Flashcards in LA#16 - Stanhope Chap 07 and 11 Deck (45)
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
Specific 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.
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
Resilience 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.
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
When 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.
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.
Health 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.
Which of the following is a primary cause of vulnerability?a.Breakdown of family structuresb.Povertyc.Prejudiced.Social isolation
Poverty 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.
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
Screening 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.
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.”
Assumptions 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.
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
Case 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.
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.
Secondary 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.
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.
Case 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.
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
Tertiary prevention is implemented when CHNs provide directly observed therapy (DOT) to those with active TB.
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
Homeless 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.
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.”
Parents 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.
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.
Programs 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.
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.
Health 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.
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.
The 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.
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.
It 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.
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
Secondary 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.
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.
Accessibility 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.
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.
All 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.
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
Primary 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.
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
The 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.
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.
Research has shown conclusively that alcoholism is, at least in part, genetic and not just the result of family environment.
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
Primary 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.
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
Tertiary 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.
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
A primary symptom of addiction involves a refusal to acknowledge that a drug use or substance use problem exists.
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.
Enabling is the act of shielding or preventing the addict from experiencing the consequences of his or her addiction.
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.”
Emotional 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”).
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.”
Violence 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.