Evolve Questions Exam 1 -Community Health
The nurse must ask about violence at each prenatal and postpartum visit, especially with vulnerable populations such as teenagers, as well as observe for signs of violence on each visit. The nurse should be aware that the peak for postpartum intimate partner violence may be observed at various times according to ethnic group, such as: 6 months for white mothers. 10 months for white mothers. 3 months for African-American and Hispanic/Latino mothers. 12 months for African-American and Hispanic/Latino mothers.
3 months for African-American and Hispanic/Latino mothers.
The historical nursing figure who contributed to establishing the foundation for current community health and nursing in community health by working in military field hospitals using a population-based approach that improved nursing care and environmental conditions was: A. Florence Nightingale. B. Frances Root. C. Lillian Wald. D. Mary Breckinridge.
A. Florence Nightingale.
In 1902 Lillian Wald introduced the concept of school nursing to address the problem of student absenteeism by: A. enforcing the Department of Health's rules and regulations. B. excluding infectious children from the school environment. C. providing and obtaining medical treatment for absent students. D. providing shoes and clothing for absent students.
C. providing and obtaining medical treatment for absent students. In New York City in 1897, school medical examination focused on excluding infectious children from school. By 1902, more than 20% of children might be absent from school on any given day because no one was focused on providing or obtaining medical treatment so that absent children could return to school. Lillian Wald introduced an English innovation by providing nurses for schools. The first school nurses made home visits to teach parents and provide follow-up care to children absent from schools.
A district health nurse is assigned to two rural counties in the state. To achieve the best outcomes possible in reducing the health disparities for the large number of frail older clients in the two counties, the nurse should consider using what community-oriented nursing skill? Assessment Case management Geriatrics Tertiary prevention
Case management
The public health nurse deals with the examination of a community setting to determine the community's health status. Which of the following activities should be considered in the assessment phase? Select all that apply. Assisting communities to implement and evaluate plans and projects Building constituencies to work with the community Collecting, analyzing, and disseminating information Evaluating the social, economic, and environmental characteristics of the population Questioning the availability of health services to the community
Collecting, analyzing, and disseminating information Evaluating the social, economic, and environmental characteristics of the population Questioning the availability of health services to the community The core public health function of assessment includes the following: · Engaging in activities that involve the collection, analysis, and dissemination of information on both the health and health-relevant aspects of a community or specific population · Questioning, for example, whether the health services of the community are available to the population and are adequate to address needs · Monitoring the health status of the community or population and the services provided over time · Evaluating the social, economic, environmental, and lifestyle characteristics and practices of a population as well as the health services and capability available within the community to support good health for the population
A nurse planning a smoking cessation clinic for adolescents in the local middle schools and high schools is providing: community-oriented care. community-based care. secondary care. tertiary care.
Community oriented care Community-oriented nurses emphasize health protection, maintenance, and promotion and disease prevention, as well as self-reliance among clients. Regardless of whether the client is a person, a family, or a group, the goal is to promote health through education about prevailing health problems, proper nutrition, beneficial forms of exercise, and environmental factors such as safe food, water, air, and buildings. Community-based care is nursing care that is provided in a setting. A smoking cessation clinic is an example of primary prevention, not secondary or tertiary.
A nurse performing home hospice case management notes the increasing number of hospice clients that lack caregivers in the home environment. The nurse identifies the potential need for a hospice house facility to meet the needs of these clients. The case management process frequently reveals such larger picture issues as: (select all that apply) Select all that apply. Community cost concerns Community conflict-resolution skills Community satisfaction Community weaknesses in quality of services Community weaknesses in quantity of services
Community weaknesses in quality of services Community weaknesses in quantity of services
The community health nurse performs an assessment of violence by observing which of the following community characteristics? Select all that apply. Presence of social support networks Crime rates Levels of unemployment Presence of physical disabilities in individuals Presence of family violence
Crime rates Levels of unemployment
A recent movie release portrays a criminal as a black female drug user whose abusive boyfriend has two children by different women. She lives in the riot-torn inner city of a large metropolitan area. This best demonstrates what type of factor that influences poverty? Cultural Environmental Political Social
Cultural
Which of the following best supports the concept of community-oriented nursing practice? Select all that apply. Direct nursing care of individuals with tuberculosis (TB) Hospice home care for a terminally ill individual and family Nursing interventions to stop elder abuse Nutrition education programs for teenagers and their families Wound care for a homebound individual
Direct nursing care of individuals with tuberculosis (TB) Nursing interventions to stop elder abuse Nutrition education programs for teenagers and their families
A nurse in community health conducting a home visit notices a 4-year-old girl sitting on a stool in an adjoining room. The girl is quiet and withdrawn, rarely makes eye contact, and does not leave the room. The nurse proceeds to ask about the child and attempts to engage the child in conversation. The nurse is assessing for what indicators of child abuse? Emotional abuse Emotional neglect Physical abuse Physical neglect
Emotional neglect
Rural residents appear to have a more persistent, endemic level of depression. The factors that may contribute to this level of depression may be related to which of the following? Select all that apply. Crisis intervention Gaps in continuum of mental health services Sufficient number of mental health services Tolerance for destructive coping behaviors Trust in the health care professionals
Gaps in continuum of mental health services Tolerance for destructive coping behaviors
A nurse in community health is participating in a community service board strategic team that is currently assessing the community's strengths, the local public mental health system, the community's mental health status, and other variables. This best describes what strategic program planning model used today in the public health arena? Assessment Protocol for Excellence in Public Health (APEXPH) Health Evaluation Data Information System (HEDIS) Mobilizing for Action Through Planning and Partnership (MAPP) Planning Approach to Community Health (PATCH)
MAAP
Marijuana (Cannabis sativa or C. indica) is the most widely used illicit drug in the United States. The nurse should be aware that marijuana has which of the following characteristics? Select all that apply. Decreases appetite May lead to tolerance Is highly toxic Has little quality control Is a safe therapeutic agent
May lead to tolerance Has little quality control Is a safe therapeutic agent
Methadone maintenance for heroin addiction is a harm reduction strategy because it reduces deviant behavior and introduces addicted persons to the health care system. What is a disadvantage to the use of Methadone? Methadone is inexpensive. Methadone carries a risk of overdose. Methadone prevents relapse. Methadone is long acting and effective orally.
