Chapter 21: Vulnerable Populations Nursing School Test Banks

Chapter 21: Vulnerable Populations
Test Bank

MULTIPLE CHOICE

1. What is the single most crucial variable associated with health status?
a. Cultural background
b. Ethnic group
c. Race
d. Socioeconomic class
ANS: D
The most important factor associated with health status is economic status. Poverty drastically increases a persons/groups vulnerability to poor health status.

DIF: Cognitive Level: Knowledge REF: p. 528

2. In 2010, how many people fell below the poverty in the United States?
a. About 4.5% or 13 million people
b. About 8.5% or 25 million people
c. About 15.1% or 46 million people
d. Fewer people than in the year 2008
ANS: C
According to the U.S. Census Bureau (2010), 15.1% of all people in the United States fall below the poverty level, or about 46 million, an increase of 6.6 million since 2008.

DIF: Cognitive Level: Knowledge REF: p. 529

3. What is the relationship between race and ethnicity and health status?
a. Ethnic and racial minorities are equally as vulnerable to poor health status as the rest of the population.
b. Ethnic and racial minorities are less vulnerable to poor health status than the rest of the population.
c. Ethnic and racial minorities are more vulnerable to poor health status than the rest of the population.
d. There is no significant relationship between ethnic and racial background and health status.
ANS: C
Ethnic and racial minorities are more vulnerable to poor health status than the rest of the population because minorities are at greater risk for poverty. Other factors include discrimination and some health behaviors and beliefs.

DIF: Cognitive Level: Comprehension REF: p. 531

4. Approximately what percentage of the American population does not have health insurance according to the U.S. Census Bureau?
a. 4%
b. 8%
c. 12%
d. 16%
ANS: D
The U.S. Census Bureau reports about 49.9 million Americans, or 16.3% of the population, do not have health insurance.

DIF: Cognitive Level: Knowledge REF: p. 533

5. Which of the following is the primary reason that only a small percentage of those eligible participate in COBRA insurance?
a. COBRA is too costly for most eligible people.
b. They do not think it is important to have health care insurance.
c. Medicaid is a more effective choice to obtain health care.
d. They are healthy and are willing to not carry insurance.
ANS: A
Over 90% of people choose not to participate in the COBRA plan because of the cost of the premiums.

DIF: Cognitive Level: Knowledge REF: pp. 533-534

6. An uninsured child lives in a family which has an income level below the poverty level. Under which of the following programs can this child receive health care?
a. Childrens Health For All initiative
b. No Child Left Behind Act
c. State Childrens Health Insurance Program
d. Temporary Assistance to Needy Families Program
ANS: C
The uninsured rate for children has been cut in half because of the 1997 passage of the State Childrens Health Insurance Program. Despite the success of CHIP, eligible children are still missed and are not receiving care.

DIF: Cognitive Level: Application REF: pp. 533-534

7. A homeless veteran, who finds his posttraumatic stress disorder so overwhelming that he cannot deal with society, lives by the river underneath a bridge, in a large packing crate, and seems to have adapted to his situation. Which of the following best describes this type of homelessness?
a. Chronic
b. Episodic
c. Not really homelessness
d. Temporary
ANS: A
Because this is an ongoing, apparently permanent situation to which the veteran has adapted, this has become the norm for him, hence chronic.

DIF: Cognitive Level: Application REF: p. 535

8. The middle-aged white woman seemed unable to relate to the staff in any meaningful way or to behave in an appropriate manner in the emergency department, where the police officer had brought her as a result of inappropriate behavior at a public gathering. Which of the following would best describe this woman?
a. A public nuisance
b. An unfortunate drain on society
c. Extremely mentally and physically ill
d. Psychologically and socially decompensated
ANS: D
A homeless woman with such symptoms is said to be suffering from psychological and social decomposition. That is, she is unable to interact with others by communicating well or behaving in socially acceptable ways and is emotionally and mentally separated from society.

DIF: Cognitive Level: Application REF: p. 535

9. Although single men are the largest single group of homeless people, which of the following is the fastest growing group of homeless people?
a. Adolescents
b. Adult single women
c. Elderly
d. Families with children
ANS: D
Single homeless men still make up the largest and most visible subgroup of the homeless. However, families with children are the fastest growing group.

DIF: Cognitive Level: Knowledge REF: p. 535

10. What is the primary reason women with small children are homeless?
a. Domestic abuse
b. Lack of education
c. Lack of employment
d. Lack of job skills
ANS: A
Although lack of education and job skills makes it difficult to find employment and funds with which to pay for housing, the primary reason a woman with small children would be homeless is a result of domestic abuse.

