Chapter 15: Health in the Global Community, Chapter 30: School Health, Chapter 31: Occupational Health, Chapter 32: Forensic and Correctional Nursing, Chapter 33: Faith Community Nursing, Chapter 1: Health: A Community View, Chapter 03: Thinking Upst...

On which of the following levels of care do most faith community nurses (FCNs) focus? a. Hospice care b. Primary c. Secondary d. Tertiary

ANS: B The FCN practice focuses on health promotion and wellness, which is primary intervention. It holds the spiritual dimension central to health and healing within the context of the faith community.

What factors are most responsible for the increasing length of life of Americans over the past 100 years? a. Better nutrition and family planning options b. Education concerning the need to reduce salt and fat in the diet c. Improved medical care, including exciting new technologies d. More efficient cancer screenings and early intervention

ANS: A Average increased life span over the past 100 years can be largely attributed to higher standards of living, better nutrition, a healthier environment, and having fewer children. Public health efforts such as immunization and medical care have also contributed.

Which of the following levels of government primarily establishes regulations and provides funding for health care? a. Federal government b. Local health departments c. Regional health districts d. State health departments

ANS: A The federal government has been assuming a larger role in the protection of the population through regulation and funding. Local health departments establish local health codes, fund public hospitals, and provide services to populations at risk who often lack health insurance. State health departments are highly dependent on the federal level of resources and guidance. Regional health districts are not used as a level of government in the United States.

A nurse is employed by the state nursing association to serve as a lobbyist. Which of the following would be the most crucial task to achieve? a. Be seen as a reliable and credible source of accurate information b. Convince colleagues in nursing to join their local nursing organization and write to encourage legislators to vote according to nurses' goals c. Offer to make large donations to the legislator who can forward nursing's agenda d. Visit every single legislator so the nurse is recognized in this role

ANS: A An individual who establishes a reputation as a reliable and accurate resource as a lobbyist has substantial influence. Certainly, it is also useful to convince colleagues to join nursing organizations and write legislators or contribute to campaigns of legislators supportive of nursing goals. Legislators rely on lobbyists to educate them on issues. The official must trust the lobbyists to give accurate (though predictably biased) information, which is timely and up to date.

In what way is the U.S. approach to primary health care inconsistent with the World Health Organization (WHO) approach? a. Our primary health care system does not provide universal coverage to all citizens. b. Most U.S. citizens can afford health care through employer insurance plans. c. Tertiary care is preferred over primary care. d. U.S. hospitals make maximum use of the newest and best technology.

ANS: A As a market-based society, the United States does not focus on primary health care and does not provide coverage to all U.S. citizens. Few managed care models propose universal access or the comprehensive primary health care that WHO, U.S. President Barack Obama, and the late Senator Edward Kennedy advocate.

Which of the following is the basis for any American citizen to feel comfortable expressing an opinion on a political issue? a. Amendments to the Constitution b. Articles of the Constitution of the United States c. Declaration of Independence d. Gettysburg Address

ANS: A Amendments to the Constitution, later known as the Bill of Rights, were added after the original Articles of the Constitution were ratified. These amendments protect individuals' rights and freedoms. The Declaration of Independence announced the freedom of America from the British Empire. The Gettysburg Address was a speech given by President Abraham Lincoln following the Civil War.

A forensic nurse is responsible for conducting a thorough examination, including a history, performing a physical assessment, and collecting forensic evidence on a female client following a rape. In which of the following subspecialties of forensic nursing is this nurse practicing? a. Sexual assault nurse examiner (SANE) b. Nurse coroner c. Legal nurse consultant d. Forensic nurse death investigator

ANS: A A SANE is a specially trained registered nurse who applies the nursing process during forensic examinations to victims or perpetrators of sexual assault. The SANE collects forensic evidence related to a reported crime and frequently testifies as an expert witness at subsequent trials. If the client is medically stable, the SANE is responsible for conducting a thorough examination, including obtaining a history, performing the physical assessment, and collecting forensic evidence. The nurse coroner would be responsible for ensuring that appropriate measures were taken to perform death investigations and certify death certificates. Legal nurse consultants provide assistance within the legal system using specialized nursing knowledge and expertise when interactions of law and health issues arise. The forensic nurse death investigator evaluates the death scene from a holistic nursing perspective and might interpret the scene differently.

What was the poverty guideline for a family of four in mainland United States in 2013? a. Below $23,550 b. Below $25,250 c. Below $28,550 d. Below $32,250

ANS: A A four-person household must make less than $23,550 to be considered under the poverty guideline according to the U.S. Department of Health and Human Services.

Which of the following groups makes up about 30% of the world's population? a. Children b. Elderly c. Teenaged adolescents d. Caucasians

ANS: A According to the World Health Organization, in 2007, 30% of the world population consisted of children and 8% of the population were over age 60. The percentage of teenaged adolescents and Caucasians is not reported in the text.

Which of the following is the most commonly used drug among children and adolescents in the United States? a. Alcohol b. Marijuana c. Methamphetamine d. Cocaine e. Steroids

ANS: A All 50 states and the District of Columbia have outlawed the sale of alcohol to anyone under the age of 21 years, yet it is still the most commonly used drug among children and adolescents. Marijuana is the most commonly used illicit drug in the United States. The use of other illegal drugs in high school students includes cocaine (6.8%), inhalants (11.4%), heroin (2.9%), methamphetamine, (3.8%) and steroids (3.6%).

A community health nurse is overwhelmed with all that needs to be done in one day. Which task could most easily be postponed? a. Reviewing the most recent hospital patient data collected by the local college of nursing b. Deciding which of several possible new clinic options would be most effective in better meeting the needs of the local community c. Evaluating the results of the most recent community-wide screening program before planning for the next community health program d. Giving testimony to the state legislature on a new health and safety bill

ANS: A All of the tasks are related to assessing needs, implementing new care options, or evaluating health outcomes measures in the community except reviewing hospital patient data. Hospital patient data may be helpful but not directly related to the agency's ability to promote primary health and prevent disease.

10. Which of the following advanced nurses does not have advanced education in a clinical specialty? a. Clinical nurse leader b. Clinical nurse specialist c. Nurse midwife d. Nurse practitioner

ANS: A All the nurses have advanced education in some aspect of clinical care, such as obstetrics or primary care. However, the clinical nurse leader is a manager of care at some point of care and does not have a clinical specialty.

Which of the following statements best summarizes all of the changes resulting from attempts to control costs? a. Conflict between providers, patients, employers, and insurance plans raged. b. Costs were controlled, at least temporarily. c. Demand for health care drastically dropped. d. Most employers discontinued their insurance plans for employees.

ANS: A All these changes resulted in conflicts among providers, patients, employers, and the insurance plans, particularly when services deemed necessary by the consumer and provider were denied insurance coverage. Everyone blamed everyone else. This did not allow for costs to be controlled, impact the demand for health care, or cause employers to discontinue their insurance plans for employees.

Which of the following best describes how the federal government determines which projects are awarded special funding for health care? a. Those that are consistent with societal priorities, such as 2020 Health Objectives b. Those that are supported by legislators c. Those that are written by health care organizations that have special needs d. Those that are consistent with the state's long-term health goals

ANS: A Allocation of federal resources is based on societal priorities, such as the 2020 Health Objectives. Legislative priority, priority within health care organizations, and priority within individual states are not as important for federal funding as the societal priorities outlined in Healthy People 2020.

Which of the following best describes the primary purpose of nursing theory? a. To improve nursing practice b. To demonstrate that nursing is a profession c. To organize nursing knowledge d. To serve as a basis for ongoing nursing research

ANS: A Although nursing theory does serve as a basis for ongoing research, does help demonstrate that nursing is a profession, and may help nurses organize their knowledge, its primary purpose is to improve nursing practice.

Which of the following statements best describes the message that public health leaders are trying to emphasize to the public? a. Assume responsibility for your own health by choosing healthy behaviors b. Have a primary physician and get yearly checkups c. Obtain immunizations and screenings when they are offered d. Support legislative efforts to improve our medical care system

ANS: A Although there are many public health messages in the media, from quitting smoking to getting a checkup, the primary message currently being emphasized by public health, as well as all the media coverage of the constantly increasing cost for health care, is for each person to take responsibility for his or her own health through choosing healthy lifestyle behaviors. Supporting legislative efforts is not as important as the need for individuals to take responsiblity for their own health.

Which of the following statements best describes why nurses should contribute whenever possible to their state nursing association political action committee (PAC)? a. As PACs are a reality of political life, nursing needs to be heard. b. Contributing money may result in a future political appointment. c. Only money really has any influence on legislative votes. d. PACs are being used to increase nursing salaries and working conditions.

ANS: A Because PACs are a reality of political life, nurses need to recognize their power and support those that are committed to electing candidates sympathetic to health care issues. The contribution of money will support the current nursing practice initiatives which will change as nursing practice changes. These contributions will most likely not have any relationship to a future political appointment. Legislative votes are influenced by a variety of factors and are not limited only to money.

A nurse works hard to develop alliances among various community organizations toward improving health in the community. What are actions such as this called? a. Building coalitions b. Collaboration c. Communication d. Community cooperation

ANS: A By definition, the nurse's actions are coalition building. Although collaboration has a very similar meaning, Table 1-4 stresses that collaboration is focused more on enhancing the capacity of an individual or a group. The nurse is establishing cooperative alliances, but not yet working with them toward a goal.

Which of the following best describes a carve-out service? a. A particular service that is offered only by a designated provider or group. b. A particular procedure that receives limited reimbursement. c. A particular treatment is not allowed within a particular diagnosis. d. A particular prescription drug that is only available to those with certain conditions.

ANS: A Carve-out services might be designated for those who need the services the least. A carve-out service (for example, mental health care) is provided within a standard benefit package but delivered exclusively by a designated provider or group. The other definitions do not correctly describe a carve-out service.

Which of the following nongovernment organizations (NGOs) is active in improving health on a global scale? a. Carter Center b. Centers for Disease Control and Prevention (CDC) c. Pan American Health Organization d. UNICEF

ANS: A Collaborating with the United Nations are NGOs such as the Carter Center. The CDC is a governmental agency. The Pan American Health Organization is an international public health agency. UNICEF is an international agency.

Which of the following ethical issues is often a concern to a faith community nurse (FCN)? a. The client's right to confidentiality if a client repents and confesses sin to the nurse b. Following the Health Insurance Portability and Accountability Act (HIPAA) requirements c. The nurse's legal responsibility to the faith community leader d. Setting up appropriate medical records of care given in case of a later legal suit

ANS: A Confidentiality issues have the potential to be problematic in a church community. Church members can ask how someone is doing. Another church member would respond with whatever they have heard. The FCN cannot respond in an equally open way but must maintain confidentiality. In the role of health minister, the parish nurse may receive private and sensitive information. Congregation members should not relate information in the form of confession or repentance; however, the connection with the church ministry team may put the nurse in a position to hear this type of sensitive information. The nurse must protect the client's right to confidentiality. The nurse should share confidential information with other church ministry leaders (or prayer groups) only when given permission by the client. FCN programs within faith communities generally are not required to follow HIPAA guidelines related to medical records and confidentiality because churches are not in the category of identified health care providers.

Which of the following strategies should be used to lower the risk of malaria among the world's population? a. Distribute insecticide-treated nets and antimalarial medications b. Educate people to keep their windows closed at night c. Spray neighborhoods with insecticides to kill any mosquitoes present d. Spread DDT on bodies of water to prevent larva growth

ANS: A Effective low-cost strategies are available for malaria's prevention, treatment, and control, including insecticide-treated nets and new-generation medications such as artemisinin-based combination therapies. It would be very dangerous to spray neighborhoods with insecticides, which also contaminate food. DDT has been banned in the United States for many years because of its long-term harmful effects on the environment, including food animals. Keeping the windows closed at night is not going to prevent the threat that occurs during other times of the day.

Which of the following conclusions can be drawn from reviewing how health care costs are spread over a person's lifetime? a. Health care expenditures increase with age. b. Premature newborns incur more costs than other children from birth through adulthood. c. The majority of cost is incurred during middle age when chronic diseases strike. d. Persons aged 85 years and above spend the most money on health care.

ANS: A Expenditures increase with age. About one third of costs are incurred during middle age; half during the senior years; and, for those older than 85 years, one third of their lifetime costs occurs during their last year of life.

Which of the following symptoms would the faith community nurse (FCN) expect to see when caring for a client with the diagnosis of spiritual distress? a. Hopelessness, isolation, and loneliness b. Intense need for prayer and support c. Loss of faith d. Withdrawal from stress and the environment

ANS: A FCNs provide nursing interventions related to the nursing diagnosis as connected to spiritual distress (e.g., loneliness, isolation, and hopelessness).

A woman who spoke English was an immigrant from the Middle East, attending the clinic for the first time with two female friends. When a male nurse attempted to get a health history, the woman refused to respond to his questions. Which of the following actions should be taken by the nurse? a. Ask a female nurse to talk with the client b. Ensure that the client has privacy, with the two female friends waiting outside before trying again c. Explain that the woman cannot see a physician until the nurse obtains a health history and does an initial examination d. Stress that the clinic is free and she does not have to pay extra to see both the nurse and the physician

ANS: A He should ask a female nurse to talk with the client. Many culture groups have strong norms regarding appropriate gender behavior. Norms are the rules by which human behavior is governed and result from the cultural values held by the group. All societies have rules or norms that specify appropriate and inappropriate behavior. Individuals are rewarded or punished as they conform to, or deviate from, the established norms. Thus, this woman is likely to not deviate from these cultural norms and should be given the opportunity to speak with a female nurse. The other responses do not address the cultural needs regarding gender that this client needs to have addressed.

Which of the following best describes how hospitals initially coped when Medicare reimbursement became based on diagnosis-related groups (DRGs)? a. Charged more for patients whose care was paid by insurance b. Decreased nursing staff to cut labor costs c. Lobbied politicians to increase Medicare reimbursement to reflect actual costs d. Refused to accept Medicare patients

ANS: A Hospitals developed cost shifting to supplement losses caused by Medicare funding. Because private insurance reimbursements were cost based, hospitals included the loss in their total costs; therefore private insurance paid for covering care to both their enrollees and Medicare patients. The implementation of DRGs did not cause hospitals to decrease nursing staff, lobby politicians to increase Medicare reimbursement, or refuse to accept Medicare patients.

Who primarily provides care for military personnel, their families, and veterans, as well as Native Americans? a. Federal government b. Local health departments c. Regional health districts d. State health departments

ANS: A The federal government is responsible for the health care of specified populations including military personnel, their families, and veterans. The federal government also is responsible for health care for Native Americans. Local health departments and state health departments are not the primary provider of care for these populations. Regional health districts are not used to provide care for these populations.

A principal called the school nurse into his office and asked, "Will this student be able to attend our school?" after handing over the medical record of a severely handicapped prospective student. Which of the following would be the most appropriate response by the nurse? a. "Legally all students have a right to public education in the least restrictive environment possible, so let me think how we can manage." b. "The student clearly won't be comfortable here; other students can be so cruel. Let me talk to the student's family." c. "There are schools that specialize in the care of the severely handicapped. Let me get in touch to see if one of those schools has the needed resources." d. "This student is so handicapped there is no way to manage the needed care; the family needs a home schooling teacher."

ANS: A In 1976, Public Law 99-142 was enacted, giving all students, including those who are severely handicapped, the right to public education in the least restrictive environment possible, regardless of mental or physical disabilities. The Education for All Handicapped Children Act of 1973 and the subsequent Individuals with Disabilities Education Act of 1990 enhanced the opportunities for children previously served in acute care and long-term care settings to have access to public education.

The school nurse only had the resources for one education program for all the schools' teachers and support staff. Which of the following topics would be the most important to address in this program? a. Asthma b. Diabetes c. Epilepsy d. Measles and mumps

ANS: A In 2011, 9.6 % of children under the age of 18 had asthma, occurring most often among poor (13.5%) and non-Hispanic black children (17%). Asthma is one of the most common chronic childhood conditions, causing more than 4.6 million people to miss more than 1 day of school or work (CDC, 2011d). Because asthma is so prevalent, it is recommended that school-based support exists. Actions undertaken by some schools across the country include immediate access to asthma medications, development and implementation of asthma action plans, and student and staff education on asthma. Because of the severity and prevalence of asthma, this is the most important topic to address and should be addressed instead of diabetes, epilepsy, or measles and mumps.

Which of the following are most likely to physically abuse elderly Americans? a. A partner or spouse b. A caregiver c. A stranger d. An adult child

ANS: A In a study by Acierno et al. (2009), 1.6% of subjects report physical mistreatment, with family members accounting for 76% of the mistreatment, and specifically 57% was conducted by a partner or spouse.

Which of the following has been a common result in countries with a severe HIV/AIDS epidemic? a. Birth rate is high, but life expectancy is only 35 to 40 years. b. Free clinics have begun distributing condoms to stop the spread. c. International aid has begun to lower the infection rates. d. Missionaries are establishing orphanages within their churches.

ANS: A In countries severely affected by the HIV/AIDS epidemic, life expectancy has dropped to 35 to 40 years. In these countries, the working age population has dwindled while the birth rate has risen. International aid, orphanages, and condom distribution may be present in these countries; however, the main problem is that the birth rate is high and life expectancy is short.

As a health advocate, which of the following does the faith community nurse (FCN) need to know? a. Community resources available in the community b. Educational needs of the community c. Recruitment strategies d. Understanding of spirituality

ANS: A In the role of health advocate, the FCN facilitates clients' efforts in obtaining needed health services. The FCN uses referral skills and knowledge of community resources to guide individuals as they access available resources. The nurse may, with the client's approval, provide referrals to resources. The FCN recognizes the difficulties encountered by vulnerable populations within the faith community and helps them maneuver the health care maze to access needed resources. Knowing the educational needs of the community is necessary for the FCN to fulfill the role of health educator. As the coordinator of volunteers, the FCN should be aware of how to recruit, train, and direct volunteers to work with the FCN program or health ministry. It is necessary for the FCN to understand spirituality in order to effectively fulfill the role of integrator of health and healing.

Which variable has a major influence on a community's health? a. Behavior choices made by persons in the community b. Number of health care providers and hospitals in the community c. Quality of the public safety officers (police officers, firefighters, etc.) d. The number and credentials of public health officials in the community

ANS: A Individual behavior choices and environmental factors are responsible for about 70% of health outcomes. Individual choices are affected through interaction with other individuals, and their mutual social and physical environments. Health care providers are responsible for only 10% of the outcome. The quality of public safety officers and number of public health officials have not been identified as major contributors to the determinants of health.

A nurse established a new parent support group where new parents meet to share problems and solutions. After about 3 months, fewer people were attending. Which of the following actions should the nurse take next? a. Accept that the new parents may now be comfortable in their role and no longer need a support group b. Bring in outside experts to give presentations on specific infancy development issues c. Change the format of the group meetings to include more time for socialization d. Suggest an ongoing educational program on infant and child development to renew interest in attending the group

ANS: A It is also important to remember that groups usually have an anticipated "life expectancy." After the needs of the groups are met through education or support, there may no longer be a need for a particular support group. The FCN should document the history of the group and move forward toward new goals.

A school health nurse was concerned about the diagnosed eating disorders of three high school students. A nutrition and body image program was planned. Which of the following classes should receive the program first? a. Elementary school grades 4, 5, and 6 b. Grades 7, 8, and 9 c. High school grades 10, 11, and 12 d. Kindergarten students

ANS: A It is imperative that the school nurse recognize the association between feelings of inadequacy (e.g., low self-esteem, anger, anxiety, and depression) and unhealthy eating practices in adolescents and young people. These self-perceptions begin early in life; therefore education and counseling must begin in elementary school. This program would be offered too early for kindergarten students and too late for grades 7 through 12. Thus, the priority population would be the elementary school children.

Which of the following best describes what was done by large industrial giants to stop the constant increase in their costs for health insurance for their employees? a. Assembled their own health care programs b. Established health promotion programs that employees were required to attend c. Signed only certain providers to give care at a reduced rate in exchange for so many new patients d. Suggested that employees seek only the most necessary services

ANS: A Large industrial giants, such as Kaiser Permanente, decided to assemble their own health care programs. They built hospitals, hired physicians, and provided health care services to their employees. In an effort to market this concept, the phrase health maintenance organization was created. These organizations were designed to provide comprehensive care to employees. As these large health care programs were established, enrollees had limited freedom of choice. Preventive care was covered and encouraged, but care was somewhat restricted, and care providers were encouraged to reduce costs by providing only the most necessary services.

In a client's culture it is exceedingly rude to ask any questions about income or wealth. Which of the following actions should be taken by the nurse to draw conclusions about the client's socioeconomic status (SES)? a. Ask about the client's education or employment position b. Ask his or her religious leader to share such information with the nurse c. Let the financial office deal with the problem d. Refer the issue to the social worker who has better sources of information

ANS: A SES may be determined by examining income, occupation, and educational level. If that is not possible, age, gender, possessions, location of residence, religion, and race may also be considered.

A nurse is called by a friend who complains of symptoms of a cold. Which of the following responses would be the most appropriate by the nurse? a. Ask the friend what she usually does for a cold and suggest that be done b. Tell her to go to the urgent care center for assistance c. Suggest that she make an appointment to see her health care provider d. Point out to her that nurses are unable to treat patients

ANS: A Seventy percent to 90% of all illness episodes are treated first, or exclusively, through self-care, often with significant success. Symptoms of a cold do not seem to require drastic action such as going to the urgent care center or seeing a health care provider. Engaging in traditional healing interventions, learned in the family, will be comforting and probably will help.

Which of the following actions has been most effective in reducing HIV infections in some countries? a. ABC campaign b. Free HIV immunizations c. Religious leaders stressing abstinence or faithfulness in monogamous marriages d. Public health workers distributing free condoms

ANS: A Substantial reductions in HIV seroprevalence occurred after several countries deployed "ABC" (Abstinence, Be faithful, Condom use) strategies. There is not an immunization available to prevent HIV. The ABC strategy involves use of all three strategies, not just abstinence or condom use.

On the basis of what a faith community nurse (FCN) believed was best practice, she wanted to share various methods of dealing with infertility. However, the tradition of the church was that childbirth was in the hands of God and it was inappropriate to use artificial means of becoming pregnant. Which of the following actions should be taken by the nurse? a. Ask to be excused from the situation if a couple wants to obtain information inconsistent with the church's teaching b. Follow the teaching of the church and keep quiet; there are worse fates in life than infertility c. Suggest that a client consider adoption and suggest an appropriate adoption agency d. Tell the client all the various methods used in cases of infertility

ANS: A The FCN's roles include understanding the scope of practice for parish nurses related to ethical practice and the values and beliefs of the community served. The nurse must understand his or her own beliefs and values that are in conflict with the faith community's beliefs. It is necessary that the parish nurse know when to seek help, when to refer, and when to remove himself or herself from the ethical decision-making process.

Which of the following assumptions of the health belief model (HBM) is problematic? a. People have both free will and access to health resources. b. People listen to the advice given by health care professionals. c. People are influenced by health messages given over media channels. d. People make what they perceive as rational decisions in a given situation.

ANS: A The HBM assumes that people have access to health resources, but such resources are not always available to certain groups. Economic, political, and environmental constraints interfere with free choice.

Which of the following statements best describe what happened to the hospitals built or expanded by Hill-Burton Act funds? a. Many such hospitals have consolidated or closed. b. Not needing to expand, hospitals have used the funds to upgrade their facilities. c. They have continued to use such funds to expand. d. When funding ceased, so did hospital expansion.

ANS: A The Hill-Burton Act authorized federal assistance in construction of hospitals, making hospitals more accessible. However, with the high cost of health care and the decreasing lengths of stay and increasing use of primary care, many hospitals are closing. Because hospitals have closed, they are not further expanding or upgrading facilities.

An occupational health nurse (OHN) reminds employees to put on their safety glasses and use other personal protective equipment. Which of the following levels of prevention is being implemented? a. Primary b. Secondary c. Tertiary d. Health promotion

ANS: A The OHN uses a variety of primary prevention methods, with one-on-one interaction as an important strategy for evaluating risk reduction behavior for individuals. Understanding appropriate engineering and administrative controls and personal protective equipment specific to preventing workplace health hazard exposures is one of the responsibilities of the OHN. Secondary prevention strategies are aimed at early diagnosis, early treatment interventions, and attempts to limit disability. On a tertiary level, the OHN plays a key role in the rehabilitation and restoration of the worker to an optimal level of functioning. Health promotion is not a level of prevention.

A nurse is using Healthy People 2020 as a guide to improve the health and well-being of the community. Which of the following strategies would the nurse most likely implement? a. Address the root causes of health problems b. Choose one of the 28 focal areas for emphasis in funding and media attention c. Concentrate on the goals of improving the quality of life d. Continue funding expansion of the health care system e. Expand efforts to put all medical records on electronic media

ANS: A The chapter emphasizes the need to go beyond individual lifestyle behaviors to the social, economic, political, and value-laden processes of daily life that affect health.

Which of the following is accomplished through the use of public policy? a. Solutions to problems of public concern are developed. b. A rational, logical problem-solving decision-making process is implemented. c. Public safety nets for vulnerable populations are created. d. Economic and business management principles are applied.

ANS: A The field of public policy involves the study of specific policy problems and governmental responses to them. Political scientists involved in the study of public policy attempt to devise solutions for problems of public concern. The use of public policy may not involve the implementation of a logical problem-solving decision-making process. Public policy addresses more than safety nets for vulnerable populations. Additional principles besides economics and business management are applied through the use of public policy.

