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26. Which is an example of an aggregate or population? a. Students in a county school system b. Christians around the world c. A patient in the intensive care unit at the local hospital d. People who play cards together once a week at private homes

ANS: A A population or aggregate is a collection of individuals who have one or more personal or environmental characteristics in common. They can be defined in terms of geography or a special interest. The clients in the first option share a geographical characteristic.

14. The nurse manager who makes sure that the staff members who work in a local clinic are competent is demonstrating the public health core function of: a. Assurance b. Assessment c. Prevention d. Policy development

ANS: A Assurance refers to making sure a competent health care workforce is available.

5. Which of the following is an example of the mission of public health according to the Institute of Medicine? a. Tracking avian flu outbreaks and doing surveillance in the United States b. Providing a flu shot for an elderly person at the health department c. Keeping track of alternative therapies in use in the United States d. Keeping snake antivenom at the Centers for Disease Control and Prevention in Atlanta

ANS: A The Institute of Medicine's stated mission on public health is "to generate organized community and technical knowledge to prevent disease and promote health."

1. One of the primary focuses of improving the health of the American people in the twenty-first century is to address: a. Bioterrorism and global health threats b. Delivery of individual care and hygiene c. The need for increased hospital and acute care d. Chronic disease and disability management

ANS: A There are new concerns, and one of the most serious is bioterrorism. The others are not related to public health or are concerns that have been present for many years.

34. Implementing quality performance standards in public health is important because: a. They are used to guide improvement in the public health system. b. They rigidly control public health. c. Administrators will not monitor public health at the local level, but instead at the national level. d. They can be used as hiring guidelines for nurses.

ANS: A These standards were developed by the Centers for Disease Control and Prevention in 1998. They set the bar for the level of performance that is necessary to deliver essential public health services.

19. The necessary basic preparation for public health nursing is a(n) _____ in nursing. a. Associate's degree b. Baccalaureate degree c. Master's degree d. PhD

ANS: B A BSN is the necessary basic preparation to function as a beginning staff public health nurse.

20. Public health practitioners prepared at the graduate level should be able to: a. Teach public and community health nursing b. Assess and intervene successfully at the aggregate level c. Diagnose and treat disease and have prescriptive authority d. Run for political office as experts in public health policy

ANS: B According to the Consensus Conference, specialists should have assessment skills that allow them to intervene at the aggregate level. Public health practitioners have a broad range of practice areas within public health and are not limited to only nursing and medicine.

29. Population-focused practice focuses on defining the problems or needs of and implementing solutions for: a. Individuals b. Aggregates c. Communities d. Geographical regions

ANS: B Aggregates are a defined population made up of individuals in communities of a specific geographical region.

11. The nurse who compares the rate of teenage pregnancy in various areas of the city is practicing the public health core function of: a. Assurance b. Assessment c. Prevention d. Policy development

ANS: B Assessment refers to systematic data collection, which this nurse is doing for teenage pregnancy.

24. The term community-based nursing care is applied when implementing which nursing intervention? a. Assessing the health needs of a defined community b. Providing care to families in a community c. Promoting the health of an entire community d. Investigating environmental health problems in a community

ANS: B Community-based nursing practice is a setting-specific practice whereby care is provided for families where they live, work, and attend school. The focus is on acute and chronic care and the provision of services. Providing care to families is the only intervention that accurately describes this definition.

32. A key opportunity for public health nurses to improve population-focused care is by: a. Assuming traditional nursing roles b. Influencing public health policy c. Conducting community assessments d. Specializing in community-based nursing practice

ANS: B Public health nurses must move into positions in which they can influence policy formation. They must assume positions that are not traditionally considered nursing. Conducting community assessments is part of public health nursing practice, not necessarily a key opportunity to improve practice. Specializing in community-based nursing practice is setting-specific and does not relate to a key opportunity to improve population-focused care.

35. To better address emerging public health issues, a public health nurse enrolls in a course addressing which content area? a. Leadership b. Ethics c. Communication d. Finance

ANS: B Public health workers should be educated in eight content areas to be able to address emerging public health issues and advances in science and policy: informatics, genomics, cultural competence, community-based participatory research, policy, law, global health, and ethics.

13. Providing for the availability of essential personal health services for people who would otherwise not receive health care defines which public health core function? a. Assessment b. Prevention c. Assurance d. Policy development

ANS: C Assurance deals with the availability of health services. Prevention is not a core function, assessment refers to systematic data collection, and policy development refers to the need to provide leadership in developing health policies.

2. The threat of bioterrorism has the potential to: a. Dissolve community-based programs. b. Cause the health care system to collapse. c. Divert funds from other public safety health care programs. d. Increase the need for shelters.

ANS: C Bioterrorism may have an impact on the availability of resources for public safety health care programs.

15. The public health nurse analyzes data related to the number and type of United States Environmental Protection agency air quality standards that a community failed to meet. This data is an example of using which community health profile indicator? a. Sociodemographic characteristics b. Health status c. Health risk factor d. Functional status

ANS: C Breathing air of poor quality is a risk to health.

9. Which of the following statements about public health is accurate? a. Prevention of early deaths can be more effectively accomplished by medical treatment than by public health approaches. b. Expenditures and resources for public health have increased in recent years. c. Historically, gains in the health of populations have been related largely to changes in safety, sanitation, and personal behavior. d. Reform of the medical insurance system is the single change needed to improve the health of Americans.

ANS: C Changes, such as immunizations, tobacco use, blood pressure control, and automobile safety, have helped increase the health of communities.

