CMAN 380 Exam 2: 4, 5, 20

Emotional readiness is influenced by the learner's: attitudes and beliefs. learning ability. developmental stage. cultural background.

attitudes and beliefs. Emotional readiness is the learner's motivation or willingness to put forth the effort needed to learn. This is based on attitudes and beliefs about health-related behaviors. Experiential readiness is influenced by the learner's ability to learn. The most pertinent information to assess is the client's educational level. Developmental stage is part of experiential readiness. The developmental stage of both the learner and the family should be assessed. Cultural background is part of experiential readiness. This includes an assessment of the client's background, including cultural factors, the home environment, and socioeconomic status.

Of the following, persons, who is most likely to receive Medicaid benefits if the family income is below the poverty level? a. A 16-year-old child b. A pregnant woman with a 3-year-old child c. A single-parent family d. A two-parent family in which the father is unemployed

b. A pregnant woman with a 3-year-old child The federal government requires that benefits be extended to pregnant women and children younger than 6 years if family income is at or below the nationally set poverty level.

How are the funds obtained to pay for the Medicare program? a. A Medicare tax paid by all employees who pay Social Security tax b. A tax on wages paid by employer and employee c. Money from the federal income tax paid by all citizens d. Social security funds paid by employer and employee

b. A tax on wages paid by employer and employee A 1.45% tax of a workers salary is paid by both employer and employee, regardless of whether the employee pays into Social Security.

A nurse educator wanted to be certain that the program participants not only learned the content but also had time to practice these new behaviors. Which of the following must the nurse be sure to include in the program? a. Providing positive praise for participation b. Allowing time for role-playing c. Engaging the audience in stress-reduction exercises d. Modeling the appropriate behaviors

b. Allowing time for role-playing All of the answers are positive teaching behaviors, but to most effectively help the participants change both their attitudes and their behaviors, role-playing provides exploration of attitudes and use of problem-solving skills.

For which of the following clients will care not be reimbursed by Medicare? a. A terminally ill client who is receiving hospice care b. A client who is hospitalized for pneumonia c. A client who requires intermittent skilled home health care d. A client who needs long-term care in a nursing home

d. A client who needs long-term care in a nursing home Neither Medicare nor private Medigap insurance will pay for custodial nursing home care, the type of care required by most elderly nursing home residents. Medicare does provide coverage for hospice services, hospitalizations, and intermittent skilled home health care.

Of the following persons, who is most likely not to receive benefits under Medicaid, regardless of financial status? a. A 3-year-old child b. A 21-year-old pregnant woman c. A single-parent family d. A two-parent family

d. A two-parent family In general, the following needy groups are excluded: single persons and childless couples who are not elderly or disabled; most two-parent families; families with a parent who works at a low-paying job unless they have very low incomes as determined by state Temporary Assistance to Needy Families (TANF) criteria; and legal aliens who entered the United States on or after August 22, 1996 (are barred for 5 years).

A community/public health nurse is investigating the current health threats that are occurring at the global level. Which of the following concerns is the nurse likely to discover? a. Shortage of health care professionals b. New infectious diseases c. More potent drugs d. Terrorism

d. Terrorism Health problems associated with war, civil insurrection, and terrorism appear to be escalating, and no country is immune.

The main purpose of Medicaid is to provide: health insurance to the elderly. coordination of health services. access to health care. medical assistance to the poor.

medical assistance to the poor. Providing medical assistance to the poor is the main purpose of Medicaid. It provides health insurance coverage to poor pregnant women and young children, the aged poor, the disabled, and adults and children who are not covered under the pregnant women and children programs. Medicare is the primary provider of health insurance to the elderly. Medicaid may provide some coordination of health services for individuals who receive this insurance; however, this is not the main purpose of this grant program. Medicaid may help certain populations to access the health care system by providing them insurance; however, this is not the main purpose

A major success of managed care has been: decreased malpractice claims. reduced costs of health care. improved patient satisfaction. rationed health care.

reduced costs of health care. Managed care has been successful in reducing costs of health care in selectedareas. Federal regulations limit malpractice suits against managed care organizations. Currently, the U.S. Congress is considering legislation to limit malpractice claims out of concern that the cost of malpractice insurance may impact consumer services. Quality of care has been a continuing concern in the managed care market. It is questionable whether managed care has improved patient satisfaction. Cost-containment measures that increase out-of-pocket expenses and make health insurance unattainable for some have the effect of rationing health care. Thus, those who cannot afford care do without. Having segments of the population without health care is not a success of managed care

Which of the following populations is at greatest risk for having limited access to health care services? Adolescents Middle-aged Infants Elderly

Elderly Three groups have been hit hard by escalating costs and reductions in services: the elderly, poor children, and the medically indigent. Adolescents, the middle-aged, and infants are not at great risk for having limited access to health care services

What is the first step a nurse should take when advocating for a client during a claim appeal? Connect the client to different resources in the community. Find out the reason for the denial of the claim. Call the agency and tell them the client's situation. Identify a different source of payment.

Find out the reason for the denial of the claim. Finding out the reason for the denial of the claim would be the first step. Frequently, inadequate information was supplied to the agencies. Connecting the client to different resources, contacting the agency personnel, and identifying a different payment source may be necessary; however, these are not the first priority

Which statement best describes the Children's Health Insurance Program (CHIP)? Its purpose is to offer additional insurance to high-risk children. It provides health insurance to low-income, uninsured children. It is administered by the federal government. There are very few children who participate in this program.

It provides health insurance to low-income, uninsured children. CHIP expands health insurance coverage to low-income, uninsured children who are not already covered by other types of assistance programs. CHIP provides health insurance to children who are not already covered by other types of assistance programs. CHIP is funded by federal grants to participating states that will design and administer the program. Since the inception of CHIP, the percentage of children without health benefits has declined from 25% to 9.8%

Which activity would the Centers for Disease Control and Prevention (CDC) be involved in? Providing funding to create home emergency kits Monitoring an outbreak of measles in a community Setting up a well-child clinic in a neighborhood Educating parents about child safety

Monitoring an outbreak of measles in a community The focus of the CDC is disease control and prevention. In instances of disease outbreaks, experts in the field are dispatched to the area of need. Monitoring an outbreak of measles in a community would be an activity that may involve the CDC. Creating home emergency kits, setting up well-child clinics, and educating parents does not coincide with the focus of the CDC.

What type of payment is the provider receiving when a service is provided and payment is disbursed after the fact? Retrospective payment Insurance payment Managed care payment Prospective payment

Retrospective payment Retrospective payment is provided when a service is provided and then payment is made after the fact. An example of retrospective payment would be when a patient goes to the physician for a sore throat, is seen and treated, and then is billed for the service. Insurance payment may occur this way, in that the payment is disbursed after the fact. However, out-of-pocket costs may also be taken care of this way as well; both are methods of retrospective payment. Managed care payment may be viewed as a type of prospective payment system. Prospective payment compensates the provider on a case basis for health services. The provider will receive a predetermined amount, regardless of the amount of time, energy, and service involved in providing care.

Which statement best describes the status of reimbursement for nurse practitioner services? The AMA supports reimbursement of nurse practitioner services. Medicare provides reimbursement to nurse practitioners in select geographic locations. There is no third-party reimbursement for nurse practitioners. Select states have authorized private and commercial insurers to reimburse nurse practitioners.

Select states have authorized private and commercial insurers to reimburse nurse practitioners. Thirty-two states have passed legislation authorizing reimbursement to nurse practitioners from private and commercial insurers. Physicians and the AMA have resisted direct third-party payment for nursing services. In 1997, Congress passed legislation providing Medicare reimbursement for nurse practitioners and clinical nurse specialists, regardless of geographical locations.

Which disease has been eradicated worldwide? Measles Smallpox Polio Tuberculosis

Smallpox Smallpox has been eradicated worldwide. The last known case was in Somalia in 1977. Measles is a vaccine-preventable disease, but has the highest death rate. Measles vaccine coverage in very poor countries may be less than 50%. Significant progress has been made in the eradication of polio. It has decreased 99% since 1988. It is now found only in parts of Africa and south Asia. Tuberculosis is a leading cause of infectious-disease death. This is a serious health problem because the disease is becoming resistant to chemotherapy

The major method used to reduce costs to third-party payers has been to a. Change the eligibility requirements. b. Convert reimbursement to a retrospective payment plan. c. Require all clients to choose a managed care plan for reimbursement. d. Set fee schedules to restrict increases in provider payment.

a. Change the eligibility requirements. Although many methods are being used to cut health care costs, the major method has been to change the eligibility requirements so that fewer people receive benefits.

