TEST BANK for Health Promotion Throughout the Life Span 9th Edition by Edelman C. L & Kudzma E. C. A

Chapter 01: Health Defined: Objectives for Promotion and Prevention Edelman: Health Promotion Throughout the Life Span, 9th Edition abirb.com/test

MULTIPLE CHOICE abirb.com/test

1. Which model of health is most likely used by a person who does not believe in preventive

health care? a. Clinical model b. Role performance model c. Adaptive model d. Eudaimonistic model

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ANS: A

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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.

DIF: Cognitive Level: Remember (Knowledge)

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REF: p. 3.

2. 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? abirb.com/test a. Clinical model b. Role performance model c. Adaptive model abirb.com/test d. Eudaimonistic model ANS: D

The eudaimonistic model embodies the interaction and interrelationships among physical, abirb.com/test 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. abirb.com/test DIF: Cognitive Level: Apply (Application)

REF: p. 3

3. Halbert Dunn (1961) introduced the concept of high level abirb.com/test wellness, a health-illness continuum

which factored in the individual’s environment when determining a level of health. Which of the following statements is correct concerning his model? a. Care recipients who are terminal or dying could not be classified as having abirb.com/test high-level wellness. b. The focus is on environment and the ability to achieve health on a personal and societal level. abirb.com/test c. It provides a view of health which is in opposition to the eudaimonistic model of health. d. It is most closely aligned with a clinical model of health.

ANS: B

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Dunn’s construct of high level wellness assesses a person’s wellness not only from the perspective of his relative health but also factors in his environment—favorable or abirb.com/test unfavorable—to arrive at a more comprehensive determination of relative wellness. With this concept in mind, a person who is dying can be said to have achieved high-level wellness via emotionally preparing for death and/or supporting others toward this end. His concept defines health on both personal and societal levels. This model is similar to the eudaimonistic model abirb.com/test of health which factors in physical, social, psychological, and spiritual aspects as well as influences from the environment in defining health. For these reasons, choices A, C, and D would all be incorrect. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 4

4. A state of physical, mental, spiritual, and social functioning that realizes a person’s potential abirb.com/test and is experienced within a developmental context is known as a. growth and development. b. health. c. functioning. abirb.com/test d. high-level wellness.

ANS: B

Health is defined as a state of physical, mental, spiritual, and social functioning that realizes a abirb.com/test person’s potential and is experienced within a developmental context.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 5 abirb.com/test

5. Which of the following best describes a care recipient who has an illness? a. Someone who has well-controlled diabetes b. Someone with hypercholesterolemia abirb.com/test c. Someone with a headache d. Someone with coronary artery disease without angina ANS: C

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Someone with a headache represents a person with an illness. An illness is made up of the subjective experience of the individual and the physical manifestation of disease. It can be described as a response characterized by a mismatch between a person’s needs and the resources available to meet those needs. A person can haveabirb.com/test a disease without feeling ill. The other choices represent disease.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 6

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6. Which US report is considered a landmark document in creating a global approach to health? a. The 1990 Health Objectives for the Nation: A Midcourse Review b. Healthy People 2020 abirb.com/test c. Healthy People 2000 d. The US Surgeon General Report ANS: C

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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. abirb.com/test

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DIF: Cognitive Level: Remember (Knowledge)

REF: p. 6

7. Which of the following is one of the four overreaching goals for Healthy People 2020 (US abirb.com/test

Department of Health and Human Services)? a. Decreased tobacco use in youth throughout the nation b. Achieve health equality and eliminate disparity for all groups abirb.com/test c. Increased public funding for health insurance d. Decreased hospital re-admission rates ANS: B

Healthy people 2020 has four overarching goals to includeabirb.com/test the following: 1. attain high quality, longer lives free of preventable disease, disability, injury, and premature death. 2.

Achieve health equality, eliminate disparities, and improve the health of all groups. 3. Create social and physical environments that promote good healthabirb.com/test for all. 4. Promote quality of life, healthy development, and healthy behaviors across all life stages. Choices A, C, and D are possible strategies to achieve the state goals but they do not reflect the actual published overarching goals. abirb.com/test

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 7

8. Which of the following statements accurately reflect primordial prevention? abirb.com/test a. It concerns interventions directed at the fetus while in utero to assure lifelong

health. b. It is a more modern term used interchangeably with primary prevention. abirb.com/test c. It is a health-promotion strategy which reflects policy-level interventions. d. It refers administering vaccines to prevent individuals from developing the disease.

ANS: C abirb.com/test Primordial prevention is a fairly new concept which has been added to the more traditional modalities of primary, secondary, and tertiary prevention. Primordial refers to the time frame before a risk factor develops and before disease occurs. Primordial prevention reflects policy-level interventions which will serve to prevent disease.

Such prevention is typically abirb.com/test implemented at the “national, state, or community” levels. Examples of primordial prevention would be state regulations which mandate healthy food for school-based lunch programs or regulations which call for the elimination of trans fats in commercial foods. By contrast, abirb.com/test primary prevention are those interventions which are directed at the individual in the interest of preventing disease. Vaccinating an individual against disease would be an example of primary prevention as would be education and interventions (exercise, low fat, avoiding excess salt) aimed at preventing cardiovascular disease before it occurs. abirb.com/test

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 9

abirb.com/test 9. Which of the following represents a method of primary prevention? a. Informational session about healthy lifestyles b. Blood pressure screening c. Interventional cardiac catheterization abirb.com/test d. Diagnostic cardiac catheterization

ANS: A abirb.com/test

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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 abirb.com/test disease, but instead identifies it.

DIF: Cognitive Level: Apply (Application)

REF: p. 11

10. Which of the following represents a method of secondary abirb.com/test prevention? a. Self-breast examination education b. Yearly mammograms c. Chemotherapy for advanced breast cancer abirb.com/test d. Complete mastectomy for breast cancer ANS: B

Screening is secondary prevention because the principal goal of screenings is to identify abirb.com/test 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.

DIF: Cognitive Level: Apply (Application)

abirb.com/test REF: p. 13

11. Which of the following represents a method of tertiary prevention? a. Drunk driving campaign abirb.com/test b. Road blocks for drunk driving c. Emergency surgery for head trauma after a motor vehicle accident d. Physical and occupational therapy after a motor vehicle accident with head trauma abirb.com/test

ANS: D

Physical therapy and occupational therapy are considered tertiary prevention. Tertiary prevention occurs when a defect or disability is permanent and irreversible. It involves abirb.com/test minimizing the effect of disease and disability. The objective of tertiary prevention is to maximize remaining capacities.

DIF: Cognitive Level: Apply (Application)

REF: p. 13

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12. 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 abirb.com/test the person’s primary care provider. In this scenario, the nurse is acting as a(n) a. advocate. b. care manager. abirb.com/test c. consultant. d. educator.

ANS: B

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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.

DIF: Cognitive Level: Apply (Application)

REF: p. 14 abirb.com/test

13. During a home visit, a nurse assists an individual to complete an application for disability

services. The nurse is acting as a(n) a. advocate. b. care manager.

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c. consultant. d. educator.

ANS: A

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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 abirb.com/test needs, and assists individuals in developing skills to advocate for themselves.

DIF: Cognitive Level: Apply (Application)

REF: p. 13

abirb.com/test 14. During a home visit, a nurse discusses the dangers of smoking with an individual. In this

scenario the nurse is acting as a(n) a. advocate. b. care manager. c. consultant. d. educator.

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ANS: D

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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.

DIF: Cognitive Level: Apply (Application)

abirb.com/test REF: p. 14

15. 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 isabirb.com/test acting as a(n) a. advocate. b. care manager. c. consultant. abirb.com/test d. educator.

ANS: C

Nurses with a specialized area of expertise provide education about health promotion and abirb.com/test disease prevention to individuals and groups as consultants.

DIF: Cognitive Level: Apply (Application)

REF: p. 14 abirb.com/test

16. 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? a. Assess the motivation level of the individuals abirb.com/test b. Assess the knowledge level of the individuals c. Establish teacher–learner goals with the individuals d. Establish multiple teaching sessions with the individuals abirb.com/test

ANS: C

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. abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 14

17. The conscientious, explicit, and judicious use of current best evidence in making decisions abirb.com/test

about the care of individuals is known as abirb.com/test

a. b. c. d.

health-related quality of life. evidence-based practice. a Healthy People 2020 goal. the ecological model of health.

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ANS: B abirb.com/test Evidence-based practice is defined as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individuals.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 14 abirb.com/test

18. Which research methodology should be used to address the question, “What is the difference

in the infection rates between individuals who receive twice-a-day dressing changes versus once-a-day dressing changes?” abirb.com/test a. Evidence-based practice research b. Qualitative research c. Quantitative research abirb.com/test d. Clinical judgment research ANS: C

Quantitative research studies describe situations, correlate different variables related to care, or test causal relationships among variables related to care.abirb.com/test Evidence-based practice research and clinical judgment research are not research methodologies; they are used to answer clinical questions. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 15

19. The question, “What is the experience of teenagers who lose a sibling to cancer?” can best be

answered by using which research methodology? a. Evidence-based practice research b. Qualitative research c. Quantitative research d. Clinical judgment research

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ANS: B

Qualitative research studies describe phenomena or defineabirb.com/test the historical nature, cultural relevance, or philosophical basis of aspects of nursing care. Evidence-based practice research and clinical judgment research are not research methodologies; they are used to answer clinical questions. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 15

20. A nurse who uses findings from a randomized, controlled trial on the care of Foley catheters

to change practice at an institution is practicing a. evidence-based medicine. b. qualitative research. c. quantitative research. d. clinical judgment.

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ANS: A abirb.com/test The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.

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DIF: Cognitive Level: Apply (Application)

REF: p. 14 abirb.com/test

21. Which of the following is most influenced by the social and economic environment of a

community? a. Social health policies b. Quality of care c. Evidence-based practice d. Practice guidelines

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ANS: A

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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. abirb.com/test DIF: Cognitive Level: Remember (Knowledge)

REF: p. 15

22. A major cause of death in the early twentieth century was abirb.com/test a. cancer. b. cerebrovascular disease. c. heart disease. abirb.com/test d. infections.

ANS: D

Infections and acute disease were the major causes of death in the early part of the twentieth abirb.com/test century.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 16 abirb.com/test

23. Which of the following groups of people are likely to show an increase in numbers between

the years 2010 to 2030? a. Persons age 65 and older b. Persons of White European descent c. Infants due to rising birth rates d. Population growth and character are unpredictable ANS: A

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By the year 2050, it is predicted that the majority of people in the United States will not be of White European descent (US Census Bureau, 2010a). ……. addition to changes in the ethnic and racial distribution within the population, the projectedabirb.com/test changes in age distribution will affect health-promotion practice. Considerable growth is expected in the proportion of the population that is 25 years of age and older. For example, the post-World War II baby boom will increase the number of persons in the 65-and-older age group between the years 2010 and abirb.com/test 2030 (US Census Bureau, 2010b). …. there was a drop in births after 1960.

DIF: Cognitive Level: Apply (Application)

REF: p. 15 abirb.com/test

24. Which of the following demonstrates a nurse taking action to promote health and prevent

disease? a. Making a home visit to a person who is recovering from a heart attack abirb.com/test b. Administering medications to a cardiac care recipient in the hospital c. Providing cardiopulmonary resuscitation during a heart attack abirb.com/test

d. Educating a person about the advantages of a heart-healthy diet during a home visit ANS: D

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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-healthyabirb.com/test diet during a home visit serves to influence lifestyle choices.

DIF: Cognitive Level: Apply (Application)

REF: p. 16 abirb.com/test

25. 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? abirb.com/test a. Education regarding effects of smoking on her health b. The satisfaction that she will not contribute to secondhand smoke c. The availability of a weekly support group abirb.com/test d. A gift card for $10 to a local grocery store for every week she is smoke free ANS: D

Motivational factors play a role in influencing attitudinal changes. A financial incentive is an abirb.com/test 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. abirb.com/test DIF: Cognitive Level: Analyze (Analysis)

REF: p. 16 abirb.com/test

MULTIPLE RESPONSE 1. Which of the following “investment” themes has been identified by the National Institute of

Nursing Research? (Select all that apply.) a. Interprofessional collaboration b. Improving quality of life c. End-of-life care d. Increasing physical activity among Americans

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ANS: B, C

The National Institute of Nursing Research has identified five themes that promote health and abirb.com/test prevent disease, improve quality of life through symptom management, and support palliative and end-of-life care, innovation, and nurse scientists.

DIF: Cognitive Level: Remember (Knowledge)

abirb.com/test REF: p. 14

2. Which interventions address both the National Institute of Nursing Research themes and the

overall goals of the Healthy People 2020 leading health indicators? (Select all that apply.) abirb.com/test a. Establishing a new park with a well-lit track b. Establishing a smoking cessation campaign c. Providing reduced-cost transportation passes to senior citizens d. Providing free condoms at all federally funded health clinics abirb.com/test

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ANS: A, B, D

Establishing a new park with a well-lit track, establishing a smoking cessation campaign, and providing free condoms at all federally funded health clinics all address the National Institute abirb.com/test of Nursing Research themes and the Healthy People 2020 leading health indicators. A park, smoking cessation campaign, and free condoms address the themes of promoting health and preventing disease and the goal of increasing quality and years of healthy life. Providing abirb.com/test reduced-cost transportation passes to senior citizens may indirectly affect the health of this population; however, it is not directly related to the themes of the National Institute of Research (promote health and prevent disease, improve quality of life through symptom management, and support palliative and end-of-life care, innovation, abirb.com/test and nurse scientists) or the overall goals of Healthy People 2020 (increase quality and years of healthy life and eliminate health disparities).

DIF: Cognitive Level: Analyze (Analysis)

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REF: p. 14

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Chapter 02: Emerging Populations and Health Edelman: Health Promotion Throughout the Life Span, 9th Edition abirb.com/test

MULTIPLE CHOICE abirb.com/test

1. Which of the following statements about ethnic minorities in the United States is accurate? a. It is estimated that the percentage of ethnic minorities will decrease during the next

30 years. b. It is estimated that ethnic minorities will increase to one in two by 2050. abirb.com/test c. The increasing population of refugees has been a significant contributor to the

increase in ethnic minorities. d. The increasing population of ethnic minorities has helped decrease the health

disparities faced by this population.

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ANS: B

It is estimated that the number of ethnic minorities will increase to one in two by 2050. In abirb.com/test 2010, it was estimated that 33% of the population was from an ethnic minority. The increasing population of immigrants has been a significant contributor to the increasing populations of major ethnic groups. The increasing population of ethnic groups is one factor that is producing abirb.com/test disparities in health status and access of the health care system.

DIF: Cognitive Level: Understand (Comprehension)

REF: p. 25

2. A person states, “My grandmother is the decision maker inabirb.com/test our family.” Which of the

following is being described by the person? a. Culture b. Race c. Ethnicity d. Values

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ANS: A

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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 abirb.com/test 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 indices the history or ongoing imposition of one group’s authority above another. Values are beliefs about the worth of something and serve as standards that influence behavior and thinking. abirb.com/test DIF: Cognitive Level: Analyze (Analysis)

REF: p. 25

3. The nurse recommended to a 50-year-old woman that she abirb.com/test schedule a routine mammogram.

Which of the following would be the most important factor in this woman’s decision to schedule this exam? a. Race abirb.com/test b. Ethnicity c. Cultural values d. Value orientation abirb.com/test

ANS: C

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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 abirb.com/test 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 indices 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 abirb.com/test particular society.

DIF: Cognitive Level: Apply (Application)

REF: p. 25 abirb.com/test

4. Which of the following actions demonstrates a health care professional providing culturally

competent care? a. Encouraging the person to take medications as prescribed b. Asking the person to describe his folk healing methodsabirb.com/test c. Demonstrating the proper way to administer an insulin injection d. Assisting the person with discussing his health problems with the family ANS: B

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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 andabirb.com/test thoroughly recognize and understand the differences in his or her culture and that of the person or an individual, 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 abirb.com/test is the only action that demonstrates the health care professional seeking input from the person into the care that is received.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 27 abirb.com/test

5. Which of the following nurses is most likely to provide culturally competent care? a. A nurse who recognizes and accepts cultural diversity abirb.com/test and treatment b. A nurse who is knowledgeable in disease-specific epidemiology

efficacy for different population groups. c. A nurse who provides ethnocentric care in emergency scenarios where time

matters

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d. A nurse who assists diverse populations to integrate into the mainstream culture.

ANS: B

It is very important for health care providers to be aware of how persons interpret their health abirb.com/test issues or illnesses and to be capable of providing culturally competent care. Simply recognizing and accepting cultural diversity is insufficient to attain cultural competency in health care. Culturally competent health care professionals should be able to consistently and abirb.com/test thoroughly recognize and understand the differences in their culture and the culture of others; to respect others’ values, beliefs, and expectations; to understand the disease-specific epidemiology and treatment efficacy of different population groups; and to adjust the approach of delivering care to meet each person’s needs and expectations. Cultural abirb.com/test competency is usually reflected in a health care provider’s attitude and his or her communication style. While emergency scenarios may call for swift action (at the expense of culturally competent care), ethnocentric care is not consistent with culturally competent care. abirb.com/test Similarly, a goal of facilitating an individual to adopt mainstream values does not speak to respect for culturally diverse values, beliefs, or expectations. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 27 abirb.com/test

6. 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? abirb.com/test a. You should have told me that the current treatments were helping your pain. b. Tell me more about your treatments from the acupuncturist. c. Tell me why you decided not to continue with your treatment plan. d. You should not be seeing an acupuncturist while receiving professional care. abirb.com/test ANS: B

Through a culturally sensitive assessment process, nurses can determine what specific remedies individuals are using and whether their continuedabirb.com/test 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 abirb.com/test inferior to professional care.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 27 abirb.com/test

7. When providing an educational session about the Arab American population, which of the

following information would be included? a. The largest groups of Arab Americans were refugees in the 1960s. abirb.com/test b. The largest groups of Arab Americans are from Palestine and Iraq. c. Members of the Arab American population are most likely to live in rural communities. d. Members of the Arab American population are more likely to have college degrees abirb.com/test than Americans at large.

ANS: D

Members of the Arab American population are more likelyabirb.com/test 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 skilledabirb.com/test and semiskilled laborers.

DIF: Cognitive Level: Understand (Comprehension)

REF: p. 28 abirb.com/test

8. 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? a. This ethnic culture tends to be future oriented. b. Religion plays an important role in this culture. abirb.com/test c. Traditional cultural practices are infrequently used during a health crisis. d. Members of this culture tend to have smaller families.

ANS: B

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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 abirb.com/test 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.

DIF: Cognitive Level: Apply (Application)

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REF: p. 29

9. A health care professional is providing education to the parents of an Asian American child

who has recently been diagnosed with Type I diabetes. Which of the following actions should abirb.com/test be taken by the health care professional? a. Provide instructions to the child’s father. b. Encourage the parents to bring other siblings into the clinic for screening. abirb.com/test c. Schedule multiple educational sessions for the child and family. d. Watch for nonverbal gestures by the adults to indicate understanding.

ANS: A

In Asian American culture, the oldest male family memberabirb.com/test often is the decision maker and spokesperson. Maintaining harmony is an important value in Asian cultures, and it is strongly emphasized to avoid conflict and direct confrontation. As a result of this, Asian Americans may not show their disagreement with the recommendations of health care professionals. abirb.com/test Type I diabetes is not a common health problem experienced by this minority, so it is probably not necessary to encourage screening for siblings. Additional educational sessions may be necessary; however, Asian Americans tend to be more highly educated than any other abirb.com/test population in the United States.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 31 abirb.com/test

10. 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? abirb.com/test a. The child will get a good education. b. According to law, all children must go to school. c. The child can get health care at school. d. Exposure to different cultures in school will enhance socialization. abirb.com/test ANS: D

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. abirb.com/test DIF: Cognitive Level: Apply (Application)

REF: p. 31

abirb.com/test 11. Which of the following was the fastest-growing minority group in the United States between

2000 and 2010? a. Asian American and Pacific Islanders b. Arab American c. Hispanic American d. Native American ANS: A

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According to the 2010 Census, the estimated number of US residents of Asian descent comprised 5.6% of the total US population. Between the 2000 census and 2010 census, Asian abirb.com/test American and Pacific Islanders are the fastest growing (46% of growth) ethnic minority in the United States. A 43% increase in the Hispanic population between 2000 and 2010 makes Hispanics the second fastest-growing minority group in the United States after Asians.

DIF: Cognitive Level: Remember (Knowledge)

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REF: p. 29

12. The interrelationship of poverty and health care dollars spent by Blacks and other minorities is

affected greatly by abirb.com/test a. lack of access to preventive health care services. b. low numbers of minority health care providers. c. the practice of folk medicine. abirb.com/test d. increased infant mortality rates in African American populations.

ANS: A

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 abirb.com/test resources when severe illness occurs.

DIF: Cognitive Level: Understand (Comprehension)

REF: pp. 32, 34 abirb.com/test

13. 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 abirb.com/test Sunday worship services. What is the most likely explanation for her insisting that she participate in this cultural practice? a. The church is the only place where prayer can be performed. b. The church serves as a social support for its members. abirb.com/test c. The church is the place where the family meets on a weekly basis. d. The church serves as a site for folk healing practices.

ANS: B

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The church is a significant support system for 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 abirb.com/test 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,abirb.com/test 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. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 34

14. Which of the following ethnic groups has a disproportionately high death rate from

unintentional injuries and suicide? a. American Indian/Alaska Native Americans b. Asian Americans c. Latino/Hispanic Americans d. Black/African Americans

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ANS: A

American Indian/Alaska Native Americans have disproportionately high death rates from abirb.com/test 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. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 36

15. A health care professional is offering an educational session about providing culturally

congruent care. Which of the following information wouldabirb.com/test be included the presentation? a. Hispanic Americans value keeping balance and harmony with the earth. b. The oldest male is the decision maker in African American families. c. Native Americans are present oriented, taking one dayabirb.com/test at a time. d. The hot and cold concept of disease is part of the Arabic-American culture.

ANS: C

Native Americans are generally present oriented, emphasizing events that are occurring now abirb.com/test 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 isabirb.com/test part of the Hispanic culture.

DIF: Cognitive Level: Apply (Application)

REF: p. 36 abirb.com/test

16. A family has recently become homeless. Which of the following factors most likely

contributed to this situation? a. Being from an ethnic minority background b. Declining rates of poverty c. Having multiple chronic illnesses d. Being unable to find affordable housing

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ANS: D

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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 abirb.com/test lack of affordable health care, domestic violence, mental illness, and addiction disorders.

DIF: Cognitive Level: Apply (Application)

REF: p. 37 abirb.com/test

17. A health care professional is caring for an individual who is homeless. Which of the following

considerations should be made? a. The prevalence of substance abuse is much lower among the homeless population abirb.com/test than the general population. b. The prevalence of HIV/AIDS is much lower among the homeless population than the general population. c. The percentage of the population who has health insurance is much lower among abirb.com/test the homeless than the general population. d. The percentage of the population who has limited access to medical care is much lower among the homeless than the general population. abirb.com/test

ANS: C abirb.com/test

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 abirb.com/test substance abuse, HIV/AIDS, and mental health disorders is higher among the homeless population than the general population.

DIF: Cognitive Level: Apply (Application)

REF: p. 38 abirb.com/test

18. A health care professional is caring for an individual who is homeless and has recently been

diagnosed with Type II diabetes. Which of the following factors is the most important to consider when planning care? abirb.com/test a. Considering the cost of the purchasing medications b. Determining the pharmacy where medications will be obtained c. Obtaining insurance that will pay for the follow-up care abirb.com/test d. Finding supportive housing for the individual ANS: D

Research and practice have shown that permanent supportive housing works because housing abirb.com/test is an essential part of treatment; thus, this is the most important factor that should be considered. If supportive housing is found, the stability will help the homeless individual to follow the prescribed medical regimen. abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 39

19. A health care professional is leading a community action coalition to address the problem of abirb.com/test homelessness within the neighborhood. Which of the following statements would most likely be made by health care professional? a. Homelessness should be addressed by improving financial assistance programs. b. Homelessness should be of concern to everyone in the neighborhood. abirb.com/test c. Homelessness should be addressed by encouraging job growth in the area. d. Homelessness should be of concern to major retailers and commerce in the area.

ANS: B

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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. abirb.com/test DIF: Cognitive Level: Analyze (Analysis)

REF: p. 39 abirb.com/test

20. What is the main focus of the National Institutes of Health (NIH)? a. Addressing and reducing health disparities b. Outlining nationwide health promotion and disease prevention c. Protecting minority populations through development abirb.com/test of health policies d. Supporting communities in addressing health disparities ANS: A abirb.com/test

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The main concern of the National Institutes of Health is addressing and reducing health disparities involving cancer, diabetes, infant mortality, AIDS, cardiovascular illnesses, and abirb.com/test nationwide health many other diseases. Healthy People 2020 outlines a comprehensive, promotion and disease prevention agenda. 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 Centers abirb.com/test for Disease Control and Prevention’s Racial and Ethnic Health Disparities Action Institute supports communities to take action in addressing health disparities.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 39 abirb.com/test

21. 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 abirb.com/test federal agencies would most likely be able to assist with this initiative? a. The National Institute on Minority Health and Health Disparities b. The Centers for Disease Control and Prevention c. The Office of Minority Health abirb.com/test d. The National Institutes of Health ANS: C

The Office of Minority Health improves and protects the health of racial and ethnic minority abirb.com/test 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 abirb.com/test all address health disparities among racial and ethnic minorities, but their priority is not in funding these initiatives.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 39 abirb.com/test

22. Which of the following best demonstrates the practice of transcultural nursing? a. Using previous knowledge about ethnic minority cultures to plan care abirb.com/test b. Adapting nursing care to meet the need of a person from an ethnic minority c. Requesting an interpreter when caring for a person from an ethnic minority d. Attending a presentation about cultural diversity ANS: B

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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 abirb.com/test 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 abirb.com/test 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 abirb.com/test attending a presentation.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 40 abirb.com/test

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23. 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 abirb.com/test accurately be drawn from this statement? a. The care recipient will have adverse complications from using this form of medicine. b. The care recipient may be using meditation, acupuncture, or another therapy. abirb.com/test c. The care recipient will soon be returning to his or her native country for further treatment. d. The care recipient does not agree with the current professional care medication abirb.com/test regimen.

ANS: B

Examples of complementary and alternative medicine (CAM) include acupuncture, feedback, relaxation, music therapy, massage, art, music, and dance abirb.com/test 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. abirb.com/test Complementary and alternative medicine can be used in conjunction with the use of professional care.

DIF: Cognitive Level: Apply (Application)

REF: p. 32, Box 2-4 abirb.com/test

24. A woman reports that she has strong spiritual practices. Which of the following is she most

likely to experience? a. Improved coping skills and social support b. Increased understanding of religious differences c. Decreased pain and improved healing d. Decreased use of Western medicine

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ANS: A

Spiritual practices are likely to improve coping skills and social support, promote feelings of optimism and home, encourage healthy behavior, decreaseabirb.com/test feelings of depression and anxiety, and support a sense of relaxation.

DIF: Cognitive Level: Apply (Application)

REF: p. 41, Box 2-5 abirb.com/test

MULTIPLE RESPONSE abirb.com/test 1. Which of the following individuals will most likely experience a disparity in health and health

care? (Select all that apply.) a. African American man b. Unemployed woman c. White middle-aged man d. Single white woman ANS: A, B, D

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Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic abirb.com/test status; sex; age; mental health; cognitive, sensory, or physical disability; sexual orientation or sex identity; geographical location; or other characteristics historically linked to discrimination or exclusion. A white middle-aged man is the only individual who does not meet that definition. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 23

2. A health care professional is providing culturally competent care. Which of the following abirb.com/test

actions is being performed by the professional? (Select all that apply.) a. Recognizing and accepting cultural diversity b. Respecting the patient’s values, beliefs, and expectations abirb.com/test c. Understanding the pathophysiology of disease processes d. Providing health care services that are respectful of the individual’s cultural beliefs ANS: B, D

A culturally competent health care professional should be abirb.com/test able to consistently and thoroughly recognize and understand the differences in his or her culture and that of the care recipient; respect the individual’s values and beliefs; and adjust the approach of delivering care to meet each individual’s needs and expectations. Simply recognizing and accepting cultural diversity abirb.com/test and understanding the pathophysiology of disease processes are insufficient measures to reach cultural competency in health care.

DIF: Cognitive Level: Apply (Application)

abirb.com/test REF: p. 27

3. A health care provider is discussing the importance of receiving routine preventive care with a

Hispanic family who has recently immigrated to the United States. Which of the following abirb.com/test would best describe why they may be disinterested in receiving professional care? (Select all that apply.) a. Lack of folk remedies abirb.com/test b. Lack of interpreter services c. Lack of health insurance d. Lack of family support ANS: B, C

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Barriers experienced by Hispanic Americans in receiving appropriate health care services include lack of racial and ethnic diversity in the leadership and workforce of the health care system, lack of interpreter services for Spanish-speaking people, lack of health insurance, and abirb.com/test lack of or inadequate culturally appropriate health care resources. They may not readily seek care because of their continued reliance on their folk system of healing. The family is the most important source of support for Hispanic Americans. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 33

4. A nurse is developing a continuing education program about strategies to work with culturally abirb.com/test

diverse populations for health care professionals in the community. Which of the following organizations would provide information that could be included in this presentation? (Select all that apply.) a. The American Nurses Association abirb.com/test b. Sigma Theta Tau International abirb.com/test

c. The National League for Nursing d. The American Association of Colleges of Nursing ANS: A, C, D

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Major organizations, such as the American Nurses Association (ANA), the National League for Nursing (NLN), and the American Association of Colleges of Nursing (AACN), publish abirb.com/test culturally relevant materials to guide students, clinicians, and educators.

DIF: Cognitive Level: Apply (Application)

REF: p. 40 abirb.com/test

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Chapter 03: Health Policy and the Delivery System Edelman: Health Promotion Throughout the Life Span, 9th Edition abirb.com/test

MULTIPLE CHOICE abirb.com/test

1. Which addition to a community best demonstrates the concept of the Healthy People 2020

report? a. New cardiothoracic intensive care unit at a major hospital b. New rehabilitation center abirb.com/test c. New recreational health center d. New children’s hospital ANS: C

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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 abirb.com/test 2020 report.

DIF: Cognitive Level: Apply (Application)

REF: pp. 49-50, Box 3-1 abirb.com/test

2. Which of the following statements is correct concerning the Affordable Care Act (ACA),

signed into law in March 2010? a. Penalties are imposed for persons who fail to acquire health insurance b. The ACA was challenged in 2012, requiring Supreme abirb.com/test Court mandated revisions c. It passed secondary to bipartisan support d. All of the above statements are correct.

ANS: A

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One of the hallmark features of the ACA is the requirement that all persons obtain health care insurance stipulating penalties for those who do not comply. Provisions were included to provide financial aid for low-income individuals and families in obtaining required insurance. abirb.com/test This mandate was legally challenged where in 2012, the Supreme Court of the US agreed to adjudicate the issue. The court upheld the mandate which required all persons to obtain health insurance. The law most definitely did not have bipartisan support but rather support was abirb.com/test sharply divided along partisan lines.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 58 abirb.com/test

3. Which of the following persons would be eligible to participate in the market place exchange

program? a. Individual covered by the Children’s Health Insurance Program (CHIP) abirb.com/test b. An individual looking to shop for a better plan than what his employer provides c. A newly unemployed individual who has lost his health care insurance d. Anyone may participate in the Market Place Exchange Program ANS: C

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The market place exchange is intended for persons who do not currently have health insurance, employer sponsored insurance, Medicaid, Medicare, CHIP or other source of qualifying health insurance. The newly unemployed individual who has lost his insurance abirb.com/test would meet this criterion. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 48 abirb.com/test

4. Health insurance plans, offered under the market place exchange program, must include which

of the following features? a. Low deductibles and low out-of-pocket costs b. Birth control coverage c. Dental coverage d. Uniform monthly premiums for all persons

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ANS: B

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Market place plans have a variety of requirements with respect to coverage, one of which is a requirement that the plan include coverage for birth control and select contraceptive technologies. Dental and vision coverage is optional and will vary from plan to plan. Plans abirb.com/test will also vary with respect to monthly premiums whereby persons may choose plans and deductibles best suited to their needs. Some plans will have low deductibles with higher monthly premiums; other plans will have high deductibles with lower monthly premiums. abirb.com/test

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 48

5. The Health of the Nation is an annual report prepared by the US Department of Health and abirb.com/test

Human Services. Which of the following statements would accurately represent findings for the 2014 report? a. Cancer is the number one cause of deaths, followed by heart disease. abirb.com/test b. Life expectancy has increased for women and remained static for men. c. Suicide and drug-related deaths have decreased secondary to education programs. d. Smoking for persons 18 years and over has dropped.

ANS: D

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As per the 2014 report, heart disease is the number cause of death (24%), followed closely by cancer (23%). Life expectancy has improved for both men and women. Sadly, both suicide and drug-related deaths have increased. One area where there has been improvement is abirb.com/test smoking in persons 18 years of age or older. Rates of smoking have decreased from 23.2% in 2000 to 17.8% in 2013.

DIF: Cognitive Level: Remember (Knowledge)

abirb.com/test REF: p. 49

6. Healthy People 2020 would be most concerned with which of the following healthcare issues? a. Promoting reform regarding deaths from gun violence abirb.com/test b. Evaluating the merits of single-payer healthcare c. Treating vulnerable populations d. Eliminating healthcare fraud which consumes available funds ANS: C

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Healthy People 2020 is greatly concerned with vulnerable populations. These populations are comprised of individual who, for one reason or another, face greater obstacles to health. abirb.com/test Health disparities for such populations can be based on one or more of the following factors: race, color, or national origin; ethnic group; religion; socioeconomic status; sex; age; mental health; cognitive, sensory, or physical or other disability; sexual orientation or sex identity; geographical location; or other characteristics historically linked to discrimination or abirb.com/test exclusion. By contrast, reforms to reduce gun violence, the pros and cons of a single-payer healthcare system or problems of fraud in healthcare are all political issues and not within the purview of Healthy People 2020. These types of issues would be appropriately addressed by abirb.com/test legislative bodies.

DIF: Cognitive Level: Apply (Application)

REF: p. 49

7. Which of the following individuals is statistically the mostabirb.com/test likely to have a child who will

succumb to a cause of infant mortality? a. A 30-year-old teacher who insists on delivering her baby at home, with a midwife b. A 17-year-old African American with credits toward her GED and in good health abirb.com/test c. An Asian woman who is having a C-section due to small pelvis d. A 26-year-old accountant who quit smoking 18 months ago when she moved to NY abirb.com/test

ANS: C

The Department of Health and Human Services provide detailed statistics concerning which populations are most at risk with respect to infant mortality. African American women with abirb.com/test less than a high school education are at greatest risk. White mothers 20 years of age or older, with college education, have favorable rates. These favorable rates are second only to Asian women who have even lower rates of infant mortality. Having a bachelor’s degree, as would be the case for both an accountant and a teacher, regardless of race, predicts a low rate of abirb.com/test infant mortality. Choosing the services of a midwife does not impact infant mortality. A history of previous smoking which predates the pregnancy does not impact infant mortality.

Moreover, NY has a particularly low rate of infant mortality. Neither a previous C-section nor abirb.com/test a planned C-section is a risk factor for infant mortality for the Asian woman who already has a low risk with respect to infant mortality.

DIF: Cognitive Level: Apply (Application)

REF: p. 51 abirb.com/test

8. Which nurse is at risk of making a medical error? a. A nurse working overtime abirb.com/test care b. A nurse who works in a hospital that advocates multidisciplinary c. A nurse caring for four care recipients during the shift d. A nurse who attends regular continuing education programs ANS: A

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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 nurseabirb.com/test turnover, the need for increased care recipient-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. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 53 abirb.com/test

9. The person known as the father of British and American public health is a. Lillian Wald. abirb.com/test b. Edwin Chadwick. c. Lemuel Shattuck. d. Paul Ehrlich. abirb.com/test

ANS: B

Edwin Chadwick is known as the father of British and American public health.

DIF: Cognitive Level: Remember (Knowledge)

abirb.com/test

REF: p. 55

10. A community health nurse most effectively preserves the health of a person with tuberculosis

(TB) and the community by abirb.com/test a. administering and reading the purified protein derivative (PPD) of all close contacts. b. providing direct observed therapy (DOT) for the individual with TB. c. isolating the person because it is likely drug resistant. abirb.com/test d. telling the person to wear a mask when leaving the home.

ANS: B abirb.com/test Community health nursing practice promotes, preserves, and maintains the health of populations and the effect of their health status on that of the community as a whole through care provided to individuals, families, and groups. Thus, the most effective strategy of treating the individual and preventing the spread of TB is to provide DOT. abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 50

abirb.com/test 11. 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? a. Physician as medical director b. Interdisciplinary staff abirb.com/test c. Nurse as chief manager d. Partnership with an academic institution ANS: C

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The essential components of a community nursing center include a nurse as chief manager, a nursing staff who is accountable and responsible for care and professional practice, and nurses as the primary providers of care. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 59

12. Considering the provider and care recipient perspective, which of the following is the most

autonomous form of insurance? a. Fee-for-service plan b. Health maintenance organization (HMO) c. Preferred provider organization (PPO) d. Independent practice association (IPA)

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ANS: A

In the fee-for-service plan, a provider provides a service and bills the individual’s insurance abirb.com/test company. The individual is also allowed to choose his or her provider. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 59 abirb.com/test

13. Which could result in a change in a nurse practitioner’s practice? a. Holding a master’s degree or higher b. Moving to another state when she gets married abirb.com/test c. Caring for Medicare care recipients d. Changing to another office within the same practice ANS: B abirb.com/test Nurse practitioners generally hold master’s degrees or higher.

The nurse practice act within their states may be more comprehensive than the institutions for which they work. Legislation exists for reimbursement of nurse practitioners by Medicare. However, such facts not withstanding, practice acts and prescriptive authority varyabirb.com/test from state to state, thus influencing practice patterns.

DIF: Cognitive Level: Apply (Application)

REF: p. 73 abirb.com/test

14. Which health care provider represents a primary care provider? a. Psychiatric advanced practice nurse b. Clinical nurse specialist abirb.com/test c. Pediatric nurse practitioner d. Acute care nurse practitioner ANS: C

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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 abirb.com/test 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.

DIF: Cognitive Level: Apply (Application)

REF: p. 59

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15. Which form of managed care restricts providers to caring for individuals who are members of

their organization? a. Fee-for-service plan b. Health maintenance organization (HMO) c. Preferred provider organization (PPO) d. Independent practice association (IPA)

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ANS: B

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 abirb.com/test serving members of the HMO. Fee-for-service, IPAs, and PPOs are not restricted to serving care recipients for any one organization.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 60 abirb.com/test

16. A Medicare care recipient 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 abirb.com/test when delivering care to this individual? a. The individual must see a primary care provider before being referred to a abirb.com/test

specialist. b. The focus of care is prevention and management of individuals with chronic abirb.com/test disease. c. The individual has paid a membership fee to be part of this organization. d. The focus of care is to conserve money in a health savings account.

ANS: B

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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 abirb.com/test a defined population of care recipients. Accountable care organizations are composed of physicians, specialists, and hospitals; thus care recipients may, in fact, see a specialist will within the context of the ACO. Individuals who are part of concierge care pay a membership abirb.com/test 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. DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 61

17. Which of the following statements is correct concerning Medicare Advantage plans? a. They are plans which can be purchased in addition to traditional abirb.com/test Medicare for

greater coverage. b. They are a substitute for the traditional Medicare program. c. They are funded under the Affordable Care Act to improve availability of abirb.com/test healthcare insurance. d. They are available to persons who would not otherwise qualify for Medicare.

ANS: B

abirb.com/test Medicare Advantage Plans are offered by a variety of insurance companies, as an alternative to Medicare. The sponsoring company receives a payment from the Federal government for each person they enroll, in exchange for being responsible for that individual’s medical expenses which would have been otherwise covered underabirb.com/test Medicare. A variety of plans with varying coverages, regulations, and premiums are available. One cannot, however, purchase any such a plan, in addition to Medicare. It is an either/or option. The Affordable Care Act neither funds nor sponsors Medicare Advantage plans. Rather, these plans comprise a separate abirb.com/test program although persons who have either Medicare Advantage or traditional Medicare coverage do meet the requirement for insurance under the ACA. An individual must qualify for Medicare in order to subscribe to a Medicare Advantage plan. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 60

18. An individual states that his family has insurance, but that paying for routine medical costs is

very expensive because most routine services are paid for abirb.com/test out of pocket. Which type of insurance plan does this individual most likely have? a. High deductible health insurance plan (HDHP) b. Point-of-service plan (POS) abirb.com/test c. Health maintenance organization (HMO) d. Preferred provider organization (PPO) ANS: A

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High deductible health insurance plans (HDHPs) are structured in a way similar to traditional managed care plans and fee-for-service plans but have a very high annual out-of-pocket deductible. Thus, a family with this type of insurance will abirb.com/test pay out-of-pocket until they reach the deductible, which may make receiving health services expensive for them.

Point-of-service plans allow members, for an additional fee and higher copayment, to use providers outside of the HMO network. Health maintenance organizations (HMOs) deliver abirb.com/test comprehensive health maintenance and treatment services for a group of enrolled individuals who prepay a fixed fee. Preferred provider organizations (PPOs) have a preselected list of providers who have agreed to provide health services for those enrolled in the plan. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 62

19. Which of the following is a health plan consisting of hospitals and physician providers

providing health care services to plan members (usually atabirb.com/test discounted rates) in return for expedited claims payment? a. Health maintenance organization (HMO) b. Health savings account (HSA) abirb.com/test c. Preferred provider organization (PPO) d. Independent practice association (IPA) ANS: C

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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). abirb.com/test

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 62

20. Two working adults do not have access to health insuranceabirb.com/test for their family via their respective

employers and they do not meet the financial criteria for Medicaid. For which of the following federal programs may the children in this family be eligible? a. Medicare abirb.com/test b. Civilian Health Medical Program for Uniformed Services (CHAMPUS) c. State Children’s Health Insurance Program (SCHIP) d. Veteran’s Administration Program ANS: C

abirb.com/test

The State Children’s Health Insurance Program (SCHIP) is a public state insurance program established to provide insurance to uninsured children whose family is typically described as the working poor who do not meet Medicaid requirements.abirb.com/test In this case, both parents work but neither has access to insurance through their employers. Additionally, they do not meet the financial requirements for Medicaid. Such a family would be eligible to enroll the children in the SCHIP program. In some states, any child who has not been covered by health insurance abirb.com/test for 6 or more months may be enrolled, regardless of the family income.

DIF: Cognitive Level: Apply (Application)

REF: p. 64 abirb.com/test

21. A nurse complies with the Patient Self-Determination Act when asking a. a person upon admission to the hospital if he or she has an advanced directive. b. the family in the recovery room whether the care recipient has an advanced abirb.com/test directive. c. a person being discharged from the hospital if he or she has an advance directive.

abirb.com/test

d. the family about an advanced directive after the person has been intubated.

ANS: A

abirb.com/test

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 abirb.com/test complies with the act when she asks a person upon admission to the hospital if he or she has an advanced directive.

DIF: Cognitive Level: Apply (Application)

REF: p. 68 abirb.com/test

22. A nurse discussing the care of a person on the surgical unit following gastric bypass surgery

with a friend is in violation of the a. Patient Self-Determination Act. abirb.com/test b. Health Insurance Portability and Accountability Act of 1996. c. Americans with Disabilities Act. d. Civil Rights Act. abirb.com/test

ANS: B

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 abirb.com/test are permitted only to public health authorities and, then only to those authorities authorized to access information needed to prevent and control disease, injury, or disability. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 68

23. Which is a violation of the Health Insurance Portability and Accountability Act of 1996? a. Nurse reporting a case of TB to the health department abirb.com/test b. Nurse reporting a case of child abuse to the Department of Human Services c. Nurse discussing the person’s case with his or her physician d. Nurse discussing the person’s case with his or her school nurse abirb.com/test ANS: D

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 abirb.com/test 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. The school nurse would not qualify as a public health authority. Accordingly, parental authorization mustabirb.com/test be obtained before speaking to the school nurse.

DIF: Cognitive Level: Apply (Application)

REF: p. 68

abirb.com/test

24. Which nurse is functioning as a care manager? a. A nurse working with a family to coordinate care for a child with multiple abirb.com/test previous hospital admissions due to exacerbation of asthma b. A nurse providing asthma education in an office setting to a child with moderate, persistent asthma c. A nurse administering the appropriate anti-inflammatory medication to a child abirb.com/test hospitalized for exacerbation of asthma

abirb.com/test

d. Nurse making a home visit to perform a respiratory assessment on a child

discharged from the hospital following an admission for an asthma exacerbation ANS: A

abirb.com/test

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 abirb.com/test collaborate with providers and with the care recipient/family.

Care managers are especially helpful following a care recipient after discharge and care recipients 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. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 74

25. A pregnant woman with two toddlers living at less than 135% of the federal poverty level abirb.com/test

would be eligible for a. Medicare Part A. b. Medicare Part B. abirb.com/test c. Medicaid. d. State Children’s Health Insurance Program (SCHIP).

ANS: C abirb.com/test 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. State 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%abirb.com/test 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.

DIF: Cognitive Level: Apply (Application)

abirb.com/test REF: pp. 77, 79

26. Which person is at highest risk for being uninsured? a. 68-year-old retired mailman abirb.com/test b. 48-year-old on renal dialysis c. 2-year-old whose parents work but do not have benefits through their employers d. 27-year-old who attends college and works part-time in a small pizza parlor abirb.com/test

ANS: D

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 abirb.com/test 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.abirb.com/test Young adults often go without insurance because of the high costs.

DIF: Cognitive Level: Apply (Application)

REF: p. 79 abirb.com/test

27. Adoption of a Canadian-style health care system in the United States has the potential to a. decrease waiting times for tests and procedures. b. create further health disparities. abirb.com/test c. increase the number of HMOs.

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d. increase the amount of funding available for health care.

ANS: B

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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. abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 81

28. 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 abirb.com/test by discouraging unnecessary treatments, is known as a. managed care. b. gate keeping. abirb.com/test c. utilization review. d. Capitation.

ANS: C

abirb.com/test

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. abirb.com/test

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 60, Box 3-5

29. The country with the lowest infant mortality rate in 2011 was abirb.com/test a. Canada. b. Mexico. c. Sweden. abirb.com/test d. the United States.

ANS: C

Sweden had the lowest infant mortality in 2011 with a mortality rate of 2.74 per 1000 live abirb.com/test births.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 50, TBL 3-1 abirb.com/test

30. The country with the highest life expectancy for women in 2011 was a. France. b. Germany. c. Sweden. abirb.com/test d. the United States.

ANS: A

France was the country with the highest life expectancy forabirb.com/test women (85 years of age) in 2011.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 50, TBL 3-1 abirb.com/test

MULTIPLE RESPONSE 1. A community health nurse is presenting information about the current health of the nation to a abirb.com/test local political action group in 2011. Which of the following information would be included in this presentation? (Select all that apply.)

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a. b. c. d.

Funding of public health programs has improved the health of the nation.

Provision of health care has improved the health of the nation. abirb.com/test Advances in technology have improved the health of the nation.

Consumer education has improved the health of the nation.

ANS: A, B, D abirb.com/test According to the 2010 Report of Health, the health of the nation has improved in many areas as a result of substantial funding of public health programs, research, provision of health care, and initiatives to support consumer education.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 49

2. Which of the following statements about the financing of health care in the United States is

accurate? (Select all that apply.) abirb.com/test a. Employee-sponsored health insurance premiums experienced minimal increases from 2001 to 2011. b. State tax dollars must fund at least 50% of a state’s Medicaid cost. abirb.com/test c. The largest percentage of health care dollars is spent on hospital care. d. Most workers who have an employer-sponsored health insurance plan are enrolled in preferred provider organizations (PPOs).

ANS: C, D

abirb.com/test

In 2010, almost one third (31%) of health care dollars was spent on hospital care. The majority of employee-covered workers were enrolled in PPOs (55%). Employee-sponsored health insurance premiums rose dramatically from 2001 toabirb.com/test 2011 by 113%. Federal dollars must fund a minimum of 50% of a state’s Medicaid cost; the state is responsible for contributing whatever percentage is not funded by the federal government.

DIF: Cognitive Level: Understand (Comprehension)

abirb.com/test REF: pp. 63, 70

3. Which of the following would be considered part of a vulnerable population? (Select all that

apply.) a. Deaf man b. Cocaine-addicted teenage girl c. Handicapped child d. College graduate

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abirb.com/test

ANS: A, B, C

Those who are physically disabled or handicapped, substance abusers, and those with abirb.com/test communication difficulties are considered part of the vulnerable population in the United States.

DIF: Cognitive Level: Apply (Application)

REF: p. 50, Box 3-2

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Chapter 04: The Therapeutic Relationship Edelman: Health Promotion Throughout the Life Span, 9th Edition abirb.com/test

MULTIPLE CHOICE abirb.com/test

1. Which of the following statements about values is true? a. It is impossible for someone to understand his or her values. b. Values evolve over time; they are not static. c. Values assimilated in childhood are those held for a lifetime. abirb.com/test d. Values clarification tells a person how to act.

ANS: B abirb.com/test Values take time to develop, and they may change with education, experience, exposure, or a combination of these.

DIF: Cognitive Level: Understand (Comprehension)

REF: p. 85 abirb.com/test

2. 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 care recipients do first to improve their self-awareness? abirb.com/test a. Use self-disclosure to share aspects of self. b. Listen to and learn from others. c. Listen to oneself and pay attention to emotions, thoughts, and reactions. abirb.com/test d. Use others to bounce back your own thoughts and recollections.

ANS: C

To achieve a high self-awareness, three steps must be taken. The first step is listening to abirb.com/test 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. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 86

3. The nurse shares with her care recipient the news that she, the nurse, is going to be married

soon and tells the care recipient about her wedding plans. abirb.com/test Which of the following best describes the nurse’s actions? a. The nurse is sharing inappropriate personal information with her care recipient. b. The nurse is exhibiting a communication technique called self-disclosure. abirb.com/test c. The nurse is attempting to show empathy with her care recipient. d. The nurse is violating care recipient confidentiality rights of the Health Insurance Portability and Accountability Act (HIPAA). abirb.com/test

ANS: B

Sharing aspects of the self enriches interpersonal life and is a use of the technique labeled self-disclosure. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 87

4. A nurse has started admitting a new person on home care and is beginning to establish a abirb.com/test

relationship. Which of the following would be the most important thing for the nurse to do?

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a. b. c. d.

Complete the paperwork in a timely fashion.

Establish open communication.

Conduct a complete physical health assessment.

Provide feedback to the person’s questions.

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ANS: B abirb.com/testIt is the cornerstone of a Communication is the foundation for any professional relationship. positive nurse–person relationship. It refers to a set of strategies and actions to enhance reciprocity, mutual understanding, and decision-making.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 87

5. Which of the following best describes person-centered communication? a. The nurse says to the person seeking care, “Why do you continue to drink when abirb.com/test

you know it is not good for you?” b. 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 h ago.” abirb.com/test c. The care recipient 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?” d. The care recipient says to the nurse, “I can’t believe I have cancer.” The nurse abirb.com/test responds by saying, “One of my closest friends had cancer and had to have chemotherapy.”

ANS: C abirb.com/test 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.

DIF: Cognitive Level: Analyze (Analysis)

abirb.com/test

REF: p. 90, Box 4-7

6. Which of the following statements is correct concerning Telehealth? a. It is appropriately used for initial assessment but not for diagnosis or treatment. abirb.com/test b. It can encompass both spoken and written word. c. Issues of confidentiality continue to prevent its widespread use. d. All of the above statements are correct. abirb.com/test

ANS: B

Telehealth as well as Internet health is becoming increasingly widespread. It can involve spoken or written forms of communication. The use of this modality is not limited to any one abirb.com/test phase of healthcare delivery. Confidentiality would apply to telehealth and Internet health just as it would in face-to-face scenarios. Safeguards to protect patient confidentiality can be, in fact, put into place to protect confidentiality in either setting. There is no reason to limit its use abirb.com/test in the interest of maintaining confidentiality. “Increasingly, communication is electron.

Telehealth, mhealth (i.e., mobile health), or ihealth (i.e., Internet health)—the use of telecommunications and data technologies to deliver health care services including assessment/diagnostic services treatment, consultation, and health information across abirb.com/test platforms—is rapidly growing as a communication/intervention system. Such electronic communication can encompass the spoken and written word, and nonverbal forms of communication. Using technology to engage patients in clinical communications is already in place with potential for future development and brings its abirb.com/test own challenges.”

abirb.com/test

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 88

7. Which of the following scenarios described is correct concerning feedback? abirb.com/test a. It is a monitoring system, which controls and accommodates responses to

behavior. b. Negative feedback counterproductive and should be avoided. abirb.com/test c. Positive feedback encourages homeostasis. d. A feedback loop refers to a static process where the parties are “stuck” in a pattern.

ANS: A abirb.com/test Feedback is an important facet of therapeutic communication.

It allows the provider to modify the interaction in response to the patient’s response and reaction, thus tailoring therapy in a manner which best serves the patient. Both positive and negative feedback are useful in this capacity. Both can be productive. Feedback fosters a dynamic versus a static scenario. abirb.com/test Homeostasis is not a therapeutic goal in this context.

The following information concerning feedback in the context of therapeutic communication: “A new information exchange is triggered at this point in the cycle by the response called abirb.com/test feedback, a monitoring system through which the person or group controls the internal and external responses to behavior (output) and accommodates these responses appropriately. A feedback loop shows the dynamic nature of communication. Each piece of communication is both a stimulus designed to elicit a response and a response to a different stimulus….(positive abirb.com/test and negative feedback)” Rather than meaning “good” or “bad,” positive feedback and negative feedback refer to promotion of system change and stability, which is the process of balancing the direction and magnitude of change. Both types of feedback are needed, abirb.com/test depending on the situation. The situational context of communication is important.

DIF: Cognitive Level: Apply (Application)

REF: p. 89 abirb.com/test

8. 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? abirb.com/test a. Verbal communication b. Nonverbal communication c. Metacommunication d. Functional communication abirb.com/test ANS: A

Verbal communication is the transmission of messages using words, spoken or written.

Nonverbal communication encompasses all messages thatabirb.com/test are not spoken or written.

Metacommunication refers to a message about the message, the relationship aspect of communication.

DIF: Cognitive Level: Apply (Application)

abirb.com/test REF: pp. 90, 91

9. Which of the following statements about nonverbal communication is true? a. Nonverbal behavior is not usually contextual. abirb.com/test b. Nonverbal behavior is culturally and situationally bound. c. Nonverbal communication is the most important type of communication. d. Nonverbal communication is easy to interpret.

ANS: B

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abirb.com/test

Cultural exposure and situational impact are essential components of interpreting nonverbal communication and must be taken into consideration in attempts to interpret nonverbal abirb.com/test communication.

DIF: Cognitive Level: Understand (Comprehension)

REF: p. 91

abirb.com/test 10. Which of the following scenarios best describes a nurse using metacommunication? a. Using both touch and silence when counseling an individual b. Practicing reflection when interaction with an individual c. Discussing with an individual how to solve a problem abirb.com/test d. Understanding that an individual needs a break before proceeding

ANS: D

Metacommunication refers to a message about the message.

It is the relationship aspect of abirb.com/test communication. In a sense, it involves reading between the lines or going past the surface content of the message to glean nuances of meaning.

DIF: Cognitive Level: Analyze (Analysis)

abirb.com/test REF: p. 91

11. Which of the following statements can be identified as a method for clarifying a message? a. “I get very upset when you talk to me in that tone.” abirb.com/test b. “You make me very angry when you drink alcohol.” c. “I can make you happy. I know I can.” d. “What I want from you is to be left alone!” abirb.com/test

ANS: A

Use of “I” statements is one technique that can be used for clarifying and qualifying messages. abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 92

12. A nurse and a man are involved in a conversation. When the person folds his arms across his abirb.com/test

chest, the nurse almost simultaneously folds her arms across her chest. This behavior is recognized as a. empathy. b. reciprocity. abirb.com/test c. flexibility. d. spacing.

ANS: B

abirb.com/test

The patterning of similar activities within the same interval by two people can facilitate communication. This patterning is known as reciprocity.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 93

13. A nurse and her care recipient are engaged in meaningful conversation when suddenly there is

silence between the two. To facilitate effective care recipient-centered abirb.com/test communication, the nurse should a. ask the person what he is thinking, so they can understand each other. b. restate what the person said before silence ensued, to get clarification. c. change the subject to one that is more pleasant for the abirb.com/test person to discuss. d. wait quietly to give the person time to reflect where he wants to lead the abirb.com/test

conversation.

ANS: D

abirb.com/test

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.

DIF: Cognitive Level: Apply (Application)

REF: p. 93 abirb.com/test

14. 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 abirb.com/test characteristic of the therapeutic relationship is being demonstrated? a. Empathy b. Trust c. Rapport abirb.com/test d. Purposeful communication ANS: D

The nurse focuses communication for a particular aim: to abirb.com/test obtain information to be used in care of the person.

DIF: Cognitive Level: Apply (Application)

REF: p. 96 abirb.com/test

15. 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? abirb.com/test a. “You know that what you are doing is wrong.” b. “Why would you want do something like that?” c. “How could you do that to your wife and children?” abirb.com/test d. “This affair seems to be troubling you.”

ANS: D

The nurse is seeking to determine the care recipient’s own feelings about his affair. By abirb.com/test 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.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 98

16. 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? abirb.com/test a. “I have also struggled with finding time to exercise on a regular basis.” b. “Regular exercise plays an important role in preventing many health problems.” c. “You said that you have difficulty making time in your day for exercise.” abirb.com/test d. “It may be helpful if we developed a goal related to daily exercise. “ ANS: C

Reflection is the restatement of what the individual has said in the same or different words. abirb.com/test 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 abirb.com/test concern or theme, or elicit elaborated information.

abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 98

17. A woman tells the nurse that she is very nervous about their meeting today. Which of the abirb.com/test

following relationship stages are the nurse and woman most likely experiencing? a. Orientation phase b. Working phase abirb.com/test c. Therapeutic phase d. Termination phase ANS: A abirb.com/test 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.

DIF: Cognitive Level: Apply (Application)

REF: p. 102 abirb.com/test

18. Which of the following would be an example of countertransference occurring in the context

of a professional relationship? abirb.com/test a. The nurse reminds the patient of his mother with whom he had longstanding conflict. b. The patient is distorting his interaction with his physician. c. The nurse reacts to the patient in a manner reminiscentabirb.com/test of interaction with her father. d. The nurse finds the patient’s humorous comments to be racist and offensive.

ANS: C

abirb.com/test

Transference is a process where the patient is responding to the nurse (or other healthcare provider) as though the provider were someone from the patient’s past. This process is sometimes called distortion. Choices a and b are examples of transference, as they describe reactions on the part of the patient. Countertransference isabirb.com/test a scenario where the nurse (or other provider) is reacting to the patient as though the patient was someone from the provider’s past. Choice C is consistent with this concept. Choice d involves a healthcare provider who is offended by the patient’s racist humor. There is no mention in this choice of someone from abirb.com/test the nurse’s past who had a similar offensive sense of humor. Countertransference basically is the same phenomenon and involves distorting, but it is experienced by the health care professional rather than the person. The nurse experiences many feelings toward the person; abirb.com/test these feelings are not problematic, unless they remain unanalyzed and block the nurse’s ability to work effectively with the individual.

DIF: Cognitive Level: Apply (Application)

REF: p. 101

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19. Which of the following is the first step in the valuing process? a. Acting out the choice abirb.com/test b. Selecting from alternatives c. Being happy with personal beliefs and actions d. Choosing freely ANS: D

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abirb.com/test

abirb.com/test

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) abirb.com/test 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.

DIF: Cognitive Level: Remember (Knowledge)

abirb.com/test

REF: p. 85, Box 4-2

20. The nurse makes sure that the distance between himself and the care recipient is at least 6 feet

before he begins to ask questions related to the care recipient’s health history. Which of the abirb.com/test following statements is true? a. This is the ideal space for intimate communication. b. This distance is too far for the nurse to build a therapeutic relationship while abirb.com/test obtaining the information. c. This is the recommended distance between care recipient and nurse for effective therapeutic communication. d. The nurse should position himself an additional foot away to facilitate the abirb.com/test conversation.

ANS: B

Personal space of 18 inches to 4 feet is appropriate for close relationships in which touching abirb.com/test may be involved and good visualization is desired.

DIF: Cognitive Level: Apply (Application)

REF: p. 94. Box 4-9 abirb.com/test

MULTIPLE RESPONSE abirb.com/test 1. 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.) a. “Why do you smoke cigarettes? abirb.com/test b. “What do you value most in life?” c. “Who has influenced your decision to smoke?” d. “Is your decision to smoke consistent with your values?”

ANS: B, D

abirb.com/test

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 abirb.com/test your actions consistent with your values?”), and using reflection to restate the value and make it explicit.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 86, Box 4-3

abirb.com/test

2. 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.) a. Learn about the person’s interests. abirb.com/test b. Sit close to the person. c. Show interest in the person’s concerns. d. Define the parameters of the relationship with the person. abirb.com/test

ANS: C, D abirb.com/test

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 fromabirb.com/test 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. abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 96

3. Which of the following is an essential question that nursesabirb.com/test should encourage individuals to

ask at every health visit? (Select all that apply.) a. “What is my main problem?” b. “What health information do I not understand?” c. “What do I need to do?” d. “What is the plan for the next visit?”

abirb.com/test

ANS: A, C abirb.com/test 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?” abirb.com/test

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 95 abirb.com/test

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Chapter 05: Ethical Issues Related to Health Promotion Edelman: Health Promotion Throughout the Life Span, 9th Edition abirb.com/test

MULTIPLE CHOICE abirb.com/test

1. Which of the following statements is true with regard to health promotion? a. Health-promotion efforts are not concerned with addressing environmental

obstacles to health. b. Advocates of health promotion are not involved in political campaigns against abirb.com/test

harmful products. c. The business of eliminating health disparities is a unique function of Healthy

People 2010 goals. abirb.com/test d. Health promotion involves collaboration of many professional groups.

ANS: D

Health promotion is not the province of a single discipline but involves individuals, health abirb.com/test care providers, and institutions working together to create a positive environment for health and to achieve health goals.

DIF: Cognitive Level: Understand (Comprehension)

REF: p. 109 abirb.com/test

2. 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? abirb.com/test a. Descriptive value theories b. Normative theories c. Consequentialism theory d. Duty-based theories abirb.com/test ANS: A

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 abirb.com/test believe are good or moral actions.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 110 abirb.com/test

3. 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? abirb.com/test a. Descriptive value theory b. Normative theory c. Consequentialism theory abirb.com/test d. Duty-based theory ANS: B

Normative theories are concerned with ensuring good actions. They are reasoned explanations abirb.com/test of the moral purpose of human interactions, or they are divinely “revealed” truths about good action (religious ethics).

DIF: Cognitive Level: Apply (Application)

REF: p. 110

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4. 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? a. Descriptive value theory abirb.com/test b. Normative theory c. Consequentialism theory d. Duty-based theory abirb.com/test

ANS: C

Consequentialism theory proposes that actions are good insofar as they are aimed at yielding the greatest amount of happiness or pleasure or causing the least amount of harm or pain to abirb.com/test individuals and overall in society. Administration of flu vaccines proposes the best result for individuals and decreased risk for others in the community.

DIF: Cognitive Level: Apply (Application)

REF: p. 110 abirb.com/test

5. Which ethical theory is rooted in character-based ethics? a. Duty-based ethics abirb.com/test b. Utilitarian-based ethics c. Virtue-based ethics d. The ethics of care ANS: C

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Virtue-based ethics is based on the concept that the individual must do the “right thing” based upon such person learning to acquire a preference for such “right” choices.

Also referred to as virtue ethics, character-based approaches to ethics center on the individual abirb.com/test agent making the decision. Aristotle (384-322 BCE) argued that being moral was a matter of habits and desires. If a person can learn to desire the right things, then he or she will do the right things. For Aristotle (1985/350 BCE), doing the right thing is all about who you are. If abirb.com/test you are a moral person with good ethical thinking skills, you will do the right thing. So, in any given situation, I might ask myself, “What would a good person do in this situation?” or “If I do this, will I be the kind of person I would consider to be a good person?” abirb.com/test

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 111

6. Which philosophic approach evaluates ethical perspectives in terms of their congruence and abirb.com/test usefulness in human decision-making, across multiple environments? a. Utilitarian ethics b. Metaethics c. Virtue ethics abirb.com/test d. Practical wisdom ethics

ANS: B

Moral theories are problematic in that they develop secondary to a particular perspective, abirb.com/test philosophy, or worldview. Metaethics, then, attempts to evaluate various theories of ethics as to whether they are useful across multiple settings or environments. abirb.com/test

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It is important to keep in mind that moral theories arise out of a particular perspective or philosophy about the world. They are conceptualized as a result of this perspective and within abirb.com/test a historical and political context. The philosophical approach that evaluates value theories or ethical perspectives for their congruence and usefulness in human decision-making across environments is metaethics. Philosophers interested in metaethical questions investigate where our ethical principles come from and what they mean. Are they merely social abirb.com/test inventions? Do they involve more than expressions of our individual emotions? Metaethics allows us to critique the adequacy of ethical approaches for application across a variety of practice settings and cultural environments. Other sorts of metaethical questions posed by abirb.com/test moral philosophers include the following: Are there such things as absolute ethical truths? If so, how do we go about discovering these? If not, what foundations should we use to guide our actions? What is a valid moral theory? Should human values be congruent across settings and cultures? abirb.com/test DIF: Cognitive Level: Remember (Knowledge)

REF: p. 111

7. What is a potential problem which can arise when applying utilitarian theories of ethics to a abirb.com/test

particular problem or ethical issue? a. Utilitarian theories do not account for individual culpability. b. Utilitarian theories are based on direct cause and effect which may not apply. c. Utilitarian theories tend to compromise the individual abirb.com/test in favor of the society. d. Utilitarian theories are rooted in an agriculturalist society vs society at large.

ANS: C abirb.com/test Utilitarian theories of ethics tend to favor that which brings about the most good for the whole or the society, i.e., the greatest good. Doing so, however, may compromise the well-being of individual members of a society in the interest of promoting the greatest good. Such philosophy arose in response to the Industrial Revolution in England where inequities to abirb.com/test whole sectors of society were becoming problematic.

Additionally, utilitarian theories emerged out of a particular era and as a result of perceived injustices in societal arrangements in England during the turmoil of the industrial revolution. abirb.com/test Utilitarians such as Jeremy Bentham (1748-1832) and John Stuart Mill (1806-1873) sought frameworks that would permit the rectification of unjust policy decisions and the vast economic inequities within their society. For this reason such theories have a tendency to privilege the good of the group over the needs of individuals.

