Health Promotion Throughout The Life Span 7th Edition by Carole Lium Edelman -Test Bank A+

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Edelman: Health Promotion Throughout the Life Span, 7th Edition

Chapter 05: Ethical Issues Relevant to Health Promotion

Test Bank

MULTIPLE CHOICE

1. Which of the following statements is true with regard to health promotion?

a.	Health promotion efforts are not concerned with addressing environmental obstacles to health.
b.	Advocates of health promotion are not involved in political campaigns against harmful products.
c.	The business of eliminating health disparities is a unique function of Healthy People 2010 goals.
d.	Health promotion involves collaboration of many professional groups.

ANS: D

Health promotion involves collaboration of all health professional groups with requisite knowledge and skills to protect or achieve health.

DIF: Cognitive Level: Knowledge REF: 116

1. Which of the following types of ethical theories is concerned with ensuring “good actions”?

a.	Descriptive value theories
b.	Normative theories
c.	Consequentialism theory
d.	Duty-based theories

ANS: B

Normative theories are either reasoned explanations of the moral purpose of human interactions or are divinely “revealed” truths about good actions. These are the types of actions people “ought” to take on the basis of which principles are believed to be valid.

DIF: Cognitive Level: Knowledge REF: 117

1. Which of the following statements best describes the application of moral or ethical theory to the practices involved in health promotion?

a.	One can be assured of morally correct action in a given situation if one adheres to a theory of moral principles.
b.	There are no identifiable criteria that can be used effectively to determine correct actions in a given situation.
c.	The good of the larger population always takes precedence over the good of one individual.
d.	Making ethical decisions regarding human health involves the consideration of multiple factors.

ANS: D

Making moral or ethical decisions about human health is not an easy task and requires assessing various criteria or theories.

DIF: Cognitive Level: Synthesis REF: 121

1. A liver for which two people are tissue-typed has become available after the death of a donor in a car accident. Client A is a 45-year-old substance abuser whose liver is damaged as a result of his use of alcohol. Client B is a 16-year-old in need of a liver transplant because of a birth abnormality. Which of the following would be useful for a nurse in giving input as to which of the two should receive the liver?

a.	Advocate for Client B because he is the younger of the two and will live longer.
b.	Use feminist moral theory to advocate for Client A in spite of his alcohol use.
c.	Use a guided set of moral principles in decision making before advocating for either.
d.	Advocate for Client A because he has 15 to 20 years of productive life left.

ANS: C

Systematically using a set of moral principles in making ethical decisions assists the nurse in resolving ethical dilemmas such as that described.

DIF: Cognitive Level: Synthesis REF: 123-124

1. Nurse B has been asked to participate in a termination of the pregnancy of a 16-year-old victim of date rape. Nurse B’s religious beliefs prohibit abortion. According to the revised American Nurses Association’s (ANA’s) Code of Ethics for Nurses, which of the following options addresses the immediacy of Nurse B’s situation?

a.	Suspend her religious beliefs and provide comfort and support for the 16-year-old client.
b.	Quit her job and find another source of employment.
c.	Notify her supervisor about her beliefs and ask that someone else be given the assignment.
d.	Refuse to participate in the abortion.

ANS: C

In the immediacy of the situation, the ANA Code of Ethics provides for the right of nurses to refuse to participate in procedures that violate their own values, but the nurse’s ethical behavior must ensure that arrangements for the care of the client are provided.

DIF: Cognitive Level: Application REF: 122-123

1. A 24-year-old man who is cognitively delayed with a designated developmental age of 5 to 6 years has no relatives participating in his care. A decision needs to made for a neurosurgeon to remove a brain tumor that has rendered the client totally dependent on someone else for all activities of daily living. The nurse would participate in ethical decision making on his behalf, knowing that the client in her care is unable to benefit from which of the following ethical concepts?

a.	Autonomy
b.	Justice
c.	Beneficence
d.	Advocacy

ANS: A

Because the client is cognitively delayed and is unable to understand explanations of treatment that would be given to him, the client is unable to be autonomous in making a decision regarding neurosurgery.