Research has demonstrated that which of the following relationships is true with regard to paying for care? a. The higher the co-payment, the less health care the person seeks. b. The higher the co-payment, the more the patient thinks the care was worth the cost. c. The lower the co-payment, the more compliant patients become with the suggested treatment. d. The lower the co-payment, the more patients feel they can always get the care later.

a. The higher the co-payment, the less health care the person seeks. There is an inverse relationship between services used and rate of payment; the higher the co-payment, the less people request service.

Which of the following is true about access to care? a. Care providers have always donated necessary services to make sure everyone received care. b. Health care is rationed by the ability to pay. c. Poverty-stricken patients received care from medical and nursing school students in teaching hospitals. d. Universal access has always been a component of health care in America

b. Health care is rationed by the ability to pay. Health care is rationed by the ability to pay. A persons financial status affects the quality and quantity of care that he or she receives.

Which of the following is the leading contributor to illness and death in developing countries? a. Inadequate sources of food b. Unsafe water c. Limited availability of immunizations and antibiotics d. Lack of sanitary sewer systems

b. Unsafe water Nearly 1 billion people (14% of the world population) do not have safe water supplies. Many diseases could be prevented if water supplies, sanitation, and hygiene were improved.

When teaching an educational program to an adult audience, which of the following actions should a nurse take to best meet their educational needs? a. Providing a specific, detailed explanation of each component of the program b. Using various methods of instruction, including lecture, discussion, and visual aids c. Providing an opportunity for participants to express their feelings about the program d. Using a PowerPoint presentation so that the audience can visualize the material

b. Using various methods of instruction, including lecture, discussion, and visual aids To best meet the needs of the audience, it is important to use different teaching methods so that each member of the audience can learn by his or her preferred method, whether that is hearing, reading, discussing, or another activity. Thus, the use of only a PowerPoint presentation may not meet the needs of all the members of the audience. In addition, it is helpful to include all three domains of learning, which is usually necessary to incorporate a new health behavior into the learners life. The best choices include opportunities for learning the material by preferred learning style, expressing feelings, and applying material, which represent the cognitive, affective, and psychomotor aspects.

The nurse distributed written materials with culturally appropriate pictures to the small groups in the audience and began to lecture on the important content before the planned discussion period. However, no one was listening. What should the nurse have done differently? a. Created a more interesting and entertaining lecture b. Withheld the written materials until after the lecture c. Let the audience discuss the material as a whole, not in small groups d. Skipped the lecture and went directly to the discussion period

b. Withheld the written materials until after the lecture Wait to make group assignments and to give handouts for group activity until after you have given the final instructions; otherwise, people will be reading instead of listening to you.

Which of the following descriptions is the best example of how the Bismarck model is implemented? a. Multiple insurance providers develop options for health care delivery to the population. b. A centralized government department controls all of health care that is provided in the country. c. A government system plans and pays for health care delivered by private enterprise. d. The government plans and funds care provided by its employees in government-owned health facilities.

c. A government system plans and pays for health care delivered by private enterprise. In the Bismarck model, funding is by insurance or subsidized by the government, and the patient has a choice of private providers. Organizing and delivering care are shared by government and private enterprise.

How can nurses best help expand availability of health education programs? a. Being entrepreneurs and asking patients to pay what they think the educational program was worth b. Suggesting to their friends and neighbors that they lobby local health organizations to provide such health education programs c. Teaching health education programs as unpaid volunteers in the community d. Working politically to influence public policy regarding funding health education programs

d. Working politically to influence public policy regarding funding health education programs Although nurses can volunteer, join other people in requesting health education programs, or teach such programs as nurse entrepreneurs, the best way to expand the availability of such programs is to influence public policy regarding development and funding of health education programs. Although it is not clearly stated in Chapter 20 (all the answers are recommended in the text), the book as a whole emphasizes the importance of political action for more extensive influence.

An educational need that is recognized as important to the learner is called a: real need. potential need. real educational need. felt need.

felt need. A felt need is recognized as important to the learner. A real need is one that is based on a deficiency that actually exists. A potential need is not a category of educational needs. A real educational need indicates that specific skills, knowledge, and attitudes are required to assist the client in attaining a more desirable condition.

The Bismarck model can be described as a health care system that: provides medical care to poor individuals. is funded by the government only. is funded by both personal contributions and taxes. provides medical care to all.

is funded by both personal contributions and taxes. The Bismarck model is funded by a combination of personal contributions and taxes. The national government assumes responsibility for financing and planning, but organizing and delivering care are shared with private enterprise.The Bismarck model provides medical protection to most people. It covers more than just poor individuals. The model that is funded by the government only is the Beveridge model, and it is funded by taxes. Under the Bismarck model, most people have medical care protection. Workers may have insurance from their employers while everyone else has another form of insurance or is subsidized by the government. However, this does not guarantee health insurance to al

What is the best global indicator of child health? poverty rate life expectancy immunization rates malnutrition

malnutrition Malnutrition is the best global indicator of child health. The best measure of malnutrition is growth stunting. Poverty, life expectancy, and immunization rates are major indicators of health of a population and nation; however, these are not the best global indicators of child health.

Emerging infectious diseases: will not be problematic because of advances in technology. may include new, previously unknown conditions. are of concern in developing countries. are monitored by the United Nations.

may include new, previously unknown conditions. Emerging infectious diseases are new, previously unknown conditions. The threat of a new influenza pandemic and SARS are two examples of new conditions that have emerged. Although there have been advances in technology, emerging infectious diseases are still of concern. This is especially problematic because there is a time lag between recognition of the problem and development of effective treatment. Emerging infectious diseases are of concern in all nations, both developing and developing countries. The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) are both involved in monitoring and coordinating responses related to emerging infectious diseases

A series of planned teaching-learning activities designed for individuals, families, or groups who have an identified alteration in health is called: teaching-learning process. health education. patient education. cognitive learning.

patient education. Patient education is used to describe a series of planned teaching-learning activities designed for individuals, families, or groups who have an identified alteration in health. Teaching-learning process refers to the development of content, strategies for teaching, and evaluation of the effectiveness of the health-education program. Health education focuses on health promotion and disease prevention. It is directed toward those who are not experiencing an acute alteration in health. The cognitive domain focuses on intellectual learning.

Who would be eligible for Medicare benefits? A 40-year-old man with end-stage renal disease A 22-year-old woman who has just lost her health insurance A 62-year-old man with diabetes A 9-month-old infant who is uninsured

A 40-year-old man with end-stage renal disease The primary beneficiaries of Medicare are the elderly (age 65+ years) who have contributed to the system during their working life, or the spouses of contributors. Other beneficiaries are those under age 65 years with long-term disabilities or end-stage renal disease. A 40-year-old man with end-stage renal disease would meet the criteria to qualify for Medicare. A 22-year-old woman who has just lost her health insurance would not qualify for Medicare benefits. A 62-year-old man with diabetes would not meet the age or long-term disability criteria to qualify for Medicare benefits. A 9-month-old infant who is uninsured would not meet the criteria to qualify for Medicare benefits, but may be eligible for Medicaid or CHIP

A community health nurse will be teaching a community health education class about heart disease and is deciding on which materials she should purchase for the course. Which pamphlet should she choose? A pamphlet that has no pictures A pamphlet written at a fifth-grade reading level A pamphlet written in all-capital letters A pamphlet that has minimal white space

A pamphlet written at a fifth-grade reading level Printed materials should be written at a sixth-grade level or lower. People who are able to read at a higher level are not offended by easy-to-read material. Printed materials that include pictures improve the readability. Pictures can improve comprehension when they show relationships between ideas or when the pictures have simply worded captions. A pamphlet written using all-capital letters may appear larger and clearer, but actually this makes the print more difficult to read. Because capital letters do not vary in size and shape, the eye has difficulty differentiating between letters. Using white space on pamphlets is preferred. White space is pleasing to the eye and can be used for emphasis.

Which statement about audiovisuals is correct? Audiovisuals are necessary in order to teach the adult learner. Audiovisuals are appropriate for all groups. Audiovisuals can often be adjusted to the learner's pace. Audiovisuals are usually inexpensive.

Audiovisuals can often be adjusted to the learner's pace. Audiovisuals can often be adjusted to the learner's pace to meet individual learning needs. Audiovisuals are not necessary in order to teach the adult learner. Audiovisuals need to be reviewed to determine their appropriateness based on the reading and comprehension abilities of the target group. Audiovisuals are not appropriate for all groups and need to be reviewed to determine their appropriateness based on the reading and comprehension abilities of the target group. All audiovisuals cost money. The cost of nursing time as well as the cost of purchasing or renting the audiovisual aid need to be considered when deciding whether to use an audiovisual aid.

