Community Test 3 - Evolve Q's

31.5 The nurse assesses a client with paraplegia and cataracts. The client holds a full-time job and engages in several hobbies. The nurse documents that the client has: A. Dual diagnoses. B. Functional limitations and is wheelchair bound. C. Visual and physical limitations. D. Visual impairment and physical disability.

C. Visual and physical limitations.

31.8 Physically compromised individuals often experience poverty, as do other special population groups. The impact of poverty on the onset of disability can best be expressed by which of the following statements? A. Being underinsured through the workplace limits options for health care services. B. Low income can increase the risk of preventable disability. C. Successful insurance settlements for injury claims limit the financial impact of disability. D. Transportation for persons with limited mobility affects access to health care services.

B. Low income can increase the risk of preventable disability.

19.2 When using the health measure of death rates for working adults, the nurse could expect to find the highest death rates in which areas? A. Large metropolitan areas. B. Most rural and highly populated urban areas. C. Most rural and suburban areas. D. Small suburban and all urban areas.

B. Most rural and highly populated urban areas.

19.8 Nurses practicing in rural communities often observe that protecting client confidentiality is a unique challenge because: A. Nurse's family members expect nurses to share client information when something serious is happening to a community member. B. Nurses in rural areas are well known to their service populations and are often approached by their clients in social and other settings with requests for counsel and advice. C. Professional nurses in rural areas often work in more than one role in the community, which reduces their professional credibility. D. Rural residents do not expect nurses to keep client information confidential because "everyone knows everyone" and his or her family.

B. Nurses in rural areas are well known to their service populations and are often approached by their clients in social and other settings with requests for counsel and advice.

29.7 A community health nurse is applying for funding to help reduce the incidence of the most common cause of childhood morbidity and mortality in the community. The requested grant should seek to: A. Educate the community about the dangers of lead paint for young children. B. Teach elementary school children how to choose and use a helmet for biking. C. Teach kindergarten children how and when to wash their hands. D. Teach kindergarten children how to brush their teeth.

B. Teach elementary school children how to choose and use a helmet for biking.

21.3 In nursing centers, research questions emerge from the essential organizational practice of: A. Academic affiliation. B. Creation of educational opportunities. C. Program evaluation. D. Strategic planning.

C. Program evaluation.

29.8 A parent is concerned that her child should not receive a diphtheria-pertussis-tetanus immunization inoculation because of a runny nose. The child is afebrile and otherwise asymptomatic. The most appropriate intervention for the nurse is to: A. Defer the immunization to avoid masking the symptoms of the illness. B. Defer the immunization until the child's next well-child examination. C. Educate the parent regarding the safety of immunization during a minor acute illness. D. Reschedule the immunization after the sinus drainage has cleared.

C. Educate the parent regarding the safety of immunization during a minor acute illness.

21.2 To identify the strengths and limitations of an organization and the community, and their capacity to support the establishment of a nursing center and maintain its viability, which of the following should be completed? A. Business plan B. Community assessment C. Feasibility study D. Strategic plan

C. Feasibility study

30.6 Although all men are at risk for developing prostate cancer and African-American men have a 51% higher incidence of prostate cancer than white men, those at greatest risk are men who: A. Have erectile dysfunction. B. Fail to undergo prostate-specific antigen testing or digital rectal screening. C. Have a history of prostate cancer in the immediate family. D. Have multiple sex partners.

C. Have a history of prostate cancer in the immediate family.

25.3 Advantages of community health program planning include ensuring that available resources are used to meet the needs of the population and: A. Applying for grants. B. Identifying clients and soliciting board members' support. C. Identifying resources, activities, and needs. D. Increasing the visibility of the program.

C. Identifying resources, activities, and needs.

20.4 An example of tertiary prevention related to Healthy Communities and Cities is: A. Assessing the need for programs to treat alcohol addiction. B. Assessing the strengths of local schools' adolescent pregnancy prevention programs. C. Initiating an evaluation of a program to address endemic hepatitis A in a community. D. Organizing a community forum to explore health promotion priorities.

C. Initiating an evaluation of a program to address endemic hepatitis A in a community.

21.7 Stakeholders facilitate or undermine a community's efforts to address critical needs, solve problems, and improve health. A major barrier to collaboration is: A. Limited resources. B. Shared risks. C. Professional agendas. D. Time.

C. Professional agendas.

19.9 A district health nurse is assigned to two rural communities in the state. To achieve the best outcomes possible in reducing the health disparities for the large number of frail elderly clients in the two counties, the nurse should consider using what community-oriented nursing approach? A. Assessment. B. Case management. C. Geriatrics. D. Tertiary prevention.

