Community health exam 1 test bank

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

ANS: A A public health or population-focused approach would look at the entire group of children being served to determine whether available services are effective in achieving the goal of improving the health of the school population. Caring for clients and their families focuses on individuals and families and not on the entire population. Public health focuses on care of populations

The nurse learns that a family has declined an elective medical intervention for a health care problem because paying for the care would drastically reduce the family's resources and ability to meet the needs of other family members. Ethically, which of the following actions should be taken by the nurse? a. Appreciate that the family has made the decision that it feels is best and take no further action if it is clear the family has made an informed choice. b. Stress that each individual in society has a right to health care and the family will have to create some way to raise funds for the needed treatment. c. Talk to the media to see whether a campaign to raise funds for the family can be created. d. Try to convince the agency to give the care for free, even if it means economic stress for the agency, because the medical need is obvious

ANS: A According to Callahan, although the nurse may attempt moral persuasion to change the family's values, in the absence of immediate and grievous harm, no ethical requirement exists to interfere with the family's values. Because there is no immediate or grievous harm, it is not in the best interest of the nurse to interfere with the family's decision. Thus, the other answers are not an appropriate action for the nurse to take

From an ethical standpoint, what is the problem with the belief that everyone should receive his or her fair share, that life should always be fair, and that everyone should make his or her own decisions? a. With this belief, the needs of society as a whole are ignored. b. Insufficient resources exist to give everyone a fair share. c. This belief leads to a propensity for some people to like to be taken care of. d. Some people think they deserve more than others

ANS: A All principles of justice focus on the individual, which ignores the needs of society as a whole. The rights of an individual may conflict with the rights of the community as a whole. It is recognized that distribution should be based on what needs and deserves there is considerable disagreement that exists when considering what these terms mean in the context of fairness

Which question asked by a novice nurse would be the most reflective of an understanding of the role of a public health nurse? a. "Which groups are at the greatest risk for problems?" b. "Which patients should I see first as I begin my day?" c. "With which physicians will I be most closely collaborating?" d. "With which nursing assistants will I partner the most?"

ANS: A Asking which groups are at greatest risk reflects a community-oriented perspective. The incorrect responses reflect a focus on individuals rather than a community-oriented perspecti

Which statement best describes community-based nursing? A. A practice in which care is provided for individuals and families. b. Providing care with a focus on the group's needs. c. Giving care with a focus on the aggregate's needs. d. A value system in which all clients receive optimal care.

ANS: A By definition, community-based nursing is a setting-specific practice in which care is provided for "sick" individuals and families where they live, work, and attend school. The emphasis is on acute and chronic care and the provision of comprehensive, coordinated, and continuous care. These nurses may be generalists or specialists in maternal-infant, pediatric, adult, or psychiatric mental health nursing. Community-based nursing emphasizes acute and chronic care to individuals and families, rather than focusing on groups, aggregates, or systems

A city has announced its plans to build a city dump near a community of poor and predominantly African-American citizens. Which of the following principles would the nurse be using when vocalizing opposition for this plan? a. Environmental justice b. Environmental epidemiology c. Tertiary prevention d. Risk communication

ANS: A Environmental justice is the goal of campaigns seeking to improve the unequal burden of environmental risks borne by impoverished and minority communities. The Environmental Justice Act would be used in support of the nurse's position. Environmental epidemiology is concerned with the discovery of environmental exposures that contribute or protect against disease or illness which is not accomplished by the nurse vocalizing opposition to the plan. Vocalizing opposition to the plan would not be a tertiary prevention strategy as the nurse is addressing a problem that does not yet exist. Risk communication includes general principles of good communication (right information, to the right people, at the right time). In this scenario, the nurse is vocalizing opposition, not communicating risks

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

ANS: A In most nursing practices, the client seeks out and requests assistance. In public health nursing, the nurse often reaches out to those who might benefit from a service or intervention, beginning with assessment of needs. The other answers reflect responses where the nurse is trying to give assistance to this population that may or may not be helpful or welcomed

Which of the following terms describes when a nurse practitioner receives a set monthly payment to take care of a group of clients regardless of the services needed and provided? a. Capitation b. Fee for service c. Rationing d. Retrospective reimbursement

ANS: A In payment by capitation, practitioners are paid a set amount to provide care to a given client or group of clients for a set period of time. In the fee-for-service payment system, which is like the retrospective reimbursement, the practitioner determines the costs of providing a service, delivers the service to a client, submits a bill for the delivered service to a third-party payer, and is paid by the third-party payer. Rationing implies reduced access to care and potential decreases in the acceptable quality of services offered

A client states to the nurse, "I have heard the Affordable Care Act is supposed to help improve the health care I receive, but so far I have seen no benefits from this legislation." Which of the following statements would be the best reply by the nurse? a. "Maybe you have not directly seen the changes; however, several things have changed in health care because of this bill." b. "It will take years to see any effects from the act because of the delays in implementation of the changes." c. "This legislation will primarily improve care for the elderly and poor populations, so this is why you may not have seen any benefits." d. "The way health care operates at the federal and state levels has changed, so most individuals will not see any direct impact."

ANS: A It is possible that unless one has been in a situation where changes have been made, that one may not realize any of the effects of this law. The goal of the Affordable Care Act was to improve the health of the nation and access care. Several changes to health care have already been made because of this legislation, and more changes will continue in the future. Multiple provisions of the act will affect individuals and families

Which of the following best defines the word politics? a. The art of influencing others b. The outcome of governmental policies c. A provision of power for making decisions d. The result of legislative action

ANS: A Politics is the art of influencing others to accept a specific course of action. Political action results in governmental policies and legislation. The result of legislative action typically is done in the form of laws and policies. The provision of power for making decisions is typically assumed by the government

Which of the following actions represents the use of secondary prevention to reduce environmental health risks? a. Collecting blood specimens from preschool children to check for lead levels b. Meeting with local government officials to request that the city clean up a hazardous vacant lot c. Referring a child with toxic lead levels to a neurologist d. Teaching parents of a 2-year-old about the dangers of lead-based paint in older home

ANS: A Secondary prevention refers to actions such as surveillance and screening, which are undertaken so that problems may be detected at early stages. Meeting with local government officials to request that the city clean up a hazardous vacant lot and referring child with toxic lead levels to a neurologist are examples of tertiary prevention as the problem already exists. Education to avoid exposure is part of primary prevention which relates to teaching parents about the dangers of lead-based paint in older homes

Which of the following is generally considered to be nursing's first code of ethics? a. Nightingale Pledge b. Code for Professional Nurses c. Code of Ethics for Nurses d. Principles of the Ethical Practice of Public Health

ANS: A The Nightingale Pledge is generally considered to be nursing's first code of ethics. After the Nightingale Pledge, the Code for Professional Nurses was formally adopted by the ANA House of Delegates in 1950. It was amended and revised five more times, until, in 2001 the ANA House of Delegates adopted the Code of Ethics for Nurses with Interpretive Statements. The Principles of the Ethical Practice of Public Health was approved in 2002

Which of the following demographic factors is expected to have the greatest influence on national health care spending? a. The aging population b. Use of diagnosis-related groups to determine reimbursement c. Insurance reform d. An increasing number of people without health insurance

ANS: A The aging population is expected to affect health services more than any other demographic factor. The majority of older adults rely on publicly funded programs. As the Baby Boom generation ages and retires, federal expenses for Social Security and health care will increase. The use of diagnosis-related groups to determine reimbursement started in 1983 and is not expected to have a great influence on national health care spending at this time. Insurance reform is not a demographic factor. Due to the Affordable Care Act, the number of people without health insurance is decreasing

Which of the following payment systems tries to keep clients healthy through education and health promotion, with the goal of reducing the need for professional health care intervention and therefore also lowering cost? a. Managed care plan b. Fee-for-service payment c. Prospective reimbursement d. Retrospective reimbursement

ANS: A The concept of managed care is that costly care could be reduced if consumers had access to education and health promotion. Fee-for-service payment encourages more services to be given. Reimbursement, whether prospective or retrospective, is based on the same criteria, but managed care integrates the financing and the delivery of health care

A community citizen reports to the public health nurse that the city water in one neighborhood has had an unusual taste for the past few months. Which of the following actions should the nurse take first? a. Check the most recent consumer confidence report. b. Consult the Centers for Disease Control and Prevention. c. Notify the Environmental Protection Agency (EPA). d. Place a call to the poison control center.

