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WorksheetsW5 eDapt: Health Disparities
Total questions: 97
Worksheet time: 2hrs 32mins
Which groups are considered vulnerable populations? Select all that apply.
Older adults
Lesbian, gay, bisexual, transgender, and queer populations
Racial and ethnic minorities
People experiencing homelessness
Veterans
When caring for a vulnerable population, it is important for the nurse to understand the ______________________.
population preferences
unique disparities of the population
culture specifics of the population
The lesbian, gay, bisexual, transgender, and queer populations are at higher risk for which problems? Select all that apply.
Human immunodeficiency virus (HIV)
Chronic diseases
Suicide
Bullying
Drug abuse
Match the nursing ethics provision with the best nursing example.
"The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person."
The nurse advocates for legislation regarding social determinants of health in a planned nurses’ rally at their state legislature.
The nurse serves on a facility-wide committee to plan outreach to vulnerable populations within the community.
The nurse turns the bedside monitor of the electronic health record away from the client’s visitors when documenting care.
The nurse allows a dying client's same-sex partner to assist with comfort measures.
Match the nursing ethics provision with the best nursing example.
"The nurse promotes, advocates for, and protects the rights, health, and safety of the patient."
The nurse advocates for legislation regarding social determinants of health in a planned nurses’ rally at their state legislature.
The nurse serves on a facility-wide committee to plan outreach to vulnerable populations within the community.
The nurse turns the bedside monitor of the electronic health record away from the client’s visitors when documenting care.
The nurse allows a dying client's same-sex partner to assist with comfort measures.
Match the nursing ethics provision with the best nursing example.
"The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy."
The nurse advocates for legislation regarding social determinants of health in a planned nurses’ rally at their state legislature.
The nurse serves on a facility-wide committee to plan outreach to vulnerable populations within the community.
The nurse turns the bedside monitor of the electronic health record away from the client’s visitors when documenting care.
The nurse allows a dying client's same-sex partner to assist with comfort measures.
Match the nursing ethics provision with the best nursing example.
"The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities."
The nurse advocates for legislation regarding social determinants of health in a planned nurses’ rally at their state legislature.
The nurse serves on a facility-wide committee to plan outreach to vulnerable populations within the community.
The nurse turns the bedside monitor of the electronic health record away from the client’s visitors when documenting care.
The nurse allows a dying client's same-sex partner to assist with comfort measures.
When caring for an older adult, the nurse educates the client and family about home safety because the client is at highest risk for which problem?
Falls
Burns
Abuse
Poisoning
Which assessment questions should the nurse ask a client who identified themselves as a veteran? Select all that apply.
When did you serve?
Did you serve in combat?
What was your job in the military?
Did you have any injuries related to your military service?
Were you exposed to noise, chemicals, gasses, or other hazardous substances?
The school nurse is working to support the lesbian, gay, bisexual, transgender, and queer students in the school. What action(s) should the nurse take? Select all that apply.
Start a lesbian, gay, bisexual, transgender, and queer extracurricular organization
Assess school policies and curriculum for inclusivity
Maintain confidentiality of students who identify as lesbian, gay, bisexual, transgender, or queer
Designate a lesbian, gay, bisexual, transgender, queer student representative
Engage teachers to designate their classroom as a “safe space”
The nurse is caring for a veteran with suicidal ideations. The nurse is implementing a crisis response plan. Select the nursing action(s) that is/are contraindicated.
Recommend inpatient hospitalization
Interview client about recent suicide ideation
Assess recent stressors
Identify with the client skills to self-manage stress
Address barriers to care
The nurse is caring for an 80-year-old female. The client lives alone, has no family nearby, and has a caregiver who comes regularly to the client’s home to take care of her. The client has bruising on both arms and reports she cannot remember how it happened. The client has lost weight since the last visit and appears unkempt. Which action should the nurse take first?
Report the findings to Adult Protective Services.
Ask the client abuse assessment questions.
Ask the caregiver to provide information about the injury.
Monitor the client’s weight and hygiene at the next visit.
The nurse is caring for a veteran who served in the military for 25 years and had several deployments. Which is the most likely barrier to this client to seeking needed care?
Acclimation to military culture
Having a service-related disability
Lack of knowledge of benefit eligibility
Having post-traumatic stress disorder
CASE STUDY: Recognizing Cues
Review the case, then select the assessment findings that are concerning to the nurse and require follow up.
The home health nurse is caring for an older adult in his apartment at a senior housing complex where he lives alone. The home health nurse comes weekly to set up the client’s medications and monitor his health. The nurse noticed spoiled food in the refrigerator. The client no longer drives. The client has worsening dementia and macular degeneration. The client has rugs throughout the apartment. The client’s family visits regularly, but he reports being lonely.
home health nurse comes weekly to set up the client’s medications
spoiled food in the refrigerator and rugs throughout the apartment
worsening dementia & macular degeneration
family visits regularly
reports being lonely
CASE STUDY: Analyzing Cues
Review the case, then for each finding, select the one that is/are consistent with the client being at risk for falls:
The home health nurse is caring for an older adult in his apartment at a senior housing complex where he lives alone. The home health nurse comes weekly to set up the client’s medications and monitor his health. The nurse noticed spoiled food in the refrigerator. The client no longer drives. The client has worsening dementia and macular degeneration. The client has rugs throughout the apartment. The client’s family visits regularly, but he reports being lonely.
Reports being lonely
Rugs in the home
Macular degeneration
Lives alone
Spoiled food found in refrigerator
CASE STUDY: Analyzing Cues
Review the case, then for each finding, select the one that is/are consistent with the client being at risk for depression:
The home health nurse is caring for an older adult in his apartment at a senior housing complex where he lives alone. The home health nurse comes weekly to set up the client’s medications and monitor his health. The nurse noticed spoiled food in the refrigerator. The client no longer drives. The client has worsening dementia and macular degeneration. The client has rugs throughout the apartment. The client’s family visits regularly, but he reports being lonely.
Reports being lonely
Rugs in the home
Macular degeneration
Lives alone
Spoiled food found in refrigerator
CASE STUDY: Analyzing Cues
Review the case, then for each finding, select the one that is/are consistent with the client being at risk for nutritional deficit:
The home health nurse is caring for an older adult in his apartment at a senior housing complex where he lives alone. The home health nurse comes weekly to set up the client’s medications and monitor his health. The nurse noticed spoiled food in the refrigerator. The client no longer drives. The client has worsening dementia and macular degeneration. The client has rugs throughout the apartment. The client’s family visits regularly, but he reports being lonely.
