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Foundations of Nursing In The Community 3rd Edition By  Stanhope Lancaster – Test Bank 

 

 

Stanhope: Foundations of Nursing in the Community: Community-Oriented Practice, 3rd Edition

 

Chapter 1: Community-Oriented Nursing and Community-Based Nursing

 

Test Bank

 

MULTIPLE CHOICE

 

  1. Which of the following best describes community-based nursing?
a. A philosophy that guides family-centered illness care
b. Giving care with a focus on the group’s needs
c. Giving care with a focus on the aggregate’s needs
d. Having the goal of giving optimal care to all clients

 

 

ANS:   A

By definition, community-based nursing is nursing that focuses on family-centered illness care to individuals and families in the community.

 

DIF:    Cognitive Level: Knowledge             REF:    p. 3

 

  1. Which of the following best describes community-oriented nursing?
a. A practice that focuses on individuals and families
b. Giving care to manage acute or chronic conditions
c. Giving direct care to ill individuals within their family setting
d. Having the goal of health promotion and disease prevention

 

 

ANS:   D

By definition, community-oriented nursing has the goal of preserving, protecting, or maintaining health to promote the quality of life. All nurses may focus on individuals and families, give direct to care to ill persons within their family setting, and help manage acute or chronic conditions.

 

DIF:    Cognitive Level: Knowledge             REF:    p. 3

 

  1. What is the unique primary focus of public health nursing?
a. Families and groups
b. Illness-oriented care
c. Individuals in their families
d. Promotion of quality of life

 

 

ANS:   D

The key difference between community-based and community-oriented nursing is that community-based nurses deal primarily with illness-oriented care, whereas community-oriented nurses—or public health nurses—provide health care to promote quality of life.

 

DIF:    Cognitive Level: Knowledge             REF:    p. 3

 

  1. Life expectancy increased dramatically during the twentieth century, primarily because of:
a. Findings from medical laboratory research
b. Incredible advances in surgical techniques and procedures
c. Sanitation and other public health activities
d. Use of antibiotics to fight infections

 

 

ANS:   C

Improvement in control of infectious diseases through immunizations, sanitation, and other public health activities led to the increase in life expectancy from less than 50 years in 1900 to more than 77 years in 2002.

 

DIF:    Cognitive Level: Knowledge             REF:    p. 5

 

  1. What is the preferred public health approach to avoid premature deaths in America?
a. Increasing the public’s knowledge concerning hospice care
b. Influencing Americans’ lifestyle behavior choices
c. Requiring employers to have wellness centers in each industrial site
d. Requiring that all prospective parents receive appropriate prenatal care
e. Timely and effective medical intervention and treatment

 

 

ANS:   B

Public health approaches could help prevent about 70% of early deaths through influencing the way people eat, drink, drive, engage in exercise, and treat the environment.

 

DIF:    Cognitive Level: Knowledge             REF:    p. 5

 

  1. What action would be most typical of a public health nurse?
a. The nurse asks community leaders what interventions should be chosen.
b. The nurse assesses the community and decides on appropriate interventions.
c. The nurse uses data from the main health care institutions in the community to determine needed health services.
d. The nurse works with community groups to create policies to improve the community’s environment.

 

 

ANS:   D

Although the public health nurse might engage in any of the tasks listed, he or she primarily works with members of the community to carry out core public health functions, including assessment of the population as a whole and engaging in promoting health and improving the environment.

 

DIF:    Cognitive Level: Application             REF:    p. 5

 

  1. How is an aggregate defined?
a. A large group of persons
b. A collection of individuals and families
c. A group of persons who share one or more characteristics
d. Another name for demographic group

 

 

ANS:   C

An aggregate is defined as a collection of people who share one or more personal or environmental characteristics, such as geography or special interest.

 

DIF:    Cognitive Level: Knowledge             REF:    p. 9

 

  1. A registered nurse (RN) was just employed as a public health nurse. Which question might be very relevant as the nurse begins employment?
a. “Which groups are at the greatest risk for problems?”
b. “Which patients should I see first as I begin my day?”
c. “With which physicians will I be most closely collaborating?”
d. “Who is the nursing assistant to whom I can refer patients?”

 

 

ANS:   A

Asking which groups are at greatest risk reflects a community-oriented perspective. The other possible responses reflect a focus on individuals.

 

DIF:    Cognitive Level: Application             REF:    p. 9 (How To box)

 

  1. When an RN talked to the women at the senior citizens’ center, the nurse reminded them that the only way the center would be able to afford a driver and van service for those who could no longer drive themselves would be to continue to write letters to their local city council representatives requesting funding for such a service. What was the nurse trying to accomplish?
a. Ensuring that the women did not expect the nurse to solve their problem
b. Demonstrating that the nurse understood the women’s concerns and needs
c. Expressing empathy, support, and concern
d. Helping the women engage in political action

 

 

ANS:   D

Public health nurses engage themselves and others in policy development and encourage and assist persons with a need to communicate that need to those with the power to take action.

 

DIF:    Cognitive Level: Application             REF:    p. 5

 

  1. What is a basic assumption of public health efforts?
a. Any disparities among any groups are morally and legally wrong.
b. Health care is the most important priority in government planning and funding.
c. The health of individuals cannot be separated from the health of the community.
d. The government is responsible for lengthening the life span of Americans.

 

 

ANS:   C

Public health can be described as what society collectively does to ensure that conditions exist in which people can be healthy.

 

DIF:    Cognitive Level: Knowledge             REF:    p. 5

 

  1. Which public health nurse is most clearly fulfilling responsibilities?
a. The nurse who met with several groups to discuss community recreation issues.
b. The nurse who spent the day attending meetings of various health agencies.
c. The nurse who talked to several people about their particular health concerns.
d. The nurse who watched the city council meeting on local cable television.

