Pop Health Exam 3 Questions

15. When describing primary prevention activities that would occur in the preparedness phase of a terrorist attack involving biologic weapons like smallpox or anthrax to a local community group, which of the following would the nurse include? A) Investigating outbreaks to determine source B) Administering vaccines C) Screening suspected cases D) Treating persons who have been infected

B Feedback: Primary prevention activities that would occur in the preparedness phase of a terrorist attack involving biologic weapons like smallpox or anthrax would include administering vaccines. Investigating outbreaks to determine the source, screening suspected cases, and treating persons who have been infected would be secondary prevention activities.

8. When assessing a group of individuals for factors related to an increased risk for alcohol use disorders, which of the following would the nurse expect to find? Select all that apply. A) Academic engagement/achievement B) Antisocial peer affiliations C) Decreased impulsivity D) Positive mother-child/father-child relationships E) Stressful life events

A, B, E Feedback: Individual factors associated with the development of AUDs include problems with academic engagement/achievement, antisocial peer affiliations, problems in the mother- child/father-child relationship, and other stressful life events.

9. Which of the following would a community health nurse expect to assess in the population of homeless men? A) Marital status B) Substance abuse C) Permanent employment D) Frequent use of shelters

B Feedback: The majority of homeless men are single adults. Homeless men are more likely to be employed than their homeless female counterparts; yet, they usually hold temporary, low wage jobs that offer little security. They are also more likely than homeless women to have uncontrolled substance abuse issues. This makes it more difficult for them to access shelters, which tend to require abstinence for admission

3. Which of the following would likely provide the best estimate of the number of persons who are homeless? A) Counting the number of homeless people on a particular day B) Counting the persons who are homeless in a given week C) Counting the number of persons who are homeless at a specific time on a specific date D) The number of people who have been homeless over the course of a year

D Feedback: Rather than trying to count the number of homeless people on a given day or week (point in time counts), it may be more prudent to measure the number of people who have been homeless over a longer timeframe such as over the course of a year (period prevalence counts).

8. A community health nurse is working with a community that is involved with identifying risk factors for program development in case of a disaster. This community is in which phase of disaster management? A) Prevention B) Preparedness C) Response D) Recovery

A Feedback: During the prevention phase, no disaster is expected or anticipated. The task during this phase is to identify community risk factors and to develop and implement programs to prevent disasters from occurring. Disaster preparedness involves improving community and individual reaction and responses so that the effects of a disaster are minimized. The response phase begins immediately after the onset of the disastrous event. During the recovery phase, the community takes actions to repair, rebuild, or relocate damaged homes and businesses and restore health and economic vitality to the community.

4. A community health nurse is applying the normative-reductive strategy of change when working with clients. In doing so, the nurse engages them into changing their behavior in addition to providing education, based on which assumption? A) Information alone is not enough, and behaviors change through persuasion. B) Compliance by the client system will occur through the use of power to effect change. C) People are rational and will adopt a new practice because it is in their best interest. D) The clients can assume a high degree of responsibility for their own help.

A Feedback: Normative-reductive strategies not only give information but also directly influence people to change attitudes and behaviors through persuasion. Use of power or coercion is associated with the power-coercive change strategy. The Empiric-rational change strategy is based on the assumption that people are rational and, when presented with empiric information, will adopt new practices that appear to be in their best interest. The empiric-rational strategy is best used with clients who can assume a relatively high degree of responsibility for their own health.

15. A community health nurse working as part of group uses the group as a sounding board, often expressing personal, nongroup-related feelings. This nurse is demonstrating which of the following nonfunctional behaviors? A) Self-confession B) Aggression C) Competition D) Sympathy seeking

A Feedback: Self-confession involves using the group as a sounding board, expressing personal, nongroup-oriented feelings or points of view. Aggression involves working for status by criticizing or blaming others, showing hostility toward the group or some individual and deflating egos or status of others. Competition involves vying with others to produce the best idea, talk the most, play the most roles, and gain favor with the leader. Sympathy seeking involves trying to induce other group members to be sympathetic to one's problems or misfortunes, for example, deploring one's own situation, or disparaging one's own ideas to gain support.

9. A community health nurse is working with a community that is involved with improving community and individual reaction and responses, so that the effects of a disaster are minimized. This community is in which phase of disaster management? A) Prevention B) Preparedness C) Response D) Recovery

B Feedback: Disaster preparedness involves improving community and individual reaction and responses so that the effects of a disaster are minimized. During the prevention phase, no disaster is expected or anticipated. The task during this phase is to identify community risk factors and to develop and implement programs to prevent disasters from occurring. The response phase begins immediately after the onset of the disastrous event. During the recovery phase, the community takes actions to repair, rebuild, or relocate damaged homes and businesses and restore health and economic vitality to the community.

2. A community health nurse working as a part of a disaster response team is told that the disaster is classified as a multiple-casualty incident. The nurse would interpret this to mean which of the following? A) There is more than 1 but less than 10 casualties. B) The number of casualties is between 2 and 100. C) Casualties number over 100. D) There are too many casualties to count.

B Feedback: If casualties number more than two people but fewer than 100, the disaster is characterized as a multiple-casualty incident. A mass- casualty incident involves100 or more casualties.

25. Which of the following would be most appropriate for community health nurses to encourage when helping communities cope with the anxiety associated with terrorism? A) Maintaining high levels of alertness and fear B) Spending time with children and young people C) Spending more time indoors D) Keeping a fear journal

B Feedback: Most young people carry a charge of positive energy that is infectious. Maintaining high levels of alertness and fear are not healthy. Instead individuals should be a little afraid because a certain level of fear is healthy if the person learns to use it as positive energy. Spending more time outdoors is helpful remedy. Individuals should keep a courage journal; fear immobilizes and courage takes action.

9. Which action by a community health nurse demonstrates respect to the client? A) Feeling the same emotion that the client has B) Addressing the client as "Mr." or "Mrs." C) Being open and genuine with the client D) Having self-awareness

B Feedback: Showing respect means conveying the attitude that clients and others have importance, dignity, and worth, such as by the manner in which the nurse addresses people—for instance, by using the courtesy titles of "Mr." or "Mrs." until it is determined how the client wants to be addressed. Putting one's self in the client's shoes demonstrates empathy; this is not the same as feeling the same emotion that the client has. Being open and genuine establishes rapport. Having self-awareness is a part of empathy that allows an individual to accurately demonstrate this understanding to the client.

5. After teaching a class about the factors that contribute to disasters, the instructor determines that the teaching was successful when the students identify which of the following as the agent? A) Population's age B) Radiation C) Level of preparedness D) Flood-prone location

B Feedback: The agent is the natural or technologic element that causes the disaster. For example, the high winds of a hurricane and the lava of an erupting volcano are agents, as are radiation, industrial chemicals, biologic agents, and bombs. The population's age is an example of host factor. The level of preparedness and flood-prone location are examples of environmental factors.

7. The nurse is using the epidemiological triad to explain the factors contributing the disaster. Which one of the following statements about the environment factors that contribute to disasters is most accurate? A) The environment is the natural or technologic element that causes the disaster. B) The environment is the human being who experiences the disaster. C) Factors that could potentially contribute to or mitigate a disaster are environmental. D) Examples of environmental factors that cause a disaster are high winds of a hurricane and the lava of an erupting volcano.

C Feedback: Factors that could potentially contribute to or mitigate a disaster are environmental. The agent factor is the natural or technologic element that causes the disaster, for example the high winds of a hurricane and the lava of an erupting volcano. The host is the human being who experiences the disaster.

11. A community health nurse has been teaching nutrition to a group of seniors in a local senior center. After attending the nurse's class on nutrition, the nurse determines the group's cognitive level of learning. Which of the following indicates knowing? A) Comparing the nutrient value in foods B) Eating well-balanced meals C) Planning recipes that are low in fat D) Naming three foods high in iron

D Feedback: Naming three foods reflect the knowledge level of the cognitive domain of learning. Comparing nutrient values reflects analysis; eating well-balanced meals reflects application; and planning recipes reflects synthesis.

11. A community health nurse is providing an in- service program to the agency staff about effect theory, which will be used to develop behavioral intervention programs. The nurse determines that the staff needs additional teaching when they identify which of the following as a component of the theory? A) Determinant theory B) Intervention theory C) Impact theory D) Process theory

D Feedback: Process theory is a theoretical framework used in community/public health science. It is not a component of effect theory. Effect theory has four components: determinant theory, intervention theory, impact theory, and outcome theory.

18. Several community health agencies are collaborating on health promotion strategies. The community health nurse observes that the team is working on assessment, planning, implementation, and evaluation. The nurse correctly concludes that A) the team is made up solely of nurses. B) the team is in the beginning phase. C) the team is determining the goals they will work toward. D) the team is working together to accomplish desired goals.

D Feedback: The three phases common to the collaboration process are the beginning phase when the team relationship is being established and are identifying the project needs and determine the goals toward which they will work. The second phase occurs when team members start working together to accomplish desired goals. The work of the second phase may include assessment, planning, implementation, and evaluation that will recur cyclically until the goals are satisfactorily accomplished. The third phase occurs when the need for team members to work together has ended.

22. Which of the following vulnerable populations have been subjected to perceived poor quality of care and access to care? Select all that apply. A) HIV-infected persons B) Persons who use illicit drugs C) People of non-White race/ethnicity D) People of White race/ethnicity E) Homeless persons

A, B, C, E Feedback: Higher perceived discrimination was associated with HIV infection, homelessness, drug use, and race/ethnicity, emphasizing the perceived poor quality of care and difficulties with access to care.

14. A community health nurse is engaged in primary prevention activities related to disasters. Which of the following would be examples of appropriate activities? Select all that apply. A) Providing anticipatory guidance B) Practicing an escape plan C) Providing emergency assistance D) Planning disaster drills E) Providing immediate response F) Reducing the degree of disability

A, B, D Feedback: Anticipatory guidance, practicing escape plans, and planning disaster drills all constitute primary prevention activities. Providing emergency assistance and immediate response reflect secondary prevention activities. Reducing the degree of disability or damage resulting from the disaster reflects tertiary level prevention activities.

2. When assessing vulnerable populations, a community health nurse uses a popular model that contains three related concepts. Which of the following would the nurse include? Select all that apply. A) Resource availability B) Relative risk C) Health status D) Housing E) Education

A, B, C Feedback: A popular conceptual framework of vulnerability contains three related concepts: resource availability, relative risk, and health status. Housing and education are not one of the three related concepts in this popular model.

6. Which of the following are subpopulations that are more likely to be sheltered homeless in urban areas? Select all that apply A) Adult males B) African Americans C) Veterans D) Disabled E) Migrant workers

A, B, C, D Feedback: When compared to their housed counterparts nationwide, the sheltered homeless are more likely to be adult males, African Americans, veterans, unaccompanied, and disabled. In rural areas, the homeless are more likely to be White, Native American, or migrant workers.

