Community Health Nursing Chapter 21 MC

A community health nurse is conducting an in-service program for a group of maternal and child health nurses. When describing the critical population health indicators affecting this population globally and nationally, the nurse would include which component? Select all that apply

A)Maternal mortality rate

B)Infant mortality rate

C)HIV/AIDS

D)Crude mortality rate

E)Fetal alcohol syndrome

A)Maternal mortality rate

B)Infant mortality rate

C)HIV/AIDS

E)Fetal alcohol syndrome

Feedback:

Critical population health indicators that affect childbearing women, infant, toddler, and preschool populations globally and in the United States include maternal mortality rate, infant mortality rate, HIV/AIDS, and fetal alcohol syndrome. Crude mortality rate does not apply specifically to childbearing women, infant, toddler, and preschool populations.

A community health nurse is conducting a program at a local women's health clinic for a group of at-risk women of childbearing age. When describing low-birth-weight and very-low-birth-weight babies to this group, which statement would the nurse most likely

include?

A) Low-birth-weight is more common in Whites and Hispanics than African Americans.

B) Birth weight is one of the most important predictors of infant mortality.

C) The incidence of low-birth-weight in the United States is decreasing in relation to the increase in multiple births.

D) Recent trends in very-low-birth-weight babies show that they continue to have morbidity with significant increases in survival.

B) Birth weight is one of the most important predictors of infant mortality.

Feedback:

Birth weight is one of the most important predictors of infant mortality. Low birth weight is more common in African Americans than in Whites and Hispanics. The overall incidence of low-birth-weight is increasing slightly, which can be explained by increased multiple births.

A community health nurse is developing a program that would encourage mothers to use breast-feeding exclusively for their babies' nutrition for the first 6 months. The nurse bases this program on the understanding about which of the following?

A)Exclusive breast-feeding promotes better growth and development.

B)Its lower cost provides more money for other needed items.

C)Infant mortality would significantly decrease.

D) It would aid in decreasing maternal mortality rates.

C)Infant mortality would significantly decrease.

Feedback:

Approximately 1.3 million infants would survive annually if mothers were able to exclusively breast-feed their infants for 6 months. The lack of breast-feeding is related to decreased survival and increased morbidity from infections, lower intelligence test scores, increased cardiac risk factors, and inadequate nutrition. The superiority of breast milk and lower costs would not be factors for developing a community health program for breast-feeding. Exclusive breast-feeding is not associated with decreasing maternal mortality rates.

A community health nurse is integrating the Healthy People 2010 goals into suggested programs for a local community. Which of the following goals would the nurse identify as having been met?

A)Reduction in low-birth-weight infants

B)Reduction in total preterm births

C)Increase in the number of infants put to sleep on their backs

D)Increased proportion of mothers breast- feeding at 6 months

C)Increase in the number of infants put to sleep on their backs

Feedback:

After years of working toward improving maternal-child health, the United States has made limited progress. One objective, however, has been met: 70% of infants are now being put to sleep on their backs (up from 35% baseline), largely due to public health educational efforts and reminders. Objectives for LBW, VLBW, and preterm births all moved away from their Healthy People 2010 targets. Breast-feeding is beneficial to both mother and infant, and in 2005, almost 73% of infants were breast-fed for some period of time. However, the goal has not been met.

A nurse is preparing a presentation to a group of community officials about maternal and child health and the need for educational programs to foster achievement of Healthy People 2020 goals. Which area would the nurse continue to emphasize even in light of the objective having been met?

A)The number of infants being put to sleep on their backs and the rate for sudden infant death syndrome

B)Improving the proportion of infants who are breast-fed

C)Reduce the rate of fetal and infant deaths

D)Reduce the occurrence of fetal alcohol syndrome

A)The number of infants being put to sleep on their backs and the rate for sudden infant death syndrome

Feedback: After years of working toward improving maternal-child health, the United States has made limited progress. One objective, however, has been met

A community health nurse is providing a class for pregnant women about the dangers of alcohol consumption during pregnancy. After teaching the group, the nurse determines that the teaching was successful when the group identifies which effect in the newborn

as being related to alcohol consumption by the mother? Select all that apply.

A)Intellectual impairment

B)Low-birth-weight

C)Leukemia

D)Respiratory distress

E)Altered growth and development

F)Childhood cancers

A)Intellectual impairment

B)Low-birth-weight

E)Altered growth and development

Feedback:

The health of infants can be dramatically affected by maternal consumption of alcohol. The pregnancy itself can be threatened. However, the most devastating consequence of alcohol consumption during pregnancy is fetal alcohol spectrum disorders (FASD) and fetal alcohol syndrome (FAS), both of which compromise the intellectual functioning, birth weight, and altered growth and development of the infant or child. Respiratory distress, leukemia, and other childhood cancers are not associated with maternal alcohol consumption.

