Population Health Evolve Questions

Which environmental stressor directly assaults human health? a. Global warming b. Air pollution c. Noise d. Litter

b. Air pollution Air pollution and lead poisoning directly assault human health. Noise and litter affect quality of life. Global warming affects the ecologic balance.

Based on the Department of Housing and Urban Development (HUD) definitions of homelessness, which individual would be considered homeless? a. An individual whose residence lacks access to public water and electricity b. An individual who has a permanent nighttime residence in the housing for mentally ill people c. An individual imprisoned or detained under an act of Congress or state law d. An individual who spends most nights at public or private places not designed for regular sleeping accommodations

HUD defines homelessness in four categories: (1) literally homeless, (2) imminent risk of homelessness, (3) homeless under other federal statutes, and (4) fleeing/attempting to flee intimate partner violence. An individual who spends most nights at public or private places not designed for regular sleeping accommodations is considered literally homeless. Literally homeless is defined as individuals and families who lack a fixed, regular, and adequate nighttime residence and includes a subset for an individual who resided in an emergency shelter or a place not meant for human habitation and who is exiting an institution where he or she temporarily resided. An individual whose residence lacks access to public water and electricity, an individual who has a permanent nighttime residence in the housing for mentally ill people, and an individual imprisoned or detained under an act of Congress or state law are not considered homeless under the HUD definition. d. An individual who spends most nights at public or private places not designed for regular sleeping accommodations

Chronic stress characterizes the lives of people living with domestic violence. As the community health nurse, you recognize which as a long-term effect of violence? a. Spontaneous disclosure of abuse to health care provider b. Not complaining of physical symptoms c. Having disturbed eating patterns, but sleeping well d. Suffering chronic fatigue and tension

When subject to repeated abuse, the victim experiences a variety of responses, including shock, denial, confusion, withdrawal, psychological numbing, and fear. He or she lives in anticipatory terror and experiences chronic fatigue and tension, disturbed sleeping and eating patterns, and vague gastrointestinal and genitourinary complaints. The other options are not symptoms of chronic violence.

Which statement indicates that further teaching is needed for a patient involved in family planning? a. "I can't get human papilloma virus (HPV) from my boyfriend because we're not having intercourse." b. "I need to use condoms to prevent transmission of sexually transmitted diseases." c. "Even though I have no signs or symptoms, I still may have Chlamydia." d. "I can give my unborn baby warts during childbirth."

a. "I can't get human papilloma virus (HPV) from my boyfriend because we're not having intercourse." Option A indicates the patient needs more teaching. HPV can be transmitted via sexual intercourse, as well as any other means of direct contact. The other statements are true.

Rural residents in the United States compose more than _____% of the nation's poor. a. 50 b. 35 c. 20 d. 18

a. 50 More than 50% of the nation's poor live in rural areas, while 15% of the nation's elderly live in rural areas.

Which diseases contribute to higher mortality rates in developing countries? (Select all that apply.) a. AIDS b. Hepatitis C c. Cancer d. Parasitic infection e. Dengue fever

a. AIDS d. Parasitic infection e. Dengue fever Among the infectious diseases that contribute to higher mortality rates in developing countries are AIDS, tuberculosis (TB), malaria, hepatitis B, rheumatic heart disease, parasitic infection, and dengue fever. Although these diseases claim the lives of millions, it is estimated they could be reduced by up to 50% through effective public health interventions.

The community health nurse is working in an emergency shelter with displaced families. Which clients have risk factors for posttraumatic stress disorder (PTSD)? (Select all that apply.) a. An 18-year-old client with a previous gunshot wound b. A 50-year-old client who saw people die in the disaster c. A 23-year-old client experiencing extreme fear d. A 60-year-old client who had little social support before the event e. A 35-year-old client with a history of schizophrenia

a. An 18-year-old client with a previous gunshot wound b. A 50-year-old client who saw people die in the disaster c. A 23-year-old client experiencing extreme fear e. A 35-year-old client with a history of schizophrenia Risks for PTSD include living through dangerous events or traumas; having a history of mental illness; getting hurt; seeing people hurt or killed; feeling horror, helplessness, or extreme fear; having little or no social support after the event; and dealing with extra stress after the event, such as loss of a loved one, pain and injury, or loss of a job or home.

The public health nurse is working with a specific population and is preparing to participate in a descriptive epidemiology study. Which of the statements apply to descriptive epidemiology? (Select all that apply.) a. Descriptive epidemiology seeks to answer questions about the amount of disease in a given population. b. Descriptive epidemiology seeks to answer questions about the cause of disease in a given population. c. Descriptive epidemiology seeks to answer questions about the cure for disease in a given population. d. Descriptive epidemiology seeks to answer questions about the distribution of disease in a given population.

a. Descriptive epidemiology seeks to answer questions about the amount of disease in a given population. d. Descriptive epidemiology seeks to answer questions about the distribution of disease in a given population. The study of the amount and distribution of disease constitutes descriptive epidemiology. Patterns identified through descriptive epidemiology may indicate possible causes. When these possible causes are investigated with different and more advanced epidemiologic methods, this is analytic epidemiology.

Which statement best describes the demographics of rural America? a. Despite the shrinking number of family farms and full-time farmers, agriculture continues to be an important part of the rural and U.S. economy. b. There has been a shift in the economic base of rural America as more communities are dependent on income generated from mining and construction. c. There has been a decline in diversity in rural America, with more Hispanics and youth moving to urban areas rather than rural communities and small towns. d. There are more positive health behaviors (e.g., less smoking, obesity, and drug use) among residents of rural America when compared with urban America.

a. Despite the shrinking number of family farms and full-time farmers, agriculture continues to be an important part of the rural and U.S. economy. Despite the shrinking number of family farms and full-time farmers, agriculture continues to be an important part of the rural and U.S. economy, with agriculture-related employment representing 5% of the gross domestic product (GDP) and farms representing 1% of the GDP. Changes in rural demographics include a shift in the economic base from agriculture to industry, as well as more diversity as the number of rural Hispanics increases. Additionally, there has been a rise in negative health outcomes for rural residents; obesity, smoking, and drug use are more prevalent in rural America than in urban America.

When assisting specific aggregates, which should be included in the community health nurse's outcomes? a. Helping people learn from their own experiences and analyzing the world with the intention to change it b. Honesty, fairness, and mutuality in the interactions c. Intervening in mutual exchanges with community members and citing the current literature d. Asking critical questions of the aggregates involved

a. Helping people learn from their own experiences and analyzing the world with the intention to change it Nursing's role in the community is to create a context from which people can learn and identify health-damaging problems from within their environment. It is essential that the affected people participate in the process of identifying and working to solve environmental problems. The other options do not allow the people to participate in the process that affects their ability to learn and thus make change.

Which factors cause primary vaccine failure? (Select all that apply.) a. Inefficient storage b. An intramuscular vaccine injection given subcutaneously c. Waning immunity in immunocompromised patients d. Light-sensitive vaccines exposed to light e. Seroconversion

a. Inefficient storage b. An intramuscular vaccine injection given subcutaneously d. Light-sensitive vaccines exposed to light e. Seroconversion Primary vaccine failure is the failure of a vaccine to stimulate any immune response. It can be caused by improper storage that renders the vaccines ineffective, an improper administration route, or light-sensitive vaccines exposed to light. Additionally, some immunized persons never seroconvert, either because of failure of their own immune system or for some other unknown reason. Secondary vaccine failure is the waning of immunity after an initial immune response.

The report requested by Congress that recommended a more systematic approach to promote quality in government-funded programs was a. Leadership by Example. b. Crossing the Quality Chasm. c. To Err is Human, Building a Safer Health System. d. Health Professions Education.

a. Leadership by Example. Leadership by Example was a report requested by Congress that recommended a more systematic approach to promote quality and to use technology in government-funded programs. Crossing the Quality Chasm recommendations included the promotion of evidence-based care, more attention to patients' need for information, and improved access to clinical expertise. To Err Is Human focused on promoting patient safety. In the report Health Professions Education, the education of all health professionals is viewed as a bridge to quality care.

Decisions on public policy are made by which part of the federal government? a. Legislative, executive, or judicial branches of the government b. Only the executive branch (president, governor, mayor) c. Supreme Court d. House of Representatives and Senate

a. Legislative, executive, or judicial branches of the government Public policy refers to decisions made by legislative, executive, or judicial branches at the local, state, or federal levels of government.