DIF: Cognitive Level: Knowledge REF: p. 535

11. The nurse was assessing a child who had spent the last 3 years living with her mother in homeless family shelters. Which of the following would the nurse expect of the child in relation to intellectual development?
a. Development is somewhat below grade level
b. Development is above grade level
c. Development is at the appropriate grade level
d. Development is quite low for her age and grade level
ANS: D
Many homeless children have attended school programs on a sporadic basis. They often have deficiencies in acquiring learning readiness and social interaction skills and experience long intervals between school attendances. This lost school time results in academic underachievement and gaps in learning and experience.

DIF: Cognitive Level: Application REF: p. 535

12. Which of the following would a homeless adolescent see as an important survival skill?
a. Being able to beg, manipulate, and lie to obtain resources
b. Using free clinics to obtain access to health care providers
c. Trying to keep a list of all social programs in the community
d. Trying to look and act like a middle class member of society
ANS: A
Homeless youths adapt quickly to life on the street, where they are subject to criminal victimization such as learning to solicit money and drugs through prostitution.

DIF: Cognitive Level: Application REF: p. 536

13. A community/public health nurse is caring for clients living at a local homeless shelter. Which of the following would be most likely expected of many of the clients?
a. Many suffer from alcohol or drug abuse or are mentally ill.
b. Many are extremely violent and dangerous to be around.
c. Many receive free care at the local public health clinics.
d. Many suffer from acute illnesses resulting from exposure to weather extremes.
ANS: A
Research demonstrates that the majority of the homeless are men, many are veterans, almost one third abuse alcohol or other drugs, and one fourth will be mentally ill.

DIF: Cognitive Level: Application REF: p. 536

14. Why do many migrant/seasonal workers not complain about their poor living conditions?
a. Being undocumented, they risk discovery and deportation
b. Conditions here are so much better than in their original home
c. There is nothing a nurse can do about housing conditions
d. It is not a part of their ethnic groups culture to complain
ANS: A
Although the other reasons may also be true, the main reason this population does not complain is because many migrant/seasonal workers are undocumented and fear discovery and deportation.

DIF: Cognitive Level: Knowledge REF: p. 537

15. The two wage earners in a family with four children have recently become unemployed. Suddenly, they are unsure as to how they are going to pay their mortgage, monthly bills, and purchase groceries. To which of the following governmental assistance programs would the nurse most likely refer this family?
a. Aid to Families with Dependent Children (AFDC)
b. Medicaid
c. Temporary Assistance for Needy Families (TANF)
d. Women, Infants, and Children Program (WIC)
ANS: C
AFDC was abolished under the Welfare Reform Act, and TANF replaced it. The two biggest programs are TANF and Social Security Income (SSI), but both programs only cover about one third of the 37 million people below the poverty line. TANF provides temporary financial assistance to needy families with dependent children. Medicaid provides health care services to certain people in need. WIC provides supplemental food and formula for infants, young children, and pregnant and new mothers.

DIF: Cognitive Level: Application REF: p. 538

16. Which of the following populations was most affected by the federal budget cuts made in 1996?
a. The upper and middle class
b. The wealthy
c. The lower-middle class
d. The poverty-stricken
ANS: D
Poverty programs were cut in 1996 under the Personal Responsibility and Work Opportunity Reconciliation Act, also known as the Welfare Reform Act.

DIF: Cognitive Level: Knowledge REF: p. 539

17. What has happened to the funds set aside for nutrition and food programs, such as WIC?
a. They have decreased a small amount in an effort to be fair to everyone
b. They have increased the recognition of the number of low-income mothers seeking assistance
c. They have been maintained at current levels, even though more women are documenting eligibility for help
d. They have been sharply reduced with benefits limited to one year
ANS: D
WIC was sharply curtailed so mothers living with others could have only 1 year of benefits, women in prison or detention centers were denied benefits for their children, and adults without children could have only 3 months of assistance every 3 years.

