population health exam 2 (evolve)

A useful way to distinguish between Medicare Part A and Medicare Part B is to recognize that: (Select all that apply.) a. Part A is hospital insurance. b. Part B covers limited skilled nursing care. c. Part A covers outpatient hospital care. d. Part B is a voluntary supplemental program. e. Part B is noninstitutional care insurance.

a, d, e The Medicare program, established in Title XVIII of the Social Security Act of 1965, provides hospital insurance and medical insurance to persons ages 65 years and older, permanently disabled persons, and persons with end-stage renal disease. Medicare has two parts: Part A (hospital insurance) covers hospital care, home care, and limited skilled nursing care, and Part B (noninstitutional care insurance) covers medical care, diagnostic services, and physiotherapy. Part B is a voluntary supplemental program available to Medicare-eligible recipients.

A nurse performing home hospice case management notes the increasing number of hospice clients that lack caregivers in the home environment. The nurse identifies the potential need for a hospice house facility to meet the needs of these clients. The case management process frequently reveals such larger picture issues as: (Select all that apply.) a. community weaknesses in quality of services. b. community satisfaction. c. community conflict-resolution skills. d. community cost concerns. e. community weaknesses in quantity of services.

a, e Case management activities with individual clients and families will reveal the larger picture of health services and health status of a community. Through a nurse's case management activities, general community weaknesses in quality and quantity of services often are discovered.

Since 1998, nurse practitioners (NPs) and clinical nurse specialists (CNSs) are reimbursed by Medicare Part B at a rate that is what percent of physician rates for the same service? a. 85% b. 95% c. 70% d. 50%

a. 85% Spurred by efforts to control the costs of medical care, effective January 1, 1998, nurse practitioners (NPs) and clinical nurse specialists (CNSs) were granted third-party reimbursement for Medicare Part B services only. The reimbursement rate was set at 85% of physician rates for the same service. The new law was an extension of previous legislation that allowed the same rate of reimbursement to NPs and CNSs practicing in rural areas.

When final health care-related regulations are published, they often lead to changes in practice. After a period of draft review, public comment/hearing, further study if necessary, and then final redrafting, the regulations at both federal and state levels carry the weight of law and are published in the: a. Code of Regulations. b. ANA Code of Conduct. c. Interstate Nurse Licensure Compact. d. Patient Safety Act of 1997.

a. Code of Regulations. Revisions made to proposed regulations are based on public comment and public hearing. Depending on the amount and content of the public reaction, final regulations are prepared, or the area and issues are studied further. Final regulations are published in the Code of Regulations at the state and federal level and carry the force of law. When regulations become effective, health care practice is changed to conform to the new regulations. Monitoring administrative regulations is essential for the professional nurse, who can influence regulations by attending the hearings, providing comments, testifying, and engaging in lobbying aimed at individuals involved in the writing of the regulations. Concrete written suggestions for revision submitted to these individuals are frequently persuasive and must be acknowledged by government in publishing the final rules.

The community-oriented nurse best exemplifies the application of feminist ethics when the nurse does which of the following? a. Design health care programs that incorporate social justice, respect and equity, and address social and political power. b. Ensure that male providers do not use sexist terms with clients, families, and coworkers c. Design health care programs for women that respect their dignity and autonomy. d. Participate in political action that focuses on women's rights and status in the community.

a. Design health care programs that incorporate social justice, respect and equity, and address social and political power. Feminine ethics not only focuses on equity between genders, but also recognizes the social and political powers that help maintain a socially unjust system. The best way to apply feminist ethics for this nurse is to design programs that focus on equity, respect, and social justice and attempt to address the social and political forces.

When planning a new community health center, a nurse will integrate knowledge of the nursing process and program management. What action would be the nurse's initial and most critical step for funding purposes? a. Identifying the target population's health problems and needs b. Prioritizing the community's problems c. Finding the lay leaders in the community d. Outlining the major causes of mortality in the community

a. Identifying the target population's health problems and needs Planning for effective and efficient programs must be based on determination of the needs of populations within the community. Identification of at-risk groups and documentation of the health needs of the targeted population provide the basic justification and rationale for the proposed program plan. Such documentation of needs is essential if funding will be sought to implement the plan. An assessment of health needs may be approached as either a community assessment or a population needs assessment.

A state health department nurse with budgetary responsibility for a population health framework would allocate priority funding to which activity? a. Promoting healthy lifestyles or improvement of social and physical environments b. Chronic disease surveillance and treatment programs c. Well and sick child clinics d. Pediatric and adolescent primary care and nutrition programs

a. Promoting healthy lifestyles or improvement of social and physical environments A key to the success of a population health framework is the identification and definition of health issues and of the investment decisions within a population that are guided by evidence about what keeps people healthy. Therefore, a population health approach directs investments that have the greatest potential to influence the health of that population in a positive manner. The activities that promote healthy lifestyles and improve social and physical environments would best illustrate this concept.

Commitment to which of the following best demonstrates nursing's advocacy role in primary health care initiatives in developed countries? a. Provision of direct client care b. Higher education for nurses c. Quality of care d. Equality of health care

a. Provision of direct client care In developed countries, nurses are often viewed as one of the strongest advocates of primary health care through nursing's social commitment to health care equality.

Collaboration is essential for public health nursing practice, and collaboration with existing groups at the local level is encouraged for which of the following reasons? a. Public health departments do not have the resources to accomplish these goals independently. b. The public demands that the government protect the people. c. State health agencies must take a universal approach to achieving objectives. d. The federal government is ultimately responsible for the health status of the nation.

a. Public health departments do not have the resources to accomplish these goals independently. Partnerships and collaboration among groups are much more powerful in making change than the individual client and PHN working alone. Because public health departments do not have the resources to accomplish the Healthy People 2030 goals independently, collaboration is essential to quality public health nursing practice, and collaboration with existing groups at the local level is encouraged. New partnerships are formed related to specific goals. Communities develop coalitions to address selected objectives, based on community needs that include all of the local community stakeholders, such as social service; mental health; educational, recreational, and governmental agencies and institutions; as well as businesses.

The ethical question, "Are persons assigned to develop community knowledge adequately prepared to collect data on groups and populations?", is based on an ethical tenet that supports the community-oriented core function of: a. assessment. b. assurance. c. policy development. d. compliance.

a. assessment. Assessment is systematic data collecting about the population, monitoring of the population's health status, and making information available about the health of the community. Competency related to knowledge development, analysis, and dissemination is important because the research, measurement, and analysis techniques used to gather information about groups and populations usually differ from techniques used to assess individuals. Policy development and assurance are core functions that use ethical decision making in community-oriented health services.

A case manager is concerned that some of the clients at the neighborhood clinic are getting fewer services because of their financial situations. The case manager is confronting the ethical principle of: a. beneficence. b. justice. c. deontology. d. veracity.

a. beneficence. Beneficence can be impaired when excessive attention to cost supersedes or impairs the nurse's duty to provide measures to improve health or relieve suffering. Justice, as an ethical principle for case managers, considers equal distribution of health care with reasonable quality. Veracity, or truth telling, is absolutely necessary to the practice of advocacy and building a trusting relationship with a client. Deontology is not an ethical principle that applies to this situation.

