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Chapter 25: Health Promotion in the Twenty-First Century

Edelman: Health Promotion Throughout the Life Span, 8th Edition


MULTIPLE CHOICE
1. A nurse is encouraging members of the community to advocate for the prevention of

premature deaths in children under the age of 5 at the international level. Which of the
following interventions would most likely be discussed by the nurse?
a. Using mosquito netting in sleeping areas
b. Participating in international vaccination programs
c. Implementing accident prevention programs
d. Providing nutritional supplements
ANS: D

Protein-energy malnutrition can be severely harmful to the mental and physical development
of individuals, especially young children under the age of 5. Worldwide, one out of two deaths
among children younger than 5 years old stems from protein-energy malnutrition.
DIF: Cognitive Level: Apply (Application)

REF: pp. 622-623

2. A nurse is working at a clinic in a third world country and suspects a child has severe acute

malnutrition (SAM). Which of the following assessment findings would be expected?


a. Distended abdomen
b. Bulging eyes
c. Large tears when crying
d. Lethargy
ANS: A

Severe wasting is characterized by sunken eyes, visible ribs, and protruding shoulder blades.
Children with severe wasting usually have a distended abdomen and general overall
appearance in some way similar to an older adult. In general, these children are irritable,
anxious, and cry easily; yet they will often have absence of tears while crying due to
lachrymal gland atrophy.
DIF: Cognitive Level: Apply (Application)

REF: pp. 622-623

3. A nurse is determining if children with severe acute malnutrition (SAM) should receive

facility-based or community-based care. Which of the following children should receive care
in the community?
a. 3-year-old male who has a history of dehydration
b. 9-month-old male whose family has adequate support and resources to obtain the
recommended treatment
c. 4-year-old female who has sensitivity to milk products
d. 6-month-old female who has a good appetite and no underlying medical conditions
ANS: D

When a child has a good appetite with no medical conditions (hypoglycemia, hypothermia,
dehydration, electrolyte imbalance, and/or infections), Ready-to-Use Therapeutic Foods
(RUTF) under community-based care are appropriate. RUTF are special milk-based foods
which are soft, crushable, and tasty nutrient- and energy-rich foods that can be consumed by
children six months or older.
DIF: Cognitive Level: Apply (Application)

REF: p. 623

4. A nurse working on a post-partum unit of a large urban hospital has received a grant to begin a

Baby-Friendly Hospital Initiative developed by WHO. Which of the following statements


would the nurse most likely make when explaining the major premises of the initiative to the
unit manager?
a. This program is meant to encourage sibling visits in the early postpartum period,
so the adjustment to a new baby is a smooth process.
b. A major goal of this program is to ensure that all infant/pediatric units have
implemented basic safety initiatives.
c. Improving nutrition by promoting breast-feeding of newborns through four
months of age is what this program is all about.
d. The purpose of this program is to make sure that all health care providers who
care for newborns and children up to the age of 18 really understand basic
principles of growth and development.
ANS: C

The purpose of the initiative is to improve newborn nutrition by promoting breast-feeding of


newborns through age 4 months.
DIF: Cognitive Level: Apply (Application)

REF: pp. 623-624

5. Which of the following projects would most likely be administered by International

Micronutrient Malnutrition Prevention and Control (IMMPaCT) Program?


Researching best methods to preserve the freshness of foods
Surveying various populations about consumption patterns
Comparing the effectiveness of vitamin pills versus fresh fruit and vegetables
Analyzing the relationship between BMI and cardiovascular disease

a.
b.
c.
d.

ANS: B

IMMPaCt provides its skills and resources toward working to eradicate vitamin and mineral
deficiencies around the globe. The IMMPaCT programs activities include conducting
surveys; providing micronutrients to infants, young children, and women of childbearing age;
and monitoring and evaluating intervention systems.
DIF: Cognitive Level: Analyze (Analysis)

REF: p. 624

6. The school nurse has been asked to present a workshop on CA-MRSA for high school

teachers. Which of the following information would the nurse most likely include?
CA-MRSA is a common viral infection that responds well to antiviral meds.
CA-MRSA is a serious bacterial infection that does not spread easily.
CA-MRSA is a fungal infection common in school settings.
CA-MRSA is a potentially fatal skin infection that is difficult to treat.

a.
b.
c.
d.

