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Public Health Nursing Exam 2

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ANS: A A rate is a measure of the frequency of a health event in a defined population in a specified period of time. A rate is a ratio but not a proportion, because the denominator is a function of both the population size and the dimension of time, whereas the numerator is the number of events. Rates relate to change: moving from one state of being to another, such as from illness to health or from life to death. In this example, seven child deaths divided by the total number of children age 15 years and younger in the population (which is 84,000) = 0.0000833 ´ 1000 = 0.0833/1000.

The nurse is educating her Nigerian client regarding the prenatal services available through the maternal-child health clinic. The client is interested in confirming her pregnancy at this visit but does not see the need for ongoing visits because childbirth is viewed as a natural process in her culture. The nurse negotiates with the client to structure a strategy to achieve a healthy pregnancy outcome that uses the clinic's resources in a manner that is satisfactory to the client. This is an example of: a. cultural accommodation. b. cultural brokering. c. cultural preservation. d. cultural repatterning.

ANS: A Culture is defined as a set of beliefs, values, and assumptions about life that are widely held among a group of people and that are transmitted intergenerationally. Culture is important to nurses because it helps them to understand the beliefs and practices clients bring to the clinical setting, their expression of concerns, and the type of health care they are pursuing. Quality of care means that positive health care outcomes are achieved. Failure to focus care according to the client's values and ideas is likely to increase cost and decrease quality. Care that is not culturally competent may lead to increased cost of health care and decrease the opportunity for positive client outcomes. Techniques such as cultural accommodation can ensure that a positive health outcome is achieved while providing for the cost-effective use of limited resources. Failure of clients to keep scheduled appointments with clinics may reflect a cultural preference for the type and frequency of contact with the health care system. Understanding the type of health care service that the client is seeking can ensure that opportunities to negotiate compliance with treatment can occur to the satisfaction of both parties so that precious resources can be managed effectively.

Bruising and swelling on a client's face and torso are noticed by a nurse during a prenatal examination. The client's exchange-student husband, who speaks for the client, tells the nurse his wife deserved the bruises. The client looks at the floor and shakes her head in agreement. The nursing student leaves the examination room angry and confused, experiencing what can best be described as: a. culture shock. b. prejudice. c. ignorance. d. racism.

ANS: A Culture shock is the feeling of helplessness, discomfort, and disorientation experienced by an individual attempting to understand or effectively adapt to a cultural group whose beliefs and values are radically different from those of the individual's own culture. There are cultures in which it is considered acceptable for men to hit their wives and/or children. The nurse can consult with the nursing supervisor or clinic social worker, who can intervene on the client's behalf with the cooperation of a community advocate from the client's culture of origin.

A nurse who is ethnocentric in interacting with a client of a different culture: a. most likely has little previous experience with the client's culture and is uncomfortable with people from other cultures. b. is appreciative of the client's cultural beliefs. c. accommodates the client's cultural beliefs when planning care. d. imposes the nurse's value system on the client.

ANS: A Ethnocentrism, an inhibitor to developing cultural competence, is the belief that one's own cultural beliefs are the standards that should be used to judge people from other cultures. Ethnocentric nurses are unfamiliar and uncomfortable with that which is different from their own culture. Their inability to accept different worldviews often leads them to devalue the experiences of others and judge them to be inferior, treating those that are different from themselves with suspicion or hostility. The belief in one's own superiority, or ethnocentrism, may lead to "cultural imposition." Cultural imposition is the act of imposing one's cultural beliefs, values, and practices on individuals from another culture. By developing an approach of "cultural relativism" nurses recognize that clients have different approaches to health care, and that each culture should be judged on its own merit and not on the nurse's personal beliefs. Nurses use "cultural awareness and knowledge" to overcome unfamiliarity and discomfort with cultures outside of their own. Nurses who may have ethnocentric beliefs can avoid inhibiting behaviors/actions such as cultural imposition by developing cultural competence.

