Community Total Questions from Both

2. Which factors are included in Pender's model explaining what influences individuals to pursue health promotion activities? Select all that apply.

A belief that one can change one's behaviors, Environmental choices possible, The rewards one believes will result if action is taken, What one's family and peers believe should be done Fear and threat are not aspects of Pender's model. Although fear may cause an initial attempt at change, fear is not a long-term motivator for ongoing action. Pender does include perceived benefits, perceived self-efficacy, interpersonal influences, and available situational (environmental) options as factors that motivate persons to engage in health actions.

4. Which two groups does critical theoretical perspective say should be held responsible for many of the illnesses of Americans today? Select the best two answers.

All manufacturers of products that increase morbidity and mortality, Any corporation whose processes result in environmental carcinogens Although all the answers could be correct, the two inclusive responses are manufacturers of products that increase morbidity and mortality or whose processes result in environmental carcinogens. Choosing just one industry will not change the overall social recognition of the broader problem.

25. As in other developed countries, what is the primary focus of health care efforts in the United States?

Chronic diseases Whereas diarrhea, starvation, and infectious diseases are major causes of death in developing countries, in developed countries such as the United States, chronic diseases are the primary cause of mortality.

4. What current emphases are focusing attention on public health? Select all that apply.

Cost containment and managed care models, Fear of bioterrorism within our borders With a current focus on cost containment and organization of health care services under managed care, the emphasis is increasingly on the community and public health. Unfortunately, funding has not increased, and legislation is not focused on public health. However, because bioterrorism is a major current concern and steps are being taken to be able to respond quickly and appropriately to a bioterrorist threat, public health has again become an area of focus.

6. With what endemic infectious disease did people choose to become infected?

Cowpox Those that had an infection of cowpox were thereafter immune from smallpox, which was endemic and killed about 10% of the population.

1. How does having a broader, aggregate focus approach to care help an individual nurse and client improve that client's outcomes? Select all that apply.

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

3. What is the proper term for those diseases that are always at a consistent level in populations?

Endemic By definition, when diseases are always present in a population they are called endemic.

5. What actions have been effective in reducing problems related to alcohol use? Select all that apply.

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

1. A nurse reviewed some handouts before meeting the community residents attending a program on healthful living. What is this nurse's behavior called?

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

4. A nurse was becoming frustrated. She had given her client extensive information on his health problem, but the client continued to be noncompliant in making needed changes. What had the nurse forgotten?

Information, while necessary, will not motivate people to change. Although other priorities may result in delay of change, the fact that the client has returned to the nurse demonstrates interest in changing. Repetition may be helpful, but apparently the nurse has given information on more than one occasion because she believes extensive information has been given. Information alone is rarely enough to motivate a person to act. Information is necessary to know what to do and how to do it before the person chooses to act, but other factors are primarily responsible for motivating people to change their behavior.

14. Which listed factor is most closely associated with morbidity and mortality outcomes?

Insurance status Social political variables such as race-ethnicity, educational status, gender, and income are highly predictive of health status, but the single most relevant factor of those listed is whether or not the person has insurance.

5. What measure(s) did persons use for self-protection from the Black Death (bubonic plague) in the fourteenth century?

Isolation and quarantine Modern public health practices such as isolation, disinfection, and ship quarantines emerged in response to the bubonic plague.

10. What is the advantage of using Nancy Milio's approach to caring for a client?

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

15. What characteristics of the nurse are crucial to success when nursing in the community?

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

6. Why do nurses often ask clients how they are sleeping? Select all that apply.

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

3. What is a weakness among the many nursing theories created throughout the years on the most appropriate ways to approach patient care?

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

26. What helps explain the increased numbers of advanced practice nurses in primary care?

Most physicians are specialists. Because so many physicians are specialists and there is increasing demand for primary care providers, there are increased opportunities for advanced practice nurses in primary care. Hospitals are decreasing the number of beds, not increasing them.

27. How do we explain the continued incidence of infectious diseases in the United States today?

No single theory adequately explains why a particular person gets a particular illness at a particular time. Each theory explains some disease under some conditions, but no single theory accounts for all disease. Infectious agents cause disease when a person is susceptible as a result of stress and/or environmental conditions.

16. Which nurse is using a macroscopic rather than microscopic approach?

One who provides testimony to legislators concerning proposed legislation All the choices focus on individual client care except for the nurse who is politically involved as demonstrated by providing testimony relevant to proposed legislation.

2. Many of Nightingale's ideas were absorbed into nursing education in both England and other countries. Which of the following of Nightingale's ideas were forgotten until recently? Select all that apply.

Recognizing the influence of environment on health, Use of statistics and a sound research base As the text remarks, it is interesting to note that the paradigm for nursing education and practice did not incorporate her emphasis on statistics and a sound research base. It is also curious why her writing on health's social and environmental determinants was not consulted until much later.

30. Based on public health issues today, what is the major challenge for health care provider education?

Refocusing the curriculum from care of the individual to needs of aggregates There is an obvious need for a primary care curriculum that prepares students to meet the needs of aggregates through community strategies that include understanding of statistical data and epidemiology. Primary health care and health promotion rather than acute care treatment would be emphasized. Such a curriculum would move the focus from the individual to a broader population approach.

9. How did John Snow decrease deaths from cholera?

Removed a source of contaminated water John Snow demonstrated that cholera was transmissible through contaminated water. He removed the pump handle from the contaminated water so an alternate source of water had to be used.

12. How did Nightingale respond to some powerful leaders challenging her suggestions for reform of health care beyond the military war arena?

She conveyed her statistical data in more detail and depth and shared it with political leaders. Nightingale felt very strongly about the unnecessary loss of life and shared her findings widely. When prominent male leaders challenged her conclusions, she rewrote her report in more depth and redistributed it to members of Parliament and military leaders.

1. What is most impressive about Lillian Wald's achievements?

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

11. What health-related variable does critical theoretical perspective examine?

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

14. What scientific belief or idea eventually changed medical practice and decreased morbidity and mortality?

Specific contagious organisms cause disease. The emergence of the germ theory of disease focused diagnosis and treatment on the individual organism and the individual disease.

6. What assumption can make Dorothea Orem's theory difficult to use?

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

18. What group was primarily responsible for the establishment of the first school of public health?

The Rockefeller Foundation Philanthropic foundations influenced many health care efforts. The Rockefeller Sanitary Commission strived for the eradication of hookworm. This model of prevention was so successful that the Rockefeller Foundation established the first school of public health in 1916.

4. What is the primary purpose of nursing theory?

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

22. How might the approach to home nursing established by Wald and Brewster best be summarized?

"Helping people to help themselves" The nursing service adopted the philosophy of meeting health needs of aggregates including social, economic, and environmental determinants of health. This aggregate approach empowered people of the community. A later director summarized their role as "one of helping people to help themselves."

2. Historically, what were among the first measures large communities began to undertake to ensure community health?

Building safe sewage disposal systems In classical times, large cities grew, and elaborate drainage systems were constructed.

17. What level of prevention does a screening examination, required for each school athlete before being active in school sports, represent?

Secondary prevention Screening, because it may result in early diagnosis and treatment, is secondary prevention.

17. On what basis does the federal government give special funding for health care?

To stay consistent with the societal priorities such as 2020 Health Objectives Allocation of resources is based on societal priorities such as the 2020 Health Objectives.

12. What is the cause of most preventable deaths in the United States?

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

10. Which federal agency is responsible for administering most of the federal health-related activities?

Department of Health and Human Services Most health-related activities at the federal level are implemented and administered by the Department of Health and Human Services (DHHS).

17. What is the most important first step before interviewing a Hispanic family?

Establish rapport, and gain trust and confidence Regardless of the culture of the client family, it is crucial to establish rapport and gain trust and confidence before attempting to gather data.

27. A nurse was creating an ecomap for a family, which consisted of a 3-year-old girl, an 8-year-old boy, and their mother. Which question might be useful for the nurse?

"Are you involved with any groups or resources in the community?" The ecomap is another classic tool that is used to depict a family's linkages to their suprasystems. The nurse can note people, institutions, and agencies significant to the family with some notations as to the nature of the ties that exist. Knowing what resources the family is currently able to assess will help the nurse know what resources to suggest to the family.

5. A nurse carefully explained that the medication had to be taken three times a day, with each meal. The patient came to the clinic with symptoms of medication overdose. How should the nurse respond?

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

3. A patient had wrapped a tummy band around her newborn's abdomen. What should the nurse say to the new mother?

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

13. A nurse asked of a family, "Could each of you tell me what you typically do during the week?" How might the nurse follow up such an open-ended question?

"Could you tell me about what you do at your job?" Obtaining an occupational history from all family members will allow the nurse to assess occupational hazards. Many employment hazards such as toxic agents can transfer to other family members via clothes and equipment. Thus it is important to determine who is employed and what they do at their employment site.

18. What would be an appropriate response if a nurse were asked, "Why are you so rarely in the department office?"

"I have to be where the people are." One of the underlying premises of community health is to "start where the people are." Therefore, the nurse must spend a great deal of time and effort in the community, interacting with community members.

25. A nurse asked a family if they'd work with her to create a family genogram. The mother asked, "Why would you want to know so much about our family?" What is a good response?

"If you're willing to share, we can discuss family history and possibly some hereditary health issues." A genogram is an excellent opening to the discussion of family history and possible hereditary health problems. It may also point to a need for health education. Some families may be sensitive to the sharing of such information, but obviously any patient can answer with however much or little he or she wishes to share.

11. A young son was so physically fidgety that his mother was seriously embarrassed by his inability to be quiet and involved in the interview. What comment by the nurse might be most helpful?

"Isn't it marvelous how much energy your son has?" Sending the son to his room might be seen as punitive and would remove him from being informed about interventions planned and decisions made. A compliment reinforces family strengths and tends to further progress toward open trusting relationships. The comment took a flaw (physically fidgeting) and reframed it as an asset (high energy).

26. Some nurses do not want to become involved in politics because of family, school, work, and other commitments. The best thing to say to such nurses is

"It won't take much time to join ANA and pay dues so their lobbyist can represent you." The whole chapter emphasizes the importance of nurses being involved in policy decisions.

17. A father was very excited about his new job offer in a nearby state. But he asks you, "Will my daughter still be under Medicaid until I get on my feet?" What is your response?

"Medicaid requirements vary by state so you'd have to check in your new location." A minimum is established for all; however, as demonstrated with Medicare and Medicaid, unequal care exists in Medicaid as a result of geographical location. Previous chapters have also emphasized that Medicaid is a program with federal-state cooperation and based on minimum federal requirements, but with the maximum decided by each individual state.

6. What is the basis for any American citizen to feel comfortable expressing an opinion on a political issue?

Amendments to the Constitution Amendments to the Constitution, later known as the Bill of Rights, were added after the original Articles of the Constitution were ratified. These amendments protect individuals' rights and freedoms.

17. A community health clinic put a tax levy on the ballot. An angry man asks you, "How can you ask me to pay taxes to buy immunizations for parents who don't want to pay for their kids to get their shots?" What is your response?

"Only by getting almost everyone immunized can we prevent epidemics that can hurt us all." Herd immunity is a state in which those not immune to an infectious agent will be protected if a certain proportion (generally considered to be 80%) of the population has been vaccinated or is otherwise immune. If most persons are immune, it will be difficult for an infectious disease to spread.

18. A 36-year-old woman had diabetes diagnosed at a free health-screening program at a large employer. What would you most want to emphasize when you help the woman make an appointment at the diabetic clinic for follow-up testing and treatment?

"Please encourage all your family members, including your parents, to be tested for diabetes as well." Although the nurse might make any of these comments, it is particularly important that the rest of the family also get tested. Any problem that affects one or more family members probably affects other family members and the family as a whole. Commonalities in risk factors and diseases shared by family members can lead to case finding within the family. Because families often choose similar foods and engage in similar lifestyle behaviors, they all are at similar risk for problems such as diabetes. The earlier the diagnosis and treatment, the more likely it is that secondary problems can be avoided.

24. A mother says to you, "I know I should be feeling an empty nest sadness now that our youngest has left for college—but mainly I'm dying to turn his room into my craft room. Do you think that's normal for a mom? I really do love my kids." What is your response?

"Very normal; you've launched your family and now you can devote attention to your own life and preferences—such as crafts." To assess the family, the community health nurse must comprehend developmental phases and the struggles that families experience while going through them. The mother is recognizing the stage of launching family that occurs when the youngest child leaves home. The development requirement of this stage of life includes establishment of independent identities for parents—such as focusing on becoming a crafts person.

10. Which question is crucial to ask very early in a family interview?

"What do you all as a family hope to achieve during your time with me?" Therapeutic questions are key questions that the nurse uses to facilitate the interview. One important basic theme is to determine the family's expectations of the interview or home visit.

26. You have just begun a family health tree. Which question might be most helpful as you work with the family on promoting their health?

"What do your family members do to keep in shape and handle stress?" The family health tree is based on the genogram of the current generations—that is, parents, their children, and their own parents. Spouses and past generations aren't included. The family health tree provides a mechanism for recording the family's medical and health histories. The nurse should note causes of death of deceased family members, genetically linked diseases, and lifestyle-related risk factors (i.e., by asking what family members do to "handle stress" and "keep in shape"). The family health tree can be used in planning positive familial influences on risk factors such as diet, exercise, coping with stress, or pressure to have a physical examination.

5. The school health nurse was driving home when a child darted out into the road and hit the side of the nurse's car. What should the nurse ask the child?

"Whom do you live with that I can call to come be with you at the hospital?" Legally only a parent can sign for medical treatment, but, in an emergency, care can be given without consent. Because the nurse didn't know with whom the child lived (i.e., who was in the child's family), the broader question of "whom can I call?" is inclusive, whereas "what is the telephone number of your mother?" is based on assumptions that may not be valid.

6. A nurse was teaching a class on good hygiene at a local day care center when one child volunteered, "I have two mommies." What would be your response?

"Yes, some children have two mommies, some have a mommy and a daddy, and some just have daddies. Some people only have one grown-up to love them." The nurse must show acceptance of life choices. The child with two mommies isn't that rare. Estimates of the number of children who live in lesbian- or gay-parented families, including children conceived in heterosexual marriages, range from 6% to 11% of children (Women's Educational Media, 2005). These numbers are estimates because the U.S. Census Bureau does not count the number of lesbians and gay men. The University of California at Los Angeles (2009) reports that "more than one in every three lesbians have given birth and one in six gay men have fathered or adopted a child. An estimated 14,100 foster children are living with same-sex couples."

22. A man had been in an extended-care facility for 5 weeks and was now home. His wife tells you, "He's trying to take up where he left off but we've adapted to not having him home. He keeps thinking things will be just as they were when he left but they aren't." What is your response?

"You all adapted to running the house without him; it will be challenging now to adapt back." Family functional assessment, or how family members behave toward one another, is divided into two categories. The first is instrumental functioning, which refers to routine activities of daily living. This area takes on important meaning for the family when one member of the family becomes ill or disabled and changes were made. When the family member is better, the family must again adapt to changes, even if the change is to return to the original mode of functioning. It will help the family to be able to recognize the problem; labeling it makes it more manageable.

4. A baby was dehydrated because of diarrhea. The mother explained that she had finally gone to a folk healer who told her to give the baby herbal tea, which did seem to be helping a bit, but the baby still seemed ill. What would be the best approach?

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

10. A newspaper published an article about the athletic banquet at the local high school that had approximately 1000 family members in attendance. Exactly 650 persons became ill within 24 hours, complaining of severe diarrhea, vomiting, and cramping. What is the attack rate?

650:1000 Rates are calculated by the number of people with the problem over the number exposed to the problem. In this case, 650 persons out of the 1000 at the banquet complained of illness. Although this rate could be presented as an attack rate of 65%, 6.5% is incorrect.

7. What is meant by the epidemiological transition?

A change from mainly infectious diseases to chronic diseases Many developed countries experienced an epidemiological transition from having an infectious disease profile to having a chronic disease profile and are now plagued by chronic diseases. Once plagued with high rates of infectious disease, developed countries significantly reduce high mortality rates from these diseases through improved sanitation, nutrition, and immunization and improved health care. Most developed countries have a more stable economy and a wide range of industrial and technological development. These countries experience an epidemiological transition.

11. What were the conclusions when Congress asked for a report on the federal government's quality enhancement process on the care the federal government gave? Select all that apply.

A clear responsibility at the federal level is to lead by example. Federally sponsored education and training programs have a strong impact. Writing regulations influences nonfederal health care providers and organizations. The report Leadership by Example concluded that there is a lack of consistent performance measurement, the information is not useful, computerized clinical data are missing, and the approach to gathering data is not systematic. The federal government is the largest purchaser of care because it gives direct care to specified groups and requires conforming to regulations for those accepting Medicare and Medicaid funds. Sponsored research, education, and training also have an impact. The report concluded that the federal government must accept leadership both by example and by coordinating improvement in health care quality.

4. A nurse was becoming frustrated. It had been 2 weeks, and although the client had verbalized that the best time of day to take a 15-minute walk was early in the morning, the client had not begun to exercise. What had the nurse forgotten? Select all that appl

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

18. Which disaster would probably cause the most long-lasting mental health concerns for its victims?

A forest fire was deliberately set but was not a major concern until the fire suddenly changed direction and people attempting to evacuate at the last minute were burned in their cars. Research has identified four keys to gauging the mental health impact of such events, any two of which may result in severe, lasting, and pervasive psychological effects. The key factors are (1) extreme and widespread property damage; (2) serious and ongoing financial problems; (3) high prevalence of trauma in the form of injuries, threat to life, and loss of life; and (4) when human intent caused the disaster. Because the fire was deliberately set and lives were lost, that disaster will be more disruptive than disasters when only property was damaged.

3. Which is the best definition of health?

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

16. Based on statistics, which group is probably more physically active?

A group of highly paid college graduates Research has shown that those with higher levels of education and higher income enjoy physical activity more. Those of mature age, with less education, with less income, and/or living in the southern U.S. states engage in far less activity.

8. How does community health nursing define community?

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

12. Which process determines public policies?

A negotiated balance between the desires of interest groups In a perfect world, policies would be based on rationally determined actions to achieve desired outcomes. In the real world, policies represent negotiated outcome to conflict as various interest groups compete with one another for various policy changes.

15. What is a "carve-out" service?

A particular service that is offered only by a designated provider or group. Carve-out services might be designated for those who need the services the least. A carve-out service (for example, mental health care) is provided within a standard benefit package but delivered exclusively by a designated provider or group.

8. What assumption inherent in the health belief model (HBM) is problematic?

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

6. What is the chief determinant of whether a health education program will create change?

Amount of input and participation by learners The lasting effect of cognitive and behavioral changes is determined by learner participation.

6. What were the effects of Medicare and Medicaid? Select all that apply.

A previously unseen rise in demand for services occurred. Many persons previously without access now receive health care. Medicare reimbursement rates became the standard for all insurance carriers. Now almost half of all health care costs in the United States are paid by government financing. The enactment of Medicare and Medicaid created an unprecedented demand for services. Medicare reimbursement rates generally became the standard for all insurance carriers.