B. Case management.

27.6 When the community health nurse displays pertinent family information in a family tree format, the family can see the family structure, its members and their relationships over at least three generations and provides a visual source for planning family interventions. This approach also assists the nurse in making clinical judgments relevant to family structure and history. This type of family assessment instrument is referred to as: A. Ecomap. B. Genogram. C. Family developmental task. D. Family diagnosis.

B. Genogram.

31.3 Women with disabilities may be at higher risk for abuse because women with disabilities are: A. Less exposed to multiple caretakers. B. Less likely to live alone. C. More independent. D. Socially unattractive.

B. Less likely to live alone.

30.7 A new primary health clinic is established to address the top causes of mortality in men. The nurse at the clinic uses a community-focused nursing process to plan interventions aimed at reducing the incidence of: A. Cardiovascular accident, lung cancer, alcoholism, and drug abuse. B. Depression, alcohol abuse, obesity, intravenous drug use, and prostate disease. C. Cardiovascular and cerebrovascular disease, chronic pulmonary disease, unintentional injuries, cancer, and diabetes. D. Mental illness, drug and alcohol abuse, cardiovascular disease, accidents, and suicide.

C. Cardiovascular and cerebrovascular disease, chronic pulmonary disease, unintentional injuries, cancer, and diabetes.

22.6 A community health nurse involved in care management would most likely: A. Develop, conduct, and evaluate health teaching programs in primary care. B. Manage the staff at a free clinic. C. Monitor the health status, resources, and outcomes for an aggregate. D. Provide immunizations to migrant workers.

C. Monitor the health status, resources, and outcomes for an aggregate.

29.2 A school nurse is working with a parents and teachers organization to improve the health status of students in an urban lower socioeconomic community that has a high concentration of Hispanic and African-American individuals. Given the demographics of the community, the nurse is aware that these children will be at highest risk for: A. Asthma. B. Attention deficit disorder. C. Obesity. D. Poisoning.

C. Obesity.

22.10 A nurse performing home hospice case management notes the increasing number of hospice clients who lack caregivers in the home environment. The nurse identifies the potential need for a hospice house facility to meet the needs of these clients. The case management process frequently reveals larger-picture issues such as which of the following (select all that apply)? A. Community cost concerns. B. Community conflict resolution skills. C. Community satisfaction. D. Community weaknesses in quality of services. E. Community weaknesses in quantity of services.

D. Community weaknesses in quality of services. E. Community weaknesses in quantity of services.

22.1 A home health case manager is charged with identifying opportunities for health promotion and illness prevention. The fulfillment of this charge would best be demonstrated when the case manager: A. Collaborates with a local chaplain to ensure that the spiritual needs of cancer clients are addressed. B. Refers a new diabetic client to a nutrition counselor for dietary teaching. C. Teaches a school nurse how to care for a client who will be returning to school and will require new asthma treatments. D. Tracks the immunization status of clients and facilitates access to immunization when needed.

D. Tracks the immunization status of clients and facilitates access to immunization when needed.

20.8 The Community Health Improvement Model: Step 3-Development of the Community Structure for Health Promotion supports the development of local collaborative partnerships to enhance the objectives of Healthy Communities and Cities. The collaborative partnership best practice of "identifying specific community and system changes to be sought to effect widespread behavior change and community health improvement" would best apply to which concept of the Ottawa Charter for Health Promotion strategic framework? A. Creating supportive environments. B. Establishing health-promoting public policy. C. Reorienting health services. D. Strengthening community action.

D. Strengthening community action.

27.8 The nurse working with the family of a child recently diagnosed with juvenile diabetic asks the parents about any changes in their relationship since the child's diagnosis. This family nursing approach can best be described as treating the family as a: A. Client. B. Component of society. C. Context. D. System.

D. System.

31.7 Conditions that may lead to disability typically are the focus of primary prevention activities. However, all three levels of prevention apply to physically compromised clients, primarily because the focus should be on which of the following (select all that apply)? A. Addressing the client's perception of himself or herself in terms of the disability. B. Establishing lifelong, health-promoting behaviors. C. Integrating appropriate complementary and alternative medicine treatments. D. Overcoming barriers to disease prevention activities. E. Preventing complications from the effects of immobility and the disease process.

B. Establishing lifelong, health-promoting behaviors. D. Overcoming barriers to disease prevention activities. E. Preventing complications from the effects of immobility and the disease process.

29.1 In implementing an antismoking program in the local middle school, a school nurse is aware that programs are more effective when they are consistent with the developmental stage of the target age group. Besides including information about immediate health risks and cosmetic effects, the nurse should also consider: A. Teaching behavior modification techniques. B. Describing effects on the environment. C. Outlining laws regarding tobacco sales to minors. D. Teaching the social skills to resist peer pressure.