A nurse is conducting a diabetes self-management group-education session. When participants are asked to remove their shoes, two male clients look at the floor and leave their shoes and socks on their feet. An effective intervention is for the nurse to: a. clarify that no one has to remove his or her shoes unless he or she wants to and continue foot inspection and foot care instruction. b. explain that everyone must learn to do foot inspection to manage their diabetes. c. loudly and slowly repeat the instructions for all participants to remove their shoes. d. stop the group session, pull the two gentlemen aside, and apologize to them.

ANS: A Exposing one's foot in public is not considered appropriate in all cultures. In some cultures, it is considered rude to display the sole of the foot. In the scenario described, the nurse should give the group permission to comply or not comply with the previous instructions and proceed with the class. Ideally, a nurse should become familiar with the values of the target population(s) before asking anyone to remove an article of clothing in a group setting. Integrating cultural awareness and knowledge allows the nurse to demonstrate cultural skill in meeting the needs of culturally diverse groups.

A nurse providing a tertiary prevention intervention to a population of women who are HIV positive will most likely: a. educate about self-care and the women's rights as employees. b. establish a partnership with a community to initiate a community health center. c. help identify new cases and ensure that clients receive proper treatment. d. teach how to lobby state legislators.

ANS: A Helping clients understand their rights to protect from on-the-job discrimination is part of the nurse-advocate role. Tertiary prevention includes educating women with a chronic disease such as HIV about self-care strategies and health-promotion activities to minimize risky behaviors and poor health outcomes. Enhancing levels of self-esteem and empowerment can prevent feelings of powerlessness and hopelessness, which contribute to vulnerability.

Community health nurses conducting health education among populations vulnerable to HIV infection should explain the natural history of the infection, including the fact that HIV infection may go undetected during the primary infection stage because: a. antibody test results are typically negative. b. antibody production by the immune system increases. c. incubation period is prolonged. d. symptoms include myalgias, sore throats, and rash.

ANS: A Individuals may experience flu-like symptoms such as lymphadenopathy, myalgias, sore throat, lethargy, rash, and fever during the primary stage of HIV infection. Results of an antibody test during this phase are usually negative, so the illness often is not recognized as HIV infection. After a variable period of time, commonly 6 weeks to 3 months, HIV antibodies appear in the blood and can be used to confirm the presence of HIV infection.

When a nurse evaluates the completeness and accuracy of information made available to community residents regarding the impact of rezoning of land parcels for industrial use, the nurse can best be described as: a. advocating for ethical choices. b. communicating risk. c. controlling environmental damage. d. volunteering for service on state boards.

ANS: A Nurses, using sound risk communication skills as trusted communicators, advocate for environmental justice. Ethical issues likely to arise in environmental health decisions are: · Who has access to information and when? · How complete and accurate is the information? · Who is included in the decision making and when? · What and whose values and priorities are given weight in decisions? · How are short-term and long-term consequences considered?

A woman comes to the community health center complaining of increasing lower abdominal pain, fever, and abnormal menses for several months. During the assessment, the client indicates that she is aware that her husband has had multiple sex partners in the past 2 years. Appropriate intervention by the nurse would be to: a. arrange to have the client referred for medical evaluation for pelvic inflammatory disease (PID) and appropriate intervention and treatment. b. contact the health department to confirm the spouse's diagnosis of Chlamydia infection to determine the client's exposure, give the client antibiotics, and have her return to the clinic if symptoms worsen. c. provide STD prevention and treatment education and refer the client to the health department for STD screening for gonorrhea and/or Chlamydia infection. d. supply the client with nonsteroidal anti-inflammatory drugs and caution her to call the after-hours call doctor if her symptoms worsen.

ANS: A Nursing assessment should always include taking a comprehensive sexual history to determine an individual's potential risk for STDs. Each sexual partner is potentially exposed to all the STDs of all the persons with whom their partner has been sexually active. PID is a serious infection involving the fallopian tubes and is the most common complication of gonorrhea, but it may also result from chlamydial infections. Symptoms include fever, abnormal menses, and lower abdominal pain. Symptoms can vary among women. PID can cause ectopic pregnancy, and this should be ruled out in all cases. Stillbirth, premature labor, and infertility are also possible complications.