Methadone carries a risk of overdose.
When using the health measure of death rates for working-age adults, the nurse could expect to find the highest rates in which areas? Large metropolitan areas Most rural and highly populated urban areas Most rural and suburban areas Small suburban and all urban areas
Most rural and highly populated urban areas
A nurse functioning in the role of a case manager performs which of the following functions in the care delivery process? Select all that apply. Risk analysis Data mapping Provision of illness care Epidemiologic investigation of unexpected illnesses Counseling and education
Risk analysis Data mapping Epidemiologic investigation of unexpected illnesses
A client diagnosed with human papillomavirus (HPV) states to the nurse, "I'm not concerned; I know the lesions disappear after a while." The nurse should counsel the client on which of the following? Select all that apply. The link between HPV and cervical cancer The fact that HPV is a reportable disease The need to surgically remove tumors, if present The serious complications for men The lack of a cure
The link between HPV and cervical cancer The need to surgically remove tumors, if present The lack of a cure
A 3-year smoking cessation program for teens has just concluded. The type of evaluation the staff will conduct is:
a summative eval
In giving care to the survivors of violence, the nurse should demonstrate respect and caring for all family members, insist that safety is the first priority, and demonstrate intolerance for violent behavior. Additionally, the nurse should be: absolutely honest about what will be reported and what the family can expect. authoritarian in approaching the problem. cautious in reporting unconfirmed reports of violence. sincere in concern for the victims.
absolutely honest about what will be reported and what the family can expect.
Immunity to disease through vaccination is known as: natural immunity. resistance. acquired immunity. herd immunity.
acquired immunity
A nurse in community health directly contacts a mammography clinic to arrange an appointment for a female migrant worker with limited English language abilities. The nurse communicates with the client through an interpreter to ensure that the client's appointment is scheduled to meet her needs and that the client understands the procedure to be performed. This strategy used with vulnerable populations can best be described as: advocacy. culturally competent care. partnership. social justice.
advocacy
A nurse coordinating care for undocumented minority workers with a high incidence of tuberculosis (TB) conducts a presentation before the local community health board to focus attention on the magnitude of the problem and its potential impact on the local community. The presentation stimulates the community to explore innovative solutions to increase screening for and treatment of TB cases. This scenario is an example of the relationship between: advocacy and case management. advocacy and continuity of care. care management and case management. care management and continuity of care.
advocacy and case management.
An American takes a long-awaited vacation in sunny Mexico, spending days on the beach eating fresh raspberries from a nearby vendor and drinking bottled water. The tourist may be altering: agent-host-environment interaction. circadian rhythms. herd immunity. resistance.
agent-host-environment interaction.
The nurse in community health identifies an elder abuse problem because of caregiver stress among families in the local community resulting from lack of caregiver support services. The next step in the community-oriented nursing process would be to: analyze the community problem. establish priorities. establish goals and objectives. identify intervention activities.
analyze the community problem
Nurses in community health conducting health education classes for populations vulnerable to HIV/AIDS should explain the natural history of the progression of human immunodeficiency virus (HIV). Of particular importance is the fact that the disease may go undetected during the primary infection phase because: antibody tests are typically negative. the immune system increases antibody production. the incubation period is prolonged. symptoms include myalgias, sore throat, and rash.
antibody tests are typically negative.
