FNP 590 Midterm and Finals Questions with Answers and Explanations.

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FNP 590 Midterm and Finals Questions with Answers and Explanations. Midterm Ch 1-8 Finals Ch 1-14, 25 CHAPTER 1 Which model of health is most likely used by a person who does not believe in ... preventive health care? Question options: Clinical model Role performance model Adaptive model Eudaimonistic model The clinical model of health views the absence of signs and symptoms of disease as indicative of health. People who use this model wait until they are very sick to seek care. A person with chronic back pain is cared for by her primary care provider as well as receives acupuncture. Which model of health does this person likely favor? Question options: Clinical model Role performance model Adaptive model Eudaimonistic model The eudaimonistic model embodies the interaction and interrelationships among physical, social, psychological, and spiritual aspects of life and the environment in goal attainment and creating meaning in life. Practitioners who practice the clinical model may not be enough for someone who believes in the eudaimonistic model. Those who believe in the eudaimonistic model often look for alternative providers of care. A state of physical, mental, spiritual, and social functioning that realizes a person’s potential and is experienced within a developmental context is known as: Question options: growth and development. health. functioning. high-level wellness. Health is defined as a state of physical, mental, spiritual, and social functioning that realizes a person’s potential and is experienced within a developmental context. Which US report is considered a landmark document in creating a global approach to health? Question options: The 1990 Health Objectives for the Nation: A Midcourse Review Healthy People 2020 Healthy People 2000 The U.S. Surgeon General Report Healthy People 2000 and its Midcourse Review and 1995 Revisions were landmark documents in which a consortium of people representing national organizations worked with US Public Health Service officials to create a more global approach to health. Which of the following represents a method of primary prevention? Question options: Informational session about healthy lifestyles Blood pressure screening Interventional cardiac catheterization Diagnostic cardiac catheterization Primary prevention precedes disease or dysfunction. It includes health promotion and specific protection and encourages increased awareness; thus, education about healthy lifestyles fits this definition. Blood pressure screening does not prevent disease, but instead identifies it. Which of the following represents a method of secondary prevention? Question options: Self–breast examination education Yearly mammograms Chemotherapy for advanced breast cancer Complete mastectomy for breast cancer Screening is secondary prevention because the principal goal of screenings is to identify individuals in an early, detectable stage of the disease process. A mammogram is a screening tool for breast cancer and thus is considered a method of secondary prevention. In reviewing a person’s medical claims, a nurse realizes that the individual with moderate persistent asthma has had several emergency department visits and is not on inhaled steroids as recommended by the NHLBI asthma management guidelines. The nurse discusses this with the person’s primary care provider. In this scenario, the nurse is acting as a(n): Question options: advocate. care manager. consultant. educator. Care managers act to prevent duplication of service and reduce cost. Care managers base recommendation on reliable data sources such as evidence-based practices and protocols. During a home visit, a nurse assists an individual to complete an application for disability services. The nurse is acting as a(n): Question options: advocate. care manager. consultant. educator. The advocacy role of the nurse helps individuals obtain what they are entitled to receive from the health care system, tries to make the system more responsive to individuals’ community needs, and assists individuals in developing skills to advocate for themselves. During a home visit, a nurse discusses the dangers of smoking with an individual. In this scenario the nurse is acting as a(n): Question options: advocate. care manager. consultant. educator. Health education is a primary prevention technique available to avoid major causes of disease. Teaching can range from a chance remark to a planned lesson. A nurse is asked to provide an expert opinion about the development of an education program for newly diagnosed diabetics. In this scenario, the nurse is acting as a(n): Question options: advocate. care manager. consultant. educator. Nurses with a specialized area of expertise provide education about health promotion and disease prevention to individuals and groups as consultants. A nurse is planning to deliver an educational program to individuals with diabetes. Which of the following should be the initial action taken by the nurse to ensure the success of the program? Question options: Assess the motivation level of the individuals Assess the knowledge level of the individuals Establish teacher-learner goals with the individuals Establish multiple teaching sessions with the individuals Selection of the methods most likely to succeed involves the establishment of teacher-learner goals. Thus, the first step by the nurse should be establishment of goals. A nurse who uses findings from a randomized, controlled trial on the care of Foley catheters to change practice at an institution is practicing: Question options: evidence-based medicine. qualitative research. quantitative research. clinical judgment. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. Which of the following is most influenced by the social and economic environment of a community? Question options: Social health policies Quality of care Evidence-based practice Practice guidelines Social policies concerning health are influenced by the social and economic environment of a population. Analysis of population trends and projections is necessary to help health professionals determine changing needs. A major cause of death in the early twentieth century was: Question options: cancer. cerebrovascular disease. heart disease. infections. Infections and acute disease were the major causes of death in the early part of the twentieth century. Which of the following demonstrates a nurse taking action to promote health and prevent disease? Question options: Making a home visit to a person who is recovering from a heart attack Administering medications to a cardiac client in the hospital Providing cardiopulmonary resuscitation during a heart attack Educating a person about the advantages of a heart-healthy diet during a home visit Solutions for health promotion are focused on individual and government involvement. To promote health and wellness, an emphasis must be placed on primary prevention. This is often related to actions such as education that influence lifestyle choices. In the preceding example, educating a person about the advantages of a heart-healthy diet during a home visit serves to influence lifestyle choices. Which factor may have the most influence in changing the health behavior of a single, adult woman who smokes and is the care provider for her mother, her own children, and granddaughter? Question options: Education regarding effects of smoking on her health The satisfaction that she will not contribute to secondhand smoke The availability of a weekly support group A gift card for $10 to a local grocery store for every week she is smoke free Motivational factors play a role in influencing attitudinal changes. A financial incentive is an example of a motivating factor. For this woman, who is financially responsible for the health and well-being of other individuals, finances will likely play a significant role in motivating her actions. Remember that education regarding the benefits of not smoking is not enough. Thus, the $10 gift card may have the most influence in changing her health behavior. An example of a Hispanic American nurse promoting cultural competency is: Question options: providing translation services for all Hispanic Americans. focusing on episodic care of illnesses with Hispanic Americans. taking a class about the Hispanic American culture. providing care for all Hispanic American persons in her clinic. Nurses must be aware of their beliefs, values, and customs. They should not assume that their perspective is correct and shared by others. Additionally, they should avoid stereotyping. Broadening one’s educational base regarding cultural beliefs is a way to develop and thus promote cultural competency. The devaluing of beliefs, values, and customs of others is known as: Question options: ethnocentrism. racism. cultural competency. empathy. Racism is defined as the devaluing of beliefs, values, and customs of others. Building a partnership with an obese individual who is trying to lose weight requires the nurse to: Question options: schedule a day to exercise with the individual. go grocery shopping for the individual. learn about the methods of weight loss. give the individual a weight loss goal. Nurses must work with individuals to determine what they are willing to do to lose weight. To do this successfully, nurses must know what options are available to the individuals for weight loss. Once nurses learn about the methods of weight loss, they can then develop goals for weight loss with the individual. Assuming that an individual’s own perspective is correct and shared by others is known as: Question options: ethnocentrism. racism. cultural competency. empathy. Assuming that an individual’s own perspective is correct and shared by others is known as ethnocentrism. CHAPTER 2 A person states, “My grandmother is the decision maker in our family.” Which of the following is being described by the person? Question options: Culture Race Ethnicity Values Culture, as an element of ethnicity, refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. The term “ethnicity” encompasses more than a cultural practice, which is what is being described by the person; it focuses on differences in meanings, values, and ways of living. Race is associated with power and indexes the history or ongoing imposition of one’s group’s authority above another. Values are beliefs about the worth of something and serve as standards that influence behavior and thinking. The nurse recommended to a 50-year-old woman that she schedule a routine mammogram. Which of the following would be the most important factor in this woman’s decision to schedule this exam? Question options: Race Ethnicity Cultural values Value orientation Cultural values guide actions and decision-making that facilitates self-worth and self-esteem. They shape human behaviors and determine what individuals will do to maintain their health status, how they will care for themselves, and others who become ill, and where and from whom they will seek health care. Race is associated with power and indexes the history or ongoing imposition of one’s group’s authority above another. Ethnicity focuses on differences in meanings, values, and ways of living. Value orientations reflect the personality type of a particular society. Which of the following actions demonstrates a health care professional providing culturally competent care? Question options: Encouraging the person to take medications as prescribed Asking the person to describe his folk healing methods Demonstrating the proper way to administer an insulin injection Assisting the person with discussing his health problems with the family It is very important for health care providers to be aware of how people interpret their health issues or illnesses to be capable to provide culturally competent care. A culturally competent health care professional should be able to consistently and thoroughly recognize and understand the differences in his or her culture and that of the patient or client, to respect the person’s values and beliefs, and adjust the approach of delivering care to meet each person’s needs and expectations. Asking the person to describe his folk healing methods is the only action that demonstrates the health care professional seeking input from the person into the care that is received. A person reports that she has been seeking care from an acupuncturist to help relieve the chronic pain that she has been experiencing. Which of the following statements would be the most appropriate response from the nurse? Question options: “You should have told me that the current treatments were helping your pain.” “Tell me more about your treatments from the acupuncturist.” “Tell me why you decided to not to continue with your treatment plan.” “You should not be seeing an acupuncturist while receiving professional care.” Through a culturally sensitive assessment process, nurses can determine what specific remedies individuals are using and whether their continued use would interfere with the prescribed method. The nurse asking the person to describe the treatments from the acupuncturist allows the nurse to learn this information. The other responses demonstrate an ethnocentric perspective by the nurse, viewing the treatments from the acupuncturist as inferior to professional care. When providing an educational session about the Arab American population, which of the following information would be included? Question options: The largest group of Arab Americans was refugees in the 1960s. The largest groups of Arab Americans are from Palestine and Iraq. Members of the Arab American population are most likely to live in rural communities. Members of the Arab American population are more likely to have college degrees than Americans at large. Members of the Arab American population are more likely to have college degrees (+45%) than Americans at large (28%). About 94% of Arab Americans live in metropolitan areas. The largest groups of Arab Americans are the Lebanese, Syrians, and Egyptians. Arab Americans came to the United States in three immigration waves; the last occurred in the 1960s and consisted of many professionals, entrepreneurs, and skilled and semiskilled laborers. A health care professional is caring for an Arab American individual. Which of the following cultural practices of this ethnic minority should be considered when planning care? Question options: This ethnic culture tends to be future oriented. Religion plays an important role in this culture. Traditional cultural practices are infrequently used during a health crisis. Members of this culture tend to have smaller families. Religion plays an important part in Arab culture, and there are dietary rules and prescribed rituals for praying and washing. Arab Americans are present oriented and view the future as uncertain. During a health crisis, many Arab Americans seek out their family, community, and traditional values and cultural practices. Arab American families are, on average, larger than non–Arab American families. An Asian American family has recently immigrated to the United States. Which of the following would provide an appropriate rationale when encouraging the family to send their child to school? Question options: The child will get a good education. According to law, all children must go to school. The child can get health care at school. Exposure to different cultures in school will enhance socialization. Exposure to different cultures in school facilitates the adoption of other cultural beliefs and aids in the socialization of the child into a new environment. Which of the following was the fastest-growing minority group in the United States between 2000 and 2010? Question options: Asian American Arab American Hispanic American Native American A 43% increase in the Hispanic population between 2000 and 2010 makes Hispanics the fastest-growing minority group in the United States. The interrelationship of poverty and health care dollars spent by Blacks and other minorities is affected greatly by: Question options: lack of access to preventive health care services low numbers of minority health care providers use of emergency rooms for care increased infant mortality rates in African American populations A decrease in resources for preventive care leads to the use of emergency rooms and other more expensive health care services that are often used as resources when severe illness occurs. A health care provider is working with an African American woman who has recently suffered a stroke and is homebound. She insists that she must get out of the house and attend Sunday worship services. What is the most likely explanation for her insisting that she participate in this cultural practice? Question options: The church is the only place where prayer can be performed. The church serves as a social support for its members. The church is the place where the family meets on a weekly basis. The church serves as a site for folk healing practices. The church is significant support system many African Americans. It serves many purposes beyond worship and formation, including serving as a place to meet where members could pass news, take care of business, and find strength of purpose; providing direct social welfare services; acting as a stabilizing force in the community; facilitating citizenship training and community social action; serving as a transmitter of cultural history; and providing the means for coping and surviving in a hostile world. African Americans often find comfort in the support their religious leader can give them, but it does not have to happen within the church. African Americans believe in the healing power of prayer, but that can happen outside of the church as well. Family is the strongest source of support for African Americans, and most meet more often than weekly at church. Which of the following ethnic groups has a disproportionately high death rate from unintentional injuries and suicide? Question options: American Indian/Alaska Native Americans Asian Americans Latino/Hispanic Americans Black/African Americans American Indian/Alaska Native Americans have disproportionately high death rates from unintentional injuries and suicide. Difficult life situations and stresses of daily life contribute to an array of problems, including feelings of hopelessness, desperation, family dissolution, and substance abuse. A health care professional is offering an educational session about providing culturally congruent care. Which of the following information would be included the presentation? Question options: Hispanic Americans value keeping balance and harmony with the earth. The oldest male is the decision maker in African American families. Native Americans are present oriented, taking one day at a time. The hot and cold concept of disease is part of the Asian American culture. Native Americans are generally present oriented, emphasizing events that are occurring now rather than events that will happen later. They take one day at a time and in times of illness they cope by hoping for improvements the next day. Native Americans value keeping balance and harmony with the earth. The oldest male is the decision maker and spokesperson in Asian American families. The hot and cold concept of disease is part of the Hispanic culture. A family has recently become homeless. Which of the following factors most likely contributed to this situation? Question options: Being from an ethnic minority background Declining rates of poverty Having multiple chronic illnesses Being unable to find affordable housing The inability to find affordable housing, decline in public assistance, poverty, and eroding work opportunities all contribute to homelessness. The increasing prevalence of poverty has caused an increase in the homeless population. Other factors that may affect this situation are lack of affordable health care, domestic violence, mental illness, and addiction disorders. A health care professional is caring for an individual who is homeless. Which of the following considerations should be made? Question options: The prevalence of substance abuse is much lower among the homeless population than the general population. The prevalence of HIV/AIDS is much lower among the homeless population than the general population. The percentage of the population who has health insurance is much lower among the homeless than the general population. The percentage of the population who has limited access to medical care is much lower among the homeless than the general population. Most homeless people do not have health insurance or the ability to pay for needed health care, and many providers refuse to deliver treatments to these people. The prevalence of substance abuse, HIV/AIDS, and mental health disorders is higher among the homeless population than the general population. A health care professional is leading a community action coalition to address the problem of homelessness within the neighborhood. Which of the following statements would most likely be made by health care professional? Question options: Homelessness should be addressed by improving financial assistance programs. Homelessness should be of concern to everyone in the neighborhood. Homelessness should be addressed by encouraging job growth in the area. Homelessness should be of concern to the mental health providers in the area. Homelessness is everyone’s problem, and people can ultimately affect the establishment of priorities to facilitate an improved quality of life. As more people understand homelessness, this will serve as an excellent guide in providing input, taking necessary action, and making the final decision as to what will make a healthy nation. A health care professional is searching for a funding source to develop a colorectal cancer screening program for ethnic and racial minorities in the community. Which of the following federal agencies would most likely be able to assist with this initiative? Question options: The National Institute on Minority Health and Health Disparities The Centers for Disease Control and Prevention The Office of Minority Health The National Institutes of Health The Office of Minority Health improves and protects the health of racial and ethnic minority populations through the development of health policies and programs that concentrate on eliminating health disparities. The National Institute on Minority Health and Health Disparities, The Centers for Disease Control and Prevention, and National Institutes of Health all address health disparities among racial and ethnic minorities, but their priority is not in funding these initiatives. Which of the following best demonstrates the practice of transcultural nursing? Question options: Using previous knowledge about ethnic minority cultures to plan care Adapting nursing care to meet the need of a person from an ethnic minority Requesting an interpreter when caring for a person from an ethnic minority Attending a presentation about cultural diversity Transcultural nursing is defined as an area of nursing study and practice that focuses on discovering and explaining cultural factors that influence the health, well-being, illness, or death of individuals or groups and seeks to provide culturally based appropriate care to people of diverse cultures. Adapting nursing care to meet the needs of a person from an ethnic minority best meets this definition of transcultural nursing. A nurse may initially use previous knowledge about minority cultures to plan care, but then must individualize the care based on individual differences within the culture. Having an interpreter present will not be necessary when working with all persons from ethnic minorities. Attending a presentation about cultural diversity would assist the nurse in becoming more culturally competent, but it is not the best example of practicing transcultural nursing because no nursing care is being provided when attending a presentation. A nurse would like to improve his cultural competence. Which of the following is the best strategy to use? Question options: Explore complementary and alternative medicine practices used by other cultures. Discuss cultural differences with coworkers. Provide care to diverse populations. Participate in continuing education programs about cultural diversity. Salman et al. (2007) assessed cultural awareness and cultural competence levels among staff nurses who participated in a continuing education program aimed at increasing knowledge of culturally competent care of geriatric populations. Staff nurses who participated in this training program had higher cultural competence levels as compared with those who did not join this training program. Exploring complementary and alternative medicine practices used by other cultures will assist if a nurse is using these practices; however, depending on whom the nurse is caring for, this information may have limited