Comm T1

A PHN is studying the rate of H1N1 in the community. If there are five cases of H1N1 in the community of 1,000 people, what is the prevalence rate? ____________________

ANS: .005 Feedback: The prevalence rate is calculated by dividing the existing number of cases (numerator) divided by the total number of persons in the population (denominator).

If the total number of cases of a disease is 100, and the total number of persons in a population is 1,000, what would the prevalence be? ____________________

ANS: 0.1 Feedback: The prevalence of a disease is calculated by dividing the total number of disease cases (100) by the total number of persons in a population (1,000) to equal the total number of cases of disease in a population. 100 ÷ 1,000 = 0.1.

A local health department reports that there are 1,375 smokers in a town of 5,000. Of these smokers, 536 have reported that they have influenza. What percent of smokers have influenza? Round your answer to the nearest whole percent. ____________________

ANS: 39% Feedback: The number of reported smokers with influenza (536) is divided by the number of total smokers (1,375) and then multiplied by 100 to get the percent of smokers with influenza. (536/1,375) 100 39%.

A public health team wanted to track the changes in a population within their town, particularly a shift in the Hispanic population. Currently, the town's population is 60% Hispanic, whereas five years ago, it was 39%. The percentage change is ____________________.

ANS: 53.8% Feedback: Percentage Change is the change in a variable from one point in time to another. Percentage change = [(new value - old value) / old value] 100. [(60 - 39) / 39] 100 53.8%.

A PHN wants to calculate the age-adjusted crude death rate of a community. If the total number of expected deaths is 365 and the total standard population is 60,000, then the death rate would be ____________________.

ANS: 608 per 100,000 deaths Feedback: Age-adjusted rate (per 100,000 deaths) = (total expected number of deaths / total standard population) 100,000. (365/60,000) 100,000 608.

In a hypertensive study, nurses took the blood pressure readings of 250 participants. In order to determine the accuracy of their readings, they wanted to test the sensitivity of their instruments. If the number of true positives is 40, and the total number of participants with disease (true positives plus false negatives) is 55, the sensitivity of the instrument is ____________________.

ANS: 72.7% Feedback: The number of true positives (40) is divided by the total number of people with the disease (true positives plus false negatives = 55) and multiplied by 100 to equal the sensitivity of the instrument. (40/55) 100 72.7%.

A PHN goes to a factory to find out why employees are missing so many work days. What type of assessment would be the most appropriate in this case? A. Setting-specific assessment B. Health impact assessment C. Problem or health issue-based assessment D. Population-focused assessment

ANS: A Feedback A A setting-specific assessment treats the setting as the community, takes into account the population that is located in the setting, and looks for factors that are relevant to the setting. B A health impact assessment is a combination of procedures, methods, and tools by which a policy, program, or project may be judged as to its potential effects on the health of a population and the distribution of those effects within the population. C A problem or health issue based assessment focuses on a specific problem or health issue. D A population-focused assessment is an assessment that can be focused on a specific population for purposes of planning and developing intervention programs.

A nursing instructor is giving a lecture on community participation in an ecological public health system. She teaches that the benefits of this collaboration for participants in the community's public health are that their efforts increase effectiveness and productivity, empower the participants, strengthen social engagement, and ____. A. Decrease disease rates B. Ensure accountability C. Increase the number of medical facilities D. Monitor childhood illnesses

ANS: A Feedback A Decreased disease rate is a definite sign that the ecology of a health population is improving. Community collaboration efforts are a good way to achieve this. B Ensuring accountability among members of a community to stay healthy and for the health care providers to provide good care is possible through collaboration, but the end result is better health for all, as in the form of decreased disease rates. C More facilities are not an assurance that health care will improve. Collaboration in the community ensures that the environment drives good public health. D Avoiding childhood illnesses, not monitoring their onset, is one of the goals of community collaboration.

A PHN is gathering evaluation information on a program to be used for several purposes, except A. To share with the media for public relations B. To make improvements on the program C. To redefine the population being served D. To share with funding agencies

ANS: A Feedback A Evaluation information is generally used for the appropriate agencies that directly influence the program's welfare, not for public disclosure. B Evaluation information helps the management team and the participants make the program better. C The population of a program sometimes needs to be evaluated to reassess the needs being addressed and the people being helped. D The information of a program evaluation can be shared with funding agencies to receive more funding for a successful program.

With aging, there is an increase in noncommunicable (chronic) illness. The PHN recognizes that an example of a noncommunicable illness is A. Heart disease B. Human immunodeficiency virus (HIV) C. Hepatitis D. Severe acute respiratory syndrome (SARS)

ANS: A Feedback A Heart disease cannot be transmitted between humans, so it is a noncommunicable disease. B Human Immunodeficiency virus (HIV) is transmitted between humans through body fluids. C Hepatitis is transmitted between humans through blood exchanged in transfusions and needle sticks. D Severe acute respiratory syndrome (SARS) is transmitted between humans through respiratory fluids in coughing and sneezing.

Population attributable risk (PAR) is based on the assumption that the risk factor is removed from the entire population being targeted. It also can be used to calculate the cost benefit and the ____ of a prevention program. A. Cost effectiveness B. Necessity C. Population ecology D. Percent of repeat participants

ANS: A Feedback A PAR can be used as a measurement of the cost benefit and cost effectiveness of a prevention program, which is based on the strength of the risk factor and the prevalence of the risk factor in a population. B PAR can be used to estimate the cost effectiveness of a prevention program. The estimation of the cost effectiveness of a program is a separate issue from whether a program is necessary or not. C PAR can be used to estimate the cost effectiveness of a prevention program. There is no measurement of the population ecology, only of the strength and prevalence of the risk factor. D PAR can be used to estimate the cost effectiveness of a prevention program. The percent of repeat participants is not a measure of the cost effectiveness of the program when the risk factor has been removed from the targeted population.

A PHN is looking into the high rate of diabetes in the community. The nurse knows that there are three categories of risk factors in the field of epidemiology to be considered in the investigation. These categories include all of the following except: A. Prevalence B. Behavioral C. Environmental D. Genetic

ANS: A Feedback A Prevalence is the total number of accumulated cases of a disease or illness both new and preexisting at a given time. B Person-related aspects are certainly aligned with behavioral risk factors. C Place-related considerations are effectively illustrated by environmental risk factors. D Genetic risk is associated with the biological make-up of individuals that provides protective factors or risk factors for the development of disease.

A public health nurse (PHN) conducts a community health assessment to identify the needs of a population. For example, the PHN might gather data to provide the rationale for a pediatric clinic in a low income area. He or she would take into account the sociodemographics of the community, as well as the: A. Preventive health concerns B. Need for medical facilities C. Collaboration of the community D. Lifestyle concerns

ANS: A Feedback A Preventative health concerns would drive the need for the community assessment. In the example, the prevalence of childhood illnesses might indicate a need for a clinic. B The need for medical facilities would be a part of the assessment, but also a plan of action for health intervention. C The willingness of a community to create a healthy environment is always essential to the success of a program, but this factor would be more necessary at the intervention stage than at the assessment stage. D Lifestyle concerns, such as diet and exercise, would affect noncommunicable diseases, but not communicable diseases.

The Institute of Medicine (IOM) stated in their report, The Future of the Public's Health, that there are three core functions that society carries out to collectively support the optimum conditions for public health. Which one of the following is not one of these functions? A. Prevention B. Assessment C. Policy development D. Assurance

ANS: A Feedback A Prevention is not considered a core function of public health, as assessment, policy development, and assurance have prevention as an implied goal of each function. B Assessment focuses on analysis and collection of data, as well as the monitoring of health problems and needs. C Policy development uses the acquired knowledge from assessments to create useful public health policies. D Assurance creates trust in health-care agencies to provide necessary services that are in line with public health goals.

John Snow, considered the founder of epidemiology, realized the source of the London's cholera epidemic through: A. A residential pattern of death B. Mapping of the food supply C. Interviewing the families of the sick D. Performing autopsies

ANS: A Feedback A Snow developed a frequency distribution of the number of human deaths by placing hash marks on a city street map and realized a cluster of deaths occurred near the Broad Street water pump. B Snow developed a frequency distribution of the number of human deaths and found that they were clustered around the Broad Street water pump, not the food supply. C Snow developed a frequency distribution of the number of human deaths; he did not interview the families of the sick. D Snow developed a frequency distribution of the number of human deaths; he did not perform autopsies.

When a PHN is working on a community diagnosis for an industrial town with a high incidence of a normally water-borne illness, the nurse researches the characteristics of the problem. This part of a community diagnosis looks at A. What the problem is related to B. The assessment C. The population D. How the problem is demonstrated

ANS: A Feedback A The characteristics of a population are what factors the problem is related to. B The assessment is the entire process by which the problem is evaluated. C The population is the group of people that is impacted by the problem. D The indicators of the problem are how the problem is demonstrated.