 

 

ANS:   B

Any of these descriptions might represent a nurse communicating, cooperating, or collaborating with community residents or groups about health concerns. However, the nurse who spent the day attending meetings of various health agencies is the most representative, because in public health, concerns are broader than recreation, individual concerns are not as important as aggregate priorities, and watching television (a one-way form of communication) is less effective than interacting with others.

 

DIF:    Cognitive Level: Synthesis                REF:    Entire chapter

 

  1. The nurse often has to make resource allocation decisions. What best describes the criterion the nurse should use in such cases?
a. A specific moral or ethical principle
b. The cheapest, most economical approach
c. The most rational probable outcome
d. The needs of the aggregate rather than a few individuals

 

 

ANS:   D

Although all of the choices represent components of a decision that the nurse might consider, the dominant needs of the population outweigh the expressed needs of one or a few people.

 

DIF:    Cognitive Level: Application             REF:    p. 9

 

  1. Which action best represents public health nursing?
a. Assessing the effectiveness of the large high school health clinic
b. Caring for clients in their home after their outpatient surgeries
c. Giving care to children and their families at the school clinic
d. Following up care for pediatric clients at an outpatient clinic

 

 

ANS:   A

A public health or population-focused approach would look at the entire group of children being served to determine whether available services are effective in achieving the goal of improving the health of the school population.

 

DIF:    Cognitive Level: Application             REF:    p. 6

 

  1. Which public health service represents secondary health prevention?
a. Developing a health education program on the dangers of smoking
b. Providing a diabetes clinic for adults in low-income housing
c. Providing an influenza vaccination program in a community retirement village
d. Teaching school-age children about the positive effects of exercise

 

 

ANS:   C

Although all of these services are appropriate and valuable, providing the flu vaccine to healthy adults is the only choice that represents a secondary health prevention action.

 

DIF:    Cognitive Level: Application             REF:    p. 12 (Levels of Prevention box)

 

  1. It is very clear to the public health nurse what needs to be done and where to begin to improve the health of a certain community. So why does this nurse spend time meeting with community groups to discuss what is the most important task to be addressed first?
a. To increase the group’s self-esteem
b. To maintain communication links with the groups
c. To make the groups feel good about their contribution
d. To work with the groups, not for the groups

 

 

ANS:   D

Historically, health care providers have been accused of providing care for or to people without actually involving the recipients in the decisions. Public health nursing is a “with the people”—not a “to the people” or “for the people”—approach to planning.

 

DIF:    Cognitive Level: Knowledge             REF:    p. 10

 

  1. Two nurses plan to walk under a huge downtown bridge where various homeless persons live. Why would the two nurses go to such an unsafe area?
a. To assess needs of the homeless who live there
b. To demonstrate their courage and commitment
c. To distribute some of their own surplus clothes to those who can use them
d. To share with various churches and other charities what their members need to contribute

 

 

ANS:   A

In most nursing practices, the client seeks out and requests assistance. In public health nursing, the nurse often reaches out to those who might benefit from a service or intervention, beginning with assessment of needs.

 

DIF:    Cognitive Level: Application             REF:    p. 11

 

MULTIPLE RESPONSE

 

  1. What variables have led to a stronger commitment to population-focused services? Select all that apply.
a. Economic turmoil and demand for high-technology care
b. Emergence of new or drug-resistant infectious diseases
c. Emphasis on overall health care needs rather than only on acute care treatment
d. Need to reduce constantly increasing costs of health care
e. Threat of bioterrorism and recent weather disasters
f. Widespread weather disasters (hurricanes, floods) with concurrent illnesses

 

 

ANS:   B, C, D, E, F

As overall health needs become the focus of care in the United States, a stronger commitment to population-focused services is emerging. Threats of bioterrorism, anthrax scares, and the emergence of modern-day epidemics have drawn attention to population-focused safety and services. Although the textbook does not mention widespread weather disasters, the inevitability of these events, along with concurrent illnesses and the magnitude of need during such disasters, would clearly support a commitment to population-focused services.

 

DIF:    Cognitive Level: Application             REF:    p. 5

 

  1. What actions would demonstrate effective public health nursing practice in the community? Select all that apply.
a. Epidemiologic investigations examine the environment for health hazards.
b. New services are organized where particular vulnerable populations live.
c. Partnerships are established with community coalitions.
d. Staff members at the public health agency continue to increase in number.
e. The emergency department continues to see more patients each week.
f. The nurses continue to make presentations at the city council about health needs.

 

 

ANS:   A, B, C, F

Evidence that public health nurses are practicing effectively in the community would include these: organizing services where people live, work, play, and learn; working in partnerships and with coalitions; participating in epidemiologic studies; and working with policymakers for policy change.

 

DIF:    Cognitive Level: Knowledge             REF:    p. 12

 

  1. Why are nurses increasingly providing care in clients’ homes rather than in hospitals? Select all that apply.
a. Home care is less expensive.
b. It is much more efficient to give care in the home.
c. Nurses prefer to give home care with individual attention.
d. People prefer to receive care in their homes rather than in hospitals.
e. People expect hospital staff to act like those in TV dramas and are invariably disappointed.
f. Physicians find it more convenient to visit in the home to educate families about client care.

 

 

ANS:   A, D

Home care is growing because it is less expensive and because clients prefer to receive care in familiar and comfortable settings. It is not more efficient or more convenient, since travel time has to be considered. Nurses differ as to their preferred employment setting.

 

DIF:    Cognitive Level: Knowledge             REF:    pp. 12-13

 

Stanhope: Foundations of Nursing in the Community: Community-Oriented Practice, 3rd Edition

 

Chapter 11: Using Health Education and Group Process in the Community

 

Test Bank

 

MULTIPLE CHOICE

 

  1. If the nurse teaches solely by lecturing to clients, what part of the education process is missing?
a. Evaluation
b. Experience
c. Participation
d. Understanding

 

 

ANS:   C

Educators should include participation. (This is one of the six principles of education.) Merely sitting and listening to someone lecture are not as effective as discussion, even when the presentation is stimulating, interesting, and dynamic.