D. Teaching the social skills to resist peer pressure.

29.6 Parents of a 12-year-old have started the Weight Watchers program and are concerned about the appropriateness of their eating plan for the preteen's nutritional needs. The preteen's weight is within accepted guidelines for the given height. Which of the following would be the most appropriate guidance? A. A nutritional plan that includes whole foods, fruits, vegetables, lean protein and dairy sources, whole wheat breads, and legumes is healthy for the whole family. B. An extremely low-carbohydrate diet would be more effective to avoid obesity. C. Preteens naturally limit their own intake of unnecessary foods. D. The Weight Watchers plan is appropriate, but children can benefit from having convenient prepackaged processed snack foods to eat as soon as they come home from school.

A. A nutritional plan that includes whole foods, fruits, vegetables, lean protein and dairy sources, whole wheat breads, and legumes is healthy for the whole family.

31.2 During an Individuals with Disabilities Education Act (IDEA) screening to detect mental or psychological conditions in young school-age children, a child is identified as having a cognitive disability. The school nurse should now consider this child to be at greatest risk for: A. Abuse or neglect. B. Age-inappropriate friendships. C. Embarrassment. D. Physical inactivity.

A. Abuse or neglect.

29.10 Which of the following are factors that significantly influence the health status of children in the United States (select all that apply)? A. Access to health care. B. Education. C. Infant mortality among minority groups. D. Poverty status. E. Risk-taking behavior.

A. Access to health care. B. Education. C. Infant mortality among minority groups. D. Poverty status. E. Risk-taking behavior.

29.4 The developmental theory of human ecology emphasizes the complex relationship between a growing child and their immediate environment that help the child to learn to: A. Accommodate. B. Achieve ego identity. C. Create mental schemes. D. Differentiate.

A. Accommodate.

21.1 A comprehensive primary health care center housed on the campus of the local high school in a predominately urban African-American community provides 24-hour/5-day-a-week access to physical and behavioral health care services for community residents of all ages. The center is measuring outcomes related to the use of services; immunization rates; use of alcohol, tobacco, and other drugs; weight; functionality; and responsible sexual behavior. These indices best identify a systematic approach to: A. Achieving Healthy People 2020 objectives. B. Addressing the World Health Organization (WHO) common nursing research agenda. C. Achieving designation as a federally qualified health center. D. Qualifying for insurance reimbursement as a safety net provider.

A. Achieving Healthy People 2020 objectives.

30.9 Diabetes mortality rates continue to rise for all ethnic and socioeconomic groups, but evidence shows that which of the following is(are) true (select all that apply)? A. Addressing the diabetic epidemic involves more than a focus on individual factors. B. Community-based education programs have done little to address the problem. C. Complications and mortality rates are highest among low-income and minority groups. D. Selection of healthy food options is both an availability issue and an education issue. E. Standard of living does not affect decision making.

A. Addressing the diabetic epidemic involves more than a focus on individual factors. C. Complications and mortality rates are highest among low-income and minority groups. D. Selection of healthy food options is both an availability issue and an education issue.

20.6 Instrumental in the development of Healthy Communities and Cities is the concept of primary health care, which refers to meeting the basic health needs of a community by providing readily accessible health services. Primary health care seeks to provide affordable social, biomedical, and health services that are relevant and acceptable in terms of the individual's health, needs, and concerns. This is the primary health care principle of: A. Affordable technology. B. Community participation. C. Equity. D. Multisectoral participation.

A. Affordable technology.

31.1 A nurse is planning a training session for new group of disability determination workers regarding the leading causes of severe disabilities in U.S. adults. The training should address: A. Arthritis, back/spine problems, and heart attack. B. Arthritis, lung disease, and back problems. C. Back problems, heart disease, and pulmonary disease. D. Genetic abnormalities, arthritis, and orthopedic pathology.

A. Arthritis, back/spine problems, and heart attack.

22.2 During a home visit, a case manager for a community health center notes marked pitting edema, shortness of breath, and increased fatigue in a 52-year-old male client who lives alone. The client is admitted to the hospital, where he is diagnosed with congestive heart failure. The case manager works with the hospital's utilization manager to devise a discharge plan. The case manager's most logical next step would be to: A. Assess the client; obtain information on the scope of services covered by the benefit plan for the client; if needed services are not covered, seek to identify and arrange for the resources to provide these services. B. Call the client, reintroduce himself or herself, and explain his or her role as a case manager for homebound clients. C. Discuss with the family their schedule of availability to offer care in the client's home; ensure that the client has daily visits by family members. D. Investigate the availability of local support and rehabilitation services for clients with congestive heart failure; contact the client's family.

A. Assess the client; obtain information on the scope of services covered by the benefit plan for the client; if needed services are not covered, seek to identify and arrange for the resources to provide these services.

