CH Final Quiz

Once there has been validation of the nursing diagnoses with the community, what is the next step in planning a community-based health program? A) Identify measurable community health goals. B) Establish a sequence of actions and a time schedule for achieving goals. C) List resources needed to accomplish the plan. D) Acknowledge potential obstacles to planned actions and revised actions.

A Feedback: After validating the nursing diagnoses with the community, the community-based measurable goals have to be identified.

Toxic substances have received a great deal of attention in governmental regulations and the news media. When determining ways to control the effects of exposure, the nurse must consider the anticipated risk. Anticipated risk is primarily determined by what characteristic of a substance? A) Toxicity B) Prevalence C) Neurotoxic effect D) Amount in the environment

A Feedback: Both the toxicity of the substance and the expected exposure to the organism must be considered to define the anticipated risk. The prevalence, neurotoxic effect, and the amount in the environment are not considered primary in determining the anticipated risk.

Which statement best represents a core principle of participatory and action research? A) Community members and the researchers should strive to achieve mutual goals. B) The community health nurse for the research project determines the research agenda. C) The process should be laissez faire and empower the participation of a wide range of community members. D) The relationship between health care experts and community memhers must be kept confidential.

A Feedback: The six core principles of participatory and action research are as follows: the participants in the research project determine the research agenda; the research project should benefit the community as a whole and allow community members to make informed decisions and act collectively; the relationship between health care experts and community members should be a collaborative effort based on the principles of shared dialogue; community members should have access to all information and knowledge from which they might normally be excluded; the process should be democratic and empower the participation of a wide range of community members; and community members and the researchers should strive to achieve mutual goals.

Which describes a man-made disaster? A) Chemical spill B) Droughts C) Earthquakes D) Wikdfires

Ans: A Feedback: A chemical spill is an example of a man-made disaster. Droughts, earthquakes, and wildfires are examples of natural disasters.

Which of the following represents the best way for a new nurse to complete an in-depth self-examination of cultural competence? A) Acknowledge and be aware of one's own culture and willingness to explore one's own feelings and biases B) Be responsible for having excellent on-the-job motivation and commitment to caring for assigned clients C) Complete a self-examination of superior social, cultural, and biophysical factors in the community D) Become involved on a monthly basis in at least one cross-cultural interaction or workshop

Ans: A Feedback: A major component of cultural competence is an acknowledgment and awareness of one's own culture and a willingness to explore one's own feelings and biases.

Which is an example of a health care policy decision made at the community level? A) Health clinic for low-income families B) Licensure of health care professionals C) Ensured access to public health care D) Focus of client safety in hospitals

Ans: A Feedback: A new health clinic for low-income families is an example of a bealth care policy decision made on a community level, because it is funded with budget allocations from local city and county governments. The licensure of health care professionals is an example of a policy decision made at the state level, because the state government provides funding. National health policy focuses on issues of concern to all citizens, such as legislation and regulations that focus on client safety in hospitals and ensure access to public health care.

Several nursing interventions can be used to decrease environmental influences on health. How can a nurse use primary prevention to decrease pollution? A) Promote routine immunizations to minimize diseases caused by biologic agents. B) Monitor for signs of hazardous environmental conditions, such as blood lead levels. C) Assess for signs of illness related to environmental hazards in the community. D) Treat and monitor disorders caused by environmental conditions.

Ans: A Feedback: A nurse can use primary prevention to decrease pollution by promoting routine immunizations to minimize discases caused by biologic agents. The nurse can use many techniques involving secondary preventions, including monitoring for signs of hazardous environmental conditions, such as blood lead levels; assessing for signs of illness related to environmental hazards in the community: and treating and monitoring disorders caused by environmental conditions.

Who is considered to make up the school community? Select all that apply A) School-aged children and adolescents B) Parents and guardians C) School personnel D) Neighborhood residents, business owners, and service providers E) Facebook friends

Ans: A, B. C. D Feedback: Health-education approaches must be comprehensive and include the children as well as all groups of individuals involved in their care and nurturing. These key adults, together with the children and adolescents they serve, are referred to as the school community. The school community encompasses school-aged children and adolescents, parents and guardians, school personnel (faculty, staff, and administrators), and neighborhood residents, business owners, and service providers. Facebook friends are not considered part of the school community

All community organization staff members have been informed by the community health nurse of the elderly community health needs, and cach organization has desired to become involved in the planning process. According to Reinkemeyer's stages of planned change, when would this activity occur? A) Stage 1: Identification and development of a felt need and desire for the change B) Stage 2: Development of a change relationship between the community health nurse and the community C) Stage 3: Clarification or diagnosis of the community's problem, need, or objective D) Stage 4: Examination of alternative routes and tentative goals and intention of actions

Ans: B Feedback: All community organization staff members have been informed by the community health nurse of the elderly community health needs, and cach organization has desired to become involved in the planning process; this occurs during stage 2.

Which is most influential when determining how an individual acts when he or she is ill? A) Community health nurse B) Ethnic culture C) Individual who is sick D) Primary care provider

Ans: B Feedback: How an individual acts when "ill" is determined by ethnic culture. Some cultures have specific norms for sick role behavior, whereas other cultures suggest that you continue to carry out your everyday role to the best of your abilities.

If you could only study the effects of pollutants on one ecosystem, the one that would potentially generate the greatest result would be which ecosystem? A) Air B) Aquatic C) Plants D) Terrestrial

Ans: B Feedback: Pollutants generally exert greater influence on aquatic ecosystems than on terrestrial environments. Air pollutants can be carried by the winds; but once they fall to carth, they continue their transport along the waterways,

Which is the first priority in the Disaster Paradigm? A) Assess hazards. B) Detect. C) Evacuate and transport victims and casualties. D) Incident command

Ans: B Feedback: The Disaster Paradigm (AMA, 2004a, 2005) is a useful model for recognizing and managing a disaster scene. This paradigm establishes the eight priorities following the acronym DISASTER: detect, incident command, scene security and safety, assess hazards, support, triage and treatment, evacuation and transport of victims and casualties, and recovery.

The community health nurse is reviewing education system barriers for the homeless in the community. What is an example of enrollment barrier? A) Frequent mobility B) Poor health C) Transportation D) Isolation

Ans: C Feedback: An enrollment barrier is transportation. School success barriers include frequent mobility, poor health, and isolation.

The community health nurse is involved in carrying out the community-based plan. When carrying out this plan, the nurse is utilizing which phase of the nursing process? A) Assessment B) Planning C) Implementation D) Evaluation

Ans: C Feedback: Implementation is the action phase of the nursing process; it is carrying out the community-based plan. Assessment entails looking closely at what is needed or what is wrong; planning involves finding out what to do once the assessment is completed; and evaluation occurs after implementation and determines how well the plan worked to know whether it is working or needs adjustment.

The idea of a health program based on unified goals and objectives is central to the Healthy People documents. In 1979, the first "health" initiative for the United States promoted five goals. Which population should the health professional target for increasing their independence? A) Adolescents B) Children C) Older adults D) Young adults

Ans: C Feedback: In 1979, the first "health" initiative for the United States (Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention) promoted five goals. These broad goals focused on reducing mortality among targeted age groups infants, children, adolescents, young adults, and adults-and on increasing the independence of older adults.

The community health nurse needs to have an understanding of the environmental factors that affect the hcalth of communities. As practitioners of community health, how does this information aid us? A) Health of any population cannot be affected by its surrounding environment. B) We should support any claims of perfect disposal schemes for pollutants. C) Pollutants can travel long distances because there are no perfect disposal schemes. D) Water treatment systems usually precipitate pollutants to a top sludge.

Ans: C Feedback: Nurses must be aware that the health of any population can be affected by its surrounding environment. Next, nurses must be skeptical of any claims of perfect disposal schemes for pollutants; they do not exist. Remember that pollutants can travel long distances and remain undetected. Water treatment systems usually precipitate pollutants to a bottom sludge.

What type of evaluation would the nurse use to measure whether the community health program activities changed the initial reason for the program? A) Formative B) Impact C) Outcome D) Process

Ans: C Feedback: Outcome evaluation measures whether the program activities changed the initial reason for the program. Impact or summative evaluation is concerned with the immediate impact of a program on a target group. Process or formative evaluation answers the question: Are we doing what we said we would do? Some authors make a distinction between formative and process evaluation by using process to denote evaluation conducted during the program, whereas formative may be applied at formative or preprogram stages.

Partnerships between community members and health care professionals are critical. For these partnerships to be successful promoting awareness and understanding of a community's health needs, the partners must have which type of relationship? A) Independent B) Dependent C) Collaborative D) Autonomous

Ans: C Feedback: Partnerships between community members and health care professionals are critical for collaborative decisions that promote awareness and understanding of a community's health needs. Community health nurses have power to develop healing relationships or capacity- building activities that promote health and to empower others to engage community members in collaborative efforts, partnerships, and coalitions.

The community health nurse understands that politics is which of the following? A) Laws to promote the health of citizens B) Promoting of the welfare of the public C) Process of influencing the allocation of scarce resources D) Applies to all members of a society and includes preseribed sanctions for failure comply

Ans: C Feedback: Politics is defined as the process of influencing the allocation of scarce resources. Health policy includes the laws to promote the health of citizens. Policy that promotes the welfare of the public is termed sociał welfare policy. Public policy applies to all members of a society and includes prescribed sanctions for failure to comply.

The community health nurse needs to develop objectives for an upcoming program to improve health. Which type of objective attribute can be achieved through population-based and health service intervention? A) Drive action B) Measurable C) Prevention oriented D) Useful and relevant

Ans: C Feedback: Prevention-oriented attributes should address health improvements that can be achieved through population-based and health service intervention. The objective attribute of drive action includes suggestion of steps that will achieve the proposed targets. Measurable should include a range of measures directed toward improving health outcomes and quality of life. Useful and relevant should be usable by states, localities, and private sector to target schools, communities, worksites, health practices, and other settings.

Which principle for effective risk communication is probably the most difficult to achieve? A) Early announcement B) Trust C) Transparency D) Listening

Ans: C Feedback: Transparent communication is truthful and easy to understand. It reinforces trust. This principle is probably the most difficult to achieve. Health officials and professionals may withhold information because of worry that they will be blamed or held accountable for the cmergency.

Community health nurses must continue to collect data about the policy that has been implemented in a community agency. In what step of the nursing process does the community health nurse continue to collect data? A) Assessment B) Diagnosis C) Evaluation D) Implementation

Ans: C Feedback: When equating the nursing process to the steps of policy making, evaluation equates to policy evaluation, assessment equates to problem recognition and definition, diagnosis equates to policy formation, and implementation equates to budgeting and policy implementation.

The basic building blocks of nursing, the steps of the nursing process, are similar to the process used in policy making. In what step of the nursing process does adoption of a policy by the appropriate agency occur? A) Assessment B) Diagnosis C) Planning D) Implementation

Ans: C Feedback: When equating the nursing process to the steps of policy making, planning equates to policy adoption, assessment equates to problem recognition and definition, diagnosis equates to policy formation, and implementation equates to budgeting and policy implementation.

The historical focus of nursing in the community has been replaced by site-managed care systems in the United States. Where is the primary base when planning interventions for this system? Select all that apply. A) Community B) Home C) Primary care clinic D) Hospital E) Long-term care facility

Ans: C.D Feedback: Our historical focus of nursing in the community has been replaced by "site-managed care systems," such as hospitals and primary care clinics, that require the client to come to a facility, rather than the nurse providing care within the community.

When developing an agenda in a community to effect change, which person(s) would be primary to engage in the development of this agenda? A) Community medical director B) Academic experts C) Individual client D) Community members

Ans: D Feedback: A basic tenet of community empowerment is that the community defines its own agenda. Community participation is a crucial element in engaging community members to develop agendas that serve as a cohesive force to mobilize the community toward a process of change.

The community health nurse is adapting a program for vulnerable and marginalized populations. Which overarching goal for Healthy People 2020 directly applies to the issue of health disparity? A) Eliminate preventable disease, disability, injury, and premature death. B) Create social and physical environments that promote good health for all. C) Promote healthy development and healthy behaviors across every stage of life D) Achieve health equity, eliminate disparities, and improve the health of all groups.

Ans: D Feedback: An overarching goal for HP 2020 directly applies to the issue of health disparity. The goal is "to achieve health equity, eliminate disparities, and improve the health of all groups."

People older than 65 years need regular primary health care services to maintain health and prevent disabling chronic illness and life-threatening conditions. What is a health promotion service that can form the basis for a community nursing intervention? A) Referral to existing national pharmacy assistance programs B) Continuous source of tertiary care C) Connection to acute illness support groups D) One-stop shopping for health care Ans:

Ans: D Feedback: Health promotion services that can form the basis for a community nursing intervention include referral to existing state pharmacy assistance programs; continuous source of primary care; connection to chronic illness support groups; and one-stop shopping for health care.

Partnerships between local health departments and faith-based organizations potentially can do much to deliver services and reduce health disparities experienced by vulnerable groups. Which Healthy People 2020 goal is consistent with this philosophy of faith communities A) Individual health is closely related to community health. B) Increase quality and years of life with elimination of preventable disease. C) Develop partnerships between individual and community health. D) Achieve health equity, eliminate disparities, and improve the health of all groups.

Ans: D Feedback: The Healthy People 2020 goals are to eliminate preventable disease, disability, injury, and premature death; to achieve health equity, eliminate disparities, and improve the health of all groups; to create social and physical environments that promote good health for all; and to promote healthy development and healthy behaviors across every stage of life

Humans are hosts to a number of disease-causing pathogens and parasites. Which is an example of a vector? A) Dressings B) Food C) Handkerchiefs D) Insects

Ans: D Feedback: Vectors are animals or flying or crawling insects or other arthropods that serve as an intermediate means of transporting the infectious agent. Vehicles, such as dressings, food, and handkerchiefs, are substances that serve as an intermediate means to transport and introduce an infectious agent into a susceptible host.

The basic building blocks of nursing, the steps of the nursing process, are similar to the process used in policy making. In what step of the nursing process would the budget be established for a policy that is being developed? A) Assessment B) Diagnosis C) Planning D) Implementation

Ans: D Feedback: When equating the nursing process to the steps of policy making. implementation equates to budgeting and policy implementation, assessment equates to problem recognition and definition, diagnosis equates to policy formation, and planning equates to policy adoption.

To promote the health of the community, health policy development is required. Which statement describes public policy? A) Policy that promotes the welfare of the public B) Policy that applies to all members of a society and includes prescribed sanctions for failure to comply C) Policy that applies to groups who have similar interests or special interests, such as professional organizations D) Policy based on the institution's mission and goals and that determines how the institution will function and relate to employees

B Feedback: Public policy applies to all members of a society and includes prescribed sanctions for failure to comply. Policy that promotes the welfare of the public is termed social welfare policy. Organizational policy is formed and applies to groups who have similar interests or special interests, such as professional associations. Instirutional policy governs work sites. Institutional policies are based on the institution's mission and goals, and they determine how the institution will function and relate to employees.

Which is the highest priority for success of a unified program between agency personnel who implement a community health program and the target population of program recipients? A) Collaboration B) Agency ownership for program C) Limited time for publicizing the program D) Limited need for coordination between these groups

Ans: A Feedback: A unified program requires collaboration and coordination between the agency personnel who will implement the program and the program's recipients (the target population). Allowing plenty of time for publicizing the program (and how you perform the mechanics of publicity-how, where, and to whom) can make a crucial difference in whether people attend and what the subsequent impact will be.

There are three essential components for community participation in health programs. Select the answer that best reflects one of the essential components. A) Framework to define the community B) Participation is a passive, ongoing process. C) Decisions made through participation must be effective. D) People have the right and power to make decisions that affect their lives.

Ans: A Feedback: Essential components for community participation include the following: a framework to define the community; shared awareness by members of the community, and mechanisms to mobilize the community to recognize its neceds and develop a culture of participation.

In seeking ways to alleviate problems associated with health, the nurse must be cognizant of which statement that reflects one of nature's operating principles? A) Everything has to go somewhere. B) Everything is not connected to everything else. C) Everything has the same rate of change. D) Everything that goes up is dispersed in the air.

Ans: A Feedback: Everything has to go somewhere. Everything is connected to everything else, but some things are connected more tightly than others. Everything is constantly changing. Some changes seem irreversible, permanent, or barely detectable from our perspective in time. Other changes are cyclic or transient. Everything that goes up must come down.

The American Nurses Association legislative initiatives include issues of access, cost, and quality of care. What is an example of a cost of care initiative? A) Medicare reform B) Advanced practice nurse coverage C) Safe health care reporting D) Safe client handling

Ans: B Feedback: Access to care includes access to health coverage, health plans, and Medicare reform. Cost of care includes advanced practice nurse coverage, health plans, Medicaid cost containment, medical errors, medical malpractice liability/tort reform, and Medicare reform/prescription drugs. Quality of care includes adequate and appropriate nurse staffing, mandatory overtime, safe health care reporting, "whistle-blowing" protection for nurses, and safe client handling.

The American Heart Association and the community health nurse have selected topies that are congruent with survey questionnaire results to be included in classes for spouses of individuals who have had a myocardial infarction. What does this represent in a plan for a community-based health program? A) Community health goal B) Program activity C) Learning objective D) Collaboration

Ans: B Feedback: After formulation of goals, the next step is specifying the program activities. Program activities map out the actions necessary to deliver the program and thereby reach the goals).

The community health nurse considers specific interventions for population-based nursing practice when developing plans to address the problems identified in the community. Which action is based upon the cornerstones for public health nursing? A) Focus on individual family B) Policy development and enforcement C) Reflect individual priorities and needs D) Promote health through epidemiologic evidence

Ans: B Feedback: An example of an intervention for population-based nursing practice is policy development and enforcement. Examples of criteria for public hcalth nursing include focusing on entire population; reflecting community priorities and needs; and promoting health through epidemiologic evidence.

The community health nurse plans to implement a specific program that will involve use of the new community center that includes a pool and elubbouse. Which would be the best intervention when looking at who and how this center will be utilized? A) Focus on entire population B) Policy development and enforcement C) Reflect community priorities and needs D) Promote health through epidemiologic evidence

Ans: B Feedback: An example of an intervention for population-based nursing practice is policy development and enforcement. It will be imperative to develop a policy for use and how this policy will be enforced. Focus on the entire population; reflect community priorities and needs; and promote health through epidemiologic evidence do not reach the goal of who and how the center will be utilized

The school nurse is developing a health education program on domestic violence for parents that addresses the effects on children and sources of help for the whole family, What major issue affecting children does this address? A) Mental health issues B) Interpersonal violence C) Sexuality D) Environmental hazards

Ans: B Feedback: An example of interpersonal violence programming could be domestic violence and its effects on children and sources of help for the whole family. Examples of mental health issue programming could be self-esteem; attention deficit disorder hyperactivity disorder; depression; and suicide. Sexuality programs coukd be personal hygiene; teenage pregnancy, teen parenting, and sexually transmitted diseases. Psychological environment programs could be grade stress; parent-child discord; parent-teacher and teacher-teacher conflicts; and peer harassment.

An experimental design has been used to evaluate the effectiveness of a preventive health fair. An experimental design is very useful to answer questions about: A) Cost efficiency B) Outcome C) Progress D) Relevancy

Ans: B Feedback: An experimental design can yield data on whether a program has produced the desired outcomes when compared with the absence of such a program or, alternatively, whether one program strategy has produced better results with regard to the desired outcomes than some other strategy. However, the experimental design is not useful for evaluation of program progress or program cost efficiency.

When should the evaluation plan be established for a community health program? A) During implementation of the program B) Before the program is implemented C) Essential after implementation of the program D) When promoting health partnerships only with schools

Ans: B Feedback: Before a program is implemented, the manner in which it is to be evaluated must be established. Establishing criteria during or after implementation will not help direct the program. It should be done when promoting health partnerships with school, but not solely in this case, and should always be done before implementing any program no matter where it is implemented.

The nurse evaluates the responses of the community to a bealth program to measure progress that is being made toward the program's goals and objectives. When evaluating these responses, the nurse understands that this is part of what nursing process? A) Assessment B) Evaluation C) Planning D) Implementation

Ans: B Feedback: Evaluation is crucial for revision of the database and the community nursing diagnoses. Nursing practice is cyclic as well as dynamic, and for community-based interventions to be timely and relevant, the community database, nursing diagnoses, and health program plans must be evaluated routinely.