In health promotion, seeking a abirb.com/test balance between good for the group or community with good for the individual can be a particular challenge. Utilitarian theories, in particular, are in danger of favoring the group (the majority) over those who are in fewer numbers (the minority). abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 112

8. Which of the following represents a comprehensive view of all of the genes within a given abirb.com/test

individual? a. Genetics b. Genomics c. Genotype d. Phenotype

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ANS: B abirb.com/test

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The rapidly increasing discoveries in genetic research challenge nurses to gain new competencies in order to be knowledgeable about the often difficult ethical situations related abirb.com/test to these discoveries. Genetics involves the study of a single gene’s function. Genomics represents a wider view to include all genes in a person, including interactions of the genes with themselves and also the environment (Huddleston, 2013; Lyon et al., 2011). Two other terms sound similar but have different meanings. Genotype refers to a set of genes in our abirb.com/test DNA that is responsible for a particular trait. Phenotype is the physical expression of that trait and is determined by interaction between the genotype and the environment. Genotype is an inherited trait; the entire genetic information about an organism is contained in a genotype. abirb.com/test Examples of genotype are the genes responsible for eye and hair color and the sound of one’s voice. Phenotype is what you see; it is the visible expression of the results of the genes combined with the environmental influence on one’s appearance or behavior. Examples of phenotypes are the visible or observable characteristic of eye and hair color and the sound of abirb.com/test one’s voice.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 113, Box 5-4 abirb.com/test

9. A primary care nurse practitioner has advised a care recipient that she is positive for BrCA2,

the gene associated with breast cancer in women. The care recipient has two small children.

What would be the most appropriate next step for the nurse practitioner to take with respect to abirb.com/test this care recipient? a. Help the care recipient to understand that a prophylactic mastectomy would be in the best interest of her children. b. Explore the care recipient’s values, believes, and relationships. abirb.com/test c. Offer no counsel since respecting care recipient autonomy will be adequate. d. Deferring the matter to the care recipient’s physician.

ANS: B

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There is no one best solution, as is suggested by choice A, which is universally applicable to all persons or all settings. Simply allowing for care recipient autonomy is not sufficient.

Nurses are expected to be knowledgeable regarding specific circumstances for each care abirb.com/test recipient in order to best serve the care recipient. The nurse practitioner is functioning as a primary care provider. Accordingly, deferring the problem to a physician does not appropriately discharge the nurse’s duties and responsibilities. The nurse would be expected to assist the care recipient in exploring options and choosing a course of action. abirb.com/test

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Specific principles derived from ethical theories have proved useful because they highlight salient aspects of complex problems and help to examine implications of different proposed abirb.com/test courses of action. Selection of pertinent principles, however, depends both on the context of the problem and on the beliefs and values of the individual or group for which action is needed. For example, imagine a woman who seeks assistance in deciding whether to undergo genetic testing for the breast cancer gene BRCA2 because several members of her immediate abirb.com/test and antecedent families have been diagnosed with breast or associated cancers. She tells her nurse practitioner that she is not sure whether it would be beneficial to be tested. The nurse practitioner, in facilitating the woman’s health-promotion efforts, understands that she must abirb.com/test use clinical judgment to facilitate the woman’s autonomous choice. Understanding the requirements of the principle of autonomy is important in helping the woman make her decision. It is not sufficient, however, to understand the meaning of autonomy and its limits; the nurse practitioner must also know something about theabirb.com/test woman’s life, values, beliefs, and relationships in order to provide her with the information and resources necessary for her decision. If the woman is screened and the results found positive for the gene, the woman not only must decide her next actions but also must consider the implications of the results (e.g., how the results affect her children or her decision to have abirb.com/test children).

DIF: Cognitive Level: Apply (Application)

REF: p. 112

10. Which of the following theorists has been associated with abirb.com/test the ethics of care? a. Carole Gilligan b. Immanuel Kant c. Jeremy Bentham abirb.com/test d. John Stuart Mill ANS: A

The feminist ethic of care is an important concept for health promotion because it focuses on abirb.com/test the nature of nurse–person relationships and on the context of people’s lives. This approach to care has found increasing acceptance in nursing as both a virtue of the nurse and a responsibility of practice in which treatment is offered on a common ground basis that will abirb.com/test support people within their relationships. Carol Gilligan’s (1982, 2013) research, among that of others, has been instrumental in the acceptance of the concept of care as informing ethics in nursing practice. abirb.com/test

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 114

11. Which of the following represents a limitation to the Ethic of Care model? abirb.com/test a. There are no criteria for right or wrong actions. b. The model fosters an ethnocentric view. c. The model, as practiced, is not holistic in focus. d. The model does not account for interrelationships nor abirb.com/test the context of actions.

ANS: A

The lack of criteria for that which is right vs wrong is problematic for this model of ethics.

There are no issues with ethnocentric views or a lack of holistic care. The model does, in fact, abirb.com/test account for interrelationships and the context of actions. abirb.com/test

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One problem with using care as an ethic of health-promotion practice has to do with the concern of moral predictability or certainty (Nelson, 1992), much like with Aristotle’s virtue ethics. If the emphasis in ethics of care is on relationships abirb.com/test and there are no criteria for right and wrong actions, how can one be assured of the morally correct action in a given situation?

An answer to this question could be that a morally correct action emerges as a result of judgment based on prior knowledge, experience, and an engaged relationship with the person. abirb.com/test Thus the process of the interaction, coupled with the character, knowledge, experience, and intent of the moral agent, is the crucial factor that achieves the moral good for an individual.

A person’s control of his or her own care is important. In a nursing setting, the action is right abirb.com/test if the nurse incorporates this person-control into meeting the complex needs of the person being cared for.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 114

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12. A nurse uses ethical reasoning to solve an ethical dilemma. Why would the nurse use this

process? a. Assists in predicting all of the possible consequences of future actions abirb.com/test b. Facilitates gathering of the most important information to solve the problem c. Considers the importance of caring when solving the problem d. Highlights salient aspects of future actions abirb.com/test

ANS: B

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 abirb.com/test 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. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 114

13. Which of the following statements is correct concerning a Code of Ethics for professionals? abirb.com/test a. The code is drawn in conjunction with input from the public. b. They are absolute rules which must be observed and may not be changed. c. They prescribe how members of a profession are expected to act. d. All of the above statements are correct. abirb.com/test ANS: C

The public is not consulted when professional code of ethics is developed. Rather, the professions determine what will be the duties and expectations of members. These rules and abirb.com/test codes of conduct are not etched in stone. Instead, they evolve over time as experience is garnered and as the dynamics within a society change.

Codes of ethics are examples of normative ethics in that they prescribe how members of a abirb.com/test profession ought to act, given the goals and purposes of the profession related to individuals and society. The provisions of codes of ethics for nurses provide direction and expectations of ethical behavior. They represent the profession’s promises to society. Although the public is not directly involved in the formulation of such codes and,abirb.com/test indeed, is for the most part not even aware of their existence, the profession is responsive to the evolving needs of a given society. It can be said that codes of ethics are the tentative end results of a discipline’s political process in that they are not static but result from debate and discussion over time among the profession’s scholars, leaders, and members. abirb.com/test

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DIF: Cognitive Level: Remember (Knowledge)

REF: p. 115

14. Which of the following statements concerning care recipient advocacy is correct? abirb.com/test a. Care recipient advocacy is not a justification for refusing to follow an order. b. A nurse’s responsibility is to the assigned care recipient(s) and not others affected. c. Nurses are responsible to speak up on behalf of compromised or vulnerable

individuals. d. All of the above statements are correct.

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ANS: C abirb.com/test Nurses are not expected to blindly follow orders. Rather, as care recipient advocates, they need to question any order which seems inappropriate, even harmful to a care recipient. If a nurse truly believes that following a particular order will cause bonafide harm to a care recipient, it is appropriate to not carry out the order, although the proper parties would need to abirb.com/test be notified, e.g., the person writing the order, the supervisor, etc. The nurse’s responsibility is not limited to the care recipient but rather includes consideration of other persons potentially affected. The concept of advocacy is based on speaking up and acting on the behalf of abirb.com/test vulnerable persons.

Advocacy, as an expectation of nurses, is strongly reinforced both in the Code of Ethics and in innumerable scholarly articles. However, advocacy is a controversial concept. The meaning of the term advocacy is derived from its use in law. In legal jurisprudence, advocacy is an abirb.com/test aggressive action taken on behalf of an individual, or perhaps a group viewed as an individual entity, to protect or secure that individual’s or group’s rights. The individual lawyer does not have an opposing obligation to attend to social justice issues. This attention to broader abirb.com/test questions of justice is the responsibility of other areas of the justice system.

Nurses and other health care professionals have a responsibility to speak up on behalf of people whose rights have been compromised or endangered. This is part of the nurse’s role because people may not recognize either what is needed toabirb.com/test meet their needs or when the care they are receiving is substandard. However, that is not the end of their responsibilities. They must also consider that specific actions they undertake in the name of advocacy may pose problems for other people who are relying on them for health care services. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 115

15. Which of the following scenarios describes a nurse facing abirb.com/test an ethical dilemma? a. A nurse who must work Christmas over the strong objections of her family. b. A nurse who must choose between two undesirable options. c. A nurse assigned to take care of an abusive care recipient. abirb.com/test d. A nurse who must choose between preferred employment or a better-paying job.

ANS: B

An ethical dilemma involves making a choice between two options—each of which is abirb.com/test ethically undesirable. Deciding between violating care recipient confidentiality and allowing harm to come to an innocent individual. Deciding which of two equally critically ill persons get the only available ICU beds. A practical dilemma is a decision which does not involve an ethical principle. Choices a, c, and d describe practical dilemma.

Working holidays, caring for abirb.com/test abusive care recipients, or deciding whether job satisfaction or money is more important do not involve ethical principles. They involve inconveniences or practical problems involved in nursing. abirb.com/test

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Organizations such as hospitals often give rise to “practical problems, not individual dilemmas”……. Ethical dilemmas are those situations in which a choice must be made abirb.com/test between two undesirable options. Weston (2010) claims that true dilemmas are actually quite rare and that often additional, better options can be found by changing the way the situation is examined.

DIF: Cognitive Level: Apply (Application)

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REF: p. 116

16. Under what circumstances would a nurse likely experience moral distress? a. The nurse feels powerless to take the correct action. abirb.com/test b. The nurse is uncertain regarding the appropriate course of action. c. The nurse is caring for a breast cancer care recipient shortly after her own mother

died from cancer. abirb.com/test d. The nurse has been served with a subpoena for a malpractice suit.

ANS: A

Moral distress occurs when a nurse knows the appropriate ethical course of action but the abirb.com/test nurse is prevented from acting on or implementing such action.

The forces which obstruct implementing an ethical course of action can come from a variety of sources—the employer, the institution, legal issues, etc. The nurse is powerless to implement the right course of action and thus experiences moral distress. Choices, b, c and d doabirb.com/test not describe such dynamics.

Moral distress occurs when a nurse knows the ethically correct action to take but feels powerless to take that action (Epstein & Delgado, 2010). Nurses who are faced with ethical issues that seem to be irresolvable may experience guilt, frustration, and a sense of powerlessness, sometimes because they do not believe thatabirb.com/test they can adhere to their personal values. Moral distress can occur when the nurse’s values and perceived obligations conflict with the needs and prevailing views of the work environment. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 116

17. Which concept is aimed at interrupting potential ethical problems before they develop? abirb.com/test a. Feminist ethics b. Preventive ethics c. Metaethics d. Normative ethics abirb.com/test ANS: B

Preventive ethics is a requirement of health promotion in which practitioners envision potential problems and institute actions that stop their development. abirb.com/test DIF: Cognitive Level: Remember (Knowledge)

REF: p. 117

18. When providing preoperative teaching for a care recipientabirb.com/test who will be undergoing total knee

arthroplasty, the nurse asks the care recipient questions to assess his understanding of the surgery. Which type of ethics is the nurse implementing? a. Duty-based ethics abirb.com/test b. Normative ethics c. Metaethics d. Preventive ethics ANS: D

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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 abirb.com/test nurse, as well as social and political activism with other nurses or professional nursing organizations. Assessing the care recipient’s understanding of what is going to happen during a surgical procedure before the care recipient signs the consent for the procedure makes sure the care recipient understands the information and should help prevent ethical problems. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 117

19. There is sometimes a conflict between health promotion and autonomy within a society. abirb.com/test

Which of the following concepts may be jeopardized in the course of public safety? a. Educational choices including freedom to attend charter schools b. Family dynamics and especially spousal privilege in a court of law abirb.com/test c. Civil liberties within a society d. Constraints on provider’s choice due to Affordable Care Act ANS: C abirb.com/test Civil liberties are sometimes at risk in the interest of promoting health within society. An example would be Direct Observed Therapy (DOT)_for TB medication in an effort to avoid drug resistance. Choices a, b, and d do not represent conflicts between health promotion and individual liberties. abirb.com/test In health-promotion settings and endeavors the concept of autonomy can be understood from two different perspectives. From the vantage point of public health, the extent of individual autonomy, or freedom of action, may be limited by the duty of protecting the health and safety abirb.com/test of the society. From this perspective there is an age-old struggle between civil rights and public safety. Moral questions ask to what degree society is justified in regulating the health and safety of society at large. There is an inevitable tension associated with curtailing civil liberties in the name of safety or health. This tension arisesabirb.com/test from perceptions that, in most Western contexts, freedom of action is a prerequisite of human flourishing.

DIF: Cognitive Level: Apply (Application)

REF: p. 117 abirb.com/test

20. 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 abirb.com/test decision-making on his behalf, knowing that the care recipient is unable to benefit from which of the following ethical concepts? a. Autonomy abirb.com/test b. Justice c. Beneficence d. Advocacy ANS: A

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Because the care recipient is cognitively delayed and is unable to understand explanations of treatment that would be given to him, the care recipient is unable to be autonomous in making a decision regarding neurosurgery. abirb.com/test DIF: Cognitive Level: Apply (Application)

REF: p. 119 abirb.com/test

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21. A care recipient 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 abirb.com/test concepts has been ignored in rendering care for this care recipient? a. Beneficence b. Autonomy abirb.com/test c. Justice d. Informed consent ANS: D

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The care recipient 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 care recipient has not been informed of his chances of dying during the abirb.com/test surgery.

DIF: Cognitive Level: Apply (Application)

REF: p. 119

abirb.com/test 22. 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? abirb.com/test a. Follow the principle of veracity and tell the mother the diagnosis. b. Respect the principle of confidentiality and support the care recipient’s request not to tell her mother the diagnosis. abirb.com/test c. Tell the care recipient’s mother that she has a urinary tract infection, to protect the care recipient’s privacy and honor the mother’s request. d. Ignore the mother’s request for information.

ANS: B

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The Health Insurance Portability and Accountability Act (HIPAA) guarantees care recipient confidentiality. The care recipient 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 abirb.com/test diagnosis. The nurse could appropriately respond to the mother by saying, “I cannot share that information with you because of care recipient confidentiality legislation. You might ask your daughter to share that information with you.” abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: pp. 121-122

23. A nurse is providing care to a 15-year old female who hasabirb.com/test recently been diagnosed with a

sexually transmitted infection (STI). Which of the following actions should the nurse take next? a. Seek advice from an ethics expert. abirb.com/test b. Facilitate interaction between the adolescent and her parents/guardians. c. Report the STI to the appropriate authorities. d. Contact the adolescent’s parents/guardians.

ANS: B

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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, abirb.com/test maintaining trust, and preserving confidentiality. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 122 abirb.com/test

24. An elderly care recipient has recently been diagnosed with cancer. The care recipient’s family

has asked the nurse to withhold this information from the care recipient because they feel that this information would cause the care recipient to give up on life and become very depressed. abirb.com/test Which ethical principle The nurse believes the care recipient should be told this information. is being upheld by the nurse? a. Justice b. Beneficence abirb.com/test c. Veracity d. Nonmaleficence ANS: C

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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 orabirb.com/test intervention, conflicts with veracity.

DIF: Cognitive Level: Apply (Application)

REF: p. 123 abirb.com/test

25. Which of the following concepts of ethics is described as the “duty to maximize the benefits

of actions while minimizing harm”? a. Advocacy b. Justice c. Beneficence d. Autonomy

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ANS: C

Beneficence governs actions taken to further the overall health or well-being of an individual or society. “Beneficence” means doing good. abirb.com/test DIF: Cognitive Level: Remember (Knowledge)

REF: p. 124

26. A nurse reflects on previous experiences with minority populations abirb.com/testand considers how these

interactions have influenced her present care to these populations. Which part of values clarification and reflection has the nurse used? a. Formulate a possible course of action. abirb.com/test b. Examine the influence of beliefs. c. Reflect on practice. d. Determine the prevalent values.

ANS: B

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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 ethicalabirb.com/test problem-solving.

DIF: Cognitive Level: Apply (Application)

REF: p. 125 abirb.com/test

MULTIPLE RESPONSE

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1. 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 abirb.com/test performing this action? (Select all that apply.) a. It is the right thing to do. b. It is a moral responsibility. abirb.com/test c. It is an ethical responsibility. d. It is the role of the nurse.

ANS: B, C

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When nurses provide service to society through health-promotion interventions, their care for care recipients 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 abirb.com/test 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 abirb.com/test throughout the chapter.

DIF: Cognitive Level: Apply (Application)

REF: p. 109 abirb.com/test

2. 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.) a. Importance of virtue in formulating ethical conduct abirb.com/test b. Concern for the rights and equality of all individuals c. Importance of responsibility when caring for others d. Understanding the dynamics and root cause of the imbalance of power abirb.com/test ANS: B, C

Characteristics of feminist ethics include: understanding that human beings are inseparable from their relationships with others; a focus on care and responsibility abirb.com/test 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 abirb.com/test that is not limited to the oppression of women.

DIF: Cognitive Level: Apply (Application)

REF: p. 113 abirb.com/test

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Chapter 06: Health Promotion and the Individual Edelman: Health Promotion Throughout the Life Span, 9th Edition abirb.com/test

MULTIPLE CHOICE abirb.com/test

1. Healthy People 2020 objectives provide a framework for a. assessment. b. diagnosis. c. prevention. abirb.com/test d. treatment.

ANS: C abirb.com/test The health-promotion initiative named Healthy People 2010 provides a framework for prevention.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 133 abirb.com/test

2. Which of the following best describes a primary prevention method for colon cancer? a. Hemoccult testing b. High fiber diet abirb.com/test c. Colonoscopy d. Laparoscopy ANS: B

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Primary prevention includes generalized health promotion and specific protection from disease. Hemoccult and colonoscopy are forms of screening, not prevention. Eating a healthy diet high in fiber is a preventive measure. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 134

3. Who authored the framework that provides the foundationabirb.com/test for nursing assessment and

diagnosis using the functional health patterns? a. Erikson b. Gordon c. Newman d. Nightingale

abirb.com/test

ANS: B abirb.com/test 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.

DIF: Cognitive Level: Remember (Knowledge)

abirb.com/test

REF: p. 134

4. 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 abirb.com/test by utilizing which area of focus? a. Age-developmental b. Functional abirb.com/test c. Individual–environmental

abirb.com/test

d. Pattern ANS: D

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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. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 135

5. A nurse is using a functional focus to assess a person. Which of the following the nurse be

evaluating? a. Visual acuity b. Pupil reactivity c. Ability to drive d. The red reflex

abirb.com/test

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ANS: C

Functional focus refers to the individual’s performance level.

Nurses assess how particular abirb.com/test visual patterns affect lifestyle. The ability to drive would affect a person’s lifestyle and might require a change in how the person functions.

DIF: Cognitive Level: Analyze (Analysis)

abirb.com/test REF: p. 137

6. Which of the following nurses is providing culturally competent care to the care recipient? a. A nurse who refuses to care for a care recipient after an abortion when abortion abirb.com/test

violates the nurse’s ethics. b. A nurse who honors a Native American care recipient’s request to allow an ICU visit from the tribe’s medicine man. c. A nurse who only assigns aides from the same culture abirb.com/test to care for care recipients. d. All of the above.

ANS: B

Culturally competent care is delivered with knowledge of abirb.com/test and sensitivity to cultural factors influencing health behavior. Complex cultural patterns transmitted from former generations contribute to individuals’ health behavior. Culturally competent care respects the underlying personal and cultural reality of individuals. Given that oneabirb.com/test may never be fully competent in cultures other than their own culture, the term cultural attunement may be more descriptive of the aim.

Culturally competent care is not about the nurse’s ethics or culture. It is about the cultural abirb.com/test beliefs of the care recipient. Moreover, while nurses are exempt from assisting in a procedure which violates their ethics, they are not permitted to refuse care to individual care recipients who have had procedures which violate the nurse’s ethics. The nurse depicted in choice A is clearly out of line. Also, it is not always possible to assignabirb.com/test a staff who is from the same culture as the care recipient and doing so would not guarantee of culturally competent care, in any event. The aide from a given culture could conceivably reject that culture. The nurse who honors a care recipient’s request to allow a visit from the tribal medicine man is practicing abirb.com/test culturally competent care.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 137 abirb.com/test

abirb.com/test

7. Which of the following statements is correct concerning functional focus in assessing a care

recipient? a. It is an assessment unique to nursing. abirb.com/test b. It emphasizes the underlying disease process. c. It refers to an individual’s level of performance. d. It is a newer replacement for the NANDA-International Taxonomy. abirb.com/test

ANS: C

Functional focus speaks to level of performance. Such focus is not unique to nursing and, in fact, utilized by a variety of disciplines across the healthcare spectrum. It is not a replacement abirb.com/test to NANDA, but rather best used in transdisciplinary communication in conjunction with NANDA-I. The text offers the following info: Functional focus refers to an individual’s performance level. Other disciplines plan care using functional patterns, but assessment data abirb.com/test vary among disciplines. Physical therapists and occupational therapists, for example, focus on physical ability to perform activities of daily living and rely on assessments of independent ability to carry out personal activities of daily living to develop their plans. For physicians, genitourinary function refers to frequency or voiding patterns and characteristics of urine, abirb.com/test such as color, odor, and laboratory analysis results. In addition to these factors of genitourinary function, nurses assess how the particular voiding pattern affects lifestyle, particularly how urinary frequency affects sleep patterns and the ability to perform activities such as shopping or socializing. Additional concerns mightabirb.com/test include the individual’s ability to walk or climb stairs to the bathroom or to manage these activities safely at night. It has been suggested for all health disciplines to employ the Classification of Functioning, Disability and Health. Relying on this classification could promote transdisciplinary communication about abirb.com/test functional patterns when used along with the NANDA-International taxonomy.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 137 abirb.com/test

8. Which nurse is rendering culturally attuned care? a. A nurse who assists the wife of a Hispanic care recipient to safely light candles b. A nurse who assists a Native American care recipient to choose hot and cold care abirb.com/test

foods c. A nurse who assists an African care recipient to find an acupuncture provider d. A nurse who arranges for a drumming ceremony for an Asian care recipient ANS: A

abirb.com/test

The nurse who assists family of a Hispanic care recipient to light candles is the only nurse providing culturally attuned care. Hispanic culture provides for religious rituals to including the lighting of candles especially within the context of Catholicism. abirb.com/testAll of the other choices depict nurses facilitating healing measures which are not recognized within that particular culture, although the practices mentioned are, in fact, recognized by other cultures. Box 6-2 presents information on common cultural perspectives for various populations of care abirb.com/test recipients who commonly present for care.

The text defines culturally attuned care as follows: Culturally competent care respects the underlying personal and cultural reality of individuals. Given that one may never be fully abirb.com/test competent in cultures other than their own culture, the term cultural attunement may be more descriptive of the aim. Nurses provide more culturally attuned care when they use cultural norms, values, communication, and time patterns in reflective practice.

DIF: Cognitive Level: Analyze (Analysis)

abirb.com/test

REF: p. 137

abirb.com/test

9. A 27-year-old woman has not received a Pap test in

identifies an alteration in which functional pattern? a. Health perception–health management pattern b. Elimination pattern c. Activity–rest pattern d. Self-perception–self-concept pattern

years. This assessment finding abirb.com/test

abirb.com/test

ANS: A

Assessment objectives for the health perception–health management pattern consist of obtaining data about perceptions, management, and preventive health practices. Exploring abirb.com/test these values identifies potential health hazards. A 27-year-old woman should receive a Pap test every 2 years. Failing to do so could place her at risk for health problems; thus, this finding identifies an alteration in the health perception–health management pattern. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 138

10. A care recipient is experiencing an alteration in the health perception–health management abirb.com/test

pattern and an alteration in the values–beliefs pattern. Which of the following best describes the behavior of this person? a. Never sees a physician abirb.com/test b. Only sees a physician if not feeling well c. Sees a physician for screenings only d. Sees a physician for follow-up care of a chronic disease ANS: B

abirb.com/test

Health beliefs and perceptions directly affect participation in care. Dimensions of assessment in the values–beliefs pattern include the individual’s values, beliefs, or goals that guide choices or decisions that are related to health. People whoabirb.com/test do not believe in health-promotion activities will likely see a physician only when sick. Thus, someone with an alteration in the health perception–health management and values–beliefs patterns will likely only see a physician if not feeling well. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 148

11. When assessing a person’s nutritional–metabolic pattern, which objective finding would have

implications for nursing intervention? a. The person’s 24-h diet diary b. The person’s dentition c. The person’s food preferences d. The person’s financial status

abirb.com/test

abirb.com/test

ANS: B abirb.com/test Although all of the assessment parameters listed have implications for nursing diagnosis and planning for this care recipient, the only objective measure is the care recipient’s dentition. It is the only one that can be validated with a physical exam.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 140

12. When assessing a care recipient’s activity–exercise pattern, which subjective finding has

implications for nursing practice? a. A person’s decreased muscle tone

abirb.com/test

abirb.com/test

b. A person’s amount of leisure time c. A person’s decreased range of motion d. A person’s use of a cane

abirb.com/test

ANS: B

Although all findings are important in assessing the activity–exercise pattern, the only abirb.com/test 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.

DIF: Cognitive Level: Apply (Application)

REF: pp. 141-142 abirb.com/test

13. During a health history, a person reports getting 5 h of sleep a night. What does this

information indicate to the nurse? a. The person is not receiving enough sleep. b. The person is receiving adequate sleep. c. The nurse must determine where the person sleeps. d. The nurse must ask additional questions.

abirb.com/test

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ANS: D

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’sabirb.com/test 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. abirb.com/test DIF: Cognitive Level: Apply (Application)

REF: p. 143

abirb.com/test 14. A nurse assesses the cognitive–perceptual pattern of a Type 1 diabetic care recipient. Which

finding has implications for the individual’s nursing plan of care? a. Decreased sense of hearing b. Decreased sense of smell abirb.com/test c. Decreased sense of taste d. Decreased visual acuity ANS: D

abirb.com/test

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 abirb.com/test will influence the nurse’s plan of care.

DIF: Cognitive Level: Analyze (Analysis)

REF: pp. 144-145 abirb.com/test

15. Which scenario indicates a potentially dysfunctional pattern? a. Adult with frequent urination b. Woman who lost her job c. Elderly person with blurred vision abirb.com/test d. Overweight adult with a sweet tooth ANS: B abirb.com/test

abirb.com/test

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 abirb.com/test 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 abirb.com/test definition, they are dysfunctional.

DIF: Cognitive Level: Apply (Application)

REF: p. 150 abirb.com/test

16. Which scenario represents a dysfunctional pattern? a. Sexually active teenager who does not use condoms b. Salesman who sleeps only 5 h a night c. Single mother of three children d. Woman with a small extended family

abirb.com/test

ANS: A abirb.com/test 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 the individual’s previous condition orabirb.com/test goal. Dysfunctional patterns may be present in the absence of disease, and nursing care may be necessary for health promotion and maintenance. The teenager, although free of disease, is in need of health promotion and disease prevention strategies because her sexual behavior indicates a dysfunction in her abirb.com/test sexuality-reproductive pattern that places her at risk for a sexually transmitted disease and pregnancy.

DIF: Cognitive Level: Apply (Application)

REF: p. 150 abirb.com/test

17. A nurse is counseling a person with a dysfunctional sleep pattern. Which of the following

recommendations would the nurse most likely give the person? abirb.com/test a. Read in bed until he falls asleep. b. Avoid fluids after 7 PM. c. Exercise immediately before bedtime. d. Watch television in the recliner in the evening. abirb.com/test ANS: B

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, abirb.com/test 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. abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 143

18. A nurse is caring for a person with a potential dysfunction in the health perception–health abirb.com/test

management pattern. Which of the following nursing interventions would most likely be performed? a. Arranging for home delivery of medication from the pharmacy b. Providing education regarding the dangers of smokingabirb.com/test c. Instituting visiting nurse services for blood pressure checks abirb.com/test

d. Providing direct observed therapy for tuberculosis medications ANS: B

abirb.com/test

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. abirb.com/test 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.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 150

19. 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?abirb.com/test a. Weigh the person. b. Set a goal weight with the person. c. Ask the person what her favorite foods are. abirb.com/test d. Develop a plan for weight loss.

ANS: B

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 abirb.com/test 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 care recipient. abirb.com/test DIF: Cognitive Level: Apply (Application)

REF: p. 150

abirb.com/test in the 20. A nurse weighs a person who has been diagnosed with a dysfunction

nutritional–metabolic pattern. Which aspect of the nursing process is being performed? a. Assessment b. Implementation abirb.com/test c. Planning d. Evaluation ANS: D

abirb.com/test

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 abirb.com/test 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.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 151

abirb.com/test

21. 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 a. requires interventions for problem drinking. abirb.com/test b. lacks evidence of problem drinking. c. requires interventions for sexually transmitted disease risks. d. lacks evidence of sexually transmitted disease risks. abirb.com/test

ANS: A abirb.com/test

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 care recipient had a score of abirb.com/test 3, which would require an intervention for problem drinking.

DIF: Cognitive Level: Apply (Application)

REF: p. 132 -Think About It

abirb.com/test 22. 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? a. Acupuncture b. Cupping abirb.com/test c. Hot tea d. Massage ANS: C

abirb.com/test

The Hispanic population ascribe to the hot–cold imbalance view of disease where asthma is viewed as a cold disease. Accordingly, administering hot tea to the child would be considered an appropriate therapy to maintain equilibrium within this framework. Even without knowing abirb.com/test that asthma is a cold disease, option C is the only logical choice.

Acupuncture, cupping, and massage are all modalities used in the Asian culture and they not recognized as therapeutic modalities by Hispanic persons. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 139, Box 6-2

23. Which classification system fulfills needs that are exclusive to nursing? abirb.com/test a. The International Classification of Nursing Practice (ICNP) b. The International Classification of Functioning, Disability, and Health (ICF) c. The International Nursing Diagnoses Classification (NANDA-I) d. The Nursing Diagnostic System (NDS) abirb.com/test

ANS: C

The NANDA-I system includes diagnostic criteria, and related etiologies in addition to the description. This system is often referred to as “nursing diagnoses.”

The NANDA-I fulfills abirb.com/test needs that are exclusive to nursing. Other disciplines do not use nursing diagnoses.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 149 abirb.com/test

24. Erikson’s task of autonomy vs. shame and doubt occurs during which stage of development? a. Infancy b. Early childhood abirb.com/test c. Late childhood d. Early adolescence ANS: B

abirb.com/test

Erikson’s task of autonomy vs. shame and doubt occurs during early childhood.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 136 Tab 6-3 abirb.com/test

25. A young couple is deciding if they should get married and start a family. Which of Erikson’s

life stages are they experiencing? a. Identity vs. role confusion b. Intimacy vs. isolation c. Generativity vs. stagnation

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abirb.com/test

d. Ego integrity vs. despair ANS: B

abirb.com/test

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.abirb.com/test despair occurs during maturity.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 136 Tab 6-3

abirb.com/test 26. Which cultural group defines illness as a price that is being paid for the past or the future? a. African b. Native American c. Arabian abirb.com/test d. Asian

ANS: B

American Indians define illness as a price that is being paid for the past or the future. abirb.com/test DIF: Cognitive Level: Remember (Knowledge)

REF: p. 139, Box 6-2

abirb.com/test 27. 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? a. African b. Alaska Native c. Asian d. Hispanic ANS: D

Hispanics define health as a gift from God. DIF: Cognitive Level: Apply (Application)

abirb.com/test

abirb.com/test

REF: p. 139, Box 6-2 abirb.com/test

28. Which of the following statements as it pertains to patient assessment is accurate? a. Patient perceptions are subjective thus not reliable data for the assessment

purposes. abirb.com/test b. Previous compliance to regimens introduces prejudice thus should not be included. c. Means to access health (finance, insurance, etc.) is best delegated to the social worker. d. Exploring values can identify health hazards and unrealistic expectations. abirb.com/test ANS: D

Exploring values identifies potential health hazards, such as lack of adherence to a prescribed abirb.com/test medical or nursing regimen or ability to manage health effectively.

In addition to these kinds of assessment cues, nurses identify unrealistic health and illness perceptions and expectations.

Patient perceptions, previous compliance to prescribed regimens, and means to access health are all valid nursing assessment parameters and need to be explored. These areas provide abirb.com/test information which will assist the nurse in planning and implementing care for the care recipient. While the social worker may be interested in means to access care, this information is also of interest to the nurse and should be addressed. Similarly patient perceptions and abirb.com/test previous adherence to healthcare regimens provide important predictive information.

abirb.com/test

DIF: Cognitive Level: Apply (Application) MULTIPLE RESPONSE

REF: p. 138 abirb.com/test

1. A care recipient who fails to take his insulin on a regular basis may have a conflict in which of

the following functional health patterns? (Select all that apply) abirb.com/test a. Health perception–health management b. Cognitive–perceptual c. Elimination abirb.com/test d. Values–beliefs ANS: A, B, D

A problem in one area serves as a clue to dysfunction in other areas. Cognitive patterns abirb.com/test include the ability of the individual to understand and follow directions, retain information, make decisions, solve problems, and use language appropriately. As a result, this person may not understand how to give himself the insulin properly. The values–beliefs pattern describes values including the individual’s spiritual values, beliefs, and goals. This person may not abirb.com/test believe in the use of medications unless he is symptomatic. The health perception–health management pattern involves the individual’s health status and health practices used to reach the current level of health or wellness, with a focus on perceived health status and meaning of abirb.com/test health to the individual. This person may not believe in health promotion and prevention.

Thus, a person who fails to take his insulin on a regular basis may have a conflict in the health perception–health management, cognitive–perceptual, and values–beliefs patterns. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 140

2. Which individual is at risk for a dysfunction in elimination pattern? (Select all that apply) abirb.com/test a. 46-year-old mother of two b. 32-year-old male who eats primarily burgers, sandwiches, and pizza c. 15-year-old girl d. 72-year-old white woman abirb.com/test ANS: A, B, C, D

When evaluating elimination patterns, nurses must consider age, developmental level, and cultural considerations. A 46-year-old mother of two is at abirb.com/test risk for urinary stress incontinence because of the two vaginal births; an older adult is at risk for urinary control problems; persons who do not eat fruits or vegetables (burgers, sandwiches, and pizza) have a diet low in fiber, which can lead to constipation; and teenagers, especially girls, may have problems with abirb.com/test body image, leading to abuse of laxatives. Thus, all persons listed are at risk for a dysfunction in elimination patterns.

DIF: Cognitive Level: Analyze (Analysis)

REF: pp. 140-141

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Chapter 07: Health Promotion and the Family Edelman: Health Promotion Throughout the Life Span, 9th Edition abirb.com/test

MULTIPLE CHOICE abirb.com/test

1. 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? a. The number of questions asked on the assessment toolabirb.com/test b. The linkages of the assessment to Healthy People 2020 c. The amount of involvement that the family has in completing the tool d. The capability of the tool to assess goals and outcomes abirb.com/test

ANS: C

Useful health-promotion family assessments involve listening to families, engaging in participatory dialogue, recognizing patterns, and assessing family potential for active, positive abirb.com/test change.

DIF: Cognitive Level: Apply (Application)

REF: p. 155 abirb.com/test

2. Which of the following best describes the nurse’s role in health promotion and disease

prevention? a. Educating about home safety measures abirb.com/test b. Identifying areas for family improvement c. Implementing the nursing process using a systems perspective d. Acting as a role model for the family ANS: D

abirb.com/test

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 abirb.com/test are all part of the nurse’s role but do not describe the comprehensive role of the nurse.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 156 abirb.com/test

3. 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? a. Feminist theory abirb.com/test b. Systems theory c. Developmental theory d. Resiliency theory abirb.com/test

ANS: B

Systems theory is an attempt to explain patterns of living among the individuals who make up the family system. abirb.com/test

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 156 abirb.com/test

abirb.com/test

4. 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 abirb.com/test implementing? a. Risk-factor b. Structural-functional c. Open systems abirb.com/test d. Developmental ANS: D

Duvall and Miller identified stages of the family life cycle and critical family developmental abirb.com/test 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. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 157

5. Which of the following would be described as a family structural component? abirb.com/test a. Income earner of the house b. Socialization for the family c. Immunization of infants d. Launching of children abirb.com/test ANS: A

Structural components of the family refer to family roles and relationships. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 163

6. Which of the following statements is correct concerning family risk factors? a. Psychological factors are too subjective to be valid abirb.com/test b. Risk factors can be inferred from lifestyle c. Epidemiology explores disease outcomes but not risks d. All of the above statements are correct. abirb.com/test ANS: B

Identifying risk factors is an important component of nursing assessment. Evaluating a family’s lifestyle can provide important clues to family risk factors. Psychological factors are abirb.com/test valid as are epidemiology concerns when determining risk factors. Family risk factors can be inferred from lifestyle; biological factors; environmental factors; social, psychological, cultural, and spiritual dimensions; and the health care system. Epidemiology often describes a abirb.com/test or psychological. disease association in terms of risk. Health risks can be physiological DIF: Cognitive Level: Remember (Knowledge)

REF: p. 158 abirb.com/test

7. Gordon’s functional health patterns outline eleven (11) areas, which should be pursued for

purposes of family assessment. Of the eleven areas, which one should be pursued first so as to provide an overview and also identify other patterns or areas which should be pursued abirb.com/test further? a. Cognitive–perceptual patterns b. Self-perception–self-concept patterns c. Health perception–health management patterns abirb.com/test d. Roles–relationships patterns

abirb.com/test

ANS: C

Family history begins with the health perception–health management pattern. Exploring issues within this pattern first provides an overview to help locateabirb.com/test where problems exist in other patterns and to determine which problems require more thorough assessment. Interviewing from the family’s perspective helps families define situations. The roles–relationships pattern defines family structure and function. The remaining nine patterns address lifestyle indicators. abirb.com/test

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 159

8. A nurse is collecting data for a family assessment using Gordon’s functional health patterns. abirb.com/test

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? a. Roles–relationship abirb.com/test b. Cognitive–perceptual c. Health perception–health management d. Self-perception–self-concept ANS: B

abirb.com/test

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. abirb.com/test DIF: Cognitive Level: Analyze (Analysis)

REF: p. 163

abirb.com/test 9. 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? a. What is the family’s philosophy of health? abirb.com/test b. What does the family do to have fun? c. How are problems in the family resolved? d. Who decides when and how children go to sleep?

ANS: C

abirb.com/test

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 abirb.com/test 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.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 161

abirb.com/test

10. The Jones family comprises Ralph, 49, and Mary, 45, Jones plus their 3 children, Maria 19,

Nicholas 17, and Mark 13. Last year, Nicholas was arrested and convicted for drunken driving and underage drinking. The family members were distraught but they worked together to keep abirb.com/test the family unit intact and also to deal with Nicholas’ behavior. Nicholas initially resisted attending a rehab program but subsequently, he agreed to do so in order to avoid a juvenile detention sentence. Thus far, he has not re-offended. Which of the following statements is abirb.com/test correct concerning this scenario? a. The family has good family spirituality. b. The family shows good family resilience. c. The family is enmeshment, i.e., has diffuse personal boundaries. abirb.com/test d. The family is dysfunctional. abirb.com/test

ANS: B

A family resilience framework may be useful to promote strategies for prevention efforts abirb.com/test aimed at strengthening families as they face life challenges.

Masten & Monn describe an integrated method for understanding and promoting resilience in children and families. Family disruption has been associated with substance abuse and psychosocial maladjustment in adolescents and young adults. Based on the information given, we cannot conclude anything abirb.com/test regarding spirituality in this family. Neither, is the family, as a whole, showing evidence of dysfunction although certainly one member is doing so. An enmeshed family has inappropriate boundaries where no such evidence is noted indicated in the scenario presented. abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 164

11. A nurse is using a genogram to represent a family. Which abirb.com/test of the following statements is

accurate? a. A genogram identifies the genetic disorders of the family. b. A genogram includes information about the past two generations. abirb.com/test c. A genogram can be used to make connections about family health patterns. d. A genogram begins with a circle in the center of the page.

ANS: C abirb.com/test 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 abirb.com/testconnections but does not begin with a circle in the center of the page. The ecomap starts with a circle in the center of the page.

DIF: Cognitive Level: Apply (Application)

abirb.com/test REF: p. 167

12. The ecomap of a care recipient’s family has slashed lines drawn from the son to the family

church. Based on this information, what conclusion can the nurse make? abirb.com/test a. The son is deceased. b. The son is actively involved with the family church. c. The son has a stressful relationship with the church. abirb.com/test d. The son has no relationship with the church.

ANS: C

Slashed lines on an ecomap signify stressful relationships. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 167

13. A care recipient reports that her family will be moving because her husband is taking a new

abirb.com/test job in another state. She is very unhappy about the decision and does not want to move. What action should the nurse take next? a. Assess the care recipient’s and family’s coping mechanisms in handling stress. b. Encourage the care recipient to act excited about the move. abirb.com/test c. Talk to the husband to get his perspective on the move. d. Tell her that all families must cope with new situations from time to time.

ANS: A

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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 abirb.com/test current situation.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 167

abirb.com/test 14. 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? a. Assist them to develop strategies that are congruent with their values. abirb.com/test b. Allow each of them to defend his or her own values. c. Focus on outcomes that each wants to accomplish. d. Divert their attention to areas in which they are successful. abirb.com/test

ANS: A

When strategies are used that are congruent with each individual’s values, the couple adjusts.

DIF: Cognitive Level: Apply (Application)

abirb.com/test REF: p. 172

15. A blended family has six children, aged 2, 4, 4, 5, 7, and 10, respectively. During a visit to the

home, the nurse notices that the 7-year-old seems quiet and withdrawn, whereas the other abirb.com/test children are playing loudly in the garage. Which of the following conclusions can the nurse make from this observation? a. This child has most likely been abused. b. This child is one of multiple children closely spaced inabirb.com/test age. c. This family suffers from low self-esteem. d. This family provides harsh punishment for their children.

ANS: B

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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.

DIF: Cognitive Level: Apply (Application)

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REF: p. 160, Tab 7-3

16. 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 abirb.com/test plan of care for this couple? a. Wear bicycle helmets for safety. b. Use caution around the family swimming pool. c. Cross the street at using the crosswalks. abirb.com/test d. Advocate for the day care to provide adequate socialization.

ANS: B

Safety balanced with exploration by the child results in health-promoting home environments. abirb.com/test With this thought in mind, the nurse would be alert to potential safety hazards in the home environment. In this scenario, backyard pools in families with toddlers need both fencing and water alarms to safeguard two-year-olds. Toddlers are prone to wandering and exploring thus abirb.com/test could easily fall into a swimming pool without being noticed.

The other choices are not age-appropriate for a toddler.

DIF: Cognitive Level: Apply (Application)

REF: p. 173 abirb.com/test

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17. 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? a. The age of the house in which the family lives abirb.com/test b. Genetic diseases in the family c. Driving practices in the family d. Toilet training for the child abirb.com/test

ANS: A

A typical 9-month-old is beginning to crawl. Older houses may contain lead-based paint, to which a crawling baby might have access. Lead causes neurological damage and anemia. abirb.com/test Genetic diseases are typically not a concern regarding a 9-month-old, although this issue might be important in pregnancy or for couples who are planning a family. Driving practices in a family are not specific to an infant. Driving practices would affect persons of all age abirb.com/test groups. The 9-month-old is too young to begin toilet training.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 173

abirb.com/test 18. 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? a. Concerns about career decisions b. Concerns about exposure to environmental hazards abirb.com/test c. Difficulty with parents finding fulfillment with raising the child d. Difficulty with open communication with the child ANS: D

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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 abirb.com/test concerns with families with younger children. Concerns about career decisions are typically problematic for families with older children/young adults.

DIF: Cognitive Level: Apply (Application)

REF: p. 174 abirb.com/test

19. The nurse is working with a middle-age married couple whose son has just graduated from

college. Which developmental tasks would the nurse expect to find in this family? abirb.com/test a. Attending activities for their son b. Strengthening their marital relationship for future family stages c. Acting as a launching center for their son d. Responding to the prospect of changing careers abirb.com/test ANS: C

Families with young adults act as a launching center when children begin to leave home. As children leave home, parents relinquish their parenting roles of many years to return to the abirb.com/test marital dyad. The couple builds a new life together while maintaining relationships with aging parents, children, grandchildren, and in-laws. Couples focus on redefining relationships during this stage. As children develop, they no longer need a primary caregiver, often their mother, in the same way as during childhood. None of theabirb.com/test other choices are specific to a family with a young adult child. In fact, choice A would be appropriate for a young child and not a young adult.

DIF: Cognitive Level: Apply (Application)

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REF: p. 174

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20. The nurse has made a home visit and has assessed the family and its members. The nurse

notes that one of the family members is having a problem abirb.com/test with ego integrity and has assessed that a patient is having an issue with ego integrity and may require additional professional support. Which of the following family members is most likely to be experiencing this problem? abirb.com/test a. The 8-year-old child who is being bullied by schoolmates b. The 40-year-old father who is facing challenges of a new and demanding job c. The 38-year-old mother who is trying to balance work, family and career d. The 64-year-old grandfather who is just drawn his firstabirb.com/test social security check ANS: D

Ego integrity (the union of all previous phases of the life cycle) is the challenge in this stage and demands successful aging through continued activity. abirb.com/test Having gone through the various stages of family development, the couple accepts what they have done as their own. At this time, they may need family or professional support to pursue other interests or maintain former activities to feel needed and useful. abirb.com/test Bullying does not involve issues of ego integrity. The mother and the father are both facing challenging jobs and demands related to work. Ego integrity to include the need to feel useful and needed would not be issues for either of these persons. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 176

21. A nurse has developed a family nursing diagnosis. Which of the following best describes the abirb.com/test purpose of this action? a. Describes the strengths of the family b. Allows for creation of goals for the family c. Promotes behavioral change among family members abirb.com/test d. Validates health problems with the family

ANS: D

Writing a family nursing diagnosis helps families promoteabirb.com/test 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 abirb.com/test interventions first identifying what the problem is.

DIF: Cognitive Level: Apply (Application)

REF: p. 176 abirb.com/test

22. 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? abirb.com/test a. Education about building on current strengths of the family b. Education about hand hygiene c. Education about health care resources in the community d. Education about child safety seats abirb.com/test ANS: B abirb.com/test

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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 meansabirb.com/test 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.

DIF: Cognitive Level: Analyze (Analysis)

abirb.com/test

REF: p. 177

23. 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? abirb.com/test a. Obtain vital signs from all members of the family. b. Ask the family members to state the goals that were previously developed. c. Collect data similar to that which was collected at the initial visit for comparison. abirb.com/test d. Educate about the importance of using role relationships to create a healthy family.

ANS: C

The purpose of evaluation is to determine how the family has responded to the planned abirb.com/test 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 abirb.com/test determine whether change has occurred.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 178 abirb.com/test

24. A nurse is planning a home visit for a family. Which of the following actions would be most

appropriate for the nurse to take? a. Study information regarding the family from agency records and other sources. abirb.com/test b. Make a contract with the family that states specific goals and objectives. c. Identify how the home visit will be financed. d. Understand the situation from the family’s perspective. abirb.com/test

ANS: A

This question asks about planning for a home visit. Part of planning the home visit is studying information regarding the family from agency records, referral forms, and other sources. After the planning phase is complete, the activities of making a abirb.com/test 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.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 156, Box 7-1

25. A nurse is providing follow-up care for a family who has recently had a baby. Which of the abirb.com/test following topics should the nurse anticipate discussing with the family? a. Type 1 diabetes b. Fetal alcohol syndrome c. Communicable diseases abirb.com/test d. SIDS

ANS: D abirb.com/test

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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 abirb.com/test 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.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 160, Tab 7-3

MULTIPLE RESPONSE abirb.com/test

1. A home health nurse is admitting a 54-year-old man for services following a coronary artery

bypass graft (CABG). As part of the initial visit the nurse completes a family assessment.

What is the purpose of this nursing action? (Select all thatabirb.com/test apply.) a. Allows for health promotion and disease prevention appraisal b. Allows for inclusion of family members in decision-making c. Allows for data collection necessary for comparison to Healthy People 2020 abirb.com/test d. Allows for development of patient-centered care ANS: A, B

Families provide the structure for many health-promotion practices; therefore, family abirb.com/test assessment informs health promotion and disease prevention appraisal. Additionally, health providers are encouraged to include families in decision-making and encouraging their presence and participation in all aspects of care from acute care to health promotion. Thus, it is important to have assessed the family so that the familyabirb.com/test can be included in the care process.

DIF: Cognitive Level: Apply (Application)

REF: p. 154

abirb.com/test 2. A nurse is providing care for a family in the community. Which of the following

characteristics would the nurse assess to determine the health of the family? (Select all that apply.) a. Developmental stage of each family member abirb.com/test b. Coping mechanisms of each family member c. Potential risk factors within the family d. Maintenance of trust within the family ANS: B, C, D

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Coping mechanisms of each family member, potential risk factors within the family, and maintenance of trust within the family are all necessary characteristics for the nurse to assess when determining the health of a family. When assessing aabirb.com/test family, the nurse will consider the developmental stage of the family before considering the developmental stage of each of the individual family members.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: pp. 157, 158, Tab 7-2

3. A nurse is conducting an environmental assessment as part of a family assessment. Which of

the following would the nurse assess? (Select all that apply.) abirb.com/test a. Garbage collection in the neighborhood b. Convenience stores in the neighborhood c. Safety of the home abirb.com/test d. Climate of the home

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ANS: A, B, C, D

The family environment is made up of the home, neighborhood, and community. Thus, aspects of the community as well as aspects of the home environment abirb.com/test need to be analyzed during this assessment.

DIF: Cognitive Level: Apply (Application)

REF: p. 171 abirb.com/test

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Chapter 08: Health Promotion and the Community Edelman: Health Promotion Throughout the Life Span, 9th Edition abirb.com/test

MULTIPLE CHOICE abirb.com/test

1. Which of the following is NOT usually considered a parameter for defining a broad sense

community within the context of nursing? a. Groups of people who live within the same geographical region b. Groups of people who share common interests abirb.com/test c. Groups of people who have the very near the same income and net worth d. Groups of people who share social relationships ANS: C

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The term community is used in various contexts with various meanings, depending on the frame of reference. Nursing generally adopts a broad sense of community that includes the concepts of groups of people that share social relationships, generally live within the same abirb.com/test geographical location, and share common interests (Stanhope & Lancaster, 2015). A broad definition of community encompasses a wide variety of settings, such as school, workplace, and the international community. While some communities may, indeed, be relatively wealthy while others are fairly indigent, the actual income and net abirb.com/test worth of particular individuals is typically not a nursing consideration in defining a community. In fact, such parameters may considerably within any given community.

DIF: Cognitive Level: Remember (Knowledge)

abirb.com/test

REF: p. 185

2. Which of the following communities are relatively disadvantaged with respect to lower levels

of health promotion and limited resources from local, state, or federal public health agencies? abirb.com/test a. Urban communities b. Rural communities c. Communities within southern states abirb.com/test d. Communities with large maritime (sea-faring) industries ANS: B

Disparities in health across the world are associated with poverty, industrialization, violence, abirb.com/test social disruption, education, food access, and maternal health.

Even in developed countries with health resources, disparity occurs. Health may be different in urban versus rural geographical areas. Rural communities are doubly disadvantaged with lower levels of health-promotion behaviors and limited resources from local, state, and federal public health abirb.com/test agencies. Southern states have both rural and urban communities; thus such distinction is not valid. Similarly, maritime communities such as Boston or San Francisco tend to be highly urbanized. abirb.com/test

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 186

3. Various theories guide the nursing process in assessing patients or communities with a goal abirb.com/test

toward formulating and implementing a plan of care. Which of the following theoretical frameworks is most useful in the context of assessing communities? a. Abraham Maslow’s theory of motivation abirb.com/test or society b. John Rawls’ theory of resource distribution within a community c. Marjory Gordon’s functional health patterns abirb.com/test

d. Gordon Allport’s theory of prejudice and discrimination ANS: C

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Methods of data collection and sources of information about communities differ from individual sources. Systems theory, developmental theory, and risk-factor theory guide nursing process. Diverse communities require comprehensive assessment techniques that abirb.com/test (e.g., cultural health gather information about the unique characteristics of the population practices or herbal remedies). Gordon’s functional health patterns provide the assessment framework for this text. Although other community assessment strategies exist, Gordon’s patterns are useful to align community assessment findings with those of families and abirb.com/test individuals to plan health promotion. Maslow’s theory would be more appropriate for assessing an individual. Similarly, Allport’s theory is directed at the personality of the individual. Rawls’ theory is aimed at ethics and justice for allocating scare resources within abirb.com/test society. It is not intended as a modality or framework of assessment.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 186

abirb.com/test 4. Which of the following scenarios is an example of a community health nurses serving a health

advocate for a community? a. A nurse who proactively participates in health policy decision-making b. A nurse who staffs the first aid station at lawful demonstrations abirb.com/testand protest rallies c. A nurse serving as a community organizer who defends protesters unfairly arrested d. All of the above are examples of nurses serving as community health advocates ANS: A

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A major portion of the nurse’s role is to advocate not only for the individual but also for justice in health care delivery. Nurses need to be aware of issues that have an effect on the health of the American people and know how to influence necessary change. Participation in abirb.com/test policy decision-making requires that nurses take a proactive stance to determine needs before a problem arises. Policy development and change take place on many levels, from within the nurse’s agency or work group to the community, state, and national levels. At the institutional level, clinical decisions influence policy, as do management issues. The nurse examines abirb.com/test rationales underlying existing or planned policy and determines their current relevance.

Nurses, by virtue of their education and experience, develop communication skills and apply change theory to influence policy. Staffing a first aid station is not a professional role for the abirb.com/test community health nurse who is advocating on behalf of a community. One might expect an EMT to serve in this role; even a lay person can do so. Similarly, the role of community organizer and/or defending persons arrested is best left to the attorneys. It is beyond the scope of community health nursing. abirb.com/test DIF: Cognitive Level: Apply (Application)

REF: p. 187

abirb.com/test 5. Which of the following statements is correct concerning political lobbying? a. It is a form of influence peddling and thus illegal. b. Nurses can and often do participate in lobbying. c. It is legal but also considered unprofessional for a nurse to lobby. abirb.com/test d. Nurses may, in fact, lobby but they may not accept pay for this role.

ANS: B abirb.com/test

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Nurses can and do legally participate in lobbying, including paid lobbying. There is nothing illegal or unprofessional about such activity. The process of seeking to influence legislators’ views and votes is called lobbying. When an individual is abirb.com/test employed to lobby he/she is known as a lobbyist and is required to register as the representative of a special interest group. The ANA, located in Washington, DC, employs nurse lobbyists as do many states.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 189

6. Why is nursing’s collective voice weak and rarely heard? a. Nurses are primarily women. abirb.com/test b. Health issues have taken a back seat to other issues in politics. c. The public does not trust nurses or physicians. d. Only 20% of nurses join a collective professional organization. abirb.com/test

ANS: D

Unfortunately, nursing’s collective voice is rarely heard. Only about 20% of the entire nursing workforce are members of a collective professional organization (Woodward, Smart & Benavides-Vaello, 2015). Other health care professionals,abirb.com/test like the American Medical Association, have more united professional organizations with large memberships, providing a united voice and political clout that influences health care policy and law. Nurses have multiple professional organizations. With high membership dues, nurses likely join only a few abirb.com/test groups and may gravitate toward their specialty organization. Without a single national organization with the majority of nurses as members, nursing’s voice is diluted. When organizations promote an issue, the collective voice of the group rather than the individual sends a more powerful message to influence policymakers.abirb.com/test Without a collective voice, nursing’s influence on shaping health care policy is weakened. The fact that nurses are women is not relevant to this issue, the problem is percent of participation in professional organizations and not the gender of the participants. Health issues are most certainly on the abirb.com/test forefront of the political climate especially as it pertains to the Affordable Care Act. While physicians have some issue with patient trust, nurses enjoy an extremely high rate of patient respect and trust, often polling as the most trusted professionals. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 188

7. Obtaining data though observation via all of one’s senses is called a abirb.com/test a. pan-sensory survey. b. multi-observational survey. c. windshield survey. abirb.com/test d. unofficial survey.

ANS: C abirb.com/test

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Nurses obtain community assessment data through observation, interviews (including focus groups), and measurement. These three methods are used most frequently in various abirb.com/test combinations to ensure the validity of the information. Obtaining data through observation—often referred to as the windshield survey approach to assessment—includes the use of the senses (sight, touch, hearing, smell, and taste) to determine community appearances. These appearances include types and condition of residential dwellings and their abirb.com/test people and also physical and biological characteristics, such as animal and plant life, temperature, transportation, sounds, and odors. Some communities have a characteristic “flavor.” Community’s physical characteristics influence health. What type of space is available? Children need space to run and play; young andabirb.com/test middle-aged adults require space for recreation and exercise. What spatial barriers exist? Where is this space located in relation to traffic and schools? What does the air feel and smell like? What does the water taste like?

DIF: Cognitive Level: Remember (Knowledge)

abirb.com/test

REF: p. 189

8. Which of the following is an example of community assessment using a key informant

approach? a. Interviewing the local union representative b. Carefully reviewing the most recent census data c. Conducting a random survey letters to the editor d. Interviewing the State senator

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ANS: A

Interview data, the most common source of information from people, include verbal abirb.com/test statements from community residents, key community officials, health care personnel, and various community agency staff. Key informants provide useful ways to learn how members perceive their community. Key community leaders often provide important information about community health concerns, necessary health resources, and community strengths along with abirb.com/test particular health beliefs and community health goals. The State senator represents the State, as a whole, and likely would not have much insight into any one particular community.

Interviewing the district’s congressman or congresswoman would be a better choice. Certainly abirb.com/test the local union representative would have some insights into community concerns and would constitute a key informant. Choices B and C are not consistent with interviewing key persons within the community. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 189

9. A nurse is employed by a local health department. Which of the following would be one of abirb.com/test her primary responsibilities? a. Providing appropriate treatment for the flu to an elderly man b. Providing education to the community about prevention of the flu c. Ensuring that the family members of the man with the abirb.com/test flu get tested for the flu d. Ensuring that the family members of the man with the flu receive the flu vaccine

ANS: B

Community health nursing combines nursing practice andabirb.com/test public health concepts to promote the health of populations without limitation to any particular individual or group of individuals. Nursing concerns become community’s responses to existing and potential health-related problems, including such health-supporting responses as monitoring and abirb.com/test teaching population groups. Nurses supply educational information to at-risk communities to develop health-oriented skills, attitudes, and related behavioral changes. abirb.com/test

The role of the community health nurse is to promote the health of the population. It is important that the nurse view the community structure as a population and consider existing abirb.com/test health services. Therefore, the primary responsibility of this nurse is to the community she serves by providing education about flu prevention.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 190 abirb.com/test

10. A parish nurse is concerned about the number of parishioners who smoke. How would the

parish nurse best address this issue? a. Ban smoking on parish property. abirb.com/test b. Invite local experts to participate in a health fair at the parish. c. Find literature about smoking cessation. d. Hand out free nicotine-replacement systems. abirb.com/test

ANS: B

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 abirb.com/test 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. abirb.com/test DIF: Cognitive Level: Analyze (Analysis)

REF: p. 189

abirb.com/test 11. 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) a. codependent function. b. independent function. c. interdependent function. d. dependent function.

ANS: C

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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 abirb.com/test health.

DIF: Cognitive Level: Apply (Application)

REF: p. 189 abirb.com/test

12. Which of the following health concerns should the nurse have as a priority when planning

care for a community? a. The limited recreational areas identified through a windshield survey b. The high crime rate reported in the town records abirb.com/test c. The absence of health clinics on the local bus route d. The lack of grocery stores within walking distance identified by the community ANS: D

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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. abirb.com/test Therefore, the lack of grocery stores identified by the community should take first priority.

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DIF: Cognitive Level: Analyze (Analysis)

REF: p. 190 abirb.com/test

13. A nurse who is new to the area wants to get a “feel for the community she will be working

with.” Which of the following would be the best way for the nurse to start learning about the community? abirb.com/test a. Driving around the neighborhood b. Going door to door asking people about the community c. Searching on-line to obtain population statistics d. Talking to the police captain at the local police department abirb.com/test ANS: A

Community nurses assess communities by observation, interview, and measurement. Driving around and observing the community uses one’s senses toabirb.com/test obtain information about the community, its health problems, and its strengths. This type of assessment (driving around and observing) gives the nurse an idea of how the community functions.

DIF: Cognitive Level: Analyze (Analysis)

abirb.com/test REF: p. 189

14. A community believes many people in that community lead sedentary lives because they lack

safe areas in which to exercise. What action should the nurse take in order to confirm or reject abirb.com/test these beliefs? a. Walk around the neighborhood. b. Interview members of the community. abirb.com/test c. Obtain town morbidity and mortality rates. d. Go to the town hall to obtain the number of parks in the community.

ANS: B abirb.com/test The nurse has generated a hypothesis (people lead sedentary lives because of a lack of safe areas). To explore this hypothesis, the nurse should follow it up with interviews and measurement data. In this situation, town statistics would not be sufficient to address the hypothesis. The nurse needs to interview members of the community to determine how they abirb.com/test perceive it.

Interview data, the most common source of information from people, include verbal statements from community residents, key community officials, health care personnel, and abirb.com/test various community agency staff. Key informants provide useful ways to learn how members perceive their community. Key community leaders often provide important information about community health concerns, necessary health resources, and community strengths along with particular health beliefs and community health goals. Community residents provide useful abirb.com/test information about their perceptions of health, health concerns, and needs as well as of the availability, accessibility, and acceptability of health services. Health agency personnel provide data about health resources, population served, availability, and perceptions of abirb.com/test concerns and needs.

DIF: Cognitive Level: Apply (Application)

REF: p. 189 abirb.com/test

15. 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? a. Structure of a community b. Subsystem of a community abirb.com/test c. Supra system of a community abirb.com/test

d. Interaction of a community ANS: B

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Communities’ structural parts form the subsystems, each of which is in itself a system. Health agencies, schools, fire departments, and governmental bodies are examples of structural parts.

As it applies to this case, structural parts of a community form subsystems within a larger abirb.com/test 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 abirb.com/test local VA hospital) of a community (the VA hospital and family of hospitals).

DIF: Cognitive Level: Apply (Application)

REF: p. 190 abirb.com/test

16. The study of a population is referred to as (a) a. community pattern. b. windshield survey. c. demography. d. community diagnosis.

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ANS: C

Demography is defined as the study of a population.

DIF: Cognitive Level: Remember (Knowledge)

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REF: p. 190 abirb.com/test

17. The process of dynamic change with adaptation in the system’s parts, and how community

systems and subsystems interact is known as a. structure of a community. b. community health promotion. c. community diagnosis. d. function of a community.

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ANS: D

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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.

DIF: Cognitive Level: Remember (Knowledge)

abirb.com/test

REF: p. 190

18. A nurse is assessing a community from both a developmental and a risk perspective. Which of

the following characteristics would be of most interest to the nurse? abirb.com/test a. Sex b. Age c. Race abirb.com/test d. Socioeconomic level ANS: B

Community nurses use a developmental-age-correlated approach to identify health promotion abirb.com/test 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, sex, race, geographical location, and lack of health services. Age canabirb.com/test thus be used to assess a community from both a developmental and a risk perspective. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 192 abirb.com/test

19. Using developmental theory, a community nurse assesses the community and determines that

the majority of residents who are 45 years of age or older lead sedentary lives. Which of the following would be the priority for this nurse to promote? abirb.com/test a. Health-promotion activities b. Accident prevention activities c. Drug prevention activities d. Pregnancy prevention activities abirb.com/test ANS: A

Developmental theory can be used to identify existing or potential health problems for a particular age group in the community. Age-related risk factors associated with individuals abirb.com/test can be extended to the community. It is well known that physical activity decreases with age and chronic illnesses increase with age. Therefore, health-promotion and disease prevention activities become a priority for the nurse serving this community. The other choices represent abirb.com/test issues common for younger persons.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 189 abirb.com/test

20. Which of the following demonstrates the nurse using subjective data to indicate a health

concern in the health perception–health management pattern? a. Examining high sexually transmitted disease rates recorded by the health abirb.com/test department b. Listening to community members discuss the high smoking rate among teenagers c. Analyzing the high infant mortality rate reported by state hospitals d. Discussing the high rate of teenage motor vehicle crashes recorded by the local abirb.com/test police department ANS: B

Subjective data is based on the perceptions of individuals abirb.com/test in the community. Perceptions of community members play a key role in the context of the health perception–health management perspective. Interviewing provides a way to learn how members perceive their communities and their perceptions of health. Similarly, listening to community members discuss their views would also be consistent with assessingabirb.com/test perceptions. It is subjective data.

The other choices are all forms of objective data, and are independent of persons’ perceptions.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 192

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21. 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? a. Nutritional–metabolic pattern abirb.com/test b. Elimination pattern c. Health perception–health management pattern d. Values–beliefs pattern abirb.com/test

ANS: B

The elimination pattern identifies factors including exposure to pollutants in the community through contaminated soil, water, air, and food. abirb.com/test

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DIF: Cognitive Level: Apply (Application)

REF: p. 194

22. Which functional health pattern provides information about problem-solving and abirb.com/test

decision-making within communities? a. Cognitive–perceptual pattern b. Self-perception–self-concept pattern c. Coping–stress tolerance pattern d. Health perception–health management pattern

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ANS: A abirb.com/test The cognitive–perceptual pattern provides information about problem-solving and decision-making within communities.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 195 abirb.com/test

23. 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 abirb.com/test highest risk to experience an alteration in which of the following functional health patterns? a. Self-perception–self-concept pattern b. Role–relationships pattern c. Cognitive–perceptual pattern abirb.com/test d. Sexuality–reproduction pattern ANS: A

The elevated high-school dropout rate is a risk factor in theabirb.com/test 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 abirb.com/test community cannot adequately control or cope with.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 195 abirb.com/test

24. A nurse is using the technique of mapping while implementing the nursing process in the

community setting. The nurse is engaged in which aspect of the nursing process? a. Collection b. Planning abirb.com/test c. Analysis d. Implementation ANS: C

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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.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 196

25. A nurse is collecting data regarding the number of crosswalks within a community. Which

perspective is being used to gather this data? a. Developmental perspective b. Functional perspective c. Risk-factor perspective d. Systems perspective

abirb.com/test

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abirb.com/test

ANS: C

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 abirb.com/test predicting the likelihood of adverse health conditions. Risk factors include a combination of demographic, psychological, physiological, or environmental characteristics. In the case, crosswalks have implications for pedestrian safety. Select groups may be at risk based on shared risks. Knowing which risk abirb.com/test factors are present assists community nurses in developing action plans for health promotion and disease prevention.

DIF: Cognitive Level: Apply (Application)

REF: p. 193 abirb.com/test

26. A community nurse has collected rates of alcohol-related motor vehicle accidents involving

teenagers. Which action should the nurse take next? abirb.com/test a. Develop a plan to address the high rates of alcohol-related motor vehicle accidents. b. Partner with high school nurses to educate students about the risks of drinking and driving. c. Diagnose the community with ineffective health management patterns related to abirb.com/test the high levels of drunk driving. d. Establish support groups for teenagers with alcohol abuse.

ANS: C

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The role of the community nurse includes the interaction of independent, interdependent, and dependent functions. Independent functions include assessing, analyzing, diagnosing, planning, implementing, and evaluating. In this case, once the nurse analyzes the alcohol-related motor vehicle accident rates, the next step abirb.com/test is to diagnose the community.