Which of the following actions would be the least expensive approach to treating chronic diseases? a. Choose healthy lifestyle behaviors to retain health b. Continue media campaigns encouraging early detection and treatment c. Encourage patients to seek care at a local neighborhood health clinic d. Suggest self-therapies that have been demonstrated to be effective

ANS: A The five leading causes of death and illness can be positively affected by changes in lifestyle. Healthy lifestyles can modify or even prevent most chronic illnesses. Seeking care at a neighborhood health clinic, producing media campaigns, and engaging in self-therapies are all more expensive approaches to treating chronic diseases than choosing healthy lifestyle behaviors.

Which of the following statements best describes an effect of the Welfare Reform Act of 1996? a. Individuals who were required to obtain employment lost their health coverage. b. Many were happy to be off the government dole and self-supporting. c. Persons sought and obtained employment that often included insurance benefits. d. The food stamp program decreased in size.

ANS: A The law decreased the number of people on welfare and forced many individuals to take low-paying jobs, many of which did not offer health insurance. Many individuals, particularly women and children, subsequently lost Medicaid coverage.

Which of the following realities would cause difficult ethical conflicts for a faith community nurse? a. Best clinical practice may suggest behaviors contrary to the faith community's values and beliefs. b. Individuals might pressure the nurse to make medical decisions for them. c. Persons do not always follow the nurse's advice as to appropriate actions. d. Some political maneuvers within the faith community have implications for the nurse's practice.

ANS: A The nurse must understand the policies and beliefs of the congregation related to specific health issues. Church doctrine may guide members to adopt values and beliefs that are in conflict with current health care recommendations, such as issues of homosexuality, infertility, birth control, or sex education for youth. The parish nurse must understand that the politics of working within the faith system require acceptance of individual and system values and beliefs.

A nurse is using Milio's framework for prevention to improve the health of clients. Which of the following would the nurse most likely implement? a. Create appropriate national health policies b. Develop health programs that make healthy choices the easiest choices c. Promote nationwide educational programs with information on making healthy choices d. Stress that clients are responsible for their own health

ANS: A The range of available choices is critical in shaping a society's overall health status. Policy decisions in governmental and private organizations shape these choices. Hence, national-level policy making is the best way to impact the health of most Americans rather than continue to concentrate on imparting information in an effort to change individual behaviors.

A patient had wrapped a tummy band around her newborn's abdomen. What should the nurse say to the new mother? a. "Can you explain to me the purpose of wrapping a band around the baby's tummy?" b. "In the hospital, we prefer to expose the umbilical cord to air so it's easier to put medication on it as it dries up." c. "Let me put some medication on the baby's cord, and then I'll put the tummy band back." d. "Please remove that band; it is not helpful as the umbilical cord needs to be kept clean and dry."

ANS: A Unless a particular action is harmful, the nurse should engage in culture care preservation and maintenance. Before acting, it is helpful to know why the mother is engaging in this behavior. If the mother responds, "I'm not sure; it's just always been done," the nurse can educate the mother on how to care for the cord. If the mother appears to believe the tummy band is very important, the nurse can cooperate with the behavior, because tummy bands will not hurt the baby.

A client living in the 1920s received health care services. Which of the following would have been the most likely form of payment? a. Patients paid out of their pockets for whatever care the provider charged. b. Public health employees gave care to those who needed it. c. There was little health care to be had, regardless of a person's wealth. d. Workers who belonged to a union had their bills paid by insurance.

ANS: A Until the 1930s, the predominant method of health care financing was self-payment. Health care providers charged a fee for the services they rendered, and the patient paid the out-of-pocket expense. The assumption was that those who could pay would pay and those who could not pay should receive care and pay what they could. Insurance companies did not exist in the 1920s.

2. Which of the following statements best describes "thinking upstream"? a. Focus on economic, political, and environmental factors b. Prepare for your nursing career long-term goals by planning now c. Seek causes of water and air pollution "upstream" from cities d. Try to understand how or why someone got ill

ANS: A Upstream thinking actions focus on modifying economic, political, and environmental factors that are the precursors of poor health throughout the world.

Everyone in a high school was very upset over the fact that one of the students had shot and killed another student. The nurse decided this was an appropriate time to establish a program to help prevent violence. Which of the following groups of students should receive the program first? a. Elementary school grades 4, 5, and 6 b. Grades 7, 8, and 9 c. High school grades 10, 11, and 12 d. The students who knew the victim and his assailant

ANS: A Violence prevention programs should begin in elementary schools. Children who exhibit aggressive behavior in elementary school are more likely to exhibit antisocial and violent behavior as adolescents and adults. Programs should teach stress management, conflict and anger resolution, and personal and self-esteem development. This program would be offered too late for children in grades 7 through 12, and should be offered to a larger audience than only those who knew the victim and assailant. Thus, the priority population would be the elementary school children.

A woman comes to the clinic, and the nurse believes that she is speaking French. She seems to understand English. A provider will need to complete a physical examination to confirm the health problem. Which of the following actions should be taken by the nurse? a. Ask the client if she prefers a male or female provider b. Ask a female provider to assume care c. Ask the physician provider to see her immediately d. Ask the secretary in the office who speaks French to assist in collecting a health history from the client

ANS: A When in doubt, the best way is to ask the client about culturally relevant aspects of male-female relationships. This should be done at the beginning of the interaction before an opportunity arises to violate culturally based practices. It is not appropriate to ask other staff members to serve as interpreters during nurse-client interactions.

Some people believe that the air within their workplace makes them ill. Which of the following premises support this belief? a. They consistently feel worse on workdays and weeks without holidays. b. There has been media coverage of "sick buildings" where there is very little air exchange with fresh air outside. c. Research has demonstrated that some buildings emit poisonous vapors that make anyone who works there ill. d. When a small group of persons begins to believe something, the others in the larger group begin to believe it as well.

ANS: A As the question discusses risk, the textbook states that the risk factor must precede the problem and that the problem would increase with exposure. Feeling ill only on workdays would imply that some factor in the workplace is responsible. The media coverage, research related to poisonous vapors, and "group think" responses do not address the fact that the repeated exposure to the risk factor may be what is making them ill.

Which of the following is the best definition of health? a. A goal and a resource for living b. A lack of disease or illness c. Complete state of well-being d. Freedom from pain or discomfort

ANS: A Health was originally defined as a lack of illness or disease. More recently, health has been defined as a state of complete physical, mental, and social well-being. Today, health's definition is based on the realization that health allows one to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is a goal but also a resource for living.

A nurse is using the theory of reasoned action when working with a client to exercise on a regular basis. Which of the following would be the easiest way for the nurse to determine if the client will engage in this activity? a. The client's intention to exercise regularly b. The client's perception of the threat of illness if he doesn't exercise regularly c. Society's emphasis on the importance of regular exercise d. The pros and cons of regular exercise

ANS: A The theory of reasoned action attempts to predict a person's intention to perform or not perform a certain behavior based on the assumption that all behavior is determined by one's behavioral intention. The client's perception of the threat of illness, the opinion of society, and benefits of regular exercise are not major factors discussed using the theory of reasoned action.

A nurse was becoming frustrated. It had been 2 weeks, and although the client had verbalized that the best time of day to take a 15-minute walk was early in the morning, the client had not begun to exercise. Which of the following principles of the Transtheoretical Model had the nurse forgotten? (Select all that apply.) a. A decision to act always occurs before action begins. b. Behavior change is difficult and takes time. c. Continuing to stress to the client how important exercise is will help the client decide to exercise. d. Discussing with the client why he or she is not yet exercising may help the client recognize his or her own resistance. e. The nurse should offer some reward if the person exercises for at least a week. f. Verbalizing compassion for how difficult it is to change is a crucial intervention.

ANS: A, B The Transtheoretical Model is based on the assumption that behavior change takes place over time, progressing through a sequence of stages. The fact that the person had stated the best time to exercise demonstrates the client has moved through precontemplation and contemplation and is preparing to act. The nurse is being rather optimistic in thinking change will occur within 2 weeks. Although being compassionate is helpful, it is not a crucial step in the beginning of the process. Personal resistance to change is probably obvious and does not need further discussion as the patient has moved beyond the stage of analyzing pros and cons to the change.

Which of the following best describes how schools can determine what their school health education priorities should include? (Select all that apply.) a. Provide opportunities for students to practice decision-making skills b. Choose priorities according to which behaviors lead to avoidable problems c. Make priorities consistent with the six topics identified by Healthy People 2020 d. Determine priorities by the education and expertise of the local school nurse e. Select priorities according to parent and student interests f. Decide on priorities based on whatever funding sources are willing to fund

ANS: A, B, C Healthy People 2020 sets goals that schools provide health education courses in priority areas. The six behavioral categories or topics identified include the following negative behaviors that often start in childhood or adolescence and persist into adulthood: (1) alcohol and drug use; (2) injury and violence; (3) tobacco use; (4) poor nutrition; (5) lack of physical activity; and (6) sexual behavior that results in sexually transmitted diseases or unwanted pregnancies. These problems and behaviors are preventable and lead to additional problems. In a comprehensive health education program, students should be given the opportunity to practice decision-making and communication skills. Funding may not fit local needs. All school nurses should be competent in teaching related to healthy behaviors or know experts who could assist. The priorities should be based on Healthy People 2020, not on the parent and student interests or on the basis of available funding sources.

Which of the following describe current legislation acts that limit what managed care organizations (MCOs) are allowed to do? (Select all that apply.) a. Allowing patients to see a specialist without having to obtain approval from their primary care provider b. Allowing patients to go to the emergency department without first telephoning for approval c. Allowing patients the right to choose a physician d. Requiring the MCO to fulfill expectations of the national patients' rights bill e. Requiring the MCO to accept any provider who meets plan requirements f. Requiring the MCO to accept advanced practice nurses as primary care providers

ANS: A, B, C In 1999, the House and Senate passed bills that focused on client rights in the managed care environment, but more needs to be done to improve client rights. Client rights issues that are vitally important are information disclosure, physician and provider choice, direct access to specialists, reimbursement for emergency care, and reimbursement denial. As has been discussed, there is still no national patients' bill of rights.

What have been the foci of international nursing research? (Select all that apply.) a. Development of home care or transition from hospital to home b. Diverse clinical experiences c. Educational exchange programs for students and faculty d. How to integrate technology into developing country health care systems e. How to use a career in nursing to change the cultural expectations of gender roles f. The importance of sharing resources with poverty stricken countries

ANS: A, B, C Since 1990, international nursing research has focused predominantly on the following three areas: (1) student and faculty educational exchange programs, (2) diverse clinical experiences, and (3) the international development of home care or transition from hospital to home. International nursing research has not focused on integrating technology into the health care systems of developing countries, using a career in nursing to change cultural expectations of gender roles, or the importance of sharing resources.

An occupational health nurse has been asked to perform a complete physical examination, including drug testing, on both a prospective and a current employee. Which of the following best describe the purposes of these examinations? (Select all that apply.) a. To measure the strength of organs that may be affected by workplace responsibilities b. To document changes that may have occurred while the employee engaged in particular processes or in a particular work area c. To establish a baseline before the employee is exposed to possible workplace hazards d. To help decide whether or not to hire the prospective employee e. To update employee records and fill in any missing information f. To warn the employer about specific weaknesses or disabilities in the prospective employee

ANS: A, B, C The preplacement evaluation is performed before the worker begins employment in a new company or is placed in a different job. The evaluation is a baseline examination that consists of a medical history, an occupational health history, and a physical assessment that should target the type of work that the employee will be performing. The preplacement examination may also include medical tests to determine specific organ functions that may be affected by exposure to existing agents in the employee's workplace. Examinations of individuals transferring to other jobs are critical to document any changes in health that may have occurred while the employee was working in a specific area or with a specific process. Preplacement health examinations by law will be permitted only if phrased in terms of the applicant's general ability to perform job-related functions rather than in terms of any disability and only after a job offer has been made. The examination must be job related and consistently conducted for all applicants performing similar work.

Which of the following best describes when the nurse can share confidential information about an employee's health with others? (Select all that apply.) a. If needed for workers' compensation documents b. If a life-threatening emergency occurs c. If authorized by the employee to specific recipients, such as insurance companies or health care providers d. If requested by the employer for management purposes e. In compliance with governmental laws and regulation f. In educational programs so others can avoid similar injuries and risks

ANS: A, B, C, E Occupational health nurses sometimes experience ethical dilemmas because of dual responsibility to both their employer and employees. In dealing with health information, the employee has a right to privacy and should "be protected from unauthorized and inappropriate disclosure of personal information" Exceptions can, and in some situations must, be made, however. These include: (1) life- threatening emergencies, (2) authorization by the employee to release information to others (e.g., insurance company, health care provider), (3) workers' compensation information, and (4) compliance with government laws and regulations. The nurse is unable to share confidential information about an employee's health with the employer for management purposes or during an educational program.

Which of the following factors have a profound, if sometimes unrecognized, impact on one's health? (Select all that apply.) a. Adequate resources to allow easy access to health services b. Interpersonal relationships with family and friends c. Local, state, and national policies d. Number and quality of health care providers within transportation range e. Physical neighborhood where one works and lives f. Understanding the need for healthy lifestyle choices

ANS: A, B, C, E Health is affected by biology. Behaviors, social environment, physical environment, policies, and access to quality health care are all factors that affect health. The number and quality of health care providers is not relevant if one does not have access to them because of lack of insurance or financial resources. Understanding the need for healthy lifestyle choices is important, but knowledge alone is not adequate to change behavior.

Which of the following best describes what insurance companies did to decrease their constantly increasing costs? (Select all that apply.) a. Did not cover any illnesses that were diagnosed before the person (or his or her employer) purchased insurance b. Limited coverage to only certain services, eliminating any that were experimental, nontraditional, or too costly c. Reimbursed only the care that was requested by the patient's primary physician d. Limited providing insurance to companies who hired mainly young, healthy persons e. Required preapproval before expensive services were used f. Ceased coverage on any person who used an exorbitant number of services, whenever possible

ANS: A, B, C, E, F Insurance companies attempted to reduce unnecessary use by limiting coverage for certain services and people. Restrictions such as the establishment of a gatekeeper that required preauthorization, limited coverage for preexisting illnesses, and exclusion of participants whose use was deemed exorbitant were instituted. Such restrictions increased resentment and resistance and were not very successful.

Which of the following statements best describes what was unfortunate about the original private health insurance plans that were developed? (Select all that apply.) a. Because providers were paid for any service they gave, it was economically advantageous for them to give as much care as possible. b. Health care costs increased very rapidly. c. Health education and health promotion interventions were not included in the idea of health insurance. d. It was immediately seen how much profit could be made by owning or managing an insurance company. e. Patients wanted any and all care that might help, regardless of how expensive it was. f. There was no limit on what care could be sought and given.

ANS: A, B, C, E, F The majority of the population was protected. The emphasis was placed on illness care, because providers received a fee only when a service was rendered, and all costs were reimbursed. Insulated from having to pay for health care, consumers demanded complex and technologically advanced services. These demands were a major force rapidly increasing health care costs because people with insurance felt entitled to care, and, after all, there was a guaranteed payer. Medical orientation was on curing at any cost. The profits of owning or managing an insurance company were not immediately seen.

Which of the following current issues are leading the World Health Organization (WHO) to reconsider its initial definition of health? (Select all that apply.) a. Environmental issues such as industrial toxins or carcinogenic commercial products b. Global, not local, problems such as spread of antibiotic-resistant bacteria c. Need to move from containment and treatment to social intervention d. Pressure from industrialized nations to emphasize chronic diseases rather than infectious diseases e. Realization that government actions influence the basic human right of health f. Worldwide pandemics such as human immunodeficiency virus (HIV) and swine flu, which require a different approach

ANS: A, B, C, E, F WHO is refocusing as it attempts to deal with environmental issues of nuclear contamination and industrial toxins, and the exploration of carcinogenic commercial products (such as tobacco). Globally, WHO is trying to eliminate antibiotic-resistant bacteria and the HIV pandemic. HIV has changed the paradigm from traditional containment and treatment to a more comprehensive approach of social intervention. There is a realization that health is a basic human right and health problems are linked to government action and affect human rights. The WHO is not emphasizing the chronic diseases faced by industrialized nations.

According to the critical theoretical perspective, which of the following should be held responsible for many of the illnesses of Americans today? (Select all that apply.) a. Advertisers who market sugar- and fat-saturated food products b. Alcoholic beverage manufacturers, marketers, and sellers c. Manufacturers of products that increase morbidity and mortality d. Corporations who modify their emission rates e. Restaurants that attempt to keep meal costs low f. Tobacco manufacturers who sponsor sports events

ANS: A, B, C, F McKinlay (1979) further delineated the activities of the "manufacturers of illness—those individuals, interest groups, and organizations which, in addition to producing material goods and services, also produce, as an inevitable byproduct, widespread morbidity and mortality" (pp. 9, 10). The manufacturers of illness embed desired behaviors in the dominant cultural norm and thus foster the habituation of high- risk behavior in the population. The manufacturers of illness include everyday examples such as the tobacco industry, the alcohol industry, and multiple corporations that produce environmental carcinogens. The existing U. S. Health Care System, in a misguided attempt to help, devotes its efforts to changing the products of the illness manufacturers and neglects the processes that create the products.

In which of the following ways are occupational health nurses (OHNs) role models of good community health nursing? (Select all that apply.) a. The majority of OHNs are prepared at the baccalaureate level or higher. b. OHNs actively influence policy in health and safety within a particular area. c. OHNs are skilled at assessing both people and their home environment. d. OHNs focus on health promotion and avoidance of injury or disease. e. OHNs plan and implement health programs for populations of employees. f. OHNs work closely with physicians in planning and implementing care for individuals and families.

ANS: A, B, D, E OHNs focus on the promotion, prevention, and restoration of health within the context of a safe and healthy work environment. Focus includes prevention of adverse health effects from occupational and environmental hazards. Approximately 60% of these 35,000 nurses work alone, making decisions regarding health and safety issues, influencing policy in health and safety, and planning and implementing myriad health programs. More than 65% of nurses practicing in occupational health are prepared at the baccalaureate level or higher. OHNs do not usually make home visits. Most collaboration is done with occupational health professionals, such as industrial hygienists and ergonomists, rather than physicians. Studies show that physician collaboration occurs in up to only 8% of cases.

A nurse is using Pender's model to explain what influences individuals to pursue health promotion activities. Which of the following factors would be examined? (Select all that apply.) a. A belief that one can change one's behaviors b. Environmental choices possible c. Fear of negative consequences if action is not taken d. The rewards one believes will result if action is taken e. The threat of an early death if behavior is not changed f. What one's family and peers believe should be done

ANS: A, B, D, F Fear and threat are not aspects of Pender's model. Although fear may cause an initial attempt at change, fear is not a long-term motivator for ongoing action. Pender does include perceived benefits, perceived self-efficacy, interpersonal influences, and available situational (environmental) options as factors that motivate persons to engage in health actions.

Which of the following best describes the challenges when providing care to someone from a minority group? (Select all that apply.) a. Communication, both words and gestures, may be unfamiliar. b. Few members of the minority group are nurses themselves. c. Immigrants will soon adapt to the mainstream culture, but in the meantime many are clinging to "the old ways." d. So few patients are minority group members that it is difficult to remember how they prefer to receive care. e. The nurse may have to confront personal values and beliefs.

ANS: A, B, E Nurses must understand how patients define health and illness, how their cultural group cures and cares for members, and how the nurse's personal cultural background influences the way in which care is delivered. The context and process of helping people involves at least two people who often have different cultural orientations and lifestyles. Very few nurses are members of a minority group. Although immigrants may adopt some of the ideas of the mainstream culture, many will continue to use traditional practices and the nurse must be aware and respect these cultural beliefs. Many minority group members represent the patient population who receives care, so nurses must be aware and respect these cultural beliefs.

A community health nurse is assigned to cover a school health office when the school's nurse is ill. A child is waiting for the nurse's arrival, saying a particular medication is needed. Which of the following can the nurse expect to find in the school health office? (Select all that apply.) a. A nursing policy book with standing orders and nursing protocols b. Medications clearly labeled with student name, as well as typical medication information (e.g., name, dose) c. Approval from the student's teacher for the student to see the nurse for the medication each day d. The student's written assent for the medication to be administered when requested e. Written request from a health care provider for that student to receive that medication f. Written request from the student's parents for the specific medication to be administered

ANS: A, B, E, F The guidelines from the National Association of School Nurses indicate that medications should be in containers that are properly labeled with all appropriate student and medication information, accompanied by a written request from the health care provider and parent or guardian, and administered without violating standing orders or nursing protocols. The nurse would not typically find approval from the student's teacher for the student to see the nurse each day for a medication or a student's assent for the medication to be administered. The parents and health care provider are responsible for the written request for the medication to be administered.

Which of the following variables create differences from school to school regarding the health services that are available? (Select all that apply.) a. Community resources b. National statistics on health problems c. School leadership preferences d. State legislative requirements e. Students' needs f. Teacher preferences

ANS: A, C, D, E School health services goals and objectives vary from state to state, community to community, and school to school. These differences reflect wide variations in state regulation, student needs, community resources, funding sources, and school leadership preferences. The national statistics on health problems and teacher preferences do not create differences among schools in regards to health services that are available.

An occupational health nurse (OHN) realizes that an injured employee is going to be temporarily disabled. Which of the following actions can the nurse take to avoid the employee having disability syndrome? (Select all that apply.) a. Analyze the physical requirements necessary for doing specific jobs within the workplace b. Collaborate with the legal consultant to ensure that the employer cannot be held responsible for the employee's injury c. Facilitate appropriate equipment or process changes necessary for the employee to be able to engage in temporary work functions d. Implement and monitor the employee's health to prevent adverse health effects from the injury e. Negotiate with workers' compensation to gradually decrease benefits to encourage the employee to return to employment as soon as possible f. Collaborate with the primary care provider to identify potential barriers in the employee's return-to-work process

ANS: A, C, D, F The behavioral change of the individual to avoid returning to work, even after medical clearance has been granted, is called the disability syndrome. The process of returning an individual to work begins with the onset of injury or illness. The nurse works closely with the primary care provider to monitor the progress of the worker and to identify and eliminate potential barriers in the return-to-work process. The nurse must know the workplace and the physical requirements necessary for the employee to work, perhaps by doing a physical demands analysis of the various jobs. The OHN can facilitate the employee being temporarily assigned less physically demanding work, perhaps on a part-time basis, until full employment can be resumed. Then the nurse would continue to monitor and support the employee to avoid adverse health effects. The nurse would most likely not collaborate with legal consultant or negotiate to try to decrease the employee's workers' compensation benefits.

Which of the following best explains how occupational health nursing differs from other nursing specialties? (Select all that apply.) a. Occupational health nursing has a major focus on the environment. b. Occupational health nurses are required to have a master's degree in occupational health. c. Occupational health nurses are more autonomous and work independently. d. Occupational health nurses have a primary emphasis on health promotion and disease prevention. e. Occupational health nurses may work with unions, as well as management groups. f. Occupational health nurses work in the community.

ANS: A, C, E The occupational health nurse (OHN) focuses on the workplace environment, examining the environment for hazards. Within the worksite, the nurse is an autonomous health professional. The nurse often meets with unions representing the employees, as well as management. The roles and responsibilities of the OHN must be clearly articulated to lay people, managers, workers, union representatives, and colleagues. The nurse may interact with occupational medicine professionals, industrial hygienists, safety professionals, employee assistance counselors, personnel professionals, and union representatives. Nurses who work in occupational health settings are not required to have a master's degree in occupational health. It is hoped that all nurses emphasize health promotion and disease prevention. Several specialties such as home health nursing and school nursing also work in the community

Which of the following activities are consistent with the conclusions of the report Crossing the Quality Chasm? (Select all that apply.) a. Increased emphasis on evidence-based practice b. Improved reimbursement schedules that allow primary care providers to spend more time with each individual client c. Increased attention to patients' needs for health education and self-management d. Increased communication, cooperation, and collaboration between various components of the health care system e. Increased use of information technology (electronic medical records and data management) f. Improved organization of the health care system

ANS: A, C, E The report suggested the following changes: need for evidence-based planned care; reorganization of practices to meet needs of patients who require more time; attention to patients' need for information and behavioral change; ready access to clinical expertise needed; and supportive information systems. Current trends, which reflect these suggestions, are the focus on evidence-based care; more patient education; need for accepting self-management responsibility; and expansion of electronic medical records and other information technologies. Health care may be improving its organization, but it is not an obvious trend with obvious change, nor are reimbursement schedules allowing care providers more time to spend with clients. Cost containment is decreasing the time care providers can spend with clients.

Which of the following best describes the strengths of the American healthcare system? (Select all that apply.) a. Offering the availability and use of technological advances in equipment and procedures b. Having the ability to overcome concerns regarding access and rationing c. Providing the highest quality of life among any industrialized nation d. Having the lowest maternal and infant mortality rate among industrialized nations e. Leading the world in laboratory and clinical research f. Creating the best patient care outcomes

ANS: A, E The United States leads the world in laboratory and clinical research. The United States also exceeds other industrialized countries in the availability and use of technological advances. We do not rank near the top in length of life or patient care outcomes, although we spend far more on health care than other industrialized nations. We are just beginning to confront the issues of access and rationing.

Which of the following conclusions were made when Congress asked for a report on the federal government's quality enhancement process on the care the federal government gave? (Select all that apply.) a. A clear responsibility at the federal level is to lead by example. b. Computerized clinical data have enabled practice guidelines to be written. c. Federally sponsored education and training programs have a strong impact. d. Quality assurance information has been consistent and useful in improvement. e. The quality of federal health care was very good. f. Writing regulations influences nonfederal health care providers and organizations.