usefulness. Discussing cultural differences with coworkers may help the nurse learn about other cultures, but it may not provide the best source of information. Providing care to diverse populations may not help the nurse to become more culturally competent without having some baseline knowledge about cultural diversity. A nurse is told by a colleague that an Asian American individual on home care is using complementary and alternative medicine (CAM). Which of the following conclusions can accurately be drawn from this statement? Question options: The client will have adverse complications from using this form of medicine. The client may be using meditation, acupuncture, or another therapy. The client will soon be returning to his or her native country for further treatment. The client does not agree with the current professional care medication regimen. Examples of complementary and alternative medicine (CAM) include acupuncture, feedback, relaxation, music therapy, massage, art, music, and dance therapy. Persons who do not experience relief from chronic conditions often resort to complementary alternative medicine. It is important the nurse learn more about the CAM that the person is using so that any potential interactions between the use of CAM and professional care can be addressed. Complementary and alternative medicine can be used in conjunction with the use of professional care. A woman reports that she has strong spiritual practices. Which of the following is she most likely to experience? Question options: Improved coping skills and social support Increased understanding of religious differences Decreased pain and improved healing Decreased use of Western medicine Spiritual practices are likely to improve coping skills and social support, promote feelings of optimism and home, encourage healthy behavior, decrease feelings of depression and anxiety, and support a sense of relaxation. CHAPTER 3 Which addition to a community best demonstrates the concept of the Healthy People 2020 report? Question options: New cardiothoracic intensive care unit at a major hospital New rehabilitation center New recreational health center New children’s hospital The Healthy People 2020 report promotes health care, not illness care. A hospital, ICU, and rehabilitation center emphasize episodic care after an illness. The recreation health center serves to preserve health in the community and helps meet the goals of the Healthy People 2020 report. Which nurse is at risk of making a medical error? Question options: Working overtime Works in a hospital that advocates multidisciplinary care Caring for four clients during the shift Attends regular continuing education programs Health care systems are the basic cause of medical errors. Organizational and workforce management, work design, and organizational culture are problem areas that contribute to medical errors. Poor management leads to increased nurse turnover, the need for increased client-to-nurse ratios, increased need for overtime, and decreased number of nurses, all of which can lead to medical errors. A nurse working overtime is at risk of making a medical error. What is the most effective policy a staff nurse can implement to help decrease medical errors on the unit? Question options: Forgo opportunities for continuing education so the unit is never understaffed. Foster a collaborative working environment on the unit. Check all medications a minimum of three times before administering them. Develop a policy that mandates the firing of any nurse who commits an error. Health care systems are the basic cause of medical errors. Organizational and workforce management, work design, and organizational culture are problem areas that contribute to medical errors. Creating a collaborative working environment helps improve organizational culture, thereby reducing the chance of medical errors. The person known as the father of British and American public health is: Question options: Lillian Wald. Edwin Chadwick. Lemuel Shattuck. Paul Ehrlich. A community planning committee is working on the development of a community nursing center. Which of the following essential components should be included in this center? Question options: Physician as medical director Interdisciplinary staff Nurse as chief manager Partnership with an academic institution The essential components of a community nursing center include a nurse as chief manager, a nursing staff that is accountable and responsible for care and professional practice, and nurses as the primary providers of care. Considering the provider and client perspective, which of the following is the most autonomous form of insurance? Question options: Fee-for-service plan Health maintenance organization (HMO) Preferred provider organization (PPO) Independent practice association (IPA) In the fee-for-service plan, a provider provides a service and bills the individual’s insurance company. The individual is also allowed to choose his or her provider. Which health care provider represents a primary care provider? Question options: Psychiatric advanced practice nurse Clinical nurse specialist Pediatric nurse practitioner Acute care nurse practitioner A primary care provider serves as a gatekeeper, coordinating care of individuals by determining the need for referrals and procedures. A primary care provider can be a physician, physician’s assistant, or advanced practice nurse in a primary care setting. The primary care provider provides basic and routine care usually in an office or a clinic. A pediatric nurse practitioner is an example of a primary care provider. Which form of managed care restricts providers to caring for individuals who are members of their organization? Question options: Fee-for-service plan Health maintenance organization (HMO) Preferred provider organization (PPO) Independent practice association (IPA) The traditional HMO was a group or staff model in which a group of physicians and some specialty services provided care to its members. Providers generally spent all their time serving members of the HMO. Fee-for-service, IPAs, and PPOs are not restricted to serving clients for any one organization. A Medicare client reports to the home care nurse that he is receiving care through an accountable care organization (ACO). Which of the following considerations should be made when delivering care to this individual? Question options: The individual must see a primary care provider before being referred to a specialist. The focus of care is prevention and management of individuals with chronic disease. The individual has paid a membership fee to be part of this organization. The focus of care is to conserve money in a health savings account. The focus of care of accountable care organizations (ACOs) is to focus on prevention and management of individuals with chronic disease out of the hospital. In an ACO, physicians accept the responsibility for the quality of care provided and overall costs of delivering care to a defined population of patients. Accountable care organizations are composed of physicians, specialists, and hospitals, so a specialist will be able to be seen within the ACO. Individuals who are part of concierge care pay a membership fee in return for enhanced health care services or amenities. Health savings accounts are used in conjunction with high deductible health insurance plans and are not related to the use of ACOs. Which of the following is a health plan consisting of hospitals and physician providers providing health care services to plan members (usually at discounted rates) in return for expedited claims payment? Question options: Health maintenance organization (HMO) Health savings account (HSA) Preferred provider organization (PPO) Independent practice association (IPA) A health plan consisting of hospitals and physician providers providing health care services to plan members (usually at discounted rates) in return for expedited claims payment is known as a preferred provider organization (PPO). A nurse complies with the Patient Self-Determination Act when asking: Question options: a person upon admission to the hospital if he or she has an advanced directive the family in the recovery room if the client has an advanced directive a person before discharge from the hospital if he or she has an advance directive the family about an advanced directive after the person has been intubated The Patient Self-Determination Act is designed to increase individual involvement in decisions about life- sustaining treatments. The nurse must ensure that advanced directives are available to physicians at the time the medical decision is being made. Therefore, the nurse complies with the act when she asks a person upon admission to the hospital if he or she has an advanced directive. Which is a violation of the Health Insurance Portability and Accountability Act of 1996? Question options: Nurse reporting a case of TB to the health department Nurse reporting a case of child abuse to the Department of Human Services Nurse discussing the person’s case with his or her physician Nurse discussing the person’s case with his or her school nurse The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal privacy standard that requires safeguards to protect the security and confidentiality of health information. Disclosures without individual authorization are allowed only to public health authorities authorized by law to collect and receive information for the purpose of preventing or controlling disease, injury, or disability. Before speaking to the school nurse, the nurse must obtain authorization from the client’s parents. Which nurse is functioning as a care manager? Question options: Nurse working with a family to coordinate care after their child experiences a second hospitalization for an asthma exacerbation Nurse providing asthma education in the office setting to a child with moderate, persistent asthma Nurse administering the appropriate antiinflammatory medication to a child admitted to the hospital with an asthma exacerbation Nurse making a home visit for a respiratory assessment to a child following an admission for an asthma exacerbation Care managers help determine what medical care is necessary, monitor care, and arrange for individuals to receive the most cost-effective care in the most appropriate settings. They must collaborate with providers and with the client/family. Care managers are especially helpful following a client after discharge and clients with complex needs. A nurse working with a family to coordinate service after a hospitalization is a good example of services provided by a care manager. A pregnant woman with two toddlers living at less than 135% of the federal poverty level would be eligible for: Question options: Medicare Part A Medicare Part B Medicaid State Children’s Health Insurance Program (SCHIP) State Medicaid programs must cover all pregnant women and children up to 6 years of age with a family income of less than 133% of the federal poverty level. States Children’s Health Insurance Program provides insurance coverage to children whose family income is below 200% of the federal poverty level or whose income is 50% higher than the state’s Medicaid eligibility threshold. In this case, the woman is pregnant, her children are under the age of 6, and they meet the financial criteria for Medicaid but not SCHIP. Which of the following is a major factor limiting health care services in the United States? Question options: Lack of nurses Lack of health care facilities Lack of funding Lack of client interest in health promotion The lack of nurses may prevent health care providers from offering health promotional education activities. The cost of health care and prescription drugs is a major limitation to health care services. The United States has the highest proportion of population with no health insurance, thereby limiting health care services available to Americans. Which person is at highest risk for being uninsured? Question options: 68-year-old retired mailman 48-year-old on renal dialysis 2-year-old whose parents work but do not have benefits through their employers 27-year-old who attends college and works part time in a small pizza parlor Young adults (27 years of age or older) are not eligible to be covered under their parents’ insurance. Medicare is available for those over the age of 65 and for people who require dialysis. Medicaid and SCHIP are available for children whose families meet the financial requirements. This child would likely meet criteria for either Medicaid or SCHIP because the parents are considered working poor. Because health care insurance is so expensive, it would be difficult for a 27-year-old to afford his or her own plan. Young adults often go without insurance because of the high costs. Adoption of a Canadian-style health care system in the United States has the potential to: Question options: decrease waiting times for tests and procedures. create further health disparities. increase the number of HMOs. increase the amount of funding available for health care. Canadians with private health insurance and higher incomes have access to greater health care services and more expedient health care. This translates to a two-tier system of health care, which can contribute to health disparities in health care access and quality. A system used to evaluate the necessity, appropriateness, and efficiency of the use of the health care system, the purpose of which is to lower costs by discouraging unnecessary treatments, is known as: Question options: managed care gate keeping utilization review capitation A system used to evaluate the necessity, appropriateness, and efficiency of the use of the health care system, the purpose of which is to lower costs by discouraging unnecessary treatments, is known as utilization review. The country with the lowest infant mortality rate in 2011 was: Question options: Canada Mexico Sweden the United States Sweden had the lowest infant mortality in 2011 with a mortality rate of 2.74 per 1000 live births. The country with the highest life expectancy for women in 2011 was: Question options: France Germany Sweden the United States France was the country with the highest life expectancy for women (85 years of age) in 2011. CHAPTER 4 Which of the following statements about values is true? Question options: It is impossible for someone to understand his or her values. Values evolve over time; they are not static. Values assimilated in childhood are those held for a lifetime. Values clarification tells a person how to act. Values take time to develop, and they may change with education, experience, exposure, or a combination of these. A nurse is providing education about improving self-awareness to a small group of women who have been victims of domestic violence. Which of the following should the nurse recommend the clients do first to improve their self-awareness? Question options: Use self-disclosure to share aspects of self. Listen to and learn from others. Listen to oneself and pay attention to emotions, thoughts, and reactions. Use others to bounce back your own thoughts and recollections. To achieve a high self-awareness, three steps must be taken. The first step is listening to oneself and paying attention to emotions, thoughts, memories, reactions, and impulses. The second step is listening to and learning from others. The third step is using self-disclosure to share aspects of self. The nurse shares with her client the news that she, the nurse, is going to be married soon and tells the client about her wedding plans. Which of the following best describes the nurse’s actions? Question options: The nurse is sharing inappropriate personal information with her client. The nurse is exhibiting a communication technique called self-disclosure. The nurse is attempting to show empathy with her client. The nurse is violating client confidentiality rights of the Health Insurance Portability and Accountability Act (HIPAA). Sharing aspects of the self enriches interpersonal life and is a use of the technique labeled self- disclosure. A nurse has started admitting a new person on home care and is beginning to establish a relationship. Which of the following would be the most important thing for the nurse to do? Question options: Complete the paperwork in a timely fashion Establish open communication Conduct a complete physical health assessment Provide feedback to the person’s questions Communication is the foundation for any professional relationship. It is the cornerstone of a positive nurse-person relationship. It refers to a set of strategies and actions to enhance reciprocity, mutual understanding, and decision making. Which of the following best describes person-centered communication? Question options: The nurse says to the person seeking care, “Why do you continue to drink when you know it is not good for you?” The nurse responds to person seeking care’s request for pain medicine by saying, “It is not time for your pain medicine. You had it hours ago.” The client says to the nurse, “I think my husband is cheating on me.” The nurse responds by saying, “You think your husband is cheating on you?” The client says to the nurse, “I can’t believe I have cancer.” The nurse responds by saying, “One of my closest friends had cancer and had to have chemotherapy.” The nurse recognizes that the person seeking care has some concerns that she would like to discuss and paraphrases her statement to give the person an opportunity to elaborate on thoughts that are important to him or her. A nurse is counseling someone who has recently been diagnosed with diabetes. The nurse says, “Tell me more about how this diagnosis has affected your daily activities.” Which of the following best describes the type of communication the nurse is using? Question options: Verbal communication Nonverbal communication Metacommunication Functional communication Verbal communication is the transmission of messages using words, spoken or written. Nonverbal communication encompasses all messages that are not spoken or written. Metacommunication refers to a message about the message, the relationship aspect of communication. Which of the following statements about nonverbal communication is true? Question options: Nonverbal behavior is not usually contextual. Nonverbal behavior is culturally and situationally bound. Nonverbal communication is the most important type of communication. Nonverbal communication is easy to interpret. Cultural exposure and situational impact are essential components of interpreting nonverbal communication and must be taken into consideration in attempts to interpret nonverbal communication. Which of the following scenarios best describes a nurse using metacommunication? Question options: Using both touch and silence when counseling an individual Practicing reflection when interaction with an individual Discussing with an individual how to solve a problem Understanding that an individual needs a break before proceeding Metacommunication refers to a message about the message. It is the relationship aspect of communication. In a sense, it involves reading between the lines or going past the surface content of the message to glean nuances of meaning. Which of the following statements can be identified as a method for clarifying a message? Question options: “I get very upset when you talk to me in that tone.” “You make me very angry when you drink alcohol.” “I can make you happy. I know I can.” “What I want from you is to be left alone!” Use of “I” statements is one technique that can be used for clarifying and qualifying messages. A nurse and a man are involved in a conversation. When the person folds his arms across his chest, the nurse almost simultaneously folds her arms across her chest. This behavior is recognized as: Question options: empathy. reciprocity. flexibility. spacing. The patterning of similar activities within the same interval by two people can facilitate communication. This patterning is known as reciprocity. A nurse and her client are engaged in meaningful conversation when suddenly there is silence between the two. To facilitate effective client-centered communication, the nurse should: Question options: ask the person what he is thinking, so they can understand each other. restate what the person said before silence ensued, to get clarification. change the subject to one that is more pleasant for the person to discuss. wait quietly to give the person time to reflect where he wants to lead the conversation. Silence allows the person to reflect on what is being discussed or experienced and lets him or her know that the nurse is willing to wait until he or she is ready to say more. A person has just been admitted to the hospital. In talking with the person, the nurse is able to elicit from her that the reason for her hospitalization is that her husband beat her up. Which characteristic of the therapeutic relationship is being demonstrated? Question options: Empathy Trust Rapport Purposeful communication The nurse focuses communication for a particular aim: to obtain information to be used in care of the person. An individual reveals to the nurse that he is having an affair with his wife’s best friend. Which of the following statements will enhance effective therapeutic communication between him and the nurse? Question options: “You know that what you are doing is wrong.” “Why would you want do something like that?” “How could you do that to your wife and children?” “This affair seems to be troubling you.” The nurse is seeking to determine the client’s own feelings about his affair. By seeking feedback, the nurse helps explain the meaning further. The nurse suspends judgment and responds in such a way as to encourage him to keep talking rather than make judgments about his behavior, which would shut down communication. A nurse is working with a person to increase his daily exercise and activity. Which of the following statements by the nurse best demonstrates the use of reflection? Question options: “I have also struggled with finding time to exercise on a regular basis.” “Regular exercise plays an important role in preventing many health problems.” “You said that you have difficulty making time in your day for exercise.” “It may be helpful if we developed a goal related to daily exercise. “ Reflection is the restatement of what the individual has said in the same or different words. This technique can involve paraphrasing or summarizing the person’s main point to indicate interest and to focus the discussion. It is the selective paraphrasing or literal repetition of the person’s words to underscore the importance of what has been said, summarize a main concern or theme, or elicit elaborated information. A woman tells the nurse that she is very nervous about their meeting today. Which of the following relationship stages are the nurse and woman most likely experiencing? Question options: Orientation phase Working phase Therapeutic phase Termination phase The orientation phase begins when the nurse and individual meet. This meeting typically involves some feeling of anxiety because neither party knows what to expect. Which of the following is the first step in the valuing process? Question options: Acting out the choice Selecting from alternatives Being happy with personal beliefs and actions Choosing freely The seven-step valuing process involves (1) choosing freely, (2) choosing from alternatives, (3) choosing after careful consideration of potential outcomes of each alternative, (4) cherishing and being happy with personal beliefs and actions, (5) affirming the choice in public, when appropriate, (6) acting out the choice, and (7) repeatedly acting in some type of pattern. The nurse makes sure that the distance between himself and the client is at least 6 feet before he begins to ask questions related to the client’s health history. Which of the following statements is true? Question options: This is the ideal space for intimate communication. This distance is too far for the nurse to build a therapeutic relationship while obtaining the information. This is the recommended distance between client and nurse for effective therapeutic communication. The nurse should position himself an additional foot away to facilitate the conversation. Personal space of 18 inches to 4 feet is appropriate for close relationships in which touching may be involved and good visualization is desired. A nurse is working on values clarification with a person who has chosen to smoke during her pregnancy. Which of the following statements would be the most appropriate for the nurse to assist in this process? (select all that apply) Question options: “Why do you smoke cigarettes? “What do you value most in life?” “Who has influenced your decision to smoke?” “Is your decision to smoke consistent with your values?” Techniques to clarify values include assisting the person to identify her own values (“What is important to you?”), identify values conflicts or conflicts