Reports being lonely
Rugs in the home
Macular degeneration
Lives alone
Spoiled food found in refrigerator
CASE STUDY: Prioritizing Hypothesis
Review the case. The nurse should address the client’s loneliness by recommending the client move to ___________:
The home health nurse is caring for an older adult in his apartment at a senior housing complex where he lives alone. The home health nurse comes weekly to set up the client’s medications and monitor his health. The nurse noticed spoiled food in the refrigerator. The client no longer drives. The client has worsening dementia and macular degeneration. The client has rugs throughout the apartment. The client’s family visits regularly, but he reports being lonely.
hospitalization
an assisted living facility
a rehabilitation facility
CASE STUDY: Generating Solutions
Review the case. For each potential nursing intervention, select the intervention that is/are contraindicated.
The home health nurse is caring for an older adult in his apartment at a senior housing complex where he lives alone. The home health nurse comes weekly to set up the client’s medications and monitor his health. The nurse noticed spoiled food in the refrigerator. The client no longer drives. The client has worsening dementia and macular degeneration. The client has rugs throughout the apartment. The client’s family visits regularly, but he reports being lonely.
Assess if worsening symptoms are related to Alzheimer’s disease or normal signs of aging.
Visit potential facilities with the family.
Assess client’s ability to perform basic activities of daily living.
Provide family with resources about facility options.
Assist family in determining eligibility for insurance coverage for other facilities.
CASE STUDY: Taking Action
Review the case. For each potential nursing action, select the action that is/are contraindicated.
The home health nurse is caring for an older adult in his apartment at a senior housing complex where he lives alone. The home health nurse comes weekly to set up the client’s medications and monitor his health. The nurse noticed spoiled food in the refrigerator. The client no longer drives. The client has worsening dementia and macular degeneration. The client has rugs throughout the apartment. The client’s family visits regularly, but he reports being lonely.
The client lived in an assisted living facility for a year. He enjoyed participating in the planned social activities, having housekeeping services, and having meals provided. However, the client’s mental and physical health continued to deteriorate. The assisted living facility staff was no longer able to provide the level of care the client required and suggested to the family that the client would need more skilled care.
The family decided to move the client to an Alzheimer’s unit.
Complete medication reconciliation.
Assess if client has advanced directives.
If the client repeatedly states they want to go home once they arrive at the new facility, explain that they are at their new home each time they ask.
Suggest the family move familiar items to the living facility.
Engage the client in decision making.
CASE STUDY: Evaluating Outcomes
Review the case., then select the outcome that is/are unexpected.
The home health nurse is caring for an older adult in his apartment at a senior housing complex where he lives alone. The home health nurse comes weekly to set up the client’s medications and monitor his health. The nurse noticed spoiled food in the refrigerator. The client no longer drives. The client has worsening dementia and macular degeneration. The client has rugs throughout the apartment. The client’s family visits regularly, but he reports being lonely.
The client lived in an assisted living facility for a year. He enjoyed participating in the planned social activities, having housekeeping services, and having meals provided. However, the client’s mental and physical health continued to deteriorate. The assisted living facility staff was no longer able to provide the level of care the client required and suggested to the family that the client would need more skilled care.
The family decided to move the client to an Alzheimer’s unit.
One year later, the client remains at the Alzheimer’s unit and has had a significant decline in health. The client experienced a fall and broken hip after getting out of bed unassisted. The client is unable to intake inadequate nutrition. The client had signed an advanced directive that he did not wish to have a feeding tube or life-sustaining measures, so the family honored his wishes, and the client was placed in hospice care.
Unable to take in adequate nutrition
Decline in health
Broken hip
Family honoring advanced directives
Placement in hospice care
Which of the following are health disparity outcomes for minorities? Select all that apply.
Increased healthcare costs
Higher mortality rates
Poorer health outcomes
Achievement of health equity
Higher prevalence of chronic conditions
Which are federal programs to improve the health of minority groups? Select all that apply.
Title VIII Nursing Workforce Reauthorization Act
National Breast and Cervical Cancer Early Detection Program
Ryan White Comprehensive AIDS Resources Emergency (CARE)
National Institute on Minority Health and Health Disparities
Racial and Ethnic Approaches to Community Health (REACH)
Which actions promote social justice? Select all that apply.
Increasing access to care through virtual healthcare
Training nurses to advocate for client rights
Increasing diversity of healthcare staff
Employing healthcare staff who speak multiple languages
Health policies that support equal access to healthcare
The Racial and Ethnic Approaches to Community Health (REACH) aims to engage community members to help shape the strategies that will be most effective for their communities. Many REACH projects have been implemented to reduce health inequities and achieved various outcomes. Each of these outcomes addressed a specific goal of the REACH program.
Identify the program goal that has been addressed in the outcome below.
"Trained community health workers to serve in the Navajo Nation"
Increase options for healthy nutrition across the lifespan.
Promote community planning and transportation plans that create places for safe and accessible physical activity.
Connect clinics to community programs so people can manage chronic diseases, such as heart disease and diabetes.
Support tobacco-free living.
The nurse is completing a cultural assessment. Match the assessment question with the coordinating component of the cultural assessment.
What does your sickness mean to you? → ___a___
What is important for me to know about your faith or spiritual needs? → ___b___
What has your experience been since coming to the United States? → ___c___
How are decisions about healthcare made in your family? → ___d___
(a) Beliefs
(b) Decision-making style
(c) Context
(d) Attitude
(a) Context
(b) Decision-making style
(c) Beliefs
(d) Attitude
(a) Attitude
(b) Beliefs
(c) Context
(d) Decision-making style
The nurse is caring for a client who is a Jehovah’s Witness, a member of a denomination of a Christian Church which practices a form of Christianity. For each nursing action below, specify whether it is an example of maintenance, negotiation, or restructuring under the Sunrise Model.