Which has contributed to the movement of nursing in faith communities? A) Dissatisfaction with the disease-focused holistic model B) Access to health care and insurance coverage C) Decrease in lay ministry responsibilities in faith-based communities D) Need for ongoing chronic disease management in faith-based communities

Ans: B Feedback: Factors such as an increasing concem for disparities in health care; access to health care and insurance coverage; dissatisfaction with the discase-focused medical model; recent emphasis on bioethics as evidenced by institutions devoted to the interface of medicine and health; and church-based 12-step and meal programs historically have contributed to the movement. Other influencing components are self-responsibility for health care, increasing autonomous roles in nursing, increasing lay ministry responsibilities in faith-based communities, and limited health care system resources.

When writing a proposal as to the importance of implementing a program aimed at decreasing childhood obesity, the nurse emphasizes which statistic? A) One of two children is obese as children. B) One of eight preschoolers is overweight. C) Twenty-five percent of school-aged children experience obesity. D) One of five children is considered obese.

Ans: B Feedback: For instance; according to the Centers for Disease Control and Prevention (2014), one out of every eight preschool-aged children is considered overweight.

Which of the following is a major reason that health disparities exist? A) No sensitivity to the needs of the individuals to be served B) Problems experienced in accessing and effectively utilizing health services C) Belief that individual's health is not closely related to community hcalth. D) Common ground exists among clients and communities to encourage culturally competent health care partnerships.

Ans: B Feedback: Health disparities exist and are due, at least in part, to problems experienced in accessing and effectively utilizing health services. Reducing and eventually eliminating disparities depends on building common ground among clients, providers, agencies, and communities so that culturally competent health care partnerships can grow in number and quality of services.

Which is an example of health policy? A) Child labor laws B) Laws to promote health of citizens C) Rules for smoking environments for employees and clients D) State nurses' associations that determine governing rules for membership

Ans: B Feedback: Health policy includes the laws to promote the health of citizens. Child labor laws are an example of a social welfare policy. Rules of smoking environments for employees and clients are institutional policies. An example of organizational policy is a state nurses association or a specialty nursing organization that determines governing rules for membership.

A community health nurse is developing a workshop on health promotion and development for a group of school-aged children. The nurse would incorporate which goal into the development of this workshop? A) Achieve health equity, eliminate disparities, and improve the health of all groups. B) Promote healthy development and healthy behaviors across every stage of life. C) Increase quality and years of a hcalthy life. D) Eliminate health disparities.

Ans: B Feedback: Healthy People 2010 identified two broad goals: eliminate health disparities and increase quality and years of healthy life. Healthy People 2020 identifies four overarching goals: eliminate preventable discase, disability, injury, and premature death; achieve health equity, eliminate disparities, and improve the health of all groups; ereate social and physical environments that promote good health for all; and promote healthy development and healthy behaviors across every stage of life. Promoting healthy development and healthy behaviors across every stage of life apply to the development and focus of the workshop on health promotion. The school community is an ideal center for health promotion activities.

Which would the nurse consider an outbreak of infectious disease? A) Identification of the occurrence of new cases in a population B) Unexpected occurrence of an infectious discase in a limited geographic area during a limited period of time C) Steady occurrence of discase over a large geographic area or worldwide D) Unexpected increase of an infectious discase in a geographic area over an extended period of time

Ans: B Feedback: Outbreak refers to the unexpected occurrence of an infectious discase in a limited geographic area during a limited period of time. Identification of the occurrence of new cases in a population is referred to as incidence. Pandemic defines the steady occurrence of disease over a large geographic area or worldwide. Epidemic refers to the unexpected increase of an infectious disease in a geographic area over an extended period of time.

One creative approach to rural health is the concept of clinical peripherality. What does clinical peripherality encompass? A) Remoteness from primary and secondary care B) Low population density regions with remoteness from tertiary and specialty care C) Inaccessibility of any primary and acute health care services in rural America D) Rapid availability of services for decisions that might affect quality, cost, or access to care

Ans: B Feedback: One creative approach to rural health is the concept of "clinical peripherality," which encompasses not only low population density and remoteness from tertiary and specialty care, but also remoteness from the administrative offices where decisions are made that might affect quality, cost, or access to care.

Which of the following represents rescarch that is problem focused and involves all participants? A) Action B) Participatory C) Qualitative D) Quantitative

Ans: B Feedback: Participatory research is problem-focused or context-specific research centered on a particular problem involving all participants. Participatory rescarch is similar to action rescarch, in which cach person or group engaged in the process is committed to improvement through continuous interaction among dialogue, rescarch, action, reflection, and evaluation. Quantitative research refers to a study in which items can be counted or measured and statistics can be used to analyze the results. Qualitative research refers to a study that involves phenomena as they naturally occur.

Most health promotion programs involve lifestyle behavioral changes. The person has decided to try and change a behavior and is ready for information and skills to maintain the behavioral change. The nurse would document this in which stage of the change process? A) Contemplation B) Preparation C) Action D) Maintenance

Ans: B Feedback: Preparation: A person at this stage has decided to try to change a behavior(s). This employee desires help in making the change and is ready for information and skills to maintain the behavioral change.

A community health nurse proposed that a survey questionnaire to assess the target population's perception of their health concems be developed. When drafting a questionnaire, what is the maximum amount of time that the whole questionnaire should take to complete? A) 5 minutes B) 10 minutes C) 15 minutes D) 20 minutes

Ans: B Feedback: Questions need to be able to be answered quickly, and the whole questionnaire should not take longer than 10 minutes to complete.

Which of the following describes the reservoir in the chain of transmission? A) The organism capable of producing infection or infectious disease B) The environment in which a pathogen lives and multiplies C) The means by which an infectious agent is transported from the host D) The method whereby the infectious agent is transmitted from one host to another host

Ans: B Feedback: The reservoir is the environment in which a pathogen lives and multiplies. The infectious agent is an organism capable of producing infection or infectious discase. The portal of exit is the means by which an infectious agent is transported from the host. The mode of transmission is the method whereby the infectious agent is transmitted from one host to another host.

The community health nurse is working with a community health program. What type of evaluation is important to use in revising a community program? A) Effective B) Impact C) Summative D) Formative

Ans: D Feedback: Just as the community members were part of assessment, analysis, planning, and implementation, so too they must be partners in evaluation. It is critical to have created a participatory process. Formative evaluation answers the question: Are we doing what we said we would do? Based on the formative evaluation, revisions can take place. Impact (or summative) evaluation is concerned with the immediate impact of a program on a target group. Effective is not an evaluation type.

Which of the following toxic substances are most likely to pose a risk to human health, both in prevalence and severity? A) Cardiotoxins B) Hepatotoxins C) Nephrotoxins D) Neurotoxins

Ans: D Feedback: Neurotoxins are most likely to be the most significant toxic substances in both prevalence and severity that pose a risk to human health.

Which is an example of an action a nurse can take to influence health policy? A) Encourage voter registration. B) Be a passive constituent in the community. C) Know the executive process. D) Identify government representatives.

Ans: D Feedback: Nurses can influence health policy by learning the legislative process; staying informed on current issues; identifying government representatives; being an active constituent; and speaking out.

When planning the integration of health resources in a community, which of the following people would be the best to lead this effort? A) Physicians B) Nurse practitioners C) Social workers D) Nurses

Ans: D Feedback: Nurses have long been at the forefront of integrating health resources by forming partnerships with clients, families, and communities. Community health nurses have the power to develop healing relationships or capacity-building activities that promote health and to empower others to engage community members in collaborative efforts, partnerships, and coalitions. Physicians, nurse practitioners, and social workers serve a specific purpose once the nurse identifies the needs of the individuals within a community.

Many rural communities have assessed how activity friendly they are. What assessment tool is especially useful for local rural community leaders seeking to buikd partnerships and involve community members in identifying needs and designing and implementing active living interventions? A) Robert Wood Johnson Foundation Activity Friendly Tool B) SPACES instrument C) Irvine-Minnesota Inventory D) Rural Active Living Assessment

Ans: D Feedback: Often with funding from the Robert Wood Johnson Foundation (RWJF), communities have assessed how "activity friendly" they are. This assessment process has typically involved a process of walking the sidewalks of a neighborhood with a checklist or other formal assessment tool in hand, observing the condition of the housing, sidewalks, crosswalks, intersections, recreational facilities, school areas, and such. Until very recently, the tools available for these assessments were developed for, and field tested in, urban and suburban neighborhoods, including the SPACES instrument and Irvine-Minnesota Inventory. Active Living Research and Healthy Eating Research are national programs funded by RWJF, providing research to address childhood obesity. In recent years, these programs have funded a small number of projects to begin exploring the needs of rural communities in this effort. Collaboration among three of their grantees has produced a set of instruments that are designed specifically for use in rural communities. Known as the Rural Active Living Assessment tools, these instruments are especially useful for local community leaders seeking to build partnerships and to involve community members in identifying nceds and designing and implementing interventions.

Disaster epidemiology focuses on the range of short-term and long-term negative effects of community disasters. A study of the people of Fukushima, Japan, after the earthquake in 2011 showed what negative effect? A) Higher risk of cancer in general Japanese population B) Lower levels of cesium in the elderly C) Overpopulation D) Environmental contamination

Ans: D Feedback: The Fukushima disaster in 2011 produced environmental contamination and increased radioactivity. There is no higher rate of cancer in the general Japanese population, higher levels of cesium in the elderly, and no evidence of overpopulation due to the Fukushima disaster.

A community health nurse is trying to locate information commonalities among marginalized groups. The nurse is interested in knowing about the number of noninstitutionalized individuals who have a limitation in usual activities due to a chronic condition. Which group would provide the most pertinent information to the nurse? A) The Centers for Disease Control and Prevention B) The U.S. Census Bureau C) The World Health Organization D) The National Center for Health Statistics

Ans: D Feedback: The National Center for Health Statistics (NCHS) reports that 34,4 million (11.8%) of noninstitutionalized individuals have a limitation in usual activities due to a chronic condition. The Centers for Disease Control and Prevention maintains information on diseases, not limitations of individuals. The U.S. Census Bureau has more specific disability information, not the general information. The World Health Organization does not have this type of disability information but is more involved in control and prevention on a more global basis

When treating a disaster victim, which is the last step of the START triage system? A) Rescuers instruct persons at the scene of the incident to move to a designated area away from the scene. B) For those unable to move, rescuers assess and designate patients to a general category. C) Rescuers locate patients in the immediate care priority and address airway or severe bleeding issues. D) For those with potential or suspected injuries, rescuers recheck as often as resources and time permit.

Ans: D Feedback: The Simple Triage and Rapid Treatment (START) system uses a systematic approach based on three observations (Respiration, Perfusion, and Mental status [RPM]) to triage multiple victims into four categories of care: minor, delayed, immediate, and dead. The steps of assessment are as follows: (1) rescuers instruct persons at the scene of the incident to move to a designated area away from the scene; (2) for those unable to move, rescuers assess and designate patients to a general category: (3) rescuers locate patients in the immediate care priority and address airway or severe bleeding issues; and (4) for those with potential or suspected injuries, rescuers recheck as often as resources and time permit.

The community health nurse is involved in a creative program that promotes health and generates a more social school atmosphere. What would be the most appropriate program that can be implemented with groups such as teachers or staff in a school setting? A) Late breakfast meetings; "second cup of coffee meeting B) Grandparents' day C) Monthly health bulletin board D) Monthly blood pressure assessments

Ans: D Feedback: The following are ideas for health promotion strategies that can be used with groups such as teachers or staff in the school setting: blood pressure sereening on the same day each month; cancer awareness programs; stuffing payroll envelopes with health promotion material; healthy heart lunches, such as salad day once a week; referral and resource information; and TB skin testing.

When federal agencies such as the Health Resources and Services Administration target programs to special populations, it has been found that poverty is strongly correlated to what health behavior? A) Prenatal care B) Premature death C) Mental health care D) Dental care

B Feedback: Whether the issue is delivering health services, engaging in health education and health promotion, or using/availing prenatal care, dental care, or mental health care, life in these areas is qualitatively different from that in other parts of the country. When federal agencies such as the Health Resources and Services Administration target their programs to special populations, these areas are often included, for good reason. Poverty is strongly correlated with premature death.

The disparities facing rural populations go beyond demographics to include an alarming array of health status indicators and health behaviors, When planning interventions for high-risk behaviors, which health behavior would be considered high in urban popalations? A) Adults who smoke B) Adults overweight or obese C) Adolescents who had five or more drinks in one episode D) Total tooth loss among adults aged 65 years and older

B Feedback: In urban areas, 27.4% of adults are overweight or obese; in rural areas, the number is 23.9%. In urban areas, 22% of adults smoke; in rural areas, the number is 25%. In urban areas, 10% of adolescents had 5 or more drinks in one episode; in rural areas, the number is 15%. Total tooth loss among adults aged 65 years and older is 28% in urban areas and 36% in rural areas.

After the planning phase of the MAP-IT process, which would the narse do next? A) Form a coalition of individuals who care about the faith community's health. B) Identify areas of greatest need in the faith community. C) Plan strategies and action steps to achieve the community vision. D) Implement a plan of concrete action steps that can be monitored and make a difference.

D Feedback: The MAP-IT Strategy for creating a health community means M. mobilize: A, assess; P. plan; I, implement; T. track. After planning, implementation begins. Mobilization and assessment occur before the planning phase, and tracking occurs after the implementation phase.

school nurse is implementing a muscle mover club in the elementary school. What goal would the nurse document when requesting the implementation of this program? A) Encourage physical activity B) Reward anaerobic exercise C) Importance of pet exercise responsibilities D) Educate on methods to promote cardiovascular function

Ans: A . Feedback: A muscle mover club encourages physical activity by rewarding aerobic exercise, such as walking, running, swimming, and biking.

Nurses throughout history and in modern times have been concemed about vulnerable populations. During a conversation, the word marginalized is used when talking about a group of people. The nurse asks what that means. Which answer is most accurate? A) Treat someone or something as unimportant B) Lacks a fixed, regular, and adequate nighttime residence C) Blame society for the health issues that arise D) Experience limited resources with high risk for morbidity

Ans: A . Feedback: The word marginalizes means to treat someone or something as if he or she is of no consequence or is unimportant. Marginalization conveys a process in which individuals in certain groups seem not to matter or to be of little concern to the rest of society, thus falling beyond the margins. To marginalize or be marginalized may be more accurate terminology than the concept of vulnerability, which may imply a degree of "blaming the victim." "Vulnerable" stems from the Latin word vulnare, which means "to wound." This terminology implies that the wounded or the "less than perfeet" are not particularly valued and easily marginalized. By using the terminology of marginalization instead, the emphasis is societal. Vulnerable populations are social groups who experience limited resources and consequent high relative risk for morbidity and premature mortality. A homeless person is one who "lacks a fixed, regular, and adequate nighttime residence."

What is a category of health promotion and health protection intervention that targets the individual or family? A) Health screenings B) Crime prevention activities C) Health fairs in the community D) Collaboration with organizations to provide comprehensive services to elderly

Ans: A Feedback: A category of health promotion and health protection intervention that targets the individual or family is health screenings. Examples of community-focused interventions include collaboration with universities, churches, senior centers, senior housing projects, and other established community organizations to provide comprehensive services to subgroups of elders; crime prevention activities; and participation in community-based health fairs.

The public health nurse is adapting a program for a vulnerable or marginalized population. What type of program would be best for offering screening procedures such as dental, blood pressure, cholesterol, blood glucose, vision, hearing, and lead poison? A) Health fair B) Positive parenting C) Community health education D) Diabetes education

Ans: A Feedback: A health fair is a way to cover a number of health promotion and education areas at once. Screening procedures such as dental, blood pressure, cholesterol, blood glucose, vision, hearing, and lead poison can be included in the agenda.

The occupational health nurse is administering a health risk appraisal to employees of a medium-sized business. The employee asks what this risk appraisal is. What response by the nurse is most accurate? A) Easily administered, confidential instrument used to determine life expectancy based on current risk behaviors B) Instrument that calculates the amount of benefit that can occur with current lifestyle behaviors C) Appraisal used as a teaching tool that gives feedback about unhealthy behaviors D) Often completed with paper and pencil, a form to allow for accurate individualized reports

Ans: A Feedback: A health risk appraisal (HRA) is an easily administered, confidential instrument used to determine life expectancey based on current risk behaviors. The HRA can also calculate the amount of risk that could be avoided if lifestyle behaviors were changed. Some HRAS determine the person's readiness to change behavior. An HRA can be used as a teaching tool that gives positive feedback for healthy behaviors and encouragement and information for changing those unhealthy behaviors. An HRA is often completed on an interactive computer program and provides an accurate individualized report to each employee in a timely manner.

A major issue that affects rural youth is substance abuse. In most rural communities, what finding about rural teens has been reported by recent studies? A) Alcohol is the most used and abused substance. B) Lower rate of binge drinking in rural teens than urban teens. C) Methamphetamine is the most commonly used substance. D) Lower rate of driving while intoxicated than urban teens.

Ans: A Feedback: A major issue that affects rural youth disproportionately is substance abuse. In most rural communities, the substance most used and abused by young people is alcohol. Recent studies have found that rural teens are more likely to use alcohol, to engage in binge drinking. and to drive while intoxicated than are urban teens. Young adults living in rural areas are another population at high risk, with higher rates of binge drinking and methamphetamine and prescription drug abuse than those of their urban counterparts.

The community health nurse is reviewing education system barriers for the homeless in the community. What is an example of a school success barrier? A) Inability to complete assignments B) School fees C) Lack of immunization/medical records D) Lack of previous school records

Ans: A Feedback: A school success barrier is inability to complete assignments. Enrollment barriers include school fees, lack of immunization/medical records, and lack of previous school records.

Childhood obesity rates are highest among low-income populations and among racial'ethnic minorities. Research has demonstrated that this trend applies to rural youth, where the prevalence of obesity and overweight has been shown to be higher than state and national averages and higher than rates among youth in urban areas. What is an environmental health strategy that is appropriate for rural populations to assist in the prevention of obesity? A) Physical activity B) Low-fat, low-calorie diet C) Low-cost bariatric surgery D) Nutrition education sessions

A Feedback: Attention has been cast on the role that active living plays in obesity prevention among youth in urban and, more recently. in rural areas. The concept of active living incorporates an ecological, population-based approach to physical activity by recognizing that individual behavior, social environments, physical environments, and policies all contribute to behavior change. Active living targets entire communities to promote accessible and safe opportunities for residents to engage in physical activity during transportation, occupation, recreation, and while at home.

Rural populations face all of the same preventable illnesses that are faced by urban populations. How can the prevention of the major contributors to preventable death be addressed? A) Primary care practices B) Secondary care practices C) Tertiary care practices D) Public health department clinics

A Feedback: Rural populations face all of the same preventable illnesses that are faced by urban populations. To a large extent, prevention of the major contributors to preventable deaths is addressed by public health systems and primary care practices. There are practitioners in both sectors who can be effective partners in health promotion. However, in rural areas, there are typically fewer primary care practitioners than in urban areas, and they tend to be very busy. Many rural areas have no local public health department or one that offers a limited number of services. Prevention initiatives are often undertaken by partnerships involving healthy communities' coalitions, hospitals, primary health clinics, schools, social services, law enforcement, and local businesses.

There are several social and geographic factors that have an impact on the health status and health behavior of rural residents. Individuals who have made a study of rural health during the past 20 years are most often concerned with what care issue? A) Access B) Cost C) Quality D) Inferiority

A Feedback: Those who have made a study of rural health during the past 20 years most often have been concerned with access to services. The traditional approach has been to gather data on services that can be easily quantified, such as the number of primary care physicians, the number of hospital beds, or the number of dentists. Ratios of services to population are then calculated, and the rural ratio is compared with the urban ratio,

The nurse in the community wants to implement a new program. To be more certain of success, the nurse should be sure to use which primary step in implementing a unified program? A) Bring together the agency and the target population. B) Use a piecemeal approach to emphasize each piece. C) Emphasize the agency involvement to get everyone excited about the change. D) Widely publicize the program immediately before implementation.

Ans: A Feedback: A unified program requires collaboration and coordination between the agency personnel who will implement the program. Bringing together the agency and the target population will enhance the success of the new program. Implementing a piecemeal approach minimizes the impact of the program. Allowing plenty of time for publicizing the program is crucial to whether people attend and the programs have an impact. Emphasizing the program itself, not the agency involved, will increase the impact of the program.

The American Nurses Association legislative initiatives include issues of access, cost, and quality of care. What is an example of an access of care initiative? A) Health coverage B) Mandatory overtime C) Medicare reform of prescription drugs D) Whistle-blowing protection for nurses

Ans: A Feedback: Access to care includes access to health coverage, health plans, and Medicare reform. Cost of care includes advanced practice nurse coverage, health plans, Medicaid cost containment, medical errors, medical malpractice liability/tort reform, and Medicare reform/prescription drugs. Quality of care includes adequate and appropriate nurse staffing, mandatory overtime, safe health care reporting, "whistle-blowing" protection for nurses, and safe client handling.