between values and actions (“Are your actions consistent with your values?”), and using reflection to restate the value and make it explicit. A nurse is in the process of establishing a therapeutic relationship with a person. Which of the following techniques should be used by the nurse? (select all that apply) Question options: Learn about the person’s interests. Sit close to the person. Show interest in the person’s concerns. Define the parameters of the relationship with the person. Purposeful communication should be an aim of the therapeutic relationship. Social chitchat, communication without a goal, should not make up the bulk of the therapeutic interaction. The amount of space between communicators varies from culture to culture, so sitting close to the person may not be culturally appropriate. Building rapport by showing the person that his or her concerns interest the nurse is important. Also, trust can be built with the person by clearly defining the relationship parameters and expectations. Which of the following is an essential question that nurses should encourage individuals to ask at every health visit? (select all that apply) Question options: “What is my main problem?” “What health information do I not understand?” “What do I need to do?” “What is the plan for the next visit?” Health literacy is the capacity to read, comprehend, and follow through on health information; it is a critical component of health promotion. To combat low health literacy, nurses can encourage individuals to ask three essential questions at every health visit: “What is my main problem?” “What do I need to do?” “Why is it important for me to do this?” CHAPTER 5 Which of the following statements is true with regard to health promotion? Question options: Health promotion efforts are not concerned with addressing environmental obstacles to health. Advocates of health promotion are not involved in political campaigns against harmful products. The business of eliminating health disparities is a unique function of Healthy People 2010 goals. Health promotion involves collaboration of many professional groups. Health promotion is not the province of a single discipline but involves individuals, health care providers, and institutions working together to create a positive environment for health and to achieve health goals. Which of the following types of ethical theories tells us how people act toward each other and their environments and what they believe are good or moral actions? Question options: Descriptive value theories Normative theories Consequentialism theory Duty-based theories Descriptive theories do not tell us what actions we ought to take. They are not directive; they tell us how people act toward each other and their environments and what they seem to believe are good or moral actions. A nurse includes the statement, “Treat others the way you would like to be treated.” when teaching a group of adolescents about bullying. Which type of ethical theory is being used in this example? Question options: Descriptive value theory Normative theory Consequentialism theory Duty-based theory Normative theories are concerned with ensuring good actions. They are reasoned explanations of the moral purpose of human interactions, or they are divinely “revealed” truths about good action (religious ethics). A nurse believes that it is his responsibility to ensure the safety of the public by administering flu shots to everyone in the community. Which ethical theory is being used by the nurse? Question options: Descriptive value theory Normative theory Consequentialism theory Duty-based theory Consequentialism theory proposes that actions are good insofar as they are aimed at yielding the greatest amount of happiness or pleasure or cause the least amount of harm or pain to individuals and overall in society. Administration of flu vaccines proposes the best result for individuals and decreased risk for others in the community. Which of the following statements best describes the application of moral or ethical theory to the practices involved in health promotion? Question options: One can be assured of morally correct action in a given situation if one adheres to a theory of moral principles. There are no identifiable criteria that can be used effectively to determine correct actions in a given situation. The good of the larger population always takes precedence over the good of one individual. Making ethical decisions regarding human health involves the consideration of multiple factors. Making moral or ethical decisions about human health is not an easy task and requires assessing various criteria or theories. An emergency department provides care for all individuals regardless of circumstances and ability to pay. This is an example of: Question options: ethic of justice. ethic of care. applied ethics. metaethics. The ethic of justice is impartial and nondiscriminatory. An ethic of care, however, requires an understanding of situational particularities, ensuring that we try to understand a given individual’s needs in the context of his or her life. A nurse uses ethical reasoning to solve an ethical dilemma. Why would the nurse use this process? Question options: Assists in predicting all of the possible consequences of future actions Facilitates gathering of the most important information to solve the problem Considers the importance of caring when solving the problem Highlights salient aspects of future actions The purpose of ethical inquiry is to gain clarity on actual or potential moral issues arising in the context of health-promotion endeavors and to understand what is expected of the health-promotion agent viewed as a moral agent. Ethical reasoning can facilitate appropriate and in-depth data gathering, permit the uncovering of hidden agendas and interests, and focus on the most salient aspects of a particular problem. A nurse whose religious beliefs prohibit abortion has been asked to participate in a termination of the pregnancy of a 16-year-old victim of date rape. According to the revised American Nurses Association’s (ANA’s) Code of Ethics for Nurses, which of the following actions should the nurse take next? Question options: Suspend her religious beliefs and provide comfort and support for the client. Quit her job and find another source of employment. Notify her supervisor about her beliefs and request a change in assignment. Refuse to participate in the abortion. In the immediacy of the situation, the ANA Code of Ethics provides for the right of nurses to refuse to participate in procedures that violate their own values, but the nurse’s ethical behavior must ensure that arrangements for the care of the client are provided. A liver for which two people are tissue-typed has become available after the death of a donor in a car accident. Client A is a 45-year-old substance abuser whose liver is damaged as a result of his use of alcohol. Client B is a 16-year-old adolescent in need of a liver transplant because of a birth abnormality. Which of the following would be useful for a nurse in giving input as to which of the two should receive the liver? Question options: Advocate for Client B because he is the younger of the two and will live longer. Use feminist moral theory to advocate for Client A in spite of his alcohol use. Use a guided set of moral principles in decision-making before advocating for either. Advocate for Client A because he has 15 to 20 years of productive life left. Systematically using a set of moral principles in making ethical decisions assists the nurse in resolving ethical dilemmas such as that described. Which concept is aimed at interrupting potential ethical problems before they develop? Question options: Feminist ethics Preventive ethics Metaethics Normative ethics Preventive ethics is a requirement of health promotion in which practitioners envision potential problems and institute actions that stop their development. When providing preoperative teaching for a client who will be undergoing total knee arthroplasty, the nurse asks the client questions to assess his understanding of the surgery. Which type of ethics is the nurse implementing? Question options: Duty-based ethics Normative ethics Metaethics Preventive ethics Preventive ethics aims to forestall ethical problems before they develop. Preventive ethics is an important requirement of health-promotion endeavors that includes individual action by the nurse, as well as social and political activism with other nurses or professional nursing organizations. Assessing the client’s understanding of what is going to happen during a surgical procedure before the client signs the consent for the procedure makes sure the client understands the information and should help prevent ethical problems. A 24-year-old man with severe cognitive impairment, and no relatives participating in his care, needs to make a decision about removal of a brain tumor that will render him totally dependent for completion of all activities of daily living. The nurse participates in ethical decision making on his behalf, knowing that the client is unable to benefit from which of the following ethical concepts? Question options: Autonomy Justice Beneficence Advocacy Because the client is cognitively delayed and is unable to understand explanations of treatment that would be given to him, the client is unable to be autonomous in making a decision regarding neurosurgery. A client is scheduled to have open-heart surgery. His physical condition is such that he is at high risk to experience complications during the procedure, but he has not been advised of this possibility. Which of the following ethical concepts has been ignored in rendering care for this client? Question options: Beneficence Autonomy Justice Informed consent The client is able to “substantially understand” his care. Ethical care ensures that a person has all of the appropriate information necessary to make an autonomous decision about his or her care. This client has not been informed of his chances of dying during the surgery. An 18-year-old woman in whom a sexually transmitted disease (STD) was recently diagnosed asks the nurse not to tell her mother that she has an STD. Her mother asks the nurse what is causing her daughter’s vaginal discharge. Which of the following actions should the nurse take? Question options: Follow the principle of veracity and tell the mother the diagnosis. Respect the principle of confidentiality and support the client’s request not to tell her mother the diagnosis. Tell the client’s mother that she has a urinary tract infection, to protect the client’s privacy and honor the mother’s request. Ignore the mother’s request for information. The Health Insurance Portability and Accountability Act (HIPAA) guarantees client confidentiality. The client is the only person who can inform her mother of the diagnosis and the only person who can give the nurse permission to inform her mother of the diagnosis. The nurse could appropriately respond to the mother by saying, “I cannot share that information with you because of client confidentiality legislation. You might ask your daughter to share that information with you.” A nurse is providing care to a 15-year old female who has recently been diagnosed with a sexually transmitted infection (STI). Which of the following actions should the nurse take next? Question options: Seek advice from an ethics expert. Facilitate interaction between the adolescent and her parents/guardians. Report the STI to the appropriate authorities. Contact the adolescent’s parents/guardians. Federal and state laws generally serve to protect the privacy and autonomy of adolescents. Responsibilities of the nurse include helping an adolescent to grasp his or her authentic options and rights, facilitating interaction between the adolescent and parents or guardians, maintaining trust, and preserving confidentiality. An elderly client has recently been diagnosed with cancer. The client’s family has asked the nurse to withhold this information from the client because they feel that this information would cause the client to give up on life and become very depressed. The nurse believes the client should be told this information. Which ethical principle is being upheld by the nurse? Question options: Justice Beneficence Veracity Nonmaleficence Veracity is also known as devotion to the truth. Veracity in giving people information about their health care needs facilitates autonomous choice and enhances personal decision-making. Withholding information, or providing information that is misleading or incomprehensible, in an attempt to influence someone to agree to a treatment or intervention, conflicts with veracity. Which of the following concepts of ethics is described as the “duty to maximize the benefits of actions while minimizing harm”? Question options: Advocacy Justice Beneficence Autonomy Beneficence governs actions taken to further the overall health or well-being of an individual or society. “Beneficence” means doing good. A nurse reflects on previous experiences with minority populations and considers how these interactions have influenced her present care to these populations. Which part of values clarification and reflection has the nurse used? Question options: Formulate a possible course of action. Examine the influence of beliefs. Reflect on practice. Determine the prevalent values. It is important for the nurse to think about the influence that beliefs and values have on his or her practice. An understanding of how personal beliefs and values are either congruent, or are liable to interfere, with the task at hand is crucial to ethical problem solving. A nurse is working with a community to increase its awareness about the dangers of lead poisoning. Which of the following provides the best explanation as to why the nurse is performing this action? (select all that apply) Question options: It is the right thing to do. It is a moral responsibility. It is an ethical responsibility. It is the role of the nurse. When nurses provide service to society through health promotion interventions, their care for clients can be seen as a moral endeavor. Moral issues are confronted in the process of attempting to enhance the well-being of a society overall, as well as promoting and protecting health for individual members of a society. The ANA Code of Ethics for Nurses Interpretive Statements promises that “nursing encompasses the prevention of illness, the alleviation of suffering, and the protection, promotion, and restoration of health in the care of individuals, families, groups and communities.” The terms ethical and moral are used interchangeably throughout the chapter. A nurse is using feminist ethics when planning a program for women to promote screening and early detection of breast cancer. Which of the following considerations would be made by the nurse? (select all that apply) Question options: Importance of relationships Understanding of the oppression of women Importance of responsibility when caring for others Understanding of the imbalance of power Characteristics of feminist ethics include: understanding that human beings are inseparable from their relationships with others; a focus on care and responsibility aspects of relationships, rather than application of abstract principles; a concern with the development of character and attitudes that result in caring actions reflective of a person who is related to rather than detached from context; and a concern for the rights and equality of all individuals that is not limited to the oppression of women. CHAPTER 6 Who authored the framework which provides the foundation for nursing assessment and diagnosis using the functional health patterns? Question options: Erikson Gordon Newman Nightingale Gordon’s framework provides the foundation for most NANDA nursing diagnoses using the functional health pattern. Nurses use the framework to combine assessment skills with subjective and objective data to construct patterns. Over the last week, a person has had finger stick glucose levels of 127, 132, 140, 138, 143, 145, and 140. This information allows the nurse to characterize the person’s function pattern by utilizing which area of focus? Question options: Age-developmental Functional Individual-environmental Pattern Pattern focus implies that the nurse explores patterns or sequences of behavior over time. Pattern recognition occurs during information collection. Functional health patterns then provide structure to analyze factors. A nurse is using a functional focus to assess a person. Which of the following the nurse be evaluating? Question options: Visual acuity Pupil reactivity Ability to drive The red reflex Functional focus refers to the individual’s performance level. Nurses assess how particular visual patterns affect lifestyle. The ability to drive would affect a person’s lifestyle and might require a change in how the person functions. A nurse working with a Hispanic family is explaining the plan for managing a child’s asthma to the child’s mother, father, and grandmother. To whom should the nurse direct the education? Question options: Mother Father Grandmother Parents and grandmother Culturally competent care is delivered with understanding of and sensitivity to cultural factors influencing health behaviors. Nurses provide culturally competent care when they identify and use cultural norms and values. In the Hispanic population, the male figure is usually the decision maker, and the family elders are highly respected. However, assumptions about cultural norms should not be made. As a result, the nurse should direct education to all three adults because they may all have an impact on the child’s health care needs. When assessing a person’s nutritional-metabolic pattern, which objective finding would have implications for nursing intervention? Question options: The person’s 24-hour diet diary The person’s dentition The person’s food preferences The person’s financial status Although all of the assessment parameters listed have implications for nursing diagnosis and planning for this client, the only objective measure is the client’s dentition. It is the only one that can be validated with a physical exam. When assessing a client’s activity-exercise pattern, which subjective finding has implications for nursing practice? Question options: A person’s decreased muscle tone A person’s amount of leisure time A person’s decreased range of motion A person’s use of a cane Although all findings are important in assessing the activity-exercise pattern, the only subjective finding is the amount of leisure time that the person reports having. All others are objective findings and can be validated with a physical exam. During a health history, a person reports getting 5 hours of sleep a night. What does this information indicate to the nurse? Question options: The person is not receiving enough sleep. The person is receiving adequate sleep. The nurse must determine where the person sleeps. The nurse must ask additional questions. The single most important factor assessed in the sleep-rest pattern is probably the perception of adequacy of sleep and relaxation. The objective when assessing the sleep-rest pattern is to describe the effectiveness of the pattern from the person’s perspective. Wide variation in sleep time does not necessarily affect functional performance. Different individuals require different amounts of sleep. Thus, without further subjective data, the nurse is not able to make a diagnosis in this functional pattern. A nurse assesses the cognitive-perceptual pattern of a Type 1 diabetic client. Which finding has implications for the individual’s nursing plan of care? Question options: Decreased sense of hearing Decreased sense of smell Decreased sense of taste Decreased visual acuity Assessment parameters in the cognitive-perceptual pattern include hearing, vision, smell, and taste. A person with Type 1 diabetes mellitus requires insulin injections. A decrease in visual acuity will make it difficult for the individual to draw up his or her medication and therefore will influence the nurse’s plan of care. Which scenario indicates a potentially dysfunctional pattern? Question options: Adult with frequent urination Woman who lost her job Elderly person with blurred vision Overweight adult with a sweet tooth A pattern is potentially dysfunctional when sufficient evidence exists or enough risk factors are present to indicate that a pattern of dysfunction will likely occur if interventions are not instituted. A dysfunctional pattern is a problem when it represents a deviation from established norms or from the individual’s previous condition or goal. The woman who lost her job indicates a potential dysfunction pattern because the stress of losing her job places her at risk for ineffective coping. The other scenarios are not potentially dysfunctional; by definition, they are dysfunctional. A nurse is counseling a person with a dysfunctional sleep pattern. Which of the following recommendations would the nurse most likely give the person? Question options: Read in bed until he falls asleep. Avoid fluids after 7 PM. Exercise immediately before bedtime. Watch television in the recliner in the evening. Etiological factors of most dysfunctional patterns often lie within another pattern or patterns. Outcomes and plans are based on probable cause. Exercising before bed, watching television, and reading in bed are not considered appropriate sleep hygiene. Frequent urination may be the cause of his dysfunctional sleep pattern and, if so, avoiding fluids before bed would be an appropriate plan. A nurse is caring for a person with a potential dysfunction in the health-perception–health- management pattern. Which of the following nursing interventions would most likely be performed? Question options: Arranging for home delivery of medication from the pharmacy Providing education regarding the dangers of smoking Instituting visiting nurse services for blood pressure checks Providing direct observed therapy for tuberculosis medications Potential problems are risk states. Nursing interventions are directed toward risk reduction through education. Health promotion requires the individual to participate in his own care, and he cannot do this if he does not recognize his susceptibility to an impending health problem. Providing education addresses the risk and provides the person with information needed to change beliefs. The other options make the person a passive participant rather than an active one. The nurse has determined that a person has a dysfunction in the nutritional-metabolic pattern. Which action would be the next step for the nurse to take? Question options: Weigh the person. Set a goal weight with the person. Ask the person what her favorite foods are. Develop a plan for weight loss. The individual’s goals and the determined diagnosis provide the basis for planning. Before developing a plan, a goal must be set. Clarity of the goals and diagnosis is critical to the development of an effective plan. In this case, the diagnosis has already been established and thus assessment of this pattern has occurred (weight, favorite foods). The next step before developing a plan is to set a goal weight with the client. A nurse weighs a person who has been diagnosed with a dysfunction in the nutritional-metabolic pattern. Which aspect of the nursing process is being performed? Question options: Assessment Implementation Planning Evaluation The nursing process consists of assessment, diagnosis, planning, implementation, and evaluation. A person who has been diagnosed with a dysfunction has already been assessed. The process of analyzing changes experienced by a person after a plan has been implemented occurs in the evaluation phase. In this question, a weight will determine whether or not the person is moving toward her goals of weight loss. A nurse administers the T-ACE test to a pregnant woman. The woman’s responses result in a score of 3. This score indicates that the woman: Question options: requires interventions for problem drinking. lacks evidence of problem drinking. requires interventions for sexually transmitted disease risks. lacks evidence of sexually transmitted disease risks. The T-ACE provides a sensitive measure of alcohol-intake pattern in pregnant women. A score of 2 or more indicates evidence of problem drinking. This client had a score of 3, which would require an intervention for problem drinking. A Hispanic mother tells the nurse that she has been using home remedies for her child’s asthma. Which home remedy might this mother be using? Question options: Acupuncture Cupping Hot tea Massage In the Hispanic population, asthma is viewed as a cold disease (hot-cold imbalance) and thus is treated with warm therapies. Diet is often used to maintain equilibrium. Thus, warm tea added to the child’s diet might be used to restore equilibrium between hot and cold in this child who has asthma. Which classification system fulfills