Public 3

ANS: B In a passive system of surveillance, health care providers, agencies, or laboratories send case reports to local health departments. The case reports are summarized and forwarded to the state health department, national governmental agency, or organization responsible for monitoring the problem, or to an international organization like the World Health Organization. This system can then be used to derive disease-specific demographic, geographic, and seasonal trends for reported events. These data are useful to a PHN conducting a community assessment or mobilizing for action through planning and partnerships (MAPPS) on a defined community. Cognitive Level: Analysis Associated Chapter Objective: 2 REF: p. 536

A PHN uses the state health department's reportable disease system to complete a community assessment of a rural county with issues of access to primary care services. This can best be described as what type of surveillance system? a. Active b. Passive c. Sentinel d. Special

5. A case manager employed by a health maintenance organization is charged with discontinuing home health services for a disabled homebound elderly client in an effort to reduce costs. The case manager reviews the client's record and determines that home health services are still indicated for this client. The ethical dilemma faced by the case manager is: a. beneficence. b. justice. c. nonmaleficence. d. veracity.

ANS: A Beneficence—"doing good"—becomes an ethical dilemma when the insurer's goal of containing costs supersedes the case manager's duty to improve health and relieve suffering. This ethical tenet of nursing practice to act in the best interest of the client also involves fidelity to the nurse-client trust relationship. Duty to clients to secure benefits on their behalf and to limit unnecessary expenditures can create dilemmas when the goals are not uniform. Advocacy on this client's behalf with accurate and updated information based on sound assessment, evidence-based practice, and liability risk management could produce a favorable outcome for all parties. The incorrect action would be to do nothing.

2. During a home visit, a case manager for a community health center notes marked pitting edema, shortness of breath, and increased fatigue in a 52-year-old male client who lives alone. The client is admitted to the hospital, where he is diagnosed with congestive heart failure. The case manager works with the hospital's utilization manager to devise a discharge plan. The case manager's most logical next step would be to: a. assess the client; obtain information on the scope of services covered by the benefit plan for the client; if needed services are not covered, seek to identify and arrange for the resources to provide these services. b. call the client, reintroduce himself or herself, and explain his or her role as a case manager for homebound clients. c. discuss with the family their schedule of availability to offer care in the client's home; ensure that the client has daily visits by family members. d. investigate the availability of local support and rehabilitation services for clients with congestive heart failure; contact the client's family.

ANS: A Case management has been described as a set of logical steps and process of interaction within a service network that ensures that a client receives needed services in a supportive, effective, efficient, and cost-effective manner. The National Case Management Task Force defines case management as a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services to meet an individual's needs, using communication and available resources to promote quality cost-effective outcomes. Case management has been defined in the public health nursing literature as the establishment of an appropriate plan of care based on assessment of the client/family and coordination of the necessary resources and services for the client's benefit. Therefore, a critical role of the case manager is to help clients obtain the care they need to achieve a maximum level of health. The nurse needs to understand what the client's insurance covers (broker). If necessary services or equipment is not covered by insurance, the nurse may act as an advocate (facilitator) and connect the client with other resources in the community (coordinator) if available.

7. In case management, it is unlikely that any single professional has the expertise, knowledge, or skills required to achieve success. The synergy produced by all involved parties (client, providers, payers, family/significant others, and community organizations) can result in successful outcomes. These statements relate to the sequential process of: a. collaboration. b. communication. c. cooperation. d. negotiation.

ANS: A Collaboration is achieved through a developmental process carried out in a sequence, yet it is reciprocal among those involved. Teamwork and collaboration require extensive skill sets to achieve successful outcomes. No single professional has the expertise required for all aspects. Synergy among all parties involved is required. Although communication is essential to collaboration, it is not sufficient to create or maintain collaboration.

What information is shared among agencies when they collaborate to implement a quality surveillance system? a. How to use algorithms to identify which events should be investigated b. Who is to blame for a disease outbreak c. What shelters will be used and by whom d. How political action will be necessary to ensure public health

ANS: A Collaboration promotes the development of plans and a directory of emergency responses. How to use algorithms is a key type of information that is shared. Blaming others is not part of collaboration. Determining what shelters will be used and by whom is not the priority for collaboration. How political action will be necessary to ensure public health is not a priority for collaboration.

3. A community-oriented nurse is writing a grant application for funding for a nurse-run clinic serving clients with chronic illnesses. The grant application asks for information regarding program benefits, effectiveness, and efficiency. The most effective tool to obtain this information would be: a. cost studies. b. Mobilizing for Action through Planning and Partnerships (MAPP) model. c. Planning Approach to Community Health (PATCH) method. d. Tracer method.

ANS: A Cost studies are essential to show the value of nursing in the marketplace now and in the future. All cost studies involve three major tasks: financial, research, and statistical. The financial tasks include identifying total program costs. The statistical tasks include identifying appropriate, quantifiable measures for analyzing data. The research tasks include setting up an appropriate study design to answer questions about benefit, efficiency, or effectiveness. Types of cost studies include cost-accounting, cost-benefit, cost-effectiveness, and cost-efficiency studies.

A public health nurse (PHN) is investigating an outbreak of salmonellosis in a community. Which type of surveillance system is being used? a. Active b. Passive c. Sentinel d. Special

ANS: A In the active system, a PHN begins to search for cases through contacts in the community. The nurse names the disease and gathers data about existing cases to try to determine the magnitude of the problem. In the passive system, case reports are sent to local health departments by health care providers. In the sentinel system, trends in commonly occurring diseases or key health indicators are monitored. Special systems are developed for collecting particular types of data and may be a combination of active, passive, and/or sentinel systems.

Which is a feature of public health surveillance? a. Sharing of the results with others b. Defining public health policy c. Evaluating interventions d. Planning national programs

ANS: A One of the features of public health surveillance is sharing of the results with others. Defining public health policy, evaluating interventions, and planning national programs are all purposes of surveillance, not features.

The federal-state-local partnership teams with other organizations to develop and implement responses to identified public health concerns because: a. community health is a shared responsibility. b. health objectives are defined nationally. c. population health is the responsibility of the government. d. public health trends focus on bioterrorism.

ANS: A PHNs partner with multidisciplinary teams of people within public health areas, in other human services and public safety agencies, and in community-based organizations. The health of communities is a shared responsibility that requires a variety of diverse and often nontraditional partnerships. Public health agency staffs include physicians, PHNs, nutritionists, environmental health professionals, health educators, various laboratory workers, epidemiologists, health planners, paraprofessionals who make home visits, and outreach workers. Community-based organizations include the American Red Cross (ARC), free clinics, advocacy groups, Head Start programs, daycare centers, community health centers, hospitals, senior centers, churches, academic institutions, and businesses. Other government agencies include fire/emergency services departments, law enforcement agencies, schools, parks/recreation departments, and elected officials. Cognitive Level: Analysis Associated Chapter Objective: 8 REF: p. 994

6. The nurse engaging in a formative program evaluation would most likely: a. conduct medical record audits for quality assurance. b. make a home visit before a client is discharged from the program. c. participate in a new client evaluation. d. write a policy for risk management.

ANS: A Process evaluation, also referred to as formative evaluation, occurs during program implementation and makes it possible to make midterm corrections to ensure the achievement of program goals. Process evaluation is an ongoing function of examining, documenting, and analyzing the progress of a program. This type of program monitoring can be used to justify continuing the program, because it will address the efficiency and effectiveness of the program in meeting its goals. Quality assurance programs are examples of program evaluation in health care delivery.