Congress passed the Balanced Budget Act of 1997 with provisions intended to ensure the appropriateness of home health services for those who received them; however, the act may have increased health disparities for vulnerable populations such as: a. frail older adults. b. low-income families with newborns. c. poor clients discharged from acute care. d. clients requiring intravenous antibiotics.

ANS: A One objective of the balanced Budget Act of 1997 was to curb the rapid growth of home health spending and financial fraud in the home health industry following a shift of hospital reimbursement methods in 1982 (Tax Equity and Fiscal Responsibility Act) through the adoption of prospective reimbursement for home health services. The act's more stringent regulations regarding which services will be reimbursed and for how long may limit access to care for certain vulnerable groups, such as frail older adults, chronically ill individuals whose care is largely home based, and people who are HIV positive.

A school nurse notes that 60 children have missed days of high school because of pertussis this past year and this rate has been relatively constant for the past 5 years. The nurse plans to work with the community to increase awareness of the seriousness of this disease for children younger than 6 months of age and to raise and maintain the immunization rates, because in this community the pertussis is: a. endemic. b. epidemic. c. pandemic. d. sporadic.

ANS: A Pertussis (whooping cough) is caused by the bacterium Bordetella pertussis. It is highly contagious and is considered endemic in the United States. Endemic means that the disease is constantly present within a geographic area or population. Vaccination against pertussis, delivered in combination with diphtheria and tetanus vaccination, is a part of the routine childhood immunization schedule. The increase in adolescent and adult pertussis is alarming not because of the increased morbidity—cases are mild or inapparent in these groups—but because these individuals serve as a reservoir of infection for infants, especially those younger than 6 months of age, who are the most vulnerable to pertussis and the most likely to suffer complications resulting in hospitalization and death.

After hearing about home radon exposure on the news, a man and his wife contact the public health department to inquire about whether or not he should have his home tested. Which stage of the transtheoretical model (TTM) are the man and his wife at in regards to the process of change? a. Preparation b. Contemplation c. Action d. Precontemplation

ANS: A Preparation is the stage where the person intends to do something. Precontemplation is when the person does not plan to change; this may be because the person does not know there is a problem or does not want to do anything about it. In the contemplation stage, the person begins thinking about making a change in the future and examines the pros and cons of doing so. Action occurs when the person actually buys a radon testing kit and uses it in his home.

The World Health Organization (WHO) developed the Five Keys to Safer Food campaign in 2001 to address the problem of foodborne and waterborne diarrheal diseases worldwide. This campaign emphasizes which of the following practices? a. Keep clean, separate raw and cooked, cook thoroughly b. Never use raw, always cook, buy better c. Wash, cut, cook, and throw away d. Wash, cover, and always refrigerate

ANS: A Protecting the nation's food supply from contamination by virulent microbes is a multifaceted issue that is and will continue to be incredibly costly, controversial, and time-consuming to address. The specter of terrorist threats to the food supply adds an additional layer of complexity. However, much foodborne illness, regardless of the causal agent, can be easily prevented through simple changes in food preparation, handling, and storage. WHO estimates that 2.2 million people, most of them children, die annually from foodborne and waterborne diarrheal diseases in less-developed countries. In 2001, WHO initiated a new campaign entitled Five Keys to Safer Food, a simplified version of an earlier campaign that includes the following elements: keep clean, separate raw and cooked, cook thoroughly, keep food at safe temperatures, and use safe water and raw materials.

The clients most at risk of reactivation of latent infections of tuberculosis (TB) are: a. immunocompromised persons, substance abusers, and those with diabetes. b. individuals previously treated for TB. c. long-term cigarette smokers. d. persons with new-onset asthma or emphysema.