20. Which time after the disaster would be the ideal time for this to occur? A) Within 18 hours B) 1 to 3 days C) 4 to 6 days D) 7 to 10 days

B Feedback: The ideal time for CISD is between 24 and 72 hours after the disaster event.

20. Which of the following statements accurately describe Pender's Health Promotion Model? Select all that apply. A) It has been revised to reflect a number of major theoretical changes. B) It is not effective. C) It is unrelated to interpersonal influence of others. D) It allows the community health nurse to predict health promotion behaviors which enhances the ability to work with clients. E) Individual characteristics and experiences are seen to interact with behavior-specific cognitions and affect to influence specific behavioral outcomes.

A, D, E Feedback: Pender's Health Promotion Model has been revised from the earlier framework that was published in 1980 and has been revised to reflect a number of major theoretical changes. It is viewed as an effective model. It focused on predicting behaviors that influence health promotion and includes the variable of interpersonal influence of others.

1. When educating clients, which of the following parts of the communication process would be most important for the nurse to ensure? A) Limit setting B) Feedback loop C) Goal direction D) Nonverbal expression

B Feedback: A major component of the communication process is the feedback loop, which allows both the sender and the receiver to check on the success of the transference of meaning and to renegotiate the message to allow for clarity and better understanding. Limit setting may or may not be appropriate. Although therapeutic communication is goal directed and involves nonverbal expressions, these are not parts of the communication and they are not as important as making sure the message has been understood correctly.

11. Which of the following statements about disaster planning is most accurate? A) Disaster planning is essential for a community, business, or hospital. B) A disaster plan must be lengthy and detailed. C) A disaster plan should be created by the person responsible for the emergency management of the community. D) It is assumed that all professionals have addressed their personal preparation.

A Feedback: Disaster planning is essential for a community, business, or hospital. A disaster plan need not be lengthy. A disaster plan should be created by all involved, including community leaders, health and safety professionals, and lay people. All nurses should address their own personal preparedness to respond in a disaster, but this may not be assumed.

20. When the nurse and client enter a contract in community health nursing and the nurse and client share participation and agreement between them, which characteristic of contracting is being enacted? A) Partnership and mutuality B) Commitment C) Format D) Negotiation

A Feedback: The four features of contracting in community health nursing are partnership and mutuality (the nurse and the client share participation and agreement), commitment (the involved parties make a decision that binds them to fulfilling the purposed of the contract), format (outlining of specific terms of the relationship), and negotiation (the parties propose to accept certain responsibilities that are agreed upon by both parties).

23. When developing an educational program for the community, which of the following must the community health nurse do first? A) Assess the clients' readiness to learn B) Ensure a conducive environment for learning C) Assess the client's perception of the problem D) Determine the appropriate subject matter

A Feedback: Before any teaching can begin, it is essential to assess the clients' readiness to learn. Once this is determined, the nurse can determine the clients' perceptions of the problem and identify the appropriate subject matter. Ensuring a conducive environment occurs when the teaching begins.

23. After teaching a group of students about the process of contracting, which statement by the group indicates successful teaching? A) The process is dynamic as it moves through various phases. B) Contracting involves a unidirectional client- nurse relationship. C) The process must move backward before it can move forward. D) Once the contract is developed, it remains relatively stable.

A Feedback: Contracting is a dynamic process that moves through phases. It forms a reciprocal relationship between clients, nurse, and other persons. The process moves forward, focused on meeting clients' needs, and enables the collaborating group to facilitate ultimate achievement of clients' goals.

18. When performing triage during a disaster, which color would indicate that the victim is in urgent need of care? A) Red B) Yellow C) Green D) Black

A Feedback: During triage, red indicates that the victim has injuries or medical problems that will likely lead to death if no treated immediately. Yellow indicates that the person has injuries that require medical attention but time to treatment is not yet critical. Green indicates that the victim has minor injuries or are presenting with minimal signs of illness. Black indicates that the victim is dead or has suffered mortal wounds.

15. A community health nurse is working to empower clients of a vulnerable population. Which of the following client behaviors indicates that the nurse is achieving this goal? A) Collaboration with their health care providers B) Demonstration of a reactive focus C) Hesitancy in the use of resources D) Viewing of situations as nonchangeable

A Feedback: Empowerment would be manifested by the clients engaging in collaboration with their health care providers, becoming more proactive than reactive, being better able to seek and use services, and being realistic about barriers with a view for ways to change things for the better.

3. A community health nurse is applying the Behavioral Model for Vulnerable Populations when evaluating a local community. Which of the following would the nurse include as an enabling factor? A) Insurance B) Acculturation C) Knowledge of disease D) Marital status

A Feedback: Enabling factors include personal and family resources, as well as community resources (e.g., income, insurance, social support, region, health services resources, public benefits, transportation, telephone, crime rates, social services resources). Acculturation, knowledge of disease, and marital status are examples of predisposing factors.

17. A community health nurse is involved in a screening program for alcohol use with an ethnically diverse population. Which of the following would be the best instrument to use? A) Alcohol Use Disorders Identification Test (AUDIT) B) CAGE questionnaire C) Michigan Alcoholism Screening Test (MAST) D) Drug Abuse Screening Test (DAST)

A Feedback: For alcohol use, the screening instrument recommended by the NIAAA is the AUDIT. WHO developed this instrument for use across populations, and it has established high reliability and validity across ethnic groups. Other tests that can be used include the CAGE questionnaire and MAST. The DAST would be appropriate to screen for drug use.

18. women who are victims of intimate partner violence, the nurse develops interventions aimed at the primary level of prevention. Which of the following would be most appropriate for the nurse to include? A) Assisting them to locate a safe shelter B) Providing immunizations C) Screening for sexually transmitted infections D) Teaching about basic hygiene measures

A Feedback: For women who are victims of intimate partner violence, counseling and helping them locate a safe shelter can assist in preventing homelessness. Providing immunizations and teaching about basic hygiene may be appropriate, but these would not priorities at this time. Screening for sexually transmitted disease would be a secondary level of prevention activity. 19. A community health nurse is working with a group of homeless clients with substance abuse problems. Which of the following would be appropriate for the nurse to do at the tertiary level of prevention? A) Conduct mass screening for common communicable diseases B) Institute a mobile van to assist in early diagnosis of common illnesses C) Advocate for counseling programs to address high risk behaviors and abuse D) Assist in ensuring participation in substance abuse rehabilitation programs Ans: D Feedback: Tertiary prevention level activities include treatment of complications of advanced disease, providing rehabilitative care, such as participation in a substance abuse rehabilitation program, and offering counseling and support. Conducting mass screenings for common communicable diseases associated with substance abuse and a mobile van program to assist in early diagnosis are secondary prevention level activities. Advocating for counseling programs to address risk behaviors and abuse would be a primary prevention level activity.

13. A community health nurse is part of a group working with local and state legislators to expand health insurance coverage for those with inadequate or no insurance. Which outcome would the nurse hope to achieve if the group is successful? A) Increase use of early screenings B) Increase emergency room visits C) Increase episodic care D) Increase disparities in care

A Feedback: Having inadequate or no health insurance leads to poor health outcomes due to lack of early screening and preventive measures, including regular physical exams and immunizations, delays in getting treatment, and use of emergency rooms for worsening conditions with no continuity of care, all as efforts to save money. Expanding health insurance hopefully would promote increased use of early screenings, decreased emergency room visits, more continuity of care, and better health outcomes all around with less disparities.

3. A client who needs to lose weight as part of an overall plan to become healthier has contracted with a nurse for behavior change. The client is working on increasing fruits and vegetables in his or her diet and currently consumes less than one fruit or vegetable per day. The nurse knows that the client is in the unfreezing stage of change when the client stated: A) "I have been reading a lot about the healing powers of many fruits and vegetables. I never ate many fruits and vegetables as a child so I am not sure how to prepare them. Can you refer me to some sources of information?" B) "I have started to try one serving of fruits and one serving of vegetables at each meal. I am starting to discover some of my favorites." C) "I still hate fruits and vegetables and I don't think I will be successful at integrating them into my diet." D) "Today I ate a total of 10 servings of fruits and vegetables. I really do like them and I feel great!"

A Feedback: In the first stage, a disequilibrium develops and the system is more vulnerable to change. People in this stage have a sense of dissatisfaction and have a void that they would like to fill. When the client stated, "I have been reading a lot about the healing powers of many fruits and vegetables...," he or she was expressing disequilibrium. When the client stated, "I have started to try one serving of fruit and one serving at vegetables at each meal...," he or she was indicating that he or she is changing. When the client stated, "I still hate fruits and vegetables...," he or she was expressing opposition to change which is not a part of the change process. When the client stated, "Today I ate a total of 10 servings of fruits and vegetables...," the client was expressing that the change has become established as an accepted and permanent part of the system.

11. The nurse educator knows the nursing student understands the effect of homelessness on the health of children when the nursing student identifies which of the following? A) "Homeless children are four times more likely to become ill." B) "While approximately 87% of homeless children are enrolled in school, only about 77% attend regularly." C) "Fewer than 25% of homeless children graduate from high school." D) "Homeless children are twice as likely as their housed counterparts to repeat a grade in school."

A Feedback: Only one of these statements that directly relates to the effect of homelessness on the health of children is, "Homeless children are four times more likely to become ill."

1. A community health nurse is meeting with a group of individuals who have been diagnosed with a serious mental illness. The nurse interprets this to mean which of the following? A) The clients have impaired level of functioning and quality of life. B) The clients' disorder is chronic and persistent. C) The clients have issues of impaired control and dependency. D) The clients have a significant behavior syndrome with present distress.

A Feedback: Serious mental illness (SMI) is mental illness that has compromised both the client's level of function and his or her quality of life. Serious and persistent mental illness (SPMI) is the preferred term for serious mental illness of a chronic nature. Impaired control and dependency are components of addiction. A significant behavior syndrome with present distress characterizes a mental illness.

15. A community health nurse develops a written teaching plan for a community education program about nutrition and salt-reduction. Which objective would reflect synthesis learning in the cognitive domain? A) The client will create an enjoyable meal using low-sodium foods. B) The client will compare the salt content in a variety of packaged foods. C) The client will practice eating meals that contain low-sodium foods. D) The client will list foods that are low in sodium.

A Feedback: Synthesis, the fifth level of cognitive learning, is the ability not only to break down and understand the elements of a situation but also to form elements into a new whole. Synthesis combines all of the earlier levels of cognitive learning to culminate in the production of a unique plan or solution. The objective with the verb create demonstrates this level. Being able to compare foods of varying salt content reflects analysis. Practicing eating meals demonstrates application. Listing foods demonstrates knowledge.