The concept of managed care is most often associated with processes such as utilization management, disease prevention, health promotion, wellness, and: a. consumer education. b. retrospective payment. c. third-party payer. d. ambulatory payment classes (APCs).

a. consumer education. The concept of managed care is based on the notion that use of costly care could be reduced if consumers had access to care and services that would prevent illness through consumer education and health maintenance. Therefore, managed care uses disease prevention, health promotion, wellness, and consumer education. Managed care also makes use of utilization management that often includes using less expensive alternative services to redirect care away from hospital care, preauthorization of inpatient admissions when essential, and reducing length of stay. Managed care is typically provided through an HMO or PPO and is not related to ambulatory payment classes.

Nurses in community health who understand the basis of their own behaviors and how those behaviors help or hinder the delivery of competent care to persons from cultures other than their own are demonstrating the cultural competence development process construct of: a. cultural awareness. b. cultural desire. c. cultural encounter. d. cultural skill.

a. cultural awareness. The five constructs that explain the process of developing cultural competence are cultural awareness, cultural knowledge, cultural skill, cultural encounter, and cultural desire. Cultural awareness is self-examination and in-depth exploration of one's own beliefs and values as they influence behavior. Nurses who are receptive to learning about cultural dimensions understand the basis of their own behaviors and how they help or hinder the delivery of competent care, and nurses who recognize that health is expressed differently across cultures have developed cultural awareness. Cultural desire refers to the nurse's intrinsic motivation to provide culturally competent care. Cultural encounter is the process that permits nurses to seek opportunities to engage in cross-cultural interactions. Cultural skill refers to the effective integration of cultural awareness and cultural knowledge to obtain relevant cultural data and meet the needs of culturally diverse clients.

The nurse in community health serves as a bridge between the at-risk populations and the community's health care resources. This role is based on the nurse's responsibility to: a. ensure that all populations have access to affordable, quality health care. b. provide evidence-based use of resources. c. collect and analyze data on programs. d. monitor and assess critical health status indicators.

a. ensure that all populations have access to affordable, quality health care. Nurses in community health retain responsibility for ensuring that all populations have access to affordable, quality health care services. Despite the shift in focus in recent years from a direct service model, nurses in community health may provide direct services to populations that are underserved/not served and conduct case management activities to link at-risk populations to appropriate community services.

A mother brings her child to the nurse's office a few days before the first day of class for the new school year. The mother wants the child to begin school but says, "I'm going to take care of the immunizations tomorrow." The most important action the nurse should take is to: a. explain to the parent that all required immunizations must be given before the child will be allowed to enter school. b. let the child begin school but ensure that the school keeps the child separated from the other children. c. conduct a physical examination to determine whether the child is healthy. d. make sure the child does have an appointment for tomorrow.

a. explain to the parent that all required immunizations must be given before the child will be allowed to enter school. Community-oriented nursing practice interacts with many legal aspects of nursing in community health. Nurses employed by health departments or boards of education may deliver school and family health nursing, a specialty area of practice with its own legal aspects. School health legislation establishes a minimum of services that must be provided to children in public and private schools. Children must have immunizations against certain communicable diseases before entering school.

In caring for a young adult from West Africa, the community nurse is introduced to another individual who is referred to as "auntie." A culturally competent nurse who is aware of the basic organizing factor of culture related to social organization would: a. find out who is considered to be a member of the family. b. assess the competence of the "auntie" to care for the young adult. c. assume that the "auntie" is related to one of the young adult's parents. d. declare that the young adult is capable of making personal health decisions.

a. find out who is considered to be a member of the family. Social organization is one of the basic organizing factors related to cultures. It refers to the way in which a cultural group structures itself around family to carry out roles and functions. In some cultures, family may include people who are not actually related to one another. The nurse should find out who is considered to be in the family, who the key decision makers are, and if the needs of the family supersede those of the individuals in the family. Nurses should advocate for the individual, so that when families make decisions, the individual's needs are also considered.

A nurse who speaks only English has just gotten a new client for an intake interview. The client is a refugee who has very limited English proficiency (LEP). The nurse should: a. get an interpreter. b. see what helpful information is on the Internet. c. see whether another nurse, more comfortable with refugees, will work with the client. d. try to communicate with hand gestures.

a. get an interpreter. Nurses who do not speak or understand the client's language should use an interpreter. In selecting an interpreter, nurses should consider the clients' cultural needs and respect their right to privacy.

A nurse working with a Hispanic client explains the referral options available for the client to receive a mammogram. One option is free and has limited Spanish language resources. The other option has a nominal fee and comprehensive Spanish language resources. The nurse supports the client's decision to choose the provider that the client feels would best meet her needs. This advocacy role is best described as: a. promoter. b. mediator. c. intercessor. d. obstructer.

a. promoter. The nurse advocate makes the client's rights the priority. The goal of promoter for the client's autonomy and self-determination may result in a high degree of client independence in decision making. Mediation is an activity in which a third party attempts to provide assistance to those who may be experiencing a conflict in obtaining what they desire. The nurse advocate does not exhibit roles of intercessor or obstructer in this situation.

A nurse in community health that speaks out in a public hearing in support of changes to existing requirements for reporting any long-term effects of structural or organizational changes within the community's health care organizations would be demonstrating: a. regulatory action. b. health policy. c. regulatory monitoring. d. legislative action.

a. regulatory action. The regulatory process, although it may not be as visible as the legislative process, can also be used to shape laws and dramatically affect health policy. Because regulations flow from legislation, they have the force of law. The legislative process begins with ideas (policy options) that are developed into bills. At each level of government, the executive branch can and, in most cases, must prepare regulations for implementing policy and new programs. These regulations are detailed, and they establish, fix, and control standards and criteria for carrying out certain laws.

The 1989 changes to Medicaid required states to provide care for children younger than 6 years and to pregnant women under 133% of the poverty level. These changes also ensured adequate access to qualified providers by: a. reimbursing pediatric and family nurse practitioners. b. reimbursing skilled and intermediate nursing home care. c. reimbursing early periodic screening, diagnosis, and treatment (EPSDT) for those younger than 21 years. d. adding coverage for the medically indigent.

a. reimbursing pediatric and family nurse practitioners. rationale: Any state participating in the Medicaid program is required to provide the following:· Inpatient and outpatient hospital care· Laboratory and radiology services· Physician services· Skilled nursing care at home or in a nursing home for people older than 21 years· Early periodic screening, diagnosis, and treatment (EPSDT) for those younger than 21 years· Family planningIn 1989 changes in Medicaid required states to provide care for children younger than 6 years and to pregnant women under 133% of the poverty level. These changes also ensured adequate access to qualified providers to meet the demand of the required changes by providing reimbursement for pediatric and family nurse practitioners.

