Documente Academic
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Documente Cultură
-Pack Smart
*pack light able to move quickly & have free hand when need it
*minimal # of valuables & places to conceal them
*check bags, clothing, and/or vehicle to make sure not carrying
banned items or substances into destination country
~covered luggage tags to avoid casual observation of
identity/nationality
*avoid packing IDs, tickets, & other vital documents in
backpacks/other locations you wont be able to see at all times
-Itinerary & Travel Documents
*make 2 copies of all travel documents in case of emergency or
if documents are lost/stolen
~leave 1 w/ friend or relative at home & someone know
exactly where you are staying and how to contact you
~carry other copy stored separate from originals
****What to copy?
~Passport ID Page
~Foreign Visa (if Applicable)
~Itinerary
~Hotel Confirmation & Airline Ticket
~Drivers License
~Credit Cards Brought on Trip
~Travelers Check Serial Numbers
>SAFETY: (What to take with you; Actions to be taken on-route & during stay;
What should returning travelers consider)
-Currency
*Check & understand the exchange rate before you go
*Before you leave, notify your back, credit card company, or other
financial institutions that you are going overseas
*Avoid carrying cash
~Consider travelers checks OR major credit cards (make
sure theyre accepted before departure)
*Change travelers checks only as you need them
*Dont flash large amounts of money when paying bill
-Local Laws & Customs
*subject to local laws & legal systems while abroad
~US Passport wont help avoid arrest/prosecution
~US Embassy cant get you out of jail
-Operating Motorized Vehicles
*International Driving Permit (IDP)
limited validity, will need
local license if overseas for extended period of time and/or
resident
~most countries dont recognize US license---illegal to
drive w/o valid license & insurance (most places)
=contact embassy of travel
*Renewing US License abroad contact DMV in home state
>HEALTH:
-Medical Emergency
*consular officer from embassy/consulate can assist in locating
medical services and informing friends/family (may also assist in
transfer of funds from US)
=payment of hospital & other expenses is patients
responsibility
=local info at website of embassy/consulate near person
[usembassy.gov]
-Health Insurance
*if covered. Carry BOTH insurance policy identity card (proof of
May require short
insurance) AND claim form
term travel
=many cover customary & reasonable costs; VERY FEW
cover medical evacuation back to US (costs 10,000+
medical
depending on location & medical condition)
insurance to
=may still be required to pay for care when you receive it
cover cost of care
regardless of whether or not your insurance covers the cost
[NOTE: travel
*Medicare
& Medicaid do NOT cover care abroad---contact
insurance is for
AARP
-Prescriptions
*Enough to last trip (plus extra in case of delay)
*Carry in original labeled containers in carry-on (in case of lost or
delayed luggage)
*Ask pharmacy/physician for generic equivalent names in case
need to purchase additional medications abroad
*Letter from physician in case questioned about carry-on
medication---some countries have strict limitations w/o proper
medical documentation (on Rx & OTC)
>SELECT TRAVEL DESTINATION:
-What vaccines & medicines are mandatory and/or recommended?
Mandatory
=International Certificate of Vaccination (aka Yellow Card)
or other proof of inoculations/medical tests before
entrance/departure
=check Country Specific Information AND contact
embassy for current entry requirements
Recommended
=through CDC/WHO (details on vaccinations & other
health precautions)
-What non-vaccine preventable diseases are listed?
>TRAVEL NOTICES POSTED?:
-Warning: avoid non-essential travel?
-Alert: practice enhanced precautions
-Watch: practice usual precautions
>If yes, what are the risks?
>environmental factors
-global burden of disease: environmental factors
*environmental stressor types
1) factors that directly assault human health: air
pollution/lead pollution
2) secondary damage to societys goods & services: air
pollution
3) quality of life: noise & liter
4) ecological balance: global warming
5) all aspects of life: natural disasters, terrorism, war
-sustainable development?
*as world becomes more urbanizedpeople living closer means
increased disease as sanitation and pollution (CO) build/become a
problem
~Differentiate patterns of health and disease in developed (high income) vs. developing
(low income) countries
>neglected diseases
-AIDs, TB, (endemic) malaria, hep B, parasitic infections, dengue fever,
rheumatic heart disease
***immunization! Most cost-effective tool to combat
>tobacco, burning of solid fuels
>occupational & environmental safety & health hazards
>cycle of war, famine, disease
Primary Causes of Mortality
epidemiological
Developing Countries
Developed Countries
transition from having
Infections
Cardiovascular Disease (CVD)
infectious disease profile
Malnutrition
Cancer
to chronic disease
Violence
Respiratory Disease
(secondary to tobacco
(CVDs increasing)
Stroke
use & air pollution)
Violence
more middle aged &
elderly instead of young
Traumatic Injury
~Recognize international agencies, government organizations and non-governmental
organizations that are actively involved in global health
>International Agencies and Organizations goal: health for all
-Who Health Organization (WHO)
*international health agency of UN
*directs & coordinates international health efforts, producing &
disseminating global health standards & guidelines, helping
countries address public health issues & supporting health research
-Pan American Health Organization (PAHO)
*international public health agency
*works to improve health & living standards of the Americas
*regional office of WHO
*part of UN system
-United Nations
*192 nations committed to world peace & security through
international cooperation
*resolves global conflicts & formulates policies that impact all
nations
***all member nations have equal vote
*developed the Millennium Development Goals to coordinate &
strengthen global efforts to meet the needs of the poorest of the
poor:
1) Eradicate extreme hunger & poverty
2) Achieve universal primary education
3) Promote gender equality & empower women
4) Reduce child mortality
5) Combat maternal health
6) Combat HIV/AIDs, malaria, and other infectious disease
7) Ensure environmental sustainability
8) Develop global partnerships
>Non-governmental Organizations (NGOs)
help the UN
-Bill and Melinda Gates Foundation
*local, national, and global objectives
*global: reduce extreme poverty; improve health; increase public
library access
*Africa: increase anti-retroviral medications &
prevention/treatment for HIV/AIDS, malaria & TB
-Clinton Global Health Initiative (initiative of Clinton Foundation)
*convenes global leaders to create & implement innovative
solutions to the worlds most pressing challengesrather than
directly implementing project, CGI facilitates action by helping
members connect, collaborate, and make effective & measurable
commitments to action
=through: Inspiration, Networking, Knowledge Building, &
Collaboration
-UNICEF (UN Childrens Fund)
*needs of women & children across world
*implement community-based programs & establish/maintain
womens rights
-International Red Cross/Crescent
* an international humanitarian movement founded to protect
human life and health, to ensure respect for all human beings by
upholding human dignity especially during armed conflict & other
emergencies, and to prevent and alleviate human suffering
=consists of several distinct organizations that are legally
independent from each other, but united within the
By the middle of the 21st century, the world population is expected to do which of the
following?