19. When William Rathbone created district nursing, who was sent to each district?

A social worker and a nurse A nurse and a social worker were assigned to each district to meet the needs of their communities in nursing, social work, and health education. This plan was widely accepted and very successful.

16. What eventually was helpful in decreasing the incidence of tuberculosis (TB)?

A volunteer organization began a public campaign of education. The National Tuberculosis Association enlisted community support through a campaign of public health education with many voluntary health organizations assisting. Physicians fought being required to maintain surveillance of TB and TB health education. States did have to build large state hospitals for treatment but that did not notably decrease incidence.

8. What action has been effective in reducing HIV infections in some countries?

ABC campaign Substantial reductions in HIV seroprevalence occurred after several countries deployed "ABC" (Abstinence, Be faithful, Condom use) strategies.

25. What is the importance of ANSRA?

ANSRA is a united approach to improving policies to improve the nursing shortage. ANSRA is a coalition of thirty-seven nursing organizations founded to influence policy and funding decisions related to nursing shortages through media attention, advocacy for legislation, working with Congress, developing funding initiatives, and continuing research into nursing staffing issues.

7. Which community characteristic would suggest a healthy community?

Ability to adapt and respond to changes The community's ability to respond effectively to changing dynamics and meet the needs of its members indicates productive functioning. A community may or may not be able to control environmental pollution because the pollution is often from outside the community itself. Similarly, employment, or lack thereof, may be due to factors outside the community's control. In many communities growth is not expected; simply not losing more population is a great achievement.

23. What was the poverty guideline for a family of four in mainland United States in 2009?

Above $22,000 A four-person household must make less than $22,000 to be considered under the poverty guideline according to the U.S. DHHS.

2. What are the most important factors in reducing disparities in health outcomes between different cultural groups? Select all that apply.

Access to a health care provider Health care insurance Disparities in health care can be reduced or even eliminated when adults have health care insurance and a medical home defined as a setting that provides patients with timely, well-organized care and enhanced access to providers.

18. Which task will be most helpful in meeting the public health agency's goals?

Actively participate in community agencies' collaborative action plan to meet the community's health goals for the year Although all tasks may be necessary and important, intra-agency cooperation to meet the health goals of the community as a whole is more central to the agency's mission than other choices that meet the needs of individuals or groups rather than the community as a whole.

13. As Healthy People 2020 suggests, by thinking and acting strategically, what will be the most effective way to improve the health and well-being of American citizens?

Addressing the root causes of health problems The chapter emphasizes the need to go beyond individual lifestyle behaviors to the social, economic, political, and value-laden processes of daily life that affect health.

1. Which factors have a profound, if sometimes unrecognized, impact on one's health? Select all that apply.

Adequate resources to allow easy access to health services, Interpersonal relationships with family and friends, Local, state, and national policies, Physical neighborhood where one works and lives Health is affected by biology. Behaviors, social environment, physical environment, policies, and access to quality health care are all factors that affect health. The number and quality of health care providers is not relevant if one does not have access to them because of lack of insurance or financial resources. Understanding the need for healthy lifestyle choices is important, but knowledge alone is not adequate to change behavior.

10. What must a nurse do to be successful in addition to the typical assessment, diagnosing, and planning directly related to the intervention project?

Advocate for community empowerment throughout the process An essential component is to have a strong level of community involvement. The nurse is responsible for advocating for client empowerment throughout the process. Attention to community involvement and empowerment helps ensure that the outcomes reflect the community's needs and will be accepted.

28. The lack of certain B vitamins can result in pellagra. Where would a nutritional deficiency fit in the agent-host-environment model?

Agent factor Nutritional deficiencies are included under agent factors. Although too much of an agent can cause disease (such as obesity related to diabetes), so can too little of an agent.

13. Who should create a disaster plan including emergency supplies and where to meet in case of an emergency?

All families The American Red Cross publishes many pamphlets and educational materials to help individuals, families, neighborhoods, schools, and businesses prepare for potential disasters. The key actions it recommends are (1) identify potential disaster events, (2) create a disaster plan for sheltering in place or for evacuation, (3) assemble a disaster supplies kit, and (4) practice and maintain the plan. The disaster plan should include an emergency communications plan, a predetermined meeting place for family members or significant others, and plans for care of pets in the event that evacuation is required.

7. What are some of the current state legislation acts limiting what managed care organizations (MCOs) are allowed to do? Select all that apply.

Allowing patients to see a specialist without having to obtain approval from their primary care provider Allowing patients to go to the emergency department without first telephoning for approval Allowing new mothers to stay in hospital longer than 24 hours if needed Requiring the MCO to accept any provider who meets plan requirements and is willing to accept the contract Much recent legislation concerns managed care organizations in response to consumer concern about the MCOs' efforts to control costs. MCOs have to accept any provider who meets plan requirements and is willing to agree to the contract. The legislation mandates certain benefits such as emergency department visits without prior approval, coverage for experimental treatments, mental health parity, screening, and chiropractic treatment and hospice services. Other examples are allowing longer lengths of stays such as after childbirth and having an impartial mechanism for grievances. A national patients' rights bill has not yet occurred.

2. How is a disaster the same as or different from an emergency?

An emergency is personal, whereas a disaster is community-wide. A disaster is any event that causes a level of destruction, death, or injury that affects the abilities of the community to respond to the incident using available resources. Emergencies differ from disasters in that the agency, community, family, or individual can manage an emergency using their own resources. However, a disaster event may be beyond the ability of the community to respond to and recover from the incident using its own resources. Disasters frequently require assistance from outside the immediate community.

23. The Assessment Protocol for Excellence in Public Health (APEX-PH), created by the APHA, ASPH, ASTHO, NACCHO, USCLHO, and CDC, is a voluntary process for what purpose?

An evaluation process involving both community and public organizations The APEX-PH program is a true self-assessment and is intended to be more of a public endeavor involving the community, as well as public organizations.

17. What was the principal outcome of the Hill-Burton Act?

An increase in the number of hospital beds The Hill-Burton Act was also called the Hospital Survey and Construction Act, which was to address the need for better hospital access. Federal aid was given to states for construction of hospitals.

4. Whether caring for an individual, a family, or an aggregate, the nurse can use a systems framework. Which aspect might be more challenging in caring for an aggregate as opposed to caring for an individual?

Analyzing power and decision making within the system Although all aspects can be challenging, it is probably more challenging to recognize the interacting aspects of a large aggregate system in its power distribution, consensus activities, accommodation, and authority within the decision-making process.

2. Why is it crucial that nurses who focus on the care of individual patients also be able to work with families? Select all that apply.

Anytime a person is ill, his or her whole family is affected. By understanding the family, understanding of the individual is improved. Individuals depend on their families for care and support. Risks caused by genetics or environment affect the whole family, not just the individual Reasons that it is important for nurses to work with families include that the family is a resource in giving care to its members and working together on health promotion and wellness activities; any dysfunction (illness, injury, separation) that affects one family member will affect the whole family; the nurse can often identify a health problem that involves risks for the entire family. Finally, understanding the whole family helps the nurse understand and provide more holistic care to the individual.

12. A nurse assessed carefully and created a comprehensive intervention plan including primary, secondary, and tertiary care for individuals and families. What crucial factor might the nurse have overlooked?

Are there adequate resources for such a project? The nurse must validate the practicality of any planned intervention, in other words, determine whether there are adequate resources to implement it.

21. Why should nurses contribute whenever possible to their state nursing association political action committee (PAC)?

As PACs are a reality of political life, nursing needs to be heard. Because PACs are a reality of political life, nurses need to recognize their power and support those that are committed to electing candidates sympathetic to health care issues.

11. In a particular community, the rate of new cases of diabetes and the rate of new cases of flu during the month of January were precisely the same. Which disease would have the higher prevalence rate?

As a chronic condition, diabetes would have the higher prevalence rate Diabetes would have the higher prevalence rate because it is a long-term chronic condition that typically does not decrease. Although flu might have a higher incidence rate of new cases, because flu is typically of short duration, the prevalence rate would remain low. Flu is contagious, which could increase the incidence rate but not the prevalence rate.

27. The ANA Code for Nurses states which of the following in relation to politics?

As nurses collaborate with others to meet community needs, participation in policy-making processes is an ethical obligation. The whole chapter emphasizes the importance of nurses being involved in policy decisions.

7. A woman, who spoke English, was an immigrant from the Middle East, attending the clinic for the first time with two female friends. When a male nurse attempted to get a health history, the woman refused to respond to his questions. What can the nurse do?

Ask a female nurse to talk with the client Many culture groups have strong norms regarding appropriate gender behavior.

14. In a client's culture it was exceedingly rude to ask any question about income or wealth. How might the nurse draw conclusions about the client's socioeconomic status (SES) or ability to pay?

Ask about the client's education or employment position SES may be determined by examining income, occupation, and educational level. If that is not possible, age, gender, possessions, location of residence, religion, and race may also be considered.

22. A woman comes to the clinic, and your best guess is that she is speaking French. She seems to understand English. You need to do a physical examination to confirm the health problem. If you are a male, what should you do?

Ask the client if she prefers a female caregiver When in doubt, the best way is to ask the client about culturally relevant aspects of male-female relationships. This should be done at the beginning of the interaction before an opportunity arises to violate culturally based practices.

19. A nurse became frustrated because after each interview question there was a long pause before the client responded. What should the nurse do?

Ask the client what silence after a question means Wide cultural variation exists when interpreting silence. Some individuals find silence uncomfortable, whereas others use silence to show understanding and respect. Because the nurse is uncomfortable, action should be taken. The only way to know the meaning of the silence is to ask.

25. Your friend calls you complaining of symptoms of a cold. What would you tell your friend?

Ask what your friend's family usually does for a cold; suggest that be done but to call you back if the situation worsens Seventy percent to 90% of all illness episodes are treated first, or exclusively, through self-care, often with significant success. Symptoms of a cold don't seem to require drastic action such as going to the urgent care center or seeing a health care provider. Engaging in traditional healing interventions, learned in the family, will be comforting and probably will help. Just suggest that the friend call you back if he or she feels worse to allow further intervention if needed.

25. How can a nurse determine a patient's reading level?

Ask, "Do you find it useful to have someone help when you receive written material from your doctor or pharmacy?" Any of the responses might be effective at assessing literacy, but the single question asking how often help might be needed is the fastest and easiest. Nurses are limited in the time available for assessment. One question is easier for a client than a complete assessment tool. Asking about years of education can be dismaying to someone who did not complete many years of formal schooling. Clients may not understand the question when asked to assess their own health literacy.

21. What did large industrial giants do to stop the constant increase in their costs for health insurance for their employees?

Assembled their own health care programs Large industrial giants, such as Kaiser Permanente, decided to assemble their own health care programs. They built hospitals, hired physicians, and provided health care services to their employees. In an effort to market this concept, the phrase health maintenance organization was created. These organizations were designed to provide comprehensive care to employees.

9. What is an appropriate action to take if there is a rumor that some factor in a building was causing the persons employed there to feel ill?

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

6. What message are public health leaders trying to emphasize to the public?

Assume responsibility for your own health by choosing healthy behaviors Although there are many public health messages in the media, from stop smoking to get a checkup, the primary message currently being emphasized by public health, as well as all the media coverage of the constantly increasing cost for health care, is for each person to take responsibility for his or her own health through choosing healthy lifestyle behaviors

10. What led to the creation of the Health Belief Model (HBM)?

Attempting to understand why people did not flock to free health care The HBM was created to explain why people did or did not participate in health education programs to prevent or detect disease, even when the programs were free.

3. Of what can the American health care system be especially proud? Select all that apply.

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

30. What would be most helpful in caring for a patient from a different culture?

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

5. Which suggestions would be helpful for effective teaching? Select all that apply.

Be encouraging and give positive feedback for helpful comments, Review and summarize the key points at periodic intervals Incorporate demonstrations, illustrations, and real-life examples The nurse must determine what the client wants to know, not what the nurse believes the client needs to know. The nurse should not go into excess detail but focus on a few concepts or key points, that is, stick with the essentials; use clear and concise language while avoiding technical terms; encourage participants by use of questions related to their life experiences; use demonstrations and real-life examples to illustrate major points and summarize the key points to help the audience retain the material.

1. Why would a patient not do what the nurse instructs after being told several times what needs to be done to get better?

Barriers prevent action. Often the patient is blamed and labeled as being noncompliant. It is more helpful to wonder what barriers interfered with the patient's ability to engage in appropriate action

5. What or who determines eligibility for Medicaid to pay for health care? Select all that apply.

Baseline eligibility is established by the federal government, but states may be more lenient. Children in low-income families are eligible for free care. Eligibility depends on family size and total family income. Medicaid provides universal health care coverage for the indigent and children. Eligibility is dependent on the size and income of the family. The federal government sets baseline eligibility requirements. State governments who wish to provide care to more citizens can lower the eligibility requirements. The federal government mandates covered services, but state governments may provide more services.

21. As a nurse as well as a citizen, what is your additional responsibility in relation to disasters?

Be aware if there is an unusual increase in the number of people seeking care with similar symptoms As a nurse, you are expected to be informed regarding the Guidelines for Early Detection for Biochemical Terrorist Incidents, including noting if there is a sudden increase in a particular disease, an unusual number of persons seeking care with similar complaints, clusters of patients from a single location, or a person presenting with an uncommon disease.

8. What is crucial to remember about the first assessment interview with the family for a nurse entering an apartment for the first time?

Be on best behavior with manners and courtesy, starting with a self-introduction Manners are common social behaviors that set the tone for the interview and begin the development of a therapeutic relationship. The nurse introduces himself or herself by name and title and always addresses the client and family members by name (i.e., Mr., Mrs., or Ms., unless otherwise directed by client).

19. A nurse who represents the state professional association would engage in what actions related to legislation?

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

18. If a nurse is employed by the state nursing association to serve as a lobbyist, what is the most crucial task to be achieved?

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

13. Why are health care providers concerned over such social issues as mass transit, clean power, and the farming industry?

Because air pollutants are contributors to asthma and other health problems. All three (mass transit, clean power, and industry) emit air pollutants, which result in smog, the most common outdoor air pollutant in the United States. Atmospheric pollutants cause or contribute to asthma, allergic reactions, bronchitis, lung cancer, chronic respiratory disease, and death. They also harm animals and plants. The most inclusive answer refers to air pollutants, although certainly, the others are true in society today.

15. Because the current school year is now over, why would the school health nurse spend time summarizing the records of all the children who had come into the school health office during the completed school year?

Because analysis can help establish priorities for future health programs The challenge is to focus not only on individual students but extend practice to the whole school community of children. Fiscal constraints hold the nurse accountable for the best delegation of scarce resources. In times of limited budgets the school health nurse, on the basis of the most frequent problems presented in the office, can draw conclusions as to what are the major health needs of children in the community. On the basis of those conclusions, health programs can be planned to maximize health promotion and disease prevention in the school.

9. Why do so many Americans continue to engage in unhealthy behaviors?

Because of the belief that most illnesses can be cured with insurance footing the bill Society sees insurance as an economic shield protecting against all disease and illness. The belief in cure rather than prevention, combined with this financial safety net, encourages society to become a passive participant in health care. The pervasive societal thought is "I don't have to worry; I have insurance."

26. Why would the nurse continue to ask questions and encourage attendees to contribute examples from their own lives relevant to the discussion?

Because persons learn by doing through active participation One of the key concepts of community organizing practice is the principle of participation, which essentially means that active participation—or learning by doing—results in a greater likelihood of change in behavior and attitude.

1. What was unfortunate about the idea of private health insurance? Select all that apply.

Because providers were paid for any service they gave, it was economically advantageous for them to give as much care as possible. Health care costs increased very rapidly. Health education and health promotion interventions were not included in the idea of health insurance. Patients wanted any and all care that might help, regardless of how expensive it was. There was no limit on what care could be sought and given. The majority of the population was protected. The emphasis was placed on illness care, because providers received a fee only when a service was rendered, and all costs were reimbursed. Insulated from having to pay for health care, consumers demanded complex and technologically advanced services. These demands were a major force rapidly increasing health care costs because people with insurance felt entitled to care, and, after all, there was a guaranteed payer. Medical orientation was on curing at any cost.

23. When does disaster management begin?

Before a disaster occurs When one is aware of the types and characteristics of disasters, the question then becomes: What can be done to prevent, prepare for, respond to, and recover from disasters? Disaster management requires an interdisciplinary, collaborative team effort and involves a network of agencies and individuals to develop a disaster plan that covers the multiple elements necessary for an effective plan. Communities can respond more quickly, more effectively, and with less confusion if the efforts needed in the event of a disaster have been anticipated and plans for meeting them have been identified. The results of planning are that more lives are saved and less property is damaged. Planning ensures that resources are available and that roles and responsibilities of all personnel and agencies, both official and unofficial, are delineated.

9. Which variable has a major influence on a community's health?

Behavior choices made by persons in the community Individual behavior choices and environmental factors are responsible for about 70% of health outcomes. Individual choices are affected through interaction with other individuals and their mutual social and physical environments. Health care providers are responsible for only 10% of the outcome.

5. Why is there such a community health emphasis on heath education programs?

Behavioral change must be voluntary. Health education is designed to predispose, enable, and reinforce voluntary behavior conducive to health.

3. What is the most important factor in legislation?

Beliefs, attitudes, and values of the policy Public policy encompasses the choices made regarding goals, priorities, and how resources are allocated. Policy choices reflect the values, beliefs, and attitudes of those designing the policy.

20. A community health nurse found a very small number of families in the community who were desperately in need of basic preventive health services. What ethical approach supports expending agency resources on these few, but needy, families?

Beneficence suggests focusing on the most needy, so resources should be expended on these families. Each response is an accurate portrayal of a branch of ethics. This situation is reviewed in the Ethical Insights box in the text. Beneficence and social justice would give moral advantage to the most vulnerable. By caring for these families, the demands of utilitarianism (the most good for the largest number) would also be met as caring for the weakest supports the whole community.

12. What factors are most responsible for the increasing length of life of Americans over the past 100 years?

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

15. What nongovernmental group has been expending millions of dollars to reduce the impact of infectious diseases with profound effect on prevention and treatment for HIV/AIDS, tuberculosis (TB), and malaria?

Bill and Melinda Gates Foundation The Bill and Melinda Gates Foundation has local, national, and global objectives. Globally, the foundation focuses on reducing extreme poverty, improving health, and increasing public library access. Within Africa, the foundation has had a profound effect on improving access to antiviral medications and prevention and treatment for HIV/AIDS, TB, and malaria.

4. What is a common result in countries with a severe HIV/AIDS epidemic?

Birth rate is high, but life expectancy is only 35 to 40 years. In countries severely affected by the HIV/AIDS epidemic, life expectancy has dropped to 35 to 40 years. In these countries, the working age population has dwindled while the birth rate has risen.

23. The local nursing association and the local medical association disagreed vehemently on advanced practice nursing reimbursement. Why then would the two groups agree to join a coalition to send representatives to testify on a particular bill?

Both associations had formed a coalition to collaborate on a bill that would benefit patients. When two or more groups join to maximize resources, increasing their influence and improving their chances of success in achieving a common goal, it is a coalition. Professional groups often form coalitions to advance their shared interests.