Therefore, the nurse would diagnose this community with ineffective health management patterns related to the high levels of drunk driving. In terms of stepwise approach using the nursing process, before formulating a plan, a diagnosis must be made. Choices A, B, and D all abirb.com/test represent plans which would follow a diagnosis DIF: Cognitive Level: Analyze (Analysis)

REF: p. 189 abirb.com/test

27. Which of the following best describes the primary goal of community nurses? a. Create charts/graphs of data collected. b. Create plans for community health-promotion programs. abirb.com/test c. Create evaluation tools for health-promotion programs. d. Create a culture of health promotion/health protection with the community.

ANS: D

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Over the last 2 decades, several social trends in the United States have increased the public interest in health promotion and disease prevention. Community health nursing combines nursing practice and public health concepts to promote the health of populations. Community abirb.com/test participation in health planning facilitates effective assignment of priorities. Additionally, change results from efforts by individuals or groups and involves fundamental shifts of behavior. It is important that the community nurse create a culture of health promotion and health protection within a community in order to facilitateabirb.com/test positive change in health behaviors.

Choices A, B, and C describe various means to an end but they are each of limited focus and do not describe the overall primary goal DIF: Cognitive Level: Analyze (Analysis)

abirb.com/test REF: p. 183

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28. A community nurse develops a plan to address the problem of teenage pregnancies. Which of

the following actions should the nurse take next? a. Determine the rate of teenage pregnancies. abirb.com/test b. Evaluate the success of her plan. c. Provide educational programs at local schools regarding pregnancy prevention. d. Determine which factors related to teenage pregnancy require intervention. abirb.com/test

ANS: C

Plans guide nursing actions. Implementation of the nursing process begins based on the health promotion/health protection plan. Recalling the steps of the nursing process, providing abirb.com/test 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. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 200

29. A nurse has implemented a smoking cessation program for teenagers and is now evaluating abirb.com/test the rate of teenage smoking in the community. Which of the following functions is being demonstrated by the nurse? a. Codependent function b. Independent function abirb.com/test c. Interdependent function d. Dependent function

ANS: B

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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. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 189

30. Which factor has the greatest implication for a communityabirb.com/test nurse when developing a

health-promotion program for church members? a. The majority of members live within a 3-mile radius. b. The majority of members are African American. c. The majority of members are high school graduates. abirb.com/test d. The majority of members are employed.

ANS: B

abirb.com/test Demographic data provide the basis for analysis and a means to identify groups that may be at high risk for health concerns. Age, sex, race, geographical location, consumption pattern, or lack of health services may be considered risk factors because one or more may contribute to disease or death and place the population sharing them at risk.

Such information also provides abirb.com/test clues for the direction of health strategies. African Americans have a high rate of poverty, second only to Native American, placing them at risk for health disparities. Poverty is a known risk factor with widespread health implications. As a result, knowing that a majority of abirb.com/test church members are African American has greatest implications for a community nurse when developing health-promotion programs.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 190

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31. A community is in the maintenance stage of change. Which of the following would be an

appropriate intervention for the community health nurse? a. Highlight past successes abirb.com/test b. Discuss the benefits of changing c. Develop strategies to prevent relapse d. Provide information abirb.com/test

ANS: A

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. abirb.com/test Developing strategies to prevent relapse should happen during the action phase. Providing information should occur during the precontemplation stage.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 196, Tab 8-2 abirb.com/test

32. 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? abirb.com/test a. Provide the community with statistics regarding childhood smoking rates. b. Point out positive outcomes associated with banning smoking such as maintenance of good lung function. c. Help the community develop a plan to implement the ban. abirb.com/test d. Praise the members of the community for their actions.

ANS: B

A community that is considering implementing a smokingabirb.com/test 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. Choice A (provide statistics) would be appropriateabirb.com/test for the precontemplation phase.

Developing and implementing a plan, choice C, is appropriate for the planning phase. Praising members for their actions is really not a part of the Stages for Change and could incidentally occur at anytime. abirb.com/test DIF: Cognitive Level: Analyze (Analysis)

REF: p. 196, Tab 8-2 abirb.com/test

MULTIPLE RESPONSE 1. In response to the growing elderly population, community health nurses should do which of abirb.com/test the following? (Select all that apply.) a. Work with the board of education to emphasize the importance of adequate physical activity for children and the importance of healthy meals. b. Work with local nursing schools to emphasize the importance of geriatric training abirb.com/test in the curriculum. c. Work with the state and local departments of health to devise a plan to increase nursing home beds. abirb.com/test d. Work with local health departments to increase recreational activities for elderly members of the community.

ANS: A, B, C, D abirb.com/test

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Community leadership provides direction for health promotion and health protection. The change in age distribution indicates that people will be living longer and thus have more chronic illness issues. Services need to be made available abirb.com/test for this population.

Health-promotion services need to be made available to the younger population as well to decrease their risk factors for future illnesses such as obesity and heart disease. Therefore, all responses are correct. abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 190

2. According to Pender, which of the following is a stage of change?

(Select all that apply.) abirb.com/test a. Reflection b. Action c. Maintenance abirb.com/test d. Acceptance ANS: B, C

According to Pender, the five stages of change include precontemplation, contemplation, abirb.com/test planning, action, and maintenance.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 196, Tab 8-2 abirb.com/test

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Chapter 09: Screening Edelman: Health Promotion Throughout the Life Span, 9th Edition MULTIPLE CHOICE 1. Which is an example of asymptomatic pathogenesis? a. Blood pressure of 170/98 experiencing headaches b. Positive finding on colonoscopy and blood in his or her stool c. Elevated prostate-specific antigen (PSA) d. Elevated TSH who is always tired ANS: C

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).

DIF: Cognitive Level: Apply (Application)

REF: p. 207

2. An occupational health nurse is planning a cholesterol screening with the employees at the

factory. Which of the following would be an advantage of conducting this screening? a. Allows for the beginning of a multiple test screening process b. Provides an opportunity for health education c. Allows for preliminary diagnosis of coronary artery disease d. Provides the opportunity for a referral to a physician ANS: B

Screenings create an opportunity for providing health education to a group of individuals who may not otherwise receive it. This allows the nurse to take advantage of a teachable moment with the employees in the factory.

DIF: Cognitive Level: Apply (Application)

REF: p. 208

3. Researchers are studying a particular disease which occurs among Americans at a rate of 36

per 100 annually. What type of rate is this statement describing?

Prevalence rate Incidence rate Morbidity rate Mortality rate

a. b. c. d.

ANS: A

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).

DIF: Cognitive Level: Apply (Application)

REF: p. 209

4. Which of the following is a disadvantage of screening? a. Uncertainties of scientific evidence b. Negative patient perception c. Some tests have high sensitivity and high specificity d. Lack of patient autonomy ANS: A

The primary disadvantages of screening stem largely from uncertainties in scientific evidence, which sets normal testing ranges and therefore, also ranges of error for screening tests. When effectiveness depends on the screening program’s ability to distinguish those who probably have the disease from those who do not, any margin of error can result in serious consequences. Some individuals who do not have the condition will be referred for further tests and some who do have the disease will not get needed referrals. Those incorrectly referred (false positive) suffer needless anxiety and unnecessary medical interventions, some of which can be harmful, while awaiting more definitive diagnosis (e.g., high levels of prostate-specific antigen [PSA]). False-positive osteoporosis screens can lead to unnecessary bone building medication treatment that may have adverse effects.

Tests with high sensitivity and high specificity are desirable tests and would not represent a disadvantage—these types of tests are highly accurate. Autonomy is not an issue since patients consent to screening—they may decline or not participate, if they wish. There is not evidence to support a perspective that most care recipients have a negative view of screening. Any care recipient who is so disposed is free to decline recommendations for screening.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 209

5. Which type of cases tends to be expressed in terms of incidence? a. Chronic conditions b. Acute conditions c. Diseases which target primarily children d. Conditions where full recovery is expected ANS: B

Key factors in assessing the need for screening criteria are quantifying measures of disease frequency. Two measures most used in epidemiology are incidence and prevalence. Incidence indicates the rate of a new population problem and estimates the risk of an individual developing a 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. It provides the best estimate of whether a person is likely to become ill during a specific period of time. In short, incidence is new cases, and prevalence is all cases within a set period of time. Usually chronic conditions are measured by their prevalence (generally existing), whereas acute conditions are assessed by their incidence (rate of new occurrences).

Whether the disease affects children and whether full recovery is expected are not relevant considerations to the concept of incidence.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 209

6. 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? a. Quality adjusted life year (QALY)

b. Quantity of life c. Disability adjusted life year (DALY) d. Satisfaction of life ANS: B

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.

DIF: Cognitive Level: Apply (Application)

REF: p. 210

7. Which represents a disadvantage of screening? a. Utilization of group screening methods b. Utilization of multiple test screening c. Utilization of a test with high specificity d. Utilization of a test with low sensitivity ANS: D

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.

DIF: Cognitive Level: Understand (Comprehension)

REF: pp. 208, 211

8. 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? a. Sensitivity b. Specificity c. Validity d. Efficacy ANS: C

Validity is defined as a test’s ability to distinguish correctly between diseased and nondiseased individuals.

DIF: Cognitive Level: Apply (Application)

REF: p. 211

9. The proportion of people with a condition who correctly test positive when screened is known

as a. b. c. d.

sensitivity. specificity. validity. efficacy.

ANS: A

Sensitivity refers to the proportion of people with a condition who correctly test positive when screened.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 211

10. The Denver Developmental Screening Test (DDST) has been said to have excellent test

specificity. What does this statement mean?

Rarely identifies children who have developmental delays.

Rarely identifies children who do not actually have developmental delays.

Has a large number of false positive results.

Has a large number of false negative results.

a. b. c. d.

ANS: B

Specificity measures a test’s ability to recognize negative reactions or nondiseased individuals. A test with excellent specificity will rarely be positive if the disease is not present.

DIF: Cognitive Level: Apply (Application)

REF: p. 211

11. A nurse determined the interobserver reliability of a blood pressure reading. Which of the

following describes the method that was used by the nurse? a. Blood pressure readings of 124/82 were obtained two days in a row by two

different nurses. b. Three consecutive blood pressure readings of 124/82 were obtained by the same

nurse. c. Blood pressure readings of 124/82 in the right arm and 124/82 in the left arm were

obtained. d. A blood pressure reading of 124/82 was obtained immediately followed by another

blood pressure reading of 147/92.

ANS: A

Reliability is an assessment of the reproducibility of the test’s results when different individuals with the same level of skill perform the test during different periods and under different conditions. If the same result emerges when two individuals perform the test, interobserver reliability is shown. Therefore, a care recipient with a blood pressure reading of 124/82 two days in a row by two different nurses is an example of interobserver reliability.

DIF: Cognitive Level: Apply (Application)

REF: p. 211

12. A nurse is using a sweat test to screen people for cystic fibrosis. Which of the following

results demonstrates poor sensitivity? a. When 6 out of every 10 sweat tests performed are negative, but the six individuals

actually have cystic fibrosis. b. When 6 out of every 10 sweat tests performed are positive, but the six individuals

do not actually have cystic fibrosis. c. When 6 out of every 10 sweat tests performed are negative, and the six individuals really do not have cystic fibrosis. d. When 6 out of every 10 sweat tests performed are positive, and the six individuals really do have cystic fibrosis.

ANS: A

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.

DIF: Cognitive Level: Apply (Application)

REF: p. 211

13. A nurse is creating a hypertension screening program. Which of the following methods would

be the best way to design a successful program?

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.

a. b. c. d.

ANS: A

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.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 212

14. 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?

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

a. b. c. d.

ANS: A

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.

DIF: Cognitive Level: Apply (Application)

REF: p. 213

15. A nurse is implementing a test that screens for hypercholesterolemia. Which of the following

parameters should this test have?

No cutoff point Low cutoff point Intermediate cutoff point High cutoff point

a. b. c. d.

ANS: B

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.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 214

16. During a screening, a test with a high specificity and low sensitivity is utilized. Which of the

following issues could arise by using this test?

Ethical issues Race issues Gender issues Cultural issues

a. b. c. d.

ANS: A

Misinterpretation caused by screening instruments is of great ethical concern. A difficult ethical issue in screening is determining whether the benefits received by those who receive correct results are worth the problems experienced by those who receive incorrect results. In this case, the high specificity of the test would result in low false-positive rates and would correctly identify nondiseased individuals. However, the low sensitivity would result in a high false-negative rate and therefore would miss a large number of people who are actually positive, resulting in ethical issues.

DIF: Cognitive Level: Apply (Application)

REF: p. 211

17. 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? a. Cost-disease analysis b. Cost-efficiency analysis c. Cost-benefit ratio analysis d. Cost-effectiveness analysis ANS: C

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.

DIF: Cognitive Level: Apply (Application)

REF: p. 215

18. Which of the following analyses is used to determine the optimal use of resources to reach a

predetermined constant end-point or the desired health outcome?

Cost-benefit ratio analysis Cost-effectiveness analysis Cost-efficiency analysis Cost-disease analysis

a. b. c. d.

ANS: B

An analysis that determines the optimal use of resources to reach a predetermined, constant end-point or the desired health outcome is known as cost-effectiveness analysis.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 215

19. Which of the following is an example of a screenable population for hypertension? a. High school students b. Professional hockey players c. High-level business executives attending an annual conference d. Cardiac rehabilitation clients ANS: C

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.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 215

20. A nurse is assessing a low-income population in a community. Which of the following would

be most appropriate for this population?

HIV screening Blood pressure screening Colorectal cancer screening Breast cancer mammography screening

a. b. c. d.

ANS: B

According to a 2010 Gallup poll, “Low-income Americans are more likely than their highincome 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.”

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 216

21. A nurse is working at a women’s health clinic and is asked by a care recipient when she

should return for her next Pap test. Which of the following resources would the nurse use to find the most current recommendations? a. National Health Information Center b. Healthy People 2020 c. US Preventive Services Task Force (USPSTF) website d. Centers for Disease Control and Prevention (CDC) website ANS: C

The most current information about recommendations for screening tests can be found on the Agency for Healthcare Research and Quality (AHRQ) US Preventive Services Task Force (USPSTF) website. These recommendations evolve as new scientific evidence becomes available.

DIF: Cognitive Level: Apply (Application)

REF: p. 217

22. A nurse is educating a 26-year-old, sexually active, female care recipient about preventive

care and health screening. Which of the following screening services would the nurse include in this discussion? a. Osteoporosis screening b. HIV screening c. Ovarian cancer screening d. All of the above.

ANS: B

One result of the Affordable Care Act that was passed in 2010 was the movement toward prevention and health promotion. One result is that preventive services are required to be covered by new health insurance plans or policies. When covered by a network provider, HIV screening must be provided by insurance plans without copayment or co-insurance.

Osteoporosis is not a problem for young women. Accordingly, screening for this condition would not be covered, nor would it be recommended for a young woman, age 26. Unlike cervical cancer screening which is covered, ovarian cancer screening is not a mandated covered service. By contrast, HIV screening is, indeed, covered in this context. Since the patient is sexually active, it would be appropriate screening for her and the nurse would include it in the discussion.

DIF: Cognitive Level: Apply (Application)

REF: p. 218

23. 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? a. Obtaining blood pressures and distributing free BP home measuring devises b. Obtaining blood pressures and family histories during a screening c. Obtaining blood pressures and discussing the importance of exercise during a screening d. Obtaining blood pressures and scheduling follow up visits with a hypertension clinic.

ANS: C

The combined nursing roles of health educator and screener means that the nurse continues to educate individuals about risk factors and teach them ways to alter and reduce risks generally through lifestyle changes, such as proper diet, exercise, and stress management, and by limiting the use of alcohol, drugs, and tobacco. The role as educator is essential in the screening process, because nurses provide individuals with the information necessary for choices they will make regarding healthy behavioral change. The nurse is actually practicing primary prevention interventions, but it is in coordination with a secondary preventive role.

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.

DIF: Cognitive Level: Apply (Application)

REF: p. 221

24. Which of the following statements regarding screening for Down’s Syndrome via blood work

is NOT accurate?

It is an invasive but highly accurate test.

It can detect occult maternal cancer.

It is a form of genomic testing.

It has decreased the incidence of amniocentesis.

a. b. c. d.

ANS: A

Prenatal screening on blood samples is becoming the norm and reducing amniocentesis testing. This less invasive blood test determines whether the fetus has a chromosomal abnormality (Down syndrome-chromosome 21, or other chromosomes-13, 18, X & Y) by testing free DNA. If the finding is abnormal, amniocentesis is used to confirm the original result. In this study, of 125, 426 blood samples, 3% were found to be abnormal.

What is interesting about this study is that this prenatal screening may not only identify problems in the fetus but also identify problems in the mother’s cells’ arrangement indicative of cancer. From the set of 3757 abnormal fetal results, 10 cases of maternal cancer were found. The uses of genomic testing are just beginning to be realized and may lead in directions unexpected from the original purpose of the screening.

While less accurate as a method of chromosomal abnormality detection, the screening via blood work is far less invasive than amniocentesis. Accordingly, blood work testing has cut down on the need for more invasive screening. Only care recipients with positive results for the blood work need have the amniocentesis procedure. As an additional benefit, the blood work testing can detect cases of occult maternal malignancies.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 212, Box 9-1

25. Which of the following plans is appropriate when planning and implementing a health

screening event directed at diverse and minority populations? a. Provide a standard care approach for everyone in the interest of equality for all

persons. b. Partner with key individuals and organizations c. Provide pre-screening sessions to help diverse populations integrate with the

mainstream culture. d. Insure that all personnel at the screening site are members of minority populations.

ANS: B

In order to plan, implement, and evaluate a screening program that targets a specific population, the provider must have an awareness of the target population that includes components such as lifestyle, socioeconomic characteristics, education, heredity, environmental factors, values, religious and cultural beliefs, communication style, and language. Partnering with key individuals and organizations in the community through the entire process is important for any screening program to be successful. In order for screening to be successful, care must be adapted to particular cultures. Partnering with key individuals and organizations within such culture is likely to facilitate success for a screening program.

Adhering to a one-size fits all, i.e., standard care and offering sessions with a goal toward facilitating integration with mainstream culture are likely to be counterproductive in this context. The goal of this program is not to assist persons to integrate into mainstream culture.

Neither is it necessary to utilize only minority persons to staff the screening site.

DIF: Cognitive Level: Apply (Application)

REF: p. 216, Box 9-3

26. Which of the following goals would be consistent with Healthy People 2020, as it pertains to

screening and health promotion?

Promoting mammography for all women Encourage colonoscopy to screen for colorectal cancer for all adults Educate high-school students regarding sun safety Increase screening via cat scans to detect for brain tumors.

a. b. c. d.

ANS: C

Increase the proportion of elementary, middle, and senior high schools that provide school health education to promote personal health and wellness in the following areas: handwashing or hand hygiene; oral health; growth and development; sun safety and skin cancer prevention; benefits of rest and sleep; ways to prevent vision and hearing loss; and the importance of health screenings and check-ups.

Healthy People 2020 emphasizes screening but promotes such screening based on current guidelines. Accordingly, mammography for all women and colonoscopy for all adults is not appropriate nor is it consistent with current guidelines. By contrast, all high-school students would benefit from education on sun screening and skin cancer prevention. This goal, in fact, is a part of the published objectives. Cat-scan screening for brain tumors is neither recommended nor part of the Healthy People 2020 goals and guidelines.

DIF: Cognitive Level: Apply (Application)

REF: p. 217, Box 9-4

27. Which of the following screening parameters is NOT included among recommended

preventative screening services for children and adolescents?

Anemia screening Screening for high blood pressure in children Screening or major depressive disorder Screening for IQ in children

a. b. c. d.

ANS: D

Guidelines are published which advise clinicians regarding recommended screening for children and adolescents. Screening is directed at early detection of disease so as to initiate early treatment and minimize sequelae of disease. Screening for anemia, hypertension, and depression are all included in the list of recommended screening parameters. Determining the IQ of the child is not included and moreover not in keeping with the concept of early detection of disease states.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 217, Box 9-4

28. Which of the following statements is correct regarding the Pender Health Promotion model? a. The model assists to identify factors which will influence behavioral changes. b. The model promotes health through standard, time-tested strategies. c. The model avoids asking subjective questions thus is non-threatening to the care

recipient. d. The model is excellent for screening but less useful for teaching or primary

prevention.

ANS: A

The health-promotion model is a useful guide for practice. The model presents the interrelationship among behavior-specific cognitions and affective factors and individual characteristics and experiences that motivate individuals to engage in behaviors that promote health and decrease unsafe habits and practices. The health care provider may find that the application of this model in practice influences the relationship between the provider and the individual in a positive way. The model is a framework that assists the provider in assessing factors believed to influence health behavioral changes. Once the provider has an accurate assessment, obtained via questions, decisions may be made concerning factors that inhibit health-promoting behaviors and, ultimately, potential interventions to assist individuals in achieving positive health outcomes. This information will assist the provider to develop appropriate teaching methods. The model supports an individual approach directed at strategies best suited to the individual after the patient has answered a series of subjective questions. The model provides an excellent framework for teaching health promotion based on the assessment it facilitates.

DIF: Cognitive Level: Apply (Application)

REF: p. 219, Box 9-8

29. REACH (Racial and Ethnic Approaches to Community Health) provides strategies to facilitate

health promotion within to diverse populations. The common thread to all of these strategies is a. providing mentorship. b. building trust. c. creating safe and crime-free communities. d. decreasing poverty and economic disparities.

ANS: B

Trust: Build a Culture of Collaboration with Communities that IS Based on Trust. The other choices depict objectives which are desirable in their own right within the context of community improvement but they are not a part of the REACH paradigm. REACH has been developed by the Centers for Disease Control and Prevention as a strategy to promote community health.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 221, Box 9-9

MULTIPLE RESPONSE 1. Which of the following is an example of screening? (Select all that apply.) a. Asking if someone performs self-breast exam b. Performing a self-breast exam c. Obtaining a mammogram d. Undergoing a needle biopsy ANS: B, C

Screening is an important component of clinical preventive services, because it is a valuable tool for health care professionals to identify chronic conditions and risk factors before the condition becomes costly both in financial terms and in quality of life. This is particularly important as the health care paradigm shifts from medical and volume-based, to a healthpromotion and value-based model of care. Although health education about screening is categorized as part of the rubric of primary prevention, the actual process of screening is part of secondary prevention.

Screening is not considered a diagnostic measure. The ultimate goal could be curative, but more often, it is to prevent further development of the condition or disease. Screenings are done by oneself, or can be clinical, procedural, or lab based. Performing a self-breast exam and obtaining a mammogram are examples of screening. Asking if someone performs a selfbreast exam may increase awareness but does not screen for disease. A needle biopsy would be diagnostic.

DIF: Cognitive Level: Apply (Application)

REF: p. 208

2. A nurse is assessing a community and is trying to determine the appropriateness of conducting

a Type 2 diabetes screening in the community. Which of the following questions would the nurse need to answer when making this decision? (Select all that apply.) a. Is Type 2 diabetes considered a community problem? b. What are the health benefits of screening for Type 2 diabetes? c. Can Type 2 diabetes be detected by screening? d. What are the tangible and intangible costs?

ANS: A, B, C, D

The selection of a screened diseases goes beyond examination of any disease alone. The potential uncertainties confounding the decision to screen emphasize the need to conduct an analysis of available material to obtain a decision that is as objective and scientific as possible.

Answers to the following questions may provide a basis for designating a disease as screenable or nonscreenable: · Does the significance of the disorder warrant its consideration as a community problem? · Can the disease be detected by screening? · Should screening for the disease be done? · What are the health benefits? For example, can it be treated? · What are the tangible and intangible costs?

DIF: Cognitive Level: Apply (Application)

REF: p. 209

Chapter 10: Health Education Edelman: Health Promotion Throughout the Life Span, 9th Edition abirb.com/test

MULTIPLE CHOICE abirb.com/test

1. 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? a. Encourage Americans to stop smoking. b. Lobby for state-of-the-art magnetic resonance imagingabirb.com/test machines in all hospitals. c. Provide free medications for Americans. d. Offer free condoms to teenagers.

ANS: A

abirb.com/test

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 abirb.com/test 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. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 225

2. A nurse is using a health-education component when teaching about smoking cessation.

Which of the following actions is the nurse implementing?abirb.com/test a. Setting a quit date for people in a smoking cessation class b. Providing education regarding the benefits of smoking cessation c. Allowing smokers to participate in a smoking cessation program only if they use abirb.com/test the patch nicotine replacement system d. Encouraging attendees of a smoking cessation program to participate in a research study abirb.com/test

ANS: B

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 abirb.com/test 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. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 226

3. Any combination of planned experiences based on sound theories that provide individuals, abirb.com/testand skills needed to make groups, and communities the opportunity to acquire the information quality health decisions is known as health a. promotion. b. counseling. abirb.com/test c. education. d. knowledge.

ANS: C

abirb.com/test

abirb.com/test

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 abirb.com/test quality health decisions is known as health education.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 226

abirb.com/test 4. An overweight woman joins a support group to help her lose weight. During her first session,

the nurse explains the components of a healthy diet and discusses with the woman how she can eat out and still maintain a healthy diet. She asks the woman what her goal is and emphasizes that she herself is the key to success. What is the nurse promoting through the use abirb.com/test of this strategy? a. Communication b. Values abirb.com/test c. Advanced planning d. Empowerment ANS: D abirb.com/test A goal of health education is empowerment. People who believe they can make a difference in their own health and who are included in decision-making are more likely to make changes.

By giving the woman the tools (education about a healthy diet) and involving her in the decision-making (set her own goal), the nurse empowers the woman to make a change in her abirb.com/test eating habits.

DIF: Cognitive Level: Apply (Application)

REF: p. 227 abirb.com/test

5. Which of the following illustrates that the objectives of health education and counseling are

being met? a. Diabetic who attends a diabetes education program abirb.com/test b. Diabetic who watches a video about self-administration of insulin c. Diabetic who starts taking his medications regularly d. Diabetic who is admitted in diabetic ketoacidosis abirb.com/test

ANS: C

Health education encourages positive, informed changes in lifestyle behaviors that prevent acute and chronic disease, decrease disability, and enhance wellness. Two main objectives of abirb.com/test 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.

DIF: Cognitive Level: Analyze (Analysis)

abirb.com/test

REF: p. 227

6. Which of the following illustrates that the objectives of health education and counseling have abirb.com/test been met? a. Asthmatic who has a decrease in emergency department visits b. Asthmatic who has been prescribed an albuterol inhaler c. Asthmatic who attends an asthma education program abirb.com/test d. Asthmatic who visits the emergency department with an exacerbation

ANS: A abirb.com/test

abirb.com/test

Health education encourages positive, informed changes in lifestyle behaviors that prevent acute and chronic disease, decrease disability, and enhance wellness. Two main objectives of abirb.com/test 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. abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 227

7. A teenager, who lives at home with her parents and school-aged brother, has been diagnosed abirb.com/test

with anorexia nervosa. Which of the following would be the most appropriate teaching goal for this family? a. Increased energy level abirb.com/test b. Improved coping c. Enhanced self-esteem d. Facilitated family conversation ANS: B

abirb.com/test

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 abirb.com/test 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. abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 228

8. Which of the following describes a nurse with a perspective consistent with an ecological abirb.com/test

model of health behavior? a. A nurse who considers the role of the individual’s church on healthcare choices b. A nurse who focuses on genetic determinants and genomic screening for health abirb.com/test promotion c. A nurse who recognizes that perceptions are neither reliable nor valid in promoting heath d. All of the above are consistent with an ecological model of health behavior. abirb.com/test ANS: A

The process of health education directs people toward voluntary changes of their health behaviors. Viewing health behavior through an ecologicalabirb.com/test model, the nurse recognizes the complex interaction of individuals with their environment and the multiple influences of the individual, the interpersonal group, and the community on health behavior. This section examines the use of commonly used models of individual health behavior change. Community abirb.com/test and group models in health-education planning are addressed later in this chapter.

An individual’s church is one of many community influences which affect health behavior.

The ecological model recognizes the role of the individual’s environment—which would include church and religious affiliation on health behavior.abirb.com/test Genetic determinants and genomic screening, while valid concepts in their own right, are not environmental influences which might affect a person’s health behavior. Perceptions held by an individual are, indeed, valid considerations in promoting health—regardless of whether such perceptions are accurate or abirb.com/test inaccurate. The nurse must absolutely consider the individual’s pre-existing health perceptions when formulating strategies for health promotion. abirb.com/test

REF: p. 229 abirb.com/test

9. Which of the following would be consistent with viewing health behavior through an ecologic

model? a. Viewing health in terms of energy saving focus. abirb.com/test b. Viewing health in terms of an individual’s inner feelings. c. Viewing health in terms of an individual’s interaction with their environment. d. Viewing health in terms of an individual achieving self-actualization.

ANS: C

abirb.com/test

Viewing health behavior through an ecological model, the nurse recognizes the complex interaction of individuals with their environment and the multiple influences of the individual, the interpersonal group, and the community on health behavior. abirb.com/test Choice “C” which views health in terms of the individual’s interaction with their environment would be consistent with this concept. Having an energy-saving focus is not relevant in this context. A focus on an individual’s inner feelings does not speak to interaction with the abirb.com/test environment. Similarly, achieving self-actualization is a concept from Maslow’s Hierarchy of Needs theory and is not relevant in this context.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 229 abirb.com/test

10. 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. abirb.com/test Which of the following considerations will need to be made? a. How empowerment can be used to motivate community members b. How modeling can be used in the community to increase public awareness c. Perceived susceptibility in the community about getting influenza abirb.com/test d. Perceived stage of behavior change that exists in the community ANS: C

The components of the health belief model that need to beabirb.com/test 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 orabirb.com/test culture, medical history, or other causes; perceived benefits of health action; perceived barriers to promotion action.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 229

abirb.com/test

11. Which of the following emphasizes that an individual’s belief in being personally capable of

performing the behavior is required to influence one’s own health? a. Social cognitive theory abirb.com/test b. Self-efficacy theory c. Health belief model d. Transtheoretical model abirb.com/test

ANS: A

The model that emphasizes an individual’s belief in being personally capable of performing the behavior required to influence one’s own health is known as the social cognitive theory. abirb.com/test

abirb.com/test

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 229

12. A nurse is counseling a teenager who smokes one pack of abirb.com/test 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 abirb.com/test a. precontemplation stage of change. b. preparation stage of change. c. action stage of change. d. maintenance stage of change. abirb.com/test ANS: A

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 abirb.com/test 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.

DIF: Cognitive Level: Apply (Application)

abirb.com/test REF: p. 229

13. An overweight woman is in the preparation stage of change. Which of the following

interventions would be the most appropriate for the nurse abirb.com/test to implement? a. Inform her of the health risks associated with being overweight. b. Prepare her for the setbacks. c. Develop a low-calorie/low-fat diet with her so she can follow it at home. abirb.com/test d. Praise her for her recent successes.

ANS: C

A person in the preparation stage of change has made a change or is seriously thinking about abirb.com/test 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 abirb.com/test a diet. Enlisting her cooperation achieves better results.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 229 abirb.com/test

14. 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? abirb.com/test a. A speed limit sign b. Having his parents telling him not to speed c. A previous traffic violation for speeding abirb.com/test d. Seeing someone get pulled over for speeding ANS: C abirb.com/test

abirb.com/test

abirb.com/test

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 abirb.com/test 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 abirb.com/test 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, abirb.com/test teenagers believe they are invincible and therefore would probably not be effective in this age group.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 230

abirb.com/test

15. 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? a. He is a Catholic. abirb.com/test b. His wife recently died from breast cancer. c. Buying alcohol is expensive. d. He was educated on the dangers of excessive drinking. abirb.com/test

ANS: B

Effective health education requires an understanding of the influential factors affecting the individual’s decision-making. These factors include values, beliefs, attitudes, life stresses, abirb.com/test 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. abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 230

16. A nurse is educating a group of adults who are attempting smoking cessation. Which abirb.com/test intervention would be most effective for the nurse to implement? a. Give the group members a handout on the dangers of smoking. b. Set a quit date with the group and determine which pharmacological method is most suitable for group members. abirb.com/test c. Provide a month’s supply of nicotine replacement to use before the next visit. d. Have a guest speaker who has been diagnosed with lung cancer speak to the group.

ANS: B

abirb.com/test

Educators can increase a person’s motivation and capabilities to change by involving the person in the planning and goal setting. By picking a quit date and developing an action plan with the person, the educator is positively influencing the person’s motivation level. abirb.com/test Education alone is not enough to influence change.

DIF: Cognitive Level: Analyze (Analysis) 17. The primary objective of social marketing is to a. plan behavior. b. analyze behavior. c. limit behavior. d. change behavior.

REF: p. 230 abirb.com/test

abirb.com/test

abirb.com/test

ANS: D

The primary objective of social marketing is to change behavior.

abirb.com/test

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 231

18. A nurse distributes a demographic questionnaire to attendees of a weight management abirb.com/test

program. Which step in the teaching–learning process is being implemented? a. Assessment b. Development abirb.com/test c. Implementation d. Evaluation ANS: A

abirb.com/test 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.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 232

19. The goal for the educational session is for the individual to correctly demonstrate proper abirb.com/test technique for checking blood sugar levels. Which of the following teaching strategies would be most effective? a. Provide the individual with one-on-one education about blood sugar monitoring. b. Provide the individual with a scenario about blood sugar monitoring. abirb.com/test c. Provide the individual with the opportunity to practice blood sugar monitoring. d. Provide the individual with a blood sugar monitor.

ANS: C

abirb.com/test

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 abirb.com/test strategies allow the nurse to provide the individual with feedback and encouragement.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 235

abirb.com/test 20. The goal for the educational session is to have the individual explain when he should check

his blood sugar level. Which of the following teaching strategies would be most effective for the nurse to implement? a. Provide the individual with one-on-one education about blood sugar monitoring. abirb.com/test b. Provide the individual with a scenario about blood sugar monitoring. c. Provide the individual with the opportunity to practice blood sugar monitoring. d. Provide the individual with a blood sugar monitor. abirb.com/test

ANS: A

Teaching is directed toward one or more of the three learning domains. The goal of having the individual explain when to monitor blood sugar levels relates to the cognitive domain, and it abirb.com/test is best achieved by using strategies such as lecture, one-on-one education, and discussion.

This allows the educator to provide the individual with a large amount of information at one time. abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 235

abirb.com/test

21. The goal is for the individual to verbalize the importance of checking blood sugar levels.

Which of the following strategies would be best for the nurse to implement to achieve this abirb.com/test goal? a. Provide one-on-one education about blood sugar monitoring. b. Provide the individual with a scenario about blood sugar monitoring. c. Provide the individual with the opportunity to practiceabirb.com/test blood sugar monitoring. d. Provide the individual with a blood sugar monitor.

ANS: B

abirb.com/test

Teaching is directed toward one or more of the three learning domains. The goals of having the individual verbalized the importance of checking blood sugar levels relates to the affective domain. Teaching strategies for this domain include role modeling and role playing. Such strategies allow the individual to formulate appropriate responses, attitudes, and feelings. abirb.com/test DIF: Cognitive Level: Analyze (Analysis)

REF: p. 235

22. A nurse is developing learning objectives for an individualabirb.com/test who has been placed on a low-fat,

low-cholesterol diet. Which is an example of an appropriately written cognitive learning objective? a. The individual will understand the importance of a low-fat, low-cholesterol diet. abirb.com/test b. The individual will correctly identify and purchase low-fat, low-cholesterol foods. c. The individual will believe that his heart will benefit from a low-fat, low-cholesterol diet. abirb.com/test d. The individual will feel healthier if he follows a low-fat, low-cholesterol diet.

ANS: B

Cognitive learning refers to the development of new facts or concepts and builds on or applies abirb.com/test 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. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 233

23. A nurse is developing learning objectives for an individual who is becoming more physically abirb.com/test active. Which of the following is an example of an appropriately written affective learning objective? a. The individual will understand the importance of daily exercise. b. The individual will demonstrate the importance of daily exercise. abirb.com/test c. The individual will verbalize the importance of daily exercise. d. The individual will believe in the importance of daily exercise.

ANS: C

abirb.com/test

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 abirb.com/test indicate observable learning. Verbalizing the importance of daily exercise alludes to the recognition of the value of daily exercise to the individual.

DIF: Cognitive Level: Apply (Application)

REF: p. 233

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24. 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 abirb.com/test objective? a. The individual will understand how to correctly use an inhaler. b. The individual will realize the importance of using an inhaler correctly. c. The individual will feel better when using the inhaler correctly. abirb.com/test d. The individual will demonstrate proper use of the inhaler.

ANS: D

Psychomotor learning involves developing physical skills from simple to complex. Objectives abirb.com/test 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. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 233

25. A nurse plans to use lectures, handouts, and a video to teach a group of teenagers the abirb.com/test importance of safe sex practices. Which step in the teaching–learning process is the nurse demonstrating? a. Assessment b. Development abirb.com/test c. Implementation d. Evaluation

ANS: B

abirb.com/test

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. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 232, Box 10-7

26. A nurse is providing health education about the importance of dental health to Latino abirb.com/test

residents in a community. Which of the following considerations should be made to promote health literacy within this program? a. Use simple, every day words. abirb.com/test b. Refer the client to an interpreter. c. Avoid using words in person’s language as this appears condescending. d. Consider methods to facilitate empowerment.

ANS: A

abirb.com/test

Box 10-6, in the textbook, addresses the issue of teaching when there is a language barrier.

The following strategies are recommended: • Use courtesy and a formal approach. abirb.com/test • Address the person by his or her last name.

• Introduce yourself, pointing to yourself as you give your name.

• Project a friendly attitude with a smile and a handshake. abirb.com/test • Speak with a moderate tone and volume.

• Attempt to use words in the person’s language, which indicates respect for the individual’s culture. abirb.com/test • Use simple, everyday words rather than complex words, medical jargon, or colloquialisms. abirb.com/test

• • • • •

Use hand gestures to help the person understand.

Instruct the person in small increments.

Have the person demonstrate understanding of the abirb.com/test message.

Provide written instructions for the person to take home.

When available, use flash cards and phrase books in other languages. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 232, Box 10-6

27. Which of the following would be correct with respect to the concept of social justice in the abirb.com/test context of health promotion? a. A social justice view allocates kidneys to persons who had no fault in losing renal function. b. A social justice lens can identify the structural cause of targeted health disparities. abirb.com/test c. Social justice initiatives serve to stigmatize low income and minority persons. d. Social justice measures can risk compromising self-determination.

ANS: B

abirb.com/test

The three lenses used to organize the community to advocate for a healthy sustainable environment included (1) social justice, (2) culture-place, and (3) organizational capacity-organizing approach. Social justice refers to fair treatment, equal access to goods and resources, and the right to self-determination and cultural abirb.com/test expression for all people. The social justice lens is used to identify the structural cause of the targeted health disparity.

Allocation of organs is a complex issue. The organizations responsible for determining the allocation protocols seek to find the just and equitable systems for determining who gets abirb.com/test organs. Inequalities concerning qualifications for organ transplants, especially ones which would factor in a person’s past status, would not be in keeping with a notion of fair treatment and equal access to goods and resources. Social justice measures strive to eliminate health abirb.com/test disparities which commonly plague low income and minority populations. Far from stigmatizing such populations, the initiatives serve improve their access to health care.

Finally, there is nothing about the concept of social justice which would compromise the self-determination of persons. In fact, the basic concept ofabirb.com/test social justice serves to promote the right to self-determination for all people.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 227, Box 10-2 abirb.com/test

MULTIPLE RESPONSE 1. A nurse is developing health-education content for an educational session with adults about abirb.com/test

the prevention of cardiovascular disease. Which of the following domains should be considered when developing the teaching plan? (Select all that apply.) a. Cognitive abirb.com/test b. Psychomotor c. Gross motor d. Affective ANS: A, B, D

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The three domains of health education are cognitive, affective, and psychomotor.

DIF: Cognitive Level: Apply (Application)

REF: p. 233 abirb.com/test

abirb.com/test

2. A nurse is providing a group presentation about the importance of healthy eating. Which of

the following activities must be addressed to ensure an adequate learning climate? (Select all abirb.com/test that apply.) a. Creating a sense of preparedness and organization b. Planning for alternative learning activities c. Assessing group needs abirb.com/test d. Observing group interactions ANS: A, C, D

Several activities need to be addressed in group presentations. They include creating a sense abirb.com/test of preparedness and organization; anticipating group needs; assessing group needs; maintaining a high level of motivation and a sense of individualized attention and progression; and observing group interactions. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 235

3. A nurse is developing an educational session for adolescents related to avoidance of risky abirb.com/test behaviors. Which of the following steps of the teaching–learning process will need to be considered? (Select all that apply.) a. Assessment b. Diagnosis abirb.com/test c. Development d. Implementation

ANS: A, C, D

abirb.com/test

Steps in the teaching–learning process include assessment, development of learning outcomes and teaching plan, implementation of the teaching plan, and evaluation of expected outcomes.

DIF: Cognitive Level: Apply (Application)

abirb.com/test REF: p. 232, Box 10-7

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abirb.com/test

Chapter 11: Nutrition Counseling for Health Promotion Edelman: Health Promotion Throughout the Life Span, 9th Edition abirb.com/test

MULTIPLE CHOICE abirb.com/test

1. Which of the following statements about the current prevalence of obesity is accurate? a. The current generation of children may be less healthy and have a shorter life

expectancy than their parents. b. The current incidence of obesity among American adults has stabilized. abirb.com/test c. The current statistics show that greater than 75% of American adults are either

overweight or obese. d. The current statistics report that about 50% of American children are either

overweight or obese.

abirb.com/test

ANS: A

Because of the increasing rates of obesity, unhealthy eating habits, and physical inactivity, we abirb.com/test 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. abirb.com/test

DIF: Cognitive Level: Understand (Comprehension)

REF: p. 241

2. A nurse is working with a family that is experiencing food insecurity. Which of the following abirb.com/test statements best describes this family? a. Members of this family are susceptible to food-borne illness. b. This family’s access to adequate food is limited by lack of money. c. This family is unable to purchase fresh fruits and vegetables. abirb.com/test d. Members of this family are obese.

ANS: B

When a family experiences food insecurity, it means that their access to adequate food is abirb.com/test 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. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: pp. 243, 245

3. Which of the following statements about the dietary reference intakes (DRI) is correct? abirb.com/test a. The DRI is used to monitor deficiencies in nutritional intakes of obese populations. b. The DRI is used to establish minimal amounts of nutrients needed to protect

against nutrient deficiency. abirb.com/test c. The DRI is used to plan and assess diets of healthy people. d. The DRI is used to set minimal guidelines to reduce risk of adverse outcomes from inadequate consumption of nutrients.

ANS: C

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The DRI are a set of values for the dietary nutrient intakes of healthy people in the United States and Canada. They are used for planning and assessing diets. The four sets of values abirb.com/test included in the DRI are Recommended Daily Allowance (RDA), Adequate Intake, Estimated Average Requirement, and Tolerable Upper Intake Levels. The previous RDA, which existed before 1997, established minimal amounts of nutrients needed to protect against nutrient deficiency. abirb.com/test

DIF: Cognitive Level: Understand (Comprehension)

REF: p. 245

4. A community health nurse is using the dietary reference intakes (DRIs) as a guide while abirb.com/test

developing an education presentation about nutrition for a community group. How will the use of the DRIs be helpful in developing this presentation? a. It considers the unique differences among children, pregnant women, and elderly abirb.com/test people. b. It contains well-researched data that are reviewed on an annual basis. c. It is prescriptive in the amount of nutrients that are needed on a daily basis. d. It serves as an overall guideline for the population. abirb.com/test ANS: D

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 abirb.com/test 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 abirb.com/test women, and elderly people.

DIF: Cognitive Level: Apply (Application)

REF: p. 245 abirb.com/test

5. After the 2015–2020 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? a. Consumption of increased amounts of carbohydrates abirb.com/test b. Follow healthy eating patterns across the life span c. Revised guidelines for the use of MyPyramid d. Inclusion of physical activity standards abirb.com/test ANS: B

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 abirb.com/test 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, abirb.com/test and seeds.

DIF: Cognitive Level: Apply (Application)

REF: pp. 245, 246 abirb.com/test

6. A community health nurse is educating a community group about the 2015–2020 Dietary

Guidelines for Americans. Which of the following information would be included in this presentation? a. Limit consumption of dairy products. abirb.com/test b. Purchase organic fruits and vegetables. abirb.com/test

c. Choose nutritionally dense food and beverages. d. Consume fish on a weekly basis.

ANS: C

abirb.com/test

Dietary Guidelines for American 2015–2020 (DGAC) Key recommendations from the 2015–2020 DGAC include to abirb.com/test 1. follow a healthy eating pattern across the life span.

All food and beverage choices matter. Choose a healthy eating pattern at an appropriate calorie level to help achieve and maintain a healthy body weight, support nutrient adequacy, and reduce the risk of chronic disease. abirb.com/test 2. focus on variety, nutrient density, and amount. To meet nutrient needs within calorie limits, choose a variety of nutrient-dense foods across and within all food groups in recommended amounts.

3. limit calories from added sugars and saturated fatsabirb.com/test and reduce sodium intake.

Consume an eating pattern low in added sugars, saturated fats, and sodium. Cut back on foods and beverages higher in these components to amounts that fit within healthy eating patterns. abirb.com/test 4. shift to healthier food and beverage choices. Choose nutrient-dense foods and beverages across and within all food groups in place of less healthy choices. Consider cultural and personal preferences to make these shifts easier to accomplish and abirb.com/test maintain.

5. support healthy eating patterns for all. Everyone has a role in helping to create and support healthy eating patterns in multiple settings nationwide, from home to school to work to communities. abirb.com/test Other messages include “make at least half of your grains whole grains,” and “switch to fat-free or low-fat (1%) milk.” There is not an essential message to consume fish on a weekly basis. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 246

7. A person asks the nurse: “Why was MyPyramid replaced with MyPlate?” Which of the abirb.com/test

following would be the best response from the nurse? a. “The USDA is constantly making changes in order to decrease the alarming rates of obesity in our country.” b. “MyPyramid” was developed in 2005, so it was time for this graphic to be abirb.com/test revised.” c. “The creation of MyPlate has decreased the need for additional teaching resources for nutrition.” abirb.com/test d. “MyPlate serves as a better visual aid, reminding Americans what a healthy ‘plate’ looks like.”

ANS: D

abirb.com/test

MyPlate 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. abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 247

8. A person asks the nurse if it is safe to use dietary supplements. Which of the following would abirb.com/test be the best reply from the nurse? a. “It is important to be cautious when using any supplements.”

abirb.com/test

b. “All dietary supplements must be approved by the FDA before they can be sold

and are safe.” c. “No, dietary supplements have very limited regulationsabirb.com/test and should not be used.” d. “Be sure to read the product label before using the supplement to see what health

claims have been made by the product.”

ANS: A

abirb.com/test

The desirable way for the general public to obtain recommended levels of nutrients is by eating a variety of foods. Low-dose supplements that contain the recommended intakes for micronutrients appear to be generally safe. Caution is advised when using supplements. abirb.com/test Dietary supplements are unregulated by the FDA in the sense that they do not require premarket review or approval by the FDA. DIF: Cognitive Level: Apply (Application)

REF: p. 247 abirb.com/test

9. A woman has asked the nurse about the benefits and risks of using ginseng to control her hot

flashes associated with menopause. Which of the following governmental offices would most likely serve as a resource to answer the woman’s question?abirb.com/test a. American Dietetic Association (ADA) b. National Center for Complementary and Alternative Medicine (NCCAM) c. Food and Drug Administration (FDA) abirb.com/test d. United States Department of Agriculture (USDA) ANS: B

The National Center for Complementary and Alternative Medicine (NCCAM) promotes and abirb.com/test conducts the scientific study of the benefits and risks of dietary supplements, including medicinal herbs, in health maintenance and disease prevention.

DIF: Cognitive Level: Apply (Application)

abirb.com/test REF: p. 247

10. 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? abirb.com/test a. “Postmenopausal women should take a calcium supplement to prevent osteoporosis.” b. “Many people use supplements as drugs instead of as supplements.” abirb.com/test c. “Supplements can enhance the medications that you take.” d. “The best way to obtain nutrients is by eating a variety of foods.”

ANS: D abirb.com/test The desirable way for the general public to obtain nutrients is by eating a variety of foods.

Dietary supplements need to be used cautiously so that excess amounts are not consumed, which could lead to possible adverse effects.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 248

11. A care recipient who is taking Coumadin tells the nurse that she has started taking a vitamin E abirb.com/test 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? a. “Vitamin E supplements are unnecessary, so I don’t recommend you use this supplement.” abirb.com/test b. “Vitamin E can interfere with the actions of vitamin K and enhance the effects of

abirb.com/test

Coumadin.” c. “Vitamin E supplements can interfere with the absorption of iron and create abirb.com/test additional health problems.” d. “Vitamin E must be used cautiously, as it is easy to experience a toxicity of this nutrient.”

ANS: B

abirb.com/test

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 abirb.com/test supplement, it may be necessary to adjust the dosage of Coumadin the woman is prescribed.

DIF: Cognitive Level: Apply (Application)

REF: p. 249 abirb.com/test

12. 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? a. Unintended allergen added to food abirb.com/test b. Bacteria on the countertops c. Pesticide on the fresh fruit d. Metal shavings in the food from a dull can opener ANS: C

abirb.com/test

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). abirb.com/test DIF: Cognitive Level: Apply (Application)

REF: p. 250

abirb.com/test 13. 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? a. Wash hands thoroughly with running warm water withabirb.com/test soap for 30 seconds. b. Scrub firm services of all fruits and vegetables with a produce brush before eating. c. Pay close visual attention to assure that meat is cooked all of the way through. d. Refrigerate leftovers within 30 minutes of serving. abirb.com/test

ANS: A

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 toabirb.com/test 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 h or 1 h in temperatures abirb.com/test greater than 90° F. DIF: Cognitive Level: Apply (Application)

REF: p. 251 abirb.com/test

14. 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? abirb.com/test a. Nutrition Service Incentive Program (NSIP)

abirb.com/test

b. Supplemental Nutrition for Women Infants and Children (WIC) c. National School Lunch Program (NSLP) d. Supplemental Nutrition Assistance Program (SNAP) abirb.com/test ANS: D

Supplemental Nutrition Assistance Program (SNAP) supplements the food-buying power of abirb.com/test 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.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 252

15. A school nurse is discussing the income eligibility requirements for free and reduced-price

school meals with a family who is new to the school district.

Which of the following abirb.com/test statements would the nurse most likely make? a. “If the employed member of your family earns less than $50,000 per year, your child will qualify for reduced-price meals.” abirb.com/test b. “If your family’s income is less than 185% above the federal poverty level, your child will qualify for free or reduced-price meals.” c. “If you have more than five members living in your household, your child will qualify for reduced-price meals.” abirb.com/test d. “If your family has an income above the federal poverty level, your child will not qualify for free or reduced-price meals.”

ANS: B

abirb.com/test

Children from families with incomes greater than 130% to 185% of the federal poverty level are eligible for reduced-price school meals. Children from families with incomes at or less than 130% of the federal poverty level are eligible for free school meals. Consideration is given to both income level and number of members livingabirb.com/test in the household when interpreting the federal poverty guidelines.

DIF: Cognitive Level: Apply (Application)

REF: p. 253 abirb.com/test

16. 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? abirb.com/test a. “I drink skim milk on a regular basis.” b. “I try not to eat foods that have added salt on the label.” c. “I eat American cheese about once every 2 weeks.” d. “I add salt to many of the food that I eat to enhance theabirb.com/test flavor.”

ANS: D

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 abirb.com/test 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. abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 256

17. A 45-year-old man has been diagnosed with metabolic syndrome. Which of the following

characteristics would this man exhibit?

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a. b. c. d.

Blood pressure: 146/88 mm Hg Waist measurement: 36 inches HDL: 48 mg/dL Triglycerides: 140 mg/dL

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ANS: A

Metabolic syndrome is diagnosed when a person has threeabirb.com/test 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). abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 257

18. Which of the following individuals has a modifiable, nutrition-related abirb.com/test risk factor for stroke? a. African American man, age 65, who has a low salt intake b. White woman, age 32, who follows the MyPlate recommendations c. Russian man, age 40, who drinks 3 oz of vodka daily abirb.com/test d. Hispanic man, age 42, who exercises regularly ANS: C

Modifiable risk factors are those that the person can control. Race, age, and gender are abirb.com/test nonmodifiable risk factors. Habitual alcohol intake is a modifiable risk factor for stroke.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 258 abirb.com/test

19. 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? a. The use of this dietary plan has the same health effectsabirb.com/test as a daily exercise program. b. The use of this dietary plan will eliminate the need for medication to treat hypertension. c. This dietary plan is excludes the consumption of processed foods. abirb.com/test d. This dietary plan includes eating greater amounts of fruits and vegetables.

ANS: D

Clinical studies show that blood pressure can be lowered by following the DASH eating plan. abirb.com/test 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. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 259

20. A man states that he would like to change his dietary habits to decrease his risk of developing abirb.com/test

cancer in the future. Which of the following statements would be the best response for the nurse? a. “Consume at least cups of fruits and vegetables each day.” abirb.com/test b. “Dietary habits have minimal effect in reducing your risk of developing cancer.” c. “A glass of red wine should be consumed daily.” d. “Dietary supplements of specific nutrients will maximize the effects of dietary changes.” abirb.com/test ANS: A abirb.com/test

Eating at least 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 abirb.com/test the dietary recommendations included in the American Cancer Society Guidelines (2011) 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. abirb.com/test DIF: Cognitive Level: Apply (Application)

REF: p. 260

abirb.com/test 21. Which of the following people is at greatest risk for a hip fracture secondary to osteoporosis? a. A 66-year-old White woman b. A 66-year-old African American woman c. A 66-year-old White man abirb.com/test d. A 66-year-old African American man

ANS: A

White postmenopausal women have the greatest prevalence of osteoporosis and incidence of abirb.com/test hip fracture by gender and race.

DIF: Cognitive Level: Apply (Application)

REF: pp. 260-261 abirb.com/test

22. 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? a. BMI can be correlated to a specific percentage of body fat. abirb.com/test b. BMI can be used to help identify children who have the potential to become overweight. c. BMI can be used to determine if a child will develop Type 1 diabetes. d. BMI is higher with low muscle mass thus can identify abirb.com/test children who do not exercise enough.

ANS: B

The BMI is an early warning signal that is helpful as earlyabirb.com/test as age 2 years to help identify children who have the potential to become overweight. Early identification of obesity risk gives parents the opportunity to modify their family eating and activity patterns before their children develop a weight problem. abirb.com/test 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 healthabirb.com/test 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. BMI is higher (not lower) with high muscle mass; thus, choice D is not correct. BMI cannot be used to predict whether a child will develop Type abirb.com/test 1 diabetes, which is not related to obesity.

DIF: Cognitive Level: Apply (Application)

REF: p. 263 abirb.com/test

23. A community health nurse is educating health care providers in a local clinic about steps to

take to help their care recipients improve their health-related behaviors. Which of the following would be included as the nurse teaches about the acronym LEARN? abirb.com/test a. Explain how small changes can affect health. b. Acknowledge that action needs to be taken. abirb.com/test

c. Negotiate an agreement. d. Refer to community resources.

ANS: C

abirb.com/test

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 abirb.com/test 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.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 264

24. Which of the following individuals would be at greatest risk to develop Type 2 diabetes? a. White, 50-year-old woman, obese, second child weighed 10 pounds at birth abirb.com/test b. African American, 55-year-old man, hypertension, exercises regularly c. Hispanic, 22-year-old woman, healthy weight, family history of diabetes d. White, 75-year-old man, history of prostate cancer and high triglycerides abirb.com/test

ANS: A

Risk factors for Type 2 diabetes include: having pre-diabetes (impaired glucose tolerance [IGT] and/or impaired fasting glucose [IFG]), age greater than 45, being overweight or obese, abirb.com/test 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 childabirb.com/test weighing 10 pounds, has the most risk factors of the clients described.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 265 abirb.com/test

25. 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? abirb.com/test a. Adjusting sliding scale insulin therapy as needed b. Taking oral hypoglycemic medication as prescribed c. Monitoring blood glucose daily abirb.com/test d. Adhering to medical nutrition therapy ANS: D

Medicine may be used to control blood glucose level, and measuring the blood glucose daily abirb.com/test 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.

DIF: Cognitive Level: Apply (Application)

REF: p. 266

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26. A nurse is conducting an initial nutritional assessment on a person who is HIV positive.

Which of the following questions would be most important for the nurse to ask? a. What fresh fruits and vegetables do you like to eat? abirb.com/test b. Are you taking a daily multivitamin? c. How often do you eat at restaurants? d. Do you have any questions about your current medications? abirb.com/test

ANS: B abirb.com/test

Evidence suggests that micronutrient deficiencies are common among those with HIV and that those not taking vitamin supplementation have increased morbidity and mortality. Thus, abirb.com/test asking about use of a daily multivitamin is the most important information for the nurse to collect. A nutrient-dense, protein-rich, well-balanced diet should be stressed as well as vitamin and mineral supplementation. Because of an altered immune function, they get sicker when exposed to food-borne organisms, so discussion about how to avoid food-borne illness abirb.com/test is also important.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 267 abirb.com/test

MULTIPLE RESPONSE 1. Which of the following causes of death is/are directly associated with diet? (Select all that abirb.com/test

apply.) a. Diabetes mellitus b. Cirrhosis of the liver c. Stroke d. Coronary heart disease (CHD)

abirb.com/test

ANS: A, C, D abirb.com/test Four leading causes of death directly associated with diet are coronary heart disease (CHD), some types of cancer, stroke, and diabetes mellitus. Four more major causes of death—accidents, cirrhosis of the liver, suicide, and homicide—are associated with excessive alcohol intake. abirb.com/test

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 240

abirb.com/test 2. A community health nurse is preparing an educational brochure about improving the

nutritional behaviors of Americans. Which of the following topics would most likely be included in the brochure? (Select all that apply.) a. Explanation of the food pyramid abirb.com/test b. Decreasing daily sodium intake c. Increasing daily intake of fruits and vegetables d. Decreasing daily intake of sugar-sweetened drinks ANS: B, C, D

abirb.com/test

Fewer than 15% of adults and 10% of adolescents eat the recommended amounts of fruits and vegetables every day. Sixty-three percent of adults and 84% of adolescents consume at least abirb.com/test one sugar-sweetened drink each day. Most American adults consume more than twice the recommended average daily sodium intake level. The food pyramid has been replaced with MyPlate.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 243

3. A community health nurse is developing educational materials related to nutrition. Which of

the following resources would be most appropriate for theabirb.com/test nurse to use? (Select all that apply.) a. FDA pre-market review of dietary supplements b. MyPyramid c. Dietary reference intakes (DRIs) abirb.com/test d. MyPlate

abirb.com/test

ANS: C, D

The most current food and nutrition recommendations are found using the dietary reference intakes (DRIs) and MyPlate. These two resources replacedabirb.com/test the previously issued recommended dietary allowances (RDAs) and MyPyramid, although RDAs have not been totally eliminated. Unlike drugs—prescription or non-prescription —the FDA does not conduct pre-market review of dietary supplements abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 245

4. A person has been diagnosed with salmonellosis. Which ofabirb.com/test the following symptoms would the

person most likely exhibit? (Select all that apply.) a. Bloody diarrhea b. Vomiting c. Hypoactive bowel sounds d. Abdominal cramping

abirb.com/test

ANS: B, D

Symptoms of salmonellosis include abdominal cramping, abirb.com/test mild to severe diarrhea, nausea, vomiting, and fever within 8 to 72 h after infection. Bloody diarrhea is more likely seen with E. coli infection. Diarrhea is associated with hyperactive bowel sounds.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 250

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abirb.com/test

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Chapter 12: Exercise Edelman: Health Promotion Throughout the Life Span, 9th Edition MULTIPLE CHOICE 1. 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 a. aerobic activity. b. anaerobic activity. c. flexibility. d. muscular fitness.

ANS: A

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.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 272

2. 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? a. White man who works 50 to 60 h a week as a business executive b. Unemployed, obese Hispanic woman c. Employed White woman with hypertension d. White man with a high school diploma ANS: B

The number of adults with no leisure-time physical activity varies by race, ethnicity, sex, education level, geographical 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.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 273

3. 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?

16% 26% 30% 46%

a. b. c. d.

ANS: C

Unfortunately, only 23% of the adult population performs enough regular, sustained exercise to gain any significant health benefit, and slightly more than 10% of the population exercises at an intensity necessary to promote cardiorespiratory fitness. According to the Physical Activity and Fitness section (focus area) of Healthy People 2020, overall 30.3% of adults 18 years and older in 2013 reported no leisure-time physical activity.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 273

4. Which of the following is the definition of physical fitness? a. Painless joint mobility and muscle flexibility when engaging in exercise b. The ability to perform physical activity without undue fatigue or risk of injury c. Achieving at least 85% of age-specific activity levels d. Heart rate and respiratory rate returning to baseline within 30 seconds after

exercise ANS: B

Physical fitness: a set of attributes (cardiorespiratory fitness, muscular fitness, and flexibility) that people have or achieve that relates to the ability to perform physical activity without undue fatigue or risk of injury. A person can be physically fit and still have some joint pain or muscle stiffness on exercise. In fact, such a scenario is common with arthritis and other common medical conditions. There are not published age-specific activity levels. Heart rate and respiratory rate do not necessarily return to baseline within 30 seconds, even for highly fit persons. Anyone who has watched TV coverage of Olympic athletes after they perform will know that it commonly takes considerably longer than 30 seconds for respiratory rate to return to normal.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 273

5. 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?

Normal weight Overweight Obese Morbidly obese

a. b. c. d.

ANS: A

The prevalence of obese children, adolescents, and adults has increased in the United States and is considered an epidemic. Children and adolescents (ages 2 to 19) are categorized as being obese if their body mass index (BMI), expressed as weight/height2, is equal to or greater than the 85th percentile of age- and sex-specific BMI growth charts.

Accordingly, the 10-year-old child with a BMI at the 80th percentile is considered to be normal weight.

DIF: Cognitive Level: Apply (Application)

REF: p. 274

6. Which of the following statements regarding childhood obesity is correct according to the

2011–2014 National Health and Nutrition Examination Survey (NHANES)? a. The prevalence of obese children, adolescents, and adults has increased and is

epidemic. b. Ten percent (10%) of children and adolescents are obese. c. The rate of childhood obesity shows sex differences.

d. All of the above statements are correct.

ANS: A

The prevalence of obese children, adolescents, and adults has increased in the United States and is considered an epidemic. Children and adolescents (ages 2 to 19) are categorized as being obese if their body mass index (BMI), expressed as weight/height2, is equal to or greater than the 85th percentile of age- and sex-specific BMI growth charts. According to results from the recent 2011–2014 National Health and Nutrition Examination Survey (NHANES), which is conducted by CDC’s National Center for Health Statistics, 17.0% of children and adolescents are obese. By age group 8.9%, 17.5%, and 20.5% of children and adolescents 2 to 5, 6 to 11, and 12 to 19 years of age, respectively, were obese with the same pattern found in both sexes.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 274

7. A nurse is providing care for a 40-year-old adult with a BMI of 32. Which of the following

best describes this person?

Normal weight Overweight Obese Morbidly obese

a. b. c. d.

ANS: C

An adult 20 years of age or older is considered overweight if his or her BMI is 25 to 29.9, obese if his or her BMI is 30 or higher, and morbidly obese if his or her BMI is 40 or higher.

Thus, the 40-year-old adult with a BMI of 32 is considered obese.

DIF: Cognitive Level: Apply (Application)

REF: p. 275

8. 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?

Respect her decision in the name of honoring patient autonomy.

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.

a. b. c. d.

ANS: B

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. Respecting patient autonomy does not mean a provider cannot advocate for a course of action, which will benefit the patient. Rather, a patient cannot be forced into such a choice. Providers, however, may appropriately provide information, in this case information about the benefits of exercising. Scheduling follow-up expressly for the purpose of revisiting this topic would not be appropriate.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 298

9. During an office visit, a nurse provides counseling to a 70-year-old woman with osteoporosis.

The patient is otherwise very healthy. Which of the following information should the nurse provide to the woman? a. Osteoporosis is an exception to the rule of exercise due to risk of fracture. b. Walk, preferably with a partner, at least 30 minutes a day 5 days a week. c. Use a scooter where feasible in the interest of preventing falls. d. Use non-weight bearing exercise like swimming to avoid stressing the bones ANS: B

Weight-bearing actions that stress the skeleton (walking, stair climbing, floor calisthenics, and aerobic dance) have a positive effect on bone density. Weight-bearing exercise, which increases mechanical stresses on the skeleton, is an important component of reducing osteoporosis risk. These exercises should be performed for 20 to 30 minutes or more, at least three to five times per 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 weightbearing 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 maintain motivation and notify someone if a fall occurs.

DIF: Cognitive Level: Apply (Application)

REF: p. 282

10. 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? a. A person who takes a beta-blocker for hypertension b. A person who has a total cholesterol level of 201 c. A person who does not participate in any form of regular physical activity d. A person who has a family history of Type 2 diabetes mellitus ANS: C

The literature strongly demonstrates that the risk of coronary heart disease (CHD) decreases as physical activity increases and that a plausible relationship between the decreased risk and a number of potential physiological and metabolic mechanisms exists: · Increasing levels of high-density lipoprotein (HDL) cholesterol · Decreasing levels of low-density lipoprotein (LDL) cholesterol · Decreasing total cholesterol (TC) · Decreasing serum triglyceride (TRG) levels · Decreasing high blood pressure · Improving glucose tolerance and insulin sensitivity · Decreasing obesity; altering distribution of body fat · Reducing the sensitivity of the myocardium to the effects of catecholamines, thereby decreasing the risk of ventricular arrhythmias · Enhancing fibrinolysis and altering platelet function

Beta-blocker therapy is not a risk factor for developing coronary heart disease (CHD). In fact, it is often used to treat CHD. Knowing the total cholesterol without knowing the HDL is not informative, in terms of risk factors. Having diabetes is certainly a strong risk factor for coronary heart disease but a family history of Type 2 DM, in the absence of the patient actually having this disease, would not be a risk factor. A person who does not participate in any form of regular physical activity, however, would be at risk.

DIF: Cognitive Level: Apply (Application)

REF: p. 277

11. During a home visit, a nurse notes that a person with hypertension lives on the third floor of a

subsidized housing project, located, on a busy road with no sidewalks and few street lights.

Which of the following would be the best recommendation for exercise which the nurse could offer this individual? a. Join a gym to provide for a safer environment to exercise. b. Use the stairs whenever you are entering or leaving the building. c. Go for short walks around the block but during the daytime hours only. d. Purchase an exercise bike.

ANS: B

Exercise decreases blood pressure and thus should be encouraged in those with hypertension, especially exercise involving aerobic activity. Participation in physical activity depends on the availability of facilities and a safe environment. Walking around the block in an area with no sidewalks and few street lights is not safe, regardless of the time of day, and, thus, would be contraindicated for this patient. It is unlikely that an individual living in subsidized housing would have sufficient funds to either purchase an exercise bike or join a gym. Therefore, using the stairs as much as possible would be a safe, inexpensive form of exercise for this person.

DIF: Cognitive Level: Analyze (Analysis)

REF: pp. 277, 298

12. 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 bone loss accelerates rapidly during the first 5 years after menopause and can approach a _____ loss of peak over a woman’s lifetime. a. 3% b. 7% c. 15% d. 40% ANS: D

Women have less bone mass than men at all ages and by their mid-thirties can expect agerelated bone loss at approximately 1% annually. The rate of bone loss accelerates rapidly during the first 5 postmenopausal years, with annual losses of 3% to 5% common. By the fifth decade, or during their forties, women can anticipate a 10% loss of vertebral bone mass.