DIF: Cognitive Level: Application REF: 128-129

1. A client is scheduled to have open-heart surgery. His physical condition is such that he stands a 50-50 chance of dying on the operating table. He has not been advised of this possibility. Which of the following ethical concepts has been ignored in rendering care for this client?

a.	Beneficence
b.	Autonomy
c.	Justice
d.	Informed consent

ANS: D

The client is able to “substantially understand” his care. Ethical care ensures that a person has all of the appropriate information necessary to make an autonomous decision about his or her care. This client has not been informed of his chances of dying during the surgery.

DIF: Cognitive Level: Application REF: 129

1. An 18-year-old woman in whom a sexually transmitted disease (STD) was recently diagnosed asks the nurse not to tell her mother that she has an STD. Her mother asks the nurse what is causing her daughter’s vaginal discharge. The nurse should:

a.	Follow the principle of veracity and tell the mother the diagnosis
b.	Respect the principle of confidentiality and support the client’s request not to tell her mother the diagnosis
c.	Tell the client’s mother that she has a urinary tract infection, to protect the client’s privacy and honor the mother’s request
d.	Ignore the mother’s request for information

ANS: B

The Health Insurance Portability and Accountability Act (HIPAA) guarantees client confidentiality. The client is the only person who can inform her mother of the diagnosis and the only person who can give the nurse permission to inform her mother of the diagnosis. The nurse could appropriately respond to the mother by saying, “I cannot share that information with you because of client confidentiality legislation. You might ask your daughter to share that information with you.”

DIF: Cognitive Level: Synthesis REF: 131

1. Which of the following concepts of ethics is described as the “duty to maximize the benefits of actions while minimizing harm”?

a.	Advocacy
b.	Justice
c.	Beneficence
d.	Autonomy

ANS: C

Beneficence governs actions taken to further the overall health or well-being of an individual or society. “Beneficence” means doing good.

DIF: Cognitive Level: Knowledge REF: 133

1. Which concept is aimed at interrupting potential ethical problems before they develop?

a.	Feminist ethics
b.	Preventive ethics
c.	Metaethics
d.	Normative ethics

ANS: B

Preventive ethics is a requirement of health promotion in which practitioners envision potential problems and institute actions that stop their development.

DIF: Cognitive Level: Knowledge REF: 125-126

Edelman: Health Promotion Throughout the Life Span, 7th Edition

Chapter 07: Health Promotion and the Family

Test Bank

MULTIPLE CHOICE

1. Which of the following theories is an attempt to explain families as a set of interacting individuals with patterns of living that influence health decisions?

a.	Feminist theory
b.	Systems theory
c.	Developmental theory
d.	Resiliency theory

ANS: B

Systems theory is an attempt to explain patterns of living among the individuals who make up the family system.

DIF: Cognitive Level: Knowledge REF: 173

1. Which of the following would be described as a family structural component?

a.	Breadwinner of house
b.	Socialization of children
c.	Immunization of children
d.	Launching of children

ANS: A

Structural components of the family refer to family roles and relationships.

DIF: Cognitive Level: Application REF: 174

1. Your clients are a middle-age married couple, with a son who has just graduated from college. Which developmental tasks would you expect from your clients?

a.	Involvement in after-school activities for their son
b.	Strengthening the marital relationship for future family stages
c.	Acting as a launching center for their son
d.	Responding to the prospect of a sharp reduction in income

ANS: C

Families with young adults act as launching centers for children ready to leave home.

DIF: Cognitive Level: Knowledge REF: 191

1. The ecomap of a client’s family has slashed lines drawn from the son to the family church. This lets the nurse know:

a.	That the son is deceased
b.	That the son is actively involved with the family church
c.	That the son has a stressful relationship with the church
d.	That the son has no relationship with the church

ANS: C

Slashed lines on an ecomap signify stressful relationships.

DIF: Cognitive Level: Application REF: 182

1. A client reports that her husband is taking a new job in another city. She is very depressed about the move and does not want to go. The nurse should:

a.	Assess the client’s and family’s coping mechanisms in handling stress
b.	Encourage the client to act excited about the move
c.	Talk to the husband to get his perspective on the move
d.	Tell her that all families must cope with new situations from time to time

ANS: A

The family’s ability to cope with demands of everyday living determines its level of success. The nurse needs to assess how the family usually copes with stressful situations to find ways that might be available to the family now to cope with the current situation.