ANS: A Reactivation of latent TB infections later in life is common, and the incidence rises in immunocompromised persons, substance abusers, underweight and undernourished individuals, and those with diabetes, silicosis, or gastrectomy.

In the community-based participatory research (CBPR) approach, the use of lay community members to promote health within the community is an effective intervention because community members: a. are best at determining the health needs and plan interventions for their community. b. create a passive partnership. c. provide oversight for the health promotion activities. d. relieve local service providers of mundane tasks.

ANS: A The CBPR approach to community assessment allows understanding of sociocultural contexts, systems, and meaning through a collaborative research process. In CBPR, partnerships are active and community members are involved in assessing, planning, implementing, and evaluating change. Both professionals and community residents determine health needs and plan interventions. As residents increase their awareness, they are better able to determine what they want for themselves, their families, and their community and they are more likely to take leadership roles in program development, using health professionals as consultants.

The local public health nurse (PHN) participates in a town board's community assessment process, which identifies teenage pregnancy as a community concern for action. Based on the Healthy People in Healthy Communities MAP-IT model, a logical next step would be: a. coalition building. b. evaluation of outcomes. c. health-risk assessment. d. wellness appraisal.

ANS: A The MAP-IT technique helps the community plan a path to achieve the change that its members want to see in the community. The Healthy People in Healthy Communities MAP-IT process recommends mobilization of individuals and organizations; assessment of the areas of greatest need, resources, and strengths; the planning of an approach; implementation of the plan; and tracking of progress over time.

An American takes a long-awaited vacation in sunny Mexico, spending days on the beach eating fresh raspberries from a nearby vendor and drinking bottled water. The tourist may be altering: a. agent-host-environment interaction. b. circadian rhythms. c. herd immunity. d. host resistance.

ANS: A The balance among agent, host, and environment is often precarious and may be unintentionally disrupted. Changes in the characteristics of any of these factors may result in disease transmission. Many travelers are at risk for foodborne and waterborne diseases and should be careful to eat only thoroughly cooked foods prepared under reasonable hygienic conditions. Eating foods purchased from street vendors may not be wise. Fruits that can be peeled immediately before eating, such as bananas, are less likely to be a source of infection. Dairy products should be pasteurized and appropriately refrigerated. Only potable water (safe to drink) should be consumed, such as boiled water or bottled water. Other diarrheal diseases may not be related to viral or bacterial infective agents and may be the result of stress, fatigue, schedule changes, and consumption of unfamiliar foods.

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

ANS: A The goal of virtue ethics, one of the oldest ethical theories, is to enable individuals to flourish as human beings. According to Aristotle, virtues are acquired, excellent traits of character that dispose humans to act in accordance with natural good. Examples of such traits in virtue ethics are benevolence, compassion, discernment, trustworthiness, integrity, and conscientiousness.

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

ANS: A The historical, sociological, cultural, psychological, economic, political, communal, environmental, and demographic contexts affect the way ethical issues and dilemmas are formulated and justified.

A community health nurse directly contacts a mammography clinic to arrange an appointment for a migrant worker with limited English language skills. The nurse communicates with the client through an interpreter to ensure that the appointment is scheduled to meet her needs and that the client understands the procedure to be performed. The role played by the nurse in this encounter with a member of a vulnerable population can best be described as: a. advocacy. b. empowerment. c. partnership. d. social justice.

ANS: A The nurse functions as an advocate when referring clients to other agencies and ensuring that the clients' preferences are accommodated.

A PHN in a maternal-child health clinic encounters a client from Ethiopia. The clinic typically sees Hispanic clients. The nurse should first conduct: a. general cultural assessment. b. head-to-toe assessment. c. in-depth cultural assessment. d. nonverbal communication assessment.