Enacted in 1965 as part of the Social Security Act, __________ was intended to provide health care to the population of U.S. citizens 65 years of age and older. a. Medicare b. Medicaid c. Social Security d. Blue Cross/Blue Shield

a. Medicare The intent for Medicare, when enacted in 1965, was to provide health care to the growing population of those 65 years of age or older. Medicaid is a public welfare assistance program that finances health care coverage for the indigent and children. Social Security was created in 1935 to provide retirement benefits to workers. Blue Cross and Blue Shield were health insurance plans that paid all of the costs of covered services provided to the enrollee.

Which statement about homicide in the United States is false? a. Most homicides are caused by stabbings. b. Homicide is the third leading cause of death for 1- to 4-year-old children. c. Blacks are more likely to be the victims of homicide than whites. d. Over 50% of homicide victims are killed by someone they knew.

a. Most homicides are caused by stabbings. Most homicides are caused by firearms. The other statements are true.

A community health nurse participating in planning programs for the coming year considers incidence rates to better understand the needs of the community. Which statement below is the most accurate explanation of incidence rates? a. New cases of a disease or condition in a community over a period of time are included in incidence rates. b. The number of all cases of a specific disease or condition in a population at a given point in time relative to the population at the same point in time is included in incidence rates. c. Incidence rate refers to the number of new cases of a disease in those exposed to the disease. d. The term incidence rate refers to the percentage of deaths in a specific period of time from a specific cause.

a. New cases of a disease or condition in a community over a period of time are included in incidence rates. Incidence rates describe the occurrence of new cases of a disease or condition in a community during a period of time relative to the size of the population at risk for that disease or condition during that same time period. In calculating this rate, the numerator is the number of new cases during the specific period of time, and the denominator consists only of those who are at risk for developing the disease or condition during the specific period of time. A prevalence rate is the number of all cases of a specific disease or condition in a population at a given point in time relative to the population at the same point in time. Attack rates document the number of new cases of a disease in those exposed to the disease. The percentage of deaths in a specific period of time from a specific cause refers to the mortality rate.

A female veteran has just given birth to her first child. Which resource is most appropriate for this veteran at this time? a. PC3 b. VHA c. CHAMPVA Incorrect d. TRICARE

a. PC3 Patient-Centered Community Care (PC3) is a program for veterans needing certain primary care or inpatient-related care, particularly for female veterans after delivery and requiring limited newborn care. Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a program in which the costs of some health care services for eligible civilian beneficiaries are covered by the VA. TRICARE is sponsored by the Department of Defense (DoD) and provides health care for active duty military personnel, their families, and their survivors. VHA is the Veterans Health Administration, which provides health care to veterans.

You teach a community disaster preparedness class on how to find shelter during and after a disaster situation. This is an example of what kind of prevention? a. Primary b. Secondary c. Tertiary d. Disaster

a. Primary Primary prevention occurs in the nondisaster and predisaster stages. Actions during these stages includes developing local, state, and federal disaster plans; conducting drill tests; training volunteers and health care providers; and providing educational programs. Secondary measures are those taken after the disaster has occurred and tertiary measures are aimed at rehabilitation. Disaster prevention is a broad term covering all types.

Through epidemiologic investigations, effective prevention measures are often identified. When the nurse is engaged in providing prevention for the community before disease has developed, the prevention activities meet the definition for what level of prevention? a. Primary b. Secondary c. Tertiary d. Pathogenic

a. Primary Primary prevention occurs when intervention activities take place before disease development. Immunization is an example of primary prevention that provides specific protection. Secondary prevention occurs after pathogenesis, namely screening and physical examinations that are aimed at early diagnosis. Tertiary prevention focuses on rehabilitation and limitation of disability. Pathogenic does not describe a type of prevention.

The percentage of deaths resulting from a specific cause provides the nurse with information about areas in which public health programs might make significant contributions in reducing deaths. Select the statistic often used for this purpose. a. Proportionate mortality rate b. Crude death rate c. Age-adjusted death rate d. Standardized mortality rate

a. Proportionate mortality rate Proportionate mortality rate is calculated using the number of deaths resulting from a specific cause in a specific time period as the numerator and the total number of deaths in the same time period as the denominator. In crude death rates, the numerator is the number of deaths and the denominator is the average population size or the population size at midyear multiplied by a constant. Age adjustment or standardization reduces bias when there is a difference between the age distributions of two populations.

Which criteria is required in order for veterans to receive U.S. Department of Veterans Affairs(VA)benefits? (Select all that apply.) a. Serving in active duty for 24 consecutive months b. Serving for a half period of call in the Reserves c. Committing to the Guard for 12 months d. Being separated under any condition other than dishonorable e. Being deployed overseas for 6 months

a. Serving in active duty for 24 consecutive months d. Being separated under any condition other than dishonorable Veterans are eligible for VA benefits when they fulfill two requirements related to service and separation. 1) Service: they must have served in active duty for 24 consecutive months or for a full period of call (Reserves and Guard) and 2) Separation: they must have been separated under any condition other than dishonorable.

Which model supports upstream thinking with the purpose to improve homelessness through reduction of structural conditions contributing to homelessness? a. Social justice b. Market justice c. Physical justice d. Mental justice

a. Social justice The social justice model seeks to reduce the structural conditions contributing to homelessness through collective action, thus supporting upstream thinking.

A community health nurse is concerned about reducing the fatal injuries to America's rural children. To address this problem, the nurse organizes a community of solution (see Chapter 1). For this group, it would be important to have representatives from all groups or organizations: (Select all that apply.) a. The Department of Public Highway and Safety b. Emergency department staff (both doctors and nurses) from local hospitals c. Teachers and coaches from area schools d. Area employers e. City or county government

a. The Department of Public Highway and Safety b. Emergency department staff (both doctors and nurses) from local hospitals c. Teachers and coaches from area schools e. City or county government Limited resources are available in rural areas, and more can be accomplished when resources are pooled. Also, to ensure a more successful outcome, all players with a vested interest in the problem should have a voice in the problem-solving approach. This would include public personnel (city and county government, police, teachers) and private groups (RNs and MDs). Less important for looking at children's issues, however, would be private employers.

Which assessment findings by the community health nurse would suggest that an elderly client may be the survivor of physical abuse by a caregiver? (Select all that apply.) a. The client has a laceration on her forehead that was sutured. b. The client has a flat affect. c. The client has bruises on her forearms in various stages of healing. d. The client withdraws from soft touch. e. The client is not sexually active but has a diagnosis of Chlamydia.

a. The client has a laceration on her forehead that was sutured. c. The client has bruises on her forearms in various stages of healing. e. The client is not sexually active but has a diagnosis of Chlamydia. Signs of physical abuse include bruises, lacerations, fractures, dislocations, untreated injuries in various stages of healing, and STDs in sexually inactive clients. The other options are not indications of physical abuse.

Which of these statements is true regarding income insufficiency in the United States? a. The poverty rate from 2010 to 2015 did not differ statistically. b. People who make minimum wage would not be categorized as impoverished. c. Alcoholism is the major reason for lack of employment. Incorrect d. The median household income in 2015 was around $40,000.

a. The poverty rate from 2010 to 2015 did not differ statistically. The poverty rate increased did not change statistically from 2010 to 2015. The median income in 2015 was $53,889. The economy and related issues are the most common reasons for unemployment. Working at minimum wage places a person below the poverty line.

In the United States today, where are most personal health care services provided? a. The private sector b. The public sector c. The nonprofit sector d. The community health sector

a. The private sector Most personal health care services are provided in the private sector, usually in clinics, physicians' offices, hospitals, hospital ambulatory centers, skilled care facilities, and homes. The public health subsystem and community health nursing focus on prevention of disease and illness from a broader, population-based perspective. Hospitals may be for profit or nonprofit.

Seven cases of hepatitis A are diagnosed in a community over a period of 2 weeks. An investigation results in a determination that all of the infected individuals ate at a local restaurant. Which statement explains the possible connection between hepatitis A and a restaurant? a. The route of transmission for hepatitis A is fecal-oral. b. A food worker likely coughed on the customers. c. A food worker may have a bleeding wound. d. Hepatitis A is transmitted where people congregate.

a. The route of transmission for hepatitis A is fecal-oral. Hepatitis A is transmitted by fecal-oral route. Coughing or bleeding would not transmit hepatitis A. Option D does not have enough information to form a conclusion about hepatitis A transmission.

When building a collective strategy by framing an environmental problem, the community health nurse should ask which question? a. Who is affected by the problem? b. What individual should I talk to? c. What nursing diagnosis is involved? d. What is my role?

a. Who is affected by the problem? Dialogue from critical thinking should facilitate community involvement and is not focused on a single individual. Asking about role or diagnosis does not facilitate community involvement.