ANS: A, C, F The report Leadership by Example concluded that there is a lack of consistent performance measurement, the information is not useful, computerized clinical data are missing, and the approach to gathering data is not systematic. The federal government is the largest purchaser of care because it gives direct care to specified groups and requires conforming to regulations for those accepting Medicare and Medicaid funds. Sponsored research, education, and training also have an impact. The report concluded that the federal government must accept leadership both by example and by coordinating improvement in health care quality.

Which of the following critical issues in health care were addressed by The Health Insurance Portability and Accountability Act (HIPAA) of 1996? (Select all that apply.) a. Portability of insurance coverage b. COBRA, maintaining coverage for those who lose their jobs c. Insurance companies having a total monopoly in a certain geographic area d. Insurance companies setting limits on coverage of longer than 12 months e. Insurance companies charging seriously ill persons more than healthy persons f. Insurance companies paying the same for mental health coverage as for physical illnesses

ANS: A, D The HIPAA of 1996 addressed insurance issues. Critical were the portability of coverage and preexisting conditions. Insurers cannot set limits on coverage longer than 12 months. COBRA was established through the Consolidated Omnibus Budget Reconciliation Act of 1985. The McCarren-Ferguson Act of 1945 gave states the exclusive right to regulate health insurance plans. The Mental Health Parity and Addictions Equity Act of 2008 mandated that insurance companies must provide the same coverage for mental health as for physical illness. Health Care Reform legislation prevents insurance companies from charging seriously ill persons more than healthy persons.

Which of the following is a current challenge for occupational health nurses? (Select all that apply.) a. Changes in employee demographics including gender, ethnicity, and age b. Expansion in sites offering care using new, creative approaches c. Increased affordability of health care services d. Increase in managed care plans with need for case managers e. Moving from large manufacturing facilities to smaller, service-based businesses f. Ongoing need to demonstrate cost-effectiveness of services rendered

ANS: A, D, E, F At the beginning of the twenty-first century, sweeping transformations in industry are influencing the direction of occupational health nursing. These transformations include changing workforce demographics, rising health care costs, diversity of health care systems with the integration of managed care, influence of the world economy, shift in production from goods to services, and proliferation of advanced technologies. The focus of U.S. industry is moving away from large manufacturing facilities to smaller, service-based businesses. The increasing availability of older workers, women, minorities, and immigrants will have far-reaching implications for employers and pose specific challenges for occupational health professionals. Rather than expanding, health care facilities are consolidating in the ongoing quest to give care more economically. Health care costs are rising and are not becoming more affordable.

Which of the following screenings are typically administered in the school setting? (Select all that apply.) a. Blood pressure b. Chest x-ray c. Cholesterol and blood glucose d. Height and weight e. Scoliosis f. Visual and hearing acuity

ANS: A, D, E, F Height, weight, vision, and hearing screenings are provided at most schools. Scoliosis or postural screening should be done to identify spinal deviations and intervene early to prevent related secondary problems. The detection of high blood pressure during childhood is important in identifying children who have hypertension and who will benefit from early intervention and follow-up. Screenings in schools must be relatively fast, easy, and noninvasive. Blood work is invasive and cannot be done without parental consent. It is also expensive because test strips must be purchased. Due to the equipment needed, it is not typical that chest x-rays or cholesterol and blood glucose screenings are administered in the school setting.

Which of the following best describes the purposes of professional societies such as the American Nurses Association (ANA)? (Select all that apply.) a. Providing control and oversight of the occupation b. Creating licensing laws to control entry into the profession c. Determining appropriate requirements for education into the profession d. Establishing standards for practice e. Protecting the interests of the practitioners f. Safeguarding the public trust

ANS: A, D, E, F Professional societies seek to further a particular profession, the interests of persons engaged in that profession, and the public interest. Their roles are to maintain control and oversight of the occupation— such as by writing standards for practice—as well as safeguarding the public trust. Licensure and educational standards are responsibilities of individual states.

Which of the following functions are responsibilities of the states?? (Select all that apply.) a. Delegating power to localities and holding them accountable for results b. Creating managed health organizations to decrease state health care costs c. Establishing and managing local health departments d. Licensure of professional health care providers e. Overseeing all insurance programs f. Providing access to necessary health services

ANS: A, D, E, F State governments focus particularly on financing and delivery of services and oversight of insurance. The state is responsible for addressing the mission of public health—assessment, policy development, and assurance—throughout the state. Tasks include assessment of health needs based on statewide data collection; establishment of statewide health objectives; and delegating power to localities as appropriate and holding them accountable. States license health professionals as part of the statewide effort to develop and maintain essential personnel. Creating managed health organizations and establishing and managing local health departments are not a main responsibility of the state.

Which of the following is often discovered when female prisoners are interviewed for their health histories? (Select all that apply.) a. A history of physical and sexual abuse b. Evidence of active tuberculosis (TB) c. Extensive tattooing and body piercings d. Personal use of drugs and alcohol e. Positive test results for HIV and hepatitis f. Previous childbirth with living children

ANS: A, D, F In midyear 2007, there were 65,500 mothers in jail who reported having 147,400 children under the age of 18 years. Women suffer stress from being separated from their children. More than four in every 10 women in prison admit to being abused before the current imprisonment: 34% physically abused and 34% sexually abused. Almost half of the women in prison report being under the influence of drugs or alcohol at the time of the offense and using drugs months before the offense. It is not typically discovered that female prisoners have evidence of active TB, extensive tattooing and body piercings, or test positive for HIV and hepatitis.

As in Healthy People 2010, what are the two primary goals of Healthy People 2020? (Select all that apply.) a. Eliminate health disparities b. Expand health promotion activities in every community c. Improve funding, including diverting funds from other priorities to health care d. Improve health outcomes measures to be more consistent with other developed nations' outcomes e. Increase quality and years of healthy life f. Reduce mortality and morbidity figures nationwide

ANS: A, E As published, the two goals are to increase quality and years of healthy life and eliminate health disparities. Expanding health promotion activities in every community, improving funding and improving health outcomes, and reducing mortality and morbidity are not the primary goals of Healthy People 2020.

Which of the following would most likely be the result of a medicolegal death investigation? (Select all that apply.) a. Clarification of the unnatural circumstances in which death occurred b. Court testimony as to cause of death based on evidence c. Consultation with defendant's attorney for a fee d. Consultation with prosecuting attorneys for a fee e. Death certificate with cause and manner of death f. Permission to use deceased organs for transplant

ANS: A, E Medicolegal death investigations are usually conducted to clarify the unnatural circumstances in which death occurred. One of the outcomes of death investigation is death certificates. Outcomes of medicolegal death investigations do not typically involve court testimony, consultation with the defending or prosecuting attorneys for a fee, or permission to use the deceased organs for transplant.

A community health nurse is using the health belief model (HBM) as a basis for providing client care. Which of the following best describe the problems associated with using the HBM? (Select all that apply.) a. It ignores the need to reduce health system barriers to action. b. It is extremely difficult to change the client's belief system. c. It is the nurse's responsibility to persuade clients to engage in the appropriate behavior. d. Clients do not have the knowledge to correctly analyze the seriousness of the disease or their susceptibility to it. e. Clients expect health professionals to take preventive actions for them. f. The choice and the burden for acting are entirely with the client.

ANS: A, F A major problem with this model is that the burden for taking action is totally with the client. The model requires health professionals to assume responsibility for modifying the client's perceptions so they recognize the need to act. Although the line between persuading and educating is a fine one, nurses are responsible for education. Persuasion may border on coercion. Further, the model assumes that all responsibility is personal, ignoring barriers in the health care system, which may make it difficult for an individual to take appropriate action.

Which of the following best describes how a legal nurse consultant (LNC) would best prepare for testifying in court as an expert witness? (Select all that apply.) a. By carefully analyzing the client's medical record and related documents b. By creating a PowerPoint slide presentation to help educate the jury c. By helping to examine all the witnesses in preparation for the court trial d. By personally doing or observing the autopsy on the deceased e. By preparing charts and tables illustrating the important legal points f. By summarizing the literature regarding the standard of care

ANS: A, F LNCs perform many different services and activities, including organizing and analyzing medical records and related materials; preparing chronologies of health care events; and identifying standards of care. It is essential that the LNC be prepared, having reviewed the case and all related materials very thoroughly. The LNC would probably not create a PowerPoint slide presentation, examine all witnesses in preparation for the trial, personally complete the autopsy, or prepare charts and tables to illustrate the important legal points.

A nurse is using the critical theoretical perspective in practice. Which of the following best describes how the nurse would respond when a client suggests that the physician prescribe a widely advertised medication for tension and anxiety? (Select all that apply.) a. Can you tell me what is going on in your life right now? b. Do you know anyone else who is suffering such tension and anxiety? c. How does your family feel about you having so much tension and anxiety? d. Would you consider using the generic equivalent of this medication? e. What led you to believe this medication would be of help to you? f. What have you tried in the past to relieve tension and anxiety?

ANS: A, F The best answer is to ask what is going on in the client's life at that moment because situational stresses often occur to everyone. Next, asking what previously has been effective in relieving the symptoms may suggest more appropriate actions than medication. Although generics would be less expensive than brand-name medication, medication should not be the first approach to resolving a symptom before even examining why the symptom is occurring.

3. Which of the following best describes the most important factor in legislation? a. The amount of financing and lobbying behind each choice b. The beliefs, attitudes, and values of the policy c. The preferences of the majority of American voters d. The president's ongoing encouragement for one particular choice

ANS: B Public policy encompasses the choices made regarding goals, priorities, and how resources are allocated. Policy choices reflect the values, beliefs, and attitudes of those designing the policy. The influence of the president, preferences of Americans, and amount of financing related to the legislation are not as important as the beliefs, attitudes, and values of the policy.

Which of the following statements best describes what happened to health care providers during the Great Depression? a. The amount of charity care greatly increased. b. Both hospitals and physicians went bankrupt. c. Government funding was legislated to assist those in need. d. Public health greatly expanded to care for those in need.

ANS: B With 25% of the population out of work, the number of patients capable of paying their medical bills was reduced. Because public financing was limited, hospitals, physicians, and other providers went bankrupt. Because hospitals and physicians were going bankrupt, there was no way to increase charity care or services for those in need.

A female coach walks into your office and shares that one student concerns her. The student will not change into her gym clothes and does not seem to "move right." Which of the following actions would be most appropriate for the nurse to take next? a. Call the student into your office and discuss the importance of physical education to one's health b. Meet with the student and ask directly about sexual or physical abuse c. Offer to attend the next physical education class and talk to the student d. Point out how female adolescents are very concerned over body image and are usually embarrassed by their own lack of perfection, and suggest the coach be more understanding

ANS: B Adolescents being physically or sexually abused may have symptoms that include changes in behavior; difficulty in walking, sitting, or other movements; and refusing to change into gym attire or participate in physical activities. It would not be appropriate to minimize the situation, call the student out in front of the class, or have a conversation about the importance of physical education. Rather, the nurse should address the potential signs and symptoms that have been displayed by this student.

A 14-year-old was found guilty of beating and raping a 73-year-old neighbor. The prosecutor had successfully argued for the child to be tried as an adult. The jury is considering a long adult prison term. Which of the following would the nurse most likely suggest when called on as an expert witness? a. The child must be mentally ill to have done such a thing and should be in a mental hospital. b. The child should be in a juvenile facility to avoid the high risk of sexual assaults, beatings, and suicide in adult prison. c. The child should be given a long adult prison sentence to protect society from such a predator. d. The child must be given an opportunity to complete high school while incarcerated in the adult prison.

ANS: B Adult correctional facilities are not generally equipped to deal with the challenges of adolescent development. Adolescents in an adult correctional facility are five times more likely to be sexually assaulted, three times more likely to be beaten by prison guards, and 50% more likely to be assaulted with a weapon, compared with adolescents held in a juvenile center. Juveniles in adult correctional facilities are eight times more likely than juveniles in the juvenile center to commit suicide. Thus, it is in the best interest of the adolescent to be placed in a juvenile facility. The placement of an adult prison or mental hospital would not be in the best interest of this child.

Which primary prevention would the school nurse choose to address the school's number of unwed pregnancies? a. Create a class on parenting for both the moms-to-be and the dads-to-be b. Convince the school board to allow sex education classes to include birth control measures c. Employ the moms-to-be as 1-hour-a-day employees in the school day care center for children born to school students d. Establish a class where all the unwed moms-to-be can learn infant care

ANS: B Although all choices would be appropriate actions in a school, only education regarding sexuality and birth control would help prevent future pregnancies.

Which task will be most helpful in meeting the public health agency's goals? a. Complete staff evaluations in preparation for individual meetings to plan their agency and individual goals for the next year b. Actively participate in community agencies' collaborative action plan to meet the community's health goals for the year c. Meet with the college of nursing faculty to finalize student objectives and schedules for the next semester d. Teach a free course in healthful living for community residents

ANS: B Although all tasks may be necessary and important, intra-agency cooperation to meet the health goals of the community as a whole is more central to the agency's mission than other choices that meet the needs of individuals or groups rather than the community as a whole.

Why would a public health nurse want to know about morbidity and mortality statistics on the local, state, and national level? a. To be able to share current trends in health problems with the community b. To be able to observe the community's statistics over time and compare the community with other communities c. To justify local budgets and the need for increased income from citizens d. To publicize current health issues and suggest appropriate actions to citizens

ANS: B Although being informed and being able to educate the public is always preferred and nurses often do have to justify budgets, data are needed to compare the local community with itself over time and with other communities so that problems may be recognized and action taken to confront health issues. The first step is always to recognize problems as they develop.

Which of the following aspects of a developed country would be most worthwhile to be copied by a developing country? a. Education of health care professions b. Health care reform policies to improve health care delivery c. Advanced technology with its miracle interventions and cures d. Our approach to rationing health care

ANS: B Although transferring specialized medical technologies from developed to developing countries may not always be appropriate, developing countries are currently learning from health care reform policies and the technological revolution in developed countries. The health care reform policies will improve healthcare delivery and be more helpful than changing the education of health care professionals. There is not a rationing approach to health care services in the United States that could be used by other countries.

An occupational health nurse (OHN) works in a state that requires continuing education units per year for renewing a nursing license. Which of the following courses would probably be most helpful in the role? a. Diversity and Human Caring b. Ergonomics and Toxicology c. Evaluating Risks and Personnel Management d. Health Assessment and Home Health Care

ANS: B Any of the programs might be helpful, but only Ergonomics and Toxicology are inherent in the science needed to function in occupational health. Evaluating Risks is relevant to the job description, but many OHNs are the only professionals in the area, so there are no personnel to manage. Health Assessment is relevant, but rarely would a home visit be made for health care; rather a referral would be done.

A client, accompanied by her son, spoke only Spanish while the nurse did not. Which of the following actions should be taken by the nurse to best meet the client's need? a. Ask the woman if it's OK if the son translates for her b. Call until she finds a Spanish interpreter employed by the agency c. Let the son translate because he's obviously informed about the problem d. Use gestures and pantomime to make oneself clear

ANS: B Asking the son would violate confidentiality, and gender issues may also arise. The only safe approach is to obtain a Spanish interpreter who is knowledgeable about medical terminology and procedures, as well as comfortable with cultural beliefs and health practices. It is important to have an interpreter rather than trying to make gestures and pantomime so that the communication between the nurse and client is clear and accurate.

How does community health nursing define community? a. A group of persons living within specific geographic boundaries b. A group of persons who share a common identity and environment c. A group of persons who work together to meet common goals d. Persons who form a group to resolve a common concern

ANS: B Community health nurses work with both geopolitical groups (within specific geographic boundaries) and phenomenological groups (who have a common identity based on culture, history, or goals). A particular phenomenological group may or may not have been a planned group—that is, a group that came together to resolve a recognized common problem or to meet a common goal. However, of all the choices, a group of persons who share a common identity (phenomenological group) and environment (which implies a specific geographic setting) is the broadest and most complete definition.

Which of the following entities has been most active in creating change and alternative approaches in health care delivery? a. Consumers b. Corporations c. Health care professionals d. State legislators

ANS: B Corporations have become driving forces in shaping the development of alternative approaches to health care. Businesses, that is, employers, have consistently fought to keep health care costs down and to maximize the value of their dollars spent on health care services. Corporations have taken the most active force in health care delivery in comparison to consumers, health care professionals, and state legislators.

Which of the following statements best defines Leininger's term "culture universal"? a. The preference to be cared for by someone from their own cultural group for maximum ease and comfort b. The commonalities of values, norms, and life patterns that are held in all cultures c. The particular values, beliefs, and patterning of behavior that is universal within a particular culture d. The health care roles, norms, and behaviors that are involved when illness or injury occurs

ANS: B Culture universal is used by Leininger to refer to the commonalities of values, norms of behavior, and life patterns that are similarly held among cultures about human behavior and lifestyles and form the basis for formulating theories for developing cross-cultural laws of human behavior.

At a military base, a family from Qatar, a Muslim Arabic country, came in to the prenatal clinic because the wife believed she was pregnant. Which of the following providers would be the most appropriate choice for this client? a. A male obstetrician, expert in high-risk pregnancies b. The female nurse midwife c. The male obstetrician with a female nurse always in the room with the wife d. Whichever provider was on duty until the pregnancy was confirmed

ANS: B During pregnancy, many female clients will prefer female health care providers and may refuse to be examined by a man. People from Arab Muslim countries feel even more strongly about males touching a female.

Which factor is most responsible for differences in an individual's health? a. Culture of the majority of the community's citizens b. Individual's education and income c. Number of physicians and other health care providers in the community d. Quality of the community health agency and hospital in the community

ANS: B Factors that contribute to wide variations in health disparities are education, income, and occupation. This is best addressed by looking at an individual's education and income. The culture, number of physicians, and quality of agencies in the community do not play as important of a role in individual health.

A nurse is unable to be actively involved in attending meetings at the state level. Which of the following actions would be most useful for the nurse? a. Asking students to remain informed regarding proposed legislation b. Communicating, with rationales, her stand on proposed legislation to legislators c. Remaining uninvolved so incorrect information is not inadvertently given d. Writing letters to the local newspaper asking nurses to become involved

ANS: B Grassroots cooperation can influence decisions. A high number of communications from individual constituents via e-mail, telephone, or postal mail have great influence.

Which of the following best describes the most crucial step in policy formation? a. Convincing both political parties and independents to support the proposed policy b. Defining the issue and placing it on the agenda for possible action c. Determining who has vested interest in what aspects of the policy d. Trying to simplify the proposed legislation so the public will support it

ANS: B How an issue is defined determines what the possible approaches to resolution might be. With all the demands on legislators' time, it is difficult for an issue to be seen as important enough to have action taken. Defining the issue as crucially important and worthy of a place on the agenda for possible action is the most critical step.

A nurse is using the critical theoretical perspective in daily nursing practice. Which of the following activities would the nurse most likely complete? a. Criticize health insurance programs as a barrier to health care b. Expose social values underlying the health care system c. Promote individual freedom and decision making d. Exert control over the client's environment

ANS: B Improvements can only be made if societal and personal values are made explicit. Once these values are recognized, they are more easily confronted. Change may be sought toward a more just society.

Which of the following best describes what physicians did to compete with new competition from health maintenance organizations (HMOs)? a. Accepted employment directly under the insurance company b. Organized preferred provider organizations (PPOs) to negotiate with insurance companies c. Created private practices with colleagues within hospital medical complexes d. Decided to strike and refused to work in the new HMOs

ANS: B In an effort to compete with HMOs, physicians and hospitals organized the independent practice model, which provided services to enrollees of one insurance company. This model evolved into the PPO, which offered services at a reduced rate in exchange for a guaranteed increase in consumers. Physicians did not become directly employed by insurance companies, set up private practices with colleagues, or decide to strike in order to compete with the HMOs.

Why are high-risk and vulnerable subpopulations identified by public health nurses before deciding on appropriate interventions? a. It is easiest to make improvements among these groups. b. Populations are not homogeneous, and resources are limited. c. Such groups are most vocal about their needs and wants. d. These groups are often recipients of special funding.

ANS: B Populations are not all the same. The needs of subpopulations must be assessed. The high-risk and vulnerable subpopulations must be identified early. Those individuals who do not receive service early become very expensive high-cost users later.

Which of the following best describes why it is crucial that the faith community nurse (FCN) have at least a baccalaureate degree, as well as several years of experience in clinical practice, in addition to formal education in the role? a. To ensure continued prestige and relatively high salary for the role b. To be autonomous with self-direction and independent decision making c. To enable the FCN to assess the faith community and prioritize its needs d. To function in varied settings from the religious building to the clients' homes

ANS: B Incredible diversity and autonomy are found in faith community nursing. The self-direction and independent decision making required by the autonomous roles of the FCN require a highly educated nurse experienced in clinical nursing and community-based nursing practice. Typically, there is not a high salary associated with the role of FCN. The autonomy and independent decision making required in this role allow the nurse to be able to effectively assess the community and function in a variety of settings.

Which of the following best describes why a nurse working in a U.S. urban area should be knowledgeable about infectious diseases common to areas of Africa? a. Nurses have an ethical commitment to care for others throughout the world. b. Every infectious disease is just one airplane ride away. c. Infection could occur if a nurse goes out in public. d. Nurses meet people who may originally have been born elsewhere.

ANS: B Infectious diseases do not recognize or respect country borders. With rapid international travel, an infected person could easily be in any country in a very short period of time. Problems throughout the globe can threaten human life. Although nurses have an ethical commitment to provide care, infections can occur anywhere, and nurses may care for populations who were originally born outside of the United States, the primary need for the nurse to have this knowledge exists because infectious diseases can spread throughout the world in a very short period of time because of the ease of travel in the world.

The forces for the proposed bill are roughly as persuasive, powerful, and well financed as the forces against the proposed bill. Which of the following describes the most likely outcome? a. The bill will be debated through a public hearing. b. The bill will fail. c. The bill will pass. d. The bill will remain in the legislature until one side or the other has a majority of votes.

ANS: B It is far easier to defeat a bill than get one passed; therefore, the opposition always has the advantage.

The female nurse was called to the emergency department (ED) to help with a woman who had been beaten and raped. Which of the following are the nurse's responsibilities as a forensic nurse? a. Discuss with police officers what is known and what needs to be known to close the case b. Initiate the proper collection, preservation, and chain of custody of evidence with appropriate documentation c. Serve as chaperone while the physician completes the physical examination d. Be empathetic and supportive to the victim

ANS: B It is imperative that ED registered nurses identify forensic cases and initiate the proper collection, preservation, and chain of custody of evidence and provide accurate documentation for this unique population. This collection of evidence plays an important role in the investigation of crimes and can have a major impact on legal decisions. Accurate collection of evidence is the primary responsibility of the nurse and needs to be completed before any additional action is taken. This collection of evidence plays an important role in the investigation of crimes and can have a major impact on legal decisions. It is important for the nurse to collect the necessary evidence whereas it is the responsibility of the legal system to prosecute and close the case. The primary role of the female forensic nurse would not be to serve as a chaperone to the physician or provide support to the victim.

A nurse carefully explained that the medication had to be taken three times a day, with each meal. The patient came to the clinic with symptoms of medication overdose. How should the nurse respond? a. "Can you explain what you believe happened to make you so ill now?" b. "Can you tell me when in the day you and your family eat?" c. "Please review with me when I taught you to take your medication." d. "Why did you take more medication than we suggested?"

ANS: B It is not helpful to confront the patient or accuse someone of noncompliance. A review of the prescription may have been helpful, but because the patient had an overdose, one might assume the medication is being taken more than three times a day. The nurse has engaged in cultural imposition—that is, assuming the patient's beliefs, values, and patterns of behavior are identical to hers. Not everyone eats exactly three times a day. The family may eat more or less than three times a day.

Which of the following statements best summarizes Lillian Wald's achievements? a. She suggested new nursing specialties. b. She demonstrated how to improve health in communities. c. She gave expert clinical nursing care to her clients. d. She was appointed a national nursing leader.

ANS: B Lillian Wald improved health in a community by using diplomacy and neighborhood power. She was elected president of a national nursing organization and created new nursing specialties such as school nursing. However, she is primarily known for her creation of Henry Street House (see Chapter 2 of text), which led to the Visiting Nurses Association and notably improved health in many communities.`

What conclusion can be drawn from examining where nurses are employed? a. There is a trend toward consolidation of health care into large central medical centers. b. There is an increased emphasis on community-based health care. c. There is an obvious need to decrease health care costs by cutting positions. d. Managed care organizations (MCOs) are employing nurses to improve customer relations.

ANS: B MCOs are employing nurses in many capacities. Although hospitals are closing and acute care is increasingly found in central medical centers, the same trend may be seen in an increase in neighborhood- based practice centers. While positions are cut in most industries, health care is recognized as an area where growth in employment is expected. However, nurses are increasingly employed in community settings as opposed to hospitals. This change reflects the move toward community-based care rather than hospital-based tertiary care. To help decrease the continued rise in health care costs, the increased emphasis is on disease prevention rather than high-cost treatment.

In which of the following areas would the faith community nurse (FCN) most desire more education to continue in the role? a. Basic community health nursing practice, especially in finding and accessing resources b. Spiritual assessment skills and acquiring theological knowledge c. Use of spirituality in faith healing d. Physical assessment, pathophysiology, and pharmacology

ANS: B Many FCNs find the need for further education to develop spiritual assessment skills, acquire theological knowledge, and learn the nurse's role in healing.

