NR 222 test 3 health n wellness latest Chamberlain

NR 222 test 3 health n wellness Chapter 24: Older Adult Edelman: Health Promotion Throughout the Life Span, 8th Edition MULTIPLE CHOICE 1. A nurse is planning to write a grant for a health promotion project in the community. Which of considerations should the nurse make when determining the appropriate population for this project? a. The fastest growing population is children under the age of 12. b. The fastest growing population is young Black American adults. c. The fastest growing population is White middle-age adults. d. The fastest growing population is non-White older adults age 65 and older. ANS: D Adults age 85 and older are the fastest growing population in the United States, and the percentage of White Americans greater than age of 65 is decreasing compared with other ethnic groups. DIF: Cognitive Level: Apply (Application) REF: p. 592 2. Which of the following statements made by a client best identifies someone who would benefit from health promotion interventions? a. “I have a new grandchild and want to be part of her life.” b. “My mother lived until she was 90, so a long life is in my genes.” c. “Some chronic illness is just a part of aging.” d. “I hope I’ll live a lot longer, but one never knows.” ANS: A Motivation to adopt a healthy lifestyle is a primary predictor of successful interventions. Feeling that illness is just part of aging or leaving health up to chance will not help the person make necessary lifestyle changes. DIF: Cognitive Level: Analyze (Analysis) REF: p. 595 3. Which of the following statements concerning nutrition and older adults is true? a. Older adults who live in their own homes are more likely to be malnourished than older adults living in a nursing home. b. Older adults lose their desire for high-fat, salty foods. c. Meals served in long-term care institutions are usually more well-balanced than foods eaten by older adults living at home.d. Many older adults are not aware of food assistance programs. ANS: D Barriers that may interfere with the ability of independent seniors to obtain adequate nutritional food include limited transportation, income, and social support resources. Many older persons are unaware that they are eligible to participate in SNAP. The percent of older adults who live in their own homes and are malnourished is lower than that of older adults who live in a nursing home. Older adults do not lose their desire for high-fat, high-cholesterol, highsodium foods. Fresh fruits and vegetables are not always available for older adults living in nursing homes. DIF: Cognitive Level: Understand (Comprehension) REF: pp. 596-597 4. Which of the following statements concerning urinary incontinence is correct? a. Urge incontinence occurs when one has the urge to void but is unable. b. Stress incontinence is associated with emotional turmoil. c. Functional incontinence occurs is associated with environmental barriers. d. Incontinence with high post-void residual occurs when someone laughs or sneezes. ANS: C Functional incontinence is associated with environmental barriers, physical limitations, or cognitive impairment in which the client is unable to reach the toilet. Stress incontinence occurs when someone coughs or sneezes. Urge incontinence occurs when someone cannot wait to void once the urge to void is felt. Urge, mixed, or stress incontinence with high postvoid residual is caused by physiological changes that affect voiding, such as an enlarged prostate gland. DIF: Cognitive Level: Understand (Comprehension) REF: p. 597 5. Which of the following nursing diagnoses is a priority related to the problem of urinary incontinence? a. Risk for social isolation b. Risk for impaired skin integrity c. Risk for inadequate fluid intake d. Risk for impaired coping ANS: B Although social isolation and decreased fluid intake may occur because of urinary incontinence, impaired skin integrity is a major concern because of its impact on physical and psychological health. DIF: Cognitive Level: Analyze (Analysis) REF: p. 5976. A 75-year-old man tells the nurse that he has difficulty staying asleep during the night. Which of the following responses should be made by the nurse? a. “Older adults need as much sleep as middle-age and younger adults. Let’s talk about your sleep patterns.” b. “I’ll ask the nurse practitioner to prescribe a sleeping pill for you.” c. “Taking naps during the day can help relieve excessive fatigue and will help you sleep better.” d. “Let’s talk about your sleep schedule and things that may prevent you from getting a restful night’s sleep.” ANS: D Nurses should assist older adults in achieving a good night’s sleep through assessment that might reveal possible causes of sleep disturbances. Older adults need less sleep than younger adults. Daytime naps may prevent sleeping adequately at night. Medications to assist in sleeping are not the initial therapy choice because of side effects. DIF: Cognitive Level: Apply (Application) REF: pp. 599-560 7. A nurse is conducting a community education program about cognition in older adults. Which of the following information should be included? a. Some form of mild dementia is a normal part of aging. b. All forms of dementia have the same symptoms, but progress at different rates. c. Assessment for dementia should be part of routine physical exams. d. Elders who score below 27 points on the Mini-Mental State Exam (MMSE) are not likely to have a cognition problem. ANS: C Cognitive alterations are key symptoms that indicate changes in physiological function among older persons. Thus, assessment of cognition is an important part of routine assessments. Dementia is not a normal part of aging. Dementia symptoms vary according to the specific type of dementia. A score of 23 or lower on the MMSE indicates a problem with cognition. DIF: Cognitive Level: Apply (Application) REF: pp. 600-601 8. A nurse has recently accepted the position of unit nurse manager on a long-term care unit. Which of the following directives should the nurse give to the staff nurses? a. Encourage residents to participate in unit activities such as Scrabble™ and bingo. b. Demonstrate the caring aspect of nursing by dressing residents before breakfast. c. Fill in “missing words” during conversation with the residents to avoid embarrassment. d. Instruct the aides to get residents ready for breakfast as quickly as possible to make sure they are ready to eat. ANS: ATo encourage cognitive health nurses should inspire older individuals to take classes, read, engage in stimulating conversation and entertainment, keep their minds active, and continue learning throughout their lives. They are encouraged to continue with self-care activities rather than relinquish them to caregivers. Residents should be encouraged to perform self-care activities themselves. When help is required, it should be provided in an unhurried manner. Filling in missing words makes the resident dependent on the staff and reduces motivation to communicate, and the words supplied may not be the intended words. DIF: Cognitive Level: Apply (Application) REF: p. 602 9. A nurse is assisting with development of menu items at a long-term care facility. Which of the following menus would the nurse most likely recommend? a. One egg over easy, one slice of whole wheat toast with sugar-free jam, 4 oz orange juice b. 5-oz cheeseburger cooked medium well with lettuce and tomato, 10 baked potato chips, and 1 cup of decaf coffee with low-fat milk and artificial sweetener c. Chef salad with 2 oz each ham and turkey, lettuce, tomato, bean sprouts, onion, green pepper with low-fat dressing, and one small roll with low-fat spread d. Turkey bacon, lettuce, and tomato sandwich on whole wheat bread with two teaspoons of low-fat mayonnaise, 10 vegetable chips, and ice tea with artificial sweetener ANS: D The United States Department of Agriculture recommends that infants and young