 

DIF:    Cognitive Level: Application             REF:    pp. 191 and 195

 

  1. A member of a community weight-loss group has maintained a healthy weight for 2 years through healthy eating and daily exercise. At which step of the affective domain is this participant?
a. Analysis
b. Application
c. Evaluation
d. Knowledge

 

 

ANS:   C

Steps in the affective domain have the learner doing the following in this sequence: (1) knowledge: receives the information; (2) comprehension: responds to what is being taught; (3) application: values the information; (4) analysis: makes sense of the information; (5) synthesis: organizes the information; (6) evaluation: adopts behaviors consistent with the new values. In this example, the individual has adopted the behavior and this has resulted in the ability to maintain the value of a healthy weight.

 

DIF:    Cognitive Level: Application             REF:    p. 192

 

  1. A nurse just finished teaching breast self-examination to a large group of women at a professional conference. During the session, she distributed literature and used culturally appropriate visual aids. However, the session was not as effective as it could have been. What is the most important thing the nurse forgot to include?
a. Lots of time for audience members to ask questions and clarify the information
b. An explanation of why culturally appropriate images are more acceptable
c. The opportunity for the women to practice what they learned
d. The use of simple language instead of printed material in case the women could not read

 

 

ANS:   C

The learner must have opportunities to practice the new skills being learned. Provide practice sessions during the program because many people may not have the time, facilities, motivation, and/or support to practice at home what they have learned.

 

DIF:    Cognitive Level: Application             REF:    p. 192

 

  1. A nurse planned a superb presentation on the latest trends in disaster planning for the senior nursing students at the local college. However, when the nurse began to share knowledge, the students were talking to one another and essentially ignoring the nurse. What should the nurse do?
a. Ask the students why they are being so rude
b. Explain why the information is crucial to their current clinical practice
c. Nothing; let the instructor of the course handle the problem
d. Tell a risqué joke to get the students’ attention

 

 

ANS:   B

Before learning can take place, you need to gain the learner’s attention. One way to do this is by convincing the learner that the information about to be presented is important and beneficial to them personally.

 

DIF:    Cognitive Level: Application             REF:    p. 193

 

  1. A nurse explained to a family exactly how to care for their family member, who had just been discharged home from the hospital. When the nurse visited the family 3 days later, it was apparent that neither the patient nor the family had completed certain activities since the previous visit. What is the most probable explanation?
a. Cultural issues interfered with family’s ability to listen.
b. Emotional stress limited the information the family could absorb.
c. The family hadn’t seen any reason to engage in the activities.
d. The nurse hadn’t reinforced teaching with written literature repeating the information.

 

 

ANS:   B

Although any of the answers could be correct, the most probable cause is the stress of illness and hospitalization. Both emotional stress and physical illness may limit the amount of information that learners can absorb.

 

DIF:    Cognitive Level: Application             REF:    p. 193

 

  1. When is the optimal time for the nurse educator to elicit feedback from program participants?
a. At the beginning of the program
b. At the program midpoint
c. Immediately following program completion
d. Throughout the program

 

 

ANS:   D

Not only should learners receive feedback, but the educator should also elicit feedback from learners throughout the educational process. On the basis of the feedback that the educator receives from learners, the implementation and presentation of the educational program can be modified.

 

DIF:    Cognitive Level: Knowledge             REF:    p. 195

 

  1. A nurse invited all the teenagers who were newly diagnosed with diabetes to a group meeting to discuss issues they all had in common. One teenager replied, “I don’t know if I want to share all the problems I’m having with strangers.” What is the best nurse response?
a. “Don’t share anything with anyone until you’re comfortable doing so.”
b. “I can understand what you are saying.”
c. “No one will require you to do anything you don’t want to do.”
d. “The purpose of the group is to have a safe place to share problems with others who may be having similar problems.”

 

 

ANS:   D

All the responses are empathetic and supportive. However, during the first phase, potential participants do not know whether they can trust one another. The primary task of the leader at this point is to clarify the purpose. Even though a statement such as “Don’t share anything until you’re comfortable” is supportive, the response explaining that “the purpose is to have a safe place” both recognizes what was said and clarifies the purpose of the group.

 

DIF:    Cognitive Level: Synthesis                REF:    p. 196

 

  1. A nurse is meeting to discuss problems and solutions with a group of teenagers who have been newly diagnosed with diabetes. One teenager states “My mom found this particular brand of popcorn that has only 15 carbohydrates in the whole giant bag.” What group purpose is being served by the teenager’s statement?
a. Maintenance function of encouraging everyone to continue the discussion
b. Maintenance function of helping everyone feel comfortable talking about food
c. Task function of resolving problems about what to nibble during movies
d. Task function of sharing information and resources

 

 

ANS:   D

A task function is anything a member does that deliberately contributes to the group’s purpose. Members with task-directed abilities are attractive to the group. These traits include strong problem-solving skills, access to material resources, and skills in directing. The teenager’s statement shared information about a good resource for the group.

 

DIF:    Cognitive Level: Application             REF:    p. 197

 

  1. A nurse established an ongoing group meeting of teenagers with diabetes. In the early stages, the nurse was very directive in arranging location, providing low-carbohydrate drinks and snacks, steering the discussion, and trying to meet all the teenagers’ needs. After the group had been meeting for about 3 months, the nurse noticed that the group members no longer simply accepted everything the nurse suggested. Instead, the teenagers began making decisions themselves, and eventually, the nurse no longer controlled the group. What most likely happened to cause this shift?
a. The group became cohesive enough to share leadership tasks.
b. Teenagers don’t like feeling dependent on adults with power.
c. Teenagers often rebel against adult authority.
d. The nurse was overwhelmed and lost control of task process.