Which statement best describes the role of the World Health Organization (WHO)? Its emphasis is to provide health care services and support to poor countries. Its overall goal is to improve the health status of developed countries. Its focus is in the areas of child and maternal health. Its mission is to serve as a primary lender for third-world countries.

Its emphasis is to provide health care services and support to poor countries. The WHO provides both technical support and health care services to member nations, with an emphasis on poorer countries. The WHO involves approximately 193 countries and its focus is on working with the underdeveloped, poorer member countries. The WHO does not have a specific area of health where it focuses its efforts. It directs and coordinates international health projects, collaborates with other organizations and agencies in health care programs, and monitors and reports on worldwide disease conditions. The United Nations International Children's Emergency Fund (UNICEF) concentrates its efforts in the area of maternal and child health. Although the WHO does provide funding for its international projects, it does not serve as a primary lender for third-world countries. The World Bank funds loans to poorer nations

Which is an example of a third-party payer? Insurance company Self-payment High-deductible health plan Health savings account

Insurance company Insurance and government-funded programs are examples of third-party payment, in which a third party directly pays for all or part of the health services provided.Self-payment is a method by which a person or a family essentially assumes the financial cost of all medical services. High-deductible health plans are a "consumer-directed" plan where the health care consumer decides how to use the money in the account. A health savings account is an account into which an employer usually places a certain amount of money and the employee has the option of adding more. The employee usually picks the insurance plan or opts to pay for health care costs from this account

Which statement about financial reimbursement for wellness activities is correct? Wellness activities are reimbursed using the same structure as illness care. No method exists for direct reimbursement for providing health-promotion education to the community. Individuals who value self-care are often able to receive financial reimbursement for health-promotion education. Physician-ordered education relating to an existing illness is usually not reimbursed.

No method exists for direct reimbursement for providing health-promotion education to the community. No method exists for direct reimbursement for providing health-promotion education to the community. Thus, community educational programs are sometimes offered to the community for a fee. Wellness activities are not reimbursed using the same structure as illness care. Currently, there is very little reimbursement for wellness promotion in the current structure of insurance companies. Individuals who value self-care will often pay out of pocket for educational programs because such programs are normally not reimbursable by an insurance company. Physician-ordered education relating to an existing illness usually is reimbursed. An example of this is diabetic education; if a patient is diagnosed with diabetes, he may be able to receive diabetic education that is reimbursed by an insurance company.

Which intervention has been effective in helping prevent the spread of HIV in developing countries? Voluntary counseling and testing Immunization against the virus Providing medications to those who have the virus Mandatory screening

Voluntary counseling and testing Voluntary counseling and testing (VCT) is a major strategy of HIV prevention and treatment. With the help of trained counselors, people learn how to reduce their risk of infection. They are also helpful in getting more people tested. AIDS vaccine development is progressing, but at this time it is not a readily available option. Medication to maintain the immune status or treat the illnesses that accompany HIV infection is costly and not available to large segments of the developing world. Mandatory screening is not feasible, considering the few economic resources that are available in developing countries. Also, it appears that peer education and voluntary testing may be more effective.

Which intervention best demonstrates how nurses can participate in global health? Reading a foreign newspaper Educating the neighborhood about HIV/AIDS Volunteering with international organizations Recruiting international students into nursing

Volunteering with international organizations Ways to participate in global health include volunteering, research and clinical practice, membership in international nursing groups, and engaging in the political process. Reading a foreign newspaper may help increase a nurse's awareness of global health issues, but it does not demonstrate participation in global health. Educating the neighborhood about HIV/AIDS will help increase awareness and knowledge at the local level, but does not demonstrate the focus on worldwide health. Recruiting international students into nursing may help add diversity to the nursing profession. However, it does not show how a nurse can participate in global health

Which of the following were among the specific goals of the United Nations Millennium Declaration? (Select all that apply.) a. Achieving universal primary education b. Achieving agriculture efficiency and effectiveness c. Ensuring democracy in all governments d. Eradicating extreme poverty and hunger e. Establishing a global partnership for development f. Promoting gender equality and female empowerment

a. Achieving universal primary education d. Eradicating extreme poverty and hunger e. Establishing a global partnership for development f. Promoting gender equality and female empowerment The primary goal is elimination of worldwide poverty. Among the eight steps were to eradicate extreme poverty and hunger, to achieve universal primary education, to promote gender equality and empower women, to reduce child mortality, to improve maternal health, and to establish a global partnership for development.

Which of the following statements represents an example of the epidemiologic transition? a. As economics improve, the life expectancy increases. b. As education improves, the number of physicians and nurses increases. c. As global funding increases, the incidence of communicable disease decreases. d. As preventable diseases increase, the global infection rate decreases.

a. As economics improve, the life expectancy increases. The poorer the country, the more likely its citizens are to suffer from preventable diseases and early death. The epidemiologic transition refers to a change in illness pattern. Currently, a shift is being seen again as chronic diseases are replacing deaths from infectious disease worldwide.

What are the primary reasons for the ongoing increase in health care costs in the United States? (Select all that apply.) a. Changes in population demographics b. Improved end-of-life care c. Ongoing research studies d. Periodic financial inflation e. Rising expectations by consumers f. Technologic advances

a. Changes in population demographics d. Periodic financial inflation f. Technologic advances Heavy inflation occurs periodically and affects all services, including health care. Demographics in the United States have changed; there is an increasing aging population, which has created additional demand. Finally, technologic advances have been enormous but also expensive.

Which of the following factors most influences a clients ability to learn from a health education program? a. Clients belief that the information will be useful or enjoyable b. Handouts given to the client c. Nurses ability to teach d. Setting in which the educational program is given

a. Clients belief that the information will be useful or enjoyable Learning depends primarily on emotional readiness, which is reinforced primarily by internal motivation. The learner must be willing to put forth the effort needed to learn. Internal motivation is self-directive and long lasting and is based on the belief that the clients action will be useful or enjoyable.

Which of the following characterizations best describes the approach to paying for health care used in the United States? a. Decentralized, free market approach that does not provide care to all citizens b. Central government control of all aspects of health care, which is consistent with socialist philosophy c. Health care that is planned and paid for and in which independent practitioners are employed d. Federal government as the entity that negotiates and funds care for persons who cannot afford it

a. Decentralized, free market approach that does not provide care to all citizens The U.S. health care system is based on the free market approach, capitalism, and an entrepreneurial model. All other industrialized countries have some form of national health care system that provides coverage to all, or nearly all, citizens.

The primary criticism that may truthfully be made of the Medicare program is that it a. Does not meet the most serious medical needs of the population it serves. b. Has inadequate controls on the amounts paid to health care providers. c. Has not sufficiently reduced taxpayer cost. d. Lacks adequate funding, and Medicare taxes continue to increase.

a. Does not meet the most serious medical needs of the population it serves. Medicare has not changed substantially since it began, but benefits have been restricted as costs rise so that it does not meet the most serious medical needs of the population it serves. The greatest cost burdens are placed on poor persons because their out-of-pocket expenses reflect a larger proportion of their incomes than does the cost to persons with larger incomes.

Which factor is primarily responsible for the differences in health care needs and health care outcomes among the various countries? a. Economic development b. Political system c. Social-cultural system d. Religious affiliation

a. Economic development Health is dramatically affected by poverty, which is an outcome of economic development.

A community/public health nurse is visiting a nuclear family. Both of the parents are employed full-time, have a moderate income, and have health insurance. Which of the following is the most likely source of their health insurance? a. Employer-paid insurance b. Federal governmentsubsidized health insurance c. Medicare/Medicaid program d. Private-paid insurance

a. Employer-paid insurance Currently, the most common form of health insurance is employer-provided insurance, although its availability is decreasing.

What were some of the Top 10 Best Buys of health interventions? (Select all that apply.) a. Encouraging condom use and treating sexually transmitted diseases (STDs) b. Enforcing traffic regulations and installing speed bumps c. Giving nutrients to children and pregnant women d. Imposing taxes on tobacco products e. Providing insecticide-treated bed nets in malaria-endemic areas f. Distributing prescription drugs for free to low-income persons

a. Encouraging condom use and treating sexually transmitted diseases (STDs) b. Enforcing traffic regulations and installing speed bumps c. Giving nutrients to children and pregnant women d. Imposing taxes on tobacco products e. Providing insecticide-treated bed nets in malaria-endemic areas If money, time, and effort are invested, the actions suggested included monitoring childrens health and vaccinating against major childhood killers, imposing taxes on tobacco products to increase their cost, mounting a coordinated attack on the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) epidemic by promoting 100% condom use in at-risk populations and providing antiretroviral treatment, providing children and pregnant women with essential nutrients, providing insecticide-treated bed nets in malaria-endemic areas, and enforcing traffic regulations and installing speed bumps at dangerous intersections to reduce traffic-related injuries.