DIF: Cognitive Level: Synthesis REF: 186

1. In a blended family in which the mother and the father differ on how to spend and save money, the parents are constantly arguing with each other. The nurse knows that her plan of care for this couple must include which of the following?

a.	Assisting the couple in developing strategies that are congruent with their values
b.	Recognizing that the couple will be most effective if each partner defends his or her own values
c.	Focusing the couple on outcomes that each wants to accomplish
d.	Diverting the couple’s attention to areas in which they are successful

ANS: A

When strategies are used that are congruent with each individual’s values, the couple adjusts.

DIF: Cognitive Level: Application REF: 188

1. A blended family has six children, ages 2, 4, 4, 5, 7, and 10. During a visit to the home, you notice that the 7-year-old seems quiet and withdrawn, whereas the other children are playing loudly in the garage. You suspect that the child’s quiet state may result from:

a.	Having been abused
b.	Being one of multiple children closely spaced in age
c.	Low family self-esteem
d.	Having received a spanking before your arrival

ANS: B

Risks associated with role relationships in blended families include multiple closely spaced children, which limits the parents’ time for interaction to meet individual children’s needs.

DIF: Cognitive Level: Application REF: 189

1. Your clients have 2-year-old twins. Health promotion advice to be included in your plan of care for this couple should include:

a.	Wearing bicycle helmets for safety
b.	Caution around the family swimming pool
c.	Education on crossing the street at lights
d.	Advocating day care for adequate socialization

ANS: B

Two-year-olds are prone to wandering to where water is and could fall into a swimming pool without being noticed.

DIF: Cognitive Level: Application REF: 189

1. Health promotion assessment for a family with a 9-month-old should be most concerned about questions relating to which of the following?

a.	The age of the house in which the family lives
b.	Genetic diseases in the family
c.	Driving practices in the family
d.	Toilet training for the child

ANS: A

A typical 9-month-old is beginning to crawl. Houses built before 1974 may contain lead-based paint, to which a crawling baby might have access. Lead causes neurological damage and anemia.

DIF: Cognitive Level: Synthesis REF: 189

Edelman: Health Promotion Throughout the Life Span, 7th Edition

Chapter 09: Screening

Test Bank

MULTIPLE CHOICE

1. A test’s ability to distinguish correctly between diseased and nondiseased individuals is known as:

a.	Sensitivity
b.	Specificity
c.	Validity
d.	Efficacy

ANS: C

Validity is defined as a test’s ability to distinguish correctly between diseased and nondiseased individuals.

DIF: Cognitive Level: Knowledge REF: 224

1. The proportion of people with a condition who correctly test positive when screened is known as:

a.	Sensitivity
b.	Specificity
c.	Validity
d.	Efficacy

ANS: A

Sensitivity refers to the proportion of people with a condition who correctly test positive when screened.

DIF: Cognitive Level: Knowledge REF: 224

1. A test’s ability to recognize negative reactions or nondiseased individuals is known as:

a.	Sensitivity
b.	Specificity
c.	Validity
d.	Efficacy

ANS: B

Specificity measures a test’s ability to recognize negative reactions or nondiseased individuals.

DIF: Cognitive Level: Knowledge REF: 224

1. An analysis that determines the optimal use of resources to reach a predetermined constant end point or the desired health outcome is known as:

a.	Cost-benefit ratio analysis
b.	Cost-effectiveness analysis
c.	Cost-efficiency analysis
d.	Cost-disease analysis

ANS: B

An analysis that determines the optimal use of resources to reach a predetermined, constant end point or the desired health outcome is known as cost-effectiveness analysis.

DIF: Cognitive Level: Knowledge REF: 228

1. To screen for breast cancer, mammography should be conducted every 1 to 2 years beginning at age:

a.	18
b.	21
c.	35
d.	40

ANS: D

It is recommended that all women age 40 and older have a mammography performed every 1 to 2 years to screen for breast cancer.

DIF: Cognitive Level: Knowledge REF: 230 (Table 9-1)

1. To screen for colorectal cancer, colonoscopy should be conducted every 10 years beginning at age:

a.	30
b.	40
c.	50
d.	60

ANS: C

It is recommended that men and women age 50 and older have a colonoscopy performed every 10 years to screen for colorectal cancer.

