Stanhope Ch 1, Stanhope Ch. 12: Communicable and Infection Disease Risks, Chapter 14: Communicable and Infectious Disease Risks; Stanhope, Chapter 14: Communicable and Infectious Disease Risks (Stanhope: Public Health Nursing, 8th Ed), Chapter 12: Ep…

An example of a bacterial STD is: a. Trichomonas b. HIV c. Syphilis d. Genital warts

ANS: C Trichomonas, HIV, and genital warts are caused by viruses.

The most common reportable infectious disease in the United States is: a. Gonorrhea b. Syphilis c. Herpes d. Chlamydia

ANS: D The most common reportable infectious disease in the United States is Chlamydia.

Which of the following variables have led to a stronger commitment to population-focused services? Select all that apply. a) Economic turmoil and demand for high-technology care b) Emergence of new or drug-resistant infectious diseases c) Emphasis on overall healthcare needs rather than only on acute care treatment d) Threat of bioterrorism

B, C, D As overall health needs become the focus of care in the U.S., a stronger commitment to population-focused services is emerging. Threats of bioterrorism, anthrax scares, and the emergence of modern-day epidemics have drawn attention to population-focused safety and services.

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

C

A public health department makes sure that the essential community-oriented health services are available in the community. Which of the following core public health functions is being implemented? a) Policy development b) Assessment c) Assurance d) Scientific knowledge-based care

C Assurance focuses on the responsibility of public health agencies to ensure certain activities have been appropriately carried out to meet public health goals and plans.

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

D

Which of the following is the primary focus of public health nursing? a) Families and groups b) Illness-oriented care c) Individuals within the family unit d) Promotion of quality of life

D The key difference between community-based and community-oriented nursing is that community-based nurses deal primarily with illness-oriented care, whereas community-oriented nurses - or public health nurses - provide healthcare to promote quality of life.

Which of the following best describes community-based nursing? a) A philosophy that guides family-centered illness care b) Providing care with a focus on the group's needs c) Giving care with a focus on the aggregate's needs d) A value system in which all clients receive optimal care

A By definition, community-based nursing is nursing that focuses on family-centered illness care to individuals and families in the community.

The nurse counsels a client to have the enzyme-linked immunosorbent assay (EIA) test in order to: a. Indicate the presence of the antibody to HIV. b. Reveal whether or not the client has AIDS. c. Isolate the HIV virus. d. Confirm HIV after having a positive Western blot.

ANS: A The EIA is used to indicate the presence of the antibody to HIV.

In comparison with HIV infection in adults, HIV infection in infants and children: a. Has the same signs and symptoms b. Has a shorter incubation period c. Has a longer survival period d. Is detected by using the same tests

ANS: B HIV infection in infants and children has a shorter incubation period.

Which of the following best describes the characteristic appearance of lesions of human papillomavirus (HPV)? a. Solitary growth with elevated borders and a central depression b. Elevated growths with a "cauliflower" appearance c. Thin-walled pustules that rupture to form honey-colored crusts d. Vesicles that ulcerate and crust within 1 to 4 days

ANS: B HPV causes genital warts that appear as textured surface lesions, with what is sometimes described as a cauliflower appearance. The warts are usually multiple and vary between 1 and 5 mm in diameter. The other descriptions are not characteristic of lesions of the human papillomavirus (HPV).

In which of the following cases would the school nurse be correct to advise the parents of an HIV-infected child to keep the child home from school? (Select all that apply.) a. The child develops allergies with sneezing. b. The child is unable to control body secretions. c. The nurse is not comfortable with being responsible for the child. d. There is an outbreak of chickenpox in the school. e. The child persists in biting behavior.

ANS: B, D, E Not attending school may be advisable if cases of childhood infections, such as chickenpox or measles, occur in the school, because the immunosuppressed child is at greater risk for suffering complications. Alternative arrangements, such as homebound instruction, might be instituted if a child is unable to control body secretions or displays biting behavior. HIV-positive children are encouraged to obtain routine immunizations, because their immune systems are compromised and they are more susceptible to such infections. To date, no cases of HIV infections being transmitted in a school setting have occurred in the United States. Thus, the nurse should not be fearful of providing care to this child.

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

A

Which of the following actions best represents public health nursing? a) Assessing the effectiveness of the large high school health clinic b) Caring for clients in their home following their outpatient surgeries c) Providing care to children and their families at the school clinic d) Administering follow-up care for pediatric clients at an outpatient clinic

A A public health or population-focused approach would look at the entire group of children being served to determine whether available services are effective in achieving the goal of improving the health of the school population.

A registered nurse was employed as a public health nurse. Which question would be most relevant for the nurse to ask? a) "Which groups are at the greatest risk for problems?" b) "Which patients should I see first as I begin my day?" c) "With which physicians will I be most closely collaborating?" d) "With which nursing assistants will I partner the most?"

A Asking which groups are at greatest risk reflects a community-oriented perspective. The other possible responses reflect a focus on individuals.

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

A Assessment is a core function of public health and refers to systematically collecting data concerning the population, monitoring the population's health status, and making information available on the health of the community.

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

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

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

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

A clinic treating a child for otitis media is an example of: a) Community-based care b) Public health care c) Tertiary health care d) Community-oriented care

A In community-based nursing, the nurse focuses on "illness care" of individuals and families across the life span. The aim is to manage acute and chronic health conditions in the community, and the practice is family-centered illness care.

Two nurses plan to walk under a huge downtown bridge where various homeless persons live. Why would the nurses go to such an unsafe area? a) To assess the needs of the homeless who live there b) To demonstrate their courage and commitment c) To distribute some of their own surplus clothes to those who can use them d) To share with various churches and other charities what is needed

A In most nursing practices, the client seeks out and requests assistance. In public health nursing, the nurse often reaches out to those who might benefit from a service or intervention, beginning with assessment of needs.

A school nurse teaches three middle school students with asthma conditions techniques to minimize their incidence of bronchial spasms. This is an application of: a) community-based nursing. b) community-oriented nursing. c) institutional nursing. d) public health nursing.

A The goal of community-based nursing (CBN) is to manage acute or chronic conditions while promoting self-care among individuals and families. In CBN the nursing care is family centered, which means that the nurse works to improve the competencies of families to enable them to take better care of themselves. The nurse pays particular attention to the uniqueness of each family and works to plan the most useful interventions. Nurses practicing in the community and many staff public health nurses focus on providing direct care services, including health education, to persons or families outside of institutional settings, either in the home or in a clinic.