12. Public health nurses who develop and implement local public health policies through partnerships with agencies, organizations, and consumers within the community are using which core public health function? a. Assessment b. Prevention c. Assurance d. Policy development

ANS: D Prevention is not a core function, assurance is making sure essential services are available, and assessment refers to systematic data collection. Policy development deals with developing and implementing health policies.

17. The public health workforce should demonstrate competency in which of the following competency categories? a. Financial planning and management b. Workforce needs assessment c. Acute care services d. Curriculum development

ANS: A Workforce needs assessment, acute care services, and curriculum development are not considered categories of core competencies of public health. Rather there are eight categories of competency, which include: analytic/assessment, policy development/program planning, communication, cultural competence, community dimensions of practice, basic public health sciences, financial planning and management, and leadership and systems thinking.

MULTIPLE RESPONSE 1. Which of the following are considered barriers to public health nursing? Select all that apply. a. The mindset that the only role for the nurse is at the bedside. b. The structures within which nurses work and the process of role socialization within those structures. c. Few nurses receive graduate-level preparation in the concepts and strategies of the disciplines basic to public health. d. The number of job opportunities in the area has been steadily declining.

ANS: A, B, C All are considered barriers to nurses specializing in public health nursing, except the number of job opportunities, which is not declining.

MULTIPLE RESPONSE 1. Public health nursing specialists are interested in which of the following topic(s)? (Select all that apply.) a. Educational materials for individuals with HIV/AIDS b. Evaluation of an outreach program for at-risk pregnant teenagers c. Community subpopulations with high rates of type 2 diabetes d. New technologies to monitor diabetes e. Prevalence of hypertension among various age, race, and gender groups

ANS: B, C, E Public health specialists often define problems at the population or aggregate level as opposed to the individual level. At the population level, public health specialists are usually concerned with more than one subpopulation and frequently with the health of the entire community.

5. A community-oriented nurse has identified obesity as a problem in the middle school. The next step in a population-focused practice is to make information available about the health of the middle school students. This describes the core public health function of: a. assessment. b. assurance. c. policy development. d. research.

ANS: A Assessment is a core function of public health and refers to systematically collecting data concerning the population, monitoring the population's health status, and making information available on the health of the community. In a community-oriented approach, a nurse would apply both nursing and public health theory. In this case, assessment would be the first step from the perspective of both theories. Because the practice is population focused and community oriented, it would involve the assessment of the community subpopulation of middle school children and the impact of obesity on their overall health status.

7. A nurse planning a smoking cessation clinic for adolescents in the local middle schools and high schools is providing: a. community-oriented care. b. community-based care. c. secondary care. d. tertiary care.

ANS: A Community-oriented nurses emphasize health promotion, health maintenance, and disease prevention, as well as self-reliance on the part of clients. Regardless of whether the client is a person, family, or group, the goal is to promote health through education about prevailing health problems, proper nutrition, beneficial forms of exercise, and environmental factors such as the safety of food, water, air, and buildings.

8. A community-oriented nurse conducts home visits to new parents to assess the health status of the infant, the parent-child relationship, the parents' knowledge regarding the care of the infant, and the need for health department and social services referrals to support the needs of the new parents and the infant. This can best be described as an example of: a. clinical community health practice. b. community-based practice. c. population-focused practice. d. public health nursing.

ANS: A Community-oriented nurses who provide direct care services to individuals, families, or groups are engaging in a clinically oriented practice even when they apply concepts of population-focused, community-oriented strategies along with their direct care clinical strategies.

4. A nurse providing a tertiary prevention intervention to a population of women who are HIV positive will most likely: a. educate about self-care and the women's rights as employees. b. establish a partnership with a community to initiate a community health center. c. help identify new cases and ensure that clients receive proper treatment. d. teach how to lobby state legislators.

ANS: A Helping clients understand their rights to protect from on-the-job discrimination is part of the nurse-advocate role. Tertiary prevention includes educating women with a chronic disease such as HIV about self-care strategies and health-promotion activities to minimize risky behaviors and poor health outcomes. Enhancing levels of self-esteem and empowerment can prevent feelings of powerlessness and hopelessness, which contribute to vulnerability.

6. A recent movie release portrays a female drug user living with her abusive boyfriend, who has two children by different women, in a rundown inner city neighborhood with high levels of poverty and unemployment. This portrayal best describes the influence of which class of factors on societal responses to poverty and homelessness? a. Cultural b. Environmental c. Political d. Social

ANS: A Individual perceptions of poverty and poor persons are rooted in social, political, cultural, and environmental factors. Societal responses to poverty and homeless persons (what actions are taken to assist them) are deeply rooted in history, and that history has helped to shape cultural attitudes. Cultural attitudes affect, and are affected by, the discourses in various media. Portrayals of poor people as lazy and shiftless folk, desperate persons, criminals, and slackers living off of public assistance influence what we believe to be true about poor persons.

8. Congress passed the Balanced Budget Act of 1997 with provisions intended to ensure the appropriateness of home health services for those who received them; however, the act may have increased health disparities for vulnerable populations such as: a. frail older adults. b. low-income families with newborns. c. poor clients discharged from acute care. d. clients requiring intravenous antibiotics.

ANS: A One objective of the balanced Budget Act of 1997 was to curb the rapid growth of home health spending and financial fraud in the home health industry following a shift of hospital reimbursement methods in 1982 (Tax Equity and Fiscal Responsibility Act) through the adoption of prospective reimbursement for home health services. The act's more stringent regulations regarding which services will be reimbursed and for how long may limit access to care for certain vulnerable groups, such as frail older adults, chronically ill individuals whose care is largely home based, and people who are HIV positive.

