FNP 590 Midterm and Finals Questions with Answers and Explanations. Midterm Ch 1-8 Finals Ch 1-14, 25 CHAPTER 1 Which model of health is most likely used by a person who does not believe in preventive health care? Question options: Clinical model Role performance model Adaptive model Eudaimonistic model The clinical model of health views the absence of signs and symptoms of disease as indicative of health. People who use this model wait until they are very sick to seek care. A person with chronic back pain is cared for by her primary care provider as well as receives acupuncture. Which model of health does this person likely favor? Question options: Clinical model Role performance model Adaptive model Eudaimonistic model The eudaimonistic model embodies the interaction and interrelationships among physical, social, psychological, and spiritual aspects of life and the environment in goal attainment and creating meaning in life. Practitioners who practice the clinical model may not be enough for someone who believes in the eudaimonistic model. Those who believe in the eudaimonistic model often look for alternative providers of care. A state of physical, mental, spiritual, and social functioning that realizes a person’s potential and is experienced within a developmental context is known as: Question options: growth and development. health. functioning. high-level wellness. Health is defined as a state of physical, mental, spiritual, and social functioning that realizes a person’s potential and is experienced within a developmental context. Which US report is considered a landmark document in creating a global approach to health? Question options: The 1990 Health Objectives for the Nation: A Midcourse Review Healthy People 2020 Healthy People 2000 The U.S. Surgeon General Report Healthy People 2000 and its Midcourse Review and 1995 Revisions were landmark documents in which a consortium of people representing national organizations worked with US Public Health Service officials to create a more global approach to health. Which of the following represents a method of primary prevention? Question options: Informational session about healthy lifestyles Blood pressure screening Interventional cardiac catheterization Diagnostic cardiac catheterization Primary prevention precedes disease or dysfunction. It includes health promotion and specific protection and encourages increased awareness; thus, education about healthy lifestyles fits this definition. Blood pressure screening does not prevent disease, but instead identifies it. Which of the following represents a method of secondary prevention? Question options: Self–breast examination education Yearly mammograms Chemotherapy for advanced breast cancer Complete mastectomy for breast cancer Screening is secondary prevention because the principal goal of screenings is to identify individuals in an early, detectable stage of the disease process. A mammogram is a screening tool for breast cancer and thus is considered a method of secondary prevention. In reviewing a person’s medical claims, a nurse realizes that the individual with moderate persistent asthma has had several emergency department visits and is not on inhaled steroids as recommended by the NHLBI asthma management guidelines. The nurse discusses this with the person’s primary care provider. In this scenario, the nurse is acting as a(n): Question options: advocate. care manager. consultant. educator. Care managers act to prevent duplication of service and reduce cost. Care managers base recommendation on reliable data sources such as evidence-based practices and protocols. During a home visit, a nurse assists an individual to complete an application for disability services. The nurse is acting as a(n): Question options: advocate. care manager. consultant. educator. The advocacy role of the nurse helps individuals obtain what they are entitled to receive from the health care system, tries to make the system more responsive to individuals’ community needs, and assists individuals in developing skills to advocate for themselves. During a home visit, a nurse discusses the dangers of smoking with an individual. In this scenario the nurse is acting as a(n): Question options: advocate. care manager. consultant. educator. Health education is a primary prevention technique available to avoid major causes of disease. Teaching can range from a chance remark to a planned lesson. A nurse is asked to provide an expert opinion about the development of an education program for newly diagnosed diabetics. In this scenario, the nurse is acting as a(n): Question options: advocate. care manager. consultant. educator. Nurses with a specialized area of expertise provide education about health promotion and disease prevention to individuals and groups as consultants. A nurse is planning to deliver an educational program to individuals with diabetes. Which of the following should be the initial action taken by the nurse to ensure the success of the program? Question options: Assess the motivation level of the individuals Assess the knowledge level of the individuals Establish teacher-learner goals with the individuals Establish multiple teaching sessions with the individuals Selection of the methods most likely to succeed involves the establishment of teacher-learner goals. Thus, the first step by the nurse should be establishment of goals. A nurse who uses findings from a randomized, controlled trial on the care of Foley catheters to change practice at an institution is practicing: Question options: evidence-based medicine. qualitative research. quantitative research. clinical judgment. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. Which of the following is most influenced by the social and economic environment of a community? Question options: Social health policies Quality of care Evidence-based practice Practice guidelines Social policies concerning health are influenced by the social and economic environment of a population. Analysis of population trends and projections is necessary to help health professionals determine changing needs. A major cause of death in the early twentieth century was: Question options: cancer. cerebrovascular disease. heart disease. infections. Infections and acute disease were the major causes of death in the early part of the twentieth century. Which of the following demonstrates a nurse taking action to promote health and prevent disease? Question options: Making a home visit to a person who is recovering from a heart attack Administering medications to a cardiac client in the hospital Providing cardiopulmonary resuscitation during a heart attack Educating a person about the advantages of a heart-healthy diet during a home visit Solutions for health promotion are focused on individual and government involvement. To promote health and wellness, an emphasis must be placed on primary prevention. This is often related to actions such as education that influence lifestyle choices. In the preceding example, educating a person about the advantages of a heart-healthy diet during a home visit serves to influence lifestyle choices. Which factor may have the most influence in changing the health behavior of a single, adult woman who smokes and is the care provider for her mother, her own children, and granddaughter? Question options: Education regarding effects of smoking on her health The satisfaction that she will not contribute to secondhand smoke The availability of a weekly support group A gift card for $10 to a local grocery store for every week she is smoke free Motivational factors play a role in influencing attitudinal changes. A financial incentive is an example of a motivating factor. For this woman, who is financially responsible for the health and well-being of other individuals, finances will likely play a significant role in motivating her actions. Remember that education regarding the benefits of not smoking is not enough. Thus, the $10 gift card may have the most influence in changing her health behavior. An example of a Hispanic American nurse