A nurse in a clinic that provides direct care services to clients with tuberculosis would be classified as practicing: a) community-based nursing b) community-oriented nursing c) institutional nursing d) public health nursing

A The nurse practicing as a community-based nurse is more likely to give direct care to people than are nurses who practice from a community-oriented framework. A community-oriented framework includes community-oriented nursing and public health nursing. Institutional nursing care is generally delivered in a hospital or nursing home setting.

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

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

In a federally funded preschool program such as Head Start, nursing services that include conducting developmental-level screening for cognitive and psychomotor development of individual children would most likely be considered community-oriented nursing care when: a) individual results are compared with established standards for children of the same age group b) program characteristics are assessed for their effectiveness in making the school population healthier c) referral is provided for a child identified with delayed psychomotor development d) treatment is initiated for a child with an identified learning disability

A Within federally funded programs for preschool children, from a community-oriented nursing care perspective, nursing services could be provided to individual children by conducting developmental-level screening tests to evaluate each child's level of cognitive and psychomotor development in comparison with established standards for children of the same age. This is population-focused service. A community-based nurse may deliver illness care or direct services to individual children. A public health nurse may assess the program's ability to achieve the overall goal of making its population of children healthier by evaluating the characteristics of the facility, program, and environment for their effectiveness in achieving the goal.

Which of the following actions demonstrate(s) effective public health nursing practice in the community? (Select all that apply). a) Epidemiologic investigations examine the environment for health hazards b) New services are organized where particular vulnerable populations live c) Partnerships are established with community coalitions d) Staff members are the public health agency continue to increase in number

A, B, C Evidence that public health nurses are practicing effectively in the community would include these: organizing services where people live, work, play, and learn; working in partnerships and with coalitions; and participating in epidemiologic studies.

Why are nurses increasingly providing care in clients' homes rather than in hospitals? Select all that apply. a) Home care is less expensive b) It is much more efficient to give care in the home c) Nurses prefer to give home care with individual attention d) People prefer to receive care in their homes rather than in hospitals

A, D An increasing number of clients are receiving care in the home because it is less expensive and clients prefer to receive care in familiar and comfortable settings.

Community health nurses conducting health education among populations vulnerable to HIV infection should explain the natural history of the infection, including the fact that HIV infection may go undetected during the primary infection stage because: a. antibody test results are typically negative. b. antibody production by the immune system increases. c. incubation period is prolonged. d. symptoms include myalgias, sore throats, and rash.

ANS: A Individuals may experience flu-like symptoms such as lymphadenopathy, myalgias, sore throat, lethargy, rash, and fever during the primary stage of HIV infection. Results of an antibody test during this phase are usually negative, so the illness often is not recognized as HIV infection. After a variable period of time, commonly 6 weeks to 3 months, HIV antibodies appear in the blood and can be used to confirm the presence of HIV infection. Cognitive Level: Analysis Associated Chapter Objective: 1 REF: p. 321

A woman comes to the community health center complaining of increasing lower abdominal pain, fever, and abnormal menses for several months. During the assessment, the client indicates that she is aware that her husband has had multiple sex partners in the past 2 years. Appropriate intervention by the nurse would be to: a. arrange to have the client referred for medical evaluation for pelvic inflammatory disease (PID) and appropriate intervention and treatment. b. contact the health department to confirm the spouse's diagnosis of Chlamydia infection to determine the client's exposure, give the client antibiotics, and have her return to the clinic if symptoms worsen. c. provide STD prevention and treatment education and refer the client to the health department for STD screening for gonorrhea and/or Chlamydia infection. d. supply the client with nonsteroidal anti-inflammatory drugs and caution her to call the after-hours call doctor if her symptoms worsen.

ANS: A Nursing assessment should always include taking a comprehensive sexual history to determine an individual's potential risk for STDs. Each sexual partner is potentially exposed to all the STDs of all the persons with whom their partner has been sexually active. PID is a serious infection involving the fallopian tubes and is the most common complication of gonorrhea, but it may also result from chlamydial infections. Symptoms include fever, abnormal menses, and lower abdominal pain. Symptoms can vary among women. PID can cause ectopic pregnancy, and this should be ruled out in all cases. Stillbirth, premature labor, and infertility are also possible complications. Cognitive Level: Analysis Associated Chapter Objective: 2 & 3 REF: p. 328 & p. 334

The clients most at risk of reactivation of latent infections of tuberculosis (TB) are: a. immunocompromised persons, substance abusers, and those with diabetes. b. individuals previously treated for TB. c. long-term cigarette smokers. d. persons with new-onset asthma or emphysema.

ANS: A Reactivation of latent TB infections later in life is common, and the incidence rises in immunocompromised persons, substance abusers, underweight and undernourished individuals, and those with diabetes, silicosis, or gastrectomy. Cognitive Level: Application Associated Chapter Objective: 3 & 4 REF: p. 332

A nurse examining a child in the early stages of HIV infection would expect to see: a. Failure to thrive and developmental delays b. Kaposis sarcoma and developmental delays c. Toxoplasmosis and oral candidiasis d. Fatigue and shortness of breath

ANS: A Early symptoms of pediatric HIV infection include failure to thrive and developmental delays.

HIV transmission can occur through: a. Exposure to blood b. Insect bites c. Sharing of school supplies d. Toilets

ANS: A HIV can be transmitted through exposure to blood.

Which type of hepatitis would likely be found where sanitation is inadequate? a. A b. B c. C d. D

ANS: A Hepatitis A would likely be found where sanitation is inadequate.

A nurse is uncomfortable discussing such topics as sexual behavior and sexual orientation when counseling clients. By avoiding this topic with clients: a. Potential risks and risky behaviors will not be identified. b. Transmission of sexually transmitted diseases will decrease. c. Clients will be reluctant to return to care providers. d. The nurse will be violating the laws in most states.

ANS: A It is important that nurses be able to discuss these topics to help prevent and control STDs. Without discussion of these topics, it is possible that clients will not be aware that they have an STD and may transmit it to others.

