Chapter 13: Cultural Diversity and Community Health Nursing

1. The community health nurse is caring for a client who abstains from eating any form of meat. This
dietary preference is commonly practiced by members of which faith?
A.  Hinduism
B.  Mormonism
C.  Judaism
D.  Islam

 People of the Hindu faith abstain from eating meat of any type.
 Mormons do not necessarily restrict meat from their diets.
 Muslims abstain from eating pork but do eat other types of meat.
 Members of the Jewish faith do not eat pork, predatory fowl, shellfish, or some other water creatures.

2. What is the process used when conceptual differences, which impact the provision of health care, exist
between the client and the nurse?
A.  Cultural diversity
B.  Cultural negotiation
C.  Cultural competence
D.  Cultural imposition

 Cultural negotiation refers to the process in which messages, instructions, and belief systems are
manipulated, linked, or processed between the professional and lay models of health problems and
preferred treatment. In each act, the nurse gives attention to eliciting the client's views regarding a
health-related experience (e.g., pregnancy, complications of pregnancy, or illness of an infant).
 Cultural diversity is a multifaceted and complex concept that refers to the differences among people,
especially those related to values, attitudes, beliefs, norms, behaviors, customs, and ways of living.
 Cultural competence is respecting and understanding the values and beliefs of a certain cultural group
so that one can function effectively in caring for members of that cultural group.
 Cultural imposition is a person's tendency to impose his or her own beliefs, values, and patterns of
behavior on individuals from another culture.

3. Over 13% of residents in the United States were born in other countries. More than half (52%) of
these individuals were born in
A.  Asia.
B.  Europe.
C.  Africa.
D.  Mexico and Latin America.

4. When making health-related decisions, clients from different cultural backgrounds depend on
relationships. One type of relationship involves the client seeking assistance from other members of
the family and allowing a relative to make decisions about important health-related issues. This
relationship is a(n)
 A.  lineal relationship.
B.  collateral relationship.
C.  cultural relationship.
D.  individual relationship.

 Lineal relationships involve a client seeking assistance from another family member and allowing a
relative to make important decisions related to health matters.
 Collateral relationships focus primarily on group goals, and family orientation is important.
 Cultural relationship is characterized by tolerance and respect.
 Individual relationships refer to personal autonomy and independence. Individual goals dominate, and
group goals become secondary.

5. While caring for a client from a different culture, the community health nurse must assess the client's
health-related beliefs. All of the following questions would be appropriate and would elicit the desired
information except
A.  "Are there certain foods you eat when you are sick?"
B.  "When do you know you are sick enough to visit a health care provider?"
C.  "Is it OK if I speak in English?"
D.  "What does health mean to you?"

 Determining the meaning of health, health practices, and habits and usual health practices of the client
will help the nurse provide culturally sensitive care that will be accepted by the client. "Is it OK if I
speak in English?" does not address health.

6. Which minority group hit an all-time low high school drop-out rate in 2013?
A.  African Americans
B.  Chinese Americans
C.  Polish Americans
D.  Italian Americans

 In 2013, high school dropout rates reached an all-time low for African Americans and Hispanics.
 Health care status has a direct correlation to socioeconomic status and educational level.

7. A community health nurse is caring for a Native American client who often stares at the floor while
the nurse is talking. The nurse knows this indicates which culturally appropriate behavior?
A.  The client is showing respect to the nurse.
B.  The client is listening carefully.
C.  The client’s religion forbids him from making eye contact with women.
D.  The client is depressed.

 Eye contact is among the most culturally variable nonverbal behaviors. Although most nurses have
been taught to maintain eye contact while talking with clients, individuals from culturally diverse
backgrounds may misconstrue this behavior.
 Asian, Native American, Indochinese, Arab, and Appalachian clients may consider direct eye contact
impolite or aggressive, and they may avert their own eyes during the conversation.
 Native American clients often stare at the floor when the nurse is talking. This culturally appropriate
behavior indicates that the listener is paying close attention to the speaker.

8. A community health nurse is caring for a family that includes the husband, wife, children, and other
blood relatives. This type of family is called a(n)
A.  nuclear family.
B.  communal family.
C.  extended family.
D.  nuclear dyad.