9. A cultural belief and an environmental factor that may increase the risk of potential pesticide exposure for some migrant workers are: a. hot-cold balance and housing. b. cuarentena and distance from health care services. c. need to achieve high productivity and transportation challenges. d. disease causality and proximity to the farm fields.

ANS: A Some migrant workers may not shower when they return from the fields as a result of cultural beliefs about being exposed to cooler water while feeling hot from working. Inadequate housing that lacks showers and/or adequate laundry machines also prevent farmworkers from washing pesticides off themselves and their clothing in a timely manner. This exposes the farmworker and the entire family to the risk of pesticide exposure.

8. When working with the poor or homeless, to develop effective nursing interventions the nurse should evaluate clients and populations in the context of: a. environment. b. improvement in the quality of services. c. human dignity. d. nursing theories.

ANS: A The foundation of nursing theories is the assumption that human beings have inherent dignity and worth. Nursing is based on valuing individuals, promoting health, respecting and restoring dignity, and improving the quality of life of individuals, families, and aggregates. Conflicts in values, beliefs, and perceptions often arise when nurses work with persons from different social, cultural, and economic backgrounds. A lack of agreement between the professional's and the client's perceptions of need can lead to conflict. As a result of this conflict, clients may fail to follow the prescribed treatment protocol. The nurse may then inaccurately interpret the client's behavior as resistance, lack of cooperation, or noncompliance. Nurses should evaluate clients and populations in the context of the environment to develop effective nursing interventions. Care must be multidimensional and should include consideration of biological, psychological, social, political, cultural, environmental, economic, and spiritual factors.

6. A community health nurse directly contacts a mammography clinic to arrange an appointment for a migrant worker with limited English language skills. The nurse communicates with the client through an interpreter to ensure that the appointment is scheduled to meet her needs and that the client understands the procedure to be performed. The role played by the nurse in this encounter with a member of a vulnerable population can best be described as: a. advocacy. b. empowerment. c. partnership. d. social justice.

ANS: A The nurse functions as an advocate when referring clients to other agencies and ensuring that the clients' preferences are accommodated.

6. The state public health agency has received multiple complaints regarding the availability of elder transportation services to a specific county senior center. The state agency assigns a public health nurse to work with the community to evaluate its program for elder transportation services to publicly sponsored eldercare programs. The public health core function applied is: a. assurance. b. policy development. c. primary prevention. d. public transportation.

ANS: A The public health core function of assurance focuses on the responsibility of public health agencies to be sure that activities are appropriately carried out to meet public health goals and plans. This involves making sure that essential community-oriented health services are available and accessible, especially to vulnerable populations who would otherwise not receive necessary services. Assurance also includes assisting communities to implement and evaluate plans and practices.

7. A nurse case manager identifies a potential health outcomes concern for a 1 year old with special needs living in an impoverished neighborhood, because this child is at increased risk for: a. developmental delays. b. ear infections. c. frequent colds and infections. d. irritability.

ANS: A Young children (0-5 years of age) are at highest risk for the most harmful effects of poverty. Good nutrition during the first years of life is crucial for normal cognitive development. Unfortunately, many children live in poverty during their early childhood years. The brain is directly affected by environmental stimulation during a critical time that extends from the prenatal period through early childhood. Among the risk factors that impede cognitive development in young children are inadequate nutrition, maternal substance abuse, maternal depression, environmental hazards, trauma, and abuse. Unfortunately, poor children often have greater exposure to risk factors such as these. Poverty increases the likelihood of chronic diseases, injuries, traumatic death, developmental delays, poor nutrition, inadequate immunization levels, iron-deficiency anemia, and elevated blood lead levels.

8. The purpose of public health core functions is to: a. Clarify the role of the government in fulfilling the mission of public health. b. Ensure the safety of populations in receiving quality health care. c. Provide community-based individualized care to every person in the United States. d. Unite public and private providers of care in a comprehensive approach to providing health care.

ANS: A As defined by the Institute of Medicine in its 1988 report The Future of Public Health, assessment, policy development, and assurance are core functions at all levels of government for the purpose of clarifying the government's role.

23. Which statement about community health nursing practice is correct? a. It focuses on the delivery of personal health services to individuals and families. b. It provides care to protect the health of the community as a whole. c. It emphasizes the setting where care is provided for clients and families. d. It requires a baccalaureate preparation for practice.

ANS: A By definition, the first option is correct. Public health nursing provides care to protect the health of the community as a whole. Community-based nursing practice emphasizes the setting where care is provided for clients and families. It is generally assumed that a graduate of any baccalaureate program has the necessary basic preparation to function as a beginning staff public health nurse; however, this is not a requirement for public health nursing or community health nursing practices.

22. An example of a community health nursing practice is: a. Administrating a flu shot to a client in a physician's office b. Conducting a flu shot clinic at a community center c. Performing a client assessment in a hospital d. Providing supervision of staff in a rehabilitation center

ANS: A Community health nursing practice focuses on providing individual interventions in the community. Administrating a flu shot to an individual is the only example that meets this criterion.

27. The nurse investigating environmental health problems caused by contaminated ground water is best described as practicing: a. Community-oriented nursing b. Community-based nursing c. Policy development d. Tertiary care

ANS: A Community-oriented nursing emphasizes the prevention of disease and disability.