A nursing student is listening to a lecture on poor health outcomes. Based on research by the Institute of Medicine (IOM), the instructor says that less knowledge of chronic disease management, performance of fewer health promotion activities, low usage of the health-care system, and less use of preventative services are due to: A. Low health literacy B. Poor insurance C. Limited access to medical services D. Few prevention programs

ANS: A Feedback A The lack of health-care literacy is the problem, particularly in older Americans with limited education. There is a causal relationship between low health literacy and poor health outcomes due to the lack of understanding of one's health problems. B Poor insurance produces problems such as a lack of access to health services and inability to receive proper care. However, this is not the cause cited by the IOM research of the trends mentioned above. C Limited access to medical services due to transportation or financial issues means poorer outcomes, but this is not the cause cited by the IOM research. D Few prevention programs means more intervention programs are needed, but this is not related to the trends mentioned above.

A school cafeteria is planning menus for the school year. They must follow the 2012 national law that calls for school lunch programs to: A. Have larger portions of fruits and vegetables, less sodium, and no trans fats B. Have more protein and fewer carbohydrates C. Offer 2% milk and low fat dairy products D. Places a cap on lunch calories at 900, for all grades

ANS: A Feedback A The new law mandates larger portions of fruits and vegetables, less sodium, and no trans fats. B The law does not mention proteins and carbohydrates; it mandates larger portions of fruits and vegetables, less sodium, and no trans fats. C The law states that milk can be, at the most, 1% fat, and flavored milk must be fat-free. D The calories for each grade group must be 650 for grades K-5, 700 for grades 6-8, and 850 for grades 9-12.

A PHN notices the rising incidence of H1N1 (swine flu) in a geographic area. The nurse considers possible interventions, knowing that the preclinical phase of H1N1 lasts: A. One to two days B. Two to four days C. Three to four days D. Five to seven days

ANS: A Feedback A The preclinical phase of H1N1 lasts one to two days, and people that are infected can infect others on the first day. Symptoms develop rapidly, and intervention cannot prevent progression to the clinical phase. B This is past the preclinical phase of H1N1. The preclinical phase lasts only one to two days. C This is past the preclinical phase of H1N1. The preclinical phase lasts only one to two days. D This is past the preclinical phase of H1N1. The preclinical phase lasts only one to two days.

A nurse is presenting a lecture about global health and life expectancy and states that in America, the biggest reason for the increase in life expectancy is: A. Better public health practices B. Increased education C. Decrease in crime D. Improved housing

ANS: A Feedback A This is correct. In America, the biggest reason for the dramatic increase in life expectancy is advances in public health, such as workplace safety, vaccinations, family planning, clean water, and improved sanitation practices. B This is incorrect. In America, the biggest reason for the dramatic increase in life expectancy is advances in public health, such as workplace safety, vaccinations, family planning, clean water, and improved sanitation practices. C This is incorrect. In America, the biggest reason for the dramatic increase in life expectancy is advances in public health, such as workplace safety, vaccinations, family planning, clean water, and improved sanitation practices. D This is incorrect. In America, the biggest reason for the dramatic increase in life expectancy is advances in public health, such as workplace safety, vaccinations, family planning, clean water, and improved sanitation practices.

The obesity rate in a local neighborhood is the product of a poor quality grocery store and a lack of dedicated venues for exercise. This is an example of "upstream" determinants of public health determining the ecology of a community's health "downstream." The PHN understands that upstream determinants include social relations, neighborhoods and communities, institutions, and ____. A. Social and economic policies B. Availability of medicine C. Nursing interventions D. Government programs

ANS: A Feedback A Upstream refers to determinants of health that are somewhat removed from the more downstream biological and behavioral bases for disease. Upstream determinants can include social and economic policies. B Availability of medicine is not an example of an upstream determinant of health. C A nursing intervention is not an example of an upstream determinant of health. D Government programs do not represent their own category in the upstream determinants of health.

A community assessment team found that the problem with their surveys of older adults was that there was not enough information on the health-related quality of life (HRQoL) for those over the age of 65 who were not living in a health-care facility. The best approach to assess this population is to do surveys: A. By personal interview B. By mail C. By telephone D. Online

ANS: A Feedback A Doing personal interviews has many advantages, such as flexibility, being able to probe for specific answers, being able to observe nonverbal behavior, being able to control the physical environment, and being able to use more complex questions. B Mail is not the best method as it is sometimes forgotten or thrown away. C In some geographic areas—such as where Amish people live—telephones are not used, so the survey response would be low in those areas. D Many older people do not use the computer or go online, so conducting the survey online would result in low participation.

A PHN is studying a geriatric population in a high-rise building. As part of the community diagnosis, there are several factors to be examined, including the factor that is particularly significant to designing the program since it alters the outcome. This factor is called the: A. Causal factor B. Mediating factor C. Moderating factor D. Antecedent factor

ANS: B Feedback A The causal factors are the factors that caused the problem. B Mediating factors occur between the causal factors and the outcomes and are important to designing the program since they alter outcomes. C Moderating factors are factors that can make the problem better or worse. D Antecedent factors are behaviors that existed prior to the health problem.

A PHN is evaluating the effectiveness of a health intervention program for children by looking at the program characteristics. According to Lisbeth Scherer's criteria, the nurse will be looking for which of the following? SELECT ALL THAT APPLY. A. Whether the program is meeting all the needs of the children B. Whether the program continues to reach out to the families in neighborhoods C. Whether the program stays true to its goals D. Whether the staff and managers are able to support the mission of the program E. Whether the program is able to attract grant money

ANS: A, B, C, D Feedback 1 This is correct. The program is effective according to Scherer's criteria if it perseveres in its mission and sees children in the context of their families. 2 This is correct. The program is effective according to Scherer's criteria if it deals with families as parts of neighborhoods. 3 This is correct. The program is effective according to Scherer's criteria if it has a long-term, preventative orientation and a clear mission. 4 This is correct. The program is effective according to Scherer's criteria if it is managed by competent people with good skills and staffed by well-trained individuals. 5 This is incorrect. The program characteristics pertain to the human factor of a health program and not the financial aspects.

A PHN recognizes that which of the following are types of cohort studies? Select all that apply. A. Prospective B. Retrospective C. Historical D. Longitudinal E. Statistical

ANS: A, B, C, D Feedback 1. A prospective study is being performed when participants are enrolled and watched for disease over a long period of time. Because this study follows a group over a specified period of time, it is considered a type of cohort study. 2. A retrospective study is being performed when participants are asked to report on their medical history. Because this study looks at a group over a specified period of time, it is considered a type of cohort study. 3. A historical prospective is a combination of the retrospective and prospective methods. Because this study follows a group over a specified period of time, it is considered a type of cohort study. 4. A study that follows a group over a long period of time, such as 30 years or more, is considered a longitudinal study. Because this study follows a group over a specified period of time, it is considered a type of cohort study. 5. All studies involve the use of statistics, and so this answer does not refer to a cohort study specifically.

A nursing student learns that an outbreak investigation could be used in which of the following situations? Select all that apply. A. High numbers of hip injuries at a local nursing home B. Gastroenteritis illness investigations at a community daycare C. Food borne illnesses resulting from salmonella at a restaurant D. Employees with elevated levels of asbestosis E. A community with an unexpectedly high number of infants with elevated blood lead levels

ANS: A, B, C, D, E Feedback 1. Although not necessarily demonstrative of traditional outbreak investigation, noncommunicable diseases or injuries can be studied with epidemiological methods comparing risk factors. 2. The outbreak of an enteric illness would warrant an investigation of food, water, and environment to protect the children and their families. 3. The outbreak of an enteric illness would warrant an investigation of food, water, and environment to protect the customers and the community. 4. Outbreak investigation is data analysis methods at the population level to better understand health-related circumstances within communities, including non-infectious situations. 5. An evaluation of the environment would be needed to analyze the reason for these unusual blood test results. Although not necessarily demonstrative of traditional outbreak investigation, noncommunicable diseases or injuries can be studied with epidemiological methods comparing risk factors.