3. A community health nurse is serving as a case manager for premature infants receiving home health care. The case manager arranges for an in-home apnea monitor and daily home visits by a registered nurse who specializes in high-risk pediatrics. The case manager is demonstrating which of the following case manager roles? a. Consultant and coordinator b. Mentor and liaison c. Monitor and reporter d. Standardization monitor and negotiator

ANS: A The case manager is responsible for fulfilling a variety of roles. The nurse is acting as a consultant when working with suppliers to arrange for the apnea monitor. The nurse is acting as a coordinator when arranging for needed heath care services such as daily home visits by a specially trained pediatric registered nurse.

The PHN applies knowledge in working with a local school board coalition to develop a helmet safety campaign in the middle and high schools. This best exemplifies which aspect of public health? a. Core Competency b. Core function c. Nursing role d. Standard of practice

ANS: A The core public health competencies are divided into eight domains: analytical assessment skills, basic public health science skills, cultural competency skills, communication skills, community dimensions of practice skills, financial planning and management skills, leadership and systems thinking skills, and policy development/program planning skills. This example demonstrates such competencies as analytical assessment, communication, leadership, and policy skills. Cognitive Level: Application Associated Chapter Objective: 7 REF: pp. 1002-1003

7. Local officials have requested a program evaluation of a comprehensive teen sex education program offered in the local schools in preparation for annual budget-planning discussions. The public health nurse (PHN) determines that the teen pregnancy rate has gradually declined over the years that the program has been in place. The nurse has also identified the evaluation plan that was articulated during the program planning phase. The best tool for demonstrating the efficiency of this program is: a. cost-benefit analysis. b. cost-efficiency analysis. c. relevance assessment. d. school records audit.

ANS: A The efficiency of a program can be evaluated through a formative or summative evaluation. The evaluator may be able to determine whether a given program provides better benefits at a lower cost than a similar program, or whether the benefits to the clients justify the costs of the program (efficiency). Public health programs are usually recognized as having a net positive impact, and appropriate sex education can reduce the incidence of teen pregnancy by altering teen sexual behaviors. To perform a cost-benefit study, the evaluator must decide which costs and which benefits are to be included, how the costs and benefits are to be valued, and what constraints are to be considered (e.g., legal, ethical, social, and/or economic). Health programs involving politically sensitive issues such as teen sex education can benefit from the articulation of measures to determine costs, benefits, and constraints in the program planning phase.

Public health nurses (PHNs) are challenged to respond to public health-related trends of the twenty-first century, which include: a. racial, ethnic, and economic health disparities; rise of drug-resistant pathogens; unequal access to health care; and violence. b. violence, availability of health care for all, and increasing life expectancy. c. health disparities, access issues, and adequate mental health program funding. d. rise of drug-resistant organisms, increased life expectancy, societal violence, and more effective disease surveillance.

ANS: A Twenty-first-century challenges include increasing rates of drug resistance in community-acquired pathogens and societal issues such as welfare reform, economic disparities, racial/ethnic disparities, behavioral influences on health, and unequal access to health care. Cognitive Level: Analysis Associated Chapter Objective: 2 REF: p. 1000

Which statement about disasters is true? a. They can be natural or human-made. b. They can be relieved without assistance. c. There is always injury and death when a disaster occurs. d. The timing of a disaster does not influence the types of injuries that will occur.

ANS: A A disaster is any natural or human-made incident that causes disruption, destruction, and/or devastation requiring external assistance. Although natural incidents like earthquakes of hurricanes trigger many disasters, predictable and preventable human-made factors can further affect the disaster. In the disaster response phase, the incident type and time predict subsequent injuries and illnesses.

A nurse responds to a human-made disaster. Which of the following describes what the nurse is responding to? a. Structural collapse b. Communicable disease epidemics c. Mud slides d. Floods

ANS: A A structural collapse would be considered a human-made disaster. Communicable disease epidemics, mud slides, and floods are considered to be natural disasters.

What is the most critical action a nurse should take when planning a health program? a. Assessing need of the community b. Considering alternative solutions or options c. Detailing the costs and resources needed d. Weighing each alternative

ANS: A Assessing need provides the reasons and rationale for the program plan.

7. What are the five "rights" of case management? a. Care, time, provider, setting, price b. Patient, medication, route, time, documentation c. Place, setting, patient, plan, outcomes d. Disease process, time, place, beneficence, advocate

ANS: A Care, time, provider, setting, and price are used to judge the effectiveness of case management

A nurse is working in a temporary shelter for victims following a natural disaster. Which condition is the nurse most likely to encounter? a. Stress b. Communicable disease c. Depression d. Injuries requiring first aid

ANS: A Causes of stress can be the shock of the disaster itself, loss of personal possessions, fear of the unknown, living in close proximity to total strangers, and boredom. Illnesses requiring first aid and communicable diseases are not the primary concern of the nurse working in the shelter. Immediately following the disaster, it is unlikely that the victims will immediately encounter depression because of the shock of the disaster.

3. A patient with a long history of asthma with many hospital admissions is referred to a case manager to assist in the management of her disease. Disease management targets: a. Chronic and costly disease conditions that require long-term care interventions b. Patients who cannot handle their disease c. Those who seek to control use by providing clients with correct information d. Patients who will need an advanced practice nurse instead of physician for monitoring

ANS: A Disease management activities target chronic and costly disease conditions that require long-term care interventions. The other answers are false and/or describe other types of management.

5. Why must a nurse who is using population management be able to work with integrated care delivery systems? a. Management has shifted from inpatient care to primary care providers as points of entry. b. Emphasis is on episodic illness care for individuals rather than on population management. c. Care management services and programs do not provide access and accountability, as provided by case management services. d. Assessment of the needs of the population is no longer necessary.

ANS: A Management has shifted from inpatient care as a point of entry to primary care providers as points of entry. The other statements are false.

When a nurse matches client needs, provider strengths and competence, and agency resources, which type of planning is being used? a. Strategic planning b. Program planning c. Management planning d. Process planning

ANS: A Matching client needs, provider strengths and competence, and agency resources is considered strategic planning.

A riverfront community builds a retaining wall to divert flood water away from the town. Which term describes what has happened? a. Mitigation b. A natural disaster c. Community resilience d. Rapid needs assessment

ANS: A Mitigation is defined as actions or measures that can either prevent the occurrence of a disaster or reduce the severity of the effects. A natural disaster, such as an earthquake or hurricane, causes disruption, destruction, and/or devastation requiring external assistance. Community resilience is defined as the sustained ability of a community to withstand and recover from adversity. A rapid needs assessment is based on the traditional model of community assessment where there is a rapid appraisal of a sector or region's population, social systems, and geophysical features.

Providing information about safe-sex practices is an example of which level of prevention? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Assessment

ANS: A Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability.

An example of secondary prevention is: a. Screening children for lead poisoning b. Working with communities on emergency preparedness plans c. Developing social networking interventions to modify community norms d. Educating patients with strokes at rehab centers to help optimize their functioning

ANS: A Screenings are secondary prevention activities.

Which event has the potential to weaken existing public health programs? a. The shift in funding to support bioterrorism response efforts b. The outbreaks of H1N1 influenza c. The number of citizens with human immunodeficiency virus d. The lack of public health nurses

ANS: A The events of the twenty-first century have shifted funding to bioterrorism programs. This shift of funding has the potential to weaken existing important public health programs.