4. What is a factor that makes environmental health (EH) challenging?

People going about daily tasks ignore their surroundings or take them for granted Ordinarily, society takes systems and structures (buildings, schools, transportation, workplace) for granted, ignoring or overlooking potentially harmful environmental situations.

3. What happened to health care providers during the Great Depression when so many persons were unemployed?

Both hospitals and physicians went bankrupt. With 25% of the population out of work, the number of patients capable of paying their medical bills was reduced. Because public financing was limited, hospitals, physicians, and other providers went bankrupt.

24. A nurse works very hard to develop alliances among various community organizations toward improving health in the community. What are actions such as this called?

Building coalitions By definition, the nurse's actions are coalition building. Although collaboration has a very similar meaning, Table 1-5 stresses that collaboration is focused more on enhancing the capacity of an individual or a group. The nurse is establishing cooperative alliances, not yet working with them toward a goal.

3. How have the majority of American women chosen to first have a long-term relationship?

By cohabitation (living together but without legal sanction) Fifty-two percent of American women currently in their 30s reported their first relationship was cohabitation.

19. A nurse explained the causes of asthma in a child, how to observe for "triggers" that lead to an attack, and how to use the inhaler. What does this nurse-patient interaction ignore?

By focusing only on the child, the nurse has absolved local government and industry from taking any action to improve air quality. By placing responsibility for the cause and cure of health problems exclusively on the individual, the belief is reinforced that all individuals are free to control their lives. Such a perspective absolves society, government, industry, and business from accountability.

14. How will a community know whether its disaster plan is adequate?

By following practice drills involving various feasible scenarios as an initial step of planning For a plan to be effective, it must be tested by having different disaster scenario drills. The more times realistic scenarios are created to test the plan in actual practice sessions, and not just tabletop or paper drills, the more problems with the plan will be identified and solutions for those problems can be found. Without practice drills, plans may have many unrecognized faults and, as a result, many more individuals may be harmed and communities damaged when an actual disaster occurs.

1. How does critical social theory (CST) differ from other nursing theories such as the health belief model or Orem's self-care deficit theory?

CST focuses on oppression and facilitates group action. CST is an approach that raises questions about oppressive situations, involves community members in the definition and solution of problems, and facilitates group interventions. The other two theories focus more on individual beliefs and choice of action.

3. A hospital emergency department received a call that multiple casualties were on their way, primarily burns from a large factory fire. What should the hospital immediately do?

Call in physicians and nursing staff who are experts in burn care A multiple casualty event is one in which more than two but fewer than 100 individuals are involved. Until more is known, only staff expert in burn care need be asked for assistance. Only a mass casualty event with 100 or more individuals involved requires community or state involvement.

14. Who primarily provides care for military personnel, their families, and veterans, as well as Native Americans?

Federal government The federal government is responsible for the health care of specified populations including military personnel, their families, and veterans. The federal government also is responsible for health care for Native Americans.

20. A client, accompanied by her son, spoke only Spanish while the nurse did not. What should the nurse do to meet the client's need?

Call until she finds a Spanish interpreter employed by the agency Asking the son would violate confidentiality, and gender issues may also arise. The only safe approach is to obtain a Spanish interpreter who is knowledgeable about medical terminology and procedures, as well as comfortable with cultural beliefs and health practices.

3. In what way(s) would a nurse, who uses the critical theoretical perspective in practice, respond when a patient suggests that the physician should prescribe a widely advertised medication for tension and anxiety? Select all that apply.

Can you tell me what is going on in your life right now?, What have you tried in the past to relieve tension and anxiety? The best answer is to ask what is going on the client's life at that moment because situational stresses often occur to everyone. Next, asking what previously has been effective in relieving the symptoms may suggest more appropriate actions than medication. Although generics would be less expensive than brand-name medication, medication should not be the first approach to resolving a symptom before even examining why the symptom is occurring.

5. Which crucial question, needed by the nurse to determine health problems, might not be written on the health history form?

Can you tell me what you do at work? Because 25% of worldwide preventable illnesses are caused by poor environmental quality, nurses need to ask critical questions about their clients' work and home environments to help discern the contributions of specific hazards to their health. This can be accomplished by an environmental health history.

16. In which type of intervention does a community health nurse spend most of the allotted time?

Caring for individuals Although the focus of care is the aggregate, the community health nurse will find the majority of time is spent caring for individuals.

14. What nongovernment organization is active in improving health on a global scale?

Carter Center Collaborating with the United Nations are nongovernmental organizations (NGOs) such as the Carter Center.

3. What is a fairly recent surprise regarding infectious diseases in the United States?

Cervical cancer and coronary artery disease may be caused by infectious agents. Recent scientific discoveries on the infectious etiology of stomach ulcers, coronary artery disease, and cervical cancer, for example, suggest that infectious agents may be responsible for more morbidity and mortality than previously recognized.

2. The Omnibus Budget Reconciliation Act influenced funding and set up regulations. What were some of the notable changes that resulted? Select all that apply.

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

23. When Medicare first began reimbursing hospitals based on diagnosis-related groups (DRGs), which might have been less than actual cost, how did hospitals cope?

Charged more for patients whose care was paid by insurance Hospitals developed cost shifting to supplement losses caused by Medicare funding. Because private insurance reimbursements were cost based, hospitals included the loss in their total costs; therefore private insurance paid for covering care to both their enrollees and Medicare patients. By 1985 Medicare paid $0.87 for each hospital dollar and insurance providers paid $1.27.

7. A day care center asked the nurse to come because they had several children out as a result of chickenpox. How might the nurse reassure the staff?

Chickenpox has low virulence so the children will be back at the day care center in a week or so. Other considerations for understanding the action of agents include their power to invade and infect large numbers of people (infectivity), their ability to produce disease in those infected with the agent (pathogenicity), and their ability to produce serious disease in their hosts (virulence). When the above concepts are applied, the chickenpox virus has high infectivity, high pathogenicity, and very low virulence.

3. What do polls suggest that most people believe are the most important determinants of a healthy community? Select all that apply.

Child-friendly neighborhoods, Low crime rate The public is more concerned with quality-of-life issues, with the most important determinants of a healthy community being low crime rates and a child-friendly neighborhood environment. Although employment opportunities are important, many are low-paying, no-benefit service positions that are inadequate to support family life. Although the food may be expensive, most cities have safe food and water supplies.

3. What group of persons makes up about 40% of the world's population?

Children Elderly make up about 12% and children 40% of the world's population (World Health Organization).

7. What would be the least expensive approach to treating chronic diseases?

Choose healthy lifestyle behaviors to retain health The five leading causes of death and illness can be positively affected by changes in lifestyle. Healthy lifestyles can modify or even prevent most chronic illnesses.

16. Which advanced nurse does not have advanced education in a clinical specialty?

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

11. In what way are the U.S. Census Bureau surveys helpful to a community health nurse?

Demographic data suggest distribution of age, sex, race, and ethnicity. Although they may offer temporary employment to some community residents and ideally all residents are counted, the value of the Census Bureau data is in clarifying the distribution of age, sex, race, and ethnicity of the community, which may also suggest health needs. The Census Bureau does not collect data on mortality and morbidity.

20. What actions are most useful for nurses who cannot be actively involved in attending meetings at the state level?

Communicating, with rationale, their stand on proposed legislation to legislators Grassroots cooperation can influence decisions. A high number of communications from individual constituents via e-mail, telephone, or postal mail have great influence.

1. Why is it challenging to give care to someone from a minority group? Select all that apply.

Communication, both words and gestures, may be unfamiliar. Few members of the minority group are nurses themselves. The nurse may have to confront personal values and beliefs. Nurses must understand how patients define health and illness, how their cultural group cures and cares for members, and how the nurse's personal cultural background influences the way in which care is delivered. The context and process of helping people involves at least two people who often have different cultural orientations and lifestyles. Very few nurses are members of a minority group.

22. What is the most important component of the Planning Approach to Community Health (PATCH) model?

Community participation throughout the process An essential element of the PATCH model is community participation. The idea is that health promotion is a process that enables the population to have more control of its own health.

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

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

7. A community health nurse determined exactly how many cases of a particular disease were current in the community. What should the nurse do before determining what interventions should be planned?

Compare the current rate with the previous rate of disease No conclusions can really be drawn from just knowing a number. Only by converting that count to a rate and then comparing the rate with the previous rate, or with the rate in the broader environment or a similar community nearby, can any conclusions be drawn as to whether there is a problem or intervention needed.

21. Healthy People 2020 establishes goals for improving the health of all Americans. What is most necessary to determine whether Americans' health is improving?

Comprehensive and systematically collected surveillance data on the health status of various population groups Effectiveness of Healthy People 2020 depends on the availability of reliable baseline and continuing data to characterize health problems and evaluate goal achievement. Surveillance is crucial.

24. How might all the changes resulting from attempts to control costs be summarized?

Conflict between providers, patients, employer, and insurance plans raged. All these changes resulted in conflicts among providers, patients, employers, and the insurance plans, particularly when services deemed necessary by the consumer and provider were denied insurance coverage. Everyone blamed everyone else.

1. Nurses give individualized care to unique individuals. How can care be appropriately given in a community?

Consider the community itself as the "patient." As it is clearly impossible and impractical to give service to each person in a community, the best approach considers the community itself to be the unit of service.

1. Which disasters are NA-TECH disasters? Select all that apply.

Constant rain led to mud slides, and whole neighborhoods were buried. Earthquake caused structural collapse of bridges and highways in the area. River flooding resulted in overflow of the sewage plant and contaminated drinking water throughout the city. The tsunami washed out all the power and telephone lines throughout the downtown area of the city. Disasters are identified as natural, man-made, or a combination of both. A NA-TECH (natural-technological) disaster is a natural disaster that creates or results in a widespread technological problem. An example of a NA-TECH disaster is an earthquake that causes structural collapse of roadways or bridges that, in turn, cause downed electrical wires and subsequent fires.

2. What did Florence Nightingale suggest is one of the most fundamental nursing principles?

Constantly engage in health teaching. Although Nightingale would probably agree with each of the listed suggestions, she emphasized that health teaching is one of the most fundamental nursing principles.

1. How is the population of the United States changing?

Growth will occur because of ongoing immigration. The number of immigrants and refugees in the United States is projected to continue to increase. The United States has grown largely through immigration.

1. What are the purposes of professional societies such as the American Nurses Association? Select all that apply.

Control and oversight of the occupation, Establishing standards for practice Protecting the interests of the practitioners Safeguarding the public trust Professional societies seek to further a particular profession, the interests of persons engaged in that profession, and the public interest. Their roles are to maintain control and oversight of the occupation—such as by writing standards for practice—as well as safeguarding the public trust. Licensure and educational standards are responsibilities of individual states.

14. What seems to be the problem with action to reduce the amount of toxic elements in our housing?

Controversy exists because of the high cost in removing toxic substances. Much controversy surrounds the economic hardship that industry, government, business, and multidwelling owners would face if they were forced to reduce concentrations of toxic elements.

15. Which primary prevention would the school nurse choose to address the school's number of unwed pregnancies?

Convince the school board to allow sex education classes to include birth control measures Although all choices would be appropriate actions in a school, only education regarding sexuality and birth control would help prevent future pregnancies.

27. What may help the nurse be effective in helping clients change their behavior?

Counseling through the Ask, Advise, Assess, Assist, and Arrange approach Ask, Advise, Assess, Assist, and Arrange is the five A's approach to counseling as seen, for example, in smoking cessation programs.

3. Which of the following are you legally required to obey? Select all that apply.

Court decisions related to legislative law, Laws passed by your state or the federal government, Rules and regulations from agencies such as the state board of nursing Laws that all must obey include legislative law, regulatory agency rules and regulations, and judiciary rulings regarding the law. It is probably wise to obey school assignments, but it remains your choice. Although physicians may delegate a task, a physician cannot delegate responsibility.

9. What did Nancy Milio suggest was the most effective way to improve the health of clients?

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

5. What do terrorists hope to accomplish by causing mass destruction and violence toward innocent persons going about their daily lives?

Create fear to intimidate and coerce to accomplish a political goal The U.S. Code of Federal Regulations defines terrorism as "the unlawful use of force and violence against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in furtherance of political or social objectives."

2. What are new national health goals as seen in Healthy People 2020? Select all that apply.

Create social and physical environments that promote good health, Eliminate preventable disease, disability, injury, and premature death Promote healthy behaviors at every stage of life Increasing equality and years of healthy life was a Healthy People 2010 goal. Eliminating health disparities was a goal of Healthy People 2010 and continues as a goal of Healthy People 2020. New goals for Healthy People 2020 include eliminating preventable disease, disability, injury, and premature death; creating social and physical environments that promote good health; and promoting healthy behaviors at every stage of life.

29. What did the federal government do to help improve health disparities among minorities?

Created the National Center on Minority Health and Health Disparities The National Center on Minority Health and Health Disparities was developed in 2000 to assist in the investigation of factors affecting minority health. Its mission is to promote minority health and to ultimately eliminate health disparities.

5. Which actions represent a shift in philosophy at the Centers for Disease Control and Prevention? Select all that apply.

Creating integrated health information systems, Encouraging partnerships and strategic alliances, Levering resources to steer the larger health system Rather than allocating resources, resources will be leveraged to influence the larger health system. Rather than collecting and analyzing health data, they now are creating integrated health information systems. Rather than transaction-based relationships, they now encourage partnerships and strategic alliances.

22. Which kind of study would be most helpful in examining potential risk factors in comparison with disease at a specific time through collecting data regarding current exercise, sleep patterns, and current health status among 12-year-olds?

Cross-sectional study By definition a cross-sectional study examines relationships between potential causal factors and disease at a specific time.

2. Which of these can be found in both the Health Belief Model and Pender's Health Promotion Model? Select all that apply.

Cues to action Demographics Perceived barriers Perceived benefits A review of the tables will show that only the HBM includes both perceived severity and perceived susceptibility. All other factors are found in both models.

11. Which federal agency is responsible for the Women, Infants, and Children Program, food stamps, and school-based nutrition programs?

Department of Agriculture The Department of Agriculture administers the inspection of meat and milk and provides funds for the Women, Infants, and Children Program (supplemental nutrition), the food stamp program, and the school-based nutrition program.

13. Comparing a surgeon today with a surgeon of Nightingale's time, what would be the primary difference in how they operate on a patient?

Current physicians would carefully scrub between cases. Physicians in Nightingale's time believed in spontaneous generation and were unaware of how diseases spread. Consequently, they did not use sanitary operating procedures.

19. What will a community health nurse use to most accurately determine whether a planned intervention was successful?

Current problem data to compare with original baseline data By comparing baseline data, the nurse can construct benchmarks to gauge the achievement of program objectives. Such epidemiological data are also important for documentation of a program's long-term effectiveness.

17. What is the significance of the Health Plan Effectiveness Data and Information Set (HEDIS)?

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

21. How might the U.S. total health care costs be reduced by at least 10%?

Decrease current fraud and abuse Officials estimate that up to 10% of total health care expenditures, or about $170 billion in 2003, were lost to fraud and abuse.

5. What were important events related to health care during the Reagan administration in the 1980s? Select all that apply.

Decrease in both federal control and federal funding, Implementation of Medicare funding based on diagnosis-related groups, Suggestions to shift costs and reduce costs The Reagan administration encouraged competition. Emphasis was on cost shifting and cost reduction with greater state power, less centralization, and less national control. The Omnibus Budget Reconciliation Act of 1981 reduced federal funding, which also decreased federal planning efforts. The federal government recommended eliminating planning agencies. Cost shifting and cost reduction were emphasized.

19. What would be one of the first steps in attempting to control a disease?

Define what the disease looks like in confirmed or probable cases Standardized definitions of diseases are necessary for public health monitoring and surveillance across all levels of government. Diseases are defined and classified according to confirmed cases, probable cases, laboratory-confirmed cases, clinically compatible cases, epidemiologically linked cases, genetic typing, and clinical case definition. Once defined, disease occurrence can be compared across time, populations, and geographic areas; and appropriate control efforts can be implemented.

14. What is the most crucial step in policy formation?

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

5. Which functions are responsibilities of the states? Select all that apply.

Delegating power to localities and holding them accountable for results, Licensure of professional health care providers Overseeing all insurance programs Providing access to necessary health services State governments focus particularly on financing and delivery of services and oversight of insurance. The state is responsible for addressing the mission of public health—assessment, policy development, and assurance—throughout the state. Tasks include assessment of health needs based on statewide data collection; establishment of statewide health objectives; and delegating power to localities as appropriate and holding them accountable. States license health professionals as part of the statewide effort to develop and maintain essential personnel.

18. What would a developed country possibly learn from a developing country in relation to health care?

Delivery of primary health care Likewise, developed countries have much to learn about low-technology initiatives such as oral rehydration therapy for the treatment of diarrhea and the delivery of primary health care as defined by the World Health Organization.

3. What might be an appropriate indicator for determining what an aggregate's needs are? Select all that apply.

Demand for services as seen in the behaviors of the chosen aggregate members, Experts' determination of what is needed in the situation, Obvious health disparities between the advantaged and disadvantaged populations, Verbalized expression of need from the chosen aggregate There are four types of needs to be assessed: expressed need as seen in behavior; normative need or the need determined by expert health professionals; perceived need expressed by the aggregate including wants and preferences; and, finally, relative need, which is the gap showing health disparities between the advantaged and disadvantaged populations.

1. What types of data do epidemiologists gather to try to determine which factors may lead to disease? Select all that apply.

Demographic characteristics, Geographic data, When disease struck the area The person-place-time model suggests epidemiologists examine demographic characteristics of the community (person characteristics), geographic or environmental factors (place), and common time factors (time—or when the disease struck).

20. As the nurse in charge that day, you note that two patients had communicable infectious diseases and were treated appropriately. Should anything further be done?

Depends on your state health department's requirements Because state health departments have the responsibility for monitoring and controlling communicable diseases within their respective states, they determine which diseases will be reported within their jurisdiction.

2. What kind of information must be analyzed to derive an adequate explanation of disease? Select all that apply.

Description of commonalities among those who became ill, Depiction of the possible pathogen, Portrayal of the geographic area where people became ill The epidemiological triangle includes the agent (pathogen), host (people who are susceptible and become ill), and environment (the geographic area where people became ill). These three areas allow for an explanation of disease.

1. What is it called when an epidemiologist writes a summary of a food poisoning outbreak, from cause to plans, for prevention in the future?

Descriptive epidemiology There are two principal types of epidemiology, analytic epidemiology and descriptive epidemiology. Descriptive epidemiology describes the amount and distribution of disease, which may suggest possible causes. These causes can then be confirmed or corrected through more advanced methods of research.

3. What are the Department of Health and Human Services' responsibilities in relation to disasters? Select all that apply.

Detecting disease outbreaks, their cause, and risk factors, and implementing interventions for control Ensuring that drinking water, food, shelter, and medical care are available to victims After the rescue of survivors has been accomplished, the Department of Health and Human Services (HHS), Centers for Disease Control and Prevention (CDC)—which is responsible to the HHS—steps in to ensure that clean drinking water, food, shelter, and medical care are available for those affected. Preparedness includes vigilance and reporting of suspicious illnesses (e.g., signs and symptoms of biological agents, food-borne diseases, and communicable diseases) in the community by physicians and nurses in local health care facilities or private offices and clinics. Public health officials then have the responsibility of detecting outbreaks, determining the cause of illness, identifying the risk factors for the population, implementing interventions to control the outbreak, and informing the public of the health risks and preventive measures that need to be taken. Many of the other choices are actually services offered by the American Red Cross.

