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

Edelman- Health Promotion Throughout the Life Span, 8th Edition Edelman: Health Promotion Throughout the Life Span, 8th Edition Chapter 01: Health Defined: Objectives for Promotion and Prevention Edelman: Health Promotion Throughout the Life Span, 8th Edition MULTIPLE CHOICE 1. Which model of health is most likely used by a person who does not believe in preventive health care? a. Clinical model b. Role performance model c. Adaptive model d. Eudaimonistic model ANS: A The clinical model of health views the absence of signs and symptoms of disease as indicative of health. People who use this model wait until they are very sick to seek care. DIF: Cognitive Level: Remember (Knowledge) REF: p. 3 2. A person with chronic back pain is cared for by her primary care provider as well as receives acupuncture. Which model of health does this person likely favor? a. Clinical model b. Role performance model c. Adaptive model d. Eudaimonistic model ANS: D 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. DIF: Cognitive Level: Apply (Application) REF: p. 3 3. 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: a. growth and development. b. health. c. functioning. d. high-level wellness. ANS: B 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. DIF: Cognitive Level: Remember (Knowledge) REF: p. 5 4. Which of the following best describes a client who has an illness? a. Someone who has well-controlled diabetes b. Someone with hypercholesterolemia c. Someone with a headache d. Someone with coronary artery disease without angina ANS: C Someone with a headache represents a person with an illness. An illness is made up of the subjective experience of the individual and the physical manifestation of disease. It can be described as a response characterized by a mismatch between a person‘s needs and the resources available to meet those needs. A person can have a disease without feeling ill. The other choices represent disease. DIF: Cognitive Level: Analyze (Analysis) REF: p. 6 5. Which US report is considered a landmark document in creating a global approach to health? a. The 1990 Health Objectives for the Nation: A Midcourse Review b. Healthy People 2020 c. Healthy People 2000 d. The U.S. Surgeon General Report ANS: C 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. DIF: Cognitive Level: Remember (Knowledge) REF: p. 6 6. Which of the following represents a method of primary prevention? a. Informational session about healthy lifestyles b. Blood pressure screening c. Interventional cardiac catheterization d. Diagnostic cardiac catheterization ANS: A 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. DIF: Cognitive Level: Apply (Application) REF: p. 11 7. Which of the following represents a method of secondary prevention? a. Self–breast examination education b. Yearly mammograms c. Chemotherapy for advanced breast cancer d. Complete mastectomy for breast cancer ANS: B 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. DIF: Cognitive Level: Apply (Application) REF: p. 15 8. Which of the following represents a method of tertiary prevention? a. Drunk driving campaign b. Road blocks for drunk driving c. Emergency surgery for head trauma after a motor vehicle accident d. Physical and occupational therapy after a motor vehicle accident with head trauma ANS: D Physical therapy and occupational therapy are considered tertiary prevention. Tertiary prevention occurs when a defect or disability is permanent and irreversible. It involves minimizing the effect of disease and disability. The objective of tertiary prevention is to maximize remaining capacities. DIF: Cognitive Level: Apply (Application) REF: p. 15 9. 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): a. advocate. b. care manager. c. consultant. d. educator. ANS: B Care managers act to prevent duplication of service and reduce cost. Care managers base recommendation on reliable data sources such as evidence-based practices and protocols. DIF: Cognitive Level: Apply (Application) REF: p. 15 10. During a home visit, a nurse assists an individual to complete an application for disability services. The nurse is acting as a(n): a. advocate. b. care manager. c. consultant. d. educator. ANS: A 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. DIF: Cognitive Level: Apply (Application) REF: p. 15 11. During a home visit, a nurse discusses the dangers of smoking with an individual. In this scenario the nurse is acting as a(n): a. advocate. b. care manager. c. consultant. d. educator. ANS: D Health education is a primary prevention technique available to avoid major causes of disease. Teaching can range from a chance remark to a planned lesson. DIF: Cognitive Level: Apply (Application) REF: p. 16 12. 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): a. advocate. b. care manager. c. consultant. d. educator. ANS: C Nurses with a specialized area of expertise provide education about health promotion and disease prevention to individuals and groups as consultants. DIF: Cognitive Level: Apply (Application) REF: p. 16 13. A nurse is planning to deliver an educational program to individuals with diabetes. Which of the following should be the initial action taken by the nurse to ensure the success of the program? a. Assess the motivation level of the individuals b. Assess the knowledge level of the individuals c. Establish teacher-learner goals with the individuals d. Establish multiple teaching sessions with the individuals ANS: B 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. DIF: Cognitive Level: Analyze (Analysis) REF: p. 16 14. The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individuals is known as: a. health-related quality of life. b. evidence-based practice. c. a Healthy People 2010 goal. d. the ecological model of health. ANS: B Evidence-based practice is defined as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individuals. DIF: Cognitive Level: Remember (Knowledge) REF: p. 16 15. Which research methodology should be used to address the question, ―What is the difference in the infection rates between individuals who receive twice-a-day dressing changes versus once-a-day dressing changes?