3. A community health nurse is part of a disaster response team that is first to respond to an earthquake. The team evaluates the level of destruction and devastation, identifying this as which of the following? A) Intensity B) Scope C) Casualty D) Range of effect

A Feedback: The intensity of a disaster is the level of destruction and devastation it causes. The scope of a disaster is the range of its effect, either geographically or in terms of the number of victims. Casualty refers to the human being(s) injured or killed by or as a direct result of an accident.

21. contracting would be effective to use with client groups based on the understanding that this method is beneficial for which of the following? A) Encouraging client participation in the decision-making process B) Contributing to a trusting nurse-client relationship C) Decreasing client stress during home visits D) Reducing client visit time by over 50%

A Feedback: The nurse and the client contribute to the formulation of the contract, thus fostering client participation in decisions regarding the direction and activities within the contract. Contracting also involves commitment, format, and negotiation. Contributing to trust, decreasing client stress, and reducing visit time are not considered benefits associated with contracting.

6. As part of a community-wide program addressing the needs of seniors in the county, the nurse engages the seniors as well as their families in the program. The nurse is demonstrating which principle for effecting positive change? A) Participation B) Proper timing C) Resistance to change D) Interdependence

A Feedback: The principle of participation requires involvement of the persons who will be affected by the change. The principle of proper timing requires that it be the right time to introduce the change. The principle of resistance to change involves responding to the instinctive nature of the desire to preserve the status quo because change poses a threat to stability and security. The principle of interdependence requires the view that every system has many subsystems intricately related such that a change in one part of the system may affect other parts.

22. Which of the following is the best example of a community health nurse focusing on the secondary level of prevention? A) Teaching clients how to navigate the health care system to receive prompt treatment B) Teaching clients about the importance of immunization C) Teaching stroke survivors about the importance of diet, rest, and exercise to prevent a secondary health problem D) Teaching a class on sensible nutrition for adolescents

A Feedback: The secondary level of prevention would be exemplified by the community health nurse when teaching clients how to navigate the health care system to receive prompt treatment. Teaching clients about the importance of immunization is focused on the primary level of prevention. Teaching stroke survivors about the importance of diet, rest, and exercise to prevent a secondary health problem is focused on the tertiary level of prevention. Teaching a class on sensible nutrition for adolescents is focused on the primary level of prevention.

29. Which of the following endings to this sentence most accurately describes the reason a community health nurse must consider the social determinants of health? The community health nurse must consider the social determinants of health A) because the social determinants of health affect a wide range of health, functioning, and quality-of-life outcomes and risks. B) because in our country all people are treated equally. C) because it is the right thing to do. D) because the community health nurse believes in social justice.

A Feedback: The social determinants of health affect a wide range of health, functioning, and qualityof-life outcomes and risks. There is a growing inequity in the distribution of disease, illness, and wellness across our society and not all people are treated equally. It is not enough to do this because it is the right thing to do. If the community health nurse believes in social justice, this is one thing but really implementing social justice in considering outcomes and risks is more accurate.

13. As part of secondary prevention, the community health nurse engages in crisis intervention to achieve which of the following? A) Reestablish equilibrium to the lives of those involved B) Prevent the crisis altogether C) Involve as many people as possible in the resolution D) Triage clients during the recovery phase of the crisis

A Feedback: The stated goal of crisis intervention is to reestablish equilibrium. Prevention is the best approach, but some crises, such as natural disasters, cannot be prevented. They can, however, be prepared for to decrease the negative effects of the crisis as much as possible. It is important to have an adequate number of people needed to come to resolution. However, too many people involved in resolution may cause additional confusion, chaos, and unnecessary delays. Triage decisions need to be made during the response phase of the disaster or crisis and not deferred until the recovery phase. Triage is an ongoing process throughout the response phase.

17. A 32-year-old wife and mother of two children was a bank manager before entering the nursing program. She is finishing a Baccalaureate nursing program in a few months. She learns best when she can plan and carry out her own learning activities, uses past experiences to help with current learning, and applies learning immediately. Which learning theory best fits this woman's learning style? A) Knowles' adult learning theory B) Bandura's social learning theory C) The Gestalt-Field family of theories D) Maslow's Hierarchy of Needs theory

A Feedback: The woman's behaviors support the tenets of Knowles' adult learning theory. She is a self- directed learner, experienced, ready to learn, and is problem centered rather than theoretically oriented. Bandura's social learning theory attempts to explain behavior and facilitate learning. With social learning theory, learners are benefitted by role models, building selfconfidence, persuasion, and personal mastery. The Gestalt-Field family of cognitive theories assumes that people are neither good nor bad; they simply interact with their environment and their learning is related to perception. Maslow's hierarchy of needs requires lower level basic needs to be met before working toward self-actualization.

18. A community health nurse is preparing a presentation for a group of local community nurses about measures to help decrease health disparities. Which of the following would be the least effective suggestion? A) Avoiding political involvement in issues B) Working with schools to reduce the dropout rate C) Organizing task forces to raise community awareness D) Holding community meetings to identify needs

A Feedback: To help decrease health disparities, political advocacy is necessary to influence health policy. In addition, working with schools to reduce the dropout rate helps to address the connection between education and outcomes. Organizing task forces, raising community awareness, and community input for need identification are all effective methods to address vulnerable populations and health disparities.

5. When determining a target population for education about alcohol use, which age group would the community health nurse most likely plan to address? A) 18- to 25-year-olds B) 30- to 40-year-olds C) 45- to 55-year-olds D) 65 years of age and older

A Feedback: Trends in alcohol use in the United States differ across subsets of the population. Young adults (age 18 to 25) have the highest incidence of problem drinking. Thus the community health nurse would most likely address this age group.

17. A community health nurse is responding to a disaster. Which of the following would most likely be the least appropriate area for the nurse to be located? A) The disaster site B) Triage C) Victim treatment area D) Local hospitals

A Feedback: Usually, the immediate disaster site is not the best place for the disaster nurse, who can be far more effective in triage and treatment of victims. One of the lessons of the World Trade Center bombing was that the greatest need for medical professionals was at the local hospitals, not at the disaster site.

16. A community health nurse is assisting the local community in preparing a disaster plan. Which of the following would the nurse expect to be addressed? Select all that apply. A) Chain of command B) Routes for transportation C) Triage D) Basic equipment E) Copies of licenses

A, B, C Feedback: A disaster plan should address the chain of command, routes and modes of transportation, and triage methods. Basic equipment and licenses are items that a nurse should bring along when preparing to work in a disaster area.

26. A community health nurse is preparing a presentation for a community group about possible agents of terrorism. Which of the following would the nurse include as an example of a bioweapon? Select all that apply. A) Mustard gas B) Sarin C) VX gas D) Nerve agents E) Bombs

A, B, C Feedback: Bioweapons include mustard gas, sarin, VX gas, and anthrax. Nerve agents and bombs are examples of chemical warfare agents.

12. Which of the following are necessary components of a nurse's personal preparedness? Select all that apply. A) Workplace and community disaster plans have been reviewed by the nurse. B) An individual disaster plan for the nurse's own family has been developed. C) The nurse participated in disaster drills at the workplace and had a family disaster drill to practice what actions to take in the event of a disaster. D) It is not necessary for the nurse to bring copies of their nursing license and driver's license. E) In the case of an actual disaster, the nurse will be able to use equipment made available to them.

A, B, C Feedback: To be personally prepared, a nurse should have read and understood workplace and community disaster plans, should have developed a disaster plan for his or her own family, and should have participated in disaster drills. Nurses preparing to work in disaster areas should bring copies of their nursing license and driver's license and bring basic equipment.

21. Which of the following are types of health disparities that are due to inequities that can be corrected? Select all that apply. A) Patients feel that they are unable to trust the information given to them and may not follow it as explained. B) Limited access to appropriate level of care C) Poor access to quality care D) Overt discrimination E) Health-damaging behaviors that are chosen by an individual despite health education and counseling efforts

A, B, C, D Feedback: Health disparities may be unavoidable, such as health-damaging behaviors that are chosen by an individual despite health education and counseling efforts, but most are thought to be due to inequities than can be corrected. Reported disparities exist in the areas of quality of health care, access to care, levels and types of care, and care settings; they exist within subpopulations (e.g., elderly, women, children, rural residents, disabled) and across clinical conditions. Patients can also react to providers in a way that promotes disparities; they may not trust the information given to them and may not follow it as explained, leading to inadequate care.

2. When addressing homeless children and youth, which of the following situations are also considered homeless according to the education subtitle of the McKinney-Vento Homeless Assistance Act? Select all that apply. A) Children who share housing with others due to economic hardship or loss of housing B) Children who are abandoned in hospitals C) Children who are awaiting placement in foster care D) Children who are living in motels, trailer parks, or camping grounds E) Children who are living apart from one or more of their parents

A, B, C, D Feedback: The education subtitle of the McKinney- Vento Homeless Assistance Act expands on the definition of homelessness when addressing homeless children and youth. The act includes as homeless those children who share housing with others due to economic hardship or loss of housing, are abandoned in hospitals, are awaiting placement in foster care, or are living in motels, trailer parks, or camping grounds. Children who are living apart from one or more of their parents may not be homeless.

4. Which of the following are reasons why it is difficult to estimate the number of persons who are homeless? Select all that apply. A) It is difficult to estimate the number of people who are homeless, since homelessness is a temporary condition. B) It is difficult to locate and account for people who are homeless. C) Some people are unable to access shelters where they would be counted as homeless because the shelter is already overcrowded and there is limited capacity. D) In rural areas, there are fewer housing options and resources for the homeless and as a result people may be forced to live temporarily with friends or family. E) Homelessness is increasing due to poverty and the growing shortage of affordable rental housing.

A, B, C, D Feedback: The following are reasons: It is difficult to estimate the number of people who are homeless, since homelessness is a temporary condition. It is difficult to locate and account for people who are homeless. Some people are unable to access shelters where they would be counted as homeless because the shelter is already overcrowded and there is limited capacity. In rural areas, there are fewer housing options and resources for the homeless, and as a result, people may be forced to live temporarily with friends or family. It is true that homelessness is increasing due to poverty and the growing shortage of affordable rental housing, but this is not a reason why it is difficult to estimate the number of people who are homeless.

19. The student nurse correctly identifies the four characteristics of contracting as: Select all that apply. A) format. B) partnership and mutuality. C) negotiation. D) commitment. E) legal fees.

A, B, C, D Feedback: The four features of contracting in community health nursing are partnership and mutuality, commitment, format, and negotiation. Legal fees are not involved as contracting in community health nursing is not legally binding.

7. Which of the following are reasons for the increase in poverty rates over recent years? Select all that apply. A) Declining wages B) Decline in public assistance C) Loss of jobs that offer security and carry benefits D) A decline in manufacturing jobs in favor of lower paying service jobs E) Globalization and outsourcing F) Homelessness

A, B, C, D, E Feedback: The increase in poverty rates over recent years may be attributed to declining wages, loss of jobs that offer security and carry benefits, and increase in temporary and part- time employment, erosion of the true value of the minimum wage, a decline in manufacturing jobs in favor of lower paying service jobs, globalization and outsourcing, and a decline in public service. As wages drop, the potential to secure adequate housing wanes. This does not mean that homelessness is a cause of poverty. Actually, it is poverty that is known to cause homelessness.