10. Collecting data and monitoring the health status of the population defines which of the core public health functions? a. Assessment b. Prevention c. Assurance d. Policy development

ANS: A Prevention is not a core function, assurance is making sure essential services are available, and policy development is needed to provide leadership in developing policies. Assessment consists of systematic data collection and monitoring health status.

33. Proposed changes to the health care delivery system in the United States will: a. Provide new opportunities for public health specialists. b. Result in isolated care being provided to individuals. c. Emphasize specialty care. d. Increase the utilization of acute care services.

ANS: A Proposed changes in the health care delivery system will provide new opportunities for public health specialists and result in the creation of new roles within the system. The proposed changes will build an integrated system (not isolated), decrease emphasis on acute care services, and focus on health promotion and disease prevention.

18. Public health nursing is a specialty because: a. It has a distinct focus and scope of practice. b. It must be done by a registered nurse with a master's degree. c. It is focused on disadvantaged citizens. d. It performs interventions at the acute care level.

ANS: A Public health nursing has a distinct focus and requires a special knowledge base. The other answers are not characteristics of a specialty.

7. The number and proportion of persons aged 25 or older with less than a high school education is an example of: a. Sociodemographic characteristics b. Health status c. Health risk factors d. Health care resource consumption

ANS: A The number and proportion of people is a demographical characteristic.

MULTIPLE RESPONSE 1. Effects of homelessness on health care outcomes can be devastating and may include which of the following? (Select all that apply.) a. Higher incidence of acute and chronic disease b. Higher risk of physical trauma c. Crisis-oriented health care, usually in emergency departments d. Reduced eligibility for entitlement/assistance programs e. Lack of awareness of care options

ANS: A, B, C, E Homelessness is correlated with poor health outcomes. The incidence of acute and chronic illness, acquired immune deficiency syndrome (AIDS), and trauma is significantly higher among homeless persons. Although homeless persons are at higher risk for physiological problems, they have greater difficulty accessing health care services. Health care is usually crisis oriented and sought in emergency departments, and those who access health care have a hard time following prescribed regimens. Health problems of homeless clients are often directly related to poor preventive health care services. In addition to facing challenges related to self-care, homeless people usually give lower priority to health promotion and health maintenance than to obtaining food and shelter. They spend most of their time trying to survive. Just getting money to buy food is a major challenge. Although some homeless persons are eligible for entitlement programs such as Temporary Assistance for Needy Families (TANF), Women, Infants, and Children (WIC), or Social Security, others must beg for money, sell plasma or blood products, steal, sell drugs, or engage in prostitution. Barriers to treatment include lack of awareness of treatment options, lack of available space in treatment facilities, inability to pay for treatment, lack of transportation, nonsupportive attitudes of service providers, and lack of coordinated services.

7. Health education is often used as a strategy in working with vulnerable populations. The benefits of health education can be greatly affected by the individual's or group's: a. cycle of dependency. b. health literacy. c. level of income. d. race and ethnicity.

ANS: B A new concern for public and community health nurses is whether the populations with whom they work have adequate health literacy to benefit from health education. Health literacy is a measure of the client's ability to read, comprehend, and act on medical instructions. It may be necessary to collaborate with an educator, an interpreter, or an expert in health communications to design messages that vulnerable individuals and groups can understand and use.

1. The population group that is likely to be the MOST vulnerable is: a. children with a family history of sickle cell disease and hypertension. b. homeless pregnant teens in a substance abuse program. c. nNative Americans at risk for diabetes. d. overweight children.

ANS: B A vulnerable population group is a subgroup of the population that is more likely to develop health problems as a result of exposure to risk and to have worse outcomes from these health problems than the rest of the population. That is, the interaction among many variables creates a more powerful combination of factors that predispose the person to illness. Vulnerable populations often experience multiple cumulative risks, and they are particularly sensitive to the effects of those risks. Examples of vulnerable populations of concern to nurses are persons who are poor and homeless, people with special needs, pregnant teens, migrant workers and immigrants, individuals with mental health problems, people who abuse addictive substances, persons who have been incarcerated, persons with communicable diseases and those who are risk, and persons who are human immunodeficiency virus (HIV) positive or have hepatitis B virus or sexually transmitted diseases (STDs).

2. The nurse case manager in a migrant farmworker clinic assesses this vulnerable population from the perspective of occupational and environmental risks related to: a. contaminated water, applied chemicals, and unfamiliar farm equipment. b. naturally occurring plant substances, pesticides, and fear of injury reporting. c. traffic accidents, weather, lack of worker supervision, and inadequate sewage. d. weather, pesticides, and strict enforcement of occupational regulations.

ANS: B Annually agricultural work ranks in the top four most dangerous occupations in the United States. Migrant farmworkers are exposed to weather because they work outside in the elements, very often for long hours, and typically live in inadequate housing. Exposure to both naturally occurring plant substances and applied chemicals such as pesticides places farmworkers at risk of immediate health problems (contact dermatitis, allergies, and conjunctivitis) and long-term health effects (lung diseases and cancer). Workers may not receive adequate training regarding the use of mechanical equipment, and the equipment may not be properly maintained. The workers' low educational level may impede their ability to comprehend essential training or warnings. In most states, migrant farmworkers are not protected by the same occupational health regulations and worker's compensation benefits as workers in other industries. Workers may fear loss of their jobs if they report injuries and may not be able to afford personal protective equipment.