 An extended family includes a husband, wife, children, as well as other blood relatives.
 A nuclear family includes the husband, wife, and child or children.
 A communal family is a group of men and women with or without children.
 A nuclear dyad is the husband and wife alone, either childless or with no children living at home.

9. The phrase "All Chinese people like rice" is an example of

A.  cultural stereotyping.
B.  culture-bound syndrome.
C.  cultural imposition.
D.  ethnocentrism.

 The tendency to view individuals of common cultural backgrounds similarly and according to a
preconceived notion of how they behave is called cultural stereotyping.
 Culture-bound syndrome is a condition that is culturally defined.
 Cultural imposition is a person's tendency to impose his or her own beliefs, values, and patterns of
behavior on individuals from another culture.
 Ethnocentrism is a person's tendency to view his or her own way of life as the most desirable,
acceptable, or best and tendency to act in a superior manner toward individuals from another culture.

10. While caring for a client from an Asian culture, the community health nurse might expect which
behaviors? (Select all that apply.)
A.  The client is quiet and compliant, asking few questions.
B.  The client asks many questions related to the health problem and the nurse's instructions.
C.  The client may avert his or her eyes during the conversation.
D.  Folk healers and complementary health care providers may also be present.
E.  The client may provide the nurse with the answers he or she thinks the nurse wants to
hear.

 Asian and Native American clients are likely to appear quiet and compliant.
 Asian, Native American, Indochinese, Arab, and Appalachian clients may consider direct eye contact
impolite or aggressive, and they may avert their own eyes during the conversation.
 Asian clients may provide the nurse with the answers they think the nurse wants to hear.
o The nurse must be aware that this behavior does not mean that the client or family
understands his or her instructions and they will not necessarily be compliant in future health
behavior.

Chapter 14: Environmental Health

1. How would a community health nurse use Executive Order 12898?

A.  Recognize that its focus is to decrease urban sprawl.
B.  Use its definition of sick building syndrome in completing an environmental assessment.
C.  Recognize that it would help achieve environmental justice.
D.  Cite it as a law to decrease carbon dioxide emissions for industries regulated by the
Environmental Protection Agency.

 Executive Order 12898 (signed by President Clinton in 1994 with a memorandum signed by President
Obama in 2008) required all federal agencies to develop comprehensive strategies to identify and
address environmental justice.
 Sick building syndrome describes a phenomenon in which public structures and homes cause
occupants to experience a variety of symptoms, such as headache, fatigue, and exacerbation of
allergies.
 Executive Order 12898 is not citable as law to decrease carbon dioxide emissions.

2. Using critical theory when exploring issues of environmental health ultimately allows the nurse to
A.  develop a community diagnosis.
B.  raise additional questions related to environmental health and safety.
C.  design community health interventions.
D.  alter the precursors of poor health.

 Critical theory is used to help community health nurses think about social, cultural, economic, and
political factors of health, thereby assisting them to attack the problem at its source and alter
community-wide precursors of poor health.
 The community health nurse can develop a community nursing diagnosis and design interventions by
using the nursing process.

3. Which intervention would be the most appropriate to implement for a community that has a high risk
for environmental health hazards?
A.  Facilitate the evaluation of ongoing community health interventions.
B.  Document participation levels of families in environmental issues.
C.  Involve citizens in decision-making processes about proposed activities that could pose an
environmental threat.
D.  Screen at-risk populations for asthma and test blood levels for air pollutants.
 Community health nurses have a mandate to assist vulnerable aggregates who have fewer options in
protecting themselves from:
o Pollution
o inadequate housing
o toxic poisoning
o unsafe products
o other hazards
 An appropriate nursing intervention would be to involve citizens in decision-making processes about
proposed activities that could pose an environmental threat.
 Evaluating ongoing health interventions, documenting participation levels of families, and screening
at-risk populations are important evaluation methods for determining the needs of the community but
are not the most appropriate intervention.

4. A public health nurse is surveying a population of coal miners. Which question would elicit
information about related risk to a miner's children?
A.  "Do you wear a respirator?"
B.  "How close do you live to your workplace?"
C.  "How many accidents has the mine had this year?"
D.  "Do you have a good rapport with your boss?"

 Environmental health effects can be immediate, long term, or intergenerational.