children, pregnant women, older adults, and those who are immune compromised should not consume raw (unpasteurized) milk or any products from unpasteurized milk, raw or partially cooked eggs or foods containing raw eggs, raw or undercooked meat and poultry, raw or undercooked fish or shellfish, unpasteurized juices, or raw sprouts. DIF: Cognitive Level: Analyze (Analysis) REF: p. 603 10. Which of the following individuals would be at greatest risk of injury? a. 80-year-old who does not have air conditioning or a fan b. 70-year-old who has new dentures c. 68-year-old who has difficulty tasting salt in food d. 84-year-old who needs hearing aids ANS: A Sweating decreases in older adults, predisposing them to heat stroke. DIF: Cognitive Level: Analyze (Analysis) REF: p. 60311. According to Erikson’s theory of development, which of the following older adults has successfully navigated the stage of ego integrity versus despair? a. 72-year-old man who is reluctant to retire because “work is everything to me” b. 78-year-old woman who has scheduled her third face lift c. 80-year-old man who has informed his children that he has made his funeral arrangements d. 67-year-old woman who is depressed because she has not been promoted at work for the past 10 years ANS: C Successfully navigating the stage of ego integrity versus despair requires that the individual accept normal bodily changes associated with aging, find meaning in life apart from work, accepts the inevitability of death, and is at peace with his or her life. DIF: Cognitive Level: Analyze (Analysis) REF: p. 604 12. A couple in their sixties has assumed responsibility for raising their two grandchildren ages 9 and 12 because the children’s parents died in a car accident. Which of the following are priority nursing interventions that the nurse can implement to help the grandparents cope with the responsibility of raising their grandchildren? a. Connecting them with the “Grandparents Raising Grandchildren” support group b. Encouraging them by reinforcing how they successfully raised their own children c. Volunteering to provide respite time for them as needed d. Assuring them that their stress level will lessen as they gain confidence ANS: A Stress experienced by grandparents who must raise grandchildren can be lessened by counseling and participation in support groups. DIF: Cognitive Level: Apply (Application) REF: pp. 604-605 13. A nurse is conducting a staff development program about human sexuality for nurses who work in a long-term care facility. Which of the following statements would most likely be made by the nurse? a. “The desire for sexual intimacy declines rapidly with age.” b. “Older adults are very well-informed about sexuality.” c. “Older adults need to practice safe sex.” d. “The danger of contracting STDs during sexual intimacy is extremely low in older adults.” ANS: C The desire for sexual intimacy remains a primary force throughout life. Older adults need teaching related to safe sexual practices, STD transmission, and so on. HIV infection is a concern in all age groups. DIF: Cognitive Level: Apply (Application) REF: p. 60614. The clinic nurse has seen the following four people today. Which of the following people is demonstrating a healthy coping pattern? a. Discusses very little except the loss of her husband 3 years ago b. Talks about the “good times” she and her husband had before his illness and death 1 year ago c. States that life is not worth living without her husband, who died 2 years ago d. Blames herself for her husband’s death because she did not “make him go” to the doctor ANS: B Research has demonstrated that rumination, self-blame, and catastrophizing have negative effects on coping, whereas positive reappraisal has a positive effect. DIF: Cognitive Level: Apply (Application) REF: p. 606 15. A nurse is assigned to provide care for a 96-year-old bedridden man who experiences severe pain from a chronic neurological disease. The man asks the nurse to please help him leave this world so that his suffering ends. Which of the following actions would be most appropriate for the nurse to take? a. Assist the doctor with the man’s request b. Refuse to care for the man c. Contact the pain care specialist d. Provide the man with names of doctors who participate in assisted suicide ANS: C Nurses caring for chronically ill older adults have the added responsibility of determining who is at risk for wanting physician-assisted suicide and helping them to be as comfortable as possible and free of pain through the use of pharmacological and nonpharmacological interventions. Refusing to care for the man could be construed as abandonment and is not necessary. Consulting a pain care specialist is the correct action. DIF: Cognitive Level: Apply (Application) REF: p. 607 16. A nurse is conducting a home visit for an older adult in the summer. Which of the following items should the nurse should locate in the home? a. Fan b. Porch chair c. Synthetic blend clothing d. Thermometer ANS: A Older adults are susceptible to heat stroke. The availability of a fan will help cool the ambient air. Light-weight cotton clothing “breathes” and facilitates cooling, whereas synthetic material retains heat.DIF: Cognitive Level: Analyze (Analysis) REF: p. 609 17. The community health nurse has obtained a grant to offer a “Safe Driving” series for older adults. Which of the following information should the nurse stress during the series? a. Traffic fatalities involving older adults occur mainly at dusk. b. The cause of two-vehicle accidents is frequently an older driver striking another car. c. The average blood alcohol level in older adults involved in accidents is higher than the blood alcohol level of younger drivers involved in accidents. d. Relearning the art of defensive driving can help reduce the likelihood that an older driver will be involved in a motor vehicle accident. ANS: D Traffic fatalities involving older adults occur mainly during the daytime. The cause of two vehicle accidents is frequently a younger driver striking the car driven by an older adult. The average blood alcohol level in older adults involved in accidents is lower than the blood alcohol level of younger drivers involved in accidents. DIF: Cognitive Level: Apply (Application) REF: p. 609 18. As part of a community-wide flu vaccination program for older adults, the nurse is assisting at a vaccination clinic. Which of the following questions should the nurse ask before administering the vaccine? a. “Do you have any food allergies?” b. “Have you had the pneumococcal vaccine?” c. “Have you had the flu in the past 5 years?” d. “Do you have Medicare?” ANS: A An allergy to eggs is a contraindication to receiving flu vaccine grown in chick embryo cells. DIF: Cognitive Level: Analyze (Analysis) REF: p. 610 19. A man tells a nurse that he is concerned about his risk of developing cancer. Which of the following behaviors would place the man at higher risk of developing cancer? a. Smoking a half of a pack of cigarettes a day b. Exercising three times a week c. Consuming green, leafy vegetables several times a week d. Visiting a chiropractor every week ANS: A Habits that place older adults at a high risk for developing cancer: not following nutritional guidelines, high stress levels, not engaging in a regular exercise program, and smoking cigarettes and using other tobacco products.DIF: Cognitive Level: Apply (Application) REF: p. 611 20. Which of the following statements is the best definition of polypharmacy? a. The use of more than five medications prescribed by different physicians b. The use of multiple medications for the same or different health problems c. The use of multiple pharmacies and self-management of medications d. The use of multiple medications and supplements simultaneously ANS: B Polypharmacy is the use of multiple medications for the same or different health problems. It is a major concern for