Cumulative bone loss can approach 40% of peak bone mass over a woman’s lifetime.

DIF: Cognitive Level: Apply (Application)

REF: p. 282

13. A nurse is educating a 35-year-old woman about the best type of exercises to choose in an

effort to prevent bone loss. Which of the following exercises would the nurse recommend? a. Walking b. Swimming

c. Bike riding d. The type does not matter—the key is for the person to engage in exercise ANS: A

Physical activities, those that involve weight bearing in particular, increase bone mineral density (BMD) and provide support for a stronger skeletal foundation throughout aging.

Maintenance of bone mass may be related to the intensity of the physical activity and the degree to which the activity stresses the bone. Weight-bearing actions that stress the skeleton (walking, stair climbing, floor calisthenics, and aerobic dance) have a positive effect on bone density. Weight-bearing exercise, which increases mechanical stresses on the skeleton, is an important component of reducing osteoporosis risk.

Weight-bearing activities have a positive effect on bone density. Walking is a weight-bearing activity. Concerning osteoporosis, the goal for a young woman would be to maximize peak bone mineral density so as to minimize the evitable bone loss which occurs after menopause.

Walking or other weight-bearing exercise is the exercise of choice, for maximizing bone density. Swimming and bike riding, both of which are excellent forms of beneficial aerobic exercise, are not weight bearing. Women who prefer these forms of exercise should also include a form of weight-bearing exercise in their regimen in the interest of maximizing peak bone density DIF: Cognitive Level: Apply (Application)

REF: p. 282

14. 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?

Step aerobics Running Water aerobics Bike riding

a. b. c. d.

ANS: C

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. Impact forms of exercise such as step aerobics and running are typically contraindicated for persons with osteoarthritis of the knee. Bicycle riding stresses the knee and thus can exacerbate knee pain secondary for persons with osteoarthritis of the knee.

It would not be a preferred choice.

DIF: Cognitive Level: Analyze (Analysis)

REF: pp. 283, 284

15. Which of the following statements is correct regarding exercise for persons with low back

pain?

Exercise that strengthens paraspinal muscles has been shown to be effective Unweighted or suspended exercise should be avoided.

Limit physical therapy referrals to the more severe cases of back pain.

All of the above statements are correct.

a. b. c. d.

ANS: A

The American Pain Society and American College of Physicians have also jointly stated that there is good evidence for the effectiveness of exercise in reducing chronic low back pain.

Specific types of exercise that have been shown to be effective in persons with low back pain include training of the deep and superficial paraspinal muscles as well as unweighted or suspended exercise. The only systematic review of the effects of unweighted movement on persons with chronic low back pain concluded that there was consistent and strong evidence to support unweighted exercise to decrease pain and improve function. Exercise targeting specific lumbar paraspinal muscles has been shown to substantially reduce pain and restore function. A referral to a physical therapist is warranted in most, if not all, cases of low back pain to allow for proper comprehensive management, which may include exercise as well as other safe and effective interventions.

DIF: Cognitive Level: Apply (Application)

REF: p. 286

16. Which of the following statements concerning the effects of exercise on the immune system is

correct? a. Care recipients with impaired immune systems need to take a cautious approach to

exercise. b. Exercise may be protective versus some types of cancer. c. Recommended parameters are that HIV patients limit exercise to 30 minutes

weekly. d. All of the above statements are correct.

ANS: B

Several studies demonstrate that people with impaired immune function can exercise safely without risk to their health status and can enhance their physiological and psychological wellbeing with regular exercise. Furthermore, two recently updated meta-analyses suggest that aerobic exercise, either alone or in conjunction with progressive resistance exercise, can be safely performed by adults living with HIV/acquired immunodeficiency syndrome (AIDS) and may improve fitness, body composition, and well-being. Recommended parameters include exercising at least three times per week for 20 minutes over a period of 5 weeks or more. A recent Position Statement on Immune Function and Exercise offered the following conclusion: “There is consensus that exercise training protects against some types of cancers.”

DIF: Cognitive Level: Apply (Application)

REF: p. 286

17. 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?

126 142 178 184

a. b. c. d.

ANS: C

A generic formula for determining MHR is 220 minus age: 220 – 42 = 178.

DIF: Cognitive Level: Apply (Application)

REF: p. 290

18. A nurse is counseling a 40-year-old person who is going to start an exercise program. The

nurse will base her guidance on a goal of the patient achieving the recommended RPE of 11 to 14, while exercising. Accordingly, which of the following heart rate ranges would the nurse encourage the person to maintain while exercising? a. 70 to 140 beats/min b. 80 to 143 beats/min c. 90 to 153 beats/min d. 100 to 180 beats/min ANS: C

RPE = rating the perceived exertion. Despite this potential for variability in perception, RPE correlates well with HR clinically, and together they form a complementary means of helping individuals determine a comfortable, beneficial level of exercise intensity. An RPE of 11 to 14 corresponds well with 50% to 85% MHR. Subjective parameters include being slightly short of breath, but not out of breath; being able to talk without difficulty, but unable to sing a song easily; being pleasantly fatigued, but not exhausted; and having mild musculoskeletal discomfort, but no pain.

The maximum heart rate for a 40-year-old is 180. Exercise should produce a heart rate that is 50% to 85% of maximum heart rate. This percentage corresponds to a rate of perceived exertion of 11 to 14: 50% of 180 = 90, 85% of 180 = 153. Thus, the range should be 90 to 153.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 290

19. The nurse is counseling a care recipient who prefers to exercise every day of the week.

Accordingly the nurse has recommended that the care recipient to perform different types of exercises on different days of the week. This practice is commonly called a. multiple aerobic practice. b. cross training. c. diverse exercising. d. bimodal exercise patterning.

ANS: B

The benefits of exercising more than five times a week are outweighed by the risk of injury, especially with higher impact activities. When more frequent exercising is a goal, cross training is recommended. Cross training means performing different types of exercise on different days of the week or performing different types of exercise within one session. The benefits of cross training include a decreased risk of musculoskeletal injury, an increased potential for total body conditioning, and improved long-term compliance because variety decreases boredom and eliminates the exercise barrier of limited choices.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 288

20. 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?

Ciprofloxacin (Cipro) Metoprolol (Toprol) Atorvastatin (Lipitor) Lansoprazole (Prevacid)

a. b. c. d.

ANS: B

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.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 290

21. 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? a. Talking and singing without difficulty b. Feeling extremely fatigued c. Having mild musculoskeletal discomfort d. Being out of breath ANS: C

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.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 290

22. Which of the following statements is accurate concerning yoga as a form of exercise? a. It is too mild a form of exercise to be beneficial. b. It is suitable for warm up periods prior to exercise. c. Too frequent practice will compromise joint flexibility. d. All of the above.

ANS: B

Yoga is an excellent example of one form of exercise to use during warm-up and cool-down periods. Movement into and out of yoga postures (called asanas) provides the necessary stimulation of weight-bearing activity to help keep bones strong, provides the movement to increase joint ROM, and stretches and tones muscles. Flexibility is a basic component of physical fitness; a safe stretch is one that is gentle and relaxing. Stretching mindfully, as in yoga, will ensure a safe stretch. Holding the position for 10 to 20 seconds and repeating the stretch three to five times will encourage optimal flexibility.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 291

23. An inborn set of physiological changes that offset those of the fight or flight response is

known as self-efficacy. catecholamine surge. relaxation response. catabolic response.

a. b. c. d.

ANS: C

Relaxation response is an inborn set of physiological changes that offset those of the fight or flight response.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 292

24. 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?

Ask questions to test his sincerity.

Provide him with information on the benefits of exercising.

Develop an exercise prescription with him.

Refer the patient to a professional trainer.

a. b. c. d.

ANS: C

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. It is not necessary to question or test his sincerity. Neither is it necessary to refer the patient to a trainer in order to initiate exercise. Doing so is an expensive option and could well be counterproductive.

Persons can successfully exercise without a trainer.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 298

25. A nurse is counseling a 19-year-old person who has recently been diagnosed with Type 1

diabetes mellitus. He will be injecting prescribed insulin twice daily. The care recipient asks if there is anything specific concerning his insulin which should be done before playing tennis with a friend. Which of the following instructions should the nurse give the person to avoid hypoglycemia? a. Inject the insulin into the abdomen. b. Inject the insulin into the arm. c. Inject the insulin into the thigh. d. Skip taking any insulin before exercising.

ANS: A

When insulin is injected into a muscle that is 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 injected into the abdomen. Additionally, not all insulins have the same onset or duration of action. Insulin dosage schedules should not be changes without knowing the onset or duration of action.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 296, Box 12-9

26. A woman is going for a 2-h hike in the Grand Canyon and she asks the nurse how much fluid

she should take along with her. Which of the following recommendations would be the most appropriate response? a. Bring at least 24 ounces of water. b. Bring at least 72 ounces of water. c. Bring at least 24 ounces of sports drink. d. Bring at least 72 ounces of sports drink.

ANS: D

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 h, a drink that provides carbohydrates and electrolytes (versus water) helps delay fatigue and improve performance. By any calculation, 24 ounces would be inadequate. Seventy-two ounces would be appropriate. Since the hike is going involve more than 1 h of exercise, the sports drink is the better choice.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 293

27. An occupational health nurse is trying to promote regular activity at her institution. Which of

the following interventions would most likely be the most successful?

Educate all employees regarding the benefits of exercise.

Initiate a lunchtime walking group that employees can join.

Provide all employees with an exercise prescription.

Recommend that employees who do not exercise be held accountable.

a. b. c. d.

ANS: B

Individuals are more likely to initiate and maintain physical activity if they feel competent doing the activity, feel safe doing it, perceive no negative financial or social cost, can access the activity easily on a regular basis, and can fit the activity into their regular schedule.

Knowledge is not enough to sustain activity. Role models are helpful. Initiating a lunchtime walking group demonstrates enthusiasm on the part of the nurse, provides an activity that is easy and mastered by most, and provides a social activity that can promote reinforcement by others who participate. Simply educating the employees (choice A) is not adequate. Providing all employees with an exercise prescriptions—regardless of their interest in exercise—would not be appropriate. Neither would be punitive approaches such as suggested in choice D. DIF: Cognitive Level: Analyze (Analysis)

REF: p. 297

MULTIPLE RESPONSE 1. A nurse is providing an educational program addressing the importance of being physically

active. The nurse states that individuals should engage in exercise for a minimum of 30 minutes of activity on most days of the week. For which of the following individuals is that recommendation appropriate? (Select all that apply.) a. A 54-year-old with hypercholesterolemia b. A 66-year-old with hypertension c. A 48-year-old with obesity d. A 58-year-old with Type 2 diabetes mellitus ANS: A, B, D

The risk of CHD decreases with an increase in physical activity. Exercise positively affects lipoprotein metabolism and is a common part of the treatment for hypertriglyceridemia.

Regular exercise also decreases blood pressure in adults. Exercise improves glycemic control by increasing insulin sensitivity in people with Type 2 diabetes mellitus. The Physical Activity Guidelines for Americans advise adults to perform at least 150 minutes of moderate intensity or 75 minutes of vigorous activity per week. Exercise also has a positive effect on obesity.

However, the American College of Sports Medicine recommends a minimum of 40 to 60 minutes of exercise 5 to 7 days a week for those with obesity.

DIF: Cognitive Level: Analyze (Analysis)

REF: pp. 273, 281

2. A nurse is reviewing an exercise prescription for a person. Which of the following aspects

should be included? (Select all that apply.)

Frequency of exercise Intensity level of exercise Time and duration of exercise Type of exercise

a. b. c. d.

ANS: A, B, C, D

An exercise prescription should include frequency of exercise, intensity level of exercise, time and duration of exercise, and type of exercise.

DIF: Cognitive Level: Apply (Application)

REF: p. 288

Chapter 13: Stress Management Edelman: Health Promotion Throughout the Life Span, 9th Edition abirb.com/test

MULTIPLE CHOICE abirb.com/test

1. A nurse is defining stress to a person. Which of the following statements should the nurse

should make? a. “Happy events, such as the birth of a child, are rarely as stressful as unhappy events.” abirb.com/test b. “Stress is a state of threatened homeostasis that triggers an adaptive response.” c. “All stressors create a challenge to health.” d. “Once stressors are identified, they can be controlled.” abirb.com/test

ANS: B

Stress is understood as a state of threatened homeostasis/homeodynamics that triggers an array of adaptive physiological, behavioral, and even social responses in an effort to abirb.com/test reestablish homeostasis or relative balance to avoid chaos. These descriptions of stress underscore important ideas: even welcome events, such as a child’s wedding, are stressors because they precipitate change. Nonetheless, stress is not intrinsically bad or unhealthy, and abirb.com/test stress is experienced psychophysiologically and socially, i.e., as an interplay across all domains of individual and communal living. Stress is an essential component of being alive.

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. abirb.com/test DIF: Cognitive Level: Apply (Application)

REF: p. 309

2. The nurse is conducting community education about stress.

Which of the following statements abirb.com/test

should be made by the nurse? a. “Stress always has a negative effect on the body.” b. “A moderate amount of short-term stress can make a person more efficient and abirb.com/test goal-focused.” c. “Long-term stress is useful in helping one to meet goals.” d. “Stress always has a positive effect on the body.”

ANS: B

abirb.com/test

Stress can be both useful and harmful. As stress increases, efficiency and performance also increase, but not endlessly. At a certain point performance and efficiency start to decrease significantly if stress continues unabated. It is important toabirb.com/test understand the many causes of stress and the negative physical, psychosocial, and spiritual consequences of distress.

Stress may be either harmful or helpful. Long-term stress is harmful. A moderate amount of stress is a motivator. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 310

3. A nurse is discussing various types of stress to a group of abirb.com/test adults. Which of the following

would be used as an example of eustress? a. Increasing alcohol intake to deal with loss of a job b. Avoidance of social activities because of anxiety c. Severely limiting food intake as a way to control stressabirb.com/test d. Joining a cardiac rehabilitation exercise program after a myocardial infarction abirb.com/test

ANS: D

Hans Selye first introduced the General Adaptation Syndrome, which led the way to continual interest in stress and the effect on the body. Selye reportedabirb.com/test that, to a certain extent, stress can be challenging and useful, which he identified as eustress. Selye also observed that when stress becomes chronic or excessive, the body is unable to adapt and maintain homeostasis and thus the process becomes distress. Stress can be both useful and harmful. abirb.com/test Eustress is useful, not harmful. Although a myocardial infarction (MI) is stressful physically and psychologically, joining a cardiac rehab program in response to the MI will improve cardiac and overall health and well-being. The other examples indicate unhealthy coping abirb.com/test strategies.

DIF: Cognitive Level: Apply (Application)

REF: p. 310 abirb.com/test

4. 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? a. Lowered blood pressure abirb.com/test b. Elevated heart rate c. Lowered respiratory rate d. Elevated blood supply to the gut ANS: B

abirb.com/test

Perception of threat stimulates a physiological pattern of neuroendocrine activation and behavioral changes mediated by the central nervous system. Nonetheless, in most cases this reaction is an adaptive, short-term, acute response to a stressor; this is first termed the abirb.com/test fight-or-flight response and later called the stress response. The hypothalamus signals the sympathetic nervous system to release epinephrine and norepinephrine, along with other related hormones. A resultant state of arousal is characterized by increased levels of the abirb.com/test following: metabolism, pulse rate, blood pressure, respirations, and muscle tension.

DIF: Cognitive Level: Apply (Application)

REF: p. 311 abirb.com/test

5. Which of the following statements concerning spirituality is correct? a. Spirituality is a search for the meaning of existence. b. To fully experience spirituality, one needs a religious affiliation. abirb.com/test c. Stress always strengthens the quest for spirituality. d. Spirituality always prevents depression, which is common following a stressful

event.

ANS: A

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Interest in the connection between spirituality and health is significant. Spirituality is defined in many ways but key components typically are that spirituality comprises feelings, thoughts, experiences, and behaviors that arise from a search for meaning and may include abirb.com/test interconnectedness with self, others, nature, and a higher force called God, a life-force/higher power, nature, or the transcendent. Spirituality and religion intersect for many, yet they are not synonymous. abirb.com/test 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.

DIF: Cognitive Level: Understand (Comprehension)

abirb.com/test

REF: p. 313

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6. A nurse has stated that the person she is working with demonstrates stress hardiness. Which of

the following individuals is most likely being described? abirb.com/test a. Refuses to see family members after the nurse practitioner tells him or her about test results b. Conducts Internet research to learn about the latest treatment options for a health abirb.com/test deviation c. Calls in sick when faced with a personal relationship problem d. Views stressors as negative life events ANS: B

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The characteristics of stress hardiness are control, challenge, and commitment. For stress-hardy individuals, stress is viewed as a challenge rather than a threat; they feel in control of situations in their lives, and they are committedabirb.com/test to rather than alienated from work, home, and family. Hardiness continues to be assessed (recognized) by nurses in assisting individuals and families dealing with crisis and promoting the strengths of survivorship in dealing with new stressors. Another term that is used is resiliency. abirb.com/test Stress hardiness is characterized by feeling in control of situations, viewing stressors as challenging rather than negative events, and using effective coping techniques. None of the other choices describe persons using effective coping mechanisms for stressful events. In fact, abirb.com/test they describe persons who are alienated from work and family.

DIF: Cognitive Level: Apply (Application)

REF: p. 314

abirb.com/test 7. A nurse is describing adults who are in the “sandwich generation.”

Which of the following

provides the best description of this term? a. Middle-aged adults who are starting a family at an older age b. Young adults who are beginning to find jobs, marry, and start a family abirb.com/test c. Middle-aged adults who are caring for children and aging parents d. Young adults who have several small children ANS: C

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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. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 314

8. A nurse is collecting health assessment data about a person’s coping mechanisms in relation abirb.com/test

to stressors. Who would provide the best source of this information? a. Person’s primary care physician b. Person’s spouse/significant other abirb.com/test c. The person d. Expert objective analysis skills of the nurse ANS: C

Each individual is the primary data source; no other personabirb.com/test can explain accurately the individual’s perceptions of the stressors, stress responses, and resources to prevent or alleviate the stress. People are the best source of information related to their coping skills.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 314

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9. A nurse is assisting a person to cope with stress. Which statement by the nurse would be the

most helpful? abirb.com/test a. “Most people in this situation feel the way you feel.” b. “Tell me what this event means to you.” c. “There are many support groups available for you to use.” abirb.com/test d. “Your family wants to help you through this stressful event.

May I call them?”

ANS: B

Stress is experienced across biological, psychosocial, and spiritual domains; therefore, all abirb.com/test perceptions are important to the assessment. Throughout the assessment process, individuals may become aware of information of which they were previously unaware, or they may identify information related to their perceived problems. For example, a man may be aware of the stress of his job but may be unaware that his high blood pressure was caused at least in abirb.com/test part by this stress.

Self-awareness is necessary to evaluate the meaning of an event and can only be assessed by asking the person to think about the meaning of the event. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 314

10. A nurse is counseling a person on how to effectively deal abirb.com/test with stress. Which of the following

actions would the nurse recommend the person take first? a. Recognize signs of stress. b. Take action to reduce stress. abirb.com/test c. Connect warning signs with stressors. d. Develop effective coping skills.

ANS: A abirb.com/test Recognizing warning signs of stress is a necessary first step.

Often individuals have long ignored physical, emotional, or behavioral cues or reactions to a stressor that are stress warning signs. A man who suffers from chronic, intermittent backaches and ignores the daily muscle tension caused by poor posture that precedes the backaches abirb.com/testprovides an example. If he had attended to his early stress warning signs of poor posture and muscle tension, he might have avoided the backache that kept him from exercising and socializing. Becoming aware of these stress warning signs is the first step. abirb.com/test 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. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 316

11. A nurse is providing education to a community support group about ways to decrease stress. abirb.com/test Which of the following would be the initial nursing intervention discussed by the nurse? a. Explain how support groups function. b. Demonstrate deep breathing techniques. c. Practice guided imagery techniques. abirb.com/test d. Help people to identify their response to stress.

ANS: D abirb.com/test

abirb.com/test

Nurses teach people to identify their warning signals of stress and to stop, take a few breaths, and break the cycle. These signals or cues differ among individuals and can be physical, abirb.com/test emotional, behavioral, cognitive, relational, or spiritual. When asked to monitor their responses to a particular event, individuals become more consciously aware of these cues.

Although this heightened awareness initially may increase an individual’s consciousness of physical pain or emotional discomfort, awareness is a necessary first step in recognizing the abirb.com/test negative effects of stress and the relationship of thoughts, feelings, behavior, and biological processes. In addition, nurses and other clinicians have a responsibility to screen for emotional distress to help people recognize and monitor their own physical and mood states. abirb.com/test The priority nursing intervention is to help the person become aware of the effects of stress on physical, emotional, and spiritual well-being. The other interventions are used after the person becomes aware of the individual reaction to stress.

DIF: Cognitive Level: Analyze (Analysis)

abirb.com/test

REF: p. 316

12. A nurse is explaining the relaxation response to a person. Which of the following statements

would be most appropriate for the nurse to make? abirb.com/test a. “When the relaxation response is used, your sympathetic nervous system is activated and your pulse rate slows down.” b. “The relaxation response helps you to become more aware of your surroundings.” abirb.com/test c. “Deep breathing is very effective in relaxing muscle groups and relieving stress.” d. “Holding your breath for 10 to 15 seconds will reduce your blood pressure and pulse rate.”

ANS: C

abirb.com/test

Relaxation response techniques oppose the stress response by reducing sympathetic arousal.

Most people hold their breath when they perceive a threat (stress), feel anxious, or become angry. By stopping and taking a few deep breaths when they become aware of physical abirb.com/test changes (holding the breath or clenching the jaw) or emotional changes (feeling anxious or angry), individuals can elicit the relaxation response, reduce sympathetic arousal, calm negative mood states, and gain a sense of control. abirb.com/test The relaxation response causes blood pressure and pulse rate to lower and muscles to relax.

Activation of the sympathetic nervous system has the opposite result.

DIF: Cognitive Level: Apply (Application)

REF: p. 318 abirb.com/test

13. 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 abirb.com/test participant makes which of the following statements? a. “Acupuncture is a technique that can be easily learned and practiced.” b. “Hypnosis can be safely used by a licensed hypnotist to treat all cases of anxiety.” c. “Reiki is a type of massage that can be used to relieve abirb.com/test stress.” d. “Herbal products must be used with caution because some can interact with prescription medications.”

ANS: D

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In particular, herbal remedies require cautious use because they can have harmful, as well as beneficial, effects, and they sometimes interfere with other treatments and medications. abirb.com/test Among the alternative therapies available, there is strong evidence of effectiveness of acupuncture and hypnosis, and they are becoming widely accepted within mainstream health care. Acupuncture is not a self-help approach, so seeking treatment from an experienced acupuncturist is required. One note of caution is warranted: hypnosis is not recommended for abirb.com/test people with organic brain disorders, psychotic disorders, or other severe mental disorders.

Reiki is a therapy that uses energy fields with the intent to affect health. To transmit ki, believed to be a life-force energy, the reiki practitioner places hands on or near the person abirb.com/test receiving treatment.

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.

DIF: Cognitive Level: Analyze (Analysis)

abirb.com/test

REF: p. 319

14. 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 abirb.com/test should the nurse expect? a. Immediate relief of stress through storytelling b. Insight into the personal meaning of the experience abirb.com/test c. Absence of the symptoms of stress d. Feeling a great sense of relief immediately after making a journal entry ANS: B

Expressive writing, including journaling, can help people abirb.com/test reflect on stressful events and their reactions to these events. Such reflection is an opportunity to reform perceptions and to consider alternative ways to manage stress. Individuals may find resolutions to conflicts that work uniquely for them. These resolutions then may increase a sense of control and mediate abirb.com/test negative consequences of stress. The nurse should warn that the individual may feel sad or depressed immediately after the writing session, but these feelings usually dissipate within an hour. Feeling better instantly after writing cannot be expected. A person can, however, abirb.com/test develop a clearer understanding of feelings and of the situation through journal writing.

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. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 319

15. A nurse is helping a person reduce stress disinhibition related to poor dietary choices. Which abirb.com/test of the following nursing interventions would be most appropriate? a. Work with the person to develop a plan to slowly replace high-fat, high-calorie foods with more healthy choices. b. Encourage the person to eliminate all high-calorie, high-fat foods from the diet as abirb.com/test quickly as possible. c. Give the person a standard list of low-fat, low-calorie foods. d. Provide the person a copy of the Food Guide Pyramid. abirb.com/test

ANS: A

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abirb.com/test

Americans frequently replace nutritionally balanced meals with readily available high-fat, high-calorie food. Nurses assist in planning and correctly choosing a variety of foods, and eating a diet low in fat, saturated fat, and cholesterol, withabirb.com/test plenty of vegetables, fruits, and grain products. The current U.S. dietary guidelines are based on the following two overarching concepts: focus on caloric balance over time to achieve and maintain a healthy weight; focus on consuming nutrient-dense foods and beverages. abirb.com/test 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 process will involve planning and modifying the diet over time. The Food Guide Pyramid has been abirb.com/test replaced with MyPlate.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 320

abirb.com/test 16. 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? a. Educate the person that 60 minutes of moderate to strenuous exercise a day is required to lower the risk of heart disease. abirb.com/test b. Suggest that the person participate in a formal exercise program that has been demonstrated to produce the best results. c. Educate the person that exercise patterns established in young adulthood are more abirb.com/test effective than those established later in life. d. 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.

ANS: D

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Regular physical activity, even at moderate levels, is associated with lower death rates for adults of any age. Regular physical activity helps people adopt a more active lifestyle as they begin to feel better physically and emotionally, thereby breaking the negative stress cycle abirb.com/test (Figure 13-4 in the textbook). Positive effects can be obtained with exercise of only moderate intensity. For example, a brisk walk of 30 to 60 minutes, 3 to 5 times a week, promotes fitness and decreases risk of disease. abirb.com/test 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.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 320 abirb.com/test

17. 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 abirb.com/test person? a. Encourage writing in a journal on a daily basis. b. Suggest joining a support group. c. Offer referral to individual or group therapy sessions. abirb.com/test d. Promote purchasing a gym membership.

ANS: A abirb.com/test

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Self-awareness is one of the most effective stress-management tools. Before any meaningful change in behavior can take place, one must have an awareness of, and reflection about, abirb.com/test personal behavior. Journal writing—more specifically, self-confessional writing—is a form of expressive writing that typically is done via entries in a journal over time that describe unfolding personal responses to life events. Expressive writing, including journaling, can help people reflect on stressful events and their reactions to these events. Such reflection is an abirb.com/test opportunity to reform perceptions and to consider alternative ways to manage stress.

Before any meaningful change in behavior can take place, one must have an awareness of, and reflection about, personal behavior. Gym membership is not necessary to achieve exercise for abirb.com/test stress reduction and overall health. Journaling is an effective and inexpensive modality to gain self-awareness with a goal toward behavior change to reduce stress.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 316

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18. A nurse is counseling a patient about styles of communication commonly used when dealing

with conflict involving another person. Which of the following statements illustrates the most appropriate and effective communication style? abirb.com/test a. “I am so angry that you are late again that you are grounded for a week.” b. “When you are late, I am hurt.” c. “Because you cannot be on time, you cannot have the car for a week.” abirb.com/test d. “I feel anxious when you do not come home on time because I worry about your safety.”

ANS: D abirb.com/test The next guideline for effective communication is to be assertive.

Assertive communication, in most cases, is the most effective way to communicate. An assertive statement is nonjudgmental, expresses feelings and opinions, and reaffirms perceived rights. The general format of an assertive statement is: I feel [emotion], when abirb.com/test you [the behavior], because [explanation].

Effective communication relies on assertive communication, which requires an assertive statement (emotion), expressed feelings (behavior), and perceived rights (explanation). Choice abirb.com/test D reflects these guidelines. Choices A, B, and C are likely to foster further discord between the individuals versus promoting resolution of conflict.

DIF: Cognitive Level: Apply (Application)

REF: p. 323 abirb.com/test

19. Which of the following comments best illustrates the technique of active listening? a. You sound upset about the committee’s recommendations. abirb.com/test b. I heard your remarks when you addressed the committee last Tuesday. c. I have been listening to many people speak to the same issues you raise. d. I noticed that you were listening intently when the chairman was speaking.

ANS: A

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Empathy can be facilitated through the technique of active listening. Active listening requires conscious, empathic, nonjudgmental awareness. Listening also helps clarify the issues involved and can deescalate many emotional exchanges. Try to understand (person’s) abirb.com/test perspective using the phrase: “You sound ____ about ____ and listen to (person’s) response.”

Active listening requires the listener to hear what the person is saying, mirror his or her feelings, listening to the person’s response, and communicate in a nonaggressive manner. abirb.com/test Choice A follows the guidelines for active listening by mirroring the person’s feelings using the recommended phrase “You sound ____ about ____.” abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 324 abirb.com/test

20. Which of the following statements concerning hobbies is true? a. Attention to hobbies diverts energy which should be used to deal with stressors. b. Hobbies can help manage stress and are encouraged. abirb.com/test c. Hobbies promote perfectionism which, in turn, typically adds to stress. d. Hobbies should be limited to monthly activity until stressor(s) resolves.

ANS: B abirb.com/test Hobbies are purposeful leisure activities that can balance hectic, stressful lives. A hobby should be chosen from interest and/or talent. Nurses advise individuals to make leisure activities a regular part of the week as a purposeful and conscious plan to break the stress cycle. abirb.com/test

DIF: Cognitive Level: Understand (Comprehension)

REF: p. 324

21. A nurse is assisting a client in values clarification. Which abirb.com/test of the following actions should the

nurse assist the client to complete first? a. Develop a religious affiliation to assist with the process. b. Identify what is meaningful in one’s life. abirb.com/test c. Act in a way that is consistent with one’s beliefs. d. Follow values held by one’s mentors as a first step.

ANS: B

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To manage stress and develop a balanced lifestyle, people must recognize the things and values that are important to them, reflect on where they are in life, evaluate what needs to be changed, and generate an action plan for that change (see Chapter 4). This process is known as abirb.com/test values clarification. The first step is to identify what is important, meaningful, and valuable so as to assess whether actions are consistent with beliefs. What people believe and value guides their actions by endorsing certain behaviors and changing others. When people assess their values and beliefs, they employ the ability to make their own choices rather than relying on abirb.com/test beliefs and values dictated to them by others.

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. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 325

22. The nurse is caring for a person who is obese, sedentary, and has recently been diagnosed abirb.com/test

with Type 2 diabetes mellitus. Which of the following goals for the person is correctly stated? a. The person will exercise more often. b. The person will consume 900 calories a day. c. The person will walk one-quarter mile a day, 5 days a abirb.com/test week. d. The person will eliminate all refined sugar and processed foods from her diet.

ANS: C abirb.com/test Goal setting is a dynamic process that involves both the individual and the nurse. 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 abirb.com/test realistic.

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DIF: Cognitive Level: Analyze (Analysis)

REF: p. 325 abirb.com/test

23. 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? abirb.com/test a. Encourage daytime naps. b. Encourage exercise 1 h before bedtime. c. Encourage a cool shower before bedtime. d. Encourage a consistent sleep-wake schedule. abirb.com/test ANS: D

Once factors associated with sleep disturbance are identified, nurses can help individuals improve their sleep patterns by counseling them to follow abirb.com/test several sleep hygiene or behavior guidelines (keeping a sleep diary, having a regular sleep-wake cycle, and making prudent dietary changes).

Daytime napping, exercising within 1 h of bedtime, and taking a cool shower prior to bedtime abirb.com/test will not promote nighttime sleep. In fact, such measures will have the opposite effect, making it more difficult to sleep at bedtime. Following a consistent sleep-wake cycle seven days a week will help establish a sleep pattern. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 321

24. A nurse is educating a person about the process of cognitive restructuring. Which of the

following statements is correct regarding this technique forabirb.com/test stress management? a. An advantage is that no advanced training is required. b. Replace negative thoughts with a realistic alternative thought. c. Denying negative thoughts/feelings is used as a means to disempower them abirb.com/test d. All of the above statements are correct.

ANS: B

In this structured method, individuals are asked to considerabirb.com/test their cognitive appraisal of a situation and how this assessment affects feelings, behaviors, and physiological processes.

Reframing, or cognitive reappraisal, educates individuals in monitoring thoughts and replacing those that are negative and irrational with those that are more realistic and helpful. abirb.com/test Adding behaviors that are consistent with reframed thinking follows.

Advanced training is required to implement this technique with patients although nurses are encouraged to become trained. This technique does not “does not gloss over or deny misfortune, suffering, or negative feelings.” abirb.com/test DIF: Cognitive Level: Apply (Application)

REF: p. 321

abirb.com/test in the context of stress 25. Which of the following statements is correct concerning affirmations

management? a. Creating and coaching care recipients in the use of affirmations requires specialized training. abirb.com/test b. A therapeutic affirmation can be either a positive or a negative thought. c. Repeating an affirmation throughout the day can reduce stress. d. All of the above statements are correct.

ANS: C

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An affirmation is a positive thought, in the form of a short phrase or saying, which has meaning for the individual. By reinforcing new ways of thinking or behaving in the present moment, affirmations are statements that people can use toabirb.com/test reaffirm new intentions and to clarify goals. Repeating an affirmation often throughout the day, perhaps after eliciting the relaxation response or as part of a breathing exercise, can become second nature and can help to enhance self-esteem and reduce stress. abirb.com/test No special training is required to assist patients to create affirmations and then coach them in their use. Anyone can create affirmations and this technique is often advocated in the lay press as a self-help modality. Therapeutic affirmations are always positive thoughts. abirb.com/test

DIF: Cognitive Level: Understand (Comprehension) MULTIPLE RESPONSE

REF: p. 322

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1. A nurse is educating a group of adults about stress-management strategies. Which of the

following examples would the nurse include in the presentation? (Select all that apply.) abirb.com/test a. Participation in a swimming class b. Keeping a food diary as part of a weight reduction program c. Joining a smoking cessation support group d. Setting a goal of walking one mile a day abirb.com/test ANS: A, B, C, D

Understanding stress and its management involves attention to the interactions of social and biological life at individual and family/communal levels; therefore interventions may need to abirb.com/test encompass a variety and combination of psychosocial and biological approaches at the primary, secondary, and tertiary levels of prevention.

A variety of stress-management techniques are discussed throughout the chapter. There are abirb.com/test many approaches to reducing stress. Goal setting, self-monitoring, exercise, and problem solving are all effective stress reduction strategies.

DIF: Cognitive Level: Apply (Application)

REF: p. 311

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2. The nurse in the pediatric oncology unit is working with a family whose toddler has been

diagnosed with leukemia. The nurse can best assist the family to deal with this extrinsic abirb.com/test stressor by doing which of the following? (Select all that apply.) a. Setting treatment goals for them until they are able to do so themselves b. Encouraging them to talk about their concerns c. Discussing relaxation techniques such as guided imagery with them abirb.com/test d. Asking them if they would like to meet with a member of a pediatric oncology support group ANS: B, C, D

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The nurse can assist this family by active listening, encouraging the family to discuss concerns, teaching them relaxation techniques, and providing access to a support group. It is not appropriate for the nurse to set goals for the family. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 327 abirb.com/test

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Chapter 14: Complementary and Alternative Strategies Edelman: Health Promotion Throughout the Life Span, 9th Edition abirb.com/test

MULTIPLE CHOICE abirb.com/test

1. Which of the following statements best defines the concept of holistic nursing care? a. Holistic nursing care is a family-centered approach to care. b. Holistic nursing care relies primarily on alternative medicine. c. Holistic nursing care takes into consideration all aspects of a person’s life. abirb.com/test d. Holistic nursing care focuses on wellness rather than illness.

ANS: C abirb.com/test Holistic health considers the whole person and how he or she interacts with his or her environment. It emphasizes the connection of mind, body, and spirit. Holistic health is a system of preventive care that takes into account the whole individual, one’s own responsibility for one’s well-being, and the total influences—social, psychological, abirb.com/test environmental—that affect health, including nutrition, exercise, and mental relaxation Holism entails a focus on proactive, healthy living and considers not only prevention but also the root cause of the illness. abirb.com/test Holistic nursing care takes into account all aspects of a person’s life experiences including environmental, physical, social, spiritual, and psychological constructs.

DIF: Cognitive Level: Understand (Comprehension)

REF: p. 333

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2. In contrast to holistic health care, Western or allopathic medicine focuses on the a. mind–body connection. b. impact of family relationships on health-seeking behaviors. abirb.com/test c. symptoms and disease. d. environmental impact on health.

ANS: C

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Health care and delivery in the United States, is most often allopathic medicine, a system in which medical doctors and other healthcare professionals, such as nurses, pharmacists, and therapists, treat symptoms and diseases using medications, radiation, lasers or surgical abirb.com/test interventions. Allopathy is also called biomedicine, conventional medicine, mainstream medicine, orthodox medicine, and Western medicine.

Holistic health care focuses on the whole person, mind, body, spirituality, and so forth.

Western or allopathic medicine focuses mainly on physicalabirb.com/test aspects of disease.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 333

abirb.com/test 3. A nurse is discussing holistic health care with an individual.

Which of the following

explanations should the nurse include in this discussion? a. Empirical research has consistently demonstrated the value of alternative/complementary therapy. abirb.com/test b. Many herbal remedies have side effects and drug interactions. c. CAM providers must meet required training, testing, and continuing education to practice. abirb.com/test d. FDA requires proof of efficacy and safety for dietary supplements.

abirb.com/test

ANS: B

Most CAM therapies lack a strong scientific evidence base, as many have not been studied with rigorous, well-designed clinical trials. The NIH is sponsoring research to fill the abirb.com/test knowledge gap and build this foundation for safety, efficacy, and suitability for specific conditions.

Herbal medicines may act on the body like prescription drugs and may interact with abirb.com/test prescription medications; thus it is important to elicit a full profile of what care recipients are taking and in what doses as part of medication reconciliation.

The US Food and Drug Administration (FDA) regulates dietary supplements, but the regulations are less strict than those for prescription or over-the-counter medications. For abirb.com/test example, safety and efficacy do not have to be proven before marketed, although, once on the market, it does monitor label claims and inserts. Most CAM providers are not credentialed in a standardized national system, so credentialing regulations and standards vary nationally. abirb.com/test Some require training, testing, and continuing education, but most do not.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 343 abirb.com/test

4. The nurse is conducting a community health-education program concerning

alternative/complementary therapies. Which of the following should be included in the presentation? abirb.com/test a. Alternative/complementary therapy is primarily used when conventional medicine has failed to achieve desired results. b. Alternative/complementary therapy is used in both hospital and outpatient settings. c. Alternative/complementary therapy was popular in theabirb.com/test late 1980s but is rarely used today. d. Alternative/complementary therapy primarily focuses on herbal remedies for common health deviations. abirb.com/test

ANS: B

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 abirb.com/test (e.g., environmental, spiritual), not just herbal products. Alternative/complementary therapies involve a wide variety of formats and modalities discussed throughout the chapter. Herbal therapies are but one component. Interest in alternative/complementary therapies has not waned. A 2012 National Health Interview Survey identified that people in the United States abirb.com/test use CAM modalities and they spent $33.9 billion out-of-pocket on CAM. Alternative and complementary practices are moving into mainstream medical practice. Many traditional medical centers now include a holistic viewpoint and integrative therapies, including Harvard, abirb.com/test Stanford, Duke, and the Mayo Clinic.

DIF: Cognitive Level: Apply (Application)

REF: p. 333 abirb.com/test

5. Which of the following complementary/alternative therapies involves emphasizing healthy

lifestyle, strengthening and cleansing the body, and noninvasive treatments? a. Homeopathy abirb.com/test b. Naturopathy c. Traditional Chinese medicine (TCM) d. Ayurvedic medicine ANS: B

abirb.com/test

abirb.com/test

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 abirb.com/test alternative medicine modalities, emphasizing healthy lifestyle, strengthening and cleansing the body, and noninvasive treatments.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 338 abirb.com/test

6. A nurse is discussing aromatherapy at a community health fair. Which of the following

aspects of this technique should be stressed? a. Aromatherapy can be used by individuals without special training. abirb.com/test b. Aromatherapy requires that the care recipient have an acute sense of smell to be effective. c. Aromatherapy uses herbal scents in candles or incense as the primary method of abirb.com/test delivery. d. Oils used in aroma therapy carry specific warnings and have contraindications.

ANS: D abirb.com/test Aromatherapy, also referred to as essential oil therapy, is defined by the National Association of Holistic Aromatherapy as the art and science of using naturally extracted oils from plants to balance, harmonize, and promote the health of body, mind, and spirit. The therapeutic use of the oils may be via inhalation, external application, or ingestion.

The use of aromatherapy, abirb.com/test like many complementary and alternative medicine modalities, without professional clinical training is strongly discouraged. Individuals must have this training to know the specific warnings and contraindication for each oil, as well as to understand how to handle the oils. abirb.com/test 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 oils need not necessarily involve inhalation or even a sense of smell. They may be ingested or applied to the skin. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 339

abirb.com/test 7. A nurse is instructing a person on the use of breath meditation.

Which of the following

instructions would the nurse give the person? a. “You may use this form of meditation when walking down the street.” b. “The best time of day to engage in this form of meditation is while you are doing abirb.com/test chores.” c. “Watching the sunset and reflecting on its beauty is a great way to use breath meditation.” d. “It is important to observe your breathing when using abirb.com/test this technique.”

ANS: D

Breath meditation is the simplest because it can be done anywhere and can evoke the abirb.com/test relaxation response (Box 14-5). It can be taught and is useful for anyone. Centering focuses on a chosen word. Mindfulness meditation is a way of paying attention or being mindful of a variety of topics such as thoughts, actions, or the environment. Walking meditation is a form of mindfulness because the individual is mindful of the interaction of the inner body, the abirb.com/test external body, and the environment with each step. abirb.com/test

abirb.com/test

Breath meditation is the simplest form of meditation. It can be done anywhere and can evoke the relaxation response. This type of meditation should not be done while competing other abirb.com/test activities, i.e., doing chores. One should stand, sit, or lie quietly when beginning to focus on breathing. Doing chores would not be consistent with this technique. Breathing should be observed using this technique, but not controlled. Choice “A” would be consistent with walking meditation. Choice “C” would be consistent with mindfulness meditation. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 340

8. A nurse is teaching a person about the technique of breathabirb.com/test meditation. Which of the following

aspects of this technique should the nurse stress to the person? a. Hold your breath for short amounts of time in order to regulate your breathing pattern. abirb.com/test b. Focus on calming thoughts that come to mind during the meditation. c. Practice this technique when sitting and when walking. d. Concentrate on the breath.

ANS: D

abirb.com/test

This technique should be practiced when standing, sitting, or laying quietly. Thoughts that emerge during this technique should be let go, so the focus is on the sensation of breathing.

Holding one’s breath is not part of the technique. abirb.com/test DIF: Cognitive Level: Apply (Application)

REF: p. 340, Box14-5

abirb.com/test 9. 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? a. The benefits of guided imagery are primarily psychological. b. This technique promotes a sense of well-being. abirb.com/test c. A “prayer circle” is needed for imagery to be most effective. d. Imagery has not been scientifically studied.

ANS: B

abirb.com/test

Visual or guided imagery encourages clients to relax by focusing on calming thoughts or experiences. Imagery is “a gentle but powerful technique that focuses and directs the imagination” in order to, among other things, promote a sense of well-being and to help abirb.com/test people relax. In a randomized control study, men with prostate cancer and women diagnosed with breast cancer undergoing chemotherapy had a better quality of life, less depression, and some positive impact on laboratory values if they used relaxation training and guided imagery, compared to the control group. abirb.com/test Imagery is an individual exercise and does not include a prayer circle. Imagery has, in fact, been studied via randomized controlled trials with cancer patients.

DIF: Cognitive Level: Apply (Application)

abirb.com/test REF: p. 340

10. An individual asks the nurse to explain yoga. Which of the following statements would be

made by the nurse? abirb.com/test a. There have not been studies involving yoga but care recipients speak favorably of the practice. b. Yoga, while largely beneficial, is decreasing in popularity as other CAMs emerge. c. A major benefit of yoga is an increase in flexibility. abirb.com/test d. All of the above statements are correct. abirb.com/test

ANS: C

Yoga is a meditative movement practice that originated in India as a form of spiritual practice, abirb.com/test and aids in flexibility, agility, balance, and relaxation. Many types and branches of yoga exist.

Several studies of individuals with a variety of diagnoses have documented several health-related benefits from the practice of yoga, including reducing stress and anxiety, improving pain management, flexibility and the NHIS reported yoga use up from 6% in 2007 abirb.com/test to almost 10% in 2015. Given the increase in this practice in traditional medicine centers, the prevalence of yoga will likely rise.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 340

11. Which of the following statements is correct concerning energy therapy? a. One of the goals of energy therapy is to reduce blockages. abirb.com/test b. Body energy is strongly suspected but not yet documented. c. Seasonal affective disorder has been successfully treated with laser energy. d. All of the above statements are correct. abirb.com/test

ANS: A

Certain types of body energy are well known. Electrical energy in the body is reflected in diagnostic studies including electrocardiographic, electromyography, and abirb.com/test electroencephalographic tracings. Lasers, focused light energy, are used in many types of surgery and to treat other disorders such as psoriasis. Light energy is useful in treating seasonal affective disorder. The basic goal behind the various modalities of energy therapy is to release blockages to energy flow, stimulate deficient lifeabirb.com/test energy, and rebalance life energy.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 340

abirb.com/test 12. Which of the following states is correct concerning Qi gong? a. It is one of the several forms of yoga. b. It is a movement therapy. c. It is a form of energy therapy to balance life energy. abirb.com/test d. It originated as a Chinese martial art form.

ANS: B

The movement arts such as Qi gong, tai chi, and yoga are abirb.com/test helpful for body, mind, and spirit, and, though technically not energy work, do manipulate life energies. Qi gong (pronounced chee gung) is part of traditional Chinese medicine, combining relaxed movements with a meditative aspect and controlled breathing to move qi energy through the energy channels and increase vital energy. Tai chi (pronounced tie chee) beganabirb.com/test as a Chinese martial art and combines physical movement, breath control, and meditation in a dancelike sequence of poses based on the movements of animals.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 340

13. The nurse is asked to explain acupuncture to a person. Which of the following statements

concerning acupuncture would the nurse include in the explanation? abirb.com/test a. Acupuncture lacks empirical evidence of efficacy; thus is rarely covered by insurance. b. Acupuncture manipulates life energy or chi. abirb.com/test c. Acupuncture focuses on meridians which are defined as points of diseased tissue.

abirb.com/test

d. Moxibustion is the term used to describe a disturbed energy flow, which results in

disease.

ANS: B

abirb.com/test

Acupuncture manipulates life energy, referred to as chi or qi in some cultures, by stimulating precisely mapped points on the skin surface. The points overlie the channels, called meridians, through which chi travels. The channels are named for theabirb.com/test organs they affect, such as the lung meridian, heart meridian, and kidney meridian. When stimulated, the valve may open to release blocked or excess chi or close to allow chi to collect if chi is deficient. Stimulation of the points may be accomplished in several ways to include burning herbs on or over the points abirb.com/test to increase point stimulation, a technique called moxibustion. Good evidence exists for the efficacy of acupuncture in a variety of realms and the cost of treatment is often covered by insurance providers. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 341

14. A person asks the nurse to explain the difference between acupuncture and acupressure.

Which statement would be the appropriate response by theabirb.com/test nurse? a. Acupressure uses massage and oil aromatherapy to stimulate meridian points. b. Acupuncture but not acupressure has been shown to relieve nausea and vomiting. c. Acupressure stimulates meridian points via pressing and stretching movements. abirb.com/test d. Acupressure is achieved by applying more pressure to the fine needles inserted as part of acupuncture.

ANS: C

abirb.com/test

Acupressure is a form of acupuncture, were the meridian points are stimulated with pressing, rubbing, squeezing, and stretching movements. The technique is taught in some massage schools because it is often used along with massage to move and balance the body’s energies. abirb.com/test Shiatsu uses a sequence of rhythmic pressure on acupressure meridians.

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. It does not involve applying pressure to needles inserted abirb.com/test during acupuncture.

DIF: Cognitive Level: Apply (Application)

REF: p. 341 abirb.com/test

15. The nurse has just discussed reflexology with an individual. Which of the following

statements made by the individual would demonstrate that learning has taken place? a. Reflexology uses upper back massage to control tension and stress. abirb.com/test b. Reflexology uses the body’s natural reflexes to optimize positive energy flow. c. Reflexology uses pressure applied to hand and foot areas to relieve tension. d. Reflexology uses massaging and stretching motions to the lower legs and feet to abirb.com/test restore a positive energy flow.

ANS: C

Reflexology is a mixed method of CAM as it involves a type of manipulation and the concept of energy fields. A reflexologist applies pressure with the abirb.com/test thumbs to mapped points on the feet or hands, or both, by pressing deeply into the point to release tension and stimulate circulation of blood, lymph, and energy. Reflexology is more than massage because practitioners believe that the points correspond to the organs of the body and that stimulating the points will abirb.com/test stimulate the organs to heal. abirb.com/test

Reflexology is a hand pressure technique applied to the hands or feet. It does not involve massage, squeezing, or stretching like acupressure. Neither does it involve the back or legs aside from the feet. Natural body reflexes are not a part ofabirb.com/test this system.

DIF: Cognitive Level: Apply (Application)

REF: p. 339

16. A nurse has completed an educational session about touchabirb.com/test therapy with a group of adults.

Which of the following statements made by an individual would demonstrate understanding of this topic? a. “Shiatsu is one of the more popular forms of touch therapy.” abirb.com/test b. “Touch therapy is effective because deep massage relaxes muscles.” c. “During touch therapy the therapist’s hands may not actually touch me.” d. “Both statements A and B demonstrate correct understanding.” abirb.com/test

ANS: C

In touch therapies such as therapeutic touch, healing touch, reiki among others, practitioners use their hands to direct life energies drawn from the environment to the individual in an abirb.com/test effort to restore balance and harmony within the human energy system. During these therapies, the hands can be placed directly on the person’s body or at a distance from the body.

Touch therapy does not involve massage: neither shiatsu, deep massage nor any other form of abirb.com/test massage. In some forms of touch therapy, the therapist’s hands are placed on the care recipient’s body. With other forms of touch therapy, the therapist holds the hands near the care recipient’s body but does not actually touch the care recipient. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 341

17. A nurse is performing therapeutic touch with a person. Which of the following would be the abirb.com/test

first action that the nurse would take? a. Centering b. Movement of hands above the body c. Treatment technique d. Attunement

abirb.com/test

ANS: A abirb.com/test The first element is centering by the practitioner. Centering is a process of becoming calm, present in the moment, and connected with the individual being treated, allowing the practitioner to give the person undivided attention. During assessment, the second element, the practitioner’s hands move over the individual’s body atabirb.com/test a height of about 3 inches above the skin in an attempt to sense disturbances or imbalances in the person’s energy field. The final element is a series of techniques to change the patterns in the human energy field.

DIF: Cognitive Level: Apply (Application)

abirb.com/test REF: p. 343

18. 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? abirb.com/test a. Polarity therapy b. Reiki c. Qi gong d. Pranic healing abirb.com/test

abirb.com/test

ANS: A

Polarity therapy utilizes a combination of energy work, caring intention, movement exercises, and dietary regimens and is aimed at clearing energy blockages and building health. Polarity abirb.com/test therapy utilizes energy therapy and dietary restructuring. Reiki, Qi gong, and pranic healing are all forms of touch therapy.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 342

19. The nurse is assisting an individual who is interested in music therapy. Which of the

following statements made by the person indicates an understanding abirb.com/test of this type of therapy? a. “I will select the music carefully. Energetic or rap music is not a good choice.” b. “Studies have shown that music therapy affects vital signs especially heart rate.” c. “Chants, nature sounds, or “spa music” are generally the preferred choices.” d. “Music has been shown to decrease pain perception inabirb.com/test the hospital.”

ANS: D

Music therapy employs a variety of methods in a therapeutic relationship to address physical, abirb.com/test emotional, cognitive, and social needs of individuals. Music influences the limbic system, the area of the brain involved with emotions and feelings. Music is a form of sound energy, and this energy can be relaxing or stimulating and has been used to decrease pain, depression, and disability. Depending on the person and the mood desired,abirb.com/test all forms of music can be used. In a random controlled trial in an ICU setting, harp music significantly decreased pain perception by 27% but did not significantly affect vital signs.

Music selection is an individual choice; all forms can be used depending on patient abirb.com/test preference. There is no one “best” type of music. Relaxation music also known as “spa music” can be very annoying to some people. Similarly, high energy music including rap music can be relaxing to persons who like this form of music. Music choice is totally up to the individual. abirb.com/test DIF: Cognitive Level: Apply (Application)

REF: p. 343

abirb.com/test 20. A nurse would like to include holistic nursing care in her nursing practice. Which of the

following actions would be recommended for the nurse as first step? a. Learn the specific therapy method. b. Engage in self-exploration to gain insight and balance. abirb.com/test c. Explore the various types of complementary therapies available. d. Ask the person which type of therapy he or she prefers.

ANS: B

abirb.com/test

Holistic health involves knowing the physical self, the emotional self, the mental self, and the spiritual self, seeking a comfortable balance among these aspects of being and knowing what changes need to be made to achieve this balance. This knowledge is vital to both the nurse attempting holistic practice and the individual interested inabirb.com/test pursuing holistic health.

With insight gained from self-awareness, one or more of the holistic health strategies mentioned in this chapter, as well as emerging therapies, can be useful in helping people achieve optimal wellness. Achieving personal balance firstabirb.com/test will prepare the nurse to facilitate that quality in others.

DIF: Cognitive Level: Apply (Application)

REF: p. 343 abirb.com/test

21. Which of the following describes a nurse who is “being with” the care recipient? abirb.com/test

a. b. c. d.

Answers a call bell promptly Completes a dressing change with minimal discomfort to patient Silently prays with a client when requested to do so abirb.com/test Teaches a client about his or her medication regime

ANS: C abirb.com/test Nurses have the potential to alleviate suffering and improve health care outcomes through their therapeutic presence. By connecting deeply with care recipients and their families, nurses are in a unique position to facilitate their journey toward recovery or a peaceful death. When using nursing presence as a holistic intervention and establishing a therapeutic relationship, abirb.com/test nurses are fulfilling the definition of nursing as an art and a science. There is a plethora of evidence about positive outcomes, lower mortality, and morbidity, decreased readmission rates and improved patient and nurse satisfaction scores when nurses are able to be present in abirb.com/test meaningful ways.

Performing one’s duty competently (choices A, B, or D) enables a nurse to “be there” with the care recipient. Therapeutic presence involves connecting with a care recipient on a deeper level. Entering the care recipient’s world and praying withabirb.com/test him or her, when requested to do so, exemplifies truly “being with” the care recipient. Table 14-3 provides examples of the difference between “being there” and “being with” the patient.

DIF: Cognitive Level: Apply (Application)

REF: p. 343 abirb.com/test

22. 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 abirb.com/test included in this presentation? a. Most treatments are covered by insurance. b. The US Food and Drug Administration strictly regulates dietary supplements. c. It is important to research and understand the treatmentabirb.com/test before starting to use it. d. There are minimal interactions between allopathic and holistic treatments.

ANS: C

Most CAM therapies lack a strong scientific evidence base, as many have not been studied abirb.com/test with rigorous, well-designed clinical trials. The US Food and Drug Administration (FDA) regulates dietary supplements, but the regulations are less strict than those for prescription or over-the-counter medications. It is imperative that nurses and other health care professionals abirb.com/test have knowledge of CAM practices, safety and guidelines for use to inform and protect users.

Many medical and nursing schools now include alternative/complementary therapies in their curricula.

Table 14-2 illustrates the many interactions between CAMabirb.com/test and allopathic medications. It is imperative for the therapist using CAM approaches to take time to research and understand the treatment to ensure that it is safe and appropriate for the individual. Lacking strong scientific evidence, CAM treatments are commonly not covered by insurance. Both allopathic abirb.com/test and holistic providers should know about the care and treatment provided by the other in the interest of avoiding harmful interactions.

DIF: Cognitive Level: Apply (Application)

REF: p. 343 abirb.com/test

23. 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 abirb.com/test Motion Injury.” Which of the following actions must the nurse take first when planning interventions for this person? abirb.com/test

a. b. c. d.

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.

abirb.com/test

ANS: C abirb.com/test Before giving informed consent, the person must understand the proposed therapy. The nurse needs to explain the proposed therapy and be certain the care recipient understands everything before obtaining consent.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 345, care plan

24. A nurse is caring for a Hispanic individual. Which question should the nurse ask the person

during the assessment process? abirb.com/test a. “How many herbal medicines do you take?” b. “You cannot use any herbal products in the hospital. Did you bring any?” c. “Interactions between herbal products and medications can be very dangerous. abirb.com/test Which ones do you use? d. “Tell me how you treat your asthma at home. What treatments work especially well for you?”

ANS: D

abirb.com/test

Because there is potential for drug interactions between allopathic medicines and the traditional medicines of the Hispanic population, it is especially important that allopathic providers understand the home treatments that this population is using. One way to ease the abirb.com/test assessment of the use of home treatments is with an open mind and with acceptance of folk practices.

Many in the Hispanic culture use herbal products and alternative therapy. Keeping an open abirb.com/test mind during the assessment process and asking open-ended questions will encourage the person to share his or her stories.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 341, Box 14-7 abirb.com/test

MULTIPLE RESPONSE abirb.com/test

1. Which of the following people are participating in alternative/complementary therapies?

(Select all that apply.) a. A 15-year-old who listens to rap music to lessen anxiety from a painful dressing abirb.com/test change b. A 45-year-old who burns lavender-scented candles while meditating c. A 10-year-old who uses prayer during his mother’s hospitalization d. A 78-year-old who practices yoga to increase balance abirb.com/test ANS: A, B, C, D

Music, art therapy, aromatherapy, prayer, and movement therapy are all alternative/complementary therapies. Table 14-3 summarizes a variety of alternative abirb.com/test complementary therapies presented in the chapter.

DIF: Cognitive Level: Apply (Application)

REF: p. 338, Tab 14-3 abirb.com/test

abirb.com/test

2. During an alternative therapy conference, a nurse attends a session related to massage therapy.

Which of the following statements made by the presenter should the nurse question? (Select abirb.com/test all that apply.) a. “Qi gong is a form of traditional Chinese massage technique.” b. “Hippocrates referenced massage” c. “Several massage techniques can be used, including kneading and rubbing the abirb.com/test skin.” d. “Reiki combines massage therapy with energy balancing techniques.”

ANS: A, D

abirb.com/test

Qi gong is a form of traditional Chinese medicine involving movement therapy. It does not involve massage. Similarly, reiki is not a form of massage but rather a form of touch therapy intended to balance human energy. In fact, pending the care recipient’s preference, the abirb.com/test therapist may not even touch the care recipient. Hippocrates did, in fact, mention massage in his writings. Massage encompasses many techniques for manipulation of muscle and soft tissue including kneading and rubbing the skin.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: pp. 339-341

3. A 66-year-old woman with osteoarthritis of the knees and hands tells the nurse she is

interested in movement therapy. Which of the following would be the most appropriate for the abirb.com/test nurse to suggest to this person? (Select all that apply.) a. Tai Chi b. Hatha yoga abirb.com/test c. Qi gong d. Dance therapy ANS: A, C

abirb.com/test Tai Chi combines slow, relaxed, gentle movement with controlled breathing. Qi gong combines relaxed movements with a meditative aspect and controlled breathing. Hatha yoga involves poses, which might be difficult for this person to achieve. Similarly, dance therapy may also be difficult for this person to complete. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 340 abirb.com/test

abirb.com/test

abirb.com/test

abirb.com/test

abirb.com/test

abirb.com/test

Chapter 15: Overview of Growth and Development Framework Edelman: Health Promotion Throughout the Life Span, 9th Edition abirb.com/test

MULTIPLE CHOICE abirb.com/test

1. The nurse is explaining the concept of growth to a parent. Which of the following statements

should be made by the nurse? a. “Growth means adding height and weight to your body.” b. “We continue to grow in various ways throughout life.” abirb.com/test c. “How much we grow is based on gender.” d. “Growth stops when we are young adults.”

ANS: B

abirb.com/test

Table 15-2 outlines growth as it takes place throughout the body systems and life span. The growth of some systems, such as the skeletal and muscular systems, is more influenced by gender, whereas the growth of others, such as the nervous and respiratory systems, is less abirb.com/test dependent on gender. Growth changes that take place in young, middle-aged, and older adults should be noted. Thinking of growth only as it applies to infants, children, and adolescents misses important changes that occur from conception and throughout all the stages of abirb.com/test adulthood.

Growth, in some form, continues throughout life, not just during puberty. Not all growth is based on gender. Growth indicates more than a change in height and weight.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: pp. 349-350, TBL 15-2

2. Which of the following statements is correct related to the concept of growth? a. Growth occurs mainly during early childhood. abirb.com/test b. Older adults do not experience growth-related changes. c. Growth refers only to the increase in the size of specific organs and systems. d. Growth occurs throughout the life cycle. abirb.com/test

ANS: D

Table 15-2 outlines growth as it takes place throughout the body systems and life span. The growth of some systems, such as the skeletal and muscular systems, is more influenced by gender, whereas the growth of others, such as the nervous abirb.com/test and respiratory systems, is less dependent on gender. Growth changes that take place in young, middle-aged, and older adults should be noted. Thinking of growth only as it applies to infants, children, and adolescents misses important changes that occur from conception and abirb.com/test throughout all the stages of adulthood.

People experience developmental transitions throughout life, not just during times of rapid physical growth. Growth changes that take place in young, middle-aged, and older adults abirb.com/test should be noted. People who think of growth only as it applies to infants, children, and adolescents are missing important changes from conception throughout adulthood.

DIF: Cognitive Level: Understand (Comprehension)

REF: pp. 349-350, TBL 15-2 abirb.com/test

3. The nurse at a well-baby clinic is assessing a 12-month-old child. At birth, the child weighed

7 lb. 3 oz. During this visit, the child weighs 21 lb. 10 oz. Which of the following conclusions abirb.com/test would the nurse make about the child’s weight? a. The infant is gaining weight faster than anticipated. abirb.com/test

b. The infant is malnourished. c. The infant is at the expected weight for his or her age. d. The infant is having a growth spurt. abirb.com/test ANS: C

Infants typically double their birth weight by six months of age and triple their birth weight by abirb.com/test 1 year of age. This infant has tripled his or her weight as would be expected at 12.

DIF: Cognitive Level: Apply (Application)

REF: p. 357

abirb.com/test 4. The school nurse has been asked to order growth charts. Which of the following growth charts

should be selected to assessing children in first through fifth grades? a. Generic body mass index chart b. Height and weight chart abirb.com/test c. Revised CDC growth chart d. WHO international growth chart ANS: C

abirb.com/test

Based on input from an expert panel, the Centers for Disease Control and Prevention (CDC) recommended that health practitioners within the United States use the 2006 World Health Organization (WHO) international growth charts for children from birth to 24 months, and abirb.com/test continue to use the revised 2000 CDC growth charts (including the body mass index [BMI] and the 3rd and 97th percentiles) for children aged 2 to 20 years.

DIF: Cognitive Level: Apply (Application)

REF: p. 357 abirb.com/test

5. A school nurse is obtaining the height and weight of a 9-year-old child. Which of the

following is the best method to assess the child’s growth? abirb.com/test a. Use serial measurements over time. b. Use this measurement. c. Use this measurement and compare it with the child’s peers. d. Use the WHO growth chart to assess this child’s measurements. abirb.com/test ANS: A

When assessing growth data for use in growth charts, it is important to remember that a single measurement taken at one point in time, although helpful in providing a baseline, does not abirb.com/test allow for the best assessment of a child’s growth. Serial measurements, plotted on a growth chart over time, best reflect a child’s pattern of growth.

DIF: Cognitive Level: Apply (Application)

abirb.com/test REF: p. 358

6. An infant’s central nervous system develops before his peripheral nervous system. This

pattern is an example of which of the following? a. Cephalocaudal b. Proximodistal c. Differentiation d. Specialization

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ANS: B

All individuals follow similar developmental patterns, with one stage of development building on and leading to the next. Early development proceeds asabirb.com/test follows: Cephalocaudal: from head to toe abirb.com/test

Proximodistal: from midline to periphery Differentiation: follows a pattern: simple to complex, and general to specific abirb.com/test Examples of Patterns of Development: Cephalocaudal: infants advance in neck and head control before controlling the movements of the extremities.

Proximodistal: infants’ central nervous systems develop before peripheral nervous abirb.com/test systems.

Differentiation: infants use a whole-hand grasp before learning the finer control of the pincer grasp, and they coo or babble before they speak. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 358

7. Which of the following would be an example of differentiation as a pattern of development? a. An infant raises his head before controlling his arms. abirb.com/test b. An infant shows the Morro reflex when startled. c. An infant uses his whole hand to grasp and months later he has a pincer grasp. d. A child walks sooner than did any of his siblings. abirb.com/test ANS: C

All individuals follow similar developmental patterns, with one stage of development building on and leading to the next. Early development proceeds asabirb.com/test follows: Cephalocaudal: from head to toe Proximodistal: from midline to periphery Differentiation: follows a pattern: simple to complex, and general to specific abirb.com/test (Example) Differentiation: infants use a whole-hand grasp before learning the finer control of the pincer grasp, and they coo or babble before they speak.

Choice A describes cephalocaudal development; choice B describes a normal reflex having no relevance to this issue; choice D simply describes a child who developed faster than his abirb.com/test siblings. It does not offer provide an example of differentiation.

DIF: Cognitive Level: Apply (Application)

REF: p. 358 abirb.com/test

8. A mother comes to the pediatric clinic and says to the nurse, “I am worried about my

11-month-old baby because he is not crawling yet and his brother crawled when he was 11 months old. Is something wrong?” Which of the followingabirb.com/test statements should the nurse make? a. “It is highly unusual for siblings not to reach developmental milestones at the same time. I’ll ask the doctor to assess him.” b. “All babies reach developmental milestones at different rates.” abirb.com/test c. “This may be something to worry about. I’ll have the doctor examine him.” d. “Don’t worry; he’ll crawl soon enough.”

ANS: B

Although the sequence of development is predictable, the abirb.com/test exact timing of the sequencing is individual. Individuals develop at their own rate, on their own schedule. For example, infants creep and crawl before they walk and their primary teeth erupt in a predictable sequence, but each will walk and develop primary teeth on an individualabirb.com/test schedule. However, there are guidelines or parameters that assist parents and health care providers in assessing whether children are progressing in an acceptable developmental sequence within a reasonable time frame. abirb.com/test Although developmental milestones follow a predictable pattern, each child develops at his or her own rate. Telling the mother not to worry is not answering her question. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 358 abirb.com/test

9. Which of the following statements describes Erikson’s theory of development? a. A healthy personality is defined by the lack of pathology. b. Stages of development advance based on psychosocial factors. abirb.com/test c. The main premise of the theory is that individuals are interdependent beings and

rely on each other in order to develop successfully. d. An individual must successfully accomplish the developmental stage before

proceeding to the next stage.

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ANS: D

According to Erikson, psychosocial development is composed of critical stages, each requiring resolution of a conflict between two opposing forces (e.g., intimacy versus abirb.com/test isolation). Each stage depends on the preceding stage, which must be accomplished successfully for the person to proceed.