The process of program management is similar to: a. The nursing process b. The medical model of care delivery c. The requirements for licensure as a registered nurse d. Summative and formative evaluation

ANS: A The nursing process has the same basic steps but addresses the needs of a specific population.

The Quad Council of Public Health Nursing identified eight principles that distinguish the public health nursing specialty from other nursing specialties, including which of the following? (Select all that apply.) a. Collaboration with other professions, organizations, and entities b. Optimal use of available resources c. Population-based unit of care d. Primary obligation to work for the good of individuals and families e. Engagement with clients as an equal partner

ANS: A, B, C, E The tenets (principles) of public health nursing were developed by the Quad Council of Public Health Nursing and integrated into the Scope and Standards of Public Health Nursing Practice of the American Nurses Association (ANA, 2005). These principles distinguish public health nursing from other nursing specialties. The eight principles include population-based unit of care; primary obligation to achieve the "greatest good for the greatest number"; engagement with clients as an equal partner; priority emphasis on primary prevention; focus on strategies that create healthy environmental, social, and economic conditions in which populations may thrive; obligation to reach out to all who might benefit; optimal use of available resources; and collaboration with other professionals, organizations, and entities. Cognitive Level: Synthesis Associated Chapter Objective: 1 REF: p. 998

10. Disaster-related nursing is an evolving specialty. Nurses have unique skills that can be applied in which of the following aspects of disaster management? (Select all that apply.) a. Completion of the American Red Cross disaster management course and registration as a disaster responder b. Clinical management of blast lung injury c. Engagement of the BioWatch system d. Monitoring of the environment to contain infectious disease e. Planning and organization of mass prophylaxis and vaccine campaigns

ANS: A, B, D, E Nurses have skills in assessment, planning, implementation, evaluation, education, priority setting, collaboration, and provision of health care services to address both preventive and acute care needs. These skills sets are important in the four stages of disaster-related work prevention (planning/drill participation), preparedness, (course work/registration), response (clinical expertise), and recovery (monitoring). BioWatch is a system of sensors that test the air in several major metropolitan areas for biological agents that terrorists might use. This technology-based early warning system is distinctly different from BioSense, which is a public health surveillance initiative that is intended to serve as a biosurveillance program for early detection and quantification of a bioterrorism event or disease outbreak. Nursing skill sets lend themselves to participation in BioSense.

10. Which of the following are the major sources of information for program evaluation? (Select all that apply.) a. Community indices b. Media reports c. Program clients d. Program providers e. Program records

ANS: A, C, E Both quantitative and qualitative methods may be used to conduct an evaluation. However, the strongest evaluation designs combine both qualitative and quantitative methods. Major sources of information for program evaluation are the program clients (especially user satisfaction information), program records (especially clinical records), and community indices (epidemiologic data).

8. The community planning board is attempting to determine if the clients and health care providers affected by a recent mental health outreach initiative are satisfied that the program interventions have accomplished the program objectives and that clients have benefited from this program. The analysis model that is best designed to provide an estimate of costs to achieve an outcome is: a. cost-benefit analysis. b. cost-effectiveness analysis. c. cost-efficiency analysis. d. Multi-Attribute Utility Technique.

ANS: B An evaluation of program effectiveness may help determine whether both providers and clients are satisfied with program activities, as well as whether the program met its stated objectives. A cost-effectiveness analysis is a subset of a cost-benefit analysis and is designed to provide an estimate of the costs to achieve a given outcome. Such an analysis can answer several questions: Did the program meet its objectives? Were the clients and providers satisfied with the effects of the interventions? Are things better as a result of the interventions? In cost-benefit analysis, both the cost and outcomes are quantitative. In cost-effectiveness analysis, the outcomes are both qualitative (satisfaction) and quantitative (cost).

A PHN in the local health department assists the community in identifying the health need priorities and the services that can best meet these needs in a cost-effective manner. This is an example of the tertiary prevention public health nursing function of: a. case finding. b. case management. c. collaboration. d. provision of direct services.

ANS: B Case management is a major tertiary prevention function for PHNs at the community level of practice. Case managers assist clients in identifying the services they need the most at the least cost. They also assist communities and populations in identifying services that will improve the overall community health status. Cognitive Level: Application Associated Chapter Objective: 3 REF: pp. 1006-1007

The PHN ensures that a local community coalition for improving school lunches takes the time to listen to each stakeholder's view, develops a common validated language for discussing the initiative, and shares the credit for the success of the initiative. The PHN is adhering to the principles of: a. collaboration. b. partnership. c. public health care. d. public health nursing.

ANS: B Changes can be accomplished more easily and effectively by partnerships and collaboration among groups than by the individual client and PHN working alone. The Community Campus Partnerships for Health involved its members and partners in developing nine principles of good practice for community partnerships in 1998. These include agreeing on a mission; values, goals, and measurable outcomes; establishing a relationship characterized by mutual trust, respect, genuineness, and commitment; building on identified strengths and assets but also determining areas for improvement; balancing power and enabling resources to be shared; ensuring clear, open, and accessible communication with ongoing listening and a common validated language; mutually establishing roles, norms, and processes; ensuring feedback to, among, and from all stakeholders; sharing the credit for accomplishments; and taking time for the partnership to develop and evolve. Cognitive Level: Analysis Associated Chapter Objective: 6 REF: p. 994

A nurse is conducting disease surveillance. Which of the following describes the rationale for this action? a. To eradicate a disease before it starts b. To establish a baseline rate of disease occurrence and patterns of spread c. To target populations for triage d. To reduce the incidence of heart disease in a community

ANS: B Disease surveillance helps establish baseline rates of disease occurrence and patterns of spread to make it possible to initiate a rapid response to an outbreak. Disease surveillance is unable to eradicate a disease before it starts, to target populations for triage, or to reduce the incidence of heart disease in a community. However, disease surveillance does make it possible to initiate a rapid response to an outbreak of a disease or an event that can cause a health problem.

9. The insurer's risk manager has informed an independently contracted case manager that a liability risk related to experimental treatment and technology was identified in a recent recommendation made by the case manager. Which of the following is the best example of action by a case manager that might be associated with potential liability risk related to experimental treatment and technology? a. Inappropriately recommending that treatment be curtailed when treatment was actually needed b. Failing to apply the contractual definition of "experimental" treatment found in the client's insurance policy c. Substituting the case manager's clinical judgment for that of the insurer's medical director d. Upcoding intensity of care or intervention requirements

ANS: B For case managers, liability concerns exist when three conditions are met: (1) the provider had a duty to treat (i.e., provide reasonable care); (2) a breach of contract occurred through an act of omission; and (3) the act of omission caused injury or damage to the client. Five general areas of risk are liability for managing care, negligent referrals, use of experimental treatment or technology, breach of confidentiality/security, and fraud and abuse. With regard to the use of experimental treatment and technology, the case manager is obligated to apply the contractual definition of "experimental" treatment found in the client's insurance policy (certificate of coverage), because this a legally binding document between the insurer and the insured.

A nurse practitioner reports a case of gonorrhea to the local health department. Which type of surveillance system is being used? a. Active b. Passive c. Sentinel d. Special

ANS: B In the passive system, case reports are sent to local health departments by health care providers. In the active system, the public health nurse may begin a search for cases through contacts with local health providers and health care agencies. In the sentinel system, trends in commonly occurring diseases or key health indicators are monitored. Special systems are developed for collecting particular types of data and may be a combination of active, passive, and/or sentinel systems.

