Chapter 9: Environmental Health Risks: At Home, at Work, and in the Community Nursing School Test Banks

Chapter 9: Environmental Health Risks: At Home, at Work, and in the Community
Test Bank

MULTIPLE CHOICE

1. Which of the following events marked the beginning of the most outstanding improvements in public health?
a. Discovery of antibiotics
b. Creation of safe water purification and sewer systems
c. Implementation of surgery as a clean procedure in the operating rooms
d. Physician education on the benefits of hand-washing between procedures
ANS: B
The biggest improvements in health occurred after the germ theory began to be accepted and sewage disposal and water purification systems were installed in cities in the United States.

DIF: Cognitive Level: Comprehension REF: p. 236

2. To what does the term environmental justice refer?
a. Applying environmental laws equally throughout the country
b. Being fair (or just) in relation to how the costs of environmental pollution cleanup are distributed
c. Putting the most environmental pollution waste in the already polluted sites (known as Superfund sites)
d. Recognizing that environmental risks are disproportionately high for low-income and minority populations who live in more highly polluted neighborhoods
ANS: D
The effects of low income, discrimination, and limited choices in employment and housing are more exposure to pollution and are being recognized by use of the term environmental justice.

DIF: Cognitive Level: Knowledge REF: p. 236

3. Between what two aspects does the ecologic systems model distinguish?
a. Ecologic disasters and lifestyle behavior problems
b. Housing and school or employment hazards
c. The immediate environment and the broader environment
d. The United States and the rest of the world
ANS: C
The ecologic systems model distinguishes between the microsystem immediately around the person (family and home) and the macrosystem, or the larger context (culture, government, and physical environment).

DIF: Cognitive Level: Knowledge REF: p. 238

4. What, in basic terms, do Barry Commoners laws of ecology state?
a. Everything is connected to everything else, and everything must go somewhere.
b. Long-term survival requires protection of our environment.
c. Only humans contaminate their own environment.
d. Take care of the planet; its the only one weve got.
ANS: A
Commoners laws of ecology are the basic principle of ecologic systems: everything is interconnected and nothing disappears; everything is connected to everything else.

DIF: Cognitive Level: Knowledge REF: p. 241

5. Which of the following information would the nurse document when conducting an exposure assessment with a client?
a. The chemicals used at work or in hobbies
b. The substances used to clean the house or keep the yard/garden beautiful
c. The home, work site, and neighborhood
d. The environmental and psychological stress that is encountered
ANS: C
An exposure assessment of potential environmental hazards questions the primary environments for most individuals: namely, home, work site, and community.

DIF: Cognitive Level: Application REF: p. 241

6. Which of the following is the most appropriate secondary prevention approach when a nurse is working in a community with known high lead levels?
a. Educating parents about avoiding purchasing toys painted with lead-based paint
b. Screening all minority children
c. Educating parents about early signs of lead poisoning
d. Screening all children who are living in poverty
ANS: D
Developing targeted lead surveillance and intervention programs in areas with poor children who live in older housing stock has proved to be a successful form of secondary prevention. Educating parents about avoiding purchasing toys painted with lead-based paint and the early signs of lead poisoning would be examples of primary prevention.

DIF: Cognitive Level: Application REF: pp. 241-242

7. A nurse learned that a client was taken to the hospital with carbon monoxide poisoning after neglecting to turn off the car parked in the garage. Which of the following would be the most appropriate intervention to suggest at the next nursing visit?
a. Encourage the client to leave one window open a crack, so there is always a constant supply of fresh air from outside the home.
b. Advise the client to install a carbon monoxide detector in the home.
c. Suggest that the family move to a house with a detached garage.
d. Teach the family the symptoms of breathing carbon monoxide gas so they can act quickly to get out of the house.
ANS: B
Nurses must make reasonable suggestions, and leaving windows open in winter or moving to a different residence is not reasonable. The use of a carbon monoxide detector will allow the family to leave the house before harm is done. Because carbon monoxide is odorless, families cannot be taught to smell the gas and leave.

DIF: Cognitive Level: Application REF: p. 245

8. A nurse who had just undergone orientation for a staff position in the emergency department noticed a material safety data sheet attached to a solvent used to clean the skin around wounds. What is the purpose of this sheet?
a. Hospitals are now attaching such documents for emergency department nurses, who are at high risk for trauma and injury from chemicals that patients use.
b. It is part of the risk management program of hospitals that do not want to be sued by employees who misuse chemicals.
c. It is required by federal law so that employees know the potential effects of the chemicals with which they are working.
d. The sheet is the equivalent of a drug information sheet and should be given to patients who have their wounds cleaned with the solvent.
ANS: C
The material safety data sheet is required by the Occupational Safety and Health Administration (OSHA) under the right to know legislation so that employees know what chemicals they are working with and their potential side effects.