DIF: Cognitive Level: Knowledge REF: 230 (Table 9-1)

1. The second leading cause of cancer deaths in the United States is:

a.	Breast cancer
b.	Cervical cancer
c.	Colorectal cancer
d.	Prostate cancer

ANS: C

The second leading cause of cancer deaths in the United States is colorectal cancer.

DIF: Cognitive Level: Knowledge REF: 237

1. It is recommended that testing for phenylketonuria be done before:

a.	1 day of age
b.	4 days of age
c.	7 days of age
d.	10 days of age

ANS: C

The U.S. Preventive Services Task Force recommends newborn testing after 24 hours of life but before 7 days of age for phenylketonuria.

DIF: Cognitive Level: Knowledge REF: 239

1. Which is an example of asymptomatic pathogenesis?

a.	Someone with a blood pressure of 170/98 experiencing headaches
b.	Someone with a positive finding on colonoscopy and blood in his or her stool
c.	Someone with an elevated prostate-specific antigen (PSA)
d.	Someone with an elevated TSH who is always tired

ANS: C

The primary objective of screening is the detection of a disease in its early stages, to treat it and deter its progression. The screening process is based on the principle that disease is preceded by a period of asymptomatic pathogenesis when risk factors predisposing a person to the pathological condition are building momentum toward manifestation of the disease. Therefore, someone with an elevated PSA without any symptoms is an example of asymptomatic pathogenesis. The other three examples demonstrate manifestation of disease (headaches, blood in stool, and tiredness).

DIF: Cognitive Level: Application REF: 222

1. Which is an example of interobserver reliability?

a.	A client with a blood pressure reading of 124/82 two days in a row by two different nurses
b.	A client with three consecutive blood pressure readings of 124/82 by the same nurse
c.	A client with a blood pressure reading of 124/82 in the right arm and 124/82 in the left arm
d.	A client with a blood pressure reading of 124/82 immediately followed by a blood pressure reading of 147/92

ANS: A

Reliability is an assessment of the reproducibility of the test’s results when different individuals with the same level of skill perform the test during different periods and under different conditions. If the same result emerges when two individuals perform the test, interobserver reliability is shown. Therefore, a client with a blood pressure reading of 124/82 two days in a row by two different nurses is an example of interobserver reliability.

DIF: Cognitive Level: Application REF: 224

1. Which is an example of intraobserver reliability?

a.	A client with a blood pressure reading of 124/82 two days in a row by two different nurses
b.	A client with three consecutive blood pressure readings of 124/82 by the same nurse
c.	A client with a blood pressure reading of 124/82 in the right arm and 124/82 in the left arm
d.	A client with a blood pressure reading of 124/82 immediately followed by a blood pressure reading of 147/92

ANS: B

Reliability is an assessment of the reproducibility of the test’s results when different individuals with the same level of skill perform the test during different periods and under different conditions. If the same individual is able to reproduce the results several times, intraobserver reliability is shown. Therefore, a client with three consecutive blood pressure readings of 124/82 by the same nurse is an example of intraobserver reliability.

DIF: Cognitive Level: Application REF: 224

1. Which is an example of poor sensitivity?

a.	When 6 out of every 10 sweat tests performed are negative but the six clients actually have cystic fibrosis
b.	When 6 out of every 10 sweat tests performed are positive but the six clients do not actually have cystic fibrosis
c.	When 6 out of every 10 sweat tests performed are negative and the six clients really do not have cystic fibrosis
d.	When 6 out of every 10 sweat tests performed are positive and the six clients really do have cystic fibrosis

ANS: A

Sensitivity refers to the proportion of people with a condition who correctly test positive when screened. A test with poor sensitivity will miss individuals with the condition, and there will be a large number of false-negative results; individuals actually have the condition but were told they were disease free. Thus when 6 out of every 10 sweat tests performed are negative but the six clients actually have cystic fibrosis, it is an example of poor sensitivity.