A community health nurse is working with a group of pregnant women in the community to reduce lifestyle risk factors associated with low-birth-weight newborns and infant mortality. Which of the following would the nurse address?

A) Multiparity

B) College level education

C) Environmental toxins

D) Single gestation pregnancy

C) Environmental toxins

Feedback:

Environmental toxins are lifestyle risk factors associated with low-birth-weight newborns and infant mortality. Other risk factors include primiparity, low educational level, and multiple gestation among others.

A community health nurse visits a local women's health center to provide teaching about the effects of smoking during pregnancy. One of the women in the class asks the nurse, "But aren't e-cigarettes safer?" Which response by the nurse would be most appropriate?

A) "Yes, they are much safer than smoking cigarettes."

B) "Actually, there isn't any information about their safety."

C) "No, they still pose a threat to the baby and you."

D) "It's okay to use them as long as you don't inhale."

C) "No, they still pose a threat to the baby and you."

A local community health center is providing classes to childbearing families about the effects of alcohol use during pregnancy. During one of the classes, a community health nurse describes fetal alcohol spectrum disorder (FASD). Which of the following would the nurse include as a common finding in the newborn?

A) Large for gestational age

B) Facial abnormalities

C) Hypoactive behavior

D) Enhanced intellectual development

B) Facial abnormalities

Feedback:

A newborn with FASD typically exhibits facial abnormalities, is small for gestational age, demonstrates hyperactivity and intellectual impairment.

A community health nurse integrates knowledge of which concept when providing preconception counseling to a group of women and the need for adequate weight gain during pregnancy?

A) Maternal nutritional habits do not affect later life.

B) Inadequate weight gain increases the woman's risk for cesarean birth.

C) Prolonged labor can occur with too little or too much weight gain.

D) Adequate weight gain is positively correlated with normal birth weight.

D) Adequate weight gain is positively correlated with normal birth weight.

Research has demonstrated a positive correlation between weight gain during pregnancy and normal birth weight in babies. Inadequate weight gain is related to LBW, premature births, and perinatal mortality. Gaining large amounts of weight can also cause problems at birth, including increased numbers of cesarean deliveries, large-for- gestational-age babies, along with the mother's retention of excessive weight. Maternal nutritional habits set gene switches that affect later life.

After teaching a group of pregnant women about the need for proper oral health during pregnancy, which of the following statements by the group indicates the need for additional teaching?

A) "We should continue seeing the dentist like we always do."

B) "Chewing sugar-free gum is okay even with the pregnancy."

C) "If we need dental work, we can postpone it until after the birth."

D) "Flossing and brushing are just as important now as before."

C) "If we need dental work, we can postpone it until after the birth."

Feedback:

Postponing dental work is inappropriate. Dental health procedures have generally been found to be effective and safe for pregnant women, especially during the second trimester. Statements about the importance of regular dental health checkups and proper dental hygiene, along with referrals for dental treatment when needed, indicate effective teaching. Sugar-free gums that contain xylitol and chlorhexidine may be helpful in reducing the maternal-child transmission of caries- causing bacteria.

What are the roles that public and community health nurses need to enact in order to maximize the outcome for pregnant adolescents? Select all that apply.

A) Clinician

B) Educator

C) Counselor

D) Provider of referrals

E) Friend

A) Clinician

B) Educator

C) Counselor

D) Provider of referrals

Feedback:

Roles that public and community health nurses need to enact in order to maximize the outcome for pregnant adolescents include clinician, educator, counselor, and provider of referrals. It is not appropriate for the nurse to enact the role of friend with pregnant adolescent clients or any other client.

A pregnant woman with hypertensive disease comes to the community health center for follow up. Which of the following would be appropriate to include when teaching the woman about controlling her blood pressure at this time?

A) Ensuring rest periods with legs elevated

B) Limiting her daily intake of fluid

C) Restricting intake of fresh fruits

D) Encouraging additional weight gain

A) Ensuring rest periods with legs elevated

Various methods are employed to attempt to prevent and control hypertension during pregnancy, namely, a diet rich in fresh fruits and vegetables, adequate fluid intake, weight gain limitations, rest, and regular exercise. These remain the most common preventive suggestions that community health nurses, in collaboration with the clients' primary health care providers, can give to their pregnant clients. A calm environment, along with periods of rest with the pregnant woman either elevating her feet or reclining in a left side-lying position, is also recommended.