19. Which of the following statements about Healthy People 2020 and reducing substance use and addressing mental health needs is most accurate? Select all that apply. A) After a diagnosis is established, the nurse can decide on an intervention that can address the specific public health issue identified in the diagnosis using the Healthy People 2020 objectives. B) It could be considered a priority as two of the top ten health indicators relate to substance use and mental health. C) Target benchmarks and data derivation for each objective can be used to guide program development. D) Reducing substance abuse and addressing mental health needs are not priority with Healthy People 2020. E) The goals are to improve mental health through prevention and to reduce substance abuse to protect the health, safety, and quality of life for all, especially children.

A, B, C, E Feedback: Reducing substance abuse and addressing mental health needs is a priority with Healthy People 2020.

24. Which of the following are involved in accessing and using epidemiologic data to understand and serve populations with mental illness? Select all that apply. A) Identifying the incidence and prevalence of mental disorders B) Understanding that all data are accurate C) Examining the causes and risk factors associated with mental illness D) Identifying the needs of people with mental disorders

A, C, D Feedback: This means identifying the incidence and prevalence of mental disorders, examining the causes and risk factors associated with mental illness, and identifying the needs of populations with mental illness. However, not all data are accurate.

11. Which of the following are key issues related to health literacy? Select all that apply. A) Health literacy is characterized as critical to health promotion and disease prevention. B) Limited health literacy only affects those who have low educational levels. C) Poor health literacy skills can contribute to increased health care costs. D) Health literacy involves the ability to read, understand, and act on health information. E) Health literacy goes beyond the basic definitions of literacy.

A, C, D, E Feedback: Health literacy is characterized as critical to health promotion and disease prevention. Limited health literacy affects people of all races, incomes, ages, and educational levels. Poor health literacy skills have been associated with poorer health status and increased health care costs because people with a low-literacy level are less knowledgeable about their health conditions and are less likely to seek preventative care. Health literacy involves the ability to read, understand, and act on health information. Health literacy goes beyond the basic definitions of literacy and includes cultural literacy, computer literacy, scientific, media, and technological literacy.

4. Which of the following examples of disasters are natural disasters? Select all that apply. A) The Earthquake and tsunami in Japan in 2011 B) The 2008 shootings at Virginia Tech C) The terrorist attacks on the United States on September 11, 2001 D) Wildfires that affected California in October 2007 E) The oil spill in the gulf coast in 2010 that threatened hundreds of species of wildlife

A, D Feedback: Examples of natural disasters include the earthquake and tsunami in Japan in 2011 and wildfires that affected California in October 2007. The following disasters are man-made: the 2008 shootings at Virginia Tech; the terrorist attacks on the United States on September 11, 2001; and the oil spill in the gulf coast in 2010 that threatened hundreds of species of wildlife.

9. Which of the following are examples of a community health nurse providing health promotion teaching? Select all that apply. A) The community health nurse teaches a class of kindergartners how to properly wash their hands. B) The community health nurse is a guest on a radio talk show to provide information how to avoid an infection that is endemic. C) The community health nurse encourages an individual whose blood pressure screening was elevated to have his or her blood pressure rechecked in 1 week. D) The community health nurse teaches a group of preschoolers about different fruits and vegetables that they might like to try. E) The community health nurse teaches a mother and baby exercise group. F) The community health nurse leads a group of stroke survivors in soft exercise.

A, D, E Feedback: Health promotion is behavior that is motivated by the desire to increase well-being and actualize human potential. This is different from disease prevention/health protection, which is behavior motivated by a desire to actively avoid illness, detect it early, or maintain functioning within the constraints of illness. The activities of teaching a class of kindergartners how to properly wash their hands, teaching a group of preschoolers about different fruits and vegetables that they might like to try, and teaching a mother and baby exercise group are focused on wellbeing and not a particular illness. The activities of being a guest on a talk show to provide information how to avoid an infection that is endemic, encouraging an individual whose blood pressure screening was abnormal to have their blood pressure rechecked in 1 week, and leading a group of stroke survivors in soft exercise are focused on avoiding specific illnesses and not on improved general health.

8. Which one of the following statements regarding mental illness and homelessness is most accurate? A) 75% of the sheltered homeless report a severe mental illness. B) Deinstitutionalization or being released from institutions into the community contributes to the number of persons who have a severe mental illness who are homeless. C) Mental illness only contributes to homelessness because poor mental health adversely affects an individual's ability to make sound judgments, solve problems, and make wise decisions. D) Mental illness and substance abuse are not often comorbid conditions that contribute to homelessness.

B Feedback: Deinstitutionalization or being released from institutions into the community contributes to the number of severely mentally ill persons represented in the homeless population. Twenty-five percent of the sheltered homeless report a severe mental illness. Mental illness contributes to homelessness because poor mental health adversely affects an individual's ability to make sound judgments, solve problems, and make wise decisions. Mental illness and substance abuse are often comorbid conditions, which, coupled with poor physical health, make it especially difficult to secure employment and safe, affordable housing.

26. Which of the following is the best example of a positive learning environment for a group of developmentally disabled adults? A) A local diner, seated near the door to the kitchen during lunchtime B) A brightly lit conference room with comfortable chairs C) A kindergarten classroom with small chairs that are low to the ground D) A park on a beautiful, sunny day

B Feedback: A brightly lit conference room with comfortable chairs would be the best example of a positive learning environment among the choices listed. A local diner, seated near the door to the kitchen during lunchtime would not be a good choice as it is likely very noisy. A kindergarten classroom with small chairs that are low to the ground would not be a good choice as the adults could not comfortably sit in the chairs. A park on a beautiful, sunny day would not be a good choice as there would be too many distractions making it difficult for the clients to focus.

17. A community health nurse working with a group of vulnerable clients is focusing on empowering them. Which of the following would be most effective? A) Keeping the clients to a firm schedule of visits B) Viewing the clients as active partners in the process C) Having the clients cut through bureaucratic red tape D) Focusing on the clients' limitations

B Feedback: Activities that are most effective in promoting empowerment include viewing the clients as active partners (shows mutual respect and helps build a trusting relationship), being flexible in dealing with the clients (demonstrates a client-centered approach), cutting through the bureaucratic red tape (demonstrates advocacy), and focusing on the clients' strengths rather than limitations (helps to build client capacity).

18. Which of the following would the community health nurse identify as a major limitation for using biological markers for screening for substance use? A) Sensitivity of the test B) Cost of the test C) Factors influencing the test D) Ease of obtaining a specimen

B Feedback: Biological screening tests are rarely used in a community-based screening program due to the cost and the problems with obtaining biological specimens. In addition, numerous factors can influence sensitivity and specificity of biological markers, including other metabolic disorders or other diseases, medication use, and reliability of the method.

12. After teaching a group of students about factors associated with vulnerable populations, the instructor determines the need for additional teaching when the students identify which as a factor? A) Homelessness B) Acute illness C) Income D) Immigrant status

B Feedback: Factors associated with vulnerable populations include income and education, age and gender, race and ethnicity, homelessness, chronic illness and disability, and immigration among others. Chronic, not acute, illness is considered as a factor.

14. To ensure learning in the psychomotor domain, which of the following would be most important for the nurse to ensure about the learner? A) Has a sensory image of how to do the skill B) Has the ability to perform the necessary skill C) Is willing to listen to the information about the skill D) Can continue to practice the skill independently

B Feedback: For psychomotor learning to occur, the nurse must ensure that the learner is physically, intellectually, and emotionally capable of performing the skill. Otherwise, the other two conditions, having a sensory image and practicing the skill, would not occur. A willingness to listen is an important aspect for all learning, especially learning in the affective domain.

13. Which one of the following statements about mental health issues and homeless young people is most accurate? A) 87% of homeless children has suffered emotional disturbances due to the effects of traumatic stress and violence. B) Homeless youth suffer disproportionately from anxiety, depression, conduct disorders, posttraumatic stress, and low self-esteem. C) It is not common for homeless youths to be arrested for running away, breaking curfews, or being without supervision. D) Homeless youth are persons under age 18 who lack parental, foster, or institutional care.

B Feedback: Homeless youth suffer disproportionately from anxiety, depression, conduct disorders, posttraumatic stress, and low self-esteem. One in six homeless children has suffered emotional disturbances due to the effects of traumatic stress and violence. It is not uncommon for homeless youth to be arrested for running away, breaking curfews, or being without supervision. Homeless youth are persons under age 18 who lack parental, foster, or institutional care, but this is not necessarily related to mental health issues.

14. Which of the following statements about the National Alliance on Mental Illness (NAMI) is most accurate? A) NAMI focuses on the needs of the people who actually have mental illness. B) NAMI is committed to enhance the care of those with mental illness and improve the quality of life of those who are affected. C) The NAMI Web site contains some information that is intended to be used exclusively by care providers. D) All services of NAMI are provided at the main headquarters.

B Feedback: NAMI is committed to enhance the care of those with mental illness and improve the quality of life of those who are affected. NAMI focuses on the needs of the families, peers, and consumers of Mental Health services. The NAMI Web site contains extensive information that can be utilized by both consumer and care providers. NAMI is a nationwide organization with chapters in each state and county.

8. Which one of the following statements about relative risk is most accurate? A) Lifestyle, behaviors, and choices do not relate to relative risk. B) Relative risk refers to exposure to risk factors identified from a substantial body of research. C) Relative risk means that if a risk exists, the illness or adverse event will occur. D) Any factor that is likely to cause increased risk is considered relative risk.

B Feedback: Relative risk refers to exposure to risk factors identified from a substantial body of research. Lifestyle, behaviors, and choices are risk factors. Relative risk is not an absolute cause and effect that if a risk exists, the illness or adverse event will occur. Only factors that are identified by a substantial body of research are considered relative risk.

10. Which one of the following statements is true regarding social capital? A) Social capital includes investments in individuals' capabilities and skills. B) Social capital includes marital status and family structure. C) Social capital includes jobs, income, housing, and education. D) Examples of social capital are education and job training.

B Feedback: Social capital consists of marital status, family structure, social ties and networks, and memberships in voluntary organizations. Human capital is linked to investments in individuals' capabilities in skills (e.g., education, job training) and comprises jobs, income, housing, and education.