DIF: Cognitive Level: Application REF: p. 246

9. Which of the following actions demonstrates the occupational health nurses need to balance conflict between what is legal and what is ethical?
a. Ensuring the employers profit and keeping the employees happy
b. Fulfilling what the nurses supervisor wants and what the employees want
c. Encouraging primary prevention and first aid to the injured
d. Reporting health problems to employers and keeping health records confidential
ANS: D
The conflicts arise because the nurse has a responsibility to the employer and to the client. Thus the nurse needs to report health problems in the aggregate but also has to keep individual information confidential. The American Association of Occupational Health Nurses (AAOHN) has issued two useful advisories to help nurses manage confidentiality and record-keeping.

DIF: Cognitive Level: Application REF: p. 248

10. Which of the following activities is an ergonomist most likely to perform?
a. Studying the prevention, detection, and treatment of work-related injuries
b. Designing equipment for the interface of humans, their tools, and work activities
c. Recognizing natural history of occupational disease and injuries in certain groups
d. Describing the toxic properties of chemical agents used in the employment setting
ANS: B
An ergonomist studies, designs, and promotes the healthy interface of humans, tools, and their work requirements. Physicians diagnose and treat disease, an epidemiologist studies and describes the natural history of diseases or injuries, and toxicologists examine toxic properties of chemicals.

DIF: Cognitive Level: Application REF: p. 252

11. Which of the following would be an appropriate response by a public health department if there is some evidence of a relationship between a substance and human health but research has not yet drawn conclusions?
a. Be cautious.
b. Do not worry about it.
c. Contact the Centers for Disease Control and Prevention.
d. Refuse to be involved.
ANS: A
The Precautionary Principle states that if there is some evidence about the relationship between toxic substances or environmental hazards and human health, even if scientific evidence about cause and effect is not available, precautionary measures should be taken to protect the environment and human health.

DIF: Cognitive Level: Application REF: p. 251

12. Among other variables, upon what does damage from a specific chemical depend?
a. The dose
b. The environmental factors
c. The toxicology
d. The virulence and infectivity
ANS: A
The extent of biologic damage produced by a chemical depends on the amount of the exposure and the response of the person. This is called a doseresponse ratio. The damage depends on the exposure or dose and the response of the person exposed. The higher the dose of the chemical, the greater the response usually is.

DIF: Cognitive Level: Comprehension REF: p. 254

13. Which of the following statements is the most accurate description of a client who has received a diagnosis of hypersensitivity?
a. He or she gets his or her feelings hurt frequently.
b. His or her skin burns very easily from sunlight.
c. He or she reacts to much smaller doses of chemicals than do most people.
d. He or she experiences an allergic reaction.
ANS: C
Hypersensitivity, or hypersusceptibility, means the person will have a sensitivity response to a much lower than expected dosage of a certain chemical.

DIF: Cognitive Level: Application REF: p. 254

14. What is one of the most prevalent and noxious pollutants in modern America?
a. Noise
b. Sewage in septic tanks
c. Unsafe discarded medications
d. Unsafe water
ANS: A
Noise, although considered innocuous, has major effects on hearing, stress-related conditions, mental illness, social maladjustment, and pathologic conditions.

DIF: Cognitive Level: Knowledge REF: p. 254

15. The Mr. Yuk educational campaign and the practice of routinely dispensing medications in childproof containers are examples of
a. Primary prevention programs that have had little effect on poisoning deaths.
b. Primary prevention programs that have notably decreased deaths from poisoning.
c. Secondary prevention programs that have had little effect on poisoning deaths.
d. Secondary prevention programs that have notably decreased deaths from poisoning.
ANS: B
Both campaigns were extremely effective, as seen in a dramatic decrease in poisoning deaths among children from birth to 4 years of age. Both interventions are examples of primary prevention.

DIF: Cognitive Level: Application REF: p. 255

16. A nurse wanted to increase the safety of a family with a small toddler. Which of the following would be a secondary prevention measure in relation to poisoning?
a. Assessing for hazardous materials in the home and suggesting that these materials be kept in a locked cabinet over the refrigerator
b. Encouraging the family to minimize the use of household chemicals and pesticides
c. Encouraging the family to use household chemicals only when proper ventilation is available
d. Printing stickers for the parents to attach to the phone with the telephone number of the nearest poison control center
ANS: A
Assessing for hazardous materials in the home requires the nurse to perform an assessment of the home, or screening, which is secondary prevention. The other interventions are primary prevention strategies: encouraging minimization of the use of household chemicals, using household chemicals only when proper ventilation is available, and printing stickers to attach to the telephone.