The nurse administers a transfusion of clotting factor → ___(a)___
The nurse administers normal saline → ___(b)___
The nurse administers a blood transfusion → ___(c)___
(a) Maintenance
(b) Negotiation
(c) Restructuring
(a) Negotiation
(b) Maintenance
(c) Restructuring
(a) Restructuring
(b) Negotiation
(c) Maintenance
The nurse is caring for a client whose cultural practice is that the family receives the client’s health information and then the family discloses the information to the client at the time when they consider it is most appropriate. The client has a terminal diagnosis and the family has not told the client the diagnosis yet. At this point, the nurse should ________________________ the diagnosis.
tell the client
not tell the client
tell the family the client has the right to know
The nurse is caring for an American Indian woman who reports having intermittent acid reflux. The client tells the nurse that some medications provided by the tribal healer have been helpful. Which is the best response made by the nurse?
“I am not concerned about medications provided by your tribal healer.”
“You should take the medication from the tribal healer more often.”
“You should only take medications prescribed by your traditional healthcare provider.”
“Tell me more about the medications and how you take them.”
The nurse leader of a healthcare clinic is trying to promote culturally responsive healthcare services to the community. Which actions should the nurse leader take? Select all that apply.
Ensure client education materials are prepared in multiple languages.
Compare the diversity of individuals served at the clinic to the diversity of the community.
Develop a healthcare advisory board that includes community members.
Participate in community events to promote the services available.
Provide staff with cultural professional development opportunities.
The nurse is caring for a client in an acute care unit. The healthcare provider rounds on all the clients in the unit except one because the healthcare provider runs out of time. The nurse calls the healthcare provider back to the unit to round on that client. The nurse is demonstrating _____________________.
cultural competence
healthcare inequality
social justice
Case Study:
A 45-year-old African American man called into work because he had a temperature of 101ºF, a slight dry cough, and was fatigued. His wife wanted him to get tested for coronavirus. The client did not want to see the healthcare provider because, during his last appointment, it was found that he had a high cholesterol level and the healthcare provider only told him to “lay off the fried foods.” The client did not eat fried foods.
A few days later, the client began to have a worsened cough and difficulty breathing. The client went to urgent care and requested a coronavirus test but was told he did not meet the criteria and was at low risk. The client tried to explain his risk, but the healthcare provider insisted the client had bronchitis. Being dismissed, the client did not disclose information that his parents had returned from another country two weeks prior and each of them had slight colds upon returning home. The client was prescribed medication to treat bronchitis.
The client took the medication as prescribed, however, symptoms became worse a few days later. The client’s wife called the primary healthcare provider and an urgent care center asking that he be tested for coronavirus. The wife was told to wait for the prescribed medicationto begin to work.
Recognizing Cues: Review the case information and select the findings that are concerning to the nurse.
The client did not want to see the healthcare provider
provider only told him to “lay off the fried foods.”
told he did not meet the criteria and was at low risk
the client did not disclose information
The wife was told to wait for the prescribed medication to begin to work
Analyzing Cues: The assumptions and biases of the healthcare provider contributed to which outcomes? Select all that apply.
Lack of treatment for cholesterol
Delay in needed care
Mistrust of healthcare providers
Delay in seeking treatment
Critical information not communicated
Prioritizing Hypotheses: The client continued to decline, so his wife took him to the hospital. He was admitted with pneumonia. The client coded, was intubated, and transferred to the intensive care unit. The client was diagnosed with coronavirus. One nurse noticed that the client was not receiving the same treatment as other coronavirus clients. The client is at highest risk for a _____(a)______ related to _______(b).
(a) chronic condition
(b) health equity
(a) lack of access to care
(b) lack of advocacy
(a) poor outcomes
(b) bias and discrimination
Generating Solutions: For each potential nursing intervention, select the intervention that is/are contraindicated.
File a civil rights complaint on behalf of the client
Stay up-to-date on evidence-based practices and guidelines
Ask questions about all treatment options for all clients
Notice patterns of clients who are and are not receiving the same treatment for similar conditions
Reflect on own biases
Taking Action: Select the nursing action that is/are contraindicated.
Advocate for all clients’ beliefs even when care is not based on evidence.
Always implement healthcare provider orders without question.
Take time to educate the client and family about all the treatment options.
Be mindful and understanding of medical mistrust.
Acknowledge the client’s potential fears or concerns.
Evaluating Outcomes: The nurse challenged the care team to consider and educate the client’s wife about all treatment options. The client’s treatment plan was changed to integrate the most recent evidence and he eventually recovered. Which action contributed the most to the client’s health outcome?
Early diagnosis of coronavirus and initiating treatment
Basing the treatment plan on the most recent evidence
The care team educating the client’s wife about treatment options
The nurse speaking up about the difference in the care provided for the client
What are societal factors that contribute to homelessness? Select all that apply.
Addiction
Mental illness
Lack of support services
Insufficient income
Shortage of affordable housing
Which groups of people are at risk for being homeless? Select all that apply.
Families with children and Veterans
Older adults without support systems
People with substance use disorders
Adults who earn low wages and those who are unemployed
People with mental illness
Select a situation(s) that represents a market justice model.
Nurses should be trained to be culturally competent
Everyone should have access to high-quality healthcare
A healthcare model without government involvement
Everyone should have access to quality education
Safe housing is a basic human right
For these individuals, select the one who is/are not considered homeless.
Adult staying at a shelter or living on the streets
14-year-old staying at a shelter
Adult with no home address admitted to a psychiatric facility
Adult who lives in a community group home for developmentally disabled adults
Adult living in their vehicle or the one who moves between friends and family homes
The nurse is caring for a homeless teenage female at a Federally Qualified Health Center (FQHC). The teenager reports engaging in survival sex.
The client is most at risk for ___(a)___ and ___(b)___.
(a) hunger
(b) substance abuse
(a) sexually transmitted infections
(b) unintended pregnancy
(a) mental health disorder
(b) suicide
The nurse is caring for a homeless teenage female at a Federally Qualified Health Center (FQHC). The teenager reports engaging in survival sex. For each nursing assessment, identify which one is nonessential.
Assess results of pregnancy test
Assess level of education
Assess mental health
Assess overall physical health
Assess results of sexually transmitted infections testing
The nurse is caring for a homeless teenage female at a Federally Qualified Health Center (FQHC). The teenager reports engaging in survival sex. The nurse has completed an assessment and the teenager is not pregnant, does not have any sexually transmitted infections, and her physical health is adequate. The teenager has symptoms of depression. What actions should the nurse take? Select all that apply.