A public health nurse is reviewing Healthy People 2020 to determine where to prioritize programming for the county health department. Based on Healthy People 2020, the nurse decides to implement programming to: a. Reduce the rate of HIV transmission among adults and adolescents. b. Eliminate STDs from developed countries. c. Reduce deaths from gonorrhea. d. Increase awareness about HIV in lesbian females.

ANS: A One of the Healthy People 2020 objectives is reducing the number of cases of HIV infection among adults and adolescents.

Pelvic inflammatory disease (PID) is a common complication of: a. Gonorrhea b. Syphilis c. Chancroid d. Herpes

ANS: A PID is a common complication of gonorrhea.

Screening blood products and donor organs and tissue for hepatitis C infection is: a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion

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

A nurse explained to a new mother that because she had tested positive for the hepatitis B virus, her newborn son would need the hepatitis B vaccine immediately and then also an immune globulin injection. "Wait," said the new mother. "Why is my son getting two shots?" Which of the following statements would be the best response by the nurse? a. "One injection protects your son, while the other encourages his body to build up immunity." b. "One shot keeps your son from getting sick, while the other is a typical vaccine to prevent you from accidentally infecting him." c. "Since you've already been infected with the virus, your son needs twice as much protection." d. "The second shot is just to make sure the first one works."

ANS: A Because infected persons may not have any symptoms, all pregnant women should be tested for HBsAg. If the mother tests positive, her newborn needs hepatitis B immune globulin to provide passive immunity and thus prevent infection. In addition, the newborn is given the hepatitis B vaccine at birth, with two follow-up injections, to build active immunity to the infection. One of the shots provides passive immunity and the other provides active immunity. The active immunity continues to be built up by receiving two follow-up injections weeks later.

A school nurse asks a class about the ways HIV can be transmitted. Which of the following comments by a student indicates a need for additional teaching? a. "I wouldn't sit next to someone with HIV." b. "Having unprotected sex with someone who is infected spreads HIV." c. "Sharing needles when shooting up drugs spreads HIV." d. "Transfusions of blood products that are contaminated can spread HIV."

ANS: A HIV is not transmitted through casual contact such as touching or hugging someone who has HIV infection. It is not transmitted by insects, coughing, sneezing, office equipment, or sitting next to or eating with someone who has HIV infection. HIV can be transmitted through exposure to blood, semen, vaginal secretions, and breast milk and by sharing needles, syringes, and other equipment used to prepare injectable drugs. It can also be spread by perinatal transmission from mother to child through delivery or breastfeeding and by transfusions of contaminated blood. Worldwide, the largest number of HIV infections result from heterosexual transmission

A male client visits the clinic office reporting a yellow-green discharge from his penis. Which of the following STIs has the client most likely contracted? a. Gonorrhea b. Syphilis c. Herpes simplex virus 2 d. Human papillomavirus

ANS: A The symptoms for gonorrhea in a male include a burning sensation when urinating, or a white, yellow-green discharge from the penis. Some men may get swollen or painful testicles. In men, gonorrhea can cause epididymitis, a painful condition of the testicles that if untreated can lead to infertility. Symptoms of syphilis may not appear for several years after contracting the disease. The first stage of syphilis is called primary syphilis when a chancre, a firm, round, small and painless lesion, develops. Signs and symptoms of HSV-2 infection range from no symptoms to painful lesions or blisters around the genitals, rectum, or mouth. Most people with HPV are asymptomatic.

Which of the following statements best explains why HSV-2 infection is more challenging for a client than gonorrhea infection? a. HSV-2 is a viral infection that is both chronic and incurable. b. HSV-2 is extremely expensive to treat. c. HSV-2, like HIV, is almost impossible to diagnosis in the early stages. d. Once a person has been treated for HSV-2, the person is immune to further outbreaks.

ANS: A Unlike gonorrhea, there is no cure for HSV-2 infection; it is considered a chronic disease. Recurrence with HSV-2 is common. The treatment for HSV-2 may be episodic or suppressive for frequent recurrence, which is not expensive to treat. HSV-2 may be asymptomatic but does appear as vesicles, painful ulceration of penis, vagina, labia, perineum, and anus with lesions lasting 5 to 6 weeks.

A woman and man who have come to the health clinic begin to argue loudly. "You gave me an STI!" the man yells. The woman screams back, "Not me. I don't have an STI!" Which of the following statements would be most appropriate for the nurse to say to them? (Select all that apply.) a. "Actually, you're very fortunate to have been tested, so you and your partner can begin treatment before more serious damage is done." b. "Some STIs may not have any symptoms, so you need to be tested for other conditions and treated if necessary." c. "Sometimes the test is inaccurate, so before getting too upset, you should ask to be tested again." d. "You may be able to get treatment from your pharmacist so you won't have to be embarrassed like this again." e. "Some STIs are spread in ways that are non-sexual in nature."

ANS: A, B, C Often cases of gonorrhea and chlamydia are asymptomatic, so treatment may not be sought and these infections are spread to others through sexual activity. Similarly, during latency, syphilis has no symptoms. It should be noted, however, that STI test results can sometimes be incorrect and the coexistence of other medical conditions may cause a false-positive test result. Having a partner retested, if the results were negative, would also suggest retesting the first person. The pharmacist must receive an order from the primary care provider in order to dispense a prescription.

A client diagnosed with HPV infection states, "I'm not concerned, I know the warts disappear after a while." The nurse should counsel the client regarding which of the following? (Select all that apply.) a. Link between HPV and cervical cancer b. Status of HPV infection as a reportable disease c. Need to eliminate the warts d. Serious complications of HPV infection for men e. Lack of cure for HPV infection

ANS: A, C, E The complications of HPV infection are especially serious for women. The link between HPV infection and cervical cancer has been established, and this cancer is associated with specific types of the virus. HPV infection is exacerbated during pregnancy and immune-related disorders, a fetus may become infected, and there is no cure. Although the warts will disappear over time, the goal is to eliminate the warts through surgical removal and other treatments to prevent skin-to-skin contact with them. Cognitive Level: Synthesis Associated Chapter Objective: 2, 3, 5, & 6 REF: p. 330

A client comes to the local clinic with acute symptoms of fever, nausea, lack of appetite, malaise, and abdominal discomfort. During the course of the assessment, the nurse determines that the client is a health care aide working at a daycare center. These facts are important because: a. acute hepatitis B is self-limiting. b. hepatitis A outbreaks commonly occur in facilities where staff change diapers. c. hepatitis C is a "silent stalker." d. individuals with chronic liver disease are at greater risk for hepatitis A.