Which problem does a health department usually have the legal authority to investigate? a. Pandemics b. Unusual clusters of illness c. World trends of disease d. Cases of the common cold and pneumonia

ANS: B Powers of local government include surveillance of unusual clusters of illness. A health department does not have legal authority to investigate pandemics, world trends of disease, and cases of the common cold and pneumonia.

6. A nurse takes the time to read and understand the community's disaster plans and participates in mock disaster drills as a leader of the triage team. The nurse obtained disaster management training through the local Red Cross chapter and registered with the state as a disaster management nurse. The best description of the nurse's activities is: a. American Red Cross disaster training. b. community preparedness. c. personal preparedness. d. professional preparedness.

ANS: B Preparedness takes place at three levels: personal, professional, and community. The nurse who is professionally prepared is aware of and understands the disaster plans at the workplace and in the community. Preparedness also involves the development of the knowledge one needs to respond to specific types of incidents (chemical, biological, radiological, nuclear, and explosive events, and those involving weapons of mass destruction): how to treat those injured by each, how to use personal protective equipment, and how to work safely near dangerous materials. Nurses who seek greater participation or desire more in-depth understanding of disaster management can become involved with any number of community organizations that are part of the official response team. After receiving formal disaster training nurses can register with national and state registries to provide disaster response when needed. The importance of being adequately trained and properly associated with an official response organization to ensure an orderly, effective, and efficient response cannot be overstated.

The PHN serves as a bridge between at-risk populations and the community's health care resources. This role is based on the nurse's responsibility to: a. collect and analyze data on public health programs. b. ensure that all populations have access to affordable, quality health care. c. monitor and assess critical health status indicators. d. provide evidence-based use of resources.

ANS: B Public health's shift from being the primary care provider of last resort to the developing partnerships to meet the health promotion and disease prevention needs of populations has raised concerns about available health care for the uninsured and underinsured. The role of the PHN given this ongoing shift in health care delivery is still being developed in many agencies. PHNs retain responsibility for ensuring that all populations have access to affordable, quality health care services. They accomplish this by advocating for legislation that promotes universal health care, such as increased funding for community health centers and expansion of Medicaid eligibility criteria, and by forming partnerships with hospitals, free clinics, and other organizations to ensure the availability of health care for all populations in the community. Cognitive Level: Analysis Associated Chapter Objective: 4 REF: p. 999

8. An extensive train derailment occurs in the suburbs of a large metropolitan area. First responders determine that although no fatalities occurred, the derailed cars contain a noxious gas that diffuses readily into the air. The event easily overwhelms the capability of the local responders and hazmat teams are required. The local office of emergency management would coordinate through the emergency operation center to request assistance through which of the following? a. Environmental Protection Agency (EPA) b. Mutual aid agreement c. NIMS d. National Response Plan

ANS: B The first level of disaster response occurs at the locality, with mobilization of entities such as the fire department, law enforcement, public health agencies, and voluntary organizations like the Red Cross. If the disaster warrants significant local attention and overwhelms the capacity of the local responders, then the county or city office of emergency management will coordinate activities through the emergency operation center. Generally localities within a county are signatories to a regional or statewide mutual aid agreement. This agreement provides that the signatories will assist one another with needed personnel, equipment, services, and supplies. Mutual aid agreements are established between facilities and other emergency responding entities within localities, jurisdiction(s), and states; between states; and across borders to ensure seamless service in responding to disaster events, whether caused by people or by nature. When state resources and capabilities are overwhelmed, the governor may request federal assistance under a presidential declaration of disaster or emergency.

4. When planning a new community health center, a nurse will integrate knowledge of the nursing process and program management. The nurse's initial and most critical step for funding purposes would be: a. finding the lay leaders in the community. b. identifying the target population's health problems and needs. c. outlining the major causes of mortality in the community. d. prioritizing the community's problems.

ANS: B The program management process is parallel to the nursing process and consists of a rational decision making system designed to help nurses know when to make a decision to develop a program (assessment and problem identification); where they want to be at the end of the program (goal setting); how to decide what to do to ensure a successful program (planning); how to develop a plan to go from where they are to where they want to be (implementation); how to know that they are getting there (formative evaluation); and what to measure to know that the program has successful outcomes (summative evaluation). Planning for effective and efficient programs must be based on determination of the needs of populations within the community. Identification of at-risk groups and documentation of the health needs of the targeted population provide the basic justification and rationale for the proposed program plan. Such documentation of needs is essential if funding will be sought to implement the plan. An assessment of health needs may be approached as either a community assessment or a population needs assessment.

2. A community health nurse is conducting a community assessment as part of a program planning initiative and is seeking a tool that is low cost, allows clients to participate in identification of need, and would stimulate community support for the program. The nurse would most likely use which of the following? a. Community forum b. Focus group c. Indicators approach d. Survey

ANS: B There are several types of needs assessment tools, including community forums, focus groups, key informants, indicators approach, survey of existing agencies, and general surveys. Both community forums and focus groups are low-cost tools. The focus group provides clients with the opportunity to participate in identification of needs and can help increase community support for a program. The focus group method has several disadvantages, such as being time consuming to carry out and tending to focus on irrelevant or political "hot button" issues. Leading focus groups requires strong skills in group process to maintain the focus of the group.

A nurse is working with an older person following a disaster. Which of the following emotions of the client should be anticipated by the nurse? a. Anger b. Fear of loss of independence c. Violence d. Regression

ANS: B A common reaction of older persons experiencing disaster may be fear of loss of independence. Young children may respond with regression. The community in general may respond will feelings of anger, sorrow, guilt, and perceived blame for the disaster or the outcomes of the disaster. Violence should not be anticipated with any of the populations discussed in the text.

A nurse providing services for uninsured women is performing the function of: a. Role model b. Primary caregiver c. Outreach worker d. Case manager

ANS: B A nurse providing services for uninsured women is acting in the role of primary caregiver.

When a public health nurse discusses with a client which services are appropriate to meet her needs, the public health nurse is functioning as a(n): a. Case manager b. Advocate c. Counselor d. Role model

ANS: B A public health nurse discusses with a client which services are appropriate to meet her needs. In this case, the nurses the public health function is that of an advocate.

1. An enduring process in which a manager establishes systems and monitors the health status, resources, and outcomes for a targeted aggregate of the population is called: a. Case management b. Care management c. Advocacy d. Continuity of care

ANS: B Care management is an enduring process in which a manager establishes systems and monitors the health status, resources, and outcomes for a targeted aggregate of the population.

For the purpose of obtaining information about services needed to meet community needs, business leaders within a community were interviewed. This method of obtaining needs assessment data is called a(n): a. Community forum b. Key informant interview c. Survey of existing agencies d. Indicator approach

ANS: B Interviewing business leaders within a community is an example of key informant interviews.

To increase the immunization rates among children in the community, a nurse manager considering holding immunization clinics on Saturdays one month before school begins. This is an example of: a. Assessing b. Planning c. Organizing d. Evaluating

ANS: B Planning is selecting and carrying out a series of actions to achieve stated goals

6. Which activity would a nurse engage in when using population management? a. Census taking to determine the total number of people in the population b. Assessing the needs of the client population through compilation of health histories c. Providing case management services for every citizen in the community d. Selecting programs for wellness that are repeated annually

ANS: B Population management involves assessing the needs of the client population through health histories, claims, use-of-service patterns, and risk factors.