6. Which of the following federal agencies would a community health nurse expect to be contacted to assist with a disaster in the United States? A) American Red Cross B) Federal Emergency Management Agency (FEMA) C) WHO's Emergency Relief Operations D) Pan American Health Organization

B Feedback: The Federal Emergency Management Agency (FEMA) is the federal agency responsible for assessing and responding to disaster events in the United States. The American Red Cross is authorized to provide disaster assistance free of charge across the country through its more than 1 million volunteers. It is not supported by the federal government. The World Health Organization's Emergency Relief Operations provide disaster assistance internationally, and the Pan American Health Organization works to coordinate relief efforts in Latin America and the Caribbean.

15. community-based organization to develop programs to provide quality accessible health care to the homeless population. Which of the following would be the most appropriate source from which to seek funding for this program? A) Projects for Assistance in Transition from Homelessness (PATH) B) Health Care for the Homeless (HCH) C) The Interagency Council on Homelessness D) U.S. Department of Housing and Urban Development

B Feedback: The HCH program (a provision of the McKinney Act) awards grants to communitybased organizations that seek to provide quality, accessible health care to the homeless and would be the most appropriate source for funding. PATH is a grant program created under the McKinney Act to support the delivery of services to persons with severe mental illnesses, including those who are homeless or at risk of becoming homeless. The Interagency Council on Homelessness coordinates the federal response to homelessness and creates a national partnership with public and private sectors to reduce and end homelessness in the United States. HUD provides funding for supportive housing for low-income families, as well as low-income individuals with disabilities, and low-income elderly.

19. After teaching a group of students about the socioeconomic gradient in health, the instructor determines that the students understand the concept when they state that the relationship between social class and health is which of the following? A) Direct B) Inverse C) Positive D) Unequal

B Feedback: The socioeconomic gradient refers to the inverse relationship between social class or income and health, such that the lower the social class or income, the higher the rates of disease.

23. A group of ten people from the commune in the hills come into town dressed in robes and have their faces covered. They have weapons hidden in their clothing and begin entering the three banks in town to rob them. These actions can be classified as which of the following? A) Natural disaster B) Terrorism C) Casualty D) Adventitious crisis

B Feedback: The actions resemble terrorism, 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. The actions are not a natural disaster. Casualty refers to the person who is injured or killed by or as a direct result of an accident. An adventitious crisis is an event that is out of the ordinary in magnitude and personal experience.

6. A community health nurse is dealing with a family in crisis. The nurse remains calm and firmly reassuring when communicating with them. This nurse is avoiding which barrier to communication? A) Filtering information B) Emotional influence C) Language barrier D) Selective perception

B Feedback: The nurse is avoiding emotional influence, that is, how a person feels at the time a message is sent or received, which can influence its meaning. Senders can distort messages and receivers can interpret messages incorrectly when emotions cloud their perception. Emotions can interfere with rational and objective reasoning, thus blocking communication. Filtering information means manipulating information by the sender to influence the receiver's response. Language barriers involve the different interpretations of words by people. Selective perception involves the receivers interpreting a message through their own perceptions, which are influenced by their own experiences, interests, values, motivations, and expectations.

14. A community health nurse is part of a group dealing with health issues. During one of the meetings, the nurse states, "Let's all take about 5 minutes to share ideas so that everybody will have a chance to be heard." The nurse is demonstrating which of the following? A) Encouraging B) Gatekeeping C) Blocking D) Mediating

B Feedback: The nurse is demonstrating the maintenance role behavior of gatekeeping, by trying to make it possible for another member to make a contribution to the group such as by saying, "We haven't heard from Jim yet" or suggesting limited talking time for everyone so that all will have a chance to be heard. Encouraging is demonstrated by being friendly, warm, and responsive to others, praising others and their ideas, and agreeing with and accepting the contributions of others. Blocking is demonstrated by going off on a tangent, citing personal experiences unrelated to the problem, arguing too much on a point, or rejecting ideas without consideration. Mediating involves attempts to harmonize, conciliate differences in point of view, or suggest compromises.

13. Which of the following interventions by the nurse is most likely to have a positive influence on the client's adoption of a new healthy behavior? A) Providing feedback about what the client is doing incorrectly B) Providing feedback about what the client is doing correctly C) Not providing feedback D) Not providing role modeling of the desired change

B Feedback: The nurse who recognizes clients' participation in a group praises them for completing assignments or commends them for sticking to diet plans will have more success than the nurse who only criticizes failures.

7. unsuccessful attempts before quitting 1 year ago today. The nurse decides to share this information with the group and tells them that all the attempts he or she had made before stopping smoking were necessary steps for his or her eventual success. Which principle of change was the nurse enacting? A) Principle of flexibility B) Principle of self-understanding C) Principle of interdependence D) Principle of proper timing

B Feedback: The principle of self-understanding relates to the change agent (the community health nurse) should be able to clearly define his or her role and learn how others define it. The principle of flexibility is the ability of the change agent to adapt to unexpected events and make the most of them. The principle of interdependence is that a change in one part of a system affects other parts and a change in one system may affect other systems. The principle of proper timing relates to the knowledge that even the right change may not occur if the timing is not right.

12. For which reason are homeless youth at higher risk for HIV, hepatitis, and sexually transmitted infections? A) They are not likely to receive treatment for HIV, hepatitis, and sexually transmitted infections. B) They lack education or job training skills and may resort to prostitution or survival sex, which increases their risk for HIV, hepatitis, and sexually transmitted infections. C) Homeless adolescents may have difficulty accessing emergency shelter because of shelter policies that prohibit older youth from the facility. D) It is not uncommon for homeless youth to be arrested for running away, breaking curfews, or being without supervision.

B Feedback: The reason that homeless youth are at higher risk for HIV, hepatitis, and sexually transmitted infections is that they lack education or job training skills and may resort to prostitution or survival sex. The following factors do not increase the risk for HIV, hepatitis, and sexually transmitted infections: They are not likely to receive treatment for HIV, hepatitis, and sexually transmitted infection; they may have difficulty accessing emergency shelter because of shelter policies that prohibit older youth from the facility; and it is not uncommon for homeless youth to be arrested for running away, breaking curfews, or being without supervision.

10. When would the nurse expect the response phase of a disaster to occur? A) When no disaster is expected or anticipated B) Immediately after the onset of the disastrous event C) Long-term phase occurring after the disastrous event D) Prior to the disastrous event

B Feedback: The response phase of disaster occurs immediately after the onset of the disastrous event. During the prevention phase no disaster is expected or anticipated. Long-term phase occurring after the disastrous event is the recovery phase. Prior to the disastrous event is the preparedness phase.

20. Which one of the following statements is true regarding the socioeconomic gradient of health? A) The behavior of smoking is lowest among those who have low income and low educational levels. B) The socioeconomic gradient of health has been found in populations around the world. C) All persons who have a low socioeconomic status will develop particular health problems. D) The socioeconomic gradient of health is universal.

B Feedback: The socioeconomic gradient of health has been found in populations around the world, although not always unfailingly. The behavior of smoking is highest among those who have low income and low educational levels. Not all persons who have low socioeconomic status will develop particular health problems.

19. When choosing an appropriate model for health education, community health nurses often select the PRECEDE-PROCEED model for which reason? A) It emphasizes the desired outcome of the teaching. B) The steps are similar to those of the nursing process. C) The nurse's perception of the problem is the key to this model. D) Evaluation of outcomes is the final step.

B Feedback: The steps of the PRECEDE-PROCEED model are similar to the nursing process, and thus this model has become a useful tool for nurses teaching in the community. It does emphasize outcomes with evaluation of the outcomes as the final step. But these are not reasons for nurses selecting this model. The client's or community's perception of the problem is key to this model.

19. A community health nurse responding to a disaster is involved with caring for the bodies of the casualties who have died. Which of the following would be an appropriate method for documentation? A) Making a note on the triage tag B) Using a toe tag for identification C) Placing the name on a casualty list D) Recording the name on the victim's body

B Feedback: Toe tags make documentation visible and accessible and are the most appropriate means for documentation. Making a note on the triage tag, placing the name on a casualty list and recording the name on the victim's body are inappropriate.

16. When the community health nurse encourages the group members of a collaborative partnership of interdisciplinary teams to effectively share ideas and frustrations on an equal, reciprocal basis, the community health nurse is focusing on which of the five characteristics of collaboration in community health? A) Maximized use of resources B) Clear responsibilities C) Shared goals D) Mutual participation

B Feedback: When the community health nurse encourages the group members of a collaborative partnership of an interdisciplinary team to effectively share ideas and frustrations on an equal, reciprocal basis, the community health nurse is focusing on the mutual participation characteristic. The characteristic of maximized use of resources involves designing the collaborative partnership of those who are most knowledgeable and in the best positions to influence a favorable outcome. The characteristic of clear responsibilities involves each member in the partnership plays a specific role with related tasks. The characteristic of shared goals involves each member of the team entering the collaborative relationship with broad needs or purposed to be met and specific objectives to accomplish.

10. The community health nurse is using effect theory to design a prevention program for behavioral health. Which of the following would be the most likely place for the nurse to start? A) Identifying antecedent factors leading to the problem B) Identifying the specific health problem C) Determining the desired health problem impact D) Specifying the health problem outcome

B Feedback: When using effect theory to design a prevention program for behavioral health, a good place to start is to identify the specific health problem and then the desired health problem impact and health problem outcome. As the program is developed, the community health nurse starts by identifying the antecedent factors that lead to behavioral health problems. This provides a clear rationale for why the intervention should provide the desired impact.

17. A community health nurse who will be working with a homeless population is planning care. Which of the following would the nurse need to do first? A) Develop trust with the population B) Clarify personal values and beliefs C) Focus on the issue of homelessness D) Visit the local shelter where the clients are

B Feedback: When working with the homeless population, it is crucial that the nurse clarify personal beliefs and values about poverty, homelessness, addictions, and mental disorders to ensure nonjudgmental care. Trust too is essential, but this would need to occur after the nurse has clarified his or her values and beliefs. Biases or judgments on the nurse's part would undermine the development of trust. The nurse needs to use a comprehensive, holistic approach or focus, not just focus on the population's homelessness. Visiting the local shelter may be helpful to gather information about what the nurse might expect, but it isn't the first thing the nurse would do.

3. After teaching a group of women in the community about common mental health disorders affecting them, the community health nurse determines that the teaching has been effective when the group identifies which one of the following? A) Anxiety disorders and mood disorders occur twice as frequently in men as in women. B) Women of color, women on welfare, poor women, and uneducated women are more likely to experience depression than women in the general population. C) The three main types of eating disorders affect more men than women. D) The three main types of eating disorders include undereating due to food unavailability.

B Feedback: Women of color, women on welfare, poor women, and uneducated women are more likely to experience depression than women in the general population. Anxiety disorders and mood disorders occur twice as frequently in women as in men. The three main types of eating disorders affect more women than men. The three main types of eating disorders (anorexia, bulimia nervosa, and binge eating) also affect more women than men.