20.5 Nurses working with communities to implement the Community Health Promotion Model (CHPM) are most effective when they: A. Begin where the community is and then work to facilitate implementation of all nine steps. B. Serve in the role of expert, spearheading the community's work. C. Teach basic community and public health concepts before beginning to explain and teach the Health Communities Model. D. Work with community leaders to begin with step one and progress through step nine of the model.

A. Begin where the community is and then work to facilitate implementation of all nine steps.

22.5 A case manager employed by a health maintenance organization is charged with discontinuing home health services for a disabled homebound elderly client in an effort to reduce costs. The case manager reviews the client's record and determines that home health services are still indicated for this client. The ethical dilemma faced by the case manager is: A. Beneficence. B. Justice. C. Nonmaleficence. D. Veracity.

A. Beneficence.

30.4 To detect the presence of the leading cause of disease burden for women in the United States, a screening program for women would include: A. Blood pressure screening, mammography, and dietary assessment. B. Testing for HIV/AIDS and sexually transmitted diseases. C. Pap smear, screening for smoking, and assessment for exposure to violence. D. Questions about a family history of depression, employment status, and chronic diseases.

A. Blood pressure screening, mammography, and dietary assessment.

21.9 When a business plan for a nursing center is being developed, the essential elements to include are a forecast for minimum startup funding, projected income for 1 to 3 years out, and: A. Breakeven analysis. B. Community assessment. C. Feasibility study. D. Managed care contracts.

A. Breakeven analysis.

19.6 Community and public health nurses practicing in rural locales consistently note which of the following characteristics of their practice environments? A. Broad scope of practice, independence and autonomy, and opportunity for community involvement. B. Expanding scope of practice, plentiful resources, and increased opportunity for less formal interactions. C. Lack of autonomy and independence, along with greater flexibility than in an urban practice. D. Narrower scope of practice and focus than in an urban practice.

A. Broad scope of practice, independence and autonomy, and opportunity for community involvement.

27.5 More than 50% of divorced people remarry, and for middle-aged families this results in more blended families This trend has increased challenges for these families in the area of: A. Childcare. B. Family size. C. Family stability. D. Financial survival.

A. Childcare.

22.7 In case management, it is unlikely that any single professional has the expertise, knowledge, or skills required to achieve success. The synergy produced by all involved parties (client, providers, payers, family/significant others, and community organizations) can result in successful outcomes. These statements relate to the sequential process of: A. Collaboration. B. Communication. C. Cooperation. D. Negotiation.

A. Collaboration.

31.10 The role of the community-oriented nurse working with the special needs population is largely influenced by which of the following? A. Community awareness of and commitment to meeting the needs of people with disabilities. B. Educational institutions in the community. C. Number of people with disabilities in the community. D. Nurse's attitude toward people with physical challenges.

A. Community awareness of and commitment to meeting the needs of people with disabilities.

25.4 Which of the following are the major sources of information for program evaluation (select all that apply)? A. Community indices. B. Media reports. C. Program clients. D. Program providers. E. Program records.

A. Community indices. C. Program clients. E. Program records.

25.9 The nurse engaging in a formative program evaluation would most likely: A. Conduct medical record audits for quality assurance. B. Make a home visit before a client is discharged from the program. C. Participate in a new client evaluation. D. Write a policy for risk management.

A. Conduct medical record audits for quality assurance.

22.3 A community health nurse is serving as a case manager for premature infants receiving home health care. The case manager arranges for an in-home apnea monitor and daily home visits by a registered nurse who specializes in high-risk pediatrics. The case manager is demonstrating which of the following case manager roles? A. Consultant and coordinator. B. Mentor and liaison. C. Monitor and reporter. D. Standardization monitor and negotiator.

A. Consultant and coordinator.

22.9 The insurer's risk manager has informed an independently contracted case manager that a liability risk related to experimental treatment and technology was identified in a recent recommendation made by the case manager. Which of the following is the best example of action by a case manager that might be associated with potential liability risk related to experimental treatment and technology? A. Inappropriately recommending that treatment be curtailed when treatment was actually needed. B. Failing to apply the contractual definition of "experimental" treatment found in the client's insurance policy. C. Substituting the case manager's clinical judgment for that of the insurer's medical director. D. Upcoding intensity of care or intervention requirements.

B. Failing to apply the contractual definition of "experimental" treatment found in the client's insurance policy.

21.10 The nursing center director, in collaboration with key stakeholders, is identifying a research agenda for the nursing center. The research agenda incorporates World Health Organization (WHO) priorities for a common nursing research agenda, so it will include, at a minimum, which of the following (select all that apply)? A. Cost analysis and documentation of cost-effectiveness. B. Demonstration of effective interventions that produce appropriate outcomes. C. Description of nursing interventions and linkages with consumer needs and resources. D. Identification and clarification of client needs, particularly those not engaged. E. Welfare-to-work transitions that influence access and use patterns.