needs that are exclusive to nursing? Question options: The International Classification of Nursing Practice (ICNP) The International Classification of Functioning, Disability, and Health (ICF) The International Nursing Diagnoses Classification (NANDA-I) The Nursing Diagnostic System (NDS) The NANDA-I system includes diagnostic criteria, and related etiologies in addition to the description. The NANDA-I fulfills needs that are exclusive to nursing. A young couple is deciding if they should get married and start a family. Which of Erikson’s life stages are they experiencing? Question options: Identity vs. role confusion Intimacy vs. isolation Generativity vs. stagnation Ego integrity vs. despair During early adulthood individuals experience Erikson’s life stage of intimacy vs. isolation. Examples of life events in this stage include committing to a mate and family responsibilities and selecting a career. Identity vs. role confusion occurs during adolescence. Intimacy vs. isolation occurs during middle adulthood. Ego integrity vs. despair occurs during maturity. Which cultural group defines illness as a price that is being paid for the past or the future? Question options: African Native American Arabian Asian American Indians define illness as a price that is being paid for the past or the future. A man is telling a nurse that he feels that his health is a gift from God. This statement most closely coincides with beliefs of which cultural group? Question options: African Alaska Native Asian Hispanic Hispanics define health as a gift from God. Which of the following is the leading cause of death among women? Question options: Accidents Cancer Coronary artery disease Stroke The leading cause of death in women is coronary artery disease. CHAPTER 7 A nurse is determining which family assessment tool would be best to implement with a family when planning home visits for health promotion. Which of the following criteria should the nurse use to evaluate these tools? Question options: The number of questions asked on the assessment tool The linkages of the assessment to Healthy People 2020 The amount of involvement that the family has in completing the tool The capability of the tool to assess goals and outcomes Useful health-promotion family assessments involve listening to families, engaging in participatory dialogue, recognizing patterns, and assessing family potential for active, positive change. Which of the following best describes the nurse’s role in health promotion and disease prevention? Question options: Educating about home safety measures Identifying areas for family improvement Implementing the nursing process using a systems perspective Acting as a role model for the family The nurse’s role in health promotion and disease prevention is best described as acting as a role model for the family. Implementing the nursing process, identifying areas for family improvement, and educating about home safety measures are all part of the nurse’s role but do not describe the comprehensive role of the nurse. Which of the following theories is an attempt to explain families as a set of interacting individuals with patterns of living that influence health decisions? Question options: Feminist theory Systems theory Developmental theory Resiliency theory Systems theory is an attempt to explain patterns of living among the individuals who make up the family system. A nurse is assessing how a family will transition and adapt after their youngest child leaves for college. By using this framework, which of the following perspectives is the nurse implementing? Question options: Risk-factor Structural-functional Open systems Developmental Duvall and Miller identified stages of the family life cycle and critical family developmental tasks, through a developmental perspective. This conceptual model helps to anticipate family events and discusses how families complete basic family tasks as they transition through these events. Which of the following would be described as a family structural component? Question options: Income earner of the house Socialization for the family Immunization of infants Launching of children Structural components of the family refer to family roles and relationships. A nurse is collecting data for a family assessment using Gordon’s functional health patterns. The nurse learns that the family has no books in the home to read to the preschool-age children. To which of the following functional health patterns does this information pertain? Question options: Roles-relationship Cognitive-perceptual Health-perception–health-management Self-perception–self-concept The cognitive-perceptual pattern identified characteristics of language, cognitive skills, and perception that influence desired or required family activities. The availability of books in the home for preschool age children impacts this functional health pattern. A nurse who is using Gordon’s functional health patterns is planning to assess its roles- relationships pattern. Which of the following questions would be most appropriate for the nurse to ask? Question options: What is the family’s philosophy of health? What does the family do to have fun? How are problems in the family resolved? Who decides when and how children go to sleep? How problems in the family are resolved relates to assessment of the roles-relationships pattern. The family’s philosophy of health relates to the health perception-health management pattern. What the family does to have fun relates to the activity-exercise pattern. The decision concerning when and how children go to sleep relates to the sleep-rest pattern. A nurse is using a genogram to represent a family. Which of the following statements is accurate? Question options: A genogram identifies the genetic disorders of the family. A genogram includes information about the past two generations. A genogram can be used to make connections about family health patterns. A genogram begins with a circle in the center of the page. A genogram shows a variety of family structures and highlights family health patterns, which can be used for anticipatory health guidance. Significant diseases and disorders of the family members are highlighted on the genogram. Data on at least three generations are reported on a genogram. The genogram uses a variety of symbols to demonstrate connections but does not begin with a circle in the center of the page. The ecomap of a client’s family has slashed lines drawn from the son to the family church. Based on this information, what conclusion can the nurse make? Question options: The son is deceased. The son is actively involved with the family church. The son has a stressful relationship with the church. The son has no relationship with the church. Slashed lines on an ecomap signify stressful relationships. A client reports that her family will be moving because her husband is taking a new job in another state. She is very unhappy about the decision and doesn’t want to move. What action should the nurse take next? Question options: Assess the client’s and family’s coping mechanisms in handling stress. Encourage the client to act excited about the move. Talk to the husband to get his perspective on the move. Tell her that all families must cope with new situations from time to time. The family’s ability to cope with demands of everyday living determines its level of success. The nurse needs to assess how the family usually copes with stressful situations to find ways that might be available to the family now to cope with the current situation. In a family in which the mother and the father differ on how to spend and save money, the parents are constantly arguing with each other. Which of the following interventions should the nurse include in the plan of care for this couple? Question options: Assist them to develop strategies that are congruent with their values. Allow each of them to defend his or her own values. Focus on outcomes that each wants to accomplish. Divert their attention to areas in which they are successful. When strategies are used that are congruent with each individual’s values, the couple adjusts. A blended family has six children, ages 2, 4, 4, 5, 7, and 10. During a visit to the home, the nurse notices that the 7-year-old seems quiet and withdrawn, whereas the other children are playing loudly in the garage. Which of the following conclusions can the nurse make from this observation? Question options: This child has most likely been abused. This child is one of multiple children closely spaced in age. This family suffers from low self-esteem. This family provides harsh punishment for their children. Risks associated with role relationships in blended families include multiple closely spaced children, which limits the parents’ time for interaction to meet individual children’s needs. The nurse is caring for a family who has 2-year-old twins. Which of the following health promotion advice would be included in the nurse’s plan of care for this couple? Question options: Wear bicycle helmets for safety. Use caution around the family swimming pool. Cross the street at using the crosswalks. Advocate for the day care to provide adequate socialization. Two-year-olds are prone to wandering to where water is and could fall into a swimming pool without being noticed. A nurse is conducting a health promotion assessment for a family with a 9-month-old. Which of the following should be of most concern to the nurse? Question options: The age of the house in which the family lives Genetic diseases in the family Driving practices in the family Toilet training for the child A typical 9-month-old is beginning to crawl. Houses built before 1974 may contain lead-based paint, to which a crawling baby might have access. Lead causes neurological damage and anemia. A nurse is caring for a family with an adolescent child. Which of the following problems would the nurse anticipate that the family would report? Question options: Concerns about career decisions Concerns about exposure to environmental hazards Difficulty with parents finding fulfillment with raising the child Difficulty with open communication with the child Open communication with parents is often difficult during the adolescent stage, partly because of the differing developmental tasks of adolescents and adults. Concerns about exposure to environmental hazards and parents finding fulfillment with raising the child typically are concerns with families with younger children. Concerns about career decisions are typically problematic for families with older children/young adults. A nurse has developed a family nursing diagnosis. Which of the following best describes the purpose of this action? Question options: Describes the strengths of the family Allows for creation of goals for the family Promotes behavioral change among family members Validates health problems with the family Writing a family nursing diagnosis helps families promote health throughout the life cycle and prevents disease through decreasing risk-taking behaviors. Nurses derive diagnoses from assessed validated data. The nursing diagnosis describes and validates potential or actual health problems with families. The diagnosis provides direction for outcomes and interventions first identifying what the problem is. A home care nurse is planning an intervention with a family focusing on decreasing susceptibility. Which of the following nursing interventions would be most appropriate to implement? Question options: Education about building on current strengths of the family Education about hand hygiene Education about health care resources in the community Education about child safety seats Four types of nursing interventions appear in health-promotion and disease-prevention planning: increasing knowledge and skills; increasing strengths; decreasing exposure; and decreasing susceptibility. Decreasing susceptibility means educating families about prevention principles. Examples include education about hand hygiene and how diseases are spread from person to person and by other factors in the environment. A nurse is making a final home visit with a family to evaluate the nursing care plan. Which of the following actions would the nurse most likely complete during this visit? Question options: Obtain vital signs from all members of the family. Ask the family members to state the goals that were previously developed. Collect data similar to that which was collected at the initial visit for comparison. Educate about the importance of using role relationships to create a healthy family. The purpose of evaluation is to determine how the family has responded to the planned interventions and whether these interventions were successful. The family’s baseline data are used as comparative criteria in evaluation; thus, it would be worthwhile to collect data similar to that collected at the initial visit to see if any changes have occurred. The nurse reassesses the situation and compares the new information with that on the original assessment to determine whether change has occurred. A nurse is planning a home visit for a family. Which of the following actions would be most appropriate for the nurse to take? Question options: Study information regarding the family from agency records and other sources. Make a contract with the family that states specific goals and objectives. Identify how the home visit will be financed. Understand the situation from the family’s perspective. Part of planning the home visit is studying information regarding the family from agency records, referral forms, and other sources. Making a contract, identifying how the visit will be financed, and understanding the situation from the family’s perspective are all part of the process of making the visit. A nurse is providing follow-up care for a family who has recently had a baby. Which of the following topics should the nurse anticipate discussing with the family? Question options: Type 1 diabetes Fetal alcohol syndrome Communicable diseases SIDS Families in the beginning childbearing stage need education about the risk of SIDS for their infant. After the birth of the child, it is most likely that they do not need education about fetal alcohol syndrome, unless there were issues with alcohol use during the prenatal period. Discussion about communicable diseases and potentially Type 1 diabetes would be more common with families with school-aged children. CHAPTER 8 A nurse is employed by a local health department. Which of the following would be one of her primary responsibilities? Question options: Providing appropriate treatment for the flu to an elderly man Providing education to the community about prevention of the flu Ensuring that the family members of the man with the flu get tested for the flu Ensuring that the family members of the man with the flu receive the flu vaccine The role of the community health nurse is to promote the health of the population. It is not limited to any particular individual or group of individuals. It is important that the nurse view the community structure as a population and consider existing health services. Therefore, the primary responsibility of this nurse is to the community she serves by providing education about flu prevention. A parish nurse is concerned about the number of parishioners who smoke. How would the parish nurse best address this issue? Question options: Ban smoking on parish property. Invite local experts to participate in a health fair at the parish. Find literature about smoking cessation. Hand out free nicotine-replacement systems. Nurses interact with communities to promote health. They supply educational information to at-risk groups to develop health-oriented skills as well as encourage behavior change. As such, nurses act as advocates collaborating with other disciplines and agencies. The success of health promotion programs depends on support from prominent community members. Therefore, arranging for a health fair and inviting local experts to participate is the best way for the nurse to address the smoking issue at her parish. Partnering with school-based clinics and local pediatric dentists so that children can have access to preventive dental care is an example of a(n): Question options: codependent function. independent function. interdependent function. dependent function. Collaboration with community members and interdisciplinary teamwork functions crucial to effective community health are considered interdependent functions. Partnering with school-based clinics and local dentists is a collaborative effort to improve the community’s health. Which of the following health concerns should the nurse have as a priority when planning care for a community? Question options: The limited recreational areas identified through a windshield survey The high crime rate reported in the town records The absence of health clinics on the local bus route The lack of grocery stores within walking distance identified by the community As a community liaison, the nurse establishes priorities for programming and matches resources with needs determined by a community-needs assessment. The goal is to maintain the community’s vision. Nurses’ concerns should be based on the community’s concerns. Therefore, the lack of grocery stores identified by the community should take first priority. A nurse is interviewing members of a substance abuse unit at a local Veterans Administration (VA) hospital. Which of the following parts of a community is the nurse assessing? Question options: Structure of a community Subsystem of a community Supra system of a community Interaction of a community Structural parts of a community form subsystems within a larger supra system. A substance abuse unit of a local VA hospital is a subsystem of a larger system (the VA hospital and family of hospitals). The structure of a community system or subsystem forms a formal or informal arrangement of parts. As a result, because interviewing is a form of assessment, the nurse in this example is assessing the subsystem (substance abuse unit of a local VA hospital) of a community (the VA hospital and family of hospitals). The study of a population is referred to as (a): Question options: community pattern. windshield survey. demography. community diagnosis. Demography is defined as the study of a population. The process of dynamic change with adaptation in the system’s parts, and how community systems and subsystems interact is known as: Question options: structure of a community. community health promotion. community diagnosis. function of a community. The function of a community is defined as the process of dynamic change with adaptation in the system’s parts and how community systems and subsystems interact. A nurse is assessing a community from both a developmental and risk perspective. Which of the following characteristics would be of most interest to the nurse? Question options: Gender Age Race Socioeconomic level Community nurses use a developmental-age-correlated approach to identify health promotion and health protection activities. Age is an indication of development. Additionally, community nurses assess those risk factors in a community that can cause adverse health outcomes. Risk factors can vary from person to person but include age, gender, race, geographical location, and lack of health services. Age can thus be used to assess a community from both a developmental and a risk perspective. Which of the following demonstrates the nurse using subjective data to indicate a health concern in the health-perception–health-management pattern? Question options: Examining high sexually transmitted disease rates recorded by the health department Listening to community members discuss the high smoking rate among teenagers Analyzing the high infant mortality rate reported by state hospitals Discussing the high rate of teenage motor vehicle crashes recorded by the local police department Subjective data is based on the perceptions of individuals in the community. Interviewing provides a way to learn how members perceive their communities and their perceptions of health. Therefore, the high smoking rates among teenagers reported by community members indicates subjective data. The others are forms of objective data. After assessing the community, the nurse concludes that the community is having difficulty meeting its nutritional-metabolic pattern. Which of the following findings would the nurse most likely have discovered during the assessment? Question options: Decreased availability of grocery stores Poor nutritional habits Lack of subsidized food programs Inadequate knowledge about proper nutrition The nutritional-metabolic pattern identifies data relevant to community eating habits. These habits are the result of decreased availability of grocery stores, lack of subsidized food programs, and inadequate knowledge. The habits are also influenced by a community’s culture. Therefore, the end results of health concerns in the nutritional-metabolic pattern of a community are poor nutritional habits. A nurse is assessing a community’s exposure to pollutants by examining contaminated soil, air, water, and food. Which functional health pattern is being assessed by the nurse? Question options: Nutritional-metabolic pattern Elimination pattern Health-perception–health management pattern Values-beliefs pattern The elimination pattern identifies factors including exposure to pollutants in the community through contaminated soil, water, air, and food. Which functional health pattern provides information about problem-solving and decision- making within communities? Question options: Cognitive-perceptual pattern Self-perception–self-concept pattern Coping-stress tolerance pattern Health-perception–health-management pattern The cognitive-perceptual pattern provides information about problem-solving and decision making within communities. Within a community there is an elevated high-school dropout rate and its high school students are experiencing a decreased sense of self-worth. Based on this data, the community is at highest risk to experience an alteration in which of the following functional health patterns? Question options: Self-perception–self-concept pattern Role-relationships pattern Cognitive-perceptual pattern Sexuality-reproduction pattern The elevated high-school dropout rate is a risk factor in the values-beliefs pattern, and the decreased sense of self-worth is a risk factor in the self-perception–self-concept pattern. Risk factors from several pattern areas may form clusters of risks for certain groups. Elevated high-school dropout rates and a decreased sense of self-worth may lead to crimes that the community cannot adequately control or cope with. A nurse is working with a community that is experiencing an alteration in its values-beliefs pattern. Which of the following is most likely to result because of a disturbance in this functional health pattern? Question options: Respiratory disorders Hearing loss Coronary artery disease Stress The values-beliefs pattern identifies the community values and beliefs. Values underlie decisions regarding prevention programs. A lack of primary prevention methods (e.g., exercise and a healthy diet) can lead to coronary artery disease. A nurse is using the technique of mapping while implementing the nursing process in the community setting. The nurse is engaging in which aspect of the nursing process? Question options: Collection Planning Analysis Implementation Analysis refers to data categorization and pattern determination. The organization of data is used to determine patterns. Mapping is an organizational technique used in data analysis. A nurse is collecting data regarding the number of crosswalks within a community. Which perspective is being used to gather this data? Question options: Developmental perspective Functional perspective Risk-factor perspective Systems perspective One way to assess a community is from a risk-factor perspective. Risk factors associated with community diseases, illness, and death rates play a role in predicting the likelihood of adverse health conditions. Risk factors include a combination of demographic, psychological, physiological, or environmental characteristics. Select groups may be at risk based on shared risks. Knowing which risk factors are present assists community nurses in developing action plans for health promotion and disease prevention. A community nurse develops a plan to address the problem of teenage pregnancies. Which of the following actions should the nurse take next? Question options: Determine the rate of teenage pregnancies. Evaluate the success of her plan. Provide educational programs at local schools regarding pregnancy prevention. Determine which factors related to teenage pregnancy require intervention. Plans guide nursing actions. Implementation of the nursing process begins based on the health promotion/health protection plan. Providing education is an action item in a plan and thus should be the next