A.
Reach 10 to 12 billion Correct
B.
Reach 8 billion
C.
D.
The world's population soared to 4 billion between 1960 and 1974 and then to 5 billion between
1974 and 1987. In 1999, the world population was 6 billion; in 2005, it was nearly 7 billion. The
population is projected to reach 8 billion by 2025 and 10 to 12 billion by midcentury.
REF: Page 273
2.
Improved education
C.
D.
Decreased mortality
Overcrowding leads to pollution, stress, disease, and violence. Mortality rates are increased, and
quality of life decreases.
REF: Page 273
3.
C.
Noise
D.
Litter
Air pollution and poisoning directly assault human health. Noise and litter affect quality of life.
Global warming affects the ecologic balance.
REF: Page 273
4.
cardiovascular diseases.
C.
cancer.
D.
Improved sanitation has led to reduced mortality rates from infectious diseases. Respiratory
disease, cancer, and cardiovascular diseases are the primary causes of death in developed
countries.
REF: Page 274
5.
The life-threatening parasitic disease that causes at least one million deaths annually is:
A.
AIDS.
B.
malaria. Correct
C.
tuberculosis.
D.
hepatitis.
The concept of "health for all by the year 2000" was initially introduced by which of the
following international organizations?
A.
World Health Organization (WHO) Correct
B.
C.
D.
The WHO introduced the goal of "health for all." The CDC strives to prevent and control
infectious and chronic diseases, injuries, workplace hazards, disabilities, and environmental
health threats. UNICEF focuses on child and women's health.
REF: Page 275
7.
The global health organization that works for children's survival, development, and
protection is the
A.
B.
C.
D.
UNICEF works for children's survival, development, and protection by developing and
implementing community-based programs. UNICEF achievements are well documented in child
health, nutrition, education, water, sanitation, and progress for women. PAHO is an international
public health agency that works to improve the health and living standards of the Americas. The
WHO introduced the goal of "health for all." The CDC strives to prevent and control infectious
and chronic diseases, injuries, workplace hazards, disabilities, and environmental health threats.
REF: Page 277
8.
Mary Breckenridge.
C.
Dorothea Dix.
D.
Florence Nightingale's legacy serves as the foundation for community health nursing in the
global health care arena. She channeled her energy into all aspects of health from the care of
wounded soldiers at Scutari to the broad public policies that affected health in her time. The
other three women were instrumental primarily for their contributions in the United States
REF: Page 279
9.
People who live in developing countries are at risk for a variety of health threats as a
result of all of the following factors except:
A.
limited sanitation facilities.
B.
D.
After the implementation of various policies to reduce tobacco use, the tobacco industry
has begun targeting: (Select all that apply.)
A.
elderly people.
B.
Hispanics.
C.
D.
African Americans.
E.
The tobacco industry has now started targeting youths and dramatically increased international
exports. Tobacco sales among American adults is down.
REF: Page 274
Class 11: Vulnerable Populations (35) Chapters 22, 23, 27
Based on
~Discuss the role of the public health/community health nurse who is providing
public
healthcare for vulnerable populations
>***the nurse breaks down barriers between RN and homeless by treating the health
interventi
person with respect, compassion, and concern
>OUTREACH: nursing approach to making health care more readily available toon wheel
vulnerable populations by implementing education, counseling, and support
services where people congregate
Downstream: surveillance; disease
***Upstream: collaboration;
investigation; outreach; screening; case
coalition building; community
**Social justice: all people
equally entitled to key ends
finding referral & follow-up; case
organizing; advocacy; social
(i.e access to health care &
management; delegated functions; health
marketing; policy development &
minimum income); all
teaching; counseling; consultation
enforcement
members of society must
accept collective burdens for a
Soup kitchens
Change the system ! (economics,
fair distribution
inequality, discrimination)
Market justice: people are
Mobile
vans
Education
entitled to valued ends (i.e
Shelters
Jobs
status, income, happiness)
according to own individual
Clothing drives
Housing
Food drives
Drug & ETOH problems
Runaway youth
~Define homeless
>European conceptual definition of homeless: [developed by researchers]
*broken down by (3) domains of home
Any individual lacking a
-physical: having adequate dwelling for which a person/family has
fixed, regular, &
exclusive possession
-social: able to maintain privacy & enjoy relations
adequate nighttime
-legal: exclusive possession, security of occupation, and legal title
residence---something
to occupation
temporary is still
*broken down into (4) classes subdivided for policies/ interventions
homeless
(rooflessness; houselessness; insecure housing; inadequate housing
Individuals with no
mailing address or
place to sleep; people
who sleep outdoors on
streets or in parks, train
stations, subways,
underground, in cars
and people on the
>Skin infestations
>URI
>TB
>HIV/AIDs
~Describe the challenges of caring for homeless populations (healthcare
for the homeless)
>resources lacking in food, shelter, safety
-foods primary fats & grains75% never eat fruit/veggies
>healthcare is tertiary in nature
>ER utilization rate is high
>barriers to care: transportation, phone, address, health insurance
-lack of access
-may not have regular family practitioner
-may be discouraged from obtaining services OR turned away from
private clinics
~ patient dumping/ cogomer phenomenon----statutorily
imposed liability that occurs when a hospital capable of providing
the necessary medical care transfers a patient to another facility or
simply turns the patient away because of the patient's inability to
pay for services.