Which of the following actions should be considered when a nurse provides an educational program to adults? (Select all that apply.) a. Encouraging the learner to share resources with the group during the program b. Focusing on the content that needs to be presented c. Providing a detailed overview of the program before starting the formal education d. Teaching what the learner wants to know before continuing the instruction e. Establishing an ongoing support group for the participants f. Relating the content to life experiences

a. Encouraging the learner to share resources with the group during the program d. Teaching what the learner wants to know before continuing the instruction f. Relating the content to life experiences When a nurse is teaching adults, a few of the strategies that should be included are encouraging the learner to share resources with the group during the program, teaching what the learner wants to know before continuing the instruction (otherwise the learner will not be able to focus on instruction if a question is not answered), and relating the content to life experiences. Because the learners needs should be addressed throughout the program, the focus should not be solely on delivering necessary content. An overview of the program is a good idea before the education is started; however, this does not need to be detailed. An ongoing support group may be appropriate for some participants depending on the nature of the presentation, but it is not necessary for some topics and groups.

Which of the following efforts is being led by the World Health Organization (WHO)? a. Establishing standards for medications and vaccines b. Providing food for all the worlds residents c. Eliminating polio as an infectious disease d. Ensuring safe water for all the citizens of the world

a. Establishing standards for medications and vaccines WHO is leading the effort to establish international standards for medications and vaccines. It was founded to be the worlds health advocate and provides technical support and health care services to member nations, with an emphasis on poorer nations.

What approach have nurses historically used when providing care and paying attention to costs? a. Giving the best possible nursing care regardless of ability to pay b. Giving whatever care the nurse has the expertise to give c. Giving whatever care the patient could afford d. Giving whatever care the patient desired and for which he or she was willing to pay

a. Giving the best possible nursing care regardless of ability to pay Historically, cost was not considered relevant to the practice of nursing. The topic of cost was ignored by both clinicians and educators.

Which of the following was true concerning the amounts paid by private funds and governmental funds in 2009? a. Government spent 49%, and private funding accounted for 51%. b. Government spent 75%, whereas private funding accounted for 25%. c. Government spent 40%, whereas private funding accounted for 60%. d. It is unknown what proportion of funds was governmental and what proportion was private

a. Government spent 49%, and private funding accounted for 51%. In 2009, governments at all levels provided 49%, and private funding provided 51%.

A public health nurse is concerned about a recent influenza outbreak in Germany. Why would the nurse be interested in a health issue occurring outside of the United States? a. Highly infectious diseases can circle the world quickly through worldwide travel. b. Other nations rely on the United States for guidance to address health issues. c. According to the World Health Organization (WHO) guidelines, nurses should assist in disease control efforts. d. Nurses have a moral obligation to keep the public safe and healthy.

a. Highly infectious diseases can circle the world quickly through worldwide travel. Although there are certainly ethical and moral commitments to help fellow humans, the practical reason is that it is almost impossible to isolate a contagious disease within the country of origin, since more than 2 million people cross national boundaries daily.

Which audience comment best demonstrates self-efficacy? a. I believe I can learn to do this. b. I think the nurse is a real expert in this stuff. c. Those computer graphics really make it clear how people can do this. d. Wow. The nurse really expects us to do this.

a. I believe I can learn to do this. Self-efficacy is the belief that the learner is capable of engaging in the desired action. Stating I believe I can learn to do this demonstrates the belief by the learner that implementation is possible.

Which comment to the nurse best demonstrates a successful health education program? a. Im going to take a 30-minute walk each day. b. I certainly enjoyed the program, and thank you for the freebies. c. You gave me so much new information; thank you so much. d. Wow! I learned many things that I can use in my daily activities.

a. Im going to take a 30-minute walk each day. The overall goal is to teach a health-promoting activity that can be incorporated into the learners lifestyle. Assessment of learner outcomes has traditionally been based on achievement of the behavioral objectives. If the objectives are properly written, each objective is measurable. Planning to take a daily walk demonstrates intention to incorporate the program content into personal lifestyle.

What are the factors that have caused expenditures in health care to increase (select all that apply)? a. Increase in available technology b.Increased demand for services c. Inflation d. Decreased number of elderly e. Existence of political parties f. Decreased global population

a. Increase in available technology b.Increased demand for services c. Inflation There has been an increase in available technology, which has caused health care spending to rise. There has been an increased demand for services owing to Medicare and Medicaid as well as an aging population. Inflation is a basic factor responsible for escalating costs. As inflation increases prices, the health care industry's costs for these goods and services are also increased, and these higher expenses are passed on to the consumer. There has been a growth in the number of elderly in the population, which has created an additional demand for services. Health care expenditures continue to rise despite the presence of political parties. More people on the planet means use of more resources. The increase in population, especially the elderly, has caused health care to increase in cost.

Why is tuberculosis a serious health problem? (Select all that apply.) a. The largest numbers of new cases are occurring in the South-East Asia Region of the World Health Organization. b. Receiving treatment for tuberculosis is a social stigma. c. People are often co-infected with tuberculosis and human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). d. Many cases of tuberculosis are occurring in industrialized countries. e. The disease is endemic in Africa. f. The standard treatment for the disease is a short course of directly observed therapy (DOTS).

a. The largest numbers of new cases are occurring in the South-East Asia Region of the World Health Organization. c. People are often co-infected with tuberculosis and human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). f. The standard treatment for the disease is a short course of directly observed therapy (DOTS). Tuberculosis is the second leading infectious disease killer of adults worldwide, with the largest numbers of new cases occurring in the South-East Asia Region of the World Health Organization (WHO). People are often co-infected with tuberculosis and HIV/AIDS; tuberculosis case rates and deaths have increased since 1995 in African countries with the highest rates of HIV infection. Drug-resistant strains have complicated the treatment regimen for tuberculosis, and so the standard treatment has become DOTS. No social stigma is associated with this treatment plan. Many cases are occurring in developing countries, not industrialized countries (such as the United States).

Which of the following statements best demonstrates an appropriately written behavioral objective? a. The learner will be able to verbally explain the need for political action. b. The panel of experts will have discussed knowledge, assumptions, and cultural values. c. The participant will understand the material presented. d. The teacher will distribute and collect evaluation forms.

a. The learner will be able to verbally explain the need for political action. Behavioral objectives focus on the learner and what the learner demonstrates in terms of knowledge, attitudes, or beliefs. Understanding is not observable, whereas an accurate verbal explanation is observable.

A community/public health nurse is providing home care services to an elderly couple. They report that they believe they are spending more and more money on health care services and have limited funds available to meet their everyday living expenses. Which of the following offers the best explanation for their situation? a. The proportion of the gross domestic product devoted to health care is increasing. b. The health care costs are increasing for the elderly population. c. The cost of living is increasing because of recent rapid inflation. d. The cost of health care is increasing because more people are insured.

a. The proportion of the gross domestic product devoted to health care is increasing. As a result of the increasing proportion of the gross domestic product (GDP) devoted to health care, individuals and families spend more on health care and have less to spend on food, clothing, housing, schooling, leisure, and other needs or interests. The number of elderly persons in the population has increased, but the health care costs are increasing for everyone, not just this population. Both the cost of living and the cost of health care are increasing because of inflation. Higher numbers of uninsured and underinsured clients have also increased the cost of health care.

Poorer countries experience (select all that apply): a. higher death rates. b. shorter life expectancy. c. greater incidence of infectious diseases. d. a poorer standard of health and health care. e. more natural disasters. f. more crime.

a. higher death rates. b. shorter life expectancy. c. greater incidence of infectious diseases. d. a poorer standard of health and health care. Poorer countries have higher rates of death, disease, and disability. Life expectancy in poorer countries is lower. Infectious diseases, which may be nonexistent in developed countries, are rampant in poorer countries. Poorer countries have less ability to provide health care for their people. Poorer countries do not experience more natural disasters than wealthier countries, but they are not as well equipped to handle the disasters. Poorer countries do not experience more crime than wealthier countries, but poorer countries do not have the resources to react to crime like wealthier countries.