ANS: A The nurse proceeds with a systematic identification and documentation of the culture care beliefs, meanings, values, symbols, and practices of individuals and groups within a holistic perspective, which includes worldview, life experiences, environmental context, ethnohistory, language, and diverse social structure influences. Cultural assessments should focus on those aspects relevant to the presenting problem, necessary intervention, and participatory education. During initial contacts with clients, nurses should perform a general cultural assessment to obtain an overview. In-depth cultural assessments are conducted over a period of time. This gives the nurse and client time to get to know each other and is especially beneficial to the client because it allows the client to see the nurse in a helping relationship.

When a situation exists in which there is potential contact with blood or body fluids, health care workers must always perform hand hygiene and wear gloves, masks, protective clothing, and other indicated personal protective barriers. The underlying reason for requiring these practices, known as universal precautions, is that: a. blood and body fluids of all clients need to be handled as if they were infected. b. effective infection control surveillance programs are in place. c. health care settings are reservoirs of infection. d. health care workers do not effectively use hand hygiene.

ANS: A The practice of universal precautions is a policy relevant for all health care settings. In 1985, in response to concern regarding the transmission of HIV infection during health care procedures, the Centers for Disease Control and Prevention recommended implementation of a universal precautions policy in all health care settings. This policy requires that all blood and body fluids from all clients be handled as if they were infected with HIV or other blood-borne pathogens.

A nurse is teaching a postpartum mother how to breastfeed her infant. The nurse notes that the mother is alert and agrees that breastfeeding is important to her and beneficial to her baby. The nurse outlines the expectations of breastfeeding for the mother and the baby and presents the material. In terms of the sequencing of instruction, what should the nurse do next? a. Ask the mother about her previous experience with breastfeeding b. Demonstrate how to position the baby for breastfeeding c. Have the mother demonstrate breastfeeding d. Show the mother a video about breastfeeding

ANS: A To facilitate skill learning, the nurse should teach and demonstrate the skill. The educator should allow learners to practice and immediately correct any errors in performing the skill. The basic sequence of instruction includes nine steps: gain attention, inform the learner of the objectives, stimulate recall of prior learning, present the material, provide learning guidance, elicit performance, provide feedback, assess performance, and enhance retention and transfer of knowledge.

The community-oriented nurse best exemplifies the application of feminist ethics when the nurse: a. designs health care programs for the underserved that incorporate social justice, treat men and women with respect and equity, and include community interventions that elevate the status of the underserved in the community. b. designs health care programs for women that respect their dignity and autonomy. c. ensures that male providers do not use sexist terms when counseling clients and their spouses and when dealing with female colleagues. d. participates in political action committees that focus on women's rights and status in the community.

ANS: A Whereas feminism rejects the devaluing of women and their experiences, believes that the oppression of women is morally wrong, and demands social justice and political action, feminist ethics holds a broader worldview advocating just relationships for both men and women, adopts a feminist perspective that facilitates critical thought, and focuses on broad issues such as power, gender, and socioeconomic structures.

At the request of a local housing authority, a PHN conducted a survey at a public housing facility to determine the need for a nurse-managed clinic. When residents and community leaders were asked what services were most needed from the clinic, they listed well-child screening, parenting education, and medication management. The PHN , the local health department, and the community members collaborated in all phases of the project from planning to evaluation to establish a community nursing center at the site. This example best illustrates the application of population-focused community model at which level? a. Aggregate client system level b. Environmental level c. Family client system level d. Individual client system level

ANS: A Within the integrative model of community health promotion, for the needs of this resident population to be met, it was paramount that the nurse understand the perceived problems of both the housing authority and the residents; the services desired by the residents; the resources available at the facility; and the strengths of the aggregate community to participate actively in the assessment, planning, implementation, and evaluation of a community nursing center. Application of a population-focused community model at the aggregate client system level laid the foundation for an active partnership and sustainable and effective intervention.