‖ a. Evidence-based practice research b. Qualitative research c. Quantitative research d. Clinical judgment research ANS: C Quantitative research studies describe situations, correlate different variables related to care, or test causal relationships among variables related to care. Evidence-based practice research and clinical judgment research are not research methodologies; they are used to answer clinical questions. DIF: Cognitive Level: Apply (Application) REF: p. 16 16. The question, ―What is the experience of teenagers who lose a sibling to cancer?‖ can best be answered by using which research methodology? a. Evidence-based practice research b. Qualitative research c. Quantitative research d. Clinical judgment research ANS: B Qualitative research studies describe phenomena or define the historical nature, cultural relevance, or philosophical basis of aspects of nursing care. Evidence-based practice research and clinical judgment research are not research methodologies; they are used to answer clinical questions. DIF: Cognitive Level: Apply (Application) REF: p. 16 17. A nurse who uses findings from a randomized, controlled trial on the care of Foley catheters to change practice at an institution is practicing: a. evidence-based medicine. b. qualitative research. c. quantitative research. d. clinical judgment. ANS: A The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. DIF: Cognitive Level: Apply (Application) REF: p. 16 18. Which of the following is most influenced by the social and economic environment of a community? a. Social health policies b. Quality of care c. Evidence-based practice d. Practice guidelines ANS: A 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. DIF: Cognitive Level: Remember (Knowledge) REF: p. 17 19. A major cause of death in the early twentieth century was: a. cancer. b. cerebrovascular disease. c. heart disease. d. infections. ANS: D Infections and acute disease were the major causes of death in the early part of the twentieth century. DIF: Cognitive Level: Remember (Knowledge) REF: p. 17 20. A mainstay of therapy for the management of chronic diseases is: a. lifestyle changes. b. occupational and physical therapy. c. medications. d. surgery. ANS: A The application of complex technology is not only costly but contributes minimally to improvement of health. One needs to focus on the cause of disease. The needs of a person with chronic disease are related to and affected by the individual‘s biochemical functioning, genetics, environment, and personal choices. DIF: Cognitive Level: Apply (Application) REF: p. 17 21. Which of the following demonstrates a nurse taking action to promote health and prevent disease? a. Making a home visit to a person who is recovering from a heart attack b. Administering medications to a cardiac client in the hospital c. Providing cardiopulmonary resuscitation during a heart attack d. Educating a person about the advantages of a heart-healthy diet during a home visit ANS: D 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. DIF: Cognitive Level: Apply (Application) REF: p. 17 22. 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? a. Education regarding effects of smoking on her health b. The satisfaction that she will not contribute to secondhand smoke c. The availability of a weekly support group d. A gift card for $10 to a local grocery store for every week she is smoke free ANS: D Motivational factors play a role in influencing attitudinal changes. A financial incentive is an 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. DIF: Cognitive Level: Analyze (Analysis) REF: p. 14 (Box 1-6) | p. 18 23. An example of a Hispanic American nurse promoting cultural competency is: a. providing translation services for all Hispanic Americans. b. focusing on episodic care of illnesses with Hispanic Americans. c. taking a class about the Hispanic American culture. d. providing care for all Hispanic American persons in her clinic. ANS: C 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. DIF: Cognitive Level: Apply (Application) REF: p. 17 (Box 1-2) 24. The devaluing of beliefs, values, and customs of others is known as: a. ethnocentrism. b. racism. c. cultural competency. d. empathy. ANS: B Racism is defined as the devaluing of beliefs, values, and customs of others. DIF: Cognitive Level: Remember (Knowledge) REF: p. 7 (Box 1-2) 25. Building a partnership with an obese individual who is trying to lose weight requires the nurse to: a. schedule a day to exercise with the individual. b. go grocery shopping for the individual. c. learn about the methods of weight loss. d. give the individual a weight loss goal. ANS: C 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. DIF: Cognitive Level: Apply (Application) REF: p. 8 (Box 1-3) 26. Assuming that an individual‘s own perspective is correct and shared by others is known as: a. ethnocentrism. b. racism. c. cultural competency. d. empathy. ANS: A Assuming that an individual‘s own perspective is correct and shared by others is known as ethnocentrism. DIF: Cognitive Level: Remember (Knowledge) REF: p. 8 (Box 1-2) MULTIPLE RESPONSE 1. Which of the following ―investment‖ themes has been identified by the National Institute of Nursing Research? (select