ANS: A The consumer confidence report (also known as the right-to-know report) reports the condition of drinking water. Because this is only one citizen, whose sense of taste may be affected by many conditions, it would not be appropriate to overreact by calling in governmental agencies or poison control first. Even so, in case one needed to contact an authority, it would be appropriate to start with local governmental agencies such as the city water department rather than federal agencies

Which statement best describes the goal of community-oriented nursing? A. Providing care to individuals and families b. Providing care to manage acute or chronic conditions c. Giving direct care to ill individuals within their family setting d. To preserve, protect, promote, or maintain health and prevent disease

ANS: D By definition, community-oriented nursing has the goal of preserving, protecting, or maintaining health and preventing disease to promote the quality of life. All nurses may focus on individuals and families, give direct care to ill persons within their family setting, and help manage acute or chronic conditions. These definitions are not specific to community-oriented nursing

A public health agency is planning to implement the electronic health record. (Which is a benefit of this choice? a. Facilitation of interprofessional care b. Improved client compliance with medical regimens c. Cost savings to the agency d. Compliance with JCAHO standard

ANS: A The electronic medical record facilitates interprofessional care in chronic disease management and coordination of referrals; 24-hour availability of records with downloaded laboratory results and up-to-date assessments; incorporation of protocol reminders for prevention, screening, and management of chronic disease; improvement of quality measurement and monitoring; increased client safety; and decline in medication errors. There is no evidence that an electronic health record improves client compliance with medical regimens. Electronic health records can increase costs to an agency. JCAHO does not accredit public health agencies

Which of the following activities is completed by the executive branch of the federal government? a. Administration of policy b. Interpretation of policy c. Proposal of policy d. Passage of policy

ANS: A The executive branch administers and regulates policy. The legislative branch proposes policy (as bills) and passes policy (as laws). The judicial branch interprets laws

A pregnant teenager has approached a nurse asking about ways to improve the health outcomes for her and her unborn child. Which of the following statements would be most appropriate for the nurse to make? a. "Don't drop out of school." b. "Sign up for childbirth classes." c. "Sign up for the WIC program." d. "Take your prenatal vitamins daily.

ANS: A The question specifies the health of both the mother and the child. Socioeconomic conditions improve with education. Because socioeconomic status is inversely related to mortality and morbidity, by becoming better educated, the mother-to-be will be less likely to live a life of poverty and, as a consequence, will enjoy a greater chance of better health for herself and for her child. The priority of the nurse should be to encourage the teenager to stay in school as this choice will provide for the best long-term outcome for the client. Signing up for childbirth classes, the WIC program, and taking prenatal vitamins all address short-term outcomes which are not as important as the future of the teenager raising this child

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

ANS: B Any of these descriptions might represent a nurse communicating, cooperating, or collaborating with community residents or groups about health concerns. A major challenge for the future is the need for public health nursing specialists to be more aggressive in working collaboratively with various groups in the community as well as professional colleagues in institutional settings to deal with barriers to health. However, the nurse who spent the day attending meetings of various health agencies is the most representative, because in public health, concerns are addressed from a broader perspective. In public health, broad concerns of the community should be addressed. Concerns are broader than recreation, individual concerns are not as important as aggregate priorities, and watching television (a one-way form of communication) is less effective than interacting with others.

Which of the following statements about children and environmental hazards is correct? a. The prevalence of autism is directly related to the increase in environmental toxins. b. Children are more susceptible to environmental toxins because of their smaller size. c. The incidence of asthma among children has been decreasing. d. Children are more susceptible to cancer if they have a family history of the disease.

ANS: B Because of the smaller size of children, they are exposed to higher doses of pesticide residues in the foods they eat and drink. Infants and young children drink more fluids per body weight than adults, and this increases the dose of contaminants in their drinking water, milk (hormones and antibiotics), and juices (particularly pesticides). Only a small percentage of childhood cancers are associated with heredity. However, exposure to ionizing radiation increases the risk of childhood leukemia and possibly other cancers. All of the causes of autism spectrum disorder are not currently known. Environmental factors are thought to be a possible cause, as are biologic and genetic factors. Asthma is common among children, and the strongest risk factors are genetic factors and inhaled substances and particles that provoke an allergic reaction or irritate the airways. Indoor air quality is a growing concern because of the alarming rise in the incidence of asthma in the United States, particularly among children

A nurse is discussing how health care rationing occurs in the United States. Which of the following would most likely be discussed as the criterion that is used to ration health care? a. Clinic operating hours b. Ability to pay for services c. Availability of local provider services d. Transportation availability

ANS: B Because there are not enough health care services available to provide desired services to everyone, the focus has been on reducing costs by controlling the use of services. All of the factors listed affect health care access and therefore affect health care rationing (either directly or indirectly). The primary determinant, however, is the ability to pay for services. Without this ability, services are denied; therefore, those without insurance that is accepted by a provider or institution or who do not have the money to pay out of pocket are unable to obtain services regardless of operating hours, transportation issues, or availability

Which of the following groups pays the largest amount for health care in the United States today? a. Consumers b. Federal and state government c. Insurance companies and other third-party payers d. Hospitals and health care providers

ANS: B Combined state and federal governments paid the most for health care in 2018. Health care financing has evolved from a time when the most money was expended by consumers, then to a system financed by third-party payers such as insurance companies, and finally, to today, when state and federal government payments (primarily through Medicare and Medicaid) pay more than private insurance companies or consumers. From 1960 to 2018, the percentage of third-party public insurance payments increased and the percent of out-of-pocket payments declined

A nurse is assessing potential environmental health risks in the community. Which of the following would be the first step that the nurse should take? a. Conduct health risk assessments of randomly selected individuals. b. Perform a windshield survey. c. Review facility permits and consumer confidence reports. d. Survey community members.

ANS: B Conducting a windshield survey is a useful first step to understanding potential environmental health risks. This provides firsthand information about the community and areas of concern that must be investigated. Conducting health risk assessments of randomly selected individuals or surveying community members does not give the nurse a good assessment of potential environmental health risks of the entire community. Reviewing facility permits and consumer confidence reports would not provide enough information to assess the environment of a community

A nurse is determining whether a hospital has the right to require infected patients to be isolated against their will. To which type of law will the nurse refer? a. Common law b. Constitutional law c. Legislation and regulation d. Judicial law

ANS: B Constitutional law provides the right to intervene in a reasonable manner to protect the health, safety, and welfare of the citizenry. State power concerning health care is called police power. This power allows states to act to protect the health, safety, and welfare of their citizens. The state must show that it has a compelling interest in taking actions, especially actions that might infringe on individual rights. The state can isolate an individual to prevent an epidemic, even though this infringes on individual rights. The community's rights are deemed more important than the individual's rights when there is a threat to the health of the public. Judicial law, based on court and jury decisions, and the principles of common law (precedent, justice, fairness, respect for an individual's autonomy, and self-determination) are both used by court's as the basis to make a decision and do not relate to having the right to isolate a patient. Legislation is law that comes from the legislative branches of the government and regulations are specific statements of law related to defining or implanting individual pieces of legislation. Neither are as important in this case as the constitutional law of the police power of the states in regards to isolation of a patient

Minority nurses represented about 30.1 percent of the RN population. What is this an example of? a. Projection b. Disparity c. Racism d. A sentinel event

ANS: B Disparities are racial or ethnic differences in the quality of health care or representation of a faction of the population, not based on access or clinical needs, preferences, or appropriateness of an intervention. Projection is an estimate or forecast of a future situation based on current trends. Racism is a prejudice that exists against someone of a different race based on the belief that one's own race is superior. A sentinel event is an unanticipated event in health care that results in death or serious injury to the patient

Which of the following best describes the purpose of local health departments making unannounced inspections of local restaurants? a. To enforce local laws and regulations b. To ensure compliance c. To provide oversight to potential exposure d. To monitor employee safety

ANS: B Ensuring compliance refers to the process of making certain that permitting requirements are met. Although this activity may be seen as a type of monitoring, the question asks for the purpose, which is to ensure compliance. Enforcement involves penalties such as fines or facility closure

