LA#1 Potter & Perry Chapter 2, Stanhope Chaps 1,2,3,11 Flashcards Preview

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Flashcards in LA#1 Potter & Perry Chapter 2, Stanhope Chaps 1,2,3,11 Deck (78):
1

Which one of the following is a reason to study nursing history?a.To fulfill provincial/territorial nursing requirementsb.To help fill up the necessary credit hours for graduationc.To meet accreditation requirementsd.To understand the present and plan for tomorrow

DOne of the best ways to make plans for today and tomorrow is to look at the past to see what did or did not work. Lessons learned through history provide direction for current and future community health nursing practice.

2

Which of the following makes public health nursing appealing to many nurses?a.The autonomy of practice and independence in decision making it affordsb.Its focus on acute care and immediately visible outcomesc.The backup support of other health care professionalsd.The rapport among the nursing staff

AInpatient acute care nurses focus on acute care where outcomes are known fairly quickly. Part of the appeal of community health nursing is the autonomy of practice and independence in problem solving and decision making it affords, as well as its interdisciplinary nature.

3

Which group was the first to establish hospitals?a.Feudal lords, to keep their peons workingb.Small towns, to care for their own citizensc.The military, to enable soldiers to keep fightingd.Religious orders, to care for the sick, poor, and neglected

DHistorically, most people were responsible for their own health care services. However, during the Middles Ages, religious convents and monasteries established hospitals to care for the aged, disabled, orphaned, sick, poor, and neglected.

4

The Industrial Revolution caused earlier caregiving approaches—where care was provided by families, friends, and neighbours—to become inadequate because of constantly increasing demand. Which one of the following situations also contributed to the inadequacy of caregiving approaches at this time?a.Ongoing wars, which caused frequent deaths and injuriesb.Horrific plagues that swept through Europec.Migration and urbanizationd.The need to pay caregivers

COlder forms of care became inadequate because of the social changes in Europe, with great advances in transportation, communication, and other technologies. Increased mobility led to increased demand for health care, migration, and urbanization.

5

Which one of the following events notably changed health care?a.The creation of the discipline of nursing by Florence Nightingaleb.The formation of sisterhoods by nuns who gave carec.The establishment of the Sisters of Mercy in Dublind.The formation of the Dames de la Charité by Saint Vincent de Paul

AMany innovations in health care led to improvements in care, but Florence Nightingale revolutionized health care by establishing the discipline of nursing.

6

Eunice Dyke was a public health nursing pioneer in Canada. In which of the following areas did she play a key role at the beginning of the twentieth century?a.Decentralization of public health nursingb.Specialization of public health nursingc.Inclusion of powerful citizens on health department boards to ensure adequate funds to pay for cared.Development of a system for accurate records of births and deaths

AEunice Dyke played a key role in the decentralization of public health nursing in 1914. Before this time, public health nurses (PHNs) had been working in specialized areas of nursing, such as tuberculosis (TB) care, but now they became generalists (though they did not provide bedside nursing care in the home as community health nurses [CHNs] or visiting nurses would).

7

In what year did the first training school for nurses open in Canada?a.1874b.1894c.1904d.1914

A.The first training school for nurses in Canada opened in 1874, in Ontario.

8

Which one of the following was a very important factor in the success of early visiting nurses?a.The care they provided that served as a model for all later hospitalsb.The more economical care they provided to familiesc.Their role model, Edna Moored.The superb publicity campaign that was created by the health departments

BVisiting nurses, who provided care wherever the client was located—at home, work, or school—took care of several families in one day (rather than taking care of only one patient or family as the private duty nurse did), which made their care more economical.

9

Which of the following nurses was instrumental in establishing the first integrated basic nursing degree program in Canada?a.Florence Nightingaleb.Kathleen Russellc.Edna Moored.Lillian Wald

BIn 1920, Kathleen Russell, Director of the Department of Public Health Nursing at the University of Toronto, was instrumental in establishing the first integrated basic degree nursing program, a major milestone in nursing education, including public health nursing education.

10

Which of the following arguments was used to convince the Metropolitan Life Insurance Company to establish the first community health nursing program for workers in 1909?a.Creating such a service was the morally right thing to do.b.Employing nurses directly would be less expensive than paying taxes to the city to provide nursing services.c.Having the company’s nurses make home visits would increase morale among workers.d.Using PHNs would keep workers healthier, which would increase worker productivity.

DLillian Wald argued that it would be more economical to use the services of a CHN than to employ the company’s own nurses and that keeping workers healthier would increase their productivity.

11

What has been the main achievement of the Community Health Nurses Association of Canada (CHNAC)?a.Licensed practical nurses (LPNs) as well as registered nurses (RNs) were allowed to join the association.b.Nurses who were not PHNs were encouraged to join.c.National standards of practice were developed.d.A process was developed to choose the organization’s leaders and officers.

CIn 1987, the CHNAC, an interest group of the Canadian Nurses Association (CNA), was formed. This association developed the national standards of practice (published in 2003) for CHNs. These standards of practice have helped establish the term community health nursing as the umbrella term for all nurses working in and with communities and defined the minimum scope of practice for CHNs.

12

Following the release of the Romanow Report in 2002, which type of care was identified as the most rapidly growing area of community health care?a.Home careb.Community problemsc.Immunizationd.Women’s issues

AThe Romanow Report (2002) identified home care as the most rapidly growing area of community health care.