Which of the following statements best define epidemiological transition? a. A change from morbidity due to a particular infectious disease to a different infectious disease b. A change from mainly infectious diseases to chronic diseases c. A change in infectious diseases caused by a difference in agent, host, or environment d. A change in life spans of various age groups in a specific country

ANS: B Many developed countries experienced an epidemiological transition from having an infectious disease profile to having a chronic disease profile and are now plagued by chronic diseases. Once plagued with high rates of infectious disease, developed countries significantly reduce high mortality rates from these diseases through improved sanitation, nutrition, and immunization and improved health care. Most developed countries have a more stable economy and a wide range of industrial and technological development. These countries experience an epidemiological transition. The other statements do not define epidemiological transition.

Which of the following federal agencies is responsible for administering most of the federal health-related activities? a. Centers for Disease Control and Prevention (CDC) b. Department of Health and Human Services (DHHS) c. Health Resources and Services Administration (HRSA) d. National Institutes of Health (NIH)

ANS: B Most health-related activities at the federal level are implemented and administered by the DHHS. The responsibility of the CDC is to keep the public safe and healthy. The responsibility of the HRSA is to improve access to health care services for vulnerable groups in the population. The main responsibility of the NIH is biomedical and health-related research.

3. Which of the following statements best describes a weakness of early nursing theories? a. Many nurses did not know or understand the theoretical basis of nursing practice. b. Most nursing theories focused on microscopic individual concerns. c. The theories did not reflect the actual world of nursing practice. d. The theories had global applicability to nursing practice.

ANS: B Most nursing theories have an extremely narrow focus on individual nurse-patient care situations. This microscopic focus ignores the broader global social macroscopic perspective.

A correctional nurse was preparing to give an inmate his psychotropic drug when the prisoner hit the nurse's arm, sending the medication flying, and yelled, "No more. I'm not taking that poison anymore!" The prisoner is obviously mentally ill. Which of the following actions should be taken by the nurse? a. Inject the medication rather than debate taking the oral pill with the inmate b. Recognize the prisoner's right to refuse treatment c. Throw the medication away, obtain another pill, and try to persuade the prisoner to take the drug d. Force the medication down the prisoner's throat with the assistance of two prison guards

ANS: B Nurses practicing in correctional settings must respect the right to refuse care even if the result is an adverse outcome.

Which of the following best describes what the Code of Federal Regulations, especially Title 29, requires of the occupational health nurse (OHN)? a. All employees must be trained in first aid. b. Postwork-related injuries, illnesses, and death records must be recorded yearly. c. The OHN must serve as an emergency warden, helping employees to the emergency exit in a safe manner. d. The Occupational Safety and Health Administration (OSHA) inspector must make a worksite inspection on an annual basis.

ANS: B OSHA has record-keeping requirements that mandate the employer to keep records of work-related injuries, illnesses, and deaths. These records must be posted in the workplace for 1 month per year and made available for review by OSHA at any time. In many cases, the OHN has full responsibility for compliance with this standard.

Which of the following health problems continues to increase in school-aged and adolescent children? a. Contagious diseases b. Obesity and related problems (diabetes) c. Sexually transmitted diseases (STDs) d. Stomach flu (viral gastroenteritis)

ANS: B Obesity is the fastest rising public health concern in the nation and may overtake tobacco use as the single leading preventable cause of death. The obesity rate has more than doubled in children and tripled in adolescents over the past three decades. More than one third of children and adolescents are considered overweight or obese. Vaccine-preventable deaths (VPD) related to contagious diseases are at or near record-low levels. According to the Centers for Disease Control and Prevention, many communicable diseases have been reduced by greater than 99% as a result of immunizations. STDs and stomach flu have not been increasing in school-aged and adolescent children.

Which of the following is one of the most frequent health complaints of school-aged children? a. Anxiety over grades b. Dental caries c. Headaches in response to stress d. Stomachaches

ANS: B One of the most frequent complaints of school-aged children is dental caries. Causes include poor oral hygiene, lack of fluoridated water, and lack of funds or insurance for dental care. Half of children aged 12 to 15 years will have dental caries. Approximately 75% of those between the ages of 12 and 19 years have had tooth decay. Dental caries occur as a more frequent complaint than anxiety over grades, headaches in response to stress, and stomachaches.

A nurse is using Milio's framework to promote healthy eating choices among members of the community. Which of the following interventions would the nurse most likely implement? a. Provide community education about healthy food choices b. Promote legislation to increase taxation on unhealthy food choices c. Lobby for health insurance providers to pay for participation in health promotion programs d. Encourage community members to be responsible for making healthy choices

ANS: B One of the propositions of Milio's framework is that alteration in patterns of behavior resulting from decision making of a significant number of people in a population can result in social change. Some behaviors, such as tobacco use, have become difficult to maintain in many settings or situations in response to organizational and public policy mandates. Increasing taxation on unhealthy food choices may make it more difficult for community members to make these unhealthy choices.

Which of the following assumptions makes Orem's theory difficult to use? a. That nurses will always be caring for families and groups b. That clients are able to control their environment c. That clients recognize the need for nursing intervention d. That teaching clients self-care is the primary goal of nursing practice

ANS: B Orem's theory is focused on patient-nurse interaction within institutional settings. It assumes that the client can control his or her environment, whereas most persons cannot control work, school, or neighborhood environments.

A nurse suggests to the students that they attend the local district nurses' association meeting, where the nurse is an officer. Which of the following provides the best rationale for this action? a. Meeting outside the clinical area allows for more effective informal learning based on discussion and interaction. b. Role models are typically the major influence on nurses choosing to become politically active. c. Students are often given extra credit from their instructor for such community involvement. d. Such groups want students to attend their meetings to encourage them to join and to accept a committee responsibility.

ANS: B Professional groups do not usually accept students into membership (especially since many students may want a different specialty practice). Nurses most often identify positive role models as the major influence that assisted them to become politically active. Therefore, mentorship at the student level up to the expert level is important. Providing extra credit should not be the motivator for students to learn from these role models. The learning that occurs is a formal learning process related to learning more about political advocacy and something that is difficult to demonstrate in a classroom environment.

A nurse is caring for a client from a different culture. Which of the following actions would be the most helpful for the nurse to take? a. Ask to have a nurse from that culture assigned to the patient even if the nurse must be obtained from a different clinical area b. Be aware of cultural similarities and differences between the nurse and the client c. Explain that the patient must follow the rules of the hospital while a patient d. Verbalize the nurse's own discomfort, and ask for assistance with surmounting the cultural differences

ANS: B Recognizing both similarities and differences is being culturally aware. Although it would be helpful to have a nurse from the same culture give care, that is often not feasible. A nurse from another area cannot be expected to be clinically expert, to say nothing of the legal problems of having a nurse from a different agency give care. Asking the patient for help makes the problem belong to the patient, but it is the nurse's problem. Asking the patient to comply with the hospital regulations is being culturally insensitive.

Before interviewing an Hispanic family, what is the most important action for the nurse to take? a. Compliment each member on some visible asset b. Establish rapport, and gain trust and confidence c. Greet them in Spanish even if badly spoken and accented d. Recognize the male as the authority figure in the family

ANS: B Regardless of the culture of the client family, it is crucial to establish rapport and gain trust and confidence before attempting to gather data. First impressions are important and the nurse should ensure a mutually respectful relationship is created. Thus, starting by providing compliments, greeting them with poor Spanish, or assuming that the male is the authority in the family may all lead to an unacceptable first impression of the nurse to the family.

In addition to their homes, where are children most likely to be injured? a. At entertainment sites (theaters, amusement parks) b. At school, especially on playgrounds c. At their part-time job settings d. Transportation (automobiles, school buses)

ANS: B Safety on the schoolyard and playground is also important for this age group, because about 200,000 children per year are injured on playgrounds in the United States. Thus, school playgrounds are the most likely place where children are injured. Injuries at entertainment sites, part-time job settings, and through modes of transportation are less likely to occur than injuries at school.

A woman stood very close to the nurse and asked a question about her husband's condition. The nurse took a step back and shared the requested information. No other questions were asked. Was this a successful interaction? a. No, because the nurse should not answer any questions about a client, even if the wife is the one asking b. No, because the woman and the nurse had different perceptions of personal space c. Obviously yes, because the woman sought information, received it, and had no further questions d. Yes, because the nurse was knowledgeable and able to respond appropriately

ANS: B Sense of spatial distance is significant because culturally appropriate distance zones vary widely. Many cultures stand closer for important conversations, whereas the nurse stepped back because being so close made the nurse uncomfortable.

Which of the following best describes why so many Americans continue to engage in unhealthy behaviors? a. Americans are not knowledgeable on how to change their behavior. b. Americans believe that most illnesses can be cured with insurance footing the bill. c. Health is not a concern to most Americans. d. Most Americans do not know which behaviors are unhealthy.

ANS: B Society sees insurance as an economic shield protecting against all disease and illness. The belief in cure rather than prevention, combined with this financial safety net, encourages society to become a passive participant in health care. The pervasive societal thought is "I don't have to worry; I have insurance." Americans are aware of which behaviors are unhealthy, have knowledge on how to change their behavior, and are concerned about health, but insurance has allowed them to take a passive approach to health.

Which of the following nongovernmental groups has been expending millions of dollars to reduce the impact of infectious diseases with profound effect on prevention and treatment for HIV/AIDS, tuberculosis (TB), and malaria? a. Carter Center b. Bill and Melinda Gates Foundation c. Families for Freedom Foundation d. Bradley Foundation

ANS: B The Bill and Melinda Gates Foundation has local, national, and global objectives. Globally, the foundation focuses on reducing extreme poverty, improving health, and increasing public library access. Within Africa, the foundation has had a profound effect on improving access to antiviral medications and prevention and treatment for HIV/AIDS, TB, and malaria. The objectives of the Carter Center are to prevent and resolve conflicts, to enhance freedom and democracy, and improve health. The Families for Freedom Foundation provides education and support to families who are affected by deportation. The Bradley Foundation supports public policy organizations and conservative causes.

Which of the following federal agencies is responsible for the Women, Infants, and Children (WIC) program, food stamps, and school-based nutrition programs? a. Aid to Dependent Children Department b. Department of Agriculture c. Department of Education d. Department of Health and Human Services

ANS: B The Department of Agriculture administers the inspection of meat and milk, and provides funds for the WIC program (supplemental nutrition), the food stamp program, and the school-based nutrition program. The Aid to Dependent Children is a program, not a department, that provided financial assistance to families with limited financial resources. The Department of Education administers and coordinates resources related to education. The Department of Health and Human Services is responsible for protecting the health of all Americans.

Which of the following suggestions was made by the Health Professions Education report? a. Expand efforts to increase enrollment in nursing education programs. b. Interdisciplinary teams should use informatics to provide patient-centered care. c. Primary care should be emphasized over education for specialty practice. d. All health professions should be required to communicate and collaborate in patient education.

ANS: B The Health Professions Education report concluded there were five core competencies—provide patient- centered care, work in interdisciplinary teams, employ evidence-based practice, apply quality improvement, and use informatics. The expansion of enrollment in nursing programs, emphasis in primary care education, and emphasis on patient education were not suggestions made through this report.

Which of the following actions was taken by the federal government to help improve health disparities among minorities? a. Created scholarships and traineeships only for minority applicants b. Created the National Center on Minority Health and Health Disparities c. Established grants that funded only minority health projects d. Legislated funds to create new colleges for preparing health professionals in minority neighborhoods

ANS: B The National Center on Minority Health and Health Disparities was developed in 2000 to assist in the investigation of factors affecting minority health. Its mission is to promote minority health and to ultimately eliminate health disparities. The federal government did not create scholarships and traineeships specifically for minority applicants, establish grants for minority health projects, or legislate funds to create new colleges to address the improvement in health disparities.

Which of the following statements best describes the significance of the Health Plan Effectiveness Data and Information Set (HEDIS)? a. Data are publicized so consumers can make informed decisions about where to go for care. b. Data are used to measure performance in the accreditation of managed care organizations (MCOs). c. Obvious improvement in the provision of health care has resulted from requiring health care providers to collect and analyze such data. d. Physicians and other health care providers can publicize the data to market their services to new clients.

ANS: B The National Committee for Quality Assurance accredits MCOs and uses HEDIS to measure performance and consumer satisfaction. Some outcome data are available to informed consumers on the Web, but the data are not widely available. To date, these efforts have not been successful to ensure quality care. Errors continue to be high and patients continue to be dissatisfied.

Which of the following best describes the first government step in trying to stop constantly rising costs? a. Insurance companies were told to cease adding new members to their plan. b. Payment reimbursement was based on diagnosis and client characteristics rather than on treatment given. c. Physicians were limited to a maximum amount that would be paid for any particular service. d. Reimbursement was based on prospective payment; that is, in advance of admittance for care.

ANS: B The first efforts to control costs were made by the federal government when Medicare hospital reimbursement was based on a prospective payment system. Payment would be based on a classification system that identified costs according to diagnosis and client characteristics. Restricting insurance companies to add new members to their plan was not part of the first steps to try to stop constantly rising costs.

Which of the following is the most commonly used illegal drug among children and adolescents in the United States? a. Inhalants b. Marijuana c. Methamphetamine d. Cocaine e. Steroids

ANS: B The most commonly used illicit drug among youth in the United States is marijuana. The use of other illegal drugs in high school students includes cocaine (6.8%), inhalants (11.4%), heroin (2.9%), methamphetamine (3.8%), and steroids (3.6%). Inhalants are the most widely abused.

Which of the following statements best describes how the population of the United States is changing? a. Growth will occur because of a decrease in the death rate. b. Growth will occur because of ongoing immigration. c. Growth will occur because of an increase in the birth rate. d. Growth will occur because of lengthening of the normal life span.

ANS: B The number of immigrants and refugees in the United States is projected to continue to increase. The U.S. has grown largely through immigration. The growth will not occur because of changes in death rate, birth rate, or life span.

A nurse who works on the surgical unit at the local hospital was asked by the home health unit to make a home visit to a patient who had been discharged the previous day and to give follow-up care (for overload pay). What kind of nursing would this nurse be doing? a. Acute care hospital nursing b. Community-based nursing c. Community health nursing d. Public health nursing

ANS: B The nurse is caring for a patient in the home. Community-based nursing is nursing somewhere in the community. As the nurse is not focusing on the health of the community but on an individual, it is not community or public health nursing. It is not acute care hospital nursing because the nurse is seeing the patient in his or her home.

Every day a child came into the school nurse's office with vague complaints, but sometimes it seemed to the nurse that the child just wanted to talk and be listened to for a while. Unfortunately, the child took up almost 15 minutes of the nurse's very busy day. Which of the following actions should be taken by the nurse? a. Ask a staff person to talk with the child so the nurse could complete required tasks b. Continue to listen while assessing for possible underlying problems c. Refer the child to a private physician for follow-up on the constant physical symptoms the child presented d. Talk to the teacher about not letting the child leave the classroom unless obvious symptoms (fever, vomiting) of illness were present

ANS: B The nurse or teacher may be the only stable adult in the child's life who will listen without being judgmental. Therefore, one of the most important roles of the school nurse is to act as counselor and confidante. Children may come to the school nurse with various vague complaints, such as recurrent stomachaches, headaches, or sexually promiscuous behavior, and the nurse must look beyond the initial complaint to identify underlying problems.

Which of the following best describes a current trend related to health care services? a. Nonprofit organizations are assuming responsibilities for service from for-profit organizations. b. Health care organizations are offering services low in cost and higher in reimbursement. c. Ways to minimize reimbursement using current procedural terminology (CPT) codes have been created. d. Postponing computerized medical record programs increases profitability.

ANS: B There is a national shift from nonprofit health care to for-profit health care as large for-profit organizations take over smaller community organizations. Because emphasis is on profit, mechanisms of achieving higher reimbursement have been developed. Coding of the patient's illness from the CPT codes results in an increase in reimbursement. Use of computerized medical record programs almost ensures that service can be reimbursed at the highest rate possible. This has changed health care practices to the use of services that are low in cost and higher in reimbursement. High-cost services are limited or not offered.

Which of the following is most closely associated with morbidity and mortality outcomes? a. Number of physicians per capita b. Insurance status c. Crime rate d. Personality traits

ANS: B Tremendous disparities for access exist between insured and uninsured people in the United States. Access to care is associated with economic, social, and political factors, and depending on individual and population needs, it can be a primary determinant of health status and survival. Structural variables such as race-ethnicity, educational status, gender, and income are highly predictive of health status.

A prisoner was bleeding where another inmate had attacked him with a fork. Which of the following would be the correctional nurse's first and most crucial responsibility? a. Perform a complete physical assessment, specifically looking for internal injuries b. Maintain an escape route to help ensure personal safety c. Report the incident to administration, indicating who was responsible for injuring the inmate d. Stop the bleeding, apply an antibiotic, and bandage the wound

ANS: B Unlike any other care setting, clients are inmates, and care is negotiated and provided with recognition of safety and security issues for the nurse. The nurse must maintain an escape route, should a situation of personal violence be imminent. If the nurse is able to maintain an escape route, the nurse would then be able to complete a physical assessment, stop the bleeding, and then report the incident to administration.

Which of the following health problems has been reduced in school-aged and adolescent children? a. Chronic diseases (such as asthma or diabetes) b. Contagious diseases c. Sexually transmitted diseases (STDs) d. Stomach flu (viral gastroenteritis)

ANS: B Vaccine-preventable deaths (VPD) are at or near record-low levels. According to the Centers for Disease Control and Prevention, many communicable diseases have been reduced by greater than 99% as a result of immunizations. Chronic diseases have been increasing in school-aged and adolescent populations due to the increase in overweight and obesity. STDs and stomach flu have not been greatly reduced in school- aged and adolescent children.

A student had been absent 4 days out of the last 3 weeks. When the school nurse asked what was wrong, the student replied, "Headaches" in a rather angry tone. The student had previously been heard complaining that school was boring and it was hard to concentrate on such dumb stuff. Which of the following actions would be most appropriate for the nurse to take next? a. Emphasize the importance of completing school for lifelong success b. Express concern that the student was under a lot of stress and offer to help if possible c. Meet with the student's parents to discuss the headaches and the school absences d. Refer the student to a neurologist for a workup to see what is causing the headaches

ANS: B Warning signs of stress include angry or hostile feelings, inability to concentrate, increased boredom, frequent headaches or other ailments, and inconsistent school attendance.

The local nursing association and the local medical association disagreed vehemently on advanced practice nursing reimbursement. Which of the following best describes why the two groups agreed to join a coalition to send representatives to testify on a particular bill? a. Although there was disagreement, both groups agreed to behave politely and professionally. b. Both associations had formed a coalition to collaborate on a bill that would benefit patients. c. Because the legislators had asked both groups to appear, the groups did not have a choice. d. The two groups were sharing costs and expenses, but their testimony would give opposing viewpoints.

ANS: B When two or more groups join to maximize resources, increasing their influence and improving their chances of success in achieving a common goal, it is a coalition. Professional groups often form coalitions to advance their shared interests.

A nurse became frustrated because after each interview question there was a long pause before the client responded. Which of the following actions should be taken by the nurse? a. Accept the hesitation before receiving an answer b. Ask the client what silence after a question means c. Copy the client's behavior; insert a pause before asking the next question d. Recognize that the client was distracted, and reschedule the home visit

ANS: B Wide cultural variation exists when interpreting silence. Some individuals find silence uncomfortable, whereas others use silence to show understanding and respect. Because the nurse is uncomfortable, action should be taken. The only way to know the meaning of the silence is to ask.

Which of the following best describes the principal factor behind ongoing legislation on the federal level related to health care? a. Change is needed to reflect differences in health needs today. b. Efforts must be put in place to control constantly increasing costs. c. There is a need to focus on the population as a whole. d. Technological breakthroughs should be expanded.

ANS: B With the rapid growth of technology and increased demands on the private and public health care subsystems, health care costs have become prohibitive. Cost-effectiveness and cost containment have become critical driving forces as health care delivery system changes are made; however, cost- effectiveness often conflicts with the provision of quality care. The Institute of Medicine (IOM) report Best Care at Lower Costs: The Path to Continuously Learning Health Care in America "presents a vision of what is possible if the nation applies the resources and tools at hand by marshaling science, information technology, incentives, and care culture to transform the effectiveness and efficiency of care—to produce high-quality health care that continuously learns to be better" (2012, p. ix). Since 1999, the IOM has completed many extensive reports examining the status of health care in the United States. Some improvement has been seen in the delivery system, but much more needs to be done. This report addresses these critical concerns again.

Which of the following best describes the reason why so many Americans are obese? a. Culture requires eating at celebrations and holidays. b. For many people, caloric intake is more than needed for their physical activity. c. Physical education is no longer a required subject in most elementary and secondary schools. d. The expected portion size in restaurants has vastly increased over time.

ANS: B Although many factors have led to obesity in American society—including cultural pressure, increased portion sizes in restaurants (portion distortion), offers of more food at a reduced price ("super-size"), and a perceived lack of time to cook nutritious inexpensive foods—the primary cause remains the consumption of more calories than needed for physical activity. With computers and television as recreational choices, Americans are as a group sedentary rather than physically active.

10. Which of the following risk factors are least subject to modification? a. Choice of lifestyle behaviors b. Environmental exposure c. Nutritional options d. Recreational activities

ANS: B An individual may choose to control lifestyle behaviors, nutrition choices, and recreational options. An individual cannot alone control his or her neighborhood, employment setting, or other environmental exposures.

A nurse reviewed information before meeting with the community residents who were attending a program on healthful living. Which of the following best describes the action by the nurse? a. Disease prevention b. Health promotion c. Health improvement d. Specific protection

ANS: B Health promotion is any combination of health education and related support for health behaviors. It is not specific protection or disease prevention because no specific disease is being avoided. Although healthful living may indeed improve health, there is nothing to suggest the attendees were not currently healthy.

A nurse was becoming frustrated. She had given her client extensive information on his health problem, but the client continued to be noncompliant in making needed changes. Which of the following principles had the nurse forgotten? a. A person may have a higher priority than improving his or her health. b. Information, while necessary, will not motivate people to change. c. People need repetition over time to be able to absorb information. d. Physicians, not nurses, are perceived as experts in health.

ANS: B Information alone is rarely enough to motivate a person to act. Information is necessary to know what to do and how to do it before the person chooses to act, but other factors are primarily responsible for motivating people to change their behavior. Although other priorities may result in delay of change, the fact that the client has returned to the nurse demonstrates interest in changing. Repetition may be helpful, but apparently the nurse has given information on more than one occasion because she believes extensive information has been given.

It is rumored that there is something in the workplace that is causing persons employed there to feel ill. Which of the following actions would be most appropriate for the nurse to take? a. Ask researchers to set up a study to confirm the health hazard in the environment b. Assess the risk, including identifying any toxic substance c. Confirm the extent to which the illness resulted from intergroup agreement on the illness and cause d. Insist that the media not further spread stories of possible sick buildings until the truth of the situation can be studied

ANS: B The media report news; they do not create it without any basis. Researchers are not asked to confirm a preconceived conclusion but to seek what factors are active in a situation. "Group think" is a well-known phenomenon, but one would have to ask what led the communication leaders to believe originally that there was a hazard in the environment. Risk assessment in a questionable situation begins with identifying a possible hazard and describing the risk.

Which of the following actions have been effective in reducing problems related to alcohol use? (Select all that apply.) a. Abstinence education programs in elementary schools b. Enforcement of ban on sales of alcohol to minors c. Increased taxes on alcoholic beverages d. Media campaigns that show unpleasant behaviors such as vomiting after drinking e. Stringent laws on accurate labeling of alcoholic content in beverages f. Suggesting children be taught appropriate use of alcohol in the home

ANS: B, C The prevalence of underage drinking declined significantly when states enacted the minimum legal drinking age of 21 years. The states with more stringent drinking laws have a lower prevalence of binge drinking. Enforcement of the legal drinking age, as well as enforcement of bans on sales of alcohol to minors, helps prevent underage drinking, as have increased excise taxes on alcoholic beverages.

Which of the following best describes how having health insurance has affected lifestyle behaviors? a. Health promotion disease prevention programs are attended because they are reimbursable. b. Health education is widespread, because insurance companies promote such education. c. Medications and medical treatment are relied on for cure. d. Screening is widespread because of insurance sponsorship.

ANS: C Funding for behavioral changes is limited, inadequate, or unavailable. Weight loss programs or smoking cessation programs are not reimbursable treatment regimens, although more expensive pharmaceutical interventions are reimbursable. Therefore, it is financially wise not to worry until illness strikes because illness care is reimbursable, whereas preventive health care is not.

Which of the following best describes how eligibility for Medicaid services is determined? (Select all that apply.) a. Anyone over age 65 years who is eligible for Social Security benefits may apply for Medicaid. b. Baseline eligibility is established by the federal government, but states may be more lenient. c. Children in low-income families are eligible for free care. d. Eligibility depends on family size and total family income. e. Federal government establishes eligibility and gives funds to the states in reimbursement for this care. f. State government establishes guidelines for whether to participate and who will be covered.

ANS: B, C, D Medicaid provides universal health care coverage for the indigent and children. Eligibility is dependent on the size and income of the family. The federal government sets baseline eligibility requirements. State governments who wish to provide care to more citizens can lower the eligibility requirements. The federal government mandates covered services, but state governments may provide more services.