A community health nurse would include which in her assessment of environmental health? (Select all that apply.) a. Work-related exposures b. Atmospheric quality c. Families d. Job availability e. Radiation risks

a. Work-related exposures b. Atmospheric quality e. Radiation risks Environmental health is a vast field of subcategories, including living patterns, work risks, atmospheric quality, water quality, housing, food quality, waste control, and radiation risks. Families and job availability are not environmentally related.

The concept of "health for all by the year 2000" was initially introduced by which international organization? a. World Health Organization (WHO) b. Centers for Disease Control (CDC) c. United Nations International Children Emergency Fund (UNICEF) d. National Institutes of Health (NIH) Healthy People 2000

a. World Health Organization (WHO) The WHO introduced the goal of "health for all." The CDC strives to prevent and control infectious and chronic diseases, injuries, workplace hazards, disabilities, and environmental health threats. UNICEF focuses on child and women's health.

The U.S. Department of Education defines a homeless child as a. a child abandoned in a hospital. b. a child in foster care. c. a child in a group home. d. a child living with a grandparent.

a. a child abandoned in a hospital. The definition of a homeless child according to the U.S. Department of Education includes children and youth who are: Sharing the housing of other persons because of loss of or inadequate housing? Abandoned in hospitals? Awaiting foster care placement

Public health policy in the United States is influenced by two types of justice, market justice and social justice. Examples of market justice include (Select all that apply.) a. all people are entitled to the status they create for themselves. b. all people are entitled to a livable minimum wage. c. all people are entitled to happiness if they put forth enough effort. d. all people are entitled to the income they work for. e. all people are entitled to access to health care.

a. all people are entitled to the status they create for themselves. c. all people are entitled to happiness if they put forth enough effort. d. all people are entitled to the income they work for. Market justice has been the dominant model in the United States and purports that people are entitled to valued ends (i.e., status, income, and happiness) according to their own individual efforts. Moreover, this model stresses individual responsibility, minimal collective action, and freedom from collective obligations other than respect for another person's fundamental rights. In contrast, under a social justice model, all people are equally entitled to key ends (i.e., access to health care and minimum standards of income).

Political action committees (PAC) are formed by professional organizations, business, or labor groups for the purpose of a. attracting candidates who are sympathetic to particular health care issues. b. lobbying legislation about health policies. c. being an advocate for health care reform. d. providing financing to professional organizations.

a. attracting candidates who are sympathetic to particular health care issues. PACs are nonpartisan entities that promote the election of candidates believed to be sympathetic to their interests. The purpose of specific PACs could be to promote certain health care issues or health care reform or to obtain financing for certain professional organizations.

Cost containment incentives include (Select all that apply.) a. capitated reimbursement. b. limited access to care. c. fee-for-service billing. d. health care rationing. e. carve-out services.

a. capitated reimbursement. b. limited access to care. d. health care rationing. Economic or cost-containment incentives can be divided into the following broad categories: capitated reimbursement, access limitation, and rationing. Fee-for-service billing has a potential for overuse. Carve-out services are services provided within a standard benefit package but delivered exclusively by a designated provider or group, such as mental health services or dialysis services.

Nurses' involvement in policy can be achieved by (Select all that apply.) a. conducting and supporting health policy research. b. avoiding discussions that involve health policy that may be controversial. c. working with health care professionals to influence change in the quality of health care. d. writing letters to educate legislators about health care issues. e. monitoring the quality ratings of health care organizations and suggesting changes that would improve care.

a. conducting and supporting health policy research. c. working with health care professionals to influence change in the quality of health care. d. writing letters to educate legislators about health care issues. e. monitoring the quality ratings of health care organizations and suggesting changes that would improve care. Nurses can support and use nursing research that demonstrates positive clinical and economic outcomes. This would serve to validate the importance of nursing within the health system. External strategies that nurses can use to influence private health policy include participation in discussion regarding quality and managed care. Nurses should work cooperatively with other health professions to influence managed care organizations to improve quality of care. Nurses should monitor the quality ratings of health care organizations and suggest changes that would improve care. Writing letters to legislators is a direct way to communicate opinions and concerns. Avoiding controversial discussions on health policy, however, will not foster positive changes.

The number one health concern identified by the majority of rural health care leaders is a. lack of health insurance. b. limited access to health care. c. increase in communicable diseases. d. social isolation of rural dwellers.

a. lack of health insurance. Rural health leaders identified ten priorities for health care in rural America, with access and affordability to care topping the list. Surveys have found rural uninsured people are more likely to have a usual source of care compared with their urban counterparts. An increase in communicable diseases and social isolation of rural dwellers were not listed as a priority health concern identified by rural health leaders.

Provisions of the Patient Protection and Affordable Care act included (Select all that apply.) a. mandating that all citizens obtain health insurance. b. reducing Medicaid eligibility. c. subsidizing insurance premiums for all citizens. d. prohibiting denial of coverage for preexisting conditions. e. establishing health insurance exchanges.

a. mandating that all citizens obtain health insurance. d. prohibiting denial of coverage for preexisting conditions. e. establishing health insurance exchanges. The Patient Protection and Affordable Care Act provisions included mandating that all citizens obtain health insurance, expanding Medicaid eligibility, subsidizing insurance premiums for low income purchasers, prohibiting denial of coverage for preexisting conditions, and establishing health insurance exchanges.

A veteran has a traumatic brain injury (TBI), hearing impairment, and an amputated arm. The nurse knows that this patient is suffering from a. polytrauma. b. posttraumatic stress disorder. c. military sexual trauma. d. substance use disorder.

a. polytrauma. The term polytrauma refers to two or more injuries sustained in the same incident, affecting multiple body parts or organ systems, and resulting in various kinds of impairments and functional disabilities. Polytrauma is often the result of a blast-related event, and frequently includes TBI.

The report Health Professions Education identified core competencies that apply to all health care professions. These competencies include (Select all that apply.) a. provide patient-centered care. b. prioritize hands-off communication. c. use evidence-based practice. d. apply quality improvement. e. use informatics.

a. provide patient-centered care. c. use evidence-based practice. d. apply quality improvement. e. use informatics. Health Professions Education identified five core competencies that all apply to all health care professions: (1) provide patient-centered care, (2) work in interdisciplinary or interprofessional teams, (3) use evidence-based practice, (4) apply quality improvement, and (5) use informatics.

By the middle of the 21st century, the world population is expected to a. reach almost 10 billion. b. reach 8 billion. c. be largely unchanged from the 20th century. d. show a slight decline.

a. reach almost 10 billion. The world's population soared to 4 billion between 1960 and 1974 and then to 5 billion between 1974 and 1987. In 1999, the world population was 6 billion; in 2016, it was 7.4 billion. The population is projected to reach 8 billion by 2025 and 9.8 billion by midcentury.

A single white male veteran served two tours in Afghanistan. The veteran has returned home from Afghanistan where he lives alone, begins drinking alcohol daily around 11 am, and watches television from rising until bedtime. This veteran is at high risk for a. suicide. b. cognitive impairment c. chronic pain d. unresolved conflict

a. suicide. Risk factors for suicide among veterans include non-Hispanic white race/ethnicity, male gender, sexual minority status, preenlisted and/or current mental health conditions, history of self-directed violence, substance use, poor physical health and functioning, intimate partner conflict, lack of social support, and sexual trauma.

As a school nurse, you know the leading reason cited as the cause of school violence is a. use of violence to handle disputes. b. an unhappy home life. Incorrect c. overly protective parental situations. d. poor communication with authority figures.

a. use of violence to handle disputes. Adolescents and children increasingly use violence to settle disputes. Children are often not taught peaceful ways of resolving differences and learn by what they observe at home, on television, in video games, and in movies. Consequently, schools have become a common site for violence. The reasons for violence are complicated and multilayered, but the most common reason cited is use of violence to handle disputes.

Chemical warfare agents such as pulmonary agents and cyanides are classified as a. weapons of mass destruction. b. computer-based attack weapons. c. recovery agents. d. prevention medications.

a. weapons of mass destruction Weapons of mass destruction refer to any weapon that is designed or intended to cause death or serious bodily injury through release, dissemination, or impact of toxic or poisonous chemicals or their precursors. Chemical warfare agents are classified as nerve agents, vesicants, pulmonary agents, and cyanides.

Nurses, including public health nurses, are at increased risk for workplace violence. Risk factors for violence in the workplace include all except a. working in pairs. b. access to medications. c. increased number of mentally ill patients. d. inadequate security.

a. working in pairs. Risk factors for violence in the workplace include increasing number of acute and chronically mentally ill patients, working alone, availability of drugs at worksite, low staffing levels, poorly lit parking areas and corridors, long waits for service, inadequate security, increasing number of substance abusers, and access to firearms.