13

In which area was the first PHNs in Canada employed?a.Healthy baby clinicsb.Outpost nursingc.School health programsd.Tuberculosis education, prevention, and treatment

DFrom the 1920s to the 1940s, nurses specializing in TB care were replaced by PHNs, as it was believed that visiting nurses would be more effective and efficient if they moved to general nursing care. Therefore, PHNs became specialists in TB education, prevention, and treatment.

14

What was the main reason for the brief existence of the nurse practitioner–model educational program?a.Inadequate assessment and planning in the local areab.Insufficient provincial/territorial fundingc.The large number of primary care physicians practicing in urban areasd.The need for nursing expertise and skills

CIn Ontario, the nurse practitioner model for alternative health care delivery was initiated with the educational program offered by McMaster University. However, its existence was short-lived because of a perceived duplication of services and a lack of career opportunities for nurse practitioners, partly because there were too many primary care physicians practising in urban areas.

15

Which one of the following is the main area of concern for the occupational health nurse (OHN)?a.Increasing benefits upon renewal of employment contractsb.Ensuring higher salaries and bonuses upon acceptance of employmentc.Returning most nursing care to the home, where family members give all needed cared.Focusing on disease prevention activities in the workplace

DOccupational health nursing is a specialty area within community health nursing, with a focus on disease prevention, rehabilitation, and health promotion activities in the workplace.

16

Which of the following best describes the concept of public health?a.A population health approach designed to prevent disease, promote health, and protect populationsb.Health care provision offered in primary and secondary institutions or in clients’ homesc.Provision of health care services in institutions located in the community but outside the hospitald.Use of the nursing process and evidence-informed practice to meet the objectives for community health improvement

AIn Canada, public health takes a population health approach to protecting and promoting health and preventing disease for all Canadians. Public health nurses (PHNs) work with many partners, both within the public health unit or health authority (e.g., nutritionists, epidemiologists, dental hygienists, health inspectors) and external to the health unit (e.g., community coalitions for heart health, cancer screening, diabetes, and obesity prevention; school and hospital administrators; regional planners; social service and child-care workers; lobbyists for health issues such as antismoking legislation and homelessness).

17

The increasing complexity of societal needs and rapid changes in public health no longer allow adequate time for on-the-job training and education. As a result, which of the following is the current minimum level of educational preparation for a military nurse?a.Training as a registered practical nurseb.Training as a registered nursec.A baccalaureate degree in nursingd.A master of science degree in nursing

CEducational preparation for military nurses should be at least a baccalaureate degree.

18

Which of the following is a core competency required of PHNs?a.Advanced knowledge in the use of high-technology diagnosticsb.Familiarity with current life-support technologyc.Highly tuned skills for assessment of critically ill clientsd.Skill in developing policy and planning programs to improve health

DSkill in developing policy and planning programs to improve health is part of the set of core public health competencies, which are divided into the following eight domains: 1) Public Health and Nursing Sciences; 2) Assessment and Analysis; 3) Policy and Program Planning, Implementation, and Evaluation; 4) Partnerships, Collaboration, and Advocacy; 5) Diversity and Inclusiveness; 6) Communication; 7) Leadership and Professional Responsibility; and 8) Accountability. The other competencies listed are better suited to nurses who work in tertiary facilities, such as hospitals.

19

A public health administrator is in the process of hiring a new PHN. Which of the following statements by a potential employee would raise the greatest concern for the employer?a.“I like to be the only person working on a project because individual team members have their own ideas and plans, and the resulting debate slows progress.”b.“I prefer to work in teams because no single person has too much responsibility and the burden is shared.”c.“Teamwork is better than work done by individuals because teamwork incorporates different perspectives.”d.“Whether teamwork is better than work done by individuals depends on the nature of the work being performed.”

AWorking in collaborative partnerships is an essential role of public health nursing. Partnerships and collaboration among groups are much more powerful in making changes than are the individual client and the PHN working separately. Part of the reason for this is that multiple perspectives are examined in the process of arriving at the best solution.

20

Which one of the following is a primary prevention activity for decreasing the incidence of communicable diseases?a.Identifying and treating clients in a clinic for sexually transmitted infections (STIs)b.Partnering with school teachers to teach handwashing to elementary school children and observe their techniquesc.Providing case management services that link clients with communicable diseases to health care and community support servicesd.Providing directly observed therapy (DOT) to clients with active tuberculosis (TB)

BAn example of primary prevention is to educate daycare centres, schools, and the general community about the importance of hand hygiene to prevent transmission of communicable diseases.

21

A PHN is participating in which activity when tracing the sexual contacts of clients with STIs for screening purposes?a.Primary preventionb.Secondary preventionc.Tertiary preventiond.Secondary and tertiary prevention

APrimary prevention activities include contacting and tracing individuals exposed to a client with an active case of TB or an STI. Once contact has been made, the actual screening is a secondary prevention activity.

22

Through which one of the following actions can the community health nurse (CHN) provide tertiary prevention?a.Disseminating information about mental health to community organizationsb.Partnering with PHNs for early identification of children with mental health challengesc.Providing case management services that link clients with serious mental illnesses to mental health and community support servicesd.Screening clients at high risk for mental disorders

CAn example of tertiary prevention is the provision of case management services that link clients identified with serious mental illnesses to mental health and community support services.