9. A nurse assessed an aggregate, determined the priority health needs, and decided what intervention to offer. What may determine whether the nurse's intervention will be successful?

Determination of the aggregate's perspective of the need for the intervention Interventions are seldom successful unless the aggregate has input into determination of need, its priority, and appropriateness of the intervention.

8. Which activities would be a responsibility of local health departments? Select all that apply.

Determining the safety of residents' wells Providing free health screenings Providing health education programs on proper nutrition Inspecting restaurants Local health departments are responsible for the health needs of their constituents. Community health services include surveillance and immunizations, as well as health education programs. Environmental health services on the local level include inspection of food processing plants and restaurants and control of waste, air, and noise and water pollution. Local health departments protect the environment through such activities as inspecting wells and public swimming pools. Ensuring quality of nursing education programs and continuing competence of health professions are both state functions.

11. What should you and your family do when the national threat level is color-coded green or blue?

Develop a personal family emergency plan The actions to take build on what is done at the low-risk or green level (e.g., develop a family emergency plan) to monitoring local emergency management officials and the media for specific measures to take at the severe-risk or red level (e.g., evacuate).

4. What must the nurse do before implementing a comprehensive and entertaining educational program?

Develop an open and trusting relationship with participants. At the core of health education is the development of trusting relationships based on nurturing interactions.

8. Besides resolving current problems, community health nurses also try to help a community develop its capacity to address future problems. What are such nursing activities called?

Developing community competence Although such activities are educational, collaborative, and ideally do address problems in some order by priority, building a community's capacity to address future problems is called developing community competence.

1. What have been the foci of international nursing research? Select all that apply.

Development of home care or transition from hospital to home Diverse clinical experiences Educational exchange programs for students and faculty Since 1990, international nursing research has focused predominantly on the following three areas: (1) student and faculty educational exchange programs, (2) diverse clinical experiences, and (3) the international development of home care or transition from hospital to home.

2. What did insurance companies do to decrease their constantly increasing costs? Select all that apply.

Did not cover any illnesses that were diagnosed before the person (or his or her employer) purchased insurance Limited coverage to only certain services, eliminating any that were experimental, nontraditional, or too costly Only care requested by the patient's primary physician was eligible for reimbursement. Required preapproval before expensive services were used Whenever possible, ceased coverage on any person who used an exorbitant number of services Insurance companies attempted to reduce unnecessary utilization by limiting coverage for certain services and people. Restrictions such as the establishment of a gatekeeper that requires preauthorization, limited coverage for preexisting illnesses, and exclusion of participants whose use was deemed exorbitant were instituted. Such restrictions increased resentment and resistance and were not very successful.

2. Two brothers played with their cousin. One brother later became quite ill, whereas the other did not. How can this be explained?

Difference in genetic inheritance between the two brothers Assuming the two brothers lived in the same household, the environment and the agent or infectious organism are the same. The only difference could be between the two brothers themselves and their genetic inheritance.

18. What disease would be the best choice for screening if any of the following were possible?

Disease B, which can be controlled if caught early in the disease process There is no point in doing a screening if there is no treatment or if there is a known risk of social stigma and discrimination if it becomes known that the person has the disease. Discussion and disagreement continue as to whether genetic information should be used in family planning. However, it is extremely useful to the individuals concerned and society if screening can lead to early diagnosis and successful control of the disease process.

9. What can be done to lower the threat of malaria to 40% of the world's population?

Distribute insecticide-treated nets and antimalaria meds Effective low-cost strategies are available for malaria's prevention, treatment, and control, including insecticide-treated nets and new-generation medications such as artemisinin-based combination therapies. It would be very dangerous to spray neighborhoods with insecticides, which also contaminate food. DDT has been banned in the United States for many years because of its long-term harmful effects on the environment, including food animals.

4. What information from vital statistics records is useful to community health nurses? Select all that apply.

Documentation of the mortality and morbidity of the local community, Indication of whether the total population is growing or declining, Records of occurrence of congenital malformations Vital statistics record births, marriages, divorce, adoptions, and deaths in the community. Useful information would include conditions of birth such as congenital malformations from the birth records. Death records suggest local mortality and morbidity trends. Overall growth or decline in the community's population can be seen.

2. In what way is environmental health (EH) more challenging than other variables related to an individual's health?

EH requires social, economic, and political changes to improve Intervening to improve environmental conditions requires basic social, economic, and political changes. Aggregates must work together to create such change.

29. Which theoretical approach would be most useful to the nurse who wants to improve patient-provider communication and address the gap between what providers discuss and what families want to know about?

Ecological framework The ecological framework is a blend of systems and developmental theory with an individual's understanding of his or her environment. Kogan and others investigated parent-health care provider discussions of family and community health risks during well-child examinations, as well as the gaps in issues discussed by the practitioner and the information the parent desired. The results indicate the need for better communication and education between health care providers and clients.

1. What is the principal factor behind ongoing legislation on the federal level related to health care?

Efforts to control constantly increasing costs In the past, legislation reflected the need to improve the health of populations and coping with changing health care needs. During the last 20 years, concerns about increasing health care costs have stimulated additional legislation. Indeed health care reform/health insurance reform were major issues during the 2008 presidential election.

3. As in Healthy People 2010, what are the two primary goals of Healthy People 2020? Select the two that apply.

Eliminate health disparities, Increase quality and years of healthy life As published, the two goals are to increase quality and years of healthy life and eliminate health disparities.

17. A nurse was debating about which approach to use to both obtain data about community needs and encourage community participation in their resolution. Which approach would be most effective in meeting both goals?

Establishing focus groups with selected participants All the responses would be helpful in obtaining information about the community. However, only focus groups promote group interaction and encourage further participation in planning solutions to identified problems.

4. Which ethical belief would be most helpful in the current health care crisis?

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

11. A nurse found that several professionals resented time spent interacting with and teaching clients. What might be the underlying motivation for resisting client involvement?

Empowering others shifts power from the experts to the community. Successful programs rely on empowering citizens to make decisions about their care. Empowering citizens causes power to shift from health providers to community members. Many prefer to remain in positions of power rather than sharing.

14. Which method is most consistent with Freire's approach to empowerment?

Encouraging active participation and dialogue in critical reflection Banking education where teachers give information, which learners then regurgitate at exam time, is not useful. Problem-solving education with active participation and ongoing dialogue encourages learners to be critical and reflective about health issues.

10. What is possibly the easiest and fastest way to obtain an overview of the community?

Engage in a windshield survey The easiest way to obtain an overview of the community is through a windshield survey by driving or walking throughout the area and making organized observations. A group that is willing to respond to surveys and review public health records and that lives in the community would be very helpful but not easy or fast.

9. What purpose is served by the nurse interviewing the family beyond gathering needed information for future interventions?

Engaging in focused planned conversation, which has healing potential in itself The second key element in the interview is the therapeutic conversation. This type of conversation is focused and planned and engages the family. The nurse must listen and remember that even one sentence has the potential to heal or help a family member. Every encounter, whether brief or extended, has "healing potential."

2. What historically have been public health nurses' two most important priorities? Select all that apply.

Engaging in political activity to improve living conditions, Working with the community to confront health issues and poverty Neither administering bedside clinical nursing nor teaching family members to deliver care in the home has adequately addressed the true determinants of health and disease. The early public health nurses resolved that collective political activity should focus on improving social and environmental conditions such as poverty.

4. What must be done to evaluate a project once it has been completed? Select all that apply.

Ensure that adequacy and appropriateness of the intervention are measured, Be certain the efficiency and cost benefits are measured, Communicate follow-up recommendations to the community A comprehensive outcome evaluation includes measurement of adequacy, appropriateness, efficiency, and cost-benefit measurements. The intervention will have limited impact unless follow-up recommendations are communicated to the aggregate on completion of the project. Media coverage may or may not be helpful, depending on the project and the intervention. Statistics are useless unless carefully chosen to reflect measurement of objectives. Reports are often shelved without being read, so only those immediately involved should have both input into any report and a copy of the outcome findings.

10. Individual responsibility can be assumed for modifiable risk factors, but what risk factors are least subject to modification?

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

4. What current issues are leading the World Health Organization (WHO) to reconsider its initial definition of health? Select all that apply.

Environmental issues such as industrial toxins or carcinogenic commercial products Global, not local, problems such as spread of antibiotic-resistant bacteria Need to move from containment and treatment to social intervention Realization that government actions influence the basic human right of health Worldwide pandemics such as human immunodeficiency virus (HIV) and swine flu, which require a different approach WHO is refocusing as it attempts to deal with environmental issues of nuclear contamination and industrial toxins and the exploration of carcinogenic commercial products (such as tobacco). Globally WHO is trying to eliminate antibiotic-resistant bacteria and the HIV pandemic. HIV has changed the paradigm from traditional containment and treatment to a more comprehensive approach of social intervention. There is a realization that health is a basic human right and health problems are linked to government action and affect human rights.

21. What were the first efforts at improving community health?

Environmental planning of water and sewer systems The first community-wide efforts toward improving health were environmental planning for water and sewer systems.

4. What is a major factor in determining which persons or groups are most likely to be helpful to a particular individual?

Environmental proximity Although it is certainly more common to have friends who are similar to ourselves in many ways, those most likely to be called on and respond are those in close environmental proximity.

1. Why should a nurse working in a U.S. urban area be knowledgeable about infectious diseases common to areas of Africa?

Every infectious disease is just one airplane ride away. Infectious diseases do not recognize or respect country borders. With rapid international travel, an infected person could easily be in any country in a very short period of time. Problems throughout the globe can threaten human life.

19. What sorts of behavior would you expect to see when a disaster first strikes a community?

Everyone tries to help strangers, as well as their neighbors, survive The classic four phases of a community's reaction to a disaster are the heroic phase, honeymoon phase, disillusionment phase, and reconstruction phase. During the heroic phase, nearly everyone feels the need to rush to help people survive the disaster.

3. What interventions might a nurse choose based on the Health Belief Model to help a client improve his or her lifestyle choices? Select all that apply.

Examine the individual's perceptions of his or her health in relation to current lifestyle behavior choices Review how lifestyle changes can reduce risk and improve the client's life Share statistics regarding the probability of health problems and their seriousness if action is not take Use communication channels to send reminders of action currently needed Unfortunately, although people have to know what to do and how to do it before they can take action, information alone will not motivate people to act. Continued harassment, as in emphasizing how important it is for people to act, also is not motivating. What is effective begins with examining the individual's perceptions of his or her health and current lifestyle choices so education to change perceptions can occur. Sharing information regarding the probability of illness or perceived susceptibility and using communication channels to serve as cues to action may both be motivating. Similarly, reviewing how lifestyle changes can reduce risk and improve life may change the person's perception of the benefits of acting.

20. What nurse behavior would be most effective at creating a base for providing culturally effective care?

Exhibiting sensitivity to individual differences resulting from culture and experiences Unfortunately, voicing the need for valuing diversity is not always consistent with behavior. It is often useful to change communication patterns to increase client comfort, although the nurse must sometimes refuse to fulfill client demands. However, it is always crucial to exhibit sensitivity to individual concerns, cultural background, or previous life experiences.

12. What conclusion can be drawn from reviewing how health care costs are spread over a person's lifetime?

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

27. On the basis of findings related to elevated blood levels of cholesterol, a researcher wanted to determine whether a new drug would notably lower the blood levels of cholesterol in otherwise healthy persons. What kind of study would the researcher probably choose?

Experimental study Experimental design is used to test treatment and prevention strategies. Subjects are randomly assigned to the experimental group to obtain the new drug while the control group receives a placebo or alternative. The changes in blood cholesterol level would then be measured.

12. What would a nurse working from a critical theoretical perspective attempt to do in daily practice?

Expose and make explicit social values underlying decisions and the health care system itself Improvements can only be made if societal and personal values are made explicit. Once these values are recognized, they are more easily confronted. Change may be sought toward a more just society.

6. What do contemporary historians now suggest has been previously ignored in relation to health care? Select all that apply.

Extensive care giving by female healers in the home, Social and environmental contexts of care Historians have typically ignored the extensive care by women healers, referring to them as marginal amateurs, as well as the major influence of social and environmental contexts on health and medical care that is necessary to place health care in a broader context.

25. Why is it believed that states will increasingly monitor and report on quality and cost of health care?

Failure of Congress to act to reduce health care costs forced states to assume responsibility. When Congress rejected Clinton's plan for health care in 1994, the federal government withdrew from active health planning. Most states have become very involved in various aspects of health care planning as state funding from the federal government decreased and state budgets are not increasing. States are forced to determine priorities for the resources available.

13. Which level of government primarily establishes regulations and provides funding for health care?

Federal government The federal government has been assuming a larger role in the protection of the population through regulation and funding.

17. What conclusion can be drawn concerning efforts to decrease environmental pollution?

Federal policies have been weakened, and enforcement lacks funding. Legislation in the 1970s was aimed toward a comprehensive national environmental policy. The momentum slowed in the 1980s, with policies being reversed and regulation losing its funding. This trend has continued. The EPA sets rules but lacks resources to accomplish the goals.

16. A school had tried very hard to uphold the requirement for all children to be vaccinated. However, state law allowed parents to exempt their child if they had a religious reason for refusal. Two children had come down with chickenpox. What will be the probable result?

Few children will get chickenpox because of herd immunity. Herd immunity is a state in which those not immune to an infectious agent will be protected if a certain proportion (generally considered to be 80%) of the population has been vaccinated or is otherwise immune. Because most children in the school are immune, it will be difficult for the chickenpox to spread.

6. Which activities by some managed care organizations (MCOs) are ethically questionable? Select all that apply.

Financial incentive to physicians if some treatments are not given Requirements that only certain treatment options be discussed with patients Protection is needed for health care providers. Gag rules have been an area of concern when MCOs control what their providers discuss with clients about treatment options. Many MCOs provide financial incentives to providers to control cost. Providers receive extra money if they restrict hospital admissions, reduce hospital stay, and write fewer prescriptions. Legislation is being passed to make these unethical behaviors illegal.

2. What is meant by "thinking upstream"?

Focus on economic, political, and environmental factors "Thinking upstream" means focusing on modifying economic, political, and environmental factors that are the precursors of poor health throughout the world.

10. What current activities are consistent with the conclusions of the report Crossing the Quality Chasm? Select all that apply.

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

2. Which is the most accurate way to explain community health nursing?

Focusing care on the community as a whole Not only is community a context or place where a community health nurse gives care, but the community as a whole is the focus of the nurse's efforts.

3. Why do folk healers continue to be consulted by many people, including well-educated American citizens? Select all reasons that apply.

Folk healers are often effective., Folk healers integrate religion and medicine., Folk healers often use social interventions involving the whole family, as well as friends and neighbors. Folk healers offer repeated success, as many of their medicines are effective; their healing practices are socially cohesive, often including family and neighbors; and folk healers often integrate religion and morality with medicine.

15. What is the primary reason that so many Americans are obese?

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

24. What has research concluded about the view of nurses as seen in novels over the past 100 years?

For the past 50 years, nurses were primarily viewed as promiscuous women. Nurses were strong independent women in novels until the 1960s and 1970s when they were presented very negatively as promiscuous "bed hoppers."

21. How could a small community group hope to accomplish goals against a large powerful corporation?

Form coalitions with other groups that have similar goals Brainstorm about all possible groups that might have a stake in the outcome of the issue. Nurses can help make connections with larger, more powerful organizations.

15. What would be the purpose of a nurse starting to collect evaluation data when a major heath project has only been in process for short period of time?

Formative evaluation allows the nurse to make changes if needed. Evaluation includes reflecting on each previous stage to determine strengths and weaknesses. Process evaluation, also called formative evaluation, would allow one to change the project while it is being implemented. This reality (being able to change while in process) is not discussed in the textbook.

17. The Carnegie Commission appointed Abraham Flexner to evaluate medical schools on the basis of the German model. What was the overall result of his report?

Funding was withdrawn from weak medical schools. The Flexner Report outlined shortcomings of weak schools that were not built on the German model of a scientific base. Funding was withdrawn such that scientifically inadequate medical schools closed. Physicians now emerged who had been taught the germ theory of disease.

5. What is the nurse's first task when dealing with an aggregate as client?

Gaining access into the aggregate Once the nurse has chosen the target aggregate (which would not be possible without also knowing the aggregate's meeting place or geographic location), the nurse must gain entry into the group. It can be assumed that the nurse is knowledgeable about personal strengths and preferences and what resources are available to function.

2. Besides giving appropriate care, what is a central function unique to community health nursing? Select all that apply.

Gathering appropriate comprehensive assessment data on the community, Incorporating epidemiological approaches throughout the nursing process, Willing to contribute to health policy development Although all nurses ideally arrange transportation to their employment site, keep accurate records, and collaborate with health care team members, only community health nurses are expected to engage in comprehensive community assessment, incorporate epidemiology, and contribute to health policy development.

21. Which are examples of the internal structure of the family?

Gender and rank order of birth Internal structure of the family refers to such items as family composition, gender, rank order (by age and sex), subsystems through which the family functions, and boundaries or who is in and who is not in the family system. Extended family members are part of the external structure.

1. What are central aspects to the definition of community? Select all that apply.

Geographic boundaries at a point in time, Persons who band together to address a shared problem, The name the people have given themselves The person-place-time model suggests epidemiologists examine demographic characteristics of the community (person characteristics), geographic or environmental factors (place), and a point in time (i.e., the present in comparison with the past and hope for future). Therefore, using the model, any item related to geographic boundaries, persons with shared goals, or a particular time would be correct.

5. How do people typically respond when asked of what community are they a member?

Geographic community (neighborhood or city) Although individuals might well respond in terms of any of the possible responses, the most common response is in terms of geographic location of one's home or place of residence.

21. Which task is most crucial for the community health nurse to do very well?

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

21. Parents requested that their child be brought up to date on appropriate immunizations. After reviewing the child's medical history, you prepare to give the two immunizations. Is there anything else you should do?

Give the parents the Vaccine Information Statement The Centers for Disease Control and Prevention (CDC) produces Vaccine Information Statements (VISs) that explain the benefits and risks of vaccine to vaccine recipients, their parents, or their legal representatives. Federal law requires that VISs be handed out whenever (before each dose) certain vaccinations are given. Because the parents have previously had the child receive immunizations, they clearly have chosen to continue with immunizations so they don't need to hear the pros and cons of children being immunized. Children can't give consent, only assent, to procedures. Because the child is a minor, the child's parents make the decisions.

12. Why do we not know the incidence or prevalence of gonorrhea?

Gonorrhea is not a reportable condition. The text states that data on many conditions are not available because surveillance is not widely conducted. In other words, there is no responsibility to report cases of most diseases, including gonorrhea. Further morbidity rates are subject to underreporting. Information is only available related to conditions where care providers are required to report that specific condition or where those affected die and mortality data are available.

11. Who pays the majority of the costs for pharmaceutical drugs in the United States today?

Government Government pays 47.8%, insurance companies pay 22.3%, and individuals out of pocket pay 30%.