With which of the following ethical approaches are Gilligan and Noddings associated? a. Distributive justice approach b. Feminine ethic c. Principlism approach d. Virtue ethics

ANS: B Gilligan and Noddings are associated with the approach known as the feminine ethic, which focuses on the morality of responsibility in relationships that emphasize connection and caring as a moral imperative. Distributive justice (fair distribution of the benefits and burdens of society), Principlism (relying on ethical principles for decision- making), and virtue ethics (seeking to enable persons to flourish as human beings) were not developed by Gilligan and Noddings

Which of the following accurately describes a challenge that will be faced by health care providers in the 21st century? a. Lack of available space to provide care for clients in hospitals b. Emergence of new and old communicable and infectious diseases c. New guidelines for chronic disease management d. Increased use of technology leading to a decreased need for health care workers

ANS: B In the 21st century, the emergence of new and the reemergence of old communicable and infectious diseases are occurring as well as larger foodborne disease outbreaks and acts of terrorism. Care for clients continues to move out of the hospital setting and into the community. Chronic disease management will be a challenge for health care providers; however, new guidelines should ease the care provided for these diseases and wouldn't be seen as a challenge. The use of technology will continue to increase, but the need for health care workers will not be decreasing. New health care careers will emerge because of the changes in technology

How does managed care (MC) attempt to control costs of care? a. By encouraging families to use the point of service list of individual practice associates b. By requiring families to choose a care provider from the MC network and not allowing access to other services without their provider's permission c. By moving Medicaid-eligible families onto state Medicare enrollment d. By refusing permission for families to use urgent care or emergency department services

ANS: B Managed care is a system in which care is delivered by a specific network of providers. Each provider serves as a gatekeeper who controls access to other providers and services. Cost is reduced because members cannot use specialists or seek hospital or other care without permission from their primary-care providers. Thus, those enrolled in Medicaid managed care have restrictions that help keep costs down for government (and for taxpayers). Managed care provides care through a specific network of providers who agree to comply with the care approaches established through a case management approach, not through a point of service list of individual practice associates. Medicaid and Medicare programs are not interchangeable, these programs serve different populations. Managed care does not refuse permission for certain services such as urgent care or emergency department, rather a case management approach is used to control costs

A Medicare recipient has elected to pay a monthly premium for Medicare that will cover expenses such as durable medical equipment. Which of the following best describes this part of Medicare? a. Part A b. Part B c. Part C d. Part D

ANS: B Medicare Part B is a supplemental (voluntary) program; it provides coverage for services that are not covered by Part A, such as laboratory services, ambulance transportation, prostheses, durable medical equipment, and some supplies. Medicare Part A covers hospital care, home care, and skilled nursing care. Medicare Part C plans are coordinated care plans that include health maintenance organizations, private fee-for-service plans, and medical savings accounts. Medicare Part D provides prescription drug coverage

Which of the following statements best describes the law in relation to clinical practice by nursing students? a. Students are considered certified until licensure is obtained. b. Students are expected to meet the same standard of care as the professional nurse. c. Students are not legally liable for errors because they practice under the license of their instructor. d. Students have a scope of practice determined by the nurse practice act

ANS: B Nursing students need to be aware that the same laws and rules that govern the professional nurse apply to them as well. Students are expected to meet the same standard of care as that met by any licensed nurse practicing under the same or similar circumstances. Although it is true that students cannot practice outside the scope of practice determined by the nurse practice act, they also cannot perform the tasks and responsibilities of the licensed practitioner within the scope of practice until they have received adequate knowledge; therefore, the scope of practice for the student is determined by the instructor, based on the student's level of education

A bill with the potential to decrease health care services is passed by Congress. Which of the following actions should the nurse take to influence the bill's implications? a. Exercise veto power by calling for petitions from health care agencies. b. Contact the regulatory agency and participate in public hearings. c. Call members of congress to request that they rescind the legislation that was passed. d. Discuss the change in services with the administrators at the hospital

ANS: B Once a bill is passed and becomes law, it is too late to influence congressional members to change their vote; however, it is not too late to influence the outcome of the vote because the nurse can influence how the law is regulated. An agency typically writes the regulations that control how the law is implemented in more specific detail. Often this process can be just as important as lobbying against a bill because it shapes the final implementation of the law. Health care agencies do not have the ability to veto a bill. After a bill has been passed, it is too late to contact members of congress. Calling the hospital will not change the implications of the bill. Contact must be made with the regulatory agency in order to influence how the law is regulated

Which of the following is most closely correlated with poor health? a. Age and gender (i.e., older males) b. Low socioeconomic status c. Minority race status d. High-risk lifestyle behaviors

ANS: B Poverty is more closely related to health status even when controlling for age, gender, race, education, and lifestyle behaviors. The rate of uninsured remained higher among people with lower incomes and lower among those with higher incomes. Households of three with less than $20,000 annual income are at the highest risk for being uninsured. Socioeconomic status has the closest correlation to health status; thus, age, gender, minority race status, and high-risk lifestyle behaviors do not have the closest correlation

Which statement best describes ideal primary health care? a. Based on a multidisciplinary group of health care providers that work as a team b. Essential care available to all community members, which encourages self-management c. Focused on health promotion and disease prevention for everyone enrolled in the health center d. Local efforts to meet the Declaration of Alma Ata principles

ANS: B Primary health care is generally defined as essential care made universally accessible to individuals, families, and the community. Health care is made available to them with their full participation and is provided at a cost that the community and country can afford. Public health is described as organized and multidisciplinary efforts aimed at preventing disease and promoting health, not primary care. Primary care provides for the integration of health promotion, disease prevention, with curative and rehabilitative services. The Declaration of Alma Ata was aimed at a world-wide, not local goal, to attain a level of health that permitted all citizens of the world to live socially and economically productive lives

A nurse is implementing a primary prevention strategy focusing on economics within the community. Which of the following interventions is the nurse most likely completing? a. Applying for a grant to establish a daycare center to serve dependent older adult clients living with working families b. Persuading legislators to pass a bill offering health care financial aid to families at risk c. Screening cocaine addicts for financial assistance eligibility for drug treatment d. Referring clients with renal failure to apply for Medicare

ANS: B Primary prevention occurs before an illness or condition develops. Of the options provided, only persuading legislators to pass a bill offering health care financial aid to families at risk addresses initiating interventions before an illness occurs. Applying for a grant and referring clients with renal failure both demonstrate the use of tertiary prevention as the illness or condition has already developed. Screening cocaine addicts displays the use of secondary prevention as a screening technique is being used to identify the problem as soon as possible

Which of the following is considered the most important goal in nursing today? a. Adapting to technological advances such as electronic medical records b. Demonstrating caring as the basis of nursing practice c. Distinguishing nursing care from medical care d. Seeking evidence-based outcomes to demonstrate nursing's contribution to care

ANS: B Since the mid-1980s, nurses have written about caring as the essence of nursing and as the ethical and moral ideal of nursing practice. Caring is part of the core values of public health nursing and addresses the importance of the fiduciary relationship between the patient and the care provider. The primary goal of nursing is not to adapt to technological advances, distinguish nursing from medical care, or seek evidence-based outcomes; rather, the goal of nursing is to implement caring which has been the moral ideal of nursing for many years

Which of the following best describes why local, state, and federal governmental agencies have started to cooperate and collaborate more closely in the last few years? a. Increased administrative pressures to demonstrate outcomes b. Increased focus on emergency preparedness and response c. Increased taxpayers' complaints and general unhappiness d. Increased pressure to decrease overlap in services

ANS: B Since the tragedy of September 11, 2001, health departments have increasingly focused on emergency preparedness and response. In case of an emergency event, state and local health departments in the affected area will be expected to collect data and accurately report the situation, to respond appropriately to any type of emergency, and to ensure the safety of the residents of the immediate area, while protecting those just outside the danger zone. This goal—to enable public health agencies to anticipate, prepare for, recognize, and respond to terrorist threats or natural disasters—has required an unprecedented level of interstate and federal-local planning and cooperation among these agencies. Demonstrating outcomes and decreasing overlap of services are both important factors to consider; however, this is not the reason why increased collaboration has occurred. There has not been an increase in taxpayer complaints or unhappiness that has caused these changes to occur

A nurse wants to find information about environmental threats that are present in the community. Which of the following would be the best source of data for the nurse? a. Cumulative Index of Nursing and Allied Health (CINAHL) database b. National Library of Medicine c. State health department d. Closest local library