DIF: Cognitive Level: Knowledge REF: p. 540

18. When the nurse accepted a position at the local community health center, the nurse was told to not ask the immigration status of any client. Why would an agency have such a policy?
a. Agency personnel do not want to get involved in political or legal concerns in any possible way.
b. All state and federally funded programs are barred from using funds to care for illegal immigrants, so care can only be given if status is unknown.
c. The agency did not want to inadvertently refuse care to a U.S. citizen by constantly requiring documentation, which wastes agency time, effort, and money.
d. The agency recognizes that immigration status has no bearing on a clients health or need for care, so there is no reason to ask.
ANS: B
All states are required to bar illegal immigrants from state and locally funded programs. This ruling has created a dilemma for health care workers, who feel they have been asked to operate as agents of Immigration Services. Many facilities simply do not ask immigration status when providing care.

DIF: Cognitive Level: Application REF: p. 540

19. How has requiring proof of citizenship for all Medicaid recipients caused a problem for these clients?
a. Additional paperwork always increases workload and costs for agencies.
b. Citizens are not accustomed to having to prove they are citizens and may not have appropriate documentation immediately available.
c. Many low-income people do not have drivers licenses or birth certificates immediately available with which to prove citizenship.
d. Most agencies recognize that immigration status has no bearing on a clients need for Medicaid assistance.
ANS: C
Congress requires states to demand proof of citizenship, which is an additional administrative burden that causes delay in Medicaid coverage for families. Poor people are particularly at risk because many do not have passports, drivers licenses, or birth certificates.

DIF: Cognitive Level: Comprehension REF: p. 541

20. A single adult male is employed full-time and is earning the minimum wage. Under which of the following conditions could he afford housing?
a. If he combines his earnings with another adult who is employed part-time
b. If he chooses to live in a one-room efficiency apartment
c. If he lives in an apartment located in a low-income housing area
d. If he uses over 50% of his net income to pay for housing
ANS: D
An estimated 7.1 million low-income households spend more than 50% of their income on housing with no assistance from public assistance housing programs. Such households are one paycheck away from being homeless. Two adults, both employed full-time, may be able to rent a small apartment, but it is still difficult to save enough for the required deposit on a rental.

DIF: Cognitive Level: Knowledge REF: p. 541

21. Facing the changes in society, what have most state and local governments chosen to do?
a. Cut programs for low-income families to balance the budget
b. Cut programs that primarily serve the middle class
c. Increase taxes to meet revenue requirements
d. Ignore any federal mandates that are unfunded
ANS: A
States have had to contend with shrinking revenues and increased program responsibilities and federal mandates. States have used program cuts, especially in programs serving low-income families, as the primary method for balancing their budgets.

DIF: Cognitive Level: Knowledge REF: p. 541

22. What is an extremely important strategy that a community/public health nurse can take to assist vulnerable families?
a. Encourage the families to find and use free food distribution centers
b. Encourage the families to find and attend so-called free clinics for health care
c. Share information about local assistance programs and eligibility requirements
d. Write letters to the editor in the local newspapers
ANS: C
Although letters to the editor might be helpful, it would be more effective for the nurse to write about community problems than for individual families to beg for help. Certainly sharing the location of community resources is central to the nurses role, including eligibility requirements and benefits available for food, clothing, housing, emotional support, etc.

DIF: Cognitive Level: Application REF: pp. 541-542

23. The nurse wanted to engage in primary prevention in relation to the vulnerable populations for whom the nurse provided care. For what might the nurse choose to volunteer?
a. Counselor at the homeless shelter
b. Instructor for the community college home aide course
c. Nurse in a homeless clinic
d. Speaker to community groups as an advocate for vulnerable groups
ANS: D
Primary prevention tries to prevent health problems. Therefore, the nurse must advocate for vulnerable groups and speak to community groups on such issues as the need for low-cost housing and funding for poverty-level families.

DIF: Cognitive Level: Application REF: p. 542

MULTIPLE RESPONSE

1. By definition, what must a group be in order to be considered a vulnerable population? Select all that apply.
a. Aware that they are at risk
b. Diagnosed with an observable medical problem
c. Have difficulty obtaining appropriate health care
d. Acutely ill with several comorbidities
e. Likely to develop health-related problems
f. Probably confronting a shorter life span than others their age
ANS: C, E, F
By definition, a vulnerable population has mitigating factors that place them at greater risk for ongoing poor health status than other at-risk people or groups. A vulnerable population is more likely to develop health-related problems, have more difficulty accessing health care to address those health problems, and is more likely to experience a poor outcome or shorter life span from those health conditions. Awareness of problems is not a factor, since many diseases, such as hypertension, do not have observable symptoms and may not be diagnosed because the person may not have sought assistance.