ANS: B Hepatitis A virus is most often transmitted through the fecal-oral route. It remains the most frequently reported vaccine-preventable disease. Outbreaks are common in daycare centers where staff must change diapers, among household and sexual contacts of infected individuals, and among travelers to countries were hepatitis A is endemic. Cognitive Level: Analysis Associated Chapter Objective: 2 & 4 REF: p. 330

Many behaviors place any individual—regardless of age, gender, ethnicity, or other characteristics—at greater risk for STDs. The nurse should include primary prevention interventions in all client encounters through the discussion of: a. partner notification. b. safer sex. c. standard precautions. d. STD testing.

ANS: B Sexual abstinence is the best way to prevent STDs; however, for many people it is not realistic. Therefore, education about how to make sexual behavior safer is critical. Safer sexual behavior includes masturbation, dry kissing, touching, fantasy, and vaginal or oral sex with a condom. Nurses should not base assessments on considerations of age, gender, ethnicity, or any other factor, but should discuss safe sex in all client encounters. Cognitive Level: Application Associated Chapter Objective: 5 & 6 REF: p. 336

A nurse is assigned to teach clients STD prevention information. The nurse updates her teaching plan to incorporate new guidelines from the Centers for Disease Control and Prevention. She includes which of the following as updated information during her next teaching session? a. Always use spermicides with condoms to reduce the risk of contracting chlamydia or gonorrhea. b. Condoms can be effective in preventing infections transmitted by fluids from mucosal surfaces but are not always effective in preventing infections transmitted by skin-to-skin contact. c. Condoms should not be used during oral sex, because they are not effective in preventing transmission of infection. d. When genital ulcers are present, condoms should be used to prevent the spread of infection.

ANS: B The lesions of HSV-2 and HPV infection as well as other lesions capable of transmitting STDs can occur on all parts of the male and female genitalia and rectum. Condoms are effective in reducing transmission via body fluids from the penis and vagina. However, lesions not covered by a male or female condom can still transmit infection even with proper condom use. Cognitive Level: Analysis Associated Chapter Objective: 5 & 6 REF: p. 330

An example of HIV transmission is: a. Having contact with a HIV-positive individual who is coughing b. An infant receiving breast milk from a HIV-positive mother c. Receiving a mosquito bite while in Africa d. Being near a HIV-positive individual who is sneezing

ANS: B HIV can be transmitted through breast milk.

Teaching a client with gonorrhea how to prevent reinfection and further spread is an example of _____ prevention. a. Primary b. Secondary c. Tertiary d. Primary health care

ANS: B Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability.

Which part of the immunological system suffers the greatest damage as a result of HIV infection? a. Dendrite cells b. CD4+ T-lymphocytes c. Macrophages d. Monocytes

ANS: B The count drops when the virus is most plentiful in the body.

What information would be appropriate for a nurse to share when educating IV drug users about sharing equipment? a. Tell the clients to throw away their equipment after one use. b. Educate the clients on using full-strength bleach on their drug paraphernalia for 30 seconds. c. Report illegal activities to the authorities and confiscate the needles and syringes. d. Give out needles and syringes to whoever wants them.

ANS: B Using bleach on the needles and syringes is a way to decrease cross contamination.

Which of the following best explains why some health clinics allow clients to be tested for HIV anonymously with no record of the client's name, address, or contact information? a. Client doesn't actually ever have to be told the results of the test. b. Client may be engaged in illegal activities (drug use). c. Client plans on not paying for the test, and collection agencies will not be able to harass them. d. Client wants to be sure care providers don't share results with their family.

ANS: B An advantage of anonymous testing may be that it increases the number of people who are willing to be tested, because many of those at risk are engaged in illegal activities. The anonymity eliminates their concern about the possibility of arrest or discrimination. If testing is anonymous, the client is given an identification code number that is attached to all records of the test results and is not linked to the person's name and address. Demographic data such as the person's sex, age, and race may be collected, but there is no record of the client's name and associated identifying information. Thus, the client is able to know the results of the test while staying anonymous. It would be a violation of HIPAA for the providers to share the results of this test or any other medical information with family members. The follow-up related to payment is not a main concern for the population who is requesting anonymous testing.

A mother felt very guilty that her baby was born HIV positive. When the nurse suggested the usual DPT and MMR immunizations, the mother was extremely upset. "Don't you know HIV children are immunosuppressed?" she exclaimed. Which of the following would be the nurse's best response? a. "All children have to have these immunizations before they can attend school." b. "Being HIV positive, your child is more likely to catch an infection and be very ill if not immunized." c. "I'm so sorry; I forgot for a moment your child was HIV positive." d. "The American Pediatric Association requires all health care providers to offer these immunizations to all parents; it is your choice whether or not to accept them."

ANS: B Because of impaired immunity, children with HIV infection are more likely to get childhood diseases and suffer serious consequences of the diseases. Therefore, DPT, IPV, and MMR vaccines should be given at regularly scheduled times for children infected with HIV. Other immunizations may also be recommended after medical evaluation. Although this child is HIV positive, there is no medical reason why the child should not be immunized. Many states do have a "no shots, no school" law, but exceptions can be made. The APA does recommend immunizations for most children, but this is not the best answer

A client diagnosed with tuberculosis (TB) asks why the nurse is required to watch the client swallow the medication each day. Which of the following statements is the best response by the nurse? a. "Clients with TB are often noncompliant, so if I directly observe, you will be sure to take the drugs that have been ordered." b. "This therapy is recommended to make sure that you receive the treatment you need and the infection doesn't become resistant to the drugs." c. "This is to make sure you take your medication if your condition becomes so advanced that you do not have enough cerebral oxygenation to remember." d. "Tuberculosis medications are very expensive so this method ensures that government money doesn't get wasted on those who will not take the drugs."