promoting cultural competency is: Question options: providing translation services for all Hispanic Americans. focusing on episodic care of illnesses with Hispanic Americans. taking a class about the Hispanic American culture. providing care for all Hispanic American persons in her clinic. Nurses must be aware of their beliefs, values, and customs. They should not assume that their perspective is correct and shared by others. Additionally, they should avoid stereotyping. Broadening one’s educational base regarding cultural beliefs is a way to develop and thus promote cultural competency. The devaluing of beliefs, values, and customs of others is known as: Question options: ethnocentrism. racism. cultural competency. empathy. Racism is defined as the devaluing of beliefs, values, and customs of others. Building a partnership with an obese individual who is trying to lose weight requires the nurse to: Question options: schedule a day to exercise with the individual. go grocery shopping for the individual. learn about the methods of weight loss. give the individual a weight loss goal. Nurses must work with individuals to determine what they are willing to do to lose weight. To do this successfully, nurses must know what options are available to the individuals for weight loss. Once nurses learn about the methods of weight loss, they can then develop goals for weight loss with the individual. Assuming that an individual’s own perspective is correct and shared by others is known as: Question options: ethnocentrism. racism. cultural competency. empathy. Assuming that an individual’s own perspective is correct and shared by others is known as ethnocentrism. CHAPTER 2 A person states, “My grandmother is the decision maker in our family.” Which of the following is being described by the person? Question options: Culture Race Ethnicity Values Culture, as an element of ethnicity, refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. The term “ethnicity” encompasses more than a cultural practice, which is what is being described by the person; it focuses on differences in meanings, values, and ways of living. Race is associated with power and indexes the history or ongoing imposition of one’s group’s authority above another. Values are beliefs about the worth of something and serve as standards that influence behavior and thinking. The nurse recommended to a 50-year-old woman that she schedule a routine mammogram. Which of the following would be the most important factor in this woman’s decision to schedule this exam? Question options: Race Ethnicity Cultural values Value orientation Cultural values guide actions and decision-making that facilitates self-worth and self-esteem. They shape human behaviors and determine what individuals will do to maintain their health status, how they will care for themselves, and others who become ill, and where and from whom they will seek health care. Race is associated with power and indexes the history or ongoing imposition of one’s group’s authority above another. Ethnicity focuses on differences in meanings, values, and ways of living. Value orientations reflect the personality type of a particular society. Which of the following actions demonstrates a health care professional providing culturally competent care? Question options: Encouraging the person to take medications as prescribed Asking the person to describe his folk healing methods Demonstrating the proper way to administer an insulin injection Assisting the person with discussing his health problems with the family It is very important for health care providers to be aware of how people interpret their health issues or illnesses to be capable to provide culturally competent care. A culturally competent health care professional should be able to consistently and thoroughly recognize and understand the differences in his or her culture and that of the patient or client, to respect the person’s values and beliefs, and adjust the approach of delivering care to meet each person’s needs and expectations. Asking the person to describe his folk healing methods is the only action that demonstrates the health care professional seeking input from the person into the care that is received. A person reports that she has been seeking care from an acupuncturist to help relieve the chronic pain that she has been experiencing. Which of the following statements would be the most appropriate response from the nurse? Question options: “You should have told me that the current treatments were helping your pain.” “Tell me more about your treatments from the acupuncturist.” “Tell me why you decided to not to continue with your treatment plan.” “You should not be seeing an acupuncturist while receiving professional care.” Through a culturally sensitive assessment process, nurses can determine what specific remedies individuals are using and whether their continued use would interfere with the prescribed method. The nurse asking the person to describe the treatments from the acupuncturist allows the nurse to learn this information. The other responses demonstrate an ethnocentric perspective by the nurse, viewing the treatments from the acupuncturist as inferior to professional care. When providing an educational session about the Arab American population, which of the following information would be included? Question options: The largest group of Arab Americans was refugees in the 1960s. The largest groups of Arab Americans are from Palestine and Iraq. Members of the Arab American population are most likely to live in rural communities. Members of the Arab American population are more likely to have college degrees than Americans at large. Members of the Arab American population are more likely to have college degrees (+45%) than Americans at large (28%). About 94% of Arab Americans live in metropolitan areas. The largest groups of Arab Americans are the Lebanese, Syrians, and Egyptians. Arab Americans came to the United States in three immigration waves; the last occurred in the 1960s and consisted of many professionals, entrepreneurs, and skilled and semiskilled laborers. A health care professional is caring for an Arab American individual. Which of the following cultural practices of this ethnic minority should be considered when planning care? Question options: This ethnic culture tends to be future oriented. Religion plays an important role in this culture. Traditional cultural practices are infrequently used during a health crisis. Members of this culture tend to have smaller families. Religion plays an important part in Arab culture, and there are dietary rules and prescribed rituals for praying and washing. Arab Americans are present oriented and view the future as uncertain. During a health crisis, many Arab Americans seek out their family, community, and traditional values and cultural practices. Arab American families are, on average, larger than non–Arab American families. An Asian American family has recently immigrated to the United States. Which of the following would provide an appropriate rationale when encouraging the family to send their child to school? Question options: The child will get a good education. According to law, all children must go to school. The child can get health care at school. Exposure to different cultures in school will enhance socialization. Exposure to different cultures in school facilitates the adoption of other cultural beliefs and aids in the socialization of the child into a new environment. Which of the following was the fastest-growing minority group in the United States between 2000 and 2010? Question options: Asian American Arab American Hispanic American Native American A 43% increase in the Hispanic population between 2000 and 2010 makes Hispanics the fastest-growing minority group in the United States. The interrelationship of poverty and health care dollars spent by Blacks and other minorities is affected greatly by: Question options: lack of access to preventive health care services low numbers of minority health care providers use of emergency