elderly people, with the rate of polypharmacy in this population being between 9% and 39%. DIF: Cognitive Level: Understand (Comprehension) REF: p. 611 21. A person is preparing to return home following a 2-week hospital stay for congestive heart failure and pneumonia. Which of the following referrals would be most beneficial for the person? a. Transportation assistance b. Home-delivered meals c. Adult day care d. Home health nursing ANS: D Home care nurses provide health care information and services to individuals and families. The resources available to community health nurses frequently are rich and enable the nurses to draw on a variety of sources to assist in promoting the health of community-dwelling older adults. Although all of the referrals listed may be of benefit to the person, the home health nurse will provide the most comprehensive services and be able to connect the person to necessary community resources. DIF: Cognitive Level: Analyze (Analysis) REF: p. 614 22. The son of a 70-year-old man dying of cancer asks the nurse to tell him about the hospice program, so he can help his father decide if the program would be of benefit to him. Which of the following responses should be given by the nurse? a. “At hospice, your father will be heavily medicated, so he will not have pain.” b. “All of your father’s care will be provided by nurses at hospice.” c. “Hospice care can take place either at home or in a hospice facility.” d. “Visiting hours are about the same at hospice as they are here in the hospital.” ANS: C Once the person is placed in hospice care, treatment to relieve pain and other symptoms is continued by the physician after they have decided to end all curative treatment. Hospice care can occur in the home, a hospice inpatient facility, nursing home, and acute care hospital. The focus of hospice care is to help the person remain alert but free of pain. Families are encouraged to participate in care giving. There are no restrictions to visiting hours. DIF: Cognitive Level: Apply (Application) REF: p. 614 23. A community health nurse is working with a diverse population of older adults within the community. Based on the data from the National Health Interview Survey, which of the following assumptions should be made by the nurse when working with this diverse population? a. White Non-Hispanic older adults tend to require more assistance with their activities of daily living. b. Hispanic older adults tend to rate their health as poorer than other ethnic groups. c. Older adults who tend to rate their health as fair or poor are also financially poor. d. Older adults tend to require more assistance with activities of daily living than with meeting their routine needs. ANS: C The National Health Interview Survey conducted by the Centers for Disease Control and Prevention in 2010 provides interesting information about the perceptions of a variety of ethnic groups regarding their health status, their perceived need for assistance with routine needs, and the need for assistance with activities of daily living. In all groups, those who described their health as fair or poor were also more likely to be financially poor. DIF: Cognitive Level: Apply (Application) REF: p. 594 (Box 24-2) 24. A woman who is being discharged from the hospital is oriented to person, place, and time, and her memory is intact. She has occasional forgetfulness without a consistent pattern of memory loss. Which of the following housing options would be most appropriate for this woman? a. Independent living b. Retirement community c. Assisted living d. Nursing facility ANS: B Retirement community living is suited for a person who is oriented to person, place, and time and has a memory that is intact, but has occasional forgetfulness without a consistent pattern of memory loss. Independent living may be appropriate for the person if she had a consistent pattern of memory loss. Assisted living or nursing facility living may be appropriate if the woman has difficulty with orientation to person, place, or time or has difficulty with confusion that results in anxiety, social withdrawal, or depression. DIF: Cognitive Level: Analyze (Analysis) REF: p. 612 (Table 24-4) MULTIPLE RESPONSE1. Which of the following interventions will have the greatest impact on reducing constipation in older adults? (select all that apply) a. Offering pureed foods that are easy to digest b. Encouraging fluids between meals c. Administering laxatives on a daily basis d. Assisting with ambulation ANS: B, D Nurses can help reduce the incidence of constipation by encouraging older adults to exercise and increase their fluid and dietary intake. Dietary modifications, such as increasing fiber and fluid intake, can stimulate the colon and resolve constipation. Pureed foods do not contain adequate fiber. Increased fluid intake and exercise should be implemented before relying on medication to relieve constipation. DIF: Cognitive Level: Apply (Application) REF: p. 597 2. A nurse has accepted a position as director of health services in a retirement community. Which of the following statements about retirees is important for the nurse to consider as she plans programs? (select all that apply) a. Depressed and inactive. b. Left their job to spend more time with family. c. Left their job because of ill health. d. Happy and well-adjusted to retirement. ANS: B, D Research has demonstrated that the majority of retirees are in good health and happy with their decision to leave work so as to spend more time with their families. DIF: Cognitive Level: Apply (Application) REF: pp. 604-605 3. The nurse working in a retirement community for older adults is conducting a psychosocial assessment of all residents. Which of the following questions should the nurse ask during the assessment process? (select all that apply) a. “Have you thought about harming yourself?” b. “Are you still playing bridge every Thursday?” c. “How does your congestive heart failure affect your life?” d. “Has your financial situation changed since last year?” ANS: A, B, C Suicide ideation, loss of interest in activities, and chronic illness are signs of, or may lead to, depression. Economic difficulty is not a predictor of suicide in older adults. DIF: Cognitive Level: Analyze (Analysis) REF: p. 6074. Which of the following nursing interventions implies respect for a person’s spirituality? (select all that apply) a. Changing the position of the bed in a Muslim client’s room so that it faces east b. Contacting the chaplain to assess the client’s spiritual needs c. Saying a silent prayer with a client at the client’s request d. Praying out loud in the room of a dying client ANS: A, C Because of the highly personal quality of spirituality, an unobtrusive and sensitive presence by the nurse is needed to allow the person in any setting to achieve spiritual health. The nurse can provide an environment that is supportive to the practice of the person’s spirituality. Praying out loud does not demonstrate respect for a person’s spirituality but imposes the nurse’s belief system on the person. Nurses should be able to assess the person’s spirituality initially and determine if it is necessary to further consult the chaplain. DIF: Cognitive Level: Apply (Application) REF: p. 607 5. A nurse is conducting a community health education program about osteoporosis with a group of older adults. Which of the following individuals in attendance is at greatest risk for developing osteoporosis? (select all that apply) a. 65-year-old Asian woman who smokes one pack of cigarettes per week b. 80-year-old White man who has three glasses of wine per day c. 74-year-old White woman on daily oral prednisone for emphysema d. 68-year-old Black man who has a sedentary lifestyle ANS: A, B, C Osteoporosis is a disease of bone loss common to women age 70 and older and men age 80 and older. The disease occurs six times more frequently in women than it does in