9. Which are examples of knowledge domains used in case management? a. Legal issues, malpractice recognition, and community involvement b. Teaching, counseling, and education skills c. Advocacy, political campaigning and legislative change d. Grant application, bargaining contracts, and securing funding

ANS: B Teaching, counseling, and education skills are an important part of case management in addition to program evaluation and research.

Which agency delegates the authority of the local health department? a. The federal government b. The state c. Local authorities d. Regional governing boards

ANS: B The authority of the local health department is delegated by the state.

Which is a benefit of systematic planning? a. Allowing nurses to be in charge of materials presented b. Ensuring that resources are used to address the needs of the community c. Linking local politicians with the community d. Educating student nurses about public health nursing

ANS: B The focus should be on what the organization and health provider are attempting to do for clients.

Which phase of the program planning process is being used when the provider and client consider the possibilities of solving a problem using one of the solutions identified? a. Conceptualization b. Detailing c. Implementation d. Evaluation

ANS: B The provider details the costs, resources, and program activities needed to choose one of the solutions from the conceptualizing phase.

8. Which model addresses the structure and processes of using the population-based tools of disease management and critical pathways to offer care for client populations? a. Client-focused b. System-focused c. Social service d. Long-term care

ANS: B The system-focused model addresses the structure and processes of using the population-based tools of disease management and critical pathways to offer care for client populations.

Acts of bioterrorism or natural disasters, such as earthquakes, will often have more casualties because: a. they cause the most widespread destruction. b. victims have little time to make evacuation preparations. c. those with chronic conditions cannot escape in time. d. the early warning systems are not effective.

ANS: B The use of weapons of mass destruction or natural disasters, such as earthquakes, will often have more casualties because victims have little time to make evacuation preparations. The other answers are false.

6. A community health nurse involved in care management would most likely: a. develop, conduct, and evaluate health teaching programs in primary care. b. manage the staff at a free clinic. c. monitor the health status, resources, and outcomes for an aggregate. d. provide immunizations to migrant workers.

ANS: C Care management is a continuing process in which a case manager establishes systems and monitors the health status, resources, and outcomes for an aggregate—a targeted segment of the population or group.

1. Advantages of community health program planning include ensuring that available resources are used to meet the needs of the population and: a. applying for grants. b. identifying clients and soliciting board members' support. c. identifying resources, activities, and needs. d. increasing the visibility of the program.

ANS: C Community health program planning is population focused and puts the well-being of the public above private interests. Systematic planning for meeting the needs of populations in a community has benefits for clients, nurses, employing agencies, and the community. It ensures that available resources are used to address the actual needs of people in the community, focuses attention on what the organization and health provider are attempting to do for clients, identifies resources and activities that are needed to meet the objectives of client services, reduces role ambiguity by giving responsibility to specific providers to meet program objectives, reduces uncertainty within the program environment, increases the ability of the provider and agency to cope with the external environment and anticipate events, allows for quality decision making, and provides better control over the actual program results. Identifying clients, soliciting board support, applying for grants, and promoting the actual program are steps in the implementation phase of program management.

9. The nurse program manager is determining the direct client care costs as well as the cost of indirect nursing activities for home visits for a home health agency. Analysis of this information along with nursing workload information and client needs can best provide an agency evaluation measure for: a. program decision making. b. cost-effectiveness. c. cost-efficiency. d. perceived value.

ANS: C Cost-efficiency analysis determines the actual cost of performing a number of program services, both direct and indirect, by addressing the productivity of the workforce in achieving specific objectives. The relationship between direct and indirect activities, workforce, caseloads, client needs, and actual costs determines the productivity of the program.

State public health agency responsibilities include: a. conducting community health assessments. b. enforcing public health codes. c. monitoring health status. d. providing expertise that facilitates evidence-based practice.

ANS: C Federal public health agencies develop regulations that implement policies formulated by Congress, provide funding to state and territorial health agencies for public health activities, survey the nation's health status and health needs, set practices and standards, provide expertise that facilitates evidence-based practice, coordinate public health activities across state lines, and support health service research. State public health agencies are responsible for monitoring health status and enforcing laws and regulations that protect and improve the public's health. They receive funding from federal agencies to implement public health initiatives. Local public health agencies are responsible for implementing and enforcing local public health codes and ordinances and providing essential public health services to the community. Cognitive Level: Application Associated Chapter Objective: 1 REF: p. 995

Rapid changes in public health are providing a challenge to PHNs because there is neither time nor staff to provide nurses with the on-the-job training needed to acquire the core public health competencies required of the PHN. This resulted in revisions to the American Nurses Association (ANA)'s Scope and Standards of Public Health Nursing Practice in 2005 that established: a. core public health functions as the competency framework. b. Minnesota Department of Health's Intervention Wheel as the practice competencies. c. standards for baccalaureate- and master's-prepared PHNs. d. Quad Council principles as the primary framework for practice.

ANS: C Historically, many of the core public health competencies were provided by PHNs who had learned these skills in the workplace while gaining knowledge through years of practice. Because of rapid changes in public health and limited resources, this approach to competency development can no longer be sustained. In 2007 and again in 2013, the ANA revised the 1999 Scope and Standards of Public Health Practice to reflect the increasing complexity and rapid changes faced by PHNs. The revised standards include standards that must be met by all nurses with baccalaureate degrees, the entry level into public health nursing, as well as standards that must be fulfilled by advanced practice PHNs prepared at the master's level. Cognitive Level: Analysis Associated Chapter Objective: 7 REF: pp. 1002-1003

A hospital is using surveillance. Which of the following describes the rationale for this action? a. To protect the public against isolated patients b. To eliminate pathogens from the environment c. To improve quality of care and outcomes d. To decrease the incidence of ventilator-acquired pneumonia

ANS: C Hospital surveillance is used to improve quality of care and outcomes. An example is an infection that occurs in patients who had procedures at that facility. Reduction of the incidence of ventilator-acquired pneumonia is one reason why a hospital uses surveillance, but it does not address the entire issue. Hospital surveillance is unable to eliminate pathogens from the environment and cannot protect the public against isolated patients.

A nurse is using surveillance to collect outcome data. What information would most likely be collected? a. Number of clinic services which use evidence-based protocols b. Proportion of the population vaccinated against influenza c. Incidence of breast cancer in the population d. Probability of a bioterrorism attack occurring in the community

ANS: C Outcome data focus on change in health status; incidence rates are one example of this type of information. Process data focus on what is done, such as services provided or protocols for health care delivery. An example of process data is collection of data about the proportion of the eligible population vaccinated against influenza in any 1 year.

