The Nurse in Occupational Health

1. An occupational health nurse sees the various injuries and diseases that persons can acquire from employment. Which of the following recommendations would the nurse most likely provide about safety in the workplace?

a.
Find employment in physical labor; at least your body will be in good condition.
b.
Professional positions are the safest choice for employment.
c.
White collar positions provide the least risk for injury.
d.
There is no “safe” occupation or profession.

ANS: D

Most adults spend about one third of their time at work. Every single industry grapples with serious hazard. No work is completely risk free.

DIF: Cognitive Level: Apply (Application) REF: p. 586

2. A nurse who works for a hospital in employee health notes that several nurses from one unit have missed work after contracting a communicable disease from a patient. Which of the following best describes the host factor?

a.
Each sick nurse
b.
The communicable disease
c.
The hospital
d.
The patient

ANS: A

Each worker represents a host within the worker population group.

DIF: Cognitive Level: Apply (Application) REF: p. 590

3. Which of the following groups should the occupational health nurse devote the most time to regarding education and follow-up evaluation?

a.
New workers employed less than 1 year
b.
Older workers with chronic illnesses
c.
Older workers with diminished hearing
d.
Women in their childbearing years

ANS: A

The population group at greatest risk for experiencing work-related accidents with subsequent injuries is new workers with less than 1 year of experience on the current job. Because of the inherent risks, the nurse should spend extra time with this group to decrease risk.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 590

4. An employee in a laboratory drops a flask, resulting in a chemical splash into the employee’s eyes, which in turn results in burns to the eyes. Which of the following would be considered the agent?

a.
The chemical
b.
The employee
c.
The flask
d.
The laboratory

ANS: A

Agents represent potential dangers or risk to the health and safety of workers. If the flask had broken and glass got into the employee’s eye, then the flask would be an agent. However, in the case given, the chemical itself caused the damage.

DIF: Cognitive Level: Apply (Application) REF: p. 591

5. Which of the following hospital employees are most at risk for being exposed to and possibly developing active drug-resistant TB?

a.
Housekeeping staff
b.
Medical staff
c.
Nursing staff
d.
Ward clerks

ANS: A

Transmission of tuberculosis (TB) within health care settings has reemerged as a major public health problem. Outbreaks of this type of TB have been reported in hospitals, and some workers have developed active drug-resistant TB. Many workers in these settings are employed as maintenance workers, security guards, aides, or cleaning people, who tend not to be well protected from inadvertent exposures, which include contaminated bed linen in the laundry, soiled equipment, and trash containing contaminated dressings or specimens.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 591

6. Which of the following is the most common disabling condition when measured by days away from work?

a.
Bruises
b.
Cuts and lacerations
c.
Mental illnesses
d.
Sprains and strains

ANS: D

In 2010, sprains, strains, and tears were by far the most frequent disabling conditions, accounting for 46.9% of days away from work (Bureau of Labor Statistics, 2011).

DIF: Cognitive Level: Understand (Comprehension) REF: p. 592

7. A nurse makes the suggestion that the 2-week shift rotations should be set up so that the next rotation in shifts is later rather than earlier. Which of the following is the nurse attempting to prevent through this suggestion?

a.
Anxiety, depression, and exhaustion
b.
Family turmoil
c.
Physical illnesses
d.
Sleeping disorders

ANS: A

An estimated 10% of Americans do some form of shift work that has the potential to lead to a variety of psychological and physical problems, including exhaustion, depression, anxiety, and gastrointestinal disturbance. Strategies to minimize the adverse effects of shift work, such as rotating shifts clockwise, are beneficial.

DIF: Cognitive Level: Apply (Application) REF: p. 593

8. In which of the following settings have nurses most often reported being the victims of violence, especially by patients and their families?

a.
Acute care inpatient settings
b.
Community clinics and physicians’ offices
c.
Emergency departments and psychiatric units
d.
In homes during home health visits

ANS: C

Nonfatal violence in the health care worker’s workplace is a serious problem that seems to be underreported. Much of the study of health care worker violence has been in psychiatric settings and emergency departments.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 593

9. The occupational health nurse makes certain all employees have and know how to use personal protective equipment (PPE). Which of the following factors will most likely determine how effective the PPE is in keeping employees safe?

a.
Comfort level of the PPE
b.
Effectiveness of the nurse’s teaching
c.
Knowledge level of the employee
d.
Psychosocial norms of the setting

ANS: D

The employee will only be safe if the employee uses the PPE. If the employee doesn’t use the PPE or uses only part of the equipment, then the employee will be at risk. The primary determination of whether the PPE is used correctly and used all the time is the psychosocial norms of the setting. If others are careless in PPE use, then such carelessness is the norm. If everyone is extremely careful to use their PPE, then that is the norm in that setting.