men. Risk factors include a small, thin frame; White or Asian ancestry; family history; excessive thyroid medication or high doses of cortisone-like drugs for asthma, arthritis, or cancer; a diet low in dairy products and other sources of calcium; physical inactivity; smoking cigarettes; and drinking alcohol. DIF: Cognitive Level: Apply (Application) REF: pp. 607-608 6. An 80-year-old person is admitted to the hospital. During the health assessment process, which of the following conditions should the person be screened for by the nurse? (select all that apply) a. Polypharmacy b. Kidney failure c. Illegal drug use d. Alcoholism ANS: A, B, C, DAlcoholism and illegal drug use are often overlooked by health care professionals because of a person’s age. Many older adults take multiple over-the-counter and prescription medications and are at risk for drug interactions. DIF: Cognitive Level: Ap Chapter 23: Middle-Age Adult Edelman: Health Promotion Throughout the Life Span, 8th Edition MULTIPLE CHOICE 1. A 35-year-old person asks the nurse working in a dermatology clinic what causes skin to wrinkle. Which of the following statements would be most appropriate way for the nurse to reply? a. “There is really nothing you can do to prevent a lot of wrinkles. It is part of aging.” b. “As we age, we lose fat beneath the skin so wrinkles appear. There is nothing we can do to prevent it.” c. “Wrinkles appear for a number of reasons, including loss of fat beneath your skin and too much sun exposure.” d. “Wrinkles are caused by genetic factors.” ANS: C Loss of subcutaneous fat and collagen damage related to sun exposure cause wrinkles. DIF: Cognitive Level: Apply (Application) REF: p. 563 2. A 45-year-old client who has experienced a ten pound weight gain during the past year asks the nurse if she thinks iron supplements would help increase her energy. Which of the following would be the most appropriate action for the nurse to take? a. Ask the client to describe her daily activity and diet b. Leave a note requesting an iron supplement on the client’s chart for the doctor c. Provide the client with information related to aerobic exercise classes d. Ask the client if she is still menstruating ANS: A A lack of routine exercise and activity plus a diet high in calories contributes to weight gain and a lack of energy. The priority action by the nurse is assessment, which will reveal the reason for a lack of energy. DIF: Cognitive Level: Apply (Application) REF: p. 5633. Which of the following is a normal physiological change that occurs during middle age? a. Increase in gastric emptying resulting in acid reflux b. Reduction in height caused by kyphosis c. Reduction of glomerular filtration by 50% d. Increase in the amount of estrogen produced in both genders ANS: C Gastric emptying is decreased, kyphosis is not an expected part of aging, and estrogen levels decrease in women and increase in men as male testosterone levels decrease. DIF: Cognitive Level: Understand (Comprehension) REF: p. 564 4. A nurse is conducting a community education program. Which of the following should be stressed as the leading cause of death in middle-age adults? a. Automobile accidents b. Malignant disease c. Homicide d. Suicide ANS: B The leading causes of death during middle adulthood are heart disease, cancer, and accidents. Accidents are the major cause of death for children and young adults. Homicide and suicide are major causes of death for young adults. DIF: Cognitive Level: Apply (Application) REF: p. 564 | p. 564 (Box 23-1) 5. A nurse formed a political action committee to advocate for health insurance for the uninsured. On which of the following populations would the nurse focus the group’s efforts? a. Asian Americans b. Blacks c. Hispanic Americans d. Working-poor White Americans ANS: C Hispanic Americans are the largest minority group in the United States and have the highest uninsured rate. DIF: Cognitive Level: Apply (Application) REF: p. 567 6. A nurse has been asked to develop a visit plan for a mobile mammogram van. Which of the following considerations would be made by the nurse when deciding which neighborhoods to visit? a. Hispanic women have the highest rate of breast cancer of all minority groups in the United States.b. The death rate from breast cancer is higher in Hispanic women than for women in other ethnic groups. c. The death rate from breast cancer in Hispanic women has risen in the past 10 years. d. Breast cancer in Hispanic women is usually diagnosed at an early stage. ANS: B Even though Hispanic women have a breast cancer rate approximately 40% lower than nonHispanic White women, their death rate is higher and the cancer is diagnosed at a later stage. DIF: Cognitive Level: Apply (Application) REF: p. 567 7. A nurse has received a grant to provide a community-based education series for middle-age adults. Which of the following topics would allow the nurse to have the greatest impact on the health of members of this age group? a. Diet and exercise b. Seat belt use c. Depression screening d. Cancer prevention ANS: A Obesity is a major risk factor for heart disease, metabolic syndrome, and Type 2 diabetes mellitus. An educational series devoted to discussing diet and exercise will have the greatest impact on health. DIF: Cognitive Level: Analyze (Analysis) REF: pp. 568-569 8. The nurse collects the following assessment data from a woman: Hispanic ethnicity, BMI 29 kg/m2 , age 41. Which of the following actions should be taken by the nurse? a. Encourage the client to continue her dietary and exercise patterns. b. Discuss her current dietary and exercise lifestyle habits. c. Counsel the client that she will face chronic health problems because of her weight. d. Encourage the client to adopt a low-calorie diet to help control her weight. ANS: B Obesity is defined as a BMI of 30 kg/m2 . The client is at risk for obesity. Further data should be gathered related to her dietary and exercise patterns so as to plan appropriate interventions. Adoption of a low-calorie diet may not be an appropriate intervention depending on what additional data collection reveals. Also, dietary changes should be accompanied by regular aerobic exercise. DIF: Cognitive Level: Analyze (Analysis) REF: p. 5689. A nurse working in a rural location is interested in starting a weight management group for clients in the area. Which of the following interventions is most likely to ensure success? a. Using a pre-set list of topics for discussion b. Relying on printed material to relay information to the group c. Asking for a list of topics that interest the group d. Beginning each session with a 2-mile walk ANS: C When participants plan the topics of discussion, interest is maintained. A pre-set list of topics may not meet the learning needs of this particular group. A 2-mile walk may not be realistic for participants. DIF: Cognitive Level: Apply (Application) REF: p. 568 10. A 52-year-old postmenopausal woman tells the nurse that she is afraid she will develop osteoporosis like her mother did. Which of the following statements is the most appropriate response by the nurse? a. “The American diet is much better now than when your mother was your age, so you have enough calcium in your diet to keep your bones strong.” b. “You have a strong genetic risk factor. There is not much we can do to stop the process.” c. “You need about 1000 mg of calcium a day to keep your bones strong. Let’s talk about your diet.” d. “Tell me about your diet, how much walking you do each day, and what medications you take.” ANS: D The postmenopausal woman needs 1500 mg of calcium a day if she is not taking estrogen. Dietary calcium and vitamin D intake, and walking, can help prevent osteoporosis. DIF: Cognitive Level: Apply (Application) REF: p. 569 11. Which of the following statements about alcohol intake is correct? a. Women have a higher death rate related to alcoholism than men. b. A woman who drinks