A public health nurse is surveying a population of coal miners. Which question would elicit information about related risk to a miner's children? a. Do you wear a respirator?" b. "How close do you live to your workplace?" c. "How many accidents has the mine had this year?" d. "Do you have a good rapport with your boss?"

b. "How close do you live to your workplace?" Environmental health effects can be immediate, long term, or intergenerational. Although often overlooked, a parent's occupation may put his or her children in danger. Living close to a coal mine could increase the children's risk for exposure to water or ground contamination from the mine, among other environmental hazards. The other options do not assess the proximity of the environmental hazard.

Which client is at highest risk for elder abuse? a. A 75-year-old nursing home client who is alert and has osteoporosis b. A 70-year-old client with dementia who is cared for at home c. A 65-year-old client who has just had a hip replacement d. A 72-year-old client on a rehabilitation unit with bilateral above-the-knee amputations

b. A 70-year-old client with dementia who is cared for at home The most likely victims of elder abuse are individuals who are in poor physical or mental health and dependent on others for physical or financial support; these clients are often confused and depressed.

The nurse working in the community is aware that there are different models for studying the epidemiology of a health condition in a population. One model of investigation of the interrelationships and characteristics of disease is the epidemiological triangle. This model analyzes what three elements? a. Incidence, prevalence, and etiology b. Agent, host, and environment c. Person, place, and time d. Virus, bacteria, and fungus

b. Agent, host, and environment The epidemiological triangle considers the extent of the host's exposure to the agent, the virulence of the agent, and the host's genetic or immunological susceptibility to the agent. Environmental conditions at the time of exposure are also considered. Examination of these three elements allows assessment of the problem, determination of protective factors, and evaluation of the vulnerability of the host to disease. The person-place-time model organized epidemiologists' investigations of the disease pattern in the community. Answer options A and D do not represent an epidemiologic model.

The nurse who was responsible for organizing relief efforts for soldiers during the U.S. Civil War and who was the founder of the American Red Cross was a. Lavinia Dock. b. Clara Barton. c. Sojourner Truth. d. Mary Breckenridge.

b. Clara Barton Clara Barton was responsible for organizing relief efforts during the U.S. Civil War. In 1882, she successfully persuaded Congress to ratify the Treaty of Geneva, which allowed the Red Cross to perform humanitarian efforts in times of peace. Lavinia Dock was a writer and political activist. Sojourner Truth was an advocate for abolishing slavery and supporting women's rights. Mary Breckenridge developed nursing in rural Kentucky in the 1920s, establishing the Frontier Nursing Service.

Based on the common illnesses and risky health behaviors among farmers, the community health nurse should implement which health promotion activity? a. Partner with the local health department to offer smoking cessation classes for farmers and their spouses. b. Collaborate with health care providers and provide support and education for farmers with respiratory conditions and their families. c. Collaborate with health care providers to conduct skin assessments at a meeting of local farmers. d. Work with mental health consultations to outline a community-based program to address the high rate of suicide and depression among farmers. e. Plan, implement, and evaluate an outreach program designed to improve the cardiovascular status of farmers and their families.

b. Collaborate with health care providers and provide support and education for farmers with respiratory conditions and their families. Several types of farming activities are associated with higher than expected occurrences of acute and chronic respiratory conditions. The role of the nurse is to refer patients to appropriate health care providers and provide support and education for affected people and their families. Farmers have a lower rate of cardiovascular disease, use of mental health services, and tobacco use than their urban cohorts.

Studies indicate that which lifestyle behaviors can prevent many chronic illnesses? (Select all that apply.) a. Consuming a sugar-free diet b. Exercising regularly c. Maintaining an optimal body weight d. Reducing stress e. Decreasing smoking

b. Exercising regularly c. Maintaining an optimal body weight d. Reducing stress Studies indicate that the following lifestyle behaviors can prevent many chronic diseases: consuming a low-fat diet, exercising regularly, maintaining an optimal body weight, reducing stress, and ceasing smoking.

Which phase of the community response to disaster includes medical personnel contributing long hours of volunteer work helping unfamiliar people after a disaster? a. Honeymoon phase b. Heroic phase c. Reconstruction phase d. Disillusionment phase

b. Heroic phase The heroic phase of a community's reaction to a disaster involves people feeling the need to rush to help people survive the disaster. Medical personnel may volunteer to work long hours without sleep and in dangerous conditions to care for patients. During the honeymoon phase, people who have survived the disaster get together to talk about their experiences. People begin to look to the future during the reconstruction phase and during the disillusionment phase people recognize that many things are different, and much needs to be done to adjust to the current situation.

An emergency department nurse assesses a 25-year-old patient with tachycardia, headache, and nausea. The patient denies drug use, heart problems, and smoking. She works from her house and states that everyone in her house has had the "flu" but that she is the only one who has not been feeling better. The nurse notices that the patient lives in the historic section of the town. What environmental hazard should the nurse be primarily concerned about? a. Food quality b. Housing quality c. Water quality d. Occupational risks

b. Housing quality Older homes and buildings often have poor ventilation and harbor hazardous materials. The signs and symptoms this patient is experiencing may be a result of "sick building syndrome." Gastrointestinal symptoms might indicate an issue with food or water quality. Occupational risks do not take into consideration the environmental hazard related to housing.

A community nurse is reviewing health statistics to gain a better understanding of a population's health needs. Crude rates are available for several health occurrences. What statement accurately describes crude rates? a. In calculating a crude rate, the numerator is the size of the population at risk. b. In calculating a crude rate, the average population size may be used as denominator. c. The denominator in a crude rate represents the population at risk for the event. d. Crude rates are used frequently because they avoid bias in interpretation.

b. In calculating a crude rate, the average population size may be used as denominator. Crude rates are calculated by using the number of events as the numerator. The denominator used may be the average population size or the population size at midyear and not the population at risk. Crude rates are subject to certain biases in interpretation.

The life-threatening parasitic disease that causes nearly 500,000 deaths annually is a. AIDS. b. malaria. c. tuberculosis. d. hepatitis.

b. Malaria Malaria is a life-threatening parasitic disease transmitted by mosquitoes. Malaria causes more than 212 million acute illnesses and 429,000 deaths annually. AIDS is a disease caused by the HIV virus. Tuberculosis is an infectious disease caused by the tubercle bacillus. Hepatitis is inflammation of the liver.

What is the purpose of the Homeless Information Management System (HIMS)? a. Provides means to feed homeless people b. Obtains national data on homeless individuals c. Serves as a screening tool to obtain any history of criminal activity d. Provides homeless individuals with educational materials

b. Obtains national data on homeless individuals The intent of the HIMS is to obtain national data, including the number of and demographic information on the homeless population. Providing means to feed homeless people, serving as a screening tool to obtain any history of criminal activity, and providing homeless individuals with educational materials are not functions of the HIMS.

A veteran was awarded VA disability compensation for a medical condition he contracted in 1965 while serving in Vietnam. Which condition did this veteran most likely have? a. Cardiac dysrhythmia Incorrect b. Parkinson disease c. Diabetes type 1 d. Irritable bowel syndrome

b. Parkinson disease The VA awards disability compensation for the following conditions to anyone who served in the Republic of Vietnam from 1962 to 1975: AL amyloidosis, chronic B-cell leukemia, chloracne, diabetes mellitus type 2, hodgkin disease, ischemic heart disease, multiple myeloma, non-Hodgkin lymphoma, Parkinson disease, peripheral neuropathy, porphyria cutanea tarda, prostate cancer, respiratory cancers, soft tissue sarcomas, and Lou Gehrig disease (or AML).

Agricultural workers are at high risk for occupational injuries and illnesses. To reduce the most common cause of fatalities among youth on farms, which is the most important strategy for the community nurse to implement? a. Planning a community media campaign advocating the use of helmets b. Partnering with the county extension agent to offer tractor safety classes c. Working with local health care providers to encourage use of personal protective equipment, such as hearing and respiratory protection d. Offering a class for local health care providers addressing the signs and symptoms of pesticide toxicity

b. Partnering with the county extension agent to offer tractor safety classes Tractor-related accidents, especially overturns, are the most frequent cause of farm accidents. Encouraging the use of helmets is important, but the most important measure would be to offer tractor safety education. Working with local health care providers to encourage use of personal protective equipment, such as hearing and respiratory protection and offering a class for local health care providers addressing the signs and symptoms of pesticide toxicity are less important measures.

Investigating all contacts of a person infected with a sexually transmitted disease is an example of what? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Initial prevention

b. Secondary prevention Secondary prevention includes the investigation of contacts to sexually transmitted disease cases. Secondary prevention includes activities to ensure early detection of infection and effective treatment of persons who are infected. Not only does this prevent progression of the infectious disease, but it also prevents transmission of the pathogen to others. Primary prevention of communicable diseases involves measures to prevent transmission of an infectious agent and to prevent pathology in the person exposed to an infection. Tertiary prevention includes activities involved in caring for persons with an infectious disease to ensure that they are cured or that their quality of life is maintained.