If the two major goals of Healthy People 2020 are to be achieved, collaboration is essential for public health nursing practice, and collaboration with existing groups at the local level is encouraged for which of the following reasons? a. The federal government is ultimately responsible for the health status of the nation b. The public demands that the government protect the people c. Public health departments do not have the resources to accomplish these goals independently d. State health agencies must take a universal approach to achieving objectives

ANS: C Partnerships and collaboration among groups are much more powerful in making change than the individual client and PHN working alone. Because public health departments do not have the resources to accomplish the Healthy People 2020 goals independently, collaboration is essential to quality public health nursing practice, and collaboration with existing groups at the local level is encouraged. New partnerships are formed related to specific goals. Communities develop coalitions to address selected objectives, based on community needs that include all of the local community stakeholders, such as social service; mental health; educational, recreational, and governmental agencies and institutions; as well as businesses. Cognitive Level: Analysis Associated Chapter Objective: 5 REF: p. 1003

4. A nurse is working with a disaster medical assistance team as it responds to a disaster. A new team member excitedly insists that its personnel can exceed their 12-hour shifts and do not need breaks. The best intervention on the part of the nurse is to: a. arrange for the team member to be transferred to another unit. b. arrange for the team member to leave duty, return home, and talk with his or her pastor. c. educate the rescuer about necessary stress-management techniques and offer to pair up with the individual so that each can monitor the other's stress level. d. help the team member to call home to speak with his or her family.

ANS: C The nurse needs to be aware that rescue workers are repeatedly exposed to stress and, despite their training in managing such situations, have a higher than normal risk of developing post-traumatic stress syndromes. The nurse can assist the new team member by educating the rescuer about the importance of stress-management and self-management techniques. The nurse could pair up with the new team member so that they could monitor each other's stress responses and could provide guidance in adhering to stress management techniques.

5. A nurse who is the program director for a new antismoking campaign is developing a written program plan that will include the program's goals, priorities, objectives, budget, and timelines. Before implementation of the program, the written program plan should also address which of the following? a. Cost-benefit analysis b. Perspectives on the program c. Plan for the evaluation process d. Process evaluation

ANS: C When the planning process begins, the plan for evaluating the program should also begin. Everyone who will be involved in implementing a program should be given the opportunity to play a role in planning for program evaluation. Assessment of need is one component of evaluation. Once needs have been established and the program is designed, the nurse must continue plans for program evaluation, such as ongoing process evaluation (formative evaluation) and summative evaluation.

A nurse responds to a natural disaster. Which of the following is the nurse most likely responding to? a. Transportation accident b. Pollution c. Communicable disease epidemic d. Fire

ANS: C A communicable disease epidemic would be considered a natural disaster. Transportations accidents, pollution, and fire are considered human-made disasters.

2. When would a nurse use a critical path? a. When implementing the five "rights" of case management b. When demonstrating competencies required for practicing case management c. When attempting to achieve a measurable outcome for a specific client d. When effectively managing conflict resolution

ANS: C A critical path is a case management tool used to achieve a measurable outcome for a specific client case.

A nurse completes a program evaluation to identify if the objectives of the program were met. This is an example of: a. Assessment b. Goal evaluation c. Formative or process evaluation d. Summative or impact evaluation

ANS: C Formative or process evaluation is used to assess whether objectives are met or planned activities are completed.

A nurse working in public health focuses on: a. Home visiting and hospice care b. Care communicable diseases c. Health maintenance and health promotion d. Illness prevention

ANS: C Public health nurses employed in local, state, and federal agencies work together to identify, develop, and implement interventions that will improve and maintain the nations health.

The public health nurse who aims to change behaviors such as poor hand washing skills and unsafe sex practices is acting in the role of a(n): a. Case manager b. Advocate c. Educator d. Role model

ANS: C The public health nurse who aims to change behaviors, such as poor hand washing skills and unsafe sex practices, is acting in the role of educator.

10. Which case management activity would most likely be implemented by a bachelor's prepared nurse rather than an advanced practice nurse (APN)? a. Working with community aggregates b. Working with systems of disease c. Working with individuals d. Working with outcomes management processes

ANS: C Working with community aggregates, systems of disease, and outcomes management processes are implemented by an APN.

What occurs during biological terrorism? a. The intentional release of hazardous chemicals into the environment b. Environmental and occupational exposure to biological toxins c. Immunity to toxins related to repeated exposures d. An intentional release of viruses, bacteria, or other toxins

ANS: D An intentional release of viruses, bacteria, or other toxins would be described as biological terrorism. Chemical terrorism is the intentional release of hazardous chemicals into the environment for the purpose of harming or killing. Surveillance is used to monitor environmental and occupational exposures. Immunity to toxins after repeated exposures does not occur during biological terrorism.

1. A home health case manager is charged with identifying opportunities for health promotion and illness prevention. The fulfillment of this charge would best be demonstrated when the case manager: a. collaborates with a local chaplain to ensure that the spiritual needs of cancer clients are addressed. b. refers a new diabetic client to a nutrition counselor for dietary teaching. c. teaches a school nurse how to care for a client who will be returning to school and will require new asthma treatments. d. tracks the immunization status of clients and facilitates access to immunization when needed.

ANS: D Case management involves assessment—in this case, screening—and arrangement for delivery of services. Primary prevention includes case management to identify at-risk clients and arrange for services to prevent disease. Through nurse management activities, general community deficiencies in the quality or quantity of health services are often discovered. Case management activities with individual clients and families will reveal the broader picture of health services in and health status of the community. Community assessment, policy development, and assurance activities that frame the core functions of public health actions are often the logical next step in the nurse case manager's practice to intervene at the community level to make changes. Therefore, the core components of case management and the nursing process are complementary. The nursing process function of assessment is complementary to the case management process function of case finding and includes such activities as applying screening tools according to program goals and objectives.

9. A nurse wishes to become actively involved in disaster management and is extremely interested in providing first aid and delivering aggregate health promotion, disease prevention, and emotional support. It would be ideal for the nurse to train and volunteer as which of the following? a. Community emergency response team member b. Disaster medical assistance team member c. Member of the Medical Reserve Corps d. Red Cross shelter manager

ANS: D Creation and operation of shelters are generally the responsibility of the local Red Cross chapter, although the military may be charged with setting up "tent cities" or mobile home parks for large groups of people needing temporary shelter. Because nurses are comfortable performing tasks such as aggregate health promotion, disease prevention, and provision of emotional support, they make ideal shelter managers and team members. The Red Cross provides training in shelter support and use of appropriate protocols.

7. After a mock disaster drill, the nurse participates in a "hot wash" of the exercise in which participants from all units speak about successes, problem solving, failures, and unanticipated challenges or obstacles faced during the mock disaster drill. This activity best addresses the public health workforce competency of: a. describing the agency chain of command. b. identifying the limits of one's own knowledge, skill, and authority. c. recognizing unusual events that might indicate an emergency. d. writing after-action reports, updating implementation plans, and implementing changes.

ANS: D Federal agencies and professional organizations have outlined competencies for public health professionals at all points of the disaster management cycle. One competency speaks to the ability to evaluate drills, exercises, or actual events. As valuable components of preparedness, mass casualty drills and exercises can help rescuers develop the necessary coordination, skills, and confidence to operate effectively and efficiently across disciplines and agencies. Special emphasis is placed on the after-action reporting once the exercise is over, which ultimately allows improvement of the overall all-hazards disaster response plan. Such sessions may be referred to as debriefings, hot washes, or postings. Participation in these sessions develops the critical skill of evaluation that allows for process improvement.

A community coalition monitors the increasing obesity rate of children in their schools. Based on this data, they consider a variety of programming options which may possibly help decrease this trend. What was the purpose of conducting this surveillance? a. Protect the children from diseases that affect obese children b. Teach parents that obesity will not be tolerated in this community c. Educate children on surveillance techniques d. Demonstrate that new clinical and effective protocols need to be developed

ANS: D Ongoing surveillance in a community can lead to new clinical and effective protocols to address an issue. Ongoing surveillance makes it possible to have ongoing monitoring in place to ensure that disease and event patterns improve rather than deteriorate. This surveillance cannot protect children from diseases, teach parents that obesity will not be tolerated, or educate children on surveillance techniques.