two glasses of wine per day with her evening meal is considered a moderate drinker. c. More women than men are considered problem drinkers. d. Women who experience fewer cognitive effects from drinking are less likely to drink heavily than do women who get a “buzz” from drinking. ANS: A The death rate for female alcoholics is 50% to 100% higher than for male alcoholics. More men than women are considered problem drinkers. Moderate drinking for women is defined as one alcohol-containing drink a day. Women who are able to “hold their liquor” are more likely to drink excessively than those who cannot “hold their liquor.” DIF: Cognitive Level: Understand (Comprehension) REF: pp. 569-570 12. The occupational health nurse is planning a health fair for employees. Which of the following information about dental health should be included? a. Drinking bottled water helps prevent tooth decay. b. Gingivitis results in bone destruction and can be eliminated by flossing daily. c. Preventive dental care requires a visit to the dentist every 4 months. d. In addition to screening for tooth decay, dentists screen for mouth cancer. ANS: D Dental health is essential to overall health. Dental professionals may be the first to detect a symptom or irregularity that points to a potentially dangerous condition, such as cancer of the mouth and esophageal cancer. Bottled water does not contain fluoride. Periodontitis is oral bone destruction. An annual dental check-up is recommended for the average person, not a check-up every 4 months. DIF: Cognitive Level: Apply (Application) REF: p. 570 13. Which of the following people has exceeded the recommended guidelines for activity? a. A 36-year-old man who engages in bike riding and has a pulse rate of 137 during activity b. A 45-year-old woman who swims and has a pulse rate of 145 during activity c. A 50-year-old man who jogs and has a pulse rate of 120 during activity d. A 60-year-old woman who walks briskly and has a pulse rate of 125 during activity ANS: D During activity, the person’s pulse rate should not exceed 220 minus the age times 0.75. Thus the woman who is 60 years old would subtract (220 – 60 = 180); then multiply 180 by 0.75 to give 120 for the optimal heart rate for this client. A pulse rate of 125 exceeds the recommended optimal rate of 120. DIF: Cognitive Level: Apply (Application) REF: p. 572 14. A 63-year-old woman complains to the nurse that she has insomnia and sleeps only 6 hours a night. Which of the following responses should be made by the nurse? a. “Do you want a sleeping pill?” b. “Make sure that you do not nap during the day even if you are tired.” c. “Do you feel excessively tired during the day?” d. “The nurse practitioner may want to run some simple tests to find out why you are having trouble sleeping.” ANS: CIt is important to assess the quality of sleep as well as the effects that the limited sleep has on this individual’s daily activities. Medication should not be the first intervention used to help someone attain restful sleep. People should nap when tired, if they are able to do so, rather than forcing themselves to stay awake. DIF: Cognitive Level: Apply (Application) REF: p. 572 15. A nurse conducted a 5-week education series about health maintenance. Which of the following statements by a participant indicates the analysis stage of cognition as defined by Bloom’s taxonomy? a. “If I eat too much food and do not exercise, I will gain weight.” b. “Fat is more calorie-dense than is protein. If I eat calorie-dense foods and do not do moderate exercise at least 5 days a week, I will gain weight.” c. “I will walk briskly at least a mile a day, 6 days a week, to maintain a healthy weight.” d. “I can eat more if I exercise more.” ANS: B During the analysis stage of cognition, all aspects of learning come together in thought and the individual is cognizant of the relationships and interactions of all the parts. “If I eat too much food and do not exercise, I will gain weight” indicates knowledge (recall of facts). “I will walk briskly at least a mile a day, 6 days a week, to maintain a healthy weight” indicates application. “I can eat more if I exercise more” indicates comprehension. DIF: Cognitive Level: Apply (Application) REF: p. 573 16. A 62-year-old person states to the nurse, “I have trouble with my peripheral vision. Sometimes, I do not notice objects unless they are in front of me.” Which of the following disorders is the client likely experiencing? a. Presbyopia b. Glaucoma c. Cataracts d. Diabetic retinopathy ANS: B Glaucoma occurs as a result of increased intraocular pressure, which can damage the optic nerve. Damage to the optic nerve is irreversible, but visual loss can be prevented if damage is identified early and treatment is initiated. Peripheral vision is affected in glaucoma. Presbyopia is farsightedness. Cataracts cause cloudy vision. DIF: Cognitive Level: Apply (Application) REF: p. 573 17. Which of the following middle-age adults has successfully transitioned to Erikson’s generativityversus-stagnation stage of development?a. A 60-year-old woman who retired last year and volunteers at a homeless shelter 2 days a week b. A 63-year-old man who regrets his career choice and feels he cannot change careers c. A 45-year-old woman who resents having to care for her aging mother-in-law d. A 50-year-old man who has not saved for retirement but spends his discretionary income on vacations he takes by himself ANS: A Generativity according to Erikson’s theory involves a sense of productivity, creativity, and the desire to help others, whereas stagnation involves a sense of isolation and focus on oneself. DIF: Cognitive Level: Apply (Application) REF: p. 574 18. A 52-year-old woman going through menopause tells the nurse working in the women’s health center that she is interested in slowing down the aging process and asks if she should take estrogen. Which of the following statements would be the best response by the nurse? a. “The latest research has shown that estrogen is safe to take and will help keep you healthy. I’ll tell the nurse practitioner that you are interested in estrogen therapy.” b. “Estrogen is safe to take for about 10 years. I’ll get you some information on estrogen therapy that you can take home and read.” c. “The safety of long-term estrogen therapy is inconclusive. It is primarily used short-term to relieve hot flashes.” d. “You can get the same effects from natural products in a health food store, and each product is backed up by research showing that it is effective.” ANS: C Research about the safety of estrogen therapy is mixed, therefore it is only recommended for short-term use (1 to 3 years) and only to relieve hot flashes. Natural products do not need research to back up their claims of safety or efficacy. DIF: Cognitive Level: Apply (Application) REF: pp. 574-575 19. The occupational health nurse is asked to develop a plan to reduce work-related injuries. Which of the following recommendations would the nurse stress as the most effective way to reduce work-related injuries? a. Make the work environment smoke-free. b. Reduce environmental noise levels. c. Conduct regular walk-through assessments at the worksite. d. Increase paid personal days from one to three. ANS: A Accidents are twice as high among smokers than nonsmokers. Possible explanations include the loss of attention, the use of one hand for smoking, and irritation of the eyes. Because smoking has such an impact on accident rates, this would have the largest effect on reduction of workrelated injuries. DIF: Cognitive Level: Apply (Application) REF: p. 576 20. Which of the following effects of divorce on middle-age adults and children has been documented by research? a. Children adapt to divorce more rapidly than do adults. b. Emotional healing after a divorce takes approximately 24 months in adults. c. Children of divorced parents may have life-long difficulty forming