ANS: D

CA-MRSA is a highly contagious bacterial infection that is difficult to treat and can result in
pneumonia and death.
DIF: Cognitive Level: Apply (Application)

REF: p. 624

7. The school nurse has been asked to present a workshop on how to prevent CA-MRSA spread

in the school. Which of the following interventions should be emphasized?


a. Completing prophylactic antibiotic therapy for those in close contact with an

infected person
b. Using correct hand-washing technique
c. Requiring those infected stay home from school until the infection has resolved
d. Disinfecting all classrooms on a daily basis
ANS: B

Hand washing is an effective way to prevent spread of the infection. In order to contract the
infection, students must come into contact with a draining wound, etc.
DIF: Cognitive Level: Apply (Application)

REF: p. 624

8. A nurse is providing care to HIV positive clients living in sub-Saharan communities in Africa.

When discussing prevention of the transmission of HIV, which of the following statements
should be made by the nurse?
a. Alternative practices to traditional sexual cleansing should be considered after the
death of a spouse.
b. Traditional sexual cleansing should be performed with a cleanser who is known to
not have HIV.
c. Virgin cleansing is a safer option than traditional sexual cleansing.
d. Traditional sexual cleansing can lead to further transmission of HIV.
ANS: A

Although traditional sexual cleansing can lead to further transmission of HIV is a true
statement, it is not the most culturally sensitive response by the nurse. The nurse should
respect the cultural practices of the clients living in the sub-Saharan community and discuss
that alternative practices may be a better option to traditional sexual cleansing.
DIF: Cognitive Level: Apply (Application)

REF: p. 625

9. A nurse is working with UNAIDS to fight against HIV/AIDS at the global level. Which of the

following activities would the nurse most likely be involved in?


a. Determining prevalence rates of HIV/AIDS in African countries
b. Administering antiretroviral medications to pregnant women who are HIV positive
c. Providing treatment access for all HIV-positive individuals who need medication
d. Reporting confirmed cases of HIV to the World Health Organization
ANS: C

UNAIDS has outlined three strategic directions: revolutionizing HIV prevention; catalyzing
the next generation for treatment, care, and support; and advancing human rights and gender
equality in responses to HIV. Providing treatment access for all HIV-positive individuals who
need medication meets the strategic direction of catalyzing the next generation for treatment,
care, and support.

DIF: Cognitive Level: Analyze (Analysis)

REF: p. 626

10. A nurse is using the four-step public health approach to address violence in the community.

Which of the following actions would the nurse take first?


Analyze a variety of data sources to determine the cause of the problem.
Examine risk factors that have contributed to the violence.
Develop an evidence-based program to address the problem.
Train community members to discuss the problem within their neighborhoods.

a.
b.
c.
d.

ANS: B

The WHO has proposed a four-step public health approach which includes: defining the
problem; identifying risks and protective factors; devising and testing means of dealing with
violence; and applying successful means on a large scale. Defining the problem is the first
step in this process. Examination of different data sources are needed to understand the
magnitude of the problem.
DIF: Cognitive Level: Analyze (Analysis)

REF: pp. 626-627

11. A nurse using the four-step public health approach to respond to violence. Which of the

following actions would occur as the nurse identifies risk and protective factors?
Planning a community-based educational program to respond to violence
Reviewing police reports and population-based surveys
Interviewing local community members about their experiences with violence
Examining characteristics in the community where violence has not occurred

a.
b.
c.
d.

ANS: D

A risk factor is defined as a characteristic that increases the likelihood of a person


becoming a victim or perpetrator of violence, and a protective factor as a characteristic
that decreases the likelihood of a person becoming a victim or perpetrator of violence.
Knowing risk and protective factors can help responsible organizations and personnel to
estimate violence magnitudes and devise appropriate prevention measures.
DIF: Cognitive Level: Apply (Application)

REF: p. 627

12. The school nurse is planning a workshop for high school students about interpersonal violence

(IPV). Which of the following information would the nurse discuss as risk factors for IPV?
a. Cultural norms
b. Family support
c. Drug and alcohol abuse
d. Depression
ANS: C

Risk factors for IPV may include a victims low self-esteem, low self-control, and
personality/conduct disorders. Other risk factors are reported to be lack of social support,
dysfunctional family structure, family history of violence, and drug and alcohol abuse.
DIF: Cognitive Level: Apply (Application)

REF: p. 627

13. The nurse is working at a crisis hotline center. Which of the following callers would be most

at risk for suicide?


a. A 16-year-old girl who broke up with her boyfriend

b. A 26-year-old male who has been laid off from his job
c. A 50-year-old female who has a history of alcohol abuse
d. A 40-year-old male whose brother died suddenly
ANS: C

Older adults have a greater risk of committing suicide than do younger people. Major factors
contributing to suicide in Europe and North America include mental disorders especially
depression and alcohol use disorders.
DIF: Cognitive Level: Analyze (Analysis)

REF: p. 628

14. Which of the following age groups is experiencing the greatest increase in suicide rates?
a. 15 to 24
b. 25 to 39
c. 40 to 59
d. 60 to 70
ANS: A

Suicide rates among people aged 15 to 24 have been increasing to such an extent that they are
the second leading cause of death in this age group in some developed and developing
countries.
DIF: Cognitive Level: Remember (Knowledge)

