Vulnerability and Vulnerable Populations: An Overview

1. Which of the following is the primary cause of vulnerability to health problems?

a.
Breakdown of family structures
b.
Poverty
c.
Prejudice
d.
Social isolation

ANS: B

People with lower incomes and less education tend to be at higher risk for health problems. Poverty is a primary cause of vulnerability.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 375

2. Which of the following terms is used to describe aggregates who are at high risk for having poor health outcomes because of limited resources?

a.
Disadvantaged families
b.
Multi-problem families
c.
Resilient populations
d.
Vulnerable populations

ANS: D

Vulnerable populations are groups (aggregates) with an increased risk to develop adverse health outcomes. Families are a subgroup of populations.

DIF: Cognitive Level: Remember (Knowledge) REF: p. 375

3. A community health nurse would like to implement an intervention to increase lasting resilience among new immigrants. Which of the following actions should be taken by the nurse?

a.
Direct clients to English-as-second-language courses.
b.
Give immigrant clients money to help them get settled.
c.
Identify areas in the city where housing is less expensive.
d.
Solicit donations for food, clothing, and other needs.

ANS: A

Vulnerability can be reversed by obtaining resources to increase resilience. Although money, food, and clothing meet needs for the short term, they do not help the immigrant develop the power and control to improve health risks over the long term or contribute to lasting resilience. Learning the basic language of the country of residence will give immigrants the ability to communicate and navigate through systems and thus remove barriers that promote disenfranchisement and disadvantaged status.

DIF: Cognitive Level: Analyze (Analysis) REF: p. 376

4. Which of the following factors predisposes many migrant farmworkers to disenfranchisement?

a.
Being a minority group member
b.
Inability to attend religious services because of work requirements
c.
Previous experiences of physical abuse
d.
Short length of time in the community

ANS: D

Disenfranchisement refers to a feeling of separation from mainstream society. The person does not seem to have an emotional connection with any group in particular or the larger society. For migrant workers who are frequently moving, the short length of time they stay in the community does not allow for the development of social ties. Being a minority group member would not by itself cause disenfranchisement if the minority group member lived in a community with persons from similar ethnic and cultural backgrounds.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 376

5. A large financial grant was being offered to whichever health facility wanted to accept the responsibility for giving care to local vulnerable populations. Which of the following actions would most likely be taken by the local medical centers?

a.
Agree to collaboratively apply for the funds in a cooperative proposal.
b.
Individually compete eagerly for the additional funds now available.
c.
Reach out enthusiastically to this previously underserved population group.
d.
Strongly consider not applying, because this population will be expensive to treat.

ANS: D

Many agencies do not wish to provide services to vulnerable populations. Vulnerable populations are more expensive to treat because they have multiple, cumulative risks and require special service delivery considerations (e.g., to help overcome transportation problems or provide culturally competent care).

DIF: Cognitive Level: Analyze (Analysis) REF: p. 376

6. Which of the following statements best describes an outcome of the Balanced Budget Act of 1997?

a.
Additional funding was provided to the State Children’s Health Insurance Program (SCHIP).
b.
Individuals were able to keep their health insurance when moving from one place to another.
c.
Patient privacy and security of health information was enhanced.
d.
A prospective payment system for home health services was created.

ANS: D

The Balanced Budget Act of 1997 had some shifts in payment with the stipulations related to home health. In an attempt to curb the rapid growth in spending on home health and financial fraud in that industry, the Health Care Financing Administration (now the Centers for Medicare and Medicaid Services [CMS]) instituted prospective payment for home health services. The Health Insurance Portability and Accountability Act of 1996 was intended to help people keep their health insurance when moving from one place to another as well as provide privacy and security of personal health information. The State Children’s Health Insurance Program (SCHIP) was created by Title XXI of the Social Security Act in 1998.