Provide condoms
Refer to a food bank
Refer to homeless youth services
Provide oral contraceptives
Refer to mental health counseling
Using the concept of upstream thinking, select whether the intervention to prevent homelessness is an upstream intervention.
Refer clients to a shelter
Create a voucher program for rental assistance
Create new affordable housing inventory
Support legislation that increases minimum wage
Refer clients to a soup kitchen
Case Study
The nurse is caring for a client at the Veteran’s Affairs hospital. The client was admitted for treatment of cellulitis and debridement of a left foot ulcer. The client does not adhere to their diabetes treatment regimen and their A1C level is 10. The client suffers from severe post-traumatic stress disorder after serving in the Gulf War and has maximized services available through Veteran’s Affairs. The client smokes and has declined smoking cessation support. The client is homeless, and income is below the poverty level. The client intermittently stays at a shelter, regularly eats meals at a shelter, and receives additional food from a food bank.
Recognize Cues: Which are the assessment findings that should concern the nurse? Select all that apply
Client is a veteran
Client smokes
Client has post-traumatic stress disorder
Client has uncontrolled diabetes
Client is homeless
Analyze Cues: Review the client case. For each assessment finding, select if the finding is primarily caused by system factors.
Client has uncontrolled diabetes
Client suffers from severe post-traumatic stress disorder
Client smokes
Client cannot find affordable permanent housing
Prioritize Hypothesis: Review the client case. The client is at risk for which top 3 complications?
Malnutrition
Continued homelessness
Amputation
Substance abuse
Suicide
Generate Solutions: Review the client case. The nurse is discharging the client from the Veteran’s Affairs hospital to transitional housing. Select the teaching point that is nonessential.
Educate client about wound care
Education client about smoking cessation
Educate client about medication prescriptions
Educate client about potential health complications related to not adhering to treatment regimen for diabetes
Educate client about food resources
Take Action: Review the client case. The nurse is making a home visit to the client’s transitional housing. Which actions should the nurse take? Select all that apply.
Suggest the client stay with friends or family
Assess blood sugar
Assess foot wound
Refer to local clinic that provides free foot care
Assess medication adherence
Evaluate Outcomes: Review the client case. The nurse is assessing the client 3 months after wound debridement. Select the assessment finding that indicates the client’s condition has not changed.
A1C level is 10
Wound is swollen, reddened, and has a foul odor
Client has enrolled in housing assistance program
Client has enrolled in additional mental health services assistance
Highlight the findings that place this family at risk for homelessness.
The nurse is caring for a family whose income is from one parent. One parent works while the other parent cares for the children ages 2, 4, and 5. The parent working outside the home, works 40 hours a week for $10 an hour. The family is enrolled in Medicaid and Supplemental Nutrition Assistance Program (SNAP). They live in a 2-bedroom apartment and the rent is $650 a month. They have been unable to find anything less expensive. The family often experiences hunger. The family owns one vehicle. The working parent is an alcoholic and is unable to afford treatment. They frequently miss work because of their alcoholism.
40 hours a week
$10 an hour
2-bedroom apartment
rent is $650 a month
The working parent is an alcoholic and is unable to afford treatment.
The nurse is caring for a family whose income is from one parent. One parent works while the other parent cares for the children ages 2, 4, and 5. The parent working outside the home, works 40 hours a week for $10 an hour. The family is enrolled in Medicaid and Supplemental Nutrition Assistance Program (SNAP). They live in a 2-bedroom apartment and the rent is $650 a month. They have been unable to find anything less expensive. The family often experiences hunger. The family owns one vehicle. The working parent is an alcoholic and is unable to afford treatment. They frequently miss work because of their alcoholism.
Which referrals would reduce the family’s risk of becoming homeless? Select all that apply.
Resources for housing assistance
Alcohol addiction treatment
Services for lead paint testing
Community resources for transportation assistance
Resources to supplement their food supply
Which statement is the definition of mental illness?
A condition causing auditory or visual hallucinations
A condition that may disrupt activities of daily function
A condition that causes an improvement in the activities of daily function
A condition caused by a traumatic brain injury
In a veteran, which condition may be the primary cause of mental health issues?
Substance use disorder
Major depressive disorder
Post-traumatic stress syndrome
Attention deficit disorder
Which approach is the most common model currently used for the treatment of mental illness?
Institutionalization
Community-based treatment
Hospitalization
Deinstitutionalization
Which statement best describes a mental illness requiring further follow-up?
Mild symptoms are experienced for a few days.
Mental illness has been diagnosed, but no symptoms are experienced at this time.
Symptoms significantly impact functions of daily life.
A person suspects they have mental illness.
A person has similar symptoms to friends who have a mental illness.
Match this example with one of the challenges associated with mental illness.
"Andrea is on risperidone. At a recent medical appointment, she had a fasting blood sugar of 130. "
Facility inadequacy
Stigma of mental illness
Lack of resources
Comorbidity
Match this example with one of the challenges associated with mental illness.
"Josiah is unable to get counselling services because there is no funding available. "
Facility inadequacy
Stigma of mental illness
Lack of resources
Comorbidity
Match this example with one of the challenges associated with mental illness.
"Edward notices that when he applies for a job, no one will hire him even though he is taking his medications. "
Facility inadequacy
Stigma of mental illness
Lack of resources
Comorbidity
Match this example with one of the challenges associated with mental illness.
"Last time Ali was in a mental health unit, she was assaulted by another patient. "
Facility inadequacy
Stigma of mental illness
Lack of resources
Comorbidity
What occurred in the mental health history in the United States that acknowledged mental illness as a disease?
U.S. Surgeon General’s Report on Mental Health in 1999
Mental Health Parity and Addiction Equity Act (MHPAEA) in 2008
Community Mental Health Centers Act (CMHCA) in 1963
Affordable Care Act in 2010
Which represent barriers to mental health treatment in ethnic populations? Select all that apply.
Increased government assistance and trust in the health care system
Language barriers
Less stigma about mental health among minority populations
Lack of diversity among health care providers
Lack of cultural understanding by health care providers
Match the condition with the expected symptoms:
"Symptoms include verbal or auditory hallucinations, paranoia, insomnia, and psychosis."