A. Cost analysis and documentation of cost-effectiveness. B. Demonstration of effective interventions that produce appropriate outcomes. C. Description of nursing interventions and linkages with consumer needs and resources. D. Identification and clarification of client needs, particularly those not engaged.

25.7 A community-oriented nurse is writing a grant application for funding for a nurse-run clinic serving clients with chronic illnesses. The grant application asks for information regarding program benefits, effectiveness, and efficiency. The most effective tool to obtain this information would be: A. Cost studies. B. MAPP (Mobilizing for Action through Planning and Partnerships) model. C. PATCH (Planning Approach to Community Health) method. D. Tracer method.

A. Cost studies.

25.5 Local officials have requested a program evaluation of a comprehensive teen sex education program offered in the local schools in preparation for annual budget-planning discussions. The public health nurse determines that the teen pregnancy rate has gradually declined over the years that the program has been in place. The nurse has also identified the evaluation plan that was articulated during the program planning phase. The best tool for demonstrating the efficiency of this program is: A. Cost-benefit analysis. B. Cost-efficiency analysis. C. Relevance assessment. D. School records audit.

A. Cost-benefit analysis.

19.3 Depression among rural residents appears to be more persistent and endemic. Which of the following factors may contribute to this level of depression (select all that apply)? A. Delays in seeking mental health services. B. High rate of poverty. C. Gaps in the continuum of mental health services. D. Sufficient number of mental health services. E. Tolerance for destructive coping mechanisms.

A. Delays in seeking mental health services. B. High rate of poverty. C. Gaps in the continuum of mental health services. E. Tolerance for destructive coping mechanisms.

31.4 A person who is limited in independent living skills, economic self-sufficiency, and self-help ability would meet the definition of: A. Developmentally disabled. B. Dual-diagnosed. C. Impaired. D. Physically disabled.

A. Developmentally disabled.

20.10 The Healthy Communities and Cities (HCC) movement emphasizes a bottom-up approach to community practice. The Community Health Promotion Model is a bottom-up community practice model that includes multisectoral planning and action for health, which is consistent with a locality development model (bottom-up approach). The aspects of the locality development model that have been integrated can best be described as which of the following (select all that apply)? A. Emphasizing consensus and cooperation. B. Building a sense of community. C. Using a rational-empirical approach. D. Producing fundamental social change. E. Rational-empirical problem solving by outside experts.

A. Emphasizing consensus and cooperation. B. Building a sense of community.

30.5 In comparison with women, men: A. Engage in more risk-taking behavior. B. Experience lower survival rates in the first year after myocardial infarction. C. Metabolize alcohol more efficiently. D. More actively initiate preventive health care interventions.

A. Engage in more risk-taking behavior.

30.8 To develop a comprehensive population-based health plan that includes men, the nurse must examine male health from various perspectives, such as: A. Existing physical, psychological, and social contexts that constitute men's intrapersonal and environmental conditions. B. Income, culture, ethnicity, and race. C. Media and marketing initiatives that target male concerns regarding quality of life and degree of disability. D. National vital statistics on morbidity and mortality.

A. Existing physical, psychological, and social contexts that constitute men's intrapersonal and environmental conditions.

21.6 The health and wellness center is a type of nursing center that focuses on: A. Health-promotion, disease-prevention, and disease-management programs. B. Programs affiliated with major for-profit health corporations. C. Programs for special populations and specific health conditions. D. Public health programs.

A. Health-promotion, disease-prevention, and disease-management programs.

29.5 Community-oriented nurses practice in a variety of settings and therefore have the greatest opportunity to advance a major national health objective for children by: A. Increasing the access to care. B. Justifying the cost of care. C. Promoting healthy lifestyles. D. Providing anticipatory guidance.

A. Increasing the access to care.

27.9 Two of the most significant barriers to practicing family nursing are the narrow definition of family used by health care professionals and social policy makers and: A. Lack of consensus on what constitutes a healthy family. B. Medical and nursing diagnosis systems. C. Nursing's historical ties with the medical model. D. Lack of exposure of practicing nurses to family concepts.

A. Lack of consensus on what constitutes a healthy family.

30.10 A community-oriented nurse is developing goals for a community health center's senior center. The goals should focus on which of the following (select all that apply)? A. Meeting social and recreation needs. B. Helping elders accept the inevitability of the debilitation of aging. C. Maximizing functional status and minimizing functional decline. D. Implementing secondary and tertiary prevention measures.

A. Meeting social and recreation needs. C. Maximizing functional status and minimizing functional decline. D. Implementing secondary and tertiary prevention measures.

21.4 A community-oriented nurse has noted that pediatric clients diagnosed with HIV/AIDS do not have ready access to services that focus on the specific needs of this population. The nurse begins working with community stakeholders to develop a nursing center. The most appropriate model to consider for this nursing center would be: A. Comprehensive primary care center. B. Federally qualified health center. C. Health and wellness center. D. Special care center.