23

Which of the following represents the primary difference between parish nursing and all other fields of nursing?a.Affiliation with a church or congregationb.Incorporation of spiritual aspects into nursing carec.Provision of holistic nursing cared.Residence within the community of service

AParish nurses are found in faith congregations, including communities that serve diverse cultures. Parish nurses also serve faith communities in other countries.

24

To help congregation members better meet their nutritional needs, a parish nurse encourages them to participate in activities that focus on fellowship, as well as serving healthy meals to both attending and homebound church members. What do programs such as this exemplify?a.Entitlement programsb.Health ministriesc.Partnershipsd.Pastoral care practices

BHealth ministries comprise those activities and programs in faith communities that are organized around health and healing to promote whole health across the lifespan. Health ministries’ services may be specifically planned or informal and may include visiting the homebound, providing meals for families in crisis or for those returning home after hospitalization, organizing prayer circles, volunteering in community HIV/AIDS care groups, serving “heart healthy” church suppers, and holding regular grief support groups.

25

As part of primary prevention, a parish nurse wants to encourage some elementary school students to increase their vigorous exercise. Which action by the parish nurse will help these students attain an improved health status?a.Encouraging families to ensure that the students receive healthy diets and plenty of restb.Fostering relationships among families with children of similar ages so that they can work together toward goal attainmentc.Partnering with a youth pastor to establish sports activities that will include those individuals with special needsd.Working with faith-based school teachers to include in the curriculum teaching about healthy diet and food selection

CParish nursing’s goal is to develop and sustain health ministries within faith communities. Some of the usual functions of parish nurses include providing personal health counselling and health education, acting as a liaison between the faith community and the local community, facilitating activities, and providing pastoral care.

26

Which statement by a parish nurse exhibits a misunderstanding of the concept of pastoral care?a.“By working with my clients to help them identify their spiritual strengths, I am drawing on the pastoral care aspects of practice.”b.“I incorporate pastoral care in my practice when I involve the pastor in ministering to the members of the congregation.”c.“I am practising pastoral care when I emphasize the spiritual dimension of nursing while providing care.”d.“Lending support to clients during their times of joy as well as times of sorrow is part of providing pastoral care.”

BPastoral care by a parish nurse implies providing care by stressing the spiritual dimension of nursing, lending support during times of joy and sorrow, guiding the person through health and illness throughout life, and helping identify the spiritual strengths that assist in coping with particular events. The parish nurse is able to provide pastoral care; she or he does not have to involve the pastor.

27

Through which one of the following interventions can the parish nurse implement primary prevention of obesity in school-aged church members?a.Establishing a walking program that is sufficiently challenging, yet not too strenuous, for those who are obeseb.Partnering with youth camp cooks to ensure that a nutritious diet is providedc.Supervising height and weight measurements taken by clinic assistantsd.Working with parents of obese children to implement lifestyle changes in the family

BAn example of primary prevention is encouraging the provision of healthy snacks and meals to children and adults at all events inside and outside of school.

28

What is the basic difference between home health care and other types of health care?a.Home health care is individualized care for the client and family.b.Home health care is provided in the client’s environment.c.Reimbursement for home health care is different from that of care provided in institutions.d.Home health care focuses on community health.

BHome health care differs from other types of health care in that home health care providers practice in the client’s environment.

29

A CHN has just received word that the provincial health care plan will provide compensation for the care that she provided to a homeless man with schizophrenia, who was unwilling to come to the clinic to receive health care. How can this type of nursing service be best classified?a.Community-oriented nursingb.Home health nursingc.Hospice nursingd.Private duty nursing

BHome health nursing is provided in the client’s environment, wherever that may be. “Home” may be a house, apartment, trailer, boarding and care home, shelter, car, makeshift shelter under a bridge, or cardboard box.

30

Which of the following is the best way a home health nurse (HHN) can help a client who has right-sided paresis secondary to a stroke?a.Arranging for private duty nurses to assist the client with daily needsb.Assisting the client with activities of daily living (ADLs)c.Teaching self-care to the clientd.Teaching the family to assist the client with ADLs

CBecause home health care is often intermittent, a primary objective for the HHN is to facilitate self-care. This allows clients to have some control over their lives and activities and can help prevent hopelessness and a loss of self-esteem. Although assistance may be provided occasionally, this comes after helping clients help themselves.

31

An HHN in training states, “I don’t understand why we have to collaborate with so many other disciplines. Doesn’t this conflict with the concept of holistic nursing practice?” Which of the following statements would be the best response by an experienced colleague?a.“The nurse still functions holistically; however, interdisciplinary collaboration is necessary to prevent fragmentation of care.”b.“Holistic nursing is a concept applied to care in tertiary facilities such as hospitals, where materials are centrally located in one facility. In home health, this is not possible.”c.“Even though home health nursing is not as holistic as other areas of community health nursing, each discipline contributes to client needs from its special knowledge base.”d.“Yes, it does create conflict, but we as nurses are mandated to practise interdisciplinary collaboration.”

AHome health nursing involves interdisciplinary care. Coordination of care provided by an interdisciplinary team is an essential indirect function of the HHN. Team conferences are an ideal time for enhancing collaboration and continuity of services for optimal client care and use of resources and services. Without effective collaboration, there would be no continuity of care and the client’s home care program would be fragmented. This does not conflict with the concept of holism, however. Holism does not require that the HHN provide all services (i.e., direct client care). Many services, such as coordination of care, provide indirect care and contribute to holistic nursing care provision.