Erikson’s theory of development is based on the need of each person to develop a sense of abirb.com/test trust in self and others and a sense of personal worth. Although the environment and others may influence development, it is primarily an individual task. A person may regress to an earlier stage during times of stress. abirb.com/test

DIF: Cognitive Level: Understand (Comprehension)

REF: p. 360

10. Increasing competence and adaptability, which reflects understanding of complexity, defines abirb.com/test a. learning. b. maturation. c. differentiation. d. stability. abirb.com/test

ANS: B

Development is closely interrelated with the concepts of both learning and maturation.

Learning is the process of gaining specific knowledge or skills that result from exposure, abirb.com/test experience, education, and evaluation. Maturation is an increase in competence and adaptability that reflects understandings in the complexity of a structure that makes it possible for that structure to begin to function or to function at a higher level. abirb.com/test

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 359

11. According to Piaget’s theory of cognitive development, which of the following statements is abirb.com/test

correct? a. Cognitive function continues to become refined throughout life. b. A child’s greatest task is to make sense of the world around him or her. c. Culture plays a major role in cognitive development. abirb.com/test d. Learning precedes development.

ANS: B abirb.com/test

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Another aspect of development is cognitive development. Jean Piaget, a Swiss psychologist, also trained in biology and philosophy, is well known for his theory of cognitive development. abirb.com/test He viewed children as biological organisms interacting with their environment, and his theory contends that cognitive development reflects children’s attempts to make sense of their worlds; major criticism of his work is that he underestimated children’s capabilities and gave little or no consideration for cultural differences. Piaget suggests that quantitative, but no abirb.com/test further qualitative, changes in cognitive function take place after about age 15.

Piaget theorized that cognitive development was complete by about age 15. He did not factor the effects of culture into his theory and felt that learning followed cognitive development. abirb.com/test

DIF: Cognitive Level: Understand (Comprehension)

REF: p. 360

12. Which of the following statements summarizes Vygotsky’s theory of development? abirb.com/test a. All children develop cognitively at the same rate. b. Social and cultural influences are not major factors in cognitive development. c. Learning is an individual activity. d. Experience creates learning. abirb.com/test ANS: D

Vygotsky proposed that learning precedes development. He states that learning pulls development, which is in stark contrast to Piaget, who feltabirb.com/test children were not capable of learning something until they were developmentally ready. For Vygotsky, development begins as an interpersonal process of “meaning making” which when becomes an individualized process of “making sense.” There are no predetermined levels of development; abirb.com/test rather, experience is in the front—leading and expanding development in unlimited way.

Vygotsky’s theory of development stresses that social and cultural influences can have a major impact on learning. He felt that cognitive development was dependent on exposure to many life experiences, was influenced by interaction with abirb.com/test others, and did not proceed according to predetermined stages.

DIF: Cognitive Level: Understand (Comprehension)

REF: p. 361 abirb.com/test

13. Kohlberg’s theory of moral development is based on a. Erikson’s theory of psychosocial development. b. Piaget’s theory of cognitive development. c. Vygotsky’s theory of cognitive development. d. Gilligan’s theory of moral development.

ANS: B

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The three stages of moral development—preconventional, conventional, and postconventional—were based on Piaget’s theory of cognitive development and emphasize the ethics of rights and justice. abirb.com/test

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 362

14. According to Vygotsky’s theory, the distance between the actual and potential level of

development is called ____. a. Region of compromised development b. Scaffolding c. Zone of proximal development d. Developmental delay

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ANS: C

Although Vygotsky’s theory of cognitive development is less known to health care abirb.com/test professionals, educators have embraced his theory, especially what he refers to as the zone of proximal development. The zone of proximal development is the distance between the actual and potential developmental level. In this zone, children are pulled toward new learning through their interaction with others and the environment.abirb.com/test The guidance given by others in this zone is referred to as scaffolding.

DIF: Cognitive Level: Understand (Comprehension)

REF: p. 361 abirb.com/test

15. For which theorist would the social, cultural, and political environment be an important

component to learning and development? a. Kolhlberg b. Gilligan c. Vygotsky d. Piaget

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ANS: C

According to Vygotsky, all people need to understand not only the way in which an individual learns and develops but also the social, cultural, and political context in which that learning abirb.com/test and development takes place. This difference can profoundly impact how the nurse approaches teaching and learning.

DIF: Cognitive Level: Understand (Comprehension)

REF: p. 362

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16. Which of the following statements about Gilligan’s theory of moral development is accurate? a. This theory is based on a sense of absolute right and wrong. abirb.com/test b. This theory is gender specific. c. This theory is dependent on one’s stage of cognitive development. d. This theory is based on the premise that women view situations in terms of rules.

ANS: B

abirb.com/test

Carol Gilligan’s theory of moral development suggests that the process of moral development differs in women. While a doctoral student, Gilligan did research with Lawrence Kohlberg at Harvard University. She discovered that Kohlberg’s original research was conducted using abirb.com/test only men and that women often scored lower in Kohlberg’s scaling of moral levels. She asserted that women were not inferior in their moral development, just different. In developing her own research with female subjects, she proposed an alternate theory of moral development, which, like Kohlberg’s, has three stages. abirb.com/test DIF: Cognitive Level: Understand (Comprehension)

REF: p. 362 abirb.com/test

17. A nurse is caring for a person with the nursing diagnosis of chronic sorrow related to missed

opportunities. Which of the following nursing interventions would be appropriate for this person? a. Sharing a personal story with the person to demonstrate empathy abirb.com/test b. Assuring the person that he or she will be able to cope with the illness c. Encouraging the person to discuss his or her fears d. Contacting a support group representative for the person abirb.com/test

ANS: C abirb.com/test

Nursing Interventions: Grief work facilitation: Helping another cope with painful feelings of actual or perceived responsibility. For example: Listen to expression of grief, encourage abirb.com/test identification of fears, assist in identifying needed modifications in lifestyle.

It is not appropriate to discuss personal issues with an individual. Assuring the individual what he or she will be able to cope with is not appropriate because it does not encourage the person to talk about his or her fears. It is not appropriate to contact a support group without abirb.com/test the person’s permission. The person may not be ready to discuss the issue with strangers. The correct response is part of grief work facilitation: helping another cope with painful feelings of actual or perceived responsibility. abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 364, care plan

18. A nurse is teaching parents of a toddler about nutrition. Which of the following statements abirb.com/test should be made by the nurse? a. “Raisins are a good finger food because they provide fiber.” b. “Grapes are a good snack choice because they help toddlers meet their daily fruit requirements.” abirb.com/test c. “Hot dogs are not a safe food choice because they may cause choking.” d. “A small piece of chewing gum will help strengthen jaw muscle; just be sure he or she does not swallow it.” abirb.com/test

ANS: C

Avoid foods that pose a choking hazard such as nuts, hard candies, raisins, fresh carrots, whole grapes, chewing gum, hot dogs, and fish with bones. abirb.com/test Raisins, grapes, and chewing gum all pose a choking hazard and should not be given to toddlers.

DIF: Cognitive Level: Apply (Application)

REF: p. 368, Box15-3 abirb.com/test

19. A nurse who is conducting a parenting class is asked how to select a good day care center for

an 18-month-old child. Which of the following responses should be made by the nurse? abirb.com/test a. “Day care centers that schedule age-appropriate educational videos increase verbal ability.” b. “Human interaction increases a toddler’s verbal skills, so select a day care center that values adult-to-toddler interaction.” abirb.com/test c. “Learning to understand the meaning of words is increased when toddlers are exposed to educational DVDs, so select a day care center that has an extensive library of age-appropriate, educational DVDs.” d. “There really is no difference in the quality of day careabirb.com/test centers based on whether or not videos or DVDs are used for educational purposes.”

ANS: B

The American Academy of Pediatrics (AAP) recommendsabirb.com/test no screen time (television/video/computer/tablets/phone) for children younger than 2 years and recommends limits on screen time for children older than two. The AAP reports that active, not passive adult-child communication is important to expand learningabirb.com/test experiences for children. Recent studies have associated television watching with decreased language development. A study of 329 children ranging in age from 2 to 48 months found that even audible television, which decreased the child’s exposure to discernible adult speech, led to decreased child vocalizations abirb.com/test and delayed speech development.

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TV watching, DVD watching, computer, tablets, etc. have all been demonstrated to have a negative impact on language skills. By contrast, human interaction enhances skills. Day care abirb.com/test facilities that favor adult-to-toddler interaction and minimize or preferably avoid all DVD/TV watching should be selected.

DIF: Cognitive Level: Apply (Application)

REF: p. 362, Box 15-4 abirb.com/test

20. A high school sophomore engages in risky behavior to fit in with his peers. According to

Erikson’s theory of human development, which of the following developmental conflicts is this student facing? abirb.com/test a. Initiative versus guilt b. Industry versus inferiority c. Identity versus role confusion abirb.com/test d. Intimacy versus isolation ANS: C

According to Erikson, a preschool child has a developmental conflict between initiative and abirb.com/test guilt, a school-age child has a developmental conflict between industry and inferiority, and a young adult has a developmental conflict between intimacy and isolation. An adolescent has a developmental conflict between identity and role confusion. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 360, TBL 15-3

21. A child is focused on peer approval and avoidance of “not fitting in.” According to Kohlberg,

this child is experiencing which of the following stages ofabirb.com/test moral development? a. Preconventional b. Conventional c. Postconventional abirb.com/test d. Preoperational ANS: B

Kohlberg developed his theory, which is outlined in Tableabirb.com/test 15-5 in the textbook. The three stages of moral development—preconventional, conventional, and postconventional—were based on Piaget’s theory of cognitive development and emphasize the ethics of rights and justice. Progression through the successive stages of moral development generally takes place during the school-age, adolescent, and young-adult years. abirb.com/test Beyond the young-adult years, stabilization or increased consistency of thought and perhaps an increased correlation between moral judgment and moral action occur.

The goal of the conventional stage is gaining approval andabirb.com/test avoiding disapproval. The goal of the preconventional stage is avoiding punishment and gaining reward, while the goal of the postconventional stage is agreeing upon rights, establishing personal moral standards, and achieving justice. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 362

22. The nurse is caring for a person who donated a kidney to a stranger in need. According to abirb.com/test

Gilligan’s stages of moral development, the person who donated the kidney is in which of the following stages? a. Preconventional b. Conventional abirb.com/test c. Postconventional abirb.com/test

d. Midconventional ANS: B

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Characteristics of the conventional stage of Gilligan’s stages of moral development include sacrifice to fulfill the needs of others.

DIF: Cognitive Level: Apply (Application)

REF: p. 363, TBL 15-6 abirb.com/test

MULTIPLE RESPONSE abirb.com/test

1. A nurse is attending a continuing education program about growth and development. Why is it

necessary that nurses are well educated about this content? (Select all that apply.) a. Have a better understanding of genetics and genomics b. Can meet the requirements of Healthy People 2010 abirb.com/test c. Can provide more effective health education d. Can deliver anticipatory guidance to families ANS: A, C, D

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Genetics and genomics is an important part of our age of technology; understanding growth and development aids in the understanding of these topics as well. Health education is more effective when the nurse acknowledges and incorporates growth and developmental needs as abirb.com/test well as the individual’s prior understanding of beliefs about health and health-related concepts. Health promotion is an important part of Healthy People 2010, but there are no requirements within this document that nurses need to be educated about growth and abirb.com/test development.

DIF: Cognitive Level: Apply (Application)

REF: p. 363, Box 15-5 abirb.com/test

2. A nurse is educating new parents about normal growth and development for their child.

Which of the following items would the nurse include in this discussion? (Select all that apply.) abirb.com/test a. Trends in childhood obesity b. Availability of a well-balanced diet c. Exposure to lead-based pain d. Height/weight of relatives abirb.com/test ANS: B, C, D

Influences on an individual’s potential for growth include genetic factors, prenatal and postnatal exposures, nutrition, and environmental factors ….

Other influences include abirb.com/test emotional health as well as traditional cultural practices that influence childrearing, lifestyle, and health care practices (Box 15-1: Diversity Awareness). Although much of the potential for growth is primarily determined by individual genetics, health and environmental abirb.com/test exposures influence the attainment of that potential. The timing of contact with environmental hazards and stressors may determine to a great extent the amount and kind of effects of these influences.

A well-balanced diet will help assure that the child reachesabirb.com/test his or her growth potential. Lead poisoning, an environmental exposure, remains a significant threat to today’s children.

Genetic factors greatly influence growth and development. Trends in childhood obesity, while a significant societal and public health concern, are not directly relevant to this discussion. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 349, Box 15-5 abirb.com/test

3. The school nurse is conducting an in-service program for teachers that discusses the

development of elementary school children. According to abirb.com/test Piaget’s theory of cognitive development, which of the following information would the nurse include? (Select all that apply.) a. Use abstract thought to discuss a story. abirb.com/test b. Make moral decisions concerning right and wrong actions. c. Listen to a peer’s point of view about a playground situation. d. Be influenced by his or her friends.

ANS: C, D

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Children aged 7 to 11 are in the concrete operations stage of development according to Piaget.

They are influenced by friends and can listen to and think about a peer’s point of view. Moral decision-making and use of abstract thought occur during abirb.com/test the formal operations stage of development, usually between the ages of 11 and 15 years.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 361, TBL 15-4 abirb.com/test

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Chapter 16: The Prenatal Period Edelman: Health Promotion Throughout the Life Span, 9th Edition abirb.com/test

MULTIPLE CHOICE abirb.com/test

1. A pregnant woman reports to the nurse that the first day of her last menstrual period was

January 22. Using Nägele’s rule, which of the following dates would be the most accurate estimated date of delivery? a. September 16 abirb.com/test b. September 22 c. October 29 d. October 17 abirb.com/test

ANS: C

An accurate estimated date of delivery is determined by using Nägele’s rule. This is done by adding 7 days to the date of the first day of her last normal menstrual period and subtracting 3 abirb.com/test months: 22 + 7 = 29. Subtracting 3 months from January is October. Thus, the estimated date would be October 29.

DIF: Cognitive Level: Apply (Application)

REF: p. 367 abirb.com/test

2. Which of the following best describes an abnormality in structure or function that occurs

during fetal development? a. Congenital defect b. Genetic defect c. Embryonic defect d. Chromosomal defect

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ANS: A

During fetal development, an abnormality in structure or function is known as a congenital defect. abirb.com/test DIF: Cognitive Level: Understand (Comprehension)

REF: p. 367

3. During which week would pregnancy begin to pose healthabirb.com/test concerns for the fetus? a. 36 weeks b. 38 weeks c. 40 weeks abirb.com/test d. 42 weeks ANS: D

When pregnancy continues beyond 42 weeks, or 2 weeks beyond the calculated due date, abirb.com/test placental function decreases even more, posing concerns about the well-being of the fetus.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 368 abirb.com/test

4. Which of the following changes is experienced by the urinary system during pregnancy? a. Increased urinary output secondary to total body water increase b. Decreased bladder capacity abirb.com/test c. Decreased glomerular filtration rate (GFR) resulting from estrogen and

abirb.com/test

progesterone surge d. Increased renal excretion of acidic drugs ANS: A

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The urinary system undergoes dramatic changes during gestation. The changes include a 50% increase in GFR, an increase in the diameter of the ureters, and increase in urinary output abirb.com/test related to total body water increase and an increase in bladder capacity.

DIF: Cognitive Level: Understand (Comprehension)

REF: p. 369

5. During a routine clinic visit, a pregnant woman expresses abirb.com/test concern about reflux she is

experiencing. Which statement should be made by the nurse when addressing the woman’s concern? a. “Frequent heartburn may be a sign of fetal distress andabirb.com/test an ultrasound should be performed immediately.” b. “Frequent heartburn is caused by high levels of hormones during pregnancy.” c. “Frequent heartburn is a result of gastrointestinal system changes that occur during abirb.com/test pregnancy.” d. “Frequent heartburn during pregnancy requires immediate consultation with a gastroenterologist.”

ANS: C

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The gastrointestinal system undergoes dramatic changes during pregnancy, which include frequent heartburn secondary to upward displacement of the stomach and a relaxed gastroesophageal sphincter. Therefore the appropriate response for this woman would be to abirb.com/test provide her with information regarding normal changes during pregnancy. In this case the frequent heartburn is a result of gastrointestinal system changes that occur during pregnancy.

DIF: Cognitive Level: Apply (Application)

abirb.com/test REF: p. 369

6. The client who is taking prescribed _____ would require preconception management to

minimize the potential for drug-related birth defects. a. antiemetics b. antiepileptics c. iron d. non-narcotic analgesics

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ANS: B

Oral antiepileptic medications require preconception management to minimize potential birth abirb.com/test defects and minimize health problems.

DIF: Cognitive Level: Apply (Application)

REF: p. 371 abirb.com/test

7. A nurse is caring for a pregnant woman who has a pre-pregnancy body mass index (BMI) of

27. Which of the following instructions should the nurse provide the woman regarding weight gain during pregnancy? a. “You should gain 11 to 20 pounds during your pregnancy.” abirb.com/test b. “You should gain 15 to 25 pounds during your pregnancy.” c. “You should gain 25 to 35 pounds during your pregnancy.” d. “You should gain 28 to 40 pounds during your pregnancy.” abirb.com/test

ANS: B abirb.com/test

In 2009, the IOM released new weight gain guidelines that are based on revised BMI categories. Overweight women (BMI of 25 to 29.9) should gain 15 to 25 pounds. Healthy women at a normal weight for their height (BMI of 18.5 toabirb.com/test 24.9) should gain 25 to 35 pounds.

Underweight women (BMI less than 18.5) should gain 28 to 40 pounds. Obese women (BMI greater than 30) should limit their gain to 11 to 20 pounds.

DIF: Cognitive Level: Analyze (Analysis)

abirb.com/test

REF: p. 372

8. A nurse is caring for a woman who is in labor. The nurse anticipates that the labor will

progress through which of the following sequences? abirb.com/test a. Dilation stage, pressure stage, placental stage, recovery stage b. Dilation stage, pushing stage, pain stage, recovery stage c. Dilation stage, pushing stage, placental stage, recovery stage abirb.com/test d. Dilation stage, pushing stage, placental stage, refractory stage ANS: C

The sequence for the four stages of labor is dilation stage, pushing stage, placental stage, and abirb.com/test recovery stage.

DIF: Cognitive Level: Apply (Application)

REF: p. 374 abirb.com/test

9. A nurse is caring for a woman who is in labor and the fetus descends to the lower birth canal.

The woman is in which of the following stages of labor? a. First abirb.com/test b. Second c. Third d. Fourth ANS: B

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During the second stage of labor, the fetus descends through the lower birth canal toward the woman’s perineum.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 374

10. A nurse is caring for a woman during the fourth stage of labor. Which of the following best

describes an action the nurse would take during this stage?abirb.com/test a. Providing constant reinforcement and education about the labor process and assisting the woman with pushing b. Explaining unusual interventions such as the use of a fetal heart monitor abirb.com/test c. Assisting with labor discomfort by modeling breathing d. Teaching the new mother positioning of the infant to assist with breastfeeding ANS: D

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Active nursing support during the third and fourth stages of labor includes observing for excessive vaginal bleeding after the placenta is expelled, assisting the woman in breastfeeding her new baby, monitoring vital signs, and implementing uterine massage if the uterus becomes abirb.com/test boggy or fails to contract over the placental site. Emotional support during assessments and delivery of information to explain the rationale for assessments are also important nursing roles supported by professional practice standards.

The best response is the nurse teaching the new mother the football hold to assist with abirb.com/test breastfeeding. Choices A, B, and C would apply before the baby is delivered.

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DIF: Cognitive Level: Apply (Application)

REF: p. 375 abirb.com/test

11. Which of the following statements about race and culture in the United States is correct? a. The United States ranks 22nd in the world for infant mortality rate. b. Ethnic minority populations have higher rates of low-birth-weight infants. c. Black infants are more likely to have cleft palates thanabirb.com/test Native American infants. d. Whites have more fraternal twin pregnancies than non-Whites.

ANS: B abirb.com/test Currently, the United States is 49th in the world ranking for infant mortality rate (IMR). This rate, which reflects the number of infants who die before the end of their first year of life is the leading indicator of a nation’s health, reflects the higher IMRs and low-birth-weight outcomes of Blacks, American Indians, and other ethnic minority populations in the United abirb.com/test States. In the United States, non-Whites (mainly Blacks) have more fraternal twin pregnancies than Whites. More Native American, Latino, or Asian descent babies have cleft palates than do Black babies. abirb.com/test

DIF: Cognitive Level: Understand (Comprehension)

REF: p. 377

12. During the second prenatal visit, the pregnant woman informs the nurse that she has stopped abirb.com/test

smoking. This finding is based on an assessment of which functional health pattern? a. Cognitive-perceptual pattern b. Self-perception–self-concept pattern abirb.com/test c. Health perception–health management pattern d. Values-beliefs pattern ANS: C

abirb.com/test A woman’s acceptance of her pregnancy influences her health management practices. A woman who denies or has negative feelings about her pregnancy may fail to eat properly, get enough rest and exercise, breastfeed or seek prenatal care.

A woman who has stopped smoking because she is pregnant indicates that she accepts her abirb.com/test pregnancy and the health practices that must be instituted to promote a healthy pregnancy, delivery, and baby. Such an assessment is a part of the health perception–health management pattern. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 378

13. A pregnant woman who is at the end of 20 weeks of gestation is at a prenatal visit. Which of abirb.com/test

the following changes in weight from pre-pregnancy would require the nurse to take additional action? a. 6 pound increase b. 11 pound increase abirb.com/test c. 14 pound increase d. 20 pound increase ANS: A

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If at the end of 20 weeks of gestation the woman has not gained at least 10 pounds, she risks delivering an ill infant suffering from intrauterine growth restriction.

DIF: Cognitive Level: Apply (Application)

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REF: p. 380

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14. During a prenatal visit, a nurse discovers that a Black woman has been occasionally craving

and eating clay. Which of the following actions should be taken by the nurse? a. Tell the client that many pregnant women crave such nonfood abirb.com/test substances, and it is not a problem. b. Ignore the comment because pica is acceptable in some rural Black cultures. c. Encourage the client to eat it with plenty of water because of the risk of abirb.com/test constipation. d. Stress the importance of an appropriate diet and avoiding pica in a culturally sensitive way.

ANS: D

abirb.com/test

The nurse identifies instances of pica and suggests a culturally sensitive diet that will better meet the needs of the woman and her developing fetus. It is essential that the nurse remain abirb.com/test nonjudgmental but stress the importance of an adequate diet, folic acid, iodine, and iron supplements, and the dangers of pica.

Pica may negatively influence the quality of a woman’s nutrition during pregnancy. The practice of pica is acceptable in some rural Black cultures.abirb.com/test However, it can lead to lead poisoning, fecal impaction, parasitic infections, prematurity, perinatal mortality, low-birth-weight infants, and anemia in infants. When the nurse identifies instances of pica, she should suggest a culturally sensitive diet that will better meet the needs of the woman and her fetus. The nurse must remain nonjudgmental but stressabirb.com/test the importance of an appropriate diet and the dangers of pica.

DIF: Cognitive Level: Apply (Application)

REF: p. 381

abirb.com/test

15. A nurse is assessing the nutritional-metabolic patterns of a pregnant woman. Which of the

following findings would be of concern to the nurse? a. The woman drinks about 1 gallon of water a day. abirb.com/test b. The woman works out at the gym daily. c. The woman does not like vegetables. d. The woman usually eats three meals a day in addition to two snacks a day. abirb.com/test

ANS: C

In summary, the pregnant woman needs to follow the USDA Daily Food Plans for Moms as follows: abirb.com/test • Fruits and vegetables—7 or more servings daily (3 servings of fruits and 4 of vegetables) • Whole grains or enriched breads/cereals—6 to 9 servings daily abirb.com/test • Dairy products—3 to 4 servings of low-fat or nonfat milk, yogurt, or cheese daily • Meat and beans—3 servings daily (one serving = 2 ounces) Because of pressure from the enlarging uterus, slowed peristalsis, and supplemental iron and calcium intake, the woman is at risk for constipation that can then lead to hemorrhoids. abirb.com/test Therefore, the woman should eat foods high in fiber, including vegetables and fruits. A woman who does not like or eat vegetables is at risk for constipation and hemorrhoids.

DIF: Cognitive Level: Analyze (Analysis)

abirb.com/test REF: p. 382

16. A woman who is 23 weeks pregnant is concerned because her baby is moving less than it was

a few weeks ago. Which of the following statements would be the most appropriate response abirb.com/test by the nurse?

abirb.com/test

a. “Your infant is in distress. We should call an ambulance.” b. “You need to be more active; take a dance class once a week.” c. “At this point in your pregnancy, the baby moves less abirb.com/test frequently because of lack of

space in the uterus.” d. “You probably counted incorrectly.”

ANS: C

abirb.com/test

Education and guidance are important nursing functions. It is true that by the end of the second trimester fetal movement occurs less frequently because of lack of space in the uterus.

The nurse should provide the woman with this information, so she knows what to anticipate. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 383

17. Which of the following mothers would be most likely to bond appropriately with their infant? abirb.com/test a. A mother who feels unloved will bond appropriately because now the baby will

love her. b. A mother who feels great about herself will show love toward the infant and bond abirb.com/test appropriately. c. A mother who feels empty by the birth of her child will bond appropriately once she holds the baby. d. A mother who feels ugly will bond appropriately with abirb.com/test her child because her child will bring self-esteem.

ANS: B

After birth, the woman gradually sees the infant more andabirb.com/test more as a separate individual, dependent on her care. The mother starts to bond with her baby based on her self-perception.

If she feels good about herself, she will show love toward the infant. When she feels ugly or unlovable, she may make uncomplimentary remarks about the infant’s appearance. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 386

18. During the first prenatal visit, the pregnant woman informsabirb.com/test the nurse that she cannot wait to

start wearing maternity clothes. This finding is based on an assessment of which functional health pattern? a. Cognitive–perceptual pattern abirb.com/test b. Self-perception–self-concept pattern c. Health perception–health management pattern d. Values–beliefs pattern ANS: B

abirb.com/test

To develop a maternal identity, the woman must first accept the pregnant body image.

Initially she may show ambivalence based on her need to “fit” the pregnancy with her perception of self. She may dislike the physical changes ofabirb.com/test pregnancy or gladly “show off” her pregnant body to others. During the second trimester, however, the woman frequently begins to feel more positive about her changing womanly image as she feels the baby move, and increased amounts of estrogen and progesterone enhance her sense of vitality, inner peace, and acceptance. Her body begins to look pregnant, abirb.com/test and generally others respond positively to this change. abirb.com/test

abirb.com/test

To develop a maternal identity, the woman must first accept the pregnant body image. The pregnant woman’s personality, maturity level, and psychological development influence her abirb.com/test readiness to assume the role of mother. Being excited about wearing maternity clothes is an indication that she has accepted the pregnant body image. Such an assessment is a component of the self-perception–self-concept pattern.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 385

19. A nurse is caring for a client who is 30 weeks pregnant at a prenatal visit. Which of the

following statements made by the client would be of concern to the nurse and warrant further abirb.com/test explanation and close follow-up? a. “I have been feeling more tired lately.” b. “My husband complains every time I ask him to do something for me.” c. “Sometimes, the smell of food makes me nauseous.” abirb.com/test d. “I need to get up two times a night to go to the bathroom.”

ANS: B abirb.com/test The partner may feel a rivalry with the fetus and baby, because the mother is devoting increasing amounts of time to the baby. He may resent the attention that she receives during the pregnancy and the additional demands that she may make on his time. He may experience more financial pressure because of baby expenses and his abirb.com/test partner’s need to stop working on a short-term or long-term basis. These perceptions may lead him to batter or otherwise abuse his partner, possibly causing poor pregnancy and newborn outcomes (Box 16-7: Quality and Safety Scenario). The nurse assesses each pregnant woman for abuse and intervenes appropriately to protect the safety and health of the familyabirb.com/test during gestation.

Fatigue, nausea, and increased urinary frequency are all normal discomforts associated with pregnancy. These discomforts warrant anticipatory guidance from the nurse. A husband who resents the attention that his pregnant wife is receiving andabirb.com/test the additional demands she may make on his time may lead him to abuse his wife. Therefore the nurse must obtain additional information and provide close follow-up when a woman states that her husband complains every time she asks him to do something because she may be at risk for abuse. abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 386

20. A woman who is 30 weeks pregnant tells the nurse that she and her husband are having sexual abirb.com/test

difficulties. Which of the following actions should the nurse take? a. Tell the woman she should not be sexually active at this point in her pregnancy because it may harm the fetus. abirb.com/test b. Ask her to elaborate on the difficulties. c. Tell her that they should modify their positions during intercourse and that will take care of the problem. d. Tell her men like the way pregnant women look. abirb.com/test ANS: B

The nurse can use the following guidelines concerning sexual activity: Sex is generally considered safe in pregnancy. abirb.com/test Abstinence should be recommended only for women who are at risk for preterm labor, multiple gestation, premature rupture of membranes, unexplained vaginal bleeding, or antepartum hemorrhage because of placenta previa. abirb.com/test

abirb.com/test

Some women worry about intercourse during pregnancy, fearing that it will cause miscarriage or harm to the baby. Sexual dissatisfaction of the couple may result from restrictions in sexual positions, pain on penetration, increased vaginal discharge,abirb.com/test breast tenderness, or the other physical discomforts of pregnancy such as fatigue or heartburn. The couple’s feeling about the woman’s changing body may alter their sexual relationship. The nurse’s first step in primary prevention intervention is to support the couple’s needs and relate, in a sensitive fashion, abirb.com/test accurate information that facilitates couple’s intimacy during pregnancy. Asking her to elaborate on the difficulties allows the nurse to understand the root of the problem and develop an appropriate intervention. Giving the woman advice on position changes or body abirb.com/test image may not be effective if it is not the cause of the difficulties.

DIF: Cognitive Level: Apply (Application)

REF: p. 388

abirb.com/test 21. During a prenatal visit, a pregnant woman informs the nurse that she and her husband have

chosen godparents for the baby. This finding is based on an assessment of which functional health pattern? a. Cognitive–perceptual pattern abirb.com/test b. Self-perception–self-concept pattern c. Health perception–health management pattern d. Values–beliefs pattern abirb.com/test

ANS: D

For women with strong spiritual needs related to their cultural backgrounds, spiritual interventions will help them integrate various dimensions of their lives, develop the ability to abirb.com/test parent successfully, and find meaning in the changes and goals of pregnancy. Identifying godparents will help the woman find meaning in the changes and goals of pregnancy. Such religious beliefs assessments are components of the values–beliefs pattern. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 389

22. A pregnant woman is having a TORCH screening done at today’s prenatal visit. She states she

is anxious to get the results back because she recently hadabirb.com/test unprotected sex with someone she just met and is afraid she might have HIV. Which of the following statements would be the best response by the nurse? a. “You will know your HIV status in about 1 week whenabirb.com/test the results come back.” b. “You will require additional testing for HIV as it is not tested for with the TORCH screen.” c. “You will need to be tested for HIV after you deliver because pregnancy can abirb.com/test produce false HIV results.” d. “You need to be exposed for at least 6 months before being tested for HIV in order for the results to be accurate.”

ANS: B

abirb.com/test

The TORCH screening helps detect toxop y lasmosis, hepatitis B, rubella, cytomegalovirus, and herpes simplex. HIV is not detected with the TORCH screen. Therefore she should tell the woman that she will require additional testing for HIV.abirb.com/test DIF: Cognitive Level: Apply (Application)

REF: p. 390, TBL 16-6

23. A nurse makes a home visit to monitor the blood pressure abirb.com/test of a pregnant woman who is single.

Which finding would be of most concern to the nurse? abirb.com/test

a. b. c. d.

The bedroom is located on the second floor.

She has a pet cat.

There is an area rug in the living room.

She has a 1-year-old child.

abirb.com/test

ANS: B abirb.com/test Toxoplasmosis is caused by a protozoan that infects people through undercooked meat, handling of cat feces, and exposure to infected soil. Sixty percent of maternal infections acquired during the third trimester result in fetal infection, which can lead to rash, enlarged lymph nodes and liver, inflammation of the heart, pneumonia, jaundice, and severe central abirb.com/test nervous system damage after birth or years later. Thus, pregnant women should avoid handling cats or cleaning cat litter boxes to avoid exposure to toxoplasmosis.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 391 abirb.com/test

24. A client who is 36 weeks of gestation is at her prenatal visit. The nurse tells the client that she

will be screened for group B Streptococcus during today’s visit. Which of the following abirb.com/test statements would be made by the nurse when providing client education about this screening test? a. “Screening for group B Streptococcus is necessary as this infection can cause complications with pregnancy and to the unborn infant.” abirb.com/test b. “This screening will help us to determine if your unborn infant will be susceptible to respiratory distress when he or she is born.” c. “Screening for group B Streptococcus will help us identify if you have been abirb.com/test exposed to this or any other infections during your pregnancy.” d. “This screening is necessary to determine if there is any Rh blood group incompatibility between you and your unborn child.”

ANS: A

abirb.com/test

Screening at 36 to 37 weeks of pregnancy for group B Streptococcus infection has been recommended, because this infection causes preterm rupture of the amniotic membranes, preterm labor, fetal respiratory distress syndrome, fetal septicemia, and meningitis. abirb.com/test DIF: Cognitive Level: Analyze (Analysis)

REF: p. 392

abirb.com/test 25. A woman is Rh negative and the father of her baby is Rh negative.

The woman states that her

friend told her that she would need a “shot” to keep her baby alive. Which of the following statements would be the best response by the nurse? a. “Yes, you will need an injection of RhoGAM at 28 weeks of gestation and within abirb.com/test 72 h after birth.” b. “Because the father of the baby is also Rh negative, your baby will not inherit Rh positive blood cells and you will not need the injection.” abirb.com/test c. “Yes, you will need the injection because this is your first pregnancy. You will not need it with subsequent pregnancies.” d. “No, you will not need the injection because you are White. Rh incompatibility affects only Black women.” abirb.com/test ANS: B abirb.com/test

abirb.com/test

Rh incompatibility sometimes affects fetal development. The problem usually occurs when the mother has Rh-negative blood cells and the fetus has Rh-positive blood cells, inherited abirb.com/test from the father who also has Rh-positive blood cells. All women should be assessed for blood type, Rh factor, and antibody development at their first prenatal visits and again at 24 to 28 weeks, unless the father is Rh-negative. Rh incompatibility may be prevented by administering RhoGAM at 28 weeks and within 72 h after birth. In this case, because the abirb.com/test father is Rh negative, RhoGAM is not necessary.

DIF: Cognitive Level: Apply (Application)

REF: p. 394 abirb.com/test

26. A woman who just found out she is pregnant starts crying. She tells the nurse that over the last

3 days she was not feeling herself, so she took some Tylenol. She states if she knew she was pregnant, she never would have taken the medication. Which of the following actions should abirb.com/test be taken by the nurse? a. Tell the client that there is a high probability that her baby will have a birth defect b. Tell the client not to worry because research indicates that in recommended doses Tylenol is safe. abirb.com/test c. Tell the client not to worry because she did not know she was pregnant, but in the future, she should use herbal products instead of over-the-counter medication. d. Tell the client that there is a high probability of a stillbirth. abirb.com/test

ANS: B

Research on aspirin and Tylenol indicates that both medications are safe in recommended doses. Little is known about the effects of herbal products and their interaction with other medications. As a result, the nurse may need to encourageabirb.com/test a client to reconsider the use of herbs when evidence exists that the herbs may harm the fetus or the mother. Providing the mother with appropriate information will help to decrease the mother’s anxiety level. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 395

27. A nurse is discussing the harmful effects that chemical agents can have on an unborn child abirb.com/test with a woman who is pregnant. Which of the following statements made by the woman indicates a need for further teaching? a. “It is safe to eat up to 12 ounces of cooked fish weekly.” b. “I should avoid using caffeine during pregnancy.” abirb.com/test c. “Consumption of one drink per day will not cause any harm to my unborn baby.” d. “Use of nicotine during pregnancy may cause my child to be born prematurely.”

ANS: C

abirb.com/test

Numerous studies have shown that no safe level of alcohol use exists during pregnancy; therefore alcohol should be avoided during this time and when attempting conception. While some fish does contain mercury, a moderate amount of fish may be safely consumed during abirb.com/testis inconclusive; thus pregnancy. The research on the safety of caffeine during pregnancy avoiding it during pregnancy is probably the wisest approach. Even small amounts of alcohol consumed during pregnancy can have profoundly harmful effects on the fetus.

DIF: Cognitive Level: Analyze (Analysis)

abirb.com/test

REF: p. 396

28. During a prenatal visit, pregnant parents ask the nurse what they can do to prepare their abirb.com/test 4-year-old child for the birth of the new baby. Which of the following actions would be most appropriate for the nurse to suggest?

abirb.com/test

a. Discourage any negative comments the child makes about the baby or the

pregnancy. b. Do not make any plans regarding the baby in front of the abirb.com/test 4-year-old child. c. Provide him with very detailed information about the pregnancy and the birth. d. Ask the 4-year-old boy to help decorate the new baby’s room.

ANS: D

abirb.com/test

Children in the family also experience role changes during and after the pregnancy. Having a child participate in decisions about the baby helps to prepare the child for the arrival of the neonate. Helping the parents decorate the new baby’s room allows the child to participate in abirb.com/test the arrival of the new baby.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 386 abirb.com/test

29. A Mexican American woman comes to the office for a visit. She is found to be 30 weeks

pregnant. Which of the following conclusions can the nurse draw from this finding? a. The woman does not value prenatal care. abirb.com/test b. Client education may require a different approach because of dissimilar cultural beliefs. c. This culture does not believe in traditional medicine. d. Signs of pregnancy were not recognized by the woman. abirb.com/test ANS: B

Cultural groups have unique ideas and beliefs related to pregnancy, childbirth, and childbearing that must be understood by the nurse to render individualized care to each abirb.com/test pregnant woman. Mexican Americans may consider prenatal care not needed because pregnancy is a normal life event. In addition, education influences their prenatal care access.

Therefore finding out that she is 30 weeks pregnant may be an indication that this woman may abirb.com/test require a different approach to education because of dissimilar cultural beliefs.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 399 abirb.com/test

30. At 1 minute of age, an infant has a heart rate of 95, a strong cry, some flexion of extremities, a

cry reflex, and is completely pink. Which of the following is a correct assessment of the infant’s Apgar score? abirb.com/test a. 4 b. 6 c. 8 d. 10 abirb.com/test ANS: C

There are five signs that are scored using the Apgar scoring system. A heart rate under 100 receives a score of 1, a strong cry receives a score of 2, some flexion of extremities receives a abirb.com/test score of 1, a cry for the reflex irritability sign receives a score of 2, and an infant whose color is completely pink receives a score of 2: 1 + 2 + 1 + 2 + 2 = 8.

DIF: Cognitive Level: Apply (Application)

abirb.com/test REF: p. 376, TBL 16-3

31. A woman usually eats an 1800-calorie diet. She is now in the second trimester of her

pregnancy. Which of the following best describes the caloric nutritional needs for this woman abirb.com/test during the second and third trimester?

abirb.com/test

a. b. c. d.

1800 calories 2100 calories 2400 calories 2700 calories

abirb.com/test

ANS: B abirb.com/test During pregnancy, a woman’s caloric needs increase by 300 calories. Someone who usually eats an 1800-calorie diet should increase her caloric intake to 2100 calories (1800 + 300 = 2100).

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 380

MULTIPLE RESPONSE abirb.com/test

1. Which properties must the sperm possess for conception to occur? (Select all that apply.) a. High motility b. Uniform size abirb.com/test c. Ability to secrete enzymes that dissolve the membrane surrounding the egg d. Life span of at least 3 h ANS: A, B, C

abirb.com/test

The sperm must be of uniform size, be normally formed, possess high motility, and have an ability to secrete enzymes that dissolve the membrane surrounding the egg.

DIF: Cognitive Level: Remember (Knowledge)

abirb.com/test REF: p. 367

2. A nurse is assessing a woman for positive signs of pregnancy. Which of the following

assessment findings would the nurse discover? (Select all abirb.com/test that apply.) a. Positive test for HCG in the maternal urine b. Detection of fetal heart tones c. Enlargement of the uterus abirb.com/test d. Palpation of fetal body parts ANS: B, D

Positive signs of pregnancy include: detection of fetal heart tones by auscultation, abirb.com/test ultrasonography, or a Doppler; palpation of fetal body parts using Leopold maneuvers; fetal movements visible and detected by examiner; and radiological or ultrasonographic demonstration of fetal parts. Enlargement of the uterus and positive test for HCG in the maternal urine are both probable signs of pregnancy. abirb.com/test DIF: Cognitive Level: Apply (Application)

REF: p. 369, Box 16-1

3. Which of the following statements is correct regarding Zika virus disease? (Select all that abirb.com/test

apply.) a. Zika virus is transmitted primarily from a nocturnal mosquito bite. b. Up to 80% of people infected have no symptoms. abirb.com/test c. The virus can cause microcephaly in the developing fetus. d. Women who may become pregnant should receive a preventive vaccine.

ANS: B, C

abirb.com/test

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The mosquito bites occur during the daytime when the Aedes species of mosquitoes are active. There is no vaccine that prevents this disease. Choices B and C are correct statements. abirb.com/test

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 392

4. Which of the following statements is correct regarding neonatal abstinence syndrome (NAS)? abirb.com/test (Select all that apply.) a. It results from exposure of the fetus in utero to illicit substances. b. Cocaine does cause this syndrome but opioids do not cause it. c. Infants with NAS have prolonged hospital stays for serious medical complications. abirb.com/test d. This problem is limited to lower socioeconomic levels, primarily in the inner cities.

ANS: A, C

abirb.com/test

Maternal use of any illicit substance, especially opioids, can cause this syndrome. The problem of drug abuse during pregnancy has affected women in all communities, races ages, cultures, and socioeconomic levels. Choices A and C are correct statements. abirb.com/test

DIF: Cognitive Level: Remember (Knowledge)

REF: pp. 395, 396 abirb.com/test

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Chapter 17: Infant Edelman: Health Promotion Throughout the Life Span, 9th Edition abirb.com/test

MULTIPLE CHOICE abirb.com/test

1. An infant is lying in a crib watching and listening to a colorful mobile. Which of the

following statements is correct concerning a mobile for an infant? a. Provides stimulation necessary for continued growth and development for the infant abirb.com/test b. Provides too much stimulation for the infant, making it difficult for the infant to focus c. Serves as inadequate stimulation for the infant because it is an inanimate object abirb.com/test d. Serves as a distractor for the infant, making it easier to fall asleep ANS: A

The mobile is providing the stimulation necessary for continued growth and development abirb.com/test because both auditory and visual stimuli are necessary to promote growth and development.

Additionally, soft sounds and voices are soothing to infants.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 410 abirb.com/test

2. The nurse performs a home visit for a new mother and infant. The nurse observes that the

infant lacks a regular feeding schedule, has diapers that are not changed promptly, and cries abirb.com/test for long periods of time before being consoled. Which of the following problems is the infant most at risk for encountering in the future? a. Developing enuresis as a toddler b. Having difficulty forming relationships abirb.com/test c. Becoming a picky eater d. Taking longer to toilet train ANS: B

abirb.com/test

Erikson’s psychosocial developmental theory is concerned primarily with a series of tasks or crises that each individual must resolve before encountering the next one. The central task during infancy is the development of a sense of trust versus mistrust. This occurs when adults meet an infant’s basic needs for survival. Establishing thisabirb.com/test basic trust or mistrust determines the manner in which the infant approaches all future stages of growth.

The infant may have difficulty forming relationships in the future because trust influences future relationships. By attending to the infant’s needs, parents are helping the infant develop abirb.com/test trust in them. Not having his needs attended to hinders that developmental task.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 411 abirb.com/test

3. By what age is an infant’s retina fully developed? a. Birth b. 2 months c. 4 months d. 6 months ANS: C

abirb.com/test

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Rod cells in the retina of the eyes, which are responsible for light perception, are functional at birth; however, the retina (the organ of visual perception) is not fully developed until abirb.com/test approximately 4 months of age.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 412

abirb.com/test 4. A nurse is completing a well-child assessment of a 6-month-old infant. Which of the

following guidelines should be used when assessing the infant’s height and weight? a. CDC growth charts b. CDC body mass index (BMI) charts abirb.com/test c. WHO growth standards d. Denver Developmental Screening height and weight standards ANS: C

abirb.com/test

The CDC recommends that health care providers use the WHO growth standards to monitor growth for infants and children ages 0 to 2 years of age in the United States and use the CDC growth charts for children age 2 years and older in the United States. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: pp. 412-413

5. A delivery room nurse senses disappointment when a mother is told she just delivered a baby abirb.com/test

girl. Which of the following would be the most therapeutic response by the nurse? a. “Yes, you just delivered a healthy, beautiful baby girl.” b. “This is your first baby. You can always try again for a boy.” abirb.com/test c. “Don’t worry, many parents often feel the same way you do.” d. “You are tired. I think you should get some rest.”

ANS: A

abirb.com/test The gender of the infant, a major concern of many expectant parents, may well influence parental relationships and expectations. The infant’s gender can evoke disappointment; in some cases, a woman may feel disappointed in a girl because she knows that her husband wanted a boy. Today, the trend is to want one child of eachabirb.com/test gender. Because of the availability in America of better forms of contraception and economic factors such as the expense of raising children, most couples are having fewer children today when compared with the 1950s. The importance and stress of producing the “right-sex” infant is evident. Being the abirb.com/test “wrong sex” can, combined with other factors, place an infant at risk for child abuse. The parents may find fault with and place blame on the infant for not meeting this expectation.

The nurse should respond by saying, “Yes, you just delivered a healthy, beautiful baby girl.”

This response provides information that will help increaseabirb.com/test the mother’s acceptance of having a girl rather than a boy. Acceptance and bonding are important in preventing child abuse. The fact that the mother appeared disappointed should be acknowledged with a positive comment.

DIF: Cognitive Level: Analyze (Analysis)

abirb.com/test REF: p. 413

6. A nurse is working with a family of an infant to improve their health perception and health

management pattern. Which of the following interventions would be most appropriate for the abirb.com/test nurse to implement? a. Assess the home for safety hazards. b. Teach parents appropriate coping mechanisms. c. Demonstrate effective parenting skills. abirb.com/test d. Encourage appropriate stimulation of the infant. abirb.com/test

ANS: C

Health is largely a subjective judgment. With this understanding, the nurse uses every abirb.com/test opportunity to convey confidence in the parents’ health perception–health management pattern and their ability to act to enhance the infant’s health. When parents learn and adopt behaviors to improve their own health, they are more likely to ensure that the health needs of their infant are met. Parental modeling increases the changes that good health practices will be abirb.com/test retained throughout the child’s life.

DIF: Cognitive Level: Apply (Application)

REF: p. 414 abirb.com/test

7. The mother of an 8-month-old asks what the minimum recommended amount of fat intake is

for her infant. Which of the following would be the minimum recommended fat intake? a. 18 g/day abirb.com/test b. 25 g/day c. 30 g/day d. 48 g/day abirb.com/test

ANS: C

Fats for infants should include 31 g/day for the first six months of life, and 30 g/day during the second six months of life that constitute about (40% to 50% of calories) are recommended abirb.com/test for infants. This quantity is present in human milk and in all formulas prepared for infants.

Breast milk and formulas provide approximately 50% of their calories as fat. Significantly lower intakes, such as in skim milk feedings, can result in an inadequate energy intake. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 415

8. Which of the following statements concerning infant nutrition is correct? a. During hot and especially dry weather, infants should abirb.com/test have supplemental water. b. 50% of an infant’s intake should come from protein to insure adequate growth. c. Breast milk and formulas contain 50% of their calories from fat. d. Skim milk started during infancy will help prevent later childhood obesity. abirb.com/test

ANS: C

Supplemental water is not necessary, even in hot, dry climates. The sources of water are fluids (primarily milk) and food; most strained foods are 75% toabirb.com/test 85% water. Most infant diets, without supplementation, meet the basic water requirement. Recommended protein requirements are 9/day during the first 6 months and 11g per day during the second 6 months.

No more than 20% of an infant’s daily energy requirement should come from protein because they are not able to process and excrete the excess nitrogenabirb.com/test from higher protein diets. Breast milk and formulas provide approximately 50% of their calories as fat. Significantly lower intakes, such as in skim milk feedings, can result in an inadequate energy intake.

DIF: Cognitive Level: Remember (Knowledge)

abirb.com/test

REF: p. 415

9. A nurse is completing a home visit of a new mother who is breastfeeding her infant. Which of

the following instructions should the nurse provide duringabirb.com/test this visit? a. Consume 500 kcal/day above pre-pregnancy energy intake to avoid excessive weight loss. b. Drink 1 quart of fluids daily to produce sufficient quantity of breast milk. abirb.com/test c. Be sure to wipe off all breast milk on the nipples between feedings to avoid

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infection d. All of the above statements are correct.

ANS: B

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Community nurses who are caring for breastfeeding mothers should stress the following tips to increase the duration of this activity: drink 1 quart of fluids daily to produce sufficient abirb.com/test quantity of breast milk; consume 300 to 400 kcal/day above pre-pregnancy energy intake to avoid excessive weight loss. Expose nipples to air after each feeding and allow some breast milk to dry on nipples for their lubricating and anti-infective properties.

DIF: Cognitive Level: Remember (Knowledge)

abirb.com/test

REF: p. 417

10. A mother asks the nurse when she should start feeding her infant solid foods. Which of the

following is the most appropriate response by the nurse? abirb.com/test a. “It is recommended that solid foods are introduced no earlier than 3 months of age.” b. “It is recommended that solid foods are introduced no earlier than 6 months of abirb.com/test age.” c. “You should wait until your child is 9 months old to start solid foods.” d. “You should wait until your child is 1 year old to start solid foods.”

ANS: B

abirb.com/test

The AAP and WHO recommend that waiting until the child is 6 months of age to introduce solid food decreases the tendency to develop food allergies and reduce the risk of childhood obesity. The decision to start solid foods at 4 to 6 months of age is based more on abirb.com/test neuromuscular and developmental readiness of the infant than on any hard scientific data, but research does validate the lowered risk of developing food allergies if solid foods are not introduced until 6 months of age. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 418

11. A new mother has decided to breastfeed her infant after having bottle-fed her other two abirb.com/test

children. Which of the following information about having a breast-fed infant should the nurse discuss with the mother? a. Breast-fed infants have darker bowel movements than bottle-fed babies. abirb.com/test b. Breast-fed infants have smellier bowel movements than bottle-fed babies. c. Breast-fed infants have more frequent bowel movements than bottle-fed babies. d. Breast-fed infants have harder bowel movements than bottle-fed babies.

ANS: C

abirb.com/test

A breast-fed infant’s stools have an orange-yellow color and a soft, even consistency, with a slightly sour but clean smell, dissimilar to stools passed later in life. A bottle-fed infant’s stools are harder, smellier, and resemble those of an infantabirb.com/test eating solid food. The breast-fed infant has many daily stools during the first and second months of life. The bottle-fed infant has two to four stools per day during the first month.

DIF: Cognitive Level: Apply (Application)

abirb.com/test REF: p. 419

12. During a home visit, the nurse finds a 9-month-old in a playpen with a couple of toys. Which

of the following instructions would be most appropriate for the nurse to provide to the parent abirb.com/test to encourage growth and development of the child?

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a. For safety, suggest removing all toys except soft stuffed animals from the playpen. b. Suggest keeping the infant in the playpen as much as possible to promote safe

play.

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c. Encourage providing the infant with supervised time outside of the playpen. d. All of the above.

ANS: C

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Anticipatory Guidance: Knowledge of developmental landmarks allows the nurse to guide parents in proper play and stimulation for infants. Handing a 15-month-old child a ball and placing the child in a fenced-in back yard to play is not enough. These activities must provide abirb.com/test interpersonal contact, activity, and exercise. Activity and exercise through stimulation and play are extremely important for adequate and healthy development. Buying expensive toys is unnecessary; common household items, such as pots, pans, lids, and spoons, provide excellent abirb.com/test objects for play purposes. Parental stimulation of the infant is an important developmental technique; the infant needs stimulation to learn about the world.

The nurse should encourage the mother to provide the infant with supervised time outside of the playpen to allow the child to crawl and explore. Parental stimulation is important. These abirb.com/test activities help promote growth and development. Additionally, by 9 months of age, most infants are crawling and need opportunity to exercise this developmental skill.

DIF: Cognitive Level: Apply (Application)

REF: p. 421 abirb.com/test

13. A new young mother asks the nurse what she should do to play with her 3-month-old infant.

Which of the following suggestions should the nurse provide? abirb.com/test a. Take the infant for a walk outside. b. Place several toys around the infant when lying on the floor. c. Rock the infant in a rocking chair. d. Search the Internet for toys highly recommended for infants. abirb.com/test ANS: C

Three-month-old infants cannot yet walk. Parental stimulation of the infant is an important developmental technique. The infant needs stimulation to abirb.com/test learn about the world. This activity does not require expensive objects, but rather involves experiences in sight, sound, and touch that are free and can be provided by any parent. One example of a stimulating experience for infants is being rocked in a rocking chair. Infants who are 3 months old will hold toys, but not abirb.com/test actively reach for them; thus surrounding the infant with toys would not be suggested.

DIF: Cognitive Level: Apply (Application)

REF: p. 421 abirb.com/test

14. The mother of a 4-month-old infant is concerned about the possibility of SIDS because her

neighbor’s daughter passed away last year as a result of SIDS. The mother reports she is so nervous that she has taken up smoking again. The mother informs you that the 4-month-old abirb.com/test sleeps supine and takes a pacifier to help her fall asleep. Which of the following statements would be the best response from the nurse? a. “You should place the infant in the bed with you until 6 months of age.” b. “You should never give the infant a pacifier while she abirb.com/test is sleeping.” c. “You should try to stop smoking.” d. “You should place the infant on her stomach.”

ANS: C

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Behavioral risk factors identified in epidemiological studies include prone and side sleeping positions, preterm birth and/or infant low birth weight, smoke exposure, soft bedding, bed abirb.com/test sharing, not breastfeeding, and overheating. Considering using a pacifier during sleep once breastfeeding is established.

In the interest of preventing SIDS, keep the infant away from smokers and places where people smoke; sleep with the infant in the same room where you sleep, but not the same bed abirb.com/test (bed sharing is contraindicated) for the first 6 months. Pacifiers are not contraindicated and can appropriately be offered at nap time and bedtime.

DIF: Cognitive Level: Apply (Application)

REF: p. 422 abirb.com/test

15. A nurse is developing an educational program about SIDS for a new mothers’ support group

in the community. Which of the following information would be included in this presentation? abirb.com/test a. Parents are encouraged to place their infants in the supine sleeping position. b. SIDS is the leading cause of death among infants aged 6 months to 1 year old. c. SIDS is associated with infants who have had difficulty sleeping at night. d. Parents are encouraged to limit the amount of “tummyabirb.com/test time” of their infant.

ANS: A

Through the Back to Sleep program, developed by the AAP, there have been a lower number of infant deaths from SIDS. This has encouraged the supine sleeping position. One of the abirb.com/test consequences of the supine sleeping position is plagiocephaly (occipital flattening). The primary intervention to decrease the risk of plagiocephaly is “tummy time.” Parents should be instructed to allow supervised tummy time while the infant is awake and cautioned about the abirb.com/test amount of time their infant spends in a car seat. SIDS is the leading cause of death among infants 28 to 365 days of age. By definition, the cause of SIDS is not known.

DIF: Cognitive Level: Apply (Application)

REF: p. 422, Box 17-8 abirb.com/test

16. A nurse is assessing the language development of a 6-month-old infant. Which of the

following findings would the nurse anticipate? a. The infant forms two-syllable sounds. b. The infant coos and makes vowel sounds. c. The infant babbles. d. The infant says “ma-ma” and “bye-bye.”

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ANS: C

Cooing sounds are heard at approximately 2 to 3 months, usually in response to an adult’s voice. By 6 months, babbling sounds are heard, and by 9 to 10 months, the infant forms abirb.com/test two-syllable sounds. By 12 months, words such as “ma-ma,” “bye-bye,” and “da-da” are emerging. From 15 to 18 months, an expressive jargon with rhythmic intonations develops, but words are recognized only rarely. The infant uses jargon along with pointing to express abirb.com/test wishes.

DIF: Cognitive Level: Apply (Application)

REF: p. 426 abirb.com/test

17. Which of the following infants is most at risk to experience child abuse? a. The father has experienced paternal engrossment. b. The infant responds to parental touch. c. The infant’s parents have low self-esteem. abirb.com/test d. The infant has been adopted. abirb.com/test

ANS: C

Because the parents’ self-esteem is associated closely with their infant’s interactions and abirb.com/test accomplishments, when parents’ self-esteem is low, disappointment, anger, and a disturbance in the relationship with their infant can occur. In some instances this disturbed parent–infant relationship is short-lived and nothing harmful develops. When a disturbed parent–infant relationship continues, however, the infant is at risk for abuse and behavior problems. abirb.com/test The process of paternal engrossment has been used to describe the behavior patterns of fathers when they interact with their infants. Responding to parental touch is a normal response and does not portend abuse. Similarly being adopted is not a risk factor for abuse. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 426

18. A nurse is assessing a 4-month-old infant during a well-child visit. Which of the following abirb.com/test

findings will require the nurse to collect additional information? a. The infant’s shirt is wet from drooling. b. The infant has gained one pound since her 2-month well-child visit. abirb.com/test c. The infant holds his or her head steady when in a sitting position. d. The infant grasps objects with two hands.

ANS: B abirb.com/test One of the passive manifestations of abuse includes poor nutrition, failure to thrive, and severe malnutrition. Weight gain of 1 pound in 2 months indicates a problem with the infant’s growth and requires further data collection by the nurse. The other assessment findings are normal growth and development for a 4-month-old infant.abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 427

19. A nurse visits a 3-month-old infant of a single mother for abirb.com/test a weight check. She finds two older

children running around the home, the infant is crying, the mother yelling at the two children and a half-lit cigarette is in an ashtray. The mother tells the nurse the visit needs to be cut short today because she has to pick up her other children from the bus stop. Which of the abirb.com/test following would be the most beneficial intervention this nurse can provide during this visit? a. Advise the mother that the nurse will wait in the home until mom returns from the bus stop. abirb.com/test b. Advise the mother that if she does not reschedule the visit within 1 week, the nurse will notify child protective services. c. Weigh the infant and offer community resources to the mother. d. Offer to go pick up the other children at the bus stop. abirb.com/test ANS: C

Abusing parents are often socially isolated and have few people to whom they can turn during times of crisis; they also cannot support one another emotionally. abirb.com/test The most beneficial intervention the nurse can provide is to keep the visit short, weigh the infant, and offer the mother the help of community services. Threatening the mother with a call to child protective services sets up an adversarial relationship, which is neither beneficial to the child nor the mother. If the nurse feels that the homeabirb.com/test situation rises to the level of notifying child protective services, she would do so without making threats or stipulations.

Neither staying behind in the home nor picking the older children up at the bus stop represents professional nursing activity. Both have legal ramifications and would be inappropriate. abirb.com/test

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DIF: Cognitive Level: Analyze (Analysis) 20. Where do most accidents occur? a. In the home b. In the car c. At day care d. On the playground

REF: p. 427 abirb.com/test

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ANS: A

Accidents occur in many situations: in the home, outside, on the playground, and in automobiles. However, most accidents occur in the home.abirb.com/test DIF: Cognitive Level: Remember (Knowledge)

REF: p. 430 abirb.com/test

21. Which of the following is an example of passive immunity? a. An attenuated (weakened) but live vaccine—measles, mumps, rubella (MMR) b. A toxin of the disease organism, which fosters immunity abirb.com/test c. Diphtheria, tetanus, and acellular pertussis (DTaP) killed vaccine d. Protection from drinking breast milk ANS: D abirb.com/test Vaccines, whether live and attenuated (MMR) or killed (DTaP), are all forms of active immunity. Vaccines stimulate the organism to produce its own immunity. The same would apply to a toxin injected with the intention of stimulating an immune response. Passive immunity is a form of temporary immunity which relies onabirb.com/test antibodies formed by a different individual but which protect another individual. In the case of breast milk, the baby ingests the milk which contains immunity (immunoglobulins) formed by the mother and thus acquires temporary immunity. It is an example of passive immunity. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 432

22. Which of the following is the most common poison ingested by infants? abirb.com/test a. Houseplants b. Lead c. Cleaning agents d. Aspirin abirb.com/test ANS: D

The National Clearinghouse for Poison Control Centers lists plants as the third most abirb.com/test commonly ingested poison, after aspirin and household cleaning agents.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 434

23. A new father is installing a car seat for an infant in the car.abirb.com/test Which of the following

information should be given to the father by the nurse? a. The infant should be in a rear-facing car seat in the front seat. b. The infant should be in a rear-facing car seat in the back seat. abirb.com/test c. The infant should be in a front-facing car seat in the front seat. d. The infant should be in a front-facing car seat in the back seat.

ANS: B

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The AAP recommends rear-facing car safety seats for most infants up to 2 years of age. The back seat is recommended because of the danger posed by air bags. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 436

24. A 15-month-old infant has been brought into the office by his Spanish-speaking mother for

symptoms of an upper respiratory infection. Which of the abirb.com/test following should be the initial action taken by the nurse? a. Ask the mother if she would like an interpreter. b. Ask the mother what home remedies have been used. abirb.com/test c. Ask the mother how long the child has had these symptoms. d. Ask the mother about any allergies the child may have.

ANS: A

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The nurse should start by asking the mother if she would like an interpreter. Once the need for an interpreter has been definitively established, the nurse can then continue with the other questions. abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 439

25. A nurse would like to be involved in promoting change inabirb.com/test health care policies. Which of the

following statements would be accurate as applied to this goal? a. Becoming a member of a health planning counsel or joining an advisory group to a legislator would be a good first start. abirb.com/test b. Nurses must have a minimum of a master’s degree to directly advise legislators on a one-to-one basis regarding healthcare. c. Engaging in political lobbying activities is unprofessional and inappropriate to the nursing role. abirb.com/test d. All of the above statements are correct.

ANS: A

The nurse can become a member of a health planning council, a concerned citizen’s group, or abirb.com/test an advisory group to a local legislator or to a state health department grant task force. In this capacity, the nurse’s responsibility is to inform the other committee members. Because nurses have firsthand experience with many community needs, they are in a good position to speak abirb.com/test out and inform others. While advanced education is valuable in developing expertise, there is no minimum required education to advise legislators either directly, i.e., on a one-to-one basis or indirectly, as a member of an advisory group. Lobbying is an appropriate activity for nurses and many lobbyists for health care issues are, in fact, nurses. abirb.com/test DIF: Cognitive Level: Apply (Application)

REF: p. 441

abirb.com/test 26. A mother asks a nurse what the best toy would be for her 2-month-old.

Based on the growth

and development of the infant, which of the following recommendations should be made by the nurse? a. Colorful mobile with music abirb.com/test b. Rattle c. Stuffed teddy bear d. Play telephone ANS: A

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The most appropriate toy based on the child’s age and developmental level would be a colorful mobile with music. At this age, the infant can listen to sounds and follow objects. The abirb.com/test mobile provides visual and auditory stimulation to continue to promote growth and development. The 2-month-old infant cannot yet grasp objects; hence neither a rattle nor a play telephone would be suitable, as yet. The same would apply for the stuffed teddy bear and worse yet, depending on the size of the bear, it could provide a suffocation hazard at this age. abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 442, TBL 17-11

27. A 5-month-old boy was born at 6 pounds, 7 ounces. He is abirb.com/test being seen in the office for a

well-child visit. The nurse would expect him to weigh approximately a. 10 pounds, 14 ounces. b. 11 pounds, 7 ounces. abirb.com/test c. 12 pounds, 14 ounces. d. 13 pounds, 7 ounces.

ANS: C abirb.com/test The child should weigh approximately 12 pounds, 14 ounces, because by 5 months of age, the child should weigh twice the birth weight.

DIF: Cognitive Level: Apply (Application)

REF: p. 409, TBL 17-1 abirb.com/test

28. A 9-month-old has mastered the pincer grasp. Which of the following tasks would the nurse

anticipate that the infant can do by himself? a. Play with a rattle. b. Eat Cheerios off a hard surface. c. Hold a spoon to feed himself. d. Drink from a cup.

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ANS: B

The pincer grasp is a fine motor skill that is necessary for picking items up off a surface. By this age, hand–mouth coordination has usually been met and therefore feeding the self with abirb.com/test finger foods—such as the Cheerios—becomes possible. The other choices can be accomplished with a one-handed or two-handed grasp which is an earlier developmental skill.

DIF: Cognitive Level: Apply (Application)

abirb.com/test REF: p. 410, TBL 17-1

29. A nurse makes a home visit to a 15-month-old following a hospitalization for a fall. Which

finding would be concerning to the nurse? abirb.com/test a. Radiator heating system in the home b. The child drinking from a cup c. The child experiencing a temper tantrum d. A decorative bowl filled with colorful marbles on the coffee abirb.com/test table ANS: D

Infants explore objects with their mouths, so anything they pick up should be too big to abirb.com/test swallow; balloons, small objects, and foods are the most common causes of foreign-body airway obstruction in children. Parents should be advised that objects such as safety pins, peanuts, beads, coins, hot dogs, paper clips, nuts, corn, buttons, popcorn, chips, apple with peel, and parts of broken toys are frequently swallowed. Many objects can fit into this abirb.com/test category and into the infant’s mouth.

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A decorative bowl filled with colorful marbles on the coffee table is concerning because by 15 months of age the infant is mobile and can eat finger foods. By 7 months of age, the infant abirb.com/test fixates on small objects; therefore, a safe environment must be created for the infant. Small objects are the most common causes of foreign body aspiration. A bowl of colorful marbles, located on a coffee table, poses a risk for foreign body obstruction. The child can easily reach objects on a coffee table. abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 429

30. Which of the following represents a developmental task(s)abirb.com/test normally accomplished in infancy? a. Develops a feeling of affection for others b. Able to run c. Uses short sentences abirb.com/test d. Choices “A” and “C” are correct ANS: A

An infant who likes to be picked up is displaying affection for others. This task is usually abirb.com/test accomplished by 6 months of age. The infant cannot yet run or use short sentences. These milestones occur in the toddler stage of development.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 411, TBL 17-3 abirb.com/test

31. An infant is going through the toys in his toy box. He looks at each one before dropping it to

the floor and picking the next toy out of the box. Using a growth and development abirb.com/test perspective, which of the following conclusions can the nurse draw by assessing this behavior? a. The infant is testing his limits. b. The infant is exploring his environment. abirb.com/test c. The infant is expressing his emotions. d. The infant is developing fine motor skills.

ANS: B

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In the first year, infants learn to focus their vision, reach out, explore, and seek out things around them. The infant is exploring his environment. By looking at each toy, he is developing the task of learning to understand and control his world through exploration. The abirb.com/test behavior described would represent normal activity for a child of this age.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 408 abirb.com/test

32. The mother of a 16-month-old infant asks a nurse her opinion about holiday decorating.

Which of the following recommendations should the nurse provide to the mother? a. Avoid hanging a wreath with holly and berries on the front door. b. Avoid hanging decorative pictures of a bearded Santa abirb.com/test Claus on the window. c. Avoid placing poinsettia plants around the home. d. Avoid hanging stockings on the fireplace mantle.

ANS: C

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Colorful, interesting-looking houseplants are often an irresistible attraction to a young infant or child. Infants and small children cannot keep their hands out of dirt-filled plant pots or abirb.com/test resist the temptation of eating leaves from the plant. Houseplants are another source of poison if ingested. Household plants are frequently placed on the floor, where the leaves or flowers are easy to pull off and taste. Table 17-8 identifies several common household and garden plants that are poisonous. abirb.com/test The mother should avoid placing poinsettia plants around the home because, if these attractive red leaves are swallowed, they could be fatal. By 16 months the infant can walk, and infants are more susceptible than adults to the effects of poisonous plants. Worse, the shiny green or abirb.com/test brightly colored leaves of many plants are very attractive to a child who would be prone to explore them by putting the leaves in his mouth. Plants should be kept out of reach of infants.