Two nurses are establishing a primary health care clinic in a rural part of Africa. Their goal is to include as many of the essential components of primary health care, as defined during a WHO conference in Alma Alta. Which of the following functions would likely be included in their model of care? Select all that apply. A. Patient education about health problems B. Maternal and child health care C. Principles of proper nutrition D. Adequate supply of safe water and healthy foods E. Treatment and prevention of local infectious diseases

ANS: A, B, C, D, E Feedback 1 All of these are correct. The essential components of primary health care as defined by the WHO conference in Alma Alta include: 1) increased patient education; 2) promotion of proper nutrition and access to healthy food supply, 3) increased supply of fresh water and sanitation, 4) maternal and child health services, 5) increased immunizations, 6) prevention of local communicable diseases, 7) increasing the appropriate treatment of basic injuries and diseases and 8) increasing supply of medications.

When considering the outcomes of a planned intervention, a nurse should measure which of the following types of outcomes? SELECT ALL THAT APPLY. A. Short-term B. Medium-term C. Changes in knowledge, skills, or behavior D. Long-term E. Unexpected or unintended outcomes

ANS: A, B, C, E Feedback 1 This is correct. Short-term outcomes provide good feedback and direction for the program. 2 This is correct. Medium-term outcomes determine whether a program is beneficial. 3 This is correct. Changes in knowledge, skills, and behavior are indicators as to whether a program is working. 4 This is incorrect. Long-term refers to the impact of a program rather than the outcomes. 5 This is correct. Unexpected or unintended outcomes, although perhaps not part of the program's goal, will be an important part of the evaluation.

A nurse is educating emergency room nurses about the symptoms of Avian Influenza, as there is some evidence of infection overseas. The nurse wants the staff to be aware of the symptoms so they can closely monitor for the virus. Which of the following symptoms should be included? Select all that apply. A. Eye infections B. Pneumonia C. Fever D. Muscle weakness and paralysis E. Cough

ANS: A, B, C, E Feedback 1 This is correct. Symptoms of avian influenza include flu-like symptoms, such as fever, cough and muscle aches), respiratory distress, eye infections, and pneumonia. 2 This is correct. Symptoms of avian influenza include flu-like symptoms, such as fever, cough and muscle aches), respiratory distress, eye infections, and pneumonia. 3 This is correct. Symptoms of avian influenza include flu-like symptoms, such as fever, cough and muscle aches), respiratory distress, eye infections, and pneumonia. 4 This is incorrect. Symptoms of avian influenza include flu-like symptoms, such as fever, cough and muscle aches), respiratory distress, eye infections, and pneumonia. 5 This is correct. Symptoms of avian influenza include flu-like symptoms, such as fever, cough and muscle aches), respiratory distress, eye infections, and pneumonia.

If a PHN had the capabilities required in the domains of the PHN Core Competencies, he or she would be able to do which of the following? Select all that apply. A. Develop policy for handling a local quarantine. B. Understand the dietary restrictions of new immigrants. C. Create a financial plan for a clinic and manage the budget. D. Function as a medical doctor at a clinic if there is none. E. Work with corporations to create an emergency response program to bioterrorism.

ANS: A, B, C, E Objective: 6. Identify the key roles and responsibilities of public health nurses (PHNs). Feedback 1. Policy development/program planning is an essential skill for a PHN. 2. In order to reach a population that might not receive adequate health care, cultural competency and communication skills are needed to overcome any barriers. 3. Financial and management skills are needed to maintain the sustainability of programs. 4. PHNs have basic public health science to assist in the welfare of the public but are limited by their professional constraints. 5. One of the new challenges PHNs face is preparing the public for sudden, catastrophic health events, such as bioterrorism.

When analyzing evidence-based practice (EBP) literature to see if the information should be used in planning a program, a nurse should look at which of the following? SELECT ALL THAT APPLY. A. Quantitative and qualitative data from studies B. Analysis to see if the program is thriving C. Economic indicators to see if the program is financially stable D. Indicators of real outcomes and behavior change E. Indicators of outside factors that might change the program

ANS: A, B, D, E Feedback 1 This is correct. Quantitative and qualitative data from studies will help the nurse to know whether the research is solid enough information on which to build a program. 2 This is correct. The nurse should analyze the data to see if the program is still thriving and being used. 3 This is incorrect. The economic indicators are not a part of evidence-based practice. 4 This is correct. Indicators of real outcomes and behavior change are essential factors as to whether a program should be replicated elsewhere. 5 This is correct. Indicators of outside factors that might impact the program, positively or negatively, are important to consider. These factors can help the nurse determine if a program is a good fit for the community.

When screening for, monitoring, and diagnosing disease, a health-care provider always evaluates a measurement tool for which of the following attributes? Select all that apply. A. Reliability B. Validity C. Functionality D. Sensitivity E. Specificity

ANS: A, B, D, E Feedback 1. Reliability is the ability of the instrument to give consistent results on repeated trials. 2. Validity is the degree to which the instrument measures what it is supposed to measure. 3. Functionality is the quality of being suited to serve a purpose well. This not one of the attributes by which a measurement tool is always evaluated. 4. Sensitivity is the ability of the screening test to a positive finding when the person truly has the disease or is a true positive. 5. Specificity is the ability of the screening test to give a negative finding when the person does not have the disease or is a true negative

The regulatory activities of public health nursing include which of the following? Select all that apply. A. Interpreting public health laws, regulations, and policies B. Monitoring regulated entities such as nursing homes C. Writing new regulations for health care and legislating them D. Taking part in health policy debates E. Educating the public

ANS: A, B, D, E Feedback 1. This is one of the regulatory activities of public health nursing and also includes identifying and implementing public health laws, regulations, and policies. 2. This is one of the regulatory activities of public health nursing and also includes inspecting these entities. 3. PHNs can help develop laws but not enact them. 4. PHNs can participate in discussions about health care and bring valuable input. 5. An important part of regulation is making sure the public understands the laws.

A nurse working in a clinic in South America suspects that a patient, a young woman, has Chagas. What contraindications should the nurse screen for before initiating treatment? Select all that apply. A. Liver disease B. Renal disease C. Bleeding abnormalities D. Pulmonary disease E. Pregnancy

ANS: A, B, E Feedback 1 This is correct. Chagas is a parasitic infection that is transmitted through the blood. Treatment is an anti-parasitic drug that is contraindicated in patients with liver disease, renal disease, and in pregnant women. 2 This is correct. Chagas is a parasitic infection that is transmitted through the blood. Treatment is an anti-parasitic drug that is contraindicated in patients with liver disease, renal disease, and in pregnant women. 3 This is incorrect. Chagas is a parasitic infection that is transmitted through the blood. Treatment is an anti-parasitic drug that is contraindicated in patients with liver disease, renal disease, and in pregnant women. 4 This is incorrect. Chagas is a parasitic infection that is transmitted through the blood. Treatment is an anti-parasitic drug that is contraindicated in patients with liver disease, renal disease, and in pregnant women. 5 This is correct. Chagas is a parasitic infection that is transmitted through the blood. Treatment is an anti-parasitic drug that is contraindicated in patients with liver disease, renal disease, and in pregnant women.

A nurse working in a clinic in South America suspects that a patient, a young woman, has Chagas. What contraindications should the nurse screen for before initiating treatment? Select all that apply. A. Liver disease B. Renal disease C. Bleeding abnormalities D. Pulmonary disease E. Pregnancy

ANS: A, B, E Feedback 1 This is correct. Chagas is a parasitic infection that is transmitted through the blood. Treatment is an anti-parasitic drug that is contraindicated in patients with liver disease, renal disease, and in pregnant women. 2 This is correct. Chagas is a parasitic infection that is transmitted through the blood. Treatment is an anti-parasitic drug that is contraindicated in patients with liver disease, renal disease, and in pregnant women. 3 This is incorrect. Chagas is a parasitic infection that is transmitted through the blood. Treatment is an anti-parasitic drug that is contraindicated in patients with liver disease, renal disease, and in pregnant women. 4 This is incorrect. Chagas is a parasitic infection that is transmitted through the blood. Treatment is an anti-parasitic drug that is contraindicated in patients with liver disease, renal disease, and in pregnant women. 5 This is correct. Chagas is a parasitic infection that is transmitted through the blood. Treatment is an anti-parasitic drug that is contraindicated in patients with liver disease, renal disease, and in pregnant women.

A PHN wants to conduct an assessment in the community and intends to start by collecting data through the use of a survey. The PHN recognizes that the advantages of a health indicator survey that measures health-related quality of life (HRQoL) include which of the following? SELECT ALL THAT APPLY. A. HRQoL is a multidimensional construct that relates to a person's perception of the impact their physical and emotional health has on their quality of life. B. HRQoL is an indicator of how much health insurance will pay if you are in the hospital. C. Including HRQoL items on a survey will provide information on the health of the community that the secondary data does not provide. D. HRQoL ascertains if an intervention is needed. E. HRQoL contains information that is quantitative rather than qualitative in nature.