step. Determining the rate occurs before diagnosis. Determining which factors require intervention occurs during the planning phase. A nurse has implemented a smoking cessation program for teenagers and is now evaluating the rate of teenage smoking in the community. Which of the following functions is being demonstrated by the nurse? Question options: Codependent function Independent function Interdependent function Dependent function Evaluating nursing activities such as health promotion and health education is an independent function. In this case, the nurse is evaluating the nursing activity (smoking cessation program), and therefore it is an independent function. A community is in the maintenance stage of change. Which of the following would be an appropriate intervention for the community health nurse? Question options: Highlight past successes Discuss the benefits of changing Develop strategies to prevent relapse Provide information In the maintenance stage of change, a community nurse should highlight past successes and future benefits. During the contemplation phase, the benefits of changing should be discussed. Developing strategies to prevent relapse should happen during the action phase. Providing information should occur during the precontemplation stage. A community is considering banning smoking in all schools. Based on the community’s current stage of change, which action should the nurse take next? Question options: Provide the community with statistics regarding childhood smoking rates. Point out positive outcomes associated with banning smoking such as maintenance of lung function. Help the community develop a plan to implement the ban. Praise the members of the community for their actions. A community that is considering implementing a smoking ban is in the contemplation stage of change. In this stage, interventions should be focused on discussing the risks of not changing and the benefits of changing. Maintaining the lung function of children is a benefit of the ban the community members are considering and thus an appropriate intervention for the nurse to utilize. CHAPTER 9 Which is an example of asymptomatic pathogenesis? Question options: Blood pressure of 170/98 experiencing headaches Positive finding on colonoscopy and blood in his or her stool Elevated prostate-specific antigen (PSA) Elevated TSH who is always tired The primary objective of screening is the detection of a disease in its early stages, to treat it and deter its progression. The screening process is based on the principle that disease is preceded by a period of asymptomatic pathogenesis when risk factors predisposing a person to the pathological condition are building momentum toward manifestation of the disease. Therefore, someone with an elevated PSA without any symptoms is an example of asymptomatic pathogenesis. The other three examples demonstrate manifestation of disease (headaches, blood in stool, and tiredness). Influenza occurs among Americans at a rate of 36 per 100 people annually. Which type of rate is this statement describing? Question options: Prevalence rate Incidence rate Morbidity rate Mortality rate Incidence rate is the rate of a new population problem and estimates the risk of an individual developing the specific disease or condition during a specific period or over a lifetime. Prevalence is the proportion of a given population with the disease or condition at any one point in time. Usually acute conditions are assessed by their incidence (rate of occurrence), whereas chronic conditions are measured by their prevalence (generally existing). A nurse is examining the incidence, prevalence, and mortality rates of colon cancer in the community. Which of the following measures of life is being investigated? Question options: Quality adjusted life year (QALY) Quantity of life Disability adjusted life year (DALY) Satisfaction of life Measures of quantity of life affected by a disease are more readily attainable than quality of life measures. Quantity of life can be measured by using incidence and prevalence rates as well as disease- specific mortality rates. Which represents a disadvantage of screening? Question options: Utilization of group screening methods Utilization of multiple test screening Utilization of a test with high specificity Utilization of a test with low sensitivity Group screening and multiple test screening are advantages of screening programs. A disadvantage of screening occurs when the test is unable to distinguish those who probably have the disease from those who do not. Tests with low sensitivity produce a large number of false-negative tests and leave those screened with a false sense of a healthful state, resulting in them losing the opportunity to receive early treatments that could prevent irreversible damage. The nurse is examining the ability of a phenylketonuria (PKU) screening test to distinguish correctly between newborns who have and who do not have the disease. Which of the following measures of accuracy of the instrument is being evaluated? Question options: Sensitivity Specificity Validity Efficacy Validity is defined as a test’s ability to distinguish correctly between diseased and nondiseased individuals. The proportion of people with a condition who correctly test positive when screened is known as: Question options: sensitivity. specificity. validity. efficacy. Sensitivity refers to the proportion of people with a condition who correctly test positive when screened. A nurse is using a sweat test to screen people for cystic fibrosis. Which of the following results demonstrates poor sensitivity? Question options: When 6 out of every 10 sweat tests performed are negative, but the six individuals actually have cystic fibrosis When 6 out of every 10 sweat tests performed are positive, but the six individuals do not actually have cystic fibrosis When 6 out of every 10 sweat tests performed are negative, and the six individuals really do not have cystic fibrosis When 6 out of every 10 sweat tests performed are positive, and the six individuals really do have cystic fibrosis Sensitivity refers to the proportion of people with a condition who correctly test positive when screened. A test with poor sensitivity will miss individuals with the condition, and there will be a large number of false-negative results; individuals actually have the condition but were told they were disease free. Thus when 6 out of every 10 sweat tests performed are negative but the six individuals actually have cystic fibrosis, it is an example of poor sensitivity. A nurse is creating a hypertension screening program. Which of the following methods would be the best way to design a successful program? Question options: Work with stakeholders to conduct a community assessment. Purchase state-of-the-art sphygmomanometers to measure blood pressures. Use the program developed at a previous place of employment. Contact a local church to see if the program can be implemented there. Partnerships are essential to developing health programs and screening programs. The primary rule is to never assume that what is appropriate and effective for one community will be appropriate and effective for another community. A community assessment conducted as a partnership with key stakeholders provides information about the high-risk population, available health care resources, and the high-risk population’s health needs. By conducting the assessment, the nurse can identify the necessary community resources and mobilize them to achieve maximal benefits and positive outcomes. A nurse is planning to offer a depression screening at a local community center. Which of the following should be considered prior to implementation of the program? Question options: Limited referral sources in the community Limited support groups in the community Insufficient evidence that depression screening tools are cost effective Insufficient evidence mental health screening is appropriate Constraints affecting the operation of a screening program include financial concerns, political issues, cultural constraints, follow-up and referral services, and accessible treatment facilities. An efficient referral system should link the follow-up resources to the screening program, providing continuity of care. A method must be devised to encourage the participant to take positive action on the referral. Depression screening for adults is a covered preventive service for adults. A nurse is implementing a test that screens for hypercholesterolemia. Which of the following parameters should this test have? Question options: No cutoff point Low cutoff point Intermediate cutoff point High cutoff point The goal of a screening program, identifying an individual as high risk or not, depends on the numerical value of the screening instrument. When the parameter for this distinction is not clear, a cutoff point is set. Above this point, the person is considered disease positive; below this point, the individual is considered disease negative. Thus, if the disease were potentially life-threatening or if a disease is relatively benign in terms of stigmatization, anxiety, and problems with treatment, the lower cutoff would be preferred. High cholesterol, if left untreated, could contribute to life-threatening cardiac disease. Additionally, it is benign in terms of stigmatization. Therefore, a lower cutoff point should be set. A nurse is educating a group of community members about how hypertension screening is effective in reducing the rate of cardiovascular disease, thus reducing the expenses that are spent on management of this disease. Which of the following ratios is being described? Question options: Cost-disease analysis Cost-efficiency analysis Cost-benefit ratio analysis Cost-effectiveness analysis Cost-benefit ratio analysis allows the comparison of various outcomes in monetary terms. The cost of the screening versus the cost of chronic care management is considered. Which of the following is an example of a screenable population for hypertension? Question options: High school students Professional hockey players High-level business executives attending an annual conference Cardiac rehabilitation clients The objective of identifying a screenable population is to identify a high-risk group that, when tested, will yield a significant number of diseased individuals. The main criterion used to define an appropriate population is the definitive presence of risk factors related to the disorder. Most high-level business executives are middle-aged men with stressful jobs, placing them at high risk for heart disease. Thus, this would be the best example of a screenable population for hypertension. A nurse is assessing a low-income population in a community. Which of the following would be most appropriate for this population? Question options: HIV screening Blood pressure screening Colorectal cancer screening Breast cancer mammography screening According to a 2010 Gallup poll, ‘Low-income Americans are more likely than their high-income counterparts to say they have been diagnosed with each of the chronic conditions the differences are largest for depression, high blood pressure, and diabetes the high level of obesity among low- income Americans is likely a contributing factor in these differences.’ A nurse is working at a women’s health clinic and is asked by a client when she should return for her next Pap smear. Which of the following resources would the nurse use to find the most current recommendations? Question options: National Health Information Center Healthy People 2020 U.S. Preventive Services Task Force (USPSTF) website Centers for Disease Control and Prevention (CDC) website The most current information about recommendations for screening tests can be found on the Agency for Healthcare Research and Quality (AHRQ) U.S. Preventive Services Task Force (USPSTF) website. These recommendations evolve as new scientific evidence becomes available. A nurse is planning a comprehensive health promotion activity to provide community members with a better opportunity to manage their own risk. Which of the following activities would be most appropriate for the nurse to perform? Question options: Obtaining blood pressures and cholesterol levels during a screening Obtaining blood pressures and family histories during a screening Obtaining blood pressures and discussing the importance of exercise during a screening Obtaining blood pressures, cholesterol levels, and glucose levels during a screening Providing health education during a screening falls under the Scope and Standards of Nursing Practice. Many chronic diseases are the result of health behaviors. The nurse’s role as educator is essential in the screening process because nurses provide individuals with the information necessary for choices that are made regarding healthy behavioral changes. Awareness is the first step in prevention. If awareness is combined with health education and health-promotion tools, people will have a better opportunity to manage their own risks. Thus, obtaining a person’s blood pressure while discussing the importance of exercise during a blood pressure screening is an example of a comprehensive health promotion activity. To screen for colorectal cancer, colonoscopy should be conducted every 10 years beginning at age: Question options: 30. 40. 50. 60. It is recommended that men and women age 50 and older have a colonoscopy performed every 10 years to screen for colorectal cancer. For which of the following is Type 2 diabetes mellitus screening recommended? Question options: Overweight woman Teenager Man with hypertension Woman with a family history of Type 2 diabetes mellitus The risk of developing Type 2 diabetes mellitus increases with age, obesity, and lack of exercise. Although the woman with a family history of Type 2 diabetes mellitus is at risk of developing the disease, screening is only recommended for those with hypertension. Therefore, the man with hypertension should be screened for Type 2 diabetes mellitus. Which of the following women should be screened for breast cancer? Question options: A 35-year old woman with three children and no family history of breast cancer A 59-year-old woman with no children who still gets her period every month A 25-year-old woman with one child whom she gave birth to when she was a teenager A 17-year-old woman with one child who started menstruating at the age of 13 In the United States, the incidence of breast cancer increases with age. Breast cancer mammography screenings are recommended every 1 to 2 years for women over 40. A nurse is speaking to a women’s group in the community about the importance of completing mammography to screen for breast cancer. At which age should the nurse recommend that mammography begin? Question options: 18 21 35 40 It is recommended that all women age 40 and older have a mammography performed every 1 to 2 years to screen for breast cancer. A nurse is reviewing the chart of a 15-year-old girl who has been sexually active since the age of 12. Which of the following findings would be of most concern? Question options: She does not perform self-breast exams. She has never had a Pap test. She had one HIV test performed at the age of 13. She does not use birth control pills. Although self-breast exams are encouraged and considered an important aspect of breast health education, data regarding its efficacy is weak. Although she does not use birth control pills, there is no indication that she does not use other forms of birth control such as condoms that would also prevent against STDs. There is also no indication that she has had more than one sex partner and is at high risk for HIV infection. A cervical dysplasia screening is recommended for sexual active females. Therefore, the fact that she never had a Pap test to screen for cervical cancer and has been sexually active for the last 3 years is concerning. CHAPTER 10 A nurse would like to assist Americans in improving their health. Which strategy would be most beneficial to improve the health of the American public? Question options: Encourage Americans to stop smoking. Lobby for state-of-the-art magnetic resonance imaging machines in all hospitals. Provide free medications for Americans. Offer free condoms to teenagers. The greatest opportunity to improve the health of the American people lies in addressing unhealthy, personal, behavioral risk factors. Intensive lifestyle changes can be effective not only in preventing chronic diseases, but also in reversing their progression and significantly reducing health care costs. Improvement of the public’s health is more likely to come from behavior change than technology. Therefore, people deciding they are going to change their behavior and stop smoking are likely to lead to improvements in the health of the public. A nurse is using a health education component when teaching about smoking cessation. Which of the following actions is the nurse implementing? Question options: Setting a quit date for people in a smoking cessation class Providing education regarding the benefits of smoking cessation Allowing smokers to participate in a smoking cessation program only if they use the patch nicotine replacement system Encouraging attendees of a smoking cessation program to participate in a research study Essential components of health education involve using teaching strategies, having learners maintain voluntary control over the decision to make changes in their actions, and focusing on behavior changes that have been found to improve heath. Providing smokers with the information regarding the benefits of smoking cessation allows them to make their own decision and provides them with information that is known to improve health. Any combination of planned experiences based on sound theories that provide individuals, groups, and communities the opportunity to acquire the information and skills needed to make quality health decisions is known as health: Question options: promotion. counseling. education. knowledge. Any combination of planned experiences based on sound theories that provide individuals, groups, and communities the opportunity to acquire the information and skills needed to make quality health decisions is known as health education. Which of the following illustrates that the objectives of health education and counseling are being met? Question options: Diabetic who attends a diabetes education program Diabetic who watches a video about self-administration of insulin Diabetic who starts taking his medications regularly Diabetic who is admitted in diabetic ketoacidosis Health education encourages positive, informed changes in lifestyle behaviors that prevent acute and chronic disease, decrease disability, and enhance wellness. Two main objectives of health education and counseling are to change health behaviors and to improve health status. A diabetic who starts taking his medications regularly is an example of a behavior change intended to decrease disability. Which of the following illustrates that the objectives of health education and counseling have been met? Question options: Asthmatic who has a decrease in emergency department visits Asthmatic who has been prescribed an albuterol inhaler Asthmatic who attends an asthma education program Asthmatic who visits the emergency department with an exacerbation Health education encourages positive, informed changes in lifestyle behaviors that prevent acute and chronic disease, decrease disability, and enhance wellness. Two main objectives of health education and counseling are to change health behaviors and to improve health status. An asthmatic with a decrease in emergency department visits is an improvement in health status, which is a reflection of behavior changes used to prevent acute exacerbations of a chronic disease. A teenager, who lives at home with her parents and school-aged brother, has been diagnosed with anorexia nervosa. Which of the following would be the most appropriate teaching goal for this family? Question options: Increased energy level Improved coping Enhanced self-esteem Facilitated family conversation The family plays an important role in health and illness. Understanding and intervening with the family is essential to promoting health and reducing risk. Health teaching includes all family members although the general teaching goal is the same for all, approaches and specific goals for each member will be different. An illness in one member of the family can alter the entire family’s ability to cope. As a result, improved coping is the most appropriate goal. A teenager, who lives at home with her parents and school-aged brother, has been diagnosed with anorexia nervosa. Which of the following would be the most appropriate teaching goal for this teenager? Question options: Increased energy level Improved coping Enhanced self-esteem Accomplished activities of daily living Health teaching includes all family members; although the general teaching goal is the same for all, approaches and specific goals for each member will be different. Teenagers with anorexia nervosa often have decreased self-esteem. As a result, an appropriate goal for this teenager would be enhanced self- esteem. A nurse is using the health belief model as a framework when developing a community action campaign to increase the percentage of the population who receives the influenza vaccine. Which of the following considerations will need to be made? Question options: How empowerment can be used to motivate community members How modeling can be used in the community to increase public awareness Perceived susceptibility in the community about getting influenza Perceived stage of behavior change that exists in the community The components of the health belief model that need to be considered are: individual perceptions or readiness for change; the value of health to the individual compared with other aspects of living; perceived susceptibility to a health problem, disease, or complications; perceived seriousness of the disease level threatening the achievement of certain goals or aims; risk factors to a disease attributed to heredity, race or culture, medical history, or other causes; perceived benefits of health action; perceived barriers to promotion action. A nurse is counseling a teenager who smokes one pack of cigarettes a day. The teenager states he likes to smoke with his friends and does not recognize the connection between his smoking and his asthma. When planning an intervention for this person, the nurse must first recognize that the teenager is in the: Question options: precontemplation stage of change. preparation stage of change. action stage of change. maintenance stage of change. A person in the precontemplation stage of change is not thinking about or considering quitting or adopting a behavior change within the next 6 months. Health education must be matched to the stage of change. This teenager does not see a connection between his smoking and his asthma. He likes to smoke and is therefore unlikely to make any changes at this time. An overweight woman is in the preparation stage of change. Which of the following interventions would be the most appropriate for the nurse to implement? Question options: Inform her of the health risks associated with being overweight. Prepare her for the setbacks. Develop a low-calorie/low-fat diet with her so she can follow it at home. Praise her for her recent successes. A person in the preparation stage of change has made a change or is seriously thinking about making a change in the next month. At this stage, people make small or sporadic changes. Health education must be matched to the stage of change. During this stage, it is the educator’s role to provide the woman with the tools to move forward with her plan. Working on a diet together will decrease barriers to change by making it easier for the woman to follow a diet. Enlisting her cooperation achieves better results. A nurse is providing education about safe driving with a group of newly licensed teenagers. Which factor would most likely influence a teenager’s decision to drive within the speed limit? Question options: A speed limit sign Having his parents telling him not to speed A previous traffic violation for speeding Seeing someone get pulled over for speeding Effective health education requires an understanding of the influential factors affecting the individual’s decision making. These factors include values, beliefs, attitudes, life stresses, religion, previous experiences, and life goals. Having had a previous experience with receiving a speeding ticket may positively influence the teenager’s decision to drive within the speed limit because (1) he knows he is vulnerable to being caught and ticketed again, and (2) further tickets may have an effect on his ability to drive at all (e.g., his parents may punish him by not allowing him to drive, his driving privileges with the department of motor vehicles may be affected, or his insurance premium may be affected). Although