28. Which of the following are factors to consider related to the social determinants of health? Select all that apply. A) Being marginalized B) Access to safe housing C) Safe workplaces D) Being related to a politician E) Access to social and economic opportunities

B, C, E Feedback: Factors that influence an individual's ability to maintain good health include social factors, such as access to social and economic opportunities and equitable social interactions, and physical factors, such as access to safe housing and safe workplaces. Being related to a politician may or may not have a positive impact on the social determinants of health.

7. A community health nurse is discussing alcohol use disorders and is explaining what is meant by a standard drink. Which of the following would the nurse include as an example? Select all that apply. A) Two 12-oz. cans of beer B) 5-oz. glass of wine C) 1.5 oz. of an 80-proof spirit D) 3 oz. of a cordial E) Two bottles of wine cooler

B, C, D Feedback: A standard drink contains about 14 g of alcohol (0.6 fluid ounces or 1.2 tablespoons), which is equivalent to one 12-oz. bottle of beer or wine cooler; 8 to 9 oz. of malt liquor; one 5- oz. glass of table wine; 3 to 4 oz. of fortified wine, 2 to 3 oz. of cordial, liqueur, or aperitif; 1.5 oz. of brandy; or 1.5 oz. of 80- proof distilled spirits.

22. A community health nurse suspects that a client who was a victim of a disaster 3 months ago is experiencing post-traumatic stress disorder. Which of the following would the nurse expect to find? Select all that apply. A) Diminished startle response B) Hypervigilance C) Feelings of detachment D) Flashbacks E) Full range of affect

B, C, D Feedback: Signs and symptoms of post-traumatic stress disorder include increased startle response, hypervigilance, feelings of detachment, flashbacks, and restricted affect.

16. Healthy People 2020 objectives focus on tobacco, alcohol, and illicit drug use education. Which of the following are steps in the process to providing this education? Select all that apply. A) Identifying the impact of substance use on the environment B) Identifying trends of substance use to develop a prevention program C) Understanding the consequences of substance use that affect a community as a whole D) Differentiating between legal and illegal substance use E) There are no differences in prevention programs for different populations

B, C, D Feedback: The three steps in the process for providing tobacco, alcohol, and illicit drug use education are in order (1) identifying trends, (2) differentiating legal versus illegal use, and (3) consequences of use. Identifying the impact of substance use on the environment is not one of the steps. There are differences in prevention programs—if the target population is young adults, the prevention of binge drinking might be a top concern; if homeless adults, the focus will be on chronic alcohol, cocaine, and heroin use; cultural and ethnic differences in alcohol and SUDs are noted in American Indians with increased rates of fetal alcohol syndrome and increased prevalence in prison and jail populations.

1. An instructor reviews the definition of homelessness according to the McKinney Vento Homeless Assistance Act with a group of community health nursing students. The instructor determines that the students need clarification when they include which of the following as homeless? A) Someone living in a public shelter B) Someone living in a park C) Someone who is incarcerated D) Someone who lives in his or her car

C Feedback: The McKinney-Vento Homeless Assistance Act (Title 42 of the U.S. Code) defines a person as homeless who lacks a fixed, regular, adequate night time residence including supervised public or private shelters that provide temporary accommodations, institutional settings providing temporary shelter, or public or private places that are not designed for or used as a regular sleeping accommodation for human beings (i.e., cars, parks, camp grounds). Incarcerated individuals, however, are not considered homeless under this definition.

21. A community health nurse has completed a community assessment. Which of the following would be next? A) Decide on an intervention B) Locate an appropriate the specific focus area in Healthy People 2020 C) Establish a community diagnosis D) Determine the level of prevention

C Feedback: After completing a community assessment, the nurse then establishes a community diagnosis. Once this is done, the next step is to decide on an intervention that can address the specific public health issue identified in the diagnosis. A good starting point in the development of community/public health intervention is to begin with the Healthy People 2020 objectives, locating the specific focus area that matches the community diagnosis. Once the nurse identifies the focus of the intervention, the next step is to determine the level of prevention.

9. Which one of the following statements regarding the etiology of substance use disorders is most accurate? A) It is believed that nurture has substantially more influence on the development of substance use disorders than nature. B) With the mapping of the human genome, hope has decreased that the genes related to substance use disorders could be identified. C) Alcohol dependence is thought to be a multigenomic disorder influenced by the environment (gene-environment interaction). D) Only genetic heritability is involved in the etiology and course of substance use disorders.

C Feedback: Alcohol dependence is thought to be a multigenomic disorder influenced by the environment (gene-environment interaction). It is believed that genetics is a risk factor in the range of 50% to 50%. With the mapping of the human genome, hope has increased that the genes related to substance use disorders could be identified. In addition to genetic heritability, both personal and environmental factors are involved comparably in the etiology and course of substance use disorders.

6. After teaching a class about commonly used illicit substances, the instructor determines that the teaching was successful when the class identifies which of the following as the most frequently reported illicit drug? A) Heroin B) Methamphetamine C) Marijuana D) Cocaine

C Feedback: Although heroin, methamphetamine, and cocaine are frequently used illicit drugs, marijuana is the most frequently reported illicit drug.

14. The community health nurse is explaining the reasons for health problems in the homeless population. Which of the following would the nurse identify as the most likely reason? A) Issues related to storage of medications B) Lack of transportation to keep appointments C) Time and energy focus on survival needs D) Limited access to health care services

C Feedback: Although issues related to medication storage, lack of transportation, and limited access to health care play a role, many homeless people expend their time and energy trying to meet basic survival needs such that health care takes a backseat to finding food, clothing, or shelter.

24. After teaching a group of students about agents associated with chemical warfare, the instructor determines that additional teaching is needed when the students identify which as an example? A) Explosives B) Nerve agents C) Anthrax D) Jet fuel

C Feedback: Anthrax is considered a bioweapon. Explosives, nerve agents, and jet fuel are considered agents of chemical warfare.

12. A teaching plan for a group of new mothers has the following objective: "The mothers will describe the principles that relate to safety while diapering their newborn." The nurse is attempting to achieve learning at which level of the cognitive domain? A) Knowledge B) Comprehension C) Application D) Analysis

C Feedback: At the application level, the learner not only understands the material but can apply it to new situations, transferring understanding into practice. This is reflected by words such as practice, demonstrate, use, illustrate, and employ. Knowledge level learning would be reflected by words such as define, repeat, list, name, or recall. Comprehension level learning would be reflected by words such as restate, describe, explain, identify, and discuss. Analysis level learning would be reflected by words such as distinguish, debate, question, compare, examine, or calculate.

10. Which of the following statements most accurately describes the nurse's role as an educator related to the social determinants of health? A) The nurse must focus on individual behavior and encourage people to take responsibility for their own behavior. B) The nurse must examine one or two factors that contribute to our state of health. C) The nurse must look at the root causes of disease and health inequities. D) The nurse must lecture people about what is right and wrong behavior.

C Feedback: Community health nurses must look at the social determinant of health as the root causes of disease and health inequities. This requires that nurses look beyond the individual behavior and have a broader scope of what underlies illness.

1. A community health nurse is working with people who experienced a tornado and have been forced to leave their homes to escape the effects of a disaster. The nurse would identify these people as which of the following? A) Indirect victims B) Refugees C) Displaced persons D) Casualties

C Feedback: Displaced persons are those who have been forced to leave their homes to escape the effects of a disaster. Indirect victims are the relatives and friends of direct victims. Refugees are direct victims who are forced to leave their homeland, usually due to war, religious persecution, or political turmoil. A casualty is a human being who is injured or killed by or as a direct result of an accident.

1. Which of the following would a community health nurse use to define vulnerable populations? A) Those persons with higher mortality rates B) Individuals with lower life expectancy C) Those with increased risk for adverse health outcomes D) Individuals with chronic illness

C Feedback: Vulnerable populations are groups who have a heightened risk for adverse health outcomes. They may include various populations such as those with higher mortality rates, lower life expectancies, or chronic illnesses. However, presence of just one of these does not necessarily indicate that the population is vulnerable.

22. A community health nurse is contracting with a client receiving services in the home. The nurse and client are negotiating the activities for which each will be responsible. This correlates with which phase of the nursing process? A) Assessment B) Nursing diagnosis C) Planning D) Evaluation

C Feedback: Dividing responsibilities via negotiation would be part of the planning/intervention phase of the nursing process. The assessment phase would involve exploration of needs. The nursing diagnosis phase would correlate with goal establishment. Evaluation would involve formative and summative assessments of progress toward goals and renegotiation or termination.

12. While working with a community group, a community health nurse observes the group sharing ideas and opinions and being creative. The nurse determines that the group is in which stage? A) Forming B) Storming C) Norming D) Performing

C Feedback: During the norming stage, trust and openness are more apparent, and there is a sharing of ideas and opinions and creativity. The forming stage is characterized by members becoming oriented to each other. The storming stage involves conflict and competition with the group getting down to sharing more sensitive issues. The performing stage is characterized by the ability to work as a total group, in subgroups, or independently.

18. A community health nurse is preparing a teaching program for a group of elementary school-aged children about substance abuse awareness. The nurse would implement strategies that address which cognitive phase of development? A) Preconceptual B) Intuitive thought C) Concrete operations D) Formal operations

C Feedback: Elementary school-aged children would most likely be in the concrete operations stage of cognitive development where the child can solve concrete problems and recognize others' viewpoints. The preconceptual stage would apply to children between the ages of 2 to 4 years when language development is rapid and everything is related to "me." The intuitive thought stage would apply to children between the ages of 4 to 7 years when egocentric thinking diminishes and words are used to express thoughts. Formal operations stage would apply to adolescents when the child uses rational thinking and can develop ideas from general principles and apply them to future situations.

13. A community implements a plan to enforce the underage drinking law. The community health nurse interprets this action as reflecting which public health model? A) Primary prevention B) Behavioral prevention C) Environmental prevention D) Clinical prevention

C Feedback: Environmental prevention relies on a societal commitment for the implementation of the interventions and aims to alter the environment by reducing risk (e.g., community-wide decrease in availability of the substance; underage drinking law enforcement). Primary prevention is conducted when no disease is present in the target population with the primary goal being prevention of disease development. Behavioral prevention includes a broad array of strategies aimed at changing lifestyles (e.g., exercise, smoking cessation, balanced nutrition). The goal of the intervention is to change behaviors that put the person at risk for developing the disease or to prevent consequences of the disease. Clinical prevention is based on the medical model for preventive services. It relies on one-to-one, provider-to-patient interaction and occurs within the traditional health care delivery system.

2. When developing appropriate programs for adult mental health promotion, the nurse incorporates knowledge about the most prevalent mental disorders. Which of the following would the nurse identify as the most prevalent? A) Major depression B) Bipolar disorder C) Anxiety disorders D) Schizophrenia

C Feedback: For American adults, the most prevalent mental disorders are anxiety disorders, followed by mood disorders, especially major depression and bipolar disorders. Schizophrenia, which affects approximately the same number of adults as bipolar disorder, is problematic because it is so persistently disabling.