The nurse had a peer evaluation completed in order to improve her teaching expertise. Which of the following best describes this evaluation? a. A summary of the evaluation that the audience completed at the end of the program b. Another nurse observing and providing feedback on the presentation c. Completion of an evaluation of their learning and satisfaction by participants d. Videotaping of the presentation for further review by the nurse and others

b. Another nurse observing and providing feedback on the presentation All of the options are possible evaluation mechanisms, but peer evaluation is having a peerin this case, another professional nurseobserve and give feedback.

A nurse began by asking the audience, What do you want me to discuss? All responses were written on the chalkboard and then, as specific points were discussed, the nurse erased the item. However, the nurse often added material that was not requested. Why would the nurse add more content? a. Because the nurse believed the additional information was entertaining and lightened the mood b. Because the nurse knew, on the basis of personal experience, other relevant information that the audience needed c. Because the nurse knew so much about the subject and wanted to give all the details. d. Because the nurse was sure that the audience meant to ask about it

b. Because the nurse knew, on the basis of personal experience, other relevant information that the audience needed The presentation should include not only what the audience wants to learn but also what the nurse, on the basis of previous experience, knows would be useful to them.

Which of the following actions demonstrates the community/public health nurse advocating for the community? a. Encouraging the media to run personal interest stories on needy clients b. Becoming an active member of a professional nursing organization c. Offering to organize a fundraising campaign for needy families d. Suggesting appropriate agencies where families can receive services

b. Becoming an active member of a professional nursing organization To create improved health care systems, nurses must be aware that systems are subject to change. Nurses work both individually through political action and collectively as members of professional nursing associations to improve the health care system. The other actions do not demonstrate the role of nurse as advocate for the entire community.

Which of the following activities would be important for the nurse to complete when planning an educational program? a. Avoid rehearsing the content or it will sound too practiced. b. Come early to set up the audiovisual materials. c. Remind all possible participants that early registration is required. d. Try to get as many free handouts and freebies as possible.

b. Come early to set up the audiovisual materials. The nurse should visit the site to ensure the cleanliness, temperature, and lighting of the area; arrive early to set up the audiovisual materials; and bring extra supplies such as projector bulb and extension cord. Last-minute attendees should be welcomed. In addition, the nurse should practice the material until it is known forwards and backwards.

A nurse is teaching a client how to perform her own insulin injections. Which of the following should the nurse assess first to determine the clients experiential readiness to learn? a. Culture and ethnic background b. Educational ability c. Family structure d. Home environment

b. Educational ability The clients ability to learn can most easily be assessed by determining the clients educational level. Direct questioning related to years of formal education is useful but does not always provide complete and accurate information. Reading ability and learning disabilities should also be considered.

Which of the following populations accounts for the majority of the cost in the Medicaid program? a. Children younger than 5 b. Elderly persons c. Low-income families d. Single pregnant women

b. Elderly persons Elderly, blind, and disabled persons, who represent 21% of the participants, use 63% of the Medicaid budget.

What was the primary commitment agreed upon when the United Nations Millennium Declaration was adopted? a. Adoption of specific environmental actions b. Elimination of poverty c. Enforcement of maternal and infant health standards d. Provision of safe water and sanitation

b. Elimination of poverty The global representatives committed themselves to giving a very high priority to the commitment of funding toward reducing the rates of worldwide poverty by 2015.

A companys chief executive officer (CEO) discusses potential ways to control employee health care costs with the organizations occupational health nurse. Which of the following recommendations would the nurse be most likely to suggest? a. Suggest employees exercise and stop smoking to retain their employment. b. Encourage the use of generic prescriptions and outpatient services. c. Consider layoffs to decrease the number of employees who receive insurance. d. Reward employees who have limited health care expenses.

b. Encourage the use of generic prescriptions and outpatient services. Cost-containment strategies are becoming routine in employer-provided group health insurance plans as employers costs continue to escalate. Employer cost-containment strategies include reimbursement for generic-only prescriptions; increasing reliance on second opinions for surgery; and increased reliance on outpatient surgery.

According to the World Health Organization (WHO), which countries have the best health care in the world? a. Australia, Great Britain, and New Zealand b. France, Japan, and Great Britain c. Spain, Italy, and Germany d. United States and Canada

b. France, Japan, and Great Britain Using the WHOs five criteria, France has the best health care among developed countries, and the health care systems of Japan, Great Britain, and Germany are rated higher than that of the United States.

Which of the following is an example of an emerging disease? (Select all that apply.) a. Human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) b. H1N1 influenza c. Tuberculosis d. Severe acute respiratory syndrome (SARS) e. Avian influenza f. Malaria

b. H1N1 influenza d. Severe acute respiratory syndrome (SARS) e. Avian influenza Emerging infectious diseases are either old diseases that are rapidly increasing in incidence or geographic range or new, previously unknown conditions. SARS, H1N1 influenza, and avian influenza are all examples of emerging infectious diseases that have important implications for global politics, health systems, and international migration and travel.

In preparing to give a presentation on breast self-examination, a nurse went to the American Cancer Society and obtained a variety of handouts to use during the presentation. Which possibly erroneous assumption is the nurse making? a. Handouts are the best technique for emphasizing important points. b. Handouts will be easily read by people in the audience. c. People will appreciate the brochures and freebies such as shower hook reminders. d. People will use the reminders and put them in their bathrooms.

b. Handouts will be easily read by people in the audience. The use of handouts and other written materials is based on the assumption that the audience can read, but research has shown that approximately 50% of Americans lack basic literacy and math skills.

In what way is the Predisposing, Reinforcing, Enabling, Causes in Educational Diagnosis, and Evaluation (PRECEDE) model helpful when health education programs are implemented? a. It addresses the learning needs of ill individuals. b. It begins with examining an aggregates general concerns and quality of life. c. It emphasizes the learning needs of families who have an ill member. d. It focuses primarily on environmental resources.

b. It begins with examining an aggregates general concerns and quality of life. The PRECEDE model begins with the presence or absence of health problems that are linked to quality-of-life issues, with the question What are the general concerns of the population? Such assessment helps ensure that the intervention is based on diagnosis of the communitys need.

A community/public health nurses states that the United States has an integrated health care system. What is meant by this statement? a. The larger for-profit managed care organizations are absorbing smaller organizations so that eventually only three to five large companies will exist. b. Large organizations are trying to own or control a complete range of health care facilities to meet all health care needs of their enrollees. c. Large managed care organizations are employing attorneys as employees to ensure that no malpractice suit against them can be successful. d. Physicians are choosing to become employees to avoid paying for malpractice insurance and therefore are being absorbed into hospital systems.

b. Large organizations are trying to own or control a complete range of health care facilities to meet all health care needs of their enrollees. Integrated systems are a growing trend. Large companies own or control a complete range of health care facilities and provide service to a large population of consumers. Their goal is to provide all health care required by their enrollees. They save money by controlling the type of services provided.

On what basis can Medicare be criticized? (Select all that apply.) a. Even after age 65, many elderly citizens are not eligible for Medicare. b. Medicare pays less than half of recipients health care costs, which is a major hardship for many recipients. c. Medicare does not protect elderly people from financial destitution when they pay for needed care. d. Most physicians and hospitals do not accept Medicare recipients. e. Until 2007, the premiums were the same whether the recipient was very wealthy or very poor. f. Until 2011, Medicare paid for procedures in hospitals but not in outpatient settings.

b. Medicare pays less than half of recipients health care costs, which is a major hardship for many recipients. c. Medicare does not protect elderly people from financial destitution when they pay for needed care. e. Until 2007, the premiums were the same whether the recipient was very wealthy or very poor. f. Until 2011, Medicare paid for procedures in hospitals but not in outpatient settings. Several major criticisms have been made of Medicare, primarily around institutional bias, service restrictions, and lack of equity. Medicare would not pay for less expensive outpatient procedures but only for inpatient hospital-based procedures until 2011. As cost sharing is an aspect of the program, the government has increased co-payments to reduce usage. Co-payments are a major hardship for a large percentage of elderly persons. Medicare pays less than half (45%) of health care costs. Justice is not served, inasmuch as both wealthy clients and poverty-stricken clients must pay the same amount for the same benefits, although in 2007 premiums for wealthy persons (income above $82,000/year) were increased. Lastly, the program was created to protect elderly persons from financial destitution. Those who have a major illness over a period of time cannot afford needed health services. Eventually they will exhaust their assets and then may be eligible for Medicaid.