-lack of systematic communication with health care professionals
-lack of social & family support
-psychological depression; hard-to-reach
-lack of motivation to seek health care
>attitudes of health providers to the poor: normal rubbish dirty work
Chapter 22
1.
for human habitation and who is exiting an institution where he or she temporarily resided. An
individual whose residence lacks access to public water and electricity, an individual who has a
permanent nighttime residence in the housing for mentally ill people, and an individual
imprisoned or detained under an act of Congress or state law are not considered homeless under
the HUD definition.
REF: Page 431
2.
The Brown family is being evicted from their home and will be moving into a homeless
shelter in 3 days. Under the Department of Housing and Urban Development (HUD) definition,
the Brown family is:
A.
literally homeless.
B.
C.
D.
Imminent risk of homelessness defines those who will imminently lose their primary nighttime
residence. The literally homeless have no fixed, regular, or adequate nighttime residence.
Unaccompanied youth and families with children who are defined as homeless under other
federal statues but do not fit into the other HUD defined categories of homeless may be defined
as homeless under this HUD definition. Finally, individuals and families who are fleeing or
attempting to flee domestic violence or other life-threatening conditions that relate to violence
against the individual or family are defined as homeless.
REF: Page 431
3.
C.
D.
The intent of the HIMS is to obtain national data, including the number of and demographic
information on the homeless population. Providing means to feed homeless people, serving as a
screening tool to obtain any history of criminal activity, and providing homeless individuals with
educational materials are not functions of the HIMS.
REF: Page 432
4.
Which of these statements is true regarding income insufficiency in the United States?
A.
The poverty rate increased between 2007 and 2010. Correct
B.
C.
D.
The poverty rate increased from 2007 to 2010. median income in 2011 was greater than $50,000.
The economy and related issues are the most common reasons for unemployment. Working at
minimum wage places a person below the poverty line. REF: Page 435
5.
HUD, in cooperation with state and local governments and nonprofit housing organizations,
operates programs that provide financial housing assistance to low-income families. The WHO is
an organization that is concerned with international public health. FEANTSA is a European
organization that works to prevent and alleviate poverty and homelessness in Europe. The Robert
Wood Johnson Foundation provides funding for nursing education.
REF: Page 431
6.
What group of homeless individuals is known for their involvement in survival sex?
A.
Young adult gay men
B.
Middle-aged women
C.
Adolescents Correct
Which model supports upstream thinking with the purpose to improve homelessness
through reduction of structural conditions contributing to homelessness?
A.
Social justice Correct
B.
Market justice
C.
Physical justice
D.
Mental justice
The social justice model seeks to reduce the structural conditions contributing to homelessness
through collective action, thus supporting upstream thinking.
REF: Pages 439-440
8.
According to the vulnerability index, the individual at highest risk for death is:
A.
a 46-year-old person who has been homeless for 2 months and has HIV.
B.
C.
a 65-year-old person who is being evicted from his home after living there for
25 years.
D.
Those at high risk for death are individuals who have been homeless for 6 months or more with
one or more of the following conditions:
? More than three hospitalizations or emergency department (ED) visits in 1 year
? More than 3 ED visits in the previous 3 months
? 60 years or older
? Cirrhosis of the liver
? End-stage renal disease
? History of frostbite, immersion foot, or hypothermia
? HIV/AIDS
? Co-occurring psychiatric, substance abuse, and chronic medical condition
REF: Page 439
9.
C.
D.
The definition of a homeless child according to the U.S. Department of Education includes
children and youth who are:
? Sharing the housing of other persons because of loss of or inadequate housing
? Abandoned in hospitals
10.
Public health policy in the United States is influenced by two types of justice, market
justice and social justice. Examples of market justice include which of the following? (Select all
that apply.)
A.
All people are entitled to the status they create for themselves. Correct
B.
C.
All people are entitled to happiness if they put forth enough effort. Correct
D.
All people are entitled to the income they work for. Correct
E.
Market justice has been the dominant model in the United States and purports that people are
entitled to valued ends (i.e., status, income, and happiness) according to their own individual
efforts. Moreover, this model stresses individual responsibility, minimal collective action, and
freedom from collective obligations other than respect for another person's fundamental rights. In
contrast, under a social justice model, all people are equally entitled to key ends (i.e., access to
health care and minimum standards of income).
REF: Page 439
~Describe the prevalence of injury & illness among migrant farm workers
>Health Issues Experienced by Migrant Farm Workers
-Overall
~highest rate of toxic chemical injury/illness
~higher rates of HIV/TB/CA/HTN/DM
~13% occupational fatality rate
~exposure to carcinogenic agents (pesticides, sun, chemicals,
solvents)
~respiratory illnesses
~dermatitis
~parasitic infections
~urinary tract infections: not going to bathroom; dehydration
~musculoskeletal d/o
~traumatic injuries
~eye trauma
~mental health
~substance abuse
-Females
~occupational illness and injuries
~reproductive issues
~prenatal care
~domestic violence
~sexual abuse
~mental health
-Children
~pesticide related illnesses
~respiratory illnesses; lead exposure
~musculoskeletal injuries
~over/under immunized
~dental caries
~accidents
~difficulty completing their education
~List key barriers to healthcare resources experienced among migrant farm workers
>Cultural
-language
-expectations of patient/provider relationship
-beliefs about health/wellness/illness
-folk/home remedies
-community elder/healer
-structure of social group/family roles
>Geographical
-mobility required to secure employment
-continuity of care/health history
-rural location of most farms
-hours of work vs. hours of clinic operations
-lack of transportation
>Financial/Legal
-low wages/ variations in earnings or employment
-disincentives to miss work
-lack of health insurance
-eligible/not eligible for benefits
~cannot maintain PCP
~benefits may be linked to residence in a particular state
~fears of deportation
~Discuss the ethical principles of providing healthcare to migrant workers
>How Does the Migrant Farm Worker Impact the Health System?