8. A city that depended on tourist dollars had feedback that tourists were saying they were never returning because of the constant mosquito bites. What should the town do?

Have everyone in town search for and remove any standing stagnant water Knowing the reservoirs for infectious agents is important because, in some cases, transmission can be controlled by eliminating the reservoir, such as eliminating the standing water where mosquitoes breed.

14. What is a current trend regarding heath care services?

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

17. What would a developing country probably find most useful to copy from a developed country?

Health care reform policies to improve health care delivery Although transferring specialized medical technologies from developed to developing countries may not always be appropriate, developing countries are currently learning from health care reform policies and the technological revolution in developed countries.

1. Which factors make family nursing particularly challenging? Select all that apply.

Health care system primarily focuses on care of individuals. Insurance reimbursement focuses on illness care and treatment of individuals. Most theories focus on intervention with individuals Families have challenging health care needs that are not usually addressed by the health care system. Instead, the health care system most frequently addresses the individual. Traditionally, nursing has relied heavily, if not solely, on theoretical frameworks from the disciplines of psychology or social psychology, which target individuals.

11. What assumption underlies the Alma-Ala Declaration?

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

7. What is the community health nursing definition of health?

Health is families and aggregates choosing actions to ensure safety and well-being. The text stresses that health is not just the result of an individual's choices, but individuals', families', groups', and communities' choices and actions that lead to health.

2. What is it called when a 50-year-old woman comes to the clinic for her first screening mammogram?

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

1. What are the leading health indicators found in Healthy People 2020? Select all that apply.

Health systems issues, Individual behaviors, Physical and social environmental factors Ten leading health indicators are identified in Healthy People 2020, including individual behaviors, physical and social environmental factors, and health systems issues.

20. What was successful in helping people become educated on healthful living in nineteenth-century England?

Health visitors joined nurses in providing care in the homes. Health pamphlets alone had little effect, so health-visiting services enlisted home visitors to distribute health information to the poor. Eventually, although Nightingale thought district nurses should be the health teachers, district nurses provided care for the sick while the health visitor provided health information in the home.

23. Each evening, a newly disabled man becomes angry when his wife, just home from her new full-time job, does not have dinner on the table at 6 PM. As the nurse, what would you do?

Help all family members recognize that long-time roles are being changed and change is uncomfortable for everyone Roles refer to established patterns of behavior for a family. It takes other family members to keep a person in a particular role. Traditional roles are being challenged and are evolving with economic changes. Formal roles may come into conflict with roles set by family members. The husband has major life changes to which to adjust, as do all the other family members. His anger is a symptom of the painfulness of major life changes. The nurse can help the family members recognize the problem in preparation for addressing the issues.

6. Which nursing actions may be most helpful to the community's long-term health?

Helping the community create political change through organization, use of media, legislative lobbying, and mass demonstrations The ultimate goal is liberating people from health-damaging environmental conditions by using collective actions. Mechanisms have included strategic organization, litigation, public hearing testimony, letter-writing campaigns, legislative lobbying, and mass demonstrations.

13. A nurse felt very good about an Asian man who had responded positively to the instructions given to him. Later, the nurse heard him tell his wife that there was no way he could implement the suggestions. What could be the problem?

His culture may value harmonious relationships over expressing disagreement. Asian clients may provide the nurse with the answers they think the nurse wants to hear. This behavior is consistent with their cultural value for harmonious relationships with others.

10. Lemuel Shattuck is well known in the United States for which achievement?

His ideas concerning public health care reform, which were eventually adopted Lemuel Shattuck organized the American Statistical Society and issued a census, which demonstrated high mortality rates. His report of the Massachusetts Sanitary Commission recommended modern public health reforms. However, nothing was actually done about the recommendations for almost two decades. Eventually, however, the merit of his ideas was recognized.

20. The local stream was full of trash. The Boy Scouts had a cleanup day so they could again canoe on the stream. What should local nurses do?

Hold dialogue with community members about the problem and its effects An important nursing goal is to help people learn from their own experiences and analyze the world with an intention to change it. It is essential that those affected participate in the process of identifying and working to solve environmental problems. The nurse's role is to ask critical questions and help groups reflect on the environmental realities of their lives.

4. Besides a fresh safe water supply, what other innovation(s) did the Romans introduce?

Hospitals and nursing homes The Romans introduced many health innovations such as fresh water, public physicians, hospitals, surgeries, infirmaries, and nursing homes. Unfortunately, these services were only for the wealthy.

5. What were the chief factors that led to the creation and growth of Blue Cross hospital insurance? Select all that apply.

Hospitals banded together, and their leaders encouraged such plans, It was an employer alternative to increasing employee pay compensation. Physicians later sought insurance plans, but originally only hospitals created insurance plans based on American Medical Association (AMA) leadership encouragement. During World War II increasing salaries was not an option, so offering health insurance helped ensure employee retention. Although government-supported health plans were suggested as early as the 1930s, politicians were not seriously discussing government-supported care.

4. Which component of the epidemiological triangle is primarily responsible for a female client having a fungal vaginal infection after being treated with antibiotics for strep throat?

Host Infectious diseases are the result of interaction among the human host, an infectious agent, and the environment, which surrounds the human host and where transmission is occurring. This interaction is pictured in the epidemiological triad of agent, host, and environment also discussed in Chapter 5. The antibiotic therapy eliminated a specific pathological agent, but it also may alter the balance of normally occurring organisms in the woman's body, which caused a change in the vaginal environment allowing normally present fungi to proliferate, resulting in a yeast infection.

21. What was the name of the district nursing service created in the United States by Lillian Wald and Mary Brewster?

House on Henry Street They established a district nursing service on the Lower East Side of New York City called the House on Henry Street for all the unemployed and homeless immigrants who needed health care. It later evolved into the Visiting Nurse Association of New York City and helped establish public health nursing in the United States.

28. What is the primary concern both historically and today for many people when they become ill?

How can they afford to take time off from work and lose pay to be ill? This question assumes students are aware of current social reality related to illness, health insurance, and employment realities. Historically, the greatest health concerns were lost wages associated with sickness. Today many employment positions do not offer health insurance. In addition, many employment positions do not have sick leave; if you are not at work, you do not get paid.

18. Which aspect of the completed nursing diagnosis summarizes the assessment data collated by the community health nurse?

Identification of the health risk The identification of the health problem or risk represents a synthesis of all assessment data.

3. What variables are missing from both the HBM and HPM models? Select all that apply.

Ignoring the impact of being socially and politically disenfranchised Inaccessibility of health services Omitting the influence of social, structural, and physical environmental factors The models are very useful in relation to changing individual behaviors, but they do not address the complex relationships among social, structural, and physical factors in the environment such as lack of social support systems or inaccessible health services. Changes are needed to improve care for socially and politically disenfranchised groups. Knowledge is always within a social context and is always bound to power relationships. A nurse cannot assign power and control to an individual. The individual must take on power, although perhaps with the nurse's guidance.

2. Why would earthquakes be more frightening than floods to many people, even though both can cause extensive damage? Select all that apply.

Imminence of earthquakes is unknown. It's not possible to prevent an earthquake. The predictability of earthquakes is lower. Death rate, intensity, and frequency depend on location and other factors. Hawaii, for example, has frequent earthquakes with little damage resulting. However, earthquakes cannot be predicted or prevented, whereas flooding can usually be predicted and most communities have taken steps to avoid or at least lessen the damage from floods.

11. What nursing interventions did Florence Nightingale use in treating wounded soldiers?

Improvements in food, clothing, and cleanliness Discovering the appalling conditions of the hospital, Florence Nightingale set up diet kitchens and a laundry and provided food, clothing, dressings, and laboratory equipment.

7. What was one unfortunate consequence of using diagnosis-related groups (DRGs) to determine reimbursement? Select all that apply.

Incentive was to undertreat and underuse health resources. Quality of care was no longer assured. Because costs were contained by both the federal programs and insurance companies, the providers had a strong incentive to undertreat and underuse health resources. The public feared that the quality of care being provided was less to keep costs as low as possible

11. What is the health issue causing the most concern in the United States today?

Increase in obesity The widespread increase in incidence of overweight and obesity has led to calls for population-based measures to address this issue.

26. What is one approach the textbook suggests to improve the functioning of local and national health planning?

Increase nursing involvement The textbook suggests increased nursing involvement as one method of strengthening local and national health planning. Nurses can assess aggregates, identify health needs, and perform planning, intervention, and evaluation. Health would improve if nurses reemphasized the larger aggregate and shared their insights with planning groups.

10. What have tobacco companies done to counter their losses resulting from U.S. efforts to decrease smoking tobacco?

Increased international exports and targeted children Tobacco control and secondhand smoke policies have been implemented at various political levels in the United States and abroad. To continue their profits, the tobacco industry has targeted youth and dramatically increased international exports.

26. Which factor is most responsible for differences in an individual's health?

Individual's education and income Factors that contribute to wide variations in health disparities are education, income, and occupation.

2. In giving care to an individual person, why would it be important for the nurse to be knowledgeable about the community?

Individuals and families are strongly influenced by the community and environment around them. It is assumed that community health nurses can read maps—or use a global positioning system in their car—to find client addresses. Although it is indeed important to be an advocate for health care reform and to have information regarding resources available for client services, in the process of giving care, the nurse must particularly be aware of how individuals and families are influenced by the community and environment around them.

Residents may be unwilling to disrupt family ties and cultural roots to start over elsewhere, or they may be unable to afford to move. Residents are revictimized by the difficulty in obtaining compensation.

Individuals assume it is a personal problem, not an employment issue. Statistics do not reflect unreported health problems. Collective problems related to employment or occupation are often perceived as individualized injuries.

3. What was one effect of the Welfare Reform Act of 1996?

Individuals who were required to obtain employment lost their health coverage. The law decreased the number of people on welfare and forced many individuals to take low-paying jobs, many of which did not offer health insurance. Many individuals, particularly women and children, subsequently lost Medicaid coverage.

6. One child in a kindergarten room had a slight fever and didn't eat lunch. Otherwise, the child seemed OK. Three days later, several children were absent from kindergarten. What happened?

Infectious diseases can be contagious before any diagnostic symptoms occur. The communicable period, or communicability, follows latency and begins with shedding of the agent. The incubation period is the time from invasion to the time when disease symptoms first appear. Frequently, the communicable period begins before symptoms are present.

18. How are infectious diseases any different from any other health problem?

Infectious diseases have the potential to spread, creating a community emergency Most human diseases (e.g., cancer or diabetes) can be classified as personal health problems. Individuals with a personal health problem can be treated by the health care system one person at a time. By contrast, infectious diseases are categorized as public or community health problems. Because of their potential to spread and cause community-wide or worldwide emergencies, infectious diseases require organized, public efforts for their prevention and control.

20. What suggestion was in the Health Professions Education report?

Interdisciplinary teams should utilize informatics to provide patient-centered care The Health Professions Education report concluded there were five core competencies—provide patient-centered care, work in interdisciplinary teams, employ evidence-based practice, apply quality improvement, and utilize informatics.

2. Although obtaining information from the aggregates themselves would be optimal, what other source of information might the nurse use to quickly and easily become informed about an aggregate? Select all that apply.

Interview those persons who have previously been involved with the aggregate in some helping role. Review any available records or previously gathered data, Try to find a few key informants and ask for their input. Unfortunately, telephone surveys would probably not be effective because many persons no longer have landlines but rely on cell phones. There would be no easy way to obtain the appropriate telephone numbers. A mail survey would be expensive and time consuming and probably would receive few responses because participants would be asked to think, write, and act to return the survey. Observing without letting persons know they are being observed borders on unethical. However, interviewing persons previously involved and reviewing previously gathered data would be possible.

6. A nurse decided that a high-risk aggregate most needed education about diabetes. What might be the best approach to teaching the group?

Involve participants in small-group activities applying the information Most persons do not enjoy lectures, so the nurse must initiate small-group involvement and participation. Those with less educational experience are more comfortable in informal learning settings.

3. What is the advantage of the ecosocial epidemiology model over both the web of causation model and the epidemiological triangle model? Select all that apply.

It decreases the focus on the individual person., It emphasizes the role of complex political and economic context, Its use suggests possible public policy interventions. The ecosocial approach challenges both the individually focused risk factor approach and molecular epidemiology (sequencing of genes to improve individual susceptibility), as it emphasizes the role of macro-level socioenvironmental factors, especially complex political and economic forces in health and illness.

19. What was the importance of the Lalonde Report, which proposed the "health field concept" in 1974?

It first emphasized influence of lifestyle and environment. This report emphasized lifestyle and environment as determinants of health outside the traditional medical sphere. It became the basis for rethinking new paradigms for health care delivery. The report signaled the early beginnings of a health care paradigm shift from the traditional medical model to a more holistic system-environment perspective

2. From a community health nurse's perspective, what are the major problems with the health belief model? Select all that apply.

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

12. How is the American Red Cross different from FEMA or NIMS?

It is a nongovernmental volunteer agency The American Red Cross (ARC) is not a governmental agency. The ARC, however, is chartered by Congress to provide disaster relief. It works in partnership with FEMA, HHS, the CDC, and other federal agencies to provide and manage needed services.

4. Which factors are necessary to assume there might be a cause-effect relationship between a particular variable A and a specific illness? Select all that apply.

It is easy to understand how the variable A could lead to the illness, Research studies consistently demonstrate a relationship between variable A and the illness, The more of variable A present, the sicker the person becomes. There are six criteria for assuming possible causation including strength of the association, dose-response relationship, temporarily correct relationship, biological plausibility, consistency among studies, and specificity. Only the "easy-to-understand," consistent research studies and the increased dose leading to increased illness are consistent with those six criteria.

16. How is the Centers for Disease Control and Prevention (CDC) different from its many peer agencies?

It responds to health emergencies. The CDC applies research and findings to improve people's daily lives and responds to health emergencies—something that distinguishes the CDC from many of its peer agencies.

3. Which activity might be most helpful to a person in whom a serious chronic illness has been diagnosed?

Join a support group of others with the same illness Although a person might choose to do any of these, the most helpful action over the long term is to join a support group with persons having the same diagnosis for mutual learning, sharing of resources, and support. Religious leaders could also be helpful, but many persons do not have a religious leader.

23. How is "health literacy" operationally defined in the United States?

Knowing how to access and use information to make health decisions Literacy as a whole is typically defined as being able to read and write at the fifth-grade level. Health literacy, however, is defined as being able to access, understand, and use information to make health decisions. Only the latter type of literacy empowers clients to best act on their own behalf.

2. What is one of the biggest threats to developing countries being able to grow economically and make a better life for their citizens?

Large population Large populations create pressure. In developing countries, famine, trade problems, and war may occur. Malnutrition, disease, or death may result. The poor suffer excess mortality and morbidity. Quality of life is less.

1. Which nurse fought to have American nursing controlled by nurses rather than physicians?

Lavinia Dock Lavinia Dock was a political activist who waged a campaign for legislation to allow nurses to control the nursing profession.

1. What does Knowles say is especially typical of adult learners? Select all that apply.

Learning draws on the learner's previous life experiences. They need to know why professionals think this knowledge is important. They want information related to current developmental tasks. Knowles suggests all learners want to know why they need to learn material. Material related to previous life experiences, current developmental tasks, or dealing with current challenges is useful and accepted by adult learners. Material chosen by professionals based on what might happen in the future or that ignores barriers such as lack of resources or low self-esteem will not be retained. Active participation through discussion with others helps involve and motivate adult learners.

24. What is being discussed in relation to concerns over patients' safety and nurse fatigue?

Legislation has been suggested that staffing systems require the input of direct care registered nurses. The Registered Nurse Safe Staffing Act of 2005 was introduced in Congress to address concerns of inadequate and inappropriate staffing, which threatens patients' safety and the nurses' health. The act would encourage development of staffing systems that require the input of direct care registered nurses, as well as protection for RNs who speak out about patient care issues. This suggested legislation has not been acted on.

12. Why would a nurse ask about the meals of all family members, rather than focus on a nutritional history for the post-myocardial infarction patient?

Lifestyle choices among family members are usually consistent. The family remains the focus because families experience similar risk factors (i.e., physiological, behavioral, and environmental). Family health practices influence lifestyle habits among family members. Consequently, although family members may or may not eat together, they will have a tendency to make similar choices.

2. Which nurse used political expertise to influence the federal government to develop a Children's Bureau?

Lillian Wald Lillian Wald recognized the connection between social conditions and health. She was a driving force behind the federal government's development of the Children's Bureau in 1912.

15. What is the most crucial skill for a nurse teaching diabetic self-care in a small group?

Listening carefully to understand participants' issues Listening is the first phase and is essential to understanding the issues.

12. What has happened to air quality since the United States outlawed use of chlorofluorocarbons, halons, and carbon tetrachloride?

Little change, because these chemicals remain in the atmosphere. These chemicals, which were in widespread use, remain in the atmosphere.

8. What would be an appropriate term for intoxicated drivers, secondhand smoke, urban crowding, noise, and mechanization?

Living patterns risks Living patterns are the relationships among people, communities, and their surrounding environments that depend on habits, interpersonal ties, cultural values, and customs. Most people live within areas that require almost daily contact with potential health risks and threats such as intoxicated or impaired drivers, secondhand smoke, urban crowding, noise exposure, unabated traffic, and the stress of increased mechanization.

7. Who is responsible for assuring the safety and welfare of communities?

Local government The local government is responsible for the safety and welfare of its citizens. Emergencies and disaster incidents are handled at the lowest possible organizational and jurisdictional level.

9. What is meant by environmental racism?

Locating industrial hazards in low-income communities Discriminatory land use ensures that many impoverished and marginalized groups, especially people of color, live in close proximity to industrial contamination. This is called environmental racism. Members of these communities are at risk for illness and injury.

15. As funds become more limited, which health care providers are actually seeing an increase in demand for their services?

Long-term-care facilities Hospital stays have shortened and patients who are admitted are more acutely ill and require more intensive care. Consequently, decreased hospital stays result in more home care admissions and more discharges to long-term-care facilities for short-term recovery and rehabilitation.

16. Which group of persons might the community health nurse most want to interview?

Long-time residents who were informal leaders in the community The nurse needs to interview key community informants to gather data about the health of the community. Although each group could share some information, the long-time informal leaders would be most knowledgeable about the overall strengths and concerns of the community.

8. What is the most common organization for receiving personal health care in the U.S. today?

Managed care organization with capitated payments to providers, both professionals and organizations Managed care has become the dominant paradigm in health care.

1. What are some problems with U.S. water quality today? Select all that apply.

Many aquifers are contaminated with pesticides and fertilizers. More than 42 million Americans drink untreated water. Sediment from construction, agriculture, and deforestation is often present. Underground water, if contaminated, can't be cleansed. Forty-two million Americans obtain water from private wells, which have no treatment or monitoring guidelines. Water quality problems include dosing reservoirs with chemicals to reduce algae, contaminating aquifers with pesticides and fertilizers, and leaching lead from water pipes. Underground water can't be cleansed.

2. What has happened to the hospitals built or expanded by Hill-Burton Act funds?

Many such hospitals have consolidated or closed. The Hill-Burton Act authorized federal assistance in construction of hospitals, making hospitals more accessible. However, with the high cost of health care and the decreasing lengths of stay and increasing use of primary care, many hospitals are closing.