Berries on the wreath can also be fatal, but at 16 months, the child would not be able to reach the wreath; hence a wreath can safely be placed on the door. abirb.com/test DIF: Cognitive Level: Analyze (Analysis)

REF: pp. 433, 434, TBL 17-10

33. Which of the following statements is correct concerning weaning? abirb.com/test a. Weaning should not be started until the infant can sit only slightly supported. b. Weaning can not be started until the extrusion reflex is fully developed. c. Once the child has learned to use as cup, he or she should no longer have a bottle abirb.com/test or breast. d. AAP recommends weaning begin at 8 to 9 months and be completed by age 1 year.

ANS: A

The biological norm and desired method for weaning is toabirb.com/test allow the infant to self-wean.

Weaning should be started when the infant is ready. Developmentally, the infant can usually learn to use a cup by age 5 to 6 months; however, many children continue to nurse after they start using a cup. The infantile extrusion reflex needs to beabirb.com/test absent. This reflex is present in very young infants and involves the tongue pushing out any material in the mouth not associated with sucking. The safety advantages of this are obvious, but weaning cannot be commenced until the infant has matured sufficiently for the reflex to be absent. In addition, abirb.com/test weaning should not be started until the infant can sit only slightly supported and turn away his/her head to indicate food refusal. The AAP recommends breastfeeding for at least the first year of life. abirb.com/test

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 418

34. A 2-month-old infant is in for a well-baby visit. Which of the following immunizations should

the nurse administer to the infant? a. DTaP-1 b. MMR c. Varicella d. Influenza

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ANS: A

The Centers for Disease Control and Prevention (2007) recommends abirb.com/test the following vaccines at 2 months of age: DTaP-1, Hib-1, PCV, Polio, RV. DIF: Cognitive Level: Apply (Application)

REF: p. 433, TBL 17-9 abirb.com/test

abirb.com/test

MULTIPLE RESPONSE 1. Which of the following statements are correct concerning abirb.com/test language development? (Select all

that apply.) a. Infants initially make vowel sounds using the front part of their mouth. b. Cooing sounds begin at 2 to 3 months. abirb.com/test c. Babbling begins at approximately 9 to 12 months. d. By one year words such as “ma-ma” or “bye-bye” begin to emerge.

ANS: A, B

Language development, an important aspect of the infant’sabirb.com/test cognitive and perceptual pattern, is affected by development of the intellect, maturation of the central nervous system, development of the organs of speech, and exposure to human verbalization. As in other areas of development, language acquisition follows a definite sequence.

During the first 2 months, abirb.com/test most of the infant’s sounds are vowels and are made primarily in the front part of the mouth.

Crying is the major means of communication during this period. Cooing sounds are heard at approximately 2 to 3 months, usually in response to an adult’s voice. By 6 months, babbling sounds are heard, and by 9 to 10 months, the infant forms abirb.com/test two-syllable sounds. By 12 months, words such as “ma-ma,” “bye-bye,” and “da-da” are emerging. From 15 to 18 months, an expressive jargon with rhythmic intonations develops, but words are recognized only rarely.

Babbling begins by 6 months thus choice “C” is incorrect.abirb.com/test Choices “A,” “B,” and “D,” are all correct.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 425 abirb.com/test

2. A nurse is completing an initial genetic counseling interview with a couple. Which of the

following data would be collected during the interview? (Select all that apply.) a. Paternal age abirb.com/test b. Maternal age c. Family history d. Religious affiliation abirb.com/test

ANS: B, C

An important aspect of genetic counseling is identifying families at increased risk and referring them as necessary. Aspects that would be reviewed in the initial interview include abirb.com/test maternal age, ethnic background, family history, reproductive history, and maternal disease.

DIF: Cognitive Level: Apply (Application)

REF: pp. 413, 414 abirb.com/test

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Chapter 18: Toddler Edelman: Health Promotion Throughout the Life Span, 9th Edition abirb.com/test

MULTIPLE CHOICE abirb.com/test

1. At a well-child visit, a 2-year-old toddler measures 2 feet 8 inches tall. The nurse estimates

the toddler’s approximate final adult height to be a. 4 feet 8 inches. b. 5 feet. c. 5 feet 2 inches. d. 5 feet 4 inches.

abirb.com/test

ANS: D

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The toddler’s height at 2 years is approximately 50% of final adult height. Thus, at 2 feet 8 inches, the child’s approximate final adult height would be 5 feet 4 inches tall (2 feet 8 inches × 2). abirb.com/test DIF: Cognitive Level: Apply (Application)

REF: p. 450

2. A

-year-old toddler is in for an office visit. He was born at 6 pounds, 10 ounces. At abirb.com/test today’s visit, the nurse expects his weight to be a. 13 pounds, 4 ounces. b. 19 pounds, 14 ounces. abirb.com/test c. 26 pounds, 8 ounces. d. 33 pounds, 2 ounces.

ANS: C

Birth weight usually quadruples by ounces.

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years of age: 6 pounds, 10 ounces × 4 = 26 pounds 8

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 450

3. At a well-child visit, the parents of a toddler ask the nurse how they should teach their toddler

the importance of dental hygiene. Which of the following abirb.com/test actions should the nurse recommend to the parents? a. Remind the toddler to brush his teeth every day. b. Have the dentist tell the toddler about the importance of dental hygiene. abirb.com/test c. Schedule a time to brush their own teeth with their toddler. d. Have the toddler watch an educational cartoon video on the teeth brushing.

ANS: C abirb.com/test Toddlers identify with parents, caregivers, and other important role models, internalizing a wide range of lifestyle attributes. Parents’ and caregivers’ health perceptions and health behaviors should model the perceptions and behaviors desired for health promotion. Toddlers whose parents eat a variety of foods are more likely to try abirb.com/test new foods. Such modeling increases the chances that good practices will be retained throughout the toddler’s life.

Based on this principle, scheduling a time to brush their teeth with their toddler is the best way for parents to teach their toddler the importance of dental hygiene. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 452 abirb.com/test

4. A mother is concerned because her 22-month-old has been skipping meals lately. Which of

the following actions should the nurse recommend to the mother? abirb.com/test a. Put the child in time out whenever he skips a meal. b. Offer small amounts of favorite foods (cookies, chips) at meals to stimulate appetite. c. Limit the child’s consumption of juices and cookies. abirb.com/test d. Talk to the child about how important it is to eat three meals a day.

ANS: C

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Toddlers often use mealtime as an occasion to assert individuality and control as well as exploration. Families will vary in their expectations of eating behavior and mealtime routines.

The nurse’s best guide for parents of toddlers is to remind them that parents are in charge of what food is offered, when it is offered, and where. Box 18-5 lists some nursing interventions abirb.com/test to promote healthy eating in toddlers. However, it is up to the toddler to decide the amount to actually eat. Periodically, a toddler may even refuse a meal altogether. Parents need to be encouraged to offer healthy, age-appropriate food choices. Toddlers will eat them, as long as abirb.com/test they do not fill up on empty calories from juice and high-carbohydrate snacks that are often given to children “so they eat something.” Further, parents should not focus too much attention on food intake or punish children for refusing food. Toddlers may learn how easily abirb.com/test parents can be controlled by their behavior around food intake and may then continue the behavior for the attention alone.

DIF: Cognitive Level: Apply (Application)

REF: p. 453 abirb.com/test

5. Which of the following toddlers would require further investigation from the nurse? a. Sitting quietly on a couch b. Experiencing a temper tantrum abirb.com/test c. Playing with a toy next to another child also playing with a toy d. Exploring his environment and playing with new toys ANS: A

abirb.com/test

Toddlers are always busy—emptying wastebaskets and drawers, building and destroying towers, throwing, kicking, chasing after balls, or dressing and undressing. Many of their activities are repeated over and over, providing practice opportunities for their newly realized skills. The various toys designed for toddlers capitalize onabirb.com/test this ability to explore and imagine with laptop trainers, electronic coloring tablets, musical instruments, and books with accompanying audiovisual disks.

Toddlers spend most of their day playing and exploring their environment. Thus, a toddler abirb.com/test sitting quietly is not an anticipated behavior and should be evaluated further.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 454 abirb.com/test

6. Approximately how much sleep do toddlers require each day? a. 10 h b. 11 h abirb.com/test c. 12 h d. 13 h ANS: C

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Toddlers’ need for sleep decreases to 12 h a day during this developmental period. abirb.com/test

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 455 abirb.com/test

7. The inability of a toddler to put him- or herself in another’s shoes is known as a. autonomy. b. egocentrism. abirb.com/test c. self-perception. d. integrity.

ANS: B abirb.com/test The inability of a toddler to put him- or herself in another’s shoes is known as egocentrism.

This pattern is normal thinking for a toddler.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 456

abirb.com/test

8. Which of the following statements is correct concerning hearing in the toddler? a. Toddlers characteristically endlessly repeat sounds, words, and word combos. abirb.com/test b. Mild hearing loss will not affect speech skills but moderate or worse loss will do

so. c. Infants at risk who passed neonatal screening need diagnostic audiometry by age

15 to 18 months. d. All of the above statements are correct.

abirb.com/test

ANS: A

Toddlers often seek repetition of auditory input, as observed in their seemingly endless abirb.com/test repetition of sounds, words, and combinations of words. Hearing loss is one of the most common conditions present at birth. If undetected during early infancy, even mild hearing loss can impede speech, language, cognitive, and emotional development. Infants who pass the abirb.com/test neonatal screening but have a risk factor should have at least one diagnostic audiology assessment by 24 to 30 months of age.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 458

abirb.com/test

9. A deviation of the line of vision from the midline resulting from extraocular muscle weakness

or imbalance is known as a. amblyopia. b. farsightedness. c. nearsightedness. d. strabismus.

abirb.com/test

abirb.com/test

ANS: D

A deviation of the line of vision from the midline resulting from extraocular muscle weakness or imbalance is known as strabismus. abirb.com/test

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 459

10. A toddler has been diagnosed with amblyopia. Which of the following treatment measures abirb.com/test

would most likely be prescribed for the child? a. Using corrective lenses b. Patching of the eye c. Applying artificial tears to the eye d. Allowing the passage of time

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ANS: B

Management of amblyopia depends on the cause and includes surgery or paralytic and abirb.com/test autonomic, centrally acting pharmacologic agents. In addition, management includes strengthening of the eye with reduced vision by applying atropine eye drops or patching the stronger eye. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 458

11. Which of the following behaviors exemplifies a toddler working through his developmental

task? a. Clinging to his mother b. Refusing to take a bath c. Playing quietly with one toy d. Having no interest in a new toy

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ANS: B

The developmental task of toddlers is to acquire a sense ofabirb.com/test autonomy while overcoming a sense of doubt and shame. To exert autonomy, toddlers must relinquish the dependence on others that was enjoyed during infancy. The toddler must explore the world, not only the physical aspects but also the interpersonal aspects of relationships, to develop a true sense of autonomy. The child explores relationships with others byabirb.com/test searching for the limits of the child’s power: If a “no” or a temper tantrum means control of another person’s behavior, the child learns that one’s own self is more powerful than the other person’s self.

The child explores relationships with others by searching for the limits of the child’s power. A abirb.com/test child refusing to take a bath is trying to exert his autonomy.

DIF: Cognitive Level: Apply (Application)

REF: p. 459 abirb.com/test

12. A nurse is providing anticipatory guidance to parents about the self-perception–self-concept

pattern of a toddler. Which of the following statements would the nurse most likely make? a. “Temper tantrums are expected, so giving into them reduces parental stress.” abirb.com/test b. “Put your toddler in time out if he has a temper tantrum.” c. “Childproof your home.” d. “Always provide your toddler with challenging toys.” abirb.com/test

ANS: C

The nurse’s teaching focuses on the aspects that are troublesome for the toddler–parent relationship. The following examples are some general concepts to include: Match the environment to the child’s needs and abilities. Childproof abirb.com/test the home such that the child can explore safely. Provide toys that the child can master. Give opportunities to play with more challenging toys, but do not make these toys the rule. If temper tantrums occur, provide a safe environment for the toddler, identify the tantrum’s cause, and help the toddler regain control. abirb.com/test Do not reason, threaten, promise, hit, or concede.

During this stage toddlers do a lot of exploring, and this includes climbing, crawling, and tasting. As a result, they are at increased risk for injury and should be provided with a abirb.com/test childproof environment.

DIF: Cognitive Level: Apply (Application)

REF: p. 460 abirb.com/test

abirb.com/test

13. The mother of a 2-year-old toddler recently lost her job. In addition, her husband asked for a

separation. Which of the following actions should the nurse take based on this information? abirb.com/test Give the mother information about local support groups.

Provide the mother the name of a prominent local attorney.

Do not offer any advice unless the mother asks.

Help the mother find a job.

a. b. c. d.

abirb.com/test

ANS: A

Child abuse is more likely to occur with a major change or turmoil in the family. Toddlerhood is a trying time for even patient parents. Nurses need to be alert to family changes and stress. abirb.com/test Therefore, the nurse should give the mother information about local support groups.

Recommending attorneys or employers is not within the role of professional nursing. A major role for nursing, however, is to provide anticipatory guidance therefore refraining from abirb.com/test offering advice, unless asked, is not in keeping with this role.

DIF: Cognitive Level: Apply (Application)

REF: p. 461

abirb.com/test 14. A 2-year-old Asian American boy is being seen for an office visit. While examining the child,

the nurse notices round bruises on his back. The mother does not volunteer any information during the exam. Which of the following actions should the nurse take after examining the child? abirb.com/test a. Report the suspected child abuse to the Department of Children and Families. b. Not a significant concern as the vast majority of toddler bruises are from falls. c. Ask the mother about the bruises. d. Schedule a follow-up appointment in 2 weeks to see ifabirb.com/test the bruises are still present.

ANS: C

Many injuries are difficult to differentiate from accidental injuries or culturally appropriate abirb.com/test healing practices. Abusive parents are often hesitant to provide information, may be evasive, and may not exhibit feelings of guilt. However, these signs may also be present in nonabusive families. Therefore, signs consistent with abusive parents (in this case the bruises) should serve as a cue for further assessment. Therefore, in this case the nurse should first ask the abirb.com/test mother about the bruises. After listening to the mother’s explanation, the nurse still suspects child abuse than he or she is required by law to report the case to local child protective services. Finally, the nurse who is aware of cultural differences knows that coining, which can abirb.com/test result in bruising, is a common practice in Asian cultures.

DIF: Cognitive Level: Apply (Application)

REF: p. 461 abirb.com/test

15. An individual’s style of emotional and behavioral response across situations, especially those

involving change or stress, is known as a. ritual. b. temperament. c. coping. d. autonomy.

abirb.com/test

ANS: B

abirb.com/test

An individual’s style of emotional and behavioral response across situations, especially those involving change or stress, is known as temperament.

DIF: Cognitive Level: Remember (Knowledge)

abirb.com/test

REF: p. 462

abirb.com/test

16. Which of the following statements is correct concerning stress and coping for toddlers? a. Toddlers commonly imitate their parent’s behavior in abirb.com/test dealing with stressors. b. Siblings are viewed as allies and, thus, not common sources of stress for toddlers. c. Regressing to earlier infantile behavior is serious developmental problem. d. Discussing upcoming stressful events is ill-advised; it intensifies the child’s stress. abirb.com/test

ANS: A

Toddlers are developing new ways to cope with the myriad of new stresses that come with being a toddler. Typical stressors include new siblings, babysitters, day care, toilet training, abirb.com/test parental limit setting, and an endless string of tasks involving skills they have yet to develop.

Toddlers often imitate their parents’ behavior and this includes their methods of dealing with stress. They also regress, at times, to earlier infantile behavior when overwhelmed, until they regain some sense of mastery. Parents can help to anticipate and prepare toddlers for stressful abirb.com/test experiences before they happen. Preparations should be honest, simple, and focused on what the toddler will experience. Enough time should be allowed for the toddler to rehearse the coping behavior with the parent, but not so early before the event that the toddler forgets. abirb.com/test

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 462

17. A toddler needs to have blood drawn at his next appointment.

Which of the following actions abirb.com/test

would the nurse suggest that the mother do with the child before the next visit? a. Tell the child about the blood work early on the day of the appointment. b. Tell the child about the blood work right before leaving for the appointment. abirb.com/test c. Tell the child at the office right before the phlebotomist enters the room. d. Do not tell the child about the blood work.

ANS: B abirb.com/test Parents can help to prepare toddlers for stressful experiences before they happen. However, toddlers’ sense of time and ability to remember are limited. Enough time should be allowed for the toddler to rehearse the coping behavior with the parent but not so far off that the child will forget. Thus, the best time to tell the toddler is right before leaving for the appointment. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 462

a toddler’s health?

18. Which of the following events poses the greatest threat to abirb.com/test a. Childhood diseases b. Complications from adverse vaccine reactions c. Accidents abirb.com/test d. Influenza in an unvaccinated child ANS: C

Toddlers are at high risk for accidental injury, because they lack judgment and experience and abirb.com/test have only rudimentary problem-solving skills, limited physical coordination, and a heightened level of curiosity about their environment. There are also behavioral and environmental factors that increase toddlers’ risk for injury like being in new situations. Most parents think that it is natural for children to get hurt and that childhoodabirb.com/test injuries are just a part of growing up. However, most injuries are predictable and preventable and can cause disabilities requiring long-term care. Furthermore, they can cause more deaths than all childhood diseases combined. abirb.com/test

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DIF: Cognitive Level: Remember (Knowledge)

REF: p. 462

19. A nurse is assessing the home environment of a toddler. Which of the following poses the abirb.com/test

greatest and most immediate risk to the child? a. A fenced-in pool in the backyard b. An entertainment center with the remote control on the top shelf abirb.com/test c. A closed window in the child’s bedroom d. A toy box overflowing with toys ANS: B abirb.com/test The toddler will climb onto furniture or fixtures, out of windows, or into small spaces. Injuries that result from these explorations can range from minor scrapes and bruises to fatal head injuries. Toddlers are at high risk for accidental injury because they lack judgment, and have limited physical coordination and a heightened level of curiosity.

Toddlers love to explore and abirb.com/test climb objects. Injuries to toddlers occur most often when they fall from furniture, stairs, or windows. Trying to reach the remote control on the top shelf of the entertainment center puts the child at immediate and greatest risk because of the potential for the entertainment center to abirb.com/test fall on the child while he is trying to climb it.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 463 abirb.com/test

20. A nurse is providing primary prevention education to reduce the risk of lead poisoning to a

mother of a toddler. Which of the following recommendations would the nurse make? a. Encourage the toddler to drink orange juice and eat yogurt. abirb.com/test b. Encourage the toddler to eat concentrated carbohydrates to absorb the lead. c. Limit foods high in iron such as spinach because iron retains lead in the body d. Encourage dark chocolate, which contains antioxidants to help reduce lead levels.

ANS: A

abirb.com/test

Chronic poisonings, such as lead poisoning, are often undetected until irreversible damage has occurred. Primary prevention involves teaching parents about risk factors and dangers of lead poisoning and the importance of a diet that encourages decreasing fat intake, because lead is abirb.com/test retained in fat. Vitamin C, calcium, and iron intake reduce lead levels in the body. Secondary prevention involves performing periodic screening of blood lead levels on all young children identified at risk. abirb.com/test Primary prevention for lead poisoning involves teaching parents about risk factors and the importance of a diet that encourages decreasing fat intake, because lead is retained in fat.

Vitamin C, calcium, and iron products should be encouraged. Thus, orange juice, which contains vitamin C, and yogurt, which contains calcium, should be encouraged. Chocolate abirb.com/test products, as a source of antioxidants, should not be encouraged for children. There are healthy sources of antioxidants in the form of fruits and vegetables.

DIF: Cognitive Level: Apply (Application)

abirb.com/test REF: p. 465

21. An 18-month-old toddler is being seen for a well-child visit. Which of the following strategies

would the nurse use to enlist the toddler’s cooperation?

abirb.com/test

a. Ask the toddler if he wants to be examined today. b. Ask his mother to leave the room while the nurse examines him. c. Have him hold the stethoscope diaphragm on his chest while the nurse listens to abirb.com/test his chest. d. Have his mother hold him down while the nurse examines him.

abirb.com/test

ANS: C

Toddlers need to explore their environment to master it, including health care visits. They abirb.com/test need to observe their parents interact with the health care provider.

They also should have opportunities to manipulate the equipment. They benefit from simple instructions and choices, which offer the opportunity to maintain some control. Having the child hold the stethoscope on his chest while being examined will help make the visitabirb.com/test more productive. Asking the toddler whether he wants to be examined will likely elicit an answer of no. Asking mom to leave the room will likely traumatize the child resulting in crying and resistance. Mom holding him down will also likely result in resistance. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 467

22. A mother expresses her concern and frustration over the fact that her toddler has not been abirb.com/test

successful at toilet training yet. Which of the following would be the best response by the nurse? a. “Don’t worry; eventually all children become toilet-trained.” b. “How long does the child stay dry during the day?” abirb.com/test c. “Train him on a regular toilet instead of a potty chair.” d. “Here is a training schedule to follow which is almost always successful.”

ANS: B

abirb.com/test

Toilet training is a major parental concern during toddlerhood. The nurse anticipates this concern and initiates discussion to determine the parent’s understanding of developmental readiness for training. Before beginning toilet training, parents should access prerequisite abirb.com/test skills. These include being able to walk, stop, and recover, stay dry for at least 2 h during the day. Toddlers also need the ability to communicate a sensation to eliminate, as well as communicate the discomfort of wet or messy pants and/or the need for assistance. These abirb.com/test prerequisites rarely develop before 18 months of age. Determining whether the child is ready will help to guide the discussion with the mother as well as help determine appropriate recommendations. Choice “B” helps the mother understand and accept the reason for potential delays in toilet training. abirb.com/test DIF: Cognitive Level: Analyze (Analysis)

REF: p. 454

abirb.com/test training, the toddler has been 23. A mother tells the nurse that ever since she started toileting

touching his genitals. Which of the following statements is the most appropriate response by the nurse? a. “This is a sign that he is not ready to toilet train yet.” abirb.com/test b. “This behavior is developmentally normal.” c. “Tell him calmly to stop touching himself.” d. “Mentioning it to the child will increase the behavior; best to ignore it.” abirb.com/test

ANS: B

The toilet training process may precipitate curiosity about the genital organs. The nurse should provide anticipatory guidance to help the parents regard the toddler’s curiosity and abirb.com/test exploration—including masturbation—as a normal developmental process. In the interest of providing anticipatory guidance, the nurse should tell the mother that the behavior in question is developmentally normal.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 461

abirb.com/test

24. Which is a common temperament pattern described by Chess and Thomas? a. The fussy child abirb.com/test b. The happy child c. The unhappy child d. The slow-to-warm-up child abirb.com/test

ANS: D

Chess and Thomas originally described three common temperament patterns they believe are innate: the easy child, the difficult child, and the slow-to-warm-up child. abirb.com/test

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 462

25. How many words are in a toddler’s receptive language at 24 months of age? abirb.com/test a. 500 words b. 1200 words c. 2400 words abirb.com/test d. 3600 words ANS: B

By 24 months of age, a toddler’s receptive language is up to 1200 words. abirb.com/test

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 457, TBL 18-1

26. A mother asks her toddler if she is tired. The toddler responds by saying, “Sammy bed.” abirb.com/test

Based on her expressive language and speech pattern, the nurse determines that this child is likely how old? a. 18 months abirb.com/test b. 24 months c. 30 months d. 36 months ANS: B

abirb.com/test

By 24 months of age, the toddler talks in two- to three-word sentences and averages two words per response. At this age, the toddler also refers to him- or herself—by name.

Adjectives are only beginning at this age. Thus, a responseabirb.com/test of “Sammy bed” is likely that of a 24-month-old.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 457, TBL 18-1 abirb.com/test

MULTIPLE RESPONSE 1. Which scenario places a toddler at risk for injury? (Select abirb.com/test all that apply.) a. Toddler playing with his preschool sibling’s toy b. Mop and a bucket of clean water in the kitchen c. Cup of hot coffee on the kitchen counter d. A 25 pound toddler sitting in a forward-facing car seatabirb.com/test in the back seat of a car ANS: A, B, C abirb.com/test

abirb.com/test

Toys are a common source of injury, especially toys intended for older children. Hot water, boiling water, coffee, tea, and food are the most common sources of injury and should not be abirb.com/test kept within reach of the child. Additionally, toddlers can drown in water just deep enough to cover their noses and mouths, including pails of water. Once children reach 20 lb, they should be switched to a forward-facing child safety seat, and preferably be placed in the rear seat to avoid injury risk from air bags in the front seat. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 463

2. A nurse is assessing a toddler during a well-child visit. Which of the following findings abirb.com/test

warrant further investigation? (Select all that apply.) a. Bare spots on the scalp, and broken hair b. Overly concerned parents abirb.com/test c. Burns with sharply demarcated edges d. Bruises to the knees and chin, reportedly from a fall.

ANS: A, C abirb.com/test Bare spots and broken hair as well as burns with sharply demarcated edges are warning signs of child abuse. Abusive parents often do not demonstrate any guilt and are hesitant to provide information. An overly concerned parent would not be consistent with this pattern. Bruises caused by abuse are usually located on the back side of theabirb.com/test body, from the neck to the knees.

Bruises to the knee and chin are not consistent with this pattern. Children commonly fall, skinning/bruising their knees and/or chin.

DIF: Cognitive Level: Apply (Application)

abirb.com/test REF: p. 461, Box18-8

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Chapter 19: Preschool Child Edelman: Health Promotion Throughout the Life Span, 9th Edition abirb.com/test

MULTIPLE CHOICE abirb.com/test

1. The nurse is about to administer prescribed medication to a 4 year old. The medication is

renally excreted. Which of the following statements is correct concerning this scenario? a. The dosage reflects the status that kidneys are not fully matured until after age 5. b. The dosage reflects the status that kidneys have reached full maturity. abirb.com/test c. The dosage reflects the status that kidneys are hyperactive from birth to age 5. d. Renally excreted meds are contraindicated for children under 5 years. The nurse needs to call the physician for clarification. abirb.com/test

ANS: B

Kidneys reach full maturity by the end of infancy and early toddler years. As a result, medications that are renally excreted can be given at the recommended doses. abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 471

2. A nurse is discussing genetic disorders with a local community group. Which of the following abirb.com/test

statements would the nurse make during the presentation? a. Down syndrome is most likely to appear during the preschool years. b. Hemophilia is most likely to appear during the preschool years. abirb.com/test c. Cystic fibrosis is most likely to appear during the preschool years. d. Multiple sclerosis is most likely to appear during the preschool years.

ANS: C abirb.com/test The genetic problems most likely to appear during the preschool years are cystic fibrosis, Duchenne muscular dystrophy, fragile X syndrome, Williams syndrome, and autism.

DIF: Cognitive Level: Apply (Application)

REF: p. 472 abirb.com/test

3. A mother comments to the school nurse that her child has poor hygiene habits and asks the

nurse for suggestions as to how to teach her child to improve on his hygiene. Which of the abirb.com/test following recommendations would the nurse give the mother? a. Have him learn it at school. b. Model the behavior at home. c. Lecture him about hygiene. abirb.com/test d. Punish him when he forgets to brush his teeth.

ANS: B

Although preschoolers are not completely responsible for abirb.com/test their own health management, they certainly contribute by brushing their teeth, taking medication, wearing appropriate clothing for inclement weather, and performing other actions. Reinforcement of health-promotion activities, which occurs in the home and child care environments, helps to instill behaviors abirb.com/test that affect self-esteem, safety, and an individual’s overall balance with life. For example, family support for active lifestyles provides one way for parents to assume a positive role to model for children. abirb.com/test

abirb.com/test

The best way for a parent to teach a child good hygiene is to model the behavior at home.

Reinforcement of health-promotion activities helps to instill behaviors. Additionally, abirb.com/test preschoolers like to imitate adults.

DIF: Cognitive Level: Apply (Application)

REF: p. 474

abirb.com/test 4. A 5-year-old is consuming a daily caloric intake of 1400 calories.

Approximately what

portion of the diet should be comprised of carbohydrates? a. 300 calories b. 700 calories abirb.com/test c. 900 calories d. 1200 calories ANS: B

abirb.com/test

Preschoolers should consume approximately half of their diet in carbohydrates. Children aged 3 to 5 years old should receive 1200 to 1600 calories per day depending on their activity level and gender. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 474

5. A nurse is determining caloric needs for a preschooler whoabirb.com/test weighs 18 kg. Which of the

following represents the daily caloric needs for this child? a. 1360 calories b. 1540 calories abirb.com/test c. 1620 calories d. 1800 calories ANS: C

The approximate number of calories required by an 18-kgabirb.com/test preschooler is 1620. Preschoolers need approximately 90 kcal/kg of body weight per day for health maintenance, activity, and growth.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 474

6. Which of the following foods will a 5-year-old child need help eating? a. Pudding abirb.com/test b. Macaroni and cheese c. Chicken d. Jelly sandwich abirb.com/test

ANS: C

The preschooler will need help with the chicken. In the later preschool years, most children need help cutting meats. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 476

7. A 2-year-old child has hives. Of the following items ingested, which is most likely to have abirb.com/test

caused the allergic reaction? a. Apple juice b. Oatmeal–peanut cookies c. Jelly sandwich d. Banana

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abirb.com/test

ANS: B

Oatmeal–peanut cookies are most likely to have caused the allergic reaction. Nuts, and abirb.com/test especially peanuts, are a food that is commonly associated with allergic reactions.

DIF: Cognitive Level: Apply (Application)

REF: p. 476 abirb.com/test

8. A 4-year-old boy had an episode of enuresis. Which of the following actions should be taken

by the parents? a. Have him change his own pajamas before returning to bed. abirb.com/test b. Take away one video game. c. Tell his 6-year-old sister about the incident. d. Make him wear his diaper to bed.

ANS: A

abirb.com/test

They should be responsible for changing their own clothes and reminded gently and encouragingly of ways to avoid problems in the future. The parents should have the child change his own pajamas before returning to bed after the episode of enuresis. Preschoolers abirb.com/test should not be ridiculed nor punished. For this reason, choices “B,” “C,” and “D” are inappropriate.

DIF: Cognitive Level: Apply (Application)

abirb.com/test REF: p. 476

9. A nurse is working with a local day care center to develop appropriate outdoor play activities

for 5-year-old children at the center. Which of the following activities would the nurse most abirb.com/test likely recommend? a. Having the children bring their bikes to the center so they can go for bike rides in the neighborhood abirb.com/test b. Drawing outdoor scenes using portable easels and chalks or crayons c. Taking the children swimming at the neighborhood pool d. Playing on the outdoor preschool equipment while being supervised by day care personnel abirb.com/test ANS: D

Preschoolers’ physical abilities include balancing on one foot, jumping, and running.

Generally, preschoolers appreciate an audience, enjoy practicing new skills, and demonstrate abirb.com/test mastered skills to others.

Appropriate outdoor play for a 5-year-old child includes playing on age-appropriate playground equipment while being supervised by day care personnel. At the age of 5, the abirb.com/test child is still not proficient at controlling a bike in the streets.

Swimming in a pool is hazardous unless the child has been previously taught to swim and is also being closely supervised on a one-to-one basis—neither of which is practical for a day care setting. Drawing with easels and crayons/chalk is not a good use of outdoor time. It is a sedentary activity, which can be easily abirb.com/test done indoors at the day care center during indoor time.

DIF: Cognitive Level: Apply (Application)

REF: p. 476 abirb.com/test

10. A 4-year-old girl asks her mother for a second cup of yogurt before starting to eat the first cup

she was given. What will the child most likely do with the extra helping? a. Eat it herself. abirb.com/test b. Ask her brother if he wants it.

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c. Feed it to her dog. d. Give it to her imaginary friend.

ANS: D

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The extra helping is likely for the child’s imaginary friend. Preschoolers may have one or more imaginary companions. They are usually another child. Preschoolers eat, play, and sleep abirb.com/test with their imaginary companions.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 477

11. Which sleep ritual is age appropriate for a preschooler? abirb.com/test a. Asking for every light in the home to be turned on at bedtime b. Saying good night to all 20 stuffed animals in the room before going to sleep c. Going right to sleep abirb.com/test d. Asking the parent to read multiple books on the bookshelf before going to bed ANS: B

An age-appropriate sleep ritual for a preschooler is to say abirb.com/test good night to all 20 stuffed animals in the room before going to sleep. Preschoolers have longer, more rigid bedtime rituals than toddlers. They prolong bedtime routines, which for them generally last about 30 minutes.

Reasonable rituals should be honored. Unreasonable rituals such as choices “A” and “D” are abirb.com/test not appropriately implemented. Choice “C” is not a bedtime ritual.

DIF: Cognitive Level: Apply (Application)

REF: p. 478 abirb.com/test

12. During a well-child visit, a parent tells the nurse that their preschooler occasionally wakes up

during the middle of the night and tells them about “scary things.” He is fully awake when the parents enter the room. The child often recalls the incident the following morning. Based on growth and development, which of the following would beabirb.com/test the most common reason for the preschooler to wake up? a. Nightmares b. Night terrors abirb.com/test c. Enuresis d. Hunger ANS: A

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Nightmares are a common reason for nighttime awakenings. Nightmares fully waken the child and give them a feeling of fearfulness and helplessness. Consolation is readily provided by the parent. Night terrors are a more extreme manifestation typically resulting in a child who is not abirb.com/test fully awake and is inconsolable for 10 minutes. Night terrors may “cause the child to sit up in bed, scream, stare at an imaginary object, breathe heavily, perspire, and appear in obvious distress … In most cases the child does not recall the dream and in the morning does not remember the incident.” Enuresis typically does not wake abirb.com/test the child; children with adequate food intake during the day and evening would not have a problem with night-time wakening due to hunger.

DIF: Cognitive Level: Apply (Application)

abirb.com/test REF: p. 478

13. Which of the following is a hallmark of Piaget’s preconceptual substage? a. Using language to function symbolically abirb.com/test b. Using concrete thought processes

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c. Using mental abstracting d. Using transductive reasoning ANS: A

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The hallmark of Piaget’s preconceptual substage is using language to function symbolically.

The preschool child demonstrates increased symbolic functioning during the intuitive abirb.com/test substage, from age 4 to 7 years. The predominant feature of this and the following period is the concrete thought process, as compared with adult abstract thinking. As they experience symbolic mental representations, preschoolers process mental symbols as though they were actually participating in the event. abirb.com/test

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 479

14. A preschooler and her school-age brother both have received the same swimming tube as a abirb.com/test

gift. The brother accidentally took his sister’s swimming tube. The sister protested that she needed her swimming tube to go swimming. Which of the following is being demonstrated by this behavior by the sister? abirb.com/test a. Abstract thinking b. Concrete thinking c. Jealousy d. A temper tantrum abirb.com/test ANS: B

As they experience symbolic mental representations, preschoolers process mental symbols as though they were actually participating in the event. At this stage, mental abstraction, such as abirb.com/test skipping from one part of an operation to another, reversing the operation mentally, or thinking of the whole in relation to the parts, is not feasible.

The behavior is indicative of concrete thinking. Children can only concentrate on their own abirb.com/test perspective. Also, the preschooler is not able to consider more than one factor at a time when solving problems. She knows only that her tube has been taken. She is not able to grasp that the two tubes are identical; thus she could easily use her brother’s tube, which has been left behind. abirb.com/test DIF: Cognitive Level: Apply (Application)

REF: p. 479

abirb.com/test 15. A school nurse is planning to assess the visual acuity of the preschool students at the school.

Which of the following tests would be used? a. Snellen Screening test b. Denver Eye Screening test c. Ishihara’s test d. Cover test ANS: A

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Early detection requires regular screening with standardized tests such as the Denver Eye Screening Test or the Snellen Screening Test. The Snellen Screening Test, when administered under standardized procedures, has the advantage of rendering a reliable estimate of actual abirb.com/test visual acuity. The Denver Eye Screening Test was designed for preschool children and includes detection of the commonly occurring visual problems, such as refractive errors, strabismus (crossing of the eyes), and amblyopia. The Snellen E chart is designed for preschool children. abirb.com/test

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For visual acuity, Snelling is the instrument of choice. The Denver Eye is designed to pick up pathology of the eye. The Ishihara is a test for color blindness and the cover tests pick up abirb.com/test amblyopia.

DIF: Cognitive Level: Apply (Application)

REF: p. 480

abirb.com/test 16. A nurse is reviewing the chart of a preschool child who has been diagnosed with Asperger’s

syndrome. Which of the following findings is the nurse most likely to discover? a. Eating finger foods at 10 months old b. Absent crawling at 10 months old abirb.com/test c. Separation anxiety at 10 months old d. Saying “ma-ma” at 10 months old ANS: B

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Asperger’s syndrome is a form of autism. Manifestations of autism spectrum disorders vary considerably. However, these children usually have a variety of problems including failure to attain motor skill developmental milestones. Such findings are signs that warrant further abirb.com/test assessment. A failure to crawl by 10 months of age is a failure to attain a normal milestone of motor skill development. The other choices do not suggest abnormal findings.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 483 abirb.com/test

17. A 4-year-old child tells the school nurse that he invented a new song. Which of the following

would be the best response by the nurse? abirb.com/test a. Congratulate the child on a job well done. b. Tell the child that he is too young to invent anything. c. Nicely tell the child that it does not sound like a song. d. Ask the child to come back later when there is more time to listen to the song. abirb.com/test ANS: A

During the preschool years, basic self-concept emerges from the child’s personal struggle for autonomy. As children develop beyond the toddler years, they refine their sense of self abirb.com/test through both task-oriented and socially oriented experiences. By reinforcing skills and successfully accomplishing tasks, preschoolers build self-esteem, enhancing overall health.

The nurse’s best response is to congratulate the child on a job well done. Reinforcement of abirb.com/test behaviors and praising are methods that help develop self-concept.

DIF: Cognitive Level: Apply (Application)

REF: p. 484 abirb.com/test

18. Autism disorder is common and is invariably encountered by nurses providing care for

children. Which of the following statements is correct concerning this disorder? a. It is caused by maternal drug abuse especially cocaine during the in utero period. b. It is caused by child vaccines. abirb.com/test c. It is considered as a genetically determined disorder. d. It is more common with children who had high Apgar scores as newborns.

ANS: C

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Autism disorder is considered as a genetically determined disorder and is only rarely associated with non-genetic risk factors, such as maternal valproic acid use during pregnancy, congenital rubella, and cerebral palsy. Currently, multiple abirb.com/test studies have linked autism spectrum disorders with atypical birth weight (high or low), low Apgar scores, hemolytic disease, hyperbilirubinemia (jaundice), respiratory distress, advanced parental age, length of gestation, and environmental factors (viruses), all of which may be subtle and complicated by abirb.com/test the genetic influence.

While frequently reported in the lay press, there has been no scientifically sound study which has linked autism with child vaccines. The disorder is believed to be associated with genetic abirb.com/test factors.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 483

abirb.com/test 19. A nurse is using primary prevention strategies to prevent child abuse in the community.

Which of the following interventions would the nurse implement? a. Educate the public about violence and the potential for abuse. b. Remove a child who has been abused from the home. abirb.com/test c. Report a case of child abuse. d. Refer a parent who abused their child to counseling.

ANS: A

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Educating the public about violence and the potential for abuse is a form of primary prevention. Nurses provide primary prevention for violence by promoting awareness and providing anticipatory guidance. Primary prevention is used before violence actually occurs. abirb.com/test Choices “B,” “C,” and “D” deal with child abuse after it has already manifested and thus would not be consistent with strategies for primary prevention.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 486 abirb.com/test

20. During a well-child visit, a father tells the nurse that the preschool-aged child has been

enjoying their “road trips” that they take together. On such occasions, the child gets to sit in the front seat of the car with him. Which of the following abirb.com/test actions should the nurse take next? a. Report the father to the local child protective agency. b. Encourage the father to have the child sit in the back seat instead. c. Instruct the father on the dangers of having small children in the front seat. abirb.com/test d. Provide the parent with educational materials about car seat safety.

ANS: C

Federal investigations concluded that children younger than age 13 should ride in the back abirb.com/test seat of a motor vehicle, particularly because of potential injury or death from a passenger seat airbag that could inflate in a severe car accident.

Although parents may know that infants should be placed in the back seat, they do not always know that children in the front seat of a motor vehicle faceabirb.com/test danger, even if they are using a restraint system. Educating the father regarding the rationale for the recommendation, (i.e., the hazard of small children riding in the front seat), may improve his compliance. Reporting the behavior to authorities will likely set up an adversarial relationship between the father and the abirb.com/test nurse and thus will not be productive.

DIF: Cognitive Level: Apply (Application)

REF: p. 489 abirb.com/test

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21. A nurse is discussing with parents how to prevent burns in a preschooler. Which of the

following recommendations is the nurse most likely to give the parents? a. Do not read to the child while sitting on the sofa in front abirb.com/test of the fireplace. b. Do not cook on a gas grill until the child is a teenager. c. Do not leave cigarettes and matches on the kitchen counter. d. Do not cook with the child in the kitchen. abirb.com/test

ANS: C

In preschool children the number of deaths in house fires is nearly double that of other ages.

Children of this age experiment with matches and fire, and they may be unable to escape from abirb.com/test a fire once it starts. Advising a parent not to leave cigarettes and matches on the kitchen counter is the most useful recommendation for preventing burns in a preschooler, particularly as it limits their access to these potentially dangerous items. Preschoolers like to imitate and abirb.com/test act older than they are. Having cigarettes and matches on the kitchen counter makes them available for use by the preschooler and can lead to both fires and burns. Preschoolers should also be taught the dangers of matches and fire.

DIF: Cognitive Level: Analyze (Analysis)

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REF: p. 490

22. A mother thinks her 2-year-old child drank Drano. What should the nurse tell the mother to do

next? a. Call the pediatrician on call. b. Give ipecac syrup. c. Call the Poison Control Center. d. Wait to see if the child will vomit.

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ANS: C

The first thing the mother should do is call the Poison Control Center. Parents should have the abirb.com/test number for the poison control center handy. Ipecac syrup should also be in the home; however, The Poison Control Center must be contacted before administration of ipecac syrup.

Depending on the substance ingested—and especially for caustic agents—it is frequently contraindicated to induce vomiting. Time is of the essenceabirb.com/test hence calling the on-call pediatrician and waiting for a response is not appropriate. Neither is passively waiting to see if the child will vomit.

DIF: Cognitive Level: Analyze (Analysis)

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REF: p. 496, Box19-14

23. Which of the following is the most common intraocular tumor in young children? a. Neuroblastoma abirb.com/test b. Wilms’ tumor c. Retinoblastoma d. Leukemia abirb.com/test

ANS: C

Retinoblastoma is the most common intraocular tumor in young children.

DIF: Cognitive Level: Remember (Knowledge)

abirb.com/test REF: p. 493

24. The nurse suspects a 5-year-old child has asthma. Which information garnered from the

child’s medical history would be a risk factor for asthma or for exacerbating asthma? a. The child was breast-fed.

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b. The child sleeps every night with the family dog in his bed. c. The child was born via a C-section. d. The child had pressure equalizer tubes as an infant. abirb.com/test ANS: B

Risk factors for asthma include respiratory infections, genetic predisposition, allergens such as abirb.com/test animal dander or dust mites, and other nonspecific precipitants such as exercise, weather, or stress. Inhaling dog dander from nightly sleeping with the family pet is a potential risk factor for asthma and most definitely exacerbates pre-existing asthma. None of the other choices represents risk factors. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 494

25. The nurse makes a home visit to a child who has recently been diagnosed with asthma. Which abirb.com/test

environmental finding has the potential to trigger an asthma exacerbation? a. Radiator heating system b. Air conditioner abirb.com/test c. Hardwood flooring d. Wall-to-wall carpeting ANS: D abirb.com/test Multiple factors contribute to exacerbation of asthma symptoms.

High levels of exposure to tobacco smoke, pollutants, and allergens contribute. In addition to the generally known allergens of house mite dust and pet and rodent dander, cockroach particles have been implicated. Wall-to-wall carpeting is contraindicated in homes where persons—adults or abirb.com/test children—have asthma. The carpeting traps allergens to include dust mites, pet dander, and pest particles (cockroaches, rodents, etc.) Carpeting also traps pollen, another potent asthma trigger. Hardwood floors are far preferable with area rugs for those persons who want some form of rug or carpeting on their floors. Area rugs (vs w/wabirb.com/test carpeting) can be frequently cleaned, shaken out and easily replaced, etc. Air conditioning is not problematic so long as the filter is changed regularly. Radiator heating is fine, as well, and, in fact, is preferable to hot air with vents systems. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 494

abirb.com/test 26. The nurse is conducting a physical exam on a 3-year-old child.

Which of the following would

be the best way for the nurse to approach the child during the exam? a. Let the child listen to the nurse’s heart with the stethoscope. b. Tell him to sit quietly while the nurse examines him. abirb.com/test c. Ask his parents to leave the room to minimize distractions. d. Ask another nurse to hold him while the nurse examines him.

ANS: A

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Preschoolers show much interest in the tools and procedures of a health screening examination. These inquisitive children may play with the stethoscope, otoscope, and other diagnostic instruments. The nurse explains the tests in age-appropriate terminology and abirb.com/test expects the child to cooperate for most of the visit. The best way for the nurse to approach a 3-year-old during a physical exam is to let him listen to the nurse’s heart with the stethoscope.

Preschoolers like to imitate adults and like to play with medical devices. Asking parents to leave the room or having another nurse hold down the child is likely to traumatize the child. abirb.com/test Simply telling the child to sit quietly is not as effective as involving the child in the process. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 496 abirb.com/test

27. A nurse is using the Healthy People 2020 health promotion and disease prevention objectives

for preschoolers when planning for health policy development in the community. Which of the following health policies would the nurse support? abirb.com/test a. Increased regulation of WIC programs to insure compliance b. Decrease the number of children exposed to pet dander c. Regulation of the paint allowed for use with toys d. All of the above abirb.com/test ANS: C

One way to address a Healthy People 2020 health promotion and disease prevention objective for preschoolers is to regulate the paint that is allowed for abirb.com/test use in toys. One Healthy People 2020 objective is to eliminate elevated blood-lead levels in children. Paints can contain lead, and lead poisoning can lead to disabilities. Healthy People 2020 objectives do not address either WIC programs or issues of pet dander. Administration or regulation of governmental abirb.com/test organizations—e.g., WIC—is not within the purview of Healthy People 2020. Putting forth objectives or goals aimed at decreasing pet ownership in the United States would meet with huge public resistance in view of the popularity of pets within our country. It would likely result in hostility directed toward the agency and thus would be a very counterproductive abirb.com/test measure.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 492 abirb.com/test

28. The nurse is observing the development of gross motor skills of young children at a

community recreation center. The nurse is watching a particular child who alternates feet when descending stairs and uses a pencil with good control.

On average, what is the youngest abirb.com/test age this child is likely to be? a. 3 years old b. 4 years old abirb.com/test c. 5 years old d. 6 years old ANS: B abirb.com/test At the age of 4, most children descend stairs alternating feet and can hold and use a pencil with good control. Three-year-olds typically have not mastered these skills.

DIF: Cognitive Level: Apply (Application)

REF: p. 473, TBL 19-1

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29. On average, how old is a preschooler with a receptive vocabulary of up to 5600 words? a. 42 months old b. 48 months old abirb.com/test c. 54 months old d. 60 months old ANS: B

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By 48 months of age, most preschoolers have receptive language skills of up to 5600 words.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 482, TBL 19-2 abirb.com/test

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MULTIPLE RESPONSE 1. Which of the following signs may be indicative of childhood cancer? (Select all that apply.) abirb.com/test a. Bruises b. Pale skin c. Enlarged lymph nodes abirb.com/test d. Hives ANS: A, B, C

Bruises, pale skin, and enlarged lymph nodes are all warning signs that may indicate abirb.com/test childhood cancer. Hives are typically indicative of an allergic reaction, not cancer.

DIF: Cognitive Level: Apply (Application)

REF: p. 494, Box 19-11 abirb.com/test

2. Which of the following statements are correct concerning testing of developmental level?

(Select all that apply.) a. The various approved screening tools serve as valid diagnostic tools. abirb.com/test b. The Parent’s Evaluation of Developmental Status (PEDS) is valid for ages 5 to 12 years. c. Positive findings on screening tests warrant referral to developmental and medical specialists. abirb.com/test d. The Battelle Developmental Inventory Screening Tool is commonly used in the primary care setting.

ANS: C, D

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Screening instruments are not diagnostic tools. The Battelle Developmental Inventory Screening Tool is commonly used by early intervention programs and also in the primary care setting. The Parent’s Evaluation of Developmental Status (PEDS) is validated on children abirb.com/test ages 0 to 8 years, takes 2 to 10 minutes to complete, and screens for developmental and behavioral problems. When a screening tool result is positive or when concerning results the child should be referred for developmental and/or medical evaluations. Early developmental intervention/early childhood services should also be initiated if necessary. abirb.com/test DIF: Cognitive Level: Apply (Application)

REF: pp. 482, 4 83

abirb.com/test 3. Which of the following behaviors by a preschooler indicates use of an effective coping

mechanism? (Select all that apply.) a. The preschooler walks away from the situation. b. The preschooler blames a friend for causing the problem. abirb.com/test c. The preschooler states what he is upset about. d. The preschooler has a temper tantrum.

ANS: B, C

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Preschoolers use many of the coping mechanisms developed during their toddler years, but they generally show greater ability to verbalize frustration, fewer temper tantrums, and more patience in experimentation to resolve difficulty than the typical toddler. Preschoolers refine abirb.com/testsolutions or responses to their problem-solving skills. Through fantasy play, they investigate stressful events and find inner control for challenging situations. Preschoolers tend to project blame. abirb.com/test

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The greater verbal skills characteristic of the preschooler support choices “B” and “C.” The preschooler also tends to project blame; hence the friend so named may or may not be the cause of the problem. Temper tantrums is not an effective abirb.com/test coping mechanism, however, and this behavior tends to decrease as compared to the toddler where it is more common. Walking away is not effective at this stage of development (although it may be for an adult) and tends not to be common, as well. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 487 abirb.com/test

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Chapter 20: School-Age Child Edelman: Health Promotion Throughout the Life Span, 9th Edition abirb.com/test

MULTIPLE CHOICE abirb.com/test

1. The school nurse conducting an in-service program for teachers is asked about general growth

and development of school-age children. Which of the following statements would be the best response by the nurse? a. “By age 11, blood pressure readings are the same as for an adult.” abirb.com/test b. “Because of the rapid growth pattern in this age group, snacks are important to ensure sufficient caloric intake.” c. “Children in this age group have some difficulty with coordination and balance, so abirb.com/test playground supervision is important.” d. “Overall growth in school-age children is slower than during infancy and adolescence.”

ANS: D

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Children grow (physically) much more slowly during this time period as compared with growth during infancy and adolescence. Blood pressure readings for children in this age group are lower than for adults. Growth slows until adolescence.abirb.com/test Children in this age group generally have good coordination and balance.

DIF: Cognitive Level: Apply (Application)

REF: p. 502

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2. According to the American Academy of Pediatrics, at what age should blood pressure

screening begin? a. 3 b. 6 c. 9 d. 12

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ANS: A

Blood pressure screening should begin at 3 years of age and should be measured annually.

DIF: Cognitive Level: Remember (Knowledge)

abirb.com/test REF: p. 503

3. The school nurse has seen several students in the health office. For which of the following

students should the nurse suggest a follow-up exam? abirb.com/test a. A 14-year-old girl who has not experienced menarche b. A 7-year-old boy who has grown 2 inches in a year c. A 10-year-old girl who has gained 11 pounds in a year d. An 8-year-old boy who has lost four deciduous teeth inabirb.com/test the past year ANS: C

The average age of menarche is between 11 and 15 years of age. School-age children grow abirb.com/test approximately 2 inches a year, gain between approximately 4.4 to 6.6 pounds a year, and lose four deciduous teeth a year between ages 6 and 13. A weight gain of 11 pounds in 1 year requires a follow-up because of the rising rate of obesity in children.

DIF: Cognitive Level: Apply (Application)

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REF: p. 503

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4. The president of the Parent–Teacher Association asks the school nurse about the

appropriateness of sponsoring a health fair that focuses onabirb.com/test oral health for school-age children.

Which of the following statements indicates the nurse’s correct understanding of this issue? a. “Dental problems are not as prevalent a problem as asthma, so you might want to consider a health fair about respiratory problems instead.” b. “Over 40% of children age 2 to 11 have dental caries, abirb.com/test so a health fair that focuses on oral care is very appropriate.” c. “Children are not usually receptive to learning about dental care, so the topic is not the best choice for a health fair.” abirb.com/test d. “This is not an appropriate focus for a health fair because the incidence of dental caries has dropped dramatically due to the use of sealants.”

ANS: B

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Dental caries are present in up to 42% of children 2 to 11 years of age. Dental caries and other oral health issues remain a problem in the school-age population. Small gains have been made in the number of children receiving sealants to prevent caries. Dental caries is the most abirb.com/test common chronic disease of children 5 to 17 years of age, 4 times more prevalent than asthma.

DIF: Cognitive Level: Apply (Application)

REF: p. 503 abirb.com/test

5. Which of the following statements is correct? a. Tonsils in a school-age child are smaller than in an adult. b. The nervous system generally matures between ages 11 to 13. c. Fractures heal more slowly in a 10-year-old child thanabirb.com/test in an adult. d. Overweight children have muscle pain more often than average-weight children.

ANS: D abirb.com/test Overweight children are more likely to suffer bone fractures, have joint pain and more muscle pain than their normal weight counterparts. Tonsils, which are lymphoid tissues, are larger in a child than in an adult. The nervous system matures by ages 7 to 8. Fractures heal more quickly in children than in adults. abirb.com/test

DIF: Cognitive Level: Understand (Comprehension)

REF: p. 504

a school-age child’s diet?

6. Which of the following elements is most likely deficient inabirb.com/test a. Protein b. Sodium c. Iron abirb.com/test d. Vitamin B12 ANS: C

The diet of school-age children is frequently deficient in calcium, iron, and vitamin C, while it abirb.com/test is high in fat and sodium.

DIF: Cognitive Level: Understand (Comprehension)

REF: p. 506 abirb.com/test

7. Which of the following initiatives related to childhood nutrition outlined in Healthy People

2010 was most successful? a. Reduction of fat consumption b. Increase in consumption of fruit

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c. Adequate food supplies at home d. Reducing obesity rates ANS: C

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The target rate of 94% related to household adequate food supplies was surpassed with up to 98% of households found to be “food secure.” Children continue to eat too many foods high abirb.com/test in fat, obesity rates are increasing, and consumption of fruit and vegetables is low.

DIF: Cognitive Level: Understand (Comprehension)

REF: p. 506

8. A school nurse is planning a series on nutrition. Which of abirb.com/test the following factors should the

nurse take into account? a. Television commercials frequently advertise food-related products. b. Children watch approximately 2 h of television a day. abirb.com/test c. Each day, approximately 60% of children eat fast food. d. A child is three times more likely to eat in a restaurant than at home.

ANS: A

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Children watch over 3 h of television a day. About one-third of children eat fast food each day, and parents spend approximately 40% of their food budget for restaurant meals, including fast food restaurants. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 506

9. A nurse is planning activities to help children learn about good nutritional practices. Which of abirb.com/test

the following strategies should the nurse implement? a. Coordinate a “Try This” food day offering a variety of nutritious snacks. b. Find a book about nutrition to read the students. abirb.com/test c. Plan a video using the concept of MyPlate. d. Search on-line for a video about nutrition to the students.

ANS: A

Children frequently prepare their own snacks and are moreabirb.com/test likely to learn from activities that foster active participation rather than passivity. Choices B, C, and D all involve passive activities.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 506

10. A child who has a BMI of 34 visits the school nurse. Which of the following factors does the

nurse recognize that the child may be experiencing? a. Increased bullying by peers b. Increased self-esteem c. Increased resiliency d. Increased motivation to lose weight

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ANS: A

Children may not be concerned about being overweight/obese and may therefore not be abirb.com/test motivated to adopt healthier eating/exercise patterns. They may demonstrate impulsive behavior and have low self-esteem. Obese children are often ridiculed by peers.

DIF: Cognitive Level: Apply (Application)

REF: p. 507 abirb.com/test

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11. During a well-child visit, parents report to the nurse that they are concerned that their

8-year-old son has started wetting the bed at night. Which of the following statements should abirb.com/test the nurse make to the parents? a. “I’ll be sure to mention this to the doctor; we rarely see a child who wets the bed at this age.” b. “There is not much you can do to stop this problem until he gets older.” abirb.com/test c. “This is a common disease in children his age but there are treatment options.” d. “I’m going to collect a urine sample from him and then we will talk about bed wetting.”

ANS: D

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Enuresis should not be considered a disease but a variation of normal development.

Evaluation of these children begins with a urine culture to rule out urinary tract infection. If abirb.com/test no infection exists or symptoms persist after treatment, then the intervention is focused on increasing fluid intake to prevent “holding” and establishing a voiding routine of every 2 h, with a conscious effort to empty the bladder completely.

DIF: Cognitive Level: Apply (Application)

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REF: p. 508

12. Which of the following children is at risk for developing encopresis? a. A 6-year-old child who has occasional bed wetting abirb.com/test b. A 3-year-old child who is not fully toilet-trained c. A 5-year-old child who has been in four foster care homes since age 3 d. A 4-year old child who passes stool every morning after breakfast abirb.com/test

ANS: C

Another elimination problem that may occur in children is encopresis defined as the persistent voluntary or involuntary passing of stool into the child’s underpants after age 4. There may be a history of inconsistent toilet training or early life stress inabirb.com/test affected children. Encopresis is a common complication of chronic constipation. In most cases, soiling occurs during the day when the child is awake and active. Soiling at night is uncommon.

Encopresis is diagnosed after age 4. It occurs most frequently during the day. Triggers are abirb.com/test chronic constipation and stress or emotional disturbances. The child who had been placed in multiple foster homes since age 3 would certainly be a candidate for stress and emotional problems. Bed wetting is not a risk factor for encopresis. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 509

13. A nurse is discussing sleep patterns in school-age children.abirb.com/test Which of the following should be

stressed by the nurse? a. Sharing a bed with siblings/parents has a long-lasting psychological impact. b. School-age children need between 6 and 9 h of sleep a night. abirb.com/test c. Daytime naps are important in children until they reach the age of 9 or 10. d. School-age children generally agree with and adhere to a regular bedtime.

ANS: D abirb.com/test Research has not demonstrated that sharing a bed with siblings/parents has a long-lasting psychological impact on the child. Children sleep between 8 and 12 h per night and do not need daytime naps. Typically parent and child can come to an agreement bedtime with reasonable adherence to the regimen. abirb.com/test

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DIF: Cognitive Level: Apply (Application)

REF: p. 510

14. Parents of an 8-year-old boy tell the nurse that they are concerned about their son because he abirb.com/test

occasionally sleepwalks. Which of the following is the best response from the nurse? a. “Sleepwalking is much more common in girls than boys.” b. “I am glad you mentioned this. Sleepwalking is sometimes a sign of a neurological abirb.com/test deficit.” c. “Nightmares are the cause of most cases of sleepwalking.” d. “This is not abnormal for a child of this age. He will most likely outgrow this tendency as his nervous system matures.” abirb.com/test ANS: D

Sleepwalking occurs more frequently in boys than girls, is most likely caused by an immature CNS. It is not a sign of neurological deficit and it is not typically caused by or associated with abirb.com/test nightmares. As the CNS matures, the sleepwalking issue will resolve.

DIF: Cognitive Level: Apply (Application)

REF: p. 510 abirb.com/test

15. During a school gift fair, a parent asks the school nurse what gift would be most appropriate

for her 6-year-old child. Which of the following should the nurse encourage the parent to purchase? abirb.com/test a. A box of wooden blocks of various sizes for sorting b. A jar of sea shells in various shapes, colors, and textures c. A world map abirb.com/test d. A beginning encyclopedia of animals ANS: B

Classifying and ordering sea shells according to color, size, shape, and texture will help the abirb.com/test child learn about classifying and numbering. These two concepts are necessary in order to learn to read and so on. A world map and encyclopedia are not age-appropriate as they require more cognitive skills than would normally be found with a 6-year-old. Similarly, the wooden blocks would be more suitable for a younger child. The 6-year-old would likely be bored with abirb.com/test that activity.

DIF: Cognitive Level: Apply (Application)

REF: p. 511 abirb.com/test

16. The school nurse has written a grant to obtain funding for a vision screening program and

glasses for children in his pre-K to 6th grade elementary school. Which of the following statements should be included with the rationale for the need for funding? abirb.com/test a. Many preschool children are hyperopic and need glasses to prevent headaches. b. Most states require vision screening on entering school. c. Vision screening can diagnose vision/eye problems before they become severe. abirb.com/test d. Approximately one in four children has a vision problem.

ANS: D

Preschool children who are farsighted do not need corrective glasses. Their vision will abirb.com/test improve as they mature. Approximately 33% of children entering school have had eye exams.

Vision screening does not diagnose vision problems. Only 1/3 of the states require vision screening on entering school.

DIF: Cognitive Level: Apply (Application)

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REF: p. 511

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17. Which of the following statements concerning hearing in school-age children is correct? a. The rate of otitis media infections met Healthy Peopleabirb.com/test 2010 targets. b. Hearing and visual problems occur with the same frequency. c. All 50 states require routine hearing evaluations. d. The use of tympanograms has improved the accuracy of hearing screenings. abirb.com/test

ANS: A

Hearing problems occur with less frequency than do vision problems. Many states, but not all, require routine hearing evaluations. Tympanograms measure how well the tympanic abirb.com/test membrane vibrates. It is commonly used to diagnose otitis media. The rate of reduction in otitis media did, in fact, meet the Healthy People 2010 targets.

DIF: Cognitive Level: Understand (Comprehension)

REF: p. 512 abirb.com/test

18. A third grade teacher asks the school nurse what she can reasonably expect from children in

her classroom related to language ability. Which of the following statements would be the best abirb.com/test response from the nurse? a. “Children in the second grade should have about a 4000-word vocabulary.” b. “Research has shown that children will learn to read more quickly if you use the whole word approach.” abirb.com/test c. “You can expect that the children will write “b” and “d” without reversing them, and all of the letters in a word will be about the same size.” d. “You can evaluate the cognitive ability of the children in your classroom by noting abirb.com/test how legible their writing is.”

ANS: C

The child will not have a 4000-word vocabulary until about the age of 12. Both the whole abirb.com/test word approach and the phonics approach will help children learn to read. The legibility of handwriting has no correlation to intelligence. The statement found in choice C is correct.

DIF: Cognitive Level: Apply (Application)

REF: p. 512

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19. Each of the following children visits the school nurse on a regular basis. Which of these

children would the nurse identify as being at risk for a learning disability and suggest abirb.com/test follow-up care? a. 9-year-old whose parents recently divorced b. 10-year-old who is inattentive and fidgets constantly c. 12-year-old with a 4000-word vocabulary abirb.com/test d. 11-year-old who scored 102 on an IQ test ANS: B

A 10-year-old who displays hyperactive and/or inattentiveabirb.com/test behavior should have follow-up care. Hyperactivity may indicate ADHD, which would require follow-up care and potential educational difficulty. An environmental deficit such as a divorce may cause school difficulty for a child, but this does not indicate a learning disability. The average vocabulary for a abirb.com/test 12-year-old is 4000 words. A score of 102 on an IQ test falls within the average range of 90 to 110.

DIF: Cognitive Level: Apply (Application)

REF: pp. 512, 514, Box 20-4

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20. A parent asks the nurse working in a pediatric clinic how she can help her 6-year-old child

feel good about himself. Which of the following statements should be made by the nurse? a. “Doing most things for your child will give the child aabirb.com/test sense of security, and the child will have a positive self-image.” b. “Having your child help around the house with tasks such as setting the table will increase self-esteem.” abirb.com/test c. “Make sure to highly praise even the smallest effort your child makes at completing a task.” d. “There is little you can do to increase your child’s self-esteem. The child’s peers abirb.com/test have much more of an influence than parents at this age.”

ANS: B

When children succeed at age-specific tasks, they increase their sense of self-worth. Doing everything for a child prevents him or her from becoming abirb.com/test proficient at a task. Too much praise makes positive feedback lose its value and gives the child a false sense of mastery.

Although peers are important, at age 6, parents influence their children more than do peers.

DIF: Cognitive Level: Apply (Application)

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REF: p. 515

21. Which of the following statements made by a parent is most helpful when discussing rules of

the household? abirb.com/test a. “You did not feed the dog like you promised, so you cannot have ice cream for dessert.” b. “I was upset when you did not feed the dog like you promised. We all need to help abirb.com/test take care of him because he depends on us. Let’s talk about what happened.” c. “Why did you forget to feed the dog? Would you like me to forget to feed you?” d. “What you did was bad. We all need to care for the dog.”

ANS: B

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As children mature, they assume more responsibilities within the family and the community.

School-age children learn responsibility for allowance, household chores, self-care, and pets and acquire a sense of empowerment as an integral part ofabirb.com/test the family. Talking calmly, being a good listener, and encouraging negotiation, perhaps in a family meeting, to promote problem resolution. When correcting a child, explaining how one feels, the consequence of the action and then listening to the child discuss the situation is more beneficial than punishment and abirb.com/test labeling the child as “bad.” An open discussion is likely to be more fruitful than approaches based on punishment. Choice C is likely to produce a defensive reaction as compared to choice B. abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 516

22. A nurse has recently accepted a position as a school nurse at a middle school and plans to abirb.com/test offer sex education to the students and parents. Which of the following statements is NOT correct concerning how the nurse should implement this program? a. Offer gender-segregated sex education classes. b. Education on sexually transmitted diseases is not advised until high school. abirb.com/test c. Determine how this education has been provided in the past, as a first step. d. Survey parents to determine their desire for this education to be provided.

ANS: B

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Children at this age appear to respond most favorably with gender-segregated classes, based on their general discomfort with sexual topics and unique needs and questions. Some schools abirb.com/test appropriately incorporate these classes into school curricula as part of a health-promotion curriculum. Other schools have special programs focused only on sex education based on parental desires or school board policies. Most school-age children have the cognitive skills to respond to programs on responsible sexuality, including discussions on abstinence and abirb.com/test condom use, pregnancy, sexually transmitted diseases, and the human immunodeficiency virus. Given the various approaches to content, i.e., school-determined content vs parental-driven content, determining how education in the past has been provided is a good abirb.com/test first step. There is no evidence to support limiting education on STDs to only HS students. Per the text, school-aged children have sufficient cognitive skills to learn about this topic.

DIF: Cognitive Level: Apply (Application)

REF: p. 517

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23. The school nurse has been asked to conduct a community awareness program about accidents

that impact the school-age child. Which of the following facts should be included in the program? abirb.com/test a. Poisonings and falls are the leading causes of death. b. Drowning and motor vehicle accidents are the leading causes of fatality. c. The majority of accidents happen inside the home. abirb.com/test d. Burn accidents are more common in the summer months.

ANS: B

Most fatal accidents during the school-age period derive from motor vehicle accidents when abirb.com/test the child (host) is a passenger or pedestrian (walking or riding a bike). Other fatal accidents occur from fires and burns, bicycles, drowning, and firearm accidents. Accidents are the leading cause of death in children over 12 months of age. The majority of accidents occur outdoors. Burn accidents are more common in the winter, abirb.com/test especially in lower socioeconomic families where the use of space heaters is common.