D. Special care center.

20.1 The Healthy Communities and Cities movement can best be described as which of the following? A. Movement that began in Europe in 1986, which is now an international movement of communities and cities focused on mobilizing local resources, including political, professional, and community members, in an effort to improve the health of the community. B. Movement that began in the United States in 1986 that targets health promotion in community practice. C. Movement that focuses on the effective development and utilization of public policy as the primary means for improving health in communities worldwide. D. Program that uses the principles of primary, secondary, and tertiary prevention in communities throughout the world in an effort to mobilize citizens to improve the health of their communities.

A. Movement that began in Europe in 1986, which is now an international movement of communities and cities focused on mobilizing local resources, including political, professional, and community members, in an effort to improve the health of the community.

19.4 When determining whether a geographic area is rural or urban, the nurse should recognize that: A. Rural and urban areas by their nature occur on a continuum. B. Rural regions have fewer than six persons per square mile. C. Rural residents feel isolated. D. Rural areas are recreational, retirement, and resort communities.

A. Rural and urban areas by their nature occur on a continuum.

31.9 A nurse conducting a home visit for a child with cerebral palsy observes the child the child gazing out of the window into the neighborhood. The nurse should provide guidance to the parents regarding (select all that apply): A. Adjusting school schedule to keep child occupied with studies. B. Community attitudes about interacting with children with disabilities. C. Opportunities for organized and spontaneous play. D. Physical activity needs to avoid obesity.

B. Community attitudes about interacting with children with disabilities. C. Opportunities for organized and spontaneous play. D. Physical activity needs to avoid obesity.

20.3 The Healthy Communities and Cities model process relies on a problem-solving approach to achieve goals. The best example of this approach is: A. Community activists lobbying their state legislature to mandate increased primary care access. B. Community-oriented nurses using the nine-step Community Health Improvement Model to encourage and empower community members to take responsibility for change. C. Health care professionals working independently to determine priorities for their community and then educating their community about the health promotion needs they have prioritized. D. Teachers using health promotion curricula to reduce teenage smoking in their community.

B. Community-oriented nurses using the nine-step Community Health Improvement Model to encourage and empower community members to take responsibility for change.

25.1 The community planning board is attempting to determine if the clients and health care providers affected by a recent mental health outreach initiative are satisfied that the program interventions have accomplished the program's objectives and that clients have benefited from this program. The analysis model that is best designed to provide an estimate of costs to achieve an outcome is: A. Cost-benefit analysis. B. Cost-effectiveness analysis. C. Cost-efficiency analysis. D. Multi-Attribute Utility Technique.

B. Cost-effectiveness analysis.

27.2 One challenge in working with families for healthy outcomes when a following capacity-building practice model occurs when the nurse steps aside in: A. Defining the problem. B. Designing family interventions. C. Evaluating the plan. D. Pre-encountering data collection.

B. Designing family interventions.

27.4 A nurse is evaluating the outcome of a family with children's action plan to address the incorporation of caregiving needs of the paternal grandfather. Although evaluation includes many tasks, the critical thinking process includes (select all that apply): A. Conducting a summative evaluation meeting. B. Determining the timeliness of the plan outcome. C. Identifying changes in the family story. D. Identifying nurse-related barriers. E. Making the transition of nurse to family dependence.

B. Determining the timeliness of the plan outcome. C. Identifying changes in the family story. D. Identifying nurse-related barriers.

20.7 The Ottawa Charter adopted by the Healthy Communities and Cities movement defined health promotion as the process of enabling people to take control over and to improve their health by enabling community members to increase control over and assume more responsibility for health; mediating among public, private, voluntary, and community sectors; and advocating on behalf of people who are powerless to make the changes necessary to promote health. The charter identified the most effective health promotion action as: A. Creating supportive environments. B. Developing health-promoting public policy. C. Reorienting health services. D. Strengthening community action.

B. Developing health-promoting public policy.

31.6 Children with chronic health problems face challenges in school because of: A. Difficulty gaining access to public school education. B. Embarrassment and self-imposed social isolation. C. Increased special education costs in public schools. D. Psychological distress related to the severity of their disability.

B. Embarrassment and self-imposed social isolation.

27.7 Family health can be defined as a dynamic relative state of well-being that involves the biological, psychological, sociological, cultural, and spiritual aspects of the family system. This approach to family health is consistent with which of the following principles (select all that apply)? A. Assessment of the individual's health does not reveal the overall family system's health. B. Family functioning affects the health of individuals. C. Family system assessment specifically addresses the individual's health. D. The individual's health affects the family's functioning. E. Individual family members and the family system as a whole are assessed simultaneously.