A group of six nurses is charged by the nurses' manager with evaluating current unit policies. One month later, the manager determines that the group is ineffective because of lack of cohesiveness. Which of the following group concerns or behaviors would be indicative of lack of cohesion? (Select all that apply.) a. Complaints about the degree of member participation b. Dissatisfaction about demands on their schedules c. Complaints about lack of administrative support d. Lack of a work plan for accomplishing the task e. Vying for leadership

ANS: A, B, C, D, E Cohesion is the attraction between individual group members and between each member and the group that allows them to identify themselves as a unit and work toward common goals, endure frustration for the sake of the group, and defend the group against outside criticism. This attraction increases when members feel accepted and liked by others, see similar qualities in one another, and share similar attitudes and values. Members of a highly cohesive group work toward their common goal, identify with the group, are willing to endure frustration to meet their goals, and recognize the needs of individual members.

The role of the nurse who wants to become more active in environmental health could include which of the following? (Select all that apply.) a. Assessing farmworkers for pesticide exposure and providing pesticide risk education b. Conducting epidemiologic investigations as a public health nurse (PHN) c. Developing corporate policy to protect workers from unsafe levels of toxic agents d. Organizing the local community to encourage landlords to remove lead-based paint e. Working as a skilled risk communicator for a local chemical manufacturer

ANS: A, B, C, D, E Nurses can have a vital role in reducing environmental risk, educating workers and/or the community, and helping to eliminate risks in the local community. As nurses learn more about the environment, opportunities for integration of such work into their practices, educational programs, research, advocacy, and policy work will become evident and will evolve.

Emerging infectious diseases may arise as a result of factors operating singly or in combination, and these factors may include which of the following? (Select all that apply.) a. Environmental changes b. Host behavior c. Improved surveillance d. Microbial adaptation e. Public health infrastructure deterioration

ANS: A, B, D, E Emerging infectious diseases are those for which the incidence has actually increased over the past several decades or has the potential to increase in the near future, and these include both new and known infectious diseases. New viruses may appear as a result of microbial adaptation, activities and behaviors of human hosts, and environmental changes. Relevant environmental changes include such things as weather changes, deforestation, urbanization, and industrialization. Human activities and behaviors that influence the spread of these diseases include increased use of daycare centers, illegal drug use, changing sexual behavior, use of modern modes of transportation, use of air conditioning, immigration, and global travel.

Disaster-related nursing is an evolving specialty. Nurses have unique skills that can be applied in which of the following aspects of disaster management? (Select all that apply.) a. Completion of the American Red Cross disaster management course and registration as a disaster responder b. Clinical management of blast lung injury c. Engagement of the BioWatch system d. Monitoring of the environment to contain infectious disease e. Planning and organization of mass prophylaxis and vaccine campaigns

ANS: A, B, D, E Nurses have skills in assessment, planning, implementation, evaluation, education, priority setting, collaboration, and provision of health care services to address both preventive and acute care needs. These skills sets are important in the four stages of disaster-related work prevention (planning/drill participation), preparedness, (course work/registration), response (clinical expertise), and recovery (monitoring). BioWatch is a system of sensors that test the air in several major metropolitan areas for biological agents that terrorists might use. This technology-based early warning system is distinctly different from BioSense, which is a public health surveillance initiative that is intended to serve as a biosurveillance program for early detection and quantification of a bioterrorism event or disease outbreak. Nursing skill sets lend themselves to participation in BioSense.

A client diagnosed with HPV infection states, "I'm not concerned, I know the warts disappear after a while." The nurse should counsel the client regarding which of the following? (Select all that apply.) a. Link between HPV and cervical cancer b. Status of HPV infection as a reportable disease c. Need to eliminate the warts d. Serious complications of HPV infection for men e. Lack of cure for HPV infection

ANS: A, C, E The complications of HPV infection are especially serious for women. The link between HPV infection and cervical cancer has been established, and this cancer is associated with specific types of the virus. HPV infection is exacerbated during pregnancy and immune-related disorders, a fetus may become infected, and there is no cure. Although the warts will disappear over time, the goal is to eliminate the warts through surgical removal and other treatments to prevent skin-to-skin contact with them.