A community/public health nurse is planning an educational program about healthy choices to prevent heart disease. Which of the following variables will be the primary influence as the nurse selects content for the program? a. Employing agencys preferences b. Needs of the high-risk target group c. Third-party payers probable coverage of the educational program d. What the nurse feels most comfortable and skilled in teaching

b. Needs of the high-risk target group The nurse certainly must function within the constraints of the health care system, including policies of the employing agency and third-party payers; in a specific planned program, however, the actual content depends on the learning needs of the target group, as determined by a needs assessment.

A nurse educator teaches community/public health nursing students about how health care is financed in the United States. Why is it important that nursing students receive this information? a. Nurses are expected to help patients find funding sources to pay for their care. b. Nurses have to restrict their care to services that are financially reimbursed. c. Health care organizations must charge patients for all supplies consumed while care is given. d. Health care organizations must notify patients of the exact cost of the nursing services rendered.

b. Nurses have to restrict their care to services that are financially reimbursed. Nurses do have to charge for supplies used but can do so without understanding health care financing. In a position dealing with community/public health, advocating for a client may include making referrals to agencies that may be able to meet their needs on the basis of patient finances. All nurses have to focus on is giving care consistent with agency deadlines, which in turn must focus on reimbursement regulations in order to continue to be able to exist and provide care.

Behavioral objectives should be a. Comprehensive and complete. b. Observable, measurable, and clearly communicated. c. Specific and detailed. d. Written on the teaching plan.

b. Observable, measurable, and clearly communicated. Although all of the responses are consistent with careful planning, the plan will not be workable unless the objectives are measurable and the nurse is able to observe changes in learning, attitudes, or behavior. Because the objectives convey intent to other people, such as external evaluators, they must also be communicable. If clearly stated, the objectives can also be used for evaluation purposes.

. Which of the following actions demonstrate where most of the international efforts have focused in relation to the human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) epidemic? a. Caring for people who are stigmatized and not wanted by anyone b. Providing education about the cause and spread of the virus c. Funding voluntary counseling and testing programs d. Saving children who will be orphans with no one to care for them

b. Providing education about the cause and spread of the virus International efforts have concentrated on primary prevention. A few examples of these efforts are education about the cause and spread of the virus and advocacy of the use of condoms and other protective measures during sexual activity; improvement in the procurement, storage, and administration of blood; and advocacy efforts aimed at women and men who are at risk because they have multiple sexual partners. Voluntary counseling and testing programs would be an example of secondary prevention. Caring for people and saving children are examples of tertiary prevention.

A community/public health nurse has recently accepted a position with the United Nations International Childrens Fund (UNICEF). What will be the primary focus of the nurse working for this organization? a. Building and staffing hospitals in undeveloped countries b. Providing health education for mothers of children c. Establishing clinics for surgical interventions for handicapped persons d. Helping with economic development in undeveloped countries

b. Providing health education for mothers of children The efforts of UNICEF are concentrated in the area of maternal and child health. More recent efforts have been geared toward ensuring availability of fresh water and safe food supplies, providing health education for mothers of children, education for girls, and immunization programs aimed at reducing or eliminating vaccine-susceptible communicable diseases.

A community/public health nurse would like to join an international professional nursing organization that supports nursing leadership and research. Which of the following organizations would best meet this criterion? a. International Council of Nurses (ICN) b. Sigma Theta Tau c. The International Nursing Federation (INF) d. World Health Organizations Nursing Council (WHONC)

b. Sigma Theta Tau Both Sigma Theta Tau, the international nursing honor society, and the International Council of Nurses (ICN) are global organizations. However, Sigma Theta Tau is the international honor society of nursing. This organization is dedicated to supporting nursing leadership, research, and clinical excellence.

. A community/public health nurse actively implements the recommendations from the Global Treaty on Tobacco Control. On the basis of this treaty, which of the following actions is the nurse most likely to perform? a. Encouraging states to implement smoking bans b. Supporting a global ban on tobacco advertisements to youth c. Lobbying to make the production of tobacco products illegal d. Suggesting an increase in cigarette taxes across the world

b. Supporting a global ban on tobacco advertisements to youth The Global Treaty on Tobacco Control was passed at the 2003 meeting of the World Assembly. This treaty endorses a global ban on tobacco advertisement and promotion to children younger than 18 years and suggests limits to exposure to second-hand smoke. The Treaty also ends subsidies for tobacco production but does not include making its production illegal. In addition, the Treaty prohibits tax-free, duty-free sales of tobacco products but does not suggest an increase to cigarette taxes.

Which component of government is primarily responsible for health research spending? a. The federal government, through the Centers for Disease Control and Prevention b. The federal government, through the National Institutes of Health c. State governments, through grants to state universities and research centers d. State governments, through local public health departments in cooperation with local researchers

b. The federal government, through the National Institutes of Health The federal government bears the major responsibility for research, and most funds are distributed by the National Institutes of Health.

A nurse has chosen to provide home care services to a needy client even though there is no source of reimbursement for this care. What problem may result? a. The nurse will be expected to provide this care to other clients. b. The nurse may not be covered in case of a malpractice claim. c. The agencys clients will start demanding that the staff provide free care. d. The agencys clients will be at risk for being billed for the services provided.

b. The nurse may not be covered in case of a malpractice claim. The real danger that exists is that the nurse will not be covered in case of a malpractice claim because the service was not first sanctioned by the agency. The nurse should not be expected to provide free care to other clients because of the legal risks involved. Because it is stated there is no source of reimbursement for this client, the client is not at risk for being billed for the services provided. It is doubtful that other clients would start demanding free care as a result of this incident.

A community/public health nurse is preparing a presentation for a local community group about the infant mortality rate in the United States. Which of the following information would be included in the presentation? a. The number of women who are uninsured is higher in the United States than in other developed countries. b. There is a lack of comprehensive planning for prenatal care in the United States. c. The United States has one of the lowest infant mortality rates in the world. d. Additional health care services are provided to pregnant women in the United States.

b. There is a lack of comprehensive planning for prenatal care in the United States. The United States does not have comprehensive planning for prenatal care; in contrast, other countries with national health care systems do have such planning. This is a significant contributor to the infant mortality results. In 2010, the United States was ranked forty-third in infant mortality rates.

Toward which individuals and their families are health education programs primarily aimed? a. Those who are acutely ill and need information to help them recover and avoid further problems b. Those who are healthy and can support each other in maintaining healthy lifestyles c. Those who must cope with an ongoing chronic disease d. Those who have defined health problems and who can support each other in maintaining healthy lifestyles

b. Those who are healthy and can support each other in maintaining healthy lifestyles Health education focuses on helping healthy groups maintain or improve their health. Patient education describes teaching-learning activities for people with an identified alteration in health.

A nurse was asked to select an appropriate site for a nursing education program for adults in the community. Which of the following characteristics is most important in choosing the site? a. Location in a building that does not charge rent for use of the space b. Lots of room for participants to stand, walk around the room, and socialize with other participants c. Accessibility to public transportation, location in a physically safe area, and accessibility for disabled participants d. Location next to a police station, fire station, or other community resource

c. Accessibility to public transportation, location in a physically safe area, and accessibility for disabled participants Although all the criteria would be useful, the most crucial would be an area where prospective participants can get to the meeting while feeling safe doing so. Consequently, the site ideally should be in an area with public transportation, appropriate for people with disabilities, and in a safe (or at least safer) neighborhood.

A community/public health nurse is working with a low-income family that has children and is uninsured. What recommendation made by the nurse would assist the children in obtaining health care? a. Visit a free clinic at the health department. b. Apply for Medicare. c. Apply for the Childrens Health Insurance Program (CHIP). d. Visit the local pediatricians office.

c. Apply for the Childrens Health Insurance Program (CHIP). Low-income children who are not covered by other types of assistance programs may have health insurance coverage through CHIP, which took effect in 1997. Medicare is a federal program for elderly and disabled persons. A free clinic may meet short-term needs but will not help with long-term access to health care services. Visiting the local pediatricians office will not assist this family in obtaining health insurance, which is what is necessary when they receive health care.

A community/public health nurse is working with a client who has just immigrated to the United States from Canada. The client states that the Canadian health care system has many problems. Which of the following statements would the client likely have made? (Select all that apply.) a. Canada does not have enough physicians. b. Canada uses socialized medicine to provide health care services. c. Health care costs are increasing in Canada. d. Physicians working in Canada earn less money than in the United States. e. The quality of health care is poor in Canada. f. There are long waits to see a primary care physician in Canada.

c. Health care costs are increasing in Canada. d. Physicians working in Canada earn less money than in the United States. The Canadian health care system is based on social insurance, not socialized medicine. Physicians have private practices. There are an adequate number of physicians. There is no wait for a primary care physician, although there may be for specialists. Physicians in Canada are paid less than physicians in the United States. The quality of health care in Canada is better than that in the United States, with a lower infant death rate and a longer life span. The costs of health care are escalating throughout the world.