A nurse works in a free clinic for uninsured low-wage employees in the community. The free clinic setting operates in a primary health care (PHC) strategy rather than a purely primary care approach. The nurse would most likely focus on: a. self-care/management. b. physician orders for the individual. c. incidence of the disease. d. pathophysiology of the disease.

a. self-care/management. Primary health care (PHC) is generally defined more broadly than is primary care. With an emphasis on broad strategies, community participation, self-reliance, and a multidisciplinary health care delivery team, PHC promotes the integration of all health care systems within a community to come together to improve the health of the community. It includes a comprehensive range of services including public health; prevention; and diagnostic, therapeutic, and rehabilitative services. PHC is essential care made universally accessible to individuals and families in a community. PHC does not provide a focus on incidence of disease, pathophysiology of disease, or individual orders for care.

The major sources of information for program evaluation are: (Select all that apply.) a. media reports. b. program records. c. program clients. d. program providers. e. community indexes.

b, c, e Major sources of information for program evaluation are program clients, program records, and community indexes. The program participants, or clients of the service, have a unique and valuable role in program evaluation. Whether the clients, for whom the program was designed, accept the services will determine to a large extent whether the program achieves its goal. Thus their reactions, feelings, and judgments about the program are important to the evaluation.

What are some examples of programs which may be provided at the local health department level? (Select all that apply.) a. Quality and safety data b. Health education c. Family planning services d. Licensing of health care professionals e. Immunization clinics

b, c, e Some examples of programs that may be offered by local health departments include immunization clinics, health education, and family planning. The range of services varies considerably depending on the size of the area served and the resources available to fund programs. Licensing of health care professionals is conducted at the state level and quality and safety data is typically provided by federal entities.

Public health programs are designed with the goal of improving a population's health status. Which of the following apply to public health? (Select all that apply.) a. It is a branch of medicine. b. It is health status monitored at the state level. c. It is implemented at the federal level. d. It is funded at a local level. e. It is an organized community approach.

b, e All public health is based on partnerships. Public health is not a branch of medicine; it is an organized community approach designed to prevent disease, promote health, and protect populations. The federal level develops regulations. The state level is responsible for monitoring the health status and enforcing laws and regulations. Both the federal and state levels fund public health, and the local level implements public health.

A community-based HIV/AIDS clinic would be concerned about which aspects of the Public Health Code of Ethics? (Select all that apply.) a. Funding b. Promoting advocacy for disenfranchised persons c. Respecting only community rights d. Autonomy of the professional e. Confidentiality when possible

b, e The 12 principles of the Public Health Code of Ethics incorporate the ethical tenets of preventing harm; doing no harm; promoting good; respecting both individual and community rights; respecting autonomy, diversity, and confidentiality when possible; ensuring professional competency; trustworthiness; and promoting advocacy for disenfranchised persons within the community.

Several community-oriented nurses want to explore the problem of obesity in school-age children and assess their community school district health status related to that problem. When gathering information at a national level, they would begin with the: a. National Institute of Nursing Research (NINR). b. Centers for Disease Control and Prevention (CDC). c. Centers for Medicare and Medicaid Services (CMS). d. Health Resources and Services Administration (HRSA).

b. Centers for Disease Control and Prevention (CDC). The Centers for Disease Control and Prevention (CDC) serves as the national focus for developing and applying disease prevention and control, environmental health, and health promotion and education activities designed to improve the health of the people of the United States. The Centers for Medicare and Medicaid Services (CMS) administer Medicare and Medicaid accounts and guide payment policy and delivery rules for services for the poor, elderly, disabled, and unemployed. HRSA has been a long-standing contributor to the improved health status of Americans through the programs of services and health professions education that it funds. The NINR is the focal point of the nation's nursing research activities.

A low-vision client with very early dementia takes pride in her independence. The client, who lives alone in an apartment, tells her nurse she has always enjoyed using scented candles. Which is the most appropriate intervention for the nurse? a. Counsel the client of the dangers of her using candles and matches. b. Collaborates with the client to give the candles and matches to a family member who brings them during visits. c. Leave the matches and candles accessible to the client. d. Maintain the client's dignity by stating that she is capable of using them for now.

b. Collaborates with the client to give the candles and matches to a family member who brings them during visits. The best action is for the nurse to apply the principle of respect for autonomy. The nurse wants to maintain the client's dignity and quality of life, and to help the client be as independent as possible. But at the same time, the nurse must choose actions that reduce the risk of harm to others.

A nurse who is interested in disaster training through the Community Emergency Response Team (CERT) program would look to which government jurisdiction or agency to seek the certification? a. US Department of Health and Human Services b. Department of Homeland Security c. State system d. Local system

b. Department of Homeland Security The mission of the DHS is to prevent and deter terrorist attacks and protect against and respond to threats and hazards to the nation. The goals for the department include awareness, prevention, protection, response, and recovery. The DHS works with first responders throughout the United States, and through the development of programs such as the Community Emergency Response Team (CERT) program trains people to be better prepared to respond to emergency situations in their communities. Nurses working in state and local public health departments as well as those employed in hospitals and other health facilities may be called on to respond to acts of terrorism or natural disaster in the course of their careers, and the DHS, along with the Food and Drug Administration (FDA) and CDC, is developing programs to ready nurses and other health care providers for an uncertain future (USDHS, 2014).

Implementing a community-level program, such as walking for exercise, to assist citizens in improving health behaviors is an example of which level of prevention? a. Secondary prevention b. Primary prevention c. Tertiary prevention d. Disease promotion

b. Primary prevention Implementation of a community-level program like walking for exercise to assist citizens in improving health behaviors related to lifestyle is an example of primary prevention at the public health level. Implementation of a family-planning program to prevent unintended pregnancies for young couples who attend the local community health center is a secondary prevention activity. An example of tertiary prevention at the public health level is the self-management asthma program for children with chronic asthma to reduce their need for hospitalization. These examples are not disease promotion measures.

Which demographic factor is expected to affect health services the most? a. Person b. The aging population c. marketing practices for new drugs. d. technology advancement

b. The aging population The aging population is expected to affect health services more than any other demographic factor. By 2060 those over 65 are estimated to comprise up to 25% of the population. Because the majority of older adults and other special populations receive services through publicly funded programs, the growing health needs among these populations have a great effect on costs, payments, and providers associated with Medicaid and Medicare programs.

The federal agency most responsible for improving the health status of the American people is the: a. Office of Health Preparedness. b. US Department of Health and Human Services. c. Food and Drug Administration. d. Office of Global Affairs.

b. US Department of Health and Human Services. The US Department of Health and Human Services (USDHHS) is the federal agency most heavily involved with the health and welfare concerns of US citizens. The department includes the Office of the Secretary, 11 agencies, and a program support center. It is charged with regulating health care and overseeing the health status of America. Newer areas in the HHS are the Office of Public Health Preparedness, the Center for Faith-Based and Neighborhood Partnerships, and the Office of Global Affairs. The Office of Public Health Preparedness was added to assist the nation and states to prepare for bioterrorism after September 11, 2001.

As a result of recent social policy changes, public health agencies have shifted their emphasis from a focus on primary health care services to a focus on core public health activities because of new and reemerging public health issues. A critical aspect of ensuring the public health system's ability to address these issues is: a. bioterrorism strategy. b. adequate funding. c. additional regulation. d. media coverage.

b. adequate funding. For public health services to meet the demands placed on them for competing resources (services, surveillance, containment, and protection), they must receive adequate funding. It is necessary for the public and the government to be aware of the benefits provided to the community by nurses, such as achieving immunization rates that improve health and lower health care costs (i.e., measles).