ANS: B It is important to be respectful to clients and to consider their perspective and psychological health while also responding truthfully. Directly observed therapy (DOT) programs for TB medication involve the nurse observing and documenting individual clients taking their TB drugs. When clients prematurely stop taking TB medications, there is a risk that the TB will become resistant to the medications. This can affect an entire community of people who are susceptible to this airborne disease. DOT ensures that TB-infected clients receive adequate medication. Thus, DOT programs are aimed at the population level to prevent antibiotic resistance in the community and to ensure effective treatment at the individual level. Many health departments have DOT home health programs to ensure adequate treatment. The risk to client and the community if the client does not follow the treatment regimen is that the TB will become resistant to these medications. It does not have to do with the possibility of noncompliance by the patient, that the patient will not remember, or related to the cost of the medications.

Which of the following best explains why chlamydia is a major focus of public health efforts? a. It has more serious long-term outcomes than other STDs. b. It can cause problems in infants born to infected mothers. c. It is not frequently seen in the United States. d. It is so difficult and expensive to treat

ANS: B Like gonorrhea and other STDs, chlamydia can cause neonatal complications in infants born to infected mothers. It is treated rather easily with antibiotics. Chlamydia does have serious long-term outcomes for the client, but so do syphilis and other STDs. However, unlike syphilis, which in its later stages is rare in the United States, chlamydia is the most common reportable infectious disease in the United States and hence is a major focus of public health.

A nurse is concerned about the prevalence of tuberculosis among migrant farm workers. Which of the following activities would be best to use when implementing tertiary prevention? a. Administer purified protein derivative (PPD) to contacts of those with tuberculosis. b. Initiate directly observed therapy (DOT) for tuberculosis treatment. c. Provide education about the prevention of tuberculosis to members of the migrant community. d. Use skin tests to screen migrant health workers for tuberculosis infection.

ANS: B Tertiary prevention is carried out among persons already infected with the disease. In this instance, DOT ensures compliance with treatment to cure the disease and to prevent worsening or the development of secondary problems. Administering purified protein derivative (PPD) to contacts of those with tuberculosis is secondary prevention as this is an at-risk population. Providing education about the prevention of tuberculosis to members of the migrant community is a primary prevention strategy as it is aiming to prevent the disease from occurring. Using skin tests to screen migrant health workers for tuberculosis infection is secondary prevention as it is a screening aimed at early detection of the disease.

When a nurse discovers that a woman has been treated for cervical cancer, the nurse asks the woman whether she has ever been tested for HIV or other STDs. The woman is offended and asks why the nurse would ask her such a thing. Which of the following statements would be the best response from the nurse? a. "Cervical cancer treatments may decrease immunity, so that it is easier to acquire STDs." b. "Cervical cancer usually is caused by HPV, and often the presence of one STD is accompanied by other STDs." c. "The presence of an STD in women with cervical cancer may lead to congenital defects in offspring." d. "The presence of an STD in a woman with a history of cervical cancer has been associated with a relapse of the cancer after treatment."

ANS: B The link between HPV infection and cervical cancer has been established and is associated with specific types of the virus. In 80% to 90% of cases of cervical cancer, evidence of HPV has been found in the tumor. Additionally, HSV-2 infection is linked with the development of cervical cancer. Because the presence of an STD increases the risk for the presence of other STDs, it is essential to screen for this information. There is no evidence that the presence of an STD in women with cervical cancer will lead to congenital defects in offspring. The presence of an STD increases the risk for another STD. There is no evidence of relapse of cervical cancer when there is presence of an STD.

The public health nurse comes to the hospital to see a client just diagnosed with hepatitis A. The nurse says, "I'm sorry to bother you when you're not feeling well, but I need to ask you a few questions." Which of the following questions would be most appropriate for the nurse to ask the client? (Select all that apply.) a. "Do you know how you got this infection?" b. "Who lives with you?" c. "Where are you employed?" d. "Where do you usually eat?" e. "Are you sexually active?"

ANS: B, C, E The nurse should ask about sexual contacts and ask who (if anyone) lives with the client because the named individuals will need to have immune globulin administered to hopefully prevent the spread of hepatitis A and a community epidemic. The nurse should also ask about the client's place of employment because certain settings warrant special considerations. For example, in restaurants, hospitals, daycare centers, or other institutions, the lack of careful hand-washing by an infected worker can result in contamination of many others. Hepatitis A can be spread through food contaminated by an infected food-handler, contaminated produce, or contaminated water. However, this mode of transmission is not very common in the United States.

A client newly diagnosed with HPV infection, herpes simplex virus 2 (HSV-2) infection, and syphilis asks, "Okay, so how do I get rid of all this stuff?" In developing a plan of care, the nurse recognizes that it is essential to address: a. correct use of condoms to prevent transmission of all STDs. b. cures for each of the STDs identified. c. risk of skin-to-skin contact in transmitting the identified STDs. d. safety of sexual contact in the absence of lesions.

ANS: C The client needs to understand which STDs are transmitted by skin-to-skin contact and which are transmitted by body fluids. The client also needs to understand which infections are curable with antibiotics (syphilis) and which are virus infections that are treatable but not curable (HPV, HSV-2 infections). In HSV-2 infection, although the ability to pass the infection is higher when active lesions are present, some individuals can spread the infection even when they are asymptomatic. HPV transmission occurs through direct contact with the warts that result from HPV, but the virus has also been detected in semen, and exposure to the virus through body fluids is also possible. In addition, the challenge of HPV prevention is that condoms do not necessarily prevent infection because warts can grow in areas that are not covered by barriers such as condoms and skin-to-skin contact may occur. Cognitive Level: Synthesis Associated Chapter Objective: 4, 5, & 6 REF: pp. 325-328

A person has syphilis with signs and symptoms of rash, sore throat, and muscle and joint pain. This person is experiencing which stage of syphilis? a. Congenital b. Primary c. Secondary d. Tertiary

ANS: C A person with signs and symptoms of a rash, sore throat, and muscle/joint pain is experiencing the secondary stage of syphilis.

When working with a client who is HIV positive, the nurse serves as an educator, teaching about the modes of transmission, and serves as a(n): a. Advocate, lobbying for AIDS research b. Counselor, discussing implications of future sexual activity c. Role model, providing supportive care d. Policy maker, addressing laws governing privacy rights of HIV-positive persons

ANS: C Nurses must be role models because many HIV-positive patients are stigmatized.

A community health nurse visits a homeless shelter that has several clients with tuberculosis who are taking antimicrobial drugs. Supervised drug administration may be done on a daily basis with persons with poor adherence because: a. This type of client does not care about his or her health. b. Homeless people have no access to medications. c. Poor adherence can result in drug resistance. d. The antimicrobials are so powerful, clients must be observed for reactions.