21. Which of the following statements about teaching at three levels of prevention is most accurate? A) Ideally, the community health nurse would focus at the tertiary level of prevention. B) The outcome of focusing on the tertiary level of prevention is to help diminish years of morbidity and limit subsequent infirmity. C) It is ideal to focus on the primary level of prevention. D) Community health nurses do not spend a significant share of time teaching at the secondary level.

C Feedback: Ideally, the community health nurse focuses on the primary level. Because the primary level of prevention is not possible in all cases, a significant share of the nurse's time is spent teaching at the secondary or tertiary level.

24. A community health nurse is providing informal teaching to groups of parents about typical childhood developmental milestones. Which of the following would the nurse mostly likely be using? A) Lecture B) Demonstration C) Anticipatory guidance D) Visual images

C Feedback: Informal teaching such as anticipatory guidance and counseling requires the teacher to be prepared, but there is no defined plan of presentation. Lecture and demonstration are formal methods of teaching. Visual images also are often used with formal teaching.

10. Which one of the following statement about health literacy and health outcomes is most accurate for clients who have low literacy? A) It is important to make the message as basic and simple as possible because the client likely has low intelligence. B) It is best to use written materials for clients who have low literacy. C) It is very important for clients who have low literacy to have ample opportunity to provide feedback. D) Health literacy is not a very important factor in mortality and morbidity.

C Feedback: It is very important for clients who have low literacy to have ample opportunity to provide feedback that will demonstrate understanding. Communication with low-literacy, highrisk groups should be simplified and easy-to-read materials. At the same time, there is the danger of making the communication so simple that the reader feels insulted. It has been well documented that most health information pamphlets, brochures, and other materials cannot be read or comprehended by adults who have low literacy. Those who have the lowest literacy levels have the highest mortality and morbidity.

14. Which of the following would be most important for a community health nurse to do first when working with vulnerable populations? A) Helping them to make choices B) Guiding them to think things through C) Getting them to interact with the nurse D) Providing honest feedback

C Feedback: When working with vulnerable populations, the first step is to open the door and interact with the clients, engaging them, and developing rapport. Once this is accomplished, the community health nurse can then help them in making choices, guide them to think through all the issues and consequences, and provide honest feedback.

17. A collaborative community health group working with the teenage population to improve health draws on the expertise of school nurses and others working with adolescents to develop a plan. The group is demonstrating which characteristic of collaboration? A) Shared goals B) Mutual participation C) Maximized use of resources D) Clear responsibilities

C Feedback: Maximizing the use of community resources involves drawing on the expertise of those who are most knowledgeable and in the best positions to influence a favorable outcome. In this case, it would be school nurses and others working with adolescents. Shared goals are demonstrated by recognition of the specific reasons for entering into the relationship, that is, the improved health of adolescents. Mutual participation involves the reciprocal exchange among team members, with all team members contributing and receiving mutual benefit. Clear responsibilities involve each member playing a specific role with related tasks.

27. non-English speaking country about the need for immunizations, the nurse should include which in his or her plans? A) Using a lot of pictures B) Guessing about the native language and attempting to speak it C) Using an interpreter D) Talking clearly and slowly, being sure to enunciate each word

C Feedback: Planning to use an interpreter when presenting information to a group of new immigrants from a non-English speaking country is the best option among those listed. Pictures will not effectively convey the meanings that the clients need. Guessing about the native language and attempting to speak it will not be effective either, as the nurse should never assume anything and unless the language is native to the nurse, the nurse will not be any more effective at communicating with the clients. Talking clearly and slowly, being sure to enunciate each word, might be appropriate for a group of immigrants from a non-English speaking country who have been in this country for a while and have been learning the language.

4. Which of the following would a community health nurse identify as most important to sending skills involved with communication? A) Active listening B) Paraphrasing C) Nonverbal messages D) Rapport

C Feedback: Sending skills involve the ability to transmit the messages effectively. Two main channels to send messages are nonverbal and verbal messages. Active listening and paraphrasing are involved with receiving skills. Rapport is an interpersonal skill.

4. population for socioeconomic resources. Which of the following would the nurse address? A) Quality of care provided B) Access to health care services C) Educational opportunities D) Adequacy of health care providers

C Feedback: Socioeconomic resources include such things as human capital (e.g., jobs, income, housing, education), social connectedness or integration (e.g., social networks or ties, social support or the lack of it characterized by marginalization), and social status (e.g., position, power, role). Environmental resources deal mostly with access to health care and the quality of that care, including the adequacy of health care providers.

16. After teaching a group of community health students about public and private sector programs and initiatives aimed at combating homelessness, the instructor determines that they need additional teaching when they identify which of the following as a private sector organization? A) National Coalition for the Homeless B) National Alliance to End Homelessness C) National Resource Center on Homelessness and Mental Illness D) National Low Income Housing Coalition

C Feedback: The National Resource Center on Homelessness and Mental Illness is a federally sponsored public program for addressing the needs of the homeless. The National Coalition for the Homeless, the National Alliance to End Homelessness, and the National Low Income Housing Coalition are private sector resources.

22. A community health nurse is working with a political group to lobby for changes in funding for a mental health promotion program. The nurse is functioning in which role? A) Educator B) Collaborator C) Advocate D) Case manager

C Feedback: The advocacy role requires being politically involved by serving on decision-making boards and committees, lobbying for legislative changes, and helping to influence mental health policy development that will better serve this population. In the educator role, the community mental health nurse teaches clients individually and in groups about their mental health conditions, their treatment protocols, ways to function more independently in the community, prevention and health-promoting strategies, and much more. In the collaborator role, the nurse works with others, pooling the groups professional expertise to enhance the quality and effectiveness of services. In the case manager role, the nurse is involved with screening, assessment, care planning, arranging for service delivery, monitoring, reassessment, evaluation, and discharge, often within the context of a community mental health center (CMHC). Case management helps the person with an SMI to access services and live as independently as possible.

5. The community health nurse is presenting sexuality education to a group of sixth grade students. The community health nurse tells the students that they must never have unprotected sexual intercourse or they will die from a sexually transmitted infection and displays pictures of people dying from AIDS. The nurse is using which change strategy? A) Normative-reeducative B) Rational-empiric C) Power-coercive D) Planned change

C Feedback: The community nurse in this scenario is using power-coercive change strategies that are based on fear. Normative-reeducative change strategies present new information and directly influence people's attitudes and behaviors through persuasion. Empiric- rational change strategies are based on the assumption that people are rational and, when presented with empiric information, will adopt new practices that appear to be in their best interest.

21. When providing secondary prevention activities for individuals experiencing psychological consequences of a disaster, which of the following would the nurse do as a generic approach? A) Providing situational support for stress relief B) Conveying warmth and concern for the client C) Teaching about expected emotional reactions D) Reunifying family members who were separated

C Feedback: The generic approach is designed to reach high-risk individuals and large groups who have experienced the same disaster, teaching them about the expected emotional reactions to the type of disaster they have experienced and promoting adaptive responses. Environmental manipulation results in the change of a person's physical or interpersonal situation, providing situational support to relieve stress. An example of environmental manipulation is when a community health nurse coordinates the reunification of family members separated by the disaster. General support is defined as the caring, warmth, and concern the community health nurse conveys to the client as she or he delivers services.

16. Which of the following would be least helpful to a novice community health nurse working with vulnerable populations who is feeling overwhelmed and somewhat guilty about his or her personal situation as compared to his or her clients? A) Setting up an community agency clothing drive collection B) Working for changes in community attitudes C) Sending a personal donation to an agency in the area D) Remaining grounded

C Feedback: Working with disadvantaged populations can be challenging and exhausting. Often a novice community health nurse may feel overwhelmed and suffer compassion fatigue and guilt about ones one life. To be effective, it is often helpful to donate money or items on a group level such as an agency clothing drive rather than an individual level and to work for substantial changes in community attitudes. In addition, the nurse needs to remain grounded in order to continue to have the necessary energy and compassion.

13. Which of the following descriptions of the five stages in group development are accurate? Select all that apply. A) All groups eventually reach the performing stage. B) The storming stage is detrimental to group development. C) Loss of group affiliation often occurs with adjourning. D) The group begins to focus more on maintenance rather than just tasks during the norming stage. E) Conflict is inherent in the forming stage.

C, D Feedback: During the adjourning stage, the group must disengage, and this may cause feelings of loss. The group begins to focus more on maintenance rather than just tasks during the norming stage. Not all groups do reach the performing stage. The storming stage is necessary to allow group members to identify roles, expectations, and get a feel of how the group will work together. Conflict is to be avoided at the forming stage but must occur at the storming stage.

3. Which of the following steps of the communication process does the community health nurse who is serving as the sender have the most control of? Select all that apply. A) The receiver B) The decoding C) The message D) The channel E) The feedback loop F) The encoding

C, D, F Feedback: The community health nurse who is serving as the sender in the communication process has the most control over the sender, the message, the channel (the medium through which the sender conveys the message), and the encoding (the sender decides which specific signals or codes such as language, words, gestures, and body language to use). The community health nurse does not have much control over the receiver, the decoding (the receiver's interpretation of the message), or the feedback loop (a way for the sender and receiver to check on the success of the transference of meaning and to renegotiate the message to allow for clarity and better understanding), all of which are controlled by the receiver.

2. A community health nurse sends an e-mail stating a request to the local health department. This is an example of which part of communication? A) Sender B) Message C) Decoding D) Channel

D Feedback: A channel is the medium through which the sender conveys the message. It may be written, spoken, or nonverbal. Sending an e- mail is an example. The sender is the person conveying the message. The message is the expression of the purpose of the communication. Decoding is the translation of the message into an understandable form by the receiver.

1. After teaching a class about the stages of change, the instructor determines that the class understands the information when they identify the following as the proper sequence of stages? A) Unfreeze, plan, and integrate B) Plan, organize, and coordinate C) Plan, relearn, and integrate D) Unfreeze, change, and refreeze

D Feedback: According to Lewin, change occurs in the following stages: unfreezing the old behavior, implementing the change, and then refreezing the new change in place to integrate it into the system. Planning, relearning, integrating, and coordinating are not stages of change.

8. During an interview with several clients, the community health nurse assumes responsibility for and strives to understand the feelings and thoughts of the client. The nurse is demonstrating which of the following? A) Reflection B) Respect C) Empathy D) Active listening

D Feedback: Active listening is the skill of assuming responsibility for and striving to understand the feelings and thoughts in a sender's message. The nurse actively works to discover what the clients mean. Reflection involves restating what clients or others have said to clarify the received meaning. Respect involves conveying an attitude that clients and others have importance, dignity, and worth. Empathy is the ability to communicate understanding and to vicariously experience the feelings and thoughts of others.