Health care costs are influenced by factors related to inflation, demographic changes, new technology, resource intensity, and: a. professional competition. b. chronic illness. c. market practices. d. nursing shortages.

b. chronic illness. The following factors are frequently cited as having caused the increases in total and per capita health care spending since 1960: inflation, changes in population demographics, and technology and intensity of services.. The highest cost conditions are identified as those with the highest costs, utilization of bed days, work-loss days, and activity impairments. Market practices, nursing shortages, and professional competition are not factors with a direct influence on costs.

A nurse in community health is visiting with an older adult Asian woman for the first time. The nurse has not encountered many clients from this culture. An effective way to ensure client-centered care is performed is to: a. tell the client how Western medicine will fix her problem. b. listen to the client's perceptions of the problems. c. explain to the client how the nurse intends to fix the problem. d. focus on the differences between the two cultures.

b. listen to the client's perceptions of the problems. Skills such as listening, explaining, acknowledging, recommending, understanding, and negotiating help the nurse be nonjudgmental. It is vital that nurses listen to clients' perceptions of their problems and, in turn, that nurses explain to clients the nurses' perceptions of the problems. Nurses and clients should acknowledge and discuss similarities and differences between the two perceptions to develop suggestions and recommendations for managing problems. Nurses also negotiate with clients on nursing care actions to meet the needs of the clients.

A community health nurse involved in care management would most likely: a. manage the staff at a free clinic. b. monitor the health status, resources, and outcomes for an aggregate. c. develop, conduct, and evaluate health teaching programs in primary care. d. provide immunizations to migrant workers.

b. monitor the health status, resources, and outcomes for an aggregate. Care management is an enduring process in which a care manager establishes systems and monitors the health status, resources, and outcomes for an aggregate or a targeted segment of the population or a group. Care management strategies include use management, critical paths, disease management, demand management, and case management.

Ethical decision making is conducted in a generic framework. One step of ethical decision making is to place an ethical issue or dilemma within a meaningful context. The rationale for this step is: a. professional persons cannot avoid choice and action in applied ethics. b. multiple factors affect the formulation and justification of ethical issues and dilemmas. c. people cannot make sound ethical decisions if they cannot identify ethical issues and dilemmas. d. the nature of ethical issues and dilemmas determines the specific ethical approach used.

b. multiple factors affect the formulation and justification of ethical issues and dilemmas. The historical, sociological, cultural, psychological, economic, political, communal, environmental, and demographic contexts affect the way ethical issues and dilemmas are formulated and justified. The nature of ethical issues and dilemmas determines the specific ethical approach used when appropriate approaches are considered. The identification process assists people with making sound decisions. Professionals use ethical decision making to make decisions and take action.

To achieve the major goals of Healthy People 2030 the partnership between federal, state, and local agencies is critical, and local community coalitions are encouraged because the: a. federal government is ultimately responsible for the health status of the nation. b. public health departments do not have the resources to accomplish these goals independently. c. public demands that the government protect the people. d. state health department would require a universal approach to achieving objectives.

b. public health departments do not have the resources to accomplish these goals independently. State health departments play a key role in implementing the Healthy People 2030 objectives by setting the goals using the objectives as a framework. Knowing that health departments do not have the resources to accomplish these goals independently, collaboration is essential to quality nursing practice and is encouraged at the local level with existing groups. Communities establish coalitions to address selected objectives, based on community needs, to include all of the local community stakeholders. The public health team includes the local, state, and federal agencies and the private sector, each with its own variable reason (stakeholders) for participation, yet striving for an agreed-upon goal of increasing the health status of the nation.

When health care providers in the community refuse to accept Medicare clients, this implies reduced access to care, potential decreases in acceptable quality of services offered, and a form of health care rationing. Health care rationing becomes a public health and nursing issue because: a. proactive primary prevention orientation is cost effective. b. public health systems and nurses must ensure that essential clinical services are available. c. sufficient resources are available in the public health system to meet the unmet need. d. Medicare reimbursement needs to be higher.

b. public health systems and nurses must ensure that essential clinical services are available. Rationing of health care is a public health issue. Where care is not provided, the public health system and nurses must ensure that essential clinical services are available.

Politics is simply described as: a. business conducted in the senate. b. the art of influencing others. c. interaction between the policymakers and the public. d. the ability to fund a special project.

b. the art of influencing others. Politics is the art of influencing others to accept a specific course of action. Therefore, political activities are used to arrive at a course of action (the policy). Law is a system of privileges and processes by which people solve problems based on a set of established rules. Policies are made not only by governments but also by institutions such as a health department or other health care agency, a family, or a professional organization. Politics are associated with funding, business conducted in the senate, and interaction between policymakers and the public, but these are not the correct definition of the term.

The community-oriented nursing care function of policy development is supported by the ethical tenet of: a. to each person a fair share. b. what is ethical is also good policy. c. competency. d. do no harm.

b. what is ethical is also good policy. The voice of the community is the foundation on which policy is developed. Service to others over self is a necessary condition of what is "good" or "right." Service requires ethical action and what is ethical is also good policy. Therefore, moral leadership from nurses is critical to the development of ethical health care policies. Competency and do no harm refer to the assessment function of public health nursing. "To each person a fair share" applies to the assurance function of public health.

A nurse takes a new position as a community health nurse. Her first assignment is to perform an assessment of the community's migrant farmworker population. What is the most appropriate step for the nurse to take first? a. Form a relationship with the farmworkers' community leaders and other key informants. b. Begin the community assessment using a survey tool proven effective in previous assessments. c. Enroll in a college course to learn community research, measurement, and analysis techniques. d. Perform a literature review to study assessment data for similar populations.

c. Enroll in a college course to learn community research, measurement, and analysis techniques. Two core functions of community-oriented nursing are assessment and assurance. Both of these core functions have their foundation in the ethical tenets of competency. Nurses assigned to develop community knowledge must be adequately prepared to collect data on groups and populations. The techniques employed differ from those used when caring for individuals. Use of the wrong research techniques leads to wrong assessments, with the potential for developing interventions that harm rather than help the target population.

A public health nurse employed by the Department of Health is working on a team developing local health policy. The nurse recognizes which of the following about policy development? a. It is based on Socratic method. b. It is important that the policy has been approved by the American Nurses Association. c. It is very similar to the nursing process. d. It is primarily up to politicians to plan for health care.

c. It is very similar to the nursing process. Health policy is simply the process of turning health problems into workable action solutions. Thus, the policy process is very similar to the nursing process, but the focus is on the level of the larger society, and the adoption strategies require political action. The policy process includes the following:· Statement of a health care problem· Statement of policy options to address the health problem· Adoption of a particular policy option· Implementation of the policy product· Evaluation of the policy's intended and unintended consequences in solving the original health problem

A new group of migrant farmworkers has arrived in a community. What action by the public health nurse is most important prior to scheduling clinic services? a. Review written materials about the farmworkers' culture of origin. b. Consult the public health staff regarding their schedule for large open time blocks. c. Learn about the farmworkers' concept of time and their work schedule. d. Visit the farmworker camp and tell the camp leaders when clinic services will be available.

c. Learn about the farmworkers' concept of time and their work schedule. Culturally competent nursing care includes designing services that are culturally appropriate for the specific client and based on the client's cultural norms and values. The concept of time varies depending on a client's culture of origin. When possible, clinic operating times and scheduling policies should respect the community's preferences. Services should also be available when work allows; it is of no benefit to schedule services when the workers cannot leave their jobs.