Substance use disorder
Post traumatic stress syndrome
Bipolar disorder
Schizophrenia
Match the condition with the expected symptoms:
"Symptoms include significant mood swings causing erratic behavior and severe depression."
Substance use disorder
Post traumatic stress syndrome
Bipolar disorder
Schizophrenia
Match the condition with the expected symptoms:
"Symptoms include recurrent nightmares, insomnia, severe anxiety, and depression that continues after an event."
Substance use disorder
Post traumatic stress syndrome
Bipolar disorder
Schizophrenia
Match the condition with the expected symptoms:
"Symptoms include loss of control over a substance, the continued use despite injury, and obsession with obtaining more."
Substance use disorder
Post traumatic stress syndrome
Bipolar disorder
Schizophrenia
Case Study
Frank, a 22-year-old, is seen in the mental health clinic with complaints of “seeing things.” He describes someone standing next to him talking to him. There appears to be no one in the room with him. Frank’s appearance is disheveled and he has a foul odor. Frank says he does not smoke or drink alcohol. He denies a history of any illnesses. Frank states that he is currently “on the streets” and has been for a while. Mom has a history of diabetes. Father is asthmatic. One of Frank’s uncles was treated for a “mental health” issue. Frank has been unable to get a job and admits to using drugs on occasion.
Recognizing Cues: Select the assessment findings that require additional follow-up.
"seeing things."
disheveled and he has a foul odor
father is asthmatic
uncles was treated for a "mental health" issue
unable to get a job
Analyzing Cues: Which questions should the nurse ask to obtain priority information? Select all that apply.
“Do you feel the need to hurt yourself or someone else?”
“Where are you able to wash up and get a change of clothes?”
“Can you describe in more detail the things you see, and where and when you see them?”
“Did your uncle see or hear things that weren’t there?”
“Have you used any drugs?”
Prioritizing Hypotheses: Frank responds to the questions by stating the person he sees is his friend, who keeps trying to hand him a knife. Frank says that what he is seeing keeps getting more vivid. He denies drug use today but has used methamphetamines in the recent past. Frank currently has no clothes and no place where he can “clean up.” He doesn’t remember much about his uncle’s problems.
Based on Frank’s answers, the nurse determines that he is at most risk of ___(1)___ . He also may be at risk of ___(2)___ . After these, another concern is his ___(3)___ . Finally, ___(4)___ is a concern, but not as high a priority as the others.
(1) harm of self or others
(2) substance use
(3) homelessness
(4) self-care deficit
(1) self-care deficit
(2) harm of self or others
(3) substance use
(4) homelessness
(1) homelessness
(2) self-care deficit
(3) harm of self or others
(4) substance use
(1) substance use
(2) homelessness
(3) self-care deficit
(4) harm of self or others
Generating Solutions: The nurse is planning several interventions for Frank’s next visit. Select if the potential interventions are contraindicated for Frank’s condition.
Focus on reality and not the hallucination experience and document details of the hallucination
Remove dangerous objects from the room. Refer the client to a mental health professional
Review the clinic's hours of operation
Put the client in soft restraints
Reschedule the appointment for tomorrow
Taking Action: For each nursing action select the most appropriate diagnosis.
Arrange for a bed at a shelter with showers available ___(a)___
Request an assessment for possible housing assistance ___(b)___
Refer to a mental health professional: ___(c)___
Notify crisis team to further evaluate risk for violence: ___(d)___
(a) Self-care deficit
(b) Impaired home maintenance
(c) Impaired cognition
(d) Risk for harm to self or others
(a) Risk for harm to self or others
(b) Impaired cognition
(c) Self-care deficit
(d) Impaired home maintenance
(a) Impaired home maintenance
(b) Self-care deficit
(c) Impaired cognition
(d) Risk for harm to self or others
Evaluating Outcomes: Frank returned to the clinic the following week to be evaluated by the crisis team. After determining that he was a danger to others, Frank was admitted to an inpatient psychiatric unit for evaluation by a mental health provider. Frank was started on an atypical antipsychotic and discharged. He was evaluated for serious mental illness (SMI) and found to be eligible for support services. Frank is temporarily living in a shelter where he independently performs activities of daily living. His case worker is seeking placement for him in a group home. Frank continues to have visual hallucinations of his friend, but his friend does not tell him to do anything violent. Frank has not obtained any weapons and does not feel the need to harm himself or others.
Review the expected outcomes below and indicate whether they were met or not met.
Self-care deficit --- Client has a place to perform activities of daily living = (a)
Impaired home maintenance -- Client is working with a professional to obtain housing = (b)
Impaired cognition -- Client no longer has visual hallucinations = (c)
Risk for harm to self or others -- Client no longer poses a risk for harm to self or others = (d)
(a) Met
(b) Met
(c) No Met
(d) Met
(a) Met
(b) Met
(c) Met
(d) Met
(a) No Met
(b) No Met
(c) Met
(d) Met
Indicate if the client’s mental health was most impacted by biological, genetic, or social factors.
(a) = – “My mom had major depressive disorder, and now I do too.”
(b) = “I was sexually assaulted at a young age, and now I have nightmares and insomnia.”
(c) = “I have hyperthyroidism and was diagnosed with panic attacks.”
(d) = “These steroids are causing me to be depressed.”
(a) Genetic
(b) Social
(c) Biological
(d) Biological
(a) Social
(b) Biological
(c) Social
(d) Genetic
(a) Biological
(b) Social
(c) Genetic
(d) Social
Which resources are available through the Substance Abuse and Mental Health Services Administration (SAMHSA)? Select all that apply.
Assertive community treatment (ACT) team models and Community case management programs
Psychotropic medication management programs and Crisis intervention team (CIT) models
Mobile crisis units and Crisis housing programs
Supportive employment programs
Cognitive behavioral intervention for trauma in schools programs
Which level of prevention is focused on treating the long-term consequences of violence?
Tertiary prevention
Secondary prevention
Primary prevention
Focused prevention
What are risk factors for the act of violence? Select all that apply.
High IQ
Socially active
History of aggressive behavior
Learning disorder
Exposure to violence
Violence disrupts the ___(a)___ level of Maslow’s Hierarchy of Needs. Without those needs being met, disruption of ___(b)___ needs will not be fulfilled until safety is restored.