rooms for care increased infant mortality rates in African American populations A decrease in resources for preventive care leads to the use of emergency rooms and other more expensive health care services that are often used as resources when severe illness occurs. A health care provider is working with an African American woman who has recently suffered a stroke and is homebound. She insists that she must get out of the house and attend Sunday worship services. What is the most likely explanation for her insisting that she participate in this cultural practice? Question options: The church is the only place where prayer can be performed. The church serves as a social support for its members. The church is the place where the family meets on a weekly basis. The church serves as a site for folk healing practices. The church is significant support system many African Americans. It serves many purposes beyond worship and formation, including serving as a place to meet where members could pass news, take care of business, and find strength of purpose; providing direct social welfare services; acting as a stabilizing force in the community; facilitating citizenship training and community social action; serving as a transmitter of cultural history; and providing the means for coping and surviving in a hostile world. African Americans often find comfort in the support their religious leader can give them, but it does not have to happen within the church. African Americans believe in the healing power of prayer, but that can happen outside of the church as well. Family is the strongest source of support for African Americans, and most meet more often than weekly at church. Which of the following ethnic groups has a disproportionately high death rate from unintentional injuries and suicide? Question options: American Indian/Alaska Native Americans Asian Americans Latino/Hispanic Americans Black/African Americans American Indian/Alaska Native Americans have disproportionately high death rates from unintentional injuries and suicide. Difficult life situations and stresses of daily life contribute to an array of problems, including feelings of hopelessness, desperation, family dissolution, and substance abuse. A health care professional is offering an educational session about providing culturally congruent care. Which of the following information would be included the presentation? Question options: Hispanic Americans value keeping balance and harmony with the earth. The oldest male is the decision maker in African American families. Native Americans are present oriented, taking one day at a time. The hot and cold concept of disease is part of the Asian American culture. Native Americans are generally present oriented, emphasizing events that are occurring now rather than events that will happen later. They take one day at a time and in times of illness they cope by hoping for improvements the next day. Native Americans value keeping balance and harmony with the earth. The oldest male is the decision maker and spokesperson in Asian American families. The hot and cold concept of disease is part of the Hispanic culture. A family has recently become homeless. Which of the following factors most likely contributed to this situation? Question options: Being from an ethnic minority background Declining rates of poverty Having multiple chronic illnesses Being unable to find affordable housing The inability to find affordable housing, decline in public assistance, poverty, and eroding work opportunities all contribute to homelessness. The increasing prevalence of poverty has caused an increase in the homeless population. Other factors that may affect this situation are lack of affordable health care, domestic violence, mental illness, and addiction disorders. A health care professional is caring for an individual who is homeless. Which of the following considerations should be made? Question options: The prevalence of substance abuse is much lower among the homeless population than the general population. The prevalence of HIV/AIDS is much lower among the homeless population than the general population. The percentage of the population who has health insurance is much lower among the homeless than the general population. The percentage of the population who has limited access to medical care is much lower among the homeless than the general population. Most homeless people do not have health insurance or the ability to pay for needed health care, and many providers refuse to deliver treatments to these people. The prevalence of substance abuse, HIV/AIDS, and mental health disorders is higher among the homeless population than the general population. A health care professional is leading a community action coalition to address the problem of homelessness within the neighborhood. Which of the following statements would most likely be made by health care professional? Question options: Homelessness should be addressed by improving financial assistance programs. Homelessness should be of concern to everyone in the neighborhood. Homelessness should be addressed by encouraging job growth in the area. Homelessness should be of concern to the mental health providers in the area. Homelessness is everyone’s problem, and people can ultimately affect the establishment of priorities to facilitate an improved quality of life. As more people understand homelessness, this will serve as an excellent guide in providing input, taking necessary action, and making the final decision as to what will make a healthy nation. A health care professional is searching for a funding source to develop a colorectal cancer screening program for ethnic and racial minorities in the community. Which of the following federal agencies would most likely be able to assist with this initiative? Question options: The National Institute on Minority Health and Health Disparities The Centers for Disease Control and Prevention The Office of Minority Health The National Institutes of Health The Office of Minority Health improves and protects the health of racial and ethnic minority populations through the development of health policies and programs that concentrate on eliminating health disparities. The National Institute on Minority Health and Health Disparities, The Centers for Disease Control and Prevention, and National Institutes of Health all address health disparities among racial and ethnic minorities, but their priority is not in funding these initiatives. Which of the following best demonstrates the practice of transcultural nursing? Question options: Using previous knowledge about ethnic minority cultures to plan care Adapting nursing care to meet the need of a person from an ethnic minority Requesting an interpreter when caring for a person from an ethnic minority Attending a presentation about cultural diversity Transcultural nursing is defined as an area of nursing study and practice that focuses on discovering and explaining cultural factors that influence the health, well-being, illness, or death of individuals or groups and seeks to provide culturally based appropriate care to people of diverse cultures. Adapting nursing care to meet the needs of a person from an ethnic minority best meets this definition of transcultural nursing. A nurse may initially use previous knowledge about minority cultures to plan care, but then must individualize the care based on individual differences within the culture. Having an interpreter present will not be necessary when working with all persons from ethnic minorities. Attending a presentation about cultural diversity would assist the nurse in becoming more culturally competent, but it is not the best example of practicing transcultural nursing because no nursing care is being provided when attending a presentation. A nurse would like to improve his cultural competence. Which of the following is the best strategy to use? Question options: Explore complementary and alternative medicine practices used by other cultures. Discuss cultural differences with coworkers. Provide care to