ANS: A, C, D Feedback 1 This is correct. HRQoL is as assessment of how a population perceives their quality of life as it pertains to their health. 2 This is incorrect. HRQoL is not an indicator of health insurance. 3 This is correct. HRQoL gives insight on other public health aspects of the community outside of secondary data. 4 This is correct. HRQoL alerts public health officials to potential problems. 5 This is incorrect. HRQoL contains data that is qualitative rather than quantitative in nature.

A nursing student is studying preventable causes of death. In 2004, what were the three leading causes of preventable death? Select all that apply. A. Tobacco use B. Drowning C. Alcohol use D. Falls E. Improper diet and physical inactivity

ANS: A, C, E Feedback 1. The three leading causes of preventable death in 2004 were tobacco use, alcohol use, and improper diet and physical activity. 2. The three leading causes of preventable death in 2004 were tobacco use, alcohol use, and improper diet and physical activity. 3. The three leading causes of preventable death in 2004 were tobacco use, alcohol use, and improper diet and physical activity. 4. The three leading causes of preventable death in 2004 were tobacco use, alcohol use, and improper diet and physical activity. 5. The three leading causes of preventable death in 2004 were tobacco use, alcohol use, and improper diet and physical activity.

A nurse is assisting a primary health clinic in a rural South American country in establishing a quality and inclusive primary care program. The nurse consults the WHO components to primary health care for guidance. Which of the following elements is included in the WHO guide? Select all that apply. A. Diminish social disparities in health. B. Improve maternal and child health care. C. Better organize health care around the needs of the community. D. Improve funding for primary-care programs. E. Increase collaborative relationships for and stakeholder participation in public policy development.

ANS: A, C, E Feedback 1 This is correct. The WHO developed a list of components of primary health care that are beneficial in the provision of care to underserved populations. These components include: reducing social disparities of health, better organizing health care around the needs of the community, integrating health into public policy reforms and increasing collaborative relationships for and stakeholder participation in policy development. 2 This is incorrect. The WHO developed a list of components of primary health care that are beneficial in the provision of care to underserved populations. These components include: reducing social disparities of health, better organizing health care around the needs of the community, integrating health into public policy reforms and increasing collaborative relationships for and stakeholder participation in policy development. 3 This is correct. The WHO developed a list of components of primary health care that are beneficial in the provision of care to underserved populations. These components include: reducing social disparities of health, better organizing health care around the needs of the community, integrating health into public policy reforms and increasing collaborative relationships for and stakeholder participation in policy development. 4 This is incorrect. The WHO developed a list of components of primary health care that are beneficial in the provision of care to underserved populations. These components include: reducing social disparities of health, better organizing health care around the needs of the community, integrating health into public policy reforms and increasing collaborative relationships for and stakeholder participation in policy development. 5 This is correct. The WHO developed a list of components of primary health care that are beneficial in the provision of care to underserved populations. These components include: reducing social disparities of health, better organizing health care around the needs of the community, integrating health into public policy reforms and increasing collaborative relationships for and stakeholder participation in policy development.

A PHN is using the MAPP model to conduct an assessment within the community and has reached Phase 3, the four assessments. The nurse understands that analysis of the legislation, technology, and other external positive and negative influences that have an impact on the promotion and protection of the public's health is called a: A. Community themes and strengths assessment B. Forces of change assessment C. Community health status assessment D. Local Public Health System Assessment (LPHSA)

ANS: B Feedback A A community themes and strengths assessment provides important information about how the residents feel about issues facing the community. B A forces of change assessment evaluates what threat or opportunity might affect the health of the community or the local health system. It includes an analysis like the one described in this question. C A community health status assessment looks at morbidity and mortality indicators, quality of life indicators, and behavioral risk factors. D The LPHSA looks at all the organizations and entities that contribute to the public's health and how well they collaborate.

A nurse is working on a type of evaluation that examines how a program actually works and whether any outside environmental events might have an impact on the program. This type of evaluation is called a A. Formative evaluation B. Process evaluation C. Summative evaluation D. Program evaluation

ANS: B Feedback A A formative evaluation occurs during the development of a program, while the activities are being formed and implemented. The evaluations described in this question are a type of formative evaluation, but more specifically it is a process evaluation. B A process evaluation studies the process of delivering the program and how the program actually works. It is also important for an evaluator to be aware of any outside environmental events that might influence the program. C A summative evaluation occurs at the end of the program and it judges whether the program achieved the outcome. It also looks at the cost benefit and effectiveness of the program. D A program evaluation is the general term that encompasses all types of evaluations.

A nursing instructor describes one approach to conducting an assessment as a collection of data about the populations living within the community; an assessment of the assets within the community, such as the local health department capacity; and the identification of problems and issues in the community, such as unmet needs and health disparities, and opportunities for action. The instructor explains that this type of approach is called a: A. Rapid needs assessment B. Comprehensive community assessment C. Population-focused assessment D. Health impact assessment

ANS: B Feedback A A rapid needs assessment is a tool that helps establish the extent and possible evolution of an emergency by measuring the present and potential public health impact of the emergency. B This definition describes a comprehensive community assessment. C A population-focused assessment can be focused on a specific population for purposes of planning and developing intervention programs. D A health impact assessment is a combination of procedures, methods, and tools by which a policy, program, or project may be judged as to its potential effects on the health of a population and the distribution of those effects within the population.

As defined by the World Health Organization (WHO), an example of a health promotion intervention is ____ whereas a health promotion, risk reduction is ____. A. A health fair; funding a school health library B. Giving a free exercise class; offering coupons at a restaurant for healthy food C. A free antibiotic giveaway; a diet class for teenagers D. A tour of a hospital; a relaxation technique class

ANS: B Feedback A Both of these options are health promotions because they create opportunities to improve health through participation. B This is correct. A health promotion intervention creates an opportunity to improve health through participation, while a risk reduction refers to actions taken to reduce a person's risk for disease. C A free antibiotic is a health benefit only to those who have an infection. D While the relaxation techniques class would reduce risk for disease, the hospital tour is educational, but not promotional.

A community's public health nurses (PHNs) are working on building community capacity, which includes all of the following except: A. Organizing assets and resources to improve the health of a community B. Assessing how many people the community clinic will contain at one time C. Working in partnerships and supporting decision making D. Identifying root causes of health problems and working on interventions and outcomes

ANS: B Feedback A Community capacity refers to the ability of a community to work together to organize their available resources in order to aid the area. B Assessing the capacity of a clinic is not a part of building community capacity. C It can be quite self-sustaining when the community is empowered to make their own decisions about interventions and outcomes. D Through collaboration, the community can recognize, evaluate, and address key problems.

A group of public health officials want to use the logic model for program design. In this model, when a program's intended outcome is achieved, this is referred to as successful: A. Input B. Output C. Outcome D. Impact

ANS: B Feedback A Input refers to the resources that are needed and available for the program. B Output is the direct product of the activities of the program. C An outcome is the intended result or benefit of the planned intervention and what you plan to measure. D An impact is the program goal that produces long-term change in the community.

A nursing student is studying the National Prevention Council Action Plan. The student correctly identifies which one of the following interventions as not reflecting the strategic directions in this plan? A. Conducting bi-weekly visits to new mothers and newborn babies B. Paying for insurance for low-income families C. Providing nutrition classes which offer weekly fill-in guides for grocery shopping D. Building a health and exercise center in a hospital near the physical and occupational therapy areas

ANS: B Feedback A One goal of the National Prevention Council Action Plan is to build healthy and safe community efforts to create a supportive healthy ecology. B Providing financial health-care assistance for lower income families is not one of the strategic directions of the National Prevention Council Action Plan. C Empowering people to make healthy choices by educating them through health promotion and risk reduction is one of the goals of the National Prevention Council Action Plan. D Expanding quality preventive services in both clinical and community settings is one of the goals of the National Prevention Council Action Plan.

Attributable risk is the proportion of cases or injuries that would be eliminated if a risk factor did not occur, but preventable fraction is: A. The number of cases that actually occur B. What could be achieved with a program implemented in a community setting within the at-risk population when community members actually participate in the program? C. The number of cases that require intervention D. What the estimated number of cases with high-risk factors are

ANS: B Feedback A Preventable fraction is not the number of cases that actually occur. B Preventable fraction includes the portion of the population at risk that actually participates in a program and the number of cases prevented. C The preventable fraction includes the number of cases that have been prevented from happening, not the cases that now require intervention. D The estimated number of cases with high-risk factors is included in attributable risk.

A nurse wants to use evidence-based practice (EBP) to develop a program aimed at preventing social isolation in older adults. The first step the nurse should take is to A. Do an assessment. B. Develop a community diagnosis. C. Consult the literature to create a rationale for intervention. D. Begin community organizing.