(a) physiological
(b) higher-level
(a) safety
(b) higher-level
(a) love/belonging
(b) lower-level
(a) self-actualization
(b) lower-level
Which are risk factors for the act of violence? Select all that apply.
Low parental involvement
Association with delinquent peers
Life-threatening illness
Average academic performance
High level of transiency
Which statement by a young victim of violence indicates possible emotional trauma?
“I don't think about it anymore. I'll help stop violence one day.”
“Alcohol is dumb, just like those people.”
“I will graduate from school anyway. It doesn't matter what they do.”
“My friends say I’m different since the shooting.”
What percentage of homicides in the United States involve a firearm?
75%
50%
100%
25%
Select the prevention steps that are in the correct order.
1) Define the problem
2) Identify risk and protective factors
3) Develop and test prevention strategies
4) Adoption of successful strategies
1) Define the problem
2) Identify risk and protective factors
3) Adoption of successful strategies
4) Develop and test prevention strategies
1) Identify risk and protective factors
2) Define the problem
3) Adoption of successful strategies
4) Develop and test prevention strategies
Which relationships can increase the risk of experiencing violence? Select all that apply.
Partners
Politicians
Co-workers
Family members
Peers
Case Study: Community Violence
The nurse working in a clinic in a small community has heard of several incidents of youth violence and feels someone needs to take action. After looking at potential community risk factors, the nurse determines that additional investigation is needed. The evidence reviewed identified that family risk factors, instead of community risk factors, might be contributing to violent behaviors.
The nurse reached out to the mayor’s office to discuss the issue of violence in the community. The mayor asked the nurse to lead a committee to address the issue of violence.
Recognizing Cues: The nurse working in a clinic in a small community has heard of several incidents of youth violence and feels someone needs to take action. Which community issues below are potential community risk factors for violence? Select all that apply.
The previous parent-teacher organization (PTO) meeting was full of parents with lots of questions.
A local lumber mill just shut down.
The church-based homeless shelter is empty.
A new low-income housing area just opened.
The last city council meeting had a heated discussion about zoning laws.
Analyzing Cues: After looking at potential community risk factors, the nurse determines that additional investigation is needed. Which of the following issues are family risk factors for the perpetration of violence? Select all that apply.
Gang signs painted on an abandoned building
Children acting out with bursts of anger during a math class
High numbers of adults being arrested for illicit drug possession
Census data showing a large number of adults who did not finish high school
Noticing a large number of small children playing in the street during a 10 pm windshield survey
Prioritizing Hypotheses: The mayor asks the nurse to lead a committee to address the issue of violence. What should the nurse do next?
Schedule a meeting with a reporter to work on an article about violence.
Obtain data on reported incidents and arrests from the police chief.
Determine the mental health resources available in the community.
Develop a presentation on violence and substance abuse.
Generating Solutions: Data gathered by the mayor’s committee shows a growing issue of violent acts reported and arrests for violent and drug crimes in the center of town and the south side, which includes low-income housing areas and more economically challenged neighborhoods. The nurse continued the investigation of risk factors and found several individual, family, social, and community risk factors for violence. The committee decided to focus on primary preventative activities first. For each potential prevention activity below, select the tertiary prevention.
Passage of bullying law so that students who bully others are placed in a special classroom program.
Starting an adult GED® (general educational development) program, free for all residents.
Hiring an advanced practice nurse to work with victims of violence to keep them from turning to violence.
Taking Action: Data gathered by the mayor’s committee shows a growing issue of violent acts reported and arrests for violent and drug crimes in the center of town and the south side, which includes low-income housing areas and more economically challenged neighborhoods. The nurse continued the investigation of risk factors and found several individual, family, social, and community risk factors for violence. The committee decided to focus on primary preventative activities first.
Several primary prevention ideas have been discussed by the committee. The city does not have enough funding to implement all the ideas. Which two prevention activities should be trialed first?
Hold a cultural awareness fair one weekend that highlights different cultures in the area.
Promote friendship building activities within elementary school classrooms.
Start an adult GED® (general educational development) program, free for all residents.
Work with state economic development professionals to bring in a manufacturing plant to replace jobs lost due to the closure of the lumber mill.
Evaluating Outcomes: Several primary prevention ideas have been discussed by the committee. The city does not have enough funding to implement all the ideas. Two activities were selected to try:
Start an adult GED® (general educational development) program, free for all residents.
Work with state economic development professionals to bring in a manufacturing plant to replace jobs lost due to the closure of the lumber mill.
For each measured outcome, select if the outcome indicates an increased risk for the potential perpetration of violence.
Thirty adults graduated from the new, free GED® program.
A large manufacturing company is in negotiations to buy the property on the edge of town.
An expanding lumber mill in a neighboring town agreed to hire workers from the closed mill.
A local gas station closed permanently.
The city released funding for opening a new park.
Models to Guide Prevention
Using the (a) model can help people understand how factors that influence community violence interact. According to the model, which level are the following factors related to?
creating safe neighborhoods— (b)
strengthening parent-child communication—(c)
promoting social norms that protect against violence—(d)
increasing conflict resolution skills—(e)
(a) Social-ecological
(b) Community
(c) Relationship
(d) Societal
(e) Individual
(a) Societal
(b) Community
(c) Relationship
(d) Individual
(e) Social-ecological
(a) Societal
(b) Community
(c) Relationship
(d) Social-ecological
(e) Individual
Which are the examples of community violence? Select all that apply.
Motorcycle gang members attending a funeral
A fight between two 3rd grade students
A church group demonstrating and shouting derogatory slurs during a diversity pride event
An incident of road rage involving a parent who chased down someone speeding through their neighborhood
Illicit drug users conducting home invasions to steal items to sell in order to buy more illicit drugs
Which statement is true when determining if a geographic area is rural or urban?
Rural regions have fewer than six persons per square mile.
Rural areas are recreational, retirement, or resort communities.
Rural and urban areas, by relative nature, occur on a continuum.
Rural residents feel isolated.
Select the number of individuals who live in the urban areas.