Which of the following best describes the effects of Medicare and Medicaid? (Select all that apply.) a. All persons who were temporarily disabled now receive free care. b. A previously unseen rise in demand for services occurred. c. Many persons previously without access now receive health care. d. Medicare reimbursement rates became the standard for all insurance carriers. e. Indemnity insurance plans were offered. f. Public health education was now financed.

ANS: B, C, D, E The enactment of Medicare and Medicaid created an unprecedented demand for services, and many persons without access to health care were now able to receive care using an indemnity insurance plan. Medicare reimbursement rates generally became the standard for all insurance carriers. These plans did not provide services for the temporarily disabled or change financing for public health education.

An occupational health nurse (OHN) is walking through a hospital. Which of the following observations would be concerning to the nurse? (Select all that apply.) a. A nurse shares that the floor census is at capacity. b. A wet floor without a warning sign or a dry walk area on one side c. A nurse starts an IV without using gloves. d. An electric bed gives a shock when touched. e. Some biological substance on the floor and wall has not been cleaned. f. Volume has been turned very high on several TV sets, necessitating very loud verbal interactions.

ANS: B, C, D, E, F The OHN should identify work-related agents and exposures that are potentially hazardous so problems can be prevented. Some of the hazards found in the hospital that the nurse would want to note include biological-infectious hazards, such as may be found in bodily fluids; chemical hazards such as unlabeled medications or solutions; enviromechanical hazards, including any environmental hazards that could cause an accident such as slippery floors; and physical hazards such as noise, which can cause tissue trauma, or electrical equipment with a short so that persons get shocked when they touch it. The census of the floor would not be of concern to the nurse.

Which of the following statements best describes a notable change of the Omnibus Budget Reconciliation Act? (Select all that apply.) a. Legislated a funding increase for RN staffing b. Changed from process evaluation to outcome evaluation when evaluating care c. Established guidelines for the use of restraints d. Created health maintenance organizations nationwide e. Added prescription drug benefits for Medicaid recipients f. Required all states to review certificates of need before agencies could expand

ANS: B, C, E The Budget Reconciliation Act influenced funding and set up guidelines and regulations about several issues including a move from process to outcome evaluation, use of restraints, and prescription drugs for Medicaid recipients. The Health Maintenance Organization Act of 1973 established health maintenance organizations. The National Health Planning and Resources Act of 1974 required health care facilities to obtain prior approval from the state for expansion in the form of a certificate of need. The Nurse Training Act in 1964 provided funds for nursing school construction and loans and scholarships for full-time study.

Which of the following responsibilities do occupational health nurses (OHNs) have that are different from the responsibilities of most clinical nurses? (Select all that apply.) a. Completing expert physical assessments and health histories b. Coordinating site disaster planning c. Evaluating resources and vendors for case management d. Knowing relevant federal, state, and local regulations e. Managing budgets f. Performing cost-benefit analysis and outcomes monitoring

ANS: B, C, E, F Management responsibilities of the OHN include such tasks as managing budgets; handling workers' compensation and disability; performing cost-benefit analyses, cost-effectiveness analyses, and outcomes monitoring; facilitating work accommodations and return-to-work processes; coordinating medical response activities and site disaster planning; being a resource expert on health issues for employees and management; and participating in strategic operations planning. Completing physical assessments and health histories and knowing relevant federal, state, and local regulations are responsibilities of both clinical nurses and OHNs.

What are the leading health indicators found in Healthy People 2020? (Select all that apply.) a. Financial issues b. Health system issues c. Individual behaviors d. Issues related to legal and illegal immigration e. Legislative issues f. Physical and social environmental factors

ANS: B, C, F Ten leading health indicators are identified in Healthy People 2020, including individual behaviors, physical and social environmental factors, and health systems issues. Financial issues, issues related to legal and illegal immigration, and legislative issues are not found in Healthy People 2020.

Which of the following are the most important factors in reducing disparities in health outcomes between different cultural groups? (Select all that apply.) a. A strong family structure b. Access to a health care provider c. Access to transportation d. Health care insurance e. Having ongoing employment f. Owning one's own home

ANS: B, D Disparities in health care can be reduced or even eliminated when adults have health care insurance and a medical home defined as a setting that provides patients with timely, well-organized care and enhanced access to providers. According to the Commonwealth Fund (2007), when adults have insurance and a medical home, "their access to needed care, receipt of routine preventive screenings, and management of chronic conditions improve substantially." Thus, having a strong family structure, access to transportation, ongoing employment, and owning one's own home are not nearly as important as having health insurance and a medical home.

With whom would the forensic nurse primarily interact during the day in addition to clients? (Select all that apply.) a. Case managers b. Officers of the court c. Physicians d. Police officers e. Psychologists f. Social workers

ANS: B, D The International Association of Forensic Nurses explains that forensic nursing is the practice of nursing where the health and legal systems intersect (ANA, 2009). Thus, the forensic nurse's role provides a vital link between the health care system, the investigative process, and courts of law (Lynch, 2011). Officers of the court and police officers would be two key populations with whom the nurse would interact. The nurse would be less likely to interact with case managers, physicians, psychologists, and social workers.

Which activities would be a responsibility of local health departments? (Select all that apply.) a. Ensuring quality of nursing education programs b. Determining the safety of residents' wells c. Establishing requirements for professionals to maintain their licensure d. Providing free health screenings e. Providing health education programs on proper nutrition f. Inspecting restaurants

ANS: B, D, E, F Local health departments are responsible for the health needs of their constituents. Community health services include surveillance and immunizations, as well as health education programs. Environmental health services on the local level include inspection of food processing plants and restaurants and control of waste, air, and noise and water pollution. Local health departments protect the environment through such activities as inspecting wells and public swimming pools. Ensuring quality of nursing education programs and continuing competence of health professions are both state functions.

Which of the following best describes the new national health goals as seen in Healthy People 2020? (Select all that apply.) a. Achieve a plan for universal basic health care for citizens b. Create social and physical environments that promote good health c. Eliminate health disparities d. Eliminate preventable disease, disability, injury, and premature death e. Achieve health equity f. Promote healthy behaviors at every stage of life

ANS: B, D, F Building on previous iterations, the updated 2020 version has four "over-arching goals" for 2020: (1) attain high quality, longer lives free of preventable disease, disability, injury, and premature death; (2) achieve health equity, eliminate disparities, and improve the health of all age groups; (3) create social and physical environments that promote good health for all; and (4) promote quality of life, health development, and health behaviors across all life stages. Achieving a plan for universal basic health care for citizens, eliminating health care disparities, and achieving health equity are not seen as national health goals in Healthy People 2020.

Which of the following actions represent a shift in philosophy at the Centers for Disease Control and Prevention (CDC)? (Select all that apply.) a. Collecting and analyzing health data b. Creating integrated health information systems c. Allocating resources to treat specific diseases d. Encouraging partnerships and strategic alliances e. Creating transaction-based relationships f. Leveraging resources to steer the larger health system

ANS: B, D, F Rather than allocating resources, resources will be leveraged to influence the larger health system. Rather than collecting and analyzing health data, they now are creating integrated health information systems. Rather than transaction-based relationships, they now encourage partnerships and strategic alliances.

Which of the following is one legally required to obey? (Select all that apply.) a. Directions to a destination provided by a police officer b. Court decisions related to legislative law c. Delegation of responsibility for a task by a physician d. Executive decisions, such as your employer requirements e. Laws passed by your state or the federal government f. Rules and regulations from agencies, such as the state board of nursing

ANS: B, E, F Laws that all must obey include legislative law, regulatory agency rules and regulations, and judiciary rulings regarding the law. Although physicians may delegate a task, a physician cannot delegate responsibility.

Which of the following statements best describes an unfortunate consequence of using diagnosis-related groups (DRGs) to determine reimbursement? (Select all that apply.) a. Insurance companies had to greatly increase their funding from employers. b. The incentive was to undertreat and underuse health resources. c. Health care providers had to accept losses for each patient treated. d. Health care providers learned to cheat the system. e. Health care providers refused to accept more patients whose reimbursement was based on DRGs. f. High quality of care was no longer assured.

ANS: B, F Because costs were contained by both the federal programs and insurance companies, the providers had a strong incentive to undertreat and underuse health resources. The public feared that the quality of care being provided was less to keep costs as low as possible.

What historically have been public health nurses' two most important priorities? (Select all that apply.) a. Establishing school nursing to improve care of children b. Engaging in political activity to improve living conditions c. Giving superb clinical bedside care in the home d. Increasing funding to public health efforts e. Teaching family members how to care for their family f. Working with the community to confront health issues and poverty

ANS: B, F Neither administering bedside clinical nursing nor teaching family members to deliver care in the home has adequately addressed the true determinants of health and disease. The early public health nurses resolved that collective political activity should focus on improving social and environmental conditions such as poverty.

The president was sent a bill that he did not really like, but he would have been unpopular if he vetoed it, so he did nothing. Which of the following best describes what will happen to the bill? a. The bill is dead. b. The bill returns to both houses to see if enough votes can be obtained to pass the bill even without the president signing the bill. c. The bill becomes law. d. The bill sits there until the president signs it or vetoes it.

ANS: C A bill that has been passed by the legislature goes to the president. The president may sign it so it becomes law; however, if he neither signs nor vetoes it, the bill becomes law by default.

A nurse represents the state professional association. Which of the following actions would the nurse complete in relation to legislation? a. Be prepared to contribute to campaigns of legislators who vote consistently with nursing goals b. Be prepared to confront verbally those on the opposite side of legislative issues c. Be prepared to provide testimony and comment on relevant issues d. Be prepared to visit schools of nursing to present about the current legislative issues

ANS: C Although a nurse might do any of the above, the most effective is to provide testimony and comment on issues of importance to nursing. Contributing is dependent on the financial resources of the nurse. Legislators often appreciate volunteer hours spent on campaign tasks as much as sums of money. Giving presentations to schools may be useful, but it may be assumed that most nursing faculty can discuss legislative health issues. Verbal confrontations are not always useful.

A client did not attend the clinic for required follow-up care after his extensive surgery. Which of the following would be the most appropriate conclusion for the nurse to make? a. The client is noncompliant. b. The client is suffering from self-neglect. c. The health care system is not meeting the client's perceived needs. d. The health care system is not accessible for the client. e. The nurse has not motivated the client appropriately.

ANS: C Although it is easy to blame the patient for being noncompliant or neglecting himself or herself, or to blame the nurse for not "educating" the patient appropriately, it is equally plausible that the health care system is not meeting the client's perceived needs. Clients can have many reasons for not keeping an appointment, such as family emergencies, lack of funds, or lack of transportation. Sociocultural and ethnic barriers can also be factors. This is part of the health belief model where the premise is that the world of the perceiver determines the action.

A nurse had 5 years of experience in a community health clinic when she accepted a position in occupational health. Which of the following best explains how the nurse will know what to do in this new setting? a. On the basis of past experience, she can focus on relevant aspects and adapt protocols as deemed necessary b. By focusing immediately on critical aspects and determining priorities in the setting c. By following company procedures and relying on assessment checklists and clinical protocols d. By using extensive previous experience, the nurse can grasp situations quickly and initiate appropriate action(s)

ANS: C As a newcomer to the site, although experienced in other areas of nursing, the nurse would probably have sufficient experience to recognize a range of practice issues and function comfortably in such roles as clinician and case manager. But to be competent in the new role, the nurse should follow company procedures and rely on assessment checklists and clinical protocols to provide treatment. To go beyond that (i.e., adapt protocols and immediately recognize what is relevant in these new situations) will require experience in the new role.

A nurse has begun to lobby with politicians for changes to the health care system. Why is this involvement important? a. Nurses, as central characters in several popular TV series, are currently very visible in American media. b. Nurses are primarily responsible for managing the various units in our health care system. c. Nurses are the largest group of health care providers. d. Nurses are the only group that is employed both inside and outside of hospitals.

ANS: C As the largest group of health care providers, nurses are informed about the current health care system and all the problems that result from people not seeking care until they are desperately ill. Nurses, as the American Nurses Association (ANA) emphasize, usually believe that health care is a right, not a privilege. Therefore, nurses, whose work is central to our current health care delivery system, can also be instrumental in working politically to create a health care delivery system that will meet health needs. While nurses are in several current TV series and are employed both inside and outside of hospitals, physicians and other health care providers are as well. Nurses are often managers, but managers often have other backgrounds, such as business administration.

A nurse is using Milio's approach when caring for a client. Which of the following advantages will the nurse experience? a. It will allow for care interventions outside the hospital system. b. It will demonstrate the effectiveness of using a variety of community resources. . c. It will encourage the assessment of the personal and societal resources of the client. d. It facilitates open communication between the client and the nurse.

ANS: C As the model focuses on sociopolitical and environmental constraints to a client's free choice, it also encourages assessment of such constraints, as well as suggesting alternative avenues to helping the patient obtain needed care. Milio encourages the practice of nursing from a broad understanding of health and illness.

A nurse felt very good about an Asian man who had responded positively to the instructions given to him. Later, the nurse heard him tell his wife that there was no way he could implement the suggestions. Which of the following best describes the problem that the client is experiencing? a. Polite response may not equal agreement. b. Men do not take instruction from women. c. His culture may value harmonious relationships over expressing disagreement. d. The nurse told him what to do but did not ask if he could do it.

ANS: C Asian clients may provide the nurse with the answers they think the nurse wants to hear. This behavior is consistent with their cultural value for harmonious relationships with others. The other responses do not recognize this cultural variation among this population that the nurse should recognize.

A new public health nurse carefully assessed all the local mortality and morbidity data in preparation for making appropriate planning suggestions at a meeting next week. What other action is crucial before the nurse can feel prepared? a. Ask other nursing staff their perceptions of the community's needs b. Assess the nurse's own assets, strengths, and ability to contribute c. Meet members of the community to determine their culture and values d. Review discussions and decisions from previous meetings

ANS: C Community health nurses must work with the community. It is essential to assess an aggregate's needs and resources and identify its values. The best way to do this is by meeting with the members of the community to determine their culture and values. Assessing one's own assets, asking other nursing staff, and reviewing previous discussions will not allow the nurse to assess the needs of the community.

1. Which of the following is the best definition of economics? a. Assets that can be traded for different assets b. Income and outgo of monies c. Science of allocation of resources d. Study of goods, services, talents, and transportation

ANS: C Economics represents the science of allocation of resources. Resources are goods or services. The other definitions do not fully describe economics.

Which of the following describes the responsibility of the forensic psychiatric nurse? a. Assisting with the deposition b. Collecting evidence to be used in future legal proceedings c. Judging intent or diminished capacity of the client during the incident d. Preparing to testify in court

ANS: C Forensic psychiatric nurses collect evidence by determining intent or diminished capacity in the client's thinking at the time of the incident. To do this, they often spend several hours interviewing and observing the client, carefully documenting conversations and observations.

In a nationwide survey, which of the following was identified by school health nurses as the most crucial research priority for their specialty? a. Emergency preparedness b. Health education c. Obesity and nutrition d. Role of the school health nurse

ANS: C Gordon and Barry surveyed 263 school nurses in 2006 to identify what the nurses believed to be the top research priorities for the specialty. The first most crucial response was obesity/nutrition—nutrition and weight-loss counseling programs, eating disorders, obesity in children and teens, and importance of exercise.

Which of the following best describes how the government controls conditions that individuals cannot? a. Appeals to the common sense and good nature of the citizens b. Establishes social mores that enable groups to control individuals' behaviors c. Passes and enforces law d. Uses fear reinforced by police power

ANS: C Government regulates conditions that individuals cannot control and provides individual protection through a population-wide focus. These tasks are accomplished through passage and enforcement of laws. These laws control individuals' behaviors, which may lead to the establishment of social mores and common sense related to the laws that have been established.

What would be the proper term for the action of the school health nurse arranging for all the students in the elementary school to receive H1N1 immunizations? a. Health education b. Secondary prevention c. Specific protection d. Tertiary prevention

ANS: C Immunizations are a specific protection effort as part of primary prevention.

Which of the following best describes how Lillian Wald helped encourage the idea of school nurses in the schools? a. She brought political pressure to bear on school boards through her political action movement. b. She persuaded very wealthy women to convince their husbands to fund such positions. c. She demonstrated that school nurses decreased absenteeism by 50%. d. She used volunteer nurses until school boards were persuaded to fund such positions.

ANS: C In 1902, New York City hired the first nurses to help inspect children, educate families, and ensure follow-up treatment. Within a few years, the renowned nurse Lillian Wald was able to show that the presence of school nurses could reduce absenteeism by 50%.

The correctional nurse was completing an admission physical for a newly incarcerated prisoner. The nurse realized the prisoner was talking to someone other than the nurse. Which of the following does the nurse need to remember? a. Cell phones, including those with ear phones, are commonplace among everyone. b. It is common for persons to talk to themselves or think out loud. c. Prisons have become the residence for a very large number of persons who have mental illnesses. d. Prisoners get very lonely and often talk to mirrors or inanimate objects.

ANS: C In the late 1950s and early 1960s, deinstitutionalization moved people with mental illness out of state hospitals into communities that were often ill-prepared to care for them. As a result, many people with a mental illness reside in nursing homes, residential homes, prisons, or jails. People with mental illness are often jailed for crimes committed in response to the symptoms of mental illness. Approximately 34% of state inmates, 24% of federal inmates, and 17% of jail inmates received treatment for mental health problems. Thus, it is highly likely that this prisoner has a mental illness. It is less likely that the prisoner is using a cell phone or purposefully talking to himself.

Which of the following statements best describes why nurses should be knowledgeable about health care funding? a. To be able to be an effective employee for insurance companies b. To be knowledgeable when media asks for opinions on some new legislation c. To better serve as patient advocates in policy making for funding that provides appropriate care for the greatest good d. To know how to write nursing notes that reflect higher reimbursement possibilities

ANS: C Increasing knowledge of health care funding and policy making will empower nurses to advocate for the type of funding that provides appropriate care to obtain the greatest good. Nurses need to use their political power. Nurses must advocate for health promotion disease prevention funding. Although these skills are helpful when working for insurance companies, talking to the media, and writing nurses notes, the primary reason why nurses need this knowledge is to engage in the role as a patient advocate.

Which of the following best describes why the numbers of children seen by the school health nurse is increasing? a. Higher expectations for performance by parents and school administrators b. Increasing school enrollments c. Lack of another source of regular health care d. Overcrowding within the community

ANS: C Increasing numbers of children are being seen in the school setting because they lack a source of regular medical care.

A nurse would like to influence an internal private health policy. Which of the following actions should the nurse take? a. Build or join a private entrepreneurial practice to provide lower cost services to underserved groups b. Participate in public discussions regarding quality and managed care c. Support nursing research done that demonstrates positive clinical and economic outcomes d. Write managed care organizations to request that nurses receive reimbursement for health services to clients

ANS: C Internal nursing action is from within the agency, such as holding an important management position. Nurses can support and use nursing research that demonstrates positive clinical and economic outcomes. Such action also serves to validate the importance of nursing within the health system. External strategies can include participation in discussions regarding aspects of care or seeking employment in entrepreneurial practices.

The faith community nurse (FCN) finds the faith community's needs overwhelming. Which of the following best describes how the nurse can best meet the community's many needs? a. Discover appropriate resources already existing in the community b. Help the community members meet their own needs independently of the nurse or other assistance c. Recruit, train, and direct volunteers to implement needed programs d. Suggest the faith community recruit more parish nurses to help

ANS: C It would be fantastic if existing resources already in the community could meet the needs of the faith community within which the FCN is working, but that would be extremely unlikely. The role of coordinator of volunteers includes recruiting, training, and directing volunteers to work with the FCN program or health ministry. The nurse may work with other nurses and lay people within the congregation. The FCN program may encompass all programs related to the health of the church community.

Which of the following helps to balance the fact that poverty is typically a major factor in certain groups having poorer health? a. A strong community health center in the neighborhood b. Intact families where fathers are married to children's mothers c. Strong family and community support for healthy behaviors d. The large number of programs available to be of assistance in fighting poverty

ANS: C Latino children who live in poverty enjoy relatively good health compared with children in other low socioeconomic groups. It is believed that strong family-community support fosters optimum family health behaviors. Many of these behaviors are integrated into the culture as part of the family identity, traditions, and history. Without strong family and community support having other resources in the community is insignificant. Strong support structures can exist in communities where fathers are not married to children's mothers.

Which of the following nurses fought to have American nursing controlled by nurses rather than physicians? a. Clara Barton b. Florence Nightingale c. Lavinia Dock d. Lillian Wald

ANS: C Lavinia Dock was a political activist who waged a campaign for legislation to allow nurses to control the nursing profession. Florence Nightingale was the first nurse to exert political pressure on a government. Clara Barton was responsible for organizing relief efforts during the U.S. Civil War. Lillian Wald was the driving force behind the federal government's development of the Children's Bureau in 1912.

Which of the following are the most common forms of elder abuse? a. Emotional abuse by caregivers b. Financial abuse when resources are used without the elder's consent c. Neglect by self or caregivers d. Physical mistreatment resulting in injuries

ANS: C Neglect is the most common form of elder abuse, whether it is caregiver neglect or self-neglect. Neglect is more likely to occur than emotional abuse, financial abuse, or physical mistreatment resulting in injuries.

Which of the following statements best describes why nurses are not more effective in creating political change? a. Nurses are not listened to by politicians. b. Nurses are not perceived as leaders in the health care field. c. Nurses do not act or do not agree on what changes are needed. d. Nurses do not know how to negotiate, communicate, and collaborate to create change

ANS: C Nurses know how to communicate, collaborate, negotiate, and serve as leaders who can make themselves heard. However, the various nursing subgroups do not agree on public policies.

Which of the following best explains why the school nurse and the principal athletic director of the school would frequently be working together? a. As neither are teachers, each is susceptible to job layoffs if the community school tax levy does not pass. b. As support staff to teachers, they have many mutual problems in communicating how they can help teachers be more successful. c. Both are extremely concerned with the typical student's low amount of physical exercise and want to create an intervention plan. d. Both have to create a budget plan and allocate funds for their department for the year.

ANS: C Obesity and its prevention or treatment must be of concern to the school nurse. Although many of the underlying causes of obesity are not well understood, several contributing factors have been identified, including reduced access and affordability of nutritious foods, decreased physical activity, and cultural and genetic influences. The nurse and the athletic director would want to cooperate on how to increase physical activity of the students.

A nurse is employed by the state public health department. Which of the following activities would she most likely complete? a. Set up a flu shot clinic at a neighborhood church b. Lobby for health care reform to cover more preventive services c. Monitor the incidence of influenza in the state d. Serve as a volunteer for a state legislator's campaign

ANS: C One of the state health care functions is assessment of health needs based on statewide data collection. This could be done by monitoring the incidence of influenza in the state. Setting up a flu shot clinic would most likely be done at the local level, while lobbying for health care reform would most likely be done at the federal level. Serving as a volunteer for a campaign may be something a nurse would do, but would not be specifically related to employment by the state public health department.

If not at a meeting or giving an educational program, which of the following best describes why an occupational health nurse (OHN) would be absent from the health station during the nurse's employment hours? a. The nurse is reviewing position descriptions in the main company office. b. The nurse is in the management office to use the company computer. c. The nurse planned a walk-through of the workplace. d. The nurse is taking a quick bathroom break.

ANS: C Performing "walk-throughs" in the workplace on a regular basis, recognizing potential and existing hazards, and maintaining communications with safety and industrial hygiene resources to prevent illness and injury from occurring will continue to be critical work for the OHN. It is unlikely that the nurse is reviewing position descriptions in the main company office or using a company computer when these are tasks that could most likely be done in the health station. It is also unlikely that the nurse is taking a quick bathroom break.

Which of the following best describes the health care services that are provided by philanthropic groups? a. Direct care to patients with problems related to the group's primary interest area b. Legislative lobbying for increased funding for their special interests c. Informational and research activities d. Special services such as housing, transportation, or appearance aids

ANS: C Philanthropic funding, whose services are typically research or disease oriented, pays a limited amount of health care. Services are limited to the specific disease or population of interest. Informational and research activities constitute the majority of services provided, although some give direct care or meet ancillary needs such as housing, transportation, or wigs. Legislative lobbying and special services are not the primary health care services provided by philanthropic groups.

Which of the following statements best describes how policies in the private sector are different from policies in the public sector? a. Private sector policies are slow, deliberate, and reactive to events. b. Private sector policies are determined by the opinions and feelings of those employed in that sector. c. Private sector policies are based on economics and market trends. d. Private sector policies are based on rational decision making.

ANS: C Private policy is largely influenced by theories of economics and business management, including consumerism and market trends. Such policies can react quickly and are often proactive. In comparison, public policies are slow and reactive, and economics is just one of many factors involved. Public policies are determined by voting shifts, electoral realignment, and term limits.

Which ethical belief would be most helpful in the current health care crisis? a. Emphasis should be on individual and corporation freedom in the marketplace. b. Emphasis should be on individual autonomy and freedom of choice. c. Emphasis should be on social justice and collective responsibility. d. Emphasis should be on the effectiveness of technology in resolving problems.

ANS: C Public health recognizes the necessity of collective action in keeping the environment safe and in egalitarian tradition and vision. An overinvestment in technology and seeking of cures within the market justice system has stifled the evolution of a health system to protect and preserve the health of the population. Although individual autonomy and freedom of choice are important, so is the recognition of collective responsibility in ensuring social justice, which entitles all people to basic necessities.

A nurse has accepted a new position in a public health department. Which of the following characteristics is crucial to the nurse's success? a. Advanced educational preparation b. Being knowledgeable about the community's needs c. Listening and showing respect d. Caring and empathetic personality

ANS: C Rather than nursing to the community, the nurse must work with the community to be successful. Listening, being patient, providing accurate information, and respecting the experiences of community members are essential for success.