DIF: Cognitive Level: Apply (Application)

REF: p. 520 abirb.com/test

24. Which of the following statements is correct regarding firearms? a. As with video games, toy guns has been shown to increase violence later in life. b. For safety, guns should be stored apart from ammunition. abirb.com/test c. The second amendment exempts hand guns. d. All of the above statements are correct.

ANS: B

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Storing firearms in a locked cabinet apart from ammunition is a recommended strategy for gun safety. Toy guns do not result in an increase in violence or aggression later in life although video games have been shown to do so. The second amendment has no exemption for handguns. They are covered along with other firearms abirb.com/test as a fundamental right for citizens of the United States.

DIF: Cognitive Level: Apply (Application)

REF: pp. 521, 522

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25. A school nurse is caring for a child with an upper respiratory tract infection. Which of the

following nursing interventions should the nurse implement? a. Send the child with a mild sore throat back to class. abirb.com/test b. Advise the parent of a child with a group A strep throat infection that they cannot abirb.com/test

return to school for 5 days. c. Educate the parent that treatment of group A strep infections usually requires extra abirb.com/test fluid intake. d. Ask the parent of a child with a mild fever and mild sore throat to take the child to his or her health care provider.

ANS: D

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Untreated strep throat caused by group A bacteria can result in serious complications. Signs and symptoms may include a mild sore throat. After 24 h on antibiotics, the child can return to school. Thus, the parents of a child with a mild fever and mild sore throat should be evaluated abirb.com/test by his or her health care provider.

DIF: Cognitive Level: Apply (Application)

REF: p. 523 abirb.com/test

26. Which of the following statements about smoking is true? a. Black children begin smoking at an earlier age than do White children. b. Almost 90% of schools prohibit tobacco use in all locations. abirb.com/test c. Each day over 6000 children try smoking. d. Tobacco use prevention programs should be initiated in eighth grade.

ANS: C

Every day, more than 6000 school students try to smoke aabirb.com/test cigarette. Most students who smoke initiate their habit around 11 years of age. White children begin smoking at an earlier age than do Black children. Approximately 64% of schools are smoke free. Tobacco use prevention programs should begin in elementary school. abirb.com/test DIF: Cognitive Level: Understand (Comprehension)

REF: p. 524

abirb.com/test 27. A child’s parents ask the school nurse if there is any help available to help their child receive

health insurance. They state they earn too much money to qualify for Medicaid but not enough to purchase health insurance. Which of the following recommendations should the nurse provide? abirb.com/test a. “Currently, there is no health care program available for your child.” b. “The school district has a health insurance policy that you can access.” c. “The state has an insurance program to assist you.” abirb.com/test d. “You will need to find coverage through another member of your family.”

ANS: C

The State Children’s Health Insurance Program was created to assist parents in this economic abirb.com/test category. This program supports comprehensive care to children 0 to 18 years who do not meet Medicaid criteria but live in families too poor to afford private insurance.

DIF: Cognitive Level: Apply (Application)

REF: p. 528

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28. Which of the following statements is correct concerning vaccinations for the school-aged

child? a. The first of two HPV vaccines is given at age 10; the second abirb.com/test given during high school. b. Tetanus booster every 5 years or when an unclean wound is acquired. c. Meningococcal vaccine at age 11 to 12 abirb.com/test d. All of the above statements are correct.

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ANS: C

Most states require that the child’s immunizations be current before entering kindergarten or the first grade and that additional tetanus immunization beabirb.com/test given every 10 years or when an unclean wound is acquired. Other immunizations recommended by the American Academy of Pediatrics include a meningococcal vaccination at age 11 or 12 years and the series of three injections for hepatitis B and human papilloma virus (HPV) during the late school-age and abirb.com/test early adolescent years DIF: Cognitive Level: Apply (Application)

REF: p. 523 abirb.com/test

29. During a parent–nurse conference, the parent tells the nurse that her child sleeps

approximately 7 h per night. Which of the following potential health problems would be of concern to the nurse? abirb.com/test a. Hypertension b. Hyperactivity c. Obesity d. Type 2 diabetes abirb.com/test ANS: C

Based on the study by Lumeng and colleagues, children who do not get adequate sleep tend to be less active, which promotes overweight/obesity. abirb.com/test DIF: Cognitive Level: Analyze (Analysis) MULTIPLE RESPONSE

REF: p. 508, Box 20-2 abirb.com/test

1. Which of the following children should the school nurse monitor closely for hypertension abirb.com/test (HTN)? (Select all that apply.) a. 7-year-old White male with no known family history of HTN b. 9-year-old White female whose 20 year old brother has HTN c. 6-year-old Black child with no family history of HTN abirb.com/test d. 10-year-old Mexican American child with known family history of HTN

ANS: B, C, D

A White child with no family history of HTN can receive routine monitoring. The other abirb.com/test children are in the high-risk category for HTN because of race, ethnicity, or family history.

DIF: Cognitive Level: Apply (Application)

REF: p. 503 abirb.com/test

2. A nurse is planning a flu prevention fair for 9- to 11-year-old children. Which of the following

activities should be included? (Select all that apply.) a. Microscopes set up to show bacteria on common objects b. Games such as “find the germs” in a cartoon picture abirb.com/test c. Research poster showing germ transmission d. Handwashing booth with colored soap ANS: A, B, D

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Most school-age children perceive symptoms and show an ability to participate in health-promoting behaviors. Health-promoting behaviors taught at school and home must abirb.com/test meet the school-age child’s cognitive level (concrete operation) and moral level (external rules and forces) to be effective. Teaching strategies using cognitive, psychomotor, and affective senses can help children learn responsibility for their own health (Shroff, 2015). This knowledge provides an excellent foundation for health-promotion behaviors during the school abirb.com/test years.

Age-appropriate interactive activities such as games and demonstrations are effective teaching strategies. Formal research poster presentations are not appropriate for this age group. This approach would be more suitable for persons at the youngabirb.com/test adults or older stage of life.

DIF: Cognitive Level: Apply (Application)

REF: p. 504

abirb.com/test 3. The school nurse has been asked to plan play and recess activities for children in grades 2

through 6. Which of the following activities should be developed by the nurse? (Select all that apply.) a. Highly competitive games that focus on individual accomplishment and winning abirb.com/test b. Family activity days that promote nature walks and biking c. Co-ed organized sports d. 4-H club activities abirb.com/test

ANS: B, D

This desire for peer interaction, usually with one of the same gender, extends beyond school and carries over to play and outside activities. Organized sports such as baseball teach team cooperation, competition, and other social skills. Concernsabirb.com/test exist that young children have experienced too much physical and psychological pressure to perform in sports. This has generated a renewed commitment by many parents to focus more on the fun of sports than on the winning of games. Scouts and 4-H clubs teach childrenabirb.com/test about group functioning, processes involved in carrying out a task, and the power of social relationships to create change.

Emphasis should move away from highly competitive activities that promote more of a feeling of superiority than team work to reach a goal. Family activity days and participation in abirb.com/test 4H clubs are excellent activities to promote healthy interaction with others. Children in this age group generally prefer to play with children of the same sex.

DIF: Cognitive Level: Apply (Application)

REF: p. 509 abirb.com/test

4. Which of the following children may have difficulty with Erikson’s “industry versus

inferiority” stage of development? (Select all that apply.) abirb.com/test a. Poor motor skills and is rarely chosen for team play during recess b. Difficulty with math homework c. Difficulty making friends d. Cannot speak his or her native language fluently abirb.com/test ANS: A, C, D

The “industry versus inferiority” stage of development as described by Erikson is mastered when the child has a sense of accomplishment, rather thanabirb.com/test an inability to perform at the expected level. Children with poor motor skills who are not selected by their peers for a team, those who find it difficult to make new friends, and those who have difficulty assimilating into their dominant culture all are likely to have a sense of inferiority. The fact that a child is having difficulty with math homework may not be noticedabirb.com/test by his/her peer group.

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DIF: Cognitive Level: Apply (Application)

REF: p. 514

5. The school nurse is evaluating children for signs and symptoms of depression. Which of the abirb.com/test

following children may be most at risk for depression? (Select all that apply.) a. 11-year-old girl who has been involved in fighting during the past month b. 10-year-old boy who no longer wants to play on the school’s soccer team abirb.com/test c. 12-year-old boy who has started lifting weights d. 9-year-old girl who visits the nurse on a daily basis for vague complaints ANS: A, B, D abirb.com/test Symptoms of depression in school-age children include anorexia, sleeplessness, lethargy, changed affect, aggressive behavior, frequent crying, or withdrawal from previously enjoyed activities. abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 519

6. Which of the following is responsible for ensuring that children are up-to-date on their

immunizations? (Select all that apply.) a. School nurse b. Parent or caregiver c. Teacher d. School principal

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ANS: A, B

In many states, the school nurse has a responsibility to ensure that all students’ immunizations abirb.com/test are current, and if they are not current, the nurse informs the parents that the children may not attend school until their immunizations are up to date.

The parent or caregiver bears the major responsibility for ensuring that their child has had all abirb.com/test of the required immunizations; however, it is also the school nurse’s responsibility to ensure that the immunizations are current.

DIF: Cognitive Level: Understand (Comprehension)

REF: p. 524

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7. A nurse is conducting a school-wide in-service program about child abuse and is asked to

describe common indicators of abuse. Which of the following signs would the nurse include? abirb.com/test (Select all that apply.) a. Caregivers and parents who are reluctant to take the child for treatment for an injury b. Statement by the day care provider that the child was injured by falling off a chair abirb.com/test c. Explanation of the injury from the child and caregiver or parent that is similar d. Lack of emotional response from child to a playground injury ANS: A, B, D

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Signs of abuse may include physical evidence, conflicting stories about the “accident” or injury from parents or others or an injury or complaint inconsistent with the child’s history or developmental level. Also suggestive of abuse are inappropriate response of the caregiver or child, the child’s report of abuse, previous reports of abuseabirb.com/test in the family, or repeated visits to emergency facilities with injuries. An inappropriate response such as little or no response to pain is a red flag. Accordingly, the lack of expected response from the child with the playground injury is a red flag. Similarly, falling off a chair is a red flag as this sort of event abirb.com/test might be expected of a toddler but not a school-aged child.

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DIF: Cognitive Level: Apply (Application)

REF: p. 517, Box 20-7 abirb.com/test

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Chapter 21: Adolescent Edelman: Health Promotion Throughout the Life Span, 9th Edition abirb.com/test

MULTIPLE CHOICE 1. When do females usually begin puberty? a. 1 year before males b. 1 year after males c. 2 years before males d. 2 years after males

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ANS: C abirb.com/testtheir growth spurts Females usually begin puberty 2 years before males and experience earlier.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 536 abirb.com/test

2. A teenager has been using acne medications for the last 14 days. Her acne is no better, and in

fact, it is a little worse. What information should the nurse offer this girl? a. “Wash your face at least four times a day, making sureabirb.com/test to scrub well.” b. “The medications can make acne appear worse at first; try to give it a few more weeks.” c. “Avoid all chocolate products.” d. “Because it is summertime, it would be good for your abirb.com/test skin if you lie out in the sun for a few hours each day.”

ANS: B abirb.com/test Acne is common in adolescents. Evidence indicates that dietary restrictions for acne are unnecessary. Although washing with soap and water is the best way to remove dirt, vigorous scrubbing should be discouraged. Furthermore, although sunlight can have a beneficial effect on acne, prolonged exposure should be avoided. Topical acne products make acne appear abirb.com/test worse initially, and improvement occurs slowly over several months. Nurses should provide this information to teenagers planning to use acne products, so they are not discouraged early in therapy. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 545

3. The mother of a 13-year-old girl is concerned because herabirb.com/test daughter has not started

menstruating yet. The girl developed breast buds and started her height spurt at 12 years of age. Which of the following statements would be the most appropriate response from the nurse? abirb.com/test a. “Usually, girls start menstruating when they develop breast buds; an endocrine evaluation might be warranted.” b. “Everyone is different; it will happen in the near future.” c. “Based on when the breast buds first appeared, she should start menstruating abirb.com/test around in the age of 14.” d. “She will not start menstruating until her breasts are of adult size and contour.”

ANS: C

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The first sign of puberty in females is the appearance of breast buds, followed by a growth spurt. The onset of menstruation occurs approximately 2 years after the appearance of breast buds and near the end of the growth spurt. Thus, based on abirb.com/test the age of breast bud appearance, the girl should start menstruating around age 14.

DIF: Cognitive Level: Apply (Application)

REF: p. 538 abirb.com/test

4. Which genetic disorder affecting the x chromosome is found in females? a. Gynecomastia b. Menstruation abirb.com/test c. Turner syndrome d. Klinefelter syndrome ANS: C

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Turner syndrome affects females and involves alternation of the x chromosome. Often, it is not diagnosed until puberty.

DIF: Cognitive Level: Remember (Knowledge)

abirb.com/test REF: p. 539

5. Which genetic disorder affecting the x chromosome is found in males and is often diagnosed

at puberty? a. Gynecomastia b. Menstruation c. Turner syndrome d. Klinefelter syndrome

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ANS: D

A disorder affecting the x chromosome affecting males is Klinefelter syndrome. It is often abirb.com/test diagnosed in puberty.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 539 abirb.com/test

6. Parents recently discovered that their teenage daughter has been consuming alcohol on a

regular basis. They ask the nurse for advice on how best to help their daughter. In addition to closer supervision to prevent such activity, which of the following recommendations should the nurse give to the parents? abirb.com/test a. Talk to their daughter at length regarding the dangers associated with drinking. b. Have her favorite aunt, with whom she is very close, talk to her about drinking. c. Enroll their daughter in a peer support group focused on teenage drinking. abirb.com/test d. Provide their daughter with literature regarding the dangers of drinking.

ANS: C

Teens do not always consider the health risks of their behavior and have an overall sense of abirb.com/test invulnerability to illness or injury. Peer influence is primary, and parental input often is rejected. Parents need, however, to be vigilant in order to recognize when their adolescent needs assistance with avoiding situations that could lead to irreparable harm In this case, information coming from the parents (choicesabirb.com/test “A” and “D”) are likely to be rejected. Similarly, the favorite aunt, however close may be the relationship, represents an adult authority figure. Since peer influence is a primary motivating factor for teens, the parents should enroll her in a peer support group focused on teenage drinking. abirb.com/test

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DIF: Cognitive Level: Apply (Application)

REF: p. 540

7. Which of the following behaviors is most reflective of a teenager? abirb.com/test a. Riding an ATV without a helmet b. Not skiing for fear of falling and getting hurt c. Obeying a new parental rule without a challenge abirb.com/test d. Walking away from a group of friends who are smoking cigarettes ANS: A

A crucial component for understanding adolescent health is an adolescent’s own perceptions of health, illness, and health care services. Too often, theirabirb.com/test sense of invincibility and “Peter Pan” ideology couples with typical adolescent experimentation and risk-taking behaviors to produce deleterious health care choices and outcomes.

Teens take unwise risks and they often do things because their friends do it. Therefore, riding abirb.com/test an ATV without a helmet and risking a head injury is most reflective of a teenager’s behavior.

Choices B, C, and d reflect mature judgment regarding risks which characteristic is not particularly typical for teens. abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 539

8. Which of the following is NOT characteristic of anorexia abirb.com/test nervosa? a. Increased frequency or heavy menses due to increased ovulation b. Co-morbid depression or anxiety c. Perfectionism abirb.com/test d. Compulsive physical activity ANS: A

Most adolescents with an eating disorder experience comorbid psychiatric conditions, such as anxiety, depression or obsessive-compulsive disorder, andabirb.com/test suicide ideation is not uncommon.

Symptoms or warning signs include a relentless pursuit of thinness, self-starving with significant weight loss, lack of menstruation (in females) and decreased sexual interests (in males), compulsive physical activity, preoccupation with food, portioning food carefully, abirb.com/test eating only small amounts of only certain foods.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 541 abirb.com/test

9. During a physical exam, a teenager asks the nurse if she can have a stronger medication for

her constipation because the laxatives she has been taking are not helping. During the physical exam, the nurse observes mild to moderate erosion of the tooth enamel. Which of the abirb.com/test following disorders is the client most likely experiencing? a. Bulimia nervosa b. Binge eating disorder abirb.com/test c. Idiopathic constipation d. Irritable bowel syndrome ANS: A

Bulimia nervosa is characterized by binge eating and thenabirb.com/test purging by self-induced vomiting and/or laxatives. Vomiting commonly leads to erosion of the tooth enamel. Bulimia nervosa occurs more commonly in females. A teenage girl asking for stronger laxatives combined with an observation of tooth enamel erosion should cause any health care provider to consider the abirb.com/test possibility of bulimia nervosa.

abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 541 abirb.com/test

10. A teenager has a family history of Type 2 diabetes mellitus. He asks the nurse what he can do

to try to prevent developing it himself. Which of the following instructions should the nurse give this client? abirb.com/test a. Tell him to avoid any and all sweets. b. Tell him to be active, eat a balanced diet, and maintain normal weight. c. Tell him he should talk to his physician about genetic testing. d. Tell him that very little can be done to avoid developing this disorder. abirb.com/test ANS: B

Obesity is making Type 2 diabetes mellitus common among teens and young adults. Being overweight and inactive increases the risk. Therefore, encouraging activity, a balanced diet, abirb.com/test and maintaining normal weight is the best information the nurse can give to the client. Telling him to avoid all sweets would be a highly impractical if not impossible suggestion. Genetic testing does not detect the development of this disorder. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 542

11. Which of the following statements concerning sleep patterns in teenagers is correct? abirb.com/test a. Adolescents need 7 to 8 h of sleep nightly. b. Electronic devises have been associated with sleep deprivation. c. Extra-curricular sports, like all exercise, help teens maintain adequate sleep. abirb.com/test d. All of the above statements are correct.

ANS: B

During adolescence, the amount of time needed each night for sleep declines in comparison to earlier childhood needs. Although their sleep patterns varyabirb.com/test greatly, adolescents need at least 9 h of sleep per night. Adolescents who are employed, those involved in extracurricular sports, and those who have “too much on their plate” are at increased risk for sleep deprivation. They stay up late and are then forced to wake up before their sleep cycles have finished because the abirb.com/test high school day has such an early start. Many adolescents send and receive text messages at bedtime after room lights are turned off, which can interfere with a good night’s sleep. Even a moderate level of nighttime texting can greatly increase the likelihood of having long-term abirb.com/test fatigue.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 542 abirb.com/test

12. According to Piaget, which of the following developmental stages is applicable for the

teenage years? a. Concrete operational b. Formal operations c. Abstract operations d. Inductive operational

abirb.com/test

ANS: B

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Adolescence is characterized by a shift in cognitive abilities to Piaget’s stage of formal operations. Piaget’s theory used the term formal to represent the emergence of ability to focus on the “form” of thoughts, objects, and experiences rather abirb.com/test than on the exact content, which in turn lays the groundwork for abstract thinking. These new cognitive abilities are reflected in adolescent behaviors in several ways. The first change is that, because of their new ability to “think about their thinking,” adolescents become highly introspective. abirb.com/test

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 543

13. According to Erikson, which of the following teenagers isabirb.com/test at risk for not meeting his

developmental task? a. Arrested for petty theft b. Decided he wants to major in accounting c. Has recently broke up with his girlfriend d. Is a member of the varsity basketball team

abirb.com/test

ANS: A abirb.com/test Erikson’s theory of psychosocial development describes the central task of adolescence to be the establishment of identity, with the primary risk being role confusion. Teens make choices in social, recreational, volunteer, academic, familial, and occupational activities. The confusion and hesitation in making these choices arise from fears of participating in activities abirb.com/test that will not afford them the opportunity to excel or win the approval of their peers. When the threat of identity confusion is exceedingly great, delinquent behavior and alterations in mental health can occur. This threat is enhanced by conditions of poverty, racism, and other social abirb.com/test inequities. Choices B, C, and D are all normal teenage activities, which serve to foster identify formation. Petty theft is delinquent behavior and suggests identify confusion according to Erickson’s constructs. abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 543

14. From the perspective of the parents of the teenager, which of the following is an adaptive and

beneficial approach to the task of parenting teenagers? abirb.com/test a. Set strict rules to prevent the teenager from getting into any trouble. b. Learning how to let go c. Transition from the role of parent to friend/peer abirb.com/test d. Drop rules and limits so as to foster maturity and self-determination.

ANS: B

The adolescent begins to spend increased time away from abirb.com/test the family. Parents sense a narrowing of their influence as their teen not only begins to prefer the company of peers and other adults but also begins to question familial beliefs and values. Parents may respond by setting unreasonably strict limits and asking intrusive questions about their teen’s activities, friends, and ideas or decide to drop all rules and limits andabirb.com/test assume that the adolescent can now manage alone. Neither of these approaches works well. While adolescents strive for a sense of identity and independence, their parents try to learn how to let go. It is too early to drop the role of parent in favor of becoming a friend. The abirb.com/test role of a friend may be appropriate when the child is much older and well into adulthood, possibly raising a family of his/her own. During the teenage years, however, the child still requires effective parenting. During this process, the parents need to increasingly let go as the teen will eventually transition into abirb.com/test adulthood.

abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 545

15. Which of the following statements is NOT correct concerning adolescent sexual issues? abirb.com/test a. Sexting is becoming an increasingly common practice among teenagers. b. Experimenting with same sex intimacy may put teens at risk for suicide. c. Fantasizing about sexual activities has been shown to lead to promiscuity. abirb.com/test d. Anticipatory guidance appropriately includes information about contraception and

STDs. ANS: C abirb.com/test Experimenting with same sex physical intimacy does not necessarily predict future sexual orientation, but feelings associated with the possibility of homosexual identity can give rise to anxiety, mood disorders, and heightened risk for suicide. Sexting has been recognized as an increasing occurrence for several years and is a global practice among teens and young adults. abirb.com/test Sexting refers to sending a text message with sexually explicit content or a sexually explicit picture. Anticipatory guidance about the decision to become sexually active, to use contraception, and to obtain protection from STIs needs to be provided before adolescents encounter a situation in which they need this information. abirb.com/test Fantasizing about sexual activities is a normal behavior for teenagers and does not portend promiscuity. They fantasize about relationships and sex and gradually experiment with dating and a myriad of coital and noncoital physical contacts. abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 546

abirb.com/testpregnancies?

16. Which of the following statements is correct concerning adolescent a. Low birth weight is associated with teen pregnancies. b. Teen pregnancies have increased over the last two decades. c. Blacks have the highest rate of teen pregnancies. abirb.com/test d. All of the above statements are correct.

ANS: A

The overall teen birth rate has dropped dramatically by approximately abirb.com/test 57% over the past two decades, and this has occurred in all ethnic groups. The birth rate is highest in Hispanic teens, followed by non-Hispanic Blacks, American Indian/Alaskan Natives, non-Hispanic Whites, and Asian Pacific Islanders.

Adolescent pregnancy has a myriad of negative outcomes abirb.com/test for both mother and child. For the mother, these include a significant decline in her future prospects, especially educational and economic; single parenthood; reliance on government-sponsored assistance, and poverty. For the child born to adolescent mothers there is a higher risk abirb.com/test of low birth weight.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 547

abirb.com/test 17. Which of the following is the SECOND leading cause of death for teens and young adults, 15

to 24 years? a. Accidents b. Suicide c. Bone cancer d. Sport injuries, especially head trauma ANS: B

abirb.com/test

abirb.com/test

Suicide has become the second leading cause of death among adolescents, ages 15 to 24 years.

abirb.com/test

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 549 abirb.com/test

18. After offering a teenager the HPV vaccine, the teenager responds by saying, “I can’t have the

vaccine because I have already been sexually active.” Which of the following statements is the best response by the nurse? abirb.com/test a. “You can still benefit from the vaccine, but there is a chance it will not be as effective.” b. “The best way to protect yourself now is to make sure all your future sexual partners have received the vaccine.” abirb.com/test c. “You are correct, the vaccine is only indicated for females who have never been sexually active.” d. “It depends on the number of partners you have had. If you have had less than five abirb.com/test partners, you are still eligible for the vaccine.”

ANS: A

HPV vaccination series is recommended for girls and boys at age 11 or 12 years. The vaccine abirb.com/test is also recommended for all adolescent girls and women through age 26, who did not receive all three doses of the vaccine when they were younger, and for all adolescent boys and men through age 21 (age 26 if in a sexual relationship with other men) who also did not complete the vaccine series in their younger ages. Ideally, females should get the vaccine before they abirb.com/test are sexually active. This is because the vaccine is most effective in girls/women who have not yet acquired any of the HPV types covered by the vaccine. Females who are sexually active may also benefit from the vaccine, but they may receive less benefit since the vaccine will have no effect on HPV types they acquired before vaccineabirb.com/test administration. The vaccine protects against HPV-related cancers in both boys and girls.

DIF: Cognitive Level: Apply (Application)

REF: p. 552 abirb.com/test

19. Which of the following statements is correct regarding substance abuse and teenagers? a. Marijuana is the most frequently abused substance by teenagers. b. Opioid overdosing is on the decline secondary to betterabirb.com/test education on the hazards. c. Heroin is now purer than in the past, sometimes laced with fentanyl. d. Opioids when legally prescribed are safe and rarely lead to the use of street drugs.

ANS: C

abirb.com/test

Heroin is particularly dangerous because it is purer than in the past and is also frequently laced with fentanyl, a potent pain killer. Alcohol is the substance used most frequently by adolescents, with nearly 35% of adolescents reporting current use on a national survey. abirb.com/test Alcohol is followed by marijuana. Opioid overdose is becoming a leading cause of death for people in these age groups. Evidence suggests that use of prescription pain medications can lead to heroin use, and many adolescents become addicted through indiscriminate pain abirb.com/test management of a musculoskeletal or other injury.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 553 abirb.com/test

20. Which of the following statements is correct concerning tobacco use in adolescents? a. Smoking is most prevalent in Caucasian teenagers as compared to Blacks and

Hispanics. b. Advertising has not been shown as effective in promoting abirb.com/test smoking in teens. Rather

peer pressure is effective. abirb.com/test

c. Electronic cigarettes involve flavored liquids with very low levels of actual smoke. d. All of the above statements are correct.

ANS: A

abirb.com/test

Smoking is most prevalent in White males and females than in Black or Hispanic populations.

Recently, adolescents have begun using electronic cigarettes (e-cigarettes, vaping). Electronic abirb.com/test through an appliance that cigarettes, which are battery operated, vaporize liquid for inhalation resembles a cigarette; there is no smoke involved. Flavored liquid in cartridges, either with or without nicotine, are attractive and available to adolescents. Advertising by the tobacco industry directed at adolescents has been shown to encourage adolescent smoking. abirb.com/test

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 553

21. A teenager asks the school nurse for advice before gettingabirb.com/test a tattoo. Which of the following

responses would be most appropriate for the nurse? a. “You should only get tattoos which can be covered by clothing on a job interview.” b. “It is okay to get a tattoo providing that you only go toabirb.com/test a licensed artist.” c. “Tattoos are popular; however, they can lead to infection and/or bleeding.” d. “A body piercing would be safer and less permanent.”

ANS: C

abirb.com/test

Tattoos and piercings carry similar risks, which include localized infection, bleeding, and dermatitis. In addition, tattoos carry a heightened concern for blood-borne disease such as hepatitis and HIV. When providing anticipatory guidance,abirb.com/test nurses should offer information needed to make an informed decision. Whether the tattoo can be covered by clothing does not decrease the health risks involved. Not all states offer licensing for tattoo artists. Moreover, patronizing a licensed artist does not negate the risks associated with this potentially abirb.com/test hazardous activity.

DIF: Cognitive Level: Apply (Application)

REF: p. 545 abirb.com/test

22. A teenager is expecting her menstrual period on May 14. On which of the following dates

would the nurse recommend that she perform a self-breast exam? a. May 11 abirb.com/test b. May 14 c. May 17 d. May 23 ANS: D

abirb.com/test

The best day to perform a self-breast exam is 2 to 3 days after one’s period when breasts are least likely to be tender or swollen. A typical period lasts about 6 days. Thus, a teenager who starts her period on May 14 should perform a breast self-exam on May 23 (14 + 6 = 20 + 3 = abirb.com/test 23).

DIF: Cognitive Level: Apply (Application)

REF: p. 547, Box 21-6 abirb.com/test

23. Which of the following teenagers is exhibiting a behavior that cause for concern and requires

further evaluation? a. Feels happy on most days but on some days she feels sad abirb.com/test b. Is agitated and has trouble sleeping

abirb.com/test

c. Has a lot of homework and stays up late to finish it d. Values his friend’s opinion more than his parent’s opinion ANS: B

abirb.com/test

Nurses should be aware that the problem of substance abuse exists. They should also be aware of what the signs and symptoms are. Agitation and insomnia are signs of substance abuse and abirb.com/test should therefore be evaluated further.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 553, Box 21-10

abirb.com/test 24. Which Tanner stage of male genital development is characterized by initial enlargement of the

penis, mainly in length along with further growth of the testes and scrotum? a. 1 b. 2 abirb.com/test c. 3 d. 4 ANS: C

abirb.com/test

In stage 3, male genital development is characterized by initial enlargement of the penis, mainly in length along with further growth of the testes and scrotum.

DIF: Cognitive Level: Remember (Knowledge)

abirb.com/test REF: p. 537, TBL 21-1

25. Which stage of female breast development is characterized by enlargement of the areolar

diameter along with a small area of elevation around the papillae? abirb.com/test a. 1 b. 2 c. 3 abirb.com/test d. 4 ANS: B

In stage 2, female breast development is characterized by enlargement of the areolar diameter along with a small area of elevation around the papillae. abirb.com/test DIF: Cognitive Level: Remember (Knowledge)

REF: p. 537, TBL 21-1 abirb.com/test

26. A 14-year-old female is in for a physical exam. Which finding requires further investigation? a. A height spurt since her last visit b. Facial acne c. The lack of breast buds or breast development abirb.com/test d. Noticeable sweating and body odor with activity ANS: C

The onset of puberty usually begins around 11 to 13 yearsabirb.com/test of age. Stage 2 is the usual time of peak height velocity for girls. Additionally, both sweat and sebaceous glands become more active during adolescence leading to sweat, body odor, and acne. Breast buds also usually appear during stage 2 of puberty. Females who have not begun pubertal development by age abirb.com/test 14 should have an endocrine evaluation. Thus, the finding of lack of breast buds on a 14-year-old girl requires further investigation.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 535 abirb.com/test

abirb.com/test

MULTIPLE RESPONSE

abirb.com/test

1. Which of the following are symptoms or warning signs of anorexia nervosa? (Select all that

apply.) a. Lack of menstruation in females b. Preoccupation with food c. Eating only small amounts of certain foods d. Dramatic weight fluctuations

abirb.com/test

abirb.com/test

ANS: A, B, C, D

Symptoms or warning signs of anorexia nervosa include the relentless pursuit of thinness, self-starving with significant weight loss, lack of menstruation in females, decreased sexual abirb.com/test interests in males, compulsive physical activity, preoccupation with food, portioning food carefully, eating only small amounts of only certain foods, and a distorted body image.

Dramatic weight fluctuations are seen with bulimia nervosa. abirb.com/test

DIF: Cognitive Level: Understand (Comprehension)

REF: p. 541

2. A nurse is discussing being a safe driver as part of a driver’s education course. Which of the abirb.com/test following recommendations would the nurse include in this presentation? (Select all that apply.) a. Driving mid-sized two door vehicles is recommended. b. Avoiding talking on cell phones abirb.com/test c. Driving during daytime hours d. Wearing safety belt

ANS: B, C, D

abirb.com/test

The risk of motor vehicle crashes is four times higher among 16- to 19-year-old adolescents than among any other age group. Research suggests that distractions, such as talking or texting on cell phones, eating, or playing with the radio, increase teen drivers’ risk of being involved in a crash. Nurses should talk to teens about theseabirb.com/test distractions, which can also include riding with a car full of other teens. Teens have a much higher nighttime crash fatality rate as well. There are no recommendations for choice of cars.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 549

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abirb.com/test

Chapter 22: Young Adult Edelman: Health Promotion Throughout the Life Span, 9th Edition abirb.com/test

MULTIPLE CHOICE abirb.com/test

1. A nurse is planning a community health-education program for young adults. Which of the

following considerations should be made by the nurse? a. The age span encompassing young adulthood is between 20 and 30 years of age. b. The number one cause of death for young adults is injury. abirb.com/test c. The number of young adults in the United States is increasing. d. The maternal mortality rate is at its lowest point since 1980.

ANS: B

abirb.com/test

The young adult period encompasses the ages from 18 to 35 years, a time that spans from the end of adolescence to the beginning of middle adulthood. Healthy People 2020 states that 72% of all deaths among children and young adults are due to injuries. In 2014, approximately abirb.com/test 20.5% of the American population was composed of adults ages 20 to 34. The young adult population aged 18 to 24 is projected to be approximately 9.13% of the general population by the year 2020 and 8.34% by the year 2035. In 2007 the maternal mortality rate was much abirb.com/test higher, 12.7 per 100,000 live births.

In summary, injury is the primary cause of death, the number of young adults is declining and maternal mortality is increasing.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 560

2. A nurse is completing a health counseling session with a 25-year-old woman. Which of the

following statements should be made by the nurse during this session? abirb.com/test “A yearly Pap test is recommended for detection of ovarian cancer.”

“Research supports that breast self-exams reduce breast cancer mortality.”

“The incidence of cervical cancer is very low in your age group.”

“Daily physical activity and weight control is one wayabirb.com/test to stay healthy.”

a. b. c. d.

ANS: D

Screening is strongly recommended for cervical cancer in women who have been sexually abirb.com/test active (Papanicolaou [Pap] smears). The incidence of carcinoma in situ is high in young adults. It does not screen for ovarian cancer. The US Preventative Services Task Force recommends against teaching breast self-examination and concludes that the current evidence is insufficient to assess the additional benefits and harm ofabirb.com/test clinical breast examination beyond screening mammography for women 40 and older. After age 25, the preventive emphasis is on modifying coronary disease risk factors, which would be accomplished by discussing activity and weight control. Accordingly, choice “D” would be correct. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 564

3. A 26-year-old care recipient has a total cholesterol of 206 abirb.com/test mg/dL and an LDL of 110. Which

of the following conclusions can be drawn by the nurse?

The care recipient has achieved the target levels for cholesterol in young adults.

The care recipient has a very low risk of developing heart disease. abirb.com/test The care recipient requires counseling about cardiac disease risk factors.

The care recipient has early-onset cardiac disease.

a. b. c. d.

abirb.com/test

ANS: C

Cardiovascular assessment of the young adult includes determining the presence of hyperlipidemia, hypertension, diabetes, chest pain, or heartabirb.com/test disease. This care recipient has elevated cholesterol levels and requires additional education about risk factors that may lead to cardiac disease. The Healthy People 2020 target is to reduce the mean total blood cholesterol levels among adults to 177.9 mg/dL. A diagnosis of heart disease cannot be made abirb.com/test on the basis of these lab values.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 565 abirb.com/test

4. The public health nurse is conducting a screening of young adults for metabolic syndrome.

When asked about the syndrome, which of the following responses should be made by the nurse? abirb.com/test a. “Anyone who has low blood sugar, high cholesterol, and high blood pressure has this syndrome and is at risk for cardiac disease.” b. “This syndrome helps predict heart disease. Once it is diagnosed, the correct abirb.com/test medication can be prescribed and heart disease avoided.” c. “This syndrome is a warning sign that the person could develop heart disease.

When someone has metabolic syndrome, dietary and activity level changes are recommended.” abirb.com/test d. “Anyone who has high cholesterol, high blood pressure, and high blood sugar has coronary artery disease. Once we make the diagnosis, we can begin to treat the disease.” abirb.com/test

ANS: C

The metabolic syndrome includes a group of cardiovascular risk factors associated with overweight and obesity, particularly abdominal obesity. This syndrome includes the lethal abirb.com/test risks of high lipid levels, insulin resistance, and hypertension.

Many studies have demonstrated that hyperlipidemia and hypertension in young adults is directly related to later cardiovascular disease. A prominent sign of metabolic syndrome is central or waist-centered obesity. Currently, at least one fifth of US adults are estimated to have this combination of abirb.com/test metabolic risk factors and the prevalence increases with age. First-step therapy involves lifestyle alterations, including weight management and increase in physical activity.

Metabolic syndrome is diagnosed when a person has high cholesterol, high blood pressure, abirb.com/test and high blood sugar. A person with this syndrome is at risk for coronary artery disease.

Lifestyle changes are tried before medication is used.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 566 abirb.com/test

5. The university health services nurse is preparing a disease prevention program for college

students. Which of the following information should the nurse include in the program? abirb.com/test a. Living in the dorm increases one’s risk of developing meningococcal disease. b. The mortality rate from meningococcal disease is very low. c. There are no antiviral medications that can treat meningococcal outbreaks. d. A vaccine for meningococcal disease has not been developed. abirb.com/test ANS: A abirb.com/test

abirb.com/test

Most outbreaks of meningococcal disease are sporadic; however, young adults living in college/university dormitories or crowded conditions may be more susceptible than young adults not living in close settings. Although meningococciabirb.com/test are sensitive to penicillin and many antibiotics, the case fatality rate is high in otherwise healthy adults, and many survivors may have residual neurological disabilities. Most susceptible are unvaccinated or incompletely vaccinated college freshmen living in dormitories, or military recruits, who have a higher case abirb.com/test ratio.

Although most outbreaks of meningococcal disease are sporadic, young adults living in dormitories or crowded conditions may be more susceptible than young adults not living in close settings. Meningococcal disease has a high mortalityabirb.com/test rate. It is caused by a bacterium, not a virus, and antibiotics to treat the disease are readily available. A preventive vaccine is available.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 567

6. A 30-year-old woman with a BMI of 36 is counseled by the nurse regarding interventions to

assist with weight reduction. In which order would the nurse discuss the implementation of abirb.com/test these interventions?

1. Gastric stapling 2. Medication to reduce appetite 3. Nutrition and exercise education 4. Assessment of lipid profile and blood pressure a. 4, 3, 2, 1 b. 4, 2, 3, 1 c. 3, 4, 2, 1 d. 3, 2, 1, 4

abirb.com/test

abirb.com/test

abirb.com/test

ANS: A

Nurses with other health providers can investigate weight problems by measuring waist circumference, blood pressure, cholesterol, and activity levels rather than using weight alone. abirb.com/test Assessments of weight and height are used to calculate body mass index (BMI) ….

Individuals with a BMI of 30 or greater who have tried diets and exercise may be considered for weight-reducing drugs. A BMI of 35 to 40 or more may meet the criteria for bariatric surgery. However, the focus of nursing advice is conservative at first, recommending lifestyle abirb.com/test management, careful diet appraisal, and increase in exercise patterns.

Assessment data must be complete before intervention. Diet and exercise are used first, and then pharmaceutical agents to reduce appetite. Bariatric surgery is used when all other options abirb.com/test have failed.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 568 abirb.com/test

7. Which of the following statements is correct concerning aerobic exercise for young adults? a. Exercise improves cardiovascular function by decreasing capillary diameter in the

muscles and heart. abirb.com/test b. Raising heart rate to 150 beats per minute is not recommended for persons over the

age of 25. c. Young adults are encouraged to engage in activity that raises heart rate to 150

beats per minute. abirb.com/test d. Aerobic exercise should not be paired with muscle-strengthening activities so as to abirb.com/test

avoid over-taxing the heart.

ANS: C

abirb.com/test

Aerobic exercise, in which oxygen is metabolized to produce energy, develops an optimally functioning cardiorespiratory system. Aerobic conditioning achieves cardiovascular fitness through five periods of moderately intense exercise weekly for about 30 minutes or more.

Young adults are encouraged to engage in fitness activitiesabirb.com/test that increase the heart rate to approximately 150 or more beats per minute. After 5 minutes of activity at this rate, the body is required to make adjustments in cardiovascular capacity by enlarging the lungs and the capillaries in the muscles and the heart. Muscle-strengthening activities should also be abirb.com/test stressed.

DIF: Cognitive Level: Apply (Application)

REF: p. 569 abirb.com/test

8. The nurse working at the college health center is asked about tanning. Which of the following

statements is correct concerning sun exposure? a. Good quality sun-block agents protect for the entire day and should be applied in abirb.com/test the morning. b. Tanning beds are much safer than exposure to actual sunlight. c. Sun tanning should be avoided between 10 am and 2 pm. d. All of the above statements are correct. abirb.com/test ANS: C

Sun-blocking agents reduce sunburn or other skin damage with the goal of lowering the risk of skin cancer. A number of the agents are rated based on abirb.com/test skin type and sensitivity to burning.

Many lotions and creams are available with differing radiation protection levels. Young adults should avoid sunbathing during the 2-h period before and after noon, because two thirds of the day’s ultraviolet light comes through the earth’s atmosphere during this time. Best protection abirb.com/test is achieved by applying agents 15 to 30 minutes before exposure, and then reapplying every 15 to 30 minutes during exposure to the sun. Further application may be necessary if activities involve swimming, sweating, or rubbing of skin. The most effective skin cancer prevention activities for young adults include primary care counseling, sun protection, and avoidance of abirb.com/test tanning beds.

DIF: Cognitive Level: Apply (Application)

REF: p. 569 abirb.com/test

9. A nurse is working in the community to prevent bicycle and motorcycle fatalities. Which of

the following measures would be most effective for the nurse to promote? a. Use of helmets abirb.com/test b. Increasing the minimum age for motorcycle licensure c. Construction of bike paths along busy roads d. Right-of-way laws for bicyclists abirb.com/test

ANS: A

Cyclists are at risk of being involved in accidents with automobiles. Head injury is responsible for many bicycle-related fatalities. In 2013, 19 states had mandatory helmet requirements for riders under 15 years of age. Bicycle helmets are believedabirb.com/test to be the single most effective preventive measure available to decrease the incidence of brain and head injury. Using a motorcycle helmet reduces the chance of dying in an accident.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 569

abirb.com/test

10. Which of the following reflects Piaget’s theory as applied to young adults? a. Voting for a candidate based on popularity abirb.com/test b. Voting for a candidate based on media advertisements c. Voting for a candidate based on support of the candidate by peers d. Voting for a candidate based on analysis of views about various issues abirb.com/test

ANS: D

Young adult thought becomes more perceptive and insightful; issues can therefore be evaluated realistically and objectively. Young adults are energetic and can therefore contribute abirb.com/test substantially to social and occupational decision-making. Although they tend to take greater risks, young adults typically demonstrate the use of appropriate reasoning, anticipation, and analytical approaches. abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 570

11. Which of the following adults has transitioned to Erikson’s intimacy versus isolation and abirb.com/test loneliness stage of development? a. A 21-year-old man who has had multiple intimate relationships with women over the course of one year b. A 25-year-old man who makes no effort to date anyone of either gender but he is abirb.com/test very close to his two dogs. c. A stable young couple with a long-term close relationship who has decided not to marry abirb.com/test d. All of the above meet the criteria on one level or another.

ANS: C

Erikson’s intimacy versus isolation and loneliness stage of development involves reciprocal abirb.com/test expressions of affection and trust. Promiscuous behavior and shallow relationships, as is suggested by choice “A” is not characteristic of this stage of development. Choice “B” which depicts a person who seeks closeness to no one would also not be consistent with this stage of development. It is not relevant as to whether he seeks intimacy in same sex or opposite sex abirb.com/test relationships. The text does reference relationships with parents, children, and friends but Erickson had made no mention of pets in his theory. The young couple in a stable relationship who has chosen not to marry would meet the criteria. Marriage is not an essential component abirb.com/test for intimacy.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 570 abirb.com/test

12. Which of the following young adults exemplifies Kohlberg’s postconventional level of moral

reasoning? a. 28-year-old person who calls in sick so as to help a friend move to a new location b. 22-year-old man who uses marijuana on the weekendsabirb.com/test with friends c. 30-year-old woman who volunteers at a soup kitchen several days a month d. 35-year-old who works long hours so as to be considered for a promotion ANS: C

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Lawrence Kohlberg identifies this ability as the postconventional level of moral reasoning.

During this phase, the individual is able to differentiate the self from the rules and abirb.com/test expectations of others and to define principles regarding rights in terms of self-chosen principles. The interests of individuals can be weighed against the needs of society and the state, and violations of law can be justified when individual interests are in accord with principles. abirb.com/test Choice “C” depicts a woman doing something for the benefit of society versus herself. Such action would be consistent with Kohlberg’s postconventional level of moral reasoning. All of the other individuals presented—choices, A, B, and D—depict individuals acting for their own benefit or for that of a close friend. Benefit to societyabirb.com/test is not involved in these scenarios.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 571

abirb.com/test 13. Which of the following statements is correct concerning young adults in the workforce? a. Women generally experience less workplace stress than do men. b. The trend has been toward shorter hours and shorter work weeks. c. With better job prospects, young adults will be ahead in wages for years to come. abirb.com/test d. Work is of primary importance to young adults and helps form their self-image.

ANS: D

Employment is more than a source of income; it provides abirb.com/test self-esteem and social interaction.

There is concern that even with better job prospects, this young adult population will be behind in wages for years and may impact overall lifetime earnings. Younger hires may start at lower salaries and begin their employed years with firms who pay less or have less potential abirb.com/test for advancement. The nature of work is changing with a continued trend toward longer hours.

Women experience as much, and sometimes more, stress than do men because of child care issues. Women who return to work when their children are very young frequently risk the emotional strain caused by guilt feelings and role strain. abirb.com/test DIF: Cognitive Level: Remember (Knowledge)

REF: p. 571

abirb.com/test 14. Which of the following scenarios is outcome for the dissolution of families or divorce in

young adults? a. There has been a movement toward increased church membership for solace. b. Many women will be forced to shelter in welfare hotels and group shelters. abirb.com/test c. Marital counseling tends to be ineffective in this age group. d. All of the above statements are correct.

ANS: B

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As a result of the dissolution of families or divorce, many women and their young children are forced to seek emergency shelter in publicly operated homes, including welfare hotels and group shelters. The nurse recommends marital counseling by a qualified professional; this abirb.com/test may be the most beneficial source of support. Church membership is on the decline throughout the country. Marital counseling is recommended for this age group of individuals.

DIF: Cognitive Level: Apply (Application)

REF: p. 573

abirb.com/test

15. A 19-year-old college student is seen by the health services nurse. The young woman is

distraught that she had unprotected sex 4 days ago and is afraid she may have become abirb.com/test pregnant. Which of the following statements should be made by the nurse? a. “You must be 21 years of age to purchase emergency contraception.” abirb.com/test

b. “You can purchase Plan B without a prescription; it will terminate the pregnancy.” c. “Let’s talk about how to deal with an unplanned pregnancy and childbirth. d. “You have several options. Let’s discuss what would be abirb.com/test the best thing for you to

do next.”

ANS: D abirb.com/test pregnancies. In 2010, Emergency contraception (EC) can reduce the number of unintended 81% of family planning clinics offered emergency contraception and the Healthy People 2020 target is 87.7%, a 10% improvement. There is a generic two-dose form, Next Choice, and a one-dose form, Plan B One-Step. The FDA approved over the counter use for women of all abirb.com/test ages reporting that Plan B One-Step is safe and effective. In the United States, progestin-only emergency contraception is available on the shelf without any age restriction. Emergency contraception must be started within three days of unprotected sex; it works by either altering abirb.com/test tubal transport of either sperm or ova, or inhibiting implantation.

It will not terminate an existing pregnancy and it does not provide protection against STDs. Plan B is sold without age restriction. Emergency contraception does not terminate an existing pregnancy. Emergency contraception must be started within 3 days of unprotected intercourse. abirb.com/test Pregnancy and childbirth are not inevitable outcomes for this woman.

DIF: Cognitive Level: Apply (Application)

REF: p. 575 abirb.com/test

16. The nurse working in the college health center is planning a program about sexually

transmitted diseases (STDs). Which of the following information should the nurse include in the program? abirb.com/test a. STDs are the second most common infection in persons aged 15 to 24. b. STDs can be transmitted by any intimate contact, not just sexual intercourse. c. Multiple STDs increases the risk of ovarian cancer. d. Untreated genital herpes virus is a risk factor for invasive cervical cancers. abirb.com/test ANS: B

Many cases are unreported and untreated for lack of screening or failure to recognize symptoms. Many young adults do not understand that STDs can be transmitted from oral and abirb.com/test anal sex, not just vaginal intercourse. STDs are the most common infection in persons aged 15 to 24. A person may have multiple STDs. STDs are generally unreported and not treated.

Untreated HPV infection is a risk factor for up to 99% of invasive cervical cancers and early abirb.com/test recognition of HPV infection has decreased cervical cancer incidence and mortality by 70%.

The presence of multiple STDs increases the risk of HIV infection.

DIF: Cognitive Level: Apply (Application)

REF: p. 576 abirb.com/test

17. A 32-year-old woman visits the occupational health nurse because of malaise. Which of the

following assessment data indicates that the client may be experiencing achievement-oriented abirb.com/test stress? a. Sleeping 10 h/day b. Unintentional loss of 10 pounds in the past 4 weeks c. Expressed fear of company layoffs abirb.com/test d. Calling in sick once every 2 weeks for the past month ANS: B abirb.com/test

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Achievement-oriented stress is characterized by lack of sleep, skipping meals, and workaholic habits. It differs from situational stress, which would be caused by changes in job function for abirb.com/test example.

DIF: Cognitive Level: Apply (Application)

REF: p. 578

abirb.com/test 18. A nurse volunteered to work at a natural disaster site. Which of the following questions

should the nurse ask to determine if the 26-year-old individual, being screened for depression, has suicide ideation? a. “Tell me about your pets.” abirb.com/test b. “What do you do for work? How has your work been affected by this disaster?” c. “Have you thought of harming yourself?” d. “Have you seen your friends since the disaster?” abirb.com/test

ANS: C

If the health care provider becomes more concerned that the young adult may be at risk for suicide, the following two questions may be asked: “What thoughts have you had about abirb.com/test hurting yourself or even killing yourself?” To question further the nurse can ask, “Have you actually done anything to hurt yourself?” Even with education of the public and health care providers about the incidence of suicide in the young adult population, suicide continues to be a major health problem and annual rates, especially for young men, remain high. abirb.com/test Direct questioning about the intent to harm oneself is appropriate for the nurse to ask during screening/counseling sessions.

DIF: Cognitive Level: Apply (Application)

abirb.com/test REF: p. 578

19. Which of the following statements is correct concerning health services and health delivery

system? abirb.com/test a. Young adults have the highest emergency room visits. b. The Affordable Care Act exempts young adults up to age 26 from insurance. c. Young adults should be screened for cardiovascular disease starting at age 30. abirb.com/test d. Young adults, as a group, have a high rate of outpatient healthcare visits.

ANS: A

Young adults have the least outpatient visits. Young adults aged 18 to 24 years are the least likely of any age group to have a usual source of care. Theabirb.com/test Affordable Health Care for All Americans Act passed in 2010 mandates coverage for young adults up to the age of 26 within family health insurance coverage. It is necessary to screen for cardiovascular conditions after the age of 25 as well as provide education about risk factorabirb.com/test modification.

Young adults are not exempt from requirements for coverage under the affordable care act although they may be covered to age 26 under their parent’s policies. They have the highest rates of ER visits and less outpatient healthcare visits. abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 583

20. Which of the following circumstances accounts for one of the leading cause of death in young

adults? a. Tobacco use b. Binge drinking and driving c. Illegal drug use d. HIV infection

abirb.com/test

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ANS: B

Alcohol-related accidents among individuals ages 15 to 24 continue to be a leading cause of abirb.com/test preventable morbidity, disability, and death. Heavy alcohol use, that is, consuming five or more drinks on at least one occasion within a month, is more common in 18 to 24 year olds than it is for younger or older adults. abirb.com/test

DIF: Cognitive Level: Understand (Comprehension)

REF: p. 580

21. A nurse is counseling a 23-year-old woman about hormone-containing (estrogen or abirb.com/test estrogen/progestin) contraceptive methods: oral, transdermal, injectable, vaginal ring, and implant methods. Which of the following risks of using these methods should be stressed by the nurse? a. Toxic shock syndrome abirb.com/test b. Heavy menses c. Thromboembolic disorders (blood clots) d. Ectopic pregnancy abirb.com/test

ANS: C

Blood clots are a potential risk with estrogen containing contraceptive methods. Ectopic pregnancy or heavy menses is a possible complication of some IUDs. Toxic shock syndrome abirb.com/test may occur with use of a diaphragm.

DIF: Cognitive Level: Apply (Application)

REF: p. 576, TBL 22-2 abirb.com/test

22. Which of the following statements is correct concerning genetics as it pertains to

childbearing? a. Genetic testing is available for just under 50 diseases. b. Genetic impairments or congenital defects account forabirb.com/test 4% to 6% of perinatal deaths. c. Most of the genetic testing offered is for diseases with multi-gene etiologies. d. Genetic testing provides useful information but it cannot predict the probability of abirb.com/test disease transmission.

ANS: B

Genetic impairments, or congenital defects caused by abnormal chromosomes, are responsible abirb.com/test for 4% to 6% of perinatal deaths. Tests are available for about 200 genetic diseases. Most of the offered genetic testing is for single-gene impairment to mothers and fathers who have a family history of genetic disease. Young adults with a genetic disease must make many abirb.com/test important decisions; predicting the transmission of the disease to potential offspring is essential to future planning. Genetic testing does offer the ability to predict disease transmission to offspring.

DIF: Cognitive Level: Remember (Knowledge) MULTIPLE RESPONSE

abirb.com/test

REF: p. 579

abirb.com/test

1. An occupational health nurse is conducting a blood pressure screening. Which of the

following clients is at greatest risk of mortality from cardiac disease? (Select all that apply.) a. Black man with a blood pressure of 130/80 abirb.com/test b. Mexican American man with a blood pressure of 110/60 abirb.com/test

c. White woman with a bold pressure of 120/80 d. Black woman with a blood pressure of 128/78 ANS: A, D

abirb.com/test

There are also noticeable disparities in the development of hypertension in various population subgroups. Data from 2009 to 2012 indicate the Mexican American and the abirb.com/test White-only/non-Hispanic populations have the lowest percentage of high blood pressure individuals (27%); and the non-Hispanic/Black African American population has the highest (42%) level of hypertension. Although for the entire population, deaths attributable to coronary heart disease have declined since the 1960s, the mortality rate remains higher for abirb.com/test American Indians/Alaska Natives and Blacks.

According to the JNC VII, the risk for cardiovascular events rises when blood pressure is greater than 115/75. Blacks have a higher death rate from heart disease than do Whites.

Mexican Americans have the lowest rate of hypertension. abirb.com/test DIF: Cognitive Level: Analyze (Analysis)

REF: p. 566

abirb.com/test 2. A public health nurse is interested in writing a grant to improve vaccination rates of young

adults. His focus should be on obtaining funding to support which of the following vaccination initiatives? (Select all that apply.) a. Pertussis abirb.com/test b. Lyme disease prevention c. Hepatitis B prevention d. Human papilloma virus (HPV) prevention abirb.com/test

ANS: A, C, D

Cases of acute hepatitis B (HB) infection declined in young adults because of vaccination programs aimed at children, adolescents, and adults in high-risk groups. A vaccine to prevent abirb.com/test cervical cancer, Gardasil HPV vaccine, is effective against four types of the virus (HPV types 6, 11, 16, 18); it is available and is recommended for individuals from 9 to 26 years old.

Healthy People 2020 recommends three doses of HPV vaccine for females 13 to 15 years of abirb.com/test age. Pertussis (whooping cough) is part of the original vaccine series offered to infants. Since it is now known that the antibody titer protection for pertussis diminishes with age, pertussis vaccination is recommended with the 10-year tetanus booster injection. This newly formulated vaccine recommended for adults is known as Tdap (tetanus, diphtheria, acellular abirb.com/test pertussis).

There is not a vaccine available for Lyme disease. Hepatitis B and HPV can both be prevented through immunization and young adults are at high risk for contracting these diseases.

Pertussis is recommended and provided via administering abirb.com/test the Tdap formulation of the vaccine.

DIF: Cognitive Level: Apply (Application)

REF: p. 567

abirb.com/test

3. A nurse is conducting a community health-education program for Hispanic women ages 18 to

35. Which of the following items should the nurse recommend that they increase in their diet on a daily basis? (Select all that apply.) abirb.com/test a. Calcium b. Folic acid c. Iron abirb.com/test d. Sodium

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ANS: A, B, C

A blood loss of 2 to 4 mL per day (1 to 2 mg of iron) can cause iron deficiency anemia; young women who do not eat a healthy diet and have heavy periods or use nonsteroidal abirb.com/test antiinflammatory drugs are specifically at risk for iron deficiency anemia. The CDC and USDHHS recommend that all women of childbearing age consume 0.4 mg of folic acid daily to reduce the risk of fetal neural tube defects (FND), including spina bifida. Most adolescents abirb.com/test and adult women fail to meet their calcium requirements, placing them at risk for osteoporosis and bone fractures in later life.

Most adults tend to exceed recommended levels of sodium in their diet especially if they consume prepared foods or snack foods. Women of childbearing age frequently consume a abirb.com/test diet deficient in calcium, iron, and folic acid.

DIF: Cognitive Level: Apply (Application)

REF: pp. 568, 569 abirb.com/test

4. A community health nurse has received a grant to present a program about violence

prevention. Which of the following individuals has a higher than average risk of homicide?

(Select all that apply.) abirb.com/test a. 33-year-old woman who served 5 years in prison b. 20-year-old homeless man c. 28-year-old man with a history of bipolar disorder abirb.com/test d. 24-year-old woman who has a female partner ANS: A, B, C

Homicide is closely associated with alcohol and drug abuse and frequently is related to other abirb.com/test violent acts, such as robbery. Other risk factors for homicide include a history of loss of employment, detention or prison experience, access to firearms, abuse in the home, mental illness, social isolation, and homelessness. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 574

5. A nurse is working in a domestic violence shelter. Which of the following individuals would abirb.com/test the nurse expect to encounter? (Select all that apply.) a. 34-year-old White woman who is vice president of a communications company b. 26-year-old Black woman who has a live-in boyfriend c. 29-year-old Hispanic man who has been married for 2 years abirb.com/test d. 21-year-old unemployed White woman who has been with her boyfriend for 3 years

ANS: A, B, C, D

abirb.com/test

Intimate partner violence has serious health consequences for women and men; however, because of social and legal factors, it is probably the most underreported form of abuse. Abuse crosses all socioeconomic, racial, ethnic, religious, gender, and age boundaries. Abusive abirb.com/test behavior victims come from all racial, ethnic, and socioeconomic levels.

DIF: Cognitive Level: Apply (Application)

REF: p. 574 abirb.com/test

6. A nurse is planning community health programming for young adults. Based on the objectives

for Healthy People 2020, which of the following topics would be priority areas for programming? (Select all that apply.) a. Prenatal care abirb.com/test b. Physical activity abirb.com/test

c. HIV d. Suicide ANS: A, B

abirb.com/test

Healthy People 2020 objectives targeted for the young adult include increasing the proportion of adults who engage in regular aerobic activity of moderate intensity and increasing the abirb.com/test proportion of women who receive early and adequate prenatal care. HIV and suicide rates are not mentioned in the target areas for young adults.

DIF: Cognitive Level: Apply (Application)

REF: p. 562, Box 22-2 abirb.com/test

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Chapter 23: Middle-Age Adult Edelman: Health Promotion Throughout the Life Span, 9th Edition abirb.com/test

MULTIPLE CHOICE abirb.com/test

1. A 35-year-old person asks the nurse working in a dermatology clinic what causes skin to

wrinkle. Which of the following statements would be most appropriate way for the nurse to reply? a. “It is simply a part of normal aging and it is not preventable” abirb.com/test b. “As we age, we develop more cellulite under the skin which results in wrinkles.” c. “Wrinkles appear for a number of reasons, including loss of fat beneath your skin and too much sun exposure.” abirb.com/test d. “Wrinkles are caused by genetic factors combined with Vitamin D deposits under the skin.”

ANS: C

abirb.com/test

The skin’s moisture and turgor decreases, and with the loss of subcutaneous fat, wrinkling occurs. Excessive sun exposure through the years makes some changes more pronounced, especially increased coarseness of facial features. Avoiding excessive sun exposure abirb.com/test throughout life can lessen the impact and severity of wrinkles on the skin.

DIF: Cognitive Level: Apply (Application)

REF: p. 588

abirb.com/test 2. A 45-year-old care recipient who has experienced a ten pound weight gain during the past

year asks the nurse if she thinks iron supplements would help increase her energy. Which of the following would be the most appropriate action for the nurse to take? a. Ask the care recipient to describe her daily activity andabirb.com/test diet. b. Leave a note requesting an iron supplement on the care recipient’s chart for the doctor. c. Provide the care recipient with information related to aerobic exercise classes. abirb.com/test d. Ask the care recipient if she is still menstruating.

ANS: A

The body contour changes as “love handles” and “saddlebags” appear. Sedentary lifestyles abirb.com/test and unchanged dietary habits contribute considerably to these changes. The inactive lifestyle is further compromised by a decrease in energy. As functional aerobic capacity decreases, there is a resulting decrease in cardiac output. For individuals who maintain regular exercise programs that provide stretching and strengthening of skeletal muscle, cardiac output remains abirb.com/test essentially undiminished for many years.

A lack of routine exercise and activity plus a diet high in calories contributes to weight gain and a lack of energy. The priority action by the nurse is assessment, which will reveal the abirb.com/test reason for a lack of energy. Ordering supplemental iron without ascertaining whether there is, in fact, a deficit would be inappropriate. Absent inquiring, as suggested by choice “A,” we don’t know whether she even needs info regarding aerobic classes. She may already be taking such classes and adequately exercising. Assessment is needed. abirb.com/test DIF: Cognitive Level: Apply (Application)

REF: p. 588

abirb.com/test 3. Which of the following is a normal physiological change that occurs during middle age? a. Increase in gastric emptying resulting in acid reflux

abirb.com/test

b. Reduction in height resulting in kyphosis c. Reduction of glomerular filtration by 50% d. Increase in the amount of estrogen produced in both genders abirb.com/test ANS: C

Gastric emptying is decreased, kyphosis is a pathologic finding and not an expected part of aging. Estrogen levels decrease in women and increase in abirb.com/test men as male testosterone levels decrease.

DIF: Cognitive Level: Understand (Comprehension)

REF: pp. 588, 589 abirb.com/test

4. A nurse is conducting a community education program. Which of the following should be

stressed the leading cause of death in middle-age adults? a. Automobile accidents abirb.com/test b. Malignant disease c. Homicide d. Suicide abirb.com/test

ANS: B

The leading causes of death during middle adulthood are heart disease, cancer, and accidents.

Accidents are the major cause of death for children and young adults. Homicide and suicide abirb.com/test are major causes of death for young adults. For the years 35 to 44, accidents do outnumber malignancies as the main cause of death. However, beginning with age 45, cancer is the leading cause of death. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 589

5. A nurse formed a political action committee to advocate for health insurance for the abirb.com/test uninsured. On which of the following populations would the nurse focus the group’s efforts? a. Asian Americans b. Blacks c. Hispanic Americans abirb.com/test d. Working-poor White Americans

ANS: C

Hispanic Americans are the largest minority group in the United States and have the highest abirb.com/test uninsured rate.

DIF: Cognitive Level: Apply (Application)

REF: p. 591 abirb.com/test

6. A nurse has been asked to develop a visit plan for a mobile mammogram van. Which of the

following considerations would be made by the nurse when deciding which neighborhoods to visit? abirb.com/test a. Hispanic women have the highest rate of breast cancer as compared to other demographic groups in the United States. b. The death rate from breast cancer is higher in Hispanic women than for women in abirb.com/test other ethnic groups. c. The death rate from breast cancer in Hispanic women has risen in the past 10 years. d. Breast cancer in Hispanic women is usually diagnosed at an early stage. abirb.com/test

ANS: B abirb.com/test

Even though Hispanic women have a breast cancer rate which is approximately 40% lower than non-Hispanic White women, their death rate is higher. Cancer within this demographic abirb.com/test group is diagnosed at a later stage as compared to other populations.

DIF: Cognitive Level: Apply (Application)

REF: p. 592

abirb.com/test 7. A nurse has received a grant to provide a community-based education series for middle-age

adults. Which of the following topics would allow the nurse to have the greatest impact on the health of members of this age group? a. Diet and exercise abirb.com/test b. Seat belt use c. Depression screening d. Cancer prevention abirb.com/test

ANS: A

Dietary factors are correlated with 5 of the 10 leading causes of death in the United States: coronary heart disease, some cancers, stroke, non–insulin-dependent diabetes mellitus, and atherosclerosis. Physical activities and nutritional patternsabirb.com/test frequently are correlated. The middle-age adult typically leads a more sedentary lifestyle than does the young adult primarily because of increased responsibilities at work and home and the many convenience devices that are found in homes and workplaces. Linked with less abirb.com/test activity is the lack of attention to modification of food intake and calorie consumption, resulting in obesity, one of the major health problems of the middle years.

Obesity is a major risk factor for heart disease, metabolic syndrome, and Type 2 diabetes mellitus. An educational series devoted to discussing diet abirb.com/test and exercise will positively impact these disorders and thus will have the greatest influence on health for middle-aged adults.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 592 abirb.com/test

8. The nurse collects the following assessment data from a woman: Hispanic ethnicity, BMI 29

kg/m2, age 41. Which of the following actions should be taken by the nurse? abirb.com/test a. Encourage the care recipient to continue her dietary and exercise patterns. b. Discuss her current dietary and exercise lifestyle habits. c. Formulate a plan for increased exercise incorporating her preferences for type of exercise. abirb.com/test d. Encourage the care recipient to adopt a low-calorie diet to help control her weight.

ANS: B

Obesity is defined as a BMI of 30 kg/m2. The care recipient is at risk for obesity. Further data abirb.com/test should be gathered to ascertain her dietary and exercise patterns. Assessment is the first step before implementing and plan to address a problem. Adoption of a low-calorie diet may or may not be an appropriate intervention depending on what information is gathered during the assessment. Also, dietary changes should be accompaniedabirb.com/test by regular aerobic exercise.

Moreover, a plan to increase exercise cannot be formulated until we know her current exercise patterns.

DIF: Cognitive Level: Analyze (Analysis)

abirb.com/test

REF: p. 593

9. A nurse working in a rural location is interested in starting a weight management group for abirb.com/test care recipients in the area. Which of the following interventions is most likely to ensure success?

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a. Using a pre-set list of topics for discussion to be sure to cover all important areas b. Using standardized, validated State materials/tools to relay information to the

group

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c. Asking for a list of topics that interest the group d. Beginning each session with a 1 to 2-mile walk ANS: C

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When participants plan the topics of discussion, interest is maintained. A pre-set list of topics may not meet the learning needs of this particular group. A 1 to 2-mile walk may not be realistic for all of the participants. There is not standardized and validated materials, which are abirb.com/test uniformly appropriate for all groups of people. Moreover, not every state even provides such materials.

DIF: Cognitive Level: Apply (Application)

REF: p. 594 abirb.com/test

10. A 52-year-old postmenopausal woman tells the nurse that she is afraid she will develop

osteoporosis like her mother did. Which of the following statements is the most appropriate abirb.com/test response by the nurse? a. “The American diet is much better now than when your mother was your age.” b. “You have a strong genetic risk factor. The odds are that you will also develop osteoporosis.” abirb.com/test c. “You need about 1000 mg of calcium a day to keep your bones strong. Let’s talk about your diet.” d. “Tell me about your diet, how much walking you do each day, and what abirb.com/test medications you take.”