REF: p. 628

15. Which of the following information about anthrax is correct?


a. Anthrax is a viral infection.
b. Anthrax can cause skin lesions or pneumonia.
c. Anthrax is spread by person-to-person contact.
d. Anthrax is treated by IV penicillin for 30 days.
ANS: B

Anthrax is a bacillus that is not spread person-to-person. An anthrax infection is treated by


using ciprofloxacin, levofloxacin, doxycycline, or penicillin for 60 days.
DIF: Cognitive Level: Remember (Knowledge)

REF: p. 629

16. Which of the following statements about smallpox is accurate?


a. Smallpox results in a rash that looks similar to the chickenpox rash.
b. Side effects from a smallpox vaccine include acute renal failure.
c. The last case of smallpox occurred in 1997.
d. The rash associated with smallpox is most prominent on the face and extremities.
ANS: D

A rash from smallpox is most prominent on the face and extremities with the same stage of
legion development. Additionally, smallpox symptoms usually resemble influenza symptoms.
The smallpox rash is distinctive from the varicella rash. Side effects from the vaccination
mostly involve a low fever, soreness in the injection area, and enlarged glands under the
armpit. The last case of smallpox was in 1977.
DIF: Cognitive Level: Understand (Comprehension)

REF: p. 630

17. A nurse is working in the emergency department (ED). Which of the following situations

would cause the nurse to suspect bioterrorism?


a. When two people out of twenty who ate at a restaurant come to the ED with nausea

and vomiting
b. When a worker in a lab comes to the ED complaining of a severe headache
c. When thirteen people, aged 24 to 33, come to the ED with ascending flaccid

muscle paralysis
d. When five people come to the ED with an upper respiratory infection
ANS: C

The other examples are common problems for which people seek health care. Flaccid
paralysis is a symptom of botulism.
DIF: Cognitive Level: Analyze (Analysis)

REF: p. 630

18. Which of the following statements best explains priorities related to preventative health care?
a. Global initiatives have been developed to respond to health care needs around the

world.
b. Health care initiatives are focused mainly on people in developed countries because
of the access to medication.
c. Health care initiatives are focused mainly on people in developing countries
because of their great need.
d. Public health agencies are leaders in health care development.
ANS: A

Health care initiatives have a global focus and involve developing as well as developed
countries. Nurses play a major role in this initiative.
DIF: Cognitive Level: Understand (Comprehension)

REF: p. 632

19. A nurse states that many community members are concerned about the increasing number of

natural disasters that have been occurring in the United States. Which of the following would
the community members be referring to?
a. Fires and suicides
b. Wildfires and hurricanes
c. Traffic accidents and floods
d. Tornadoes and food poisonings
ANS: B

Natural disasters phenomena that occur through natural forces involving land, air, or water,
and they often have large-scale negative impacts on humans who live in the affected areas.
Examples of natural disasters include tsunamis, earthquakes, floods, landslides, mudslides,
tornadoes, hurricanes, cyclones, typhoons, wildfires, volcano eruptions, extreme heat, winter
weather, and others.
DIF: Cognitive Level: Apply (Application)

REF: p. 630

20. A hurricane has just caused extensive damage within a local community. Which of the

following are community members at risk to experience?


a. Unequal access to health care
b. Exposure to community-associated methicillin-resistant Staphylococcus aureus

c. Increased incidence of suicide


d. Outbreaks of acute respiratory infection
ANS: D

Victims of natural disasters tend to have limited access to essential infrastructures for survival
related to food, water, shelter, and sanitation. Infection outbreaks commonly diagnosed after
natural disasters include diarrhea, acute respiratory infections, viral hepatitis, and snail and
trematode infections.
DIF: Cognitive Level: Apply (Application)

REF: p. 631

21. A primary care clinic is being established in a rural county that recently experienced a

hurricane severely damaging its infrastructure for medical care. Which of the following
considerations would be the priority when planning for this clinic?
a. The ability to provide mental health services to community members
b. The ability to deliver primary care services to community members
c. The ability to refer community members to other necessary services
d. The ability to supply community members with daily necessities
ANS: A

The priority in planning should be the ability to provide mental health services to the
community members. In 2007, the Inter-Agency Standing Committee developed its
Guidelines on Mental Health and Psychosocial Support in Emergency Setting. It emphasizes
the importance of primary care clinics being able to provide mental health services to victims
of the disaster.
DIF: Cognitive Level: Analyze (Analysis)