relationships. d. Children of divorced parents undergo similar emotional turmoil as their parents. ANS: C Although research is continuing, longitudinal studies by Wallerstein and her colleagues beginning in the early 1970s indicate that children bear the emotional scars of a divorce for a lifetime. The emotional response to divorce is different for children and parents, with most parents adjusting to the divorce within 3 years after the event. DIF: Cognitive Level: Understand (Comprehension) REF: p. 578 21. A nurse is discussing sexuality with middle-age men and women. Which of the following information should be stressed by the nurse? a. Contraception usage should be decreased as a woman nears menopause. b. Difficulty with sexual performance among men happens near age 60. c. HIV infection after age 50 is rare. d. The majority of new HIV/AIDS cases occur among middle-age adults. ANS: D Adults in middle age represent 71% of all new cases of HIV/AIDS. Unintended pregnancy occurs most often in middle-age women. Male sexual performance issues begin between the ages of 40 to 50. HIV infection is not rare among middle-age adults. DIF: Cognitive Level: Apply (Application) REF: p. 579 22. An occupational health nurse is planning injury-prevention educational sessions. Which of the following considerations should be made by the nurse? a. Education should be focused on workers with the least experience. b. All workers need continued education related to safety issues. c. OSHA rules apply to all companies with more than 25 employees. d. Middle-age workers have the lowest rate of injury of any age group. ANS: B The role of the occupational health nurse is focused on keeping the worksite safe for employees. Experienced workers may not know how to prevent injury. OSHA applies to all companies. There are no data to support that middle-age workers have the lowest rate of injury. Physical and cognitive changes, which are part of middle age, may predispose workers to injury (i.e., decline in vision/hearing). DIF: Cognitive Level: Apply (Application) REF: p. 584 23. Taking into account all of the agents that affect middle-age adults, the nurse plans a health education workshop focused on developing an individualized lifestyle change program for each participant. Which of the following actions should the nurse stress that individuals take first? a. Limiting unprotected exposure to sun b. Starting a smoking cessation program c. Exercising at least three times a week d. Scheduling a complete physical and dental exam ANS: D Although limited unprotected exposure to the sun, starting a smoking cessation program, and regular exercise are important to overall health, assessment data must first be collected to create an effective lifestyle change program. Health care needs and issues vary according to race and ethnicity, socioeconomic status, marital status, and so on. Approaches to health care/education must be individualized. DIF: Cognitive Level: Analyze (Analysis) REF: pp. 585-586 24. Which of the following medications is generally recommended to help preserve cardiovascular health in middle-age women? a. Aspirin b. Folic acid c. Estrogen d. Estrogen receptor modulator ANS: A Only aspirin is recommended to help maintain cardiovascular health by lowering the risk of clot formation. DIF: Cognitive Level: Understand (Comprehension) REF: p. 577 (Box 23-7) MULTIPLE RESPONSE 1. Which of the following individuals is at risk for developing osteoporosis? (select all that apply) a. A 55-year-old man who is on a low dose of oral prednisone every day because of rheumatoid arthritis b. A 40-year-old woman who works as a secretary c. A 60-year-old woman who walks three miles a dayd. A 50-year-old man who works as a mason ANS: A, B Osteoporosis occurs most frequently in postmenopausal women who have fair complexions and are small, sedentary individuals, and people on long-term steroid use. It increases with age. DIF: Cognitive Level: Apply (Application) REF: p. 563 2. Blacks are more likely than non-Hispanic White Americans to be diagnosed with cancer at a later stage and have a less optimal outcome after the diagnosis is made. Which of the following reasons help explain this difference? (select all that apply) a. Lack of access to, or utilization of, cancer screening b. Lack of health insurance c. Genetic variations d. Lack of resiliency against disease ANS: A, B, C Although poverty and lack of access may account for lack of screening and early diagnosis, genetic variations in tumor growth and response to medication along with other major health problems also affect outcomes. DIF: Cognitive Level: Understand (Comprehension) REF: p. 566 3. A community health nurse is caring for a variety of different people in the community. Which of the following individuals would the nurse recognize as being at risk to experience increased stress related to family dynamics? (select all that apply) a. A 54-year-old couple whose young adult daughter and grandson move back into their home b. A 44-year-old single mother raising three adolescent children without child support c. A 60-year-old couple whose children have established successful careers in another state d. A 36-year-old couple whose child plays competitive tennis ANS: A, B, D Stressors of middle age include adult children moving back home, heading a single parent household, and parents whose child plays competitive sports with an emphasis on winning. The couple who has children living out of state who have established successful careers are at the least risk to have stress related to family dynamics. DIF: Cognitive Level: Apply (Application) REF: pp. 575-576 4. The occupational health nurse working for a large corporation is a member of a task force to improve the work environment. Which of the following suggestions by the nurse would help to improve work conditions? (select all that apply) a. On-site walking pathsb. On-site food vendors c. On-site counseling services d. On-site meetings of support groups such as Alcoholics Anonymous ANS: A, C, D On-site facilities that improve health (walking paths) and psychological well-being (support groups, counseling) will help to create a positive work environment. Depending on the food vendor who is on-site, the healthy food options may not be beneficial to the employees. DIF: Cognitive Level: Apply (Application) Chapter 22: Young Adult Edelman: Health Promotion Throughout the Life Span, 8th Edition MULTIPLE CHOICE 1. A nurse is planning a community health education program for young adults. Which of the following considerations should be made by the nurse? a. The age span encompassing young adulthood is between 20 to 30 years of age. b. The number one cause of death for young adults is injury. c. The number of young adults in the United States is increasing. d. The maternal mortality rate is at its lowest point since 1980. ANS: B Young adulthood spans the years between ages 18 to 35. The number of young adults in the United States is declining, and the maternal mortality rate is at its highest level since 1980. DIF: Cognitive Level: Apply (Application) REF: p. 536 2. A nurse is completing a health counseling session with a 25-year-old woman. Which of the following statements should be made by the nurse during this session? a. “A yearly Pap test is recommended for detection of ovarian cancer.” b. “Research supports that breast self-exams reduce breast cancer mortality.” c. “The incidence of cervical cancer is very low in your age group.” d. “Daily physical activity and weight control is one way to stay healthy.” ANS: D Screening is strongly recommended for cervical cancer in women who have been sexually active (Papanicolaou [Pap] smears). The incidence of carcinoma in situ is high in young adults. The US Preventative Services Task Force recommends against teaching breast self-examination and concludes that the current evidence is insufficient to assess the additional benefits and harm of