ANS: C Feedback A At this point, an assessment should have already been done. B At this point, a community diagnosis should have already been done. C Consulting the literature to create a rationale for intervention is the first step in EBP. D Community organizing could be a step after the literature is consulted.

The logic model can provide an analytical structure for better outcome development and program management and evaluation. This was applied to programs aimed at families at risk for homelessness. Researchers found that the main advantage to this model was that A. They were able to acquire government aid. B. They were able to more clearly define their goals to determine more immediate outcomes. C. They were able to get more material resources. D. They were able to build houses for those at risk.

ANS: B Feedback A The goal of the program was to move the families toward self-sufficiency. B The logic model streamlined their approach to program management and helped them to better define their goals. C The key to program planning is acquiring more human resources through community involvement. D The idea behind this project was to promote job training and community involvement to avoid homelessness.

In general, nurses using the program planning model would begin by: A. Assessing the community B. Clarifying the health problem C. Understanding the underlying factors that contribute to the problem D. Developing an intervention

ANS: B Feedback A The second step is assessing the various aspects of the community experiencing the health problem. B The first step to program planning is clearly stating the health problem that will be addressed by the program. C The third step is realizing the causes of the health problem. D The last step is developing an intervention to improve the health of the community.

The PHN recognizes that which of the following scenarios is not an example of community collaboration? A. A local service group working to organize disaster relief for tornado victims B. A city council passing an ordinance to stop smoking in restaurants C. An advocacy group working to improve health care for the mentally ill D. A school working with the local health department to start a school clinic

ANS: B Feedback A This collaboration benefits the community's public health after a natural disaster. B Community collaboration is considered non-governmental. A nongovernmental group can effect change in government but not legislate. C A volunteer group can offer valuable services to enhance the lives of people suffering from mental illness. D This institution is an example of a social system that can work with a health department to use each other's strengths to produce a meaningful project.

When a health-care provider offers nutritional health teaching on portions, patterns, and choices, he or she is using which type of approach? A. Ecological B. Downstream C. Upstream D. Health promotion

ANS: B Feedback A This refers to a larger model that includes a more upstream approach. The health promotion strategy in this question is considered a downstream approach. B This approach to health promotion is considered downstream since it does include environmental factors such as a lack of supermarkets in its focus. C The upstream approach looks more at the environmental factors that prevent or allow healthy choices, such as urban zoning for gardening or a lack of supermarkets in a community. D Health promotion is the broad term used to classify all incentives and interventions to encourage healthy lifestyles.

A public health nursing instructor educates a class that the Predisposing, Reinforcing and Enabling factors, and Causes in Educational Diagnosis and Evaluation (PRECEDE) component of the PRECEDE-PROCEED begins with: A. An examination of administrative and organizational issues B. A comprehensive community assessment C. Preventative programs D. The implementation of behavior change

ANS: B Feedback A When the assessment phase is complete, the model provides guidance on how to examine the administrative and organization issues that need to be dealt with before implementing a program aimed at improving the community's health. B When a community uses the PRECEDE process, it begins with a comprehensive community assessment process. C When a community uses the PRECEDE process, it begins with a comprehensive community assessment process. D The PRECEDE-PROCEED model is meant as a model for program planning which comes before program implementation.

A nursing student is listening to a lecture in which the instructor explains that a population pyramid is a way to visually compare a population for a certain demographic such as age. If a pyramid has a broad base and a small top, it represents: A. Slow growth B. Rapid growth C. Equal growth D. Mostly older people, with no growth

ANS: B Feedback A A pyramid with indentations that even out from top to bottom indicates slow growth in that population. B An expansive pyramid, one with a broad base and narrow top, represents a rapid rate of population growth. C A stationary pyramid has a narrow base with equal numbers over the rest of the age groups and it tapers off in the oldest age groups. D A declining pyramid is one that has a high proportion of persons in the higher age groups.

A nursing student is listening to a lecture on community assessment tools. The nursing instructor explains that PHNs have found that some of the best uses of the Geographic Information Systems (GIS) include which of the following? SELECT ALL THAT APPLY. A. To locate medical facilities B. To identify spatial data C. To display environmental risk factors and health risks D. To display demographic data E. To display socioeconomic data

ANS: B, C, D, E Feedback 1 This is incorrect. GIS is a computer-based program that can be used to collect, store, retrieve, and manipulate location-based information. 2 This is correct. The GIS has the capability to identify spatial data that is assigned by exact geographical location by geocoding, or address matching. 3 This is correct. The Toxic Release Inventory Program run by the EPA uses GIS to examine air emission sites from the Aerometric Information Retrieval System/AIRS Facility Subsystem (AIRS/AFS) database, which is a computer-based repository for information about air pollution in the U.S. 4 This is correct. GIS has the ability to retrieve noncapital data, such as the demographic data of a location, which aids identification of populations. 5 This is correct. GIS has the ability to retrieve noncapital data, such as the socioeconomic data of a location, which could aid proper placement of intervention programs.

Several nurses who work in the emergency room of an urban hospital notice that a sizable number of children in a certain ethnic population have come in with an illness, all presenting with similar symptoms. The nurses, who are not public health specialists, can intervene in the health of a community through their work with individuals by doing which of the following? Select all that apply. A. Increasing antibiotic therapy availability B. Identifying characteristics of the disease C. Grouping patients by diagnosis D. Giving classes on how to avoid infections E. Assessing the environment of the patients

ANS: B, C, D, E Feedback 1. Antibiotics may not be a necessary route of treatment for the diagnosis. 2. It would be important to note and compare symptoms, onset, and other information to ascertain whether this is the same illness. 3. Grouping the patients according to diagnosis will allow the health-care team to give better care and help create a care map. 4. Once the problem has been diagnosed, a class on avoiding infections would be a proper intervention. 5. Evaluating the environment of the patients may create an understanding of why the illness occurred and prevent a re-occurrence of the illness.

A relatively permanent statistical subdivision of a county that averages between 2,500 and 8,000 inhabitants is called a: A. Census block B. Secondary data C. Census tract D. Health-care sector

ANS: C Feedback A A census block is an area that is bounded on all sides by visible features, such as roads, streams, and railroad tracks. B Secondary data is data that is collected for a purpose other than the current assessment such as census data, crime report data, or national health survey data. C A census tract is a relatively permanent statistical subdivision of a county that averages between 2,500 and 8,000 inhabitants and is designed to be homogenous with respect to population characteristics and economic status. D A health-care sector includes places where people go to receive preventive care or treatment or emergency health-care services such as hospitals, private doctors' offices, and community clinics.

In order to assess the predominance of a disease in a population, a public health nurse (PHN) looks at a prevalence pot, which is A. A way of estimating the amount of vaccine that needs to be produced B. A way of estimating the past number of cases of a specific disease in a given area C. A way of assessing the total number of cases of a disease that takes into account all of the stages of the disease D. A method of calculating the potential number of various diseases in a given area

ANS: C Feedback A A prevalence pot is used for more epidemiological use than pharmaceutical use. B A prevalence pot estimates current data, not past cases. C A prevalence pot is a way of depicting the total number of cases of a disease in a population that takes into account issues related to duration of the disease and the incidence of the disease. D A prevalence pot depicts the number of cases of one disease for a given population.

The PHN recognizes that environmental science, epidemiology, biostatistics, biomedical sciences, and ____ form the foundational subjects of public health. A. Economics B. The humanities C. Social and behavioral sciences D. Anthropology

ANS: C Feedback A Although economics could be a useful tool to assess the impact of a health program, it is not considered one of the foundational subjects. B The humanities are not considered a key component of public health. C Many branches of social and behavioral sciences are useful for analysis of public health issues. D The study of man and his development is nonessential to public health.

The nursing student is studying learning theories. He learns that television commercials are an example of which learning theory? A. Constructivism B. Cognitivist C. Bandura's theory of social learning D. Behaviorism

ANS: C Feedback A Constructivism is a learning theory that includes reflecting on our own experiences and knowledge. B Cognitivist focuses on inner mental activity and knowledge that has changed thought patterns through rationally responding to an external stimulus. C Bandura's theory of learning specifically connects understanding, behavior, and environment. Whereas the other theories listed are based in behavior and cognitive frameworks, Bandura's theory stresses imitation and reinforcement in learning. In this example, the audience is encouraged to mimic the behavior seen on the commercial. D Behaviorism includes the theory of classical conditioning, which emphasizes that change comes with an environmental stimulus resulting in a response.