B. Family functioning affects the health of individuals. D. The individual's health affects the family's functioning. E. Individual family members and the family system as a whole are assessed simultaneously.

25.2 A community health nurse is conducting a community assessment as part of a program planning initiative and is seeking a tool that is low cost, allows clients to participate in identification of need, and would stimulate community support for the program. The nurse would most likely use which of the following? A. Community forum. B. Focus group. C. Indicators approach. D. Survey.

B. Focus group.

30.2 Counseling regarding hormone replacement therapy (HRT) should include the following information: A. Menopause is a result of hormone deficiency, and therefore HRT is appropriate for all women to treat all symptoms. B. HRT should be used to prevent osteoporosis only among women who are unable to take non-estrogen medication. C. Research concludes that HRT does prevent heart disease in menopausal women. D. HRT should be considered for prevention of osteoporosis in all women.

B. HRT should be used to prevent osteoporosis only among women who are unable to take non-estrogen medication.

30.1 To develop a baseline for a presentation at the local women's club about the status of women's health in the community, a community-oriented nurse researches national vital statistics to establish the leading cause of women's deaths in the United States. In the United States, the leading causes of death for women are: A. Domestic violence, heart disease, and cancer. B. Heart disease, cancer, and stroke. C. Heart disease, stroke, and emphysema. D. Infectious disease, cancer, and heart disease.

B. Heart disease, cancer, and stroke.

25.8 When planning a new community health center, a nurse will integrate knowledge of the nursing process and program management. The nurse's initial and most critical step for funding purposes would be: A. Finding the lay leaders in the community. B. Identifying the target population's health problems and needs. C. Outlining the major causes of mortality in the community. D. Prioritizing the community's problems.

B. Identifying the target population's health problems and needs.

19.5 A community-oriented nurse newly assigned to a rural community learns that the characteristics of rural and small town life include: A. Consistent employment, formalized professional interactions, and openness to people new to the community. B. Informal social and professional relationships, acquaintance of residents with most other members of the community, work of many residents in high-risk occupations, and often a lack of openness to newcomers. C. Lack of anonymity, fractured family systems, role of churches as socialization centers, and mistrust of newcomers. D. Tendency of residents to work in safety-oriented occupations, preference for autonomy rather than working as a community, and work in agriculture-related factories.

B. Informal social and professional relationships, acquaintance of residents with most other members of the community, work of many residents in high-risk occupations, and often a lack of openness to newcomers.

27.3 A community health nurse is working with a single parent with a special needs child and a child with asthma. The maternal grandmother lives with the family and was recently diagnosed with diabetes. The nurse understands the importance of including the grandmother in her assessment and interventions because families are: A. Resistant to outside intervention or involvement. B. Involved in the health care of their members. C. Unable to manage the stress of complex health needs. D. Restricted in their ability to identify interventions.

B. Involved in the health care of their members.

25.6 The nurse program manager is determining the direct client care costs as well as the cost of indirect nursing activities for home visits for a home health agency. Analysis of this information along with nursing workload information and client needs can best provide an agency evaluation measure for: A. Program decision making. B. Cost-effectiveness. C. Cost-efficiency. D. Perceived value.

C. Cost-efficiency.

19.10 A rural health nurse who is planning programs to address the population's needs should recognize that, in general, rural populations: A. Engage in physical activity during leisure time. B. Engage in preventive health behaviors. C. Perceive their overall health as less favorable. D. Use seat belts.

C. Perceive their overall health as less favorable.

25.10 A nurse who is the program director for a new antismoking campaign is developing a written program plan that will include the program's goals, priorities, objectives, budget, and timelines. Before implementation of the program, the written program plan should also address which of the following? A. Cost-benefit analysis. B. Perspectives on the program. C. Plan for the evaluation process. D. Process evaluation.

C. Plan for the evaluation process.

30.3 At the request of a local senior women's group, a nurse is developing an osteoporosis primary prevention program. An appropriate strategy for the program would be to: A. Design a nurse-directed program instead of a peer-directed program. B. Encourage exercise and consideration of hormone replacement therapy (HRT). C. Promote diets rich in calcium and vitamin D and daily weight-bearing exercise. D. Promote swimming and supplementation with calcium and vitamin D.

C. Promote diets rich in calcium and vitamin D and daily weight-bearing exercise.

20.9 A nurse expands a community exercise program to include a senior exercise program targeted at strength and balance training in response to the Healthy Communities and Cities initiative to address the needs of free-living elders in the local community. The nurse is most likely applying the Ottawa Charter for Health Promotion priority health promotion activity of: A. Developing personal skills. B. Establishing health-promoting public policy. C. Reorienting health services. D. Strengthening community.