Which statement is true regarding the state level subsystem? a. States share central authority of the public health care system with the federal government. b. The organization and activities of public health services vary widely among the states. c. It is the role of the governor to direct most state health agencies. d. Compared with other state programs, state health programs usually have a small, specialized staff.

b. The organization and activities of public health services vary widely among the states. States are responsible for the health of their citizens and are the central authorities in the public health care system. The organization and activities of public health services vary widely among the states. A health commissioner or secretary of health who is typically appointed by the governor directs most state health agencies. The health officer is usually a physician with a degree and experience in public health. In some states, the health officer directs the health department. Many states have boards of health, which determine policies and priorities for allocation of funds. Staffing of the state agency varies among states; however, compared with other state programs, state health programs usually have a large staff.

A family of five people presented to a hospital after the flooding of their urban home. These family members are classified as a. poverty victims. b. displaced persons. c. indirect victims. d. mass casualties.

b. displaced persons. Displaced persons are those who have to evacuate their home, school, or business as a result of a disaster. An indirect victim may be a family member or friend of the victim or a first responder. A mass casualty event is one in which 100 or more individuals are involved. Poverty is not considered a disaster classification.

A primary role of the community health nurse in facilitating community participation and partnership is a. solving environmental health problems. b. educating about environmental health hazards. c. altering individual behaviors. d. implementing solutions to environmental racism.

b. educating about environmental health hazards. Educating the public about environmental health hazards is the first step in engaging the community problems of the environment. Environmental hazards are complex and interconnected; therefore, increasing the public's knowledge of the hazards leads not only to individual action but also public action. The other options are not the primary focus of the community health nurse.

Key messages from the report To Err Is Human (Institute of Medicine, 1999) include all except a. the magnitude of harm that results from medical errors is greater than the number of deaths from breast cancer. b. errors result largely from individuals' failures, not system failures. c. health care systems must focus on error prevention. d. processes must be improved to promote patient safety.

b. errors result largely from individuals' failures, not system failures. The report supports that medication errors contribute to 44,000 to 98,000 deaths each year in the United States (more than motor vehicle accidents or breast cancer); errors largely result from system failures; and health care systems must focus on error prevention and promote changes to improve processes that will promote patient safety.

In a managed care organization, physicians are responsible for the approval or referral of some services. In this position, they are referred to as a. enforcers. b. gatekeepers. c. carriers. d. distributors.

b. gatekeepers. Some services may only be accessed on approval or referral from physicians who are called gatekeepers (the primary care providers). The other options do not pertain to the referral or approval of services by a physician.

The Brown family is being evicted from their home and will be moving into a homeless shelter in 3 days. Under the Department of Housing and Urban Development (HUD) definition, the Brown family is a. literally homeless. b. in imminent risk of homelessness. c. homeless under other federal statutes. d. fleeing or attempting to flee intimate partner violence.

b. in imminent risk of homelessness. Imminent risk of homelessness defines those who will imminently lose their primary nighttime residence. The literally homeless have no fixed, regular, or adequate nighttime residence. Unaccompanied youth and families with children who are defined as homeless under other federal statues but do not fit into the other HUD defined categories of homeless may be defined as homeless under this HUD definition. Finally, individuals and families who are fleeing or attempting to flee intimate partner violence or other life-threatening conditions that relate to violence against the individual or family are defined as homeless.

The scope of health services at the federal level subsystem targets all major health areas mentioned except a. the general population. b. individual families. c. special populations. d. international health.

b. individual families The scope of health services of the federal level subsystem targets the following major health areas: the general population, special populations, and international health. For the general population, federal activities include protection against hazards, maintenance of vital and health statistics, advancement of scientific knowledge through research, and provision of disaster relief.

A pathogen lives and multiplies in a __________ and transfers from one host to another by a __________. a. host, susceptible portal of entry b. reservoir, mode of transmission c. infectious agent, portal of exit d. mode of transmission, reservoir

b. reservoir, mode of transmission A pathogen lives and multiplies in the reservoir and transfers from one host to another by a mode of transmission.

Local health department service categories fall into all except a. community health services. b. school health services. c. personal health services. d. mental health services.

b. school health services. Local health department service categories include community health services, environmental health services, personal health services, and mental health services. School health services may be provided at the federal, state, or local level, but it is not a service category of the local health department.

The school nurse is interviewing a student who has been assaulted by another student. Both students proclaim to be gang members. The nurse understands the reasons most youth give for joining a gang include the following: (Select all that apply.) a. financial gain. b. sense of belonging. c. peer pressure. d. relative is in a gang. e. need for respect.

b. sense of belonging. c. peer pressure. e. need for respect. Reasons that young people give for joining gangs include the belief that gangs will protect them, peer pressure, the need for respect, and a sense of belonging.

Migrant and seasonal farm workers constitute a high-risk population because of their low income and migratory status. These workers lack adequate access to preventive services. The most important role of the rural community health nurse in meeting the health care needs of this vulnerable population is to a. address the multiple communicable diseases of these farm workers. b. serve as an advocate working to gain health care access for these farm workers. c. participate in political activities with an emphasis on changing immigration laws. d. learn to speak Spanish to improve communication with this specific population.

b. serve as an advocate working to gain health care access for these farm workers. One of the greatest needs of the migrant and seasonal farm workers is the lack of access to health care. The community health nurse is in a strategic position to advocate for change to restructure health services and thus reduce this rural health disparity. Providing direct care for communicable diseases is important but does not meet the overarching goal of getting adequate health care access to migrant farm workers. Participating in political activities with an emphasis on changing immigration laws and learning to speak Spanish to improve communication with this specific population do not address the health care needs of migrant farm workers.

Groups such as professional organizations, nonprofit health care organizations, and corporations that sponsor health care are/is called a. the public sector. b. the private sector. c. stakeholders d. field experts.

b. the private sector The private sector includes employers, professional organizations (e.g., American Hospital Association), nonprofit health care organizations (e.g., American Heart Association), and for-profit corporations that deliver, insure, or fund health care services outside government control. The public sector is concerned with providing government services. A stakeholder is one who can affect or be affected by the actions of an organization as a whole. An expert is one who has extensive knowledge or skill in a particular field

Posttraumatic stress disorder (PTSD) can develop due to (Select all that apply.) a. having recurring nightmares. b. viewing a dead body. c. having a history of mental illness. d. surviving a natural disaster. e. experiencing chronic pain.

b. viewing a dead body. c. having a history of mental illness. d. surviving a natural disaster. PTSD can develop among those involved in car accidents, natural disaster survivors, and victims of rape or incest. Factors that contribute to an individual developing PTSD include getting injured or seeing another person injured, viewing a dead body, feeling helpless, having little or no social support after a traumatic event, dealing with extra stress after the event (e.g., loss of a loved one, pain, and injury), or having a history of mental illness or substance abuse. Having recurring nightmares and experiencing chronic pain are symptoms of, not causes of, PTSD.

Which is the correct process a bill must take before final approval by the president? a. A bill must succeed through one of the two legislative bodies, the House of Representatives and the Senate, and then be submitted for final approval by the president. b. A bill must go through discussion by the Supreme Court and then be submitted for final approval by the president. c. A bill must succeed through the two legislative bodies, the House of Representatives and the Senate, and then be submitted for final approval by the president. d. A bill must be approved by the House and Senate and then go before a committee before being submitted for final approval by the president.

c. A bill must succeed through the two legislative bodies, the House of Representatives and the Senate, and then be submitted for final approval by the president. The bill must succeed through both legislative bodies, the House of Representatives and the Senate. The Supreme Court is not involved in creating legislation. A bill goes before a committee before going to either legislative body.

Which describes a NA-TECH (natural technological) type of disaster? a. A flood covering crops and recreational areas of a geographic area b. A terrorism attack causing major interruption of communication technologies c. A tornado resulting in flood and destruction of electrical systems for a community d. A nuclear accident at a power plant causing evacuation of people in an urban community

c. A tornado resulting in flood and destruction of electrical systems for a community A natech disaster is a natural disaster that creates or results in a widespread technological problem. A flood covering crops and recreational areas of a geographic area does not mention a technological problem, and a terrorism attack and a nuclear accident are not natural disasters.

Which prospective payment method determined the amount of reimbursement that health care providers would receive for specific illnesses from Medicare? a. Current procedural terminology codes b. Actuarial classifications c. Diagnosis-related groups d. Medigap insurance

c. Diagnosis-related groups For determination of the prospective amount, Medicare depended on the diagnosis-related groups to calculate the reimbursement. Physician services are coded according to current procedural terminology codes. Actuarial classifications ensured that adequate premiums were charged by private health insurers for the projected health care needs of those enrolled. Medigap insurance is a privately purchased individual or group health insurance plan designed to supplement Medicare coverage.