If a forensic nurse was employed in the most widely recognized subspecialty in forensic nursing, which of the following would be the nurse's primary tasks? a. Be employed by insurance companies to review and interpret medical records b. Complete the death certificate, including causes of death c. Do a history and physical assessment and collect evidence d. Review the crime scene for insights with police officers

ANS: C Sexual assault forensic examiner (SANE) is the most widely recognized subspecialty in forensic nursing. The SANE collects forensic evidence related to a reported crime and frequently testifies as an expert witness at subsequent trials.

Which of the following is considered appropriate preparation for engaging in forensic nursing specialty practice? a. Adequate number of continuing education credits plus licensure as a registered nurse b. Baccalaureate nursing program and previous community health experience c. College-based educational program including supervised clinical hours and internship d. Interest in and willingness to be employed in the field

ANS: C Simply completing a continuing education course is not adequate. Several colleges and universities offer a variety of programs to educate practitioners. During the formal programs of study, the student usually completes a minimum specified number of supervised clinical hours; a clinical internship also may be required.

The legal nurse consultant (LNC) was surprised to find that former friends were no longer interested in a colleague relationship and one even accused the LNC of trashing clinical nursing practice in the courtroom. Which of the following would be the best response by the LNC? a. "I've just accepted a position that pays an incredible amount more than staff nursing in a hospital." b. "I'm not part of clinical nursing; I'm part of the legal system now." c. "I'm defending the expertise and experience of skilled nursing clinicians by helping remove dangerous practitioners from the field." d. "I'm helping clients who were hurt by poor practice to obtain revenge."

ANS: C Some practitioners have differing opinions regarding LNCs and nurse attorneys. They may be perceived as either defending the profession or prosecuting peers by testifying against professional colleagues. LNCs are hired by attorneys and insurers to review and interpret medical records and charts, provide objective opinions based on standards of care, and possibly to testify in court as expert witnesses. LNCs are able to provide the link between clinical nursing and the legal system to help keep the practice field safe from dangerous practitioners. In contrast, meticulous practitioners who are wrongfully accused of negligence will be defended. The salary of the position does not address the accusation of the LNCs former friends. The purpose of LNCs is not to help clients obtain revenge if they were harmed by poor care.

6. What responsibility does the American Nurses Association (ANA) Code of Ethics require of the nurse beyond giving excellent care to patients? a. Accept longer work schedules to ensure that professional care is always available to clients b. Recognize the need for experienced nurses to mentor new graduates to help increase and expand the number of professionals available c. Support health legislation to improve accessibility and cost of health care d. Volunteer to work overtime as needed to ensure maximum quality of care

ANS: C The ANA Code of Ethics promotes social reform by focusing on health policy and legislation to positively affect accessibility, quality, and cost of health care. The code does not directly address workplace issues, such as work schedules or need for overtime.

A candidate's resume demonstrates a perfect fit for a position, but one glance showed the candidate was wheelchair bound. Which of the following suggestions should the nurse make to the employer? a. Be as polite as possible, but point out how difficult it would be to fulfill job responsibilities while confined to a wheelchair b. Be sure that another candidate is more qualified and "fits more closely with our company goals" c. Employ the candidate and rearrange the work area for easy access and exit for someone in a wheelchair d. Point out that other employees would probably not be kind to someone in a wheelchair who is unable to join in many of the physical recreational activities

ANS: C The Americans with Disabilities Act prohibits discrimination on the basis of disability. The core of this law requires employers to adjust facilities and practices for the purpose of making "reasonable accommodations" to enhance opportunities for individuals with disabilities. The occupational health nurse has the duty to provide or facilitate reasonable accommodations based on the nurse's familiarity with the physical requirements of jobs in the workplace. If this candidate was indeed the perfect fit for the position, not hiring the candidate because of the disability would be considered discrimination. If other employees are not kind to this candidate after the candidate is hired, they will likely face reprimand by the employer.

Which of the following statements best describes how the Centers for Disease Control and Prevention (CDC) differs from its many peer agencies? a. It focuses primarily on prevention. b. It is a uniquely American approach to problem resolution. c. It responds to health emergencies. d. It uses years of experience as the basis for its actions.

ANS: C The CDC applies research and findings to improve people's daily lives and responds to health emergencies—something that distinguishes the CDC from many of its peer agencies. Other peer agencies of the CDC also are involved in focusing on primary prevention, using an American approach to problem resolution, and using years of experience as the basis for action.

The new principal stopped the school nurse in the hall and said, "I need to get oriented here. We seem to have a lot of handicapped children. Please make me a copy of their medical records so I can be prepared to meet with the parents if they come in." Which of the following is the most appropriate response by the nurse? a. "I'd be happy to help you get oriented to our students. I'll prepare a summary of our special students' needs and problems for you." b. "I'm so happy to hear of your interest; I'll get those records to you immediately." c. "I'm glad you're interested. Student health records are confidential, but I'll give you a schoolwide overview without any identifying data." d. "Let me check our school board policies regarding sharing of information and get back to you."

ANS: C The Family Educational Rights and Privacy Act, a strong privacy protection act, protects student education records, including the health records. Student health records should be afforded the same level of confidentiality as that given to clients and patients in other settings.

Which of the following statements best describes the major assumption of the health belief model (HBM)? a. People will act if action is both easy and convenient. b. People will act if exposed to fear messages stressing their vulnerability. c. The major determinant of preventive health behavior is avoiding disease. d. The major determinant of preventive behavior is providing proper health education.

ANS: C The HBM is based on the assumption that the primary reason people act is disease avoidance. Such avoidance means they perceive themselves as susceptible to a serious disease, there is some cue to action, and there are more benefits than barriers to acting.

The legal nurse consultant (LNC) was asked to submit an affidavit to both the prosecutor's and the defendant's office. Which of the following information needs to be included? a. List of all literature reviewed in preparation for being paid as an expert witness b. Notarized signature on a summary of the LNC's education and clinical experience c. Summary of nurse's educational and experiential credentials and an analysis of the case d. An opinion under oath as to what happened in the crime situation

ANS: C The LNC may submit an affidavit, which is a written statement explaining the expert's credentials, background, and licensing or certification(s). It also provides a list of the materials read and considered in the case, and the findings of the review are summarized into a case analysis.

Which of the following is one of the most challenging areas for the occupational health nurse (OHN)? a. Allocating time between direct service to employees and management tasks b. Collaborating with other worksite professionals and retaining leadership in the arena of employee health c. Managing ethical conflicts between responsibilities to management and responsibilities to employees d. Maintaining competence through attending conferences and maintaining services when the nurse (sole provider) is absent

ANS: C The OHN is a worker advocate and has the responsibility to uphold professional standards and codes. The OHN is also responsible to management, is usually compensated by management, and must practice within a framework of company policies and guidelines. Ethical dilemmas arise because the nurse is loyal to both workers and management.

Which of the following assumptions underlies the Declaration of Alma-Ata? a. Communities should be encouraged to cooperate with national health goals. b. Gross inequalities and disparities will always exist. c. Health is a fundamental human right. d. Public health agencies are responsible to plan and take action to improve health.

ANS: C The concept of primary health care stresses health as a fundamental human right for individuals, families, and communities; the unacceptability of the gross inequalities and disparities in health status; the importance of community involvement; and the active role of all sectors.

Which of the following legislation marked the first entry of the federal government into school health? a. The Drug-Free Schools and Community Act b. The Education for the Handicapped Act c. The National School Lunch Program d. The Safe and Drug Free Schools and Communities Act

ANS: C The federal government did not get involved with school health until the passage of the National School Lunch Program in 1946. The School Breakfast Program was implemented 30 years later. The Drug-Free Schools and Community Act was implemented in 1986 to fight substance abuse through education and was expanded in 1994 to include violence prevention measures. The Education for the Handicapped Act in 1975 mandated that all children, regardless of disabilities, have access to educational services. The Safe and Drug Free Schools and Communities Act supports programs that focus on prevention of school violence and illegal use of alcohol, tobacco, and drugs.

Which of the following statements best describes why the federal government is unable to do whatever politicians currently in power want? a. The citizens would rise up in rebellion if actions were outrageous. b. The lack of funds to implement actions are seen as unreasonable by a majority of voters. c. Only the actions authorized by the Constitution are legitimate. d. The states would rebel and withdraw from the union.

ANS: C The federal government is a government of limited powers, which means that, for a federal action to be legitimate, it must be authorized. Only those actions that are within the scope of the Constitution, the supreme law of the land, are authorized. Power of the states and citizens is limited under the overall umbrella of the federal government. Funding is also controlled through the powers of the federal government.

Which of the following led to school nurses moving beyond the role of screening, assessment, intervention, and exclusion of children for communicable diseases? a. A communicable disease outbreak, which led to the requirement that all children be vaccinated against common infectious diseases b. Federal legislation, which required immunizations for communicable diseases c. Political movements such as temperance, which led schools to educate about the effects of alcohol and tobacco d. The need for inspecting schools to identify children who were ill and exclude them until they were no longer infectious

ANS: C The federal government was not involved in school health because education and health are responsibilities of the state government. The first citywide vaccination program—against smallpox—was in the 1870s before school nurses were first employed in 1902. Other issues beyond treatment for minor problems quickly became part of school nurse school practice. In the early part of the twentieth century, the temperance movement led schools to teach about the effects of alcohol and tobacco.

Which of the following best describes the history of the State Child Health Improvement Act (SCHIP) of 1997? a. The law included goals and programs but no funding to achieve them. b. The law received extensive support by both Republicans and Democrats. c. The law was extended, not renewed by the Bush administration, and then renewed by the Obama administration. d. The law was passed by the majority of states but not by the federal government.

ANS: C The law was extended several times, and then it was not renewed by the Bush administration. In January 2009, the law was renewed again by the Obama administration.

Which of the following best describes when faith communities first began to be involved with health and healing? a. In 1998, when parish nursing was first officially recognized b. In the time of Jesus and similar religious leaders of the early years AD c. Throughout history, faith communities provided basic health care d. When parish nursing began in the Lutheran Church in the 1980s

ANS: C The majority of the world's populations belong to organized faith communities. All of these religions have traditions and rituals related to health and healing. Throughout history, religious communities have provided care for the indigent and disenfranchised, meeting basic human needs of food and clothing and basic health care. Thus, parish nursing began before time of Jesus. The Old Testament

An employee had recently had a heart attack and was just discharged from the hospital. Which of the following would be an appropriate action for the nurse to take? a. Plan a party for when the client is able to return to the workplace b. Develop a program on exercise and nutrition for all employees c. Determine appropriate temporary, perhaps part-time, responsibilities to ease the employee's reentry to the workplace d. Advocate for improvements in the food being offered by the vending machines in the employees' lounge

ANS: C The nurse may work with the employer to create a transitional duty pool. The goal is to provide temporary work that is less physically demanding in nature than the employee's regular work. This facilitates the employee's return to the workplace earlier than if required to wait until full strength and health are regained.

An emergency department nurse was not sure whether there was enough evidence one way or the other to suspect child abuse with a child client, because there was not much evidence of physical harm. The forensic nurse agreed to see the child. Which of the following would be the forensic nurse's primary focus? a. Ask the child whether the family has any secrets b. Assess for old injuries or injuries in the process of healing c. Observe the child's appearance and behavior and how the child interacted with other children and adults d. Question the parents concerning the child and any discipline problems

ANS: C The nurse obtains a thorough history and assessment, focusing on several facets of abuse and neglect. These include child-parent interaction, the child's appearance and behavior, child-child interaction, and the environment.

A nurse set up a clinic appointment for Friday of the following week. An Arab patient asked to come earlier in the week. As those days were heavily booked, the nurse left the appointment on Friday. The patient was a "no show." Which of the following best explains what happened? a. A lot of people do family errands such as shopping on Fridays, Saturdays, and Sundays. b. It was inconvenient for the client so he did not come. c. A Muslim's holy day is from sunset Thursday to sunset Friday. d. Patients do not like being told what to do.

ANS: C The nurse should know the days of religious worship. Protestants usually worship on Sundays; Muslims' day of worship is from sunset Thursday to sunset on Friday; and Jews and Seventh-Day Adventists' holy day is from sunset on Friday to sunset on Saturday. The other responses do not address the recognition by the nurse of the significance of the days of worship that were indicated as a priority for the client when an appointment was requested for earlier in the week.

Which of the following best describes the primary reason that Americans are concerned about health care? a. Politicians are discussing how to improve health care. b. The media has provided mixed messages about the health care system. c. Our national health care costs keep increasing. d. The new health care system offers free services to Americans.

ANS: C The primary reason for the focus on health care is the constantly increasing costs, which cannot be sustained. The costs of caring for the sick accounted for the majority of escalating health care dollars, which increased from 5.7% of the gross domestic product in 1965 to 17.6% in 2009. Politicians and the media both influence Americans' perceptions about health care; however, they are not the primary reason why Americans are concerned. The new health care system will change the health care access and availablity, but will not necessarily be offering any free services to Americans.

Which of the following best describes a conclusion of the report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care? a. Disparities are found only in particular disease categories. b. Lack of access in some neighborhoods is a primary cause of inequities. c. Provider bias and stereotyping contribute to inequalities. d. Physiological racial and ethnic differences lead to disparities in outcomes.

ANS: C The report observed that bias and stereotyping on the part of heath care providers might contribute to differences in care. The report did not address disparities among particular disease categories, lack of access, or physiological racial and ethnic differences.

A new school nurse was concerned about being accepted, as the previous nurse had been at the school for more than 20 years. Which of the following would be the best approach for the nurse to take? a. Do the best job possible of revising policies and approaches to reflect current information and trends b. Put all the nurse's credentials (degrees, certifications) in an obvious spot in the health office c. Set up workshops on exercise, nutrition, and weight management and perhaps ongoing blood pressure screenings for school staff d. Spend time with each student, making sure the students all think she is very helpful

ANS: C The school nurse can assist the faculty and staff by giving workshops on exercise and nutrition, screening for increased blood pressure, and establishing weight management programs.

What is the health issue causing the most concern in the United States today? a. Diabetes epidemic b. Increase in cardiac disease c. Increase in obesity d. Rise in cancer rates

ANS: C The widespread increase in incidence of overweight and obesity has led to calls for population-based measures to address this issue. The overarching problem of obesity has led to an increase in diabetes as well as cardiac disease. If this health issue was controlled, there should be in a decrease in the other health issues.

Crying, a clinic patient explained that she knew she had this breast lump because she had spread nasty gossip about her neighbor. Which of the following actions by the nurse would likely be the most successful? a. Explain the causes of a breast lump and the usual treatments b. Refer the woman for an immediate biopsy to determine the status of the lump c. Suggest that she has to repent and as much as possible undo her sin, but also make an appointment for a biopsy d. Suggest that she has to repent, apologize to her neighbor, and pray for forgiveness

ANS: C The woman has expressed a magico-religious perspective on illness. Because evil has caused her illness, she must undo the evil. However, the nurse, as a practitioner of the biomedical perspective, must also arrange for a biopsy as soon as possible so treatment can be begin.

What was the importance of the Lalonde Report, which proposed the "health field concept" in 1974? a. It first called attention to the growing problem of air pollution. b. It first emphasized the importance of basic hand washing. c. It first emphasized influence of lifestyle and environment. d. It was the first report that suggested a link between smoking and lung cancer.

ANS: C This report emphasized lifestyle and environment as determinants of health outside the traditional medical sphere. It became the basis for rethinking new paradigms for health care delivery. The report signaled the early beginnings of a health care paradigm shift from the traditional medical model to a more holistic system-environment perspective. The report did not call attention to the problem of air pollution, emphasize the importance of basic hand washing, or suggest a link between smoking and lung cancer.

Which of the following statements best describes what tobacco companies have done to counter their losses resulting from U.S. efforts to decrease smoking tobacco? a. Begun advertising in more subtle ways such as sponsoring sports programs or building and naming large sport arenas b. Bought off more restrictions on tobacco through the tobacco settlement funds, which gave a large amount of money to each state c. Increased international exports and targeted children d. Rapidly decreased their tobacco components and focused on other products

ANS: C Tobacco control and secondhand smoke policies have been implemented at various political levels in the United States and abroad. To continue their profits, the tobacco industry has targeted youth and dramatically increased international exports. The tobacco industry has not begun to focus on other products, changed to more subtle advertising, or bought off more restrictions on tobacco as ways to counter their losses.

A nurse was a volunteer in a faith community when a police officer asked for specific information related to a member's behavior and mental health. The faith community nurse (FCN) told the police officer, "I'm a part-time volunteer; I'm not paid. Besides, I have client-professional privileges so I can't share information with you." Which of the following will most likely be the outcome of this encounter? a. The Health Insurance Portability and Accountability Act (HIPAA) will require the nurse to maintain confidentiality. b. The matter will be referred to the faith community leader for resolution. c. The nurse is still accountable and has no legal right not to disclose information requested by a legal authority. d. The police officer will have to accept the nurse's refusal to share information.

ANS: C Volunteers in a church are held to the same degree of accountability as are paid employees. Ministers, both ordained and nonordained, may be required to disclose confidential information in court. FCNs, as nonordained ministers, do not have client-professional privilege. Thus, HIPAA does not apply as the information has been requested by a police officer and there is not client-professional privilege involved. The faith community leader is not able to offer a resolution to this problem as client-professional privilege does not exist in this situation. Because there is not client-professional privilege, the police officer does not need to accept the nurse's refusal to share information.

Which of the following best describes why risk reduction is of such importance in the United States today? a. Families suffer when family members die from avoidable causes. b. Risk reduction activities will decrease insurance costs to individuals and their employers. c. The leading causes of death are all related to lifestyle choices. d. Risk reduction can decrease the ongoing rise in national health care expenditures.

ANS: C Approximately 50% of annual U.S. deaths occur as a result of modifiable lifestyle factors. The leading causes of death with the highest mortality are all related to lifestyle factors. A change in these factors will also reduce health care expenditures and insurance costs for those persons with insurance. However, unnecessary deaths are even more important.

During a health history, the client looked confused and said, "But everybody drinks, like at parties and such. How much drinking do you think is too much?" Which of the following would be most appropriate response by the nurse? a. "Alcohol should be used only in moderation." b. "It's okay as long as you don't binge, and you eat food with your drinks." c. "Per day, no more than one drink for women and two drinks for men." d. "Total abstinence is the only healthy choice."

ANS: C Because most Americans drink alcohol, it is probably not effective to teach total abstinence. Alcohol in moderation is not a specific answer to the client's question. The Dietary Guidelines for Americans suggest no more than one drink for women and two drinks for men per day, which is a specific response to the client's question.

A 50-year-old woman comes to the clinic for her first mammogram. Which of the following best describes the action of this client? a. Disease prevention b. Health improvement c. Health protection d. Primary health promotion

ANS: C Health protection is used to detect disease in its early state or maximize health within the constraints of disease. Unfortunately, screening will not prevent disease. Screenings are a secondary health promotion— not a primary health promotion.

A young couple is searching for a home in a new neighborhood. Which of the following neighborhoods would most likely promote a healthy lifestyle? a. One near a large active military base b. One with excellent health facilities nearby c. One with high walkability d. One with superb recreational facilities

ANS: C One's environment is a significant factor. Those living in neighborhoods with high walkability engage in significantly more walking than those living in neighborhoods with low walkability. Having health and recreational facilities in the neighborhood can assist with health, but the family would need to be able to afford to purchase services at these businesses. Having a large active military base nearby would not play a major role related to the healthy lifestyle in the neighborhood.

Which of the following actions would help decrease the total health care costs in the United States? a. Consolidate major health care facilities while expanding neighborhood primary care clinics b. Continue the move to computer-based medical records and other efficiencies in informatics c. Decrease current fraud and abuse d. Streamline and make more consistent all documents needed for third-party reimbursement

ANS: C The billions of dollars spent on health care and struggles for control between providers, consumers, and health care organizations have increased the risk of fraud and abuse. The Federal Bureau of Investigation (FBI) estimates that health care fraud costs the U.S. $80 billion annually (FBI, 2012). Thus, decreasing the fraud and abuse in the system would have the largest impact over any of the other proposed actions.

A nurse is using the theory of planned behavior when working with a client to change her behavior and improve her health. Which of the following considerations should be made by the nurse? a. If environmental limitations may prevent the person from acting b. The availability of needed environmental supports for the client c. The client's belief about factors that may facilitate or impede the behavior d. If the suggested behavior is actually the most effective approach

ANS: C The theory of planned behavior stresses that perceived control is a major factor in whether or not the client performs the behavior. Thus, the nurse needs to understand the client's beliefs about factors that may facilitate or impede the behaviors. Using this theory, the environment is not considered as a major factor in client change, nor is the analysis as to if the behavior is the most effective approach.

A nurse asks a client how she has been sleeping. Which of the following best describes the rationale behind this question? (Select all that apply.) a. Accidents and injury may occur with the sleep-deprived client at fault. b. Interventions for sleep problems are primarily common sense. c. Many adults report sleep problems or occasional lack of sleep. d. Many important functions occur during sleep. e. Nurses can determine whether the patient has a sleep disorder. f. A sleep assessment is easy and inexpensive to complete.

ANS: C, D Almost three-fourths of all adults report having a sleep problem at least once a week, yet sleep is an essential component of chronic disease prevention and health promotion. Many important functions occur while we sleep, such as release of hormones, memory consolidation, and decrease in blood pressure.

A nurse is using the health belief model to help a client improve lifestyle choices. Which of the following interventions would the nurse most likely implement? (Select all that apply.) a. Conduct an ongoing public information campaign to motivate people to take action b. Emphasize how important it is to change behavior immediately c. Examine the individual's perceptions of his or her health in relation to current lifestyle behavior choices d. Review how lifestyle changes can reduce risk and improve the client's life e. Share statistics regarding the probability of health problems and their seriousness if action is not taken f. Use communication channels to send reminders of action currently needed

ANS: C, D, E, F An effective way to evoke action begins with examining the individual's perceptions of his or her health and current lifestyle choices so education to change perceptions can occur. Sharing information regarding the probability of illness or perceived susceptibility and using communication channels to serve as cues to action may both be motivating. Similarly, reviewing how lifestyle changes can reduce risk and improve life may change the person's perception of the benefits of acting. Unfortunately, although people have to know what to do and how to do it before they can take action, information alone will not motivate people to act. Continued harassment, as in emphasizing how important it is for people to act, also is not motivating.

Who may receive benefits under Medicare? (Select all that apply.) a. Federal employees b. Persons aged 55 to 65 years who have bought into the system c. Persons with end-stage renal disease d. Those over 65 years of age, if eligible for Social Security benefits e. Those who are dependents of elderly grandparents, usually because their parents are in prison as a result of drug abuse f. Those with permanent disabilities

ANS: C, D, F Medicare pays specified health care services for all people 65 years of age and older who are eligible to receive Social Security benefits. People with permanent disabilities and those with end-stage renal disease are also covered.

A nurse has a broad, aggregate focus when providing care to clients. Which of the following best describes how this approach will help improve client outcomes? (Select all that apply.) a. Ensures that collaborative efforts of many professionals will be used b. Confirms the individual's responsibility for resolving the health problem c. Empowers decision-making based on both individual and community goals, needs, and priorities d. Enables the nurse to ask for assistance from other community professionals e. Encourages allocation of time for population-focused preventive efforts f. Upholds professional nursing standards of care

ANS: C, E Having a broader focus will help both nurse and patient make appropriate decisions. Unfortunately, it cannot ensure that others will help. Ideally, it will help both parties recognize that health problems are not just an individual's responsibility but often a result of environmental, sociopolitical, and economic factors as well. Encouraging the nurse to allocate time for population-focused health promotion efforts will also help the nurse's individual clients over the long term.

The nurse made a follow-up appointment for a client at the clinic, but the client did not come. Two days later the client presented at the clinic explaining that a temporary job had come up and he could not come back until he had finished and been paid for that job. Which of the following actions should be taken by the nurse next? a. Explain that patients are seen by appointment only, and set up another appointment for the client b. Reinforce the need to plan ahead before arranging another appointment c. Stress that health is the number one priority, and try to fit the client in sometime the same day d. Understand that some clients are present oriented, and fit the client in so care can be given

ANS: D Although health care systems are set up according to the expectation that clients can plan for the future, some clients focus on the present with little attention to the future. For the patient to receive care, the nurse should try to fit him in that day. Setting up an appointment would possibly be useless because the client may not attend the future appointment either. Poverty-stricken persons would be wise to accept employment when it becomes available.

Which of the following best explains why the infection rate of HIV and tuberculosis (TB) is so high among persons who are incarcerated? (Select all that apply.) a. Fecal oral transmission because of lack of cleanliness and hygiene among inmates b. Ignorance as to how infectious diseases are transmitted c. Engagement in tattooing, drug use, and unprotected sexual intercourse d. Lack of access to health care while incarcerated e. Overcrowding, poor ventilation, and constant change in the population f. Poor nutrition and lack of exercise while incarcerated

ANS: C, E The high rate of some infections such as HIV in this population is associated with high-risk behaviors common among inmates, including current and previous drug use, unprotected sexual intercourse, and tattooing. The rate of TB infection in correctional facilities is related to overcrowding, poor ventilation, and rapid movement of inmates into and out of jail, all conducive to the spread of the disease. Most prisoners receive a health screening at admission. Prisoners have a constitutional right to receive adequate and timely health care. Adequate food and exercise are available as the goal is to ensure a safe, secure, and humane environment for inmates. Fecal oral transmission is not related to the spread of HIV or tuberculosis. The prison and legal system are aware of how these diseases are transmitted, but some of these high-risk behaviors that this population engage in occur when they are not incarcerated.