DIF: Cognitive Level: Application REF: 224

1. Which is an example of poor specificity?

a.	When 6 out of every 10 sweat tests performed are negative but the six clients actually have cystic fibrosis
b.	When 6 out of every 10 sweat tests performed are positive but the six clients do not actually have cystic fibrosis
c.	When 6 out of every 10 sweat tests performed are negative and the six clients really do not have cystic fibrosis
d.	When 6 out of every 10 sweat tests performed are positive and the six clients really do have cystic fibrosis

ANS: B

Specificity measures a test’s ability to recognize negative reactions or nondiseased individuals. A test with poor specificity will result in false-positive test results. These individuals are told they have a condition when in actuality they do not. Thus, when 6 out of every 10 sweat tests performed are positive, but the six clients do not actually have cystic fibrosis, it is indicative of poor specificity.

DIF: Cognitive Level: Application REF: 224

1. The best way for a nurse to design a successful hypertension screening program is to:

a.	Work with stakeholders to conduct a community assessment
b.	Use state-of-the-art sphygmomanometers to measure people’s blood pressure outside a library
c.	Use the program she developed at her last place of employment because it worked well
d.	Use a program developed by her colleague in a neighboring state

ANS: A

Partnerships are essential to developing health programs and screening programs. The primary rule is to never assume that what is appropriate and effective for one community will be appropriate and effective for another community. A community assessment conducted as a partnership with key stakeholders provides information about the high-risk population, available health care resources, and the high-risk population’s health needs. By conducting the assessment, the nurse can identify the necessary community resources and mobilize them to achieve maximal benefits and positive outcomes.

DIF: Cognitive Level: Synthesis REF: 225-226

1. Which group is an example of a screenable population for hypertension?

a.	A group of high school students
b.	A professional hockey league
c.	A group of high-level business executives attending an annual conference
d.	A group of cardiac rehabilitation clients

ANS: C

The objective of identifying a screenable population is to identify a high-risk group that, when tested, will yield a significant number of diseased individuals. The main criterion used to define an appropriate population is the definitive presence of risk factors related to the disorder. Most high-level business executives are middle-aged men with stressful jobs, placing them at high risk for heart disease. Thus, this would be the best example of a screenable population for hypertension.

DIF: Cognitive Level: Synthesis REF: 228

1. Which person should be screened for cervical cancer with a Papanicolaou (Pap) test?

a.	A 14-year-old girl who has never been sexually active
b.	A 23-year-old woman who has never been sexually active
c.	A 53-year-old woman status post total hysterectomy
d.	A 67-year-old woman with a history of normal Pap tests

ANS: B

Cervical cancer screening with a Pap test is recommended for all women aged 21 years or older, or within 3 years of the onset of sexual activity. It is not recommended for women not at high risk, aged 65 and older with normal recent Pap tests, and for those with total hysterectomy. Because of her age, the woman who is 23, whether she is sexually active or not, should have a Pap test to screen for cervical cancer.

DIF: Cognitive Level: Application REF: 230 (Table 9-1) | 237

1. Which person should be screened for high cholesterol levels?

a.	An 11-year-old whose father has hypertension
b.	A 21-year-old male who smokes a half pack of cigarettes a day
c.	A 31-year-old male who does not exercise much
d.	A 41-year-old female who drinks socially

ANS: B

Recommendations for screening for high cholesterol levels are for all men aged 35 and older; women aged 45 and older; and young adults, beginning at age 20, with other coronary heart disease risk factors such as diabetes, tobacco use, hypertension, or a strong family cardiac history. Therefore, the 21-year-old, because of his smoking habit, should be screened for high cholesterol levels.

DIF: Cognitive Level: Application REF: 238

1. Which finding is most concerning to a nurse who is reviewing the chart of a 15-year-old girl who has been sexually active since the age of 12?

a.	She does not perform self breast exams.
b.	She has never had a Pap test.
c.	Her one and only HIV test was performed at the age of 13.
d.	She does not use birth control pills.

ANS: B

Although self breast exams are encouraged and considered an important aspect of breast health education, data regarding its efficacy is weak. Although she does not use birth control pills, there is no indication that she does not use other forms of birth control such as condoms that would also prevent against STDs. There is also no indication that she has had more than one sex partner. A Pap test is recommended for all women aged 21 years or older, or within 3 years of the onset of sexual activity. Therefore, the fact that she never had a Pap test to screen for cervical cancer and has been sexually active for the last 3 years is concerning.