-ER use only
-critically ill
-no follow up
-no prevention/health maintenance
-increase costs for care RT severity of illness/injuries
-treatable illnesses vs. death/disability
>***Nurse-Client Relationship
-Respecto (respect the individual)
-Personalismo (relate to the individual)
-Dignidad (dignity)
-Simpatia (polite, non-aggressive)
-cultural humility
-linguistic capability
~Conduct a health assessment of a migrant worker
>Occupational History
-type of job
-did S&S start after you began working on the farm?
-S&S worse at the end of the workday and better at night or on
weekends?
-co-workers with similar S&S?
-patients opinion of cause of S&S?
>Dermatitis (contact/allergic and heat rash)
-skin have contact w/ plant material?
-contact with pesticides, fertilizer, other chemicals?
-is rash worse where you have had contact?
-wet work?
-facilities for hand/clothes washing and/or showering
Chapter 23
1.
Rural residents in the United States compose more than _____% of the nation's poor.
A.
50 Correct
B.
35
C.
20
D.
18
More than 50% of the nation's poor live in rural areas; 35% live in the South. Current census
estimates are that 20% of the nation's children younger than age 18 years live in rural areas, as do
15% of the nation's elderly.
REF: Page 445
2.
agriculture continues to be an important part of the rural and U.S. economy. Correct
B.
There has been a shift in the economic base of rural America as more
C.
Hispanics and youth moving to urban areas rather than rural communities and small
towns.
D.
There are more positive health behaviors (e.g., less smoking, obesity,
and drug use) among residents of rural America when compared with urban America.
Despite the shrinking number of family farms and full-time farmers, agriculture continues to be
an important part of the rural and U.S. economy. Changes in rural demographics include a shift
in the economic base from agriculture to industry, as well as more diversity as the number of
rural Hispanics increases. Additionally, there has been a rise in negative health outcomes for
rural residents; obesity, smoking, and drug use are more prevalent in rural America than in urban
America.
REF: Page 445
3.
The number one health concern identified by the majority of rural health care
leaders is:
A.
B.
C.
D.
Rural health leaders identified ten priorities for health care in rural America, with access and
affordability to care topping the list. Surveys have found rural uninsured people are more likely
to have a usual source of care compared with their urban counterparts. An increase in
communicable diseases and social isolation of rural dwellers were not listed as a priority health
concern identified by rural health leaders.
REF: Pages 448-449
4.
Agricultural workers are at high risk for occupational injuries and illnesses. To
reduce the most common cause of fatalities among youth on farms, which of the following is the
most important strategy for the community nurse to implement?
A.
Planning a community media campaign advocating the use of helmets
B.
C.
D.
Based on the common illnesses and risky health behaviors among farmers, the
community health nurse should implement which of the following health promotion activities?
A.
Partner with the local health department to offer smoking cessation
classes for farmers and their spouses.
B.
C.
6.
Migrant and seasonal farm workers constitute a high-risk population due to their
low income and migratory status. These workers lack adequate access to preventive services. The
most important role of the rural community health nurse in meeting the health care needs of this
vulnerable population is to:
A.
address the multiple communicable diseases of these farm workers.
B.
serve as an advocate working to gain health care access for these farm
workers. Correct
C.
participate in political activities with an emphasis on changing
D.
immigration laws.
learn to speak Spanish to improve communication with this specific
population.
One of the greatest needs of the migrant and seasonal farm workers is the lack of access to health
care. The community health nurse is in a strategic position to advocate for change to restructure
health services and thus reduce this rural health disparity. Providing direct care for
communicable diseases is important but does not meet the overarching goal of getting adequate
health care access to migrant farm workers. C&D do not address the healthcare needs of migrant
farm workers. REF: Page 457
7.
In contrast to people who live in urban areas, rural residents frequently describe
their health by their ability to:
A.
avoid hospitalizations.
B.
C.
D.
Rural residents generally describe themselves as healthy if they can do their usual work and
remain productive. Performing activities of daily living may be one part of being productive.
Avoiding hospitalizations and maintaining social connections are the most frequent descriptions
of health by rural residents. REF: Page 458
8.
A.
The greatest promise for improving health outcomes for rural residents is:
the increase in health care providers migrating to rural areas.
B.
C.
Which statement regarding the impact of managed care on rural public health
departments is true?
A.
Managed care has expanded the safety-net role of many local health
departments by funding primary care services.
B.
Medicaid's importance for rural areas is likely to decrease.
C.
D.
fee-for-service basis.
The evolution of managed care into rural environments has limited the safety-net role of some
local health departments to provide primary care by preventing fee-for-service reimbursement
and contracting care to networks of providers or organizations. This is especially true for
Medicaid managed care, which serves that same population of people that are traditionally
served with primary care services through local public health departments. Medicaid's
importance for rural areas is likely to grow as broader health care developments, such as
declining inpatient use of rural hospitals and reductions in Medicare reimbursement, provoke
more interest in using the Medicaid system to support threatened rural infrastructure.
Consequently, the administration of the Medicaid program will increasingly seek the cost savings
promised by managed care, and the role of rural public health departments may increasingly
narrow into areas that are currently without any type of reimbursement.
REF: Page 465
10.
D.
area employers.
E.
Limited resources are available in rural areas, and more can be accomplished when resources are
pooled. Also, to ensure a more successful outcome, all players with a vested interest in the
problem should have a voice in the problem-solving approach. This would include public
personnel (city and county government, police, teachers) and private groups (RNs and MDs).
Less important for looking at children's issues, however, would be private employers.
REF: Page 461
~List the factors that contribute to violence/intentional injury to self and/or others Table
27-3 Page 551
>violence: the intentional use of physical force or power, threatened or actual
against oneself, another person, or against a group or community, which results in
-membership
-crimes committed
-supremacy
>Gang Hand Signs
~represent themselves
~identify themselves to other members
~ throwing up (putting up your gang sign)
~ situations where other identifiers may not be possible or appropriate
~Describe how youth gang members are considered a vulnerable population
>Who are gang youth?