Accessibility and affordability of health care are challenges for the elderly, particularly for rural and poor elders. What type of service that is often limited for the elderly needs to be increased to address these challenges? A) Preventive B) Secondary C) Tertiary D) Chronic disease

Ans: A Feedback: Access to preventive services is often limited for the clderly. Medicare, the primary health insurance for older adults, offers very little coverage for health promotion and preventive services. Preventive services for the clderly are often neglected because many providers do not see any point in prevention during the last years on the age continuum.

A community health nurse is working with a home health client who immigrated to this country 15 years ago. The client has changed the country of origin's cultural patterns and has adopted the health care belief system of the United States. The community health nurse recognizes this as which type of change in the individual? A) Acculturation B) Culture C) Diversity D) Ethnicity

Ans: A Feedback: Acculturation is when an individual adapts to or changes cultural patterns to those of the new country. Diversity is the condition of being different or having differences. Ethnicity is one's identification with a group composed of people who share a unique cultural background and social heritage that is passed from one generation to another. Culture is the medium through which a person's beliefs, standards, and norms for health and illness behaviors are structured, leamed, shared, practiced, and judged.

What would be a health promotion strategy for school-aged children and their families that could be implemented that would involve the community? A) Have a community parade celebrating being drug free. B) Conduct a survey to assess student opinion and food preferences for school lunches. C) Perform a plate waste study to determine what children are cating in school. D) Stuff payroll envelopes with health promotion material.

Ans: A Feedback: An example of a health promotion strategy involving the community is to involve school-aged children in a community parade celebrating being drug free. Nutrition awareness can occur if a school meal program is not healthy; form an ad hoc committee to study the problem. The committee should consist of students, parents, the public health/school nurse, cafeteria personnel, representatives of the faculty and administration, and a dietitian. It can include conducting a survey to assess student opinion and food preferences and doing a plate waste study to determine what children are actually eating. A health promotion strategy that can be used with groups such as teachers or staff in a school setting is stuffing payroll envelopes with health promotion material.

The model for population- and community-based practice is public health nursing. Which is the most important comerstone criterion for public health nursing? A) Entire populations B) Case management C) Health teaching D) Coalition building

Ans: A Feedback: An example of criteria for public health nursing includes focusing on the entire population. Examples of interventions for population-based nursing practice include case management, health teaching, and coalition building.

Which is an example of primary prevention activity for control of infectious diseases at the individual level? A) Teach barrier precautions to all health care workers. B) Screen and treat all sexually transmitted diseases. C) Mandate that health care workers are immunized for hepatitis A and B. D) Provide an adequate supply of gloves and sharps containers in client care areas.

Ans: A Feedback: An example of primary prevention activity for control of infectious diseases at the individual level is to teach barrier precautions to all health care workers. An example of secondary prevention activity for control of infectious discases at the individual level is to screen and treat all sexually transmitted diseases. Two examples of primary prevention activity for control of infectious discases at the population level are to mandate that health care workers are immunized for hepatitis A and B and provide an adequate supply of gloves and sharps containers in client care areas.

What is an example of tertiary prevention strategy that the school nurse can do to influence the school climate and reduce bullying? A) Continue school meetings and teacher-student discussion groups about bullying, sexual bullying/harassment, and violence in the school setting. B) Have separate counseling of bullies and victims. C) Involve parents of bullies and victims in monthly discussions. D) Develop individual care plans for students, both bullies and victims, addressing physical, mental, and behavioral health needs.

Ans: A Feedback: An example of tertiary prevention is to continue school meetings and teacher-student discussion groups about bullying, sexual bullying/harassment, and violence in the school setting. Examples of secondary prevention include separate counseling of bullies and victims; involving parents of bullies and victims in monthly discussions; developing individual care plans for students, both bullies and vietims, and addressing physical, mental, and behavioral health needs.

A community health nurse is working in a large urban city, situated in a culturally diverse area of the country. What does the nurse need to do to be culturally competent? A) Recognize that people with cultural backgrounds different from our own have unique values, life ways, health practices, and interpersonal styles. B) Understand and address the total context of the client's situation, using knowledge, attitudes, and skills C) Be aware that people adapt to and borrow traits from another culture and change their own cultural patterns to those of the host society. D) Remember that an individual's own traditional beliefs and practices of their culture must always be observed.

Ans: A Feedback: Being culturally competent means that we understand how cultural beliefs and practices influence our daily lives and recognize that people with cultural backgrounds different from our own have unique values, life ways, health practices, and interpersonal styles. Cultural appropriateness occurs when a nurse understands and addresses the total context of the clientr's situation, using knowledge, attitudes, and skills. Cultural acculturation is being aware that people adapt to and borrow traits from another culture and change their own cultural patterns to those of the host society. Heritage consisteney relates to the observance of beliefs and practices of an individual's traditional cultural system that may be observed.

Cardiopulmonary resuscitation (CPR) training and emergency cardiovascular care classes for the faith community are examples of which level of prevention activity? A) Primary B) Secondary C) Tertiary D) Iliness

Ans: A Feedback: CPR training and emergency cardiovascular care classes are primary prevention activities. Faith-based organizations are a logical place to conduct community training programs.

The evaluation process provides an opportunity to determine the outcomes derived by the health promotion program and directs improvement of employee health services. What common method of evaluation can be used to determine morbidity and mortality differences? A) Chart and record reviews B) Interviewing of employees C) Observation of employees D) Postprogram rating scales

Ans: A Feedback: Common methods for evaluation are postprogram rating scales, observation, and interviewing of employees about their opinions, attitudes, and satisfaction with the program. Chart-and-record reviews can be used to determine morbidity and mortality differences.

What component of evaluation would help the community health nurse measure the relationship between the benefits of a program and the costs of presenting the program? A) Cost efficiency B) Effectiveness C) Progress D) Relevancy

Ans: A Feedback: Cost efficiency evaluation measures the relationship between the results of a program and the costs of presenting the program. Relevancy is determined when the reasons for having a program or set of activities are evaluated. Progress answers the question as to whether the program activities are following the intended plan. Effectiveness focuses on formative evaluation as well as the immediate, short-term results.

The community health nurse is using principles of change theory to direct the planning process, What would the murse expect during the unfreezing stage? A) Identification of a need for change B) Identification of problems C) Consideration of alternatives D) Adaption of plan to circumstances

Ans: A Feedback: During the unfreezing stage, the client system becomes aware of a problem and the need for change. Then the problem is diagnosed, and solutions to the problem are identified. From these alternative solutions, one is chosen that seems most appropriate for the situation. In the moving stage, the change actually occurs. The problem is clarified, and the program for solving the problem is planned in detail and begun.

Involving nursing volunteers from the community ensures that the diversity of the community can be mirrored in the faith community nursing team. Other than cultural factors, what other factor is an essential concerm of program problem identification and solution? A) Economic B) Emotional C) Physical D) Social

Ans: A Feedback: Economic factors as well as cultural factors are essential concerns of problem identification and solution. Services should be accessible to all members of the faith community as appropriate. The affluence of the community will affect the type of programs that can be implemented. It is an accepted fact that families with more discretionary income are better able to engage in health promotion activities. Economics also influences how members of the community access health services. Emotional, physical, and social factors are important aspect of faith community nursing. but they are considered basic human needs rather than community factors.

Marketing is an essential part of successful program implementation. The employee uses a computer to answer a health-related quiz and receives the answer and rationale the next day. What marketing strategy was used? A) Electronic mail message B) Health newsletter C) Letter from the company president D) Wellness program announcement

Ans: A Feedback: Electronic mail messages: Count down to event; offer a related health quiz question, and give the answer and rationale the following day. Health newsletter: Detail a success story, such as early detection of malignant melanoma, weight loss regimen using a walking program, or not knowing a person had high blood pressure until participating in a screening program and how simple lifestyle changes helped control the discase (without medication). Letter from the company's president or benefits manager. Offering company time for health screening, announcing that company will pay for all or a portion of smoking cessation program/health screening test, or allowing a trade-in of 2 hours of sick time for wellness program attendance would be appropriate messages.

The occupational health nurse is assessing for employee signs and symptoms of being a victim of workplace bullying, harassment, or horizontal violence. What observation would indicate the employee is a potential victim? A) Feeling edgy, irritable, casily startled, and constantly on guard B) Employee turmover rate is higher than industry standards. C) Higher rates of absenteeism and disability insurance claims D) Employees request transfer from a certain department more often than from others.

Ans: A Feedback: Employee signs and symptoms include feeling edgy, imitable, easily startled, and constantly on guard. Departmental signs and symptoms that workplace violence may be present include an employee turnover rate that is higher than industry standards; higher rates of absentecism and disability insurance claims; and employees request transfer from a certain department more often than from others.

Constraints are the difference between needs and resources. What is an example of a universal constraint when planning a community-based health program? A) Staff B) Physical space C) Equipment D) Time

Ans: A Feedback: Universal constraints are staff and money agencies never have enough. An additional constraint is resistance to change.

What would be a good topic for a health education program that addresses mental health issues affecting children in the United States? A) Recognizing signs and symptoms of depression B) Problem-solving and decision-making skills C) Date rape and acquaintance rape D) Peer harassment

Ans: A Feedback: Examples of mental health issue programming could be self-esteem; attention deficit disorder/hyperactivity disorder; depression; and suicide. Personal safety programs could be "latchkey kids and problem-solving/decision-making skills. Sexuality programs could be personal hygiene; teenage pregnancy; teen parenting; and sexually transmitted discases. Psychological environment programs could be grade stress; parent-child discord; parent-teacher and teacher-teacher conflicts; and peer harassment.

Florence Nightingale is considered an exemplar of nurses' involvement in public policy. Nurses continue her work by: A) Being a part of the policy process and a participant in a positive process B) Cleaning of hospitals C) Determining a course of action D) Licensing of practicing nurses

Ans: A Feedback: Florence Nightingale believed not only in being a part of the policy process, but also in being a participant in a positive process. She believed that once she determined a course of action to be beneficial to the patients and was active in setting policy regarding hand washing and cleanliness procedures, it was her responsibility to make sure that the policy continued to be followed that exemplifies involvement in public policy. Nightingale was not involved in licensing of practicing nurses.

The community health nurse knows that health disparities affect many groups. What is a commonality of marginalized groups? A) Less likely to obtain health care B) Equal access to treatment for cancer C) Insurance coverage is inexpensive to obtain with HIV/AIDS D) Ability to complete major life activities without ongoing assistance

Ans: A Feedback: Gender, ethnicity or race, education or income, geographic location, or sexual preference may account for group differences that lead to marginalization and subsequent health inequities. The comprehensive report by the Institute of Medicine (2002) in its review of more than 100 studies found that minorities were less likely to obtain health care than were whites. The review also documented inequities related to cancer, heart disease, diabetes, HIV/AIDS, and mental illness.

Based on the population trends in the United States, descendants of European whites are emerging as a new minority. Which is a cause for this new minority? A) Rapid growth rate in the population of racial and ethnic group diversity B) Nurses that provide care to clients and families who represent global communities C) Less-frequent interactions with clients of diverse ethnic and cultural backgrounds whose health beliefs differ from our own D) Development of required partnerships with individuals of different ethnic groups and community health

Ans: A Feedback: Growth in racial and ethnic group diversity throughout the 21st century is causing changes in minority groups. Among descendants of European whites, the number of deaths exceeds the number of births. Racial and ethnic minorities now make up 49.9% of the under-five age group.

Health promotion and health protection are two elements of primary prevention. What definition would the nurse use when explaining health promotion? A) Emphasis on helping poople change their lifestyles B) Protecting people from disease and injury C) Providing annual immunizations D) Eliminating exposure to environmental health hazards

Ans: A Feedback: Health promotion and health protection are two elements of primary prevention. Health promotion denotes emphasis on helping people change their lifestyles and move toward a state of optimal health, whereas health protection focuses on protecting people from disease and injury by providing immunizations and reducing exposure to carcinogens, toxins, and environmental health hazards.

Which is a goal for Healthy People 2020? A) Create social and physical environments that promote health. B) Increase the span of healthy life for Americans. C) Reduce health disparities among Americans. D) Achieve access to preventive services for all Americans.

Ans: A Feedback: Healthy People 2000 identified three goals, which were to increase the span of healthy life for Americans; reduce health disparities among Americans; and achieve access to preventive services for all Americans. Healthy People 2010 identified two broad goals, which are to eliminate health disparities and to increase quality and years of healthy life. Healthy People 2020 identified four goals: attain high-quality, longer lives free of preventable discase, disability, injury, and premature death; achieve health equity, eliminate disparities, and improve the health of all groups; create social and physical environments that promote good health for all; and promote quality of life, healthy development, and healthy behaviors across all life stages.

A community health nurse works with a variety of cultures providing health care services that include acute treatment for illness. Which client most likely would believe that sickness is a punishment from God? A) Hispanic client B) Chinese client C) Female client whose culture is controlled by males D) German client

Ans: A Feedback: Hispanics believe that susto results from a traumatic experience or that sickness is a punishment from God. Susto, or fright, is an emotional response to a traumatic experience and is recognized as an illness that involves the loss of one's spirit from the body.

Immunizations are required by state law to be current and on file for all children. Immunization requirements must be strictly supported by the school administration. What information is important for the nurse to keep in mind when evaluating if a child is in compliance with this law? A) Compliance is expected by the first day of school. B) Immunizations must be complete by the end of the first month of school. C) Children have until 60 days after school starts to complete immunization requirements. D) 90 days after school starts is the final date that immunizations must be completed.

Ans: A Feedback: Immunizations are required by state law to be current and on file before or on the first day of school, although a school district can establish a short grace period, usually 30 days. Immunization requirements must be strictly supported by the school administration. Each state sets a standard for immunizations; a school district can increase the requirements but must meet the minimum standard.

During the evaluation process, the community health nurse collects information and knows that evaluation criteria must be timely and comprehensive. What type of evaluation is best when beginning to plan a community health program? A) Formative B) Impact C) Outcome D) Managed

Ans: A Feedback: Impact or summative evaluation is concermed with the immediate impact of a program on a target group. Process or formative evaluation answers the question: Are we doing what we said we would do? Long-term outcome evaluation is where it is discovered whether the changes had a lasting and real effect.

What is an example of a primary prevention strategy that the school nurse can implement to influence the school climate and reduce bullying? A) Determine whether bullying/sexual harassment policies are in place in the school system. B) Assess for bullying behaviors using a student questionnaire, such as the Peer Relations Questionnaire. C) Have a school conference day to disseminate the results of the survey and launch a multicomponent plan to tackle the problem. D) Implement effective adult supervision during recess, lunchtime, and classroom/bathroom breaks.

Ans: A Feedback: Implementing primary prevention can involve the determination of whether bullying/sexual harassment policies are in place in the school system. Secondary preventions strategies include assessing for bullying behaviors using a student questionnaire, such as the Peer Relations Questionnaire; having a school conference day to disseminate the results of the survey and launch a multicomponent plan to tackle the problem; and implementing effective adult supervision during recess, lunchtime, and elassroom/bathroom breaks.

The community health nurse is reviewing the needs of marginalized groups in the community. When planning educational needs, which group would be considered a marginalized group? A) Migrants B) Children C) Men D) Minorities

Ans: A Feedback: Individuals or groups who live on the fringes or margins of society, lack key resources, and are most often underserved or not served at all, particularly in health care systems, are considered marginalized. Included among marginalized groups are the homeless, immigrants, migrants, and those with chronic disabilities. Vulnerable groups, including minorities, women, children, and those with disabilities, are more susceptible to infectious discases, especially HIV/AIDS and sexually transmitted infections (STIS).

The community health nurse is trying to adapt a program for the most marginalized population. The nurse desires to focus on the group that is vulnerable to disabilities and disease. Which group would most meet the desire of this narse? A) Homeless B) Migrants C) Immigrants D) Persons with chronic disease

Ans: A Feedback: Individuals who make up the U.S. homeless population are among the most marginalized and vulnerable to disabilities and disease.

The nurse can help decrease pollution by beginning which of the following interventions? A) Minimize use of pollutants. B) Maximize use of disposable products. C) Incinerate paper products. D) Incinerate after use disposable products.

Ans: A Feedback: Interventions to decrease pollution include use of less resources; select products that are less toxic; reuse products; minimize use of disposable products; recycle; and avoid incineration.

Before planning a health promotion program, the school health nurse needs to: A) Observe how the students and teacher interact in the classroom. B) Plan to conduct the program when the classroom teacher is not available. C) Involve just parents planning the program because of limited teacher availability. D) Only verbally market the program a few days prior to implementation.

Ans: A Feedback: It is important for the nurse to always visit the classroom and observe how the students and teacher interact. Classroom management skills are essential. It is difficult to manage the classroom successfully when the nurse's contact with the youngsters is only occasional. Relying on the regular classroom teacher for assistance always works best. It is critical to involve key people, including the teachers, counselors, school nurses, and parents, from the very beginning of the planning phase of health programs. Outlining their expectations will contribute to the overall success of the program and help them become vested in the outcomes of the project. Such an approach is usually well received by students, administrators, teachers, and parents. Another consideration is marketing the program. It may be a great idea, but if no one attends or follows through, it will be a waste of time and resources. Use of flyers, bulletin boards, and public address announcements to reach audiences is important and needs to include various strategies to pique interest.

Trust, faith, and hope are significant concepts that relate closely to developing relationships and ultimately empowerment. For empowerment to be successful, people need to utilize which concept? A) Critical thinking B) Maintaining the "status quo" C) Examining the community outside oneself D) Incorporating theoretical concepts

Ans: A Feedback: It is through the process of critically thinking and evaluation that people are ultimately empowered. For empowerment and communication to be successful, people must engage in critical thinking, continually evaluating and reevaluating the premises behind their thoughts.

Which health insurance program would the nurse recommend to a 25-year-old client with end-stage renal discase? A) Medicare B) Medicaid C) Temporary Assistance to Needy Families D) State Children's Health Insurance Program

Ans: A Feedback: Medicare is a health insurance program for people 65 years or older, disabled people younger than 65 years, and individuals with end-stage renal disease or Lou Gehrig disease. Medicaid provides health care; insurance assistance and nursing home coverage for low- income residents and also pregnant women, a parent, or relative caregiver of a dependent child younger than 19 years, the blind, pecople with a disability or with a family member in their household with a disability, or people aged 65 years or older. Temporary Assistance to Needy Families provides financial and medical assistance to needy dependent children and parents and relatives with whom they are living. State Children's Health Insurance Program is for children younger than 19 years from families who earn too much to qualify for Medicaid.

There are several different kinds of immunity, each providing resistance in different ways to different pathogens. Which indicates there is a natural immunity? A) Innate resistance to a specific antigen or toxin B) Derived from actual exposure to the specific infectious agent C) When the body produces its own antibodies against an antigen as a result of infection with the pathogen or through a vaccine D) Temporary resistance that has been donated to the host through transfusions of plasma, proteins, immunoglobulin, or antitoxins

Ans: A Feedback: Natural immunity is an innate resistance to a specific antigen or toxin. Acquired immunity is derived from actual exposure to the specific infectious agent. Active acquired immunity is when the body produces its own antibodies against an antigen as a result of infection with the pathogen or through a vaccine. Passive acquired immunity is temporary resistance that has been donated to the host through transfusions of plasma, proteins, immunoglobulin, or antitoxins.

Which is the best path a community health nurse can take to be an active constituent? A) Write letters, make a visit, or call government representatives. B) Visit websites of local, state, and federal governments. C) Identify their representative with address and phone number to contact. D) Be an advocate, which involves speaking for those who cannot speak for themselves.

Ans: A Feedback: Nurses can be active members of a constituency by writing letters, making visits, or calling representatives. Reading the local newspaper with attention to local community issues is an excellent way to stay informed. Most govermment websites have links to enable constituents to identify their representatives and provide addresses and phone numbers for contacting representatives. Nurses as professionals may also choose to provide nursing expertise as policies and programs are being designed and to work with coalitions who have similar interests in the issues. Community health nurses can also be advocates for the people with whom they work. Being an advocate involves speaking for those who cannot speak for themselves.

Building a healthy community takes time, careful planning, and a great deal of organization. Shaping the future of decision making for health care delivery is a primary role of the faith-based nursing ministry. This ministry also may assist with: A) Maintaining cost-effectiveness B) Deciding where best to build community clinies C) Implementing the Affordable Care Act D) Helping to integrate faith into the health care

Ans: A Feedback: Nurses must participate in and help shape future decision making for health care delivery. The faith-based nursing ministry, whether volunteer or reimbursed service, is a cost-effective enhancement of health care delivery systems. Nursing partnerships with faith communities are part of the solution.