A nurse in community health is participating in a community service board strategic team that is currently assessing the community's strengths, the local public mental health system, the community's mental health status, and other variables. This best describes what strategic program planning model used today in the public health arena? a. Assessment Protocol for Excellence in Public Health (APEXPH) b. Health Evaluation Data Information System (HEDIS) c. Mobilizing for Action Through Planning and Partnership (MAPP) d. Planning Approach to Community Health (PATCH)

c. Mobilizing for Action Through Planning and Partnership (MAPP) MAPP is the newer approach to program planning in the public health arena. It is a strategic planning model that helps the community health workers be facilitators, as communities establish priorities in their public health issues and identify resources to address the issues. APEXPH addresses the three core competencies of public health: assessment, assurance, and policy development. PATCH is a health education model and HEDIS is not associated with program planning.

A community-based hospice nurse has an Asian male client with terminal stage cancer. The client complains that he is in continuous pain and receives no relief from the codeine prescribed by his primary care practitioner (PCP). The nurse contacts the client's PCP to discuss replacing the prescription of codeine with another pain-reducing non-codeine-based drug. The nurse is demonstrating knowledge of the cultural organizing factor of: a. space. b. time perception. c. biological variance. d. communication.

c. biological variance. Biological variations are the physical, biological, and physiological differences that exist and distinguish one racial group from another. They occur in areas of growth and development, skin color, enzymatic differences, and susceptibility to disease. Research findings suggest that sensitivity to codeine varies with ethnic background, and that Asian men experience significantly weaker effects from the drug than do European men. Asian men are missing an enzyme called CYP2D6 that allows the body to metabolize codeine into morphine, which is responsible for the pain relief provided by codeine. When an individual is missing the enzyme, no amount of codeine will lessen the pain, and other pain-reducing chemicals should be explored. The cultural organizing factors associated with communication, space and time perception are not related to this situation.

In case management, it is unlikely that any single professional has the expertise, knowledge, or skills required to achieve success. The synergy produced by all involved parties (client, providers, payers, family/significant others, and community organizations) can result in successful outcomes. This statement relates to the sequential process of: a. cooperation. b. communication. c. collaboration. d. negotiation.

c. collaboration. Collaboration is achieved through a developmental process that occurs in a sequence, yet it is reciprocal between those involved. Teamwork and collaboration require extensive skill sets to achieve successful outcomes. No single professional has the expertise required in all aspects. It requires the synergy of all parties involved. The goal of communication in the collaborative development process is to promote respect for, understanding of, and the accuracy of all team members' points of view. Cooperation is the ability to understand and meet the needs of others. Negotiation generally occurs in a situation involving conflict.

The role/activity of the nurse in community health that was most important during the disasters of September 11, 2001, and the subsequent anthrax bioterrorism attack involved: a. free and low-cost immunization. b. assessment. c. enhanced surveillance activities. d. client-level teaching.

c. enhanced surveillance activities. The monitoring of communicable diseases is one of the most important roles for nursing during disasters. During the September 11, 2001, airplane attacks and the October 2001 anthrax attacks, nurses at the federal, state, and local levels immediately implemented active enhanced surveillance activities. Information about communicable diseases seen at the local level was passed on to the state public health agency and finally the CDC. At each step, the data were analyzed for evidence of unusual disease trends.

A Public Health Service nurse working for the Indian Health Service is working with a client diagnosed with cancer. The client uses sweat lodges to "cure the disease." The nurse understands that within the culture, disease is often perceived as disharmony with other forces, and clients may look to hot or cold treatments to resolve or cure a cancerous condition. The nurse is integrating her knowledge of the cultural organizing factor of: a. communication. b. biological variations. c. environmental control. d. space.

c. environmental control. Environmental control refers to the relationships between humans and nature. Cultures that view a human harmony with nature may perceive illness as a disharmony with other forces and believe that medicine can only relieve the symptoms rather than cure the disease. They would use the mind-body-spirit connection to heal from within. Such cultures look to naturalistic solutions such as herbs, hot and cold treatments, or acupuncture to resolve or cure a cancerous condition. Biological variations are the physical, biological, and physiological differences that exist and distinguish one racial group from another. Communication and space are not cultural factors associated with this scenario.

A major evaluation source for a nurse to use to determine the effectiveness of a teen driver safety program is: a. recent census data. b. voter registration records. c. epidemiologic data. d. Centers for Disease Control and Prevention (CDC) reports.

c. epidemiologic data. A major source of evaluation is epidemiologic data. Mortality and morbidity data measuring health and illness indicators are probably cited more frequently than any other single index for program evaluation. Incidence and prevalence are valuable indexes used to measure program effectiveness and impact, and these data are readily available on the Internet. Major sources of information for program evaluation are program clients, program records, and community indexes.

In response to the COVID-19 pandemic, a nurse in the local health department is called upon to provide education that will prepare communities to cope, establish screening and vaccination clinics, conduct enhanced communicable disease surveillance (i.e. contact tracing), work with environmental health specialists to ensure social distancing, and serve on the local emergency planning committee. What role is the nurse acting in? a. first responder. b. professional triage. c. incident commander. d. communicable disease control.

c. incident commander. Although communicable disease control is a core public health service, the role of public health as incident commander in a widespread public health emergency is a newer role for nurses. Public health at the federal, state, and local levels are looked to for coordinated leadership and answers to a situation in which experience was limited and answers were uncertain.

It is important that nurses understand the nontraditional healing practices of their clients because: a. nurses can refer clients to the appropriate local folk healers. b. folk practices are usually ineffective. c. safe, effective nontraditional healing methods can be blended with Western medicine. d. the nurse must understand them to help the client give them up.

c. safe, effective nontraditional healing methods can be blended with Western medicine. Nurses need to understand the nontraditional healing practices that their clients use. Many of these treatments have proven effective and can be blended with traditional Western medicine. The key is to know what practices are being used so that the blending can be knowledgeably done.

A public health nurse has identified the need to make amendments in an existing law concerning the TB health assessment of individuals sentenced to serve jail terms on weekends only, based on the current criminal justice system practices and potential health risk to the free-living community. To raise this concern, the nurse has several paths to follow, but the amendment of any existing laws would ultimately be decided by: a. senate hearings. b. the executive branch of the government. c. the legislative branch of the government. d. local representatives.

c. the legislative branch of the government. Each of the government branches at the federal, state, and local levels plays an important role in developing and implementing health law and public policy. Concerned citizens have many avenues to address issues related to required laws and regulations as well as existing laws and regulations. However, each branch of government has separate and important functions. The legislative branch identifies problems, proposes debates, and passes and modifies laws to address identified problems.