~80% are African American or Latino
~relatively deprived socioeconomic background
~high rates of welfare dependency
~families with poor parenting skills
~family members who are in a gang
~communities with long histories of drug sales, crime, and gang activity
~perform poorly in school, negatively labeled by teachers & have friends
involved in crime, drug use and/or gang activity
>More likely to engage in risky behaviors
~alcohol use
~illicit drug use (50-90% more than nongang peers)
~sexual behaviors
-sex initiation at very early age
-multiple partners
-unprotected sex
-homosexual relationships in correctional facilities
~victimized by violence
-60* more likely to be killed than rest of population
>Mental Health disorders
~44% were possible psychopaths (w/ S&S of moderate psychopathy)
~4% were psychopaths (w/ S&S of high psychopathy)
~psychopath: person characterized by reduced fear, lack of empathy, coldheartedness, egocentricity, superficial charm, manipulativeness,
irresponsibility, impulsivity, criminality, antisocial behavior, lack of
remorse, and a parasitic lifestyle
~List appropriate precautions for a nurse to stay safe while providing healthcare to a
suspected or known gang member
>OMG (outlaw motorcycle gang) Vests: Dont Cut!!
>Weapons
~many gang members carry weapons: guns, knives, shivs/shanks
>Rival Gangs
~separate gang members as far away as possible
~notify police
~watch the waiting room
-Census Information
*census started to identify same-sex partnerships in 1990
NOTE: remember
up until the 90s
LGBT health
revolved around
prevention and
treatment of
HIV/AIDs and men
-A Patient-Centered Approach
*LGBT people have same health concerns as general population, as well
as some additional risk factors
*important to treat the whole person, not a collection of risk factors
*important to understand that LGBT life issues are similar, but also can
present unique challenges:
-coming out as LGBT
-relationships: marriage/long-term partnership
-children: reproduction, adoption
-parenting and families
-adolescence
-aging
-legal rights as parents and partners
-Guidelines for Health Promotion
*guidelines developed by many sources, including government sources,
professional specialty societies
*sources not always consistent with each other
*In the US, the most rigorous evidence-based analyses, which rate
interventions, are published regularly by the US Preventative Services
Task Force (USPSTF) of HHS
-Evidence Ratings: recommendation ratings based on the strength
of evidence & magnitude of net benefit (benefits minus harms)
A: strongly recommends that clinicians provide (the
service) to eligible patients
B: recommends that clinicians provide (the service) to
eligible patients
C: makes no recommendation for or against routine
provision of (the services)
D: recommends against routinely providing (the service) to
asymptomatic patients
I: concludes that the evidence is insufficient to recommend
for or against routinely providing (the services)
Chapter 27
1.
As a school nurse, you know the leading reason cited as the cause of school violence is:
A.
use of violence to handle disputes. Correct
B.
C.
D.
Adolescents and children increasingly use violence to settle disputes. Children are often not
taught peaceful ways of resolving differences and learn by what they observe at home, on
television, and in movies. Consequently, schools have become a common site for violence. The
reasons for violence are complicated and multilayered, but the most common reason cited is use
of violence to handle disputes.
REF: Page 553
2.
Chronic stress characterizes the lives of people living with domestic violence. As the
community health nurse, you recognize which of the following as a long-term effect of violence?
A.
Spontaneous disclosure of abuse to health care provider
B.
C.
D.
When subject to repeated abuse, the victim experiences a variety of responses, including shock,
denial, confusion, withdrawal, psychological numbing, and fear. He or she lives in anticipatory
terror and experiences chronic fatigue and tension, disturbed sleeping and eating patterns, and
vague gastrointestinal and genitourinary complaints. The other options are not symptoms of
chronic violence.
REF: Page 549
3.
physical abuse.
C.
psychological abuse.
D.
neglect. Correct
Seventy-one percent of all child maltreatment cases are classified as neglect. Approximately 9%
of child abuse cases are sexual abuse. Physical abuse accounts for 16% of all child maltreatment
cases. Emotional abuse accounts for 7% of child maltreatment cases.
REF: Page 550
4.
C.
D.
amputations
The most likely victims of elder abuse are individuals 70 years of age and older who are in poor
physical or mental health and dependent on others for physical or financial support; these clients
are often confused and depressed. REF: Page 552
5.
As a visiting community health nurse, you must take precautions to avoid unsafe
situations. To avoid putting yourself in danger, you would do which of the following?
A.
If you enter a house where a violent act is occurring, call 911 and wait inside
for the police to arrive.
B.
Expect the client to control angry family members.
C.
Repeat the reason for your visit and stay and continue your task.
D.
When approaching a home, as a community health nurse, you should notice the environment,
animals, fences, activities, possible indicators of crime, and places you could go for assistance if
necessary. Walk with confidence and maintain a professional attitude. Listen for signs of fighting
before knocking. If you hear sounds of fighting, leave. Do not enter a home if you suspect an
unsafe situation. REF: Page 556
6.
Which of the following statements about homicide in the United States is false?
A.
Most homicides are caused by stabbings. Correct
B.
C.
D.
Most homicides are caused by firearms. The other statements are true. REF: Page 547
7.
Nurses, including public health nurses, are at increased risk for workplace violence. Risk
factors for violence in the workplace include all of the following except:
A.
working in pairs. Correct
B.
access to medications.
C.
D.
inadequate security.
Risk factors for violence in the workplace include increasing number of acute and chronically
mentally ill patients, working alone, availability of drugs at worksite, low staffing levels, poorly
lit parking areas and corridors, long waits for service, inadequate security, increasing number of
substance abusers, and access to firearms.
REF: Page 553
8.
Which of the following individuals should be evaluated for intimate partner violence
(IPV)? (Select all that apply.)
A.
The 24-year-old white woman with low self-esteem Correct
B.
C.