If a nurse is focusing on prevention and establishing a public health intervention for an illness by following the natural history of a disease, he or she is: A. Making sure that everyone in a certain area receives treatment B. Studying the biological components of the disease C. Looking at medical trends of clients who have had the disease D. Going to the autopsies of the patients who have died

ANS: C Feedback A Following a disease does not involve treating everyone in an area. B Studying the biological components of the disease may help in some aspects, such as prescribing antibiotics, but this is not part of following the natural history of a disease. C Following the natural history of a disease allows the nurse to identify who is at the greatest risk by looking at the groups who have had it. D Following the natural history of a disease allows the nurse to identify who is at the greatest risk for developing the disease by looking at groups who have had it. This does not include attending autopsies.

If the logic model is used for its linear reasoning in program design, the implementer will read the model like a map, from left to right, whereas stakeholders will read the steps: A. From left to right B. All at once C. From right to left D. By scanning

ANS: C Feedback A Implementers will read the model like a map to understand what resources are available for implementation, what program is to be produced, and with what results. B The model is not static and can be improved through evaluation, but this would be difficult to accomplish reading it as a whole. C Stakeholders should read the steps from right to left, understanding the impact and outcomes first, then determining what activities and output are needed. Finally, they would establish what resources are necessary to implement the intended activities. D Scanning does not insure capture of the details needed to operate a program.

The PHN understands that chronic diseases have replaced communicable diseases as the major disease classification for: A. Larger third world countries B. Low-income countries C. High-income countries D. Smaller, more primitive countries

ANS: C Feedback A Larger third world countries still have many communicable diseases. However, because of better sanitation and hygiene, the numbers have decreased. B Low-income countries have fewer medical resources and problems with person to person transmission of disease. There is a lower life expectancy. C High-income countries have very few problems with communicable diseases but have significant problems with noncommunicable diseases—also called chronic or lifestyle diseases—such as heart disease and diabetes. D Smaller, more primitive countries have limited medical resources and therefore, a higher rate of emerging communicable diseases.

The nursing student is taught correctly that local health departments do not oversee A. The surveillance of disease B. Investigation of disease outbreaks C. Licensing of local hospitals D. Public sanitation and water supply

ANS: C Feedback A Local agencies protect the health of the citizens that live in their county, municipality, or township. They are watchful for conditions that might spawn disease. B Once there is a disease outbreak, local health departments work to contain it. C Hospitals are licensed by state and federal agencies, not local health departments. D Local agencies monitor waste disposal and the water supply to assure quality.

A PHN has a patient that has multiple medical issues that have developed over time. The nurse suspects that the issues are due to working in a chemical plant. The plant was monitored carefully, but a direct cause of his illness will be difficult to prove because: A. Safety records of the plant do not pertain to the health records of the patient. B. The patient has medical problems that could be caused by lifestyle decisions. C. Toxic substances often have thresholds below which exposures do not present human health risks but above which can prove to have adverse and sometimes fatal consequences. D. Some toxic substances are difficult to trace in medical tests.

ANS: C Feedback A Organizations such as the Environmental Protection Agency (EPA) and the National Institute for Occupational Safety and Health (NIOSH) have monitored safety and researched how to reduce toxic risks because the health and safety of plant workers are in fact connected. B It would be fairly straightforward to clarify what illnesses are caused by toxic substances and what diseases are caused by poor diet and health choices. C Understanding toxic substances and at what threshold they begin to have negative health effects is a continual research process. For this reason, it is difficult to establish a clear cause-and-effect relationship between exposure to toxins and disease. D As the sensitivity of pathological tests continue to improve, the presence of toxic substances is becoming easier to detect.

A nurse is planning for the community acceptance of a program, estimating resources, developing specific plans for activities, and establishing program management. The nurse is currently working on A. Project management B. Program evaluation C. Program implementation D. Program planning

ANS: C Feedback A Project management is an end-to-end process that includes everything from project planning to implementation. B Program evaluation is the process that analyzes the effectiveness of the program after it has been implemented. C Program implementation encompasses the resources needed for a program as well as the mechanism for putting the program in place. D Program planning is part of the larger health planning process, beginning with the assessment and continuing with the development of the program.

According to Issel, when planning a health intervention in a diverse community concerning improving diet, the factor that must be evaluated (which includes shared geographic origin, language and dialect, religious faith, folklore, and food preferences) is termed ____. A. Race B. Culture C. Ethnicity D. Custom

ANS: C Feedback A Race refers to the physical appearance of a group and has to do more with genetics. B Culture refers to beliefs, values, and norms shared across a group of people. C Ethnicity includes shared geographic origin, language and dialect, religious faith, folklore, and food preferences. D Customs are common rituals attributed to a group of people.

A nursing student is studying public health. She learns that, according to C.E.A. Winslow's definition, some of the goals of public health are disease prevention, promoting health, control of communicable infections, and ____. A. Risk assessment for disease B. Birth control C. Education on personal hygiene D. Governmental safety regulations

ANS: C Feedback A Risk assessment is considered a part of disease prevention. B Birth control is not considered to be one of the goals of public health. C Health education and the promotion of healthy lifestyles are essential parts of public health. D The goal of public health is to guide governmental policy but not to create regulations.

A nursing instructor explains to a nursing student that information about a community's health services and resources includes all of the following factors except: A. Service use patterns B. Treatment data C. Insurance costs D. Provider/client ratios

ANS: C Feedback A Service use patterns look at how medical services and resources are used. B Treatment data examines what types of health-care issues are currently being treated. C Insurance costs are not considered part of a community's health services and resources. D Provider/client ratios report whether there is enough, too little, or too much staff working with the population.

A nursing instructor is giving a lecture on genetics and genetic testing. The instructor explains that there is a lot of controversy over testing for BRCA1 and BRCA2, the tumor suppressing genes that, if mutated, may indicate hereditary breast and ovarian cancer. The arguments against genetic testing for BRCA1 and BRCA2 include all of the following except: A. The cost of the test is high. B. The evidence to the effectiveness of the test is limited. C. The test is difficult to perform. D. Less than 10% of all breast cancers are genetically based.

ANS: C Feedback A Testing can cost up to almost $3,000.00 for those who do not know their family history. B The direct benefit of the testing in reducing cancer rates is not known. C This is not one of the arguments against screening for BRCA1 and BRCA2. D Because so few breast cancer cases are genetically related, questions have been raised about the ethics of universal screening.

The PHN understands that which layer of government is responsible for issuing quarantines? A. Federal B. State C. Local D. All of the above

ANS: C Feedback A The Constitution did not provide for such an agency, but the Centers for Disease Control and Prevention (CDC) does public health research. Still, quarantines are mostly managed at the local level. B State constitutions empower the states to establish state boards of health. Their duty is to protect the citizens, but quarantines are mostly managed at the local level. C Quarantines are mostly managed at the local level. D All levels of government are not needed or agile enough to handle local health crises.

In 2011, the National Prevention Strategy released a plan to increase the number of Americans who are healthy at every stage of life. The National Prevention Strategy was authorized by the: A. Department of Health and Human Services B. Centers for Disease Control and Prevention C. Affordable Care Act D. American Medical Association

ANS: C Feedback A The Department of Health and Human Services is the U.S. government's main agency for the protection of health of all Americans, but it did not authorize the National Prevention Strategy. B The Centers for Disease Control and Prevention is a research facility that aids the development of better public health, but it is not a legislative body and did not authorize the National Prevention Strategy. C The National Prevention Strategy was part authorized by the legislation of the Affordable Care Act. D The American Medical Association is the professional association of medical doctors. It does not enact governmental mandates and did not authorize the National Prevention Strategy.

Due to health concerns for high-risk populations, Healthy People 2020 includes as one of its main goals: A. To provide better insurance programs B. To have collaboration among governmental agencies C. To provide access to preventive health-care services D. To improve assessment of services

ANS: C Feedback A The Healthy People 2020 document provides structure to bring a uniformity of care but not necessarily access to insurance. B Collaboration among agencies is not a distinct goal of Healthy People 2020. C The quickest method to aid high-risk populations is to give preventative health care and to avoid secondary and tertiary health problems. D Assessment of services does not directly improve health care for high-risk populations.

A PHN uses the Mobilizing for Actions through Planning and Partnerships (MAPP) strategic model because of its distinct use for assessing what particular aspect of a public health situation? A. Financial B. Mortality C. Intervention D. Geographic

ANS: C Feedback A The MAPP tool includes the full scope of health planning including assessment, diagnosis, developing an intervention, implementing the intervention, and evaluating the effectiveness of the intervention. B The MAPP tool includes the full scope of health planning including assessment, diagnosis, developing an intervention, implementing the intervention, and evaluating the effectiveness of the intervention. C The MAPP tool includes the full scope of health planning including assessment, diagnosis, developing an intervention, implementing the intervention, and evaluating the effectiveness of the intervention. D The MAPP tool includes the full scope of health planning including assessment, diagnosis, developing an intervention, implementing the intervention, and evaluating the effectiveness of the intervention.