ANS: B Technology helps us understand environmental threats. The National Library of Medicine (NLM) databases are user-friendly and accessible on the Internet. The NLM website provides access to medical databases such as PubMed and GratefulMed, which can be searched for possible environmental linkages to illnesses using key terms. The CINAHL database provides access to literature related to nursing and allied health journals and would not be as comprehensive as the National Library of Medicine. It would be difficult to access information easily through the health department. The information that is available at the local library would be dependent on the community in which one lived

A nurse is developing a plan to decrease the number of premature deaths in the community. Which of the following interventions would most likely be implemented by the nurse? a. Provide free health care to all citizens b. To increase the number of individuals with access to effective health care benefits c. Lower the cost of health care to the American population d. To lessen the governmental burden of providing health care to Americans

ANS: B The central feature in the Patient Protection and Affordable Care Act (ACA) of 2010 are the mechanisms to increase the number of people with health insurance. The care provided is not necessarily free. While the cost of health care and the burden it places on the American government are serious concerns, they are not the primary focus of ACA

How can nurses know whether they have been effective in assessing the community and planning and implementing appropriate interventions? a. Ask community leaders for their opinion of the interventions. b. Examine the morbidity and mortality rate of the community. c. Reassess the community to determine whether obvious needs have been met. d. Systematically survey community residents regarding their perception

ANS: B The end products of appropriate advocacy are decreased morbidity and mortality. In other words if advocacy has been effective, public health problems will be decreased. Effectiveness cannot be assessed accurately by asking community leaders for their opinions, reassessing the community, or surveying community members regarding their perception; data must be collected to determine results

A public health nurse is working with a client who does not have health insurance. Where will the nurse most likely direct the client to in order to receive care? a. Managed care b. Community health center c. Emergency department d. Physician office

ANS: B There is a safety net for the uninsured or underinsured. These are the federally funded community health centers which provide a broad range of health and social services, using nurse practitioners and RNs, physician assistants, physicians, social workers, and dentists. Community health centers serve primarily in medically underserved areas which can be rural or urban as well as people of all ages, races, and ethnicities, with or without health insurance. Managed care is a system in which care is delivered by a specific network of providers who agree to comply with the care approach, not a place to refer a client without health insurance. Emergency departments and physician offices are not the best place for an individual without health insurance to receive care. Both are expensive and do not provide the necessary resources for the individual to possibly receive health insurance

A new nurse states to a nursing colleague, "But why do I have to be involved in politics? I just want to be the very best clinical nurse I can." Which of the following would be the best response from the nursing colleague? a. "As long as you pay your membership fee to the American Nurses Association, you have participated in the profession's political endeavors." b. "Political action is the way you try to fulfill your ethical responsibilities to clients." c. "You're absolutely right; if you are good clinically, you have fulfilled your obligation." d. "When you've completed your clinical orientation, then you'll have time to be involved in politics.

ANS: B To be a good clinical nurse, the nurse needs resources and supportive policies that can be obtained only through political action to ensure those very resources and policies. Many clients are members of vulnerable groups who have often previously lacked access to quality care at an affordable cost. The American Nurses Association Code of Ethics for Nurses emphasizes political action as the mechanism to affect social justice and reform regarding homelessness, violence, and stigmatization. Nurses need to be involved in the political process in more ways than only being a dues paying member to the American Nurses Association. Clinical practice is not the same as political involvement; political involvement is necessary to achieve the advocacy role of the nurse. Nurses must make a conscious effort to be involved in political action

A nurse wants to help keep the community environment safe. Which of the following is the most appropriate action for the nurse to take? a. Conserve water by bathing less often. b. Downsize to a smaller living space. c. Reduce, reuse, and recycle. d. Replace all his or her appliances with new energy-efficient ones

ANS: C All persons can engage in minimizing their impact on the environment by reducing, reusing, and recycling the individual products they currently consume. Although it would be nice to replace all appliances for energy-efficient newer models, most people can't afford that—furthermore, it is an environmental issue to discard the used models. Similarly, downsizing to a smaller living space could help the environment, because the nurse would use less energy, but again, not everyone can afford all the expenses involved in moving

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

ANS: C An aggregate is defined a collection of people who share one or more personal or environmental characteristics. Members of a community can be defined in terms of either geography (e.g., a county, a group of counties, or a state) or a special interest (e.g., children attending a particular school). These members make up a population. The term population may be used interchangeably with the term aggregate. A large group of persons, a collection of individuals and families, and another name for demographic group are not accurate definitions of the term aggregate.

A nurse is completing a basic health assessment. Which of the following questions should be asked by an environmentally aware nurse? a. "Is anyone else in your family having these symptoms?" b. "How many people live in your home?" c. "What jobs have you held the longest?" d. "Where did you live 10 years ago?"

ANS: C An exposure history should identify current and past exposures, have a preliminary goal of reducing or eliminating current exposures, and have a long-term goal of reducing adverse health effects. The "I PREPARE" mnemonic consigns the important questions to categories that can be easily remembered. Asking about previous employment helps to answer the "P" of past work. The other questions do not address the topics identified in the "I PREPARE" mnemonic (investigate potential exposures, present work, residence, environmental concerns, past work, activities, referrals, and resources, and educate).

How are ethics and public policies similar? a. Both are abstract principles that often differ in actual practice. b. Both are best achieved by persons in high political office who can effect change. c. Both strive for the public good. d. Both use general principles in making decisions

ANS: C An important goal of both policy and ethics is to achieve the public good, and both are involved in good citizenship. Ethics involves the application of specific principles when making decisions. There is nothing that supports that ethics and public policies are better achieved by those in high political office

Which of the following agencies has the most influence on the health and welfare of US citizens? a. Agency for Healthcare Research and Quality (AHRQ) b. Centers for Disease Control and Prevention (CDC) c. US Department of Health and Human Services (USDHHS) d. World Health Organization (WHO)

ANS: C As the agency to which most health care legislation is delegated, the USDHHS is the agency most heavily involved with the health and welfare of citizens. The AHRQ and CDC are divisions of the USDHHS. WHO's policy-making body provides policy options and guides but not laws. In the textbook, only the USDHHS is discussed regarding its responsibility for Medicare and Medicaid through the Centers for Medicare and Medicaid Services (CMS)

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

ANS: C Assurance includes making sure that essential community-oriented health services are available in the community. The definition does not fit the terms assessment, policy development. Scientific knowledge-based care is not a core function of public health. Assessment is systematic data collection on the population, monitoring the population's health status, and making information available about the health of the community. Policy development refers to efforts to develop policies that support the health of the population, including using a scientific knowledge base to make policy decisions

Which of the following must a nurse be knowledgeable about to make decisions regarding the most cost-effective way to allocate health care resources? a. Insurance resources b. Health care rationing c. Health economics d. Medical technology

ANS: C Economics is the science concerned with the use of resources; health economics is concerned with how scarce resources affect the health care industry. Insurance resources, health care rationing, and medical technology are important components of health economics but by themselves do not provide the broad understanding called for in this question

An occupational health nurse at a local factory is using primary prevention strategies to reduce the environmental health risks among the employees. Which of the following activities would the nurse most likely implement? a. Checking radiation detectors to monitor for unsafe levels of radiation exposure b. Irrigating the eyes of an employee who has had a chemical splash to the face c. Teaching new employees who will work outdoors about the signs and symptoms of heat-related illness d. Using spirometry to rule out obstructive or restrictive lung disease for workers who will be wearing mask respirators

ANS: C Education is a primary preventive strategy. When examining the sources of environmental health risks in communities and planning intervention strategies, it is important to apply the basic principles of disease prevention. Checking radiation detectors and using spirometry are both examples of screening for potential exposure which is part of secondary prevention. Irrigating the eyes of an employee who had a chemical splash to the face addresses tertiary prevention as a problem has already occurred

A nurse who works at the local hospital asks a public health nurse what might be causing her hands to become very sore and sensitive. Which of the following statements would be the most appropriate response by the public health nurse? a. "Ask the staff in employee health if there have been any other complaints." b. "Call the local health department about any recent problems at the hospital." c. "Check the material safety data sheet on any chemicals you have used recently." d. "See the nurse's health care provider for a complete work-up."