Parents can expect their children to be immunized for communicable diseases before entering kindergarten in the local school system because: a. primary-care clinics maintain adequate supplies of immunization. b. primary-care clinics focus on prevention. c. the public health system has mandates for immunization. d. the public health system provides good access to immunization clinics.

c. the public health system has mandates for immunization. Although the goal of the public health system is to ensure that the health of the community is protected, promoted, and ensured, overlap exists between this system and the primary-care system. The overlap comes from the primary-care system, which provides health promotion and disease prevention, and through the public health system, which provides personal primary-care services for those who cannot afford to receive care elsewhere. The public health system is mandated through laws that are developed at the national, state, and local levels. Examples of public health laws instituted to protect the community are laws mandating immunization for all children entering kindergarten or laws requiring the constant monitoring of the local water supply to make sure that it meets set standards.

Caring and the ethic of care is a core value of nursing in community health. Feminist ethics is pertinent to public health because: a. principles of utilitarianism are applied. b. differentiate distributive justice from beneficence. c. the role of political and social structures in health are recognized. d. gender-related voices to moral judgment are applied.

c. the role of political and social structures in health are recognized. Caring and the ethic of care are core values of public health nursing. Like virtue ethics and other communitarian views (i.e., the relationship and responsibility between the individual and the community), feminist ethics rejects abstract rules and principles. According to Rogers (2006), feminist ethics is pertinent to public health because it recognizes the role of political and social structures in health. These concepts are not associated with utilitarianism or the differentiation between distributive justice and beneficence.

A nurse demonstrates cultural competence by using statements such as: a. "Let me show you the way you should do this." b. "I know how you feel." c. "You can do things in a more modern way now." d. "Tell me about your health care beliefs."

d. "Tell me about your health care beliefs." Culturally competent nurses learn about the cultures of the clients whom they serve and they respect people from other cultures and value diversity; this helps them provide more responsive care. Cultural competence includes acknowledging the fundamental differences in the ways clients and families respond to illness and treatment from one's own response or a more generalizable Western health care response.

A nurse asks a couple who are new parents for their baby's full name. The parents reply that in their culture they are only supposed to give the baby its first name. What response by the nurse is most appropriate? a. Tell the couple that they are the child's parents and it is up to them to name their baby. b. Give the couple the paperwork and ask when the baby will have a name. c. Explain that the Bureau of Vital Statistics has a deadline for completing the birth certificate. d. Express interest and ask the couple to share how their new baby will receive its name.

d. Express interest and ask the couple to share how their new baby will receive its name. Dealing effectively with immigrant populations includes learning about how the community deals with common events and what their traditional practices are. In some cultures, it is not the parents but their spiritual leader or a more senior family member who gives a baby its name. Nurses should engage in cultural encounters to learn about a client's culture and practices.

The historical figure whose work in providing care to poor people, primary prevention, and environmental health established that individual as nursing's first moral leader and community-oriented nurse was: a. Lillian Wald. b. William Rathbone. c. Sister Mary Augustine. d. Florence Nightingale.

d. Florence Nightingale. Modern nursing has a rich heritage of ethics and morality, beginning with Florence Nightingale (1820-1910). The morals and values she gave to nursing have endured. She was passionate about the need to provide care to poor people and also about the importance of a sanitary environment, as seen in her work with soldiers in the Crimean War (1854-1856). Because of her commitment to poor individuals in communities, her championing of primary prevention, and her work to show that healthy environments saved soldiers' lives, she is seen as nursing's first moral leader and community-oriented nurse. Sister Mary Augustine, William Rathbone, and Lillian Wald are not known as nursing's first moral leader.

The WHO initiative Health for All in the 21st Century can best be described as which of the following? a. National initiative b. Environmental initiative c. Primary care initiative d. Social justice initiative

d. Social justice initiative The Health for All in the 21st Century initiative is not a single, finite goal, but a strategic process that can lead to progressive improvement in the health of people. In essence, it is a call for social justice and solidarity to improve the economics and infrastructure of nations through a holistic approach to address determinants of health status and increase a community's responsibility for the health of its citizens. This may involve environmental initiatives and health promotion, education, and prevention initiatives aimed at the greater good of the population as a whole instead of serving the interests of individuals or select groups.

A 3-year smoking cessation program for teens has just concluded. The type of evaluation the staff will conduct is: a. on ongoing evaluation b. an informal evaluation c. a formative evaluation d. a summative evaluation

d. a summative evaluation Summative evaluations assess program outcomes or are a follow-up of the results of the program activities and look at the end result. Formative evaluations are used to evaluate the progress of a program. An evaluation of program effectiveness may help the nurse evaluator determine both client and provider satisfaction with the program activities, as well as whether the program met its stated objectives.

A nurse coordinating care for undocumented minority workers with a high incidence of tuberculosis (TB) conducts a presentation before the local community health board to focus attention on the magnitude of the problem and its potential impact on the local community. The presentation stimulates the community to explore innovative solutions to increase screening for and treatment of TB cases. This scenario is an example of the relationship between: a. care management and continuity of care. b. care management and case management. c. advocacy and continuity of care. d. advocacy and case management.

d. advocacy and case management. Clients are a part of larger systems: the family, the work environment, and the community. Each system interacts with the client to shape available options through resources, needs, and desires. The practice of advocacy may entail the ability to focus attention on the magnitude of problems caused by diseases affecting a segment of the population. Advocacy often stimulates a community's self-determination to find innovative actions to correct gaps in service.

A parent involved in conflict resolution with her teenager says, "I know that some of your friends stay out until midnight, but I think it is best if you are in at 10 o'clock." This statement, a behavior seen in conflict situations, is an example of: a. cooperation. b. negotiation. c. aggressiveness. d. assertiveness.

d. assertiveness. Assertiveness is the ability to present one's own needs and is a behavior often seen in conflict situations. Negotiating is a strategic process used to move conflicting parties toward an outcome. Cooperation is the ability to understand and meet the needs of others. Aggressiveness is a behavior which may be exhibited in a conflict situation.

When acting as a mediator, the nurse advocate would: a. choose a new health plan for a client with limited funds. b. set up a doctor's appointment for an illiterate adult. c. provide health education to teens who need knowledge about sexually transmitted diseases. d. assist new parents in communicating with their health plan regarding well-baby coverage.

d. assist new parents in communicating with their health plan regarding well-baby coverage. Mediation is an activity in which a third party attempts to provide assistance to those who may be experiencing a conflict in obtaining what they desire. The goal of the nurse advocate as mediator is to help parties understand each other on many levels so that agreement on an action is possible.

A community health nurse is working with an uninsured family with two children. The nurse assists the parents in applying for SCHIP benefits and securing an appointment for the children with a community pediatrician that participates in SCHIP. The intervention can best be described as: a. continuity of care. b. care management. c. disease management. d. case management.

d. case management. Case management is identified as one of the 17 interventions in the scope of practice in community health nursing. Case management is defined as the ability to optimize self-care capabilities of individuals and families and the capacity of systems and communities to coordinate and provide services. Case management, in contrast to the definition of care management, refers to activities implemented with individual clients in a system. Care management includes the concept of disease management.