A public health nurse is investigating the health of children worldwide. Which of the following sources of data should be used to determine which country has the healthiest children? a. Percentage of mothers who breast-feed their infants b. Rate of immunization c. Rate of malnutrition d. Percentages of generalist versus specialist physicians

c. Rate of malnutrition Undernutrition is a contributing cause to about one third of deaths in children worldwide. Stunting of growth results from long periods of malnutrition. Damage from malnutrition during fetal development and the first 2 years of life may be irreversible.

A developing country has been in contact with the World Bank. What is this country accomplishing by connecting with this intergovernmental organization? a. Ensuring that the economy is based on the U.S. dollar b. Supporting specific projects, especially to establish new businesses c. Requesting a loan to improve the infrastructure d. Helping to establish a national banking system

c. Requesting a loan to improve the infrastructure The World Bank funds government projects to improve a countrys infrastructure through low-interest loans to developing countries for improvements in education, health, agriculture, and natural resource management.

What strategies will a nurse include when planning an educational program for adults that ensures student learning? a. Individual one-on-one tutorials to ensure maximum understanding b. Large group lectures with handouts of main points along with culturally appropriate pictures c. Small peer group discussions on how to apply the new knowledge with prompt feedback d. Use of multimedia technologies such as videotapes and PowerPoint presentations

c. Small peer group discussions on how to apply the new knowledge with prompt feedback Small group discussions help adults become actively involved, often with repetition of the information as they discuss how to apply the knowledge. Individual one-on-one tutorials are extremely expensive. Large group lectures, even with handouts and pictures, still are only effective for low-level cognitive learning, not application. Table 20-1 emphasizes that adults want application of the facts and real-life context.

A community/public health nurse is discussing insurance options with a healthy, young adult client who has recently lost her job. Why would the client most likely not be receptive to obtaining privately paid health insurance? a. Health care services can be obtained at a local free clinic. b. She prefers to spend her money on higher priority needs than insurance. c. The monthly premiums are just too high to be affordable. d. She has no need for insurance because she is young and healthy.

c. The monthly premiums are just too high to be affordable. Individuals and families may not obtain privately paid insurance because they live in a state where insurance companies are not required to offer it or, especially if they are members of a high-risk group, because they cannot afford it. For low-income and marginal middle-income individuals, the premium costs are simply unaffordable. Private insurance is usually purchased only by persons who have regular employment and an adequate income to do so. Services provided at free clinics cannot meet all of the clients potential health care needs. It is highly recommended that all persons have health insurance because of the large expense associated with receiving care.

Which of the following is the leading cause of premature death in industrialized countries? a. Alcohol-related illnesses b. Automobile accidents c. Tobacco-related illnesses d. Malnutrition

c. Tobacco-related illnesses Tobacco-related illnesses are the leading cause of premature death in industrialized countries. Tobacco use accounts for 63% of deaths in the current, global, noncommunicable disease epidemic.

A community/public health nurse is working with vulnerable populations in the community. Which population would be most likely to not have health insurance? a. Elderly persons who do not qualify for Social Security b. Homeless persons who lack a permanent address c. Working poor persons whose jobs lack health insurance as a benefit d. Young families who have not yet saved enough to qualify

c. Working poor persons whose jobs lack health insurance as a benefit The working poor have low-paying jobs that lack benefits and therefore cannot afford to pay for services.

An elderly client reports that he has been told that he needs to spend down in order to be eligible for Medicaid. He is confused about what he needs to do in order to accomplish this task. Which of the following statements is the best response from the community/public health nurse? a. You will have to spend your own money to pay for the Medicaid premiums. b. You will have to spend your own funds until you are eligible for Medicare. c. You will have to exhaust most of your assets before receiving benefits. d. You will have to meet a certain deductible amount before receiving benefits.

c. You will have to exhaust most of your assets before receiving benefits. Spending down is the process whereby elderly persons must exhaust most of their own assets, paying medical bills until they qualify for Medicaid, the program for the poor.

Behavioral objectives are (select all that apply): a. written to describe the teacher's activities. b. considered either cognitive or psychomotor. c. used to facilitate evaluation of the educational program. d. created after the teaching plan has been established. e. observable or measurable. f. helpful in determining desired outcomes.

c. used to facilitate evaluation of the educational program. e. observable or measurable. f. helpful in determining desired outcomes. Behavioral objectives are used to facilitate evaluation of the educational program. The evaluation process will measure the achievement of these objectives. Behavioral objectives reflect changes in the learner that are observable or measurable. Behavioral objectives help the instructor decide which content and activities will get the learner to the desired outcomes. Behavioral objectives are statements of what the learner achieves, not statements of the teacher's activities. Behavioral objectives are classified into three domains of learning: cognitive, psychomotor, and affective. Behavioral objectives must be stated before the actual teaching begins. Behavioral objectives should be used to guide the selection of course content, teaching strategies, and teaching material

Which of the following would be the best question for a nurse to ask to determine whether an educational intervention had any effect? a. Are you interested in any other topics for me to teach? b. Did you find this program useful to you? c. Do you understand the material I presented? d. How are you going to apply these ideas at home?

d. How are you going to apply these ideas at home? Only How are you going to apply these ideas at home? will elicit responses that demonstrate whether the learner understood what was said and is willing to use the information in his or her life. It is also an excellent discussion question. Assessment of learner outcomes has traditionally been based on achievement of the behavioral objectives.

With regard to the effectiveness of the Medicare program, it can accurately be said that the program a. Ensured that elderly persons received appropriate care. b. Helped reduce health care costs. c. Prevented elderly persons from suffering any major financial hardships. d. Improved access to health care services for eligible persons.

d. Improved access to health care services for eligible persons. Although the program is unable to prevent elderly recipients from suffering financial destitution, reduce health care costs, or ensure that the elderly receive appropriate care, it has vastly increased health care access for clients who are eligible and has helped reduce poverty among elderly people.

The federal bill called HIPAA (Health Insurance Portability and Accountability Act) guarantees access to private insurance for selected groups of individuals, but the bill was not successful at making insurance more available because: a. It provided for medical savings accounts, which were not what people wanted. b. It focused primarily on protecting the confidentiality of patient records, not insurance. c. It was repealed shortly after its passage. d. It did not limit what companies could charge for the insurance.

d. It did not limit what companies could charge for the insurance. The bill guarantees access for individuals who just left an insurance plan and requires renewal of coverage, but it does not limit the amount an insurer can charge for the insurance; therefore, the premiums may be too expensive for the majority of persons eligible to purchase insurance.

Which of the following criteria must be met in order for an educational program to receive third-party reimbursement? a. It must be provided to a geriatric population. b. It must be given by an advanced nurse practitioner. c. It must occur in a rural, underserved area. d. It must be prescribed by a physician for an ill client.

d. It must be prescribed by a physician for an ill client. Insurance companies pay for illness, not wellness, and so they will pay for patient teaching regarding an existing illness only when it is prescribed by a physician.

1. For whom are patient education programs very helpful? a. Adults and families who can learn to avoid health problems b. Adults and families, who will all be clients in the future c. People who wish to learn how best to use the health care system d. People with an identified health problem

d. People with an identified health problem Patient education describes teaching-learning activities for people with an identified alteration in health. Health education focuses on helping healthy groups maintain or improve their health.

A public health nurse is discussing actions that countries must take in order to reduce poverty successfully. Which of the following actions is the nurse likely to suggest? a. Adopt a democratic government for their people. b. Create a national health care plan. c. Give preference to women and infants. d. Provide predictable and sustained funding.

d. Provide predictable and sustained funding. The health of the population in developing countries is dramatically affected by poverty. After the United Nations Millennium Summit in 2000, the governments of the 22 wealthiest donor nations agreed to commit 0.7% of their gross domestic product by the year 2015 toward accomplishment of the Millennium Development Goals. This funding is necessary in order to decrease the rates of poverty worldwide.