The 18-year-old Hispanic gay man with multiple sexual partners Correct
D.
E.
depression Correct
IPV crosses all ethnic, racial, socioeconomic, and educational lines. Risk factors for victims of
IPV include low self-esteem, poverty, risky sexual behavior, eating disorders or depression,
substance abuse, and trust and relationship issues.
REF: Page 547
9.
Which of the following assessment findings by the community health nurse would
suggest that an elderly client may be the survivor of physical abuse by a caregiver? (Select all
that apply.)
A.
The client has a laceration on her forehead that was sutured. Correct
B.
C.
The client has bruises on her forearms in various stages of healing. Correct
D.
E.
The client is not sexually active but has a diagnosis of Chlamydia. Correct
Signs of physical abuse include bruises, lacerations, fractures, dislocations, untreated injuries in
various stages of healing, and STDs in sexually inactive clients. The other options are not
indications of physical abuse.
REF: Page 553
10.
The school nurse is interviewing a student who has been assaulted by another student.
Both students proclaim to be gang members. The nurse understands the reasons most youth give
for joining a gang include the following: (Select all that apply.)
A.
financial gain.
B.
C.
D.
relative is in a gang.
E.
Reasons that young people give for joining gangs include the belief that gangs will protect them,
peer pressure, the need for respect, and a sense of belonging.
REF: Page 554
Chapter 31
1.
C.
D.
A link among the health care system, the investigative process, and
2.
A 16-year-old young woman arrives at the local emergency department (ED) early
Sunday morning and states, "I was on a date last night, and the last thing I remember was eating
dinner with my boyfriend." She comments that she woke up in her bed with her clothes "messed
up" and states, "I just don't feel right down there" as she points to her genital area. She appears
medically stable. Which of the following health care providers would be most appropriate to
conduct the physical examination?
A.
An experienced obstetrical nurse because the patient could be
pregnant
B.
C.
D.
An emergency nurse
Although all of the health care providers listed are able to complete a physical examination on
this patient, the SANE would be most appropriate because of the clues that a date rape may have
occurred. The SANE is trained specifically to collect evidence in such a case, which is why the
emergency nurse would not be most appropriate. The stem includes a statement that the patient is
medically stable; therefore, the SANE should be chosen over the physician.
REF: Page 620
3.
Discuss the dietary needs and regimen with patient and family.
C.
D.
Talk with the patient alone and question the possibility of elder
abuse. Correct
Elder abuse is underdiagnosed and underreported. The nurse must assess the possibility of elder
abuse occurring. The other interventions are not indicated based on the information provided.
REF: Page 624
4.
C.
D.
The nurse will not be diagnosing or identifying illnesses; that is a physician's role. Although the
nurse may be working in a psychiatric facility, the best reason for being knowledgeable about
these illnesses is because the forensic psychiatric nurse may be called to be an expert witness in
court.
REF: Page 625
5.
C.
D.
Although all of the interventions are important, the most appropriate initial intervention is to
complete the history and assessment. The nursing process is followed by using assessment first,
and it is also at this time when medical issues are found for the inmate.
REF: Page 626
6.
7.
Which of the following is true of adolescents who have been convicted and
incarcerated in adult facilities rather than in a juvenile facility?
A.
They are less likely to be sexually assaulted.
B.
C.
D.
Adolescents in an adult correctional facility are more likely to be sexually assaulted, attacked by
other inmates, or to threaten suicide than adolescents in a juvenile facility. REF: Page 627
8.
Joe is released from the correctional facility to return to the community. The
facility is required to do which of the following?
A.
Help with job placement.
B.
C.
D.
The correctional facility is only required to provide the psychotropic medications when returning
to the community until they are under care of their physician. REF: Page 628
9.
C.
D.
information Correct
The correctional nurse should never interrupt when testifying in court. The other actions are
appropriate. REF: Page 623
10.
All of the following factors contribute to the infection spread rate in a correctional
setting: (Select all that apply.)
A.
overcrowding. Correct
B.
C.
D.
E.
Correct Feedback:
Overcrowding, poor ventilation, and rapid movement of inmates in and out of jail contribute to
the rates of an infection spreading. The number of minorities or undocumented immigrants in a
correctional setting has not been reported as a factor in infection spread rates. REF: Page 626
=medication administration
**only meds considered necessary are administered; requires
consent to talk to PCP & proper container/storage---ADHD meds
most common
~legal for kids to self-carry asthma meds (with permission slip)
=children with special health needs
~Public Law 99-142: gives ALL students the right to public
education in the least restrictive environment possible regardless of
mental or physical disabilities
-requires school nurses to screen/identify children in need
of special education & related services & develop an
interdisciplinary IEP for educational goals & services
-Individualized health care plan: for those in need of
continuous nursing management while at school
~Individuals w/ Disabilities Education (IDEA) act of 1990:
enhanced opportunities for children previously served in acute care
& long-term care settings to have access to public education
=student records: FERPA, HIPAA
~ Family Educational Rights & Privacy Act: protects student
education & health records
=delegation of tasks
~***responsibility for assessment, diagnosis, goal setting, &
evaluation may NEVER be delegated
~nurse gives education, written procedures & ongoing
supervision/evaluation of caregivers if delegated
=nutrition: eating disorders; obesity; hunger/malnutrition
~nurse must: identify nutritional problems; counsel; make referrals
~female athlete traid: amenorrhea, eating disorder, osteoporosis
>counseling, psychological & social services [maltreatment, abuse, neglect, etc]
>healthy school environment: security, safety, and environmental health
=restraining
>school staff & educators: occupational health & safety
=exercise & nutrition workshops; BP screenings; wt management
programs
>family and community involvement
=families at risk index [those w/ 4+ of those below considered high risk]
~child not living with 2 parents
~household head is school dropout
~family income is below poverty line
~child is living w/ parent(s) w/o steady, full-time income
~family receiving welfare
~child is w/o health insurance
~Recall standards of school nursing practice
>definition: specialized practice of professional nursing that advances the wellbeing, academic success, and lifelong achievement & health of students
~facilitate positive student responses to normal development
Healthy People 2020 addresses all of the following goals for children and adolescents
except:
A.
physical activity.