seeing someone get pulled over may influence a person’s decision through modeling and observing others, teenagers believe they are invincible and therefore would probably not be effective in this age group. A nurse is counseling a person who has recently started to receive treatment for alcohol abuse. Which factor would most negatively influence the person’s decision to stop abusing alcohol? Question options: He is a Catholic. His wife recently died from breast cancer. Buying alcohol is expensive. He was educated on the dangers of excessive drinking. Effective health education requires an understanding of the influential factors affecting the individual’s decision-making. These factors include values, beliefs, attitudes, life stresses, religion, previous experiences, and life goals. Although religion and education can influence a person’s decision, the stressor of his wife’s recent death is most likely to negatively influence his decision to stop abusing alcohol. The primary objective of social marketing is to: Question options: plan behavior. analyze behavior. limit behavior. change behavior. The primary objective of social marketing is to change behavior. A nurse distributes a demographic questionnaire to attendees of a weight management program. Which step in the teaching-learning process is being implemented? Question options: Assessment Development Implementation Evaluation The assessment step in the teaching-learning process is comprised of assessing the students’ characteristics and needs. Obtaining demographic data from the attendees will help the nurse determine the characteristics of the students. The goal for the educational session is for the individual to correctly demonstrate proper technique for checking blood sugar levels. Which of the following teaching strategies would be most effective? Question options: Provide the individual with one-on-one education about blood sugar monitoring. Provide the individual with a scenario about blood sugar monitoring. Provide the individual with the opportunity to practice blood sugar monitoring. Provide the individual with a blood sugar monitor. Teaching is directed toward one or more of the three learning domains. The goal of having the individual demonstrate the proper technique for checking blood sugar levels relates to the psychomotor domain and is best achieved through demonstration and practice. These strategies allow the nurse to provide the individual with feedback and encouragement. A nurse is developing learning objectives for an individual who has been placed on a low-fat, low-cholesterol diet. Which is an example of an appropriately written cognitive learning objective? Question options: The individual will understand the importance of a low-fat, low-cholesterol diet. The individual will correctly identify and purchase low-fat, low-cholesterol foods. The individual will believe that his heart will benefit from a low-fat, low-cholesterol diet. The individual will feel healthier if he follows a low-fat, low-cholesterol diet. Cognitive learning refers to the development of new facts or concepts and builds on or applies knowledge to new situations. Objectives of this domain must incorporate action verbs that indicate observable learning. Identifying and purchasing low-fat, low-cholesterol foods demonstrates that the individual has learned which foods are low in fat and cholesterol. A nurse is developing learning objectives for an individual who is becoming more physically active. Which of the following is an example of an appropriately written affective learning objective? Question options: The individual will understand the importance of daily exercise. The individual will demonstrate the importance of daily exercise. The individual will verbalize the importance of daily exercise. The individual will believe in the importance of daily exercise. Affective learning alludes to the recognition of values, religious and spiritual beliefs, family interaction patterns and relationships, and personal attitudes that affect decisions and the problem-solving process. Objectives of this domain must incorporate action verbs that indicate observable learning. Verbalizing the importance of daily exercise alludes to the recognition of the value of daily exercise to the individual. A nurse is developing learning objectives for an individual who has been recently diagnosed with asthma. Which is an example of an appropriately written psychomotor learning objective? Question options: The individual will understand how to correctly use an inhaler. The individual will realize the importance of using an inhaler correctly. The individual will feel better when using the inhaler correctly. The individual will demonstrate proper use of the inhaler. Psychomotor learning involves developing physical skills from simple to complex. Objectives of this domain must incorporate action verbs that indicate observable learning. Demonstrating proper use indicates that the individual has developed the necessary skills to use an inhaler correctly. A nurse plans to use lectures, handouts, and a video to teach a group of teenagers the importance of safe sex practices. Which step in the teaching-learning process is the nurse demonstrating? Question options: Assessment Development Implementation Evaluation The development of a teaching plan component of the teaching-learning process is comprised of developing the course content, teaching strategies, and learning action. Lectures, handouts, and videos are all examples of teaching strategies. A nurse is providing health education about the importance of dental health to Latino residents in a community. Which of the following considerations should be made to promote health literacy within this program? Question options: Speak slowly and distinctly. Refer the client to an interpreter. Use photographs whenever possible. Consider methods to facilitate empowerment. Strategies to promote health literacy include creating a shame-free environment (speaking slowly and distinctly), using clear and purposeful communication (being specific and concrete), communicating in a patient-centered manner (assess what is already known), and reinforcing the spoken word (using a variety of methods: photographs, audio, and drawings). CHAPTER 11 Which of the following statements about the current prevalence of obesity is accurate? Question options: The current generation of children may be less healthy and have a shorter life expectancy than their parents. The current incidence of obesity among American adults has stabilized. The current statistics show that greater than 75% of American adults are either overweight or obese. The current statistics report that about 50% of American children are either overweight or obese. Because of the increasing rates of obesity, unhealthy eating habits, and physical inactivity, we may see the first generation that will be less healthy and have a shorter life expectancy than their parents. The current statistics show that two in three American adults and one in three children are either overweight or obese. A nurse is working with a family that is experiencing food insecurity. Which of the following statements best describes this family? Question options: Members of this family are susceptible to food-borne illness. This family’s access to adequate food is limited by lack of money. This family is unable to purchase fresh fruits and vegetables. Members of this family are obese. When a family experiences food insecurity it means that their access to adequate food is limited by a lack of money and other resources. Individuals and families may be more likely to be overweight or obese, potentially because the relatively lower cost of junk foods can promote overconsumption of calories. A community health nurse is using the Dietary Reference Intakes (DRIs) as a guide while developing an education presentation about nutrition for a community group. How will the use of the DRIs be helpful in developing this presentation? Question options: It considers the unique differences among children, pregnant women, and elderly people. It contains well-researched data that are reviewed on an annual basis. It is prescriptive in the amount of nutrients that are needed on a daily basis. It serves as an overall guideline for the population. Dietary Reference Intakes may be used for individuals; however, ideally they are guidelines for population groups and apply over time. It is the trend that matters not the amount on a certain day. The DRIs are created even when limited data are available as this is deemed better than no guidance at all. The DRIs are only updated when deemed necessary. There are limited data relating to genetic diversity in the population or specific groups such as children, pregnant women, and elderly people. After the 2010 Dietary Guidelines were released, a community health nurse updated a nutrition presentation that was being used to educate various community groups about healthy eating habits. Which of the following information would have been added to the presentation? Question options: Consumption of increased amounts of carbohydrates Impact of the environment on the public’s food, drink, and activity choices Revised guidelines for the use of MyPyramid Inclusion of physical activity standards For the first time, the 2010 Dietary Guidelines have an entire chapter devoted to addressing the impact of the broader food and physical environment on the public’s food, drink, and activity choices using the Social-Ecological model. Physical activity standards were included in the 2005 guidelines. MyPyramid was replaced with MyPlate. There was a shift in food intake patterns emphasizing more vegetables, cooked dried beans, fruits, whole grains, nuts and seeds. A community health nurse is educating a community group about the 2010 Dietary Guidelines for Americans. Which of the following information would be included in this presentation? Question options: Limit consumption of dairy products. Purchase organic fruits and vegetables. Make at least half of your grains whole grains. Consume fish on a daily basis. One of the principal messages for consumers is “make at least half of your grains whole grains.” Other messages include “switch to fat-free or low-fat (1%) milk” and “make half your plate fruits and vegetables.” There is not an essential message to consume fish on a daily basis. A person states to the nurse, “The guidelines for what we should eat as Americans is constantly changing, just when I got used to using MyPyramid they changed it to MyPlate. I wonder what will be next and if they really know what they are doing with all of this change.” Which of the following would be the best response from the nurse? Question options: “The USDA is constantly making changes in order to decrease the alarming rates of obesity in our country.” “MyPyramid was developed in 2005, so it was time for this graphic to be revised.” “The creation of MyPlate has decreased the need for additional teaching resources for nutrition.” “MyPlate serves as a better visual aid, reminding Americans what a healthy ‘plate’ looks like.” MyPate was released in June 2011 providing Americans easy to understand and useful advice. MyPlate visually “reminds” consumers what a healthy “plate” looks like using a familiar place setting. It is not meant to stand alone as a teaching tool. A 37-year-old woman asks the nurse if she should take a daily nutritional supplement. Which of the following would be the best reply by the nurse? Question options: “Postmenopausal women should take a calcium supplement to prevent osteoporosis.” “Many people use supplements as drugs instead of as supplements.” “Supplements can enhance the medications that you take.” “The best way to obtain nutrients is by eating a variety of foods.” The desirable way for the general public to obtain nutrients is by eating a variety of foods. Dietary supplements needs to be used cautiously so that excess amounts are not consumed, which could lead to possible adverse effects. A client who is taking Coumadin tells the nurse that she has started taking a vitamin E supplement as she has heard that this will help decrease the likelihood of her developing cancer. Which of the following would be the most appropriate response by the nurse? Question options: “Vitamin E supplements are unnecessary, so I don’t recommend you use this supplement.” “Vitamin E can interfere with the actions of vitamin K and enhance the effects of Coumadin .” “Vitamin E supplements can interfere with the absorption of iron and create additional health problems.” “Vitamin E must be used cautiously, as it is easy to experience a toxicity of this nutrient.” High doses of vitamin E can interfere with vitamin K action and enhance the effect of Coumadin as one of the anticoagulant drugs. Because of this interaction, she should probably not be taking a supplement of vitamin E while taking the Coumadin. If she continues on the supplement, it may be necessary to adjust the dosage of Coumadin the woman is prescribed. A nurse is investigating an outbreak of a food-borne illness occurring at a local school. Which of the following would contribute to a chemical contamination resulting in food-borne illness? Question options: Unintended allergen added to food Bacteria on the countertops Pesticide on the fresh fruit Metal shavings in the food from a dull can opener Food-borne illness is classified according to the source of its contamination. Food contaminants may be categorized as biological (bacteria), chemical (pesticides), or physical (metal shavings and unintended allergens). A school nurse is preparing to discuss food safety practices with high school students enrolled in a family and consumer science “foods” course. Which of the following information would be included in the presentation? Question options: Wash hands thoroughly with running warm water with soap for 30 seconds. Scrub firm services of all fruits and vegetables with a produce brush before eating. Pay close attention to assure that meat is cooked all of the way through. Refrigerate leftovers within 30 minutes of serving. There are four principles at the cornerstones of Fight BAC!, a national food safety education campaign (Clean, Separate, Cook, and Chill). Clean—wash all parts of hands thoroughly with running warm water with soap and friction for about 20-30 seconds. Scrub firm surfaces like cantaloupe and cucumbers with a produce brush, other fresh fruits and vegetables can be rinsed under running water. A food thermometer should be used to make sure that food is cooked all the way through. Leftovers should be refrigerated within 2 hours or 1 hour in temperatures greater than 90° F. A community health nurse is working with a low-income family who is experiencing food insecurity. To assist the family in getting nutritious foods in their home, the family should be referred to which of the following programs? Question options: Nutrition Service Incentive Program (NSIP) Supplemental Nutrition for Women Infants and Children (WIC) National School Lunch Program (NSLP) Supplemental Nutrition Assistance Program (SNAP) Supplemental Nutrition Assistance Program (SNAP) supplements the food-buying power of eligible low- income households and is the foundation of the Nations’ nutrition safety net. The program is designed to help low-income families and individuals purchase nutritionally adequate foods. A nurse is counseling a person with heart disease. Which of the following statements made by the individual would require the nurse to provide additional education? Question options: “I drink skim milk on a regular basis.” “I try not to eat foods that have added salt on the label.” “I eat American cheese about once every 2 weeks.” “I add salt to many of the food that I eat to enhance the flavor.” The 2006 AHA diet and lifestyle recommendations include the suggestion to reduce salt intake by comparing the sodium content of similar products and choosing products with less salt or sodium; choosing versions of processed foods, including cereals and baked goods, that are reduced in salt or sodium; and limited condiments. Sodium ingestion leads to retention of fluids and may be harmful to the cardiovascular system of someone who has heart disease. A 45-year-old man has been diagnosed with metabolic syndrome. Which of the following characteristics would this man exhibit? Question options: Blood pressure: 146/88 mm Hg Waist measurement: 36 inches HDL: 48 mg/dL Triglycerides: 140 mg/dL Metabolic syndrome is diagnosed when a person has three or more of these factors: excessive abdominal fat, as indicated by too large a waist measurement (greater than 40 inches in men); elevated blood pressure (higher than 130/85 mm Hg), low HDL level (lower than 40 mg/dL), and elevated triglyceride level (higher than 150 mg/dL). A community health nurse is providing education about the “Dietary Approaches to Stop Hypertension” (DASH) eating plan to people attending cardiac rehabilitation. Which of the following recommendations would be included in this presentation? Question options: The use of this dietary plan has the same health effects as a daily exercise program. The use of this dietary plan will eliminate the need for medication to treat hypertension. This dietary plan is excludes the consumption of processed foods. This dietary plan includes eating greater amounts of fruits and vegetables. Clinical studies show that blood pressure can be lowered by following the DASH eating plan. The DASH eating plan includes abundant fruits and vegetables, more fat-free or low-fat milk and milk products, whole grains, fish, poultry, beans, seeds, and nuts. Depending on the severity of hypertension, the plan may allow for a reduction or elimination of medication. A man states that he would like to change his dietary habits to decrease his risk of developing cancer in the future. Which of the following statements would be the best response for the nurse? Question options: “Consume at least 2 ½ cups of fruits and vegetables each day.” “Dietary habits have minimal effect in reducing your risk of developing cancer.” “A glass of red wine should be consumed daily.” “Dietary supplements of specific nutrients will maximize the effects of dietary changes.” Eating at least 2 ½ cups of a variety of fruits and vegetables can help protect against cancers at many sites, particularly for cancers of the gastrointestinal and respiratory tracks. Following the dietary recommendations included in the 2010 Dietary guidelines for Americans and MyPlate are consistent with those recommended by the ACS. Food appears to have a protective effect by itself that dietary supplements do not provide. Which of the following people is at greatest risk for a hip fracture secondary to osteoporosis? Question options: A 66-year-old White woman A 66-year-old African American woman A 66-year-old White man A 66-year-old African American man White postmenopausal women have the greatest prevalence of osteoporosis and incidence of hip fracture by gender and race. A school nurse is using height and weight measurements to calculate the body mass index (BMI) of the students. How will the nurse use these data? Question options: BMI can be correlated to a specific percentage of body fat. BMI can be used to determine if a child is obese or underweight. BMI can be used to determine if a child will develop Type 2 diabetes. BMI can be compared with others of the same ethnic background. Body mass index (BMI) is a helpful indicator of obesity and being underweight. Height and weight measurements are needed in the calculation to determine BMI. BMI is a good indicator of body fat, but it cannot be interpreted as a specific percentage of body fat. BMI is used to screen and monitor a population to detect the risk of health or nutritional disorders. In an individual, other data must be used to determine if a high BMI is associated with increased risk of disease; BMI alone is not diagnostic. The growth charts released in 2000 by the CDC more accurately reflect the nation’s cultural and racial diversity, but there is not a different chart for each ethnic background. A community health nurse is educating health care providers in a local clinic about steps to take to help their clients improve their health-related behaviors. Which of the following would be included as the nurse teaches about the acronym LEARN? Question options: Explain how small changes can affect health. Acknowledge that action needs to be taken. Negotiate an agreement. Refer to community resources. LEARN refers to the steps nurses can take to help the person who needs to improve health-related behavior. L = Listen with sympathy and understanding to the person’s perception of the problem, E = Explain personal perceptions of the problem, A = Acknowledge and discuss differences and similarities, R = Recommend treatment, N = Negotiate an agreement. Which of the following individuals would be at greatest risk to develop Type 2 diabetes? Question options: White, 50-year-old woman, obese, second child weighed 10 pounds at birth African American, 55-year-old man, hypertension, exercises regularly Hispanic, 22-year-old woman, healthy weight, family history of diabetes White, 75-year-old man, history of prostate cancer and high triglycerides Risk factors for Type 2 diabetes include: having prediabetes (impaired glucose tolerance [IGT] and/or impaired fasting glucose [IFG]), age greater than 45, being overweight or obese, not exercising regularly, having a family history of diabetes, a personal history of gestational diabetes or a baby of at least 9 pounds at birth, other risk factors such as high blood pressure, a low HDL cholesterol or high triglycerides, and one’s race and ethnicity. The White, 50-year-old woman who is obese and gave birth to a child weighing 10 pounds has the most risk factors of the clients described. A nurse is counseling a person who was recently diagnosed with diabetes about how to prevent the complications of this disease. Which of the following interventions would be stressed the most by the nurse? Question options: Adjusting sliding scale insulin therapy as needed Taking oral hypoglycemic medication as prescribed Monitoring blood glucose daily Adhering to medical nutrition therapy Medicine may be used to control blood glucose level, and measuring the blood glucose daily helps in controlling its level. But the key to maintaining diabetic control is individualized medical nutrition therapy, the purpose of which is to delay or prevent diabetic complications. CHAPTER 12 Activity that uses large muscle groups in a repetitive, rhythmic fashion over an extended period to improve the efficiency of the oxidative energy producing system and improve cardiorespiratory endurance is known as: Question options: aerobic activity. anaerobic activity. flexibility. muscular fitness. Aerobic activity is defined as activity that uses large muscle groups in a repetitive, rhythmic fashion over an extended period to improve the efficiency of the oxidative energy producing system and improve cardiorespiratory endurance. A nurse is working with a group of individuals to start an exercise program. Which of the following would require the most attention and assistance? Question options: White man who works 50 to 60 hours a week as a business executive Unemployed, obese Hispanic woman Employed White woman with hypertension White man with a high school diploma The number of adults with no leisure-time physical activity varies by race, ethnicity, gender, education level, geographic location, disability status, and age. Women are less active than men. Lower income and less educated people are not as physically active as those with higher socioeconomic and educational levels. In addition, African Americans and Hispanics are less active. The unemployed, obese Hispanic woman has three risk factors for inactivity: (1) she is unemployed and therefore likely has no or a low income level; (2) she is a woman, and (3) she is Hispanic. All of these factors place her at risk for inactivity. According to the physical activity and fitness section of the Healthy People 2020 report, what percentage of adults 18 years of age or older report no leisure-time physical activity? Question options: 16% 26% 36% 46% According to the physical activity and fitness section of the Healthy People 2020 report, 46% of adults 18 years of age or older report no leisure-time physical activity. A nurse is developing a primary prevention strategy to address the problem of obesity. Which of the following interventions is being created? Question options: Encouraging an active lifestyle during childhood years Prescribing orlistat (Alli) Recommending the Jenny Craig program Recommending gastric banding surgery Exercise is an important component of primary prevention. Less active children increase their risk of sedentary lifestyles as adults. Sedentary lifestyles lead to obesity. Therefore, a primary prevention method for obesity is to encourage an active lifestyle during the childhood years. A