For a nurse to develop a therapeutic attitude toward the treatment of alcohol, tobacco, and other drug (ATOD) problems in the community, the nurse must realize drug addiction can be successfully treated, anyone may develop drug dependence, and: any drug can be abused. illegal drugs are the category of abused drugs. prescription drugs rarely cause dependence. over-the-counter (OTC) drugs are "good drugs."
any drug can be abused
A parent involved in conflict resolution with her teenager says, "I know that some of your friends stay out until midnight, but I think it is best if you are in at 10 o'clock." This statement, a behavior seen in conflict situations, is an example of: negotiation. cooperation. assertiveness. aggressiveness.
assertiveness
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 public health core function of: assessment. assurance. policy development. research.
assessment The three public health core functions are assessment, policy development, and assurance. Assessment is systematic data collection on the population, monitoring the population's health status, and making information available about the health of the community. Policy development refers to efforts to develop policies that support the health of the population, including using a scientific knowledge base to make policy decisions. Assurance is making sure that essential community-oriented health services are available. These services might include providing essential personal health services for those who would otherwise not receive them. Assurance also includes making sure that a competent public health and personal health care workforce is available.
When acting as a mediator, the nurse advocate would: choose a new health plan for a client with limited funds. assist new parents in communicating with their health plan regarding well-baby coverage. provide health education to teens who need knowledge about sexually transmitted diseases. set up a doctor's appointment for an illiterate adult.
assist new parents in communicating with their health plan regarding well-baby coverage.
A state 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 elder care programs. The public health core function applied is: assurance. policy development. primary prevention. public transportation.
assurance 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 role requires skill in assessment, investigative functions, collaboration, consultation, and cooperation. Assurance also includes assisting communities to implement and evaluate plans and projects. Policy development refers to efforts to develop policies that support the health of the population, including using a scientific knowledge base to make policy decisions. Primary prevention does not focus on provision of services and a part of assurance is assisting communities to obtain necessary services such as transportation.
A case manager is concerned that some of the clients at the neighborhood clinic are getting fewer services because of their financial situations. The case manager is confronting the ethical principle of: justice. veracity. deontology. beneficence.
beneficence
Universal Precautions is a policy for all health care settings, where potential contact with blood or other body fluids exists, and requires that health care workers always perform hand hygiene and wear gloves, masks, protective clothing, and other indicated personal protective barriers. The underlying strategy for this policy requires that: blood and body fluids of all clients be handled as if infected. health care workers effectively use hand hygiene. health care settings are reservoirs of infection. effective infection control surveillance programs are in place.
blood and body fluids of all clients be handled as if infected.
A nurse in community health is following a pregnant teenager who attends school. The nurse plans to discuss self-care activities that will be important for the teen during her pregnancy. The discussion should include: carrying heavy book bags. changing to home education. decreasing fluid intake to avoid nausea. keeping up her grades.
carrying heavy book bags.
A community health nurse is working with an uninsured family with two children. The nurse assists the parents in applying for SCHIP benefits and securing an appointment for the children with a community pediatrician that participates in SCHIP. The intervention can best be described as: care management. case management. continuity of care. disease management.
case management.
The nurse in community health is aware that HIV-infected children should attend school, because the benefit of attendance far outweighs the risk of transmitting or acquiring infections. School attendance should be reconsidered when there is evidence of: availability of homebound instruction. cases of measles. lack of handicapped access. prejudice of teachers and/or students.
cases of measles
A nurse in community health is invited to work with a coalition of churches to address safety concerns for children in the local community. The nurse provides training in problem-solving skills, manages conflict, facilitates the process, and provides expertise in interpreting data. This nurse has chosen the implementation role of: change agent. change partner. group leader. data collector.
change partner
To reach the desired goal of maximizing the full immunization rates for preventable communicable disease and increasing herd immunity levels, it is crucial for the nurse to: assume that the primary care physician has provided all appropriate immunizations. check an individual's immunization status at each and every visit. support parents who are reluctant to immunize their children. understand the difficulties in obtaining and maintaining immunization schedules.
check an individual's immunization status at each and every visit.
A nurse in community health is working with a parent whose spouse has been called up for active duty in the military reserve. The family is experiencing financial strain due to decreased income. The extended family lives at a distance. The parent is struggling to manage the family in the spouse's absence. The family consists of four children (three preschool and one preteen). In this situation, it would be important for the nurse to further explore the potential for: child abuse. depression. intimate partner abuse. parent's resentment of the preteen.
child abuse
Identification of the discrepancies between the quality standards of the agency and the actual practice of the health care professionals is part of the interpretation component of quality assurance programs. Other factors addressed during this stage are: (select all that apply) Select all that apply. choices of possible courses of action. follow-up evaluation. strengths and weaknesses. taking action.
choices of possible courses of action. strengths and weaknesses.
A nurse in community health is following an older woman who complains frequently of migraine headaches, backaches, and GI disturbances. During a recent visit, the woman states that her adult son now lives with her. He was recently let go from his job. He enjoys hanging out with his old buddies. When he feels better he will look for a new job. Despite the added burden she really enjoys having her son around again. The nurse should explore this further to determine whether the family is: abusive. codependent. coping. estranged.
codependant
Migrant workers and their families who reside in a specific mobile home park during the summer months would best be classified as a: community. group. setting of practice. target population.
community
A multisystem approach to community disease control would include such interventions as: (select all that apply) Select all that apply. community action programs. control of vectors. improved surveillance systems. legislation. provision of chemotherapy.
community action programs. control of vectors. improved surveillance systems. legislation. provision of chemotherapy.