2. Which of the following best represents the concept of homelessness as crisis poverty? a. Man with chronic alcoholism and drug abuse living in a halfway house b. Recently unemployed man evicted from his apartment c. Teenager living on the streets and abusing drugs d. Woman with schizophrenia who is living in a shelter

ANS: B Crisis poverty is a conception of homelessness that views the homeless as people whose lives are generally marked by hardship and struggle. For this group, homelessness is often transient or episodic. Their homelessness may result from lack of employment opportunities, lack of education, obsolete job skills, and/or domestic violence.

5. A migrant worker comes to the migrant health clinic holding the abdomen and complaining of empacho. The nurse may encounter this complaint when dealing with migrant workers who are: a. natives of Guatemala. b. natives of Mexico. c. natives of Panama. d. newly arrived from Haiti.

ANS: B Four common folk illnesses that a nurse may encounter when working with clients from Mexico are mal de ojo (evil eye), susto (fright), empacho (indigestion), and, for infants, caida de moller (fallen fontanel). Symptoms and folk treatments may vary depending on the individual's or family's place of origin in Mexico. When experiencing a folk illness, the traditional Mexican individual would prefer to seek care from a folk healer. The more common healers are curanderos, herbalists, and espiritualistas. The most common herbs used by the folk healers are chamomile (manzanilla), peppermint (yerba buena), aloe vera, nopales (cactus), and epazote. The nurse needs to ask clients what herbs and other remedies they have tried to help with their symptoms. Use of some herbs with prescribed medication may be contraindicated, and the nurse needs to include that information in client counseling. Any client counseling should incorporate awareness of and sensitivity to the client's culture.

1. A nurse volunteering at a local homeless shelter notes that many of the clients have acute and chronic illnesses and are in need of primary health care services. The most effective strategy to consider when networking with homeless individuals, families, or populations is to: a. form a community partnership to establish a clinic for homeless persons. b. create a trusting environment and establish a therapeutic relationship. c. collaborate with the local United Way to obtain funding for primary care services. d. dialogue with local clergy to address the unmet primary care need for homeless persons.

ANS: B Nurses need to be able to work with poor and homeless clients to promote, maintain, and restore health. Nurses must be prepared to look at the whole picture: the person, the family, and the community interacting with the environment. In working with the homeless, it is important to create a trusting environment. Trust is essential to the development of a therapeutic relationship with poor or homeless persons. Many clients and families have been disappointed by interactions with health care and social systems. They are now mistrustful and see little hope for change. Establishing a trusting relationship lays the foundation for a more comprehensive assessment of clients' perception of their health care needs and a determination of factors that may contribute to their current health status issues.

9. An unemployed individual with acquired immune deficiency syndrome (AIDS) develops recurrent opportunistic infections that require repeated visits to the health clinic and the purchase of various medications to combat the infections and treat their associated side effects. This best demonstrates how the stress caused by poor health status can be related to: a. barriers to access. b. cascade effects. c. cumulative risk. d. socially based inequity.

ANS: B Poor health status creates stress. Vulnerable populations cope with multiple stressors, and this creates a cascade effect, with chronic stress likely to result. Chronic stress can lead to feelings of hopelessness. Hopelessness results from an overwhelming sense of powerlessness and social isolation that contributes to a continuing cycle of vulnerability. Each factor, such as lack of employment, lack of insurance or underinsurance, the disease process, transportation challenges, limited resources, and complications of treatment can predispose individuals to poor health status. The outcomes of vulnerability reinforce the predisposing factors, which leads to more negative outcomes. This cycle of vulnerability must be broken in order for vulnerable populations to change their health status.

9. Nurses should consider opportunities for population-focused practice that result from the rapid transformation of health care delivery from a medical model to a health promotion/disease prevention model. An example of such opportunity is: a. operator of a nurse practitioner-run urgent care center in a major retail location. b. director of clinical services spanning inpatient and community-based settings that provide a wide range of services to the populations seen by the system. c. clinical director of a home health agency. d. school nurse position in the local high school.

ANS: B The new focus on populations, coupled with the integration of acute, chronic, and primary care occurring in some health care systems, is likely to create new roles for individuals, including nurses, who will span inpatient and community-based settings and focus on providing a wide range of services to the populations served by the system. Such a role might be director of client care services for the health care system, who has administrative responsibility for a large program area. There will be a demand for individuals who can design programs of preventive and clinical services to be offered to targeted subpopulations and for those who can implement such programs.

5. A nurse working in a clinic in an inner city with high poverty and unemployment rates recognizes the need for programs for women because impoverished women are at higher risk for: a. decreased access to social services. b. poorer health status. c. exposure to environmental toxins. d. poorer academic success.

ANS: B The relationship between poverty and health is significant. Poverty presents a formidable obstacle to positive health across the life span. Those in lower income groups have poorer health status, and those with poor health have decreased ability to work and improve their socioeconomic status.

3. Population-based preventive programs launched in the 1970s are responsible for increased: a. Use of tobacco b. Use of automobile safety restraints c. Incidence of hypertension d. Incidence of obesity

ANS: B One outcome of preventive programs launched in the 1970s is the increased use of automobile safety restraints. These programs also are responsible for the decreased use of tobacco and improved blood pressure control. None of these programs addressed the incidence of obesity.

MULTIPLE RESPONSE 1. The community health nurse can serve as an advocate for the vulnerable migrant population by engaging in which of the following actions? (Select all that apply.) a. Becoming culturally and linguistically competent b. Collecting necessary data on migrant workers' lifestyle and health status c. Educating communities about the migrant workers in their areas d. Educating policymakers about successful programs for migrant workers e. Using lay health workers to provide health education in migrant camps

ANS: B, C, D Nurses can serve as social and political advocates for migrant populations. Educating communities regarding these individuals, collecting necessary data on their lives and health, and communicating with legislators and other policymakers at local, state, and national levels are necessary actions that nurses are prepared to undertake.