nurse is providing care for a 10-year-old child with a BMI at the 80th percentile. Which of the following best describes this child? Question options: Normal weight Overweight Obese Morbidly obese A child or adolescent is categorized as being overweight if his or her BMI is greater than or equal to the 95th percentile of age- and gender-specific BMI growth charts. Thus, the 10-year-old child with a BMI at the 80th percentile is considered to be normal weight. During an office visit, a nurse meets with a woman who states she does not have time to exercise. Which of the following actions should the nurse take next? Question options: Do nothing because she has already made the decision to not exercise. Provide her with information on the benefits of exercising. Develop an exercise prescription with her. Schedule a follow-up in 2 months to see if she still feels the same way. The woman is in the precontemplation state and thus should not be forced into a plan at this time. However, exercise has many benefits and it implementation should be encouraged. The nurse should continue to ask at each visit because when individuals are counseled by clinicians they are more likely to increase physical activity. As a result, providing the woman with information regarding the benefits of exercising and bringing up the topic of exercise is the best approach at this stage. During an office visit, a nurse provides counseling to a 70-year-old woman with osteoporosis who is otherwise very healthy. Which of the following information should the nurse provide to the woman? Question options: Avoid all forms of exercise because of the risk of fractures. Walk with a partner at least 30 minutes a day 5 days a week. Use a wheelchair to get around so that she can prevent falls. Take a step aerobics class 5 days a week. Regular physical activity helps maintain functional independence and improve quality of life throughout the aging process. The benefits of exercise have been documented for both healthy and chronically ill older adults. Exercise improves bone mineral density, especially weight-bearing activities such as walking, aerobic, and dance. Women 30 to 40 years past menopause also need to consider decreasing the risk of fractures by preventing falls. Advanced age and osteoporosis should not exclude anyone from exercise. Therefore, walking with a partner provides the exercise that is needed as well as a companion to help prevent falls or notify someone if a fall occurs. A nurse is providing health education for a group of older adults about the risks of developing coronary heart disease. Which of the following group members is at highest risk? Question options: Takes a beta-blocker for hypertension Has a total cholesterol level of 201 Doesn’t participate in any form of regular physical activity Has a family history of Type 2 diabetes mellitus Physical inactivity affects more people in the development of coronary heart disease than any other risk factor. At any level or combination of risk factors, sedentary individuals are at greater risk of developing coronary heart diseases. Exercise provides both primary and secondary prevention. Thus, the person who does not participate in any form of regular physical activity is at most risk of developing coronary heart disease. A 51-year-old woman has begun menopause. The nurse emphasizes the importance of a diet high in calcium and vitamin D as well as exercise for this woman. This recommendation is important because by the time the client is 56, she will have experienced another bone loss. Question options: 3% 7% 10% 15% The rate of bone loss accelerates rapidly during the first 5 postmenopausal years, with annual losses of 3% to 5% being common. Thus, if at least 3 % is lost over 5 years, 3%  5 years (56 – 51) = 15%. A nurse is educating a 35-year-old woman about the best exercises to engage in to prevent bone loss. Which of the following exercises would the nurse recommend? Question options: Walking Swimming Weight training Bike riding Weight-bearing activities have a positive effect on bone density, and walking is a weight-bearing activity. In young women, the goal is to increase bone mineral density; thus, walking is the best exercise to prevent osteoporosis in this woman. A nurse is developing an exercise program for a person with moderate osteoarthritis of the knees. Which of the following forms of exercise would the nurse include in this program? Question options: Step aerobics Running Water aerobics Bike riding Water activities are good exercise alternatives for people with musculoskeletal limitations who need some weight relief with exercise. The water provides buoyancy while also providing resistance to the limbs as they move. Studies have also demonstrated that people who participate in aquatic exercise experienced greater pain reduction than those who participated in land activities. Thus, water aerobics would be the most appropriate form of exercise for this individual. A nurse is providing care to a person who has lower back pain. Which of the following exercises would the nurse recommend to assist with pain reduction? Question options: Walking Pilates Swimming Bike riding Maintaining proper curves of lordosis and kyphosis in the vertebrae is important for sustaining the spring and shock absorption quality of the spine. Poor posture can increase stress on the back and lead to pain. Exercises that train the paraspinal muscles to improve posture (like Pilates) are effective for people with lower back pain. Aerobic activity is recommended to maintain endurance and prevent debilitation from inactivity. Which of the following statements about exercise is true? Question options: People who engage in high-intensity exercise are at lowest risk for illness. Aerobic exercise should be part of daily exercise routines. Regular exercise may cause people to experience fatigue and increased susceptibility to mental health disorders. Low-level physical activity may have a protective effect on gastric and pancreatic cancer. Low-level physical activity may have a protective effect on gastric and pancreatic cancer. People who engage in moderate-intensity activity are at lowest risk for illness, whereas those who engage in high- intensity activity are at higher risk for illness. Aerobic exercise is recommended at a frequency of three to five times per week. Every other day is a good frame of reference as it allows for recovery between training sessions. Cross-training is recommended as part of daily exercise routines. Regular exercise promotes positive well-being and decreased susceptibility to mental health disorders. A nurse is monitoring the exercise of a 42-year-old woman. Which of the following would be the estimated maximum heart rate (MHR) for this woman? Question options: 126 142 178 184 A generic formula for determining MHR is 220 minus age: 220 – 42 = 178. A nurse is discussing exercise intensity with a client. Which of the following medications that the client is taking may limit the usefulness of heart rate as an indicator of exercise intensity? Question options: Ciprofloxacin (Cipro) Metoprolol (Toprol) Atorvastatin (Lipitor) Lansoprazole (Prevacid) Beta-blockers may alter the relationship between heart rate and the rate of perceived exertion. Metoprolol is a beta-blocker and thus may limit the usefulness of heart rate as an indicator of exercise intensity. The nurse is discussing an exercise prescription with a person. To help him determine the appropriate intensity, the nurse tells him that he should monitor his rate of perceived exertion. Which of the following should the nurse tell the man he should experience while exercising? Question options: Talking and singing without difficulty Feeling extremely fatigued Having mild musculoskeletal discomfort Being out of breath The rate of perceived exertion helps people determine a comfortable, beneficial level of exercise intensity. Being slightly short of breath, able to talk with difficulty, being pleasantly fatigued, and having mild musculoskeletal pain reflect a rate of perceived exertion that corresponds well with 50% to 85% of maximum heart rate, an appropriate target range for most individuals. A nurse is discussing resistance training with a 24-year-old woman. The woman is resistant to weight lifting because she does not want to get too muscular. She prefers a program that is strictly aerobic. Which of the following would be the most appropriate response from the nurse? Question options: “Ok, just make sure you perform one hour of aerobics every day.” “Lifting weights is a necessary part of exercise.” “Weight lifting has many purposes and benefits; can we talk about them?” “Looking muscular at your age is attractive.” Weight training helps develop healthy muscles that provide strength to perform activities of daily living (ADLs) without injury and it stimulates bone health. Additionally, the risk of injury outweighs the benefits of aerobic exercise more than 5 days a week. Not all weight lifting leads to a bodybuilder physique. Offering the patient the opportunity to discuss weight training will allow the patient the opportunity to open up and discuss fears and concerns. It also provides the nurse with the opportunity to discuss the risks and benefits. A nurse is caring for a man who states he is ready to start exercising. Which of the following actions should the nurse take next? Question options: Do nothing because he has already made the decision to implement a change. Provide him with information on the benefits of exercising. Develop an exercise prescription with him. Schedule a follow-up in 2 months to see if he still feels the same way. Working with a person to choose an activity that he likes will improve adherence. The person is displaying that he is in the action phase of change, and he should be given a prescription that promotes exercise and places him in the maintenance phase. A nurse is counseling a 19-year-old person who has recently been diagnosed with Type 1 diabetes mellitus. The person asks if there is anything specific that should be done before going to play tennis with a friend. Which of the following instructions should the nurse give the person to avoid hypoglycemia? Question options: Inject the insulin into the abdomen. Inject the insulin into the arm. Inject the insulin into the thigh. Skip taking any insulin before exercising. When insulin is injected in a muscle that will be active, it will speed up the absorption of insulin and quickly decrease blood glucose. Because tennis involves a lot of leg and arm movement, insulin should be given in the abdomen. Additionally, not all insulins have the same onset or duration of action. Changes in insulin dosage schedules should not be made without knowing the onset or duration of action. A woman is going for a 2-hour hike in the Grand Canyon and she asks the nurse how much fluid she should take along with her. Which of the following recommendations should be given by the nurse? Question options: Bring at least 24 ounces of water. Bring at least 72 ounces of water. Bring at least 24 ounces of sports drink. Bring at least 72 ounces of sports drink. If the weather is hot, 5 to 12 oz of fluid should be taken every 15 to 20 minutes during exercise. Additionally, if exercise lasts more than 1 hour, a drink that provides carbohydrates and electrolytes helps delay fatigue and improve performance. CHAPTER 13 A nurse is defining stress to a person. Which of the following statements should the nurse should make? Question options: “Happy events, such as the birth of a child, are rarely as stressful as unhappy events.” “An event that requires any changes in behavior in stressful.” “All stressors create a challenge to health.” “Once stressors are identified, they can be controlled.” Any event that requires a change in behavior is stressful. Some stressful events are beneficial to health and not inherently harmful. Many stressors cannot be controlled. The nurse is conducting community education about stress. Which of the following statements should be made by the nurse? Question options: “Stress always has a negative effect on the body.” “A moderate amount of short-term stress can make a person more efficient and goal- focused.” “Long-term stress is useful in helping one to meet goals.” “Stress always has a positive effect on the body.” Stress may be either harmful or helpful. Long-term stress is harmful. A moderate amount of stress is a motivator. A nurse is caring for a person who has experienced a minor injury following a fall. Which of the following physiological responses to stress would the nurse anticipate? Question options: Lowered blood pressure Elevated heart rate Lowered respiratory rate Elevated blood supply to the gut Activation of the neuroendocrine system in response to stress results in elevated blood pressure, heart rate, respiratory rate, and an increased blood supply to large muscles. Which of the following statements concerning spirituality is correct? Question options: Spirituality is a search for the meaning of existence. To fully experience spirituality, one needs a religious affiliation. Stress always strengthens the quest for spirituality. Spirituality always prevents depression, which is common following a stressful event. Religion and spirituality are complementary but not the same. Spirituality is possible without a religious affiliation. Although spirituality can help one cope with stress, depression may still result. A nurse has stated that the person she is working with demonstrates stress hardiness. Which of the following individuals is most likely being described? Question options: Refuses to see family members after the nurse practitioner tells him or her about test results Conducts Internet research to learn about the latest treatment options for a health deviation Calls in sick when faced with a personal relationship problem Views stressors as negative life events Stress hardiness is characterized by feeling in control of situations, viewing stressors as challenging rather than negative events, and using effective coping techniques. A nurse is describing adults who are in the “sandwich generation.” Which of the following provides the best description of this term? Question options: Middle-aged adults who are starting a family at an older age Young adults who are beginning to find jobs, marry, and start a family Middle-aged adults who are caring for children and aging parents Young adults who have several small children Because of current trends of delayed parenting and increased life span, more middle-aged adults are in the “sandwich generation,” in which they carry the responsibility to care for their children and aging parents. A nurse is collecting health assessment data about a person’s coping mechanisms in relation to stressors. Who would provide the best source of this information? Question options: Person’s primary care physician Person’s spouse/significant other The person Expert objective analysis skills of the nurse People are the best source of information related to their coping skills. A nurse is counseling a person on how to effectively deal with stress. Which of the following actions would the nurse recommend the person take first? Question options: Recognize signs of stress. Take action to reduce stress. Connect warning signs with stressors. Develop effective coping skills. To prevent negative consequences of stress, the person must first recognize signs of stress. He or she must then pay attention to these stressors, develop coping skills, and finally use the coping skills. The nurse conducted a community health education program about the benefits and limitations of alternative therapies. The nurse recognizes that learning has occurred when a participant makes which of the following statements? Question options: “Acupuncture is a technique that can be easily learned and practiced.” “Hypnosis can be safely used by a licensed hypnotist to treat all cases of anxiety.” “Reiki is a type of massage that can be used to relieve stress.” “Herbal products must be used with caution because some can interact with prescription medications.” Acupuncture is a technique that requires administration by a trained acupuncturist. Hypnosis should not be used for people with severe mental illness. Reiki is not a massage technique. A nurse responded to a natural disaster and used expressive writing as a means of coping with the stress related to this experience. Which of the following benefits of expressive writing should the nurse expect? Question options: Immediate relief of stress through storytelling Insight into the personal meaning of the experience Absence of the symptoms of stress Feeling a great sense of relief immediately after making a journal entry Expressive writing helps one reflect on the personal meaning of an experience. Feelings of sadness or anxiety may accompany journal writing as events are analyzed. A nurse is helping a person reduce stress-disinhibition related to poor dietary choices. Which of the following nursing interventions would be most appropriate? Question options: Work with the person to develop a plan to slowly replace high-fat, high-calorie foods with more healthy choices. Encourage the person to eliminate all high-calorie, high-fat foods from the diet as quickly as possible. Give the person a standard list of low-fat, low-calorie foods. Provide the person a copy of the Food Guide Pyramid. Working with people to develop a realistic, culturally sensitive, healthy eating plan is more likely to produce lasting results than simply dictating what he or she should eat. The nurse is assisting a person to develop a positive attitude toward exercise. Which of the following nursing interventions would be most successful when working with this person? Question options: Educate the person that 60 minutes of moderate to strenuous exercise a day is required to lower the risk of heart disease. Suggest that the person participate in a formal exercise program that has been demonstrated to produce the best results. Educate the person that exercise patterns established in young adulthood are more effective than those established later in life. Suggest that the person walk at a moderate pace for 30 minutes a day, 5 days a week for improvement in physical and psychological health. Formal exercise programs are no more effective than walking 30 to 60 minutes a day for 3 to 5 days a week. Exercise is beneficial at any stage of life. A nurse is helping a man restructure his eating, sleeping, exercise, and thinking patterns to reduce stress. Which of the following nursing interventions would be most effective for this person? Question options: Encourage writing in a journal on a daily basis. Suggest joining a support group. Offer referral to individual or group therapy sessions. Promote purchasing a gym membership. Before any meaningful change in behavior can take place, one must have an awareness of, and reflection about, personal behavior. A nurse is demonstrating how to use effective communication when dealing with conflict. Which of the following statements would be most appropriate for the nurse to make? Question options: “I am so angry that you are late again that you are grounded for a week.” “When you miss an appointment, I am hurt.” “Because you cannot be on time, you cannot have the car for a week.” “I feel anxious when you do not come home on time because I worry about your safety.” Effective communication relies on assertive communication, which requires an assertive statement (emotion), expressed feelings (behavior), and perceived rights (explanation). Which of the following statements concerning enjoying healthy activities is true? Question options: People enjoy pleasant activities even when they are stressed. People cherish happy activities and feel that such activities are important even during times of stress. People generally feel that they deserve to be happy. People who have hobbies are better able to handle stress than those without hobbies. Hobbies, and other pleasurable activities, help people balance a stressful life. A nurse is assisting a client in values clarification. Which of the following actions should the nurse assist the client to complete first? Question options: Develop a religious affiliation to assist with the process. Identify what is meaningful in one’s life. Act in a way that is consistent with one’s beliefs. Use beliefs held by others as a guideline for life. Values clarification begins with examining one’s beliefs and then acting in a way that supports those beliefs. Formal religious affiliation is not required for values clarification. The nurse is caring for a person who is obese, sedentary, and has recently been diagnosed with Type 2 diabetes mellitus. Which of the following goals for the person is correctly stated? Question options: The person will exercise more often. The person will consume 900 calories a day. The person will walk one-quarter mile a day, 5 days a week. The person will eliminate all refined sugar and processed foods from her diet. Goals must be realistic, specific, and measurable. Exercising “more often” is too broad a statement. Consuming “900 calories a day” or “eliminating all refined sugar, processed foods, and bread products from his or her diet” is not realistic. A nurse is caring for a person who has a diagnosis of “Sleep disturbance related to stress as evidenced by excessive daytime fatigue.” Which of the following nursing interventions would most likely to assist this person? Question options: Encourage daytime naps. Encourage exercise one hour before bedtime. Encourage a cool shower before bedtime. Encourage a consistent sleep-wake schedule. Daytime napping, exercising within 1 hour of bedtime, and taking a cool shower prior to bedtime will not promote nighttime sleep. Following a consistent sleep-wake cycle seven days a week will help establish a sleep pattern. A nurse is educating a person about the process of cognitive restructuring. Which of the following actions should be taken at the end of this process? Question options: Take a deep breath. Select a realistic alternative thought. Reflect on the situation. Stop generating negative thoughts. The most effective approach to restructuring thought patterns is to first stop generating negative thoughts, then take a deep breath to relax, then think about how the thought process is affecting well- being, and last, select a new realistic thought pattern to replace the negative thought pattern. A nurse is explaining the concept of “presence.” The nurse should include that presence means that the person: Question options: is in the same room as another. multitasks in order to examines all aspects of a situation. sets goals in response to what another is saying. practices active listening and focuses on what is being said. The concept of “presence” means that a person’s full attention is focused on the situation at hand. Multitasking produces the opposite effect because focus is lost. CHAPTER 14 Which of the following statements best defines the concept of holistic nursing care? Question options: Holistic nursing care is a family-centered approach to care. Holistic nursing care relies primarily on alternative medicine. Holistic nursing care takes into consideration all aspects of a person’s life. Holistic nursing care focuses on wellness rather than illness. Holistic nursing care takes into account all aspects of a person’s life experiences including environmental, physical, social, spiritual, and psychological constructs. In contrast to holistic health care, Western or allopathic medicine focuses on the: Question options: mind-body connection. impact of family relationships on health-seeking behaviors. physical aspects of health deviations. environmental impact on health. Holistic health care focuses on the whole person, mind, body, spirituality, and so forth. Western or allopathic medicine focuses mainly on physical aspects of disease. A nurse is discussing holistic health care with an individual. Which of the following explanations should the nurse include in this discussion? Question options: Empirical research has consistently demonstrated the value of alternative/complementary therapy. Self-reports of stress relief related to alternative/complementary therapy are numerous. The majority of research related to alternative/complementary therapy has utilized the scientific method. Research has, to date, been unable to verify the effectiveness of alternative/complementary therapy on health and well-being. Empirical research related to the effectiveness of alternative/complementary therapy has been mixed. Some research studies have verified positive physiological reaction to this type of therapy. The nurse is conducting a community health education program concerning alternative/complementary therapies. Which of the following should be included in the presentation? Question options: Alternative/complementary therapy is primarily used when conventional medicine has failed to achieve desired results. Alternative/complementary