DIF: Cognitive Level: Knowledge REF: p. 543

2. What conclusions can be drawn when comparing the prison population in the United States to the general adult population in the United States? Select all that apply.
a. More prisoners are from low-income, single-parent homes.
b. More prisoners have been diagnosed with a mental problem and substance abuse.
c. More prisoners are exposed to drug trafficking, weapons, and gang violence.
d. More prisoners have a lower level of education.
e. More prisoners receive better and more extensive health care.
f. More prisoners have a decreased risk of injury while incarcerated.
ANS: A, B, C, D
Statistical analysis of research demonstrates that vulnerable populations are overrepresented in juvenile justice and adult prison systems. Prisoners are more likely to come from single-parent homes and poverty, have lower levels of education, and have been exposed to drug trafficking, weapons, and gang violence. There is a disproportionate representation of racial minorities. Prisoners report more physical health problems, just more than 50% have a mental problem, and the risk of injury increases with time served.

DIF: Cognitive Level: Comprehension REF: p. 543

3. What were some of the effects of welfare reform? Select all that apply.
a. Additional governmental agencies have been established to fill in the gaps in services.
b. Earned Income Tax Credit helps increase income among low-income families.
c. Fewer people can use the system to their own personal advantage.
d. Lacking transportation and child care, many parents cannot seek or retain employment.
e. More children are able to receive health insurance assistance.
f. Very few people can receive assistance while earning a GED or attending remedial classes.
ANS: B, D, F
Long-term effects of welfare reform on families include a drop in the number and percentage of needy families receiving help; lower average payment (the Earned Income Tax Credit) helps increase income; many children lost their health insurance; time limitations resulted in families losing benefits; educational pursuits are no longer considered a work activity; and the number of extremely poor is increasing. All of these have put vulnerable groups even more at risk for health problems.

DIF: Cognitive Level: Knowledge REF: p. 544

4. Even though the nurse may be employed to do a specific task or engage in specific programs, in what activities can the nurse engage to continue to help vulnerable groups in the community? Select all that apply.
a. Consider every contact with clients an opportunity to ask about the health of their family members
b. Engage in extensive multiphasic testing to diagnose other possible medical problems
c. Screen for potential problems while engaging in the tasks for which the nurse is reimbursed
d. Voice ongoing concern about the needs of the agency for ongoing funding to all the clients seen at the agency
ANS: A, C
Although the nurse must complete the responsibilities of the nurses employing agency, the nurse can multitask through screening and interviewing each person or family concerning their health and the health of their family members while engaging in the required tasks. Voicing concern about funding to individual clients is not an effective way to change the health care system. Multiphasic testing would be wonderful but is not affordable in either time or other resources.

DIF: Cognitive Level: Synthesis REF: p. 544

5. Although it was not part of the nurses employment responsibilities, the nurse often volunteered to speak before community groups as well as legislators. Why would the nurse choose to do this? Select all that apply.
a. Advocacy is an ethical and professional responsibility of all nurses.
b. Engaging in such actions will increase the nurses personal and professional visibility.
c. Speaking before such groups may well result in a promotion and an increased pay scale for the nurse when the nurses expertise is publicly recognized.
d. Such public speaking is part of the nurses role in most public health agencies.
e. The nurse may recognize that many people are truly not aware of the problems experienced by vulnerable groups.
ANS: A, E
Public speaking is not a requirement of the nurses role in most agencies. Nonetheless, the nurse may recognize that many people are truly not aware of the problems experienced by vulnerable groups. Speaking out helps increase public awareness. Furthermore, the ethical code for nurses states: The nurse provides services with respect for human dignity and the uniqueness of the client, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems. In other words, the nurse seeks to obtain care for clients and, if necessary, to seek funding for that care through political action.

DIF: Cognitive Level: Synthesis REF: p. 544

6. What should the nurse be sure to include in the research design when involved in community/public health research? Select all that apply.
a. Accurate data collection systems
b. Carefully worded research hypotheses and definition of terms
c. Cost/benefit measures as part of the research design
d. Detailed tables of the studys sample and population demographics
e. Established outcome measures
f. Lengthy detailed title and abstract to the study
ANS: A, C, E
In the current climate of economic retrenchment, cost concerns must be addressed as part of any intervention strategy. All studies should have cost/benefit measures as part of the research design. Nurses must document the effects of poor, improved, or good service through accurate data collection systems with established outcome measures. Different research approaches may or may not have research hypotheses, definition of terms, and summaries of the studys sample.

DIF: Cognitive Level: Synthesis REF: p. 544

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