ANS: C Employees have the right to know about hazardous chemicals with which they work. Employers must maintain a list of all hazardous chemicals used on the premises, along with a material safety data sheet that addresses health risks related to these chemicals, as well as information about safe use and handling. After checking the material safety data sheets, the next steps would be to connect with a health care provider which could include staff in employee health, a local health department, or one's own health care provider. The first step should be to determine what exposure occurred

How can ethics be applied to public health nursing practice? a. Ethics and actual nursing practice are not related. b. Knowing ethics allows nurse to recognize the source of most problems. c. Ethics is constantly involved in nurses' clinical decisions. d. Although ethics is important, political and legal responsibilities are more important in practice.

ANS: C Ethical problems in public health nursing include inequities in power, unacceptable practices, inequitable resource allocation, conflict between ethics and law, and inadequate systems support for nursing. Therefore, ethics permeates every aspect of public health nursing as nurses attempt to meet the needs of the community. Ethical principles are applied in nursing practice on a regular basis and assist with problem-solving. The use of ethics does not allow the nurse to recognize the source of most problems. The used of ethics is more important than political and legal responsibilities in practice

A nurse didn't know what to do when faced with a particular ethical dilemma because an option that would have a good outcome didn't seem possible. The nurse decided to talk to the agency supervisor and decide what action to take. Which of the following best describes the nurse's actions? a. Appropriate, because the supervisor is responsible for the nurse's choices. b. Intelligent, because the supervisor has access to resource persons (clergy, physicians, administrators) who might know of options the nurse hadn't considered. c. Justified, because this provides an opportunity to discuss the issue but the nurse maintains responsibility for the decision. d. Wise, because the supervisor would be more knowledgeable concerning agency priorities and traditional practices.

ANS: C Ethically, each nurse is responsible for his or her own decisions and cannot avoid ethical accountability by relying on obedience to a supervisor or any external rule or policy. The supervisor is not responsible for the nurse's choices, the nurse must maintain responsibility for his/her own decisions. The nurse should have access to the same resources as the supervisor and should have similar knowledge as the supervisor

Which statement best describes the cost of health care in the United States? a. Health care costs are kept low, and the indicators of health are among the best worldwide. b. Health care costs are low which has resulted in poor health outcomes. c. Health care costs are the highest in the world, but the indicators of health are not the best worldwide. d. Health care costs and indicators of health are the highest in the world.

ANS: C Health care costs in the United States are the highest in the world and comprise the greatest percentage of the gross domestic product, the indicators of what constitutes good health do not document that Americans are really getting their money's worth. Health care costs are not low in comparison to the rest of the world. The health outcomes in the United States are poor in comparison to other countries who spend less money on health care

A nurse is explaining the health care system in the United States to a group of health care providers visiting from South America. How would the nurse best describe the current health care system? a. "It is a logical, rational approach to meeting expressed needs while still trying to control costs." b. "It is a centralized system that provides care in hospitals." c. "It is divided primarily into two components: private health care and public health care." d. "It is the best in the world with outstanding research and high-technology care available to all."

ANS: C Health care in the United States consists of a private or personal care system and a public health system, with overlap between the two. The United States health care system is one of the most expensive systems in the world that does not do a good job at controlling costs. Care is provided through an enormous range of facilities and providers, including hospitals, physicians' and dentists' offices, nursing homes, mental health facilities, ambulatory care centers, and freestanding clinics. Although there is great research and high-technology care in the United States, the health care outcomes of the country do not reflect this. Health care disparities exist among multiple populations making this system not available to all

Who is responsible for determining the scope of practice for registered nurses? a. American Nurses Association b. Federal legislators c. State legislators d. US Department of Health and Human Service

ANS: C Health care practitioners are subject to the laws of the state in which they practice. The state nurse practice acts define the practice of professional nursing, identify the scope of nursing practice, set educational qualifications, and determine legal titles. The nurse practice act is governed by legislators in each state. The American Nurses Association, US Department of Health and Human Services, and federal government do not determine the scope of practice for nurses; this responsibility is the role of state governments. The US Department of Health and Human Services is the agency most heavily involved with the health and welfare of US citizens

A nurse is providing care to a child whose parents do not receive health insurance as an employee benefit and who do not have the financial resources to pay for health care out of pocket. Which of the following resources should the nurse recommend to the family? a. A managed care organization b. An emergency department c. Medicaid d. Medicare

ANS: C Medicaid provides coverage for adults with low income and their children. Managed care is a type of private insurance while Medicare is available to persons aged 65 and older. The emergency department would charge a co-pay for care given to both the child and the parents

Which of the following services would be covered under Medicare Part A? a. Blood draw to assess PT/INR b. Physical therapy visit c. Stay in skilled nursing facility d. Transportation by an ambulance

ANS: C Medicare Part A covers hospital care, home care, and skilled nursing care. Medicare Part B covers "medically necessary" services, such as health care provider services, outpatient care, home health, and other medical services such as diagnostic services and physiotherapy

A nurse wishes to see a bill passed to support funding for the use of interpreters for clients with limited English proficiency. Which of the following would be the best time for the nurse to request support from the local senator, who is not on the committee that is reviewing this bill? a. When the bill is first assigned to a committee. b. When the bill is discussed and debated within the committee. c. When the bill moves out of committee to be heard by the entire Senate. d. When the bill passes the Senate and moves to the House of Representatives

ANS: C Once the bill is passed by committee and moves out of committee to be heard by all senators, it will be important to contact this senator, who will then be in a position to act on it. To contact the senator when the bill is first assigned to the committee or is being discussed and debated within the committee is too early to effectively influence the individual senators. The nurse would not want to wait until after the vote has been taken in the Senate because it would then be too late for the senator to act

Which of the following statements best describes why the federal government has become involved in health care? a. The states asked the federal level to become involved. b. Because of rising costs to the states, the federal budget needed to be used to pay for necessary services. c. The Constitution gives the federal government the power to promote the general welfare. d. This step was necessary to standardize care on a national level

ANS: C One of the first constitutional challenges to a federal law passed by Congress was in the area of health and welfare in 1937. The Supreme Court (judicial branch) reviewed the legislation in question and determined, through interpretation of the Constitution, that such federal governmental action was within the powers of Congress to promote the general welfare. According to Article I, Section 8 of the US Constitution Congress has multiple roles in relation to health care: provide for the general welfare, regulate commerce among the states, raise funds to support the military, and provide spending power. Thus, Congress was within its role to become involved in health care and was not asked to do so by the states or used to standardize care on the national level

The staff cannot reach an agreement on what is the right thing to do in relation to a specific patient. Which of the following approaches should the nurse use in personally deciding what is right? a. Do whatever will not get the nurse in trouble with employer. b. Do whatever is supported by an ethical expert, such as the hospital chaplain. c. Do whatever the nurse would recommend to anyone in a similar situation. d. Do whatever the nurse supervisor would feel comfortable reporting to adminiStration

ANS: C One of the rules in deontological decision-making is to determine whether the proposed actions can be generalized so that all persons in similar situations are treated similarly. In the same way, Principlism suggests the nurse examine the context and make the decision that can be morally justified within that context. In order to apply the deontological ethics decision process, the nurse must first determine the moral rules that serve as standards by which individuals can perform their moral obligations, examine their own personal motives, and then determine whether the proposed actions can be generalized. Doing whatever will not get the nurse in trouble, whatever is supported by an ethical expert, or whatever the nurse supervisor feels comfortable with is not an appropriate way to make an ethical decision

Which of the following best explains how the government unintentionally encourages low-income persons to use emergency departments as their primary care provider? a. A huge amount of paperwork is required when Medicaid clients go to a physician's office. b. Government regulations require Medicaid clients to use emergency departments when their primary health care provider is unavailable. c. Legally, emergency departments must see clients even if clients can't pay. d. Physicians' limited office hours make them unavailable during evenings and weekends.