Observation is one method of collecting data for a case study. What does a participatory observer do during data collection? A) Collects data about the program while working within the group. B) Remains an outsider in the agency or organization during the data collection. C) Does not assume a working role in data collection within the agency. D) Reviews and examines the program for designated periods.

Ans: A Feedback: Observation can be participatory or nonparticipatory. The participant observer assumes a working role in the agency or organization and collects data about the program while working within the group. The nonparticipant observer remains an "outsider," does not assume a working role within the agency, and reviews and examines the program for designated periods.

The community health nurse is trying to locate information about ways to promote health and prevent discase among Americans. What government agency within the Public Health Service would the nurse contact to be most helpful in providing this information? A) Office of Discase Prevention and Health Promotion B) Centers for Disease Control and Prevention C) U.S. Department of Health and Human Services D) Health Resources and Services Administration

Ans: A Feedback: Office of Discase Prevention and Health Promotion (ODPHP), located within the Public Health Service, publishes a tremendous amount of information that is designed to promote health and prevent disease among Americans.

Once goals and objectives have been written for the community-based health program, what is the next step? A) Identify resources needed to accomplish the plan. B) List potential revisions that might be made to the plan. C) Document the plan in a concise, standardized, and retrievable form. D) Identify the community assessment strengths of the health program.

Ans: A Feedback: Once goals and objectives have been written, the next step is to identify available resources and any constraints to the plan.

In moving away from a disease prevention health care system, the focus of nursing has shifted to which type of health care? A) Primary B) Secondary C) Tertiary D) Both primary and secondary

Ans: A Feedback: Our challenge as community health nurses is to transform our health care system into one that reflects the values and needs of our communities based on the concepts of primary health care.

Many community-dwelling elders are virtually prisoners in their homes. Why are people older than 65 years more likely to be victims of crime in or near their own homes? A) Lack of access to transportation B) Victims of frequent scams C) Live in high-crime neighborhoods D) Fear being mugged or robbed

Ans: A Feedback: People older than 65 years are more likely to be vietims of crime in or near their own homes because elderly people often lack access to transportation and do not travel great distances.

There are several environmental hazards affecting human health. What would be one way the nurse could reduce the effects of a physical hazard on humans? A) Encourage the use of ear plugs during NASCAR races. B) Encourage the use of microwave ovens in place of gas ranges. C) Remove standing water to reduce the mosquito population. D) Remove dead plants in gardens to prevent destruction of adjacent plants.

Ans: A Feedback: Physical hazards to health include radiation, lead, other heavy metals, and noise. Biologie hazards can be infectious agents, insects, animals, and plants. Use of carplugs will reduce noise and damage to hearing. Encouraging microwave use is counterproductive to reduction of physical hazards. Reducing the mosquito population and removing dead plants are examples of preventing biologic hazards, not physical hazards.

To decrease pollution, one must understand how pollution is produced and how it affects the environment. Which statement will best assist in beginning to understand pollution? A) The rate of pollution is directly related to population size. B) The capacity of the environment to assimilate pollution is unlimited. C) Industrial development can assist with the elimination of pollutants. D) Movement of populations improves pollution.

Ans: A Feedback: Pollution is a rate function involving a quantity of pollutant introduced over a period of time. This rate is directly correlated with population size. The capacity of the environment to assimilate pollution is not unlimited; in fact, pollution of the environment occurs when pollutants overwhelm the capacity of the environment to assimilate them without being thrown out of balance. Industrial development increases the number of pollutants and environmental insults. If the population moves, both the nature and the intensity of an environmental problem can shift. Thus, one area may improve; another may become more polluted.

The community health nurse is documenting the results of a survey as part of the evaluation of a community health program. A survey is very valuable to answer questions about: A) Cost efficiency B) Effectiveness C) Outcome D) Relevance

Ans: D Feedback: Surveys can be very valuable in answering questions of relevance, or the need for proposed or existing programs, especially if the perceptions of clients, providers, and management are solicited. Cost efficiency, effectiveness, and outcome are difficult to measure using a survey.

Rural health has different meanings in different parts of the world. Rural health is often referred to as what in developing countries? A) Basic public health services B) Native or aboriginal populations C) Timely access to appropriate, effective, affordable services D) Limited services to individuals living in low population density

Ans: A Feedback: Rural health has different meanings in different parts of the world. In developing countries, it often refers to basic public health services, such as clean water, immunizations, and prevention of HIV. In Australia, New Zealand, and, to some extent, Canada and the United States, it often refers to native or aboriginal populations. In much of the United States, it is commonly used to describe issues that affect timely access to appropriate, effective, affordable services for persons who live in areas of low population density, often at a distance from specialty and tertiary care, that results in a greater role for primary care as compared with urban areas.

The effects of intimate partner violence spill into the workplace and can affect employment productivity. What would represent a tertiary prevention plan for intimate partner violence against women? A) Provide adequate security to employees. B) Support a company policy of zero tolerance against violence of all people. C) Support a company policy that rewards collaboration, collegiality, and teamwork. D) Promote policies that raise the status of women in the company.

Ans: A Feedback: Tertiary prevention includes providing adequate security to employees. Primary prevention includes a company policy of zero tolerance against violence of all people; a company policy that rewards collaboration, collegiality, and team work and promotes policies that raise the status of women in the company.

A few recent studies make it clear that much of rural America is demographically different from urban America. A nurse wants to do research involving an older population. What area of the country would best serve as her research base? A) Great Plains B) Indian country C) Mississippi delta D) Southeastern black belt

Ans: A Feedback: The Great Plains region, in the heart of the country, has a greater portion of the population older than 65 years. That means more pcople on Medicare and fewer people in the workforce, among other things. If we look at life expectancy, which is a very erude measure of health status to be sure, we find certain regions of the country much worse off than others, most notably, the southeastern "black belt," the Mississippi delta, and Indian country.

Which activity occurs during the first phase of the MAP-IT process? A) A coalition of individuals who care about the faith community's health is formed. B) Arcas of greatest need in the faith community are identified. C) Concrete action steps that can be monitored and make a difference are planned. D) Progress of the health program over time is mapped.

Ans: A Feedback: The MAP-IT Strategy for creating a health community means M, mobilize; A, assess; P, plan; I, implement; T, track. Activities include mobilize individuals who care about the faith community's health into a coalition. Assess the areas of greatest need in your community and the resources and strengths you can tap into to address those areas of need. Plan the approach by starting with a vision of where the community wants to be; then add strategies and action steps to help achieve that vision. Implement the plan using concrete action steps that can be monitored and will make a difference. Track progress over time.

Emancipatory inquiry provides a framework to expand the political consciousness of the disenfranchised in a community. Who identifies the important problems for this inquiry? A) Community members B) Community health nurse C) Community health professionals D) Community medical director

Ans: A Feedback: The problems examined through emancipatory inquiry are those that community members believe are important and not necessarily those identified by health professionals in the community. Nurses are challenged to awaken the spirit of social change among those who are most vulnerable in our communities.

Which of the following reflects the major constructs of the nursing paradigm? A) Health, environment, client, and nurse B) Client, community outreach center, nursing, health, and illness C) Society, medicine, nursing, and interactions among individuals D) Psychosocial development, discipline, nursing, and client

Ans: A Feedback: The process by which nurses develop healing or caring relationships in the community reflects interactions among the four major constructs of the nursing paradigm: health, environment, client, and nurse.

The role of the nurse with faith communities is dictated as always by the needs of the people. Which is a common role of the nurse in this setting? A) Advocate B) Leader C) Manager D) Research expert

Ans: A Feedback: The role of the nurse with faith communities includes, but is not limited to, health educator, health counselor, referral agent, advocate, facilitator, and liaison between the dimensions of spirituality and health.

Which is the second step in the process of policy making? A) Policy formation B) Policy adoption C) Policy evaluation D) Policy recognition

Ans: A Feedback: The steps in order of policy making are problem recognition and definition, policy formation, policy adoption, budgeting and policy implementation, and policy evaluation.

Organizations that report actual or potential health problems of the elderly have been contacted to attend a community meeting to report the findings of the community assessment. According to Reinkemeyer's stages of planned change, when would this report be implemented? A) Stage 1: Identification and development of a felt Need and desire for the change B) Stage 2: Development of a change relationship between the community health nurse and the community C) Stage 3: Clarification or diagnosis of the community's problem, need, or objective D) Stage 4: Examination of alternative routes and tentative goals and intention of actions

Ans: A Feedback: To initiate a felt need and desire for change within a community, those organizations that report actual or potential health concerms are contacted, and a meeting is scheduled to report the findings of the community assessment; this occurs during stage I.

There are several issues that challenge prevention partnerships in rural communities. What is one threat to the health of the public that affects rural populations disproportionately? A) Substance abuse B) Tooth decay C) Adult obesity D) Depression

Ans: A Feedback: Two issues that challenge these prevention partnerships in rural communities are substance abuse and childhood obesity. Both of these threats to the health of the public have been shown to affect rural populations disproportionately. Higher rates of obesity and substance abuse are particularly troubling when observed among rural youth, and in both cases, prevention initiatives that seek to modify not only unhealthy behaviors but also unhealthy environments are proving to be effective.

Health promotion, disease prevention and control, wellness, risk factor reduction, and preventive health care are some of the terms applied to workplace health programs. Health promotion centers on which type of strategies? A) Primary, secondary, and tertiary prevention B) A partnership between medicine and health C) Safety and health of all American workers D) Reducing injuries, illnesses, and deaths on the job

Ans: A The term health promotion is used to denote a process by which employees leam about primary, secondary, and tertiary prevention strategies to improve their health and quality of life. A partnership between employer and employee to promote the safety and heal workers, not medicine and health, benefits both parties. The Occupational Safety and Health Act of 1970 created the Occupational Safety and Health Administration (OSHA) to assure the safety and health of all American workers via partnerships and alliances w employers and other agencies. OSHA establishes and enforces standards to help employers and employees reduce injuries, illnesses, and deaths on the job.

The school nurse has observed many overweight children, children easily fatigued while running around the playground, and children choosing nonnutritious snacks. Which is the highest priority area of Healthy People 2020 that the school nurse should emphasize in a health promotion program? A) Inadequate physical activity B) Unhealthy dietary patterns C) Tobacco use and addiction D) Unintentional injury E) Proper backpack posture

Ans: A, B Feedback: Casual observations at the school have revealed a high percentage of overweight children, youngsters casily fatigued while running around the playground, and children choosing nonnutritious snacks. These children are at risk for overweight and obesity. Therefore, the health promotion program should emphasize nutritious snacks and physical activity. Children are at risk for tobacco use, addiction, unintentional injury, and back pain from improper backpack posture; however, those topics would be best addressed in other community education programs.

After assessing the community's educational preferences, the nurse plans intervention programs based on the results. The faith community is interested developing a walking map. Which information should the murse include? Select all that apply. A) Quarter-mile markers, noted by a community element such as a "no parking" sign B) One-mile loop around the worship center C) Extension trails to shopping malls, a recreational park, or neighborhood school yards D) Places to stop for food and drink E) Safe and accessible walking trails

Ans: A, B, C, E Feedback: A walking map is a self-directed exercise tool. It should include safe and accessible walking trails with quarter-mile markers, noted by a community element such as a "no parking" sign. It should have a one-mile loop around the worship center, with extension trails to shopping malls, a recreational park, or neighborhood school yards. As an exercise tool, participants should be encouraged to stop for food and drink.

Which question(s) can be helpful in examining one's ethnic culture? Select all that apply. A) What are the common bonds? B) What cultural rituals are celebrated and with whom? C) What types of things are shared when people get together? D) What sexual orientations are celebrated when people get together? E) What types of foods are prepared when people get together for an event?

Ans: A, B, C, E Feedback: Questions to think about one's own ethnic culture include the following: With what group(s) do you identify, and why? What are your common bonds? What cultural rituals do you celebrate, and with whom? What are the purposes and meanings of your gatherings and celebrations? What types of things are shared and learned when people get together? What types of foods are prepared for the event? Are there dances, special rites, or ceremonies? Foods, languages, and other bonds of common ancestry are the cultural aspects of ethnicity that serve to offer consistency and structure to life and provide individuals with abilities to interpret life events as significant and meaningful. Sexual orientation is an individual state, not one determined by culture.

Based on the "10 Tips to a Great Plate," what might the nurse suggest to a group of parents that would help them try to get their children to eat healthier? Select all that apply. A) Make half your grains whole grains. B) Switch to fat-free or low-fat (1%) milk. C) Eat larger portions but less frequently. D) Make a list of foods to cat less often. E) Drink water instead of sugary drinks.

Ans: A, B, D, E Feedback: Some tips for a great plate include making half your grains whole grains, switching to fat-free or low-fat milk, making a list of foods to cat less often, and drinking water instead of sugary drinks. Children should be encouraged to enjoy their food, but eat less as well as to avoid oversized portions. Eating larger portions less frequently is not recommended.

Community partnerships develop through a process of empowerment. Which characteristic would indicate a community displays empowerment? Select all that apply. A) Faith in all people of the community B) Hope that dialogue will be established within the health care community C) Mandate positive transformations benefiting the community as a whole D) Discussion grounded in critical thinking without fear of repercussion E) Power differences between and within communities

Ans: A, D Feedback: Four characteristics of an empowered community are faith in people; trust established through dialogue; hope in positive transformations benefiting the community as a whole; and discussions grounded in critical thinking without fear of repercussions by those who are in power

Local water supplies are threatened by organic and synthetic contaminants. Which of the following would be beneficial to Americans to study as the source of threats to water supply? (Select all that apply.) A) Lakes B) Rivers C) Groundwater D) Ponds

Ans: A. B.C Feedback: Half of all Americans obtain their drinking water from surface water sources, which include lakes, rivers, and streams. The other half of all Americans obtain their drinking water from groundwater.

The nurse is planning a health promotion program. The nurse is writing a sample business plan to teach healthy behaviors to a diverse group of employees and their families. What would the nurse put in the method section? A) Short summary of the health promotion plan B) How, when, and where the plan will be put into action C) List of outcomes of the health promotion program D) An accurate projection of program costs

Ans: B A feasibility or business plan approach to communicating your program is used to establish a common language and understanding of the project by everyone in the organization. A sample business plan might include the following: Executive summary: A short of the health promotion plan, which includes the purpose, methods, expected benefits, and costs. Methods: How, when, and where the plan will be put into action. Expected benefits: A list of the outcomes for the program. Costs: An accurate projection of progran

Which best describes bioaccumulation? A) Generally accomplished by the way of wind patterns or aquatic system B) Introduction of substances into ecologic food webs C) When the accumulation of a pollutant greatly exceeds the rate at which an organism eliminates it D) Simultaneous action of separate substances or agencies that together produce a greater total effect than the sum of individual effects

Ans: B Feedback: Bioaccumulation is the introduction of substances into ecologic food webs. Transport is generally accomplished by the way of wind patterns or aquatic system. Biomagnification is when the accumulation of a pollutant greatly exceeds the rate at which an organism eliminates it. Synergism is when a simultaneous action of separate substances or agencies together produces a greater total effect than the sum of individual effects.

Nursing in faith communities is based on which type of nursing? A) Religious B) Holistic C) Compassionate D) Participant

Ans: B Feedback: Congregational nursing, parish nursing, faith-based organizations (FBOS), and faith community nursing are deseriptive terms found in the literature and apply equally to the concept of nursing in faith communities. This movement of nursing in faith communities is based on the principles of holistic nursing that recognize the dynamic relationship between spirituality and health of mind and body throughout the life span. Faith community nursing does not require promoting religious teachings. Although faith community nurses should practice compassionate care, compassion is considered a quality of nursing rather than a type of nursing. Participant nursing involves the nurse being an active participant in the social situation being studied.

Cultural beliefs based in shared meanings, values, and norms are key guidelines to consider when a person has a health problem. What is the first step an individual has to take when he or she is ill? A) Examine all possible and probable causes of the illness. B) Agree that the symptoms represent a problem. C) Plan of action is decided upon. D) Appropriate treatment is determined.

Ans: B Feedback: Cultural beliefs based in shared meanings, values, and norms are the basic guidelines people use for recognizing that something is wrong, interpreting what it might be, and organizing a plan of appropriate actions. For example, before action is taken in response to a problem, individuals and family members must first agree that the symptoms represent a problem. Next, there is an examination of all possible and probable causes, which may range from behaviors and foods to violations of cultural norms. Once a cause has been identified, a plan of action is made and appropriate treatment is determined.

What effect would a loss of biodiversity have on the habitats of plants and animals? A) Clearing of forests to create crop lands B) Extinction of certain species of plants and animals C) Overall, continuous increase in temperatures throughout the world D) Climate changes as a result of soil erosion, climatic conditions, and air pollution

Ans: B Feedback: Deforestation is the clearing of forests to create crop lands. Deforestation contributes to soil erosion, a change in climatic conditions, and air pollution. Climate changes result in increased desertification. A loss of biodiversity results in the extinction of certain species of plants and animals and thus deforestation, desertification, and reproductive changes. There has been an overall increase in temperatures throughout the world. The greenhouse effect is a contributing factor to global warming.

Which of the following best defines diversity? A) Crosses two cultures, lifestyles, and sets of values B) Condition of being different or having differences C) Individuals with distinct identity that are related to a larger cultural group D) Basic knowledge of the different culture's health traditions in the community where the nurse is practicing

Ans: B Feedback: Derived from the Latin word divertere, meaning to turn in opposite directions, diversity is the condition of being different or having differences. Biculture is used to describe an individual who crosses two cultures, lifestyles, and sets of values. Subculture is where individuals with distinct identity are related to a larger cultural group. Cultural sensitivity is having basic knowledge of the different cultures' health traditions in the community where the nurse is practicing.

The community health nurse is trving to locate information about specific programs of the office of Disease Prevention and Health Promotion, Which program identifies objectives for the nation? A) Dietary Guidelines for Americans B) Healthy People C) Healthy Communities, Worksites, and Schools D) National Health Information Center

Ans: B Feedback: Dietary Guidelines for Americans is published with the U.S. Department of Agriculture and identifies federally mandated nutrition education activities. Healthy People was launched in 1979; it guides efforts to identify objectives for the nation. Healthy Communities, Worksites, and Schools is a coalition for healthier cities and communities that focuses on ways that communities can adapt the national Healthy People objectives for local use. National Health Information Center is a central health information service for consumers and professionals.

Which describes the direct mode of transmission for infectious agents? A) Fomite B) Person to person C) Vector D) Vehicle

Ans: B Feedback: Direct transmission is person-to-person transmission. Indirect transmission implies a vehicle of transmission, such as a biologic or mechanical vector, which can be an animal, insect or arthropod, common vehicle or fomite, which can be any inanimate object, material, or substance that acts as a transport agent for the microbe.

Which of the following best describes ethnocentric views? A) Dual patterns of identification of two cultures, lifestyles, and sets of values B) Belief that one's own culture or ways of life are better than those of others C) Belonging to a specific group of individuals who share a common social and cultural heritage D) Research framework that is used to provide the ability to focus on the culture of the community where the nurse is practicing

Ans: B Feedback: Ethnocentric views come about through believing that one's own culture or way of life is better than that of others. Biculture describes an individual with dual patterns of identification of two cultures, lifestyles, and sets of values. Being an ethnical individual occurs when one belongs to a specific group of individuals who share a common social and cultural heritage, Ethnography is a rescarch that provides a framework to focus on the culture of a group of individuals.

The faith community nurse is organizing a health fair for a faith community. How many weeks should the narse allow for the preparation phase? A) 3 B) 4 C) 5 D) 6.

D Feedback: The nurse should try to allow at least 6 to 8 weeks in preparing a health fair for the faith community to allow for appropriate planning time.

Which objective meets Healthy People 2020 disaster preparedness goals of addressing preparation, prevention, response, and recovery? A) Develop and maintain a workforce for national health campaigns. B) Ensure timely and effective communications. C) Evaluate quality improvement. D) Ensure national security.

Ans: B Feedback: Healthy People 2020 has identified a national preparedness goal: "Improve the Nation's ability to prevent, prepare for, respond to, and recover from a major health incident." To address this goal, Healthy People 2020 created related objectives to address preparation, prevention, response, and recovery: develop and maintain the workforce needed for national health security; ensure timely and effective communications; ensure prevention or mitigation of environmental and other emerging threats to health. These objectives were derived from National Health Security Strategy of the United States of America (NHSS), which stresses the importance of cross-border and global partnerships.