16. good attendance and group participation in her Saturday class on newborn care for young mothers. The participants receive free transportation and a $10 food voucher for attending. When they participate, prizes are distributed. This nurse is using behavioral theory to encourage clients, focusing the teaching on which of the following concepts? A) Meeting a hierarchy of needs B) The learner's self-confidence and personal mastery C) A person's natural tendency to learn D) Changes in response to a stimulus

D Feedback: Behavioral theory is grounded in stimulus- response behaviors, and changes occur in response to stimuli. The nurse is also using conditioning through reinforcement as described by Skinner. Meeting a hierarchy of needs is based upon Maslow, a humanistic theorist. Selfconfidence and personal mastery reflect social learning theory. A person's natural tendency to learn is based upon humanistic theories.

2. When implementing a program for teaching parenting to a group of teenagers, the community health nurse determines that the group is in the changing/moving stage of change when the group demonstrates which of the following? A) Motivation for change B) Integration of the change C) Lack of resistance to the change D) Beginning adoption of the change

D Feedback: During the changing or moving stage, people experience a series of attitude transformations, ranging from early questioning to full acceptance and commitment to accomplishing the change. They examine, accept, and try the innovation and the nurse helps them see the value of the change, encourages them to try it, and assists them in adopting it. Motivation for the change is part of the unfreezing stage. Showing a lack of resistance to the change and integration of the change characterize the refreezing stage.

5. After reviewing statistics on homelessness, which of the following would a community health nurse identify as the fastest growing segment of the homeless population? A) Children under age 18 years B) Families headed by a female single parent C) Families headed by a male single parent D) Families with children

D Feedback: Families with children are the fastest growing segment of the homeless population based on statistics, accounting for approximately 34% of the homeless population. Single female parents account for most of the homeless families. However, because many two-parent families and families headed by single fathers are becoming homeless because of the recession, and most homeless provider organizations serving families are geared to serving single women with children, it can be harder for intact families and families headed by men to access shelter.

7. Which of the following statements about filtering messages is most accurate? A) Filtering is always intentional. B) Filtering is never intentional. C) Only clients use filtering. D) Filtering leads to miscommunication and misinterpretation.

D Feedback: Filtering leads to miscommunication and misinterpretation. Filtering can be intentional or unintentional and may be used by clients or nurses.

4. A community health nurse is part of community discussion group on alcohol. The nurse recommends that adult males should have less than A) 6 standard drinks weekly. B) 8 standard drinks weekly. C) 10 standard drinks weekly. D) 14 standard drinks weekly.

D Feedback: For the general male adult population, the recommended drinking limits are fewer than five standard drinks daily or 14 weekly. For the general female adult population, the recommended drinking limits are fewer than four standard drinks daily or eight weekly, and for people age 65 and older, recommended drinking limits are no more that one standard drink daily or seven standard drinks weekly.

12. A community health nurse is applying the Institute of Medicine model based on Gordon's Classification of Disease Prevention model to address prevention of alcohol use during pregnancy and prevention of fetal alcohol syndrome. Which of the following populations would the nurse target indicated prevention strategies? A) Local women in the community of childbearing age B) Women of childbearing age living in a city C) Women of childbearing age considered at risk D) Pregnant women who have a child with fetal alcohol syndrome

D Feedback: Indicated prevention strategies would be designed to prevent the use of alcohol in pregnant women who had screened positive for alcohol use during pregnancy or already had a child diagnosed with FAS or FASD. Universal prevention strategies would address the entire population of women of childbearing age (national, local community, school, neighborhood), with messages and programs aimed at preventing the use of alcohol if pregnancy is a possibility. Selective prevention strategies would target subsets of women of childbearing age who are deemed to be at risk for alcohol use by virtue of their membership in a particular population segment.

20. Which of the following would a community health nurse address as a means for enhancing the life of the public? A) Proper nutrition B) Healthy sleep patterns C) Use of community supports D) Creative outlets

D Feedback: Life-enhancing activities to enhance public well-being include meaningful work, whether through or outside of employment, creative outlets, interpersonal relationships, recreational activities, and opportunities for spiritual and intellectual growth. Proper nutrition, healthy sleep patterns, and use of community supports are life-sustaining activities.

7. When describing the causes of vulnerability to a group of students, which of the following would the instructor include? A) Vulnerable populations are fairly similar across the nation and globally. B) Statistics about vulnerable populations are highly accurate. C) The most important causative factor is race or ethnicity. D) Many of the factors and conditions suggest vulnerability overlap.

D Feedback: Many of the factors and conditions contribute to vulnerability overlap, making it difficult to obtain accurate data and statistics for each group or category. Although there are some similarities and consistencies in terms of vulnerable populations, the factors vary. They also are interactive, making it difficult to determine which factor or cause is considered most important.

15. Which one of the following statements about nonprofit organizations that serve those with mental health issues is most accurate? A) They are all associated with the government. B) A for-profit organization that promotes mental health is Mental Health America, which was established in 1909. C) The organization National Mental Health Association is a scam. D) They focus on advocacy, education, service, and funding research endeavors.

D Feedback: Nonprofit organizations focus on advocacy, education, service, and funding research endeavors. They are not all associated with the government. Mental Health America was formerly known as National Mental Health Association, which is a leading nonprofit organization that promotes mental health.

5. When assessing a population's vulnerability, which of the following would the community health nurse identify as a predisposing factor? A) Social support networks B) Crime rates C) Transportation D) Living conditions

D Feedback: Predisposing factors include demographic variables (e.g., gender, age, marital status), social variables (e.g., education, employment, ethnicity, social networks), and health beliefs (e.g., values and attitudes toward health and health care services, knowledge of disease). Social structures (e.g., acculturation and immigration), sexual orientation, and childhood characteristics (e.g., mobility, living conditions, history of substance abuse, criminal behavior, victimization, or mental illness) are also considered as predisposing factors. Enabling factors include personal and family resources, as well as community resources (e.g., income, insurance, social support, region, health services resources, public benefits, transportation, telephone, crime rates, social services resources).

6. When assessing a vulnerable population's relative risk, which of the following would the community health nurse identify most likely as contributing to this risk? A) Well-balanced diet B) Up-to-date immunizations C) Enabling factors D) Exposure to abuse

D Feedback: Relative risk refers to exposure to risk factors identified by a substantial body of research as lifestyle, behaviors, and choices (e.g., diet, exercise, use of tobacco, alcohol and other drugs, sexual behaviors), use of health screening services (e.g., immunizations, health promotion, use of seat belts), and stressful events (e.g., crime, violence, abuse, firearm use). A well-balanced diet, up-to-date immunizations, and use of seat belts would reduce one's risk whereas exposure to abuse may increase the risk. Enabling factors relate to the Behavioral Model for Vulnerable Populations and not to the relative risk.

5. When communicating with a group of clients, which of the following would the nurse identify as a barrier to the communication process? A) The nurse's sharing of complete and accurate information with the clients B) The clients' use of medical terminology in the discussion C) The clients' offering of feedback to allow the nurse to learn what the client understands D) The clients' interpretation of the message through their own perceptions

D Feedback: Selective perception is the interpretation of a message through their own perceptions, and projects this onto the communication process as they decode a message. Sharing complete and accurate information, client's use of medical terminology, and the clients' offering of feedback to allow the nurse to learn what the client understands are important skills of effective communication.

10. A community health nurse is preparing a program for a local community group about homelessness. A portion of the program will address homeless men. Which of the following would the nurse include? A) Homeless men are not looked down upon less than other groups. B) Homeless men are usually eligible for social services. C) Homeless men are perceived as blameless for their situation. D) Single, low-income men only qualify for medical assistance if disabled.

D Feedback: Single, low-income men only get medical assistance if they are disabled. Homeless men are more likely to be treated with disdain than other homeless subgroups. Some people perceive homeless men as largely to blame for their plight, believing that they are able bodied and should be able to work. Moreover, homeless men may suffer from disabilities that are not severe enough to warrant eligibility for health and social services. Often health and social programs give priority to women and children.

9. A community health nurse is describing social capital and its impact on populations to a group of local community leaders. Which of the following would the nurse suggest as a way to improve the social capital of the community? A) Better job training B) Improved educational programs C) Expanded employment opportunities D) More community organizations

D Feedback: Social capital consists of marital status, family structure, social ties and networks, and membership in voluntary organizations, such as a church or clubs. Thus suggesting more community organizations would address social capital. Better job training, improved education, and expanded employment opportunities are examples of human capital, investments in individuals' capabilities and skills (e.g., education, job training) that comprise jobs, income, housing, and education.

23. Which one of the following are the primary roles that the community health nurse must use to understand and serve populations with mental illness? A) Advocate B) Educator C) Case manager D) Consumer of epidemiologic data

D Feedback: The access and use of epidemiologic data to understand and serve populations with mental illness are primary.

11. Which of the following would a community health nurse include when describing the differential vulnerability hypothesis? A) Exposure to risk factors affects the population's social and human capital. B) Everyone is at risk because of stressful events occurring in life. C) A risk for a negative outcome increases with lower education and income levels. D) Certain groups are impacted by stressful events more than others.

D Feedback: The differential vulnerability hypothesis states that everyone is subjected to stressful events, but that these events hurt some people more than others, thus they are vulnerable populations. Although everyone experiences stresses, not everyone is vulnerable. Deficits or problems in social and human capital can increase the population's risk. Lower education and income are associated with a higher relative risk, but these alone do not describe the hypothesis.

8. The community health nurse is talking to a group of clients about the health importance of consuming a low-fat diet. The clients are members of a particular cultural group that grows their own food and consumes a lot of animal protein. The clients state that their forefathers ate a diet that was high in animal protein and they had lived into their 90s. The community health nurse expects this argument and points out that their ancestors did not have the luxury of modern machines and they had to engage in a lot more activity than the current generation. This is an example of which principle of effecting change? A) Principle of participation B) Principle of proper timing C) Principle of self-understanding D) Principle of resistance to change

D Feedback: The nurse was aware that all systems instinctively resist change and was prepared to discuss aspects of the clients' cultural background that related to their current state of health. This is the principle of resistance to change. The principle of participation means that persons affected by the proposed change should participate as much as possible in every step of the planned change process. The principle of proper timing requires that it be the right time to introduce the change. The principle of self-understanding relates to the change agent (the community health nurse) should be able to clearly define his or her role and learn how others define it.

25. Which question would the community health nurse use as a guide to determine a client's participation in a teaching program? A) "What does the client know about the current problem?" B) "How does the client view the current situation?" C) "Does the client need special seating?" D) "What does the client want to learn?"

D Feedback: To determine client participation, one of the first questions that need to be answered is, "What does the client want to learn?" This directly influences the client's participation in the educational process. Asking the question about what the client knows about the problem determines the client's readiness to learn. Asking about the client's view of the problem helps identify the client's perceptions. Asking about special seating helps to ensure that the educational environment is conducive to the client's needs.