ANS: C People on Medicaid frequently have no primary care provider and may not be able to pay for their care. Although physicians can choose clients based on their ability to pay, emergency departments are required by law to evaluate every client regardless of ability to pay. Emergency department co-payments are modest and are frequently waived if the client is unable to pay. Thus, low out-of-pocket costs provide incentives for Medicaid clients and the uninsured to use emergency departments for primary care services. Limited physician office hours over the weekend does make it difficult for low-income persons to access care through a primary care provider; however, this is not influenced by a government decision. The government does not require Medicaid clients to use the emergency department when their primary care provider is unavailable, rather the policies of the emergency department to see all clients regardless of ability to pay may inadvertently encourage them to use this service. The paperwork at a physician's office that needs to be completed by a Medicaid client is not any different than any other client receiving care at the office

Which of the four main factors that affect health, is the most important? a. Environment b. Human biology c. Lifestyle choices d. Health care system

ANS: C Personal biology and behavior (or lifestyle), environmental factors and policies (including physical, social, health, cultural, and economic environments), social networks, living and working conditions, and the health care system—medical services are said to have the least effect. Behavior and lifestyle have been shown to have the greatest effect on longevity, with the environment and biology accounting for the greatest effect on the development of all illnesses

Which of the following statements by a client indicates a lack of understanding regarding an appropriate reason to sue for professional negligence? a. "Because the health care workers didn't turn my mother every 2 hours, she developed bedsores." b. "I received permanent nerve damage because they would not remove a cast that was too tight." c. "My daughter wasn't given a call light, and for a whole shift no one checked on her condition." d. "They amputated the wrong leg during surgery."

ANS: C Professional negligence, or malpractice, is defined as an act (or failure to act) that leads to injury. All of the choices specify an injury, except for "My daughter wasn't given a call light, and for a whole shift no one checked on her condition," in which case the care was substandard but no injury resulted. The incorrect responses all specify an injury whereas professional negligence, or malpractice, is defined as an act (or failure to act) that leads to injury

Which of the following laws established programs for provision of health services for women and children and supported community-oriented nursing practice? a. Early Periodic Screening and Developmental Testing (EPSDT) Initiative b. Healthy People 2000 Initiative c. Sheppard-Towner Act d. State Child Health Improvement Act (SCHIP)

ANS: C The Sheppard-Towner Act of 1921 played an important role in the development of public health policy, public health nursing, and social welfare policy. Of particular importance was the fact that it established standards for programs to serve women and children and made nurses available to provide these services in the community setting. Within the Sheppard-Towner Act was a provision to start the EPSDT initiative. SCHIP provides insurance for children and families who cannot otherwise afford health insurance. Healthy People 2000 focuses on promoting health and preventing disease for all Americans

The nurse is examining blood lead levels in school-age children 1 year after a community-wide education intervention. Which of the following phases of the nursing process is being implemented? a. Assessment b. Diagnosis c. Intervention d. Evaluation

ANS: D In this instance, the nurse is evaluating the results of the intervention to determine whether goals were reached. Assessment would have been done earlier in the process because this was needed to determine that a problem existed and that interventions were needed. Diagnosis occurs when the disease and environmental factors are related to the diagnosis. When intervention is used, the nurse coordinates medical, nursing, and public health actions to meet the client's needs

A man entered the emergency department bleeding profusely and screaming, "I've got to see a doctor right now! I've got a right to see a doctor! I'm hurt. You have to take care of me!" Which of the following premises would ethically justify such a demand for immediate attention? a. All hospitals receive federal money and all capable employed adults pay taxes, so all adults have a right to what their tax money has purchased. b. Saving an individual's life improves society and upholds tradition. c. Our society believes that all persons should be treated equally and that basic needs, such as not dying if death can be avoided, should be met. d. The man has a property right to his own body, and the government is responsible to ensure that property rights are protected

ANS: C The ethical theory of egalitarianism suggests that everyone is entitled to equal rights, equal treatment, and an equal share of the goods of society—and that the government's role is to ensure this happens, at least on a basic level. Therefore, the man has a right to emergency care. Hospital funding and use of taxpayer money does not demonstrate the use of an ethical principle. Saving an individual's life may or may not improve society. There is not an ethical principle that states that the man has a property right to his own body

Which of the following is the first and most crucial step in a generic ethical decision-making process? a. Assess the context or environment in which the decision must be made. b. Consider the various ethical principles or theories. c. Identify the ethical issues and dilemmas. d. Make a decision and act on it

ANS: C The first step in the ethical decision-making framework is to identify the ethical issue or dilemma. After the first step of identifying the ethical concern, the following steps are: (2) place the ethical issue or dilemma within a meaningful context, (3) obtain all relevant facts, (4) reformulate ethical issues or dilemmas, if needed, (5) consider appropriate approaches to action or options, (6) make the decision and take action, and (7) evaluate the decision and action

A nurse meets with a senator to lobby for passage of a bill to increase funding for interpreter services. With which of the following branches of the government is the nurse working? a. Constitutional branch of government b. Executive branch of government c. Legislative branch of government d. Judicial branch of government

ANS: C The legislative branch of government is composed of the Senate and the House of Representatives. The legislative branch identifies problems and proposes and then debates, passes, and modifies laws to address those problems. There is not a constitutional branch of the government. The executive branch administers and regulates policy. The judicial branch interprets laws

What is the basic assumption stated by Healthy People 2010 as it relates to public health efforts? a. Health disparities among any groups are morally and legally wrong. b. Health care is the most important priority in government planning and funding. c. The health of individuals cannot be separated from the health of the community. d. The government is responsible for lengthening the life span of Americans

ANS: C The major premise of Healthy People 2010 was that the health of the individual cannot be entirely separate from the health of the larger community. Public health practice focuses on the community as a whole, and the effect of the community's health status (resources) on the health of individuals, families, and groups. The goal is to prevent disease and disability and promote and protect the health of the community as a whole. Public health can be described as what society collectively does to ensure that conditions exist in which people can be healthy. The basic assumptions of public health do not judge the morality of health disparities. The focus is on prevention of illness not on spending more on illness care. Additionally, individual responsibility for making healthy choices is the directive for lengthening life span not the role of the government

Some nurses are debating about the appropriate action to take in relation to a particular family. The father is ill, and the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, "It is a wife's responsibility to care for an ill husband." Which of the following ethical approaches is being used by this nurse? a. Consequentialism b. Communitarianism c. Deontological ethics d. Principlism

ANS: C The nurse is focusing on duty, which is a deontological approach based on the moral obligation to engage in certain actions. The nurse is focusing on duty, which is a deontological approach based on the moral obligation to engage in certain actions. Based upon this understanding, none of the other options correctly describes the nurse's statement

Some nurses are debating about the appropriate action to take in relation to a particular family. One member of the family is ill, and the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, "But it doesn't have to be an either/or situation. Perhaps each family member could take a turn calling in sick just 2 or 3 days. That way they could all take a turn at helping and yet not upset their employers. Wouldn't that be fair?" Which of the following ethical approaches is being used by this nurse? a. Communitarianism b. Deontology c. Principlism d. Utilitarianism

ANS: C The nurse is focusing on ethical principles—in this case, beneficence (do good for the ill family member), nonmaleficence (do no harm, even to the employer), and justice (everyone takes a turn and shares equally). Communitarianism is similar to virtue ethics and looks at the relationship and responsibility between the individual and the community. The ethical approach of deontology describes adhering to moral rules or duty rather than to the consequences of the actions. Utilitarianism is a consequentialist ethical theory associated with outcomes or consequences in determining which choice to make

Some nurses are debating about the appropriate action to take in relation to a particular family. One member of the family is ill, and the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, "It's not up to us; it's the family's decision. They know what is best for them." Which of the following ethical approaches is being used by this nurse? a. Communitarianism b. Deontology c. Principlism d. Utilitarianism

ANS: C The nurse is using an ethical principle, namely autonomy, in which each person or group can choose those actions that fulfill its values and goals. Therefore, the nurse is using Principlism—that is, basic principles are the basis of the nurse's actions. Communitarianism is similar to virtue ethics and looks at the relationship and responsibility between the individual and the community. The ethical approach of deontology describes adhering to moral rules or duty rather than to the consequences of the actions. Utilitarianism is a consequentialist ethical theory associated with outcomes or consequences in determining which choice to make

Which of the following is responsible for the dramatic increase in life expectancy during the 20th century? a. Technology increases in the field of medical laboratory research b. Advances in surgical techniques and procedures c. Sanitation and other population-based prevention programs d. Use of antibiotics to fight infections

ANS: C There has to be indisputable evidence collected over time that public health policies and programs were primarily responsible for increasing the average life span from 47 in 1900 to 78.6 years in 2017, an increase of approximately 60% in just over a century plus through improvements in (1) sanitation, (2) clean water supplies, (3) making workplaces safer, (4) improving food and drug safety, (5) immunizing children, and (6) improving nutrition, hygiene, and housing. Although people are excited when a new drug is discovered that cures a disease or when a new way to transplant organs is perfected, it is important to know about the significant gains in the health of populations that have come largely from public health accomplishments

An 80-year-old woman comes to the community health care facility with a large bag of medications. She tells the nurse she can no longer afford these medications because her only income is Social Security. Which statement is the best response by the nurse? a. "Let's go through these medications and see which ones we can delete." b. "You can get these medicines at this clinic for free." c. "Let's see if we can get some help from Medicare to help you pay for these medications." d. "These medications are important. Do your best to pay for them."