 

 

ANS:   A

In the beginning, the nurse used an authoritarian style because the nurse was responsible for the group direction. However, as the group matured, continuing an authoritarian style would have resulted in low morale and lack of cohesion. After a group is well established, nurses may best facilitate leadership by relinquishing central control and encouraging group members themselves to determine the norms for their group.

 

DIF:    Cognitive Level: Synthesis                REF:    p. 199

 

  1. A group of teenagers with diabetes become upset and angry because they cannot agree on whether or not to have meetings during summer vacation. Which of the following should the nurse do to be effective in helping the teenagers resolve the conflict?
a. Admit that it is difficult for everyone to agree on everything; then ask whether the group can try to decide how to agree on the issue and ask whether group members think there are other issues involved.
b. Assume adult authority and announce that meetings will be suspended until fall.
c. Recognize that most of the teenagers want to have the meetings, but two are being stubborn; ask the two deviant members to leave the group.
d. Suggest that the group avoid discussing it further but rather think about it over the next week and try to discuss the situation more rationally next week.

 

 

ANS:   A

When you respond to conflict by avoiding (option 4), forcing with power (option 2), capitulating, or excluding some members (option 3), the behavior fails to satisfy the concerns of those involved. Open communication and recognition that conflict is inevitable may allow the group to focus on a procedure for fairly resolving the conflict.

 

DIF:    Cognitive Level: Synthesis                REF:    pp. 202-203

 

  1. Which part of an educational program probably needs improvement if only 25% of community members meet the learning objectives after completing it?
a. Educator
b. Content
c. Learners
d. Objectives

 

 

ANS:   A

Ultimately, the educator is responsible for the success or failure of the educational process and the development of learner knowledge, skills, and abilities. The educator determines how content can be tailored to the learner. The educator determines the objectives. If evaluation reveals that the learning objectives are not being met, the nurse must determine why the instruction is not effective. The educator is responsible for presenting the material creatively and meaningfully in new ways to increase learner retention and ability to apply the new knowledge.

 

DIF:    Cognitive Level: Application             REF:    p. 207

 

  1. The nurse gives a very informative and engaging presentation and then gives everyone in the audience a handout that outlines the presentation. Later, the nurse discovers that many of the handouts were thrown away before the audience left the building. What might the nurse have forgotten?
a. Audiences expect PowerPoint or video presentations, not lectures.
b. Many Americans do not have a high reading level.
c. People want photographs and images, not wordy outlines.
d. The nurse gave them too much information too fast for them to want to cope with it all.

 

 

ANS:   B

Although visual images are certainly helpful, this does not explain why the handouts were discarded. Most health information is printed at a tenth-grade reading level—yet the average U.S. adult reads at the eighth-grade level and 40% of adults over age 65 read below the fifth-grade level. If people cannot read or understand the material, they discard it.

 

DIF:    Cognitive Level: Application             REF:    p. 208

 

  1. A man says, “I just can’t get myself to leave the house and go for a 30-minute walk each day. I wish I could think of some way to motivate myself.” An effective measure by the nurse would be to suggest that the man:
a. Establish a written contract between him and his employer that states walking is required each day
b. Recognize the reasons why 30 minutes of walking each day is one of the best health promotion activities he can choose
c. Join a group that walks early each morning
d. Set up rewards for himself, such as a nice snack after he gets back from walking

 

 

ANS:   C

Health behavior is influenced by the groups to which people belong. Having someone else to walk with is an effective way to maintain the behavior.

 

DIF:    Cognitive Level: Application             REF:    pp. 200 and 203

 

  1. Which of the following is the best learning objective for teaching testicular self-examination (TSE)?
a. Each participant will state why TSE is important and explain how to do it.
b. Each participant will describe how to do TSE and discuss the dangers of testicular cancer.
c. 90% of the men will correctly demonstrate testicular self-examination.
d. 100% of the men will do a testicular examination correctly on a model.

 

 

ANS:   C

If the goal is to learn TSE, the best goal is for the person to be able to do TSE correctly. Being able to state why it is important is a helpful first step, as is practice on a model, but to be sure the person can really do the procedure, you need to allow practice time and feedback until the person can demonstrate the procedure properly.

 

DIF:    Cognitive Level: Application             REF:    p. 210 (Table 11-3)

 

  1. Of the following educational objectives, which example best meets all necessary criteria for a well-written objective?
a. All women in the group will practice breast exams on breast models.
b. Before school begins, all children will receive vaccinations.
c. By the end of class, 80% of the children in the course will correctly identify two vegetables on a page of food pictures.
d. Mrs. Smith will understand how refined carbohydrates affect her blood glucose levels by the end of class.

 

 

ANS:   C

Objectives are written statements of an intended outcome or expected change in behavior and should define the minimum degree of knowledge or ability needed by a client. Objectives must be stated clearly and defined in measurable terms. Written educational objectives should include the following: Who is expected to exhibit the behavior? What behavior is expected? What are conditions and qualifiers of the behavior? What are standards of the behavior or performance? Practice is not an outcome or change in behavior; it is a method of learning. Option 2 (all children will receive vaccinations before school begins) does not identify which children (i.e., children in a school system, children in the United States) and does not identify which vaccinations must be received. Option is also incorrect, because objectives must be measurable, but “Mrs. Smith will understand” is not measurable. Changing the wording to “Mrs. Smith will explain” would improve this objective; however, option 3 would still be the most complete and clear objective.

 

DIF:    Cognitive Level: Analysis                  REF:    p. 210 (Table 11-3)

 

  1. The nursing educator, who is offering a course on preparing for motherhood, asks the women taking her class to identify what they wish to learn and to write their own learning objectives. What is this method of gaining commitment called?
a. A learning contract
b. Clarifying objectives
c. Feedback mechanisms
d. Pedagogical principles

 

 

ANS:   A

Effective educators help learners develop learning contracts, because a learning contract engenders more commitment to learning than does being a recipient of a learning plan developed by the teacher. Steps in developing a learning contract include identifying what skills and knowledge the learner would like to obtain and specifying personal learning objectives.