14. How do public health efforts differ from medical efforts in improving the health of our citizens?

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

8. Because people respond to incentives, how has having health insurance affected lifestyle behaviors?

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

22. A new public health nurse carefully assessed all the local mortality and morbidity data in preparation for making appropriate planning suggestions at a meeting next week. What other action is crucial before the nurse can feel prepared?

Meet members of the community to determine their culture and values Community health nurses must work with the community. It is essential to assess an aggregate's needs and resources and identify its values.

19. A nurse needed to help a child who was not behaving consistently with the requirements of the new preschool program that began that fall. What would probably be most helpful for the nurse to do?

Meet with the child's parents to discuss how their parenting may need to change to help improve their child's behavior at school The teacher can be assumed to be an expert in dealing with small children. If the problem is defined as a child not behaving within expectations, the most effective approach would be to discuss with the parents how to help the child. Systems theory provides direction in understanding how health care providers can expand family capacity by changing parenting and therefore changing child behaviors.

7. A community health nurse determined that the number one priority was to help families in which one member had diabetes. Which decision would be best to maximize services to persons with diabetes?

Meet with the diabetic organization to see how the public health department can augment what it is offering. The nurse should augment existing resources or create a new service rather than duplicate what is already available to the aggregate. It is assumed that if the nurse has concluded that diabetic issues are the number one priority, there is no pressing need to ask specific questions of friends with diabetes.

23. How might a nurse remember what should be included in a health history?

Memorize the I PREPARE mnemonic The I PREPARE environmental exposure history mnemonic is a quick reference for primary care providers. This tool will help the nurse remember what to ask to determine environmental factors relevant to health.

15. What issue exists from communities using solid waste landfills to dispose of trash from private residences?

Methane gas may move through the soil to cause fire or explosions nearby. Solid waste landfills accumulate methane gas, a by-product of decomposing organic wastes. Without proper venting, this volatile gas can move through soil and cause fires and explosions in nearby areas. Waste incineration is not the best solution because it causes particulate air pollution.

24. The most recent planning model, the Mobilizing for Action Through Planning and Partnership (MAPP) model, has three phases. What is the first and perhaps most important phase?

Mobilize the community to become involved The MAPP Model is a planning model that is based on first mobilizing the community; then guiding the community toward a shared vision for long-range planning; and, third, conducting assessments of community strengths, forces of change, health status, and the local health system.

13. The United Nations (UN) uses what authority or power to implement its decisions?

Moral authority and world opinion Regardless of size, wealth, or political system, all member nations have an equal vote in the decision-making process. UN decisions reflect world opinion and the moral authority of the community of nations.

4. Roughly what proportion of children live in a single-parent family?

More than 30% In 2007, 32% of all U.S. children lived in single-parent homes.

16. A nurse set up a clinic appointment for Friday of the following week. An Arab patient asked to come earlier in the week. As those days were heavily booked, the nurse left the appointment on Friday. The patient was a "no show." What might have been the problem?

Muslims' holy day is from sunset Thursday to sunset Friday. The nurse should know the days of religious worship. Protestants usually worship on Sundays; Muslims' day of worship is from sunset Thursday to sunset on Friday; and Jews and Seventh-Day Adventists' holy day is from sunset on Friday to sunset on Saturday

16. What is the name for the model that demonstrates the progression of disease from prepathogenesis through disease outcome?

Natural history model The natural history of disease model explains disease from prepathogenesis through resolution of the disease process.

4. A nurse involved with a community group told peers that the group was learning networking, negotiating, lobbying, and information seeking. Why isn't the nurse working toward a noticeable improvement in health status for the group? Select all that apply.

Networking, negotiating, lobbying, and information seeking will continue to be useful throughout the participants' life span. There are no immediate solutions to the current health problems in most communities. Nurses use empowerment strategies when helping people develop skills in problem solving, critical thinking, networking, negotiating, lobbying, and information seeking to enhance health. Because health problems have social and political aspects, group members must develop action strategies. Health problems are complex and do not usually have easy and immediate solutions.

22. Which set of symptoms would be unexpected after a disaster?

No unusual feelings or behavior Common responses to disasters include all sorts of cognitive, emotional, physical, and behavioral symptoms. Therefore, to have no unusual feelings or behavior would indeed be unexpected.

18. A woman stood very close to the nurse and asked a question about her husband's condition. The nurse took a step back and shared the requested information. No other questions were asked. Was this a successful interaction?

No, because the woman and the nurse had different perceptions of personal space Sense of spatial distance is significant because culturally appropriate distance zones vary widely. Many cultures stand closer for important conversations, whereas the nurse stepped back because being so close made the nurse uncomfortable.

10. When it becomes known that a particular industry has vastly polluted the surrounding neighborhood, what would most persons living there do?

Nothing, because of family ties and cost of relocation Residents may be unwilling to disrupt family ties and cultural roots to start over elsewhere, or they may be unable to afford to move. Residents are revictimized by the difficulty in obtaining compensation.

8. A nurse was explaining a problem to the client so the client could make an informed decision from alternative treatment approaches. The client responded, "The doctor will choose the best treatment. Do whatever the doctor says." What should the nurse do next?

Nothing; simply accept that some fatalistic-oriented clients literally don't know how to choose One of the three ways people are oriented is destiny, in which people must endure and accept whatever comes in a fatalistic, inevitable manner, as destiny cannot be changed.

2. What is the reason nurses are encouraged to get involved in discussions about our health care system?

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

30. What is an appropriate conclusion to draw from research based on network therapy theory?

Nurses can help at-risk populations access or build support systems. Network therapy theory involves changing the network of families, be it extended family or friends, who tend to maintain a dysfunctional status quo in the nuclear family. The nurse can help the family replace or expand their network with other resources from the wider system that would be able to provide more support and enhance family functioning. Voorhees, Murray, Welk, and others studied peer networks. Their study supports the idea of building support systems for at-risk populations.

17. Why aren't nurses more effective in creating change politically?

Nurses don't act or don't agree on what changes are needed. Nurses know how to communicate, collaborate, negotiate, and serve as leaders who can make themselves heard. However, the various nursing subgroups don't agree on public policies.

1. What were the major concepts recognized through the 1950s that Lillian Wald emphasized as nursing responsibilities? Select all that apply.

Nurses should help the local community mobilize to solve their local problems, Nurses should improve environmental conditions that foster disease, Nurses should always treat the poor and vulnerable. Lillian Wald's concepts included mobilizing communities to solve local problems, treating the poor, and improving the environmental conditions that foster disease. The idea that anyone working outside the hospital is a community health nurse is very recent. Nurses serving as primary care providers is also a relatively recent trend. Clients do not join agencies; rather, agencies serve clients.

1. What did Lillian Wald suggest in regard to giving care to individuals and families?

Nurses should recognize the larger social and economic forces that the family cannot control. Wald emphasized that one could not understand an individual without understanding the family, and the family is in the grip of larger social and economic forces that they cannot control.

13. What must be created before establishing the evaluation plan to determine the success (or lack of) for a health project?

Observable and measurable objectives Goals are generally what is desired, while observable and measurable objectives are used to determine whether or not the goal was achieved and whether the project was successful.

13. Why can't we just test new, better approaches to health care with a small group to evaluate the effectiveness of that approach?

Offering a service establishes a precedent and a sense of entitlement, so it is difficult to discontinue the program. Once a direct health care service is offered, it is difficult to discontinue it. Existing programs create tradition by establishing vested interest and a sense of entitlement.

8. Who should develop a community disaster plan, have emergency drills to test the plan, and determine the proper response?

Office of Emergency Management The local Office of Emergency Management involves representatives from all official and unofficial agencies in developing the community disaster plan; developing scenarios to test the plan through drills; and assessing the scope, intensity, and number of casualties (once an incident has occurred) to initiate the proper response.

17. Which neighborhood would probably be best for someone interested in retaining his or her health?

One with high walkability One's environment is a significant factor. Those living in neighborhoods with high walkability engage in significantly more walking than those living in neighborhoods with low walkability.

6. Under the Theory of Reasoned Action, what is the easiest way to determine whether a person will change his or her behavior?

One's intention to perform a behavior The Theory of Reasoned Action attempts to predict a person's intention to perform or not perform a certain behavior based on the assumption that all behavior is determined by one's behavioral intention.

5. What prevents the federal government from essentially doing whatever politicians currently in power want the government to do?

Only actions authorized by the Constitution are legitimate. The federal government is a government of limited powers, which means that, for a federal action to be legitimate, it must be authorized. Only those actions that are within the scope of the Constitution, the supreme law of the land, are authorized.

22. What did physicians do to compete with new competition from health maintenance organizations (HMOs)?

Organized preferred provider organizations (PPOs) to negotiate with insurance companies In an effort to compete with HMOs, physicians and hospitals organized the independent practice model, which provided services to enrollees of one insurance company. This model evolved into the PPO, which offered services at a reduced rate in exchange for a guaranteed increase in consumers.

1. What is the primary reason that Americans are so concerned about health care?

Our national health care costs keep increasing. Although politicians and media do continue to discuss our health care system and people worry about the uninsured, the primary reason for the focus on health care is the constantly increasing costs, which cannot be sustained. Families worry they cannot afford care; politicians and media discuss the problem, as easy answers seem elusive

12. In what way is the U.S. approach to primary health care inconsistent with the World Health Organization approach?

Our primary health care system does not provide universal coverage to all citizens. As a market-based society, the United States does not focus on primary health care and does not provide coverage to all U.S. citizens. More than 45 million people in the United States do not have health insurance and therefore lack routine access to health care.

22. How does participatory action research (PAR) differ from other research methods in seeking knowledge?

PAR also seeks to raise consciousness. Participatory action research has as its goal not only the production of knowledge but also the generation of debate that will raise consciousness of constraints.

4. How does the government control conditions that individuals cannot?

Passage and enforcement of law Government regulates conditions that individuals cannot control and provides individual protection through a population-wide focus. These tasks are accomplished through passage and enforcement of laws.

14. During an outbreak in the hospital, all staff members were given immunoglobulin if they were not already immune to the disease. What sort of immunity will the staff that received the immunoglobulin then have?

Passive immunity Passive immunity is the temporary resistance that has been donated to the host through transfusions of plasma proteins, immunoglobulins, or antitoxins, or transplacentally, from mother to neonate. Passive immunity lasts only as long as these substances remain in the bloodstream. Active immunity is when the body produces its own antibodies against an antigen, from either infection with the pathogen or introduction of the pathogen in a vaccine.

4. Why do many persons who have Medicare decide to purchase Medigap health insurance policies? Select all that apply.

Patients have to pay a deductible (about $1000) when admitted as a hospital inpatient for care. Medicare Part A does not pay for physician services, hospital outpatient care, and medical equipment. Medicare does not pay for all health care costs of enrollees. There are costs the individual must pay. Consequently, individuals often decide to buy a Medigap policy. Medicare part B (if purchased) pays for physician services, hospital outpatient care, durable medical equipment, and other services including some home health care. The patient does have to pay a deductible, which was almost $1000 in 2010, if admitted as a hospital inpatient. Medicare part A does pay for most inpatient care in hospitals and skilled nursing facilities, hospice care, and some home health care.

2. Historically, how did patients pay for health care?

Patients paid out of their pockets for whatever care the provider charged. Until the 1930s, the predominant method of health care financing was self-payment. Health care providers charged a fee for the services they rendered, and the patient paid the out-of-pocket expense. The assumption was that those who could pay would pay and those who could not pay should receive care and pay what they could.

5. What was the first government step in trying to stop constantly rising costs?

Payment reimbursement was based on diagnosis and client characteristics rather than on treatment given. The first efforts to control costs were made by the federal government when Medicare hospital reimbursement was based on a prospective payment system. Payment would be based on a classification system that identified costs according to diagnosis and client characteristics.

7. What is one reason it is difficult to get others interested in environmental health?

People respond more to an acute crisis than chronic environmental problems. People respond to acute crises with dramatic media coverage (such as hurricanes or earthquakes), but ongoing consistent pressure is needed to ensure day-to-day environmental integrity. Chronic environmental problems are rarely addressed effectively.

10. Which groups of persons are more likely to engage in health-oriented lifestyle behaviors?

People with higher socioeconomic and education attainment Resistance to behavior change remains high among minorities and those of lower socioeconomic status and lower educational levels. Interest in health education, health promotion, and behavioral change has increased, particularly among those of higher socioeconomic and education attainment.

14. During a health history, the client looked confused and said, "But everybody drinks, like at parties and such. How much drinking do you think is too much?" How should the nurse respond?

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

11. Which factor is the main determinant of behavior within the Health Belief Model?

Perceived benefits of engaging in healthy behaviors Although all the factors are included in the model, the factor of perceived benefits was found to be the most powerful predictive element within the model, whereas perceived severity of the health threat had the lowest value.

12. What is a factor found in the Health Belief Model (HBM) that is not a factor in Pender's Health Promotion Model (HPM)?

Personal threat as motivator Pender's Health Promotion Model is a competence or approach-oriented model and, unlike the HBM, does not rely on personal threat as a motivating factor. Both attempt to explain behavior, based on individual perceptions, and both include self-efficacy as a factor. (Although the HBM did not originally have this concept, it was added in the revised model.)

5. A nurse wanted a screening test that was very sensitive in determining who might have a particular illness. What might be a problem with using such a sensitive test? Select all that apply.

Persons who do not have the illness are told that they might, which leads to anxiety, as well as time and cost of follow-up diagnostic tests. d. Such a test may have lower specificity, so some persons with the disease are told they are disease free and hence do not receive care. The problem with very sensitive tests is that the test picks up almost all people with the disease but also many others who do not have the disease. These "false positives" result in persons needing follow-up diagnostic tests. Additional time, effort, and expense, as well as worry, result until the negative test results are obtained. There is no problem with persons receiving true negative test results and celebrating that knowledge or with persons having their condition correctly diagnosed and treated.

1. Who may receive benefits under Medicare? Select all that apply.

Persons with end-stage renal disease Those over 65 years of age if eligible for Social Security benefits Those with permanent disabilities Medicare pays specified health care services for all people 65 years of age and older who are eligible to receive Social Security benefits. People with permanent disabilities and those with end-stage renal disease are also covered.

20. Indemnity plans were very much appreciated, but what flaw did they have?

Plans lacked any incentives to contain costs. Indemnity plans paid all the costs of covered services provided to the enrollee. The enrollee enjoyed free choice of provider and services. They preserve the enrollee's right of choice and allow the person to manage his or her own health care. These plans lack incentives for cost containment. Today, cost-sharing efforts (e.g., co-payments, deductible) help contain costs.

19. One hundred women received notification that their screening tests suggested that they might have a serious health problem. How can you reassure these scared women so they will come in for follow-up testing and treatment?

Point out that screening is only suggestive and that not all positive screenings mean they actually have the health problem. Not all positive screening results are confirmed with further diagnostic testing. The positive predictive value of a test (proportion of true positive results relative to all positive test results) is usually known for any screening test. Although one could argue that the test could be wrong, it is more therapeutic—because you want people to attend future screenings—to emphasize that screening is only suggestive than to say the screening test is inaccurate.

1. With what tool(s) did Florence Nightingale create change? Select all that apply.

Political advocacy, Publication of treated soldiers' death rate change from 42% to 2%, Use of statistics to demonstrate the effectiveness of her interventions Nightingale focused on the aggregate of British soldiers and used graphically depicted statistics and other data to demonstrate effectiveness of her interventions, which allowed her to become a political advocate on behalf of the soldiers.

23. Why are high-risk and vulnerable subpopulations identified by public health nurses before deciding on appropriate interventions?

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

4. The Health Insurance Portability and Accountability Act of 1996 was passed to address what critical issues in health care? Select all that apply.

Portability of insurance coverage, Insurance companies setting limits on coverage of longer than 12 months The Health Insurance Portability and Accountability Act of 1996 addressed insurance issues. Critical were the portability of coverage and preexisting conditions. Insurers cannot set limits on coverage longer than 12 months.

2. What is particularly notable about infectious disease in the United States?

Rate of infection varies extensively by income and ethnic groups. Probably one of the most profound failures in infectious disease control in the United States and elsewhere is that the successes are not equally distributed in the general population. Infectious diseases continue to be differentially distributed by income and ethnic groups, and the poor and minorities continue to experience the greater burden.

20. What might be your concern when a friend who was raped and beaten appeared to be coping well until recently when she dropped out of school and shared with you that nightmares during which it happens all over again were becoming impossible to live with?

Posttraumatic stress syndrome disorder (PTSD) PTSD is a psychiatric disorder that can occur after an individual's experiencing or witnessing a life-threatening event. People who suffer from PTSD often relive the experience through nightmares and flashbacks. The social and psychological symptoms can be severe enough, and last long enough, to significantly impair a person's daily life.

8. What is the source of local government authority?

Power is delegated from the states. States may delegate powers to the local government. Which powers they delegate vary widely from state to state.

27. How might providers legally improve their profit under the current reimbursement process?

Practice very conservatively to earn an incentive payment by delivering care for less cost than allocated As a reward for conservative medical practices, health care providers may receive a specified amount of money or a percentage of the agreed reimbursement if services are delivered below the limit set by the third-party payer.

25. When was the idea of national health care insurance first debated in the United States?

President Theodore Roosevelt advocated such national medical coverage in 1916. European countries began a social model of health insurance in the early 1900s. President Theodore Roosevelt advocated a similar plan for the United States in 1916.

22. What is the best way for the nurse to be sure that the teaching material and communication channels will be effective?

Pretest the materials with members of the target group to obtain feedback about their acceptability and understandability Pretest the materials to obtain feedback about the understandability and acceptability of the materials with this particular audience. Learning in advance what works and what does not saves time and effort later.

19. What is the primary thrust of philanthropic groups involved in health care?

Primary informational and research activities Philanthropic funding whose services are typically research or disease oriented pays a limited amount of health care. Services are limited to the specific disease or population of interest. Informational and research activities constitute the majority of services provided, although some give direct care or meet ancillary needs such as housing, transportation, or wigs.

15. The nurse couldn't find a vaccine in the refrigerator. The unopened vaccine vial had been put in a storage cabinet with the other medications. The nurse drew up the appropriate dose in the syringe and then put the vial of vaccine in the refrigerator. What will be the probable result?

Primary vaccine failure Primary vaccine failure is the failure of a vaccine to stimulate any immune response. It can be caused by improper storage that may render the vaccines ineffective, improper administration route, or exposure of light-sensitive vaccines to light.

11. In what way are policies in the private sector different from policies in the public sector?

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

2. How can a family be said to meet the needs of society?

Procreation and socialization The family fulfills two important purposes. The first is to meet the needs of society, and the second is to meet the needs of individual family members. The family meets the needs of society through procreation and socialization of family members.

31. What is one unexpected result of the decrease in funding to traditional public and private forms of health care?

Programs are developed as a result of community efforts. Most of the choices are expected consequences of decreased funding. What is unexpected is the increase in the number and type of models being created, as traditional public and private models of health care decline because of funding and shrinking resources. The programs develop in part as the result of community efforts.