diverse populations. Participate in continuing education programs about cultural diversity. Salman et al. (2007) assessed cultural awareness and cultural competence levels among staff nurses who participated in a continuing education program aimed at increasing knowledge of culturally competent care of geriatric populations. Staff nurses who participated in this training program had higher cultural competence levels as compared with those who did not join this training program. Exploring complementary and alternative medicine practices used by other cultures will assist if a nurse is using these practices; however, depending on whom the nurse is caring for, this information may have limited usefulness. Discussing cultural differences with coworkers may help the nurse learn about other cultures, but it may not provide the best source of information. Providing care to diverse populations may not help the nurse to become more culturally competent without having some baseline knowledge about cultural diversity. A nurse is told by a colleague that an Asian American individual on home care is using complementary and alternative medicine (CAM). Which of the following conclusions can accurately be drawn from this statement? Question options: The client will have adverse complications from using this form of medicine. The client may be using meditation, acupuncture, or another therapy. The client will soon be returning to his or her native country for further treatment. The client does not agree with the current professional care medication regimen. Examples of complementary and alternative medicine (CAM) include acupuncture, feedback, relaxation, music therapy, massage, art, music, and dance therapy. Persons who do not experience relief from chronic conditions often resort to complementary alternative medicine. It is important the nurse learn more about the CAM that the person is using so that any potential interactions between the use of CAM and professional care can be addressed. Complementary and alternative medicine can be used in conjunction with the use of professional care. A woman reports that she has strong spiritual practices. Which of the following is she most likely to experience? Question options: Improved coping skills and social support Increased understanding of religious differences Decreased pain and improved healing Decreased use of Western medicine Spiritual practices are likely to improve coping skills and social support, promote feelings of optimism and home, encourage healthy behavior, decrease feelings of depression and anxiety, and support a sense of relaxation. CHAPTER 3 Which addition to a community best demonstrates the concept of the Healthy People 2020 report? Question options: New cardiothoracic intensive care unit at a major hospital New rehabilitation center New recreational health center New children’s hospital The Healthy People 2020 report promotes health care, not illness care. A hospital, ICU, and rehabilitation center emphasize episodic care after an illness. The recreation health center serves to preserve health in the community and helps meet the goals of the Healthy People 2020 report. Which nurse is at risk of making a medical error? Question options: Working overtime Works in a hospital that advocates multidisciplinary care Caring for four clients during the shift Attends regular continuing education programs Health care systems are the basic cause of medical errors. Organizational and workforce management, work design, and organizational culture are problem areas that contribute to medical errors. Poor management leads to increased nurse turnover, the need for increased client-to-nurse ratios, increased need for overtime, and decreased number of nurses, all of which can lead to medical errors. A nurse working overtime is at risk of making a medical error. What is the most effective policy a staff nurse can implement to help decrease medical errors on the unit? Question options: Forgo opportunities for continuing education so the unit is never understaffed. Foster a collaborative working environment on the unit. Check all medications a minimum of three times before administering them. Develop a policy that mandates the firing of any nurse who commits an error. Health care systems are the basic cause of medical errors. Organizational and workforce management, work design, and organizational culture are problem areas that contribute to medical errors. Creating a collaborative working environment helps improve organizational culture, thereby reducing the chance of medical errors. The person known as the father of British and American public health is: Question options: Lillian Wald. Edwin Chadwick. Lemuel Shattuck. Paul Ehrlich. A community planning committee is working on the development of a community nursing center. Which of the following essential components should be included in this center? Question options: Physician as medical director Interdisciplinary staff Nurse as chief manager Partnership with an academic institution The essential components of a community nursing center include a nurse as chief manager, a nursing staff that is accountable and responsible for care and professional practice, and nurses as the primary providers of care. Considering the provider and client perspective, which of the following is the most autonomous form of insurance? Question options: Fee-for-service plan Health maintenance organization (HMO) Preferred provider organization (PPO) Independent practice association (IPA) In the fee-for-service plan, a provider provides a service and bills the individual’s insurance company. The individual is also allowed to choose his or her provider. Which health care provider represents a primary care provider? Question options: Psychiatric advanced practice nurse Clinical nurse specialist Pediatric nurse practitioner Acute care nurse practitioner A primary care provider serves as a gatekeeper, coordinating care of individuals by determining the need for referrals and procedures. A primary care provider can be a physician, physician’s assistant, or advanced practice nurse in a primary care setting. The primary care provider provides basic and routine care usually in an office or a clinic. A pediatric nurse practitioner is an example of a primary care provider. Which form of managed care restricts providers to caring for individuals who are members of their organization? Question options: Fee-for-service plan Health maintenance organization (HMO) Preferred provider organization (PPO) Independent practice association (IPA) The traditional HMO was a group or staff model in which a group of physicians and some specialty services provided care to its members. Providers generally spent all their time serving members of the HMO. Fee-for-service, IPAs, and PPOs are not restricted to serving clients for any one organization. A Medicare client reports to the home care nurse that he is receiving care through an accountable care organization (ACO). Which of the following considerations should be made when delivering care to this individual? Question options: The individual must see a primary care provider before being referred to a specialist. The focus of care is prevention and management of individuals with chronic disease. The individual has paid a membership fee to be part of this organization. The focus of care is to conserve money in a health savings account. The focus of care of accountable care organizations (ACOs) is to focus on prevention and management of individuals with chronic disease out of the hospital. In an ACO, physicians accept the responsibility for the quality of care provided and overall costs of delivering care to a defined population of patients. Accountable care organizations are composed of physicians, specialists, and hospitals, so a specialist will be able to be seen within the ACO. Individuals who are part of concierge care pay a membership fee in return for enhanced health care services or amenities. Health savings accounts are used in conjunction with high deductible health insurance plans