Healthy People 2020 has four primary goals. Which community activity would address one of these goals? A) Provide free dental screenings to all school age chikdren. B) Open a senior wellness clinic. C) Overhaul the health insurance system. D) Decrease co-payments of medication prescriptions.

Ans: B Feedback: Healthy People 2020 identified four goals. Opening a senior wellness clinic focuses on better health, which is in agreement with goal 3, create social and physical environments that promote good health for all. None of the other answers focus on the other goals of Healthy People 2020. Goal I is to attain high-quality, longer lives free of preventable disease, disability, injury, and premature death; goal 2 is to achieve health equity, eliminate disparities, and improve the health of all groups; and goal 4 is to promote quality of life, healthy development, and healthy behaviors across all life stages.

The community health nurse is completing an evaluation of a health program. If the nurse wants to evaluate the immediate impact of a parenting class, which question would be best for the nurse to ask the participants? A) "What time would be best for this class to meet?" B) "Can you tell me how you will change your behavior based on what you learned?" C) "How can we better provide information to this group?" D) "Did you learm what you expected to learn?"

Ans: B Feedback: Impact or summative evaluation is concermed with the immediate impact of a program on a target group. Asking how behavior will change based on what was learned in the class demonstrates the impact the class had on the participant. Process or formative evaluation answers the question: Are we doing what we said we would do? Some authors make a distinction between formative and process evaluation by using process to denote evaluation conducted during the program, whereas formative may be applicd at formative or preprogram stages. Long-term outcome evaluation is where it is discovered whether the changes had a lasting and real effect. All the other questions answer the process by which the class is taught or when it is held and do not show the impact the class had on the participant.

A program is being developed to collaborate with local law enforcement to conduct a gun safety awareness program that includes handgun issues. This is a health promotion strategy for a partnership at what level? A) School B) Community C) Parents D) Teachers

Ans: B Feedback: Involving the neighboring community in health promotion programs can benefit school-aged children and their families, as well as members of the surrounding community. Health promotion strategies involving the community may include collaboration with local law enforcement to conduct a gun safety awareness program, including handgun issues.

What is missing from this documentation? "I/13/10: John Brown received on 1/13/10 ABC vaccine by Great manufacturer, lot number # 12345 by Flo First. The client received 12/2009 Vaccine Information Statement." A) The documentation is complete. B) Title and address of the individual administering the vaccine C) Client name and date of immunization D) Vaccine manufacturer and vaccine lot number

Ans: B Feedback: Legal documentation of vaccinations is important for future administration and follow-up of hypersensitivity reactions. The health care provider, often the nurse, is responsible for maintaining accurate records, including client name, date(s) immunized, vaccine type. vaccine manufacturer, vaccine lot number, date of the Vaccine Information Statement (VIS); and the name, title, and address of the person administering the vaccine.

When asked about the beginning of public health nursing, the best response would include which of the following? A) Public health nursing is a term started in the mid-1900s. B) The public health nurse provided care to people in communities as far back as the 1890s. C) Public health nursing began when clinics opened that provided community health assistance D) The public health nurse was recognized after the term public health wursing was identified.

Ans: B Feedback: Lillian Wald coined the term public health nurse in 1893, Nurses have had a rich practice in the community, transforming both individual and public health for the poor and disenfranchised through political advocacy long before the 20th century. The public health nurse was one who provided health care to people within a community. Public health nursing started before coining the term public health nurse.

When planning interventions within a site-managed care system, the planners need to look closely at which type of health care to meet the current model standards? A) Aggregate community-based health care B) Individual medical care C) Family-based hcalth care D) Family- and community-based health care

Ans: B Feedback: Modem health care emphasizes individualized medical care as opposed to providing aggregate community-based health care. Our present "system" of health care has not served our profession well and has resulted in fragmented programs and limited return on improving the overall health in communities.

The community health nurse has assessed the community's health, analyzed the data, and derived community nursing diagnoses. Once the assessment is analyzed and the diagnoses chosen, the nurse would then focus on what step? A) Community analysis B) Formulate a community-based plan C) Implement a community health program D) Evaluate a community health program

Ans: B Feedback: Once a community's health has been assessed, the data have been analyzed, and community nursing diagnoses have been derived, it is time to consider mursing interventions that will promote the community's health by formulating a community-based plan.

The community health nurse is taking care of a client with a minor traumatic brain injury resulting from an automobile accident. The client developed pneumonia and is on IV antibiotics at home. Which level of prevention does this address? A) Primary B) Secondary C) Tertiary D) Chronic care

Ans: B Feedback: Secondary prevention begins after a disease or condition is present. Emphasis is on screening, early diagnosis, and treatment of possible stressors that may adversely affect the community's health. Secondary prevention addresses the current health problem and interventions that will return the person to a pre-injury level. Primary prevention improves the health and well-being of the community, making it less vulnerable to stressors. Health-promotion programs are primary prevention, as are programs that focus on protection from specific diseases, Tertiary prevention focuses on restoration and rehabilitation. Tertiary prevention programs act to return the community to an optimum level of functioning

Which indicates there is secondary vaccine failure? A) The failure of a vaccine to stimulate any immune response B) The waning of immunity following an initial immune response C) Vaccine failure caused by improper storage or improper administration route D) State in which those not immune will be safe if a certain proportion of the population has been vaccinated

Ans: B Feedback: Secondary vaccine failure is the waning of immunity following an initial immune response. Primary vaccine failure is the failure of a vaccine to stimulate any immune response. It can be caused by improper storage or improper administration route. Herd immunity refers to a state in which those not immune to an infectious agent will be safe if a certain proportion of the population has been vaccinated or is otherwise immune.

The evaluation process provides an opportunity to determine the outcomes derived by the health promotion program and directs improvement of employee health services. Which of the following represents a structural evaluation? A) Determine whether the health promotion activity was appropriate for the setting. B) Analysis of employee demographics and their health status needs C) Documentation and record keeping maintenance D) Review whether the health promotion program was designed to meet workplace needs.

Ans: B Feedback: Structural evaluation includes an analysis of employee demographics and their health status needs. Process evaluation addresses the following: (1) whether the health promotion activity was appropriate for the setting; (2) whether the health promotion program was designed to meet workplace needs (you can measure against the initial necds assessment); and (3) whether there was documentation and record keeping.

The community health nurse is using a survey that yields similar or nearly similar results each time the survey is administered. Achieving similar results for the same variable is an example of A) Consistency B) Reliability C) Validity D) Variability

Ans: B Feedback: Surveys that are used for program evaluation must be concerned with the reliability and validity of the information collected. Reliability deals with the repeatability, or reproducibility, of the data (i.e., if the same questions were asked of the same people I week later, would the same responses be recorded?). Validity is the correctness of the information. Variability refers to the difference between the highest and the lowest piece of information gathered in a study. It may also be known as the standard deviation. Consistency is the ability to repeat exactly the same results. This is different from reliability, in that reliability connotes some degree of variation in the results while still maintaining validity of the results.

The nursing practice model defines intervention as primary, secondary, and tertiary levels of prevention. Which is an example of tertiary prevention? A) Breast self-examinations B) Therapy programs for sexually abused children C) Immunizations against certain diseases D) Tine test for tuberculosis

Ans: B Feedback: Tertiary prevention focuses on restoration and rehabilitation. Tertiary prevention programs act to return the community to an optimum level of functioning. Adequate shelters for battered women and counseling and therapy programs for sexually abused children are examples of tertiary prevention. Primary prevention improves the health and well-being of the community, making it less vulnerable to stressors. Health-promotion programs are primary prevention, as are programs that focus on protection from specific diseases. Usually health promotion is nonspecific and directed toward raising the general health of the total community, such as immunizations against certain discases. Secondary prevention begins after a disease or condition is present. Emphasis is on screening, carly diagnosis, and treatment of possible stressors that may adversely affect the community's health. The tine test for tuberculosis and breast self-examination assessments are secondary prevention interventions.

The community health nurse is aware that research needs to be designed to increase understanding of the determinants of health disparities and culturally appropriate strategies and interventions to reduce and eliminate health disparities in underserved and vulnerable populations. What organization would offer the most information as the nurse begins research in that area? A) WHO B) NINR C) Office of Minority Health D) Institute of Medicine

Ans: B Feedback: The National Institute for Nursing Research (NINR), in keeping with national and intermational recognition that health is negatively affected by factors of race, ethnicity, gender, economic disadvantage, geography, and culture, has adopted a strategic plan focused on reducing health disparities. NINR supports research designed to increase understanding of the determinants of health disparities and culturally appropriate strategies and interventions to reduce and eliminate health disparities in underserved and vulnerable populations.

Which program provides supplemental foods, nutrition education, and referrals to health care? A) Medicaid B) Women, Infants, and Children C) Temporary Assistance to Needy Families D) State Children's Health Insurance Program

Ans: B Feedback: The Women, Infants, and Children program provides supplemental foods, nutrition education, and referrals to health care. Medicaid provides health care; insurance assistance and nursing home coverage for low-income residents and also pregnant women, a parent, or relative caregiver of a dependent child younger than 19 years, the blind, people with a disability or with a family member in their houschold with a disability, and people aged 65 years or older. Temporary Assistance to Needy Families provides financial and medical assistance to needy dependent children and parents and relatives with whom they are living. State Children's Health Insurance Program is for children younger than 19 years from families who earn too much to qualify for Medicaid.

Nurses work to empower communities not for domination or control of people, but rather to facilitate the development of others to promote change. Empowerment is gained through critical dialogue. Which characteristic of this dialogue is correct? A) Enables communities to see individuals as the same to impact change for the betterment of humanity B) Enables communities to see their inequities to transfornm their environment through healing interventions C) Enables communities to envision the key physical characteristics necessary to encourage individual progress of community members D) Enables communities to negotiate with others who have similar viewpoints about the health of the community

Ans: B Feedback: The emergence of a healing consciousness in which communities envision a mind-body-spirit connection with humanity can only occur through dialogue. Dialogue provides the critical mass for community transformations to take place. Dialogue enables communities to see their inequities and transform their environment through healing interventions. This spirit of openness implies people are willing to listen to others and negotiate with an understanding of opposing viewpoints. Empowerment is a process of hope, trust, faith, and critical thinking based on mutual concerns and love for other human beings. Empowerment is a dualistic interactive process involving investment in understanding yourself and others and a willingness to impact change for the betterment of humanity.

Which evaluation principle enhances the skills, knowledge, and attitudes of both professionals and nonprofessionals" A) Allow for flexibility B) Build capacity C) Create a participatory process D) Use multiple approaches

Ans: B Feedback: The evaluation principle of build capacity is important in enhancing the skills, knowledge, and attitudes of both professionals and nonprofessionals. It is important to allow for flexibility because evaluation approaches must not be rigid and prescriptive, or it will be difficult to document the incremental, complex, and often subtle changes that occur. Use of multiple approaches is important because evaluation methods are numerous and varied. No single approach is favored, but the method chosen must be congruent with the purposes of the program. The evaluation principle of create a participatory process highlights the importance of community members as partners in evaluation.

According to Kleinman's model, lay practitioners and healers are part of which sector? A) Cultural health system B) Folk C) Popular D) Professional

Ans: B Feedback: The folk sector of cultural health care systems includes the interaction between a client and sacred and secular healers. The popular sector is composed of ordinary people, families, groups, social networks, and communities. The professional sector is composed of the licensed health professionals.

What is an important point for the nurse to remember when designing a sexual health education and health care program for homeless adolescents? A) Conduct focus groups to allow parents to have a voice in planning their adolescent sexual health needs. B) Establish trust with a respectful and nonjudgmental attitude. C) Use large media, such as posters, to deliver health information. D) Provide sexual health information that is narrowly focused in nature.

Ans: B Feedback: The following points are important to consider when designing a sexual health education and health care program for homeless adolescents or adolescents in general: When possible, conduct focus groups to allow adolescents to have a voice in planning for their sexual health needs. Establish trust with a respectful and nonjudgmental attitude. Maintain confidentiality and privacy. Use small media, such as brochures, to deliver health information. Provide sexual health information that is broad in nature and not narrowly focused on HIV.

The community health nurse is participating in nominal evaluation research. The nominal group technique will A) use large survey studies. B) use a structured group meeting C) involve a series of questionnaires to a designated panel of respondents. D) distribute the initial questionnaire to a preselected group.

Ans: B Feedback: The nominal group technique uses a structured group meeting, during which all individuals are given a judgmental task, such as to list the functions of the program, problems of the program, or needed changes in the program. The Delphi technique is generally used in large survey studies but is also useful as a case-study method. This technique involves a series of questionnaires and feedback reports to a designated panel of respondents, as well as distributing an initial questionnaire by mail to a preselected group.

What question might the community health nurse ask when reviewing progress of the health program? A) "Is there a need for the program?" B) "Are program activities following the intended plan?" C) "What are the costs of a program?" D) "Were program objectives met?"

Ans: B Feedback: The nurse is evaluating progress when asking the question "Are program activities following the intended plan?"; relevancy when asking the question "Is there a need for the program?"; cost efficiency when asking the question "What are the costs of a program?": and effectiveness when asking the question "Were program objectives met?"

Which intervention is appropriate for the community health nurse to advise citizens at risk for the adverse effects of air pollution? A) It is best to exercise in the early evening hours. B) Exercise indoors when pollutants are especially high outdoors. C) It is important to have access to long-acting relief medication when active outdoors. D) Jogging, instead of walking, is best on high-ozone-level days to reduce the amount of pollution inhaled.

Ans: B Feedback: The nurse should advise to exercise indoors when pollutants are especially high outdoors. Other interventions should include exercising in the early moming and away from busy roads or industrial areas and trying a less intense outdoor activity, such as walking instead of jogging, on high-ozone-level days will reduce the amount of pollution inhaled. The community health nurse can stress the importance of access to quick relief medication when active outdoors, especially for those beginning an activity program that is more intense than usual.

When considering what age group would be a priority for health promotion planning, the nurse considers the older adult. What statement would confirm that this is a priority group? A) The number of older Americans has doubled in the past 100 years. B) The percentage of older Americans has more than tripled since 1900. C) Older Americans are more prevalent in the South but less prevalent in the North. D) California has twice the number of older Americans than any other state.

Ans: B Feedback: The percentage of older Americans has more than tripled from that of 1900 (4.1%), and the mumber has increased more than 13 times (from 3.1 million to 40.2 million).

Which provider is the most suitable to provide health care to school-aged children? A) Parents and guardians B) School nurse or public health nurse C) Pediatric nurse practitioner D) Family nurse practitioner

Ans: B Feedback: The school nurse or the public health nurse, depending on the community, is ideally suitable to provide health care to school-aged children. Nurses with advanced preparation in child health, such as pediatric nurse practitioners and family nurse practitioners, are also well prepared to initiate partnerships with schools. An ideal model is one in which the school nurse or public health nurse collaborates with the advanced practice nurse. In this way, health promotion, disease prevention, and health maintenance are important components included within the delivery of health care. School-aged children are a captive audience, and their parents'guardians are closely connected to the school community. This situation makes the school community an ideal center for health promotion activities for the entire family.

Which is a basis for faith community nursing? A) Economic recovery and casing poverty through education B) Spirituality and health of mind and body throughout the life span C) Supporting responsible motherhood through financially rewarding employment opportunities D) Fostering national interfaith communities

Ans: B Feedback: This movement of nursing in faith communities is bascd on the principles of holistic nursing that recognize the dynamic relationship between spirituality and health of mind and body throughout the life span. Helping economic recovery and easing poverty through education, supporting responsible motherhood through financially rewarding employment opportunities, and fostering national interfaith communities are all tasks nurses may perform, but they do not make up the basis of faith community nursing.

Spraying for mosquitoes is designed to: A) Control the agent B) Eradicate the nonhuman reservoir C) Control the human reservoir D) Improve host resistance and immunity

Ans: B Feedback: Treating nonhuman reservoirs or eliminating them (e.g., by spraying for mosquitoes) are effective methods of preventing replication of pathogens and thus preventing transmission. Controlling the agent is an area in which technology and medical science have been effective, Inactivating the agent is the principle behind disinfection, sterilization, and radiation of fomites that may harbor pathogens. Treating infected persons, whether they are symptomatic or not, is effective in preventing transmission of pathogens that can be transmitted directly to others. This is a way of controlling the human reservoir. Many factors, such as age, general health status, nutrition, and health behaviors, contribute to host resistance. Immunity, however, is an indispensable defense against infection.

Which indicates virulence of an infectious agent? A) Immune response in the host B) Ability to produce serious discase in the host C) Power to invade and infect large numbers of people D) Ability to produce disease in those infected with the agent

Ans: B Feedback: Virulence is the ability to produce serious disease in the host. Antigenicity is an immune response in the host. Infectivity is the power to invade and infect large numbers of people. Pathogenicity is the ability to produce disease in those infected with the agent.

The National Center for Health Statistics published a study comparing urban and rural populations on population health indicators such as smoking, obesity, chronic discase, substance abuse, suicide, and child health. When comparing the health status of rural populations with that of urban populations, what would be an accurate statement? A) Urban populations are more obese than rural populations. B) Rural populations have more instances of chronic disease than urban populations. C) Rural populations are less likely to experience substance abuse than are urban populations. D) Rural populations have healthier children than urban populations.

Ans: B Feedback: When the National Center for Health Statistics published a study comparing urban and rural populations on population health indicators such as smoking, obesity, chronic disease, substance abuse, suicide, and child health, rural populations were found to be less healthy on nearly all indicators. A first response to that study by rural health advocates was to cite these disparities as evidence that more services were needed in rural areas.

Arthur Kleinman studied members of many diverse ethnic groups. His findings showed that cultural beliefs are the basic guidelines people use to: A) Establish cultural models of health B) Recognize something is wrong C) Interpret what might be wrong D) Organize a plan of appropriate actions E) Understand the link between cultural beliefs and health and illness

Ans: B, C, D Feedback: Arthur Kleinman found that cultural beliefs based in shared meanings, values, and norms are the basic guidelines people and and use for illness illnes recognizing is interpreting mcpretng what it might be, and organizing a plan of appropriate actions. The goal of his research was to to study study members of of many many diverse ethnic groups groups to to gain gain an understanding understanding of the the links links between between cultural cultural beliefs beliefs and and health health behaviors belaniors that and end something ecten actions. From wrong, wing. his findings, community health nurses established cultural models of health.

What is an example of a health promotion program that can be planned, implemented, and evaluated that teaches a healthy safety behavior to a diverse group of employees? A) Membership at a health club B) Back care C) Hearing conversation D) Risk profiles and screenings

Ans: C Companies integrate health promotion into employee recruitment (e.g., membership at a health club), job training (e.g., back care), safety (e.g., hearing conservation), health (e.g., risk profiles and screenings), and recreation efforts (e.g., fun runs and sports teams

Many nursing skills needed in emergency or disaster situations are familiar to nurses. What is an example of a routine nursing activity that needs to be completed during stage 2 of preparedness? A) Develop/implement prevention strategies for worksites, community sites, and home. B) Participate in agency or community vulnerability assessments and strategies for improvement C) Locate/be able to respond to institutional emergency plans. D) Organize and participate in community immunization activities.

Ans: C Feedback: "Locate/be able to respond to institutional emergency plans" is an example of nursing activity to be completed during the preparedness stage of disaster response. Develop/implement prevention strategies for worksites, community sites, and home; participate in agency or community vulnerability assessments and strategies for improvement; and organize and participate in community immunization activities are examples of nursing activities to be completed during the prevention stage response.

The nurse is planning a health promotion program. The nurse is writing a sample business plan to teach healthy behaviors to a diverse group of employees and their families. Where would the nurse find the outcomes of the health promotion program in the business plan? A) Executive summary B) Methods C) Expected benefits D) Costs

Ans: C Feedback: A feasibility or business plan approach to communicating your program is used to establish a common language and understanding of the project by everyone in the organization. A sample business plan might include the following: Executive summary: A short summary of the health promotion plan, which includes the purpose, methods, expected benefits, and costs. Methods: How, when, and where the plan will be put into action. Expected benefits: List of the outcomes for the program. Costs: An accurate projection of program costs.

monitoring chart measures progress and can be used to evaluate whether a program is on schedule and within budget. What evaluation method is perfectly suited for a monitoring chart? A) Formative B) Outcome C) Process D) Summative

Ans: C Feedback: A monitoring chart measures progress and can be used to evaluate whether a program is on schedule and within budget. Perhaps no other evaluation method is as perfectly suited to process evaluation as the monitoring chart. Impact or summative evaluation is concemed with the immediate impact of a program on a target group. Process or formative evaluation answers the question: Are we doing what we said we would do? Long-term outcome evaluation is where it is discovered if the changes had a lasting and real effect.