26. How was the government successful at containing costs?

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

24. One famous study followed a cohort of nurses over their lives, collecting data and health histories as they aged. What kind of study is this?

Prospective study Prospective studies monitor a group of individuals to determine if and when disease occurs.

25. A researcher wanted to engage in the best possible research design to obtain reliable information about the possible cause(s) of a disease. Which design would the researcher choose?

Prospective study The most advantageous research design, because it obtains more reliable information and can more easily establish a stronger temporal relationship between presumed causal factors and their effects, is a longitudinal cohort prospective study.

22. What was a conclusion of the report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care?

Provider bias and stereotyping contribute to inequalities. The report observed that bias and stereotyping on the part of heath care providers might contribute to differences in care.

9. In what ways are complementary and alternative therapies different from traditional health care? Select all that apply.

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

1. What is the best definition of economics?

Science of allocation of resources Economics represents the science of allocation of resources. Resources are goods or services.

5. What is the primary problem seen in Healthy People 2020's emphasis on choosing healthy lifestyle behaviors, such as daily exercise or healthy food choices?

Public policy emphasizes personal responsibility but ignores social and environmental changes needed for well-being. Although all responses are accurate, the primary problem is the emphasis on personal choices in the Healthy People 2020 objectives. Emphasis on personal choices ignores the need for community responsibility and action that addresses environmental or cultural restraints to health.

16. A man walked to the staging area after an earthquake crying that he was hurt. A triage nurse noted he had cuts, abrasions, and an open (bone was seen) fractured arm. What should be done?

Put a yellow tag on his shirt and then await transport to a medical facility Green on the triage tag is for the walking wounded or those with minor injuries (e.g., cuts and abrasions) who can wait several hours before they receive treatment; yellow is for those with systemic but not yet life-threatening complications, who can wait 45 to 60 minutes (e.g., simple fractures); red is considered top priority or immediate and is for those with life-threatening conditions but who can be stabilized and have a high probability of survival (e.g., amputations); black is for the deceased or for those whose injuries are is so extensive that nothing can be done to save them (e.g., multiple severe injuries).

12. A case of viral hemorrhagic fever (Ebola) was diagnosed immediately on signs of illness at a tourist site in Africa. What should be done to protect the badly needed income from tourist dollars?

Quarantine the ill person and use isolation techniques in giving care Although students may not know the screening of or treatment of Ebola, they should know to isolate persons with infectious diseases. Ebola is not highly infectious until symptoms occur. Treating infected persons, whether they are symptomatic or not, is effective in preventing transmission of pathogens directly to others.

16. What is the most common cause of health problems resulting from radiation?

Radon gas in homes The three primary sources and distribution of radiation exposure are radon (43%); medical exposure (20%); and other nonnatural sources such as nuclear weapons testing, nuclear waste disposal, and transportation, storage, loss, and misuse of radioactive sources (19%). Radon contamination is the second leading cause of lung cancer mortality in the United States.

11. A nurse reviewed the treatment the surgeon recommended for a woman's breast lump. When the nurse asked the woman if she could be admitted to the hospital for immediate surgery, the husband thanked the nurse for her time and said they would get back in touch. What should the nurse do?

Recognize that the husband and other family members may need to have input into this decision We typically focus on the individual as the central figure in decisions about the self. However, in other cultures female clients may seek assistance from other members of the family and allow male relatives to make decisions about important health-related matters.

17. Which action would probably result in the largest change in health care outcomes for Americans?

Redirect a large portion of federal funding from acute care to health promotion activities Of the choices given, health promotion activities would make the largest difference. Increased expenditures on acute care will not notably change the health of the population, whereas funding that addresses health promotion such as education and safe environments would improve the health of the aggregate.

7. What is a major barrier to a nurse caring for the family as a whole?

Reimbursement is paid only for services given to an individual. Reimbursement is paid only for services given to an individual.

29. What is the issue of major concern among feminists regarding health care?

Reproductive freedom for women Feminists believe that all people are inherently equal and deserve equal opportunities. In health care, feminism focuses on reproductive freedom for women.

15. What possible problem could arise when the nurse begins to collect information about a particular health problem from community residents?

Residents might begin to expect service to be given to address the problem. Although the process of needs assessment can indicate strengths and weaknesses, it can also raise expectations for new services to address problems.

32. What has research suggested is the most critical resource for single adolescent mothers?

Resilience Study findings support the premise that resilience is a critical source for single adolescent mothers. This variable plays an important role in creating a family context in which health is nurtured. Resilience is an internal strength that develops in the context of adversity.

6. What map is crucial to be included in any disaster plan?

Resource map showing potential resources in persons and supplies A resource map is a geographic map that outlines the resources that would be available in or near the area affected by a potential disaster (e.g., potential shelter sites, potential medical sources, and location of equipment that might be needed).

7. What was the advantage of creating medical topographies?

Results demonstrated environmental factors related to regional disease. Survey methods were being used to study health problems. The medical topographies illustrated geographic factors related to regional health and disease.

26. Which research design would a researcher with limited time and funds probably choose?

Retrospective study Because longitudinal cohort or incidence studies are costly in terms of resources and staff and often lose subjects over time, a retrospective study may be used because it is faster and less demanding of resources.

23. A researcher, interested in the onset of early menses, compared the life experiences and history of 1000 14-year-old girls, half of whom had monthly periods and half of whom did not, to determine what variables might be observed. How would this study be categorized?

Retrospective study When a study looks at individuals with a particular condition in comparison with those who do not have the disease, based on their exposures to various life situations, it is a retrospective study; that is, the study requires participants to look back at previous experiences.

8. A student's assignment was to determine the needs of a selected aggregate. Eight percent of the aggregate have diabetes. How should the student determine whether that should be a priority?

Review the literature to determine the national and state diabetic rate A rate by itself is meaningless unless compared with previous trends (although the instructor or the head of the local public health department may or may not know that particular piece of information) or with state or national norms. The easiest way to find those norms would be to check the literature to determine the typical incidence in a similar environment or community. The literature review could include research reports and statistics that will help determine whether this finding represents a priority for this aggregate.

19. A community health nurse is overwhelmed with all that needs to be done in one day. Which task could most easily be postponed?

Reviewing the most recent hospital patient data collected by the local college of nursing All of the tasks are related to assessing needs, implementing new care options, or evaluating health outcomes measures in the community except reviewing hospital patient data. Hospital patient data may be helpful but not directly related to the agency's ability to promote primary health and prevent disease.

7. Despite multiple bills by Congress, what major health problem remains?

Rising number of underinsured and uninsured citizens With the rising number of uninsured and underinsured, universal coverage continues to be a critical concern that has not been solved despite multiple bills proposed in Congress.

16. Why would the nurse suggest to the students that they attend the local district nurses association meeting, where the nurse is an officer?

Role models are typically the major influence on nurses choosing to become politically active. Professional groups do not usually accept students into membership (especially since many students may want a different specialty practice). Nurses most often identify positive role models as the major influence that assisted them to become politically active. Therefore, mentorship at the student level up to expert level is important.

1. Which infections continue to increase in the United States?

STDs Treatable sexually transmitted diseases (STDs), such as syphilis and gonorrhea, had declined until 2000 but increased in 2007 for the seventh straight year. At the same time, incidence of chlamydia, another treatable STD, has increased steadily since 1995, and the number of cases reached 1,108,374 (370.2 per 100,000 people) in 2007.

23. What did Lillian Wald help create that was very useful for poor children?

School health nursing for school-aged children Wald convinced the New York City Health Commissioner to put a public health nurse into a school. The experiment was so successful that schools adopted nursing on a widespread basis, thereby creating the field of school health nursing.

15. An earthquake has hit and buildings are knocked down; people are injured and crying for help. Looters have already started grabbing essential resources. What should the community do first?

Send in law officials to secure the area and assure the safety of the victims Before search and rescue should begin, safety must be considered. In some instances, if a criminal action is suspected, law officials will be among the first to respond to secure the area and possibly gather evidence. While the area is being checked and then cleared of potential threats, a staging area can be set up at or near the site of the incident to direct on-site activities. Search and rescue of victims can begin once clearance is given, a disaster triage area is established, and an emergency treatment area is set up to provide first aid until transportation for victims to hospitals or health care facilities for treatment can be coordinated.

15. Why is it so difficult to change the paradigm of health care from disease orientation to promoting health orientation?

Serious reallocation of resources would have to occur. A shift in the paradigm would necessitate a substantial reallocation of resources because the vast majority of health spending is currently directed to medical care and biomedical research and reflects a viewpoint of health care as a commodity.

16. Because of an interest in social justice, what major event affecting health care occurred in the 1960s?

Social Security Act was amended to create Medicare and Medicaid legislation. The popularity and benefits of employer-provided insurance plans were recognized, as was the reality that some segments of society were being neglected. The 1960s, with a pervasive thrust for social justice, presented the opportunity to move toward universal health care coverage. Titles XVIII and XIX of the Social Security Act created Medicare and Medicaid, respectively.

17. What is the goal of participatory action research?

Social change resulting from stakeholders' strategies The goal of participatory action research is social change. The strategies reached collectively by the involved stakeholders lead to changes within the group and the community.

8. How did Edwin Chadwick's ideas help decrease disease in the nineteenth century?

Social reform legislation resulted in changes such as sidewalks. Edwin Chadwick's Report on an Inquiry Into the Sanitary Conditions of the Labouring Population of Great Britain led to legislation for social reform including child welfare, factory management, clean water, sewers, fireplugs, and sidewalks.

6. What sorts of things do community members receive from each other?

Socialization and role fulfillment Not all communities are safe places, have medical centers, or offer recreational opportunities. Almost all communities have socialization and role fulfillment opportunities.

28. A family agreed to bring all the children in to the clinic at one time to begin to catch up on the children's immunizations, but they didn't keep their appointment. What might you conclude?

Some barrier or restraint interfered with the family's ability to come. Families most frequently served by the community health nurse are disadvantaged in that they are unable to buy health care from the private sector. However, constraints to obtaining needed health and social services are well documented and may come from characteristics of health and social services rather than individual family limitations. The nurse should note those constraints that prevent full use of the resource such as hours of service, distance and transportation, availability of interpreters, and criteria for receiving services.

14. A nurse had all the details carefully arranged for a project: location, speaker, seating arrangement, refreshments, handouts, visual aids, and students to distribute and collect evaluation sheets. What might be a problem?

Something totally unexpected and unplanned for. Although implementation should follow the plan, the nurse must also prepare for unexpected problems. If the project fails, it is crucial to analyze what went wrong so it can be avoided in the future.

16. What would be the proper term for the action of the school health nurse arranging for all the students in the elementary school to receive H1N1 immunizations?

Specific protection Immunizations are a specific protection effort as part of primary prevention.

7. Who or what has authority to act in every area except those specifically mentioned in the Constitution?

State government Any powers not delegated to the federal government are reserved for the states

6. What has been slowly increasing in consistency among states in their approach to health care?

States frequently develop new programs as federal funds become available to pay for them. Many state and local government programs were developed on the basis of availability of federal funds. Funds are accompanied by regulations, which apply to all recipients. These have served to standardize health policy.

18. What effect did President Clinton's Advisory Commission on Consumer Protection and Quality in the Health Care Industry report (1999) have?

Stimulated the Institute of Medicine to explore quality in more depth The report had a major impact in that it stimulated a series of more in-depth explorations of the health care delivery system, which resulted in a series of reports developed by the Institute of Medicine called the Quality Chasm Series.

28. What can balance the fact that poverty is typically a major factor in certain groups having poorer health?

Strong family and community support for healthy behaviors Latino children who live in poverty enjoy relatively good health compared with children in other low socioeconomic groups. It is believed that strong family-community support fosters optimum family health behaviors. Many of these behaviors are integrated into the culture as part of the family identity, traditions, and history.

9. The daily patrons of a local town restaurant became ill with nausea, vomiting, and diarrhea. Without knowing the cause, what should be done immediately to help avoid future problems?

Strongly emphasize the importance of proper hand washing to staff Agents leave the human host through a portal of exit and invade through a portal of entry. Portals of exit include respiratory secretions, vaginal secretions, semen, saliva, lesion exudates, blood, and feces. Portals of entry are associated with the portal of exit and include the respiratory passages, mucous membranes, skin and blood vessels, oral cavity, and the placenta. Because it was food poisoning of some sort, until the cause is known, it can be assumed to probably be a fecal-oral transmission. Therefore, staff need to again be reminded of the importance of careful hand washing after using the facilities.

20. Which would be a good example of service learning?

Student nurses volunteering at the free clinic doing health assessments Service learning is a teaching and learning strategy that integrates meaningful community service with instruction and reflection to enrich the learning experience, teach civic responsibility, and strengthen communities.

14. Which research study would determine the attributable risk of a sedentary lifestyle in cardiac disease?

Subtracting the rate of cardiac disease among athletes from the rate of cardiac disease among non athletes Attributable risk is determined by subtracting the rate of disease among nonexposed individuals (such as athletes) from the rate of disease among those exposed (the individuals with a sedentary lifestyle).

10. When a nurse visited a client's home, it was apparent that the client had not begun to implement the needed exercise program. Rather, the client had been drawing about his illness experience. What should the nurse do?

Suggest his drawing might be more forceful after exercising The dominant cultural value is action oriented, so the client would be expected to have begun to exercise. Dominant cultural values include an emphasis on productivity and being busy. However, some persons are not action oriented but being oriented, with a focus on expression of impulses and desires.

23. A young woman is panic-stricken. She hadn't realized how much she was drinking, and she thinks she had unprotected sex with several men last night. She is petrified and wants an HIV test immediately. What do you do?

Suggest she be treated immediately to be safe HIV infection is usually determined by the HIV antibody test, most commonly the enzyme-linked immunosorbent assay (ELISA). False-negative findings may occur, especially before the body produces antibodies after exposure. The student should be aware that treating HIV exposure with HIV medications has been shown to decrease the incidence of seroconversion and HIV infection.

24. Crying, a clinic patient explained that she knew she had this breast lump because she had spread nasty gossip about her neighbor. What intervention would probably be most successful?

Suggest that she has to repent and as much as possible undo her sin, but also make an appointment for a biopsy The woman has expressed a magicoreligious perspective on illness. Because evil has caused her illness, she must undo the evil. However, the nurse, as a practitioner of the biomedical perspective, must also arrange for a biopsy as soon as possible so treatment can be begun.

6. What responsibility does the ANA Code of Ethics require of the nurse beyond giving excellent care to clients?

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

12. What has led to the more recent focus on cooperation between the state and the federal level in relation to public health?

The threat of bioterrorism Cooperation between the state and federal levels has been brought to the forefront with efforts to plan for bioterrorism, an event that would necessitate cooperation and sharing. In addition, the state is highly dependent on the federal level for resources and guidance.

22. What activities can all nurses to do to influence internal private health policies?

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

19. What was the primary conclusion of the report To Err Is Human: Building a Safer Health System?

System failures are resulting in an incredible amount of harm from medical errors. First was emphasis on the incredible magnitude of harm resulting from medical errors, which are largely due to system problems, not individual failure. Error reporting programs are needed as health care systems are encouraged to focus on error reduction.

15. A nurse was responsible for setting up a 1-day-long health fair with free pizza being served during lunch. The nurse observed quite a few people who didn't eat but just talked quietly during lunch. What, if anything, should the nurse do?

Talk to the group, and ask what foods might have been more acceptable Many ethnic groups prefer certain foods as part of their cultural identity. The nurse should take this opportunity to learn foods preferred by the community. It can't be assumed a supervisor in a central office would know preferred foods or the supervisor would possibly have intervened when the health fair was being set up.

21. What is the first and most crucial step according to the Framework for Developing Health Communications?

Target the program to meet the audience's learning needs as they perceive them Understanding the intended audience's learning needs and targeting the program or message to the audience is key to activating effective health education.

22. Which group is especially at risk for sexually transmitted diseases (STDs)?

Teenaged girls Teenaged girls in particular may be more susceptible to STDs because they have fewer protective antibodies to STDs and a cervix that is biologically immature.

20. What is the best way to increase the positive predictive value of a screening test?

Test a group at high risk for the health problem The positive predictive value is affected by what proportion of the tested population has the problem. To increase the positive predictive value, screen populations most at risk for the problem.

3. What were among the outcomes of the 1979 report Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention? Select all that apply.

The Health Objectives Planning Act of 1990 was passed. The federal government began to identify and monitor national health care goals. The federal government began to take a directive approach in identifying and monitoring national health care goals after The Surgeon General's Report. The Healthy Objectives Planning Act of 1990 was passed. Healthy People 2000, Healthy People 2010, and Healthy People 2020 are continuing the efforts.

12. A public health nurse wanted statistics on the disability, illness, and other health-related variables for the state. Where should the community health nurse go for the most extensive data?

The National Center for Health Statistics The National Center for Health Statistics compiles annual National Health Survey data. It also publishes reports on prevalence of disability, illness, and other health-related variables. It tracks trends by nation, state, and year.

1. Which U.S. agency is responsible for overseeing the actions of protecting against, responding to, recovering from, and preventing the effects of disaster?

The National Incident Management System Because of the recognition of the need to be prepared, programs have been created to address the national, state, and local management of disasters. President G. W. Bush established the National Incident Management System (NIMS) in 2004. The NIMS provides a systematic, proactive approach for all levels of government and nongovernmental agencies to work seamlessly to prevent, protect against, respond to, recover from, and prevent the effects of disasters (Federal Emergency Management Agency, 2009).

3. In what way is environmental health (EH) different from the usual practice based on evidence?

The Precautionary Principle suggests action even if causative factors have not been confirmed. The Precautionary Principle says, "When an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause-and-effect relationships are not fully established scientifically."

5. A patient did not attend the clinic for required follow-up care after his extensive surgery. What might the nurse appropriately conclude?

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

10. What change could most effectively lead to a longer life span in Americans?

The belief that smoking is shameful and disgusting, as well as expensive, becoming the social norm Smoking is responsible for about 20% of all deaths in the United States. Although smoking is an individual's choice, all people are affected by social norms.

9. The president was sent a bill that he did not really like, but he would have been unpopular if he vetoed it, so he did nothing. What will happen to the bill?

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

10. If the forces for a bill are roughly as persuasive, powerful, and well financed as the forces against a bill, what will probably be the outcome?

The bill will fail. It is far easier to defeat a bill than get one passed; therefore, the opposition always has the advantage

4. Eight patients were burned in a factory fire. Shortly thereafter, four firefighters were seen with possible smoke inhalation problems. How are these patients different from the first patients to arrive?

The burn patients were direct victims, whereas the firefighters are indirect victims. Both sets of victims would have inhaled smoke and have lung damage. The treatment and length of stay would be determined by the amount of damage, which may vary from victim to victim. Both sets of victims, depending on the severity of the burns, may have scarring, shortness of breath, and persistent hoarseness for the rest of their lives. A direct victim is an individual who is immediately affected by the event; the indirect victim may be a family member or friend of the victim or a first responder.

7. In addition to working with a client to change behavior to improve health, what else must be kept in mind according to the Theory of Planned Behavior?

The client's belief about factors that may facilitate or impede the behavior The Theory of Planned Behavior stresses that perceived control is a major factor in whether or not the client performs the behavior.

