Flashcards in LA#3 - Stanhope Chap 3 and 17 Deck (45):
Women who develop vaginal fungal infections (commonly referred to as yeast infections) usually have a history of having been prescribed antibiotics for bacterial infections. Which component of the epidemiological triangle (agent–host–environment) contributes most to the development of vaginal infections?a.Agentb.Environmentc.Hostd.Agent and host
BAntibiotic therapy not only eliminates a specific pathological agent but may also alter the balance of normally occurring organisms in the body. As a result, one of these agents overruns another, and disease, such as a yeast infection, occurs.
A communicable disease outbreak has occurred in a town. At a town meeting with public health officials, a community health nurse (CHN) is asked to explain the phrase “virulent organism.” Which of the following definitions of virulence is correct?a.Virulence is the ability to bypass normal immunological response mechanisms.b.Virulence is the ability to invade major organ systems.c.Virulence is the ability to produce toxins and poisons that weaken the body.d.Virulence is the ability to produce severe physical reactions.
DVirulence is the ability to produce a severe pathological reaction.
CHNs have been advised by the medical director to give injections of hepatitis A immunoglobulin to selected susceptible persons in the event of a hepatitis A epidemic. Which of the following outcomes will be the result?a.Active immunizationb.Long-lasting immunityc.Natural immunityd.Passive immunization
DPassive immunization refers to immunization through the transfer of a specific antibody from an immunized individual to a nonimmunized individual, such as the transfer of antibodies from mother to infant or the administration of an antibody-containing preparation (immune globulin or antiserum). Passive immunity from immune globulin is almost immediate but short-lived. It is often induced as a stop-gap measure until active immunity has time to develop after vaccination. Examples of commonly used immune globulins include those for hepatitis A, rabies, and tetanus.
Of the following statements about Salmonella made by class members in a class about disease prevention, which one indicates that additional teaching is needed?a.“Certain pets and farm animals may be Salmonella carriers.”b.“It is possible to transmit Salmonella through person-to-person contact.”c.“Salmonella may be spread through blood once the infected blood is exposed to air.”d.“Salmonella outbreaks are usually due to contaminated meat, poultry, and eggs.”
CMeat, poultry, and eggs are the foods most often associated with salmonellosis outbreaks. Animals are common reservoirs for the various Salmonella serotypes. Although infected humans may also be carriers, animals are more likely to be chronic carriers. Reptiles, such as iguanas, have been implicated as Salmonella carriers, as well as turtles, poultry, cattle, swine, rodents, dogs, and cats. Person-to-person transmission is an important consideration in daycare and institutional settings. Anthrax (not Salmonella) forms spores when infected blood is exposed to air.
Of the following interventions for infectious diseases, which one best represents primary prevention?a.Giving a tetanus booster every 10 years.b.Giving a tetanus booster to a client after she steps on a nail.c.Giving tetanus immunoglobulin to a client after he steps on a nail.d.Giving antibiotics to a client who has tetanus and placing the client on seizure precautions.
AGiving tetanus boosters before any exposure has occurred is a primary prevention measure. Giving boosters after exposure (i.e., the client may be infected but disease has not developed) is considered to be a secondary prevention measure (similar to the textbook examples of immunoglobulin and rabies immunizations given after exposure). Tetanus immunoglobulin would be given if the client that steps on a nail had not been previously immunized; however, this is done following exposure and would therefore be a secondary prevention. Giving antibiotics to a client who has already developed tetanus is not primary prevention.
Of the following infectious disease interventions, which one is most representative of secondary prevention?a.Clients with human immunodeficiency virus (HIV) infection are encouraged to use condoms to protect their sexual partners.b.Clients with HIV infection are given medications to improve immunological response.c.Health care workers are encouraged to receive annual vaccinations for influenza.d.Health care workers are required to have a tuberculosis (TB) skin test or chest X-ray.
DTB screening for health care workers is an example of secondary prevention. TB skin tests and chest X-rays are methods of TB screening. Encouraging HIV-positive clients to use condoms is an example of primary prevention because the goal is directed toward the partner (to prevent exposure of the unaffected partner to the infected partner), and administering medications to improve their immunological response is an example of tertiary prevention. Health care workers receiving annual vaccinations for influenza is an example of primary prevention.
A student asks the school nurse how acquired immune deficiency syndrome (AIDS) is diagnosed. Which of the following answers is correct?a.AIDS is diagnosed through the negative results of a screening test called an enzyme-linked immunosorbent assay (ELISA).b.Antibodies to HIV, which form in about 6 weeks to 3 months following infection with HIV, are detected in the blood.c.Antibodies to HIV reach peak levels of 200/mL of blood.d.AIDS is diagnosed through positive ELISA results and clinical signs of AIDS.