ANS: C Poor adherence has lead to antibiotic resistant strains.

The nurse teaches the family of an AIDS client about managing symptomatic illness by preventing deteriorating conditions, such as diarrhea, skin breakdown, and inadequate nutrition. This nursing intervention is an example of _____ prevention. a. Primary b. Secondary c. Tertiary d. Primary health care

ANS: C Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability.

The most chronic bloodborne infection in the United States is: a. Hepatitis A b. Hepatitis B c. Hepatitis C d. HIV

ANS: C The most chronic bloodborne infection in the United States is hepatitis C.

In the United States, which group is most affected by a new HIV diagnosis? a. Women having heterosexual relationships b. White IV drug abusers c. Young Black gay and bisexual men d. Men who have sex with other men

ANS: C Although new HIV diagnosis in general has declined, young Black gay and bisexual men are the most affected, with an 94% increase in diagnosis. The largest number of new infections in 2018 was in men who had sex with other men, and this was followed by heterosexual transmission. HIV infections in women are primarily due to heterosexual contact or IV drug use. This information supports the incorrectness of the other options.

Which of the following sexually transmitted diseases can be prevented through immunization? a. Chlamydia b. Gonorrhea c. Hepatitis B d. Genital Herpes Simplex

ANS: C Hepatitis B infection can be prevented by immunization; vaccines for the remaining options are not yet available. There are not yet vaccines for chlamydia, gonorrhea, or genital herpes simplex.

A nurse is providing education to a client about the use of PrEP. Which of the following statements would the nurse include as part of this teaching? a. "Side effects of PrEP include extreme lethargy and joint pain." b. "PrEP has been shown to be effective in preventing transmission of the disease from sharing needles." c. "The effectiveness of PrEP will depend on your adherence to the medication regimen." d. "PrEP will prevent you from contracting HIV and hepatitis B."

ANS: C Pre-exposure prophylaxis, or PrEP, is a new HIV prevention method for people who do not have the infection but would like to reduce their risk of becoming infected. PrEP requires taking a pill to prevent the HIV virus from getting into the body. This prevention method requires strict adherence to taking the medication and having regular HIV testing; it is also used in combination with other HIV prevention methods rather than in isolation (CDC: PrEP, 2012b). It has been shown to be effective for people at very high risk for HIV infection through sex; the results about its effectiveness with injection drug users are not yet available. Extreme lethargy and joint pain are not common side effects of PrEP. PrEp provides protection against HIV, not against hepatitis B.

Which of the following provides the best explanation as to why people do not immediately seek medical treatment when they first become ill with HIV? a. They are afraid to get tested for fear that the results will be positive. b. They avoid the problem (maybe it will go away). c. They don't recognize their symptoms as possibly being due to HIV. d. It is too expensive to get an HIV test.

ANS: C When HIV enters the body, it can cause a flu-like syndrome referred to as a primary infection or acute retroviral syndrome. This may go unrecognized. The symptoms are similar to flu or a bad cold including sore throat, lethargy, rash, fever, and muscle pain. An antibody test at this stage is usually negative. So the person or a medical provider may not recognize the illness as HIV. Thus, it is not worthwhile to be tested during this stage of the illness. This information supports the incorrectness of the other options

A school nurse is teaching a class of sophomores about the relationship between the risk of sexually transmitted disease (STD) and risk-taking behaviors. A key point to include is: a. all STDs are easily preventable with consistent condom use. b. once a young woman is pregnant, she is no longer at risk for most STDs. c. STDs are most likely to be transmitted during a student's initial sexual encounter. d. use of alcohol and drugs makes a student more likely to make decisions that result in exposure to and infection with STDs.

ANS: D Drug use is linked to STD transmission because drugs such as alcohol lower inhibitions and impair judgment about engaging in risky behaviors. Addictions to drugs may cause individuals to acquire the drug or money to purchase the drug by performing sexual favors. This increases both the frequency of sexual contacts and the chances of contracting STDs. Adolescents are particularly at risk. Not all STDs are preventable through condom use. The challenge of preventing human papillomavirus (HPV) infection (genital warts) is that condoms do not necessarily prevent infection because warts may grow in areas that barriers such as condoms do not cover and skin-to-skin contact may occur. Cognitive Level: Application Associated Chapter Objective: 4 & 5 REF: p. 335

A population-level tertiary prevention intervention typically carried out by nurses caring for those with communicable disease in the community is: a. HIV test results counseling. b. needle exchange. c. partner notification. d. instruction in standard precautions.

ANS: D Teaching caregivers about infection control in home care is vital. The nurse treating the client with HIV infection in the home environment should teach caregivers about standard precautions. Some clients, families, friends, and others may have concerns about the transmission of HIV infection. Others who may not have concerns about transmission may fail to take adequate precautions or believe myths that they cannot become infected. Cognitive Level: Application Associated Chapter Objective: 1, 5 & 6 REF: p. 339

The case rate of tuberculosis (TB) is highest among which ethnicity in the United States? a. African American b. Native American c. Hispanic d. Asian

ANS: D TB is most often found in Asian Americans, at 25.6 new TB cases per 100,000 people.

Which group should receive an injection of prophylactic immune globulin for possible exposure to hepatitis A? a. Persons who have had direct contact with blood b. Those who ate at the same restaurant as the person with hepatitis A c. All health care workers d. All those who had household or sexual contact with persons with hepatitis A

ANS: D Those who have been in close contact with persons who develop hepatitis A should receive immune globulin.

A student asks the nurse at the student health clinic how AIDS is diagnosed. Which of the following statements would be the best response by the nurse? a. "A diagnosis of AIDS is made when a screening test called an enzyme-linked immunosorbent assay (ELISA) is confirmed by the Western blot test." b. "A diagnosis of AIDS is made when antibodies to HIV are detected about 6 weeks to 3 months following possible exposure." c. "A diagnosis of AIDS is made when antibodies to HIV reach peak levels of 1000/ml of blood." d. "A diagnosis of AIDS is made when CD4 T-lymphocytes drop to less than 22 cells/mm."