and are not related to the use of ACOs. Which of the following is a health plan consisting of hospitals and physician providers providing health care services to plan members (usually at discounted rates) in return for expedited claims payment? Question options: Health maintenance organization (HMO) Health savings account (HSA) Preferred provider organization (PPO) Independent practice association (IPA) A health plan consisting of hospitals and physician providers providing health care services to plan members (usually at discounted rates) in return for expedited claims payment is known as a preferred provider organization (PPO). A nurse complies with the Patient Self-Determination Act when asking: Question options: a person upon admission to the hospital if he or she has an advanced directive the family in the recovery room if the client has an advanced directive a person before discharge from the hospital if he or she has an advance directive the family about an advanced directive after the person has been intubated The Patient Self-Determination Act is designed to increase individual involvement in decisions about life- sustaining treatments. The nurse must ensure that advanced directives are available to physicians at the time the medical decision is being made. Therefore, the nurse complies with the act when she asks a person upon admission to the hospital if he or she has an advanced directive. Which is a violation of the Health Insurance Portability and Accountability Act of 1996? Question options: Nurse reporting a case of TB to the health department Nurse reporting a case of child abuse to the Department of Human Services Nurse discussing the person’s case with his or her physician Nurse discussing the person’s case with his or her school nurse The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal privacy standard that requires safeguards to protect the security and confidentiality of health information. Disclosures without individual authorization are allowed only to public health authorities authorized by law to collect and receive information for the purpose of preventing or controlling disease, injury, or disability. Before speaking to the school nurse, the nurse must obtain authorization from the client’s parents. Which nurse is functioning as a care manager? Question options: Nurse working with a family to coordinate care after their child experiences a second hospitalization for an asthma exacerbation Nurse providing asthma education in the office setting to a child with moderate, persistent asthma Nurse administering the appropriate antiinflammatory medication to a child admitted to the hospital with an asthma exacerbation Nurse making a home visit for a respiratory assessment to a child following an admission for an asthma exacerbation Care managers help determine what medical care is necessary, monitor care, and arrange for individuals to receive the most cost-effective care in the most appropriate settings. They must collaborate with providers and with the client/family. Care managers are especially helpful following a client after discharge and clients with complex needs. A nurse working with a family to coordinate service after a hospitalization is a good example of services provided by a care manager. A pregnant woman with two toddlers living at less than 135% of the federal poverty level would be eligible for: Question options: Medicare Part A Medicare Part B Medicaid State Children’s Health Insurance Program (SCHIP) State Medicaid programs must cover all pregnant women and children up to 6 years of age with a family income of less than 133% of the federal poverty level. States Children’s Health Insurance Program provides insurance coverage to children whose family income is below 200% of the federal poverty level or whose income is 50% higher than the state’s Medicaid eligibility threshold. In this case, the woman is pregnant, her children are under the age of 6, and they meet the financial criteria for Medicaid but not SCHIP. Which of the following is a major factor limiting health care services in the United States? Question options: Lack of nurses Lack of health care facilities Lack of funding Lack of client interest in health promotion The lack of nurses may prevent health care providers from offering health promotional education activities. The cost of health care and prescription drugs is a major limitation to health care services. The United States has the highest proportion of population with no health insurance, thereby limiting health care services available to Americans. Which person is at highest risk for being uninsured? Question options: 68-year-old retired mailman 48-year-old on renal dialysis 2-year-old whose parents work but do not have benefits through their employers 27-year-old who attends college and works part time in a small pizza parlor Young adults (27 years of age or older) are not eligible to be covered under their parents’ insurance. Medicare is available for those over the age of 65 and for people who require dialysis. Medicaid and SCHIP are available for children whose families meet the financial requirements. This child would likely meet criteria for either Medicaid or SCHIP because the parents are considered working poor. Because health care insurance is so expensive, it would be difficult for a 27-year-old to afford his or her own plan. Young adults often go without insurance because of the high costs. Adoption of a Canadian-style health care system in the United States has the potential to: Question options: decrease waiting times for tests and procedures. create further health disparities. increase the number of HMOs. increase the amount of funding available for health care. Canadians with private health insurance and higher incomes have access to greater health care services and more expedient health care. This translates to a two-tier system of health care, which can contribute to health disparities in health care access and quality. A system used to evaluate the necessity, appropriateness, and efficiency of the use of the health care system, the purpose of which is to lower costs by discouraging unnecessary treatments, is known as: Question options: managed care gate keeping utilization review capitation A system used to evaluate the necessity, appropriateness, and efficiency of the use of the health care system, the purpose of which is to lower costs by discouraging unnecessary treatments, is known as utilization review. The country with the lowest infant mortality rate in 2011 was: Question options: Canada Mexico Sweden the United States Sweden had the lowest infant mortality in 2011 with a mortality rate of 2.74 per 1000 live births. The country with the highest life expectancy for women in 2011 was: Question options: France Germany Sweden the United States France was the country with the highest life expectancy for women (85 years of age) in 2011. CHAPTER 4 Which of the following statements about values is true? Question options: It is impossible for someone to understand his or her values. Values evolve over time; they are not static. Values assimilated in childhood are those held for a lifetime. Values clarification tells a person how to act. Values take time to develop, and they may change with education, experience, exposure, or a combination of these. A nurse is providing education about improving self-awareness to a small group of women who have been victims of domestic violence. Which of the following should the nurse recommend the clients do first to improve their self-awareness? Question options: Use self-disclosure to share aspects of self. Listen to and learn from others. Listen to oneself and pay attention to emotions, thoughts, and reactions. Use others to bounce back your own thoughts and recollections. To achieve a high self-awareness, three steps must be taken. The first step is listening to oneself and paying attention to emotions, thoughts, memories, reactions, and impulses. The second step is listening to and learning from others. The third step is using self-disclosure to share