 

DIF:    Cognitive Level: Knowledge             REF:    p. 195 (How To box)

 

MULTIPLE RESPONSE

 

  1. A teenager with diabetes doesn’t want to inject insulin. The nurse tries to be empathetic while teaching the teenager how to give insulin and clarifying why insulin and glucose level control are so important. The teenager still refuses. The diabetic educator decides that the teenager needs a facilitator. What behaviors can a facilitator use beyond what the nurse-teacher has done? Select all that apply.
a. The facilitator will be enthusiastic about insulin and how it saves lives.
b. The facilitator can build a relationship of mutual trust.
c. The facilitator will express empathy about the difficulties of injecting insulin while trying to appear a normal teenager.
d. The facilitator will respect the teenager’s ideas and feelings about how the diabetes can be controlled, including exercise and food choices.
e. The facilitator will share expertise about various types of insulin.
f. The facilitator will use the teenager’s own experiences as a basis for analyzing how insulin injections can be integrated with the teenager’s usual activities.

 

 

ANS:   B, D, F

Teachers have expertise, express themselves clearly, and are empathetic and understanding of the learners’ needs. In addition, facilitators help learners identify and resolve the gaps between desired outcomes and their own knowledge and skills by defining life problems the learner is experiencing, respecting the learner’s feelings and ideas, building a relationship of mutual trust and helpfulness, and drawing on the learner’s own experiences as resources for learning.

 

DIF:    Cognitive Level: Application             REF:    p. 195

 

  1. Despite a nurse’s efforts, the teenagers she is working with just do not seem to want to learn. What content should the nurse try to include in her next educational session with this group? Select all that apply.
a. Encourage discussion of feelings the teenagers may have about this material.
b. Motivate the teenagers by saying, for instance, “You know you can do this.”
c. Emphasize how easy this material is to learn and apply.
d. Remind the teenagers that their friends and family members are counting on them.
e. Ask the teenagers to consider what will happen to them if they don’t do this.
f. Encourage the teenagers to ask themselves, “Why do I want to learn this?”

 

 

ANS:   A, B, F

Saying that something is easy doesn’t make it so. Something may be easy to an experienced person, but few skills are easy for someone just learning them. Methods such as using threats (“What will happen to you?”) or playing on guilt (“Your family needs you to do this”) are not helpful, since fear and guilt are not effective long-term motivators. To help motivate these teenagers, the nurse should encourage them to engage in honest exploration by asking themselves, “Why am I learning this? Can I do this? How do I feel about this?”

 

DIF:    Cognitive Level: Application             REF:    p. 208

 

  1. A patient tells a nurse, “I know all about this already. I read about it on the Internet.” The patient then summarizes what he has learned. Since some of this information seems incorrect, what questions would be effective for the nurse to ask? Select all that apply.
a. Were you able find what you wanted easily on the website?
b. Did the website say when the information was updated?
c. Did the website state who was responsible for the information?
d. Did you enjoy reading the material on the website?
e. Was the website trying to sell anything?
f. Was the author a credentialed health care professional?

 

 

ANS:   A, B, C, E, F

To assess the quality of information, the nurse should attempt to find information about the authors, the purpose of the site (to share information or sell a product?), any available editorial reviews, the date of the material, the design of the site (easy to navigate? well organized?), etc.

 

DIF:    Cognitive Level: Application             REF:    p. 209

 

  1. A nurse has been making ongoing visits to a preschool to help the staff teach the children important skills, such as brushing their teeth after meals. Now the nurse is scheduled to teach carbohydrate counting to adults newly diagnosed with diabetes. What will the nurse need to do differently for this audience? Select all that apply.
a. Appeal to the need for autonomy and choice.
b. Emphasize that anyone with diabetes must know this information.
c. Explain how to cope with being a guest at a dinner.
d. Recognize that this audience will depend on the instructor to set goals for learning.
e. Refer to experiences in cooking at home or eating in restaurants.
f. Use external motivators such as constant compliments.

 

 

ANS:   A, C, E

For this audience, the best approach will be to use adult experiences and practical problems as learning motivators—for instance, appealing to adults’ sense of autonomy and choice, basing examples on practical adult situations such as cooking meals or eating in restaurants, and discussing how clients can cope with possibly awkward situations such as being a guest at dinner but having diet restrictions. Options 2, 4, and 6 would be effective when teaching children.

 

DIF:    Cognitive Level: Knowledge             REF:    p. 206 (Table 11-2)

Stanhope: Foundations of Nursing in the Community: Community-Oriented Practice, 3rd Edition

 

Chapter 23: Homelessness, Poverty, Mental Illness, and Teen Pregnancy

 

Test Bank

 

MULTIPLE CHOICE

 

  1. A student nurse was seriously shocked when late one night the she saw a former high school friend going through a trash bin outside a fast-food restaurant and pulling out half-eaten food. What is a likely explanation for a healthy young adult engaging in such behavior?
a. He ate his meal but wanted more and had no more money.
b. He had full-time employment, but with such a low salary it was inadequate to meet basic expenses.
c. A friend had thrown his meal away, and he thought he could find his friend’s untouched food.
d. He was doing this to fulfill obligation of fraternity initiation at the college.

 

 

ANS:   B

The causes of poverty are complex and include decreased earnings, increased unemployment rates, and inadequate education and job skills.

 

DIF:    Cognitive Level: Knowledge             REF:    p. 422

 

  1. A school nurse was caring for an 8-year-old child who had been hurt on the school playground. During the nurse’s assessment, the child admitted that her mother was working but didn’t make much money so the girl and her mother were living in their car. Based on this information, what might the nurse suspect?
a. The child is accident-prone and clumsy.
b. The child is being bullied and pushed around by other children.
c. The child may be a member of the 5H club.
d. The child tripped, so perhaps she needs vision screening.