all that apply) a. Interprofessional collaboration b. Improving quality of life c. End-of-life care d. Increasing physical activity among Americans ANS: B, C The National Institute of Nursing Research has identified five themes that promote health and prevent disease, improve quality of life through symptom management, and support palliative and end-of-life care, innovation, and nurse scientists. DIF: Cognitive Level: Remember (Knowledge) REF: p. 16 2. Which interventions address both the National Institute of Nursing Research themes and the overall goals of the Healthy People 2020 leading health indicators? (select all that apply) a. Establishing a new park with a well-lit track b. Establishing a smoking cessation campaign c. Providing reduced-cost transportation passes to senior citizens d. Providing free condoms at all federally funded health clinics ANS: A, B, D Establishing a new park with a well-lit track, establishing a smoking cessation campaign, and providing free condoms at all federally funded health clinics all address the National Institute of Nursing Research themes and the Healthy People 2020 leading health indicators. A park, smoking cessation campaign, and free condoms address the themes of promoting health and preventing disease and the goal of increasing quality and years of healthy life. Providing reduced-cost transportation passes to senior citizens may indirectly affect the health of this population; however, it is not directly related to the themes of the National Institute of Research (promote health and prevent disease, improve quality of life through symptom management, and support palliative and end-of-life care, innovation, and nurse scientists) or the overall goals of Healthy People 2020 (increase quality and years of healthy life and eliminate health disparities). DIF: Cognitive Level: Analyze (Analysis) REF: p. 7 | p. 16 Chapter 02: Emerging Populations and Health Edelman: Health Promotion Throughout the Life Span, 8th Edition MULTIPLE CHOICE 1. Which of the following statements about ethnic minorities in the United States is accurate? a. It is estimated that the percentage of ethnic minorities will decrease during the next 30 years. b. It is estimated that ethnic minorities will increase to one in two by 2050. c. The increasing population of refugees has been a significant contributor to the increase in ethnic minorities. d. The increasing population of ethnic minorities has helped decrease the health disparities faced by this population. ANS: B It is estimated that the number of ethnic minorities will increase to one in two by 2050. In 2010, it was estimated that 33% of the population was from an ethnic minority. The increasing population of immigrants has been a significant contributor to the increasing populations of major ethnic groups. The increasing populations of ethnic groups is one factor that is producing disparities in health status and access of the health care system. DIF: Cognitive Level: Understand (Comprehension) REF: p. 24 2. A person states, ―My grandmother is the decision maker in our family.‖ Which of the following is being described by the person? a. Culture b. Race c. Ethnicity d. Values ANS: A 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. DIF: Cognitive Level: Analyze (Analysis) REF: p. 24 3. 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? a. Race b. Ethnicity c. Cultural values d. Value orientation ANS: C 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. DIF: Cognitive Level: Apply (Application) REF: p. 24 4. Which of the following actions demonstrates a health care professional providing culturally competent care? a. Encouraging the person to take medications as prescribed b. Asking the person to describe his folk healing methods c. Demonstrating the proper way to administer an insulin injection d. Assisting the person with discussing his health problems with the family ANS: B 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. DIF: Cognitive Level: Analyze (Analysis) REF: p. 26 5. 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? a. ―You should have told me that the current treatments were helping your pain.‖ b. ―Tell me more about your treatments from the acupuncturist.‖ c. ―Tell me why you decided to not to continue with your treatment plan.‖ d. ―You should not be seeing an acupuncturist while receiving professional care.‖ ANS: B 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. DIF: Cognitive Level: Analyze (Analysis) REF: p. 26 6. When providing an educational session about the Arab American population, which of the following information would be included? a. The largest group of Arab Americans was refugees in the 1960s. b. The largest groups of Arab Americans are from Palestine and Iraq. c. Members of the Arab American population are most likely to live in rural communities. d. Members of the Arab American population are more likely to have college degrees than Americans at large. ANS: D 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. DIF: Cognitive Level: Understand (Comprehension) REF: p. 27 7. A health care professional is caring for an Arab American individual. Which of the following cultural practices of this ethnic minority should be considered when planning care? a. This ethnic culture tends to be future oriented. b. Religion plays an important role in this culture. c. Traditional cultural practices are infrequently used during a health crisis. d. Members of this culture tend to have smaller families. ANS: B 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. DIF: Cognitive Level: Apply (Application) REF: p. 27 8. A health care professional is providing education to the parents of an Asian American child who has recently