Which strategy would enhance an adult learner's learning experience (select all that apply)? a. Using a lecture format to present the content b. Answering all questions at the end of the teaching session c. Providing one-on-one educational sessions d. Relating the content to life experiences e. Focusing on real-world problems f. Relating the activities to learner-focused goals

d. Relating the content to life experiences e. Focusing on real-world problems f. Relating the activities to learner-focused goals Relating the content to life experiences is one strategy that can be used when teaching adults. Other useful strategies include focusing on real-world problems, relating the activities to learner-focused goals, teaching what the learner wants to know before you continue, listening to and respecting the opinions of the learner, and encouraging the learner to share resources with you and others. Standard lecture methods do not consider individual differences and may be ineffective in teaching health promotion and self-care. The program should be individualized to meet the learner's needs. Adults learn best when prompt feedback is received; thus, waiting until the end of the teaching session to provide feedback would limit the prompt feedback that adult learners desire. Also, adult learners will not be able to focus on instructions if the question is not answered when it is asked. The presence of a peer group can enhance learning by providing encouragement to the learners. Also, teaching a supportive family instead of just one family member is more effective in achieving learning objectives and modifying behavior.

As part of the orientation program at a local public health department, the newly hired nurse learns about the resources that are available in the community. What is the reason for including this information? a. So that the nurse is able to advise clients on how to obtain food stamps b. So that the nurse is able to determine who is eligible for certain services c. So that the nurse will be able to include other departments in providing care d. So that the nurse will be able to refer clients to the appropriate resources

d. So that the nurse will be able to refer clients to the appropriate resources Nurses need to know about community resources to refer families to appropriate resources for which the families may be eligible. Referral is often just a matter of matching clients to existing programs for which they qualify. This does not mean that nurses must become experts in program criteria, application processes, and benefit packages, but they should become aware of existing programs, the types of clients who are generally served by those programs, and the name and phone number of the initial contact for such programs.

Which of the following descriptions is the best example of how the Beveridge model is implemented? a. A government system plans and pays for health care delivered by private enterprise. b. Multiple insurance providers develop options for health care delivery to the population. c. A government system plans and pays for health care delivered by private enterprise. d. The government plans and funds care provided by its employees in government-owned health facilities.

d. The government plans and funds care provided by its employees in government-owned health facilities. In the Beveridge model, in contrast to the Bismarck model, national government controls health care with national planning, organizing, financing, and delivering care to all. Most health care providers are government employees, and services are provided in government-operated health centers.

Which of the following statements most accurately summarizes the current view of health care in the United States? a. The government should allow Americans to receive the health care they can afford. b. The government should trust the free market system. c. The government should assume responsibility for providing basic care to all. d. The government should provide basic care to those who cannot care for themselves.

d. The government should provide basic care to those who cannot care for themselves. According to the current system, it might be concluded that while there is strong disagreement over whether health care is a right or a privilege and whether it should be government controlled or continue with the free market system, most Americans believe that at least some care should be given to all citizens; hence, the government funds care for specific at-risk groups. The increasing concern is the lack of access to health care for many people for whom the government is not a guarantor of last resort. The new Health Care Reform Law is an attempt to expand health insurance coverage to more of the population (although it still may not be expanded to all).

A community/public health nurse is examining how health care dollars are distributed in the United States. Which of the following information would the nurse find in the literature? a. The majority of health care dollars are spent on health promotion activities. b. The percentage of health care dollars spent on public health activities is increasing. c. The percentage of health care dollars spent on health care advances is increasing. d. The majority of health care dollars are spent on personal health care services.

d. The majority of health care dollars are spent on personal health care services. Personal health care services account for 84% of the entire health budget. Hospital care is the most costly category. Public health, research, and construction together account for 9% of the entire budget.

One of the adults at a health education program introduced a rather unorthodox suggestion, claiming, I saw it on the Internet. Which of the following criteria is most important for laypeople to use in deciding whether to accept information on the Internet? a. The author of the information has written several books on the topic, all of which are for sale. b. The content of the site is supported by an international pharmaceutical company. c. The site is frequently referred to in magazine and TV advertisements. d. The site is maintained and frequently updated by a federal health agency.

d. The site is maintained and frequently updated by a federal health agency. In an Internet site, the authorship should be based on credentials and clinical reputation, preferably peer reviewed. The information should be written by staff at a reputable organization, preferably based on research, frequently updated, and not biased by being financially supported by companies or people attempting to sell products.

What is the main problem with Medicare Part D? a. The plan allows elderly persons to purchase medications from certain mail-order companies. b. The plan covers generic, not brand-name, drugs. c. Medicare recipients are confused by what the plan will or will not cover. d. There is a coverage gap in which recipients have to pay full cost of drugs.

d. There is a coverage gap in which recipients have to pay full cost of drugs. The concern with Part D is the coverage gap, or doughnut hole. If an elderly persons drug costs exceed a certain amount, then the individual pays the full cost of medications between that amount and the end of the gap. In 2012, the gap starts at $2930 and ends at $4700 (out-of-pocket personal cost of drugs of $1570, in addition to monthly premium costs).

What is notable about Medicare Advantage? a. Because it is a new program, no one has yet seen any problems with this aspect of Medicare. b. Insurance salespeople have been very careful in explaining this program to elderly persons. c. More insurance companies are marketing such plans to elderly persons. d. Unless the elderly person is very healthy, the plan may cost more than the original Medicare.

d. Unless the elderly person is very healthy, the plan may cost more than the original Medicare. Although the program is new, problems are beginning to surface. A total of 39 states report abuses related to deceptive marketing and misrepresented benefits. When states became concerned about such practices, several companies suspended marketing to elderly persons. Subscribers are locked into the plan for 1 year, so they are unable to change policies if they discover the plan is more expensive, not less.

Self-payment of health care costs are a. Almost never done because that is the purpose of health insurance. b. Frequently done because many employers do not offer a health insurance benefit. c. Frequently done by paying for ones own insurance to ensure coverage. d. Usually done by paying co-payments and deductibles required by insurance.

d. Usually done by paying co-payments and deductibles required by insurance. Today, self-payment is usually accomplished through co-payment and deductibles required by insurance companies, as well as additional out-of-pocket costs for services not provided by insurance plans.

What teaching principle is being used when, at the end of the teaching session, the nurse asks the learners how they will apply the knowledge at home? personalization building rapport effective communication using diverse strategies

personalization Asking learners how they will apply the knowledge at home is a way to personalize the teaching. Sharing application ideas in the group provides reinforcement of content and also stimulates learning by encouraging others to try new ideas. In a teaching situation, a nurse builds rapport by valuing member contributions to the group. To build rapport, the nurse should encourage group participation. Asking this question at the end of the teaching session may be a way to continue to build rapport, but its underlying purpose is to personalize the teaching project. Effective communication occurs as the nurse builds rapport with the learners. The nurse should communicate willingness to support the learners until objectives are met. Asking this question at the end of the teaching session may be a form of communication, but its underlying purpose is to personalize the teaching project. A variety of teaching strategies should be used when performing a teaching session. This will keep the learners interested as well as meet group needs. Asking this question at the end of the teaching session does not show use of diverse teaching strategies.

The community health nurse has just completed a community teaching session about providing CPR. At the end of the teaching session, the participants take a 10-question quiz over the material that was presented. This quiz is used to evaluate: teacher performance. self-efficacy. long-term outcomes. short-term outcomes.

short-term outcomes. Short-term evaluation is measured by having the participants take a quiz at the end of the teaching session. Measuring cognitive knowledge is the most common type of short-term outcome evaluation. Teacher performance is best evaluated through observation by a peer, review of videotapes of the teaching session, or through feedback from the participants. Having the students take a quiz does not measure teacher performance. Self-efficacy is the motivational factor that determines if and to what extent an individual participates in self-care activities. Self-efficacy is an important attitude for learners, but this would not be measured through the completion of a quiz. Long-term evaluation considers the effectiveness of the intervention over time. Completing a quiz at the end of the teaching session would not provide a form of long-term evaluation

It is necessary for public health nurses to be aware of global health because: the health of populations worldwide needs to be closely monitored. more nurses are being recruited to work in foreign countries. worldwide travel occurs more rapidly than in previous decades. third-world countries need assistance to treat disease.

worldwide travel occurs more rapidly than in previous decades. Worldwide travel is one of the main reasons public health nurses need to be aware of global health. Highly infectious diseases can circle the world rapidly, as more than 2 million people cross national boundaries daily. Although the health of populations worldwide is of concern, it would not be a primary role of public health nurses to closely monitor the health status of populations worldwide. Although nurses do more traveling now than in previous decades, there is not a large recruitment of U.S. nurses to foreign nations. Third-world countries may need assistance to treat disease. However, the public health nurse will not be able to provide such assistance independently.