DIF: Cognitive Level: Apply (Application) REF: p. 594

10. Which of the following is the primary reason that large companies are becoming more involved in their employees’ personal health and well-being?

a.
It is an ethical and moral responsibility.
b.
It improves public relations within the community.
c.
It allows managers to better understand their employees.
d.
It provides a cost savings to the company.

ANS: D

A significant increase in the number of health promotion and employee assistance programs offered has occurred. Health promotion programs focus on lifestyle choices that cause risks to health such as obesity or smoking. Employee assistance programs are designed to address personal problems (e.g., marital/family issues, substance abuse, financial difficulties) that affect the employee’s productivity. Such efforts are cost effective for businesses.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 595

11. The occupational health nurse continually reminds employees to wear their safety goggles and ear plugs. Which of the following levels of prevention is being implemented?

a.
Both secondary and tertiary prevention
b.
Primary prevention
c.
Secondary prevention
d.
Tertiary prevention

ANS: B

Delivery of primary prevention services to employees is directed toward promoting health and averting a problem. Primary prevention is attempting to avoid harm through protecting measures, in this case reducing ear damage due to high noise levels and eye damage from flying particles or fluids.

DIF: Cognitive Level: Apply (Application) REF: p. 595

12. An occupational health nurse is removing a foreign body from a patient’s eye. Which of the following levels of prevention is being implemented?

a.
Injury prevention
b.
Primary prevention
c.
Secondary prevention
d.
Tertiary prevention

ANS: C

This does not meet the criteria for injury prevention because the injury has already occurred. The nurse is engaging in secondary prevention when providing treatment for the injury. Tertiary prevention strategies would follow treatment to prevent recurrence and to prevent more serious problems related to the foreign body from developing.

DIF: Cognitive Level: Apply (Application) REF: p. 595

13. An occupational health nurse periodically conducts spirometry testing of employees who work around hazardous gases. Which of the following levels of prevention is being implemented?

a.
Primary prevention
b.
Secondary prevention
c.
Tertiary prevention
d.
Tertiary care prevention

ANS: B

Secondary prevention involves health surveillance and periodic screening to identify an illness at the earliest possible moment in its course and elimination or modification of the hazard-producing situation.

DIF: Cognitive Level: Apply (Application) REF: p. 595

14. The occupational health nurse suggests that an employee work only half-days for three weeks and then return to full-time employment. Which of the following best describes the rationale for this suggestion?

a.
To provide an example to other employees to ensure future cooperation with safety measures
b.
To enforce an economic penalty for not obeying nurse’s instructions regarding safety measures
c.
To ensure that all employees keep their positions during an economic downturn
d.
To continue employment and income with limited duty as a rehabilitation effort after an injury

ANS: D

Rehabilitation strategies such as return-to-work programs after a heart attack or limited duty programs after a cumulative trauma injury are examples of tertiary prevention. Tertiary prevention is intended to restore health as fully as possible and assist individuals to achieve their maximum level of functioning.

DIF: Cognitive Level: Analyze (Analysis) REF: p. 595

15. An occupational health nurse is working with the manager to change the assignment of an employee from working with heavy metal to using machinery to assist with loading and unloading boxes at the truck dock. Which of the following best explains the rationale for this change?

a.
To prevent injury
b.
To limit disability
c.
To provide primary prevention
d.
To provide tertiary prevention

ANS: B

Interventions aimed at disability limitation are intended to prevent further harm or deterioration, and they include referral for counseling and treatment of an employee with an emotional or mental health problem whose work performance has deteriorated and removal of workers from heavy metal exposure who manifest neurological symptoms.

DIF: Cognitive Level: Apply (Application) REF: p. 595

16. A nurse is completing a health history on a client during a routine physical exam. Which of the following questions, which is often omitted, should be asked by the nurse?

a.
“How is your family doing?”
b.
“What problems have you been having?”
c.
“What health concerns do you have today?”
d.
“Where do you work and what do you do there?”

ANS: D

All of these questions are appropriate during a routine physical. However, the question often omitted is, “Where do you work and what do you do there?” The occupational health history is an indispensable component of the health assessment of individuals. Because work is a part of life for most people, including an occupational health history in all routine nursing assessments is essential.

DIF: Cognitive Level: Apply (Application) REF: p. 595

17. A nurse is interviewing a person who has stated on her entry health form that she is retired. Which of the following is the most crucial question for the nurse to ask?

a.
“Have you had any problems since leaving your employment?”
b.
“How do you spend your time now?”
c.
“What has retirement been like for you?”
d.
“Where were you previously employed and what did you do there?”

