing occupational safety and health policy within the organization and function in an upper management role. The nurse has served as a consultant to both business and government and has designed and conducted significant research. At which American Association of Occupational Health Nurses (AAOHN) competency level in occupational and environmental health nursing is this nurse functioning? A)Advanced beginner B)Competent C)Proficient D)Expert

Answer 254

D (expert) The expert nurse is one who has extensive experience with a broad knowledge base that enables the nurse to grasp a situation quickly and initiate action. The nurse has a sense of salience grounded in practice guiding actions and priorities.

Question 255

The occupational and environmental health nurse quickly obtains the information needed for accurate assessment and zoom in on the critical aspects of a problem in response to a client situation. The nurse uses highly developed clinical and managerial skills in the work environment. At which American Association of Occupational Health Nurses (AAOHN) competency level in occupational and environmental health nursing is this nurse functioning? A) Advanced beginner B) Competent C) Proficient D) Expert

Answer 255

C (proficient) The proficient nurse is one with the ability to perceive client situations on the basis of past experiences, with a focus on relevant aspects of the situation. The nurse is able to predict expected events in certain situations and recognize that protocols must be altered at times to meet the needs of the client

Question 256

Which exemplifies a physical hazard? A) Infectious agents B) Hazardous drug and toxin exposures C) Electric and magnetic fields D)Sexual harassment

Answer 256

C) Electric and magnetic fields Electric and magnetic fields are an example of a physical hazard. Infectious agents are an example of a biological hazard. Hazardous drug and toxin exposures are an example of a chemical exposure. Sexual harassment is an example of a psychosocial factor.

Question 257

Which exemplify biological hazards? (Select all that apply.) ``` A) Contaminated body fluids B) Poisonous plants C) Diesel exhaust D) Venomous snakes E) Aerosols ```

Answer 257

A,B,D (contaminated body fluids, poisonous plants, venomous snakes) Contaminated body fluids, poisonous plants, and venomous snakes are examples of biological hazards. Diesel exhaust and aerosols are examples of chemical exposure.

Question 258

A line operator in a manufacturing facility comes in to the on-site clinic reporting numbness in his hands after excessive exposure to the toxin benzene. Applying the epidemiologic triad to this scenario, which is the host? A)Line operator B) Manufacturing facility C) Benzene D) Hands

Answer 258

A (Line operator) The epidemiologic triad is very helpful in occupational health nursing practice as a means to understand the complex relationships among the workers, hazards in the workplace, and hazards in the environment. In the epidemiologic triad, each worker is a host within the work population. The agents in the epidemiologic triad are workplace hazards classified as biological, chemical, physical, or psychosocial agents. The workplace exists within an external environment with specific geological and atmospheric characteristics, air and water quality, and presence or absence of environmental pollution.

Question 259

Which injury has the highest incidence rate among occupational injuries and illnesses that result in days away from work? A) Sprains B) Broken bones C) Cuts D) Carpal tunnel syndrome

Answer 259

A) Sprains The highest incidence rate resulting in days away from work occurred from sprains, strains, and tears. Cuts were in second place, fractures in fourth place, and carpal tunnel syndrome in seventh place.

Question 260

Which industry has the highest number of fatal injuries? A) Agriculture B) Construction C) Mining D) Transportation

Answer 260

D (transportation)