8. Members of an extended family are in conflict over the treatment plan for the family's 90-year-old matriarch, who has developed indications of advanced dementia. The case manager is using conflict resolution strategies to allow the parties involved to develop trust, credibility, and distance from the issue at hand, as well as to retain personal dignity. The nurse is demonstrating a knowledge of the strategic process of: a. advocating. b. clarifying. c. cooperating. d. negotiating.

ANS: D Techniques for conflict management involve a range of active communication skills. These skills are directed toward learning all parties' needs and desires, detecting their areas of agreement and disagreement, determining their abilities to collaborate, and assisting in discovering alternatives and activities for reaching the goal of mutual benefit with limited loss. Negotiating is a strategic process used to move conflicting parties toward an outcome and has several stages that allow the parties to develop trust, credibility, and distance from the issue, while retaining personal dignity. All of these factors are important when attempting to move parties toward the creation of new solutions or options through relearning, brainstorming, reflective thinking, and problem-purpose-expansion techniques (systematic problem solving approaches).

1. A nurse is assigned to provide community outreach to a small town that was partially destroyed by a tornado 3 years earlier and has been rebuilt. The first client is a family who lost their home and their best friend in the tornado. The best intervention would include: a. assessment of the family's home environment to rule out safety issues. b. avoidance of discussion of the disaster of 3 years ago. c. consideration that the family will have worked through the emotional aftermath by now. d. support of the family in preparing a personal disaster response plan.

ANS: D The approach of relief activities needs to shift from short-term aid to long-term support. Promoting individual, family, and community preparedness increases safety in the event of disaster and can help children and adults feel empowered. This builds on the resilience of the individual, family, and/or community. Individuals and families still need to be assessed for indications of mental distress (case finding) and referred to a mental health professional if the need exists. Open discussions of the family's response to the slow process of recovery or long-term results of living under adverse conditions can uncover lingering mental distress or exacerbations of chronic conditions that require attention. During the initial stages of recovery environmental safety issues should have been addressed.

4. A community health nurse is the case manager for a homebound client recovering from a hip replacement. The nurse works with the client and his family to prioritize needs and services, and to address these care needs. These activities represent which step in the nursing process? a. Assessment and planning/outcome b. Diagnosis and planning c. Implementation d. Planning/outcome

ANS: D The case management process function of problem prioritizing and planning to address care needs is complementary to the planning/outcome step of the nursing process.

5. The major factor that has led to sharply increased insurance payouts following disasters in the United States in recent decades has been: a. El Niño. b. geography. c. technology. d. human development.

ANS: D The cost in more developed countries is higher because of the extent of material possessions and complex infrastructures, including technology. In the United States, increases in population and development in areas vulnerable to natural disasters, especially coastal areas, have led to sharply increased insurance payouts.

3. The emergency support functions of the National Response Framework (NRF) and the National Incident Management System (NIMS) provide: a. authority to step in and take control of state, local, and voluntary organizations during disasters. b. command and control for American Red Cross and Disaster Medical Assistance teams. c. oversight of federal and state response operations, with minimal interaction with other organizations. d. written approach, protocol, and common language for responders from federal agencies and other voluntary organizations.

ANS: D The first level of disaster response is carried out by the locality (office of emergency management). Through mutual aid agreements, localities can arrange for additional support from surrounding communities (emergency operations center). When the response needs exceed the capability of the localities and state-level resources or capabilities, then the governor may request assistance under a presidential declaration of disaster or emergency. The way the federal government offers assistance is through the NRF. The NRF was written to approach a domestic incident in a unified, well-coordinated manner that enables all responding entities to work together more effectively and efficiently. All member organizations of the responding teams, including all relevant branches of the federal government, are assigned functions that are listed in the plan as emergency support functions. When large disasters require the services of a variety of emergency responding units with personnel coming from different parts of the country, the challenge of working together in unison may require the use of the NIMS, which provides all responders with a protocol and common language for working together. The importance of interoperable communication equipment is stressed by the NIMS.

2. The highest priority for a nurse who is among the first responders to a disaster is: a. arranging for shelter for disaster providers. b. beginning community assessment as soon as possible to ensure a rapid recovery. c. beginning surveillance and planning needed health education for disaster survivors. d. immediately developing plans for effective triage and client management.

ANS: D The first priority when responding to a disaster is to immediately plan for, coordinate, and carry out effective triage. Disaster response includes community assessment, surveillance, health education, and coordination of shelter arrangements. However, the first task is to provide care for life-threatening injuries and conditions.

Community preparedness is being used to plan for a disaster. Which of the following tasks is being implemented? a. Assembling emergency supplies b. Understanding the workplace disaster plan c. Taking a disaster training course d. Developing an evacuation plan to remove individuals from danger

ANS: D Community preparedness involves developing an evacuation plan to remove individuals from danger. Assembling emergency supplies is an example of individual preparedness. Understanding the workplace disaster plan is an example of preparedness in the workplace within the community. Taking a disaster training course is an example of professional preparedness

4. Which type of management would be most appropriate for a nurse to use when helping clients improve their health status? a. Utilization management b. Case management c. Disease management d. Demand management

ANS: D Demand management seeks to control use by providing clients with correct information and education strategies to make healthy choices, to use healthy and health-seeking behaviors to improve their health status, and to make fewer demands on the health care system

A nurse is participating in the preparedness stage of disaster management. Which of the following describes what is happening? a. Heightened inspection and increased security in the community b. Incorporation of provision of pets into local disaster plans c. Purchase of personal protective equipment for all citizens d. Assembly of disaster kits for the home, workplace, and car

ANS: D Disaster kit assembly for the home, workplace, and car, especially by nurses, occurs during the preparedness phase. Heightened inspection and increased security in the community is part of the prevention activities. Purchase of personal protective equipment for all citizens and incorporation of provision of pets into local disaster plans are not realistic plans for preparedness.

A nurse surveys program participants after completion of a wellness program to determine if the participants have increased their involvement in daily exercise. This is an example of: a. Assessment b. Goal evaluation c. Formative or process evaluation d. Summative or impact evaluation

ANS: D Summative or impact evaluation is used to assess program outcomes or as a follow-up to the results of the program activities.

A nurse experiences a stress reaction while working with the survivors of a disaster. Which of the following best describes what has happened? a. The nurse makes decisions to assist with care coordination of the survivors. b. The nurse tells the supervisor of the disaster the details of the care that was provided. c. The nurse cries after returning home at the end of the day. d. The nurse refuses to follow orders.

ANS: D Symptoms that may signal a need for stress management assistance include the following: being reluctant or refusing to leave the scene until the work is finished; denying needed rest and recovery time; feelings of overriding stress and fatigue; engaging in unnecessary risk-taking activities; difficulty communicating thoughts, remembering instructions, making decisions, or concentrating; engaging in unnecessary arguments; having a limited attention span; and refusing to follow orders.

Which role of the nurse is being used when a public health nurse assists a client in identifying the services needed the most at the least cost? a. Role model b. Primary caregiver c. Outreach worker d. Case manager

ANS: D The public health function of a nurse who assists a client in identifying the services needed the most at the least cost is a case manager.