32

A family member asks an HHN to explain the concept of hospice care. Which of the following actions would the HHN need to include as the fundamental underlying philosophy of hospice?a.Making it possible for the client to die at homeb.Ensuring that the client’s living will is honouredc.Placing experts in the position of power of attorneyd.Providing comfort measures before death

DHospice care refers to the delivery of palliative care to the very ill and dying, offering both respite and comfort. If the client and family agree, hospice care can be comfortably delivered at home with family involvement under the direction and supervision of health care providers, especially a home health nurse.

33

In an effort to prevent drug abuse among junior high–school students, a CHN has enlisted the assistance of high-school role models in the areas of both sports and scholarship for an antidrug presentation. Which level of prevention is represented by this activity?a.Primary preventionb.Secondary preventionc.Tertiary preventiond.Both primary and secondary prevention

ACHNs partner with the community to develop programs in response to identified needs. Primary prevention interventions by the CHN include educating children and adolescents about the effects of illegal drugs (e.g., marijuana, cocaine, and heroin) and alcohol abuse. By educating students, the CHN helps them stay away from these harmful substances. It is not both primary and secondary because secondary prevention involves screening, which would not take place in this instance.

34

The CHN has arranged for students in all classes at the local school to receive visual acuity testing to determine if they need glasses. Which level of prevention is represented by this activity?a.Primaryb.Secondaryc.Tertiaryd.Both primary and secondary

BCHNs implement screening programs for genetic disorders or metabolic deficiencies in newborns; breast, cervical, and testicular cancers; diabetes; hypertension; and sensory impairments in children. They also ensure follow-up services for clients with positive test results. Secondary prevention involves screening children for illnesses or conditions. In this instance, visual acuity testing is being used to screen for visual problems requiring corrective lenses.

35

A CHN is demonstrating the use of a peak flow meter to help children with chronic asthma recognize when they need to use a rescue inhaler. Which level of prevention is represented by this activity?a.Primaryb.Secondaryc.Tertiaryd.Both primary and secondary

CCHNs provide case management services that link clients with chronic illnesses to health care and community support services. Tertiary prevention includes caring for children with long-term health concerns, such as asthma, and disabling conditions. At first glance, this appears to have elements of primary and secondary prevention, but this is not the case because primary prevention aims at ensuring that a condition does not develop (whereas these children already have the disease). Furthermore, although the children are being taught techniques for recognizing respiratory danger, it is in the context of disease management (i.e., when to use an inhaler).

36

Which of the following is being implemented by the occupational health nurse (OHN) who removes a foreign body from a client’s eye?a.Primary careb.Primary preventionc.Secondary preventiond.Tertiary prevention

AThe nurse is implementing primary care of the client. This action does not meet the criteria for injury prevention because the injury has already occurred and the OHN is providing treatment for the injury. Prevention strategies will need to follow treatment to prevent recurrence and to prevent development of secondary problems related to the foreign body.

37

Which of the following is being practised by the OHN who periodically conducts spirometry testing of employees working with hazardous gases?a.Primary preventionb.Secondary preventionc.Tertiary preventiond.Tertiary care

BSecondary prevention involves health surveillance and periodic screening to identify an illness at the earliest possible stage and elimination or modification of the hazard-producing situation.

38

An employee in a laboratory drops a flask, resulting in the chemical splashing into her eyes. Which of the following is the agent in this scenario?a.Chemicalb.Employeec.Flaskd.Laboratory

AThe agents, or factors associated with illness and injury, comprise occupational exposures that are classified as biological and infectious, chemical, ergonomic, physical, or psychosocial hazards.

39

A hospital nurse working in employee health notes that several nurses from one unit are missing from work after having contracted a communicable disease from a client. In this scenario, which one of the following is the host?a.Each sick nurseb.The communicable diseasec.The hospitald.The client

AThe host is described as any susceptible human being; each sick nurse represents a host within the worker population group.

40

Which one of the following hazards tends to particularly affect employees who work in 2-week shifts?a.Biological hazardsb.Environmental hazardsc.Physical hazardsd.Psychosocial hazards

DPsychosocial hazards are factors and situations encountered or associated with one’s job or work environment that create or potentiate stress, emotional strain, or interpersonal problems.

41

Which of the following is the primary role of the forensic nurse in Canada?a.Health promoterb.Disaster plannerc.Sexual assault nurse examiner (SANE)d.Outreach worker

CIn Canada, forensic nurses primarily work as SANEs.

42

From which of the following health care professionals is a rural resident with asthma more likely to receive health care services?a.Allergistb.Nurse practitionerc.Pediatriciand.Pulmonologist

BIn rural communities, often a health care professional may live and practise in a community for decades, also providing care to people who live in several other communities. A limited number of CHNs, such as PHNs or nurse practitioners, may offer a full range of services for all residents in a specified area, which may span more than 150 km. Consequently, rural physicians and CHNs provide care to individuals and families with all kinds of conditions, in all stages of life, and across several generations. In urban communities, residents are more likely to seek care from a medical specialist.

43

In addition to the common barriers faced by most rural residents, which one of the following is an additional barrier to health care that a Mexican migrant farm worker is more likely to encounter?a.Absence of culturally appropriate careb.Availability of specialistsc.Distance of health care facilities from the place of residenced.Lack of anonymity

ABarriers to health care affecting all rural clients may be the availability, affordability, or accessibility of services and professionals. Two pertinent identified barriers to health care in rural areas are language barriers and lack of culturally appropriate care and services.