been diagnosed with Type I diabetes. Which of the following actions should be taken by the health care professional? a. Provide instructions to the child‘s father. b. Encourage the parents to bring other siblings into the clinic for screening. c. Schedule multiple educational sessions for the child and family. d. Watch for nonverbal gestures by the adults to indicate understanding. ANS: A In Asian American culture, the oldest male family member often is the decision maker and spokesperson. Maintaining harmony is an important value in Asian cultures, and it is strongly emphasized to avoid conflict and direct confrontation. As a result of this, Asian Americans may not show their disagreement with the recommendations of health care professionals. Type I diabetes is not a common health problem experienced by this minority, so it is probably not necessary to encourage screening for siblings. Additional educational sessions may be necessary; however, Asian Americans tend to be more highly educated than any other population in the United States. DIF: Cognitive Level: Analyze (Analysis) REF: p. 29 9. 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? a. The child will get a good education. b. According to law, all children must go to school. c. The child can get health care at school. d. Exposure to different cultures in school will enhance socialization. ANS: D Exposure to different cultures in school facilitates the adoption of other cultural beliefs and aids in the socialization of the child into a new environment. DIF: Cognitive Level: Apply (Application) REF: p. 29 10. Which of the following was the fastest-growing minority group in the United States between 2000 and 2010? a. Asian American b. Arab American c. Hispanic American d. Native American ANS: C A 43% increase in the Hispanic population between 2000 and 2010 makes Hispanics the fastest-growing minority group in the United States. DIF: Cognitive Level: Remember (Knowledge) REF: p. 31 11. The interrelationship of poverty and health care dollars spent by Blacks and other minorities is affected greatly by: a. lack of access to preventive health care services b. low numbers of minority health care providers c. use of emergency rooms for care d. increased infant mortality rates in African American populations ANS: A A decrease in resources for preventive care leads to the use of emergency rooms and other more expensive health care services that are often used as resources when severe illness occurs. DIF: Cognitive Level: Understand (Comprehension) REF: p. 32 12. 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? a. The church is the only place where prayer can be performed. b. The church serves as a social support for its members. c. The church is the place where the family meets on a weekly basis. d. The church serves as a site for folk healing practices. ANS: B 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. DIF: Cognitive Level: Apply (Application) REF: p. 33 13. Which of the following ethnic groups has a disproportionately high death rate from unintentional injuries and suicide? a. American Indian/Alaska Native Americans b. Asian Americans c. Latino/Hispanic Americans d. Black/African Americans ANS: A 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. DIF: Cognitive Level: Apply (Application) REF: p. 34 14. A health care professional is offering an educational session about providing culturally congruent care. Which of the following information would be included the presentation? a. Hispanic Americans value keeping balance and harmony with the earth. b. The oldest male is the decision maker in African American families. c. Native Americans are present oriented, taking one day at a time. d. The hot and cold concept of disease is part of the Asian American culture. ANS: C 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. DIF: Cognitive Level: Apply (Application) REF: p. 34 15. A family has recently become homeless. Which of the following factors most likely contributed to this situation? a. Being from an ethnic minority background b. Declining rates of poverty c. Having multiple chronic illnesses d. Being unable to find affordable housing ANS: D 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. DIF: Cognitive Level: Apply (Application) REF: p. 35 16. A health care professional is caring for an individual who is homeless. Which of the following considerations should be made? a. The prevalence of substance abuse is much lower among the homeless population than the general population. b. The prevalence of HIV/AIDS is much lower among the homeless population than the general population. c. The percentage of the population who has health insurance is much lower among the homeless than the general population. d. The percentage of the population who has limited access to medical care is much lower among the homeless than the general population. ANS: C 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. DIF: Cognitive Level: Apply (Application) REF: p. 36 17. A health care professional is caring for an individual who is homeless and has recently been diagnosed with Type II diabetes. Which of the following factors is the most important to consider when planning care? a. Considering the cost of the purchasing medications b. Determining the pharmacy where medications will be obtained c. Obtaining insurance that will pay for the follow-up care d. Finding supportive housing for the individual ANS: D Research and practice have shown that permanent supportive housing works because housing is an essential part of treatment; thus, this is the most important factor that should be considered. If supportive housing is found, the stability will help the homeless individual to follow the prescribed medical regimen. DIF: Cognitive Level: Analyze (Analysis) REF: p. 36 18. 