A community health nurse is making a home visit to a postpartum woman. The nurse suspects that the woman may be experiencing depression. During a home postpartum visit, a community health nurse suspects that the woman is experiencing depression. Which of the following responses would be most appropriate?

A) "You should try drinking more caffeine to help you be less tired."

B) "Don't worry. Good mothers don't hurt their babies."

C) "Try napping when the baby is napping."

D) "You should be able to achieve perfection with housekeeping tasks while you are still on maternity leave."

C) "Try napping when the baby is napping."

A community health nurse is conducting a program for a group of nurses from the local maternal and child health centers about various community nutritional programs available. The nurse determines that the teaching was effective when the group identifies which result is attributable to the WIC program?

A) Increased expenditures for health care

B) Decreased rates of large for gestational age babies

C) Reduced rates of infant iron deficiency anemia

D) Drop in breast-feeding rates

C) Reduced rates of infant iron deficiency anemia

In addition to supporting women and young children with nutritious foods and achieving the initial goals of decreasing the rates of preterm and LBW babies, increasing the length of pregnancy, and reducing the incidence of infant and child iron deficiency anemia, WIC also increases breast-feeding rates and improves pregnant women's nutritional status.

A community health nurse is reviewing a journal article about child health and statistics related to various age groups. Which condition would the nurse most likely find as the major cause of death due to injuries in the 1- to 4-year-old population?

A) Pneumonia

B) Poverty

C) Unintentional injuries and homicide

D) Heart disease

C) Unintentional injuries and homicide

Feedback:

Unintentional injuries and homicide cause most of the deaths for the 1- to 4-year-old population: motor vehicle crashes, falls, drowning, fires, and burns. Pneumonia is not a major cause of death among children. Poverty contributes to morbidity and mortality but is not a cause of death in and of itself. Heart disease is the fourth leading cause of death among young children.

A community health nurse is developing a plan to address the needs of pregnant adolescents. When setting up educational programs for this group, which method would the nurse most likely implement to promote success? Select all that apply.

A) Classroom lectures

B) Informal group discussions

C) Creative craft sessions

D) Small group games

E) Interactive computer activities

B) Informal group discussions

C) Creative craft sessions

D) Small group games

E) Interactive computer activities.

A community health nurse implements a teaching program for new parents about ways to reduce infant mortality. Which suggestion would the nurse include as most important?

A) "Never leave the infant alone on a dressing table or couch."

B) "Check the temperature of the bath water before bathing."

C) "Stay within an arm's length when the baby is in the tub."

D) "Put the infant to sleep on his or her back."

D) "Put the infant to sleep on his or her back."

Suffocation is the leading cause of death in infants. Therefore, the suggestion to put the baby to sleep on the back is a major preventive measure and the most important. Never leaving the infant alone would reduce the risk for falls, a leading case of nonfatal injuries for infants. Checking bath water temperature is appropriate to prevent burns. Staying within an arm's length while bathing is a suggestion to prevent drowning.

A community health nurse is involved in a screening program for lead exposure. The nurse would target this program primarily to which age group?

A) Birth to -year-olds

B) 1 1/2- to 3-year-olds

C) 3- to 5-year-olds

D) 5- to 7-year-olds

B) 1 1/2- to 3-year-olds

Feedback:

The critical age of lead exposure (or peak level) is thought to be between 18 and 36 months. Levels generally begin to decline after age 3.

A community health nurse is conducting an in-service program for a group of nurses working at the local health clinics about immunizations and disease prevention. The nurse determines that additional teaching is needed when the group identifies which issue as underlying the changes in vaccine doses and formulations at the start of the 21st century?

A) Increased virulence of the vaccine-preventable disease causative organisms.

B) Waning of pertussis immunity with age necessitating immunization of adults who

would be around infants.

C) Increased immunity when varicella vaccine given in two doses has been found to

increase immunity.

D) Outbreaks of measles in populations with parental refusal and personal belief

exemptions.

A) Increased virulence of the vaccine-preventable disease causative organisms.

A community health nurse is making a family home visit. The family consists of the mother, father, 1-year-old, and 4-year-old. The mother states that the 4-year-old who is in preschool had a cold last week and now the 1-year-old has it. She asks the nurse if she can use the over-the-counter cold medication that she gave to the 4-year-old for the 1-year-old. Which response would be most appropriate?