C. Reorienting health services.

21.8 Effective quality improvement programs for nursing centers should choose quality indicators that are priority indicators and measures for nursing centers and later add other measures after careful consideration. The best examples of priority indicators for nursing centers are: A. Billing data, client account data, and provider productivity data. B. Epidemiologic data, billing data, and client satisfaction and utilization data. C. Demographic and disease-tracking data for the specific subpopulations being served. D. Data on prevention, utilization, client satisfaction, and functional status.

D. Data on prevention, utilization, client satisfaction, and functional status.

21.5 One of the most significant challenges and threats to the survival of nursing centers is: A. Consumers' perception that nurses are less desirable health care providers. B. Decreased numbers of advanced practice nurses available to work in nursing centers. C. Increased numbers of uninsured and nurses' ineligibility for insurance reimbursement. D. Increased numbers of uninsured and underinsured, extended economic downturns, and devastating human-caused or natural events.

D. Increased numbers of uninsured and underinsured, extended economic downturns, and devastating human-caused or natural events.

29.9 To work effectively with a child and family, a nurse must understand the cognitive abilities of children at each stage of development. Cognitive development leads to: A. Achievement of ego identity and mastery of the previous stage. B. Developmental milestones in the quality of the parent-child relationship. C. Internal psychosocial developmental crisis points. D. Increasing problem-solving behavior.

D. Increasing problem-solving behavior.

19.1 A community health nurse is prioritizing health-promotion activities with the local rural community. An understanding of the health status and health risks of the rural community would lead the nurse to give priority to: A. Aerobic exercise classes and an exercise class for seniors with arthritis. B. English as a second language program using health promotion literature as reading materials. C. Mentoring program to increase adult literacy. D. Motor vehicle and farm accident prevention project and prenatal care outreach program.

D. Motor vehicle and farm accident prevention project and prenatal care outreach program.

22.8 Members of an extended family are in conflict over the treatment plan for the family's 90-year-old matriarch, who has developed indications of advanced dementia. The case manager is using conflict resolution strategies to allow the parties involved to develop trust, credibility, and distance from the issue at hand, as well as to retain personal dignity. The nurse is demonstrating a knowledge of the strategic process of: A. Advocating. B. Clarifying. C. Cooperating. D. Negotiating.

D. Negotiating.

27.1 One major challenge in the development of social policies that affect families is related to: A. Absence of any federal family policies. B. Indirect negative effects on families. C. Attempts at welfare reform. D. Ongoing debate as to what constitutes a family.

D. Ongoing debate as to what constitutes a family.

22.4 A community health nurse is the case manager for a homebound client recovering from a hip replacement. The nurse works with the client and his family to prioritize needs and services, and to address these care needs. These activities represent which step in the nursing process? A. Assessment and planning/outcome. B. Diagnosis and planning. C. Implementation. D. Planning/outcome.

D. Planning/outcome.

29.3 Nurses should assess environmental health hazards at each health care visit because of the direct impact of the environment on the health of children. The most appropriate interventions would include: A. Community assessments and referrals for treatment. B. Lobbying efforts and education for public policy changes. C. Neighborhood screening programs and education. D. Referrals for treatment and counseling for risk reduction.

D. Referrals for treatment and counseling for risk reduction.

19.7 A clinic has received funds to pay for clinic visits for farm residents who live in frontier or rural, nonmetropolitan statistical areas. Which of the following client(s) would qualify to receive this special funding? A. Client who lives next to a ranch in a town of 1200 people. B. Seventy-year-old client residing in an assisted living facility in a rural area. C. Apple grower who lives in a 100-square-mile county with a population of 19,900. D. Soybean grower and his wife who live in a 400-square-mile county with a population of 39,501.

D. Soybean grower and his wife who live in a 400-square-mile county with a population of 39,501.

27.10 When applying the bioecological systems theory to families, a major assumption of this model is A. Families experience disequilibrium when they transition from one stage to another stage. B. Focusing on the interaction of the system with other systems rather than the individual. C. Maintaining stability through adaptation to internal and external stressors. D. What happens outside the family is as equally important as what happens inside the family.

D. What happens outside the family is as equally important as what happens inside the family.

20.2 A nurse has decided to use a bottom-up approach of Healthy Communities and Cities (HCC) to meet Healthy People 2020 goals for the community setting. Which would be the most appropriate intervention? A. Design and implement a health promotion activity that can be scheduled at a senior center. B. Organize a community meeting of local politicians, clinicians, and community members to prioritize needs and plan for the purchase of equipment needed to better treat elderly clients with diabetes. C. Recruit the mayor and city council to designate an annual Elder Health day. D. Work with local city council members, health care providers, and community members to choose, design, and implement a culturally appropriate health promotion activity for older adults.

D. Work with local city council members, health care providers, and community members to choose, design, and implement a culturally appropriate health promotion activity for older adults.