A nurse overhears the doctor saying, "Let's not give the client codeine, he's Asian." The nurse reflects on the comment and determines that the doctor is which of the following? (Select all that apply.) a. Culturally competent b. Prejudiced c. Ethnocentric d. Unable to assess pain based on culture e. Planning care based on racial enzymatic differences

ANS: A, E Biological variations distinguish one racial group from another. These differences may occur in the areas of growth and development, skin color, enzymatic differences, and susceptibility to disease. Research findings suggest that sensitivity to codeine varies with ethnic background. Asian men experience significantly weaker effects from use of 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 his or her pain, and other pain-reducing medications should be explored.

Health education is often used as a strategy in working with vulnerable populations. The benefits of health education can be greatly affected by the individual's or group's: a. cycle of dependency. b. health literacy. c. level of income. d. race and ethnicity.

ANS: B A new concern for public and community health nurses is whether the populations with whom they work have adequate health literacy to benefit from health education. Health literacy is a measure of the client's ability to read, comprehend, and act on medical instructions. It may be necessary to collaborate with an educator, an interpreter, or an expert in health communications to design messages that vulnerable individuals and groups can understand and use.

The population group that is likely to be the MOST vulnerable is: a. children with a family history of sickle cell disease and hypertension. b. homeless pregnant teens in a substance abuse program. c. nNative Americans at risk for diabetes. d. overweight children.

ANS: B A vulnerable population group is a subgroup of the population that is more likely to develop health problems as a result of exposure to risk and to have worse outcomes from these health problems than the rest of the population. That is, the interaction among many variables creates a more powerful combination of factors that predispose the person to illness. Vulnerable populations often experience multiple cumulative risks, and they are particularly sensitive to the effects of those risks. Examples of vulnerable populations of concern to nurses are persons who are poor and homeless, people with special needs, pregnant teens, migrant workers and immigrants, individuals with mental health problems, people who abuse addictive substances, persons who have been incarcerated, persons with communicable diseases and those who are risk, and persons who are human immunodeficiency virus (HIV) positive or have hepatitis B virus or sexually transmitted diseases (STDs).

A state public health region reported 39 cases of meningitis in children 15 years of age and younger to date this year. Seven of those children died. The total population of the region is 780,000, of whom 84,000 are children age 15 years old and younger. Only four cases of meningitis were reported in the public health region during the previous year. No other public health region in the state has an incidence of meningitis that is higher than expected for that region. Based on the information given, the relative frequency of meningitis in the region at this time can best be described as: a. endemic. b. epidemic. c. pandemic. d. sporadic.

ANS: B An epidemic occurs when the rate of disease, injury, or other condition exceeds the usual (endemic) level of that condition.

In an effort to address West Nile virus, a community increased livestock immunization, began a vector control program, and initiated a community campaign to eliminate standing water reservoirs. This best exemplifies communicable disease control through: a. health education. b. multisystem approach. c. improved public health infrastructure. d. reduction of environmental hazards.

ANS: B Communicable diseases represent an imbalance in the usually harmonious relationship between the human host and the environment. This state of imbalance provides the infectious agent an opportunity to cause illness and death in the human population. Given the many factors that can disrupt the agent-host-environment relationship, a multisystem approach to the control of communicable diseases must be developed.

A new group of migrant farmworkers has arrived in a community. The local public health nurse (PHN) realizes that an important step before scheduling clinic services is to: a. consult the public health staff regarding their scheduling preferences. b. learn about the farmworkers' concept of time and their work schedule to determine when and how services can best be scheduled. c. review written materials about the farmworkers' culture of origin. d. visit the farmworker camp and tell the camp leaders when clinic services will be available.

ANS: B 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.

The monitoring and public reporting of air quality in a local community to assist individuals with asthma or other respiratory conditions best illustrates the application of: a. compliance and enforcement. b. environmental epidemiology. c. secondary prevention. d. toxicology.