DIF: Cognitive Level: Understand (Comprehension) REF: p. 379

7. A homeless family brought their father to the public health clinic after he reported bleeding when he went to the bathroom. Which of the following nursing actions would be most appropriate?

a.
Begin tests to determine the cause of the bleeding while asking about other family concerns from nutrition to shelter for the night.
b.
Refer the man to a urologist to address the urinary bleeding.
c.
Suggest that the family take him to an urgent care center immediately.
d.
Treat the urinary infection and give the man medication to take to prevent the return of infection.

ANS: A

It is important to provide comprehensive, family-centered, “one-stop” services. Providing multiple services during a single clinic visit is an example of one-stop services. If social and economic assistance are provided and included in interdisciplinary treatment plans, services can be more responsive to the combined effects of social and economic stressors on the health of special population groups.

DIF: Cognitive Level: Analyze (Analysis) REF: p. 380

8. Nursing students have been assigned to set up a health fair for the homeless population in a large urban setting. Without any funds to pay for space, where should the health fair be located, assuming that all of the following sites are available at no cost?

a.
At the city’s homeless shelter, which is, by policy, vacant during the day
b.
At a large medical center, where the students could get permission to use an empty clinic in the evening
c.
At the largest inner-city police station, where there was a large empty space available
d.
At the local community college, where there are plenty of tables and chairs

ANS: A

Homeless persons would probably avoid the police station, and many may not wish to go to the medical center—also, there would be transportation issues. The most convenient place for the clients would be the homeless shelter, where transportation and lack of comfort in an unfamiliar place would not be issues. It is helpful to provide comprehensive services in locations where people live and work, including schools, churches, neighborhoods, and workplaces. Thus, for the homeless population the homeless shelter would be an appropriate location.

DIF: Cognitive Level: Analyze (Analysis) REF: p. 380

9. Which of the following bills would the nurse lobbyist, who believes strongly in social justice, encourage legislators to support?

a.
A bill that establishes policies requiring all persons to pay the same cost for services regardless of income
b.
A bill that promotes universal health insurance coverage
c.
A bill that requires all health care providers to give care to uninsured persons without charge
d.
A bill that requires health care workers to report undocumented immigrants who present for treatment

ANS: B

Requiring health care professionals to give care to uninsured persons without charge would quickly bankrupt hospitals, and health professionals could not afford to continue in those roles. Such a law is unfeasible. Social justice refers to providing humane care and social supports for the most disadvantaged members of society. Nurses can be advocates for policy changes to improve social, economic, and environmental factors that predispose vulnerable populations to poor health. Many people do not have health insurance, particularly those who work in jobs where insurance is not offered or costs are too high. Promoting universal health insurance for all would be a step toward providing humane care for those who might not otherwise be able to receive care.

DIF: Cognitive Level: Analyze (Analysis) REF: p. 380

10. A nurse who is providing diabetes screening at a community clinic discovers that a new client has type 2 diabetes mellitus. The nurse provides counseling, refers the client to an endocrinologist for initial assessment and treatment, arranges for the client to see someone regarding financial assistance, contacts the mobile van to arrange transportation, and sets up a follow-up appointment. Which of the following types of service do these actions represent?

a.
Case management
b.
Client advocacy
c.
Holistic care
d.
Wrap-around services

ANS: A

Nurses often function as case managers for vulnerable clients, making referrals and linking them with community services. Case management services are especially important for vulnerable persons because they often do not have the ability or resources to make their own arrangements. Linking clients with health services is accomplished by making appropriate referrals and by following up with clients to ensure that the desired outcomes from the referral were achieved.

DIF: Cognitive Level: Apply (Application) REF: p. 381

11. A nurse offers homeless clients yearly tuberculosis (TB) screening and free treatment for those who test positive for TB. Which of the following levels of prevention is being used?

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

ANS: B

Screening homeless adults and providing medications to those who test positive for TB are examples of secondary prevention. The TB screening identifies infection in early stages. Medications work to prevent infection from developing into disease.