ANS: C This elderly patient probably is eligible for benefits through Medicare Part D. Medicare Part D has been added to Medicare to help cover the cost of prescriptions. The role of the nurse would not be to delete medications for the patient or to tell the patient to figure it out on her own. Because of the age of the patient, the nurse should see if options exist under the Medicare system before looking into receiving the medications for free as there may be other barriers which limit the abilities to get these medications at a discounted cost

Which of the following would confirm that the nurse's advocacy has been truly successful or effective? a. Audiences agree with the nurse who is serving as advocate. b. Legislators discuss appropriate legislation to better allocate resources. c. People verbalize that the disenfranchised should be better treated. d. Systematic social changes are made to improve quality of life

ANS: D Advocacy is the application of information and resources to effect systematic changes that shape the way people in a community live to reduce death and disability and improve quality of life in the community. Only when systematic social changes are made to improve quality of life can advocacy be considered truly effective. Systematic change encompasses the complete role of the nurse as an advocate. Audiences do not necessarily have to agree with the nurse who is serving as advocate as different populations may have different views than the nurse. Advocacy goes beyond only working with legislators to allocate resources. Serving those who are disenfranchised is only one part of the advocacy role

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

ANS: D Although the public health nurse might engage in any of the tasks listed, he or she works primarily with members of the community to carry out core public health functions, including assessment of the population as a whole and engaging in promoting health and improving the environment. The interventions of asking community leaders which interventions should be chosen, assessing the community and deciding on appropriate interventions, and using data from health care institutions do not demonstrate the engagement of the community when making decisions about what the community actually wants and needs

Which of the following criterion is now used for deciding the amount of the reimbursement before care is provided? a. A proportion of actual cost arbitrarily decided by the Medicare panel b. The federal budget constraints for the current fiscal year c. Hospital and health care provider feedback and political persuasion d. Prospective payment scale based on the medical diagnosis

ANS: D As a result of rising health costs, Congress passed a law in 1983 that mandated an end to cost-plus reimbursement and instituted a prospective payment system (PPS) for inpatient hospital services to shift the cost incentives away from the providing of more care and toward more efficient services. The basis for prospective reimbursement is the 468 diagnosis-related groups (DRGs). There is not a Medicare panel that determines the actual cost of services. Payments are determined in advance based on DRGs and are not determined by the budget of the federal government. Hospital and health care provider feedback do not influence the prospective reimbursement; rather, the third-party payer establishes the amount of money that will be paid for the delivery of a particular service before offering the services to the client

A nurse is determining which health care services must be offered at a local public health clinic. Which factor is most important for the nurse to consider? a. Data available from the most recent community assessment b. Suggestions from community members about what is needed c. Recommendations from Healthy People 2020 d. Services mandated by the state government

ANS: D At the local level, health departments provide care that is mandated by state and federal regulations. Data available from the most recent community assessment, suggestions from community members about need, and recommendations from Healthy People 2020 could all be used. However, funding for these types of programs may not be available. The services that are mandated by the state government will be funded and allow the clinic to be able to provide these services

Which of the following individuals would most likely experience a barrier when accessing health care? a. A 40-year-old female who speaks English as a second language b. A 25-year-old female with co-pay health insurance c. A 50-year-old male with hypertension d. A 30-year-old male who is unemployed

ANS: D Barriers to accessing care include the inability to afford health care, lack of transportation, physical barriers, communication problems, childcare needs, lack of time or information, or refusal of services by providers. The unemployed male is most likely to experience a barrier because of not having a job, which may reduce his access to health insurance and limit his income. Those who speak English as a second language and have health insurance even with co-pay requirements should both find it easier to access health insurance than someone who is unemployed since the inability to afford health care is a primary barrier. Medical diagnoses, such as having hypertension, do not present a barrier to accessing health care

Some nurses are debating about the appropriate action to take in relation to a particular family. One member of the family is ill, and the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, "The whole family is being affected and will fall apart if they don't focus on their family's needs first before anything else." Which of the following ethical approaches is being used by this nurse? a. Communitarianism b. Deontology c. Principlism d. Utilitarianism

ANS: D By focusing on the whole family, not individual members, and the consequences or outcomes for the whole family during this time of stress, the nurse is taking a utilitarian approach. Principlism relies on these ethical principles to guide decision-making. Communitarianism is similar to virtue ethics and looks at the relationship and responsibility between the individual and the community. The ethical approach of deontology describes adhering to moral rules or duty rather than to the consequences of the action

A nurse is trying to maximize the quality of life of clients while reducing health care costs. Which of the following actions would most likely be completed by the nurse? a. Assisting in cast application for a client who was injured in a skateboard incident b. Irrigating the eyes of a client splashed with chemicals c. Restoring a normal cardiac rhythm following cardiopulmonary resuscitation of a client with a heart condition d. Teaching a high school boy about sexually transmitted infections and proper condom application

ANS: D Education is primary health care prevention. A proactive investment in disease prevention and health promotion targeted at improving health behaviors and lifestyle has the potential to improve health status and reduce health care costs. Assisting in a cast application, irrigating a client's eyes, and restoring a normal cardiac rhythm are all tertiary prevention methods as a condition has already occurred and the nurse is focusing on restoring health. In order to maximize quality while reducing health care costs, the nurse should focus on primary prevention strategies

Which of the following caused health care providers to begin to focus on individual infections and trauma in the 1900s in the United States? a. Education of health care providers moved into universities. b. People finally had enough money to pay for medical care. c. The improved outcomes of hospital care were recognized. d. Advances were made in sewage disposal, and water and milk quality.

ANS: D Environmental conditions influencing health began to improve with major advances in water purity, sanitary sewage disposal, milk quality, and urban housing quality. The health problems of this era were no longer mass epidemics but individual acute infections or traumatic episodes. The education of health care providers did move into universities during this time period; however, this is not the reason why there was an increased focus on infections and trauma. Health care was paid for primarily by individuals during this time period so there was not an increase in the amount of money available to pay for health care. The outcomes of hospital care improved because of the advances that were being made in technology, not because health care providers were focusing more on infections and trauma

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

ANS: D Historically, health care providers have been accused of providing care for or to people without actually involving the recipients in the decisions. Public health nursing is a "with the people"—not a "to the people" or "for the people"—approach to planning. There is an imperative to work with members of the community to carry out core public health functions. The purpose of meeting with community groups is not to increase their self-esteem or make them feel good about their contribution, rather it is to allow them to act for themselves to solve the problems they are facing. The first task of working with the group should occur before addressing maintaining communication links

Which of the following is the dominant issue in ethical debate around an issue such as continuing or withdrawing treatment in acute health care? a. Doing what is best for the community b. Doing what is best for the family c. Obeying legal mandates d. Upholding ethical principle

ANS: D In acute care settings with a single localized issue, the primary ethical principles are usually applied, with patient autonomy being the dominant or most crucial principle. Upholding ethical principles should be the first consideration before obeying legal mandates or doing what is best for the community or family

A client expresses concern that health care coverage based on capitation may have negative side effects. Which of the following would most likely be a consequence of capitation? a. Coercing clients to attend health promotion education classes b. Encouraging clients to seek care elsewhere c. Increasing the number of interventions to maximize payment d. Neglecting to order certain tests or treatment to minimize cost to the provider

ANS: D In capitated arrangements, physicians and other practitioners are paid a set amount to provide care to a given client for a set period of time and amount of money. Thus, neglecting to order certain tests or treatment would be a way for the provider to maximize the amount of money received to provide care to members of this group. In a capitated arrangement, the provider would most likely not increase the number of interventions used or coerce clients to attend health promotion classes as both of these strategies would cost the provider more money, and the provider will be receiving a set amount of money to provide care for a given client for a set period of time. It is unlikely that the provider would encourage clients to seek care elsewhere; rather the provider would be conscientious about the number of tests and treatments that are ordered in order to try to contain costs

Which of the following is the primary focus of public health nursing? A. Families and groups b. Illness-oriented care c. Individuals within the family unit d. Health care of communities and populations

ANS: D In public health nursing, the primary focus is on the health care of communities and populations rather than on individuals, groups, and families. The goal is to prevent disease and preserve, promote, restore, and protect health for the community and the population within it. Community-based nurses deal primarily with illness-oriented care of individuals and families across the life span. The aim is to manage acute and chronic health conditions in the community, and the focus of practice is on individual or family-centered illness care.