A nurse in community health contacts three individuals who have had sexual encounters with an individual recently diagnosed with syphilis. The concept basic to community-oriented nursing practice that is best described by this intervention is: community. community as client. individual as client. partnership.
community as client
A school nurse teaches three middle school students with asthma conditions techniques to minimize their incidence of bronchial spasms. This is an application of: community-based nursing. community-oriented nursing. institutional nursing. public health nursing.
community based The goal of community-based nursing (CBN) is to manage acute or chronic conditions while promoting self-care among individuals and families. In CBN the nursing care is family centered, which means that the nurse works to improve the competencies of families to enable them to take better care of themselves. The nurse pays particular attention to the uniqueness of each family and works to plan the most useful interventions. Nurses practicing in the community and many staff public health nurses focus on providing direct care services, including health education, to persons or families outside of institutional settings, either in the home or in a clinic.
Jennifer is a nurse in a family medicine clinic. Today she is assessing Jose, a 4-year-old who is being seen for an earache. The type of nursing Jennifer practices is: community-oriented nursing. community-based nursing. public health nursing. tertiary health nursing.
community based nursing In community-based nursing, the nurse focuses on "illness care" of individuals and families across the life span. The aim is to manage acute and chronic health conditions in the community, and the practice is family-centered illness care. Community-based nursing is not a specialty in nursing but, rather, a philosophy that guides care in all nursing specialties. Community-oriented nursing has as its primary focus the health care either of of the community or populations as in public health nursing (PHN) or of individuals, families, and groups in a community.
A nurse in a clinic that provides direct care services to clients with tuberculosis would be classified as practicing: community-based nursing. community-oriented nursing. institutional nursing. public health nursing.
community based nursing The nurse practicing as a community-based nurse is more likely to give direct care to people than are nurses who practice from a community-oriented framework. A community-oriented framework includes community-oriented nursing and public health nursing. Institutional nursing care is generally delivered in a hospital or nursing home setting.
.A nurse in community health seeks a low-cost evaluation method to learn the perspectives of the largest number of persons regarding a proposed local safe haven program for unwanted infants. The best evaluation method to meet the criteria would be: community forums. focus groups. key informants. surveys.
community forum
The major sources of information for program evaluation are: (select all that apply) community indicators. media reports. program clients. program providers. program records.
community indicators program clients program records
A Hispanic outreach program works with the nurse in community health to train Hispanic health care workers in providing basic services and education within the local Hispanic community. The concept basic to community-oriented nursing practice that is best described by this intervention is: community. community client. community health. community partnerships.
community partenrship
A government agency is conducting an audit of all active clients in the local hospice program to ensure that hospice criteria for care are being applied appropriately. The type of tool being used in this specific approach to quality assurance is: concurrent audit. outcome audit. retrospective audit. peer review.
concurrent audit.
Factors that contribute to newly emerging or reemerging infectious disease can be related to microbial adaptation and changes made by the infectious agent. However, most of the emergence factors are related to environmental changes and: consequences of human activities/behaviors. increase in the number of vectors. industrialization and urbanization. unpredictable variances in the climate.
consequences of human activities/behaviors.
One specific approach to quality assurance is the use of Total Quality Management (TQM). A district public health department uses this approach and gives much attention to ensuring that studies are used to improve processes, remove management by objectives, and promote self-improvement. The major TQM guideline that would summarize these efforts would be: create, publish, and distribute aims and purposes. creating a strong customer-oriented philosophy that is process-driven. eliminate barriers to pride of work/performance. understand the purpose of inspection.
creating a strong customer-oriented philosophy that is process-driven.
A general approach to quality improvement where a qualified agent designates formal recognition to individuals or institutions that have met minimum standards of performance is best described as: accreditation. charter. credentialing. licensing.
credentialing.
Vulnerable populations may be exposed to more than one hazard at a time. This is known as: cumulative risk. disenfranchised populations. resilience. underserved populations.
cumulative risk.
While conducting a community health assessment, a nurse in community health meets with local religious leaders to understand the values, norms, perceived needs, and influence structures within the community. This process of data collection can best be described as: data gathering. data generation. data interpretation. problem identification.
data generation
A client is back for his follow-up appointment and says to the nurse, "I know. I know. I drink too much, but the job is so stressful that I need to find a way to unwind at the end of the day. You would too!" The nurse should recognize that this is a primary symptom of addiction known as: denial. social drug use patterns. setting variable. coping.
denial
It is estimated that one in 15 males becomes a father during his teen years. The nurse should be aware that many young men facing paternity have specific challenges such as: (select all that apply) Select all that apply. acting as though they are interested when they are disinterested. avoiding prenatal care involvement. desiring and needing to be involved with their children. being rejected by the young woman's family. rejecting their role as a father.
desiring and needing to be involved with their children. being rejected by the young woman's family.
