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Chapter 5: Demographic Trends and Societal Changes

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Chapter 5: Demographic Trends and Societal Changes

14 problems · 0 figures

Case Study 5.1.1 §5.1 source ↗

Read the scenario, and then answer the questions that follow.

Jose is a 53-year-old Hispanic male who has presented to the clinic with anxiety and with chest pain radiating to the right arm. Jose was recently let go from his job and has not been able to find employment. He is accompanied to the clinic by his wife and his mother. Jose indicates that he does not like coming to the doctor’s office, and he becomes more anxious as the nurse completes his health assessment. His vital signs are as follows:

• Blood Pressure: 126/82 mm Hg

• Respirations: 18 breaths/minute

• Heart Rate: 130 beats/minute

• Oxygen Saturation: 98 percent on room air

Other findings from the nurse’s health assessment of the client are as follows:

• Neurological: Within normal limits.

• Respiratory: Lungs clear to auscultation.

• Cardiovascular: Increased heart rate, but normal heart sounds. No peripheral edema noted.

• GI: Within normal limits.

• GU: Within normal limits.

• Pain: Radiating to the right arm 5 on a scale of 1–10.

When assessing Jose, what factors about his ethnic background should the nurse consider?
  1. a.
    The client is at a higher risk for certain health conditions because of his ethnic background.
  2. b.
    The client has the same risk for certain health conditions as anyone else his age.
  3. c.
    The client is a member of a minority group that is decreasing in numbers over time.
  4. d.
    The client is a member of a minority group that is eligible for additional health-related resources.

Answer

A. The client is at a higher risk for certain health conditions because of his ethnic background.
Underrepresented populations, such as ethnic minorities, tend to be impacted the most by chronic health conditions such as hypertension and heart disease.

Case Study 5.1.2 §5.1 source ↗

Read the scenario, and then answer the questions that follow.

Jose is a 53-year-old Hispanic male who has presented to the clinic with anxiety and with chest pain radiating to the right arm. Jose was recently let go from his job and has not been able to find employment. He is accompanied to the clinic by his wife and his mother. Jose indicates that he does not like coming to the doctor’s office, and he becomes more anxious as the nurse completes his health assessment. His vital signs are as follows:

• Blood Pressure: 126/82 mm Hg

• Respirations: 18 breaths/minute

• Heart Rate: 130 beats/minute

• Oxygen Saturation: 98 percent on room air

Other findings from the nurse’s health assessment of the client are as follows:

• Neurological: Within normal limits.

• Respiratory: Lungs clear to auscultation.

• Cardiovascular: Increased heart rate, but normal heart sounds. No peripheral edema noted.

• GI: Within normal limits.

• GU: Within normal limits.

• Pain: Radiating to the right arm 5 on a scale of 1–10.

How can Jose’s employment status potentially affect his health?
  1. a.
    He will be covered by Medicaid, so there should be no long-term effects.
  2. b.
    He can continue to receive health care in the local emergency department.
  3. c.
    He is more likely to be affected by a health disparity.
  4. d.
    His temporary unemployment status should not permanently affect his health.

Answer

C. He is more likely to be affected by a health disparity.
Jose’s unstable financial situation makes it likely he will experience a health disparity or a preventable difference in disease experienced by members of a vulnerable population.

Case Study 5.3.3 §5.3 source ↗

Read the scenario, and then answer the questions that follow based on all the case information provided in the chapter thus far. This case study is a follow-up to Case Study Part A.

The client, Jose, presented with chest pain. Upon further assessment and evaluation, the physician has ruled out a heart attack. Instead, the physician believes Jose is experiencing anxiety. The nurse educates Jose on the diagnosis and works with him to develop a treatment plan. The client appears to be reluctant to share information with the nurse but does reveal that he has been treated for hypertension since the age of 23. Because he recently lost his job, he has been unable to afford health insurance. For this reason, he could not afford his blood pressure medications and has not taken them for the past 6 months. Jose appears tearful and anxious. He answers the nurse’s questions with brief responses. Jose and his family have also started utilizing a local food bank and have applied to the Supplemental Nutrition Assistance Program (SNAP). The nurse suspects that Jose is experiencing more financial hardship than he is sharing. The physician has prescribed medication for Jose, but the nurse is concerned he cannot afford to get the prescription filled.