Less than 6 per square mile
Less than 20,000
20,000 to 49,999
1 million or more
A nurse in a community health clinic located in Virginia is conducting an assessment on a Hispanic worker currently working in a local apple orchard for the season. The nurse determines that the worker originates from Florida and is living in temporary housing with other orchard workers. Based on this information, the nurse should integrate the special needs of what vulnerable population?
Undocumented aliens
Underinsured
Seasonal farmworkers
Migrant farmworkers
When planning primary prevention education for a rural community, the nurse should consider interventions based on which facts about rural American health? Select all that apply.
More likely to seek preventive care & fewer occupational-associated risks
Higher rates of diabetes mellitus and obesity
Higher rates of suicide & higher infant and maternal morbidity rates
Increased risk for colon cancer
Less likely to meet physical activity recommendations
Rural residents appear to have a more persistent, endemic level of depression. The nurse understands that to improve residents' mental health, which barriers must be overcome? Select all that apply.
Tolerance for destructive coping behaviors
Trust in healthcare professionals
Number of mental health services
Crisis intervention program
Gaps in continuum of mental health services
A district health nurse is assigned to two rural counties in the state. To achieve the best outcomes possible in reducing the health disparities for the large number of frail older clients in the two counties, the nurse should consider using which community-oriented nursing skills? Select all that apply.
Geriatrics
Case management
Community-oriented primary healthcare
Tertiary prevention
Assessment
A school nurse is asked to assess a 13-year-old child because of excessive drowsiness and inattention in class. The nurse determines that this is a child of migrant workers on a local produce farm. Based on the nurse's knowledge of migrant worker families, which activity should the nurse ask about?
Delinquent behavior
Field work
Drug misuse
Migrant Education Program
An undocumented migrant farmworker has been diagnosed with tuberculosis (TB). The local health department initiates treatment by dispensing the first month's supply of medication and educates the client on the need to continue treatment for 6 to 12 months. What challenge(s) may this individual face when seeking follow-up care? Select all that apply.
Reduced availability of services
Consistent income
Fragmented services
Language barriers
Discrimination
The local hospital emergency department has recently experienced an increase in gastroenteritis cases among migrant farmworkers. After being informed of the rise in cases, the local public health nurse should schedule a case mapping of which locations?
Housing for migrant workers
Bars frequented by migrant workers
Farm fields employing migrant workers
Restaurants frequented by migrant workers
The community health nurse is meeting with the leaders of rural towns to discuss barriers to healthcare. The nurse should inquire about which situations? Select all that apply.
Shortage of healthcare providers
Underinsured/uninsured residents
Discrimination towards residents
Distance from health services
Lack of public transportation
Case Study: Rural Mental Health
The frontier health nurse is on a community task-force investigating a 100% increase in the yearly number of mental health clients involuntarily admitted to a mental health inpatient residential facility. Review the Nurses’ Note and then answer the question below.
Nurse's Notes
Date/Time: NURSES’ NOTES 03/03/20XX 16:00
A community of 175,000 people is located in an economically depressed county in the southeast portion of the state on reservation lands. Unemployment is above the national average and the median income for a family of four is $25,200 per year (5% below the current poverty line). There is one hospital in the county designated as a Critical Access Hospital by the Centers for Medicare and Medicaid Services (CMS). The facility has 22 acute inpatient beds and is 55 miles from the next nearest hospital. Clients seeking care for mental health alterations are referred to the next closest facility because the county has no inpatient mental healthcare beds or providers. In the last 6 months, five county residents have been transferred to an inpatient mental health facility, compared to zero residents in the last 3 years. Increased waiting times were seen because each of these clients’ transfers were delayed due to lack of local mental health services.
Recognizing Cues: Which two assessment findings require priority follow-up?
No mental healthcare providers
County on state reservation lands
No inpatient mental healthcare beds
Economically depressed county
Median income below state poverty level
Analyzing Cues: For each identified community assessment factor, select if the factor impacts the county's ability to provide support to residents.
22 inpatient beds at local hospital
Lack of mental health professionals in the county
Median income below state poverty level
Economically depressed county
Prioritizing Hypotheses: The task force should address ____(a)_____ as evidenced by ____(b)_____ .
(a) lack of mental health providers
(b) lack of inpatient mental healthcare locally
(a) increased wait times
(b) delayed transfer for mental healthcare
(a) lack of insurance coverage for mental healthcare
(b) low median income
Generating Solutions: For each potential community intervention proposed by the community task-force in select the intervention(s) that is/are indicated.
Recruit a mental healthcare specialist to open an office in the county.
Limit the number of referrals for inpatient mental healthcare.
Partner with a mental healthcare provider for telehealth evaluation and ongoing care.
Partner with community organizations to reduce food insecurity and increase job stability.
Improve the shared community parks to provide safe environments for residents to gather, socialize, and get physical exercise.
Taking Action: The nurse should act on which two community priorities first?
Partner with a mental healthcare provider for telehealth evaluation and ongoing care.
Partner with community organizations to reduce food insecurity and increase job stability.
Improve the shared community parks to provide safe environments for residents to gather, socialize, and get physical exercise.
Limit the number of referrals for inpatient mental healthcare.
Evaluating Outcomes: A year has passed since actions were taken to reduce the wait time for mental health treatment. For each data point, select if the finding indicates that the community health has improved.
22 inpatient beds at a local hospital
Two nurse practitioners are providing mental telehealth visits
Unemployment rates increased
Transfer to inpatient facility mental health treatments have decreased
Which services can make a positive impact on the life of a person with a disability? Select all that apply.
Loss of personal insurance coverage
Opportunities for training programs in the workforce
Caregiver services to assist with activities of daily living
Accessible public transportation
Grants for housing modifications
Which disabilities will have clinical manifestations that are present at birth? Select all that apply.
Myasthenia gravis
Cystic fibrosis
Amyotrophic lateral sclerosis
Down syndrome
Spina bifida
Which conditions are more likely to result in complications and death more frequently in children with intellectual or developmental disabilities?
Constipation
Seizures
Reflux
Head trauma
Diarrhea
Fill in the blank with the proper usage of each definition:
Sally acquired a(n) ___(a)___ after losing her right leg below the knee and three fingers on her left hand. Because of this, she ended up with a(n) ___(b)___ because she could not keep her position as a transcriptionist. When returning to work in a different job, she could not access the office with her wheelchair because of the narrow doorway and the three steps, resulting in a(n) ___(c)___.