aspects of self. The nurse shares with her client the news that she, the nurse, is going to be married soon and tells the client about her wedding plans. Which of the following best describes the nurse’s actions? Question options: The nurse is sharing inappropriate personal information with her client. The nurse is exhibiting a communication technique called self-disclosure. The nurse is attempting to show empathy with her client. The nurse is violating client confidentiality rights of the Health Insurance Portability and Accountability Act (HIPAA). Sharing aspects of the self enriches interpersonal life and is a use of the technique labeled self- disclosure. A nurse has started admitting a new person on home care and is beginning to establish a relationship. Which of the following would be the most important thing for the nurse to do? Question options: Complete the paperwork in a timely fashion Establish open communication Conduct a complete physical health assessment Provide feedback to the person’s questions Communication is the foundation for any professional relationship. It is the cornerstone of a positive nurse-person relationship. It refers to a set of strategies and actions to enhance reciprocity, mutual understanding, and decision making. Which of the following best describes person-centered communication? Question options: The nurse says to the person seeking care, “Why do you continue to drink when you know it is not good for you?” The nurse responds to person seeking care’s request for pain medicine by saying, “It is not time for your pain medicine. You had it hours ago.” The client says to the nurse, “I think my husband is cheating on me.” The nurse responds by saying, “You think your husband is cheating on you?” The client says to the nurse, “I can’t believe I have cancer.” The nurse responds by saying, “One of my closest friends had cancer and had to have chemotherapy.” The nurse recognizes that the person seeking care has some concerns that she would like to discuss and paraphrases her statement to give the person an opportunity to elaborate on thoughts that are important to him or her. A nurse is counseling someone who has recently been diagnosed with diabetes. The nurse says, “Tell me more about how this diagnosis has affected your daily activities.” Which of the following best describes the type of communication the nurse is using? Question options: Verbal communication Nonverbal communication Metacommunication Functional communication Verbal communication is the transmission of messages using words, spoken or written. Nonverbal communication encompasses all messages that are not spoken or written. Metacommunication refers to a message about the message, the relationship aspect of communication. Which of the following statements about nonverbal communication is true? Question options: Nonverbal behavior is not usually contextual. Nonverbal behavior is culturally and situationally bound. Nonverbal communication is the most important type of communication. Nonverbal communication is easy to interpret. Cultural exposure and situational impact are essential components of interpreting nonverbal communication and must be taken into consideration in attempts to interpret nonverbal communication. Which of the following scenarios best describes a nurse using metacommunication? Question options: Using both touch and silence when counseling an individual Practicing reflection when interaction with an individual Discussing with an individual how to solve a problem Understanding that an individual needs a break before proceeding Metacommunication refers to a message about the message. It is the relationship aspect of communication. In a sense, it involves reading between the lines or going past the surface content of the message to glean nuances of meaning. Which of the following statements can be identified as a method for clarifying a message? Question options: “I get very upset when you talk to me in that tone.” “You make me very angry when you drink alcohol.” “I can make you happy. I know I can.” “What I want from you is to be left alone!” Use of “I” statements is one technique that can be used for clarifying and qualifying messages. A nurse and a man are involved in a conversation. When the person folds his arms across his chest, the nurse almost simultaneously folds her arms across her chest. This behavior is recognized as: Question options: empathy. reciprocity. flexibility. spacing. The patterning of similar activities within the same interval by two people can facilitate communication. This patterning is known as reciprocity. A nurse and her client are engaged in meaningful conversation when suddenly there is silence between the two. To facilitate effective client-centered communication, the nurse should: Question options: ask the person what he is thinking, so they can understand each other. restate what the person said before silence ensued, to get clarification. change the subject to one that is more pleasant for the person to discuss. wait quietly to give the person time to reflect where he wants to lead the conversation. Silence allows the person to reflect on what is being discussed or experienced and lets him or her know that the nurse is willing to wait until he or she is ready to say more. A person has just been admitted to the hospital. In talking with the person, the nurse is able to elicit from her that the reason for her hospitalization is that her husband beat her up. Which characteristic of the therapeutic relationship is being demonstrated? Question options: Empathy Trust Rapport Purposeful communication The nurse focuses communication for a particular aim: to obtain information to be used in care of the person. An individual reveals to the nurse that he is having an affair with his wife’s best friend. Which of the following statements will enhance effective therapeutic communication between him and the nurse? Question options: “You know that what you are doing is wrong.” “Why would you want do something like that?” “How could you do that to your wife and children?” “This affair seems to be troubling you.” The nurse is seeking to determine the client’s own feelings about his affair. By seeking feedback, the nurse helps explain the meaning further. The nurse suspends judgment and responds in such a way as to encourage him to keep talking rather than make judgments about his behavior, which would shut down communication. A nurse is working with a person to increase his daily exercise and activity. Which of the following statements by the nurse best demonstrates the use of reflection? Question options: “I have also struggled with finding time to exercise on a regular basis.” “Regular exercise plays an important role in preventing many health problems.” “You said that you have difficulty making time in your day for exercise.” “It may be helpful if we developed a goal related to daily exercise. “ Reflection is the restatement of what the individual has said in the same or different words. This technique can involve paraphrasing or summarizing the person’s main point to indicate interest and to focus the discussion. It is the selective paraphrasing or literal repetition of the person’s words to underscore the importance of what has been said, summarize a main concern or theme, or elicit elaborated information. A woman tells the nurse that she is very nervous about their meeting today. Which of the following relationship stages are the nurse and woman most likely experiencing? Question options: Orientation phase Working phase Therapeutic phase Termination phase The orientation phase begins when the nurse and individual meet. This meeting typically involves some feeling of anxiety because neither party knows what to expect. Which of the following is the first step in the valuing process? Question options: Acting out the choice Selecting from alternatives Being happy with personal beliefs and actions Choosing freely The seven-step valuing process involves (1) choosing freely, (2) choosing from alternatives, (3) choosing after careful consideration