MULTIPLE RESPONSE 1. Vulnerable population groups are those that, in comparison with the population as a whole, have which of the following characteristics? (Select all that apply.) a. Better access to health care services but poor health outcomes b. Greater likelihood of exposure to risk factors c. Multiple risk factors but equal health outcomes d. Worse health outcomes

ANS: B, D Vulnerable populations are defined as those at greater risk for poor health status and health care access. In health care, risk is an epidemiologic term indicating that some people have a higher probability of illness than others. The natural history of disease model explains how certain aspects of physiology and the environment make it more likely that a certain individual will develop a particular health problem. However, not everyone who is at risk develops health problems. Some individuals are more likely to develop the health problems for which they are at risk. A vulnerable population group is a subgroup of the population that is more likely to develop health problems as a result of exposure to risk or to have worse outcomes from these health problems than the rest of the population.

3. The definition of a migrant farmworker includes which of the following? a. Farmer who helps his neighbors on their farms after his own crop fails b. High school student who works part time at his uncle's rose farm c. Teenager who moved with his family ten times in 2 years to work different crops d. Woman who works in the crop fields in the summer and at a grocery store in thewinter

ANS: C According to the Department of Labor, a migrant farmworker is a seasonal farmworker who had to travel to do the farm work and was unable to return to a permanent residence within the same day. A seasonal farmworker returns to his permanent residence, worked in agriculture for at least 25 days or parts of days and did not work year round only in agriculture.

4. The role and goals of the community health nursing practice can best be described as: a. community-based interventions aimed at promoting, preserving, and maintaining the health of populations residing in institutional facilities such as nursing homes. b. education of nurses and other staff working in community-based and community-oriented settings to improve the overall effectiveness of their programs to meet client needs. c. population-level strategies aimed at promoting, preserving, and maintaining the health of populations through the delivery of personal health care services to individuals, families, and groups in an effort to improve the health of the community as a whole. d. activities targeted at improving the health status of clients served by community-based health service agencies such as hospice and home health agencies.

ANS: C Community health nursing practice is the synthesis of nursing theory and public health theory applied to promoting, preserving, and maintaining the health of populations through the delivery of personal health care services to individuals, families, and groups. The focus of community health nursing practice is the health of individuals, families, and groups and the effect of their health status on the health of the community as a whole (individual to families to groups to community flow). This is different from public health nursing, which is the synthesis of nursing theory and public health theory applied to promoting and preserving the health of populations. The focus of public health nursing practice is the community as a whole and the effect that the community's health status, including health care resources, has on the health of individuals, families, and groups (community to groups to families to individual flow). Both community health and public health nursing are considered to be community-oriented practices involving free-living (noninstitutionalized) clients. Community-based nursing practice is setting specific, and care is provided to clients where they live (home health or hospice nursing, community-based clinic), work (occupational health nursing), and/or attend school (school nursing). The emphasis of community-based nursing practice is acute and chronic care (illness care) and the provision of comprehensive, coordinated, and continuous services, usually within a specialty area.

4. Within the impoverished older adult population, the most vulnerable group may be: a. elderly couples living in poverty with serious chronic illnesses. b. elderly men with alcoholism and limited incomes. c. homeless older adults. d. newly widowed, low-income elderly women.

ANS: C Homeless older adults are the most vulnerable of the impoverished older adult population. They have long lived in poverty, have fewer supportive relationships, and are likely to have become homeless as a result of catastrophic events. Life expectancy for homeless older adults is significantly lower than that for older housed adults. Permanent physical deformities, often secondary to poor or absent medical care, are common among homeless older adults. Homeless older adults suffer from untreated chronic conditions, including tuberculosis, hypertension, arthritis, cardiovascular disease, injuries, malnutrition, poor oral health, and hypothermia. As with younger homeless persons, older adults who are homeless must focus their energy on survival, which leaves little time for health promotion activities.

6. An undocumented migrant farmworker has been diagnosed with TB. The local health department initiates treatment by dispensing the first month's supply of medication and educates the client on the need to continue treatment for 6-12 months. A major challenge that the client may face to ongoing treatment for TB is: a. affordable care. b. discrimination. c. fragmented services. d. language barriers.

ANS: C Many factors limit adequate provision of health care services to migrant farmworkers, such as lack of knowledge regarding services, inability to afford care, lack of availability of services, lack of transportation, inconvenient hours of health service facilities, mobility and difficulty in tracking the client, discrimination, lack of documentation, lack of English language skills, and cultural aspects of health care. When migrant families move from job to job, their health records do not typically go with them, which leads to fragmentation of services in such areas as TB treatment, chronic illness management, and immunization.

7. The local hospital emergency department has recently noted an increase in gastroenteritis cases among migrant farmworkers. The local health department is informed of the rise in cases and schedules a case mapping of: a. bars frequented by migrant workers. b. farm fields employing migrant workers. c. housing for migrant workers. d. restaurants frequented by migrant workers.

ANS: C Migrant farmworkers often have trouble finding decent and affordable housing. Housing conditions vary between states and localities. Because housing may be expensive, 50 men may live in one house or three families may live in one trailer. Not only may conditions be crowded, but also housing may lack individual sanitation, bathing, or laundry facilities; provide poor cooking/refrigeration facilities; and lack window screens, fans, or heaters. Infectious diseases caused by poor sanitary conditions at work or home, poor-quality drinking water, and contaminated foods may take the form of acute gastroenteritis and parasite infestations.