(a) Disability
(b) Handicap
(c) Impairment
(a) Impairment
(b) Disability
(c) Handicap
(a) Handicap
(b) Impairment
(c) Disability
Select the disabilities listed that are acquired after birth.
Spina Bifida
Osteoarthritis
Spinal cord injury
Cystic fibrosis
Heart failure
Match the description to the following US legislation.
Existing laws concerning state vocational rehabilitation services extended.
Rehabilitation Act of 1973
Individuals with Disabilities Education Act (IDEA)
The Americans with Disabilities Act 1990
Patient Self-Determination Act (PSDA) of 1990
Ticket to Work and Work Incentives Improvement Act (1999)
Match the description to the following US legislation.
Legislation that redefined disability benefits to reduce disincentives for those who wish to be employed.
Rehabilitation Act of 1973
Individuals with Disabilities Education Act (IDEA)
The Americans with Disabilities Act 1990
Patient Self-Determination Act (PSDA) of 1990
Ticket to Work and Work Incentives Improvement Act (1999)
Match the description to the following US legislation.
Mandated health decisions are protected and communicated. Ask patients for their advanced directives.
Rehabilitation Act of 1973
Individuals with Disabilities Education Act (IDEA)
The Americans with Disabilities Act 1990
Patient Self-Determination Act (PSDA) of 1990
Ticket to Work and Work Incentives Improvement Act (1999)
Match the description to the following US legislation.
Amended 2008: Prohibits discrimination of persons with disabilities by guaranteeing equal opportunities for employment, transportation, public services and accommodation, and telecommunications.
Rehabilitation Act of 1973
Individuals with Disabilities Education Act (IDEA)
The Americans with Disabilities Act 1990
Patient Self-Determination Act (PSDA) of 1990
Ticket to Work and Work Incentives Improvement Act (1999)
Match the description to the following US legislation.
Guarantees free and appropriate public education to children with disabilities based on needs.
Rehabilitation Act of 1973
Individuals with Disabilities Education Act (IDEA)
The Americans with Disabilities Act 1990
Patient Self-Determination Act (PSDA) of 1990
Ticket to Work and Work Incentives Improvement Act (1999)
Select the assessment cue that belongs to the psychosocial cue category.
Unable to wear a shirt with buttons
No bus service nearby
Uninsured
Income below the poverty level
Poor memory
Match the statement with the appropriate nursing diagnoses.
“I don’t think I’ll ever get over this.”
Powerlessness
Situational low self-esteem
Impaired resilience
Ineffective coping
Post-trauma syndrome
Case Study: Stephanie
Stephanie is a 37-year-old who sustained a T6 level spinal cord injury about six months ago in a motor vehicle crash.
Patient Information
Name: Stephanie
Age: 37
Nurses' Notes
August 3, 202x: Home visit with Stephanie to discuss her current living status. Stephanie states, “I feel so worthless. I can’t work anymore as a restaurant server so I don’t know how I will be able to support myself. I applied for disability but haven’t completed the twenty-page questionnaire they sent me. I’m stuck in this apartment and feel like I can’t go anywhere. I’ll never be able to work again. I can’t even take a bath or shower. I use a washcloth on my face.”
Analyzing Cues: Select the assessment items from the nurse’s note that require further follow-up.
I feel so worthless
I don't know how I will be able to support myself
haven't completed the twenty-page questionnaire
I'll never be able to work again
I can't even take a bath or shower
Analyzing Cues: Select which of the following cues, per the August 3rd nurse’s note, that are in correct order from most important (1) to address to least important (4) to address immediately.
1. Hasn't completed questionnaire for disability
2. Can't bath or shower
3. Doesn't know how to support herself
4. Feels worthless
1. Can't bath or shower
2. Hasn't completed questionnaire for disability
3. Feels worthless
4.Doesn't know how to support herself
1. Doesn't know how to support herself
2. Hasn't completed questionnaire for disability
3. Feels worthless
4. Can't bath or shower
Prioritizing Hypotheses: Select the hypotheses with the appropriate nursing diagnoses.
"Doesn’t know how to support herself."
Impaired coping
Self-care deficit
Powerlessness
Low self-esteem
Generating Solutions: Select the goals that address this nursing diagnosis.
"Impaired coping"
Client will submit her questionnaire to the disability administration this week.
Client will have assistance with bathing three times per week.
Client will verbalize ideas of some positions for which she will consider applying or going to school.
Client will verbalize increased confidence in their abilities.
Taking Action: Select the action that address this nursing diagnosis.
"Low self-esteem"
Assist the client in completing the questionnaire.
Validate the client's feelings and suggest some good traits the client possesses.
Discuss possible employment positions the client could do with her current impairments.
Review possible services available for caregiver support with activities of daily living.
Evaluating Outcomes: August 10, 20XX: Return visit to Stephanie for an update on progress. Stephanie states, “You’ll be happy to know that I mailed the disability questionnaire yesterday. I was not able to call the private duty services about a caregiver that can come help with bathing. Maybe I’ll do that next week. I was thinking of going to school, but I still don’t know what I could possibly do being in this wheelchair. I’m just not worth spending time on.”
Review the August 10th nurse’s note and select if the assessment finding is improved.
Impaired coping
Self-care deficit
Powerlessness
Low self-esteem
You’re reviewing a problem list of a child with an intellectual and developmental disability. Which of the following four diagnoses are you most concerned could cause complications and or death if not aggressively treated?
Dehydration
Gastroesophageal reflux disorder (GERD)
Constipation
Seizure disorder
Asthma
Review the home visit note below and select the item that needs the most immediate follow-up.
June 15, 202x: Home visit and safety evaluation completed for Bill, a 24-year-old client with a new T8 injury and complete paraplegia. Bill uses a manual wheelchair for mobility. He has one step up into the house. He lives alone but does have a care giver come three times weekly to assist with bathing. He self-catheterizes three times daily and washes the catheters between use. He has concerns about being able to afford new catheter kits. He transfers to his bed and chair with a transfer board. He states he only slid to the floor once last week. He had to crawl into the other room to get her phone to call for help.
He washes the catheters between use.
A care giver comes three times weekly.
He states he only slid to the floor once last week.
He has one step up into the house.