The economic crisis, foreclosures, the collapse of the housing market, job shortages, and devastating natural events have affected individuals who are homeless and those at risk for homelessness despite efforts over the last decade to end homelessness. Affordable housing exceeds the means of many families. The reason a nurse would ask about the income of a family in an at-risk community would be to assess if they fall below what percentage of income which would make them at high risk for homelessness? A) 20% B) 25% C) 30% D) 35%

Ans: C Feedback: Affordable housing, defined as housing that costs no more than 30% of income, exceeds the means of many families, rendering them at risk of becoming homeless.

Farming is one of the few industries in which the families, who often share the work and live on the premises, are also at risk for injuries, illness, and death. What is an example of a potential hazard of elemental exposure for agricultural workers? A) Fertilizers, pesticides, fungicides B) Risk of transferable disease; zoonoses C) Silos, grain bins, manure pits D) Cumulative trauma: noise and ergonomics

Ans: C Feedback: An example of chemical exposure is fertilizers, pesticides, and fungicides. Examples of livestock exposure include risk of transferable discase, zoonoses; and examples of cumulative trauma are noise and ergonomics. Examples of elemental exposure are silos, grain bins, and manure pits.

Infectious diseases require organized, public efforts for their prevention and control because of their potential to spread and cause communitywide or worldwide emergencies. What laws prevail over federal laws related to health? A) Local B) Public health C) State D) International

Ans: C Feedback: An important concept to remember is that, in areas of health within a state, state laws usually prevail over federal law. The U.S. Constitution does not address health, and the Tenth Amendment reserves power to the states over all issues not addressed in the Constitution.

Planned change is a well-thought-out effort designed to make something happen; all efforts are directed and targeted to produce change. According to Reinkemeyer's stages of planned change, when are community nursing diagnoses validated? A) Stage I: Identification and development of a felt need and desire for the change B) Stage 2: Development of a change relationship between the community health nurse and the community C) Stage 3: Clarification or diagnosis of the community's problem, need, or objective D) Stage 4: Examination of alternative routes and tentative goals and intention of actions

Ans: C Feedback: Both stages I and 2 are completed during assessment presentations. The third stage is to validate the community nursing diagnoses. Stage 4 is when planning occurs.

Falls are the most common accidents experienced by people older than 70 years. It is estimated that about two thirds of falls among the elderly are preventable. What risk factor is most common and would alert the nurse to place the client on fall risk precautions? A) Osteoporosis B) Hypertension C) Poor vision D) Middle ear disturbance

Ans: C Feedback: Common risk factors for falls include use of medications or alcohol, poor physical condition, changes in visual acuity, inner ear disturbance, foot problems, gait and balance disorders, and hazards in the home and community. The presence of osteoporosis increases the likelihood of a broken bone when a fall occurs, particularly in women.

Community health nurses must make a commitment to gain knowledge about health beliefs and health practices that can be used in the delivery of culturally competent health care to at-risk populations. This knowledge is associated with which sector of Kleinman's model? A) Cultural health system B) Folk C) Populan D) Professional

Ans: C Feedback: Conflicts, misunderstandings, and barriers to effective health care will be reduced only by commitment to gain knowledge about the popular sector, where health beliefs and health practices are activated and where 70% to 90% of all illness episodes are recognized and treated. The nursing profession's commitment to health and holism and its capacity to understand complex sociocultural responses to real and potential health problems make it the most logical choice for a professional segment to act as a client advocate in facilitating interactions between the sectors.

Two of the most common methods of analyzing the economic costs and benefits of a community health program are cost-benefit analysis and cost-effectiveness analysis. What occurs in cost-effectiveness analysis? A) Consequences or benefits of a program are valued in dollar terms. B) Different program benefits are compared in relation to cost. C) Programs with similar goals and objectives are compared. D) It is determined whether total benefits exceed total costs.

Ans: C Feedback: Cost-effectiveness analysis can be used to compare programs with similar goals and objectives. Cost-effectiveness analysis does not place a dollar value on either the consequences or the costs of a project. Cost-benefit analysis makes it possible to compare different projects because all measurement is made in dollars. Cost-effectiveness analysis does not determine whether total benefits exceed total costs.

The community health nurse is trying to locate information about specific programs of the Office of Disease Prevention and Health Promotion. Which program would help the nurse focus on ways the communities can adapt the national Healthy People objectives for local use? A) Dietary Guidelines for Americans B) Healthy People C) Healthy Communities, Worksites, and Schools D) National Health Information Center

Ans: C Feedback: Dietary Guidelines for Americans is published with the U.S. Department of Agriculture and identifies federally mandated nutrition education activities. Healthy People was launched in 1979; it guides efforts to identify objectives for the nation. Healthy Communities, Worksites, and Schools is a coalition for healthier cities and communities that focuses on ways that communities can adapt the national Healthy People objectives for local use. National Health Information Center is a central health information service for consumers and professionals.

The community health nurse is using principles of change theory to direct the planning process, During what stage do the accomplished changes become integrated into the values of the client system? A) Intervention B) Moving C) Refreezing D) Unfreezing

Ans: C Feedback: During the unfreezing stage, the client system becomes aware of a problem and the need for change. Then the problem is diagnosed, and solutions to the problem are identified. From these alternative solutions, one is chosen that seems most appropriate for the situation. In the moving stage, the change actually occurs. The problem is clarified, and the program for solving the problem is planned in detail and begun. The refreezing stage consists of the accomplished changes becoming integrated into the values of the client system. In this stage, the idea is established and continues to be influential.

As functional status and sensory acuity begin to decline, the elderly become vulnerable to an assortment of abusive and neglectful situations. What assessment of the elderly would support self-negleer? A) Maltreatment of an older person residing in his her own home B) Maltreatment of an older person residing in a residential facility C) Neglect inflicted when the safety or health of older people is threatened by their living alone D) Knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable population

Ans: C Feedback: Elder abuse is an umbrella term referring to any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable population. According to the National Aging Information Center, there are three basic categories of abuse: domestic, institutional, and self-neglect. Domestic elder abuse refers to maltreatment of an older person residing in his or her own home or the home of a caregiver. Institutional abuse occurs in residential facilities. Self-neglect refers to neglect inflicted when the safety or health of older people is threatened by their living alone.

Which of the following best describes the composition of an ethnic group? A) Associated with minority or majority populations who share the same cultural background B) Associated with minority populations that do not share the traditions of their social heritage C) Composed of individuals who share a unique cultural background and social heritage that is passed from one generation to the next generation D) Composed of individuals that have distinct identity who relate well within the community at large

Ans: C Feedback: Ethnic groups are composed of people who share a unique cultural background and social heritage that is passed from one generation to another. Ethnicity is associated with minority or majority populations who share the same cultural background. An ethnic group is associated with popalations who share the traditions of their heritage. Ethnic groups do not always relate well within a community at large but do within their own communities.

A health care provider is interested in grants or incentives that would attract someone to a restricted area. What agency would be the best to contact to investigate this idea? A) Educational Rescarch Service B) Institute of Medicine C) Rural Assistance Center D) U.S. Department of Agriculture

Ans: C Feedback: For health care providers or health educators who want to know if they can qualify for a recruitment incentive or grant that is restricted to rural areas, an excellent resource can be found at the Rural Assistance Center, also known as RAC online. In addition to rural definitions, this site can generate a custom report for any zip code indicating whether or not it is rural according to various definitions, and for what federal programs the area is eligible.

Which statement represents the priority for the older adults, their families, and the health care system? A) A focus on disease prevention for institutionalized elders is critical. B) Wellness programs are necessary for the expanded elder communities to thrive. C) Health promotion and disease prevention are of increasing importance. D) Noninstitutionalized elders require health promotion to improve health status.

Ans: C Feedback: Health promotion and disease prevention activities are an increasing priority for older adults, their families, and the health care system. No support data are presented that support the other answers regarding noninstitutionalized, institutionalized, or elder community wellness programs.

Public health nurses working in the community can lobby for changes in legislation that can prevent homelessness as primary prevention. What is an example of legislation that can be supported? A) Transportation B) Case management services C) Raising the minimum wage D) Sources for funding programs

Ans: C Feedback: Health promotion strategies to support people exiting homelessness include transportation, case management services, and sources for funding programs. Public health nurses working in the community can lobby for changes in legislation that can prevent homelessness at the primary prevention level. Supporting legislation to raise the minimum wage is one example.

The sociodemographic characteristics of rural residents place them at risk for unhealthy behaviors and poor health status. Compounding these factors, rural residents are less likely to have health insurance than are their urban counterparts. Basing a health clinic in this area would assist what percentage of uninsured in rural counties with fewer than 2,500 people? A) 15% B) 19% C) 23% D) 27%

Ans: C Feedback: Rural counties with fewer than 2,500 persons had the highest rate of uninsured (23%), with larger rural counties adjacent to urban counties having the same rate as urban counties (19%).

Mental health issues faced by the elderly include social isolation and loneliness, depression, suicide, and alcohol addiction. What individuals are at highest risk for social isolation? A) People aged 65 years or older B) Elderly people living in a nursing home C) Individuals who are in frail health D) Individuals retired from career work

Ans: C Feedback: Social isolation is associated with the very old (aged 85 years and older), those in frail health, and the elderly living alone.

What is an example of a secondary prevention strategy that the school nurse can implement to influence the school elimate and reduce bullying? A) Conduct a teacher/staff in-service program to educate the members of the school community about the problem of bullying. B) Have a parent meeting to discuss preventing school violence and explain that addressing and stopping bullying is an important component of violence prevention. C) Have teacher-student discussion groups to reinforce antibullying messages and contribute to changing the school culture. D) Formally assess for bullying behaviors on an annual basis.

Ans: C Feedback: Implementing secondary prevention includes teacher-student discussion groups to reinforce antibullying messages and contribute to changing the school culture. Implementing primary prevention includes conducting a teacher'staff in-service program to educate the members of the school community about the problem of bullying and having a parent meeting to discuss preventing school violence and explaining that addressing and stopping bullying is an important component of violence prevention. Implementing tertiary prevention includes formally assessing for bullying behaviors on an annual basis.

When looking at disabilities in the older population, which statement, as of 2011, is true and would direct the nurse in planning interventions to assist with optimizing independence in this age group? A) Older men report more disabilities than do older women. B) 38% of older men report at least one disability. C) Over one third of older adults reported at least one severe disability. D) Women are more likely to have at least one severe disability

Ans: C Feedback: In 2011, 35% of older men and 38% of older women reported having at least one disability, and over one third reported at least once severe disability.

Community nurses need to be familiar with state abuse reporting laws and how to work with state adult protective services agencies, In a 2004 survey of State Adult Protective Services agencies, the National Center on Elder Abuse noted an increcase in substantiated elder abuse cases from 2000 to 2004. What statement would help direct the need for change in identifying this type of abuse? A) The National Center on Elder Abuse found a 10.5% increase in substantiated cases. B) The National Center on Elder Abuse found a 13.4% increase in substantiated cases. C) The National Center on Elder Abuse found a 15.6% increase in substantiated cases. D) The National Center on Elder Abuse found a 16.5% increase in substantiated cases.

Ans: C Feedback: In a 2004 survey of State Adult Protective Services agencies, the National Center on Elder Abuse found a 15.6% increase in substantiated elder abuse cases from 2000 to 2004.

15. What is the goal of individual- or family-focused health promotion and health protection interventions? A) Design interventions to increase the individual's or family's knowledge, skills, and competence to make health decisions B) Involvement in activities that maximize health promotion and health protection behaviors C) Empowerment of the elderly and their families to make rational health decisions D) Activities and programs that are directed toward community elders

Ans: C Feedback: Individual- or family-focused health promotion/health protection interventions are designed to increase the individual's or family's knowledge, skills, and competence to make health decisions that maximize health-promoting and health-protecting behaviors. The goal is empowerment of the elderly and their families to make rational health decisions, Community-focused interventions are activities and programs that are directed toward community elders as a whole or various elderly subgroups in a community.

Adequate nutrition is important for older adults to maintain health, prevent disease, and slow progression of existing chronic illnesses. What makes nutrition classes more effective? A) Limit recipe sharing of nondiabetic diets. B) Eliminate existing negative habits. C) Include ethnic food preferences. D) Use colorful single-page, small-print pamphlets.

Ans: C Feedback: Nutrition elasses are more effective if they are highly interactive-incorporate recipe tasting and recipe sharing, build on existing positive habits, and include ethnie food preferences. Use of colorful, large-print posters and videos is appropriate. Reinforcing handouts are also helpful.

The benefits of exercise are well established across the life span. Exercise activity for elders must be suitable to health and functional status. What is the best approach to exercise in the elderly? A) Staying active throughout the day B) Participate in 20 minutes of high-intensity exercise three times a week. C) Participate in 20 to 30 minutes of moderate-intensity exercise most days of the week. D) Low-impact activity schedules 3 times a day for 20 minutes at each session

Ans: C Feedback: Older adults who participate in 20 to 30 minutes of moderate-intensity exercise on most days of the week have better physical function than do older persons who are active throughout the day or who are inactive.

The most telling demographic marker as a determinant of health and health behavior is counties in the country designated as experiencing persistent poverty. What percentage of the population is living below the federal poverty level in these counties? A) 10% for two successive census periods B) 15% for three successive census periods C) 20% for three successive census periods D) 25% for two successive census periods

Ans: C Feedback: Perhaps the most telling demographic marker as a determinant of health and health behavior is those counties that have been designated as experiencing "persistent poverty." These counties have been found to have 20% or more of the population living below the federal poverty level for three successive census periods (30 years). Whether the issue is delivering health services, engaging in health education and health promotion, or the use'availability of prenatal care, dental care, or mental health care, life in these areas is qualitatively different from that in other parts of the country

The community health nurse is planning a health promotion program for school-aged children for Red Ribbon Week. The goal of this type of program would include which of the folowing? A) How to avoid teen pregnancies B) Healthy cardiovascular promotion measures C) Increase awareness of the dangers associated with alcohol and tobacco D) Review common cating disorders and how to prepare healthy lunches

Ans: C Feedback: Red Ribbon Week occurs in October each year to celebrate being drug-free. The Red Ribbon Campaign was established in 1988 by the U.S. Congress. The goal was to increase the awareness of the dangers associated with the use of tobacco, alocohol, and other drugs.

The community health nurse is participating in Delphi technique research. The Delphi technique will A) allow all individuals to present their ideas before the entire group. B) promote individual cooperation with the group's decisions. C) collect independently expressed thoughts through the use of respondent questionnaires. D) decrease selective perception.

Ans: C Feedback: The Delphi technique has respondents independently express their thoughts through the questionnaire and return it. The nominal group technique allows all individuals to present their ideas before the entire group. The nominal group technique involves the entire group, decreases selective perception, and promotes individual cooperation with the group's decisions because people believe that they have been involved in the decision-making process.

The nurse establishes a Healthy Heart Club. Which the leading indicator of Healthy People 2020 does this program support? A) Access to health care B) Physical activity C) Overweight and obesity D) Mental health

Ans: C Feedback: The Healthy Heart Club combines nutrition and education in a monthly gathering at lunchtime in an attempt to address the national problem of overweight and obesity. This nursing action can be geared to adults, teens, or children. It is designed to teach the basies of cating a balanced diet, how to shop wisely for healthy food, and how to make good choices in restaurants. The Healthy Heart Club does not address access to care issues, physical activity, or mental health needs.

Which activity occurs during the "P" phase of the MAP-IT process? A) A coalition of individuals who care about the faith community's health is formed. B) Areas of greatest need in the faith community are identified. C) Strategies and action steps to achieve community vision are planned. D) A plan of concrete action steps that can be monitored and make a difference is implemented.

Ans: C Feedback: The MAP-IT Strategy for creating a health community means M, mobilize; A, assess; P, plan; I, implement; T, track. During the "P" phase, community starts with a vision of where it wants to be; then adds strategies and action steps to help achieve that vision. Other activities include mobilize individuals who care about the faith community's health into a coalition. Assess the areas of greatest need in your community and the resources and strengths yoa can tap into to address those areas of need. Implement the plan using concrete action steps that can be monitored and will make a difference. Track progress over time.

Which approach to health care is applied through participatory research as a pathway to community empowerment? A ) Medical B) Health services C) Community development D) Medical and health services

Ans: C Feedback: The community development approach is at the grassroots level, in which members within the community determine what health care services should be provided. The medical and health services approaches to health care are called "top-down" approaches, in which experts prescribe their values of health care for the public.

Which evaluation principle requires the program to be rooted in the real community and based on assessment of the community? A) Strengthen programs B) Use multiple approaches C) Design evaluation to address real issues D) Create a participatory process

Ans: C Feedback: The evaluation principle of design evalwation to address real issues ensures that community-based programs are rooted in the real community and based on assessment of the community. The evaluation principle of strengthen programs describes how evaluation is invaluable in attaining the goal by providing an ongoing and systematic process for assessing the program, its impact, and its outcomes. The evaluation principle of use of multiple approaches provides for numerous and varied evaluation methods, in which no single approach is favored, but the method chosen must be congruent with the purposes of the program. The evaluation principle of create a participatory pocess highlights the importance of community members as partners in evaluation.

The community health nurse is involved in carrying out the community-based plan. What is the highest priority for the nurse to remember about the people of the community when carrying out the community-based plan? A) The people in the community do not need to assume any responsibility for implementation. B) The community health nurse will care for the individuals in the community. C) The people in the community need to feel a sense of ownership of the program. D) The community health nurses will interact professionally with individuals while carrying out the community plan.

Ans: C Feedback: The people of the community need to feel a sense of ownership of the program or event, which can come only with their full participation in the decisions regarding planning as well as their assuming some responsibility for implementation. The profession of nursing is one of nurturing, sustaining, and caring for others. It is part of our profession to do for others what they would do for themselves if they were able. Indeed, most nurses interact professionally with people during an altered health state that requires nurses to do for others, but this is not true in community health nursing.

Considering Kleinman's model, which sector includes the family? A) Cultural health system B) Folk C) Popular D) Professional

Ans: C Feedback: The popular sector of cultural health care systems is made up of informal healing relationships that occur within one's own social network. Although the family is at the nucleus of this sector, health care can take place between people linked by kinship, friendship, residence, occupation, or religion. The folk sector of cultural health care systems includes the interaction between a client and sacred and secular healers. The professional sector is composed of the licensed health professionals.

Planned change is a well-thought-out effort designed to make something happen; all efforts are directed and targeted to produce change. According to Reinkemeyer's stages of planned change, when does implementation of a community health program occur? A) Stage 3: Clarification or diagnosis of the community's problem, need, or objective B) Stage 4: Examination of alternative routes and tentative goals and intention of actions C) Stage 5: Transformation of intentions into actual change D) Stage 6: Stabilization and evaluation

Ans: C Feedback: The third stage is to validate the community nursing diagnoses. Stage 4 is when planning occurs. Stage 5 is when intervention of the community health program occurs.

Which two sectors of Kleinman's model are associated with belief systems that are nonscientific or subjective? A) Folk and professional B) Popular and cultural health system C) Popular and professional D) Popular and folk

Ans: D Feedback: Belief systems in the popular and folk sectors have often been termed as umorthodox, lay, subjective, or nonscientifie, and have been associated with non-Western societies. A client's preference for such healing practices may have been dismissed by some professional health care professionals.

What is an appropriately written measurable goal for the following diagnosis: "A nursing diagnosis of ineffective community coping related to inadequate resources for problem solving as manifested by 5% representation of all segments of the community in problem solving has been identified by the community health nurse." A) To know who participates in community actions B) To be aware of communication among community members C) To increase by 30% all segments of the community in problem solving in 30 days D) To realize common and competing interests among groups when solving community problems by next week

Ans: C Feedback: The written goal must be specific with observable outeomes in order for the community health nurse to evaluate progress. Modifiers such as know, aware, and realize are less precise terms that have many interpretations. To increase or decrease by a specific percentage a more precise term that has fewer interpretations. Each goal and objective should include a time frame for attaining the change (e.g., "By June 15th .."), the direction and magnitude of the change (e.g, "Inerease immunization levels to 95%"); the method of measuring the change (eg., "After the session, cach participant will demonstrate_").

Which of the following approaches would be best to implement when trying to modify unhealthy behaviors? A) Focus on medical professionals curing of diseases. B) Mobilize community members to focus on curing diseases. C) Mobilize community members to take an active role in the delivery of services. D) Mobilize community members to involve in the decision-making process to improve health.