ANS: D

All of these questions are appropriate during a routine physical for a person who has retired, because they relate to current problems, recreation, and mental health. However, the most crucial question is, “Where were you previously employed and what did you do there?” The occupational health history is an indispensable component of the health assessment. All persons should be questioned about their employment history. To describe only a current status of “retired” may lead to the omission of needed data. Even for retired persons, the nurse must ask about employment history, because many problems take years to manifest in signs and symptoms.

DIF: Cognitive Level: Apply (Application) REF: p. 596

18. A nurse keeps ongoing documentation of all the clients seen at the community health clinic. The nurse enters the demographic data and the primary diagnoses into the computer to have a comprehensive perspective of the clinic’s clients. Which of the following best explains why the nurse is collecting this data?

a.
This data will be useful in a research study the nurse is conducting.
b.
This data will provide evidence of clinic resources being wasted on minor health problems.
c.
This data will help identify patterns in the risk factors associated with a particular subgroup.
d.
This data can be used to show trends that can be included in the next grant proposal for further funding.

ANS: C

When health data are considered collectively, the nurse may determine some patterns in risk factors associated with the occurrence of particular injuries and illnesses in a total population of clients. There is no mention of consent, so the nurse should not be collating research data. Grants for funding typically require current client data rather than trends.

DIF: Cognitive Level: Analyze (Analysis) REF: p. 596

19. As the single occupational health employee at a company, a nurse is busy with safety programs and first aid when employees are hurt. However, the nurse still finds time to walk through the entire facility once a day. Which of the following best explains the rationale for this action by the nurse?

a.
To document employee efficiency and effectiveness at their jobs
b.
To look for evidence of personal protective equipment being torn or destroyed
c.
To observe whether employees are taking their rest periods as scheduled and drinking adequate fluids during the day
d.
To observe effectiveness of safety education and equipment

ANS: D

The nurse may conduct an assessment of the workplace itself, which is known as a worksite walk-through or survey. Direct observation allows the nurse to learn about the work processes and the materials; the requirements of various jobs; the presence of actual or potential hazards; and the work practices of employees. Such information is directly useful in planning programs, assessing their effectiveness, and reinforcing safety with individuals who have been seen behaving in a less than safe manner.

DIF: Cognitive Level: Apply (Application) REF: p. 596

20. Which of the following interventions regarding worker safety would be the least effective?

a.
Using job rotation and workplace monitoring
b.
Designing equipment so that employee exposure to hazards is minimized
c.
Having employees use safety measures and personal protective equipment
d.
Designing the environment to encourage employees to follow workplace procedures

ANS: C

Various control strategies are used to eliminate or reduce exposure and hence risk. Engineering controls can reduce worker exposure by modifying the exposure source. Administrative controls reduce exposure through job rotation, workplace monitoring, and employee training and education. Personal protective control is the last resort and requires the worker to actively engage in strategies for protection such as use of gloves, masks, and gowns to prevent blood/body fluid exposure. External controls—the way equipment is built or manufacturing processes are established—are controllable and much more effective than asking a great many individuals to engage in behaviors that they may not want to do (such as using personal protective equipment). Humans are much less programmable than external controls.

DIF: Cognitive Level: Analyze (Analysis) REF: p. 599

21. Which of the following best describes the mission of OSHA?

a.
To create an inspection system to avoid preventable loss of life
b.
To ensure safe and healthful working conditions
c.
To establish rules for employee safety
d.
To share factory illness and injury rates with the public

ANS: B

The Occupational Safety and Health Act of 1970 had as its purpose to ensure “safe and healthful working conditions for working men and women.”

DIF: Cognitive Level: Remember (Knowledge) REF: pp. 599-600

22. Which of the following statements best describes how workers’ compensation legislation has changed employer behavior?

a.
Employers have improved safety of working conditions because safety data is now public information.
b.
Companies have improved safety of working conditions because worker’s compensation insurance premiums are now based on previous claims.
c.
Employers were legally required to implement safety changes.
d.
Companies have become more involved in the legislative process.

ANS: B

Workers’ compensation acts are important state laws that govern financial compensation of employees who suffer work-related health problems. Each state sets rules for the reimbursement of employees with occupational health problems for medical expenses and lost work time associated with the illness or injury. Workers’ compensation claims and the experience-based insurance premiums paid by industry have been important motivators for increasing the health and safety of the workplace.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 600

23. Which of the following would most likely be one of the first steps taken in employer disaster planning?

a.
All employees are invited to attend sessions on disaster planning.
b.
Employers stress the importance of disaster drills and encourage active participation.
c.
Exhaustive inventory of chemicals and industrial hazards is completed.
d.
Written disaster plans are distributed to each employee and each worksite.