What is the best approach the nurse can adopt to increase Jose’s trust and facilitate further discussion about his circumstances?
  1. a.
    The nurse should provide the client with a list of financial resources.
  2. b.
    The nurse should acknowledge Jose’s concerns and explain what financial resources and other sources of support are available to him.
  3. c.
    The nurse should let the client’s family know what he needs.
  4. d.
    The nurse should tell the client that if he can control his anxiety then everything will seem better.

Answer

B. The nurse should acknowledge Jose’s concerns and explain what financial resources and other sources of support are available to him.
The nurse should be open with the client when communicating to establish trust.

Case Study 5.3.4 §5.3 source ↗

Read the scenario, and then answer the questions that follow based on all the case information provided in the chapter thus far. This case study is a follow-up to Case Study Part A.

The client, Jose, presented with chest pain. Upon further assessment and evaluation, the physician has ruled out a heart attack. Instead, the physician believes Jose is experiencing anxiety. The nurse educates Jose on the diagnosis and works with him to develop a treatment plan. The client appears to be reluctant to share information with the nurse but does reveal that he has been treated for hypertension since the age of 23. Because he recently lost his job, he has been unable to afford health insurance. For this reason, he could not afford his blood pressure medications and has not taken them for the past 6 months. Jose appears tearful and anxious. He answers the nurse’s questions with brief responses. Jose and his family have also started utilizing a local food bank and have applied to the Supplemental Nutrition Assistance Program (SNAP). The nurse suspects that Jose is experiencing more financial hardship than he is sharing. The physician has prescribed medication for Jose, but the nurse is concerned he cannot afford to get the prescription filled.

Based on the nurse’s experience working with vulnerable populations, which of the following is the best approach for ensuring that Jose takes the new medication as prescribed?
  1. a.
    Explain to Jose and his family the benefits of the new medication.
  2. b.
    Explain to Jose and his family the risks of not taking the new medication.
  3. c.
    Develop a plan for Jose to manage any adverse drug effects.
  4. d.
    Connect Jose with resources so that he can get the medication at minimal to no cost.

Answer

D. Connect Jose with resources so that he can get the medication at minimal to no cost.
Frequently clients do not take medications as prescribed due to costs. In this situation, with a client who has lost his job and has limited financial resources, the most effective strategy to encourage him to take the medication to make sure he can afford it.

5-1 §5.RQ source ↗

Which concept should the nurse consider when developing community programs to meet the needs of the baby boomer generation?
  1. a.
    The baby boomer population is steadily declining.
  2. b.
    There is an increase in the need for long-term care.
  3. c.
    The average age of the U.S. population is decreasing.
  4. d.
    The prevalence of chronic disease is declining.

Answer

B. There is an increase in the need for long-term care.
As baby boomers born from 1946 to 1964 continue to age, the United States will have an increased need for health care services in nursing homes, long-term care, and home health care facilities.

5-2 §5.RQ source ↗

A nurse works in a community health center whose population consists of many working poor. Which characteristic would the nurse expect in this population?
  1. a.
    Most clients receiving care in the clinic hold jobs but are uninsured.
  2. b.
    Most clients are working and have health insurance.
  3. c.
    Most clients engage in health-promotion activities since they do not have health insurance.
  4. d.
    Most clients will qualify for Medicaid benefits.

Answer

A. Most clients receiving care in the clinic hold jobs but are uninsured.
The working poor are individuals who make too much to qualify for public health insurance programs such as Medicaid but do not make enough money to afford health insurance premiums. These clients tend to have poor health outcomes because they often wait to seek care until their disease processes are more advanced.

5-3 §5.RQ source ↗

Which statement should guide the care a nurse provides to clients in a community health clinic that serves an ethnic minority group?
  1. a.
    Health disparities are preventable differences in health.
  2. b.
    Hypertension affects all ethnic groups equally.
  3. c.
    Underrepresented populations engage in health-promotion activities.
  4. d.
    The population of ethnic minorities in the United States is declining.

Answer

A. Health disparities are preventable differences in health.
Health disparities overwhelmingly affect ethnic minorities and are defined as “preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations” (CDC, 2020, para. 1).

5-4 §5.RQ source ↗

A client at a rural community health center has been diagnosed with diabetes and has scheduled a telehealth appointment with a diabetes educator. Which client statement about seeing a provider via telehealth indicates to the community health nurse that more teaching is needed?
  1. a.
    “I will get the same level of care as an in-person visit.”
  2. b.
    “This will save me a 2-hour drive to the city.”
  3. c.
    “Telehealth reduces communication with the diabetes educator.”
  4. d.
    “This will allow close monitoring of my diabetes.”