The harm reduction approach to substance abuse focuses on health promotion and disease prevention. A primary prevention strategy that can be used by the nurse to address substance abuse under this approach is to: assess for recreational drug use. destroy the myth of good drugs versus bad drugs. encourage children to "just say no." refer to an addiction treatment program.
destroy the myth of good drugs versus bad drugs.
A case management nurse for a locally funded program for special-needs children is increasingly concerned about a recent referral for a 1-year-old child with a congenital illness residing in a poverty-stricken community. The nurse knows that this child may be at higher risk for the most harmful effects of poverty, including: developmental delays. ear infections. frequent colds and infections. irritability.
developmental delays
The nurse at the adult day care center notices bruises on the wrists of a 90-year-old client. Besides the physical assessment of the client, the nurse should: confront the daughter when she arrives to pick the father up. discuss the findings with the caregivers to determine the cause of the injuries. educate the staff about indications of elder abuse. make a referral to the primary care provider for follow-up.
discuss the findings with the caregivers to determine the cause of the injuries.
The nurse is evaluating a new home health client for ongoing management at home following back surgery for a traumatic injury. The client has been receiving a morphine-based drug for long-term pain management over the past 6 months. The nurse's assessment should include a plan for addressing the client's: drug dependence. drug addiction. substance abuse. opiate addiction.
drug dependance
Society bears the burden of infectious disease. That burden includes the effects of morbidity and mortality as well as the staggering: economic burden. fear burden. incidence burden. vulnerability burden.
economic burden.
Local officials have requested a program evaluation of a comprehensive teen sex education program offered in the local schools in preparation for potential budget discussions. A nurse in community health conducts a program evaluation and determines that the teen pregnancy rate has gradually declined over the years that the program has been in place. The community is measuring the program's: efficiency. progress. relevance. sustainability.
efficiency
A major evaluation source for a nurse to use to determine the effectiveness of a teen driver safety program is: Centers for Disease Control and Prevention (CDC) reports. epidemiologic data. recent census data. voter registration records.
epidemilogic data
The nurse in community health defines goals and measurable objectives during the planning phase of a community health intervention. This also marks the beginning of the: evaluation phase. implementation phase. needs assessment. problem analysis.
evaluation phase
Which of the following are factors that may contribute to vulnerability? Select all that apply. Exercise habits Crime Peeling lead paint Social isolation Illiteracy
exercise habits crime Peeling lead paint Social isolation Illiteracy
A strategy that may improve compliance with tuberculosis (TB) treatment is the: expansion of directly observed therapy. increased tuberculosis testing protocols. increased confirmatory testing protocols. treatment compliance education.
expansion of directly observed therapy.
A father brings his stepdaughter to the family clinic for an immunization update before the new school year. The nurse notices the interaction between the young girl and her stepfather. The child appears tense and cautious and wraps her arms around herself in a protective manner. The child startles when touched by the stepfather and pulls away. The stepfather is overheard saying, "I'll leave you here if you don't behave and act nice." In this scenario, it would be important for the nurse to explore in her assessment the possibility of: child neglect. family secrets. father-daughter incest. impaired family functioning.
father daughter incest
A school nurse is asked to assess a 13-year-old child because of excessive drowsiness and inattention in class. The nurse determines that this is a child of migrant workers on a local produce farm. Based on the nurse's knowledge of migrant worker families, the nurse should first explore the child's potential involvement in: delinquent behavior. drug use. field work. Migrant Education Program.
field work
Protecting the nation's food supply from contamination by all the virulent microbes is complex, costly, and time consuming. However, much foodborne illness, regardless of causal organisms, can be prevented through simple changes in: food preparation, handling, and storage. importation regulations. pesticide usage. animal breeding practices.
food preparation, handling, and storage
An undocumented migrant farmworker has been diagnosed with tuberculosis (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 to 12 months. A major challenge that the client may face related to ongoing treatment for TB is: affordable care. discrimination. fragmented services. language barriers.
fragmented services.
A nurse volunteering at the free clinic in her community informs a client seeking treatment for hypertension that the family's children may qualify for enrollment in the State Children's Health Insurance Program (SCHIP). The nurse's intervention can reduce health disparities for these vulnerable children by making a referral to a program that provides: direct financial subsidies for children. funds to insure currently uninsured children. outreach efforts to enroll eligible children in Medicaid. prospective payments for child services.
funds to insure currently uninsured children.