ANS: C

The goals of a disaster plan are to prevent or minimize injuries and deaths of workers and residents, minimize property damage, provide effective triage, and facilitate necessary business activities. A disaster plan requires the cooperation of company and community. The nurse is often a key person on the disaster planning team. The potential for disaster must be identified; this is best achieved by completing an exhaustive chemical and hazard inventory of the workplace. The MSDSs and plant blueprints are critical for correctly identifying substances and work areas that may be hazardous. Worksite surveys are the first step to completing this inventory.

DIF: Cognitive Level: Remember (Knowledge) REF: p. 601

MULTIPLE RESPONSE

1. Which of the following describes how occupational health nursing differs from other nursing specialties? (Select all that apply.)

a.
It is autonomous, because the occupational nurse works independently.
b.
The major focus is on the environment.
c.
Nurses focus on health promotion and disease prevention.
d.
Nursing care is given in the community.

ANS: A, B

Occupational health specialty practice focuses on the promotion, prevention, and restoration of health within the context of a safe and healthy environment. It involves the prevention of adverse health effects from occupational and environmental hazards. It provides for and delivers occupational and environmental health and safety services to workers, worker populations, and community groups. It is an autonomous specialty, and nurses make independent nursing judgments in providing health care. All nurses should engage in health promotion and disease prevention, and many specialties provide care in the community. Several specialties (such as advanced practice nurses) are required to be nationally certified to be employed.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 586

2. An occupational health nurse should be aware of which of the following trends in the marketplace? (Select all that apply.)

a.
A majority of new jobs will be in service-oriented employment.
b.
Employees will often have compressed work weeks, shift work, and reduced job security.
c.
A majority of positions will still be held by males.
d.
Many employees will be older and suffer chronic health problems.

ANS: A, B, D

Longer hours, compressed work weeks, shift work, reduced job security, and part-time and temporary work are realities of the modern workplace. The workforce will become older, including many employees with chronic health problems. By the year 2020, minorities are projected to constitute 20.6% of the workforce and women approximately 47% of the workforce (Toossi, 2012). The U.S. economy was once based on agriculture, then primarily on manufacturing, and now on highly technological positions. Currently, service-providing positions account for virtually all job growth; soon almost one of every two worker jobs will be in service positions.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 588

3. Which of the following explains why some occupational health specialists are very concerned about chemicals in the workplace? (Select all that apply.)

a.
All chemicals are inherently dangerous to humans.
b.
Chemicals are often used when natural substances are equally effective.
c.
Effects of chemicals can be cumulative.
d.
Interactions of chemicals are typically unknown.

ANS: C, D

Of the approximately 2 million known chemicals in existence, less than 0.1% have been adequately studied for their effects on humans. Most chemicals have not been studied epidemiologically to determine the effects of exposure on humans. A variety of chemicals are found in the body tissues of the general population. Daily, low-level doses of chemicals may be below the exposure standards but may still carry a potentially chronic and perhaps cumulative assault on workers’ health. Predicting human responses to such exposures is further complicated because several chemicals are often combined to create a new chemical agent. Human effects may be associated with the interaction of these agents rather than with a single chemical. Another concern about occupational exposure to chemicals is reproductive health effects.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 591

4. Which of the following are the primary reasons that employers have increasingly focused on ensuring a healthy and safe environment for workers? (Select all that apply.)

a.
To fulfill their ethical and moral responsibility
b.
To avoid the cost of liability suits, workers’ compensation, etc.
c.
To maintain good public relations
d.
To meet legislated standards and avoid significant penalties for noncompliance

ANS: B, D

Legislation at the federal and state levels has had a significant effect on efforts to provide a healthy and safe environment for all workers. OSHA employees have distributed citations to companies that do not meet minimal occupational health and safety standards. Criminal charges have been filed against business owners when preventable work-related deaths have occurred. Another important stimulus for health and safety programs is the desire to avoid the cost of liability and workers’ compensation claims and other expenses when employees are injured or killed.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 594

5. An occupational health nurse wants to know the NAICS code of a prospective employer. Which of the following best explains why the nurse would be interested in this information? (Select all that apply.)

a.
To assess how others have rated the company in relation to employment there
b.
To compare the prospective employer’s injury rate with similar employers’ rates
c.
To learn more about the usual processes and products of the company as well as typical hazards
d.
To learn how employees feel about the employer

ANS: B, C

All business organizations are classified within the North American Industry Classification System (NAICS) with a numerical code. This code, usually a digit to digit number, indicates a company’s product and, therefore, the possible types of occupational health hazards that may be associated with the processes and materials used by its employees. NAICS codes are used to collect and report data on businesses. For example, illness and injury rates of one company are compared with the rates of other companies of similar size with the same NAICS code to determine whether the company is having an excess of illness or injury. By knowing the NAICS code of a company, a health care professional can access reference books that describe the usual processes, materials, and by-products of that kind of company.

DIF: Cognitive Level: Apply (Application) REF: pp. 596-599