of potential outcomes of each alternative, (4) cherishing and being happy with personal beliefs and actions, (5) affirming the choice in public, when appropriate, (6) acting out the choice, and (7) repeatedly acting in some type of pattern. The nurse makes sure that the distance between himself and the client is at least 6 feet before he begins to ask questions related to the client’s health history. Which of the following statements is true? Question options: This is the ideal space for intimate communication. This distance is too far for the nurse to build a therapeutic relationship while obtaining the information. This is the recommended distance between client and nurse for effective therapeutic communication. The nurse should position himself an additional foot away to facilitate the conversation. Personal space of 18 inches to 4 feet is appropriate for close relationships in which touching may be involved and good visualization is desired. A nurse is working on values clarification with a person who has chosen to smoke during her pregnancy. Which of the following statements would be the most appropriate for the nurse to assist in this process? (select all that apply) Question options: “Why do you smoke cigarettes? “What do you value most in life?” “Who has influenced your decision to smoke?” “Is your decision to smoke consistent with your values?” Techniques to clarify values include assisting the person to identify her own values (“What is important to you?”), identify values conflicts or conflicts between values and actions (“Are your actions consistent with your values?”), and using reflection to restate the value and make it explicit. A nurse is in the process of establishing a therapeutic relationship with a person. Which of the following techniques should be used by the nurse? (select all that apply) Question options: Learn about the person’s interests. Sit close to the person. Show interest in the person’s concerns. Define the parameters of the relationship with the person. Purposeful communication should be an aim of the therapeutic relationship. Social chitchat, communication without a goal, should not make up the bulk of the therapeutic interaction. The amount of space between communicators varies from culture to culture, so sitting close to the person may not be culturally appropriate. Building rapport by showing the person that his or her concerns interest the nurse is important. Also, trust can be built with the person by clearly defining the relationship parameters and expectations. Which of the following is an essential question that nurses should encourage individuals to ask at every health visit? (select all that apply) Question options: “What is my main problem?” “What health information do I not understand?” “What do I need to do?” “What is the plan for the next visit?” Health literacy is the capacity to read, comprehend, and follow through on health information; it is a critical component of health promotion. To combat low health literacy, nurses can encourage individuals to ask three essential questions at every health visit: “What is my main problem?” “What do I need to do?” “Why is it important for me to do this?” CHAPTER 5 Which of the following statements is true with regard to health promotion? Question options: Health promotion efforts are not concerned with addressing environmental obstacles to health. Advocates of health promotion are not involved in political campaigns against harmful products. The business of eliminating health disparities is a unique function of Healthy People 2010 goals. Health promotion involves collaboration of many professional groups. Health promotion is not the province of a single discipline but involves individuals, health care providers, and institutions working together to create a positive environment for health and to achieve health goals. Which of the following types of ethical theories tells us how people act toward each other and their environments and what they believe are good or moral actions? Question options: Descriptive value theories Normative theories Consequentialism theory Duty-based theories Descriptive theories do not tell us what actions we ought to take. They are not directive; they tell us how people act toward each other and their environments and what they seem to believe are good or moral actions. A nurse includes the statement, “Treat others the way you would like to be treated.” when teaching a group of adolescents about bullying. Which type of ethical theory is being used in this example? Question options: Descriptive value theory Normative theory Consequentialism theory Duty-based theory Normative theories are concerned with ensuring good actions. They are reasoned explanations of the moral purpose of human interactions, or they are divinely “revealed” truths about good action (religious ethics). A nurse believes that it is his responsibility to ensure the safety of the public by administering flu shots to everyone in the community. Which ethical theory is being used by the nurse? Question options: Descriptive value theory Normative theory Consequentialism theory Duty-based theory Consequentialism theory proposes that actions are good insofar as they are aimed at yielding the greatest amount of happiness or pleasure or cause the least amount of harm or pain to individuals and overall in society. Administration of flu vaccines proposes the best result for individuals and decreased risk for others in the community. Which of the following statements best describes the application of moral or ethical theory to the practices involved in health promotion? Question options: One can be assured of morally correct action in a given situation if one adheres to a theory of moral principles. There are no identifiable criteria that can be used effectively to determine correct actions in a given situation. The good of the larger population always takes precedence over the good of one individual. Making ethical decisions regarding human health involves the consideration of multiple factors. Making moral or ethical decisions about human health is not an easy task and requires assessing various criteria or theories. An emergency department provides care for all individuals regardless of circumstances and ability to pay. This is an example of: Question options: ethic of justice. ethic of care. applied ethics. metaethics. The ethic of justice is impartial and nondiscriminatory. An ethic of care, however, requires an understanding of situational particularities, ensuring that we try to understand a given individual’s needs in the context of his or her life. A nurse uses ethical reasoning to solve an ethical dilemma. Why would the nurse use this process? Question options: Assists in predicting all of the possible consequences of future actions Facilitates gathering of the most important information to solve the problem Considers the importance of caring when solving the problem Highlights salient aspects of future actions The purpose of ethical inquiry is to gain clarity on actual or potential moral issues arising in the context of health-promotion endeavors and to understand what is expected of the health-promotion agent viewed as a moral agent. Ethical reasoning can facilitate appropriate and in-depth data gathering, permit the uncovering of hidden agendas and interests, and focus on the most salient aspects of a particular problem. A nurse whose religious beliefs prohibit abortion has been asked to participate in a termination of the pregnancy of a 16-year-old victim of date rape. According to the revised American Nurses Association’s (ANA’s) Code of Ethics for Nurses, which of the following actions should the nurse take next? Question options: Suspend her religious beliefs and provide comfort and support for the client. Quit her job and find another source of employment. Notify her supervisor about her beliefs and request a change in assignment. Refuse to participate in the abortion. In the immediacy of the situation, the ANA Code of Ethics provides for the right of nurses to refuse to