DIF: Cognitive Level: Synthesis REF: 236-239

1. Which is an example of a comprehensive health promotion activity that provides a person with a better opportunity to manage their own risk?

a.	A nurse who obtains a person’s blood pressure and cholesterol level during a screening
b.	A nurse who obtains a person’s blood pressure and family history during a screening
c.	A nurse who obtains a person’s blood pressure and discusses the importance of exercise during a screening
d.	A nurse who obtains a person’s blood pressure, cholesterol level, and glucose level during a screening

ANS: C

Providing health education during a screening falls under the Scope and Standards of Nursing Practice. Many chronic diseases are the result of health behaviors. The nurse’s role as educator is essential in the screening process because nurses provide individuals with the information necessary for choices that are made regarding healthy behavioral changes. Awareness is the first step in prevention. If awareness is combined with health education and health-promotion tools, people will have a better opportunity to manage their own risks. Thus, obtaining a person’s blood pressure while discussing the importance of exercise during a blood pressure screening is an example of a comprehensive health promotion activity.

DIF: Cognitive Level: Application REF: 223 | 239-240

1. Which represents a disadvantage of screening?

a.	Utilization of group screening methods
b.	Utilization of multiple test screening
c.	Utilization of a test with high specificity
d.	Utilization of a test with low sensitivity

ANS: D

Group screening and multiple test screening are advantages of screening programs. A disadvantage of screening occurs when the test is unable to distinguish those who probably have the disease from those who do not. Tests with low sensitivity produce a large number of false-negative tests and leave those screened with a false sense of a healthful state, resulting in them losing the opportunity to receive early treatments that could prevent irreversible damage.

DIF: Cognitive Level: Synthesis REF: 223-224

1. During a screening, a test with a high specificity and low sensitivity is utilized. This test has the potential to cause:

a.	Ethical issues
b.	Race issues
c.	Gender issues
d.	Cultural issues

ANS: A

Misinterpretation caused by screening instruments is of great ethical concern. A difficult ethical issue in screening is determining whether the benefits received by those who receive correct results are worth the problems experienced by those who receive incorrect results. In this case, the high specificity of the test would result in low false-positive rates and would correctly identify nondiseased individuals. However, the low sensitivity would result in a high false-negative rate and therefore would miss a large number of people who are actually positive, resulting in ethical issues.

DIF: Cognitive Level: Application REF: 224 | 227

1. A test that screens for hypercholesterolemia should have:

a.	No cutoff point
b.	A low cutoff point
c.	An intermediate cutoff point
d.	A high cutoff point

ANS: B

The goal of a screening program, identifying an individual as high risk or not, depends on the numerical value of the screening instrument. When the parameter for this distinction is not clear, a cutoff point is set. Above this point, the person is considered disease positive; below this point, the individual is considered disease negative. Thus, if the disease were potentially life-threatening or if a disease is relatively benign in terms of stigmatization, anxiety, and problems with treatment, the lower cutoff would be preferred. High cholesterol, if left untreated, could contribute life-threatening cardiac disease. Additionally, it is benign in terms of stigmatization. Therefore, a lower cutoff point should be set.

DIF: Cognitive Level: Synthesis REF: 227

1. Which woman would be at high risk for developing breast cancer?

a.	A thin woman with three children and no family history of breast cancer
b.	A 59-year-old obese woman with no children who still gets her period every month
c.	A 25-year-old with one child whom she gave birth to when she was a teenager
d.	A thin woman with one child who started menstruating at the age of 13

ANS: B

In the United States, the incidence of breast cancer increases with age. Nulliparous women; women who start menstruating at an earlier age than average and reach menopause at a later age than average; women who bore their first child in their late 30s; women with fibrocystic disease of the breast; women with a family history of breast cancer; women with extended use of estrogen supplements; obese women; and women who eat a high-fat diet are at increased risk of breast cancer. Women who bore their first child before the age of 20 constitute the lowest-risk group. Thus, the 59-year-old obese woman with no children who still gets her period would be at high risk of developing breast cancer.