Virtue ethics is distinctly different from moral justification via theories or principles because the emphasis of virtue ethics is practical reasoning applied to: a. distributive justice. b. consequentialism. c. egalitarianism. d. character development.

d. character development. The goal of virtue ethics, one of the oldest ethical theories, is to enable persons to flourish as human beings. According to Aristotle, virtues are acquired excellent traits of character that dispose humans to act in accord with their natural good. Examples of virtue ethics include benevolence, compassion, discernment, trustworthiness, integrity, and conscientiousness. Consequentialism is the action that produces the greatest amount of good or the least amount of harm in a given situation. Distributive or social justice refers to the allocation of benefits and burdens to members of society. Egalitarianism is the view that everyone is entitled to equal rights and equal treatment in society.

The nurse engaging in formative program evaluation would most likely: a. write policy for risk management. b. participate in new client evaluation. c. make a home visit before a client is discharged from the program. d. conduct medical record audits for quality assurance.

d. conduct medical record audits for quality assurance. Quality assurance audits are prime examples of formative program evaluation in health care delivery. The monitoring of program activities—such as hours of services, number of providers used, number of referrals made, and amount of money spent to meet the program objectives—provides an evaluation of the progress of the program. This type of evaluation is an example of formative evaluation of processes, which occurs on an ongoing basis while the program exists. Progress evaluation occurs primarily while implementing the program. The nurse who completes a daily or weekly log of clinical activities (e.g., number of clients seen in the clinic or visited at home, number of phone contacts, number of referrals made, number of community health-promotion activities) is contributing to progress evaluation of the nursing service.

Local officials have requested a program evaluation of a comprehensive teen sex education program offered in the local schools in preparation for potential budget discussions. A nurse in community health conducts a program evaluation and determines that the teen pregnancy rate has gradually declined over the years that the program has been in place. The community is measuring the program's: a. progress. b. relevance. c. sustainability. d. efficiency.

d. efficiency. A program evaluation may be able to determine whether a program provides better benefits at a lower cost than does a similar program or whether the benefits to the clients or number of clients served justifies the costs of the program. This is a measure of the efficiency of a program. A reduction in teen pregnancies can represent significant cost savings to the overall health of the community. The monitoring of program activities—such as hours of services, number of providers used, number of referrals made, and amount of money spent to meet the program objectives—provides an evaluation of the progress of the program. Evaluation of relevance is an important component of the initial planning phase. As money, providers, facilities, and supplies for delivering health care services are more closely monitored, the needs assessment done by the nurse will determine whether the program is needed. Sustainability is the continuation of a program when resources are adequate.

The nurse in community health is meeting with staff to systematically plan for a new outreach program. Doing so helps them to: a. assess the needs of potential outreach clients. b. recognize the special needs of vulnerable people in the area. c. identify how the problems of similar programs will not be repeated. d. identify the resources and activities that will help them meet their program objectives.

d. identify the resources and activities that will help them meet their program objectives. Systematic planning for meeting client needs assists in identifying the resources and activities that are needed to meet the objectives of client services. Today this type of planning is referred to as strategic planning and it involves the successful matching of client needs with specific provider strengths and competencies and agency resources.

A community-oriented nurse is interested in studying the hospital discharge data for facilities that typically provide services to members of the community where the nurse practices. The nurse accesses the National Hospital Discharge Survey database of the Department of Health and Human Services (DHHS) to identify data at national, regional, and local levels for comparison purposes. The government health care function being used by the nurse is: a. direct services. b. policy setting. c. financing. d. information.

d. information. The federal, state, and local governments carry out four health care functions, which fall into the general categories of direct services, financing, information, and policy setting. Collecting vital statistics, including mortality and morbidity data, gathering census data, and conducting health care status surveys are government functions that relate to the role of the government to provide information. The National Hospital Discharge Survey is a national data source on the health status of the US population from the federal government, Department of Health and Human Services. Direct services may be provided to individuals or groups. Financing refers to government payment for health care services. Policy decisions about health care are made at all levels and within all branches of government.

If a small business employer desires to control company benefit expenditures by turning health care decision-making control over to the employees, the insurance reform effort that best addresses the shifting of responsibility, knowledge, and decision-making involvement to the individual receiving the care would be: a. prospective payment. b. managed care. c. health spending accounts (HSA). d. medical savings account (MSA).

d. medical savings account (MSA). Medical savings accounts (MSAs) are touted as a way of turning health care decision-making control over to the individual receiving the care. MSAs are tax-exempt accounts available to individuals who work for small companies, established usually through a bank or insurance company, that enable individuals to save money for future medical needs and expenses. The employer contributes money to an MSA, and the initial money put into an MSA does not come out of taxable income. Also, interest is earned in MSAs tax free, and unused MSA money can be held in the account from year to year until the money is used. This transfers responsibility for knowledge and decision making regarding cost/quality tradeoffs to the individual. Managed care is the term used for a variety of health care arrangements that integrate the financing and the delivery of health care. Health spending accounts and prospective payment are not associated with health care decision making.

A nurse in community health has determined that there is a need for a program for teenage fathers who want to learn about childcare. The next step in the program management process would be to: a. determine whether the fathers have benefited from this type of program before. b. provide the fathers with community resources. c. conduct a survey to determine how many children the fathers have. d. meet with community members to form a planning body.

d. meet with community members to form a planning body. The program management process is like the nursing process. Program management consists of assessing, planning, implementing, and evaluating a program. One is applied to a program, whereas the other is applied to clients. Following the assessment, planning for the program should occur.

The nurse in community health prepares a community assessment for the local planning commission and presents data that indicate an increase in violence among young children and teens within the community. The nurse projects the cost of care related to violence in ED visits, treatment of stabbing and gunshot wounds, and rehabilitation. The nurse also produces information on school absenteeism, graduation rates, and teenage rape and pregnancy. The planning commission creates a task force to explore the community outlets for child and teen recreation and the current community education programs available to families and students related to violence prevention, negotiation, and mediation. This can best be described as an example of: a. social issues. b. disparities in health care. c. outreach work. d. power of partnerships.

d. power of partnerships. Partnerships and collaborations between groups are much more powerful in making change than are an individual client and nurse working alone. Nurses can facilitate an appropriate community response by providing information in a manner that stimulates community action to address specific problems at a population level to ultimately improve the health care status of the community.

Of the four major factors that affect health care—personal behavior/lifestyle, environmental factors (physical, social, and economic), human biology, and the health care system—medical services are said to have the least effect. Yet, the US health care system remains reactionary with high-cost, high-technology, and disease-specific "sickness care." This statement supports the need for increased investment in: a. managed care. b. secondary prevention. c. tertiary prevention. d. primary prevention.

d. primary prevention. Behavior and lifestyle have been shown to have the greatest effect, with the environment and biology accounting for the greatest effect on the development of illness, yet most health care dollars are spent on secondary and tertiary care. A more proactive investment in disease prevention and health promotion targeted at improving behaviors, lifestyle, and environment has the potential to improve health status, thereby improving the quality of life while reducing health care costs.