44

For the CHN who plans to move from an urban centre to a rural region of the country, which one of the following statements should be included in the advice on preparing for role alterations?a.“Community members will probably hold you in higher regard and will look up to you.”b.“Expect to have less autonomy than you have working as a CHN in the city.”c.“You can expect more resources and supplies because there are fewer clinics.”d.“You will need to focus on developing specialized knowledge and skills.”

ACHNs working in rural areas have a prestigious status in the community and are viewed as role models. They have greater (not less) independence and autonomy as well as fewer (not more) resources, and they need to have more generalist (not specialized) knowledge and skills.

45

Which of the following primarily distinguishes case management from managed care?a.Case management is a tool for health maintenance organizations.b.Case management is targeted toward a specific segment of the population.c.Case management is implemented with individual clients.d.Case management is used to monitor the health status, resources, and outcomes for an aggregate.

CCase management, in contrast to managed care, comprises activities implemented with individual clients in the system.

46

For a CHN, which of the following describes the goal of advocacy?a.Gaining organizational and governmental support for the promotion of nursing objectivesb.Improving community service needs identified by research findingsc.Integrating evidence-informed practice guidelines in the provision of community nursing serviced.Promoting self-determination in a client, family, group, or community

DThe goal of advocacy is to promote self-determination in a constituency or client group. The constituency may be a client, family, group, or community. The advocate role includes the following three major strategies: (1) interacting with clients and families, (2) interacting with other health care providers, and (3) working through the system.

47

Research demonstrates that exercise is important for general wellness and weight control. The CHN can use this information to implement primary prevention by doing which of the following?a.Developing individualized exercise programs for overweight childrenb.Drafting policy for increases in noncompetitive physical activity programsc.Monitoring body mass index in children to identify elevations before they become difficult to managed.Notifying parents or guardians of their child’s height–weight scale in comparison with national norms

BAt the primary prevention level, campaigns to support regular exercise, greater emphasis on school-based physical education programs, and environmental and policy initiatives to create or enhance places for physical activity in communities can make significant contributions to improving the lifestyle of sedentary children. Developing individualized exercise programs for overweight children is an example of tertiary prevention. Monitoring body mass index in children to identify elevations before they become difficult to manage is an example of secondary prevention. Notifying parents or guardians of their child’s height–weight scale in comparison with national norms increases family awareness but does not meet the definition of a preventive measure.

48

Which one of the following is the designation given to groups at high risk of having poor health outcomes?a.Cumulative risk groupsb.Health disparity groupsc.Resilient populationsd.Vulnerable populations

DSpecific populations who are more vulnerable—that is, at-risk populations who are more susceptible to poor health because of socioenvironmental factors—are often referred to as vulnerable populations.

49

Which one of the following is the best intervention a community health nurse (CHN) can initiate to increase lasting resilience among new immigrants?a.Directing clients to English-as-a-second-language coursesb.Giving immigrant clients money to help them get settledc.Identifying areas in the city where housing is less expensived.Soliciting donations for food, clothing, and other needs

AResilience refers to the ability of the client to successfully cope when faced with a threat or hardship. Individuals with low resilience are more inclined to have feelings of hopelessness and may choose suicide as a method to resolve these feelings. Support needs to be provided to those with decreased resilience in order to enhance problem-solving skills and give a greater sense of personal autonomy. When the CHN places emphasis on client strengths and assets rather than client deficits and susceptibility, resilience is more likely to increase.

50

Which of the following interventions by the CHN would best serve a vulnerable population?a.Addressing multiple health concerns, including preventive education, when clients present for treatment of an illnessb.Establishing a system of networks so that clients may be referred to different services such as preventive care, acute illness care, and chronic treatmentc.Providing acute care services that focus on the client’s main health concern and setting up appointments at discharge for other concernsd.Referring clients to specialists to address specific health concerns

AWhen working with vulnerable populations, it is a good idea to arrange to have as many services as possible available in a single location and at convenient times. This “one-stop shopping” approach to care delivery is helpful for populations experiencing multiple social, economic, and health-related stresses. This becomes especially important if clients have problems accessing health care services.

51

Which definition accurately reflects the meaning of the term health inequities?a.Health inequities are the accumulation of multiple factors that lead to poor health.b.Health inequities occur when people are more inclined to become ill and usually do not seek appropriate care.c.Health inequities are unfair differences in health that could be avoided with reasonable action.d.Health inequities are wide variations in health status and services among certain population groups.

CHealth inequities refers to differences in health that could be avoided if reasonable action was taken, and therefore these differences are considered to be unfair and socially unjust.

52

Which of the following is a primary cause of vulnerability?a.Breakdown of family structuresb.Povertyc.Prejudiced.Social isolation

BPoverty is a primary cause of vulnerability. The lack of financial resources may cause some people to not seek preventive health services. This leaves them vulnerable and with increased risk of experiencing the effects of preventable illnesses.

53

Which level of prevention is a CHN practising when she offers homeless clients yearly tuberculosis (TB) screening and free treatment for those who test positive?a.Primary preventionb.Secondary preventionc.Tertiary preventiond.Secondary and tertiary prevention

BScreening homeless persons for TB and providing medications to those who test positive are examples of secondary prevention. The TB screening identifies the disease in its early stages. Medications work to prevent further development of the disease.