ANS: D AIDS is defined as a disabling or life-threatening illness caused by HIV; it is diagnosed in a person with a CD4 T-lymphocyte count of less than 22 cells/ml with or without documented HIV infection. The HIV antibody test (usually the EIA) is the most commonly used screening test for determining whether the antibody to HIV is present but does not confirm AIDS. Positive results with the EIA are tested further with the Western blot test. However, false-negative results are frequent between 6 weeks and 3 months following exposure.

A nurse was reading PPD tests 24 hours after another nurse had administered them. Which of the following findings would cause the nurse to interpret the test as positive? a. 15 mm of erythema in a client with HIV infection b. 5 mm of induration in an immigrant from a country where TB is endemic c. A 5-mm ruptured pustule with purulent drainage in a homeless client d. 10 mm of swelling and increased firmness in a client recently released from a correctional facility

ANS: D For a PPD test to be positive, induration (swelling with increased firmness) must be present. A diameter of 10-mm induration would be a positive finding in an immigrant from a region with high TB infection. Erythema alone does not indicate a positive finding. A 5-mm induration is not large enough to indicate a positive finding. A small pustule in a homeless client undoubtedly is an infection but may not be due to the PPD test.

The correctional health nurse is doing a quick assessment on a newly admitted inmate who is HIV positive. Which of the following diseases should the inmate receive screening for immediately? a. Herpes zoster b. Hepatitis B c. Hepatitis C d. Tuberculosis

ANS: D HIV-infected persons, who live near one another, such as in correctional facilities, must be carefully screened and deemed noninfectious before admission to such settings. A person with HIV is more susceptible to opportunistic infections, the most common of which is TB. Hepatitis B and hepatitis C are both transmitted through blood and body fluids which are not as highly contagious as tuberculosis which is transmitted through airborne droplets. Herpes zoster (shingles) is spread by direct contact with fluid from the rash blisters. None of the other options are as directly related to HIV as an opportunistic disease.

A client is being treated for secondary syphilis. Which of the following signs and symptoms would the nurse anticipate the client would exhibit? a. Chancre at the site of entry b. Jaundice c. Difficulty coordinating muscle movements d. Skin rash without itching

ANS: D Secondary syphilis occurs when the organism enters the lymph system and spreads throughout the body. Signs include skin rash on one or more areas of the body and do not cause itching. Other symptoms may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. A chancre at the site of entry is a symptom of primary syphilis. Difficulty coordinating movements is a sign of tertiary syphilis. Jaundice is a sign of congenital syphilis.

A high school student is planning to volunteer at the hospital after school, so he or she needs to have a Mantoux test before beginning. Which of the following information should the nurse provide to the new volunteer? a. "I will be using tiny tines to administer the TB antigen to the skin on your arm." b. "Notify the clinic immediately if you experience any redness or itching at the test site." c. "The areas should be kept dry until you return; cover it with plastic wrap when bathing." d. "You will need to return in 2 to 3 days to have any reaction interpreted."

ANS: D The Mantoux test is a TB skin test that involves a 0.1-ml injection containing 5 tuberculin units of PPD tuberculin (not tines as in the TB tine test). The site should be examined for a reaction 48 to 72 hours (2 to 3 days) after injection. Only induration should be measured, and the results should be recorded in millimeters. The Mantoux test involves a 0.1-ml injection not tines as in the TB tine test. Slight redness or itching at the test site may occur, but that should resolve on its own and does not require the client to notify the clinic. The client can engage in normal activities; the site does not need to be kept dry.

A client was clearly very relieved when an HIV test came back negative. "Thank goodness. I've had sex several times without a condom, and when one of my friends said he was sick, I think I panicked." Which of the following would be most important to emphasize to the client immediately? a. Abstinence is the only way to be certain you are HIV free. b. Sex should be restricted to one partner. c. The test could be wrong and the client might still have an HIV infection. d. The test would not cover any recent infection, so if the client has had recent unprotected sex, the test should be repeated in 3 months.

ANS: D The client needs to understand that the test cannot identify infections that may have been acquired within the previous 3 months before the test. Appearance of the HIV antibody can take up to 12 weeks; thus, this test could be negative now, but positive in 3 months. All persons who have an STD test should be counseled about risk reduction activities before and after the test is done. This information supports the incorrectness of the other options.

Which of the following statements best explains why many health care providers are more afraid of getting hepatitis B (HBV) than HIV? a. Everyone would assume the person infected with hepatitis B is a drug user. b. Having HBV would mean no further employment in health care. c. The fatality rate is higher and occurs sooner with HBV. d. There is no treatment for HBV, which can be a very serious illness.

ANS: D Unlike HIV, there is no treatment for hepatitis B, and although some persons never have symptoms and others fight off the disease, many suffer from chronic hepatitis B, a very serious illness. Others may become chronic carriers of the disease. There are multiple populations that have a high prevalence of HBV including injection drug users, persons with STDs or multiple sex partners, immigrants, and refugees and their descendants who came from areas where there is a high endemic rate of HBV, health care workers, clients on hemodialysis, and inmates of long-term correctional institutions. Those who are infected with HBV are still able to work in health care. There is no evidence that the fatality rate is higher or sooner with HBV than with HIV

A client who is very upset says to the nurse, "But we always used a condom! How could I have genital warts?" Which of the following would be the best response by the nurse? a. "Are you positive you always used a condom?" b. "Condoms don't always work." c. "The condom might have had a tear in the latex." d. "Contact may have occurred outside the area that the condom covers."

ANS: D Warts may grow where barriers, such as condoms, do not cover, and skin-to-skin contact may occur. The challenge of HPV prevention is that condoms do not necessarily prevent infection. Thus, even with correct usage and the use of undamaged condoms, transmission may still occur

Which of the following public health nurses most clearly fulfills the responsibilities of this role? a) The nurse who met with several groups to discuss community recreation issues b) The nurse who spend the day attending meeting of various health agencies c) The nurse who talked to several people about their particular health concerns d) The nurse who watched the city council meeting on local cable television

B Any of these descriptions might represent a nurse communicating, cooperating, or collaborating with community residents or groups about health concerns. However, the nurse who spent the day attending meetings of various health agencies is the most representative, because in public health, concerns are broader than recreation, individual concerns are not as important as aggregate priorities, and watching television is less effective than interacting with others.