clinical breast examination beyond screening mammography for women 40 and older. After age 25, the preventive emphasis is on modifying coronary disease risk factors, which would be accomplished by discussing activity and weight control. DIF: Cognitive Level: Apply (Application) REF: pp. 538-539 3. A 26-year-old client has a total cholesterol of 206 mg/dL and an LDL of 110. Which of the following conclusions can be drawn by the nurse? a. The client has achieved the target levels for cholesterol in young adults. b. The client has a very low risk of developing heart disease. c. The client requires counseling about cardiac disease risk factors. d. The client has early-onset cardiac disease. ANS: C Cardiovascular assessment of the young adult includes determining the presences of hyperlipemia, hypertension, diabetes, chest pain, or heart disease. This client has an elevated cholesterol levels and requires additional education about risk factors that may lead to cardiac disease. The Healthy People 2020 target is to reduce the mean total blood cholesterol levels among adults to 177.9 mg/dL. A diagnosis of heart disease cannot be made on the basis of these lab values. DIF: Cognitive Level: Analyze (Analysis) REF: pp. 538-539 4. The public health nurse is conducting a screening of young adults for metabolic syndrome. When asked about the syndrome, which of the following responses should be made by the nurse? a. “Anyone who has low blood sugar, high cholesterol, and high blood pressure has this syndrome and is at risk for cardiac disease.” b. “This syndrome helps predict heart disease. Once it is diagnosed, the correct medication can be prescribed and heart disease avoided.” c. “This syndrome is a warning sign that the person could develop heart disease. When someone has metabolic syndrome, dietary and activity level changes are recommended.” d. “Anyone who has high cholesterol, high blood pressure, and high blood sugar has coronary artery disease. Once we make the diagnosis, we can begin to treat the disease.” ANS: C Metabolic syndrome is diagnosed when a person has high cholesterol, high blood pressure, and high blood sugar. A person with this syndrome is at risk for coronary artery disease. Lifestyle changes are tried before medication is used. DIF: Cognitive Level: Analyze (Analysis) REF: p. 5415. The university health services nurse is preparing a disease prevention program for college students. Which of the following information should the nurse include in the program? a. Living in the dorm increases one’s risk of developing meningococcal disease. b. The mortality rate from meningococcal disease is very low. c. There are no antiviral medications that can treat meningococcal outbreaks. d. A vaccine for meningococcal disease has not been developed. ANS: A Although most outbreaks of meningococcal disease are sporadic, young adults living in dormitories or crowded conditions may be more susceptible than young adults not living in close settings. Meningococcal disease has a high mortality rate. It is caused by a bacterium, not a virus, and antibiotics to treat the disease are readily available. A preventive vaccine is available. DIF: Cognitive Level: Apply (Application) REF: p. 543 6. A 30-year-old woman with a BMI of 36 is counseled by the nurse regarding interventions to assist with weight reduction. In which order would the nurse discuss the implementation of these interventions? 1. Gastric stapling 2. Medication to reduce appetite 3. Nutrition and exercise education 4. Assessment of lipid profile and blood pressure a. 4, 3, 2, 1 b. 4, 2, 3, 1 c. 3, 4, 2, 1 d. 3, 2, 1, 4 ANS: A Assessment data must be complete before intervention. Diet and exercise are used first, and then pharmaceutical agents to reduce appetite. Bariatric surgery is used when all other options have failed. DIF: Cognitive Level: Analyze (Analysis) REF: p. 544 7. A nurse is discussing optimal activity for young adults. Which of the following information should be stressed? a. Forty-five minutes of moderate exercise per day are required to maximize health benefits. b. An increase in heart rate from 70 to 200 beats/min during exercise is optimal. c. Moderately brisk walking is an appropriate aerobic exercise. d. Sixty minutes of exercise three times a week is recommended.ANS: C The Healthy People 2020 goal is to increase the proportion of adults who engage in moderate physical activity for 150 minutes a week (30 minutes five times per week) to 47.9% from 43.5%. Aerobic conditioning achieves cardiovascular fitness through five periods of moderately intense exercise weekly for about 30 minutes or more at a heart rate of approximately 220 minus the age of the person multiplied by 65% to 85%. Young adults are encouraged to engage in fitness activities that increase the heart rate to approximately 150 beats or more per minute. Moderately brisk walking that increases the heart rate is an appropriate aerobic exercise. DIF: Cognitive Level: Apply (Application) REF: p. 545 8. The nurse working in the college health center is asked about a safe way to obtain a tan. Which of the following would be the best response by the nurse? a. “There is no safe way. Be sure to stay out of the sun as much as possible.” b. “Tanning beds are much safer than exposure to actual sunlight.” c. “Be sure to use sunblock agents and do not sunbathe between 10 AM and 2 PM.” d. “Once you apply sunblock, you are protected all day, so be sure to use it before any outdoor activity.” ANS: C Young adults should avoid sunbathing during the 2-hour period before and after noon because two-thirds of the day’s ultraviolet light comes through the earth’s atmosphere during this time. There is no need to stay completely out of the sun. Tanning beds are not a safe way to tan. Sunblock should be reapplied if certain outdoor activities are part of the day, such as swimming. DIF: Cognitive Level: Apply (Application) REF: p. 545 9. A nurse is working in the community to prevent bicycle and motorcycle fatalities. Which of the following measures would be most effective for the nurse to promote? a. Use of helmets b. Increasing the minimum age for motorcycle licensure c. Construction of bike paths along busy roads d. Right-of-way laws for bicyclists ANS: A Head injury is the major cause of death related to bicycle or motorcycle accidents. Bicycle helmets are believed to be the single most effective preventive measure available to decrease the incidence of brain and head injury. DIF: Cognitive Level: Apply (Application) REF: p. 545 10. Which of the following reflects Piaget’s theory as applied to young adults? a. Voting for a candidate based on popularity b. Voting for a candidate based on media advertisementsc. Voting for a candidate based on support of the candidate by peers d. Voting for a candidate based on analysis of views about various issues ANS: D Young adults are in Piaget’s formal operational thinking stage during which they analyze issues objectively and insightfully. DIF: Cognitive Level: Analyze (Analysis) REF: p. 546 11. Which of the following adults has transitioned to Erikson’s intimacy versus isolation and loneliness stage of development? a. A 21-year-old man who has a part-time job, spends most of his leisure time with his buddies, and has numerous short-term intimate relationships b. A 25-year-old woman who is very concerned with how she is perceived by her coworkers and friends c. A 30-year-old man who just graduated with a PhD and is looking for his first fulltime job d. A 26-year-old woman who has a long-term relationship with a female companion ANS: D Erikson’s intimacy versus isolation and loneliness stage of development involves reciprocal expressions of affection and trust. Promiscuous behavior is not characteristic of this stage of development. Reliance on a positive perception by friends and coworkers for self-esteem is not characteristic of this stage of development. DIF: Cognitive Level: Analyze (Analysis) REF: p. 546 12. Which of the following young adults exemplifies Kohlberg’s postconventional level of moral reasoning? a. 28-year-old person who calls in sick so as to help a friend move to a new location b. 22-year-old man who uses marijuana on the weekends with friends c. 30-year-old woman who volunteers at a soup kitchen one day a month d. 35-year-old who works long hours so as to be considered for a promotion ANS: C Someone in Kohlberg’s postconventional level of moral reasoning is able to do what is beneficial or “right” regardless of peer pressure to take another course of action. DIF: Cognitive Level: Analyze (Analysis) REF: p. 546 13. Which of the following statements should be considered by a nurse working in occupational health who organizes a stress reduction workshop? a. Women generally experience less workplace stress than do men.b. One’s first job is exciting and leads to numerous opportunities, and therefore causes little stress. c. Young adults adapt easily to changing job demands such as telecommuting and long work hours. d. Work is of primary importance to young adults and helps form their self-image. ANS: D Employment is more than a source of income to young adults; it provides self-esteem and social interaction. Women experience as much, and sometimes more, stress than do men because of child care issues. The demands of work are stressful and sometimes lead to unhealthy behavior. DIF: Cognitive Level: Apply (Application) REF: p. 547 14. The parents of a young adult female have recently divorced. Which of the following is the young adult most likely to experience? a. Relief b. Depression c. Unemployment d. Inability to sustain own relationships ANS: B Although dissatisfaction and unhappiness are frequent precursors to separation and divorce, the decision to dissolve a marriage is not easy. Divorced young adults frequently suffer severe emotional strain and depression. Some young adults are unable to adjust to role and status changes and to threats of self-concept. Young adults whose parents divorce have an increased rate of divorce, but that does not mean that they are unable to sustain their own relationships. DIF: Cognitive Level: Apply (Application) REF: p. 548 15. A 19-year-old college student is seen by the health services nurse. The young woman is distraught that she had unprotected sex 4 days ago and is afraid she may have become pregnant. Which of the following statements should be made by the nurse? a. “Let’s talk about your options because you must be 21 years of age to purchase emergency contraception.” b. “Don’t worry; you can purchase Plan B, an emergency contraception drug, without a prescription and it will terminate the pregnancy.” c. “I know you are upset, but we are in one of the 40 states that allow drugstores to carry Plan B, an emergency contraception drug. Let’s talk about how to use the medication.” d. “You have several options. Let’s discuss what would be the best thing for you to do next.” ANS: DEmergency contraception can reduce the number of unintended pregnancies. There is a generic two-dose form Next Choice, and a one-dose form, Plan B One-Step. Both require a prescription for girls under 17. Emergency contraception must be used within three days of unprotected sex. It works by either altering tubal transport of either sperm or ova, inhibiting implantation. It will not terminate an existing pregnancy and does not provide protection against sexually transmitted diseases. DIF: Cognitive Level: Apply (Application) REF: pp. 550-551 16. The nurse working in the college health center is planning a program about sexually transmitted diseases (STDs). Which of the following information should the nurse include in the program? a. STDs are the third most common infection in young adults. b. STDs can be transmitted by any intimate contact, not just sexual intercourse. c. STDs usually occur as a single infection. d. STDs are the most common reason for a visit to the health center. ANS: B STDs can be transmitted from oral and anal sex, not just vaginal intercourse, and many young adults do not understand this. STDs are the most common infection in persons age 15 to 24. A person may have multiple STDs. STDs are generally unreported and not treated. DIF: Cognitive Level: Apply (Application) REF: pp. 551-552 17. A 32-year-old woman visits the occupational health nurse because of malaise. Which of the following assessment data indicates that the client may be experiencing achievement-oriented stress? a. Sleeping 10 hours per day b. Unintentional loss of 10 pounds in the past 3 weeks c. Expressed fear of company layoffs d. Calling in sick once every 2 weeks for the past month ANS: B Achievement-oriented stress is characterized by lack of sleep, skipping meals, and workaholic habits. It differs from situational stress, which would be caused by changes in job function for example. DIF: Cognitive Level: Apply (Application) REF: p. 553 18. A nurse volunteered to work at a natural disaster site. Which of the following questions should the nurse ask to determine if the 26-year-old individual being screened is depressed or has suicide ideation? a. “Tell me about your pets.” b. “What do you do for work? How has your work been affected by this disaster?” c. “Have you thought of harming yourself?”d. “Have you seen your friends since the disaster?” ANS: C Direct questioning about the intent to harm oneself is appropriate for the nurse to ask during screening/counseling sessions. DIF: Cognitive Level: Apply (Application) REF: pp. 553-554 19. A nurse is planning health care for young adults. Which of the following factors about the interventions should be recognized by the nurse as having the greatest impact on whether they are effective? a. Culturally sensitive b. Match the person’s health care beliefs c. Cost effective d. Gender neutral ANS: A Unless the interventions are culturally sensitive, they are not likely to be successful. Although the other factors are important, the priority consideration is cultural sensitivity. DIF: Cognitive Level: Analyze (Analysis) REF: pp. 554-555 20. Which of the following circumstances accounts for one of the leading cause of death in young adults? a. Tobacco use b. Binge drinking and driving c. Illegal drug use d. HIV infection ANS: B Alcohol-related accidents among individuals ages 15 to 24 continue to be a leading cause of preventable morbidity, disability, and death. DIF: Cognitive Level: Understand (Comprehension) REF: p. 556 21. A nurse is counseling a 23-year-old woman about oral, transdermal, injectable, vaginal ring, and implant contraceptive methods. Which of the following risks of using these methods should be stressed by the nurse? a. Toxic shock syndrome b. Nausea c. Blood clots d. Ectopic pregnancyANS: C Blood clots are a potential risk with using all of these contraceptive methods. Ectopic pregnancy is a possible complication of IUDs. Nausea may occur with the use of Plan B, and toxic shock syndrome may occur with use of a diaphragm. DIF: Cognitive Level: Apply (Application) REF: p. 551 (Table 22-2) 22. Which of the following interventions are appropriate relative to the nursing diagnosis: HealthSeeking Behaviors Related to Preconceptual Assessment and Preparation for Childbearing? a. Encouraging the consumption of a moderate-fat diet to prepare for pregnancy b. Referral to genetic counseling based on family history c. Counseling to avoid “hard” liquor d. Substituting a nutritional supplement for a meal so as to assure adequate vitamin intake ANS: B Assessment of biophysical risk factor is an important intervention, which includes review of genetic disorders, nutrition problems, and current medical problems. Before and during pregnancy, the diet should be well-balanced, low in fat and sodium, and high in calcium and iron. Nutritional supplements are not required unless the woman is malnourished. Alcohol in all forms including beer and wine shoul