Which agency has a mission to support citizens and first responders to ensure that as a nation everyone works together to build, sustain, and improve the capacity to prepare for, protect against, respond to, recover from, and mitigate all? a. American Red Cross (ARC) b. National Institute for Health (NIH) c. Federal Emergency Management Agency (FEMA) d. Centers for Disease Control and Prevention (CDC)

c. Federal Emergency Management Agency (FEMA) FEMA's mission is to support citizens and first responders to ensure that as a nation everyone works together to build, sustain, and improve the capacity to prepare for, protect against, respond to, recover from, and mitigate all. The other agencies may be peripherally involved in national disasters, but it is not their primary focus.

Which statement regarding sexually transmitted diseases (STDs) is correct? a. The rate of STDs is decreasing because of effective medication therapies. b. Women are less likely to use protection methods against STDs. c. Half of the STD rate in the United States falls within the 15 to 24 age range. d. Treatment for STDs in women is usually ineffective.

c. Half of the STD rate in the United States falls within the 15 to 24 age range. An estimated 20 million cases of STDs occur each year in the United States, almost half of them in persons aged 15 to 24 years. The other statements are not true.

Approaching health at the aggregate level is the initiative of which agency or document? a. Occupational Safety and Health Administration (OSHA) b. Clean Air for All c. Healthy People 2020 d. Centers for Disease Control and Prevention (CDC)

c. Healthy People 2020 An attempt to approach health at the aggregate level is the Healthy People 2020 initiative. It deals with issues ranging from decreasing ozone levels to decreasing Escherichia coli outbreaks. All of these issues deal with the broader environmental origins of disease, not just deleterious personal habits. OSHA, Clean Air for All, and the CDC have a more narrow focus.

Which intervention would be the most appropriate to implement for a community that has a high risk for environmental health hazards? a. Facilitate the evaluation of ongoing community health interventions. b. Document participation levels of families in environmental issues. c. Involve citizens in decision-making processes about proposed activities that could pose an environmental threat. d. Screen at-risk populations for asthma and test blood levels for air pollutants.

c. Involve citizens in decision-making processes about proposed activities that could pose an environmental threat. Community health nurses have a mandate to assist vulnerable aggregates who have fewer options in protecting themselves from pollution, inadequate housing, toxic poisoning, unsafe products, and other hazards. An appropriate nursing intervention would be to involve citizens in decision-making processes about proposed activities that could pose an environmental threat. Evaluating ongoing health interventions, documenting participation levels of families, and screening at-risk populations are important evaluation methods for determining the needs of the community but are not the most appropriate intervention.

In the 1850s, a researcher studied a cholera epidemic among people living in different sections of London. The researcher who used epidemiologic methods to study the epidemic and used rates as an epidemiologic tool was a. Joseph Lister b. William Farr c. John Snow d. Edward Jenner

c. John Snow John Snow is recognized as the researcher who applied epidemiologic methods in the investigation of a cholera epidemic in London in the 1850s. Joseph Lister is considered the pioneer of antiseptic surgery. William Farr was a 19th century British epidemiologist who is regarded as a founder of medical statistics. Edward Jenner developed the smallpox vaccine.

Which statement regarding military sexual trauma (MST) is true? a. MST is more common among male veterans. b. MST is always perpetrated by a stranger. c. MST is associated with diabetes. d. MST is associated with mild PTSD.

c. MST is associated with diabetes. A number of health conditions are more prevalent among women with a history of sexual trauma, including sexually transmitted infections, diabetes, obesity, arthritis, irritable bowel syndrome, hypertension, and eating disorders. MST is reported by 32.4% of female veterans and only 4.6% of male veterans. It is estimated that in one of seven women who report MST, the trauma was perpetrated by an intimate partner. Among veterans seeking treatment for PTSD, sexual trauma has been associated with more severe PTSD than any other type of trauma, including combat trauma.

How would a community health nurse use Executive Order 12898? a. Recognize that its focus is to decrease urban sprawl. b. Use its definition of sick building syndrome in completing an environmental assessment. c. Recognize that it would help achieve environmental justice. d. Cite it as a law to decrease carbon dioxide emissions for industries regulated by the Environmental Protection Agency.

c. Recognize that it would help achieve environmental justice. Executive Order 12898 (signed by President Clinton in 1994 with a memorandum signed by President Obama in 2008) required all federal agencies to develop comprehensive strategies to identify and address environmental justice. The focus of Executive Order 12898 is not to decrease urban sprawl. Sick building syndrome describes a phenomenon in which public structures and homes cause occupants to experience a variety of symptoms, such as headache, fatigue, and exacerbation of allergies. Executive Order 12898 is not citable as law to decrease carbon dioxide emissions.

Which act, established in the 1940s, provided grants to states for the purpose of new construction of health care institutions? a. The McCarren-Ferguson Act b. The Health Amendments Act c. The Hill-Burton Act d. The Tax Equity and Fiscal Responsibility Act

c. The Hill-Burton Act The Hill-Burton Act of 1946 provided grants to states for the construction of new hospitals, targeting low income and rural areas. The McCarren-Ferguson Act gave states the right to regulate health insurance plans. The Health Amendments Act authorizes funds for registered nurse education in administration, supervision, or teaching. The Tax Equity and Fiscal Responsibility Act established the prospective payment system for Medicare.

Which statement regarding the impact of managed care on rural public health departments is true? a. Managed care has expanded the safety-net role of many local health departments by funding primary care services. b. Medicaid's importance for rural areas is likely to decrease. c. The role of rural public health departments may increasingly narrow into areas that are currently without any type of reimbursement. d. Medicaid programs will continue to serve the rural communities on a fee-for-service basis.

c. The role of rural public health departments may increasingly narrow into areas that are currently without any type of reimbursement. The evolution of managed care into rural environments has limited the safety-net role of some local health departments to provide primary care by preventing fee-for-service reimbursement and contracting care to networks of providers or organizations. This is especially true for Medicaid managed care, which serves that same population of people that are traditionally served with primary care services through local public health departments. Medicaid's importance for rural areas is likely to grow as broader health care developments, such as declining inpatient use of rural hospitals and reductions in Medicare reimbursement, provoke more interest in using the Medicaid system to support threatened rural infrastructure. Consequently, the administration of the Medicaid program will increasingly seek the cost savings promised by managed care, and the role of rural public health departments may increasingly narrow into areas that are currently without any type of reimbursement.

The global health organization that works for children's survival, development, and protection is the a. World Health Organization (WHO). b. Centers for Disease Control (CDC). c. United Nations International Children Emergency Fund (UNICEF). d. Pan American Health Organization (PAHO).

c. United Nations International Children Emergency Fund (UNICEF). UNICEF works for children's survival, development, and protection by developing and implementing community-based programs. UNICEF achievements are well documented in child health, nutrition, education, water, sanitation, and progress for women. PAHO is an international public health agency that works to improve the health and living standards of the Americas. The WHO introduced the goal of "health for all." The CDC strives to prevent and control infectious and chronic diseases, injuries, workplace hazards, disabilities, and environmental health threats.

When chronic disease became a more important cause of death in developed countries, different epidemiologic models were developed to study the many factors involved in the development of these health conditions. Which is an example of such a model? a. Person-place-time model b. Epidemiological triangle c. Web of causation d. Wheel model

c. Web of causation Chronic disease is marked by a complexity of relationships among causal factors. The web of causation model illustrates the interrelationships. The person-place-time model organized epidemiologists' investigations of the disease pattern in the community. The epidemiological triangle considers the extent of the host's exposure to the agent, the virulence of the agent, and the host's genetic or immunological susceptibility to the agent. The wheel model is an example of a model that stresses the multiplicity of host and environmental interactions.

What group of homeless individuals is known for their involvement in survival sex? a. Young adult gay men b. Middle-aged women Incorrect c. Young women d. Elderly men

c. Young women Young homeless women may become involved in survival sex because they need money to meet subsistence needs, hence the term survival sex.

Transmission of an infectious disease can be efficiently controlled by a. breaking all links in the transmission chain. b. destroying all reservoirs of infectious agents. c. breaking only one link in the transmission chain. d. maintaining high levels of herd immunity

c. breaking only one link in the transmission chain. Breaking just one link of the chain can control transmission of an infectious agent. Destroying all reservoirs of infectious agents and maintaining high levels of herd immunity are two of several ways to break a link in the chain of transmission.