A nurse in community health may have state-granted personal immunity for particular practice areas, such as giving immunizations. If the state legislature has granted personal immunity to nurses employed by public agencies to cover all aspects of their practice, the legal theory that applies is: a. worker's right to know. b. case law. c. respondeat superior. d. sovereign immunity.

d. sovereign immunity. In some states, the legislature has granted personal immunity to nurses employed by public agencies to cover all aspects of their practice under the legal theory of sovereign immunity. Respondeat superior occurs when a nurse is directed to carry out a particular function and the employer becomes responsible for negligence, along with the individual nurse. Case law and the worker's right to know are not associated with the granting of personal immunity to nurses.

Provision 1 of the Code of Ethics for Nurses addresses practicing with compassion and respect for the person being cared for regardless of the person's status, attributes, or the nature of the health problem. In applying this provision to practice, the public health nurse understands that: a. this applies only to nursing in community health. b. the profession's integrity is at stake. c. the nurse's primary commitment is to the individual being cared for. d. there are times when individual rights may be limited because of public health concerns.

d. there are times when individual rights may be limited because of public health concerns. Provision 1 and its interpretive statement primarily address the individual when discussing how the nurse practices with compassion and respect for the person being cared for regardless of the person's status, attributes, or the nature of the health problem. However, it is also recognized under provision 1 that there are times when individual rights may be limited because of public health concerns. Provision 2 states "the nurses primary commitment is to the patient whether an individual, family, group, community, or population." All nurses have a responsibility to meet the obligations highlighting professional standards, active involvement in nursing, and the integrity of the profession as outlined in the Code.

A current dramatic trend in nursing in community health involves: a. special needs programs. b. shifts in research focus. c. clinical surveillance. d. vulnerable population shifts.

d. vulnerable population shifts. Although vulnerable populations have always benefited from nursing services, the populations that are most acutely in need of public health services have changed dramatically over the past two decades (i.e., young women and their partners that have risky behaviors and put their pregnancy or children at high risk for injury or abuse).

A major emerging public health issue facing nursing in community health is: a. health literacy. b. bioterrorism. c. health ministries. d. welfare reform.

d. welfare reform. The major emerging issues in public health that affect nursing in community health are increased rates of drug-resistant community-acquired pathogens; social issues such as welfare reform; racial and ethnic disparities in health outcomes; behaviorally influenced issues (i.e., chronic disease, violence, substance abuse); emergency preparedness activities; and unequal access to health care.

The primary reasons for delay, difficulty, or failure to access care include which of the following factors? (Select all that apply.) a. Refusal of services by providers b. Lack of transportation c. Inability to afford health care and a variety of insurance-related reasons d. The increase in safety net providers e. Resolved nursing shortage

a, b, c The primary reasons for delay, difficulty, or failure to access care include the inability to afford health care and a variety of insurance-related reasons. Other barriers include lack of transportation, physical barriers, communication problems, childcare needs, lack of time or information, or refusal of services by providers. Additionally, lack of after-hours care, long office waits, and long travel distance are cited as access barriers. Community characteristics also contribute to the ability of individuals to access care. For example, the prevalence of managed care and the number of safety net providers, as well as the wealth and size of the community, affect accessibility.

The nursing student learning about cultural variations would need to study which of the following topics? SATA a. Time perception b. Biological variations c. Communication patterns d. Personal space e. Social organizations

a, b, c, d, e Cultural variations include biological variations, personal space, time perception, social organizations, communication patterns, and environmental control.

State and federal statutes and regulations affect the health care specialties of home health and hospice practice. A primary motivator for nurses to become knowledgeable about these statutes and regulations is their impact on nursing practice in which of the areas below? (Select all that apply.) a. Documentation of services b. Resident's rights in long-term care facilities c. Living wills and advance directives d. Right to death with dignity e. Documentation of client status and progress

a, b, c, d, e State laws specify licensure and certification requirements for home health care and hospice agencies. Compliance with these laws is directly linked to the method of payment for the services. For example, a service must be provided by a licensed and state-certified agency to obtain payment from Medicare. Federal regulations implementing Medicare and Medicaid programs have an enormous effect on much of nursing practice, including documentation practices and recording of visits, client care, status, and progress. Other laws focus on issues such as the right to death with dignity, the rights of residents in long-term care facilities, definitions of death and death pronouncement, and the use of living wills and advance directives.

Primary care refers to personal health care for the most common needs of members of a community. Which of the following statements also differentiates primary care from primary health care? (Select all that apply.) a. Primary care is provided within the context of family and community. b. Primary care encourages self-care and self-management. c. Primary care provides first-contact, continuous, comprehensive, and coordinated care. d. Primary care provides preventive, curative, and rehabilitative services. e. Primary care consists of a multidisciplinary team.

a, c Primary care refers to personal health care that provides first-contact and continuous, comprehensive, and coordinated care. The providing of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with clients, and practicing in the context of family and community. Primary health care is defined more broadly than is primary care. Primary health care is "essential care" made universally accessible to individuals and families in a community with the full participation of the community and provided at a cost that the community/county can afford. The primary health care workforce is a multidisciplinary team that includes providers from multiple disciplines, community outreach workers, allied health professionals, translators, and community members themselves.

During a home visit, a case manager for a community health center notes marked pitting edema, shortness of breath, and increased fatigue in a 52-year-old male client who lives alone. The client is admitted to the hospital, where he is diagnosed with congestive heart failure. The case manager works with the hospital's utilization manager to devise a discharge plan. What are the case manager's most logical next steps? (Select all that apply.) a. Research the client's health care coverage and its provisions. b. Reassess the client at discharge to ensure needed care is not overlooked. c. Identify and arrange for the resources to provide needed services. d. Gather information on local support groups. e. Discuss with the family their ability to provide daily visits to the client.

a, c, d Case management has been defined in the public health nursing literature as the establishment of an appropriate plan of care based on assessment of the client/family and coordination of the necessary resources and services for the client's benefit. Therefore, a critical role of the case manager is to help clients obtain the care the client needs to achieve a maximum level of health. The nurse needs to understand what the client's insurance covers. If necessary services or equipment is not covered by insurance, the nurse may act as an advocate and connect the client with other resources in the community if available. The nurse will want to reassess the client, but that is not part of the next steps.

What are some of the benefits of an electronic medical record in the public health setting? (Select all that apply.) a. Coordination of referrals and facilitation of chronic disease management b. Timely billing and financial reimbursement for services provided c. Incorporation of protocol reminders for prevention, screening, and management of chronic disease d. Improved public reporting of medication errors e. Improvement of quality measurement and monitoring

a, c, e rationale: The electronic medical record (EMR), a form of electronic health record, helps with ensuring patient safety and quality care. The availability of an EMR system allows the embedding of reminders so that the clinician can have access to practice guidelines at the very point of care for patients. Some additional benefits in public health, and these are some of the uses health centers make of such records, include the following:· 24 hour availability of records with downloaded laboratory results and up-to-date assessments· Coordination of referrals and facilitation of interprofessional care in chronic disease management· Incorporation of protocol reminders for prevention, screening, and management of chronic disease· Improvement of quality measurement and monitoring· Increased client safety and decline in medication errors