B.
C.
smoking prevention.
D.
Healthy People 2020 does not address cardiovascular accidents, stroke, or diabetes in its
objectives for children and adolescents. The other options are addressed. REF: Page 586
2.
A comprehensive school health program should include all of the following except:
A.
health promotion for staff and health education.
B.
C.
D.
The eight components of a comprehensive school health program are health education, physical
education, health services, nutrition services, counseling, psychological and social services,
healthy school environment, health promotion for staff and family, and community involvement.
Physical examinations and comprehensive health history are not included. REF: Page 586
3.
A week before finals, a school nurse assesses a 15-year-old girl complaining of vague
symptoms. All of the following symptoms or behaviors should result in an immediate request for
parent or guardian conference and referral to a physician for further evaluation except:
A.
B.
C.
D.
inability to concentrate.
Problems eating or sleeping, use of alcohol or other substances, problems making decisions,
persistent angry or hostile feelings, inability to concentrate, increased boredom, frequent
headaches or ailments, and inconsistent school attendance are all warning signs of stress. The
nurse should be aware that these symptoms can negatively affect an adolescent's mental and
physical health, and the student should be screened for depression and suicide REF: Page 594
4.
A priority health education topic for school-age children is which of the following?
A.
Schoolyard safety Correct
B.
C.
Sports safety
D.
Immunization schedules
Schoolyard injury accounts for 200,000 injuries yearly and is one of the greatest health concerns
for elementary children. Motor vehicle safety should be included in programs for adolescents
who are beginning to drive. Sports safety is particularly important among adolescents as
participation in sports continues to grow, especially among girls. Immunization schedules are an
important topic of education for parents of younger children and babies.
REF: Page 587
5.
C.
D.
The role of the nurse in a school-based health center includes vision, hearing, and scoliosis
screening and first-aid and medication administration, but the nurse should refer the individual to
an appropriate specialist for diagnosis and treatment.
REF: Page 586
6.
A school nurse knows that under the Family Educational Rights and Privacy Act, a
student's health record can be released:
A.
if the student is not a minor.
B.
in an emergency. Correct
C.
D.
School health records are confidential, and without permission, releasing them is unethical and
improper unless in an emergency.
REF: Page 592
7.
A 10-year-old boy visits the nurse complaining of a headache and nausea. The nurse
recognizes the boy from an earlier conference with a teacher about the boy's declining school
performance. The nurse has been concerned because the boy's father and mother are recently
divorced, and his mother works nights. An appropriate nursing intervention would be to
investigate the boy's eligibility for which of the following?
A.
The Nutritional Education and Training Program (NET)
B.
C.
D.
The school nurse has several federal resources available to assist children in need. The nurse
must be able to recognize children and families that may be eligible for assistance. Options A, B,
and C are not appropriate referrals for a child in the specified situation. NET focuses on healthy
nutritional choices and health promotion and disease prevention topics in school and child care
settings. The Youth Risk Behavior Surveillance System identifies and trends youth risk behavior.
Adult and Child Protective Services assesses and protects children from abuse. REF: Page 593
8.
A school nurse evaluates the implementation of health promotion in a high school staff.
Which of the following indicates a need for more education?
A.
flyer advertising an ice cream and pizza party for the student awards
program Correct
B.
Condoms being provided in all restrooms of the school
C.
D.
While verifying compliance with immunization requirements, a school nurse notices that
three students from the same family have not completed their immunizations. How should the
nurse address this problem?
A.
Discuss with the principal the lack of immunizations
B.
C.
D.
requirements. Correct
Pull the students from class and immunize them.
All states require proof of current immunization status or evidence of immunity unless there is an
exception (religious, moral belief, or medical contraindication). It is the nurse's responsibility to
assess the situation and educate the family. The nurse's responsibility is not to expel the students
or immunize them herself.
REF: Pages 589-590
10.
A goal set by Healthy People 2020 includes education to middle, junior, and senior high
school students in priority areas. These areas include: (Select all that apply.)
A.
lack of physical activity. Correct
B.
C.
D.
E.
An objective of Healthy People 2020 sets a goal that middle, junior, and senior high schools
provide health education courses in priority areas. Centers for Disease Control and Prevention
(CDC) (2012a) identified six high-risk behaviors that need to be targeted in health education
courses. The six behaviors identified by the CDC include: (1) alcohol and drug use, (2) injury
and violence (including suicide), (3) tobacco use, (4) poor nutrition, (5) lack of physical activity,
and (6) sexual behavior that results in sexually transmitted diseases or unwanted pregnancies.
REF: Page 586
=dynamics of workplace
-cooperate culture [culture determines nature of work]
*values
*priorities
*accomplishments
>ISO 14001 Certification: international
standards organization environmental
certification---voluntary program of
excellence to demonstrate a strong
commitment to continuous improvement
-(formal) hierarchy of company
*pyramidal (top-down decision making)
OR
*flat/wide (distributed/de-centralized decisionmaking)
ALONG WITH
-informal/undocumented organizational structure
with pressure to advocate and/or abdicate safety,
health, and environmental (SHE)-based practices
~union presence alters decision making
-measurable SHE-related performance outcomes:
-historical record of OSHA inspections
-injury/illness rates
-worker compensation claims
-environmentally-related citations
-**most important SHE management system is
institutionally-based change management (i.e the processes
& procedures by which a companys managers and
employees make decisions, accept and implement change,
and incorporate the mantra of continuous improvement)
~Describe the influence of work on health and health on work
>healthy worker effect
~workers usually exhibit lower overall death rates than the general pop
because severely ill and disabled people are excluded from employment
~any illness or injury can temporarily or permanently impact an
individuals capacity to work, thus threatening a loss of economic security
& his/her way of life
>vulnerable populations
~(have a) disproportional burden: exposure & disease
Vulnerability:
~who?