Which of the following best describes how the local government is provided authority? a. Through the ability to tax local residents to meet local needs b. Through the people themselves who band together to create the community c. Power delegated from the federal level to the local level d. Power delegated from the states

ANS: D States may delegate powers to the local government. Which powers they delegate vary widely from state to state. The federal government does not directly delegate power to the local level, this occurs through state government. Taxation and creation of a community do not provide the local government with authority.

Which of the following best describes how the practice of faith community nurses is different fro the practice of other nurse specialists? a. Advanced education is required before attempting such a challenging role. b. Practice setting is in a building dedicated to a purpose other than health care. c. The nurse is a member of the same community where the nurse practices. d. The central focus of the practice is the spiritual dimension.

ANS: D A key element of the philosophical basis of parish nursing is the spiritual dimension, which is central to the practice. All specialties require advanced education and are often practiced in non-health-oriented settings, such as workplaces, schools, or client homes.

Which of the following best describes why it is so difficult to change the paradigm of health care from disease orientation to promoting health orientation? a. The belief exists that those without insurance could obtain insurance if they worked hard enough. b. People find it difficult to agree on what the ideal paradigm should be. c. People realize the media have exaggerated the problems that result from lack of insurance. d. Serious reallocation of resources would have to occur.

ANS: D A shift in the paradigm would necessitate a substantial reallocation of resources because the vast majority of health spending is currently directed to medical care and biomedical research and reflects a viewpoint of health care as a commodity. The allocation of resources has the most influence on creating a paradigm shift. Individual opinions and the use of media do not play as great of role as where resources are spent.

Which of the following best describe how the prevalence of violence and violent crimes has changed the professional practice of health care providers? a. Vulnerable groups are now assessed for evidence of abuse. b. The focus has now shifted from patient care toward more personal safety. c. It is now recognized that new specialties continue to be created. d. Each patient is now routinely screened for violence.

ANS: D All persons should be assessed for evidence of abuse, not just vulnerable groups. Screening for violence is now considered to be a minimum standard of care for all clients.

A nurse is using a macroscopic approach when providing care. Which of the following would the nurse most likely demonstrate? a. Emphasizing behaviors that will help in healing b. Examining the family's responses to illness c. Explaining how these actions will help in healing d. Providing testimony to legislators concerning proposed legislation

ANS: D All the choices focus on individual client care except for the nurse who is politically involved as demonstrated by providing testimony relevant to proposed legislation.

What is the primary problem seen in Healthy People 2020's emphasis on choosing healthy lifestyle behaviors, such as daily exercise or healthy food choices? a. Emphasis on other lifestyle choices, such as not smoking and minimal use of alcohol or drugs, is also needed. b. All of us must work together to make unhealthy behaviors socially unacceptable. c. It costs more to make healthy choices, such as buying and eating fresh fruits and vegetables as opposed to quick and cheap fast-food choices. d. Public policy emphasizes personal responsibility but ignores social and environmental changes needed for well-being.

ANS: D Although all responses are accurate, the primary problem is the emphasis on personal choices in the Healthy People 2020 objectives. Emphasis on personal choices ignores the need for community responsibility and action that addresses environmental or cultural restraints to health.

Which of the following health-related variables is examined by the critical theoretical perspective? a. Cultural beliefs b. Effect of history and tradition c. Ethnic and racial differences d. Social inequalities

ANS: D Critical theoretical perspective examines social inequalities within the broader political, economic, and social systems of society that keep people from reaching their full potential.

Which of the following best describes a major problem faced by the U. S. health care system? a. Inadequate number of licensed professional caregivers b. Lack of sufficient clinics to serve all communities and neighborhoods c. Ongoing increase in infections, such as nosocomial infections d. Large number of underinsured and uninsured citizens

ANS: D Although the health care reform legislation of 2010 should significantly reduce the number of uninsured individuals, it is estimated that following full implementation in 2017, there will still be about 13 million people without any health care coverage and many with inadequate coverage. Thus, universal health coverage remains an important question. Considering there will still be a large number of underinsured and uninsured citizens, the consideration of an inadequate number of providers or clinics may not be an issue if citizens are unable to access care. The lack of health insurance is a greater concern at this time than the increase of infections among Americans.

A school nurse is conducting a program with high school students about adolescent sexuality. Which of the following information would the school nurse most likely include? a. Abstinence is the only way to avoid pregnancy and sexually transmitted diseases. b. Resources are available for assisting teenage parents with, for example, maternity clothing and baby needs. c. There are many sources of free or very-low-cost birth control measures. d. Teenage mothers are less likely to complete high school and often remain single and live in poverty. e. Abortion is dangerous, is illegal in most areas, and can result in lifelong sterility.

ANS: D Although the nurse might want to include information on abstinence and birth control, it is important to convey the reality of teenage pregnancy. Adolescent fathers can confront a lifetime of paying child support. Teen mothers are less likely to complete high school and are more likely to be single parents and live in poverty.

An individual has been terminated from his job and has lost his health insurance. Which of the following federal laws allows him to continue his insurance benefits for a specified period of time? a. Health Insurance Portability and Accountability Act of 1996 (HIPAA) b. Family Support Act of 1988 c. Health Maintenance Organization Act of 1973 (HMO) d. Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)

ANS: D An important requirement of COBRA focuses on the problem of the loss of insurance when a person loses his or her job. With the growing number of unemployed, COBRA is even more important. Employers who terminate an employee must continue benefits for the employee and dependents for a specified period of time if the employee had health benefits before the termination. HIPPA offers protections for patient privacy and confidentiality. The Family Support Act expanded coverage for poor women and children and required states to extend Medicaid coverage for 12 months to families who have increased earnings but are no longer receiving cash assistance. The HMO Act provides grants for HMO development.

Which of the following best describes who has the authority to act in every area except those specifically mentioned in the Constitution? a. Any individual citizen b. Federal government c. Local government d. State government

ANS: D Any powers not delegated to the federal government are reserved for the states. Thus, individual citizens, the federal government, and local governments are excluded.

Which of the following best describes how providers can legally improve their profit under the current reimbursement process? a. Accept more patients and work more hours so former high income is retained b. Order the cheapest generic medications and treatments possible c. Convince patients that they do not want expensive treatments d. Practice conservatively to earn an incentive payment

ANS: D As a reward for conservative medical practices, health care providers may receive a specified amount of money or a percentage of the agreed reimbursement if services are delivered below the limit set by the third-party payer. Thus, it is the responsibility of the provider to use this conservative practice. Patient care should not be compromised as providers practice conservatively.

Which of the following best explains why many people decide to move to large urban areas? a. To be eligible for social aid b. To be with friends c. To join family who are already there d. To seek employment

ANS: D As the world population grows, a global trend toward urbanization occurs; people live closer together and migrate to urban areas for employment. Thus, most people are choosing to move into these urban areas for employment. Being closer to friends and family or being eligible for aid may also occur with the move to the urban area, but it is not the main reason why people are deciding to move.

Which of the following was a major change after Medicare began a prescription drug benefit? a. Number of prescriptions ordered by physicians decreased b. Medications increased without affecting patient care outcomes c. U.S. expenditures on drugs approached the same level as that of other industrialized nations d. Use of drugs and their cost immediately increased

ANS: D As with other health care services, once a funding source has been established, usage and costs increase. Thus, the number of prescriptions ordered increased. For 2006, the United States expenditure for pharmaceuticals was 1.5 times that of other industrialized countries, and these expenditures continue to rise.

A nurse was assigned to create and implement a community education program with the goal of preventing diabetes among the Hispanic population. As the nurse did not speak Spanish and was just beginning to be comfortable with the neighborhood Hispanic culture, which of the following would be the best approach for the nurse to take? a. Be sure to use appropriate images in the handouts. b. Copy literature and procedures found successful in other Hispanic communities. c. Tell the supervisor the nurse is not competent for this task. d. Try to find Hispanic volunteers who may be able to do the actual teaching.

ANS: D By using volunteers, the program can disseminate culturally appropriate information in a culturally appropriate way. The success of educational efforts is often determined by the credibility of the source and the sensitivity of the speaker in communicating information in a culturally appropriate manner.

Which of the following has led to the more recent focus on cooperation between the state and the federal level in relation to public health? a. The emphasis of Healthy People 2020 b. The ongoing continued restriction of financial resources c. The new presidential administration's goals d. The threat of bioterrorism

ANS: D Cooperation between the state and federal levels has been brought to the forefront with efforts to plan for bioterrorism, an event that would necessitate cooperation and sharing. In addition, the state is highly dependent on the federal level for resources and guidance. The administrative goals of the president, emphasis of Healthy People 2020, and restriction of available financial resources have not been the main factor that has led to an increase in cooperation related to public health.

The legal nurse consultant (LNC) felt more than a little stressed after being cross-examined by both the prosecuting attorney and the defendant's attorney in intricate detail at a deposition. Which of the following actions should be taken next by the LNC? a. Get together with friends and share the experience b. Go out and have a stiff drink to relax and get over the stress c. Pray the case does not go to trial when the LNC will have to go through all this again d. Review the written transcript for accuracy

ANS: D During the deposition, the LNC will present the facts of the case and be questioned by attorneys from both sides. This process may be quite lengthy and stressful. It is essential that the LNC be prepared, having reviewed the case and all related materials very thoroughly. Following this process, the LNC will be given a written transcript of the deposition; this needs to be carefully reviewed for accuracy. It is not appropriate for the LNC to share this experience with friends. Consumption of alcohol will not help the nurse address the stressors that are being encountered. Reviewing the transcript for accuracy should decrease the level of stress experienced by the nurse and decrease the worry about this case going to trial.

After being given negative news about a health problem, the client, with tears running down her face, asks, "Why did this happen to me?" Which of the following is the most appropriate response by the nurse? a. "Could someone have cursed you?" b. "Do you feel your life is out of balance?" c. "God has a plan for each of us even if we do not understand it." d. "Why do you think it might have happened?"

ANS: D Each response represents a particular belief about illness, but without knowing the patient's perspective, the wrong one could easily be chosen. It is difficult to be comforting without knowing the client's beliefs about the causation of illness. The best way to discover this is to query the patient.

When was the idea of national health care insurance first debated in the United States? a. Clinton's 1992 presidential campaign as he attempted to achieve such a plan b. During President Johnson's administration when Medicare and Medicaid were instituted in the 1960s c. President Franklin Roosevelt's attempt to include health insurance in Social Security legislation in the 1930s d. President Theodore Roosevelt advocated such national medical coverage in 1916

ANS: D European countries began a social model of health insurance in the early 1900s. President Theodore Roosevelt advocated a similar plan for the United States in 1916. The other attempts mentioned came after Theodore Roosevelt's initial attempt in 1916.

Everyone is talking about the disaster that has been widely seen on the news programs. Which of the following suggestions would be most appropriate for the nurse to make at this time? a. That this opportunity should be used to discuss how to be brave in a crisis. b. That programs in collaborative problem solving should be created for students and staff. c. That the staff should reassure students that such a disaster would not occur here. d. That the school should develop an emergency management plan.

ANS: D Every school is encouraged to develop an emergency management plan. In fact, many states mandate that schools develop plans to address the potential threat of another terrorist attack or a natural or man-made disaster. It would not be appropriate for the nurse to discuss bravery, student safety should come before bravery. Collaborative problem solving will not help the students be safer should this type of a crisis arise at the school. It is not appropriate to provide the students with reassurance as it is impossible to prevent all of these disasters, rather the school must develop an emergency plan so that they are prepared if this would happen at their school.

When one woman asked her friend to stay while a painful procedure was done, it was explained that only one immediate family member could be in the room. The woman asked the nurse, "How do you define family?" Which of the following would be the best response by the nurse? a. "A person's husband, wife, or children" b. "Anyone related to you by law or by blood ties" c. "Someone who lives with you and has ties of commitment" d. "Whoever you tell us is your family"

ANS: D Families are changing from the norm of husband, wife, and children to single parents, blended, extended, committed, or cohabitation with domestic partners. Consequently, rather than debate the definition of family, it is more practical and comprehensive to ask the client whom he or she considers to be family.

Which of the following best explains why occupational health nurses (OHNs) felt a need to create the Factory Nurses Conference? a. All the other specialties in nursing had created their own conferences and groups. b. Creating their own group would be less expensive to maintain membership than joining the American Nurses Association (ANA). c. Funding was made available by large employers for the nurses to meet. d. Most OHNs practiced alone and wanted to be able to interact with peers.

ANS: D Few specialties existed at the time the Factory Nurses Conference was created. Industrial nurses were practicing in single-nurse settings and recognized the benefit of uniting as a group for the purpose of sharing ideas with peers practicing in the same nursing arena. External funding was not available. This group was open only to graduate, state-registered nurses affiliated with the ANA.

Which health care provider organization is seeing an increase in the demand for their services? a. Physician practice b. Hospice service c. Hospitals d. Long-term care facilities

ANS: D Hospital stays have shortened and patients who are admitted are more acutely ill and require more intensive care. Consequently, decreased hospital stays result in more home care admissions and more discharges to long-term care facilities for short-term recovery and rehabilitation. Hospice services and physician practices have not been as impacted as greatly by this shift in where care is provided.

The clinic was seeing a great number of Hmong immigrants from the mountainous regions of the Far East. If the nurse could not obtain a translator, which of the following would be the next best action? a. Require each patient to bring a family member fluent in English b. Start teaching Hmong patients English on each clinic visit c. Suggest Hmong patients might be more comfortable seeking care elsewhere d. Try to make flashcards with common phrases used during clinic visits

ANS: D If a translator is not available, the nurse can try many approaches such as pantomime, but it would also be helpful to have common phrases used with many patients on flashcards so basic information can be obtained. Other Hmong patients or family members should not be used as interpreters. It is unrealistic to teach English to patients at clinic visits. This population needs care, so suggesting that they receive care elsewhere is not a therapeutic response by the nurse.

Which of the following best describes a flaw of indemnity plans? a. Blue Cross and Blue Shield had a great idea, but they went bankrupt. b. Cost sharing was expected of Blue Cross and Blue Shield enrollees. c. Enrollees could not choose their provider or manage their own care. d. Plans lacked any incentives to contain costs.

ANS: D Indemnity plans paid all the costs of covered services provided to the enrollee. The enrollee enjoyed free choice of provider and services. They preserve the enrollee's right of choice and allow the person to manage his or her own health care. These plans lack incentives for cost containment. Today, cost-sharing efforts (e.g., copayments, deductibles) help contain costs. Blue Cross and Blue Shield continue to be a provider of health insurance.

Which of the following has been confirmed by research regarding the relationship between religion, spirituality, and health? a. Essentially, religion gives persons a sense of hope. b. Faith communities help by praying for ill persons during services. c. Healthy persons have a tendency to be active within their faith communities. d. Persons who attend services have decreased anxiety, depression, and stress.

ANS: D Individuals who reported intrinsic religion (internalized or regularly practiced) and regular attendance at a religious service reported decreased stress. In 147 studies, it was found that there was an inverse relationship between religiosity and depression. The authors found evidence in another 49 studies that indicated people who practiced religious coping had lower levels of anxiety, depression, and stress and coped more positively with many chronic diseases.

Which of the following led to a vast increase in the number of occupational health nurses? a. Increasing autonomy and salaries of nurses in that role b. Increasing industrialization of all societies c. Society demanding improvements in safety for all workers d. The health of workers involved in manufacturing during World War II was crucial

ANS: D Industrial nurses have always been autonomous in their practice and received appropriate pay, except during the Great Depression when many nurses lost their positions. The focus of health care for employees changed as a result of many factors, including the impact of the two world wars. During World War I, the government demanded health services for workers at factories and shipyards holding defense contracts. In 1942, during WWII, the U.S. Surgeon General told an audience of nurses that the health conservation of the "industrial army" was the most urgent civilian need during the war. Not all societies have industrialized.

Most of a country's citizens have died from malnutrition or as the result of violence. Which of the following conclusions can be drawn? a. Their country has a problem with an adequate water supply for agriculture. b. They live in a country where weather interferes with food crops. c. They live in a developed country involved in a war. d. They live in a developing country.

ANS: D Infections, malnutrition, and violence are the primary causes of mortality in developing countries. Cardiovascular disease, cancer, respiratory disease, stroke, violence, and traumatic injury are the primary causes of mortality in a developed country. The problem of malnutrition is broader than examining the environment associated with growing the country's food supply.

A new faith community nurse (FCN) met with a client who was dying. The client asked the FCN to pray for her out loud. The FCN had an active prayer life, but privately—not out loud relating to someone else. Which of the following would be the best response by the nurse? a. Deliberately misunderstand the request and promise to pray for the client when you are at home each evening b. Look for a religious book nearby, open it, and hope there is something there the nurse can use c. Offer to share the client's request with the faith community's leader, as well as ask the faith community to pray for the client d. Share a traditional prayer that the nurse had previously memorized for personal use

ANS: D It is good to offer to pray for the client and to ask the faith community's leader and the faith community to pray for the client. But the request was immediate, so the best response is to use the faith's traditional prayers, which the parish nurse has memorized. If nothing comes to mind, the FCN can use a book of the faith to find a prayer that is suitable. A guideline to follow is to keep the prayer simple and offer the request to the client's higher power.

Which of the following is one of the biggest threats faced by developing countries that are trying to grow economically and make a better life for their citizens? a. Lack of education and knowledge b. Political unrest c. Environmental hazards d. Large population

ANS: D Large populations create pressure. In developing countries, famine, trade problems, and war may occur. Malnutrition, disease, or death may result. The poor suffer excess mortality and morbidity. Quality of life is less. Overcrowding leads to pollution, stress, disease, and violence. Each of these challenges represents a major barrier to economic growth. Thus, the large population can cause there to be problems with lack of education, political unrest, and environmental hazards.

Which of the following aspects of health care could be learned by a developing country from a developed country? a. Acceptance of illness or disease as a learning experience b. Effective ways to treat chronic disease c. Use of healthy behaviors to prevent illness d. Delivery of primary health care

ANS: D Likewise, developed countries have much to learn about low-technology initiatives such as oral rehydration therapy for the treatment of diarrhea and the delivery of primary health care as defined by the World Health Organization. The other behaviors such as acceptance of disease, effective ways of treating chronic disease, and use of healthy behaviors to prevent illness would most likely be passed on from developed countries to developing countries.

Which of the following nurses used political expertise to influence the federal government to develop a Children's Bureau? a. Clara Barton b. Florence Nightingale c. Lavinia Dock d. Lillian Wald

ANS: D Lillian Wald recognized the connection between social conditions and health. She was a driving force behind the federal government's development of the Children's Bureau in 1912. Lavinia Dock was a political activist who waged a campaign for legislation to allow nurses to control the nursing profession. Florence Nightingale was the first nurse to exert political pressure on a government. Clara Barton was responsible for organizing relief efforts during the U.S. Civil War.

Which of the following best describes the most common organization for receiving personal health care in the United States today? a. A group of physicians all in a particular specialty group who share an office b. Community health center that includes educational and social services c. Fee for service by a physician in practice by himself or herself d. Managed care organization with capitated payments to providers, both professionals and organizations

ANS: D Managed care has become the dominant paradigm in health care. This model has replaced fee for service by a physician in independent practice or physicians in a group practice, and care in a community health center.

A nurse made a home visit for prenatal care and teaching for an Asian woman. The nurse noted the woman was having a hot lunch of foods the nurse did not recognize. When the nurse suggested some appropriate cold protein foods be added to the meal, the woman looked horrified and distrusting. Which of the following best describes what has happened in this situation? a. The interference with eating seemed incredibly intrusive and inappropriate. b. The nurse was giving advice when advice had not been sought. c. The nurse had suggested foods unknown to the woman. d. The yin and yang theory requires only hot food be eaten when female yin energy is dominant.

ANS: D Many Asians ascribe to the yin-yang theory in which health is believed to exist when all aspects of the person are in perfect balance. Yin energy is female. Yin Yang foods are hot. Therefore to maintain balance, she has to eat hot foods. Thus, in the other responses the nurse is not considering the cultural background and needs of the client in this situation.

A nurse was responsible for setting up a health fair with free pizza being served during lunch. The nurse observed a few people who did not eat but just talked quietly during lunch. Which of the following actions should be taken by the nurse? a. Assume it was a religious fast day, and not worry about it b. Discuss with the supervisor what are traditional foods in that neighborhood c. Offer to let those who did not eat take the leftover pizza home for a meal later in the day d. Talk to the group, and ask what foods might have been more acceptable

ANS: D Many ethnic groups prefer certain foods as part of their cultural identity. The nurse should take this opportunity to learn foods preferred by the community. It cannot be assumed a supervisor would know preferred foods of the community. Making assumptions about the community or offering the leftovers to those who did not eat would not be culturally sensitive approaches for the nurse to take with this population.

Which of the following best describes the approach to health care used by states? a. Federal funding encourages experimentation in creating new programs. b. Insurance regulations concerning reimbursement cross state lines. c. Information about successful programs is known to legislators. d. States frequently develop new programs as federal funds become available to pay for them.

ANS: D Many state and local government programs were developed on the basis of availability of federal funds. Funds are accompanied by regulations, which apply to all recipients. These have served to standardize health policy. Federal funding is limited, thus there is limited opportunity for experimentation. Legislators must be involved in ongoing education in order to keep up to date on what is happening with programs that have been implemented. Insurance regulations are monitored by individual states so reimbursement concerns are unable to cross state lines.

How do public health efforts differ from medical efforts in improving the health of our citizens? a. Medical care providers autonomously choose appropriate interventions, whereas public health care providers must engage in whatever actions legislation requires. b. Medical care providers are self-employed or agency employed, whereas public health care providers are employed by and paid through the government. c. Medical care providers focus only on individuals, whereas public health care providers focus only on aggregates. d. Medical care providers focus on disease diagnosis and management, whereas public health care providers focus on health promotion and disease prevention.

ANS: D Medical care providers are restricted by insurance and government regulations. Providers may also be employed in government facilities, such as Veterans Administration facilities. However, medical care providers primarily focus on diagnosis and treatment of disease, whereas public health care providers try to promote health and prevent disease. Although medical care providers primarily focus on individuals and public health care providers primarily focus on aggregates, their practice is not limited to only

A school nurse was responsible for five schools. To give students required medications during the day, the school nurse teaches a particular office staff member in each school exactly what to give to whom and when, and they practice until both are comfortable. Which of the following remains as the nurse's responsibility in relation to the administration of medications? a. To begin teaching a second person at each school because the original staff member might occasionally not be available to give the medications b. To confirm with each student that they do not mind obtaining their medication from the staff person assigned to the task c. To continue to evaluate the comfort level of the staff person in completing the task d. To systematically continue with assessment, diagnosis, goal setting, and evaluation of student health needs

ANS: D Not every school has a full-time nurse available on site. Often a nurse is assigned to three or four schools, resulting in delegation of certain tasks to unlicensed personnel. Each state's nurse practice act stipulates which procedures may be delegated. The responsibility for assessment, diagnosis, goal setting, and evaluation may never be delegated. When tasks are delegated, the nurse must provide appropriate education, written procedures, and ongoing supervision and evaluation of the caregivers.

Which of the following skills can a forensic nurse, serving in the elected office of coroner, bring to the situation compared with other professionals? a. Extensive knowledge of medicine b. Knowledge of the law c. Previous experience in testifying in court d. Superb communication and empathy skills

ANS: D Nurse coroners exhibit communication skills when dealing with grieving families. Nurses are educated in therapeutic communication and practice those skills in any setting. Nurses are acutely aware of the importance of using open-ended questions, attentively listening, and being fully present with family and friends.

Which of the following best describes what the Occupational Safety and Health Act of 1970 requires? a. All employees are eligible for a free health examination before beginning employment. b. Employers are required to make suggestions on standards for improving worker safety. c. Employers have the right to request an Occupational Safety and Health Administration (OSHA) inspection for ways to improve worksite safety. d. Employers must keep the worksite free from recognized hazards.

ANS: D OSHA promulgates occupational health and safety standards, which are published in the Code of Federal Regulations and updated on a regular basis. Having access to the most recent publication of these standards is a crucial responsibility of the occupational health nurse (OHN). The OHN must be knowledgeable of Title 29 of the code and other sections of the code that apply to specific hazards in the workplace.

Which action would probably result in the largest change in health care outcomes for Americans? a. Establish large numbers of scholarships for education of nurses, physicians, and other health care providers b. Fund a one-time extremely large stimulus to allow all health care providers and agencies to create and integrate computer network systems for client health care records c. Increase funding for hospitals and medical centers to expand their neighborhood clinics d. Redirect a large portion of federal funding from acute care to health promotion activities

ANS: D Of the choices given, health promotion activities would make the largest difference. Increased expenditures on acute care will not notably change the health of the population, whereas funding that addresses health promotion such as education and safe environments would improve the health of the aggregate.

It has been proposed that a new, better approach to health care be tested with a small group to evaluate its effectiveness. Which of the following best describes why this cannot be done? a. Any employment in the project would be only temporary, so it would be difficult to find professionals to staff the program. b. It is challenging to find appropriate sites located in the target area from which to offer the pilot project service. c. No one wants to accept free services if they include being a guinea pig in a research project. d. Offering a service establishes a precedent and a sense of entitlement, so it is difficult to discontinue the program.