DIF: Cognitive Level: Apply (Application) REF: p. 382

12. A community health nurse is implementing a tertiary prevention activity related to tuberculosis. Which of the following interventions is the nurse most likely completing?

a.
Administration of skin tests to identify persons who have been infected with tubercle bacilli
b.
Assessing for signs and symptoms of active tuberculosis
c.
Directly observing clients with active tuberculosis as they take their antitubercular medications
d.
Interpretation of tuberculosis skin test findings

ANS: C

Tertiary prevention is exemplified when nurses provide directly observed medication therapy for people with active TB.

DIF: Cognitive Level: Apply (Application) REF: p. 382

13. A staff member is orienting a new nurse to a health clinic that serves primarily vulnerable populations. Which of the following statements indicates a need for additional staff education?

a.
“If a client who does not speak English comes in, you must obtain an interpreter right away.”
b.
“We try to take care of as many problems as possible in one visit, so when you interview the client ask about additional concerns.”
c.
“You will like working with Hispanic immigrants because they have close-knit family structures.”
d.
“You will need to assist the client by scheduling any referral or follow-up appointments around their work schedules.”

ANS: C

Assumptions are not helpful. Each person and family should be assessed individually. No two people or groups are alike. Any stereotype, positive or negative, can be problematic. Even though Hispanic groups, as a whole, do have close-knit family structures, by assuming that all Hispanics are this way, staff members are less likely to be open to the possibility of issues such as family violence.

DIF: Cognitive Level: Analyze (Analysis) REF: p. 383

14. Nurses at a homeless clinic are concerned that homeless clients rarely return to have the nurses assess the findings of their tuberculosis (TB) skin tests. Which of the following is the most appropriate policy for the clinic to have regarding the screening test findings?

a.
Call all homeless clients 48 hours after TB skin testing to remind them to return to the clinic for test interpretation.
b.
Have homeless individuals read their TB skin test, if necessary, and mail in results on a postage-paid card coded to protect privacy.
c.
Re-administer the TB skin test if the client returns later than scheduled for test interpretation.
d.
Routinely refer all homeless clients for chest x-rays.

ANS: B

Homeless people often do not have a way to receive telephone calls. Additionally, they usually face numerous barriers to return to the clinic. These issues often require deviation from strict policies, especially strict policies that are not working. Nurses should develop a way for homeless individuals to read their TB skin test, if necessary, and give them a self-addressed, stamped card they can return by mail with the results.

DIF: Cognitive Level: Apply (Application) REF: p. 382

15. A nurse is working as a case manager with a vulnerable population. Which of the following actions should the nurse do when providing care?

a.
Be willing to enter into a long-term relationship with families.
b.
Direct and control the client’s care because the nurse knows what is most needed.
c.
Encourage families to become self-sufficient and less dependent on nursing personnel for advice and referrals.
d.
Rotate assignments periodically to prevent attachment and codependency.

ANS: A

Case management is a process that enhances continuity and appropriateness of care. When using case management with vulnerable populations, the nurse can be of greatest benefit if he or she is willing to develop long-term relationships with the families served. This increases trust as well as continuity of care. Care involves a partnership between nurse and client. Nurses who direct and control the client’s care cannot establish a trusting relationship and may inadvertently foster a cycle of dependency and lack of personal health control.

DIF: Cognitive Level: Apply (Application) REF: p. 385

MULTIPLE RESPONSE

1. Which statements by a nurse demonstrate understanding of the unique needs of vulnerable groups? (Select all that apply.)

a.
“I always address the problem that the client believes is the most important.”
b.
“I avoid asking clients for income or financial information, because this is an invasion of privacy.”
c.
“I try to observe the client’s cultural traditions as I probe for signs of abuse.”
d.
“I make sure to do a complete assessment, since we often don’t know when the person will return to the clinic.”

ANS: A, C

Because poverty is a primary cause of vulnerability, the nurse should include questions about the client’s financial status. Nurses should not provide financial or legal advice; however, they should make sure to connect clients with someone who can and will help them. Although an assessment must be done, a nurse should only collect data that will actually be used. Focus on what data are needed to help the client that day with the problem the client believes is most important.

DIF: Cognitive Level: Analyze (Analysis) REF: p. 382

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