susceptibility to
=age/infirmity
harm; more
=race/ethnicity
fragile, less
=socioeconomic disadvantage
resilient and/or
=disabled
less resourceful,
=fetus [most vulnerable], infants, children
the more
>Vocational Rehabilitation Act/Americans with Disabilities Act (ADA): grants
qualified employees the right to workplace accommodations for their permanent
disabilities
See
chart
Contents:
2-Butoxyethanol (7%) 20ppm
Ethanolamine (5%) 3ppm
Potassium Hydroxide (1%)
2mg/m^3
NFPA
2,0,0,0
NFPA
1,1,0,0
Physical Characteristics
pH
12.4-13.8
pH
Health Effects
Acute: Irritant
Chronic: Toxic
Acute: Irritant
Chronic: None
Reactivity
None
None
7.5
-90% water
-2-Butoxyethanol: butyl cellosolve: glycol ether
-**skin notation
>Labels and Placards [Global Harmonization Standards; National Fire Protection
Agency (NFPA)]
~Hazard Ratings
4.) Extreme
3.) Serious
2.) Moderate
1.) Slight
0.) Minimal
Halving thickness:
amount of material to
block half the gamma
rays passing through
NOTE: any material
will block, you just
have to have enough
~Radiation
=Time [want to limit time exposed to the source; maximum time
to spend in presence of radiation a.k.a stay time]
=Distance [doubling distance away reduces exposure to
(inverse square law)]
=Shielding (1/2) [placement of an absorber between the person
and the radiation; interaction within the shield, not
the
worker]
=Dose Units
(Xray) 1 rad= 1 rem= 10mSv
(Neutron) 1 rad= 5-20rem= 50-200mSv
(Alpha) 1 rad= 20 rem= 200mSv
~Radiation Protection/Limiting Exposures [understanding the math]
=Time
-radiation usually specified as a rate (mrem/hour)
-dose: total amount of radiation absorbed relative to its
Radiation Absorbed dose
(Rad): absorbed dose;
biological effect
amount of energy absorbed
-dose rate: rate radiation is absorbed (mrem per hour or
into a material (any type &
mrad per hour)limiting time, limits radiation dose
any material) physical dose
-***dose= time x dose rate [radiation dose received]
Roentgen Equivalent Man
-time= dose/dose rate [time person can spend in a specific
(Rem): equivalent dose;
area without exceeding allowable dose limit]
relates absorbed dose in
=Distance
human tissue to the effective
-reduction in dose depends on the type of radiation emitted
biological damage of radiation
and physical size of the source itself [larger particle,
[rad x quality factor
quicker reactivity, shorter distance it can travel]
(q)/weighting factor]
-line source: dose reduces directly with distance
Sievert (Sv):
2
2
R1 D1 =R2 D2 [inverse square law]
International unit
>R1 (initial rate/dose rate) R2 (new rate)
>D1 (initial distance) D2 (new distance)
-exposure reduction by distance factor
>(larger distance/smaller distance)^2
~multiply by the exposure rate if moving
toward source, divide if moving away
~Recognize the interactive relationship of agents, exposures, and health outcomes in the
context of worker, work, and workplace
>Workplace Standards
>Sometimes the Boss Makes Getting the Work Done Safely Almost Impossible
~Systems Problems
~Corporate Safety Culture
>Ergonomic Hazards in Healthcare
~No Manual Lifting
~Paradigmatic Change in Corporate Safety Culture
~List the hierarchy of strategies used to eliminate and/or reduce occupational injuries &
illnesses
>The Process
~plan intervention(s) by collaborating with stakeholders and utilizing
hierarchal based control strategies
~implement plan strategies with stakeholders participation
~evaluate effects of intervention strategies and modify plan accordingly
=evidence-based; leads to cost-effectiveness & safety
=metric benchmarks defined by OEHN [Occupational & Envir.
Health Network] in terms of levels & types of activities & program
successes, not merely absence of disease/ injury
~communicate
=OEHN makes case for SHE [safety, health & environment] to
business management continuously
Chapter 30
1.
Occupational health nursing is best described as a specialty practice that focuses on:
A.
B.
There was an increase in the number and voice of occupational health nurses
during the years of 1938 to 1943. All of the following occurrences explain the rationale for this
change except:
A.
the U.S. Department of Health and Human Services mandated
occupational health nurses be hired for industrial settings that employed more than 350
people. Correct
B.
a national association for the specialty of occupational health nursing
was created.
C.
D.
workers.
The focus of health care for employees changed as a result of the two world wars, which changed
the demographics of the workforce and increased the need for health services for employees, and
the birth of the first national association for this specialty. The federal government never required
companies to employ occupational health nurses.
REF: Page 603
3.
C.
D.
C.
Which of the following actions of the occupational health nurse is NOT mandated
by state or federal regulations?
A.
Maintaining confidentiality of medical records
B.
C.
D.
Maintaining confidentiality of medical records, reporting occupational injuries and illnesses, and
providing personal protective equipment training are all mandated by law. Sexual harassment
allegations are routinely reported to administrative officials.
REF: Page 606
7.
All of the following are challenges currently facing occupational health nursing
practice except:
A.
a younger workforce. Correct
B.
C.
D.
Escalating health care cost, increased women and minorities in the workforce, and a competitive
international marketplace all contribute to the challenges of occupational health nursing practice.
In addition, an aging workforce also presents a challenge.
REF: Page 617
8.
C.
D.
Legislation passed in the early 1970s that requires employers to provide a place of
employment free from recognized hazards to the employees is correctly referred to as the:
A.
Americans with Disabilities Act.
B.
C.
D.
The Occupational Safety and Health Act was enacted in 1970. The general clause of the Act
states that employers must "furnish a place of employment free from recognized hazards that are
causing or likely to cause death or serious physical harm to employees." The Act also identified
the role of various government agencies such as the Occupational Safety and Health
Administration under the jurisdiction of the Department of Labor.
REF: Page 613
10.
C.
D.
E.