54

A CHN is orienting a new recruit to a health clinic that primarily serves vulnerable populations. Which of the following statements by the CHN indicates a need for additional information?a.“If a client who does not speak English comes in, you must obtain an interpreter right away.”b.“We try to take care of as many problems as possible in one visit, so when you check the client in, ask about additional concerns.”c.“You will like working with Filipino immigrants because they have close-knit family structures.”d.“You will need to assist the client by scheduling any referral or follow-up appointments.”

CAssumptions are not helpful. Each person and family should be assessed individually. No two people or groups are alike. Both good and bad stereotyping can create problems. For example, even though Filipino families are generally close knit, by assuming that all Filipino families are this way, clinic care providers will likely miss recognizing such issues as family violence.

55

While screening for diabetes at a community clinic, a CHN found out that a new client had type 2 diabetes. The CHN then provided counselling, referred the client to an endocrinologist for initial assessment and treatment, helped with arrangements for financial assistance, arranged transportation, and booked a follow-up appointment. What role is this type of service most representative of?a.Case managementb.Client advocacyc.Holistic cared.Wrap-around services

ACase management involves linking clients with services and providing direct community health nursing services, including teaching, counselling, screening, and immunizing. Linking health services is accomplished by making appropriate referrals and by following up with clients to ensure that the desired outcomes from the referral were achieved.

56

CHNs at a clinic for homeless persons are concerned that clients rarely return for follow-up after their TB skin (Mantoux) tests. Which policy would be the most appropriate one for addressing this situation?a.Call all homeless clients 48 hours after testing to remind them to return to the clinic for follow-up.b.Have the homeless persons read the test result themselves and then mail in the results on a postage-paid card coded to protect privacy.c.Readminister the test if the client returns later than scheduled for follow-up.d.Routinely refer all homeless clients for chest X-rays.

BSecondary preventive activities are aimed at reducing the prevalence or pathological nature of a condition. They involve early diagnosis, prompt treatment, and the limitation of disability. CHNs can work with homeless and near-homeless aggregates to provide education about existing services and strategies for influencing public policy that will provide more comprehensive services for homeless and near-homeless persons. If necessary, CHNs should develop a method for homeless individuals to read the reaction to the TB skin test themselves and send the results to the facility where the skin test was administered.

57

Which of the following actions should a CHN take when using the case management approach with vulnerable populations?a.Be willing to enter into a long-term relationship with families.b.Direct and control the client’s care because the CHN knows what is most needed.c.Encourage families to become self-sufficient and less dependent on nursing personnel for advice and referrals.d.Rotate assignments periodically, to prevent attachment and codependency.

ACase management is a process that enhances continuity and appropriateness of care. When using case management with vulnerable populations, the CHN can offer the greatest benefit when she or he is willing to develop long-term relationships with the families served. Long-term relationships create trust and ensure continuity of care. Care involves a partnership between the CHN and the client. CHNs who direct and control the client’s care cannot establish a trusting relationship and may inadvertently foster a cycle of dependency and lack of personal health control measures.

58

Which one of the following is an example of tertiary prevention by a CHN?a.Administering the Mantoux (skin) test to identify persons with TBb.Assessing for signs and symptoms of active TBc.Directly observing clients with active TB as they take their antituberculosis medicationsd.Interpreting TB skin test results

CTertiary prevention is implemented when CHNs provide directly observed therapy (DOT) to those with active TB.

59

Which one of the following is the cause of the greatest overall costs to the community for providing health care to the homeless?a.The need for increased preventive services to address the health conditions of the homeless populationb.The need for more frequent clinic visits by homeless clients for multiple health problemsc.The spread of contagious diseases by homeless people to those they pass on the streetd.The fact that most of the care for homeless people takes place in hospital emergency departments

DHomeless persons encounter the same problems accessing health care (e.g., lack of money, lack of housing, lack of transportation) that others do in impoverished conditions. Therefore, health care of homeless persons tends to be crisis oriented and sought in emergency departments. Low-income Canadians have the highest mortality rates and the highest rates of hospitalizations and emergency visits.

60

A CHN presents a proposal for a program for preventing teen pregnancy to a group of parents. In the discussion that follows the presentation, which of the following responses by a parent indicates the need for additional teaching by the CHN?a.“I do not know if my son is sexually active; however, I have decided that I am going to talk to him about birth control, just in case.”b.“I have found that being very strict and checking on my daughter whenever she is out are the best ways to prevent trouble.”c.“I plan to sit down with my daughter and have an honest talk about sexuality and potential risks.”d.“I will start spending more time with my teens when I get home from work.”

BParents who are extremely demanding and controlling or neglectful, and who have low expectations, are the least successful in instilling good values in their children. Children of parents who are neglectful are the most sexually active, followed by children of parents who are very strict. Furthermore, parents who discuss birth control, sexuality, and pregnancy with their children can positively influence delaying initiation of sexual activity and use of effective birth control. Parents who do not talk about sexuality with their teens may find them more at risk for sexual permissiveness and unwanted pregnancies.

61

By which of the following actions can the CHN best ensure long-term positive health outcomes in pregnant teens from low-income groups and their children?a.Help teen mothers learn about body changes during pregnancy.b.Develop programs that enable teen mothers to complete their education.c.Offer courses in proper care of babies.d.Monitor pregnant teens for early detection of problems in pregnancy.