 Although often overlooked, a parent's occupation may put his or her children in danger.
 Living close to a coal mine could increase the children's risk for exposure to water or ground
contamination from the mine, among other environmental hazards.

5. Approaching health at the aggregate level is the initiative of which agency or document?
A.  Occupational Safety and Health Administration (OSHA)
B.  Clean Air for All
C.  Healthy People 2020
D.  Centers for Disease Control and Prevention (CDC)

 An attempt to approach health at the aggregate level is the Healthy People 2020 initiative.

o It deals with issues ranging from decreasing ozone levels to decreasing Escherichia coli
outbreaks.
o All of these issues deal with the broader environmental origins of disease, not just deleterious
personal habits. OSHA, Clean Air for All, and the CDC have a narrower focus.

6. When building a collective strategy by framing an environmental problem, the community health
nurse should ask which question?
A.  Who is affected by the problem?
B.  What individual should I talk to?
C.  What nursing diagnosis is involved?
D.  What is my role?

 Dialogue from critical thinking should facilitate community involvement and is not focused on a single
individual.
 Asking about role or diagnosis does not facilitate community involvement.

7. A primary role of the community health nurse in facilitating community participation and partnership
is
A.  solving environmental health problems.
B.  educating about environmental health hazards.
C.  altering individual behaviors.
D.  implementing solutions to environmental racism.
 Educating the public about environmental health hazards is the first step in engaging the community
problems of the environment.
 Environmental hazards are complex and interconnected; therefore, increasing the public's knowledge
of the hazards leads not only to individual action but also public action.
 The other options are not the primary focus of the community health nurse.
8. When assisting specific aggregates, which should be included in the community health nurse's
outcomes?
A. Helping people learn from their own experiences and analyzing the world with the intention
to change it
B. Honesty, fairness, and mutuality in the interactions
C. Intervening in mutual exchanges with community members and citing the current literature
D. Asking critical questions of the aggregates involved

 Nursing's role in the community is to create a context from which people can learn and identify
health-damaging problems from within their environment.
 It is essential that the affected people participate in the process of identifying and working to solve
environmental problems.
 The other options do not allow the people to participate in the process that affects their ability to learn
and thus make change.

9. An emergency department nurse assesses a 25-year-old patient with tachycardia, headache, and
nausea. The patient denies drug use, heart problems, and smoking. She works from her house and
states that everyone in her house has had the "flu" but that she is the only one who has not been
feeling better. The nurse notices that the patient lives in the historic section of the town. What
environmental hazard should the nurse be primarily concerned about?
A.  Food quality
B.  Housing quality
C.  Water quality
D.  Occupational risks

 Older homes and buildings often have poor ventilation and harbor hazardous materials.
 The signs and symptoms this patient is experiencing may be a result of "sick building syndrome."
 Gastrointestinal symptoms might indicate an issue with food or water quality.
 Occupational risks do not take into consideration the environmental hazard related to housing.

10. A community health nurse would include which in her assessment of environmental health? (Select all
that apply.)
A.  Work-related exposures
B.  Atmospheric quality
C.  Families
D.  Job availability
E.  Radiation risks

 Environmental health is a vast field of subcategories, including:

o living patterns
o work risks
o atmospheric quality
o water quality
o housing
o food quality
o waste control
o radiation risks.

 Families and job availability are not environmentally related.

Chapter 26: Communicable Diseases

1. Katie, a 2-year-old child, is brought to the doctor's office after 2 days of vomiting and diarrhea. Upon
completion of the medical history, the mother tells the nurse that several of the other children at the
daycare who played with the same toys as Katie have the same symptoms. The mode of transmission
for the pathogen more likely was
A. vector.
B. direct.
C. indirect. 
D. airborne.

 The stem of the question indicates that the children played with the same toys.
 This would indicate the indirect mode of transmission. The other modes of transmission do occur
through the sharing of toys.

2. Four-month-old Lucy is in for immunizations at the local health department. The Vaccine Information
Sheet is given to Lucy's mother, and informed consent is obtained. However, the mother then states,
"Lucy did have a temperature around 99.1 degrees the night of her last immunizations." After this
statement, the nurse should
A.  consult the child's pediatrician.
B.  delay the immunizations.
C.  do not give the immunizations because of the contraindication.
D.  give the immunizations.