 

 

ANS:   C

Many American children are members of the “5H” club—they are hungry, homeless, hugless, hopeless, and without health care.

 

DIF:    Cognitive Level: Application             REF:    p. 423

 

  1. A school nurse was talking to the teacher of an 8-year-old child who was living with her mother in their car. What might lead the nurse to talk to the teacher about the child?
a. Concern that other children are mistreating the child
b. Concern over developmental delays
c. Concern that the child is given adequate food during lunch
d. Concern that the child may need to sit in the front in order to be able to see well

 

 

ANS:   B

Poverty increases the likelihood of chronic disease, injuries, traumatic death, developmental delays, poor nutrition, inadequate immunization levels, iron deficiency anemia, and elevated blood lead levels. Poverty-stricken children may be hungry and fatigued and have dizziness, irritability, headaches, ear infections, frequent colds, weight loss, inability to concentrate, and increased school absenteeism. Homeless children also experience higher rates of school absenteeism, academic failure, and emotional and behavioral maladjustments. The stress of homelessness can be seen in withdrawal, depression, anxiety, aggression, regression, and self-mutilation. Homeless children may have delayed communication, more mental health problems, and histories of abuse.

 

DIF:    Cognitive Level: Application             REF:    p. 423 (Box 23-1)

 

  1. What is the most rapidly growing group of homeless?
a. Adolescents (runaways and “throw-aways”)
b. Families with children
c. Persons in crisis
d. Single men

 

 

ANS:   B

Families with children are the fastest-growing segment of the homeless population.

 

DIF:    Cognitive Level: Knowledge             REF:    p. 423

 

  1. Which finding in a young single pregnant woman would cause you the most concern?
a. Elevated blood pressure
b. First prenatal visit at 5 months’ gestation
c. Persistent homelessness
d. Positive STD test

 

 

ANS:   C

All these assessment findings are of concern and need attention. However, pregnant homeless women present several challenges. They have higher rates of sexually transmitted diseases, higher incidences of addiction to drugs and alcohol, poorer nutritional status, and higher incidences of poor birth outcomes. Thus being homeless is the most dangerous sign of those listed.

 

DIF:    Cognitive Level: Knowledge             REF:    p. 425

 

  1. Why is health care of the homeless so expensive to the community?
a. Health conditions of the homeless require increased preventive services.
b. Homeless clients typically make more clinic visits for multiple health problems.
c. Homeless people spread contagious diseases to those they pass on the street.
d. Most care to homeless people takes place in hospital emergency departments.

 

 

ANS:   D

Homeless persons have the same problems accessing care as do others in poverty (e.g., lack of money, lack of insurance, lack of transportation). Therefore health care of homeless persons is usually crisis oriented and sought in emergency departments, where the cost of service is high but is not refused as it often is in clinics.

 

DIF:    Cognitive Level: Knowledge             REF:    p. 425

 

  1. What action by the nurse can best ensure long-term positive health outcomes of poor pregnant teens and their children?
a. Assisting teen mothers to learn about their body changes during pregnancy
b. Developing programs that allow teen mothers to complete their education
c. Offering courses in proper care of babies and how to be a parent
d. Monitoring pregnant teens to detect early problems with pregnancy

 

 

ANS:   B

Single motherhood is increasing. A direct correlation exists between lack of education and poverty. Similarly, a direct correlation exists between poverty and poor health outcomes. Poor teens are nearly three times more likely to drop out of school as their nonpoor counterparts. When programs that assist the mother to complete her education are instituted, chances are increased for a better future, which improves health care over the long term across the life span. It is important to keep the pregnant adolescent in school during the pregnancy and have her return as soon as possible after the birth.

 

DIF:    Cognitive Level: Synthesis                REF:    p. 427

 

  1. A school health nurse presents a program on preventing teen pregnancy to a group of parents. Following the presentation, what comment by a parent would cause concern?
a. “I do not know if my son is sexually active; however, I have decided I’m going to talk to him about it.”
b. “My daughter is too intelligent to get involved with boys, even if her friends do sleep around.”
c. “My daughter and I have often discussed sexuality, and when she’s ready, I’ll pay for her birth control pills.
d. “I have spoken to my son about birth control. He says he’s not ready to be a father and support a baby. He wants to go to college.”

 

 

ANS:   B

Teens are often ignorant concerning sexuality and pregnancy and often very embarrassed to discuss such topics. Further, they often believe myths such as they cannot get pregnant the first time they have sex. The earlier their sexual debut, the less likely a birth control method will be used, because younger teens have less knowledge. Teens are more likely to be sexually active if their friends are sexually active. Teens who are knowledgeable and want to be responsible often find it difficult to access birth control. Confidential reproductive health care services may be available for teens, but problems are still associated with transportation, school absences, and costs of care. Parents who do not talk about sexuality with their teens may find them more at risk for sexual permissiveness and pregnancy.

 

DIF:    Cognitive Level: Application             REF:    p. 427

 

  1. What is the most important principle to keep in mind when caring for the pregnant teen?
a. All teen pregnancies are considered high-risk.
b. Limited self-care knowledge can lead to pregnancy complications.
c. Pregnant teens are likely to receive prenatal care late in the pregnancy.
d. Pregnant teens may have limited financial resources to pay for care.

 

 

ANS:   A

All of these statements are true; thus it is crucial to consider all pregnant teenagers as high-risk obstetric clients. A number of problems (e.g., poverty, late entry into prenatal care, and limited self-care knowledge) can lead to complications of pregnancy, so it is important to treat every teen pregnancy as a special high-risk pregnancy.