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? a. Homelessness should be addressed by improving financial assistance programs. b. Homelessness should be of concern to everyone in the neighborhood. c. Homelessness should be addressed by encouraging job growth in the area. d. Homelessness should be of concern to the mental health providers in the area. ANS: B 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. DIF: Cognitive Level: Analyze (Analysis) REF: p. 37 19. What is the main focus of the National Institutes of Health (NIH)? a. Addressing and reducing health disparities b. Outlining nationwide health promotion and disease prevention c. Protecting minority populations through development of health policies d. Supporting communities in addressing health disparities ANS: A The main concern of the National Institutes of Health is addressing and reducing health disparities involving cancer, diabetes, infant mortality, AIDS, cardiovascular illnesses, and many other diseases. Healthy People 2020 outlines a comprehensive, nationwide health promotion and disease prevention agenda. The Office of Minority Health improves and protects the health of racial and ethnic minority populations through the development of health policies and programs that concentrate on eliminating health disparities. The Centers for Disease Control and Prevention‘s Racial and Ethnic Health Disparities Action Institute supports communities to take action in addressing health disparities. DIF: Cognitive Level: Remember (Knowledge) REF: p. 37 20. 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? a. The National Institute on Minority Health and Health Disparities b. The Centers for Disease Control and Prevention c. The Office of Minority Health d. The National Institutes of Health ANS: C 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. DIF: Cognitive Level: Analyze (Analysis) REF: p. 37 21. Which of the following best demonstrates the practice of transcultural nursing? a. Using previous knowledge about ethnic minority cultures to plan care b. Adapting nursing care to meet the need of a person from an ethnic minority c. Requesting an interpreter when caring for a person from an ethnic minority d. Attending a presentation about cultural diversity ANS: Blm 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. DIF: Cognitive Level: Analyze (Analysis) REF: p. 38 22. A nurse would like to improve his cultural competence. Which of the following is the best strategy to use? a. Explore complementary and alternative medicine practices used by other cultures. b. Discuss cultural differences with coworkers. c. Provide care to diverse populations. d. Participate in continuing education programs about cultural diversity. ANS: D 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. DIF: Cognitive Level: Apply (Application) REF: p. 26 (Box 2-3) 23. A nurse is told by a colleague that an Asian American individual on home care is using complementary and alternative medicine (CAM). Which of the following conclusions can accurately be drawn from this statement? a. The client will have adverse complications from using this form of medicine. b. The client may be using meditation, acupuncture, or another therapy. c. The client will soon be returning to his or her native country for further treatment. d. The client does not agree with the current professional care medication regimen. ANS: B 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. DIF: Cognitive Level: Apply (Application) REF: p. 30 (Box 2-4) 24. A woman reports that she has strong spiritual practices. Which of the following is she most likely to experience? a. Improved coping skills and social support b. Increased understanding of religious differences c. Decreased pain and improved healing d. Decreased use of Western medicine ANS: A 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. DIF: Cognitive Level: Apply (Application) REF: p. 39 (Box 2-5) MULTIPLE RESPONSE 1. Which of the following individuals will most likely experience a disparity in health and health care? (select all that apply) a. African American man b. Unemployed woman c. White middle-aged man d. Single white woman ANS: A, B, D Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion. A white middle-aged man is the only individual who does not meet that definition. DIF: Cognitive Level: Apply (Application) REF: p. 23 2. A health care professional is providing culturally competent care. Which of the following actions is being performed by the professional? (select all that apply) a. Recognizing and accepting cultural diversity b. Respecting the patient‘s values, beliefs, and expectations c. Understanding the pathophysiology of disease processes d. Providing health care services that are respectful of the individual‘s cultural beliefs ANS: B, D A culturally competent health care professional should be able to consistently and thoroughly recognize and understand the differences in his or her culture and that of the patient or client; respect the individual‘s values and beliefs; and adjust the approach of delivering care to meet each individual‘s needs and expectations. Simply recognizing and accepting cultural diversity and understanding the pathophysiology of disease processes are insufficient measures to reach cultural competency in health care. DIF: Cognitive Level: Apply (Application) REF: p. 26 3. A health care provider is discussing the importance of receiving routine preventive care with a Hispanic family who has recently immigrated to the United States. Which of the following would best describe why they may be disinterested in receiving professional