Violence is a major public health problem in our communities that causes premature mortality and lifelong disability. Violence-related morbidity is a significant factor in: community deterioration. health care costs. juvenile delinquency. population density.
health care cost
A poor, older Native Alaskan woman lives in a small, remote village near the Canadian border. She has been diagnosed with hypertension and diabetes but rarely makes it to the regional clinic in a distant town for checkups. This woman is most at risk for: disenfranchisement. health disparities. loss of independence. resilience.
health disparities
Health education is often used as a strategy in working with vulnerable populations. The benefits of health education can be greatly affected by: dependency cycle. health literacy. income level. race and ethnicity.
health literacy
A client presents at the local clinic with acute symptoms of fever, nausea, lack of appetite, malaise, and abdominal discomfort. During the course of the assessment, the nurse determines that the client is a health care aide working at a day care center. These facts are important because: acute hepatitis B is self-limiting. hepatitis A outbreaks are common in facilities where staff change diapers. hepatitis C is the "silent stalker." persons with chronic liver disease are at greater risk for hepatitis A.
hepatitis A outbreaks are common in facilities where staff change diapers.
All adults should be assessed for violence in their primary intimate relationships. The abuse of female partners has the most serious community health ramifications because of the greater prevalence, the more serious long-term emotional and physical consequences, and the greater potential for: fleeing to a shelter. homicide. possessive behavior. spontaneous abortion.
homicide
The local hospital emergency department has recently experienced an increase in gastroenteritis cases among migrant farmworkers. The local health department is informed of this rise in cases and schedules a case mapping of local: bars frequented by migrant workers. farm fields employing migrant workers. housing for migrant workers. restaurants frequented by migrant workers.
housing for migrant workers.
The nurse in community health is meeting with staff to systematically plan for a new outreach program. Doing so helps them to: assess the needs of potential outreach clients. recognize the special needs of vulnerable people in the area. identify how the problems of similar programs will not be repeated. identify the resources and activities that will help them meet their program objectives.
identify the resources and activities that will help them meet their program objectives
The goal of deinstitutionalization was to improve the quality of life for people with mental disorders by providing services in the communities where they lived rather than in large institutions. At what program level did this change in locus of care fail? Assessment level Design level Evaluation level Implementation level
implimentation level
The Omaha System is a client classification system developed by the Visiting Nurses Association of Omaha, Nebraska, that has the potential to improve the delivery of care by:
improving the description of care
A nurse new to the community evaluates the resources available to a father that has sought help with his escalating abuse and threats of violence to his family. After making the referral, the nurse approaches the local newspaper about running a series on the nature and extent of human abuse in the community. This strategy would: advocate for government programs to treat survivors. demonstrate the provider's commitment to address the need for services. increase awareness of community resources to address violence and abuse. increase the number of individuals identified as perpetrators.
increase awareness of community resources to address violence and abuse.
In a federally funded preschool program such as Head Start, nursing services that include conducting developmental-level screening for cognitive and psychomotor development of individual children would most likely be considered community-oriented nursing care when: individual results are compared with established standards for children of the same age group. program characteristics are assessed for their effectiveness in making the school population healthier. referral is provided for a child identified with delayed psychomotor development. treatment is initiated for a child with an identified learning disability.
individual results are compared with established standards for children of the same age group. Within federally funded programs for preschool children, from a community-oriented nursing care perspective, nursing services could be provided to individual children by conducting developmental-level screening tests to evaluate each child's level of cognitive and psychomotor development in comparison with established standards for children of the same age. This is population-focused service. A community-based nurse may deliver illness care or direct services to individual children. A public health nurse may assess the program's ability to achieve the overall goal of making its population of children healthier by evaluating the characteristics of the facility, program, and environment for their effectiveness in achieving the goal.
An eighth-grader is brought to the emergency department by a parent for unusual skin blistering and discoloration around the nose and lips. The parent states that the child will not say what caused the injury. The nurse should consider the possible use of: crystallized methamphetamine. inhalants. MDMA (Ecstasy). PCP (phencyclidine).
inhalants
A nurse participates with a community planning board addressing housing strategies and future community needs. The nurse is aware that the community has a population of homeless families served by local churches. The nurse is also aware that this agricultural community relies on migrant workers during seasonal harvesting of local produce. The nurse is concerned that these disenfranchised populations may be: complicated to address. costly to serve. invisible to the community. resilient to the community.
invisible to the community.
For the homeless, health care is usually crisis oriented and sought in emergency departments. The most difficult challenge for nurses treating this vulnerable population is to recognize the client's: limitations in following treatment protocols. limited number of transient treatment facilities. transition to persistent poverty. use and abuse of tobacco, alcohol, and illicit drugs.
limitations in following treatment protocols.
A nurse in community health working in an inner city clinic with high poverty and unemployment rates recognizes the need for programs for pregnant women because these women often receive late or no prenatal care and deliver: at home. full term. identical twins or triplets. low-birthweight babies.
low birth weight babies
For the nurse to fully understand the threat associated with the release of biological agents and participate in an appropriate response, the Centers for Disease Control and Prevention (CDC) has stated that the biological agents most likely to be employed are those that both have a potential for high mortality and can be easily disseminated to produce: immediately severe symptoms. major panic and social disruption. multisyndrome effect. person to person transmission
major panic and social disruption.
Within a state, counties designated as Health Professional Shortage Areas (HPSAs) tend to have a high proportion of racial minorities and fewer specialists. This factor may explain conflicting data within a state related to: adult immunization rates. chronic respiratory illness rates. maternal/infant morbidity rates. obesity rates.
maternal/infant morbidity rates.