ANS: D

The postmenopausal woman needs 1500 mg of calcium a day if she is not taking estrogen. abirb.com/test Dietary calcium and vitamin D intake, and walking, can help prevent osteoporosis. We know nothing about her diet or that of her mother, absent inquiring about it. She may or may not develop osteoporosis depending on a variety of factors but, certainly, measures can be taken to lessen the chances of her doing so. abirb.com/test DIF: Cognitive Level: Apply (Application)

REF: p. 594

11. Which of the following statements about alcohol intake is abirb.com/test correct? a. Women have a higher death rate related to alcoholism than men. b. A woman who drinks two glasses of wine per day with her evening meal is

considered a moderate drinker.

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c. More women than men are considered problem drinkers. d. Women who experience fewer cognitive effects from drinking are less likely to

drink excessively. abirb.com/test

ANS: A

The death rate for female alcoholics is 50% to 100% higher than for male alcoholics. More men than women are considered problem drinkers. Moderate drinking for women is defined as one alcohol-containing drink a day. Two drinks per dayabirb.com/test is considered moderate for men.

Women who are able to “hold their liquor” are more likely to drink excessively than those who cannot “hold their liquor.”

DIF: Cognitive Level: Understand (Comprehension)

abirb.com/test

REF: p. 595

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12. The occupational health nurse is planning a health fair for employees. Which of the following

information about dental health should be included? abirb.com/test a. Drinking bottled water helps prevent tooth decay. b. Gingivitis results in bone destruction and can be eliminated by flossing daily. c. Preventive dental care requires a visit to the dentist every 4 months. d. In addition to screening for tooth decay, dentists often abirb.com/test screen for mouth cancer.

ANS: D

Dental health is essential to overall health. Dental professionals may be the first to detect a abirb.com/test symptom or irregularity that points to a potentially dangerous condition, such as cancer of the mouth and esophageal cancer. Bottled water does not contain fluoride; thus it is not preferable to other sources in terms of preventing tooth decay. Periodontitis is oral bone destruction; gingivitis pertains to the gums. An annual dental check-upabirb.com/test is recommended for the average person. Most people do not require q 4 month visits. Some people may, indeed, require such frequent visits but Healthy People 2020 speaks to improving the rate annual visits for adults.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 596

13. Which of the following people has exceeded the recommended guidelines for activity? a. A 36-year-old man who engages in bike riding and hasabirb.com/test a pulse rate of 137 during

activity b. A 45-year-old woman who swims and has a pulse rate of 145 during activity c. A 50-year-old man who jogs and has a pulse rate of 120 during activity d. A 60-year-old woman who walks briskly to achieve a abirb.com/test pulse rate of 135 during

activity ANS: D

During activity, the person’s pulse rate should not exceed abirb.com/test 220 minus the age times 0.75.

Accordingly, a woman who is 60 years old would subtract 60 from 220 to equal 180. The figure of 180 is then multiplied by 0.75 to yield the number 120, as the optimal maximum heart rate for this client. A pulse rate of 135 exceeds this recommended and optimal rate of abirb.com/test 120.

DIF: Cognitive Level: Apply (Application)

REF: p. 598 abirb.com/test

14. A 63-year-old woman complains to the nurse that she has insomnia and sleeps only 6 h a

night. Which of the following responses should be made by the nurse? a. “Prescription sleeping pills are preferable. Over-the-counter sleeping aids have abirb.com/test more undesirable side effects” b. “Make sure that you do not nap during the day, even if you are tired.” c. “Do you feel excessively tired during the day?” abirb.com/test d. “The nurse practitioner may want to run some simple tests to find out why you are having trouble sleeping.”

ANS: C abirb.com/test

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It is important to assess the quality of sleep as well as the effects that the limited sleep has on this individual’s daily activities. Medication should not be the first intervention used to help abirb.com/test someone attain restful sleep. People should nap when tired, if they are able to do so, rather than forcing themselves to stay awake. Inquiring as to whether she has excessive daytime fatigue is a first step in assessing the nature and extent of the problem. Assessment always precedes interventions. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 598

15. A nurse conducted a 5-week education series about healthabirb.com/test maintenance. Which of the

following statements by a participant indicates the analysis stage of cognition as defined by Bloom’s taxonomy? a. “If I eat too much food and do not exercise, I will gain weight.” abirb.com/test b. “Fat is more calorie-dense than is protein. If I eat calorie-dense foods and do not moderately exercise at least 5 days a week, I will gain weight.” c. “I will walk briskly at least a mile a day, 6 days a week, to maintain a healthy weight.” abirb.com/test d. “I can eat more if I exercise more.”

ANS: B

During the analysis stage of cognition, all aspects of learning come together in thought and abirb.com/test the individual is cognizant of the relationships and interactions of all the parts. “If I eat too much food and do not exercise, I will gain weight” indicates knowledge (recall of facts). “I will walk briskly at least a mile a day, 6 days a week, to maintain a healthy weight” indicates abirb.com/test application. “I can eat more if I exercise more” indicates comprehension.

By contrast, choice “B” indicates analysis, as noted above.

DIF: Cognitive Level: Apply (Application)

REF: p. 599 abirb.com/test

16. A 62-year-old person states to the nurse, “I have trouble with my peripheral vision.

Sometimes, I do not notice objects unless they are in front of me.” Which of the following abirb.com/test disorders is the client likely experiencing? a. Presbyopia b. Glaucoma c. Cataracts abirb.com/test d. Diabetic retinopathy ANS: B

Glaucoma occurs as a result of increased intraocular pressure, which can damage the optic abirb.com/test nerve. Damage to the optic nerve is irreversible, but visual loss can be prevented if damage is identified early and treatment is initiated. Peripheral vision is affected in glaucoma.

Presbyopia is farsightedness. Cataracts cause cloudy vision. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 599

17. Which of the following middle-age adults has successfully transitioned to Erikson’s abirb.com/test

generativity-versus-stagnation stage of development? a. A 60-year-old woman who retired last year and volunteers at a homeless shelter 2 days a week b. A 63-year-old man who regrets his career choice and feels abirb.com/test he cannot change careers at this late stage of his life. abirb.com/test

c. A 45-year-old woman who resents having to care for her aging mother-in-law d. A 50-year-old man who has not saved for retirement and also spends his

discretionary income on solo vacations.

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ANS: A

Generativity according to Erikson’s theory involves a sense of productivity, creativity, and the desire to help others, whereas stagnation involves a sense abirb.com/test of isolation and focus on oneself.

DIF: Cognitive Level: Apply (Application)

REF: p. 600

abirb.com/test 18. A 52-year-old woman going through menopause tells the nurse working in the women’s

health center that she is interested in slowing down the aging process and asks if she should take estrogen. Which of the following statements would be the best response by the nurse? a. “The latest research has shown that estrogen is safe to abirb.com/test take and will help keep you healthy. I’ll tell the nurse practitioner that you are interested in estrogen therapy.” b. “Estrogen is safe to take for about 10 years. I’ll get you some information on estrogen therapy that you can take home and read.” abirb.com/test c. “The safety of long-term estrogen therapy is inconclusive.

It is primarily used short-term to relieve hot flashes.” d. “You can get the same effects from natural products in a health food store, and each product is backed up by research showing that it is effective.” abirb.com/test ANS: C

Research about the safety of estrogen therapy is mixed; therefore it is only recommended for short-term use (1 to 3 years) and, then, only to relieve hot abirb.com/test flashes. Natural products do not need research to back up their claims of safety or efficacy.

DIF: Cognitive Level: Apply (Application)

REF: p. 599 abirb.com/test

19. The occupational health nurse is asked to develop a plan to reduce work-related injuries.

Which of the following recommendations would the nurse implement as the most effective way to reduce work-related injuries? abirb.com/test a. Make the work environment smoke-free. b. Reduce environmental noise levels. c. Conduct regular walk-through assessments at the work site. abirb.com/test d. Increase paid personal days from one to three.

ANS: A

Accidents are twice as high among smokers than nonsmokers. Possible explanations include the loss of attention, the use of one hand for smoking, andabirb.com/test irritation of the eyes. Because smoking has such an impact on accident rates, implementing a smoke-free work environment would have the largest effect on reduction of work-related injuries.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 602

20. Which of the following effects of divorce on middle-age adults and children has been abirb.com/test documented by research? a. Children adapt to divorce more rapidly than do adults. b. Emotional healing after a divorce takes approximately 24 months in adults. c. Children of divorced parents may have emotional effects lasting for decades abirb.com/test d. Children of divorced parents undergo similar emotional turmoil as their parents.

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ANS: C

Although research is continuing, longitudinal studies by Wallerstein and her colleagues, beginning in the early 1970s, indicate that children bear the emotional scars of a divorce for abirb.com/test decades, perhaps even for a lifetime. The emotional response to divorce is different for children and parents, with most parents adjusting to the divorce within 3 years (not 24 months) after the event. abirb.com/test

DIF: Cognitive Level: Understand (Comprehension)

REF: p. 604

21. A nurse is discussing sexuality with middle-age men and women.

Which of the following abirb.com/test

information should be stressed by the nurse? a. Contraception usage should be decreased as a woman nears menopause. b. Men are less vulnerable to sexual dysfunction than are women. abirb.com/test c. Cardiovascular disease but not diabetes can result in erectile dysfunction. d. The majority of new HIV/AIDS cases occur among middle-age adults.

ANS: D abirb.com/test Unintended pregnancies are highest in middle-aged women.

Men are more vulnerable to sexual dysfunction as compared to women. Adults in middle age represent 71% of all new cases of HIV/AIDS. HIV infection is not rare among middle-age adults. In fact, the majority of new cases occur in middle-aged adults. Both cardiovascular disease and diabetes can result abirb.com/test in erectile dysfunction.

DIF: Cognitive Level: Apply (Application)

REF: p. 605 abirb.com/test

22. An occupational health nurse is planning injury-prevention educational sessions. Which of the

following considerations should be made by the nurse? a. Food handlers should have TB testing every 2 years. abirb.com/test b. Employees may need to be educated concerning the use of protective clothing or devises when needed. c. OSHA rules apply to all companies with more than 25 employees. abirb.com/test d. In a union shop, the union steward’s approval is needed to remove a worker from a job.

ANS: B abirb.com/test The role of the occupational health nurse is focused on keeping the work site safe for employees. Experienced and new workers alike may not know all of the strategies to prevent injury. They need to be educated regarding such matters. OSHA applies to all companies.

Annual, not every 2 years, TB testing is recommended forabirb.com/test food handling. Union approval is not required to remove an employee from a job for safety or health reasons. Physical and cognitive changes, which are part of middle age, may predispose workers to injury (i.e., decline in vision/hearing). Removing a worker from a particular job may be indicated if the abirb.com/test worker might endanger coworkers, if the worker has a disease condition that might be aggravated by the job, or if the worker is taking prescribed medications with potentially harmful side effects. The worker must be aware of the protective clothing that should be worn, sanitation measures for the work environment, general hygiene measures, and proper abirb.com/test immunization.

DIF: Cognitive Level: Apply (Application)

REF: p. 611 abirb.com/test

23. Which of the following statements is correct concerning lifestyle change programs? abirb.com/test

a. Programs lasting 8 to 12 weeks are appropriate. b. Evaluation components should be discouraged in the interest of increasing

enrollment and participation.

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c. Cultural factors, but not corporate policies, should be included in the content. d. All of the above statements are correct.

ANS: A

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Lifestyle change programs last at least 8 to 12 weeks and include assessment, education, and evaluation components to help individuals implement long-term modifications in health behavior and experience the results of their instituted changes. To maintain these long-term abirb.com/test changes and to develop a healthy lifestyle, a supportive organizational environment is needed.

This type of environment includes health-promoting physical settings, corporate policies and culture, ongoing programs, and employee ownership of programs. abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 612

24. Which of the following medications is generally recommended to help preserve

cardiovascular health in middle-age women? a. Aspirin b. Folic acid c. Estrogen d. Estrogen receptor modulator

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ANS: A

Only aspirin is recommended to help maintain cardiovascular health. It lowers the risk of clot abirb.com/test formation. None of the other choices offers medications, which are recommended.

DIF: Cognitive Level: Understand (Comprehension)

REF: p. 603, Box 23-7 abirb.com/test

MULTIPLE RESPONSE abirb.com/test 1. Which of the following individuals is at risk for developing osteoporosis? (Select all that

apply.) a. A 55-year-old man who is on a low dose of oral prednisone every day because of rheumatoid arthritis abirb.com/test b. A 40-year-old woman who works as a secretary c. A 60-year-old woman who walks three miles a day d. A 50-year-old man who works as a mason abirb.com/test

ANS: A, B

Osteoporosis occurs most frequently in postmenopausal women who have fair complexions and are small, sedentary individuals. It also occurs in people on long-term steroid use. It rate abirb.com/test of osteoporosis increases with age.

DIF: Cognitive Level: Apply (Application)

REF: p. 588 abirb.com/test

2. Which of the following diseases disproportionately affects non-Hispanic black persons? These

persons are affected with a greater incidence than what would be expected based on population demographics OR because they have a higher morbidity/mortality for the disease as compared to Whites. (Select all that apply.) abirb.com/test a. Cancer abirb.com/test

b. Heart disease c. HIV disease d. Osteoporosis

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ANS: A, B, C

Of concern is that Black Americans are less likely to be diagnosed with heart disease, but they abirb.com/test are 30% more likely to die from it compared to the population in general. Black adults are less likely to survive 5 years after diagnosis than White adults. Non-Hispanic Black Americans share a disproportionate burden of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). Black men are eight times more likely than abirb.com/test non-Hispanic White men to have HIV/AIDS. Black women are 20 times more likely to have HIV/AIDS than non-Hispanic White women and almost 5 times that of Hispanic/Latino women. It occurs most frequently in postmenopausal women who have fair complexions and abirb.com/test are small, in sedentary individuals, and in people using corticosteroids on a long-term basis.

Black persons are less likely to be diagnosed with osteoporosis than White persons.

DIF: Cognitive Level: Understand (Comprehension)

REF: p. 591

abirb.com/test

3. A community health nurse is caring for a variety of different people in the community. Which

of the following individuals would the nurse recognize as being at risk to experience increased stress related to family dynamics? (Select all that apply.) abirb.com/test a. A 54-year-old couple whose young adult daughter and grandson move back into their home b. A 44-year-old single mother raising three adolescent children without child abirb.com/test support c. A 60-year-old couple whose children have established successful careers in another state d. A 36-year-old couple whose child plays competitive tennis abirb.com/test ANS: A, B, D

Approximately 21 million children, about 28 percent of children in the United States, lived with one parent in 2012, most typically the mother. The single most significant health risk in abirb.com/test families headed by a single mother is poverty.

Family life may also be threatened by older children living at home, opposition to a child’s partner, or the inability to establish satisfactory relationships with potential or actual partners abirb.com/test or sons-in-law and daughters-in-law.

For example, parents frequently become emotionally involved in the athletic activities of their children to the extent that the failure of a 6-year-old to play a winning softball game causes a great deal of parental anguish. abirb.com/test The 60-year-old couple whose children are successful would not have stressors specifically related to this status. The normal course of events is for children to grow up, leave the family of origin, and become successful in their own right. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 601

4. The occupational health nurse working for a large corporation is a member of a task force to abirb.com/test

improve the work environment. Which of the following suggestions by the nurse would help to improve work conditions? (Select all that apply.) a. On-site walking paths abirb.com/test b. On-site food vendors c. On-site counseling services abirb.com/test

d. On-site meetings of support groups such as Alcoholics Anonymous ANS: A, C, D

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On-site facilities that improve health (walking paths) and psychological well-being (support groups, counseling) will help to create a positive work environment. Occupational health nurses would appropriately facilitate such initiatives. Depending on the food vendor, abirb.com/testCommonly, food vendors implementing such service may not be beneficial to the employees. have palatability and salability vs healthy choices as the overriding criteria for food offerings.

Accordingly, food vendors commonly offer food high in fat and sodium.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 611

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Chapter 24: Older Adult Edelman: Health Promotion Throughout the Life Span, 9th Edition abirb.com/test

MULTIPLE CHOICE abirb.com/test

1. A nurse is planning to write a grant for a health-promotion project in the community. Which

of considerations should the nurse make when determining the appropriate population for this project? a. The fastest growing population is children under the age of 12. abirb.com/test b. The fastest growing population is young Black American adults. c. The fastest growing population is White middle-age adults. d. The fastest growing population is non-White older adults age 65 and older. abirb.com/test

ANS: D

Adults age 85 and older are the fastest growing population in the United States, and the percentage of White Americans greater than age 65 is decreasing compared with other ethnic abirb.com/test groups.

DIF: Cognitive Level: Apply (Application)

REF: p. 619 abirb.com/test

2. Which of the following statements made by a client best identifies someone who would likely

to be receptive to health-promotion interventions? a. “I have a new grandchild and want to be part of her life.” b. “My mother lived until she was 90, so a long life is in abirb.com/test my genes.” c. “Some chronic illness is just a part of aging.” d. “I hope I’ll live a lot longer, but one never knows.”

ANS: A

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Motivation to adopt a healthy lifestyle is a primary predictor of successful interventions.

Choice A depicts a patient who is motivated by a desire to be with her new grandchild.

Feeling that illness is an inevitable part of aging, leaving one’s health up to chance or abirb.com/test assuming a fatalistic approach will not motivate a person to make necessary lifestyle changes.

Also not likely to make changes is the person who believes that his/her own longevity is guaranteed by virtue of inheriting such genes. abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 623

3. Which of the following statements concerning nutrition and older adults is true? abirb.com/test a. Older adults who live in their own homes are more likely to be malnourished than

older adults living in a nursing home. b. Older adults lose their desire for high-fat, salty foods. c. Meals served in long-term care institutions are usuallyabirb.com/test more well balanced than

foods eaten by older adults living at home. d. Many older adults are not aware of food assistance programs.

ANS: D

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When the economy declines, there is an increase in unemployment and poverty and more people need help buying nutritious food. SNAP can provide needed help but many people abirb.com/test who are eligible for SNAP benefits, including 67% of struggling older adults, do not apply.

Only 3 out of 5 older adults who qualify for SNAP actually use it, which means that 5.2 million seniors are missing out on benefits of the program. Some older adults are too embarrassed to apply and others think it is too difficult to apply or do not even know the abirb.com/test program exists.

Research shows that the percentage of malnourished older adults who live in their own homes is lower than that of older adults who live in a nursing home. Moreover, fresh fruits and vegetables are not always available for older adults living abirb.com/test in nursing homes. Older adults do not lose their desire for foods high in fat, cholesterol, or sodium.

DIF: Cognitive Level: Understand (Comprehension)

REF: p. 626

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4. Which of the following statements concerning urinary incontinence is correct? a. Urge incontinence occurs when one has the urge to void but is unable to do so. b. Stress incontinence is associated with emotional turmoil. abirb.com/test c. Functional incontinence is associated with environmental barriers. d. Incontinence with high post-void residual occurs when someone laughs or sneezes.

ANS: C

abirb.com/test

Functional incontinence is associated with environmental barriers, physical limitations, or cognitive impairment in which the care recipient is unable to reach the toilet. Stress incontinence occurs when someone coughs or sneezes. Urge incontinence occurs when someone cannot wait to void, once the urge to void is felt.abirb.com/test Urge, mixed, or stress incontinence with high post-void residual is caused by physiological changes that affect voiding, such as an enlarged prostate gland. abirb.com/test

DIF: Cognitive Level: Understand (Comprehension)

REF: p. 626

5. Which of the following measure is appropriate for treating urinary incontinence? abirb.com/test a. Increase caffeine to tighten urinary sphincter. b. Utilize voiding schedules. c. Decrease fiber to lessen pressure on the bladder from the colon. d. Avoid pilates, which have been shown to inflame pelvic floor in the elderly. abirb.com/test ANS: B

Voiding schedules are appropriate in treating incontinence. Caffeine will worsen incontinence. Increased fiber may help to improve constipation-related incontinence; abirb.com/test decreasing fiber will increase risks for constipation and thus may worsen incontinence. Pilates have been shown to improve incontinence for some patients.

DIF: Cognitive Level: Analyze (Analysis)

abirb.com/test REF: p. 627

6. A 75-year-old man tells the nurse that he has difficulty staying asleep during the night. Which

of the following responses should be made by the nurse? abirb.com/test a. “It is best to avoid milk or reading before bedtime.” b. “I’ll ask the nurse practitioner to prescribe a sleeping pill for you.” c. “Taking naps during the day can help relieve excessive fatigue and will help you abirb.com/test sleep better.” d. “Let’s talk about your sleep schedule and things that may prevent you from getting abirb.com/test

a restful night’s sleep.”

ANS: D

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Nurses should assist older adults in achieving a good night’s sleep through assessment which might reveal possible causes of sleep disturbances. Bedtime rituals to include a glass of milk or reading have been shown to promote sleep. Daytime naps may prevent sleeping adequately at night. Medications to assist in sleeping are not the initialabirb.com/test therapy choice because of side effects.

DIF: Cognitive Level: Apply (Application)

REF: p. 628 abirb.com/test

7. A nurse is conducting a community education program about cognition in older adults. Which

of the following information should be included? a. Some form of mild dementia is a normal part of aging.abirb.com/test b. Confusion is a reliable indicator of dementia. c. Assessment for dementia should be part of routine physical exams. d. Elders who score below 27 points on the Mini-Mental State Exam (MMSE) are not abirb.com/test likely to have a cognition problem.

ANS: C

Cognitive alterations are key symptoms that indicate changes in physiological function among abirb.com/test older persons. Confusion is not always an indicator of dementia but can result from many other causes to include electrolyte imbalance, diabetes, and hypoxia. Accordingly, assessment of cognition is an important part of routine assessments. Dementia is not a normal part of aging and dementia symptoms vary according to the specific type of dementia. A score of 23 abirb.com/test or lower on the MMSE indicates a problem with cognition.

DIF: Cognitive Level: Apply (Application)

REF: p. 629 abirb.com/test

8. A nurse has recently accepted the position of unit nurse manager on a long-term care unit.

Which of the following directives should the nurse give to the staff nurses? a. Encourage residents to participate in unit activities such as Scrabble and bingo. abirb.com/test b. Demonstrate the caring aspect of nursing by dressing residents before breakfast. c. Discourage exercise for patients with Parkinson because it has been shown to accelerate muscle stiffness. abirb.com/testevery 6 weeks to d. Switch places at the table every 3 weeks and change roommates alleviate boredom.

ANS: A

To encourage cognitive health nurses should inspire older abirb.com/test individuals to take classes, read, engage in stimulating conversation and entertainment, keep their minds active, and continue learning throughout their lives. They are encouraged to continue with self-care activities rather than relinquish them to caregivers. Residents shouldabirb.com/test be encouraged to perform self-care activities, such as dressing, themselves. When help is required, it should be provided in an unhurried manner. Elderly patients like consistency in their environment and do not relish change. Change often fosters confusion. Familiar environments and consistent routines are abirb.com/test encouraged. Exercise has been shown to minimize many of the debilitating aspects of Parkinson’s disease.

DIF: Cognitive Level: Apply (Application)

REF: p. 622 abirb.com/test

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9. Which of the following statements is correct concerning the “obesity paradox” as it pertains to

older adults? a. Obesity in older adults is more detrimental than it is for abirb.com/test younger adults. b. Unlike younger people, fruits and vegetables cause obesity in elderly people. c. Obesity in older adults is not related to caloric intake or exercise. d. Obesity in older adults is not clearly linked with shorter life span. abirb.com/test

ANS: D

It is important to recognize, however, that scientists have described a phenomenon called “the obesity paradox,” in which obesity in older adults, unlike in younger individuals, does not abirb.com/test appear to be clearly associated with a shorter life span. Some studies have suggested that the “ideal” protective weight might be higher in the older population. There is still much debate about this, however, and since obesity is clearly linked to a lesser quality of life, it is important to discuss options for weight reduction. During abirb.com/test weight loss, muscle is lost, as well as fat. This is an important consideration when planning a weight loss program for older adults since, as a result of normal aging and often deconditioning, they are likely to have less muscle mass and more fat than when they were younger. abirb.com/test Fruits and vegetables are encouraged for everyone. Obesity is related to caloric take and energy expenditure (exercise), also for everyone. Obesity in younger adults is clearly detrimental to health. It may not be as detrimental for older adults especially given the abirb.com/test concept of ideal protective weight.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 625

abirb.com/test 10. Which of the following is correct concerning heat regulation in the older adult? a. Remaining indoors where temps are 90 degrees or higher is recommended. b. Increased sweating, characteristic of older adults, increases the risk of dehydration. c. Increased use of salt, secondary to declining taste, increases the risk for heat abirb.com/test

stroke. d. The ability to feel heat and cold is typically enhanced in the elderly due to thinner skin. abirb.com/test

ANS: A

The older adult’s ability to feel changes in heat and cold may be impaired as a result of normal and pathological changes of aging. This process can cause older adults to die from the abirb.com/test effects of excessive heat or cold. During periods of high heat and humidity, older people should increase fluid and salt intake, stay in a cool and shaded environment, remain calm, have more rest periods, and refrain from going outdoors when the temperature is higher than abirb.com/test 90° F. Sweating, which is reduced in older adults, can be accommodated by wearing light-colored, lightweight cotton clothing. If sweating ceases or is inadequate, the older person is at risk for heat stroke. Heat stroke can contribute to sepsis, myocardial infarction, and cerebrovascular accidents (CVAs), particularly in people with diabetes. Reduced body heat abirb.com/test can also present problems in the older adult. Symptoms of and interventions for hypothermia are listed in Box 24-9.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 637 abirb.com/test

11. According to Erikson’s theory of development, which of the following older adults has

successfully navigated the stage of ego integrity versus despair? abirb.com/test a. 72-year-old man who is reluctant to retire because “work is everything to me”

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b. 78-year-old woman who has scheduled her third face lift c. 80-year-old man who has informed his children that he has made his funeral

arrangements

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d. 67-year-old woman who is depressed because she has not been promoted at work

for the past 10 years ANS: C

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Ego integrity versus despair is the developmental stage of older adults. The quality associated with successful passage of this stage is to achieve a balance between integrity and despair.

“The process of bringing into balance feelings of integrity and despair involves a review of abirb.com/test and a coming to terms with the life one has lived thus far.” Based on the increasing life span, this stage of development was expanded into three additional stages: ego differentiation versus work role preoccupation, which involves achieving identity apart from work; body abirb.com/test transcendence versus body preoccupation, which focuses on adjusting to normal aging changes; and ego transcendence versus ego preoccupation, which involves accepting death.

Successfully navigating the stage of ego integrity versus despair requires that the individual accept normal bodily changes associated with aging, find meaning in life apart from work, abirb.com/test accepts the inevitability of death, and is at peace with his or her life. Choices A, B, and D do not depict individuals who are transitioning well to their advancing years.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 632 abirb.com/test

12. A couple in their sixties has assumed responsibility for raising their two grandchildren ages 9

and 12 because the children’s parents died in a car accident. Which of the following is nursing abirb.com/test interventions is a priority to help the grandparents cope with the responsibility of raising their grandchildren? a. Connecting them with the “Grandparents Raising Grandchildren” support group b. Encouraging them by reminding them how they successfully raised their own abirb.com/test children c. Volunteering to provide respite time for them as needed d. Assuring them that their stress level will lessen, as they gain confidence abirb.com/test

ANS: A

In the United States in 2012, 7 million grandparents (10%) lived with at least one grandchild.

The role of grandparent frequently brings great joy and happiness at a time when the older abirb.com/test adult feels loss; however, grandparents who rear grandchildren encounter both emotional and physical stress. Their new role as grandparent–caregiver may lead to role confusion and increased health-related problems. …. Thus, it is important for nurses to explore with these individuals what activities may help to reduce stress. Coping strategies such as accepting abirb.com/test responsibility, self-control, positive reappraisal, planned problem-solving, and distancing may be helpful. Support groups, counseling, and education to help them manage stress more effectively are other resources that should be explored. Encouraging and supporting older abirb.com/test adults in their caregiving role is important to help them ease the stress and strain of changes that come with the caregiving experience.

DIF: Cognitive Level: Apply (Application)

REF: p. 633 abirb.com/test

13. A nurse is conducting a staff development program about human sexuality for nurses who

work in a long-term care facility. Which of the following statements is accurate? abirb.com/test a. “The desire for sexual intimacy declines rapidly with age.” b. “Older adults are very well-informed about sexuality.” abirb.com/test

c. “Older adults need to practice safe sex.” d. “The danger of contracting STDs during sexual intimacy is extremely low in older

adults.”

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ANS: C

No data were found to show that men or women lose interest in sexual activity as they age. abirb.com/test Older adults also need to fulfill the human need for intimacy and love, and to touch and be touched. Touch is an overt expression of closeness and an integral part of sexuality …, the number of cases of HIV (human immunodeficiency virus) and AIDS in older adults continues to increase because greater numbers of older adults are becoming newly infected with the HIV abirb.com/test virus and an increasing proportion of those who have been living with the virus are reaching their older years. Older adults are just as susceptible to sexually transmitted disease (STD) as younger adults. Yet one survey showed that only 5.1% of men over 61 had used a condom in abirb.com/test recent sex. There seems to be a lack of awareness in the older adult population about risks of STDs in their sexual relationships.

The desire for sexual intimacy remains a primary force throughout life. Older adults need teaching related to safe sexual practices, STD transmission, etc. HIV infection in older adults abirb.com/test is increasing yet only 5% of men over 61 are using condoms thus choice C is correct. All of the other choices are contradicted by the evidence.

DIF: Cognitive Level: Apply (Application)

REF: p. 634 abirb.com/test

14. The clinic nurse has seen the following four widows today. Which of the following persons is

demonstrating a healthy coping pattern for her loss? a. The widow who discusses very little except the loss ofabirb.com/test her husband 3 years ago b. The widow who talks about the “good times” she and her husband had before his illness and death 1 year ago c. The widow who states that life is not worth living without her husband, who died 2 abirb.com/test years ago d. The widow who blames herself for her husband’s death because she did not “make him go” to the doctor abirb.com/test

ANS: B

An individual’s ability to cope with the common stresses of older adulthood is a key factor in maintaining self-concept. As people age, they tend to encounter many losses, such as the loss abirb.com/test of a home, spouses, friends, siblings, and even children. The nurse who cares for the older adult can provide support during the coping process related to these losses. Trying to find the positive and developmental benefits of losses is preferable to continually thinking about a loss or bad event. Negative associations have been found between depressive symptoms and abirb.com/test rumination, catastrophizing, and self-blame. After assessing the most appropriate way in which the individual desires to cope with a situation, the nurse may help create a suitable environment for coping. abirb.com/test Choice “B” depicts a widow who has a positive focus, not withstanding the loss of her husband one year ago. She focuses on positive memories pertaining to her deceased husband.

Choices A, C, and D all depict widows with a very negative outlook or a negative focus, as it abirb.com/test pertains to the loss of their husbands.

DIF: Cognitive Level: Apply (Application)

REF: p. 634 abirb.com/test

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15. A nurse is assigned to provide care for a 96-year-old bedridden man who experiences severe

pain from a chronic neurological disease. The man asks the nurse to please help him leave this abirb.com/test world so that his suffering will end. Which of the following actions would be most appropriate for the nurse to take? a. Assist the doctor with the man’s request. b. Refuse to care for the man. abirb.com/test c. Contact the pain care specialist. d. Provide the man with names of doctors who participate in assisted suicide.

ANS: C

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The suicide rate for older Americans is disproportionally high in the American population.

Many older adults have serious medical illnesses that provide an explanation for wanting to die. Nurses caring for chronically ill older adults have the added responsibility of determining abirb.com/test who is at risk for wanting physician-assisted suicide and helping them to be as comfortable as possible and free of pain through the use of pharmacological and nonpharmacological interventions. Nurses are instrumental in ensuring that the older person experiences a pain-free death by advocating for an appropriate pain-management program and working with abirb.com/test other health care professionals toward this goal.

Refusing to care for the man could be construed as abandonment and is not appropriate in any event. If the patient’s pain is controlled, he may have less focus on suicide. Consulting a pain abirb.com/test care specialist is the correct action.

DIF: Cognitive Level: Apply (Application)

REF: p. 635

16. A nurse is conducting a home visit for an older adult in theabirb.com/test summer. Which of the following

items should the nurse should locate in the home in the interest of preventing a heat stroke? a. Fan b. Porch chair abirb.com/test c. Synthetic blend clothing d. Air thermometer ANS: A

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The older adult’s ability to feel changes in heat and cold may be impaired as a result of normal and pathological changes of aging. This process can cause older adults to die from the effects of excessive heat or cold. During periods of high heat and humidity, older people abirb.com/test should increase fluid and salt intake, stay in a cool and shaded environment, remain calm, have more rest periods, and refrain from going outdoors when the temperature is higher than 90° F. Sweating, which is reduced in older adults, can be accommodated by wearing abirb.com/test light-colored, lightweight cotton clothing Older adults are susceptible to heat stroke. The availability of a fan will help cool the ambient air. Light-weight cotton clothing “breathes” and facilitates cooling, whereas synthetic material typically retains heat. The temperature can be quite hot onabirb.com/test the porch, especially absent a fan.

Remaining inside during very hot weather is recommended.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 637 abirb.com/test

17. The community health nurse has obtained a grant to offer a “Safe Driving” series for older

adults. Which of the following information should the nurse stress during the series? a. Traffic fatalities involving older adults occur mainly at dusk. abirb.com/test b. The cause of two-vehicle accidents is frequently an older driver striking another

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car. c. The average blood alcohol level in older adults involved in accidents is higher than the blood alcohol level of younger drivers involved in abirb.com/test accidents. d. Relearning the art of defensive driving can reduce the likelihood that an older driver will be involved in a motor vehicle accident.

ANS: D

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There is a decline in defensive driving as opposed to an increase in aggressive driving among older adults. Older adults are encouraged to take a Seniors Driving Safety Course to learn how aging changes can affect their driving and strategies for safer driving. Traffic fatalities abirb.com/test involving older adults occur mainly during the daytime. The cause of two vehicle accidents is frequently a younger driver striking the car driven by an older adult. The average blood alcohol level in older adults involved in accidents is lower than the blood alcohol level of abirb.com/test younger drivers involved in accidents.

DIF: Cognitive Level: Apply (Application)

REF: p. 638

18. As part of a community-wide flu vaccination program for abirb.com/test older adults, the nurse is assisting at

a vaccination clinic. Which of the following questions should the nurse ask before administering the vaccine? a. “Do you have any food allergies?” abirb.com/test b. “Have you had the pneumococcal vaccine?” c. “Have you had the flu in the past 5 years?” d. “Do you have Medicare?” abirb.com/test

ANS: A

An allergy to eggs is a contraindication to receiving flu vaccine grown in chick embryo cells.

Choices B, C, and D are not relevant to the issue of whether the person should have a flu abirb.com/test vaccine.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 639 abirb.com/test

19. A man tells a nurse that he is concerned about his risk and his wife’s risk of developing

cancer. Which of the following statements concerning cancer is accurate? a. PSA assessment alone is not ideal for purposes of screening for prostate cancer. abirb.com/test b. Breast cancer risks are lower in women who have never had children. c. Smoking does increase the risk of cancer but non-smoking tobacco products do not increase risk. d. Increased immune function to adults after age 65 impacts cancer rates. abirb.com/test ANS: A

Theories include longer exposure to carcinogens, increased susceptibility to cancer in the older body, decreased cellular healing ability, loss of tumor-suppressing genes, and decreased abirb.com/test immune function. There are three key components of an appropriate prostate screen: symptomatology, prostate-specific antigen level measurement, and a digital rectal examination. Women who have never had children or had their first child after age 30 appear abirb.com/test to have an increased risk for breast cancer. Stopping smoking and other use of tobacco products are a few of the approaches that nurses can advise to promote individual wellness.

PSA alone is not recommended for screening. Patients should have digital rectal exams and be questioned concerning symptoms. Both smoking and smokeless tobacco product are abirb.com/test implicated in cancer. Immune function decreases with age. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 639 abirb.com/test

20. Which of the following statements is the best definition of polypharmacy? a. The use of more than five medications prescribed by different physicians b. The use of multiple medications for the same or different health problems c. The use of multiple pharmacies and self-management abirb.com/test of medications d. The use of multiple medications and supplements simultaneously ANS: B abirb.com/test Polypharmacy, or the use of multiple medications for the same or for different health problems, is a major concern for older adults. Approximately one-third of older adults in the United States take 5 or more prescription drugs.

Polypharmacy is a major concern for elderly people, with abirb.com/test the rate of polypharmacy in this population being between 9% and 39%. The fact that medications are prescribed by different licensed providers is not a hallmark for polypharmacy. Neither is there a specific number, i.e., 5 medications. The fact that multiple medications are prescribed for the same or different abirb.com/test health problems is consistent with polypharmacy. No specific number is specified in the definition but commonly the elderly have very large numbers of medications prescribed for them. abirb.com/test

DIF: Cognitive Level: Understand (Comprehension)

REF: p. 640

21. A person is preparing to return home following a 2-week hospital stay for congestive heart abirb.com/test failure and pneumonia. Which of the following referrals would be most beneficial for the person? a. Transportation assistance b. Home-delivered meals abirb.com/test c. Adult day care d. Home health nursing

ANS: D

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Home care nurses provide health care information and services to individuals and families.

The resources available to community health nurses are often extensive and enable the nurses to draw on a variety of sources to assist in promoting the health of community-dwelling older abirb.com/test adults. Although all of the referrals listed may be of benefit to the person, the home health nurse will provide the most comprehensive services. The nurse will be able to connect the person to necessary community resources.

DIF: Cognitive Level: Analyze (Analysis)

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REF: p. 643

22. The son of a 70-year-old man dying of cancer asks the nurse to tell him about the hospice abirb.com/test program, so he can help his father decide if the program would be of benefit to him. Which of the following responses should be given by the nurse? a. “At hospice, your father will be heavily medicated, so he will not have pain.” b. “All of your father’s care will be provided by nurses at hospice.” abirb.com/test c. “Hospice care can take place either at home or in a hospice facility.” d. “Visiting hours are about the same at hospice as they are here in the hospital.”

ANS: C

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Once the person is placed in hospice care, treatment to relieve pain and other symptoms is continued but the person and their physician have decided to end all curative treatment …. abirb.com/test The majority of hospice care provided in 2010 was in the person’s home (41.1%), followed by a hospice inpatient facility (21.9%), nursing home (18%), and acute-care hospital (11.4%).

Hospice services provided include direct clinical care for persons and bereavement services for the person and their family. Hospice persons are empowered to live with dignity, alert, and abirb.com/test free of pain. The goal of hospice care is to facilitate a “good death” for individuals. Families and loved ones are consistently engaged in caregiving for the dying and helping them maintain the highest possible quality of life.

The focus of hospice care is to help the person remain alertabirb.com/test but free of pain. Families are encouraged to participate in care giving. There are no restrictions to visiting hours.

DIF: Cognitive Level: Apply (Application)

REF: p. 644

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23. A community health nurse is working with a diverse population of older adults within the

community. Based on the data from the National Health Interview Survey, which of the following assumptions should be made by the nurse whenabirb.com/test working with this diverse population? a. White Non-Hispanic older adults tend to require more assistance with their activities of daily living. b. Hispanic older adults tend to rate their health as poorerabirb.com/test than other ethnic groups. c. Older adults who tend to rate their health as fair or poor are also financially poor. d. Older adults tend to require more assistance with activities of daily living than with meeting their routine needs. abirb.com/test ANS: C

In all groups, those who described their health as fair or poor were also more likely to be financially poor, with 40% of White older adults, 51.6% ofabirb.com/test Black older adults, 53.4% of Hispanic older adults, and 45.6% of Asian older adults who reported their health status as fair or poor also being financially poor.

Choice C is supported by data from the National Health Interview Survey. The data contradict abirb.com/test all of the other choices.

DIF: Cognitive Level: Apply (Application)

REF: p. 623, Box 24-3 abirb.com/test

24. A woman who is being discharged from the hospital is oriented to person, place, and time, and

her memory is intact. She has occasional forgetfulness without a consistent pattern of memory loss. Which of the following housing options would be most appropriate for this woman? abirb.com/test a. Independent living b. Retirement community c. Assisted living d. Nursing facility abirb.com/test ANS: B abirb.com/test

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Retirement community living is suited for a person who is oriented to person, place, and time and has a memory that is intact. This individual may experience occasional forgetfulness without a consistent pattern of memory loss. Independent abirb.com/test living may be appropriate for the person if she had a consistent pattern of memory loss. Assisted living or nursing facility living may be appropriate if the woman has difficulty with orientation to person, place, or time or has difficulty with confusion that results in anxiety, social withdrawal, or depression. Nursing abirb.com/test facility is appropriate for patients who require much more extensive care up to and including total care.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 643, TBL 24-4 abirb.com/test

MULTIPLE RESPONSE abirb.com/test

1. Which of the following interventions will have the greatest impact on reducing constipation in

older adults? (Select all that apply.) a. Offering strained fruit and vegetable juices to increase fiber content in the diet abirb.com/test b. Encouraging fluids between meals c. Administering laxatives on a daily basis d. Assisting with ambulation ANS: A, B, D

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Encouraging older adults to exercise and increase their fluid intake helps reduce the incidence of constipation. Integrating more fiber into the diet and eating prunes each day can also be very effective for preventing constipation. abirb.com/test Nurses can help reduce the incidence of constipation by encouraging older adults to exercise and increase their fluid and dietary intake. Dietary modifications, such as increasing fiber and fluid intake, can stimulate the colon and resolve constipation. While pureed foods do retain fiber, straining juices to remove the pulp removes most ofabirb.com/test the fiber content. Fiber helps to prevent constipation. Increased fluid intake and exercise should be implemented before relying on medication to relieve constipation. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 626

2. Which of the following factors would be considered predictors of satisfaction with retirement? abirb.com/test (Select all that apply.) a. Participation in competitive sports but most especially golf b. Adequate income c. Having grandchildren abirb.com/test d. Good functional ability

ANS: B, D

Hooyman and Kiyak (2011) noted a variety of factors thatabirb.com/test were predictors of satisfaction with retirement. Those factors included good health and functional ability, adequate income, a suitable living environment, a strong social support system, and a positive outlook. abirb.com/test

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While many retired persons do, in fact enjoy their grandchildren, having grandchildren is not a predictor of satisfaction in retirement. Some happily retired persons have no grandchildren abirb.com/test while others rarely interact with their grandchildren. Still others may feel burdened by a need to become caregivers for the grandchildren. An interest in sports, including golf, also has no predictive value for satisfaction in retirement. Many happily retired persons have absolutely no interest in sports including golf. They may have wide and varied interests in the form of abirb.com/test hobbies and other pursuits.

DIF: Cognitive Level: Apply (Application)

REF: p. 633 abirb.com/test

3. The nurse working in a retirement community for older adults is conducting a psychosocial

assessment of all residents to screen for depression and suicidal ideation. Which of the following questions should the nurse ask during the assessment process? (Select all that abirb.com/test apply.) a. “Have you thought about harming yourself?” b. “Are you still playing bridge every Thursday?” c. “How does your congestive heart failure affect your life?” abirb.com/test d. “Do you still have any money left in your IRA account” ANS: A, B, C

The National Institute of Mental Health noted that the riskabirb.com/test of depression increases in older adults as they experience chronic illnesses and when their ability to function becomes impaired …. Depression is also caused by physiological changes in the aging body. The suicide rate for older Americans is disproportionally high in the American population. The abirb.com/test suicide rate for men is highest in those who are age 75 or older.

Risk factors for suicide include social isolation, alcohol and substance abuse, psychosis, bereavement, and serious medical illness. Many who committed suicide were found to have alcohol and/or pain-killing drugs in their bodies on autopsy. abirb.com/test Suicide ideation, loss of interest in activities, and chronic illness are signs of, or may lead to, depression. Depression, in turn, could lead to suicide. Choices A, B, and C are all consistent with known predictors of suicide. Economic issues are not predictors of suicide in older abirb.com/test adults.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 635 abirb.com/test

4. Which of the following nursing interventions implies respect for a person’s spirituality?

(Select all that apply.) a. Changing the position of the bed in a Muslim client’s room so that it faces east abirb.com/test b. At the request of a Buddhist patient, asking the home health aide to pick up incense when she next shops for the patient. c. Saying a silent prayer with a client, at the client’s request d. Praying out loud in the room of a dying client abirb.com/test ANS: A, B, C abirb.com/test

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Because of the highly personal quality of spirituality, an unobtrusive and sensitive presence by the nurse is needed to allow the person in any setting to achieve spiritual health. Spiritual abirb.com/test assessment tools are available to guide nurses with questions to better understand the person’s spirituality. Open-ended questions, such as, “What is your perception of a higher being and spirituality?” encourage discussions about the person’s innermost spirituality. The nurse can provide an environment that is supportive to the practice of the person’s spirituality. Assisting abirb.com/test older persons to actualize their spirituality can provide great comfort to the person and lead nurses to a deeper understanding of their own spirituality.

Choices A, B, and C all represent unobtrusive and sensitive efforts to actualize a given abirb.com/test patient’s spirituality. Praying out loud does not demonstrate respect for a person’s spirituality but imposes the nurse’s belief system on the person. Home health aides appropriately shop for a patient purchasing food and/or personal supplies. Picking up incense while at the store would appropriate and consistent with this role. abirb.com/test DIF: Cognitive Level: Apply (Application)

REF: p. 636

5. A nurse is conducting a community health-education program about osteoporosis with a group abirb.com/test

of older adults. Which of the following individuals in attendance is at greatest risk for developing osteoporosis? (Select all that apply.) a. 65-year-old Asian woman who smokes one pack of cigarettes per week b. 80-year-old White man who has three glasses of wine abirb.com/test per day c. 74-year-old White woman on daily oral prednisone for emphysema d. 68-year-old Black man who has a sedentary lifestyle ANS: A, B, C

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Because of the higher risk of osteoporosis in the older population, a fall can result in a fracture. Osteoporosis is a disease of bone loss common to women age 70 and older and men age 80 and older. The disease develops six times more frequently in women than it does in abirb.com/test men …. Risk factors for osteoporosis include a small, thin frame; White or Asian ancestry; family history; excessive thyroid medication or high doses of cortisone-like drugs for asthma, arthritis, or cancer; a diet low in dairy products and other sources of calcium; physical abirb.com/test inactivity; smoking cigarettes; and drinking alcohol.

Choices A, B, and C all depict persons with one or more risk factors. Choice D describes a patient with no risk factors. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 636

6. An 80-year-old person is admitted to the hospital. During the health assessment process, the

nurse should screen for which of the following conditions?abirb.com/test (Select all that apply.) a. Polypharmacy b. Renal insufficiency c. Illegal drug use abirb.com/test d. Alcoholism ANS: A, B, C, D abirb.com/test

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Substance abuse among Americans 60 years and older, including misuse of prescription drugs, is estimated to affect about 17% of older adults. By 2020, it is anticipated that the number of older adults with substance abuse problems willabirb.com/test double. Forty percent of adults age 65 and over drink alcohol. Alcohol and drug abuse problems among older adults have been underestimated. In Americans age 65 and older, excessive alcohol use, including binge drinking, accounts for more than 21,000 deaths each year …. Older adults are more vulnerable abirb.com/test to the effects of alcohol and illicit drugs, because their systems do not detoxify and excrete as efficiently as do those of younger people.

Substance and alcohol abuse are problems in the elderly population. Substance abuse, in abirb.com/test particular, is increasing. Polypharmacy is long-standing problem with elderly population, as well. Renal insufficiency, which is common in the elderly, hampers the ability of the body to detoxify alcohol, substances and pharmaceuticals thus further exacerbating the problem.

DIF: Cognitive Level: Apply (Application)

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REF: p. 640

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Chapter 25: Health Promotion in the Twenty-First Century Edelman: Health Promotion Throughout the Life Span, 9th Edition abirb.com/test

MULTIPLE CHOICE abirb.com/test

1. 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? a. Using mosquito netting in sleeping areas abirb.com/test b. Participating in international vaccination programs c. Implementing accident prevention programs d. Providing nutritional supplements abirb.com/test

ANS: D

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 abirb.com/test deaths among children younger than 5 years old stems from protein–energy malnutrition. The other choices, while all beneficial, would not have as great an impact.

DIF: Cognitive Level: Apply (Application)

REF: pp. 651, 652 abirb.com/test

2. 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? abirb.com/test a. Distended abdomen b. Bulging eyes c. Large tears when crying d. Lethargy abirb.com/test ANS: A

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 abirb.com/test 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. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 652

3. A nurse is determining if children with severe acute malnutrition (SAM) should receive abirb.com/test

facility-based or community-based care. Which of the following children should receive care in the community? a. 3-year-old male who has a history of dehydration abirb.com/test b. 9-month-old male with a poor appetite whose family has adequate resources to obtain the recommended treatment c. 4-year-old female who has sensitivity to milk products d. 6-month-old female who has a good appetite and no underlying abirb.com/testmedical conditions ANS: D abirb.com/test

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When a child has a good appetite with no medical conditions (hypoglycemia, hypothermia, dehydration, electrolyte imbalance, and/or infections), Ready-to-Use Therapeutic Foods abirb.com/test (RUTF) under community-based care are appropriate. However, when a child does not have an appetite and/or medical conditions are present, the child needs to receive facility-based care (WHO/UNICEF, 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. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 652

4. A nurse working on a post-partum unit of a large urban hospital has received a grant to begin abirb.com/test

a “Baby-Friendly Hospital Initiative” developed by WHO. Which of the following statements would the nurse most likely make when explaining the major premises of the initiative to the unit manager? abirb.com/test a. “This program is meant to encourage sibling visits in the early postpartum period, so the adjustment to a new baby is a smooth process.” b. “A major goal of this program is to ensure that all infant/pediatric units have implemented basic safety initiatives.” abirb.com/test c. “Improving nutrition by promoting breastfeeding of newborns through four months of age is what this program is all about.” d. “The purpose of this program is to make sure that all health care providers who abirb.com/test care for newborns and children up to the age of 18 really understand basic principles of growth and development.”

ANS: C abirb.com/test The purpose of the initiative is to improve newborn nutrition by promoting breastfeeding of newborns through age 4 months.

DIF: Cognitive Level: Apply (Application)

REF: p. 652 abirb.com/test

5. Which of the following projects would most likely be administered by International

Micronutrient Malnutrition Prevention and Control (IMMPaCT) Program? a. Researching best methods to preserve the freshness of abirb.com/test foods b. Monitoring and evaluating intervention systems concerning micronutrients c. Comparing the effectiveness of vitamin pills versus fresh fruit and vegetables d. Analyzing the relationship between BMI and cardiovascular disease abirb.com/test ANS: B

IMMPaCt provides its skills and resources toward working to eradicate vitamin and mineral deficiencies around the globe. The IMMPaCT program’s activities include conducting abirb.com/test surveys; providing micronutrients to infants, young children, and women of childbearing age; and monitoring and evaluating intervention systems.

DIF: Cognitive Level: Analyze (Analysis)

abirb.com/test REF: p. 652

6. 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? abirb.com/test a. CA-MRSA is a common viral infection that responds well to antiviral meds. b. CA-MRSA is a serious bacterial infection that does not spread easily. c. CA-MRSA is a fungal infection common in school settings. d. CA-MRSA is a potentially fatal skin infection that is difficult abirb.com/test to treat.

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ANS: D

In the community setting, community-associated methicillin-resistant S aureus (CA-MRSA) strains have emerged as serious threats in the past two decades and can cause dermatitis and abirb.com/test soft tissue infections with the ability to also cause fatal infections in the lungs (e.g., necrotizing pneumonia, purpura fulminans, and postviral toxic shock syndrome) CA-MRSA is a highly contagious bacterial infection that is difficult to treat and can result in abirb.com/test pneumonia and death.

DIF: Cognitive Level: Apply (Application)

REF: p. 655 abirb.com/test

7. 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? a. Completing prophylactic antibiotic therapy for those in close contact with an abirb.com/test infected person b. Using correct handwashing technique c. Requiring those infected stay home from school until the infection has resolved d. Disinfecting all classrooms on a daily basis abirb.com/test ANS: B

Persons who are generally healthy can contact the bacteria through close skin-to-skin contact, cuts or abrasions in the skin, crowded conditions, shared utilities (e.g., clothing items and abirb.com/test towels), and poor hygiene. Also, those who are taking or have previously received antibiotic therapy have a greater risk of infections than those who do not have a history of previous antibiotic intake. Meticulous handwashing has been found to be important and is abirb.com/test recommended as a cost-effective everyday practice.

Handwashing is an effective way to prevent spread of the infection. In order to contract the infection, students must come into direct contact with an infected source, e.g., a draining wound or other source of infection. Emphasizing handwashing would be a good intervention abirb.com/test for the nurse to emphasize and one which everyone can follow. Mandatory home confinement for infected persons would be an administrative or medical decision and thus not within the purview of the people who would be attending the nurse’s workshop. abirb.com/test

DIF: Cognitive Level: Apply (Application)

REF: p. 655

8. A nurse is providing care to HIV positive care recipients living in sub-Saharan communities abirb.com/test

in Africa. Which of the following statements is correct concerning HIV/AIDS as viewed from an international perspective? a. The greatest number of people living with HIV disease are in sub-Saharan Africa. abirb.com/test b. Cultural practices are not a factor in contributing to HIV infection. c. The majority of the new cases in Africa are caused by IV drug abuse. d. HIV incidence refers to the percentage of all cases (old and new) at a certain time point. abirb.com/test ANS: A

Approximately 36 million people worldwide are living with human immunodeficiency virus (HIV) with 25 million in sub-Saharan Africa, 3.9 million in South/Southeast Asia, 1.5 million abirb.com/test in Latin America, 1.3 million in Eastern Europe and Central Asia, 1.3 million in North America, 860,000 in Western/Central Europe, 880,000 in East Asia, 260,000 in the Middle East/North Africa, 250,000 in the Caribbean, and 51,000 in Oceania evidence also shows that abirb.com/test cultural beliefs and practices are significant factors contributing to HIV infections.

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The majority of new cases in Africa stem from heterosexual transmission. HIV prevalence (not incidence) refers to the percentage of all cases (old and new) at a certain time point. abirb.com/test “Incidence” refers to the number of new HIV infections during a certain time period.

DIF: Cognitive Level: Apply (Application)

REF: p. 655

abirb.com/test 9. 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? a. Determining prevalence rates of HIV/AIDS in African countries b. Analyzing stats regarding which medications are mostabirb.com/test effective in raising T cell counts c. Providing treatment access for all HIV-positive individuals who need medication d. Reporting confirmed cases of HIV to the World Health Organization abirb.com/test

ANS: C

UNAIDS has outlined three strategic directions: revolutionizing HIV prevention; catalyzing the next generation for treatment, care, and support; and advancing human rights and gender abirb.com/test 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. abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 656

10. A nurse is using the four-step public health approach to address violence in the community. abirb.com/test Using the four-step public health approach designed by WHO, which of the following actions would the nurse take first? a. Analyze a variety of data sources to determine the extent and cause of the problem. b. Examine risk factors that have contributed to the violence. abirb.com/test c. Develop an evidence-based program to address the problem. d. Train community members to discuss the problem within their neighborhoods.

ANS: A

abirb.com/test

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 abirb.com/test are needed to understand the magnitude of the problem, i.e., to define the problem.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 657

abirb.com/test

11. 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? a. Planning a community-based educational program to respond abirb.com/test to violence b. Reviewing police reports and population-based surveys c. Interviewing local community members about their experiences with violence d. Examining characteristics in the community where violence has not occurred abirb.com/test

ANS: D abirb.com/test

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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 abirb.com/test 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. Examining characteristics of communities where violence has not occurred will help to elucidate what are abirb.com/test the protective factors for this phenomenon.

DIF: Cognitive Level: Apply (Application)

REF: p. 657 abirb.com/test

12. 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? a. Cultural norms abirb.com/test b. Family support c. Drug and alcohol abuse d. Depression ANS: C

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Other risk factors are reported to be lack of social support, dysfunctional family structure, family history of violence, and drug and alcohol abuse. Alcohol intoxication may increase violent actions by impairing the drinker’s cognitive functions and processes through abirb.com/test alterations of social cue perceptions and inhibitions. According to the Department of Justice, 37% of convicted offenders were drinking at the time of their arrest.

Risk factors for IPV may include a victim’s low self-esteem, low self-control, and abirb.com/test 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.

DIF: Cognitive Level: Apply (Application)

REF: p. 657 abirb.com/test

13. The nurse is working at a crisis hotline center. Which of the following callers would be most

at risk for suicide? abirb.com/test a. A 16-year-old girl who broke up with her boyfriend and is distraught b. A 26-year-old male with a large college loan who has been laid off from his job c. A 50-year-old female who has a history of alcohol abuse and depression d. A 40-year-old male whose father has died suddenly from an MI abirb.com/test ANS: C

Previously, suicide rates had been highest among the male older adult. However, rates among young people ages 15 to 24 have been increasing to such an extent that suicide is the second abirb.com/test leading cause of death in this age group in some developed and developing countries.

Although major factors contributing to suicide in Europe and North America include mental disorders, especially depression, and alcohol use disorders, impulsiveness is found to be a abirb.com/test major factor in Asian countries).

Traditionally, older adults have a greater risk of committing suicide than do younger people, although the trend among persons in the 15 to 24 year old age group has been increasing in recent years. Major factors contributing to suicide in Europe and North America include abirb.com/test mental disorders especially depression and alcohol use disorders. Choice C depicts a person with multiple risk factors.

DIF: Cognitive Level: Analyze (Analysis)

abirb.com/test REF: p. 658

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14. Which of the following age groups is experiencing the greatest increase in suicide rates? a. 15 to 24 b. 25 to 39 abirb.com/test c. 40 to 59 d. 60 to 70 ANS: A

abirb.com/test

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. abirb.com/test

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 658

15. Which of the following information about anthrax is correct? abirb.com/test a. Anthrax is a viral infection. b. Anthrax can cause skin lesions or pneumonia. c. Anthrax is spread by person-to-person contact. abirb.com/test d. Anthrax is treated by IV penicillin for 10 days.

ANS: B

Anthrax is a bacillus that is not spread person-to-person contact. Rather it is spread by abirb.com/test cutaneous contact or direct inhalation. An anthrax infection is treated by using ciprofloxacin, levofloxacin, doxycycline, or penicillin for 60 days.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 660 abirb.com/test

16. Which of the following statements about smallpox is accurate? a. Smallpox results in a rash that looks similar to the chickenpox rash. abirb.com/test b. Side effects from a smallpox vaccine include acute renal failure. c. The last case of smallpox occurred in 1997. d. The rash associated with smallpox is most prominent on the face and extremities.

ANS: D

abirb.com/test

A rash from smallpox is most prominent on the face and extremities with the same stage of legion development. Additionally, smallpox symptoms usually resemble influenza symptoms.

The smallpox rash is distinctive from the varicella rash. Side effects from the vaccination abirb.com/test mostly involve a low fever, soreness in the injection area, and enlarged glands under the armpit. The last case of smallpox was in 1977.

DIF: Cognitive Level: Understand (Comprehension)

abirb.com/test REF: p. 660

17. A nurse is working in the emergency department (ED). Which of the following situations

would cause the nurse to suspect bioterrorism? abirb.com/test a. When two people out of twenty who ate at a restaurant come to the ED with nausea and vomiting b. When a worker in a lab comes to the ED complaining of a severe headache c. When thirteen people, aged 24 to 33, come to the ED with abirb.com/test ascending flaccid muscle paralysis d. When five people come to the ED with an upper respiratory infection ANS: C

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Flaccid paralysis is a symptom of botulism. The other examples are common problems for which people seek health care. abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 660

18. Which of the following statements are correct concerning natural disasters? abirb.com/test a. Infections and undernutrition are common sequela of natural disasters. b. Natural disasters occur primarily in developing countries. c. PSTD caused by natural disaster tends to have a short duration. d. Natural disasters are primarily caused by disastrous effects of excess water. abirb.com/test ANS: A

Examples of natural disasters include tsunamis, earthquakes, floods, landslides, mudslides, tornadoes, hurricanes, cyclones, typhoons, wildfires, volcano eruptions, extreme heat, winter abirb.com/test weather, and others victims tend to have limited access to essential infrastructures for survival related to food, water, shelter, and sanitation. These deficiencies can lead to infections and undernutrition. PTSD among the victims still lasted 13 years later. abirb.com/test Natural disasters are not limited to damage from water-based causes. Wildfires, volcanoes, earthquakes, heat, winter all can bring about natural disasters. They occur in all countries throughout the globe although resources may be more limited in developing countries. The effects of PSTD can be quite long lasting regardless of theabirb.com/test source of trauma.

DIF: Cognitive Level: Understand (Comprehension)

REF: p. 661

abirb.com/test 19. 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? a. Massive fires from large-scale civil unrest within an inner city. abirb.com/test b. A hurricane making landfall c. Twenty-five multi-vehicle pileup from a winter storm d. Food poisonings affecting hundreds of people aboard a cruise ship abirb.com/test

ANS: B

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. abirb.com/test Examples of natural disasters include tsunamis, earthquakes, floods, landslides, mudslides, tornadoes, hurricanes, cyclones, typhoons, wildfires, volcano eruptions, extreme heat, winter weather, and others. The other choices depict scenarios arising from human causes.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: p. 661

20. A hurricane has just caused extensive damage within a local community. Which of the

following are community members at risk to experience? abirb.com/test a. Unequal access to health care b. Exposure to community-associated methicillin-resistant Staphylococcus aureus c. Increased incidence of suicide abirb.com/test d. Outbreaks of acute respiratory infection ANS: D abirb.com/test

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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 abirb.com/test natural disasters include diarrhea, acute respiratory infections, viral hepatitis, and snail and trematode infections.

DIF: Cognitive Level: Apply (Application)

REF: p. 661 abirb.com/test

21. 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? abirb.com/test a. The ability to provide mental health services to community members b. The ability to deliver preventive care screening services to community members c. The ability to refer community members to other services abirb.com/test d. The ability to supply community members with daily necessities ANS: A

The priority in planning should be the ability to provide mental health services to the community members. In 2007, the Inter-Agency Standingabirb.com/test 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. Preventive screening is not a priority at thisabirb.com/test time. Referrals for other services are also not a priority immediately following the hurricane. Supplying community members with daily necessities is a priority but it is the function of other disaster relief organizations to do so. It would not fall within the purview of a primary care clinic. abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 661

22. A nurse is advocating for improved disease prevention andabirb.com/test health promotion within the local

community. Which of the following interventions would the nurse most likely implement? a. Educate community members about the violence rates that exist within the community. abirb.com/test b. Administer flu shots for elderly at a local senior citizens center. c. Participate in a disaster planning committee within the community. d. Talk with a state legislator about improved access to health care for the uninsured and underinsured. abirb.com/test ANS: D

To be advocates for newly emerging priorities for disease prevention and health promotion, nurses in the twenty-first century need to engage in the following: Participate in policy abirb.com/test development for health promotion as the health care of individuals in acute settings shifts from hospitals to home and community settings. (and) Influence public expectations about health promotion. Presentations and other forms of public dialogue and education will help raise awareness of the value of individual and community abirb.com/test health promotion.

Advocating for improved access to healthcare for uninsured and underinsured persons would have the broadest impact on disease prevention and health promotion within a local community. It would be the most in keeping with participation in policy development and abirb.com/test influencing public expectations concerning healthcare.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 664 abirb.com/test

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MULTIPLE RESPONSE 1. Which of the following are classifications within the World Health Organization’s (WHO) abirb.com/test

definition of malnutrition? (Select all that apply.) a. Obesity b. Micronutrients deficiencies c. Protein–energy malnutrition d. Water insufficiency

abirb.com/test

ANS: A, B, C abirb.com/test Inadequate or excessive intake of protein and or vitamins and obesity are components of the WHO’s definition of malnutrition.

DIF: Cognitive Level: Remember (Knowledge)

REF: p. 651 abirb.com/test

2. Which of the following individuals would be susceptible to CA-MRSA? (Select all that

apply.) abirb.com/test a. 16-year-old student who plays football b. 48-year-old person who has taken antibiotics for sinus infections c. 36-year-old man serving 12 months in jail for robbery d. 22-year-old woman who shares a towel after a swimming meet abirb.com/test ANS: A, B, C, D

CA-MRSA is spread by close skin-to-skin contact such as during contact sports, by sharing towels and clothing, and by those living in crowded conditions.

People who take or who have abirb.com/test been on antibiotic therapy are also susceptible to CA-MRSA. DIF: Cognitive Level: Analyze (Analysis)

REF: p. 655 abirb.com/test

3. A nurse employed by the World Health Organization is working with HIV positive clients in

Africa and is teaching them about ways to reduce transmission of this disease. Which of the following barriers should be considered when planning this education? (Select all that apply.) abirb.com/test a. Culture-specific practices b. Unavailability of antibiotic therapy c. Lack of understanding about the transmission process d. Overcrowded living areas abirb.com/test ANS: A, C

Culture-specific sexual practices and a lack of understanding about how HIV is spread contribute to its transmission. HIV is a viral infection, not abirb.com/test a bacterial infection. Simply living with someone who has HIV will not result in transmission unless the person comes into contact with blood or bodily fluid from the infected person.

DIF: Cognitive Level: Apply (Application)

abirb.com/test

REF: pp. 655, 656

4. A school nurse is planning an educational presentation for high school students about

violence. Which of the following statements would be included in the presentation? (Select all abirb.com/test that apply.) a. “Violent behavior happens when someone bullies another person.” b. “Withholding food from a child as a punishment is violent behavior.” abirb.com/test c. “Collective violence occurs during an argument between two people.”

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d. “Painting a racial slur on a building is violent behavior.”

ANS: A, B, D

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Violent behavior as defined by WHO is the intentional use of physical force or power, threatened or actual against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, abirb.com/test mal-development, or deprivation. Collective violence is defined as the instrumental use of violence by a particular group of people for specific political, economic, or social objectives.

DIF: Cognitive Level: Apply (Application)

REF: pp. 657, 658 abirb.com/test

5. Which of the following individuals assessed by the nurse is experiencing interpersonal

violence? (Select all that apply.) a. A 16-year-old female who hides in her apartment due abirb.com/test to civil unrest in the country b. A 32-year-old male whose co-worker sends him insulting e-mails at work c. A 19-year old male who has attempted suicide d. A 78-year-old female living in a nursing home who is force-fed by aides abirb.com/test

ANS: B, D

Interpersonal violence is violence committed by an individual or a small group of people in a wide range of acts and behaviors (emotional, physical, sexual, and psychological). The violence can happen to people of any age and at any place.abirb.com/test Self-directed violence occurs with self-abuse and suicide. Collective violence is defined as the instrumental use of violence by a particular group of people for specific political, economic, or social objectives. abirb.com/test

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 657

6. A nurse is participating in disaster preparedness planning for the local community. Which of abirb.com/test the following would be an appropriate responsibility for the nurse? (Select all that apply.) a. Completing a risk assessment in the community b. Implementing strategies to decrease posttraumatic stress disorder c. Coordinating meetings among multiple agencies and disciplines abirb.com/test d. Evaluating the economic impact of the disaster

ANS: A, C

The International Council for Nurses spells out its positionabirb.com/test on the role of the nurse concerning disaster preparedness to include risk assessment as well as management strategies bridging multiple disciplines and system levels. To coordinate health sector preparedness, regulatory meetings and frameworks across cultures will help nurses plan for and streamline health care abirb.com/test responses to such mass events internationally. Implementing strategies to decrease PSTD would come after a given disaster occurs and the needs of the community, in this regard, have been identified. Evaluating the impact of a disaster would also occur after the disaster has occurred and would differ depending on what actually occurred within the community. abirb.com/test DIF: Cognitive Level: Analyze (Analysis)

REF: p. 659 abirb.com/test

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