ANS: D Once a direct health care service is offered, it is difficult to discontinue it. Existing programs create tradition by establishing vested interest and a sense of entitlement.

A nurse was explaining a problem to the client so the client could make an informed decision about alternative treatment approaches. The client responded, "The doctor will choose the best treatment. Do whatever the doctor says." Which of the following actions should be taken next by the nurse? a. Ask if the client would like to discuss the choices with her family b. Explain that the client has to decide, and wait for the client's decision c. Explain that physicians cannot decide; perhaps the client could just flip a coin? d. Nothing; simply accept that some fatalistic-oriented clients literally do not know how to choose e. Suggest that the client discuss the situation with her ancestors and wait for guidance

ANS: D One of the three ways people are oriented is destiny, in which people must endure and accept whatever comes in a fatalistic, inevitable manner, as destiny cannot be changed. The other responses do not address the perspective of destiny that has been indicated by the client in the initial response.

Which of the following best describes how the government was successful at containing costs? a. The original legislation for Medicare and Medicaid had built-in cost controls. b. Certificate-of-need requirements restricted provider overtreatment. c. Utilization review determined appropriateness of care. d. Prospective payments were based on diagnosis-related groups (DRGs). e. Peer standard review organizations were effective watchdogs.

ANS: D Prospective payment based on DRGs proved to be effective. The cost reduction that resulted gave rise to the managed care revolution as providers searched for the most cost-effective mechanism of care provision. Various efforts from, for example, certificate-of-need, peer review, and utilization review were not effective.

Which task is most crucial for the community health nurse to do well? a. Review the most recent morbidity and mortality data b. Create a new clinic to better meet local health needs c. Evaluate the results of the recent screening program d. Give testimony regarding proposed state health legislation

ANS: D Public health's core functions are assurance, assessment, and policy development. Giving testimony regarding legislation directly reflects policy development, which would have a wider impact than the other options, which are more local and narrow in focus.

Which of the following best describes how the United Nations (UN) is able to implement its decisions? a. Asking for funding from all member nations to obtain appropriate resources b. Through five permanent members of its security council c. Sending military units to developing countries d. Using its moral authority and world opinion

ANS: D Regardless of size, wealth, or political system, all member nations have an equal vote in the decision- making process. UN decisions reflect world opinion and the moral authority of the community of its 192 nations. The UN does not ask for funding from all member nations, as some of the nations do not have additional funds to provide to the UN. The security council is unable to implement decisions without support from all of the member nations. It is not feasible for the UN to send military units to developing countries to implement their decisions.

A baby was dehydrated because of diarrhea. The mother explained that she had finally gone to a folk healer who told her to give the baby herbal tea, which did seem to be helping a bit, but the baby still seemed ill. Which of the following statements would be the most appropriate reply by the nurse? a. "Folk healers cannot cure such problems; let me give you appropriate fluids for your baby." b. "Let's go back to feeding the baby formula, and see how the baby does." c. "You continue to give the baby herbal tea, but let's put some sugar and salt in the tea." d. "Your healer is correct; fluids are crucial for your baby. Let me give you some special fluids for you to give the baby."

ANS: D Rejecting the folk healer's advice may cause the mother not to trust Western medicine. If possible, the nurse should build on what the mother is doing. It is usually helpful to include any behaviors that may be helpful or neutral in effect. In this case, the mother is encouraging fluid, which is crucial, and tea is boiled, so the water is clearly safe. Just adding salt and sugar is risky because of the need for careful measurement. Nothing in the example suggests the nurse recognizes what kind of tea is being given. It is easier to give the mother fluids with the appropriate electrolytes while supporting at least some aspect of the healer's advice. It must be remembered that most indigenous healing practices are innocuous.

Which of the following would be the best example of service learning? a. Student nurses collecting gloves and coats to distribute to the homeless b. Student nurses distributing food on plates at a "feed the hungry" site c. Student nurses employed as nursing assistants for minimum wage on the weekends d. Student nurses volunteering at the free clinic doing health assessments

ANS: D Service learning is a teaching and learning strategy that integrates meaningful community service with instruction and reflection to enrich the learning experience, teach civic responsibility, and strengthen communities. Volunteering at a free clinic to perform health assessments is the best example of how this definition can be applied. Collecting gloves and coats and distributing food, while allowing the student to volunteer, does not allow the student to apply materials learned in the classroom. Student employment cannot be considered volunteering of services to the community.

What change could most effectively lead to a longer life span in Americans? a. Parenting and sexual behavior classes in all public school systems b. Legislation restricting alcohol and drug use c. Notably reducing speed limits on all state and federal highways, and changing the age limit for driving to 21 years of age d. The belief that smoking is shameful and disgusting, as well as expensive, becoming the social norm

ANS: D Smoking is responsible for about 20% of all deaths in the United States. Although smoking is an individual's choice, all people are affected by social norms. Parenting and sexual behavior classes and legislative changes may influence health, but may not necessarily lead to a longer lifespan. Community health nurses should recognize that health is influenced by a web of factors, some that can be changed and some that cannot. Influencing social norms may better promote change among Americans.

After completing a master's degree, a nurse took a course in marketing. Should the agency reimburse the nurse's tuition costs? a. No, courses taken for personal enjoyment are not eligible. b. No, courses taken outside the professional's responsibilities are not eligible. c. Yes, the nurse is demonstrating professional commitment by continuing education. d. Yes, the nurse could use such information in social marketing for the agency.

ANS: D Social marketing tools using marketing principles and technologies are designed to influence the knowledge, attitudes, values, beliefs, and behaviors of populations. Such information would be extremely helpful for agency personnel in improving community health and lifestyle choices.

A nurse states that he or she does not want to become involved in politics because of family, school, work, and other commitments. Which of the following would be the best reply to this statement? a. "Good for you. We should all stay out of such dirty game playing!" b. "I am sorry to hear that but I do understand." c. "It doesn't matter; politics have nothing to do with nursing practice." d. "It won't take much time to join ANA and pay dues so their lobbyist can represent you."

ANS: D Some of the nursing organizations have full-time lobbyists who work in Congress, including the American Nurses Association (ANA). These lobbyists help represent the interests of nurses and society. Politics play a major role in nursing practice and nurses should be encouraged to participate in organizations, even if it is through paying dues, so that their voice can be represented.

Which of the following best describes why large employers would decide to self-insure? a. To claim to offer more benefits to employees b. To have more control over health care providers c. To be more effective at keeping employees happy d. To reduce administrative costs charged by insurance companies

ANS: D Some organizations have decided to self-insure their employees. This reduces the administrative cost of insurance. Self-insurance does not claim to offer more benefits to employees, allow for more control over health care providers, or do a better job at keeping employees happy.

Which of the following does the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) service include in its routine screening that may not be included in a typical private physician preschool physical? a. Comprehensive health and developmental history b. Immunizations c. Laboratory testing d. Lead toxicity screenings e. Unclothed physical examination

ANS: D The EPSDT includes lead paint screening. Medicaid-eligible children are guaranteed access to comprehensive health care services and routine dental examinations. Screening services must include a comprehensive health and developmental history, an unclothed physical examination, plus immunizations and laboratory testing that are age appropriate, as well as lead toxicity screenings. Because these children are very-low income, they probably live in older housing that may have lead paint. Private physicians caring for children with insurance see children of higher income levels who probably live in newer, safer housing.

Which of the following reports state that nurses should practice to the full extent of their education and training? a. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care b. Keeping Patients Safe: Transforming the Work Environment c. Priority Areas for National Action d. The Future of Nursing

ANS: D The Future of Nursing report contains four key messages. One of the key messages is that nurses should practice to the full extent of their education and training. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care addresses potential causes of disparities in health care. Keeping Patients Safe: Transforming the Work Environment addresses critical quality and safety issues with a particular focus on nursing care and nurses, and examines these issues from the perspective of the work environment. Priority Areas for National Action identified 19 priority areas that should be addressed to improve quality.

Which of the following best describes what happened after the Medicare Modernization Act of 2003 was enacted? a. Additional restrictions in coverage were imposed. b. Experimental treatments were approved for reimbursement. c. Reimbursement procedures became more efficient. d. A prescription drug benefit was added.

ANS: D The Medicare Modernization Act of 2003 provides seniors and people living with disabilities with some prescription drug benefit coverage, as well as more choices and better benefits. The act did not impose additional restrictions to coverage, approve experimental treatments, or provide efficiency with reimbursement procedures.

Which of the following best describes what is being discussed in relation to concerns over patients' safety and nurse fatigue? a. All hospitals are now required to report errors made that are a result of low nurse staffing. b. The Centers for Disease Control and Prevention (CDC) is monitoring the incidence of medical errors caused by nurse understaffing. c. The Registered Nurse Safe Staffing Act was passed by Congress in 2013. d. Legislation has been suggested that staffing systems require the input of direct care registered nurses.

ANS: D The Registered Nurse Safe Staffing Act of 2013 was introduced in Congress to address concerns of inadequate and inappropriate staffing, which threatens patients' safety and the nurses' health. The act would encourage development of staffing systems that require the input of direct care registered nurses, as well as protection for RNs who speak out about patient care issues. This suggested legislation has not been acted on. The CDC is not involved in monitoring medical errors caused by nurse understaffing. Hospitals are not required to report errors that occur due to nurse understaffing.

Which of the following responsibilities does the occupational health nurse (OHN) have in relation to an injured employee and the Workers' Compensation Act? a. To assist the employee in obtaining legal representation to negotiate a financial settlement b. To assist the employer to work out a settlement with the employee to avoid legal suits against the employer c. To file a claim for the employee with Workers' Compensation to ensure continued full salary until the employee is able to return to work d. To work with the employee to keep the employee informed, limit disability, and provide opportunity for rapid return to employment

ANS: D The Workers' Compensation Act protects the employer if the compensation received by the employee precludes legal suits against the employer. Workers receive an average of 66% of their take-home pay before taxes. The OHN educates the employee regarding benefits under the Workers' Compensation Act and is often the one who files the claim. The goal is to limit the worker's disability and provide an opportunity for early return to work through appropriate workplace accommodations.

Which of the following best explains why job opportunities for occupational health nurses (OHNs) have continued to expand? a. Federal legislation has required an OHN at any site with more than 50 employees. b. Legislation has required employers to engage in certain tasks, and nurses were the most expert at those tasks. c. Nurses have done an excellent job of describing the role and its benefits to the media. d. Nurses are able to document cost savings to employers.

ANS: D The cost-effectiveness of providing health care to employees was achieving increased recognition, and by 1912, after workers' compensation legislation had been instituted, 38 nurses were employed by business firms. As businesses seek ways to maximize the value of their dollars spent on health care services, OHNs and other health professionals face an opportunity from being able to demonstrate that cost-effective, quality health programs do improve the health of employees and their dependents, positively influencing their company's attempts to control rising health care costs.

When a nurse visited a client's home, it was apparent that the client had not begun to implement the needed exercise program. Rather, the client had been doing drawings about his illness experience. Which of the following actions would be most appropriate for the nurse to take next? a. Express admiration for his artistic ability, and do not schedule future visits because the patient is noncompliant b. Point out the negative consequences that will ensue if the client does not begin exercising c. Review with the client why exercise is so crucial to his recovery d. Suggest drawing might be more forceful after exercising

ANS: D The dominant cultural value is action oriented, so the client would be expected to have begun to exercise. Dominant cultural values include an emphasis on productivity and being busy. However, some persons are not action oriented but being oriented, with a focus on expression of impulses and desires.

Which of the following best describes the primary conclusion of the report To Err Is Human: Building a Safer Health System? a. Hospital staffing must be improved to focus on safety rather than cost containment. b. Quality of care and medical error are not easily defined. c. Patients must recognize that care providers are human and errors will occasionally be made. d. System failures are resulting in an incredible amount of harm from medical errors.

ANS: D The first key message from this report was the emphasis on the incredible magnitude of harm resulting from medical errors, which are largely due to system problems, not individual failure. Error reporting programs are needed as health care systems are encouraged to focus on error reduction. The report clearly states that there is no one answer to solving this problem. Errors are directly related to outcomes, which is a significant concern in quality improvement efforts.

Why did employers decide to offer health insurance as an employee benefit? a. Hospitals and physicians quit offering charity care to those who could not pay. b. Society was focused on not having to pay for doctor visits and other needed health benefits. c. Teachers were role models for unions to demand insurance as a benefit. d. To obtain and retain the limited number of persons available to work when government rules prohibited raising wages, insurance was offered.

ANS: D The idea of paying a small fee for guaranteed health care to have sickness cured was very popular. Health care providers liked knowing they would receive payment for their services. During World War II, faced with a limited workforce and governmental restrictions on wages, employers began to see health insurance as a means of supplying workers' benefits without granting a wage increase. Teachers were not demanding insurance as a benefit. Hospitals and physicians continued to provide charity care as they were able. Society understood that they needed to pay for health services; however, businesses realized that providing insurance was a way to keep their needed workforce.

An unidentified patient was injured in a hit-and-run accident and was conscious. When asked how he felt, the patient looked very confused and responded in a language the nurse did not recognize. Which of the following actions should the nurse take next? a. Look closely at the person, try to determine the patient's ethnic background, and then seek someone fluent in his language b. Report the language barrier to administration, and let them handle the problem c. Tell the unit supervisor so various translators can be brought to the floor until the language is recognized and communication can be established d. Use gestures and pantomime until the nurse is able to determine what language the patient is speaking

ANS: D The nurse can report the problem and request a translator, but in the meantime the nurse should pantomime words and simple actions while verbalizing them until communication can be established using a translator from his culture. Just looking at a patient will not allow you to assume his or her ethnic background.

Which of the following statements best describes a major event that occurred in the 1960s that affected health care? a. The amount of charity care by health care providers greatly increased. b. Hospitals began to voluntarily pay taxes to the communities where they were located. c. Legislation greatly expanded funds available to train physicians, nurses, and other health care providers. d. The Social Security Act was amended to create Medicare and Medicaid legislation.

ANS: D The popularity and benefits of employer-provided insurance plans were recognized, as was the reality that some segments of society were being neglected. The 1960s, with a pervasive thrust for social justice, presented the opportunity to move toward universal health care coverage. Titles XVIII and XIX of the Social Security Act created Medicare and Medicaid, respectively. There was no increase in funding for training of health care providers, voluntary payment of taxes by hospitals, and an increase in the amount of charity care provided in the 1960s.

Which of the following best describes the effect of President Clinton's Advisory Commission on Consumer Protection and Quality in the Health Care Industry report (1999)? a. Created improvement in both physician and nurse educational programs b. Demonstrated the incredible influence on health care made by the insurance industry c. Increased national interest in improving health care and seeking reform d. Stimulated the Institute of Medicine to explore quality in more depth

ANS: D The report had a major impact in that it stimulated a series of more in-depth explorations of the health care delivery system, which resulted in a series of reports developed by the Institute of Medicine called the Quality Chasm Series. These reports then caused several other movements within the health care system.

What is the community health nursing definition of health? a. Health is a person's goal-directed purposeful process toward well-being or wholeness. b. Health is an individual's physical, mental, and social well-being, not merely the absence of disease or infirmity. c. Health is the mutual adaptation between a person and his or her environment in meeting daily existence. d. Health is families and aggregates choosing actions to ensure safety and well-being.

ANS: D The text stresses that health is not just the result of an individual's choices, but choices and actions of individuals, families, groups, and communities that lead to better health.

Which of the following is the single leading preventable cause of death in the United States? a. Alcohol b. Firearms (guns) c. Overweight and obesity d. Tobacco use

ANS: D Tobacco use is a major problem in this country and is the single leading preventable cause of death in the United States. Overweight and obesity is the second leading cause of preventable death in the United States. Alcohol and firearms (guns) are not leaders in the causes of preventable death in the United States.

Which of the following best describes how voluntary health agencies fit into the overall health care system? a. They fill in the gaps between services offered by private and public health systems. b. They primarily serve as sources of financial aid for the underserved. c. They supplement the effort of the public health care system. d. They support research, education, and services for particular groups of patients.

ANS: D Voluntary health agencies are committed to specific diseases, organ or body structures, health and welfare of special groups, or particular phases of health. Philanthropic groups support research and programs. These organizations provide major sources of help in preventing disease, promoting health, treating illness, consumer education, and advocacy and research. Unfortunately, there continue to be overlaps among private, voluntary, and public agencies, but without voluntary agencies, fewer services would be available.

A nurse reviewed the treatment the surgeon recommended for a woman's breast lump. When the nurse asked the woman if she could be admitted to the hospital for immediate surgery, the husband thanked the nurse for her time and said they would get back in touch after they speak with other family members. Which of the following actions would be most appropriate for the nurse to take? a. Ask if there was some reason the woman could not be immediately admitted for treatment b. Explain to the woman why postponing the surgery was dangerous c. Point out it that it's the woman's decision, and stress that she should go to the hospital immediately d. Recognize that the husband and other family members may need to have input into this decision

ANS: D We typically focus on the individual as the central figure in decisions about the self. However, in other cultures female clients may seek assistance from other members of the family and allow male relatives to make decisions about important health-related matters. The husband has indicated by his response that collateral relationships are valued, thus decisions about the client may be interrelated with the influence of illness on the entire family or group. The other responses do not address the value of collateral relationships that the nurse must recognize and address.

Which of the following best describes what happens when a health care organization receives federal funding for a special health care need? a. Other groups see the project and write grants wanting similar projects in their geographic area. b. Participants continue to demand the services so local funding has to be readjusted to continue the care. c. Research is done to demonstrate whether or not the intervention was successful and should be replicated. d. When funds cease, so does the health care; therefore, continuity is lacking.

ANS: D When the funding is no longer provided, the programs cease, which results in lack of continuity of care. Research may be done related to the program, other programs may be developed because of the current program that is being implemented, and participants may encourage local funding to continue. However, the most likely outcome is that the program will end when the funding ends, so there is no continuity in the services that are provided.

Which of the following arguments would the occupational health nurse (OHN) use when trying to convince a large employer of the need for a breast cancer education program? a. It will be excellent media coverage for the employer, especially if the public is invited. b. A large number of female employees of childbearing age may be interested. c. This program would help balance all the male-oriented programs. d. Women employees who believe their employers are interested in their well-being are more productive and satisfied.

ANS: D Women who believe their employers are interested in the well-being of themselves and their families are more apt to be productive and satisfied employees. Thus, the large employer can demonstrate this belief by offering a breast cancer education program. The primary purpose of offering this program would not be to provide media coverage for the employer, spark the interest of the female employees, or help balance the male-oriented programs.

Which of the following best describes how the faith community nurse, as a health educator, decides which educational programs to offer the faith community? a. Based on feedback from the local public health department nursing professionals b. Based on what will help implement the Healthy People 2020 goals c. Based on what is consistent with the health laws of scripture or holy books d. Based on the health status and needs of faith community members

ANS: D Although any response could be the basis of a program, the program should address the needs of the local faith community. Educational efforts are planned on the basis of the church community's priorities consistent with Healthy People 2020 objectives. Because the faith community membership includes people across the life span, church-based educational programs can address all 10 major health indicators. Early in the development of a parish nurse program, and periodically thereafter, the parish nurse should assess the health status and needs of the congregation members to determine educational priorities.

A nurse is completing a health history with a client. Which of the following questions would be most important to include? a. How many alcoholic drinks do you have in a day? b. How many sexual partners have you had in the past month? c. What nonprescription drugs do you take on a routine basis? d. What kinds of tobacco do you use daily?

ANS: D As smoking is the leading cause of preventable deaths, accounting for about one out of every five deaths, it is crucial that tobacco use be queried in each health history. After asking about tobacco use, the others should also be included in a health history.

Based on statistics, which of the following groups is probably more physically active? a. A group of adults living in the southern U.S. states b. A group of elderly mall walkers c. A group of high school graduates employed in blue collar occupations d. A group of highly paid college graduates

ANS: D Research has shown that those with higher levels of education and higher income enjoy physical activity more. Those of mature age, with less education, with less income, and/or living in the southern U.S. states engage in far less activity.

Which of the following is the cause of most preventable deaths in the United States? a. Alcohol b. Drug addictions c. Sexually transmitted diseases d. Tobacco

ANS: D Smoking is the leading cause of preventable deaths, accounting for about one out of every five deaths.

The nurse working with a client to change behavior to maximize health asked the client to bring his family to the next visit. Which of the following best describes why the nurse wants the family to come with the client? a. To analyze the family's beliefs about health b. To determine the family's support of the client c. To establish the family's communication patterns d. To evaluate the family's approval of the proposed changes

ANS: D Under the Theory of Reasoned Action, it is assumed that all behavior is determined by intentions, which are determined by attitude toward the behavior and the norms associated with the behavior. That in turn is determined by whether or not important persons approve or disapprove of the behavior. The family's beliefs about health, support of the client, and communication patterns are irrelevant if the family does not approve of the changes that have been proposed.

Which of the following best describes how complementary and alternative therapies differ from traditional health care? (Select all that apply.) a. Alternative therapies have been documented as ineffective. b. Complementary medicine is expanding because of paid media coverage. c. Nurses rarely are involved in complementary or alternative therapies. d. Providers vary in training and licensure. e. Reimbursement is often unavailable. f. Alternative therapies lack any research related to their effectiveness.

ANS: D, E Alternative or complementary therapies are expanding because of consumer demand, although reimbursement for these services is lagging. The National Center for Complementary and Alternative Medicine is currently researching their effects on health and disease. Training and licensure requirements vary widely. Many nurses have incorporated alternative therapies into their practice and seek more continuing education on such care.

Which of the following were among the outcomes of the 1979 report Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention? (Select all that apply.) a. A national committee was established to have hearings and study the problem further. b. Increased funds were allocated for health planning and health care. c. Many of the recommendations were adopted on the federal level. d. The Health Objectives Planning Act of 1990 was passed. e. The federal government began to identify and monitor national healthcare goals. f. The president addressed the American people about the need for health care reform.

ANS: D, E The federal government began to take a direct approach in identifying and monitoring national health care goals after the Surgeon General's report. The Healthy Objectives Planning Act of 1990 was passed. Healthy People 2000, Healthy People 2010, and Healthy People 2020 are continuing the efforts. The establishment of a national committee, increased funding for health planning and health care, adoption of recommendations at the federal level, and the need for health care reform were not outcomes of the 1979 report.

Which of the following interventions would be appropriate for a faith community nurse who bases care on the CIRCLE Model of Spiritual Care? (Select all that apply.) a. Giving a mini sermon based on the specific client problem b. Listening and showing respect without any actual intervention c. Suggesting to the client what would be an appropriate response to the situation d. Showing love and empathy toward the client and the situation e. Calling the client by name during the conversation f. Allowing time for prayer during the client interaction

ANS: D, E, F Faith community nurses should avoid giving sermons or preaching religion to clients. Listening without any intervention is not possible, because listening in and of itself can be therapeutic. Clients retain their autonomy so nurses can give information but cannot suggest to clients what their decision should be. Appropriate emotional interventions include working with feelings, showing love, and using appropriate touch and empathy. Calling a patient by name is part of showing caring during the interaction. Intuition includes allowing time for prayer and sacrament and supports and encourages religious activities.

Which of the following medications can a school nurse expect to most frequently administer? a. Analgesics and antipyretics b. Antibiotics c. Antitussives d. Anticonvulsants e. Attention-deficit hyperactivity disorder (ADHD) medications

ANS: E Medications used to treat ADHD are the most commonly administered. Medications commonly given in schools include analgesics and antipyretics, antacids, antitussives, anticonvulsants, antiemetics and antidiarrheals, antifungals, antihistamines, and antibiotics.

Which of the following best explains why the name of parish nursing was changed to faith community nursing by the American Nurses Association (ANA)? a. To allow nurses to use the title "congregational nurse" or "church nurse" rather than "parish nurse" b. To allow nurses who were not religious to accept practice positions c. To decrease the emphasis on the church d. To emphasize the community setting of the specialty e. To reflect the diversity now found in the specialty

ANS: E The ANA revised the standards in 2005, providing a clearer definition of the practice, including advanced nursing practice and changing the name of the specialty from parish nurse to faith community nurse. While acknowledging the importance of the Judeo-Christian basis of the practice, the authors believed the change better reflected the diversity now found in the specialty.

Which of the following causes of death on a death certificate would need correction by the forensic nurse? a. Accident b. Homicide c. Natural d. Suicide e. Untimely

ANS: E The National Association of Medical Examiners identifies five acceptable options for recording manner of death: (1) natural, (2) accident, (3) suicide, (4) homicide, and (5) undetermined.

Which of the following best explains why employers are putting more effort into ensuring a safe environment for their employees? (Select all that apply.) a. To avoid National Institute for Occupational Safety and Health (NIOSH) inspections b. To be sure employees are "on the job" c. To provide good public relations, which can be seen as being a good community citizen d. Safety is an ethical and moral responsibility e. To prevent expensive lawsuits when someone is hurt or injured f. The Occupational Safety and Health Administration (OSHA) can give penalties, fines, and sentences for safety violations

ANS: E, F The Occupational Safety and Health Act of 1970 identifies the roles of the various government agencies, provides for the establishment of federal occupational safety and health standards, and identifies a structure of penalties, fines, and sentences for violations of regulations. Inspections are a responsibility of OSHA, not NIOSH. The Workers' Compensation Act helps protect employers against lawsuits, but any citizen can sue anyone at any time, so it is less expensive to keep the environment and the employee as safe as possible. Although having a safe environment shows good public relations and is an ethical and moral responsibility, these are not the main reasons why more effort has been put into ensuring a safe environment for employees.