care? (select all that apply) a. Lack of folk remedies b. Lack of interpreter services c. Lack of health insurance d. Lack of family support ANS: B, C Barriers experienced by Hispanic Americans in receiving appropriate health care services include lack of racial and ethnic diversity in the leadership and workforce of the health care system, lack of interpreter services for Spanish-speaking people, lack of health insurance, and lack of or inadequate culturally appropriate health care resources. They may not readily seek care because of their continued reliance on their folk system of healing. The family is the most important source of support for Hispanic Americans. DIF: Cognitive Level: Apply (Application) REF: p. 31 4. A nurse is developing a continuing education program about strategies to work with culturally diverse populations for health care professionals in the community. Which of the following organizations would provide information that could be included in this presentation? (select all that apply) a. The American Nurses Association b. Sigma Theta Tau International c. The National League for Nursing d. The American Association of Colleges of Nursing ANS: A, C, D Major organizations, such as the American Nurses Association (ANA), the National League for Nursing (NLN), and the American Association of Colleges of Nursing (AACN), publish culturally relevant materials to guide students, clinicians, and educators. DIF: Cognitive Level: Apply (Application) REF: p. 38 Chapter 03: Health Policy and the Delivery System Edelman: Health Promotion Throughout the Life Span, 8th Edition MULTIPLE CHOICE 1. Which addition to a community best demonstrates the concept of the Healthy People 2020 report? a. New cardiothoracic intensive care unit at a major hospital b. New rehabilitation center c. New recreational health center d. New children‘s hospital ANS: C 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. DIF: Cognitive Level: Apply (Application) REF: p. 47 | p. 47 (Box 3-1) 2. Which nurse is at risk of making a medical error? a. Working overtime b. Works in a hospital that advocates multidisciplinary care c. Caring for four clients during the shift d. Attends regular continuing education programs ANS: A 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. DIF: Cognitive Level: Apply (Application) REF: p. 50 3. What is the most effective policy a staff nurse can implement to help decrease medical errors on the unit? a. Forgo opportunities for continuing education so the unit is never understaffed. b. Foster a collaborative working environment on the unit. c. Check all medications a minimum of three times before administering them. d. Develop a policy that mandates the firing of any nurse who commits an error. ANS: B 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. DIF: Cognitive Level: Apply (Application) REF: p. 50 4. The person known as the father of British and American public health is: a. Lillian Wald. b. Edwin Chadwick. c. Lemuel Shattuck. d. Paul Ehrlich. ANS: B Edwin Chadwick is known as the father of British and American public health. DIF: Cognitive Level: Remember (Knowledge) REF: p. 51 5. A community health nurse most effectively preserves the health of a person with tuberculosis (TB) and the community by: a. administering and reading the purified protein derivative (PPD) of all close contacts b. providing direct observed therapy (DOT) for the individual with TB c. isolating the person because it is likely drug resistant d. telling the person to wear a mask when leaving the home ANS: B Community health nursing practice promotes, preserves, and maintains the health of populations and the effect of their health status on that of the community as a whole through care provided to individuals, families, and groups. Thus, the most effective strategy of treating the individual and preventing the spread of TB is to provide DOT. DIF: Cognitive Level: Analyze (Analysis) REF: p. 52 6. A community planning committee is working on the development of a community nursing center. Which of the following essential components should be included in this center? a. Physician as medical director b. Interdisciplinary staff c. Nurse as chief manager d. Partnership with an academic institution ANS: C 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. DIF: Cognitive Level: Apply (Application) REF: p. 54 7. Considering the provider and client perspective, which of the following is the most autonomous form of insurance? a. Fee-for-service plan b. Health maintenance organization (HMO) c. Preferred provider organization (PPO) d. Independent practice association (IPA) ANS: A 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. DIF: Cognitive Level: Apply (Application) REF: p. 55 8. Which could result in a change in a nurse practitioner‘s practice? a. Holding a master‘s degree or higher b. Moving to another state when she gets married c. Caring for Medicare clients d. Changing to another office within the same practice ANS: B Nurse practitioners generally hold master‘s degrees or higher. The nurse practice act within their states may be more comprehensive than the institutions for which they work. Legislation exists for reimbursement of nurse practitioners by Medicare. However, practice acts and prescriptive authority vary from state to state and thus influence practice patterns. DIF: Cognitive Level: Apply (Application) REF: p. 55 | p. 70 9. Which health care provider represents a primary care provider? a. Psychiatric advanced practice nurse b. Clinical nurse specialist c. Pediatric nurse practitioner d. Acute care nurse practitioner ANS: C 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. DIF: Cognitive Level: Apply (Application) REF: p. 55 | p. 56 (Box 3-5) 10. Which form of managed care restricts providers to caring for individuals who are members of their organization? a. Fee-for-service plan b. Health maintenance organization (HMO) c. Preferred provider organization (PPO) d. Independent practice association (IPA) ANS: B The traditional HMO was a group or staff model in which a group of physicians and some specialty services provided care to its members. Providers generally spent all their time serving members of the HMO. Fee-for- service, IPAs, and PPOs are not restricted to serving clients for any one organization. DIF: Cognitive Level: Remember (Knowledge) REF: p. 55 11. 