Question 261

``` A newly hired health and safety officer works for a large manufacturing facility. One of the officer's first jobs is to conduct a complete survey of the workplace to determine what hazards are present, the location of entries and exits, the availability of emergency equipment, and potential trouble spots. Which interventions should the officer implement to accomplish this goal? A) Ergonomics B) Occupational health history C) Root cause analysis D) Workplace walk-through ```

Answer 261

D) Workplace walk-through A workplace walk-through is a complete survey of the workplace, inside and outside, compiling information as to the presence of hazards, the location of entries and exits, the availability of emergency equipment, and potential trouble spots. Ergonomics is the study of the relationship between people and their working environment. Occupational health history is an assessment of the characteristics of the workers' present jobs, a chronological record of all past work and potential exposures, an occupational exposure inventory, and a list of other exposures in the home or community. Root cause analysis is a process for understanding and solving a problem, with the goal of determining what happened, why it happened, and what can be done to prevent its reoccurrence.

Question 262

The occupational health nurse for an electronics factory compiles an occupational health history for each worker. Which should be included? (Select all that apply.) A) Location of facility exits and entries B) A chronological record of all past work and potential exposures C) An occupational exposure inventory D) List of exposures in the home or community E) Availability of emergency equipment

Answer 262

B) Chronological record of all past work and potential exposures C)An occupational exposure inventory D) List of exposures in the home or community Components of the occupational health history include characteristics of the workers' present jobs, a chronological record of all past work and potential exposures, an occupational exposure inventory, and a list of other exposures in the home or community. The location of facility exits and entries and the availability of emergency equipment are aspects of a workplace walk-through.

Question 263

The occupational health nurse for a hydroelectric plant uses root cause analysis to investigate the recent accidental electrocution of a plant worker. The nurse currently is defining the characteristics of the case. In which step of the root cause analysis is the nurse? A) Define the problem B) Collect data C) Identify possible causal factors D) Identify the root cause

Answer 263

A) Define the problem Defining the problem includes defining the characteristics of the case and determining the circumstances under which it occurred. - Collecting data includes determining whether similar illnesses or injuries occurred in the past, comparing similarities and differences, creating a time line related to the problem, and determining the impact of the problem. -Identifying possible causal factors includes convening people involved in the situation to discuss the cause, determining the sequence of events that led to the illness or injury, identifying the conditions that allowed the problem to occur, identifying related problems, creating a chart of possible causal factors, and identifying causal factors and possible interrelationships. - Identifying the root cause includes identifying the true causes of the illness or injury, determining why the causal factor or factors exist, and determining the real reason the problem occurred.

Question 264

The occupational health nurse for a computer manufacturer is required to conduct a physical examination of each new hire. The rationale for this action is to: A) Screen for cardiac defects the worker may be unaware of. B) Ensure the worker's fitness for the job. C) Determine possible causes of the worker's chief complaint. D) Provide a baseline for future comparison. E) Determine the worker's eligibility for the company health insurance plan.

Answer 264

B) Ensure the worker's fitness for the job. A health record can be kept on the employees as part of their other employment records. This process often starts with an initial physical examination appropriate to the type of work that is going to be done. The physical examination helps ensure fitness for the job and provides a baseline for future comparison. The physical examination is not performed to screen for cardiac defects, determine possible causes of a chief complaint, or determine a worker's eligibility for the company health insurance plan.

Question 265

The occupational health nurse with a construction company is responsible for filling out a record of accidents and illnesses that occur on the company's work sites. Which source should the nurse consult to acquire the proper record-keeping form and guidelines? A) FMLA B) OSHA C) HIPAA D) NORA

Answer 265

B (OSHA) The Occupational Safety and Health Administration (OSHA) designs and distributes record-keeping forms called the OSHA log. The Occupational health nurse is usually responsible for filling out the OSHA log. This injury log is a record of accidents and illnesses that occur within a given year at every workplace facility employing 10 or more people. A-->According to the Family and Medical Leave Act (FMLA), in the case of serious illness affecting themselves or family members, when all conditions are met under this act, employees can leave work for up to 12 weeks and return to work without penalty. D)-->The National Occupational Research Agenda (NORA) is a partnership program to stimulate innovative research and improved practices for safer, healthier workplaces.

Question 266

Which data are tracked under epidemiologic workplace surveillance? (Select all that apply.) ``` A) Injuries B) Illness C) Hazards D) Exposures E) Productivity ```

Answer 266

A) Injuries B) Illness C) Hazards D) Exposures

Question 267

The occupational health nurse at a company has seen three different employees in one week who have all reported similar upper respiratory symptoms. Which rate should the nurse consider calculating to understand the severity of this problem and to determine whether a cluster or cohort is forming? A) Productivity rate B) Incidence rate C) Prevalence rate D) Ratio of affected to unaffected

Answer 267

B) Incidence rate If there happens to be more than one worker from the same department with consistent symptoms and objective findings, the OHN may immediately begin to suspect that a cluster or cohort is forming and should determine the number of new cases of the condition, or the incidence rate. Clusters are aggregations of disease diagnoses collected from a specific population within a distinct period of time or space. The calculation of incidence rates is a helpful tool in understanding the severity of a workplace problem. Prevalence reflects the total burden of the injury or illness that exists in the population—in this case, the workplace. It includes both new cases and existing cases, as opposed to the incidence rate, which only includes new cases. Ratios can compare and involve groups of workers in settings. This approach adds clarity when comparing the number of affected workers in an organization that employs workers located in various geographic locations.

Question 268

Key components of the emergency plan involve

Answer 268

Key components of the emergency plan involve alarms, reporting, communication, evacuation, a system for counting the occupants, procedures for staff who do not immediately evacuate, and rescue and medical services. Phones would not be a component of the plan.

Question 269

The occupational health nurse works in a facility located in a region that is highly prone to tornadoes. Which intervention should the nurse make sure is included in the facility's emergency plan to address this potential threat? A) A shelter-in-place policy and procedure B) Personal protective equipment C) Evacuation drills D) Decontamination procedures

Answer 269

A) A shelter-in-place policy and procedure A shelter-in-place policy and procedure must be established for emergencies such as hurricanes, tornadoes, high winds, or chemical releases in buildings such as healthcare and correctional facilities. Personal protective equipment and decontamination procedures are needed for those who work with and around hazardous materials and chemicals but would not be needed for a tornado. During a tornado, workers should shelter in place, not evacuate the building.