 

DIF:    Cognitive Level: Knowledge             REF:    p. 430

 

  1. The nurse was making a postpartum visit to a teenage mother and her month-old infant. What assessment would be most important?
a. Assessing for mother’s ability to fulfill her own growth and development tasks
b. Assessing for mother’s knowledge about normal infant growth and development
c. Assessing how much the teenager mother’s own mother is helping her cope with child care
d. Assessing whether the baby’s father is being helpful to the mother

 

 

ANS:   B

Although the nurse might assess for any and all of these options, the primary goal would be to assess how much the mother knows and understands about the needs of infants and their development. Such knowledge helps avoid unrealistic expectations and frustrations, which could lead to child abuse.

 

DIF:    Cognitive Level: Application             REF:    p. 432

 

  1. A mother and her son are in the emergency department. The mother is extremely upset. Earlier, the son had become so angry that he put his hand through a glass window and had to have stitches. The physician suggested a psychiatric consult. Now the mom asks, “Do you think my son is crazy?” Which is the most appropriate response?
a. “Absolutely not. But a psychiatrist can help your son realize more appropriate ways of displaying anger.”
b. “Have you had other reasons to think your son is crazy? Perhaps the psychiatrist can reassure you that your son is just an adolescent coping with hormones.”
c. “Your son is having problems coping with anger. And naturally you’re upset. Let the psychiatrist determine whether your son is crazy or not.”
d. “Your son is having problems with behavior, which is distressing all of you. A psychiatrist may be able to help your son cope with life in a more acceptable way.”

 

 

ANS:   D

Mental health is defined as being able to engage in productive activities and fulfilling relationships with other people, to adapt to change, and to cope with adversity. Mental disorders are conditions characterized by alterations in thinking, mood, or behavior, resulting in distress and/or impaired functioning. Most persons do not get so angry that they become self-destructive (e.g., putting their hand through a glass window and requiring medical attention). The nurse can help the mother accept appropriate assessment and intervention by using positive language and giving hope. With more time the nurse can help the mother deal with feelings of having a “crazy” family member and the effects of such behavior on the whole family.

 

DIF:    Cognitive Level: Synthesis                REF:    p. 433

 

  1. Excluding war, what is the leading cause of disability for Americans 15 to 44 years of age?
a. Accidents
b. Arthritis
c. Major depressive disorder
d. Workplace injuries

 

 

ANS:   C

Major depressive disorder is the leading cause of disability in Americans between the ages of 15 and 44 years.

 

DIF:    Cognitive Level: Knowledge             REF:    p. 433

 

  1. Which group is most at risk for suicide?
a. Adolescents under age 20
b. Men over age 85
c. Females 25 to 45 years of age
d. Women over age 65

 

 

ANS:   B

Men over age 85 are in the highest risk category for suicide.

 

DIF:    Cognitive Level: Knowledge             REF:    pp. 436-437

 

  1. What can the nurse do to decrease the risk for depression in older adults?
a. Encourage moving to a nursing home where others of the same age reside.
b. Monitor for signs and symptoms of depression.
c. Organize an exercise and health promotion program at the local senior citizen center.
d. Teach older clients to focus on their strengths rather than their weaknesses.

 

 

ANS:   C

The depression rate among older adults is half that of younger people, but the presence of a physical or chronic illness increases rates of depression. Depression rates for older adults in nursing homes range from 15% to 25%; thus encouraging older adults to move to nursing homes would certainly not decrease their risk for depression. Healthy aging activities such as physical activity and establishing social networks improve the mental health of older adults. Older adults underuse the mental health system and are more likely to be seen in primary care or to be recipients of care in institutions. The nurse can reach them by organizing health promotion programs through senior centers or other community-based settings. Telling clients to focus on strengths instead of weaknesses is not helpful—this advice can sound flippant and patronizing if (1) the weaknesses are profound and (2) tools are not given to assist in coping. Monitoring for signs of depression is not an effective approach because this—like most programs currently available for adults, families, and caregivers with health problems—focuses on identifying rather than preventing problems.

 

DIF:    Cognitive Level: Synthesis                REF:    p. 437

 

  1. The nurse who works at a homeless clinic wants to improve healing of chronic wounds in clients living on the streets. What would be the best action to take to improve client outcomes?
a. Providing antibiotics to all homeless persons with chronic, nonhealing wounds
b. Offering daily access to a room with soap, water, and bandages
c. Handing out free bandaging supplies following each clinic visit
d. Performing regular monitoring of the client’s wound condition

 

 

ANS:   B

Health problems faced by the homeless often are related directly to poor access to preventive health care services. Proper wound care relies on cleanliness; however, those living on the streets do not typically have ready access to soap and water. The nurse can help by designating a wound room, in which clients can safely carry out wound care activities taught during clinic visits.

 

DIF:    Cognitive Level: Synthesis                REF:    Entire chapter

 

  1. What action can a nurse take that will potentially increase accessibility to health care services for mentally ill homeless clients?
a. Applying for a grant to fund a mobile clinic to take health care to the clients
b. Distributing flyers to the homeless that detail the location of various types of health care services
c. Referring homeless clients to areas that provide temporary housing
d. Soliciting donations for food and clothing to be distributed to the homeless

 

 

ANS:   A

Accessibility refers to the ability of clients to obtain needed health care services. Although all of these options lead to opportunities for improvement in health, either directly or indirectly, only option 1 (applying for a grant for a mobile clinic) can potentially improve accessibility to a health care clinic. Neighborhood clinics, mobile vans, and home visits can bring health care to people otherwise unable to access care. Coordinating services at a central location often improves client compliance because it reduces the stress of getting to multiple places.

 

DIF:    Cognitive Level: Knowledge             REF:    p. 439

 

  1. A nurse is concerned about stress related to the heavy caregiving burden assumed by adult children of older clients. What action by the nurse would use secondary prevention to limit caregiver stress?
a. Asking caregivers how they are doing and suggesting coping strategies
b. Encouraging caregivers to periodically leave the house for a couple of hours
c. Establishing support groups for caregivers of older parents
d. Referring some activities to neighbors and friends

 

 

ANS:   A

Secondary prevention activities involve screening activities that allow for early recognition of problems so that prompt interventions can limit disability. By asking caregivers how they are coping (thus screening), the nurse identifies problems early so that interventions can be employed to limit the extent of stress, thus paving the way for improvement. The other options are either primary or tertiary activities depending on whether the intervention takes place before or after caregiving stress has developed. Also, option 2 could result in negative outcomes for the person needing care (unless a competent substitute is filling in for the primary caregiver).