REF: p. 631

22. A nurse is advocating for improved disease prevention and health promotion within the local

community. Which of the following interventions would the nurse most likely implement?
a. Educate community members about the violence rates that exist within the

community.
b. Administer flu shots for elderly at a local senior citizens center.
c. Participate in a disaster planning committee within the community.
d. Talk with a state legislator about improved access to health care for the uninsured

and underinsured.
ANS: D

In order to be advocates for newly emerging priorities for disease prevention and health
promotion, nurses in the twenty-first century need to participate in policy development for
health promotion as the health care of individuals in acute settings shifts from hospitals to
home and community settings, influence public expectations about health promotion, and
promote equitable access to preventive health care. Talking with a state legislator about
improving access to health care for the uninsured and underinsured is the only example that
demonstrates the nurse in the role of an advocate working in one of these priority areas.
DIF: Cognitive Level: Analyze (Analysis)
MULTIPLE RESPONSE

REF: pp. 634-635

1. Which of the following are classifications within the World Health Organizations (WHO)

definition of malnutrition? (select all that apply)


Obesity
Micronutrients deficiencies
Protein-energy malnutrition
Water insufficiency

a.
b.
c.
d.

ANS: A, B, C

Inadequate or excessive intake of protein and or vitamins and obesity are components of the
WHOs definition of malnutrition.
DIF: Cognitive Level: Remember (Knowledge)

REF: p. 622

2. Which of the following individuals would be susceptible to CA-MRSA? (select all that apply)
a. 16-year-old student who plays football
b. 48-year-old person who has taken antibiotics for sinus infections
c. 36-year-old man serving 12 months in jail for robbery
d. 22-year-old woman who shares a towel after a swimming meet
ANS: A, B, C, D

CA-MRSA is spread by close skin-to-skin contact such as during contact sports, by sharing
towels and clothing, and by those living in crowded conditions. People who take or who have
been on antibiotic therapy are also susceptible to CA-MRSA.
DIF: Cognitive Level: Analyze (Analysis)

REF: p. 624

3. A nurse employed by the World Health Organization is working with HIV positive clients in

Africa and is teaching them about ways to reduce transmission of this disease. Which of the
following barriers should be considered when planning this education? (select all that apply)
a. Culture-specific practices
b. Unavailability of antibiotic therapy
c. Lack of understanding about the transmission process
d. Overcrowded living areas
ANS: A, C

Culture-specific sexual practices such as sexual cleansing and a lack of understanding about
how HIV is spread contribute to its transmission. HIV is a viral infection, not a bacterial
infection. Simply living with someone who has HIV will not result in transmission unless the
person comes into contact with blood or bodily fluid from the infected person.
DIF: Cognitive Level: Apply (Application)

REF: pp. 625-626

4. A school nurse is planning an educational presentation for high school students about

violence. Which of the following statements would be included in the presentation? (select all
that apply)
a. Violent behavior happens when someone bullies another person.
b. Withholding food from a child as a punishment is violent behavior.
c. Collective violence occurs during an argument between two people.
d. Painting a racial slur on a building is violent behavior.
ANS: A, B, D

Violent behavior as defined by WHO is the intentional use of physical force or power,
threatened or actual against oneself, another person, or against a group or community, that
either results in or has a high likelihood of resulting in injury, death, psychological harm,
maldevelopment, or deprivation. Collective violence is defined as the instrumental use of
violence by a particular group of people for specific political, economic, or social objectives.
DIF: Cognitive Level: Apply (Application)

REF: p. 626

5. Which of the following individuals assessed by the nurse is experiencing interpersonal

violence? (select all that apply)


A 16-year-old female who hides in her apartment due to civil unrest in the country
A 32-year-old male whose co-worker sends him insulting e-mails at work
A 19-year old male who has attempted suicide
A 78-year-old female living in a nursing home who is force-fed by aides

a.
b.
c.
d.

ANS: B, D

Interpersonal violence is violence committed by an individual or a small group of people in a


wide range of acts and behaviors (emotional, physical, sexual, and psychological). The
violence can happen to people of any age and at any place. Self-directed violence occurs with
self-abuse and suicide. Collective violence is defined as the instrumental use of violence by a
particular group of people for specific political, economic, or social objectives.
DIF: Cognitive Level: Analyze (Analysis)

REF: p. 627

6. A nurse is participating in disaster preparedness planning for the local community. Which of

the following would be an appropriate responsibility for the nurse? (select all that apply)
Completing a risk assessment in the community
Implementing strategies to decrease posttraumatic stress disorder
Coordinating meetings among multiple agencies and disciplines
Evaluating the economic impact of the disaster

a.
b.
c.
d.

ANS: A, C

The International Council for Nurses spells out its position on the role of the nurse concerning
disaster preparedness to include risk assessment as well as management strategies bridging
multiple disciplines and system levels. To coordinate health sector preparedness, regulatory
meetings and frameworks across cultures will help nurses plan for and streamline health care
responses to such mass events internationally.
DIF: Cognitive Level: Analyze (Analysis)

REF: pp. 628-629

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