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? a. The individual must see a primary care provider before being referred to a specialist. b. The focus of care is prevention and management of individuals with chronic disease. c. The individual has paid a membership fee to be part of this organization. d. The focus of care is to conserve money in a health savings account. ANS: B 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. DIF: Cognitive Level: Apply (Application) REF: pp. 56-57 12. An individual states that his family has insurance, but that paying for routine medical costs is very expensive because most routine services are paid for out of pocket. Which type of insurance plan does this individual most likely have? a. High deductible health insurance plan (HDHP) b. Point-of-service plan (POS) c. Health maintenance organization (HMO) d. Preferred provider organization (PPO) ANS: A High deductible health insurance plans (HDHPs) are structured in a way similar to traditional managed care plans and fee-for-service plans but have a very high annual out-of-pocket deductible. Thus, a family with this type of insurance will pay out-of-pocket until they reach the deductible, which may make receiving health services expensive for them. Point-of-service plans allow members, for an additional fee and higher copayment, to use providers outside of the HMO network. Health maintenance organizations (HMOs) deliver comprehensive health maintenance and treatment services for a group of enrolled individuals who prepay a fixed fee. Preferred provider organizations (PPOs) have a preselected list of providers who have agreed to provide health services for those enrolled in the plan. DIF: Cognitive Level: Apply (Application) REF: p. 58 13. 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? a. Health maintenance organization (HMO) b. Health savings account (HSA) c. Preferred provider organization (PPO) d. Independent practice association (IPA) ANS: C 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). DIF: Cognitive Level: Remember (Knowledge) REF: p. 58 | p. 56 (Box 3-5) 14. Two working adults do not have access to health insurance for their family from their employers and do not meet the financial criteria for Medicaid. For which of the following federal programs may the children in this family be eligible? a. Medicare b. Civilian Health Medical Program for Uniformed Services (CHAMPUS) c. State Children‘s Health Insurance Program (SCHIP) d. Veteran‘s Administration Program ANS: C The State Children‘s Health Insurance Program is a public state insurance program established to provide insurance to uninsured children whose family is typically described as the working poor and do not meet Medicaid requirements. In this case, both parents work but do not have access to insurance through their employers. Additionally, they do not meet the financial Medicaid requirement. DIF: Cognitive Level: Apply (Application) REF: p. 60 15. A nurse complies with the Patient Self-Determination Act when asking: a. a person upon admission to the hospital if he or she has an advanced directive b. the family in the recovery room if the client has an advanced directive c. a person before discharge from the hospital if he or she has an advance directive d. the family about an advanced directive after the person has been intubated ANS: A The Patient Self-Determination Act is designed to increase individual involvement in decisions about lifesustaining 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. DIF: Cognitive Level: Apply (Application) REF: p. 64 16. A nurse discussing the care of a person on the surgical unit following gastric bypass surgery with a friend is in violation of the: a. Patient Self-Determination Act b. Health Insurance Portability and Accountability Act of 1996 c. Americans with Disabilities Act d. Civil Rights Act ANS: B The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal privacy standard that requires safeguards to protect the security and confidentiality of health information. Disclosures without individual authorization 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. DIF: Cognitive Level: Apply (Application) REF: p. 64 17. Which is a violation of the Health Insurance Portability and Accountability Act of 1996? a. Nurse reporting a case of TB to the health department b. Nurse reporting a case of child abuse to the Department of Human Services c. Nurse discussing the person‘s case with his or her physician d. Nurse discussing the person‘s case with his or her school nurse ANS: D The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal privacy standard that requires safeguards to protect the security and confidentiality of health 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. DIF: Cognitive Level: Apply (Application) REF: p. 64 18. Which nurse is functioning as a care manager? a. Nurse working with a family to coordinate care after their child experiences a second hospitalization for an asthma exacerbation b. Nurse providing asthma education in the office setting to a child with