Answer

C. “Telehealth reduces communication with the diabetes educator.”
Telehealth allows for improved communication and ease of communication between the client and provider, especially for the client who lives far from the provider.

5-5 §5.RQ source ↗

Which statement best describes the impact of COVID-19 on the nursing profession?
  1. a.
    The pandemic highlighted nursing as a desirable profession.
  2. b.
    Nurses are now more vigilant about the care they provide for clients.
  3. c.
    Many nurses left the health care system.
  4. d.
    Nursing salaries have decreased due to the impact of COVID-19 on the finances of health systems.

Answer

C. Many nurses left the health care system.
Many nurses reported that, because the stress of working through the COVID-19 epidemic adversely affected their emotional health and well-being, they chose to leave their jobs.

5-6 §5.RQ source ↗

A nurse is working in a community health clinic that serves a large Asian population. Which health factor should the nurse consider when providing care to this population?
  1. a.
    There is a higher rate of hepatitis B than in other ethnic groups.
  2. b.
    The rate of tuberculosis is lower than all people diagnosed with this infection.
  3. c.
    They are more likely to receive care for mental health issues.
  4. d.
    There is a lower genetic risk for developing prediabetes.

Answer

A. There is a higher rate of hepatitis B than in other ethnic groups.
Asian/Pacific Islanders experience the highest rate of hepatitis B when compared with other ethnic groups.

5-7 §5.RQ source ↗

A 38-year-old client, who identifies as transgender, presents to a community health center with symptoms of an upper respiratory infection. During the intake assessment, the client tells the nurse that they do not receive regular health care and do not have a primary health care provider. As the nurse performs an assessment of this individual, which finding does the nurse anticipate?
  1. a.
    An absence of preventable diseases
  2. b.
    A distrust of the health care system
  3. c.
    Positive past health care encounters
  4. d.
    Up-to-date cancer screenings

Answer

B. A distrust of the health care system
Vulnerable populations, including transgender individuals, often face discrimination and stigma by health care providers and, therefore, may have a lack of trust in the health care system.

5-8 §5.RQ source ↗

Which intervention should the nurse use to instill trust in underrepresented clients in a community health center?
  1. a.
    Asking family members to remain in the waiting area
  2. b.
    Assessing the client’s potential barriers to care
  3. c.
    Providing education materials in English
  4. d.
    Learning about the client’s culture by reading about it

Answer

B. Assessing the client’s potential barriers to care
To increase trust with clients from underrepresented populations, the nurse should be attuned to the client’s access to resources, such as transportation, and work to address any barriers.

5-9 §5.RQ source ↗

Which statement should guide the nurse in helping an underrepresented client obtain health insurance based on the ACA?
  1. a.
    The age of qualification for Medicare was lowered.
  2. b.
    Medicaid financial eligibility requirements were lowered.
  3. c.
    Administration of Medicaid was transferred to the federal government.
  4. d.
    Individuals with disabilities are no longer covered by Medicare.

Answer

B. Medicaid financial eligibility requirements were lowered.
The ACA lowered Medicaid eligibility requirements, increasing opportunities for those who need it.

5-10 §5.RQ source ↗

The nurse is recommending that a client in a rural area monitor their blood pressure electronically at home to determine the effectiveness of antihypertensive medication and lifestyle changes and to follow up using telehealth. Which information will the nurse provide the client about telehealth visits?
  1. a.
    There is no charge for telehealth visits.
  2. b.
    It allows the nurse to see trends in the client’s blood pressure.
  3. c.
    It increases the number of emergency department visits.
  4. d.
    It is not as effective in treating conditions as in-office visits.

Answer

B. It allows the nurse to see trends in the client’s blood pressure.
Telehealth allows for increased access to health care services, especially for those living in rural areas. Home monitoring is often paired with telehealth to allow for the long-term and continuous monitoring of chronic diseases, such as hypertension. When upward trends in blood pressure are observed, the health care team can more readily address the issue.

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Problems and answers are adapted from Population Health for Nurses by Jessica Ochs, Sherry L. Roper and Susan M. Schwartz, OpenStax, and are used under the CC BY-NC-SA 4.0 licence. Access for free at https://openstax.org/books/population-health/pages/1-introduction. Illustrations: Copyright Rice University, OpenStax, under CC BY-NC-SA 4.0 license. This adaptation is released under the same licence, is non-commercial, and is neither affiliated with nor endorsed by OpenStax or Rice University.