 

DIF:    Cognitive Level: Synthesis                REF:    Entire chapter

 

  1. According to the Federal Register, what is the minimum income needed by a family of four to meet the basic needs for healthy living (that is, an income below this amount is considered insufficient to provide the food, shelter and clothing needed to preserve health)?
a. $21,200
b. $23,000
c. $25,200
d. $27,000

 

 

ANS:   A

According to the Federal Register in January 2008, for a family of four, the poverty level—defined as the threshold below which families or individuals are considered to be lacking the resources to meet the basic needs for healthy living—is $21,200.

 

DIF:    Cognitive Level: Knowledge             REF:    p. 422 (Table 23-1)

 

  1. Which intervention by community mental health nurses is most likely to help prevent youth violence?
a. Distributing literature that associates violence with a lack of intelligence
b. Explaining to youth why youth violence is detrimental to society
c. Partnering with associations to provide alternative activities that improve social skills
d. Recommending increased funding to prosecute and jail teens associated with violent activity

 

 

ANS:   C

Community mental health providers can help prevent a culture of youth violence by creating coalitions and partnerships and providing activities to increase social skills by helping children learn to stop, think, and act.

 

DIF:    Cognitive Level: Knowledge             REF:    p. 435 (How To box)

 

MULTIPLE RESPONSE

 

  1. A teenager who has just come in for her prenatal visit appears to be about 6 months pregnant. What are the most typical reasons that a teenage girl might wait so long to come in for prenatal care? Select all that apply.
a. Her friends were suggesting ways to make the problem go away.
b. She knew she could not be pregnant because her boyfriend said he used a condom.
c. She was afraid her parents would pressure her to terminate the pregnancy.
d. She kept hoping the pregnancy would just go away.
e. She was scared about the examination and what health care providers do to you.
f. She was trying to keep her pregnancy a secret

 

 

ANS:   C, D, E, F

Most young women suspect pregnancy as soon as a period is late. These young women may still delay seeking care, since they falsely hope that the pregnancy will just go away. A teen also may delay seeking care because she wants to keep the pregnancy a secret from her parents, who may pressure her to terminate the pregnancy, or because she does not want to have a gynecological examination. Barriers to care early in the pregnancy also include the real or perceived costs of care, lack of transportation, dislike or fear of the needed exams, and apprehension about the attitude of care providers toward her. Being told that a condom was used doesn’t make it so. The girl should know whether a condom was used or not without relying on verbal statements.

 

DIF:    Cognitive Level: Application             REF:    p. 428

 

  1. Nursing students are offering health screenings at the local homeless shelter. Which persons or groups will the students most likely see? Select all that apply.
a. A group of men who smell strongly of body odor and alcohol
b. A man some of the students have previously met at the mental health clinic
c. A woman who has bruises peeking out from her sweater and skirt
d. Persons who just want to come in from the cold weather outside
e. A man who is distributing religious tracts and inviting clients to attend services
f. A woman and her two children who have been living in their car until it got so cold

 

 

ANS:   A, B, C, F

Groups commonly found among the homeless include persons living in poverty, victims of domestic abuse, people who abuse alcohol or other substances, persons who are mentally ill, and veterans.

 

DIF:    Cognitive Level: Application             REF:    p. 425 (Box 23-2)

 

  1. A nurse is concerned about a young teenage mother who does not seem to know how to play with an infant. What behaviors might the nurse want to role-model as good parenting behaviors? Select all that apply.
a. Allowing the baby to cry for 10 or 15 minutes before reacting so that the infant can learn to self-soothe
b. Cuddling and holding the baby while smiling and gazing into the baby’s eyes
c. Teaching the mother to keep her face about 4 or 5 inches from the baby and to gently blow on the infant’s face
d. Singing to baby with different melodies until baby seems to listen and shows a preference for certain tunes
e. Using “baby talk” (goo-goo, gaga) to help the infant recognize verbal sounds
f. Walking with the baby while pointing to bright colors and listening to sounds

 

 

ANS:   B, D, F

Suggestions for promoting interaction between an adult and a baby include the following: maintaining a distance of 8 to 10 inches from the baby, smiling, and making eye contact. Talk to the baby, but avoid “baby talk.” Singing may also help soothe a baby when fussy (try different melodies to see what the baby prefers). Babies love to play and enjoy “taking walks” and looking at brightly colored objects or toys that make noises.

 

DIF:    Cognitive Level: Application             REF:    p. 432 (How To box)

 

  1. What advice would you give a new nurse on how to care for very poor families? Select all that apply.
a. Be supportive in any way possible.
b. Educate the family on how to maximize their health using free resources.
c. Offer the family free medication samples whenever possible, keeping in mind the cost of many prescription drugs.
d. Recognize the family’s poverty and refrain from asking whether they want to make a payment toward their bill.
e. Remember to allow the family their pride by not suggesting sources of help that they may not need.
f. Try to keep the family separate from your paying clients.

 

 

ANS:   A, B, C

The textbook suggests that the poor be treated like anyone else. Don’t prejudge by assuming a poor family cannot pay anything, don’t be condescending, and don’t call attention to a family’s poverty by treating the family differently or separately. Always be supportive. Suggest all programs that might help, such as food banks, churches, and clothing centers. Remember that families are not always able to pay for medications, so free samples are often appreciated. Many families need help to learn how to promote their own health, given their lack of resources.

 

DIF:    Cognitive Level: Application             REF:    p. 423 (Briefly Noted box)