5. After performing an assessment of a client seeking treatment for hypertension at the local free clinic, the nurse informs the client that the family's children may qualify for enrollment in the state children's health insurance program. The nurse provides the enrollment forms and reviews them with the client, emphasizing how to apply for the benefits. This best exemplifies which principle for intervening with vulnerable populations? a. Carrying out primary prevention b. Setting family-centered, culturally sensitive goals c. Trying to minimize the "hassle factor" d. Using the MAP-IT approach

ANS: C Nurses empower clients by helping them acquire the skills needed to engage in healthy living and to be effective health care consumers. Vulnerable individuals and families may need to go to multiple agencies to find the services for which they qualify, because agencies tend to be specialized instead of comprehensive in their service approach. More agencies are needed that provide comprehensive services with nonrestrictive eligibility requirements. Outreach and case finding are important roles for the nurse in reducing health disparities. One of the principles of intervening with vulnerable populations is to try and minimize the "hassle factor."

3. Vulnerability is multidimensional, and one of the primary contributors to vulnerability is: a. gender. b. race and ethnicity. c. resource limitations. d. urban or rural residency.

ANS: C Resource limitations are strongly related to health. Lack of adequate social, educational, and economic resources make people more vulnerable and more likely to experience health disparities, and poverty is a primary cause of vulnerability. A correlation has been found between individual indicators of socioeconomic status (e.g., income, education, and occupational status) and a range of health indicators (e.g., morbidity and mortality resulting from various health problems). Not only do individual-level socioeconomic characteristics seem to matter, but population-level characteristics such as income inequality also make a difference. Resource limitations affect the individual's ability to show resilience in the face of problems and crises. Resource limitations may also place individuals and families at risk because of substandard housing, impoverished neighborhoods, and hazardous environments. Although race has been correlated with poor health outcomes, poverty seems to be a key contributing factor for minority populations. Poverty is more likely to affect women and children than other groups.

8. A community health nurse seeks to enhance the health promotion and health-service-seeking behaviors of the migrant farmworkers in local apple orchards. An evidence-based strategy that would be effective for this mobile population is educating: a. advocacy groups for migrant farmworkers. b. local policymakers. c. migrant lay health workers. d. workers seeking care at the migrant health clinic.

ANS: C The nurse can teach health-promotion strategies and strategies for obtaining health services to members of the migrant community, who, in turn, become empowered as lay health care workers to provide education and outreach to the migrant community as it moves from place to place. Several migrant health programs have recruited migrant workers to serve as outreach workers and lay camp aides to assist in outreach and health education of the workers. Outreach programs succeed because they recognize the diversity of vulnerable groups and the need for flexibility in the provision of services. Because these outreach workers are members of the migrant community, they are trusted and know the culture and the language. Nurses can be a part of the planning and teaching for outreach programs.

4. The migrant clinic's mobile van program provides health education through lay health workers; screening for pesticide illness, tuberculosis (TB), and diabetes; pregnancy testing; and treatment for some acute and chronic illnesses typically seen in this vulnerable population. In dealing with this population's beliefs about disease causality, this program demonstrates the application of the health promotion and disease prevention principle of: a. advocacy. b. cultural competency. c. outreach. d. primary prevention.

ANS: C The same principles of health promotion and prevention apply to migrant farmworkers as to the rest of the U.S. population. However, health promotion and disease prevention as presented by nurses may be difficult concepts for migrant workers to embrace because of their beliefs regarding disease causality, their irregular and episodic contact with the health system, and their lower educational level. Health promotion begins by informing the farmworker family about health topics and the resources available to improve health. Several migrant health programs have recruited migrant workers to serve as outreach workers and lay camp aides to assist in outreach and health education of the workers.

2. A registered nurse is seeking a position as a public health nurse. In reviewing the job description, the nurse would expect to find a description of a position that focused on functions such as: a. monitoring pregnant teenagers for symptoms of complications of pregnancy. b. offering free hypertension screening and treatment referral at local health fairs to low-income, uninsured, community members. c. partnering with local seasonal farmworkers to design a program aimed at preventing illness and injury, and advocating for this population with local political and community leaders. d. preventing injury among a population of elderly residents in an assisted living facility and treating residents' chronic illnesses.

ANS: C The scope of practice of public health nurses is population focused and community oriented, with a primary emphasis on population-level interventions that target strategies for health promotion and disease prevention. In addition, public health nursing is concerned with the health of all members of a population or community, particularly vulnerable populations, and uses political processes as a major intervention strategy.

1. In caring for migrant workers and their families, the nurse should first assess the migrant workers' lifestyle, especially their current: a. communicable diseases. b. educational level. c. housing arrangements. d. pesticide exposure.

ANS: C The way of life of migrant farmworkers and their families is stressful. They often have trouble finding decent and affordable housing. Available housing is often overcrowded and lacking in individual sanitation, bathing or laundry facilities, window screens, and fans or heaters. Housing may be located in hazardous areas next to fields or farm machinery. Housing may be rundown or structurally deficient. Some families may be living in cars or tents when housing is unavailable. All of these factors impact the health status of migrant families and need to be understood by the nurse to direct further assessment.

2. In an effort to decrease health disparities and improve life expectancy, the Social Security Act was amended in 1998 to provide federal funding to: a. assure access to health care for elderly Americans. b. build hospitals to care for the medically indigent. c. insure children without health insurance. d. provide supplementary income for citizens with disabilities.