DIF: Cognitive Level: Application REF: p. 256

17. Which of the following groups is most likely to experience an unintentional injury resulting from a fall?
a. Adults who are always in a hurry, rushing from here to there
b. Adults who are older than 65 years
c. Toddlers who are just learning to walk
d. Young children who run around without looking where they are going
ANS: B
Falls are a major cause of unintentional injuries, accountable for about 22,500 deaths in 2007, especially in adults older than 65 years.

DIF: Cognitive Level: Knowledge REF: p. 256 | p. 261

18. A nurse was very concerned about an elderly client who took care of himself in his own apartment. On the basis of statistics, which behavior would cause the nurse to be most concerned about his safety?
a. The man frequently went on long walks through the neighborhood.
b. The man often ate at the all you can eat buffet, sometimes spending several hours there.
c. The man often tripped over the rug in front of the sink.
d. The man smoked from the time he got up until he went to bed.
ANS: C
The two major causes of death in the home are falls and poisonings. The kitchen rug tripping the man is a major concern with more immediate possible ill effects than the smoking or overeating.

DIF: Cognitive Level: Analysis REF: p. 256

19. A nurse assessed the home while visiting a home care client. What would be an appropriate primary intervention in relation to burns?
a. Assessing the client for evidence of environmental hazards
b. Encouraging the clients family to install a smoke detector
c. Encouraging the whole family to practice stop, drop, and roll exercises
d. Suggesting that the family purchase a first aid kit with first aid information
ANS: B
Primary prevention is education and avoiding hazards. In relation to home safety, installing smoke detectors would alert the client or family to leave the home if smoke from a fire was present.

DIF: Cognitive Level: Application REF: p. 256

20. Why do European countries have less of a problem with regulating chemical toxicity than the United States?
a. European countries can afford more chemical products to increase their life span and comfort.
b. The United States is more technologically advanced, with more new chemicals to help with health care.
c. The United States has more resources to purchase new chemical interventions for clinical problems.
d. European countries require product manufacturers to prove that their products are safe.
ANS: D
Europe has a comprehensive policy that requires product manufacturers to prove that their product is safe. The U.S. policy allows products to come to market and has little or no way to withdraw the products if they are discovered to be toxic.

DIF: Cognitive Level: Comprehension REF: p. 257

21. Which of the following actions represents primary prevention by the nurse who wishes to be a good community member?
a. Encouraging limitation of activity when air pollution is high
b. Obtaining occupational health histories for all new clinic admissions
c. Screening toddlers attending the clinic for lead poisoning
d. Supporting programs for waste reduction and recycling
ANS: D
Although all of these options are useful, only supporting programs for waste reduction and recycling is primary prevention. Nurses should be role models for members of the community and advocate for changes in habits.

DIF: Cognitive Level: Application REF: p. 259

MULTIPLE RESPONSE

1. How have most data on environmental hazards been obtained? (Select all that apply.)
a. Through data obtained after large amounts of toxic chemicals are accidentally released
b. From descriptive research done by occupational health physicians
c. From research involving random clinical trials in a controlled laboratory setting.
d. Through the systematic use of government-obtained data from required state reports
e. By toxicologists examining the effects of chemicals on animals and assuming humans may be similarly affected
f. When occupational exposure is correlated with health problems later
ANS: A, E, F
Because of the moral constraints, such research cannot be performed on human subjects. Therefore, information is obtained by examination of occupational exposures, by assessment of accidental releases of chemicals into a community, or by toxicologic study of the effects of chemicals on animals and extrapolation to what the effects might be on humans.

DIF: Cognitive Level: Comprehension REF: p. 261

2. Which of the following is an example of environmental health awareness? (Select all that apply.)
a. Advocating legislation to require use of recyclable bags in department and discount stores
b. Helping raise funds for a lead screening program in the inner city schools
c. Including questions related to occupation of family members in health histories
d. Adopting political action to require the local school board to ensure that each playground has soft cushioning material under swings and climbing equipment
e. Recognizing that health promotion requires each individual to accept personal responsibility
f. Speaking to high school groups about using sunscreen when on the beach
ANS: A, B, C, D, F
Environmental health is freedom from illness or injury related to exposure to detrimental environmental conditions. Promoting recycling, assessing occupational and home exposures to toxic substances, ensuring environmental safety, and educating persons on avoiding risks are all examples of environmental health awareness. Occupational hazards are the most preventable cause of disease, disability, and death. Therefore, an occupational health assessment of the work environment is a crucial component of a health history.

DIF: Cognitive Level: Application REF: p. 261

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