Services provided in the private subsystem include all except a. health promotion. b. disease prevention. c. heath care regulation. d. treatment of disease.

c. health care regulation Services in the private subsystem include health promotion, prevention and early detection of disease, diagnosis and treatment of disease with a focus on cure, rehabilitative-restorative care, and custodial care. The public health subsystem is required by law to address the health of populations. Legal provisions at the local, state, and federal levels of government direct the establishment, implementation, and evaluation of these activities.

Population overcrowding can result in a. increased productivity. b. improved education. c. increased incidence of disease. d. decreased mortality.

c. increased incidence of disease. Overcrowding leads to pollution, stress, disease, and violence. Mortality rates are increased, and quality of life decreases.

The early Blue Cross and Blue Shield plan was an example of a/an a. health maintenance organization. b. prospective payment plan. c. indemnity plan. d. cafeteria plan.

c. indemnity plan The early Blue Cross and Blue Shield plan was an example of an indemnity plan. This plan paid all of the costs of covered services provided to the enrollee. The enrollee enjoyed free choice of provider and services. Indemnity plans preserved the enrollee's right of choice and allowed the person to manage his or her own health care. A health maintenance organization is a managed care plan that acts as an insurer and sometimes a provider for a fixed prepaid premium. Prospective payment is payment for health care providers based on the disease or injury that is treated. Cafeteria plans are customizable health care plans.

Katie, a 2-year-old child, is brought to the doctor's office after 2 days of vomiting and diarrhea. Upon completion of the medical history, the mother tells the nurse that several of the other children at the daycare who played with the same toys as Katie have the same symptoms. The mode of transmission for the pathogen more likely was a. vector. b. direct. c. indirect. d. airborne.

c. indirect. The stem of the question indicates that the children played with the same toys. This would indicate the indirect mode of transmission. The other modes of transmission do occur through the sharing of toys.

A person who acts as a representative for another person or organization before the legislature is called a(n) a. advocate. b. policy maker. c. lobbyist. d. field expert.

c. lobbyist A lobbyist is a person, who voluntarily or for a fee, represents him- or herself, or another individual, organization, or entity for the purpose of influencing policy or legislation. An advocate is a person who supports a cause or policy. A policy maker is one who creates policies. An expert is one who has extensive knowledge or skill in a particular field.

An example of care provided under the local health department category of environmental health services is a. disease surveillance. b. immunizations. c. occupational health. d. nutrition services.

c. occupational health. Environmental health services include food hygiene, such as inspection of food-producing and food-processing plants and restaurants; protection from hazardous substances; control of waste, air, noise, and water pollution; and occupational health. The other options are examples of community health services.

The health literature accessed by the community health nurse often addresses the probability of an adverse event. What term refers to the likelihood that healthy people exposed to a specific factor will experience a specific health condition? a. Prevalence b. Rates c. Risk d. Incidence

c. risk The term risk refers to the probability of an adverse event. Prevalence is the number of all cases of a specific disease or condition in a population. Rates are arithmetic expressions that help practitioners consider a count of an event relative to the size of the population from which it is extracted. Incidence describes the occurrence of new cases of a disease or condition in a community over a period of time.

The greatest promise for improving health outcomes for rural residents is a. the increase in health care providers migrating to rural areas. b. the expansion in Medicare services to rural hospitals and clinics. c. the increase in distribution of technology, providing more education and health services. d. the expansion of public transportation, allowing rural residents to travel to tertiary care hospitals for specialty services.

c. the increase in distribution of technology, providing more education and health services. Rural patients are able to access specialty services such and radiologic or dermatologic examinations through telemedicine, and rural people are increasingly taking advantage of the Internet to access information to make health decisions. Expansion and increased distribution of technology in rural areas has increased access to health care services and health education through distance programs for rural residents. Health care providers remain scarce in rural areas. Rural hospitals and clinics generally have Medicare services. There is still inadequate public transportation from most rural areas to tertiary hospitals.

After the implementation of various policies to reduce tobacco use, the tobacco industry has begun targeting (Select all that apply.) a. elderly people. b. Hispanics. c. youths and young adults. d. African Americans. e. international markets.

c. youths and young adults. e. international markets. The tobacco industry has now started targeting youths and dramatically increased international exports. Tobacco sales among American adults is down.

The nurse is assisting Sargeant Earl in applying for VA benefits. Which statement made by Sargeant Earl indicates he understands VA benefits? a. "This is a wonderful health insurance program that will cover all of my health care needs." b. "I can see any provider I wish under the VA health insurance plan." c. "I still need to carry private insurance to assist with the most expensive treatments." d. "My primary care copay is $15 a visit and outpatient specialist copays are $50 per visit."

d. "My primary care copay is $15 a visit and outpatient specialist copays are $50 per visit." VA primary care copays are $15 per visit, and outpatient specialist copays are $50 per visit. VA benefits are not a health insurance plan where the veteran has to "pay into" the system. VA benefits are rewarded in exchange for the veteran's service to the country. The "coverage" received in the form of VA benefits is not transferable to other non-VA providers, except through formal contracts deemed appropriate by the VA and its providers. The VA always bills an individual's private insurance for medical care, supplies, and prescriptions provided for nonservice-connected conditions. Any monies collected from a veteran's private insurance offsets his or her copayments, and furthermore, the veteran is not responsible for any balance the private insurance does not cover.

An epidemic is occurring in a public health nurse's community, and the nurse is working with the epidemiologist and other health professionals seeking to identify the causative agent. What phrase best describes such efforts? a. Cohort study b. Descriptive epidemiology c. Point prevalence study d. Analytic epidemiology

d. Analytic epidemiology Analytic epidemiology investigates the causes of disease by determining why a disease rate is lower in one population group than in another. This method tests hypotheses generated from descriptive data and either accepts or rejects them on the basis of analytic research. Cohort studies obtain information about the cause of disease by establishing a relationship between the presumed causal factors and the effect. The study of the amount and distribution of disease constitutes descriptive epidemiology. When prevalence rates describe the number of people with the disease at a specific point in time, they are sometimes called point prevalences.

One of the first health insurance companies established in the 1930s to provide health care to subscribers was a. Aetna Insurance. b. Woodmen of the World. c. Humana Health Maintenance Organization. d. Blue Cross and Blue Shield.

d. Blue Cross and Blue Shield. During the 1930s, in an effort to provide care and avoid bankruptcy, health care providers began to establish health insurance plans. One of the most recognizable of these is Blue Cross and Blue Shield. The other options were all created later.

What element of a community disaster plan investigates the citizen's reliance on telephone systems or cell phones during disasters? a. Authority b. Logistical c. Rescue d. Communication

d. Communication Communication is one of the biggest problems during a disaster. The reliance on telephone systems or cell phones should not be the only plan for communication during a disaster. Authority focuses on the people in charge, logistical includes focuses on storage of equipment and location of key responders, and search and rescue focuses on the search and rescue of victims.

What official national organization provides financial housing assistance to low-income families? a. World Health Organization (WHO) b. Federation of National Organizations Working with the Homeless (FEANTSA) c. Robert Wood Johnson Foundation d. Department of Housing and Urban Development (HUD)

d. Department of Housing and Urban Development (HUD) HUD, in cooperation with state and local governments and nonprofit housing organizations, operates programs that provide financial housing assistance to low-income families. The WHO is an organization that is concerned with international public health. FEANTSA is a European organization that works to prevent and alleviate poverty and homelessness in Europe. The Robert Wood Johnson Foundation provides funding for nursing education.

Personal care provided by physicians is delivered by various basic models. The following is an example of an integrated health maintenance model: a. Dr. Jones is a family practitioner. He has his own practice in his own office. He covers all of his own expenses. b. Dr. Cohen and Dr. Bernard are cardiologists who share a practice. They divide the expenses, income, and offices. c. Dr. Davis is a general surgeon, Dr. Brown is an orthopedic surgeon, and Dr. Burnett is a vascular surgeon. They share the practice, along with all of their expenses, income, and offices. d. Dr. Smith is an internist, Dr. Gregory is a pediatrician, and Dr. Stanley is a family practitioner. They are paid a monthly salary by an organization to see all of its patients.

d. Dr. Smith is an internist, Dr. Gregory is a pediatrician, and Dr. Stanley is a family practitioner. They are paid a monthly salary by an organization to see all of its patients. The integrated health maintenance model has prepaid multispecialty physicians, such as in option D. Option A is an example of a solo practice. Option B is an example of a single specialty group model. Option C is an example of a multispecialty group practice.