Ans: C Feedback: There are three approaches to community participation in health programs commonly used by different countries. One is the medical approach, which is focused on curing diseases and is controlled by the medical profession. The second is a health services approach, which mobilizes people to take an active role in the delivery of services based on modifying unhealthy behaviors. The third is a community development approach, in which people are involved in the decision-making process to improve health. The first two approaches to health care are called "top-down" approaches, in which experts prescribe their values of health care for the public. The third approach is at the grassroots level, in which members within the community determine what health care services should be provided. It is more consistent with the principles of primary health care.

A child born in 2010 could expect to live 77.9 years compared with about 29 years in 1900. What is the main reason for this phenomenal growth? A) Decreased mortality of adults B) Decreased morbidity of children C) Decreased mortality of children and young adults D) Decreased morbidity of adults and older adults

Ans: C Feedback: This phenomenal growth has occurred as a result of reduced mortality rates of children and young adults.

Which best describes how community health nurses can help a community achieve their common goals? A) Maintenance B) Transforming C) Empowerment D) Implementation

Ans: C Feedback: Through community empowerment, nurses can provide a moral voice to inspire change to regain our historical roots as vanguards of the community. Through empowerment, community health nurses can enable people to make decisions and to act on issues they believe are essential to their health or well-being. The other answer choices are not directly related to the empowerment of communities to achieve a set of goals.

The community health nurse is constructing a monitoring chart for program plan. Information is needed on inputs, process, and outputs. What statement would be considered an output? A) Resources necessary to carry out the program B) Personnel, equipment, and finances needed for the program C) Expected results of the program D) Program activities, their sequence, and timing

Ans: C Feedback: To construct a monitoring chart for a program plan, information is needed on the inputs (resources necessary to carry out the program, such as personnel, equipment, and finances), the process (the program activities, their sequencing, and timing), and outputs (the expected results of the program, including immediate and long-term health effects).

Primary prevention measures to prevent people who are at risk for homelessness from becoming homeless are one of the first steps in health promotion for this population. What is an example of secondary prevention health promotion strategy for people who are homeless? A) Emergency financial assistance B) Financial advisement C) Evaluation of community resources D) Legal assistance

Ans: C Feedback: To promote the hecalth of persons who are homeless, assessing and evaluating community resources for serving this population is a crucial secondary prevention measure. Primary prevention strategies include emergency financial assistance, legal assistance, and financial advisement.

There are personal protective equipment and injury prevention objectives for agricultural workers. The particular health hazard is falling and'or airborne debris encountered during repair of agricultural machinery. What personal protective equipment would indicate that the employee understands correct prevention techniques? A) Acoustic earmuffs B) Nonslip safety shoes C) Hard hat D) Seat belt

Ans: C Feedback: Wearing a hard hat when performing repairs to machinery addresses the health hazard of falling and'or airbome debris. Acoustic earmuffs address the health hazard of loud and continuous machinery and equipment noise. Wearing nonslip safety shoes addresses the health hazard of a wet, slippery working environment. Wearing a seat belt addresses the health hazard of accidents such as rollovers, collisions, and falls.

A community health nurse is developing a program on internal and external environmental issues for school nurses. In describing Healthy People 2020, which goal would the community health nurse emphasize for this group? A) Eliminate preventable disease, disability, injury, and premature death. B) Achieve health equity, eliminate disparities, and improve the health of all groups. C) Create social and physical environments that promote good health for all. D) Promote healthy development and healthy behaviors across every stage of life

Ans: C Feedbacks Healthy People 2020 identifies four overarching goals: eliminate preventable disease, disability, injury, and premature death; achieve health equity, eliminate disparities, and improve the health of all groups; create social and physical environments that promote good health for all; and promote healthy development and healthy behaviors across every stage of life. Comprehensive school health programs should focus on delivering health services mandated by state laws and the individual school system as well as on health education. Additionally, both internal and external environmental issues are critical areas of assessment and intervention for school nurses.

Health promotion in the workplace falls within three basic program types. What is an example of a behavior change activity? A) Low-fat foods in the cafeteria B) On-site aerobic classes C) Smoking cessation D) Sunscreen dispenser by walking trail

Ans: C Health promotion in the workplace typically falls within three basic program types: Awareness programs increase the employees' level of knowledge and interest (e.g., flyers, seminars, and newsletters). Behavior change activities help participants develop healthi behaviors (e.g., smoking cessation, regular exercise, and healthy nutrition). Supportive environments create work opportunities that encourage healthy lifestyles (e.g., low-fat foods in the cafeteria, on-site aerobic classes, release time for health screenings, sunscre dispenser by walking trail).

A business is interested in partnering with the community for health promotion programs specific to their workplace. In looking at hiring an individual for this lead position, the business knows the best person to fill this position would be which of the following? A) Employer B) Nurse practitioner C) Occupational health nurse D) Primary care provider

Ans: C The occupational health nurse is often responsible for health promotion programs at the worksite and is an excellent resource person for establishing a community partnership. If the organization does not have an occupational nurse, health programs may be the responsibility of the safety officer or an employee in the company's human resources or benefits department.

Nurses throughout history and in modern times have been concerned about vulnerable populations. To understand how to assist these populations, the nurse must first understand that the term vulnerable refers to what population? A) Process in which individuals in certain groups seem not to matter to the rest of society, B) Focus on the health needs of populations who have been relegated to the margins of society. C) Treat someone or something as if the individual is of no consequence or is unimportant. D) Social group who experiences limited resources and consequent high relative risk for morbidity and premature mortality.

Ans: D "Vulnerable" stems from the Latin word varlnare, which means "to wound." This terminology implies that the wounded or the "less than perfect" are not particularly valued and casily marginalized. By using the terminology of marginalization instead, the emphasis is societal, Vulnerable populations are social groups who experience limited resources and consequent high relative risk for morbidity and premature mortality.

There are differences between a program funded by the government and a policy formed and funded by the government. Which best describes program? A) Process of influencing the allocation of scarce resources B) Set of principles that is frequently formally agreed upon C) Based on the institution's mission and goals D) Set of actions to achieve a goal

Ans: D Feedback: A program is a set of actions to achieve a goal. Politics is the process of influencing the allocation of scarce resources. Policy is a set of principles that is frequently formally agreed upon. Institutional policies are based on the institution's mission and goals, and they determine how the institution will function and relate to employees.

Elderly populations, in general, are open to new health practices and respond to a variety of approaches that have the potential to improve their health. To plan effective health programs, community health nurses should validate proposed goals and strategies with the targeted elderly group. What is an action step for working with older adults in the community? A) Try to incorporate outreach activities into the program. B) Anticipate needs of those with poor hearing. C) Maintain a fast pace for activities to maintain relatively short sessions. D) Allow plenty of time for elders to share life experiences.

Ans: D Feedback: Action steps for working with older adults in the community include incorporating outreach activities into all programs; anticipating the needs of those with poor vision; maintaining a slow pace for activities and allowing adequate time for responses; allowing plenty of time for elders to share life experiences; and keeping teaching sessions relatively short.

Primary prevention measures to prevent people who are at risk for homelessness from becoming homeless are one of the first steps in health promotion for this population. What is an example of a primary prevention health promotion strategy for people who are homeless? A) Health care needs must be addressed first for a homeless individual. B) Identify the barriers homeless people encounter in receiving health care C) Categorize homeless needs as housing, health care, or employment. D) Obtain emergency financial assistance so utilities are not discontinued.

Ans: D Feedback: Affordable housing is crucial if the goal is to keep people in their homes. A primary prevention measure is emergency financial assistance-frequently, utility companies have an emergency fund that can be used to prevent utilities, such as water and electricity, from being discontinued. Secondary prevention focuses on people who no longer have stable housing. Begin by listing all their perceived needs. It is helpful to categorize needs as housing, health care, or employment. Health care needs must be addressed first. Identify the barriers homeless people encounter in receiving health care and how these barriers might be eliminated.

After considering the results of the questionnaire about elderly needs in the community, the staff from several community organizations begin to discuss the possibility of offering elasses on how to avoid falls in the home once a week. According to Reinkemeyer's stages of planned change, when would this activity occur? A) Stage 1: Identification and development of a felt need and desire for the change B) Stage 2: Development of a change relationship between the community health nurse and the community C) Stage 3: Clarification or diagnosis of the community's problem, need, or objective D) Stage 4: Examination of alternative routes and tentative goals and intention of actions

Ans: D Feedback: After considering the results of the questionnaire about elderly needs in the community, the staff from several community organizations begin to discuss the possibility of offering classes on how to avoid falls in the home once a week; this task is completed during Stage 4: examination of alternative routes and tentative goals and intention of actions.

Each state mandates certain requirements to maintain the health of school-aged children. Vision and hearing screening programs are required. When planning new student hearing and vision dates, the nurse understands that if school starts September 1, the screening should be scheduled no later than what time? A) By the end of September B) By the end of the school year C) By the end of October D) By the end-of-the-year break

Ans: D Feedback: All new students must be screened for hearing and vision within 120 days of enrollment. If the school year starts September 1, the screening would need to be completed before the end-of-the-year break.

Planned change is a well-thought-out effort designed to make something happen; all efforts are directed and targeted to produce change. According to Reinkemeyer's stages of planned change, when does planning a community health program occur? A) Stage 1: Identification and development of a felt need and desire for the change B) Stage 2: Development of a change relationship between the community health nurse and the community C) Stage 3: Clarification or diagnosis of the community's problem, need, or objective D) Stage 4: Examination of alternative routes and tentative goals and intention of actions

Ans: D Feedback: Both stages I and 2 are completed during assessment presentations. The third stage is to validate the community nursing diagnoses Stage 4 is when planning occurs.

In partnership with the community, what is the last step in planning a community-based health program? A) List the sequence of actions and prepare a time schedule for achieving goals B) Identify resources needed to accomplish the plan. C) Outline revisions to the plan as goals and objectives are achieved or changed D) Record the plan in a concise, standardized, and retrievable form

Ans: D Feedback: Community plans must be recorded in a standardized, systematic, and concise form that clearly communicates to others the purpose and actions of the plan as well as the rationale for revisions and deletions of actions.

The community health nurse is using principles of change theory to direct the planning process. What occurs during the moving stage? A) Client system becomes aware of a problem and the need for change. B) Problem is diagnosed, and solutions to the problem are identified. C) From alternative solutions, one is chosen that is most appropriate for the situation. D) The program for solving the problem is planned in detail and begun.

Ans: D Feedback: During the unfreezing stage, the client system becomes aware of a problem and the need for change. Then the problem is diagnosed, and solutions to the problem are identified. From these alternative solutions, one is chosen that seems most appropriate for the situation. In the moving stage, the change actually occurs. The problem is clarified, and the program for solving the problem is planned in detail and begun.

As functional status and sensory acuity begin to decline, the elderly become vulnerable to an assortment of abusive and neglectful situations. A survey in 2004 showed a significant increase in substantiated cases of clder abuse. What definition would have been used when looking at what constituted elder abuse? A) Maltreatment of an older person residing in his or her own home B) Maltreatment of an older person residing in a residential facility C) Neglect inflicted when the safety or health of older people is threatened by their living alone D) Knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable population

Ans: D Feedback: Elder abuse is an umbrella term referring to any knowing, intentional, or negligent act by a caregiver or any other person that causes harm or a serious risk of harm to a vulnerable population. According to the National Aging Information Center, there are three basic categories of abuse: domestic, institutional, and self-neglect. Domestic elder abuse refers to maltreatment of an older person residing in his or her own home or the home of a caregiver. Institutional abuse occurs in residential facilities. Self-neglect refers to neglect inflicted when the safety or health of older people is threatened by their living alone.

The majority of older persons have at least one chronic condition and many have multiple conditions. From 2009 to 2011, what was the most frequently occurring condition of the elderly? A) Arthritis B) Cancer C) Diabetes D) Hypertension

Ans: D Feedback: From 2009 to 2011, the most frequently occurring conditions of the elderly included hypertension (72.0%); diagnosed arthritis (51.0%); all types of heart disease (31.0%); any cancer (24.0%); and diabetes (20.0%).

The community health nurse knows that there are some alarming facts about the homeless. If the community health nurse wants to target a project around a large group of homeless people, in which state would it be best to begin this project? A) Utah B) Virginia C) Michigan D) California

Ans: D Feedback: Half of the homeless population lives in the following five states: California, New York, Florida, Georgia, and Texas, according to the PIT estimate in 2011. California would be a good state in which to begin this project.

Which of the following can be used to set an agenda for community health improvements in today's society? A) American Nurses Association Code of Ethies with Interpretive Statements B) American Nurses Association Social Policy Statement C) Contributions set forth by Lillian Wald D) Healthy People 2020

Ans: D Feedback: Health care providers are encouraged to work with communities to implement health programs to further the health of the community and to use the Healthy People goals to set an agenda for community hcalth improvements. Community health nursing is guided by the American Nurses Association (ANA) Code of Ethies with Interpretive Statements (2005) and the ANA Social Policy Statement (2003). Both of these documents include sections on nurses' responsibility to the public and threats to the health and safety of the community. Florence Nightingale, Lillian Wald, and Margaret Sanger addressed community issues for community health.

The community health nurse is trying to locate information about specific programs of the Office of Disease Prevention and Health Promotion. Which program would provide referrals services for consumers and professionals? A) Healthfinder B) Healthy People C) Healthy Communities, Worksites, and Schools D) National Health Information Center

Ans: D Feedback: Healthfinder is a gateway Web site to link consumers and professionals to Health and Human Services information from the federal govermment. Healthy People was launched in 1979; it guides efforts to identify objectives for the nation. Healthy Communities, Worksites, and Schools is a coalition for healthier cities and communities that focuses on ways that communities can adapt the national Healthy People objectives for local use. National Health Information Center is a central health information service for consumers and professionals.

Which of the following is an overarching goal of Healthy People 2020? A) Developing partnerships between individuals and community health B) Believing that individual health is closely related to community health C) Decreasing disparities among subgroups of the population D) Increasing the length and improving the quality of healthy life

Ans: D Feedback: Healthy People 2020 initiatives are guided by two overarching goals: to increase the length and improve the quality of healthy life; and to eliminate disparities among subgroups of the population.

Self-management programs teach problem-solving skills in addition to health education. Self-management programs are successful in helping clients with chronic diseases such as diabetes mellitus and arthritis to make lifestyle behavior changes that improve pain, fatigue, physical function, and emotions. Which statement is an example of tertiary prevention as it relates to chronic diseases? A) Offering routine blood sugar screenings B) Providing classes on why exercise is important for people with arthritis C) Planning an education program on how to prevent the development of chronic discase D) Participating in a biofeedback program to reduce stress

Ans: D Feedback: Participating in a biofeedback program to reduce stress is classified as tertiary prevention; its goal is to maintain or minimize discase progression or to foster rehabilitation. Offering routine blood sugar screenings, providing classes on why exercise is important for people with arthritis, and planning an education program on how to prevent the development of chronic disease do not directly minimize disease progression.

Empowerment through participation has three essential components to which nurses must be sensitive in order for community transformations to occur. Which statement best describes one of the essential components? A) Shared awareness by members of the health care community B) Mechanisms to mobilize the community to recognize its needs C) Suggest ways to develop a culture of community participation. D) People have the right to choose.

Ans: D Feedback: Participation is an active process, not a process in which one group or organization imposes its values on the community, but a process of mutuality, in which all have voice. Participation involves choice, implying people have the right and the power to make decisions that affect their lives. Decisions made through participation must have the potential to be effective, and there must be social systems to allow decisions to be implemented.

Poisoning occurs through cumulative exposure to insecticides, herbicides, fungicides, and rodenticides. What can happen to the human body as a result of poisoning? A) Alopecia B) Developmental disabilities C) Heart disease D) Respiratory cancer

Ans: D Feedback: Poisons cause sarcomas, lymphomas, myelomas, and respiratory and prostate cancers. Air pollution can cause heart disease. Water pollution can cause developmental disabilities and alopecia,

Pollution of the environment occurs when these pollutants overwhelm the capacity of the environment to assimilate them without being thrown out of balance. Which statement is corect about pollution? A) Pollution is an indirect rate function that is correlated to population size. B) Pollution is a direct rate function that is correlated to the quantity of pollutant. C) Pollution is a rate function involving the quality of pollutant introduced over a period of time. D) Pollution is a rate function involving a quantity of pollutant introduced over a period of time.

Ans: D Feedback: Pollution is a rate function involving a quantity of pollutant introduced over a period of time. This rate is directly correlated to population size.

There is an assumption that adequate health services are a necessary condition for population health. Which statement best represents population health? A) Health behaviors that are embedded in relationships that tie individuals to their family and friends, their neighborhoods, and their communities B) Planning for and implementing an equitable allocation or distribution of available health care resources C) Combination of vital and health statistical data from multiple sources, used to derive information about the health needs, health resources, use of health services, and outcomes by the people in a defined region D) Approach that focuses on interrelated conditions and factors that influence the health of populations over the life course, identifies systematic variations in their patterns of occurrence, and applies the resulting knowledge to policies and actions to improve the health and well-being of those populations

Ans: D Feedback: Population health is an approach that focuses on interrelated conditions and factors that influence the health of populations over the life course, identifies systematic variations in their patterns of occurrence, and applies the resulting knowledge to develop and implement policies and actions to improve the health and well-being of those populations. A classic premise of community health is that the determinants of population health and particularly of health behaviors are embedded in relationships that tie individuals to their family and friends, their neighborhoods, and their communities. Health care rationing is planning for and implementing an equitable allocation or distribution of available health care resources. Health information system is a combination of vital and health statistical data from multiple sources, used to derive information about the health needs, health resources, and use of health services, and outcomes by the people in a defined region.

Most health promotion programs involve lifestyle behavioral changes. What occurs during the precontemplation stage? A) The employee is considering making an effort to change behavior. B) The employee is weighing the pros and cons of change. C) The employee may not know how to make change and considers it impossible. D) The employee is made aware of benefits of change.

Ans: D Feedback: Precontemplation: In this stage, the employee is not even thinking about changing his or her behavior. The goal is to make the person aware of the benefits of change and to get him or her to start thinking about the possibility of change. Contemplation; In this stage, the employee is at least considering making an effort to change his or her behavior. The employee is weighing the pros and the cons. The employee may not know how to change and may consider the change to be almost impossible. The attempt to change is not worth the effort if failure is to occur. The goal is to help the employee identify the benefits and to decide that putting forth an effort to change is worthwhile.

The nursing practice model defines intervention as primary, secondary, and tertiary levels of prevention. Which is an example of primary prevention? A) Tine test for tuberculosis B) Denver Developmental Screening Test for developmental delays C) Community blood pressure sereenings for elderly clients D) Weekly adult exercise and fitness sessions

Ans: D Feedback: Primary prevention improves the health and well-being of the community, making it less vulnerable to stressors. Health-promotion programs are primary prevention, as are programs that focus on protection from specific diseases. Usually health promotion is nonspecific and directed toward raising the general health of the total community, such as conducting adult exercise/fitness. Secondary prevention begins after a disease or condition is present. Emphasis is on screening, early diagnosis, and treatment of possible stressors that may adversely affect the community's health. The tine test for tuberculosis, the Denver Developmental Screening Test for developmental delays, and blood pressure assessments are secondary prevention interventions.

The effects of intimate partner violence spill into the workplace and can affect employment productivity. What is an element of a domestic violence awareness program that addresses primary prevention of intimate partner violence against women? A) Promote employee counseling and intervention. B) Implement domestic violence screening questions on preemployment and annual health examinations. C) Support a company policy with a statement that clearly demonstrates concern and commitment to employees who may be experiencing violence at home. D) Maintain a workplace environment in which all employees, regardless of gender, ethnicity, sexual orientation, or religion, are treated with respect and dignity

Ans: D Feedback: Primary prevention includes maintaining a workplace environment in which all employees, regardless of gender, ethnicity, sexual orientation, or religion, are treated with respect and dignity. Secondary prevention includes promoting employee counseling and intervention; implementing domestic violence screening questions on preemployment and annual health examinations; and supporting a company policy with a statement that clearly demonstrates concem and commitment to employees who may be experiencing violence at home.

The school nurse is developing a program on breast self-examination and testicular self-examination. At which grade level should implementation of this program begin? A) Third grade B) Fifth grade C) Seventh grade D) Ninth grade

Ans: D Feedback: Programs for children and adolescents in the school setting must be age appropriate. Breast self-examination and testicular self-examination are not appropriate material for elementary school children. Breast self-examination/testicular self-examination is appropriate for teen groups in upper grades such as ninth grade. It is critical to assess the developmental and maturity level of the children before deciding on the educational content of a program or a strategy.

According to Quinn, which is the most complete definition of a right-relationship? A) One pattern of organization within the system that supports and encourages actualization at any level. B) Two patterns of organization within the system that support, encourage, and allow actualization and self-transcendence at any level. C) Any pattern of organization within the system that supports, encourages, allows, or generates self-transcendence at any and all levels. D) Any pattern of organization within the system that supports, encourages, allows, or generates actualization and self-transcendence-at any and all levels.