DThe ELISA test is a laboratory procedure that detects HIV antibodies and is the test commonly used to screen blood for the presence of the HIV antibody. Clients must know that the antibody test is not diagnostic for AIDS but is indicative of HIV infection. Therefore, a positive ELISA test is confirmed using the Western blot test (a confirmatory test). If individuals test positive for HIV and also exhibit clinical signs of AIDS, they are infected and have the disease.
A CHN asks a class to describe the ways in which HIV can be transmitted. Which of the following responses by a student indicates a need for additional teaching?a.“HIV can be transmitted by droplet spread from sneezing or coughing.”b.“HIV can be transmitted by having unprotected sex with someone who is infected.”c.“HIV can be transmitted by sharing needles when shooting up drugs.”d.“HIV can be transmitted through transfusions of blood products that are contaminated with HIV.”
AHIV transmission can occur via sexual contact, involving the exchange of body fluids, with an infected person; sharing or reusing needles, syringes, or other equipment used to prepare injectable drugs; perinatal transmission from an infected mother to her fetus during pregnancy or delivery or to an infant when breastfeeding; and transfusions or other exposure to HIV-contaminated blood or blood products, organs, or semen. It is not transmitted by insects, coughing, sneezing, office equipment, or sitting next to or eating with someone who has HIV infection.
For which of the following reasons should the school nurse recommend that an HIV-infected child not be allowed to attend school?a.The child develops allergies with sneezing.b.The school system requires students to receive routine immunizations.c.There is an outbreak of chicken pox at the school.d.There is strong objection from parents of well children.
CSchool attendance may not be advisable for the child with HIV if other children are suffering from common childhood diseases, such as chicken pox or measles. The immunosuppressed child is at greater risk of contracting any of these infectious diseases and suffering serious complications. HIV is not spread by sneezing, and immunizations are not contraindicated in children with HIV. Objection from parents of well children presents a unique opportunity to the CHN to educate these parents about HIV transmission.
Which one of the following sexually transmitted infections (STIs) can be prevented through immunization?a.Chlamydiab.Gonorrheac.Hepatitis Bd.Herpes
CAccording to current knowledge, hepatitis B infection can be prevented by immunization. In Canada, Twinrix® is a vaccine that protects against hepatitis A and B. Vaccines for Chlamydia, gonorrhea, and herpes are not yet available.
Which of the following presents a challenge with human papillomavirus (HPV) prevention?a.HPV can be transmitted through all body fluids.b.HPV warts may grow in areas that a barrier (e.g., a condom) does not cover.c.With HPV, thin-walled pustules may rupture to form honey-coloured crusts.d.With HPV, vesicles are hidden and ulcerate within 1 day.
BThe challenge of HPV prevention is that condoms do not necessarily prevent infection. Warts may grow in areas that barriers, such as condoms, do not cover, and skin-to-skin contact may occur.
Which one of the following would be a tertiary prevention measure implemented by the CHN to prevent TB?a.Administering a purified protein derivative (PPD) to the contacts of those infected with TBb.Initiating directly observed therapy (DOT) for TB-positive clientsc.Providing education about the prevention of TB to members of the communityd.Using skin tests to screen all health workers for TB
DTertiary prevention, for example, DOT, is carried out among persons already infected with the disease.
A client with TB wants to know why DOT is required as part of the treatment. Which of the following responses by the CHN would be the most appropriate one?a.“Clients with TB are often noncompliant; DOT will ensure that you take the drugs prescribed to you.”b.“This therapy is recommended by TB experts as the best way to ensure that you receive the treatment you need and that the infection doesn’t become resistant to treatment.”c.“This ensures that you get your medication even at the late stages of TB, when your memory may be affected by inadequate oxygenation to the brain.”d.“TB medications are very expensive, and this method ensures that government health care resources are not wasted by those who will not take the drugs regularly.”
BWhile responding truthfully to questions, it is important for CHNs not to talk down to clients with health concerns and to consider their perspective and psychological health as well. One tertiary intervention is DOT programs for TB medication monitoring. The CHN observes and documents individual clients taking their TB drugs. When clients prematurely stop taking TB medications, there is a risk of the TB becoming resistant to the medications. This can affect an entire community of people who are susceptible to this airborne disease. Health professionals share in the responsibility of adhering to treatment, and DOT ensures that TB-infected clients have adequate medication. Thus, DOT programs are aimed at the population level to prevent antibiotic resistance in the community and to ensure effective treatment at the individual level. Many health units and health authorities have DOT home health programs to ensure adequate treatment.
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).
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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).
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.