moderate, persistent asthma c. Nurse administering the appropriate antiinflammatory medication to a child admitted to the hospital with an asthma exacerbation d. Nurse making a home visit for a respiratory assessment to a child following an admission for an asthma exacerbation ANS: A 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. DIF: Cognitive Level: Apply (Application) REF: p. 71 19. A pregnant woman with two toddlers living at less than 135% of the federal poverty level would be eligible for: a. Medicare Part A b. Medicare Part B c. Medicaid d. State Children‘s Health Insurance Program (SCHIP) ANS: C 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. DIF: Cognitive Level: Apply (Application) REF: pp. 74-75 20. Which of the following is a major factor limiting health care services in the United States? a. Lack of nurses b. Lack of health care facilities c. Lack of funding d. Lack of client interest in health promotion ANS: C 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. DIF: Cognitive Level: Remember (Knowledge) REF: pp. 75-76 21. Which person is at highest risk for being uninsured? a. 68-year-old retired mailman b. 48-year-old on renal dialysis c. 2-year-old whose parents work but do not have benefits through their employers d. 27-year-old who attends college and works part time in a small pizza parlor ANS: D Young adults (27 years of age or older) are not eligible to be covered under their parents‘ insurance. Medicare is available for those over the age of 65 and for people who require 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. DIF: Cognitive Level: Apply (Application) REF: pp. 75-76 22. Adoption of a Canadian-style health care system in the United States has the potential to: a. decrease waiting times for tests and procedures. b. create further health disparities. c. increase the number of HMOs. d. increase the amount of funding available for health care. ANS: B 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. DIF: Cognitive Level: Analyze (Analysis) REF: p. 77 23. 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: a. managed care b. gate keeping c. utilization review d. capitation ANS: C 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. DIF: Cognitive Level: Remember (Knowledge) REF: p. 56 (Box 3-5) 24. The country with the lowest infant mortality rate in 2011 was: a. Canada b. Mexico c. Sweden d. the United States ANS: C Sweden had the lowest infant mortality in 2011 with a mortality rate of 2.74 per 1000 live births. DIF: Cognitive Level: Remember (Knowledge) REF: p. 48 (Table 3-1) 25. The country with the highest life expectancy for women in 2011 was: a. France b. Germany c. Sweden d. the United States ANS: A France was the country with the highest life expectancy for women (85 years of age) in 2011. DIF: Cognitive Level: Remember (Knowledge) REF: p. 48 (Table 3-1) MULTIPLE RESPONSE 1. A community health nurse is presenting information about the current health of the nation to a local political action group in 2011. Which of the following information would be included in this presentation? (select all that apply) a. Funding of public health programs has improved the health of the nation. b. Provision of health care has improved the health of the nation. c. Advances in technology have improved the health of the nation. d. Consumer education has improved the health of the nation. ANS: A, B, D According to the 2010 Report of Health, the health of the nation has improved in many areas as a result of substantial funding of public health programs, research, provision of health care, and initiatives to support consumer education. DIF: Cognitive Level: Apply (Application) REF: p. 42 2. Which of the following statements about the financing of health care in the United States is accurate? (select all that apply) a. Employee-sponsored health insurance premiums experienced minimal increases from 2001 to 2011. b. State tax dollars must fund at least 50% of a state‘s Medicaid cost. c. The largest percentage of health care dollars is spent on hospital care. d. Most workers who have an employer-sponsored health insurance plan are enrolled in preferred provider organizations (PPOs). ANS: C, D In 2010, almost one third (31%) of health care dollars was spent on hospital care. The majority of employee- covered workers were enrolled in PPOs (55%). Employee-sponsored health insurance premiums rose dramatically from 2001 to 2011 by 113%. Federal dollars must fund a minimum of 50% of a state‘s Medicaid cost; the state is responsible for contributing whatever percentage is not funded by the federal government. DIF: Cognitive Level: Understand (Comprehension) REF: p. 67 3. Which of the following would be considered part of a vulnerable population? (select all that apply) a. Deaf man b. Cocaine-addicted teenage girl c. Handicapped child d. College graduate ANS: A, B, C Those who are physically disabled or handicapped, substance abusers, and those with communication difficulties are considered part of the vulnerable population in the United States. DIF: Cognitive Level: Apply (Application) REF: p. 47 (Box 3-2 Chapter 04: The Therapeutic Relationship Edelman: Health Promotion Throughout the Life Span, 8th Edition MULTIPLE CHOICE 1. Which of the following statements about values is true? a. It is impossible for someone to understand his or her values. b. Values evolve over time; they are not static. c. Values assimilated in childhood are those held for a lifetime. d. Values clarification tells a person how to act. ANS: B Values take time to develop, and they may change with education, experience, exposure, or a combination of these. DIF: Cognitive Level: Unders

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