The PHN recognizes that which of these tests is not an indicator of health literacy? A. The Test of Functional Health Literacy in Adults (TOFHLA) B. Rapid Estimate of Adult Literacy in Medicine (REALM) C. National Quality Forum (NQF) D. Suitability Assessment of Material (SAM)

ANS: C Feedback A The TOFHLA is a 50-item reading comprehension and numerical test available in English and Spanish that tests the ability of the patient to understand health-related materials. B REALM is used to assess the reading skills of patients. C The NQF is an agency for health-care quality, safety, and infection control, but not a test. D SAM assesses health information for content and cultural appropriateness.

According to the CHANGE model, the aspect of a community that includes community-wide efforts that have an effect on the social and built environments such as improving food access, walkability or bike-ability, tobacco use or exposure, or personal safety is called the: A. Community institution or organization sector B. Health-care sector C. Community-at-large sector D. Preventative sector

ANS: C Feedback A The community institution or organization sector includes entities within the community that provide a broad range of human services and access to facilities such as childcare settings, faith-based organizations, senior centers, boys and girls clubs, YMCAs, and colleges or universities. B The health-care sector includes places where people go to receive preventive care or treatment or emergency health-care services such as hospitals, private doctors' offices, and community clinics. C The community-at-large sector includes community-wide efforts to improve the social and built environments. D A preventative sector is not included in the CHANGE model's list of sectors.

The history and development of epidemiology has gone through several developmental phases. The public health nursing student learns that these phases came about in history in what order? A. Risk factor phase, infectious disease phase, and sanitary phase B. Infectious disease phase, risk factor phase, and sanitary phase C. Sanitary phase, infectious disease phase, and risk factor phase D. Agent phase, host phase, and environment phase

ANS: C Feedback A The first phase, the sanitary phase, was due to the theory that sanitation needed to be improved to aid health. During the next phase, the infectious disease phase, germ theory was developed and antibiotics came into production. The third phase, the risk factor phase, turned to reducing risk for disease and prevention. B The first phase, the sanitary phase, was due to the theory that sanitation needed to be improved to aid health. During the next phase, the infectious disease phase, germ theory was developed and antibiotics came into production. The third phase, the risk factor phase, turned to reducing risk for disease and prevention. C The first phase, the sanitary phase, was due to the theory that sanitation needed to be improved to aid health. During the next phase, the infectious disease phase, germ theory was developed and antibiotics came into production. The third phase, the risk factor phase, turned to reducing risk for disease and prevention. D The agent, host, and environment model is the Epidemiology Triangle, which is the model used to explaining the occurrence of disease.

A PHN is assigned to an area to do a community assessment. The demographic data the nurse collects includes: A. Insurance company preference B. Religious affiliation C. Educational levels D. Medical results

ANS: C Feedback A The names of the insurance companies used in a community are not considered demographic information and are not necessary data to collect during a community assessment. B The religious affiliations of the community are not considered demographic data. Demographic data include age, gender, socioeconomic indicators, racial or ethnic distributions, and educational levels. C Educational levels, as well as age, gender, socioeconomic indicators, and racial or ethnic distributions, are considered demographic data. D Medical results are not considered demographic data. Demographic data include age, gender, socioeconomic indicators, racial or ethnic distributions, and educational levels.

Using the Kinship/Economics/Education/Political/Religious/Associations (KEEPRA) model for observing formal institutions in a community, the PHN recognizes that which of the following categories assesses the number or availability of recreational centers? A. Education B. Kinship C. Associations D. Economic

ANS: C Feedback A Education refers to the observation of schools and other educational institutions such as libraries and museums. B Kinship refers to the observation of family and family life. C Associations refer to the observation neighborhood associations, business associations, and recreational centers. D Economic refers to the observation of whether the community has a stable economy and whether there are signs of economic growth or decline.

Keeping in mind distal social determinants when helping a community, a nurse uses the resources available to: A. Build a better playground. B. Build a better clinic. C. Build a better school. D. Build a better community grocery store.

ANS: C Feedback A The distal social determinants are income, education, housing, and racism. Building a better playground may encourage community spirit, but it would not change the health status of the community as effectively as an intervention or program that improves these social determinants. B The distal social determinants are income, education, housing, and racism. The addition of a clinic would make health care more accessible, but it would not change the health status of the community as effectively as an intervention or program that improves these social determinants. C The distal social determinants are income, education, housing, and racism. The construction of a better school would change the distal social determinants by improving education and thus employment. D The distal social determinants are income, education, housing, and racism. The addition of a better grocery store does not address the distal social determinants.

In community organizing, the PHN recognizes that her role is that of a: SELECT ALL THAT APPLY. A. Stakeholder B. Leader C. Listener D. Facilitator E. Developer of skills

ANS: C, D, E Feedback 1 This is incorrect. A stakeholder is someone that a program will directly impact. 2 This is incorrect. In community organizing, a nurse will want to grow leaders, but is not considered to be one. 3 This is correct. When a nurse becomes a listener, he or she can more easily digest information and direct it to the correct place. 4 This is correct. A nurse will need to be a facilitator and bring the community the resources that it needs. 5 This is correct. The nurse can train the community and help them develop the skills they need to improve their health situation.

A PHN was asked to come to a town that was having some noticeable health problems. Driving through town, the nurse noted that there were many for-sale signs, as well as very little green space and some trash in the street. This preassessment phase is called a: A. Community themes and strengths assessment B. Community Health Assessment aNd Group Evaluation (CHANGE) C. Community health status assessment D. Windshield survey

ANS: D Feedback A A community themes and strengths assessment is an assessment of how the residents feel about their health and quality of life. B The CHANGE model helps communities build an action plan based on assets and needs. C A community health status assessment focuses on quantitative data covering many health indicators, such as mortality and morbidity. D A windshield survey is a drive or walk through the community to observe the community.

An epidemiologist uses the epidemiological triangle to explain the occurrence of disease by looking at the three main components of the model: the host, the environment, and the agent. The PHN understands that the agent could be one of many types except: A. Biological and chemical B. Nutritive C. Physical D. Ecological

ANS: D Feedback A An example of a biological agent is an organism. Examples of chemical agents include liquids and gases. B A nutritive agent could be a certain dietary component or the lack of a dietary component. C A physical agent could be a mechanical or atmospheric force, such as an earthquake. D Ecological does not refer to a type of agent. The final agent type is psychological, an example of which could be stress.

In order to develop maintenance and survival strategies for a community in the event of an emergency, a PHN looks for useful places, persons, and systems. This part of the assessment is called: A. Capacity building B. Needs assessment C. Participatory research D. Asset mapping

ANS: D Feedback A Capacity building is the concept that helps communities understand the deficiencies and obstacles that inhibit their people, governments, and organizations from attaining their goals while enhancing the abilities that will allow them to achieve measurable and sustainable results. B Needs assessment is a systematic set of procedures undertaken for the purpose of setting priorities and making decisions about program or organizational improvement and allocation of resources. The priorities are based on identified needs. C Participatory research aims at the engagement of members of the community as full partners in the process of assessment. The idea is to use a collaborative approach that combines the knowledge and interest of the community members with the expertise of the professionals. D Asset mapping is a combination of finding assets (useful qualities, persons, or things) and mapping—that is, exploring, planning, and locating where they are for a time when they are needed.

A public health nurse (PHN) is asked by the hospital administration to find out why there are so many pediatric asthma patients coming to the ER for treatment and to develop a plan to reduce admissions by 10%. The nurse needs to untangle the multiple risk factors involved in order to determine what type of intervention should be developed, so he or she uses: A. Descriptive data analysis B. The ecological model C. Demography D. The web of causation

ANS: D Feedback A Descriptive data analysis is the first step in the analysis of demographic data. It analyses the accuracy of the data, but does not look at risk factors. B The ecological model is used to design health promotions to maintain and improve health and evaluate behaviors. It is not used to visualize risk factors. C Demography is the population-level study of person-related variables or factors. It is used to understand population-level patterns related to health phenomena. This may be helpful, but it does not consider the other levels of risk factors. D The web of causation is a framework that demonstrates the complexity of the multiple factors of illness, injury, and disease, which are determined by multiple causes.

According to O'Donnell's definition of health promotion, how could a public health nurse advise a company to encourage its employees to work toward good health? A. Lower insurance premiums for good health habits B. Have employee exercise classes or discounted health club memberships C. Have incentives for healthy eating D. All of the above

ANS: D Feedback A Financial benefits or savings would promote behavioral change. B Health club memberships would facilitate the employees' ability for change. C Encouraging a good diet through incentives would promote healthy behavior. D All of the options listed above promote good health and reduce the risk for illness.