A) "It shouldn't be a problem if you use that same medication for the 1-year-old."

B) "I don't know if the medicine will work, but you can try it and see."

C) "That type of medicine should not be used in children under age 2."

D) "You should use a smaller dose but watch if it makes him irritable."

C) "That type of medicine should not be used in children under age 2."

Community health nurses need to emphasize that over-the-counter cough and cold medications should not be used for children under age 2. The Food and Drug Administration (FDA) deemed them unsafe and ineffective and most manufacturers took them off the market in fall of 2007 in response to emergency room visits and deaths linked to their toxic effects. Therefore, the nurse would tell the mother not to use the medicine since the child is only a 1-year-old.

A community health nurse is working with a group of parents who have infants and toddlers. Which of the following would the nurse include in a teaching plan for this group about reducing dental caries?

A) Serving sugary foods at mealtimes and not snacks

B) Providing juice in a sippy cup between meals

C) Allowing the older infant to fall asleep with a bottle

D) Permitting snacking throughout the day

A) Serving sugary foods at mealtimes and not snacks

Feedback:

It is recommended that sugary foods be eaten at mealtimes and not as snacks, and that regular snack times be established. Between- meal drinks should consist of water or milk. Juice should be given only with meals. Allowing infants to fall asleep with a bottle can lead to baby bottle tooth decay or nursing caries.

A community health nurse is involved in secondary prevention level activities focusing on child abuse and neglect. Which activity would the nurse most likely implement?

A) Prenatal parent preparation classes

B) Public service announcements for positive parenting

C) Education to improve family functioning skills

D) Respite care for families with special needs children

D) Respite care for families with special needs children

Feedback:

Providing respite care for families with special needs children is an example of a secondary prevention action. Prenatal parent preparation classes, public service announcements, and education to improve family functioning skills are examples of primary prevention level activities.

A community health nurse is conducting an educational program for a group of parents at a local community health center about promoting adequate brain development in children during the first 2 years of life. The nurse determines that the teaching was effective when the group identifies which nutrient as most important?

A) Vitamins

B) Fats

C) Protein

D) Carbohydrates

B) Fats

Feedback:

During the first 2 years, when rapid myelination is taking place, 50% of total calories should come from fat, but after age 2, the choice of 1% or 2% milk—should be the norm. A well-balanced diet including an adequate intake of vitamins, protein, and carbohydrates is needed

A community health nurse is working to develop a program to address the problem of HIV/AIDS in maternal and child health populations and mother-to-child transmission. Which area would be most important for the nurse to focus on?

A) Early antiretroviral treatment

B) Safer sex practices

C) Hand-washing practices

D) Nutritional supplements

A) Early antiretroviral treatment

A community health nurse is preparing a program for a local parent group about measures to prevent drowning in children. Which measure would the nurse most likely include in the discussion? Select all that apply.

A) Encouraging parents to have their children learn how to swim.

B) Limiting the bath water to 4 to 6 inches for bathing.

C) Keeping children within eyesight when in the water.

D) Eliminating water collection containers around the home.

E) Keeping toilet lids up, in an open position.

A) Encouraging parents to have their children learn how to swim,

D) Eliminating water collection containers around the home.

A community health nurse is providing care to a group of pregnant women at risk for hypertensive disease of pregnancy. When teaching this group about preventive measures, which suggestion would the nurse most likely include? Select all that apply.

A) Selecting processed foods for meals

B) Ensuring adequate fluid intake

C) Obtaining regular exercise

D) Limiting fresh fruit intake

E) Ensuring adequate time for rest

B) Ensuring adequate fluid intake

C) Obtaining regular exercise

E) Ensuring adequate time for rest

A community health nurse is conducting a teaching session with a group of pregnant women who have gestational diabetes. The nurse determines that the teaching was successful when the women state that which problem could occur in the infant?

A) "Our babies might be small for the gestational age."

B) "Our babies might suffer injuries at birth."

C) "Our babies have low blood sugars when born."

D) "Our babies might have heart conditions."

B) "Our babies might suffer injuries at birth."

A community health nurse is reviewing a program at a local women's community health center for pregnant women. The nurse is conducting an evaluation of the effectiveness of the center's screening for gestational diabetes. The nurse determines that the program is effective as evidenced by documentation of this screening occurring at which time?

A) At 12 weeks' gestation

B) Between 16 and 18 weeks' gestation

C) Around 24 weeks' gestation

D) At 28 weeks' gestation

C) Around 24 weeks' gestation