Jennifer is a nurse in a family medicine clinic. Today she is assessing Jose, a 4-year-old who is being seen for an earache. The type of nursing Jennifer practices is: a) community-oriented nursing. b) community-based nursing. c) public health nursing. d) tertiary health nursing.

B In community-based nursing, the nurse focuses on "illness care" of individuals and families across the life span. The aim is to manage acute and chronic health conditions in the community, and the practice is family-centered illness care. Community-based nursing is not a specialty in nursing but, rather, a philosophy that guides care in all nursing specialties. Community-oriented nursing has as its primary focus the health care either of the community or populations as in public health nursing (PHN) or of individuals, families, and groups in a community.

A nurse is developing a plan to decrease the number of premature deaths in the community. Which of the following interventions would most likely be implemented by the nurse? a) Increase the community's knowledge about hospice care b) Promote healthy lifestyle behavior choices among the community members c) Encourage employers to have wellness centers at each industrial site d) Ensure timely and effective medical intervention and treatment for community members

B Public health approaches could help prevent about 70% of early deaths by influencing the way people eat, drink, drive, engage in exercise, and treat the environment.

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

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

Public health nursing is a speciality with a distinct focus and scope of practice and requires a special knowledge base different from other specialty areas of nursing. A public health nurse would first be interested in: a) drug treatments for diabetes b) populations with the highest rate of diabetes c) educational materials for individuals with diabetes d) new technology for diabetic care

B The primary focus that has differentiated public health nursing from other specialties has been the emphasis on the population rather than on individuals or families. The primary goal of public health—the prevention of disease and disability—is achieved by ensuring that conditions exist in which people can remain healthy. Diabetes care and educational materials are provided to individuals and families by a nurse in the community or institutional setting.

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

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

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

C

Which of the following best defines aggregate? a) A large group of persons b) A collection of individuals and families c) A group of persons who share one or more characteristics d) Another name for demographic group

C An aggregate is defined as a collection of people who share one or more personal or environmental characteristics, such as geography or special interest.

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

C Community health nursing practice is the synthesis of nursing theory and public health theory applied to promoting, preserving, and maintaining the health of populations through the delivery of personal health care services to individuals, families, and groups. The focus of community health nursing practice is the health of individuals, families, and groups and the effect of their health status on the health of the community as a whole (individual to families to groups to community flow).

Which is responsible for the dramatic increase in life expectancy during the twentieth century? a) Technology increases in the field of medical laboratory research b) Advances in surgical techniques and procedures c) Sanitation and other public health activities d) Use of antibiotics to fight infections

C Improvement in control of infectious diseases through immunizations, sanitation, and other public health activities led to the increase in left expectancy from less than 50 years in 1900 to more than 77 years in 2002.

Which of the following is a basic assumption of public health efforts? a) Health disparities among any groups are morally and legally wrong b) Healthcare is the most important in government planning and funding c) The health of individuals cannot be separated from the health of the community d) The government is responsible for lengthening the life span of Americans

C Public health can be described as what society collectively does to ensure that conditions exist in which people can be healthy.

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

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

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

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

A public health nurse deals with the examination of a community setting to determine the community's health status. Which of the following activities should be considered in the assessment phase? (Select all that apply.) a) Assisting communities to implement and evaluate plans and projects b) Building constituencies to work with the community c) Collecting, analyzing, and disseminating information d) Evaluating the social, economic, and environmental characteristics e) Questioning the ability of health services to the community

C, D, E

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

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

In a community clinic that screens and treats individuals for cardiovascular disorders, the nurse practicing public health/population-focused nursing would most likely ascertain: a) a holistic treatment plan b) a specific clinical diagnosis c) individual dietary interventions for cardiovascular disorders d) the prevalence of cardiovascular disorders among various group s

D A public health nurse in a community clinic engaged in population-focused practice would ask the following questions: What is the prevalence rate of the diagnosis or condition among various age, race, and gender groups? Which subpopulations have the highest rates of untreated diagnosis or condition? What programs could reduce the problem of untreated diagnosis/condition and decrease the risk for further morbidity and mortality? Public health nurses are typically concerned with more than one subpopulation, and they often deal with the health of the entire community. Assessment, one of the public health core functions, is a logical first step in examining a community setting to determine its health status.

The nurse often has to make resource allocation decisions. Which of the following best describes the criterion the nurse should use in such cases? a) The specific moral or ethical principle related to the situation b) The cheapest, most economical approach c) The most rational probable outcome d) The needs of the aggregate rather than a few individuals

D Although all of the choices represent components of a decision that the nurse might consider, the dominant needs of the population outweigh the expressed needs of one or a few people.

Which of the following actions would most likely be performed by a public health nurse? a) Asking community leaders what interventions should be chosen b) Assessing the community and deciding on appropriate interventions c) Using data from the main healthcare institutions in the community to determine needed health services d) Working with community groups to create policies to improve the environment

D Although the public health nurse might engage in any of the tasks listed, he or she works primarily with members of the community to carry out core public health functions, including assessment of the population as a whole and engaging in promoting health and improving the environment.

Which of the following best describes community-oriented nursing? a) Focusing on the provision of care to individuals and families b) Providing care to manage acute or chronic conditions c) Giving direct care to ill individuals within their family setting d) Having the goal of health promotion and disease prevention

D By definition, community-oriented nursing has the goal of preserving, protecting, or maintaining health to promote the quality of life.

The public health nurse has a clear vision of what needs to be done and where to begin to improve the health of the community. Why would the nurse spend time meeting with community groups to discuss the most important task to be addressed first? a) To increase the group's self-esteem b) To maintain communication links with the groups c) To make the groups feel good about their contribution d) To work with the groups, not for the groups

D Historically, healthcare providers have been accused of providing care for or to a people without actually involving the recipients in the decisions. Public health nursing is a "with the people" - not a "to the people" or "for the people" approach to planning.

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

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

When talking to a women's group at the senior citizens' center, the nurse reminded them that the only way the center would be able to afford to provide transportation services for them would be for them to continue to write letters to their local city council representatives requesting funding for such a service. What was the nurse trying to accomplish through this action? a) Ensure that the women did not expect the nurse to solve their problem b) Demonstrate that the nurse understood the women's concerns and needs c) Express empathy, support, and concern d) Help the women engage in political action

D Public health nurses engage themselves and others in policy development and encourage and assist persons to communicate their needs to those with the power to take action.