A public health nurse is working with a low-income population in Massachusetts. Which of the following assumptions can the nurse make about this population? a. They have difficulty accessing health care due to a shortage of primary-care providers. b. They most likely receive health insurance through Medicare. c. They are unable to access health care due to the implementation of the Affordable Care Act. d. They have access to affordable health care insurance

ANS: D Massachusetts began an experiment in health reform in 2006. Two years after health reform legislation became effective, only 2.6% were uninsured, the lowest percentage ever recorded in any state. The shortage of primary care providers is not significantly different in Massachusetts than in other areas of the country. Low-income populations are eligible for Medicaid services, not Medicare. The program in Massachusetts became a model for the Affordable Care Act

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

ANS: D Public health nurses engage themselves and others in policy development and encourage and assist persons to communicate their needs to those with the power to take action. The nurse is demonstrating the role of advocate through this action, it goes beyond merely understanding the women's concern, and instead mobilizes them to take action. This action does not demonstrate the nurse showing empathy rather the nurse is empowering these women

What was the significance of the 1979 Surgeon General's report? a. It planned the goals and priorities for the entire Veterans Administration medical system. b. It vastly increased funding for health promotion activities. c. It identified the use of tobacco as a cause of lung cancer. d. It created national goals for promoting health and preventing disease.

ANS: D The 1979 Surgeon General's report began a focus on preventing disease and promoting health for all Americans. It was a national effort with all levels of government, as well as other interested parties, involved. The 1979 report did not plan goals and priorities for the Veterans Administration medical system; rather it looked at health of all Americans. There was no funding associated with the report. It addressed prevention of disease and promotion of health for multiple diseases, not just lung cancer

A high school student considering a job in the restaurant industry after graduation asks a nurse about workplace safety issues. Which of the following acts would the nurse most likely discuss with the student? a. Chemical Safety Information, Site Security, and Fuels Regulatory Act b. Comprehensive Environmental Response, Compensation, and Liability Act c. Food Quality Protection Act d. Occupational Safety and Health Act

ANS: D The Occupational Safety and Health Act (OSHA) was passed to ensure worker and workplace safety in all employment settings, including restaurants. The Chemical Safety Information, Site Security, and Fuels Regulatory Act, Comprehensive Environmental Response, Compensation, and Liability Act, and Food Quality Protection Act may contribute to safety but do not have the full oversight of OSHA

A nurse is asked to meet with a family who recently immigrated from Botswana (Africa). After the physician tells the husband the wife's diagnosis of breast cancer, the family thanks the physician and starts to leave. Ethically, which of the following is the nurse's most important action? a. Emphasizing that the family must set up a surgical appointment for the wife immediately b. Assessing the family's current living situation, including insurance and other assets c. Educating the family concerning the usual treatment and the prognosis of breast cancer d. Interviewing the family concerning their perspective of the threat to the family's well-being

ANS: D The United States is a multicultural nation with diverse ethnic groups and diverse values. Before any intervention can be made, the health care professionals must understand the family's cultural, psychological, social, communal, and environmental contexts, because these contexts affect the way issues are formulated and decisions are made. Consequently, it is crucial to interview the family to determine their understanding of the situation before deciding what, if any, intervention must be made. In many cultures, the family, rather than the individual, is the unit of primary concern. Setting up a surgical appointment immediately would not be an appropriate action for the nurse to take as this would be a premature action for anyone who has just been told that she has cancer. Assessing the family's current living situation would not be the first concern of the nurse; the first concern should focus on the family's well-being. After assessing the family's well-being, the next action of the nurse may be to educate the family about the treatment and prognosis of breast cancer

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

ANS: D The dominant needs of the population outweigh the expressed needs of one or a few people. All of the choices represent components of a decision that the nurse might consider in determining the needs of the aggregate

When did medicine in the United States make a shift away from the treatment of acute infection to care of chronic illnesses? a. Between 1890 and 1920 b. Between1920 and 1940 c. Between 1940 and 1960 d. Between 1945 and 1984

ANS: D The later part of the 20th Century (1945-1984) ushered in a shift away from acute infectious health problems of previous stages toward chronic health problems such as heart disease, cancer, and stroke

A nurse is advocating for the public health department to increase the number of public health nurses that it employs. Which of the following factors should the nurse emphasize? a. Providing disease investigation training b. Providing research opportunities c. Providing leadership experiences d. Providing salaries commensurate with responsibilities

ANS: D Through the input of the Division of Nursing's National Advisory Council for Nursing Education and Practice (NACNEP), the Division of Nursing sets policy for nursing nationally. A few of the factors indicated by the NACNEP that need to be in place to support the public health nurse role are competitive salaries commensurate with responsibilities, experience in health promotion and prevention, long-term trusting relationships in the community, and a commitment to social justice and eliminating health disparities. The Division of Nursing's National Advisory Council for Nursing Education and Practice (NACNEP) did not emphasize the importance of providing disease investigation training, research opportunities, or leadership experiences

A nurse wants to have a better understanding of the physiological effects of selected chemicals. Which of the following individuals would provide the most useful information to the nurse? a. Chemist b. Epidemiologist c. Pharmacist d. Toxicologis

ANS: D Toxicology is the basic science that studies the health effects associated with chemical exposures. A chemist, epidemiologist, or pharmacist would probably be able to provide some information, but the toxicologist would most likely provide information related to physiological processes

A health care provider refuses to order pain medication for a drug addict who has been severely injured in a car accident. When reminded by nurses that pain medication has not been ordered, the provider merely replies that the patient's suffering from the pain of his injuries will build character and that the addicted patient needs to get off drugs. Which of the following ethical theories is being using (or misusing)? a. Consequentialism b. Communitarianism c. Deontological ethics d. Virtue ethics

ANS: D Virtue ethics emphasizes practical reasoning applied to character development. Although such action by a care provider is paternalistic and unethical on many grounds, the physician may truly be concerned with enabling the injured addict to learn from his experience and possibly develop into a drug-free person. Communitarianism is similar to virtue ethics and looks at the relationship and responsibility between the individual and the community. When decisions are based on outcomes or consequences, it is known as consequentialism. The ethical approach of deontology describes adhering to moral rules or duty rather than to the consequences of the actions

The state board of nursing has written new regulations to clarify in a more concrete manner what the nurse practice act allows and requires. Which of the following effects will this change have on nurses in this state? a. None, because they are just helpful guidelines for maximum safety. b. None, because they just give specifics that may change over time. c. Major, because prudent nurses would follow such regulations. d. Major, because these rules and regulations have the effect of law and must be obeyed.

ANS: D When the legislature passes a law and delegates its oversight to an agency, it gives that agency the power to make regulations. Because regulations flow from legislation, they have the force of law. Whether prudent or not, nurses are obligated to practice consistent with these regulations. All nurses have the responsibility to follow the changes that are in place by legislation. They are laws that must be followed, not guidelines

Which person is most likely to be uninsured? a. An 82-year-old woman with chronic medical problems b. A 2-year-old whose mother is on welfare c. A 50-year-old business man who works for a large corporation d. A 24-year-old man who works part-time at a small business

ANS: D Young adults (ages 19 to 25 years) account for a disproportionately large share of the uninsured, largely due to their low incomes. The elderly person would be eligible for Medicare, and the 2-year-old is probably eligible for Medicaid. The man who works at the large corporation probably has health insurance, because most large businesses provide it