Ans: D Feedback: Quinn (1997) defined right-relationship as "any pattern of organization within the system that supports, encourages, allows, or generates actualization and self-transcendence-at any and all levels."

The community health nurse is evaluating a community health program. What would the nurse be trying to determine when evaluating the reasons for having a program or set of activities? A) Cost efficiency B) Effectiveness C) Progress D) Relevancy

Ans: D Feedback: Relevancy is determined when the reasons for having a program or set of activities are evaluated. Progress answers the question as to whether the program activities are following the intended plan. Cost efficiency evaluation measures the relationship between the results of a program and the costs of presenting the program. Effectiveness focuses on formative evaluation as well as the immediate, short-term results.

Which nurses would be ideal for faith community nursing, if the work is less physically demanding and provides flexibility in the work schedule? A) Ambulatory care B) Critical care C) Nurse practitioner D) Retired

Ans: D Feedback: Retired professional nurses are ideally suited to work as faith community nurses. As the nursing workforce ages, creative ways to maintain an adequate cadre of nurses to meet the health needs of the population are needed. Older nurses are likely to want or need more flexibility in their schedules and work situations that are less physically demanding.

Planned change is a well-thought-out effort designed to make something happen; all efforts are directed and targeted to produce change. According to Reinkemeyer's stages of planned change, in how many stages does specific assessment occur? A) 1 B) 2. C) 3 D) 4

Ans: D Feedback: Stages 1, 2, 6, and 7 involve assessment. Both stages 1 and 2 are completed during the assessment presentations. During stage 6, evaluation involves assessment of whether the planned intervention was effective or not effective, and stage 7 may lead to further assessment, thereby bringing the process full circle.

Which program would the community health nurse recommend for a 6-year-old child whose family carns too much to qualify for Medicaid but needs financial reimbursement for doctors' visits, immunizations, and a possible cemergeney room visit for a suspected broken bone? A) Medicare B) Women, Infants, and Children C) Temporary Assistance to Needy Families D) State Children's Health Insurance Program

Ans: D Feedback: State Children's Health Insurance Program is for children younger than 19 years from families who cam too much to qualify for Medicaid. The Women, Infants, and Children program provides supplemental foods, nutrition education, and referrals to health care. Temporary Assistance to Needy Families provides financial and medical assistance to needy dependent chikdren and parents and relatives with whom they are living. Medicare is a health insurance program for people 65 years or older, disabled people younger than 65 years, and individuals with end-stage renal disease or Lou Gehrig disease.

Which statement made by an older adult client, regarding the client's adjustment to the aging process, poses the greatest concem for the nurse conducting an assessment? A) "I used to enjoy dancing and jogging so much, but now I have arthritis in my knees, so it's hard to even walk." B) "I've given my grandchildren money for college so they can live a better life than I had." C) "Growing old certainly presents all sorts of challenges. I wish I knew then what I know now," D) "As I age l've found it is harder to do the things I love doing, but I guess it will all be over soon enough."

Ans: D Feedback: Stating "I guess it will all be over soon enough" is suggestive of depression. Estimates of depression in older adults living in the community range from less than 1% to S%, but the estimates rise to 13% for those receiving home health care and I1.5% for elderly hospital clients. The other responses show that the client is coping with the challenges of older age.

A community health nurse is participating in a survey. What type of evaluation would the nurse use when looking at the results of a survey? A) Formative B) Outcome C) Process D) Summative

Ans: D Feedback: Surveys are usually performed for summative (impact) evaluation. Impact or summative evaluation is concemed with the immediate impact of a program on a target group.

common concem for homeless people is following medication and treatment regimens. The community health nurse should be vigilant of what common condition among homeless people? A) Frequently medications can be casily refrigerated. B) Difficult-to-follow special dietary restrictions C) Food is allowed in the sleeping area of the shelter. D) Medicine is sold for cash or swapped for benefits.

Ans: D Feedback: The following is a list of common conditions that require your constant awareness as you promote healthy partnerships with homeless people: Frequently, medications cannot be easily refrigerated. It is difficult to follow special dietary restrictions when meals are caten at a shelter. Food is often very salty and high in fat, with limited fruits and vegetables. It is important for nurses to learn about food served at shelters and day centers. Ask if you might stay for a meal. Food may not be allowed in the sleeping areas at the shelter, so taking medication along with food may not be possible. Sometimes, medicine is swapped or sold for cash or people are assaulted for the medicine. Counsel those in the shelter as to where medicines may be safely stored. Often people who are homeless will request vitamins to compensate for nutritional deficits.

An infectious agent that has invaded its host and found conditions hospitable will replicate until it can be shed. Which indicates that an infection is in the incubation period? A) Shed pathogens without any disease symptoms B) Before shed of pathogens C) Shed of the pathogen agent D) Discase symptoms first appear.

Ans: D Feedback: The incubation period refers to the time of invasion to the time when disease symptoms first appear. A carrier is an individual who sheds pathogens without any disease symptoms. The period of replication before shedding of pathogens is called the latent period. The communicable period begins with the shedding of the pathogen agent.

There is often an impatience and eagerness associated with new programs, often forgetting the initial reason for implementing the program was to improve health. Considering this, when evaluating the overall effectiveness of the program, the nurse must consider which of the following? A) How many participated in the program B) Short-term health improvements C) Public marketing within the community D) Sustainability of the lifestyle change

Ans: D Feedback: The initial reason for implementing a new program, improvement of health, is often forgotten in the excitement of the new program. Considering that fact, sustainability of the lifestyle change is the primary criteria for evaluating success. How many participate, short-term health improvements, and public marketing are parts of the implementation process but will not affect the long-term health of the participants unless there is sustainability of the program.

There are several nursing interventions that can be used to decrease environmental influences on health. How can a nurse use tertiary prevention to keep the environment clean? A) Decrease environmental pollution. B) Educate the community on how to keep the environment clean C) Involvement with political actions that provide strategies to minimize environmental exposure in populations. D) Help communities to manage the long-term effects of conditions that are caused by environmental hazards.

Ans: D Feedback: The nurse can use tertiary prevention to keep the environment elean by helping communities to manage the long-term effects of conditions that are caused by environmental hazards. The nurse can use secondary prevention to keep the environment elean by decreasing environmental pollution. The nurse can use primary prevention to keep the environment clean by educating the community on how to keep the environment clean and involvement with political actions that provide strategies to minimize environmental exposure in populations.

Refugees and immigrants typically experience three phases as they assimilate into the country of destination, with each phase having specific health care implications. What phase is connected to how well the immigrant or refugee assimilates into the American culture? A) Acute B) Primary C) Transition D) Resolution

Ans: D Feedback: The resolution phase is connected to how well the immigrant or refugee assimilates into the American culture. Refugees and immigrants typically experience three phases as they assimilate into the country of destination, with each phase having specific health care implications. The phases are an acute period (the immediate arrival in the new country), followed by a time of transition, and a resolution or chronie phase.

Each cultural health care system has several recognized sectors. Select the answer that best represents Kleinman's model. A) Cultural health care system B) Popular and cultural health care system C) Folk, personal, professional D) Folk, popular, professional

Ans: D Feedback: The three sectors Kleinman's model of the health care system addresses are referred to as popular, folk, and professional.

With help from the Maine Office of Substance Abuse, county educators, law enforcement, and public health leaders determined that if they could change student attitudes, they could begin to address youth drinking. What did the approach address? A) Norms and accessibility B) Norms and enforcement C) Accessibility, availability, and enforcement D) Norms, availability, and enforcement

Ans: D Feedback: Their three-pronged approach included addressing norms (what is acceptable in the community), availability, and enforcement. Enforcement was a critical part of this plan because it would include not only reducing teen's access to alcohol, but also communicating.

Treatment for disaster victims depends on the type of emergency or disaster, scene safety, and resources needed and available. The client has a triage classification of yellow, What is the client's care priority? A) Comfort care B) Delaved care C) Immediate care D) Urgent care

Ans: D Feedback: Triage classification for care by color is as follows: green, delayed care; vellow, urgent care: red, immediate care; and black, no care and comfort care.

Which sector of Kleinman's model differs in their social and cultural values, beliefs, and assumptions? A) Cultural health system B) Folk C) Popular D) Professional

Ans: D Feedback: Unlike in the popular and folk sectors, the clients and the providers in the professional sector typically differ in their social and cultural values, beliefs, and assumptions.

The American Nurses Association legislative initiatives include issues of access, cost, and quality of care. Which is an example of a quality of care initiative? A) Access to health coverage B) Appropriate nursing staffing C) Advanced practice nursing coverage D) Medical malpractice liability and tort reform

Feedback: Adequate and appropriate nurse staffing is an example of a quality of care initiative. Access to health coverage is an example of an access to care initiative. Advanced practice nurse coverage and medical malpractice liability tort reform are examples of cost of care initiatives.

Most health promotion programs involve lifestyle behavioral changes. What action would indicate the employee is in the maintenance stage? A) The employee is observed practicing the new behaviors. B) The employee is sharing the newly learned behavior with coworkers. C) The employee is hesitant and needs support, incentives, and sincere encouragement. D) The employee states new behavior requires a lot of effort and is afraid of relapsing.

Ans: Feedback: Action: At this stage, the employee is practicing the new behavior; however, it is not yet incorporated into his or her lifestyle. The new behavior requires lots of effort, which leaves the employee at risk for relapsing to the old behavior. The employee needs support, incentives, and sincere encouragement. Maintenance: The new behavior is ingrained in the lifestyle behaviors. A crisis or major stressor at work or personal life can become the impetus to revert to the previous behavior. The employee needs reinforcement, support, and opportunities to practice the new behavior. The employee benefits by sharing the newly learned behavior.

Human ecology is influenced by other factors. To more fully understand human ecology, one must study which links? A) Pollution and space B) Human activities and the environment C) All external conditions and influences affecting life D) Complete physical, mental, and social well-being interacting within the environment

B Feedback: No one person or community is an independent entity. Each is intimately linked to the environment, frequently in ways never imagined. Thus, the environment influences health, directly and indirectly, through subtle, indirect pathways. Conversely, human activities affect the health of the environmental system. One aspect of human ecology is the study of these linkages.

A nurse has been hired to be the parish nurse in a new church community. Which is the best strategy for identifying the needs of this faith community? A) Distribute an educational needs survey to the women's auxiliary. B) Attend meetings for the representative different groups. C) Form an ad hoc committee with formal leaders to study the health ministry. D) Make decisions with input from the local community.

B Feedback: Some strategies for identifying faith community needs include attend meetings for the different groups; distribute an educational needs survey to various groups within the faith community, not just one segment; form an ad hoc committee to study the health ministry with both formal and informal leaders; and remember to only make decisions with input from the faith community.

Validating community nursing diagnoses with community residents is an important step for establishing and maintaining a partnership. Which is a key principle that the community health nurse needs to keep in mind about this partnership? A) Community leaders cannot have access to confidential privileged information. B) Community organizations have the right to choose not to participate in health planning. C) Community residents have the right not to identify their own bealth needs, D) Community leaders and organizations are not involved in negotiation of specific programs,

B Feedback: Validating community nursing diagnoses with the community residents is an important step for establishing and maintaining the partnership. Equally important is the right of community leaders, organizations, and residents to confidentiality of privileged information and the right to choose not to participate in health planning. Communities have the right to identify their own health needs and negotiate with the community health nurse with regard to interventions and specific programs.

As in other areas of community health practice, disaster management has its own terminology and classification schemes. Which describes vulnerabilities? A) Normal conditions of existence are disrupted, and the level of suffering exceeds the capacity of the hazard-affected community to respond to it. B) Social, economic, physical, or environmental factors that increase individual or community susceptibility to the effects of hazards or that inhibit ability to expect, manage, or recover from a disaster C) The potential exists to cause disruption or damage to the community (e.g., earthquake, flood, typhoon, or cyclone). D) A vast ecological breakdown in the relation between humans and their environment: a serious or sudden event on such a scale that the stricken community needs extraordinary efforts to cope, often with outside or international aid

B Feedback: Vulnerabilities are social, economic, physical, or environmental factors that increase individual or community susceptibility to the effects of hazards or that inhibit ability to expect, manage, or recover from a disaster. Disaster occurs as a result of an event where normal conditions of existence are disrupted, and the level of suffering exceeds the capacity of the hazard-affected community to respond to it. A vast ecological breakdown occurs when, in the relation between humans and their environment, a serious or sudden event happens on such a scale that the stricken community needs extraordinary efforts to cope with it, often with outside or international aid. A hazard occurs when an event has the potential to cause disruption or damage to the community (e.g., carthquake, flood, typhoon, or cyclone).

There are common definitions of rural and urban areas in this country. What would the nurse expect when an area is defined as urban clusters by the U.S. Burcau of the Census? A) Nonadjacent blocks of less than 2,000 people B) Populations of 2,500 people not adjacent to urbanized areas C) Census blocks of 25,000 people in urbanized areas D) Combined census blocks of 50,000 people

B Feedback: When these census blocks are combined with adjacent blocks so as to encompass a population of at least 50,000 people, it is called an "urbanized area." The Census Bureau also identifies "urban clusters" as places that meet the population density threshold and have at least 2,500 people but are not adjacent to an urbanized area. Many small rural towns are considered urban clusters by this definition, and as a result, few federal programs that are intended to assist rural populations rely on this definition.

Which is one step a community health nurse can take to stay informed on current issues? A) Identify government representatives about issues. B) Provide nursing expertise as policies are being designed. C) Be an advocate by speaking out for those who cannot speak for themselves. D) Read the local newspaper with attention to local community issues.

D Feedback: Reading the local newspaper with attention to local community issues is an excellent way to stay informed. Most government websites have links to enable constituents to identify their representatives and provide addresses and phone numbers for contacting representatives. Nurses as professionals also may choose to provide nursing expertise as policies and programs are being designed and to work with coalitions who have similar interests in the issues. Community health nurses can also be advocates for the people with whom they work. Being an advocate involves speaking for those who cannot speak for themselves.

When using the MAP-IT process, which activity will the nurse perform last? A) A coalition of individuals in the faith community is provided with a progress report. B) Progress in all areas of greatest need in the faith community is reviewed. C) Concrete action steps that can be monitored and make a difference are implemented. D) Progress of the individual health program over time is mapped.

D Feedback: The activities of the MAP-IT Strategy for creating a health community are performed in the following order: M, mobilize; A, assess; P, plan; I, implement; T, track.

A community health nurse is taking care of a client in the community who has severe diarrhea. A nursing diagnosis of fluid volume deficit related to active fluid loss as manifested by diarrhea has been identified for this client, What is an appropriately written mecasurable goal for this diagnosis? A) The client will understand the importance of drinking more fluids by tomorrow. B) The client will have fewer episodes of diarrhea in 24 hours. C) The client will be aware that moist mucous membranes indicate resolution of fluid volume deficit. D) The client will increase fluid intake to at least 1,500 ml. within I day.

D Feedback: The written goal must be specific with observable outcomes in order for the community health nurse to evaluate progress. Modifiers such as know, aware, and realize are less precise terms that have many interpretations. To increase or decrease by a specific percentage is a more precise term that has fewer interpretations. Each goal and objective should include a time frame for attaining the change (e.g., "By June 15th ."), the direction and magnitude of the change (e.g. "Increase immunization levels to 95%"); the method of measuring the change (e.g., "After the session, cach participant will demonstrate_").

Childhood obesity rates in the United States are on the rise, and the immediate and long-term medical and social consequences of childhood obesity are staggering. During the past four decades, rates have consistently increased. Which population has the highest childhood obesity rates and would be the best population to begin interventions to help curb obesity? A) Middle income groups B) Upper socioeconomic groups C) Low-income groups D) Lower middle class

Feedback: Childhood obesity rates in the United States are on the rise, and the immediate and long-term medical and social consequences of childhood obesity are staggering. During the past four decades, rates have consistently increased, and today more than 33% of children and adolescents are overweight or obese in this country. Childhood obesity rates are highest among low-income populations and also among racial'ethnic minorities. Research has demonstrated that this trend also applies to rural youth, where the prevalence of obesity and overweight has been shown to be higher than state and national averages and also higher than rates among youth in urban areas.

A nurse is designing and planning to implement a health promotion program in partnership with local faith communities. Which community planning guide would be helpful? A) Creative Nursing Journal B) Faith Community Nursing: Developing a Quality Practice C) International Journal for Human Caring D) Journal of Holistic Nursing

Feedback: Faith Community Niursing: Developing a Quality Practice is a guide to faith community nursing that provides practical tips for maintaining a quality health ministry program. In Creative Nursing Journal, a quarterly publication based on values, issues, experiences, and collaboration, nurses are encouraged to think creatively and take risks. Journal of Holistic Nursing integrates holistic bealth concepts of body, mind, emotions, and spirit within the context of a changing environment and is published quarterly. International Journal for Human Caring is published three times a year and focuses on the knowledge of care and caregiving within the discipline of nursing and in collaboration with other disciplines.

How can the nurse implement the environmental concept emphasized by Florence Nightingale? A) Use antibioties to help cure diseases. B) Use climate control devices for comfort. C) Keep the client and environment clean. D) Keep insects away through use of insecticides.

Feedback: Florence Nightingale emphasized the importance of clean and safe enviroments for proper recovery to health. Her emphasis was on pure air, pure water, efficient drainage, cleanliness, and light. Keeping the client and environment clean uses the concepts she emphasized.

Which of the following is a human health hazard that can result from ionizing radiation? A) Birth defects B) Fatigue C) Headache D) Hepatic system damage

Feedback: Health hazards to humans from ionizing radiation include birth defects; increased rates of cancer, stroke, diabetes, cardiovascular, renal disease; and immune system damage. Nonionizing radiation leaks from microwave ovens that have improperly fitted seals can cause fatigue and headache.

The evaluation process provides an opportunity to determine the outcomes derived by the health promotion program and directs improvement of employee health services. The occupational health nurse is focused on whether the program leads to positive outcomes, What type of evaluation is being used? A) Outcome B) Process C) Program D) Structural

Feedback: Outcome evaluation focuses on the following: (1) whether or not expected goals and objectives achieved; (2) determining whether the program led to positive outcomes; (3) determining whether the health outcomes demonstrate prevention of illness/injury, increase compliance, increase employees' self-care knowledge, restore function, or relieve discomfort; (4) determining bow program benefits compare to program costs; and (5) determining satisfaction (of employees, employers, dependents) with the quality of health promotion services received. Structural evaluation involves the following: (1) reviewing the mechanism for reporting to management and the support given to the health promotion program; (2) determining whether the physical facilities were adequate for the program; (3) identifying equipment and supplies used; (4) identifying staffing requirements and their qualifications; (5) analyzing employee demographics and their health status needs; and (6) determining whether the program mission, goals, and objectives were formulated to meet both the health needs of the employee and the business needs of the employer. Process evaluation addresses the following: (1) whether the health promotion activity was appropriate for the setting: (2) whether the health promotion program was designed to meet workplace needs (you can measure against the initial nceds assessment); and (3) whether there was documentation and record keeping.

There is a vast array of definitions of "rural." When looking at health planning and policy, what agency would be the most helpful to the nurse? A) Institute of Medicine B) U.S. Office of Technology Assessment C) U.S. Bureau of the Census D) White House Office of Management and Budget

Feedback: The most commonly used definitions of rural come from two federal agencies: the U.S. Bureau of the Census and the White House Office of Management and Budget. The White House Office of Management and Budget definition has been widely used for health planning and policy because it is based on whole counties, and most of our public health data are available at the county level. The OMB approach is primarily concemcd with identifying metropolitan areas (sometimes referred to as metropolitan statistical areas), which consist of one or more "urban core" counties and the surrounding counties that are economically tied to the core.

The community health murse is reviewing the needs of vulnerable groups in the community. To focus more specifically, what group would be the best representation of a vulnerable population? A) Men B) Caucasians C) Heterosexuals D) Individuals with HIV/AIDS

nurse asks Ans: D Feedback: Vulnerable groups in a review of five decades of nursing research included people of color; the poor, and those individuals marginalized by sexual preference, immigrant/refugee status, and religious beliefs. Vulnerable groups, including minorities, women, children, and those with disabilities, are more susceptible to infectious discases, especially HIV/AIDS and sexually transmitted infections (STIS). Individuals or groups who live on the fringes or margins of society, lack key resources, and are most often underserved or not served at all, particularly in health care systems, are considered marginalized. Included among marginalized groups are the homeless, immigrants, migrants, and those with chronic disabilities.