therapy is used in both hospital and outpatient settings. Alternative/complementary therapy was popular in the late 1980s but is rarely used today. Alternative/complementary therapy primarily focuses on herbal remedies for common health deviations. Alternative/complementary therapy is gaining popularity in both hospital and outpatient settings. It is used as an adjunct to traditional medicine and focuses on all aspects of being (e.g., environmental, spiritual), not just herbal products. Which of the following complementary/alternative therapies involves emphasizing healthy lifestyle, strengthening and cleansing the body, and noninvasive treatments? Question options: Homeopathy Naturopathy Traditional Chinese medicine (TCM) Ayurvedic medicine Naturopathy is guided by the healing power of nature. Practitioners do not use prescription drugs, injections, x-rays, or surgery, but instead use a variety of complementary and alternative medicine (CAM) modalities, emphasizing healthy lifestyle, strengthening and cleansing the body, and noninvasive treatments. A nurse discussing aromatherapy at a community health fair. Which of the following aspects of this technique should be stressed? Question options: Aromatherapy can be used by individuals without special training. Aromatherapy is a recently developed therapy based on the work of contemporary natural healers. Aromatherapy uses herbal scents in candles or incense as the primary method of delivery. Aromatherapy can cause an allergic reaction in some people. Aromatherapy uses aromatic plant materials and the essential oils of plants to treat physical imbalances, as well as to achieve psychological and spiritual well-being through inhalation, external application or ingestion. The use of aromatherapy without professional clinical training is strongly discouraged. Individuals must have this training to know the specific warnings and contraindications for each oil, as oils may cause allergic reactions or other undesirable side effects. The nurse is teaching imagery as a method to reduce anxiety in preoperative individuals. Which of the following aspects should the nurse stress when teaching this technique? Question options: The benefits of guided imagery are primarily psychological. This technique promotes a sense of well-being. A “prayer circle” is needed for imagery to be most effective. Imagery produces only beneficial, calming results. Imagery is a gentle but powerful technique that focuses and directs the imagination in order to promote a sense of well-being and help people relax. Imagery is an individual exercise and does not include a prayer circle. An individual asks the nurse to explain yoga. Which of the following statements would be made by the nurse? Question options: Yoga requires the ability to assume and maintain certain poses. There are many different types of yoga. Yoga is the most strenuous of the movement therapies. The major benefit of yoga is an increase in physical exercise and flexibility. Not all forms of yoga involve physical activity. There are many forms of yoga, some of which involve meditation and others that involve movement. A nurse working at a holistic health center is asked by a person with severe rheumatoid arthritis if yoga would be a realistic therapy choice. Which of the following would be the best response by the nurse? Question options: “Let’s discuss other alternative therapies. Yoga involves positioning that you might not be able to do.” “Hatha yoga would be a great therapy option because it involves mediation rather than positioning.” “There are many types of yoga that would be realistic for you to try. Let’s talk about the types that would be suited to your needs.” “I will ask the instructor teaching karma yoga if there is room in her class for you. I think that you would enjoy this type of yoga.” There are many types of yoga that do not involve positioning, such as raja yoga, mantra yoga, and so forth. People should be informed about all of the choices and allowed to select the one most suited to their needs. Hatha yoga involves positioning, which might not be realistic for this individual. A nurse is describing how energy flow can affect health and well-being. Which of the following examples would the nurse discuss when sharing how energy flow can become chaotic? Question options: Believing that one has been abandoned by God Reestablishing contact with a friend who has recently moved back into the area Recovering from an acute illness Walking one mile a day Spiritual distress can create a chaotic energy flow. Reestablishing friendships, having a positive outcome from an illness, and exercise can balance energy. The nurse is asked to explain acupuncture to a person. Which of the following statements concerning acupuncture would the nurse include in the explanation? Question options: Acupuncture is accomplished by inserting very fine needles into various areas of subcutaneous tissue. Acupuncture can be used to either diagnose or treat a health deviation. The main focus of acupuncture is to relieve stress. Moxibustion is the term used to describe a disturbed energy flow, which results in disease. Acupuncture is accomplished by inserting fine needles into the skin, not subcutaneous tissue. This treatment modality is used to either treat illness or diagnose illness. Moxibustion describes using burning herbs to increase point stimulation. A person asks the nurse to explain the difference between acupuncture and acupressure. Which statement would be the appropriate response by the nurse? Question options: Acupressure uses massage and oil aromatherapy to stimulate meridian points. Acupuncture has been shown to relieve nausea and vomiting, but acupressure is not effective in relieving these symptoms. Acupressure stimulates meridian points by using pressing and stretching movements. Acupressure is achieved by applying more pressure to the fine needles inserted as part of acupuncture. Massage oil is not used during acupressure therapy. Both acupressure and acupuncture have been shown to relieve nausea and vomiting. Acupressure involves pressing, knuckling, rubbing, squeezing, and stretching, not by applying pressure to needles inserted during acupuncture. The nurse has just discussed reflexology with an individual. Which of the following statements would the person make that demonstrates that learning has taken place? Question options: Reflexology is a therapy that uses upper back massage to control tension and stress. Reflexology uses massage of acupressure points to optimize positive energy flow. Reflexology uses pressure applied to specific hand and foot areas to relieve tension. Reflexology uses a squeezing or stretching motion to hands or feet to restore a positive energy flow. Reflexology is a hand pressure technique applied to the hands or feet. It does not involve massage, squeezing, or stretching like acupressure. A nurse is performing therapeutic touch with a person. Which of the following would be the first action that the nurse would take? Question options: Centering Movement of hands above the body Treatment technique Attunement The first step in therapeutic touch therapy is for the therapist to become centered, so full attention can be paid to the person receiving the therapy. The second step is to assess for disturbances by moving the hands above the body. The last step involves the actual treatment techniques. A person wishes to participate in a therapy involving energy utilization and dietary design. Which of the following therapies would the nurse recommend to the person? Question options: Polarity therapy Reiki Qi gong Pranic healing Reiki, Qi gong, and pranic healing are all forms of touch therapy. Polarity therapy utilizes touch therapy and dietary restructuring. The nurse is assisting an individual who is interested in music therapy. Which of the following statements made by the person indicates an understanding of this type of therapy? Question options: “I will select the music I listen to carefully. Energetic or rap music is not a good choice.” “I will need to find someone who has specialized in this type of therapy for best results.” “Chants, electronic sounds, or ‘designer music’ is generally the best choice.” “The music I choose may be different than what my spouse prefers.” Music selection is an individual choice. There is no one “best” type of music. Family members may also benefit from the positive effects of listening to music. A nurse would like to include holistic nursing care in her nursing practice. Which of the following actions must the nurse take first? Question options: Learn the specific therapy method. Engage in self-exploration. Explore the various types of complementary therapies available. Ask the person which type of therapy he or she prefers. The first step to providing holistic care is an exploration of self. Each of the other steps follows that step. Which of the following describes a nurse who is “being with” the client? Question options: Answers a call bell Completes a dressing change Silently prays with a client when requested to do so Teaches a client about his or her medication regime Performing one’s duty or completing a task allows a nurse to “be there” with the client, but entering the client’s world and praying with him or her when requested to do so exemplifies truly “being with” the client. A nurse is providing education about safety precautions for people to take when using complementary/alternative medicine (CAM). Which of the following information would be included in this presentation? Question options: Most treatments are covered by insurance. The U.S. Food and Drug Administration regulates the quality of dietary supplements. It is important to research and understand the treatment before starting to use it. There are minimal interactions between the treatments prescribed by allopathic and holistic medicine providers. It is important to take time to research and understand the treatment and ensure it is appropriate for the individual and the purpose. Treatments may not be covered by insurance. The U.S. Food and Drug Administration regulates dietary supplements, but does not always regulate their quality. There may be interactions between the treatment prescribed by allopathic and holistic practitioners so both providers should know about the care and treatment provided by the other. The nurse has formulated a nursing diagnosis for a person with carpal tunnel syndrome of “Energy Field Disturbance r/t Slowing or Blocking of Energy Flow Secondary to Repetitive Motion Injury.” Which of the following actions must the nurse take first when planning interventions for this person? Question options: Move his or her hands over the person. Obtain permission to use healing touch therapy. Explain healing touch therapy. Focus on the area of disturbed energy flow. Before giving informed consent, the person must understand the proposed therapy. CHAPTER 25 A nurse is encouraging members of the community to advocate for the prevention of premature deaths in children under the age of 5 at the international level. Which of the following interventions would most likely be discussed by the nurse? Question options: Using mosquito netting in sleeping areas Participating in international vaccination programs Implementing accident prevention programs Providing nutritional supplements Protein-energy malnutrition can be severely harmful to the mental and physical development of individuals, especially young children under the age of 5. Worldwide, one out of two deaths among children younger than 5 years old stems from protein-energy malnutrition. A nurse is working at a clinic in a third world country and suspects a child has severe acute malnutrition (SAM). Which of the following assessment findings would be expected? Question options: Distended abdomen Bulging eyes Large tears when crying Lethargy Severe wasting is characterized by sunken eyes, visible ribs, and protruding shoulder blades. Children with severe wasting usually have a distended abdomen and general overall appearance in some way similar to an older adult. In general, these children are irritable, anxious, and cry easily; yet they will often have absence of tears while crying due to lachrymal gland atrophy. A nurse is determining if children with severe acute malnutrition (SAM) should receive facility- based or community-based care. Which of the following children should receive care in the community? Question options: 3-year-old male who has a history of dehydration 9-month-old male whose family has adequate support and resources to obtain the recommended treatment 4-year-old female who has sensitivity to milk products 6-month-old female who has a good appetite and no underlying medical conditions When a child has a good appetite with no medical conditions (hypoglycemia, hypothermia, dehydration, electrolyte imbalance, and/or infections), Ready-to-Use Therapeutic Foods (RUTF) under community- based care are appropriate. RUTF are special milk-based foods which are soft, crushable, and tasty nutrient- and energy-rich foods that can be consumed by children six months or older. Which of the following projects would most likely be administered by International Micronutrient Malnutrition Prevention and Control (IMMPaCT) Program? Question options: Researching best methods to preserve the freshness of foods Surveying various populations about consumption patterns Comparing the effectiveness of vitamin pills versus fresh fruit and vegetables Analyzing the relationship between BMI and cardiovascular disease IMMPaCt provides its skills and resources toward working to eradicate vitamin and mineral deficiencies around the globe. The IMMPaCT program’s activities include conducting surveys; providing micronutrients to infants, young children, and women of childbearing age; and monitoring and evaluating intervention systems. The school nurse has been asked to present a workshop on CA-MRSA for high school teachers. Which of the following information would the nurse most likely include? Question options: CA-MRSA is a common viral infection that responds well to antiviral meds. CA-MRSA is a serious bacterial infection that does not spread easily. CA-MRSA is a fungal infection common in school settings. CA-MRSA is a potentially fatal skin infection that is difficult to treat. CA-MRSA is a highly contagious bacterial infection that is difficult to treat and can result in pneumonia and death. The school nurse has been asked to present a workshop on how to prevent CA-MRSA spread in the school. Which of the following interventions should be emphasized? Question options: Completing prophylactic antibiotic therapy for those in close contact with an infected person Using correct hand-washing technique Requiring those infected stay home from school until the infection has resolved Disinfecting all classrooms on a daily basis Hand washing is an effective way to prevent spread of the infection. In order to contract the infection, students must come into contact with a draining wound, etc. A nurse is providing care to HIV positive clients living in sub-Saharan communities in Africa. When discussing prevention of the transmission of HIV, which of the following statements should be made by the nurse? Question options: “Alternative practices to traditional sexual cleansing should be considered after the death of a spouse.” “Traditional sexual cleansing should be performed with a cleanser who is known to not have HIV.” “Virgin cleansing is a safer option than traditional sexual cleansing.” “Traditional sexual cleansing can lead to further transmission of HIV.” Although traditional sexual cleansing can lead to further transmission of HIV is a true statement, it is not the most culturally sensitive response by the nurse. The nurse should respect the cultural practices of the clients living in the sub-Saharan community and discuss that alternative practices may be a better option to traditional sexual cleansing. A nurse is working with UNAIDS to fight against HIV/AIDS at the global level. Which of the following activities would the nurse most likely be involved in? Question options: Determining prevalence rates of HIV/AIDS in African countries Administering antiretroviral medications to pregnant women who are HIV positive Providing treatment access for all HIV-positive individuals who need medication Reporting confirmed cases of HIV to the World Health Organization UNAIDS has outlined three strategic directions: revolutionizing HIV prevention; catalyzing the next generation for treatment, care, and support; and advancing human rights and gender equality in responses to HIV. Providing treatment access for all HIV-positive individuals who need medication meets the strategic direction of catalyzing the next generation for treatment, care, and support. A nurse is using the four-step public health approach to address violence in the community. Which of the following actions would the nurse take first? Question options: Analyze a variety of data sources to determine the cause of the problem. Examine risk factors that have contributed to the violence. Develop an evidence-based program to address the problem. Train community members to discuss the problem within their neighborhoods. The WHO has proposed a four-step public health approach which includes: defining the problem; identifying risks and protective factors; devising and testing means of dealing with violence; and applying successful means on a large scale. Defining the problem is the first step in this process. Examination of different data sources are needed to understand the magnitude of the problem. A nurse using the four-step public health approach to respond to violence. Which of the following actions would occur as the nurse identifies risk and protective factors? Question options: Planning a community-based educational program to respond to violence Reviewing police reports and population-based surveys Interviewing local community members about their experiences with violence Examining characteristics in the community where violence has not occurred A “risk factor” is defined as “a characteristic that increases the likelihood of a person becoming a victim or perpetrator of violence,” and a “protective factor” as “a characteristic that decreases the likelihood of a person becoming a victim or perpetrator of violence.” Knowing risk and protective factors can help responsible organizations and personnel to estimate violence magnitudes and devise appropriate prevention measures. The school nurse is planning a workshop for high school students about interpersonal violence (IPV). Which of the following information would the nurse discuss as risk factors for IPV? Question options: Cultural norms Family support Drug and alcohol abuse Depression Risk factors for IPV may include a victim’s low self-esteem, low self-control, and personality/conduct disorders. Other risk factors are reported to be lack of social support, dysfunctional family structure, family history of violence, and drug and alcohol abuse. The nurse is working at a crisis hotline center. Which of the following callers would be most at risk for suicide? Question options: A 16-year-old girl who broke up with her boyfriend A 26-year-old male who has been laid off from his job A 50-year-old female who has a history of alcohol abuse A 40-year-old male whose brother died suddenly Older adults have a greater risk of committing suicide than do younger people. Major factors contributing to suicide in Europe and North America include mental disorders especially depression and alcohol use disorders. Which of the following age groups is experiencing the greatest increase in suicide rates? Question options: 15 to 24 25 to 39 40 to 59 60 to 70 Suicide rates among people aged 15 to 24 have been increasing to such an extent that they are the second leading cause of death in this age group in some developed and developing countries. Which of the following information about anthrax is correct? Question options: Anthrax is a viral infection. Anthrax can cause skin lesions or pneumonia. Anthrax is spread by person-to-person contact. Anthrax is treated by IV penicillin for 30 days. Anthrax is a bacillus that is not spread person-to-person. An anthrax infection is treated by using ciprofloxacin, levofloxacin, doxycycline, or penicillin for 60 days. A nurse is working in the emergency department (ED). Which of the following situations would cause the nurse to suspect bioterrorism? Question options: When two people out of twenty who ate at a restaurant come to the ED with nausea and vomiting When a worker in a lab comes to the ED complaining of a severe headache When thirteen people, aged 24 to 33, come to the ED with ascending flaccid muscle paralysis When five people come to the ED with an upper respiratory infection The other examples are common problems for which people seek health care. Flaccid paralysis is a symptom of botulism. Which of the following statements best explains priorities related to preventative health care? Question options: Global initiatives have been developed to respond to health care needs around the world. Health care initiatives are focused mainly on people in developed countries because of the access to medication. Health care initiatives are focused mainly on people in developing countries because of their great need. Public health agencies are leaders in health care development. Health care initiatives have a global focus and involve developing as well as developed countries. Nurses play a major role in this initiative. A nurse states that many community members are concerned about the increasing number of natural disasters that have been occurring in the United States. Which of the following would the community members be referring to? Question options: Fires and suicides Wildfires and hurricanes Traffic accidents and floods Tornadoes and food poisonings Natural disasters phenomena that occur through natural forces involving land, air, or water, and they often have large-scale negative impacts on humans who live in the affected areas. Examples of natural disasters include tsunamis, earthquakes, floods, landslides, mudslides, tornadoes, hurricanes, cyclones, typhoons, wildfires, volcano eruptions, extreme heat, winter weather, and others. A hurricane has just caused extensive damage within a local community. Which of the following are community members at risk to experience? Question options: Unequal access to health care Exposure to community-associated methicillin-resistant Staphylococcus aureus Increased incidence of suicide Outbreaks of acute respiratory infection Victims of natural disasters tend to have limited access to essential infrastructures for survival related to food, water, shelter, and sanitation. Infection outbreaks commonly diagnosed after natural disasters include diarrhea, acute respiratory infections, viral hepatitis, and snail and trematode infections. A primary care clinic is being established in a rural county that recently experienced a hurricane severely damaging its infrastructure for medical care. Which of the following considerations would be the priority when planning for this clinic? Question options: The ability to provide mental health services to community members The ability to deliver primary care services to community members The ability to refer community members to other necessary services The ability to supply community members with daily necessities The priority in planning should be the ability to provide mental health services to the community members. In 2007, the Inter-Agency Standing Committee developed its Guidelines on Mental Health and Psychosocial Support in Emergency Setting. It emphasizes the importance of primary care clinics being able to provide mental health services to victims of the disaster. A nurse is advocating for improved disease prevention and health promotion within the local community. Which of the following interventions would the nurse most likely implement? Question options: Educate community members about the violence rates that exist within the community. Administer flu shots for elderly at a local senior citizens center. Participate in a disaster planning committee within the community. Talk with a state legislator about improved access to health care for the uninsured and underinsured. In order to be advocates for newly emerging priorities for disease prevention and health promotion, nurses in the twenty-first century need to participate in policy development for health promotion as the health care of individuals in acute settings shifts from hospitals to home and community settings, influence public expectations about health promotion, and promote equitable access to preventive health care. Talking with a state legislator about improving access to health care for the uninsured and underinsured is the only example that demonstrates the nurse in the role of an advocate working in one of these priority areas. [Show More]

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