BPrograms that enable the teen mother to complete her education increase her chances for a better future and improved health care over the long term, across the lifespan. Issues to discuss include education and career plans, family finances and qualifications for outside assistance, and personal values about pregnancy and parenting at this time in her life.

62

A CHN who works at a clinic for homeless persons wants to institute a more efficient treatment for chronic wounds. Which of the following actions offers the best way to improve outcomes for these clients?a.Administer antibiotics to all homeless persons with chronic, nonhealing wounds.b.Facilitate daily access to a room with soap, water, and bandages.c.Provide free bandaging supplies to clients at each clinic visit.d.Regularly monitor the wound condition of clients.

BHealth problems faced by homeless people often are related directly to poor access to preventive health care services. The CHN can implement tertiary prevention by designating a wound room in which clients can carry out wound care activities taught during clinic visits. Only infected wounds would need treatment with antibiotics, not all wounds. Free bandaging only addresses one part of the problem and monitoring does not improve outcomes; only treatment does.

63

What information is most important to keep in mind when caring for a pregnant teen?a.All teen pregnancies are considered high risk.b.Limited knowledge can lead to pregnancy complications.c.Pregnant teens are less likely to focus on proper prenatal nutrition.d.Pregnant teens who are poor are more likely to have poorer health outcomes.

CThe nutritional needs of a pregnant teenager are especially important. The CHN needs to assess the pregnant teenager's current eating pattern and provide creative guidance to address the issue of the demands of pregnancy on a normally changing teenager's body and a teenager’s usual nutritional habits of fast foods and snacking.

64

Which of the following actions is a way in which the CHN can help prevent depression in older adults who are at high risk for it?a.Encourage them to move to a nursing home where they will have the company of others in the same age group.b.Monitor for signs and symptoms of depression.c.Organize a health promotion program for older adults at the local centre.d.Encourage older adult clients to focus on their strengths rather than their weaknesses.

CIt is important for CHNs to recognize that older adults who are depressed usually have a clinically different presentation from that of clients in other age groups. Older adults who are depressed tend to present with many bodily complaints, such as chronic pain, nausea and vomiting, and insomnia, and usually do not express feelings of sadness, guilt, or worthlessness. The depression rate among older adults is half that among younger people, but the presence of a physical or chronic illness increases rates of depression. Activities to improve the mental health status of older adults include public education programs, prevention approaches, and the provision of mental health services in primary care. Depression rates for older adults in nursing homes range from 15% to 25%, and thus this would not be a good place to recommend for social networking. Encouraging older clients to focus on their strengths rather than their weaknesses can sound insensitive if (1) the weaknesses are, indeed, profound, and (2) the necessary tools for coping are not provided along with the advice. Monitoring for signs and symptoms of depression only monitors health issues, rather than preventing them.

65

A CHN is concerned about caregiver stress in the children of older clients with health concerns. Which of the following secondary prevention strategies can the CHN implement to limit caregiver stress?a.Asking caregivers how they are coping with their roleb.Encouraging caregivers to periodically take a few hours away from their dutiesc.Establishing support groups for caregivers of older adult parentsd.Referring some caregiving responsibilities to home health nurses (HHNs) or professional caregivers

ASecondary prevention includes screening that allows for early recognition of health concerns so that prompt interventions can prevent long-term disabilities. By asking caregivers how they are coping (thus screening), the CHN can identify problems early so that interventions can be made to limit the extent of stress, thus paving the way for improving the situation. The other options are either primary or tertiary activities, depending on whether the intervention takes place before or after development of caregiver stress.

66

Which of the following actions can a CHN take to potentially increase accessibility to health care services for mentally ill homeless clients?a.Apply for a grant to fund a mobile clinic to take health care to the clients.b.Distribute flyers to homeless persons that detail the location of various healthcare services.c.Refer homeless clients to temporary housing facilities.d.Solicit donations for food and clothing to be distributed to the homeless.

AAccessibility refers to the ability of clients to access needed health care services. While all of the options listed lead to opportunities for achieving better health outcomes, either directly or indirectly, only a mobile health clinic can potentially improve accessibility to health care. Neighbourhood clinics, mobile vans, and home visits can bring health care to people unable to access health care units. Coordinating health care services from a central location often improves client compliance because it reduces the stress of getting to multiple places.

67

A CHN suspects that an elementary school student is being physically abused. Which action would be the most appropriate one for the CHN to take?a.Ask the student about the abuse.b.Document findings in the student’s school record.c.Discuss the suspicions of abuse with the student’s teachers or the family’s spiritual leader.d.Notify legal authorities.

DAll individuals in Canada who suspect child abuse are required to report it to the proper child protection agencies, as mandated by law. First Nations peoples have their own child protection agencies.

68

Which of the following actions by a case manager would be classified as primary prevention?a.Advocating for the client whose values conflict with those of the medical service providerb.Collaborating between nursing and occupational health personnelc.Educating a group regarding community services that are available if they are ever neededd.Resolving conflict between a primary care clinic and a tertiary care facility

CPrimary prevention involves the use of the information exchange process to increase the client’s understanding of the health care system. Remember that primary prevention occurs at a point before an illness or a problem occurs. In all of the other options, the client’s health concern already exists and interventions have been employed.