participate in procedures that violate their own values, but the nurse’s ethical behavior must ensure that arrangements for the care of the client are provided. A liver for which two people are tissue-typed has become available after the death of a donor in a car accident. Client A is a 45-year-old substance abuser whose liver is damaged as a result of his use of alcohol. Client B is a 16-year-old adolescent in need of a liver transplant because of a birth abnormality. Which of the following would be useful for a nurse in giving input as to which of the two should receive the liver? Question options: Advocate for Client B because he is the younger of the two and will live longer. Use feminist moral theory to advocate for Client A in spite of his alcohol use. Use a guided set of moral principles in decision-making before advocating for either. Advocate for Client A because he has 15 to 20 years of productive life left. Systematically using a set of moral principles in making ethical decisions assists the nurse in resolving ethical dilemmas such as that described. Which concept is aimed at interrupting potential ethical problems before they develop? Question options: Feminist ethics Preventive ethics Metaethics Normative ethics Preventive ethics is a requirement of health promotion in which practitioners envision potential problems and institute actions that stop their development. When providing preoperative teaching for a client who will be undergoing total knee arthroplasty, the nurse asks the client questions to assess his understanding of the surgery. Which type of ethics is the nurse implementing? Question options: Duty-based ethics Normative ethics Metaethics Preventive ethics Preventive ethics aims to forestall ethical problems before they develop. Preventive ethics is an important requirement of health-promotion endeavors that includes individual action by the nurse, as well as social and political activism with other nurses or professional nursing organizations. Assessing the client’s understanding of what is going to happen during a surgical procedure before the client signs the consent for the procedure makes sure the client understands the information and should help prevent ethical problems. A 24-year-old man with severe cognitive impairment, and no relatives participating in his care, needs to make a decision about removal of a brain tumor that will render him totally dependent for completion of all activities of daily living. The nurse participates in ethical decision making on his behalf, knowing that the client is unable to benefit from which of the following ethical concepts? Question options: Autonomy Justice Beneficence Advocacy Because the client is cognitively delayed and is unable to understand explanations of treatment that would be given to him, the client is unable to be autonomous in making a decision regarding neurosurgery. A client is scheduled to have open-heart surgery. His physical condition is such that he is at high risk to experience complications during the procedure, but he has not been advised of this possibility. Which of the following ethical concepts has been ignored in rendering care for this client? Question options: Beneficence Autonomy Justice Informed consent The client is able to “substantially understand” his care. Ethical care ensures that a person has all of the appropriate information necessary to make an autonomous decision about his or her care. This client has not been informed of his chances of dying during the surgery. An 18-year-old woman in whom a sexually transmitted disease (STD) was recently diagnosed asks the nurse not to tell her mother that she has an STD. Her mother asks the nurse what is causing her daughter’s vaginal discharge. Which of the following actions should the nurse take? Question options: Follow the principle of veracity and tell the mother the diagnosis. Respect the principle of confidentiality and support the client’s request not to tell her mother the diagnosis. Tell the client’s mother that she has a urinary tract infection, to protect the client’s privacy and honor the mother’s request. Ignore the mother’s request for information. The Health Insurance Portability and Accountability Act (HIPAA) guarantees client confidentiality. The client is the only person who can inform her mother of the diagnosis and the only person who can give the nurse permission to inform her mother of the diagnosis. The nurse could appropriately respond to the mother by saying, “I cannot share that information with you because of client confidentiality legislation. You might ask your daughter to share that information with you.” A nurse is providing care to a 15-year old female who has recently been diagnosed with a sexually transmitted infection (STI). Which of the following actions should the nurse take next? Question options: Seek advice from an ethics expert. Facilitate interaction between the adolescent and her parents/guardians. Report the STI to the appropriate authorities. Contact the adolescent’s parents/guardians. Federal and state laws generally serve to protect the privacy and autonomy of adolescents. Responsibilities of the nurse include helping an adolescent to grasp his or her authentic options and rights, facilitating interaction between the adolescent and parents or guardians, maintaining trust, and preserving confidentiality. An elderly client has recently been diagnosed with cancer. The client’s family has asked the nurse to withhold this information from the client because they feel that this information would cause the client to give up on life and become very depressed. The nurse believes the client should be told this information. Which ethical principle is being upheld by the nurse? Question options: Justice Beneficence Veracity Nonmaleficence Veracity is also known as devotion to the truth. Veracity in giving people information about their health care needs facilitates autonomous choice and enhances personal decision-making. Withholding information, or providing information that is misleading or incomprehensible, in an attempt to influence someone to agree to a treatment or intervention, conflicts with veracity. Which of the following concepts of ethics is described as the “duty to maximize the benefits of actions while minimizing harm”? Question options: Advocacy Justice Beneficence Autonomy Beneficence governs actions taken to further the overall health or well-being of an individual or society. “Beneficence” means doing good. A nurse reflects on previous experiences with minority populations and considers how these interactions have influenced her present care to these populations. Which part of values clarification and reflection has the nurse used? Question options: Formulate a possible course of action. Examine the influence of beliefs. Reflect on practice. Determine the prevalent values. It is important for the nurse to think about the influence that beliefs and values have on his or her practice. An understanding of how personal beliefs and values are either congruent, or are liable to interfere, with the task at hand is crucial to ethical problem solving. A nurse is working with a community to increase its awareness about the dangers of lead poisoning. Which of the following provides the best explanation as to why the nurse is performing this action? (select all that apply) Question options: It is the right thing to do. It is a moral responsibility. It is an ethical responsibility. It is the role of the nurse. When nurses provide service to society through health promotion interventions, their care for clients can be seen as a moral endeavor. Moral issues are confronted in the process of attempting to enhance the well-being of a society overall, as well as promoting and protecting health for individual members of a society. The ANA Code of Ethics for Nurses Interpretive Statements promises that “nursing encompasses the prevention of illness, the alleviation of suffering, and the protection, promotion, and restoration of health in the care of individuals, families, groups and communi