Focus groups are used to determine the method of cleanup for contaminated groundwater in a neighborhood. What is a disadvantage of this needs assessment tool? a. Technically demanding b. Expensive c. Bias of leaders d. Time consuming

ANS: D Using focus groups to determine the method of cleanup for contaminated groundwater in a neighborhood would be very time consuming.

1. A nurse performing home hospice case management notes the increasing number of hospice clients who lack caregivers in the home environment. The nurse identifies the potential need for a hospice house facility to meet the needs of these clients. The case management process frequently reveals larger picture issues such as which of the following?(Select all that apply.) a. Community cost concerns b. Community conflict resolution skills c. Community satisfaction d. Community weaknesses in quality of services e. Community weaknesses in quantity of services

ANS: D, E Case management activities with individual clients and families very often reveal the larger picture of health services and health status of a community. General community weaknesses in the quality and quantity of services often are discovered. The nurse can then intervene at the community level to initiate changes. In this case, the nurse identified a deficiency in the quality of hospice services to individuals who did not have a caregiver in the home environment and the parallel concern of the lack of hospice-related facilities to meet the needs of these clients to achieve a quality dying process.

1. What is the goal of local public health departments? a. To monitor communicable diseases b. To improve the health status of communities c. To offer services for the uninsured d. To enforce environmental codes and laws

B The goal of local public health departments is to safeguard the publics health and improve the health status of communities.

ANS: C The Core Competencies for public health are divided into eight practice domains: analytical assessment skills, policy/program development, communication, cultural competency, community dimensions of practice, basic public health sciences, financial planning/management, and leadership. The practice domain for community dimensions of practice addresses the establishment and maintenance of links during an investigation; collaboration with partners; and development, implementation, and evaluation of an assessment to define a problem. Cognitive Level: Analysis Associated Chapter Objective: 5 REF: pp. 532-533

Collaboration among local, state, and federal agencies; health care providers, agencies, and organizations; and other community-based services that address issues of safety and welfare in a community is critical to the success of a quality surveillance program. The public health practice domain that best describes the ability to collaborate effectively is: a. communication. b. analytical assessment skills. c. community dimensions of practice. d. policy and program development.

ANS: D A nurse can contribute to surveillance systems and can best use the data collected through such systems to help manage endemic health problems and those that are emerging, such as evolving infectious diseases and bioterrorist (human-created) health problems. Cognitive Level: Application Associated Chapter Objective: 5 REF: pp. 531-532

Disease and event surveillance systems exist to help improve the health of the public through the systematic and ongoing collection, distribution, and use of health-related data. A PHN utilizes the data in available surveillance systems to make a presentation to a community planning committee that is interested in the problem of childhood obesity. This use of the data for facilitating community planning is a good example of helping the community to: a. avert a health care epidemic. b. evaluate prevention and control measures. c. identify cases for fact finding. d. manage endemic health problems.

ANS: C Surveillance is a critical role for the nurses practicing in the community. A comprehensive understanding and knowledge of surveillance systems and how they work will help nurses improve the quality and the usefulness of the data collected for the purpose of making decisions about needed community services, community actions, and public health programming. Cognitive Level: Application Associated Chapter Objective: 1 REF: p. 531

Disease surveillance, a critical role function for the public health nurse (PHN), can best be defined as the ongoing, systematic collection, analysis, interpretation, and dissemination of specific health data relevant to public health. The nurse's knowledge and understanding of surveillance systems is critical to: a. detecting epidemics and pandemics. b. facilitating planning and policy changes. c. improving the quality and usefulness of the data collected. d. understanding the relationship between epidemiologic principles.

ANS: B Once an event/outbreak has been identified, confirmed, and initially defined, early and continuously changing control measures should be initiated to contain the event and minimize further impact on the public. Then, the investigation can proceed and the proper authorities can be notified or asked for assistance and further consultation. Cognitive Level: Application Associated Chapter Objective: 3 REF: pp. 539-540

During an investigation, once the problem has been identified and the initial magnitude delineated in a case definition, the next step is to: a. check the state reportable disease list and request help. b. initiate control measures appropriate to the event/outbreak. c. seek additional cases by interviewing health care agencies. d. develop a tentative hypothesis.

ANS: A, B, D Mortality data can be found in data sources containing vital statistics, which typically include death certificates and coroner/medical examiner reports, and birth certificates. Morbidity data are typically found in reports of notifiable disease; laboratory reports; hospital discharge reports; billing data; outpatient health care data; specialized disease registries; injury surveillance systems; environmental surveys; and sentinel surveillance systems. Cognitive Level: Analysis Associated Chapter Objective: 4 REF: p. 533

Morbidity data can most easily be located in which of the following sources? (Select all that apply.) a. Environmental surveys b. Hospital discharge reports c. Medical examiners' reports d. Specialized disease registries e. Vital statistics sources

ANS: C A spatial map is a data-reporting tool that graphically presents the distribution of an event/outbreak in such a way that priority prevention target areas can easily be identified, because it shows graphically what is happening and where it is happening. Cognitive Level: Analysis Associated Chapter Objective: 3 REF: pp. 540-541

One of the unique advantages of using data reporting such as a spatial map to analyze and present data is that such a tool provides a graphical way of determining: a. characteristics of the population. b. potential hypothesis. c. priority prevention target areas. d. trends for the spread of the disease.

ANS: A The first step in conducting an investigation is to confirm that an occurrence/outbreak actually exists and that a supposed event is not a false alarm. The investigator must find out the nature, location, and severity of the problem. Only the investigator can make this determination. The investigator can then verify the diagnosis and develop a case definition to determine the magnitude of the problem. Cognitive Level: Application Associated Chapter Objective: 3 REF: pp. 539-540

The first step in initiating a surveillance strategy is to confirm the: a. existence of the event. b. magnitude of the problem. c. source of the outbreak. d. tentative hypothesis.

ANS: C A good example of a process in place to collect morbidity data is the National Program of Cancer Registries. This program provides for monitoring the types of cancer found in a state and the locations of the cancer risks and health problems in the state. Cognitive Level: Analysis Associated Chapter Objective: 4 REF: p. 533

The most common sources of surveillance data are databases maintained by the federal agencies, state health departments, and other organizations with an interest in understanding a specific disease or event. The National Program of Cancer Registries contains morbidity data for the types of cancer found in a state as well as: a. key centers for the specialized treatment of certain cancers. b. links to National Institutes of Health cancer research projects currently being conducted. c. locations of cancer risks and health problems within the state. d. major genetic determinants of cancer by age and sex.

ANS: A In an active system of surveillance, the PHN, as an employee of the health department, may begin a search for cases through contacts with the local health providers and health care agencies. The nurse names the disease or event and gathers data about existing cases to try to determine the magnitude of the problem. Cognitive Level: Analysis Associated Chapter Objective: 2 REF: p. 537

The nurse epidemiologist in a local health district receives a report from a local pediatrician that a case of chickenpox has been diagnosed in a second grader at one of the local elementary schools. The nurse proceeds to contact the school to determine whether or not any other children are absent for illness or were recently seen by the school nurse. Other area pediatricians are also contacted to determine whether or not any other cases have been identified. The nurse works with the school to notify parents about what signs and symptoms they should look for and how to manage a child with such symptoms. This is an example of which type of surveillance? a. Active b. Passive c. Sentinel d. Special