ANS: C Title XXI of the Social Security Act, passed in 1998, established the State Children's Health Insurance Program to provide funds to insure currently uninsured children. Legislation enacted subsequently provided for new outreach and case-finding efforts to enroll eligible children in Medicaid.

9. To provide effective care and advocacy for individuals, families, and populations living in poverty, nurses must first: a. apply epidemiologic principles for prevention. b. develop resource expertise in the community. c. examine their personal beliefs, values, and experiences. d. understand the federal criteria and guidelines for poverty.

ANS: C To provide effective care and advocacy for individuals, families, and populations living in poverty, nurses need to understand poverty as a concept with historical, social, political, economic, biological, psychological, and spiritual dimensions. Understanding the concepts of poverty and homelessness begins with an examination of one's own beliefs, values, and personal experience.

6. Making sure that essential community-oriented health services are available defines which of the core public health functions? a. Policy development b. Assessment c. Assurance d. Scientific knowledge-based care

ANS: C Public health is based on scientific knowledge, but is not a core function. The definition does not fit the terms assessment or policy development.

30. Which of the following statements is true with regard to a population focus in public health nursing? a. Priority is given to the highest risk population. b. Direct caregiving is limited to preventive measures, such as administration of immunizations. c. Attention is given to the population or community as a whole, regardless of whether they do or do not access the health care system. d. Only populations outside institutional settings are considered.

ANS: C Public health nurses are concerned with the health of the entire population.

31. A public health staff nurse who has a clear understanding of population-focused practice: a. Is frustrated providing care to individuals b. Would rather perform population-focused interventions c. Is able to improve the effectiveness of care provided d. Is considered a public health nurse specialist

ANS: C Public health staff nurses who have a clear understanding of population-focused care improve their effectiveness and efficiency of practice; have professional satisfaction by seeing how individual care contributes to health at the population level; and appreciate the practice of others who are population-focused specialists. Public health nurse specialists are prepared at the master's level and function in an administrative role.

16. Which is an example of the primary goal of public health? a. Ensuring that a newly diagnosed 40-year-old hypertensive man takes his medication b. Finding home care for a 70-year-old client recuperating from a hip replacement c. Conducting an infant car seat safety check d. Contacting a local hospice to admit a terminally ill 60-year-old woman

ANS: C The correct answer is concerned with the health of many people, while the other answers address individual interventions.

4. The public health nurse must participate in the essential services of public health. These include: a. Monitoring health status by completing a community assessment b. Diagnosing and investigating health problems in the world c. Informing, educating, and empowering people about health issues d. Working in law enforcement to regulate health and ensure safety

ANS: C The public health nurse monitors health status in several ways, completing a community assessment is only one way that health status is monitored. The public health nurse would not diagnose or solve "world" problems, or work in law enforcement. Rather, the public health care nurse would participate with local regulators to protect communities and empower people to address health issues.

28. A population is best defined as a: a. High-risk group b. School or institutional setting c. Collection of individuals who share at least one common characteristic d. Geographical location within a community

ANS: C The wrong answers are types of populations; they do not define a population.

21. A public health nurse provides a clinic for HIV-positive citizens in the community. This is an example of: a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Policy making

ANS: C This clinic is for clients who already have a disease process; therefore, it is tertiary prevention.

3. A public health nurse leader is encountering barriers when trying to shift the public health agency's efforts to a population-focused practice. The reasons peers are not supportive of the proposed shift to a population focus are most likely related to: a. agency colleagues' push for nurses to focus on population initiatives. b. costs associated with staff training and revision of documents. c. lack of support from the agency's funding sources. d. opinions that nursing should focus on the provision of direct client care and services.

ANS: D Barriers to implementing population-focused care include lack of understanding of the public health nurse role and its relationship to other roles in nursing, such as direct care and services; workplace role socialization that determines what roles are appropriate and inappropriate or accessible and inaccessible for nurses; and lack of comprehensive training at the graduate level in the disciplines basic to public health such as epidemiology, biostatistics, community development, service administration, and policy formation.

3. Deinstitutionalization of chronically ill individuals from publicly funded psychiatric hospitals had the unintended consequence of: a. moving clients to readily available community-based care. b. shortening hospital stays in mental health facilities. c. increasing the funding for community-based services. d. increasing the number of homeless persons.

ANS: D Deinstitutionalization of chronically mentally ill individuals from public psychiatric hospitals increased the number of homeless persons. The intent was to move clients from public psychiatric hospitals to community-based treatment centers. However, adequate community-based services were not funded. Few of the intended community mental health centers were ever built.

1. In 1988, the Institute of Medicine (IOM) published a report on the future of public health and its mission that defined public health as: a. what public-private partnerships do to treat vulnerable populations. b. what the government does to ensure that vital programs are in place. c. what the U.S. Public Health Service does to prevent disease, promote health, and deliver services. d. what society does collectively to ensure the conditions in which people can be healthy.

ANS: D In 1988, the IOM's report stated that public health is "what we, as a society, do collectively to assure the conditions in which people can be healthy." Consequently, the mission of public health is "to generate organized community effort to address the public's interest in health by applying scientific and technical knowledge to prevent disease and promote health." This clearly places the emphasis on the desire of the population and community to ensure access to services that foster the health status of the overall community through the equitable distribution of resources addressed to community problems that affect health.

25. The nurse who conducts vision screenings on children in the school setting is practicing _____ nursing practice. a. Community-oriented b. Public health c. Community health d. Community-based

ANS: D This type of nursing is a setting-specific practice.