2. What is meant by Leininger's term "culture universal"?

The commonalities of values, norms, and life patterns that are held in all cultures Culture universal is used by Leininger to refer to the commonalities of values, norms of behavior, and life patterns that are similarly held among cultures.

18. A local factory was told to clean up or face a large fine every day until it did. The local factory closed, although it had been extremely profitable. What action may probably follow?

The company will move to a country where it can continue to pollute. As corporations become global entities, many escape U.S. standards by moving operations to unregulated areas of the world.

6. The textbook summarizes a research study of sexually transmitted infections among young adults. What was determined to be a major variable in exposure to infection?

The environment in which the young adults lived The researchers concluded that ecosocial or contextual conditions strongly enhance sexually transmitted disease risk by increasing sexual risk behaviors and likelihood of exposure to infection.

20. A family came in to discuss a problem with one of their children. Which family behavior would cause you concern?

The family wanted the nurse to decide what they should do. Traits of a healthy family include open communication, ability to establish priorities, being supportive of each other, sharing a religious core, having a sense of humor, and knowing when to seek help. However, healthy families also engage in decision making and do not want others to make decisions for them.

21. At a military base, a family from Qatar, a Muslim Arabic country, came in because the wife believed she was pregnant. If there are no intervening variables, who should see the family?

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

7. What is the best way to choose the goals for a particular educational program?

The target audience must determine their needs and priorities. Learners must be involved in determining their own health education needs and priorities. Both the formal and informal leadership would have useful information to share, but the crucial component is input from the target group.

14. When making a home visit, a nurse is usually expected to focus attention on the ill family member. But whom might the nurse focus on instead?

The ill family member's primary caregiver Changes in family patterns, fears, emotional responses, and expectations of individual family members can be assessed in the family interview. Special needs of the primary caretaker (i.e., often the spouse, daughter, or daughter-in-law) must be assessed.

15. A nurse did a study of two skin lotions: an inexpensive one and an expensive one. The nurse found that there was a risk factor of 0.7 for skin sores using the inexpensive one and a risk factor of 1.2 using the expensive one. Which one should the nurse use?

The inexpensive lotion A risk factor of less than one means the factor is actually protective, so the inexpensive lotion is helpful in preventing skin sores. A risk factor of more than one means the factor increases risk, so using the expensive lotion increases the probability of getting a skin lesion.

20. Why was the National Health Planning and Resources Development Act of 1974 unsuccessful in its efforts to increase accessibility and acceptability, improve quality, and constrain rising costs?

The law did not affect the current health care delivery system. The 1974 Act was unsuccessful because it grandfathered in the entire health care system. In other words, nothing had to change.

4. What might be noticeable about the State Child Health Improvement Act (SCHIP) of 1997?

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

11. What is the primary reason risk reduction is of such importance in the United States today?

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

7. What is the major assumption of the health belief model created and used by social psychologists?

The major determinant of preventive health behavior is avoiding disease. The model is based on the assumption that the primary reason people act is disease avoidance. Such avoidance means they perceive themselves as susceptible to a serious disease, there is some cue to action, and there are more benefits than barriers to acting.

16. What is the most likely reason that a nurse responsible for teaching spends more time being quiet than giving information?

The nurse is listening to the group's dialogue to identify problems. The exchange of ideas and concerns creates a problem-posing dialogue and identifies root problems or generative themes. The group members themselves create relevant action plans that are congruent with their own reality. Therefore to be effective the nurse must listen to ensure that teaching reflects what the group wants to learn.

3. In what way does the Health Planning Model for care of aggregates differ from the customary nursing process applied to the care of an individual?

The nurse must first decide on and define the aggregate to receive care. Whether caring for an individual, a family, or an aggregate, the nurse must know the demographics of the client and choose which health need has first priority. In caring for aggregates, each participant does not receive an equal number of services, but those services that each participant needs. However, the nurse does have to decide on which aggregate to focus and then carefully define that aggregate.

8. People were very concerned about another outbreak of swine flu. All care providers were asked to report, without individual names, any new cases to the public health department for tracking. What would be most helpful for local media to report to keep citizens informed?

The ongoing incidence rate As only new cases were being reported to the health department, the media could only report the ongoing incidence rate, that is, the number of new cases reported each day.

5. What was notable about the Medicare Modernization Act of 2003?

The revision included a prescription drug benefit. After being implemented, the Medicare Modernization Act of 2003 provides seniors and people living with disabilities with some prescription drug benefit coverage, as well as more choices and better benefits.

3. Why might health education in the community be more effective than health education in a professional setting such as a hospital or clinic?

The setting is familiar and comfortable to participants. There can be interruptions and distractions anywhere, including in a patient's home. In the community, the setting is familiar and comfortable.

8. What factor is crucial to plan an effective health education program?

The sociopolitical cultural context of the community's environment Community health education with the community as client is based on practical, relevant, and scientifically sound methods and widely accessible technology. An effective program relates economical, political, and epidemiological factors to internal behavioral and communication factors. Thus the program activities are viewed within a sociopolitical structure especially within the local environmental settings.

9. In trying to determine whether the swine flu outbreak was getting worse, what rate should be carefully observed?

The swine flu incidence rate The incidence rate of new cases would be most useful for detecting short-term acute disease changes, as the swine flu duration is usually relatively short.

5. What is the advantage of the web of causation model in comparison with the epidemiological triangle model?

The web of causation model shows the relationships among variables. Although it is a more recently created model, the web of causation model is more useful because it illustrates the complexity of relationships among causable variables. It is not easier to understand and use as it has more variables than the three (agent, host, and environment) in the epidemiological model.

26. A nurse made a home visit for prenatal care and teaching to an Asian woman. The nurse noted the woman was having a hot lunch of foods the nurse didn't recognize. When the nurse suggested some appropriate cold protein foods be added to the meal, the woman looked horrified and distrusting. What might be the problem?

The yin and yang theory requires only hot food be eaten when female yin energy is dominant. Many Asians ascribe to the yin-yang theory in which health is believed to exist when all aspects of the person are in perfect balance. Yin energy is female. Yin Yang foods are hot. Therefore to maintain balance, she has to eat hot foods.

16. What might a school health nurse conclude when record data demonstrated that there were a very large number of children in the school district whose insurance plan was the Children's Health Insurance Program (CHIP)?

There are a large number of working low-income parents. CHIP has greatly increased access to health care for many low-income children. The majority of these children live in families with working, low-income parents.

9. How does one know if learning has occurred?

There is a long-term change in knowledge and behavior. By definition, learning is an enduring change involving modification of knowledge, behavior, perception, or motivation.

3. What conclusion can be drawn from examining where nurses are employed?

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

19. What is a flaw in many of the health care bills passed during the last four decades that became obvious in hindsight?

They avoided interfering with the current health care approach and did not improve problems of access or duplication of efforts. Although each bill attempted to meet some problem in health care planning and delivery, none really improved quality, access, and cost issues. Current health care providers and institutions heavily influenced outcomes.

8. Why would some people believe the air within a particular building carries a risk and makes them ill?

They consistently feel worse on workdays and weeks without holidays. As the question discusses risk, the textbook states that the causative factor must precede the problem and that the problem would increase with exposure. Feeling ill only on workdays would imply that some factor in the workplace is responsible.

6. What conclusion could you draw if most of a country's citizens died from malnutrition or as the result of violence?

They live in a developing country. Infections, malnutrition, and violence are the primary causes of mortality in developing countries.

9. How do voluntary health agencies fit into the overall health care system?

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

13. Why would a public health nurse want to know about morbidity and mortality statistics on the local, state, and national level?

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

29. Why should nurses be knowledgeable about health care funding?

To better serve as patient advocates in policy making for funding that provides appropriate care for the greatest good Increasing knowledge of health care funding and policy making will empower nurses to advocate for the type of funding that provides appropriate care to obtain the greatest good. Nurses need to utilize their political power. Nurses must advocate for health promotion disease prevention funding.

10. Why are clinical areas so careful to assure sanitization of surfaces and equipment between each patient?

To decrease transmission by fomites Indirect transmission is the spread of infection through a vehicle of transmission outside the host. These may be contaminated fomites or vectors. Fomites can be any inanimate object, material, or substance that acts as a transport agent for a microbe (e.g., water, a telephone, or a contaminated tissue).

1. Why was the Vaccine Adverse Event Reporting System legislated into being? Select all that apply.

To determine whether changes should be made in procedures or biological agents, To provide assistance to families who experience a vaccine-related injury No drug is perfectly safe or effective. Changes are made on the basis of the collected data. For example, whole cell pertussis vaccine was changed to an acellular pertussis vaccine because of adverse side effects. To monitor actual and potential vaccine-related problems, health care providers must report specific postvaccination "adverse events" to the Vaccine Adverse Event Reporting System (VAERS). The National Vaccine Injury Compensation Program reviews all VAERS reports and provides assistance for individuals and families who experience a vaccine-related injury, including disability and death.

10. What is the primary goal of the federal government in relation to disasters?

To ensure continuity of essential federal functions during any disruption The policy of the federal government is to have a comprehensive and effective program in place to ensure continuity of essential federal functions across a wide array of incidents. The national strategy is to develop a system connecting all levels of government without duplicating efforts.

5. The nurse working with a client to change behavior to maximize health asked the client to bring his family to the next visit. Why would the nurse want the family to come with the client?

To evaluate whether the family members approve of the proposed changes Under the Theory of Reasoned Action, it is assumed that all behavior is determined by intentions, which are determined by attitude toward the behavior and the norms associated with the behavior. That in turn is determined by whether or not important persons approve or disapprove of the behavior.

4. Why is it so important to discover all the variables that may be involved in creating a disease state in some persons?

To find variables susceptible to prevention or early intervention. Identifying risk factors is critical to creating or discovering specific prevention and intervention approaches that reduce chronic disease morbidity and mortality. Because some risk factors cannot be avoided, knowing other risk factors involved allows for more possibilities of preventing the problem.

13. What is the primary purpose of both the HBM and HPM models?

To help explain why individuals do or do not engage in health actions The models are meant to provide an organizing framework to explain why individuals engage in health actions. Therefore, they are also useful in assessing patients' motivations and explaining their behavior.

19. A very busy day was planned at a community health fair. Why would a nurse spend time greeting and meeting each new person who walked in?

To immediately establish a friendly relationship and a level of trust The core of health education is the therapeutic and healing relationship between the nurse and clients. Inclusion and trust must be established before creating change. The nurse enhances inclusion by greeting clients on arrival in a warm fashion.

18. What was the primary purpose of the Heart Disease, Cancer, and Stroke Amendments of 1965?

To increase the availability of high technology in health care Its purpose was to make the latest technology for the diagnosis and treatment of heart disease, cancer, stroke, and related diseases available to community health care providers through the establishment of regional cooperative arrangements.

4. Why did employers decide to offer health insurance as an employee benefit?

To obtain and retain the limited number of persons available to work when government rules forbid raising wages, insurance was offered. The idea of paying a small fee for guaranteed health care to have sickness cured was very popular. Health care providers liked knowing they would receive payment for their services. During World War II, faced with a limited workforce and governmental restrictions on wages, employers began to see health insurance as a means of supplying workers' benefits without granting a wage increase.

14. All the needed objective data on a specific health problem were available. Why then would a community health nurse interview community residents about the health problem?

To obtain the residents' personal insights and beliefs about the problem The nurse must understand the community's perspective on health status, the services used or required, and their concerns. Official data do not capture this type of information. Data collected directly from an aggregate may be more insightful and accurate.

28. Why would large employers decide to self-insure?

To reduce administrative costs charged by insurance companies Some organizations have decided to self-insure their employees. This reduces the administrative cost of insurance, which has been estimated to represent 12.5% of the cost of insurance.

5. Why do so many people decide to move to large urban areas?

To seek employment As the world population grows, a global trend toward urbanization occurs; people live closer together and migrate to urban areas for employment.

15. Why did local and state governments start to become more involved in controlling disease?

Too many citizens were too upset by local conditions. Community outcry for social reform forced state and local governments to take notice of deplorable conditions and take more responsibility for controlling the spread of bacteria and other microorganisms.

9. What is meant by shoe leather epidemiology?

Traveling throughout the community to absorb an overall impression of it Shoe leather epidemiology refers to establishing hypotheses about the community's health, strengths, and possible problems through the down-to-earth approach of traveling through the area and observing and interacting with community members.

11. What is the first step in preventing further spread of a particular sexually transmitted disease (STD)?

Treat each infected person with the appropriate pharmaceutical agent Anti-infective drugs, such as antibiotics, antivirals, antiretrovirals, and antimalarials, play important roles in controlling infectious diseases. Not only do they permit recovery of the infected person, but they also play a major role in preventing transmission of the pathogens to another. The first step in preventing transmission of tuberculosis and syphilis is to treat the infected person with antibiotics. Because the question asks about further spread, infection in a person has been diagnosed, so education is needed, but it is too late for that person. Adults not in school also are infected with STDs.

27. A nurse was assigned to create and implement a community education program with the goal of preventing diabetes among the Hispanic population. As the nurse did not speak Spanish and was just beginning to be comfortable with the neighborhood Hispanic culture, what is the nurse's best approach?

Try to find Hispanic volunteers who may be able to do the actual teaching By using volunteers, the program can disseminate culturally appropriate information in a culturally appropriate way. The success of educational efforts is often determined by the credibility of the source and the sensitivity of the speaker in communicating information in a culturally appropriate manner.

31. The clinic was seeing a great number of Hmong immigrants from the mountainous regions of the Far East. If the nurse could not obtain a translator, what might be the next best action?

Try to make flash cards with common phrases used during clinic visits If a translator isn't available, the nurse can try many approaches such as pantomime, but it would also be helpful to have common phrases used with many patients on flash cards so basic information can be obtained.

5. Which is true concerning tuberculosis infections in the United States?

Under certain conditions, susceptible hosts may be infected by the tuberculosis bacillus. The principle of multicausation emphasizes that an infectious agent alone is not sufficient to cause disease; the agent must be transmitted within a conducive environment to a susceptible host. Tuberculosis is caused by Mycobacterium tuberculosis; treatment with INH lasts for a year and is used when no active disease is present; patients can be contagious without having any symptoms.

9. The nurse made a follow-up appointment for a client at the clinic, but the client didn't come. Two days later the client presented at the clinic explaining that a temporary job had come up and he couldn't come back until he'd finished and been paid for that job. What should the nurse do?

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

29. What is the Tuskegee Syphilis Study best known for today?

Unethical and racist treatment of uninformed subjects As treatment was knowingly withheld over many years resulting in incredible harm to the subjects and their families, public outrage over unethical, racist, and discriminatory behavior of the researchers continues today.

6. An unidentified patient was injured in a hit-and-run accident and was now conscious. When asked how he felt, the patient looked very confused and responded in a language the nurse didn't recognize. What should the nurse do?

Use gestures and pantomime until the nurse is able to determine what language the patient is speaking The nurse can report the problem and request a translator, but in the meantime the nurse should pantomime words and simple actions while verbalizing them until communication can be established using a translator from his culture, once his cultural background can be determined. Just looking at a patient will not allow you to assume his or her ethnic background.

13. What can be used to protect staff at a community clinic when a patient walks in complaining of severe intestinal cramps and diarrhea?

Use universal precautions with all patients regardless of the situation In the late 1980s, the Centers for Disease Control and Prevention (CDC) developed a set of guidelines, called universal precautions, to prevent transmission of diseases found in blood and other body fluids. These guidelines were developed because infected people may be asymptomatic and have no knowledge of their conditions; therefore health care workers must assume that all patients are infectious and protect themselves.

13. What was a major change after Medicare began a prescription drug benefit?

Utilization of drugs and their cost immediately increased. As with other health care services, once a funding source has been established, utilization and costs increase. As one example, physician visits or hospital outpatient visits in which five or more prescriptions were ordered increased from 4% to 7%.

13. Which question is the most important to be included in each client's health history?

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

18. What is the usual result of a state or health care organization receiving federal funding for a special health care need?

When funds cease, so does the health care; therefore continuity is lacking. When the funding is no longer provided, the programs cease, which results in lack of continuity of care.

9. When would the National Guard become involved in a disaster?

When the state has been asked to help an overwhelmed community When a disaster overwhelms the local community's resources, then the state's Department or Office of Emergency Management is called for assistance. Before an event, state officials provide technical support for prevention, preparedness, response, and recovery. State officials are on-scene at disaster events to facilitate coordination of state resources and to disseminate information. In some cases, the National Guard may be called in to aid the community.

3. When would the wheel model of epidemiology be more helpful than the epidemiological triangle model?

When there are multiple causes for a chronic disease The epidemiological triangle model of agent-host-environment is very useful especially with single-cause infectious diseases. However, with the multiple factors involved in chronic diseases, the wheel model is more useful in analyzing and identifying the multiple variables.

13. When would a community health nurse try to collect data on a health issue?

When there is no source of previously collected data Formal data collection does not exist for all health data. Therefore many nurses must perform additional data collection, compilation, and analysis.

1. When did communities first begin to agree on collective action to stay healthy?

While people were nomads engaging in hunting and gathering Primitive prehistorical societies had health practices to ensure their survival. Isolation and fumigation were used for thousands of years.

17. What questions are asked during disaster triage?

Who are you? Are you hurt? To assess an individual within the 1-minute guideline, the system uses three characteristics. First, respirations are checked; then perfusion by pinching the nail bed and observing the reaction; and, last, mental status is checked by asking the individual simple questions beginning with "Who are you?"

1. Which definition of family is probably the most useful for the nurse practicing in the community?

Whoever the family says is in their family Although some believe even these definitions are too narrow, the widest definitions are "the members of the family are self-defined" and "the family is who they say they are."

12. When one woman asked her friend to stay while a painful procedure was done, it was explained that only one immediate family member could be in the room. The woman asked, "How do you define family?" In the clinic, what would be the best response?

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

23. After being given negative news about a health problem, the client, with tears running down her face, asks, "Why did this happen to me?" What is your response?

Why do you think it might have happened? Each response represents a particular belief about illness, but, without knowing the patient's perspective, the wrong one could easily be chosen. It is difficult to be comforting without knowing the client's beliefs about the causation of illness. The best way to discover this is to query the patient.

13. Which group should be used for determining the community's pregnancy rate?

Women between 15 and 45 years old in the community Although pregnancy is not specifically addressed, the text stresses that only those susceptible to a particular condition should be considered in the denominator. In the case of pregnancy, only women of childbearing age are susceptible.

24. When handed the consent form to sign before treatment could be given, a patient looked at the nurse and said, "I'm sorry; I forgot my glasses today." What should the nurse do?

Wonder if the patient might have difficulty with reading and therefore summarize the content of the form for the client The Institute of Medicine report related that millions of U.S. adults are unable to read and act on health instructions and messages. Among the recommendations is a need for clear communication with clients.

25. After completing a master's degree, a nurse took a course in marketing. Should the agency reimburse the nurse's tuition costs?

Yes, the nurse could use such information in social marketing for the agency. Social marketing tools utilizing marketing principles and technologies are designed to influence the knowledge, attitudes, values, beliefs, and behaviors of populations. Such information would be extremely helpful for agency personnel in improving community health and lifestyle choices.