The public health nurse (PHN) knows that he must approach a public health problem with an understanding of the related underlying risk factors in order to develop effective nursing interventions. He must also consider that these risk factors can be either ____ based or ____ based. A. Disease; individual B. Intervention; Government C. Epidemic; population D. Individual; population

ANS: D Feedback A His approach cannot be disease based, as diseases can affect populations in multiple locations but the risk factors can be different. B Interventions occur after the public health event, and governments can only follow the evidence of public health studies. C An epidemic is an occurrence of a disease and has the same limitations as a disease-based approach. D Nurses may work with patients to assess risk and intervene on a one-to-one, situational basis or as part of a larger health problem within a population.

A nursing instructor is giving a lecture on public health and the importance of maintaining a population-focused perspective when administering care. Which of the following statements might a nursing student hear from the instructor? A. Individual health occurs within the context of the population. B. Individual health occurs within the context of the environment surrounding the individual. C. Individuals achieve health at the individual level through individualistic actions. D. Both 1 and 2

ANS: D Feedback A Individual health occurs within the context of both the population and the environment surrounding the individual. B Individual health occurs within the context of both the population and the environment surrounding the individual. C Individuals do not achieve health at the individual level through uninformed, individualistic actions. Instead, individual health occurs within the context of the population and the environment surrounding the individual. D Individual health occurs within the context of the population and the environment surrounding the individual.

A patient diagnosed with diabetes buys books, reads articles, talks with knowledgeable people, informs himself about what he can do to improve his health, and takes action. The PHN recognizes this method of adult learning as A. Pedagogy B. Andragogy C. Constructivism D. Humanism

ANS: D Feedback A Pedagogy is the correct use of teaching strategies to provide the best learning. B Andragogy is the art and science of helping adults learn. C Constructivism is a learning theory that includes reflecting on our own experiences and knowledge. D Humanism is defined as self-directed learning through examining personal motivation and goals. It also includes the development of personal actions to fulfill one's personal motivation and goals.

A nurse is giving a lecture on communicable diseases and indicates that West Nile virus is spread by all of the following except: A. Poor sanitation conditions B. Insects C. Poor hygiene D. Tainted food

ANS: D Feedback A Poor sanitation can cause an increase in mosquitoes which transmit the virus. B West Nile virus could be decreased by creating a more hostile environment for mosquitoes, which carry the virus. C Improving poor hygiene can help health conditions for all diseases. D Tainted food usually results in a gastroenteric sickness, but it is not associated with West Nile virus.

A nursing student is learning about a type of sampling in which a list of the possible participants is present and the number needed for the sample is divided into the total population. From that point, n, every nth person is chosen for the sample. The student learns that this type of sampling is called: A. Quota sampling B. Convenience sampling C. Simple random sampling D. Systematic sampling

ANS: D Feedback A Quota sampling is a type of convenience sampling that involves a fixed number of subjects. B Convenience sampling takes into consideration the availability of participants. C Simple random sampling uses a list of the eligible individuals and then selection is made based on a random selection. D Systematic sampling is used for large populations and involves the method described here.

If a PHN is working for the cause of social justice within a community, he or she will distribute a vaccine A. Only to children B. Only to the elderly C. Only to those who have insurance D. To everyone equally, according to the resources available

ANS: D Feedback A Social justice dictates that everyone, not just children, should have access to basic health services. B The idea of justice states that everyone, not just the elderly, should have basic opportunities for a healthy life. C Those who have insurance are not the only ones who should have the opportunity for a healthy life, according to the concept of social justice. D Social justice dictates that everyone should have equal access to basic health services, according to the resources available.

A family does preconception testing for early identification of cerebral palsy to make childbearing decisions by using genetic markers. The PHN recognizes that this area of study is called: A. The Human Genome Project B. Behavioral Risk Factor Surveillance System (BRFSS) C. Ecological epidemiology D. Genomics

ANS: D Feedback A The Human Genome Project is a large epidemiological study that is working to understand genetic factors in populations. B The BRFSS is a resource that captures population- level trend data for health behavior. C Ecological epidemiology is the study of the environmental factors, such as community and living situation, in which a disease has been discovered. D The field of genetic epidemiology that seeks to understand the inheritability of factors that have an impact on the development of illness and disease is called genomics.

If the international medical community was working to contain several worldwide pandemics, they would look to the World Health Organization (WHO), which is A. The public health arm of the United Nations B. Working to improve health and well-being for the global population C. Working with nurses to promote public health interventions D. All of the above

ANS: D Feedback A The World Health Organization (WHO) is the "directing and coordinating authority for health within the United Nations system." B The WHO has the capability to monitor global epidemiological situations. C The WHO brings resources and knowledge to nurses who are working directly with patients in order for them to make informed decisions. D This is correct. The WHO is the public health arm of the United Nations and works toward both of the above mentioned goals.

In the traditional public health prevention framework, the level of prevention that includes early detection and initiation of treatment for disease, or screening, is referred to as the: A. Clinical level B. Primary level C. Tertiary level D. Secondary level

ANS: D Feedback A The clinical level is not a level of prevention in the traditional public health framework. B The primary level of prevention includes intervention, not screening. C The tertiary level includes prevention of disability and premature death, not screening. D The secondary level includes screening.

A nurse could encourage prevention for a patient with diabetes by A. Having the patient try an experimental treatment B. Asking them to share their experiences with other people C. Having them take doses of the prescribed medicine on a PRN, or as needed, basis. D. Helping him or her to slow the progression of the disease and prevent secondary illnesses related to the disease, such as blindness

ANS: D Feedback A The experimental medication might or might not work, so prevention might not occur. B Sharing experiences with other people might help the patient's morale and guide other people to better health, but it will not prevent the progression of the disease. C Taking the prescribed medicine as needed might lessen side effects, but it might not be the most therapeutic and beneficial path for the patient. D The most beneficial function the nurse could perform is to help the patient avoid additional illnesses by encouraging good health care through programs and practices.

Based on the ecological model of health, a nurse would evaluate which of the following to understand why a community is having a large incidence of recurring respiratory infections? A. Local health-care facilities B. Community health-care programs C. Medical tests results D. Living and employment situations

ANS: D Feedback A The local health-care facilities would not be a part of the patient's environment so the nurse would not evaluate them based on the ecological model. B The community health-care program could assist in health promotion and risk reduction activities, but it is not a place the nurse would evaluate to understand the increasing rate of infection according to the ecological model. C Medical tests could diagnose the underlying problems, but they would not illuminate the causes of the problems according to the ecological model. D Based on the ecological model, the public health nurse would evaluate how, where, and with whom the patients spent most of their time.

The public health nursing student is studying outbreak investigations and disease trends. The student learns that the disease that has seen an increase in the last 30 years after a decline in the 1970s is: A. West Nile virus B. H1N1 virus C. Influenza D. Pertussis

ANS: D Feedback A There has been a decrease in incidence of West Nile virus due to improved environmental conditions and insect management. B H1N1, or swine flu, has decreased due to better education about personal hygiene. C Influenza has decreased due to a public health vaccination program and better personal hygiene. D The recent resurgence of pertussis in adults and older people is probably due to a less aggressive vaccination campaign.

A PHN is looking for a tool to help conduct a community assessment. The nurse can get such a tool from the: A. National Institute of Occupational Safety and Health (NIOSH) B. Affordable Care Act (ACA) C. Institute of Medicine (IOM)'s report The Future of Public Health D. Community Health Assessment aNd Group Evaluation (CHANGE)

ANS: D Feedback A This is incorrect. NIOSH is responsible for conducting research and making recommendations for the prevention of work-related illnesses and injuries. B This is incorrect. The ACA is the legislation that requires that assessments should be conducted. C This is incorrect. The IOM's report The Future of Public Health indicates that improving health in populations or communities has been linked to performing comprehensive assessments. D This is correct. CHANGE has a tool that includes a process for conducting a comprehensive assessment of a community.

Pressure to slant or misuse the findings of an evaluation from the stakeholders would be what kind of problem? A. Moral B. Management C. Confidentiality D. Ethical

ANS: D Feedback A A moral problem pertains to one's personal character issues and has larger implications in an ethical system. This example is not dealing with personal character issues. B This is an example of an ethical issue, not a managerial one. If the findings of an evaluation were misused or changed, the ethical issue might become a managerial issue later. C Confidentiality would be a problem if the data of the program's participants were breached. D Ethics make up the code of behavior of a group and impact a social system. In this case, the ethics of the health program would be compromised.