69

A client reports that the narcotic she took for pain on a regular basis made her feel bad and that when she tried an alternative analgesic, she experienced withdrawal symptoms. What is this client suffering from?a.Drug abuseb.Drug addictionc.Drug dependenced.Substance abuse

CThe terms drug dependence and drug addiction often are used interchangeably, but they are not synonymous. Drug dependence is a state of neuroadaptation caused by the chronic, regular use of a drug. People who are dependent on drugs must continue using them to prevent withdrawal symptoms. Drug addiction, in contrast, is a pattern of abuse characterized by an overwhelming preoccupation with the use (compulsive use) of a drug and securing its supply, and a high tendency to relapse if the drug is removed.

70

A CHN is asked by a parent group to explain the risk factors for alcoholism. Which of the following statements should the CHN include in the explanation?a.Alcoholism is determined solely by environment.b.Alcoholism is determined partly by genes.c.Alcoholism is higher in women.d.Persons born with fetal alcohol syndrome are alcoholics from birth.

BResearch has shown conclusively that alcoholism is, at least in part, genetic and not just the result of family environment.

71

At a district board meeting, the CHN requests funding for an after-school recreation program that promotes healthy, fun activities in an effort to decrease drug abuse. Which level of prevention does this exemplify?a.Primary preventionb.Secondary preventionc.Tertiary preventiond.Primary and secondary prevention

APrimary prevention includes the promotion of healthy lifestyles and resiliency factors. The harm reduction approach to the issue of substance abuse focuses on health promotion and disease prevention.

72

An intravenous (IV) drug abuser admits to the CHN that he has no desire to give up his addiction, so the CHN counsels him on the importance of sterilizing his needles to prevent infection and transmission of blood-borne diseases. Which level of prevention does this action represent?a.Primary preventionb.Secondary preventionc.Tertiary preventiond.Primary and tertiary prevention

CTertiary prevention is implemented in people who already have a health concern or problem (in this instance, someone who is already addicted) to prevent complications (harm reduction). In this instance, because the client does not plan to stop the drug abuse, the CHN is trying to prevent complications arising from use of contaminated needles. Emphasis is placed on reducing the transmission of blood-borne diseases through contaminated needles. Giving up the addiction is the best solution but unrealistic for many addicts. Using the harm reduction model, the CHN should provide education on cleaning needles with bleach between uses and about needle exchange programs to decrease the spread of blood-borne pathogens.

73

A CHN suspects that a new client may be a drug addict. When getting the health history of the client, the CHN needs to keep in mind that the client may not admit to drug use. Which one of the following is a primary symptom of addiction?a.Confusionb.Denialc.Forgetfulnessd.Mental status changes

BA primary symptom of addiction involves a refusal to acknowledge that a drug use or substance use problem exists.

74

Which one of the following actions is the best example of enabling in a family with an alcoholic father?a.The father asks the CHN to explain why his continued drinking is dangerous.b.The son threatens to leave the home because he finds his father’s behaviour embarrassing.c.The teenage daughter turns to a favourite teacher for support.d.The wife tells her husband’s boss that her husband is sick when he is actually inebriated.

DEnabling is the act of shielding or preventing the addict from experiencing the consequences of his or her addiction.

75

Which of the following statements made by a parent indicates a need for more education about child abuse?a.“I have stopped slapping my child, and I am learning to count to 10 before reacting.”b.“I never spank or hit my children; I yell at them to stop being stupid and if they don’t, I tell them that the boogeyman will steal them away at night if they don’t obey.”c.“I use ‘time out’ when my child acts out or is naughty. Sometimes, my child doesn’t cope well with this, but I am persistent.”d.“When my child misbehaves, I distract him and try to focus his attention on other things. If he throws a tantrum, I just pick him up and leave the store or show or wherever we may be.”

BEmotional abuse involves extreme debasement of feelings and may result in the child feeling inadequate, inept, uncared for, and worthless. A parent is emotionally abusing the children by yelling at them (“to stop being stupid”) and frightening them (“boogeyman stealing them away at night”).

76

During a group counselling session for perpetrators of intimate partner violence, which of the following statements made by one of the clients indicates a lack of insight into his violent behaviour?a.“I have been taking out my frustrations about work on my girlfriend.”b.“I love my girlfriend and didn’t want to hurt her; it was an accident.”c.“It might be a good idea for me to temporarily leave the house when I feel I am getting angry.”d.“When I drink alcohol, I become more abusive toward my girlfriend.”

BViolence is defined as those nonaccidental acts that result in physical or psychological injury. Although the client may now be feeling remorse, at the time that the violent act was committed against the girlfriend, his intent was to inflict harm.

77

A mother confides to the CHN that her live-in boyfriend pushed her 2-year-old child because he was crying too much. She begs the CHN not to tell anyone because her boyfriend has agreed to take anger management classes. What should the CHN do?a.Abide by the mother’s wishes because this information was provided in confidence.b.Arrange for the earliest available counselling for the boyfriend.c.Advise the mother to take the child away from the boyfriend and find alternate housing right away.d.Report the incident to the child protection agency.

DAll individuals in Canada who suspect child abuse are required to report it to the proper child protection agencies as mandated by law. First Nations peoples have their own child protection agencies. All of the other options put the child’s welfare at risk.

78

Which one of the following characteristics observed in a teenage boy should always alert the CHN to the possibility of suicide?a.Age between 15 and 19 yearsb.A homosexual orientation and history of depressionc.Threatening to cause harm to peersd.A history of torturing and abusing animals

BDepression and homosexuality are two of the leading risk factors for adolescent suicide. Those who threaten peers or torture and abuse animals are more likely to cause harm to others than to themselves.