 A low-grade fever is not a contraindication to immunizations - The nurse should give the
immunizations.
 It is not necessary to contact the child's pediatrician.
 Vaccination should be postponed in cases of moderate or severe febrile illness to avoid any confusion
between a vaccine side effect and an unknown underlying cause

3. Which statement regarding sexually transmitted diseases (STDs) is correct?

A.  The rate of STDs is decreasing because of effective medication therapies.
B.  Women are less likely to use protection methods against STDs.
C.  Half of the STD rate in the United States falls within the 15 to 24 age range. 
D.  Treatment for STDs in women is usually ineffective.

 An estimated 20 million cases of STDs occur each year in the United States, almost half of them in
persons aged 15 to 24 years. The other statements are not true.

4. Investigating all contacts of a person infected with a sexually transmitted disease is an example of
what?
A.  Primary prevention
B.  Secondary prevention 
C.  Tertiary prevention
D.  Initial prevention

 Primary prevention of communicable diseases involves measures to prevent transmission of an

infectious agent and to prevent pathology in the person exposed to an infection.
 Secondary prevention includes the investigation of contacts to sexually transmitted disease cases.
 Secondary prevention includes activities to ensure early detection of infection and effective treatment
of persons who are infected.
 o Not only does this prevent progression of the infectious disease, but it also prevents
transmission of the pathogen to others.
 Tertiary prevention includes activities involved in caring for persons with an infectious disease to
ensure that they are cured or that their quality of life is maintained.

5. Which statement indicates that further teaching is needed for a patient involved in family planning?
A.  "I can't get human papilloma virus (HPV) from my boyfriend because we’re not having
intercourse." 
B.  "I need to use condoms to prevent transmission of sexually transmitted diseases." 
C.  "Even though I have no signs or symptoms, I still may have Chlamydia."
D.  "I can give my unborn baby warts during childbirth."

 Option A indicates the patient needs more teaching. HPV can be transmitted via sexual intercourse, as
well as any other means of direct contact.
 The other statements are true.

6. Transmission of an infectious disease can be efficiently controlled by

A.  breaking all links in the transmission chain.
B.  destroying all reservoirs of infectious agents.
C.  breaking only one link in the transmission chain.
D.  maintaining high levels of herd immunity.

 Breaking just one link of the chain can control transmission of an infectious agent.
 Destroying all reservoirs of infectious agents and maintaining high levels of herd immunity are two of
several ways to break a link in the chain of transmission.

7. Which is classified as a vector of disease?

A.  Humans
B.  Door handles
C.  Water and food
D.  Mosquitoes 
 Vectors can be animals or arthropods and can transmit disease through biological and mechanical
routes.
 The other options are not vectors.

8. A pathogen lives and multiplies in a __________ and transfers from one host to another by a
__________.
A.  host, susceptible portal of entry
B.  reservoir, mode of transmission 
C.  infectious agent, portal of exit
D.  mode of transmission, reservoir

 A pathogen lives and multiplies in the reservoir and transfers from one host to another by a mode of
transmission.

9. Seven cases of hepatitis A are diagnosed in a community over a period of 2 weeks. An investigation
results in a determination that all of the infected individuals ate at a local restaurant. Which statement
explains the possible connection between hepatitis A and a restaurant?
A.  The route of transmission for hepatitis A is fecal-oral. 
B.  A food worker likely coughed on the customers.
C.  A food worker may have a bleeding wound.
D.  Hepatitis A is transmitted where people congregate.
 Hepatitis A is transmitted by fecal-oral route.
 Coughing or bleeding would not transmit hepatitis A.
 Option D does not have enough information to form a conclusion about hepatitis A transmission.

10. Which factors cause primary vaccine failure? (Select all that apply.)
A.  Inefficient storage 
B.  An intramuscular vaccine injection given subcutaneously
C.  Waning immunity in immunocompromised patients
D.  Light-sensitive vaccines exposed to light
E.  Seroconversion

 Primary vaccine failure is the failure of a vaccine to stimulate any immune response.
o It can be caused by:
 improper storage that renders the vaccines ineffective
 an improper administration route
 light-sensitive vaccines exposed to light
o Additionally, some immunized persons never seroconvert, either because of failure of their
own immune system or for some other unknown reason.
 Secondary vaccine failure is the waning of immunity after an initial immune response.