A nurse in community health has determined that there is a need for a program for teenage fathers who want to learn about child care. The next step in the program management process would be to: conduct a survey to determine how many children the fathers have. determine whether the fathers have benefited from this type of program before. meet with community members to form a planning body. provide the fathers with community resources.
meet with community members to form a planning body.
A hospice nurse is working with a cancer client and his family. The client's 7-year-old son has developed recent school and peer problems. Understanding the risk for disruption of normal development, the nurse plans to first screen the child for: developmental disorders. mental health problems. parental neglect. violence potential.
mental health problems.
A nurse in community health located in Virginia is conducting an assessment on a Hispanic worker currently working in a local apple orchard for the season. The nurse determines that the worker originates from Florida and is living in temporary housing with other orchard workers. Based on this information, the nurse should integrate the special needs of what vulnerable population? Migrant farmworkers Seasonal farmworkers Underinsured Undocumented aliens
migrant farmworkers
A community health nurse involved in care management would most likely: develop, conduct, and evaluate health teaching programs in primary care. manage the staff at a free clinic. monitor the health status, resources, and outcomes for an aggregate. provide immunizations to migrant workers.
monitor the health status, resources, and outcomes for an aggregate.
Indiscriminate use of "good drugs" has caused more health problems from adverse reactions, drug interactions, dependence, addiction, and overdoses than has the use of "bad drugs." The high-risk population group that most experiences the negative consequences identified above is: adolescents. injection drug users. older adults. pregnant women.
older adults
A multidisciplinary quality assurance team has reviewed an organization's stated philosophy and objectives and developed a conceptual model for appraisal that integrates peer review and client satisfaction. The quality assurance program component that should be addressed next would be: action. process. structure. outcome.
outcome.
The nurse engaging in formative program evaluation would most likely: conduct medical record audits for quality assurance. make a home visit before a client is discharged from the program. participate in new client evaluation. write policy for risk management.
participate in new client evaluation.
A young female client visits a local clinic, seeking treatment for a urinary tract infection (UTI). During the assessment, the nurse conducts an extensive sexual history/activity screening to determine the risk for a sexually transmitted disease and potential complication of: genital warts. herpes simplex virus 1. pelvic inflammatory disease (PID). primary syphilis.
pelvic inflammatory disease (PID).
A nurse in community health is working in a rural setting. In planning for programs to address the population's needs, the nurse should be aware that, in general, rural populations: engage in physical activity during leisure time. engage in preventive behaviors. perceive their overall health as less favorable. use seat belts.
perceive their overall health as less favorable.
Public health nursing is a specialty with a distinct focus and scope of practice and requires a special knowledge base different from other specialty areas of nursing. A public health nurse would first be interested in: drug treatments for diabetes. populations with the highest rate of diabetes. educational materials for individuals with diabetes. new technology for diabetic care.
populations with the highest rate of diabetes. The primary focus that has differentiated public health nursing from other specialties has been the emphasis on the population rather than on individuals or families. The primary goal of public health—the prevention of disease and disability—is achieved by ensuring that conditions exist in which people can remain healthy. Diabetes care and educational materials are provided to individuals and families by a nurse in the community or institutional setting.
The general approach to quality improvement known as licensure that grants control over who can enter into and who exists in a profession can best be described as a contract between the: consumers and the profession. legislature and the state board. profession and the state. public and the professional associations.
profession and the state.
A nurse working with a Hispanic client explains the referral options available for the client to receive a mammogram. One option is free and has limited Spanish language resources. The other option has a nominal fee and comprehensive Spanish language resources. The nurse supports the client's decision to choose the provider that the client feels would best meet her needs. This advocacy role is best described as: intercessor. mediator. obstructer. promoter.
promotor
During the last stage of AIDS, many opportunistic infections proliferate in persons with weakened immune systems. HIV-infected individuals who live near one another in long-term care facilities, drug treatment facilities, and prisons should be carefully screened before admission because they are at greater risk for acquiring: fungal disease. invasive cervical cancer. oral candidiasis. pulmonary tuberculosis (TB).
pulmonary tuberculosis (TB).
A state health department wants to ensure that the local health departments are delivering quality client care and can demonstrate the degree of excellence attained. The principle that is best defined by this statement is: continuous quality improvement (CQI). quality assurance (QA). risk management. total quality management (TQM).
quality assurance (QA).
An example of secondary prevention for infectious disease prevention is: malaria chemoprophylaxis. Pneumocystis carinii pneumonia (PCP) chemoprophylaxis for people with AIDS. quarantine. restaurant inspections.
quarantine.