DIF: Cognitive Level: Application REF: 236

1. Which woman is most likely to be diagnosed with cervical cancer?

a.	A 47-year-old with a history of two sex partners who is currently sexually active
b.	A 32-year-old lawyer who had greater than 15 sex partners when she was in college
c.	A 23-year-old who has never been sexually active and does not smoke
d.	A 62-year-old on Medicare whose only sexual partner has been her husband of 40 years

ANS: B

Although all sexually active women are at risk for cervical cancer, the disease is more common among women of low socioeconomic status, women with a history of multiple sex partners, women with early first sexual intercourse, smokers, and women with certain types of human papilloma virus and human immunodeficiency virus. Thus, the woman with greater than 15 sex partners would be more likely to be diagnosed with cervical cancer.

DIF: Cognitive Level: Application REF: 236

1. Which person should undergo a colonoscopy and barium enema instead of a less intensive colorectal cancer screening test?

a.	A 50-year-old male with diabetes
b.	A 55-year-old male with a history of leukemia
c.	A 52-year-old woman with a history of breast cancer
d.	A 56-year-old woman with a history of hypertension

ANS: C

The American Cancer Society recommends that at the age of 50 men and women should have an annual fecal occult blood test plus a flexible sigmoidoscopy every 5 years, a colonoscopy every 10 years, or a double contrast barium enema every 5 to 10 years and a digital rectal exam before each screening. Most organizations recommend more intensive screening with a barium enema and colonoscopy for those in at-risk groups. Risk factors include a history of inflammatory bowel disease, family history of first-degree relative with colorectal cancer, previously diagnosed colorectal cancer, adenomatous polyps, and history of endometrial, ovarian, or breast cancer. Thus, it is recommended that the woman with a history of breast cancer should undergo the more intensive screening (colonoscopy and barium enema) for colorectal cancer because of her added risk factor (history of breast cancer).

DIF: Cognitive Level: Application REF: 237

1. Which man would be more likely to benefit from prostate cancer because of a more favorable benefit-to-harm ratio?

a.	A Black 50-year-old male
b.	A Hispanic 50-year-old male
c.	A White 50-year-old male
d.	An Asian 50-year-old male

ANS: A

The risk of prostate cancer increases with age, beginning at age 50, and is considerably higher among Black men. False positive results from prostate screening leading to unnecessary biopsies and anxiety are not uncommon, nor are the treatment complications of sexual dysfunction or incontinence. A possible exception to the benefit-to-harm ratio may exist among Black men. Thus, the Black 50-year-old male has a greater benefit-to-harm ratio and may more likely benefit from prostate cancer screening.

DIF: Cognitive Level: Application REF: 237

1. For which of the following is Type 2 Diabetes Mellitus screening recommended?

a.	An overweight woman
b.	A teenager
c.	A man with hypertension
d.	A woman with a family history of Type 2 Diabetes Mellitus

ANS: C

The risk of developing Type 2 Diabetes Mellitus increases with age, obesity, and lack of exercise. Individuals with a family history, hypertension, dyslipidemia, delivery of babies weighing more than 9 pounds, or who are members of certain racial or ethnic groups have an increased risk of developing Type 2 Diabetes Mellitus. Screening is recommended in adults with hypertension or hyperlipidemia. Mass screening of all individuals is not recommended (even those at high risk) because there is no evidence to suggest that beginning diabetic management as a result of mass screening provides an incremental benefit compared with initiating treatment after clinical diagnosis. Although the woman with a family history of Type 2 Diabetes Mellitus is at risk of developing the disease, screening is only recommended for those with hypertension or hyperlipidemia. Therefore, the man with hypertension should be screened for Type 2 Diabetes Mellitus.

DIF: Cognitive Level: Application REF: 239

MULTIPLE RESPONSE

1. Which of the following is an example of screening? Select all that apply.

a.	Asking if someone performs self breast exam
b.	Performing a self breast exam
c.	Obtaining a mammogram
d.	Undergoing a needle biopsy

ANS: B, C

Screening is not considered a diagnostic measure. The ultimate goal could be curative, but more often, it is to prevent further development of the condition or disease. Screenings are done by oneself, or can be clinical, procedural, or lab based. Performing a self breast exam and obtaining a mammogram are examples of screening. Asking if someone performs a self breast exam may increase awareness but does not screen for disease. A needle biopsy would be diagnostic.

DIF: Cognitive Level: Application REF: 222