The first nurse to establish international links and networks was a. Clara Barton. b. Mary Breckenridge. c. Dorothea Dix. d. Florence Nightingale.

d. Florence Nightingale. Florence Nightingale's legacy serves as the foundation for community health nursing in the global health care arena. She channeled her energy into all aspects of health from the care of wounded soldiers at Scutari to the broad public policies that affected health in her time. The other three women were instrumental primarily for their contributions in the United States.

The nurse at the disaster site is using the SMART triage system. What color triage tag would be provided to an ambulatory individual with a superficial cut on the left elbow and bruise to the right hand? a. Red b. Yellow c. Black d. Green

d. Green Green is for the wounded or individuals with minor injuries who are able to walk and to wait several hours before receiving medical treatment. Red is for those with life-threatening injuries but have a high probability of survival, yellow is for those with systemic but non-life-threatening complications, and black is for the deceased or those with nonsurvivable injuries.

Which is classified as a vector of disease? a. Humans b. Door handles c. Water and food d. Mosquitoes

d. Mosquitos Vectors can be animals or arthropods and can transmit disease through biological and mechanical routes. The other options are not vectors.

Veterans with a substance use disorder (SUD) are most likely to suffer from a. TBI b. MST c. VHA d. PTSD

d. PTSD Although problems with alcohol or other drugs affect veterans at about the same rates as the general population, there is a strong relationship between SUD and PTSD: more than 2 of 10 veterans with PTSD also have SUD.

Access to health care is determined by the circumstances of the individual that obstruct the means to obtain desired health care. Which is not a barrier to health care access? a. Preexisting conditions b. Nonparticipating physician c. Inability to communicate d. Personal avoidance of a health problem

d. Personal avoidance of a health problem Any condition that prevents an individual from seeking desired health care presents a barrier. Chosen avoidance is not a barrier.

Which statement about intimate partner violence (IPV) is true? a. It occurs only in poor, uneducated, minority households. b. It only occurs in heterosexual relationships. c. Victims can change the abusers' behavior. d. Professional intervention is needed to change the abusers' behavior.

d. Professional intervention is needed to change the abusers' behavior. Abusers will stop the abuse only after receiving treatment. Abusers do not change behaviors on their own. The other statements are true.

Which is the purpose of the staging area in a disaster plan? a. A triage area outside the hospital, supplying first aid and transport to medical facilities b. A stage for entertainment to cheer up disaster victims c. To provide sheltered area for displaced victims to sleep, eat, and bathe d. To act as command station for disaster responders to report to and get assignments

d. To act as command station for disaster responders to report to and get assignments The staging area is the onsite command station. Dispatch responders should report to this area and check-in. This allows everyone to be accounted for and to gather assignments. The other options are not appropriate uses for the staging area in a disaster.

A veteran is a person who has served in the military. Which statement about veterans is correct? a. There are 5 million veterans in the United States today. b. Employees of the National Aeronautics and Space Administration (NASA) are considered veterans. c. People who were honorably discharged from the military are still considered veterans. Incorrect d. Veterans include those that have served in the active military, naval, or air service.

d. Veterans include those that have served in the active military, naval, or air service. Legally, a veteran is an individual who has served in the active military, naval, or air service and who was discharged or released under conditions other than dishonorable. There were 18.8 million veterans in the United States in 2015. People who have served in the U.S. Public Health Service and some persons employed by the National Oceanic and Atmospheric Administration are also veterans.

According to the vulnerability index, the individual at highest risk for death is a. a 46-year-old person who has been homeless for 2 months and has HIV. b. a 22-year-old person who lives in a homeless shelter and is addicted to heroin. c. a 65-year-old person who is being evicted from his home after living there for 25 years. d. a 60-year-old person who has been homeless for 9 months.

d. a 60-year-old person who has been homeless for 9 months. Those at high risk for death are individuals who have been homeless for 6 months or more with one or more conditions: More than three hospitalizations or emergency department (ED) visits in 1 year? More than 3 ED visits in the previous 3 months? 60 years or older? Cirrhosis of the liver? End-stage renal disease? History of frostbite, immersion foot, or hypothermia? HIV/AIDS? Co-occurring psychiatric, substance abuse, and chronic medical conditions

A major cause for the rise in health care costs is a. an increase in the specialization of physicians. b. a decrease in nonprofit hospitals. c. a shortage in the number of primary care physicians. d. a demand for complex and advanced services.

d. a demand for complex and advanced services. The spiraling health care costs, starting from the mid-1960s and persisting into the twenty-first century, were fueled by the presence of very rapid technological advances, society's sense of entitlement to these therapies, a guaranteed payer, and the prevailing medical orientation toward curative measures. The number of physicians or hospitals is not a primary contributor to rising health care costs.

Using critical theory when exploring issues of environmental health ultimately allows the nurse to a. develop a community diagnosis. b. raise additional questions related to environmental health and safety. c. design community health interventions. d. alter the precursors of poor health.

d. alter the precursors of poor health. Critical theory is used to help community health nurses think about social, cultural, economic, and political factors of health, thereby assisting them to attack the problem at its source and alter community-wide precursors of poor health. The community health nurse can develop a community nursing diagnosis and design interventions by using the nursing process.

Four-month-old Lucy is in for immunizations at the local health department. The Vaccine Information Sheet is given to Lucy's mother, and informed consent is obtained. However, the mother then states, "Lucy did have a temperature around 99.1 degrees the night of her last immunizations." After this statement, the nurse should a. consult the child's pediatrician. b. delay the immunizations. c. do not give the immunizations because of the contraindication. d. give the immunizations.

d. give the immunizations. A low-grade fever is not a contraindication to immunizations. The nurse should give the immunizations. It is not necessary to contact the child's pediatrician. Vaccination should be postponed in cases of moderate or severe febrile illness to avoid any confusion between a vaccine side effect and an unknown underlying cause.

A statement of a decision regarding a goal in health care and a plan for achieving that goal is called a. nursing policy. b. fiscal policy. c. social policy. d. health policy.

d. health policy Health policy is a statement of a decision regarding a goal in health care and a plan for achieving that goal. Nursing policy specifies nursing leadership that influences and shapes health policy and nursing practice. Fiscal policy is related to finance. Social policy is policy associated with individuals and communities.

People who live in developing countries are at risk for a variety of health threats as a result of all factors except a. limited sanitation facilities. b. increased chance of exposure to communicable diseases, including AIDS, tuberculosis, and hepatitis B. c. higher rates of tobacco use compared with most developed countries. d. lack of interest in health issues and health care.

d. lack of interest in health issues and health care. In developing countries, people are more likely to be exposed to communicable diseases as a result of a number of factors, including high population density, lack of accessible health care and treatment, and poor or limited sanitation. In addition, although tobacco use is decreasing in most developed countries, it is increasing in many underdeveloped ones. Although people in developed countries often lack resources and information, they are nonetheless interested in health promotion, disease prevention, and many aspects of health care delivery.

Child maltreatment that allows the child to use drugs and alcohol is an example of a. sexual abuse. b. physical abuse. c. psychological abuse. d. neglect.

d. neglect. Neglect is the failure of the responsible person to provide basic needs such as shelter, food, clothing, education, and access to medical care; permitting the child to use drugs/alcohol; and inattention to the child's emotional needs. The other options are types of abuse.

The Health Resources and Services Administration (HRSA) assists nursing workforce development by a. establishing schools of nursing. b. supporting organizations with a political agenda for health care. c. providing federal funds to promote health care reform. d. providing grants to provide for education and recruitment.

d. providing grants to provide for education and recruitment. The nursing workforce development programs administered by the HRSA through Title VIII provide federal support for nurses' workforce development. The HRSA does not establish nursing schools but provides federal funding for nursing education at the undergraduate and graduate levels and favors institutions that educate nurses for practice in rural and medically underserved communities. The other options do not assist nursing workforce development.

As a visiting community health nurse, you must take precautions to avoid unsafe situations. To avoid putting yourself in danger, you would a. enter a house where a violent act is occurring and call 911. b. expect the client to control angry family members. c. always carry a concealed weapon. d. remain outside if you hear sounds of fighting in a home.

d. remain outside if you hear sounds of fighting in a home. When approaching a home, as a community health nurse, you should notice the environment, animals, fences, activities, possible indicators of crime, and places you could go for assistance if necessary. Walk with confidence and maintain a professional attitude. Listen for signs of fighting before knocking. If you hear sounds of fighting, leave. Do not enter a home if you suspect an unsafe situation.

In contrast to people who live in urban areas, rural residents frequently describe their health by their ability to a. avoid hospitalizations. b. maintain social connections. c. perform activities of daily living. d. work and be productive.

d. work and be productive. residents generally describe themselves as healthy if they can do their usual work and remain productive. Performing activities of daily living may be one part of being productive. Avoiding hospitalizations and maintaining social connections are the most frequent descriptions of health by rural residents.