The purpose of record keeping in public health agencies is to maintain complete information on clients served and the extent and quality of service provided to those clients. The records also provide information for education and research. Another important use of the records is to: determine raises for personnel. explain cost overruns. foster independence in clinical practice. resolve legal issues in malpractice suits.
resolve legal issues in malpractice suits
When determining whether a geographic area is rural or urban, the nurse should recognize that: rural and urban areas, by relative nature, occur on a continuum. rural regions have fewer than six persons per square mile. rural residents feel isolated. rural areas are recreational, retirement, or resort communities.
rural and urban areas, by relative nature, occur on a continuum.
Many behaviors place individuals of all ages, genders, ethnicities, or any other factors at greater risk for sexually transmitted diseases (STDs). The nurse should include primary prevention interventions in all client encounters through the discussion of: partner notification. safer sex. standard precautions. STD testing.
safer sex
The primary prevention of hepatitis C virus (HCV) includes: counseling and follow-up of infected clients. routine testing for health care workers. screening of blood products. testing of high-risk individuals.
screening of blood products.
A population-level tertiary prevention intervention typically performed by nurses and aimed at controlling communicable diseases is: HIV test counseling. needle-exchange program. partner notification. standard precautions teaching.
standard precautions teaching.
The nurse in community health reviews the monthly and year-to-date health service use report for the local community to monitor trends as correlates of the community's health. The nurse is viewing community health through the dimension of: partnership. process. status. structure.
status
A long-distance truck driver being assessed by a nurse in a community-based clinic states, "I smoke 3 packs of cigarettes a day. I use coffee and diet pills from the drug store to stay awake on the road. That makes it difficult to sleep when I do pull over, so I use a prescription sleeping pill from my doctor to sleep for 4 hours. It's giving me palpitations." The nurse's assessment should include a diagnosis of: drug abuse. drug addiction. substance abuse. adverse drug reaction.
substance abuse.
A nurse in community health becomes aware that a teen smoking cessation program offered at the health department is a demonstration project. In evaluating this program, the nurse would be concerned with the program's: efficiency. impact. relevance. sustainability.
sustainability
In a community clinic that screens and treats individuals for cardiovascular disorders, the nurse practicing public health/population-focused nursing would most likely ascertain: a holistic treatment plan. a specific clinical diagnosis. individual dietary interventions for cardiovascular disorders. the prevalence rate of cardiovascular disorders among various groups.
the prevalence rate of cardiovascular disorders among various groups. A public health nurse in a community clinic engaged in population-focused practice would ask the following questions: · What is the prevalence rate of the diagnosis or condition among various age, race, and gender groups? · Which subpopulations have the highest rates of untreated diagnosis or condition? · What programs could reduce the problem of untreated diagnosis/condition and decrease the risk for further morbidity and mortality? Public health nurses are typically concerned with more than one subpopulation, and they often deal with the health of the entire community. Assessment, one of the public health core functions, is a logical first step in examining a community setting to determine its health status.
Given recent vaccine shortages for the flu, the local nurses in community health form a group to evaluate the process of scheduling and operating flu vaccination clinics in the community and review the community's complaints from the previous season. The activity best represents the principle of: total quality management (TQM) to achieve continuous quality improvement (CQI). quality assurance (QA) to achieve continuous quality improvement (CQI). risk management to achieve quality. continuous quality improvement (CQI) to achieve total quality management (TQM).
total quality management (TQM) to achieve continuous quality improvement (CQI).
A nurse in community health conducts quarterly mental health-promotion and depression-screening programs at the local senior center. The nurse is aware that older adults are at increased risk for developing depression. Using such an intervention also addresses the older adults': dependence on their primary care provider. normal sensory losses. reduced social contacts. underutilization of the mental health system.
underutilization of the mental health system.
The most critical strategy that can be used by nurses in community health to improve the health status of migrant workers that spend only a few months in a geographic location is to: conduct a comprehensive assessment and formulate a plan for treatment. establish a long-term trust relationship to prevent disappointment. schedule appointments for appropriate immunizations for the children. use every opportunity to teach about preventive health care.
use every opportunity to teach about preventive health care.
A young adult with a history of prior parental abuse recently has been diagnosed with a stress-related illness. The individual works at a local convenience store, earning a little more than the federal poverty level, but receives no health benefits. This individual is predisposed to the development of: poverty. resilience. risk. vulnerability.
vulnerability
A city uses the local media (radio, television, and newspapers) to post ratings of air quality on days when the air quality is poor. This notification is directed toward older adults, very young members of the community, and those with chronic breathing problems. These groups are an example of: disenfranchised populations. disadvantaged populations. vulnerability. vulnerable populations.
vulnerable populations
Two nurses in community health schedule a day to ride through a low-income community to better understand the community and its boundaries, trends, rhythm, stability, and changes that can affect the health of that community. This direct data collection method is often referred to as: composite database. participant observation. secondary analysis. windshield survey.
windsheild
A large industrial plant has recently laid off a significant portion of its workforce because of scalebacks in production. The occupational health nurse proposes education sessions with the remaining employees about effective strategies for managing stress during economic downturns. This suggestion to management is based on the nurse's understanding that increases in aggression and violence at home and work may be triggered by: competition. unemployment. survivor guilt. work-related stress.
work related stress