ANS: B Epidemiologic studies enable us to understand the strength of the association between exposures and health effects, such as the relation between air pollution and asthma exacerbation.

A business executive develops flu-like symptoms 1 day after returning by air from a trans-Atlantic 2-day conference that involved lengthy meetings into the evening. The scenario best illustrates the interaction of: a. host and agent. b. host, agent, and environment. c. risk and causality. d. morbidity and disease.

ANS: B Epidemiologists understand that disease results from complex relationships among causal agents, susceptible persons, and environmental factors. These three elements—agent, host, and environment—are called the epidemiologic triangle. Changes in one of the elements of the triangle can influence the occurrence of disease by decreasing or increasing a person's risk of disease.

A nurse helping to form a group to deal with ongoing industrial pollution within a community understands that effective groups: a. are larger and comprised of recognized community leaders. b. can have individuals with diverse interests and yet be influential in changing the larger community. c. must include members of all involved parties, including political, corporate, health, and environmental leaders. d. should be small with informal leadership and relationships within the group.

ANS: B Groups of individuals with diverse interests can influence and change the larger social community. Alliances or coalitions unite diverse interest groups who share a common interest in perceived threats to community health, and nurses may work with groups both for community analysis and vehicles for change.

A client comes to the local clinic with acute symptoms of fever, nausea, lack of appetite, malaise, and abdominal discomfort. During the course of the assessment, the nurse determines that the client is a health care aide working at a daycare center. These facts are important because: a. acute hepatitis B is self-limiting. b. hepatitis A outbreaks commonly occur in facilities where staff change diapers. c. hepatitis C is a "silent stalker." d. individuals with chronic liver disease are at greater risk for hepatitis A.

ANS: B Hepatitis A virus is most often transmitted through the fecal-oral route. It remains the most frequently reported vaccine-preventable disease. Outbreaks are common in daycare centers where staff must change diapers, among household and sexual contacts of infected individuals, and among travelers to countries were hepatitis A is endemic.

Which objective includes all of the critical elements of an educational objective? a. After attending the diabetic education class, the client will prepare a meal plan. b. At the end of self-management training, the client will prepare a daily food plan that meets the 1800-calorie per day American Diabetes Association (ADA) diet guidelines. c. The diabetic client will prepare a list of the five food groups and the number of servings from each group that are necessary for an 1800-calorie diet following ADA guidelines. d. The client and his wife will attend all of the diabetic education classes to learn to prepare meals consistent with ADA diet guidelines.

ANS: B Objectives are specific, short-term criteria that need to be met as steps toward achieving a long-term goal. Objectives are written statements of an intended outcome or expected change in behavior and should define the minimum degree of knowledge or ability needed by the client. They must be stated clearly and defined in measurable terms. Objectives are different from goals, which are broad, long-term, expected outcomes.

An unemployed individual with acquired immune deficiency syndrome (AIDS) develops recurrent opportunistic infections that require repeated visits to the health clinic and the purchase of various medications to combat the infections and treat their associated side effects. This best demonstrates how the stress caused by poor health status can be related to: a. barriers to access. b. cascade effects. c. cumulative risk. d. socially based inequity.

ANS: B Poor health status creates stress. Vulnerable populations cope with multiple stressors, and this creates a cascade effect, with chronic stress likely to result. Chronic stress can lead to feelings of hopelessness. Hopelessness results from an overwhelming sense of powerlessness and social isolation that contributes to a continuing cycle of vulnerability. Each factor, such as lack of employment, lack of insurance or underinsurance, the disease process, transportation challenges, limited resources, and complications of treatment can predispose individuals to poor health status. The outcomes of vulnerability reinforce the predisposing factors, which leads to more negative outcomes. This cycle of vulnerability must be broken in order for vulnerable populations to change their health status.

A nurse takes the time to read and understand the community's disaster plans and participates in mock disaster drills as a leader of the triage team. The nurse obtained disaster management training through the local Red Cross chapter and registered with the state as a disaster management nurse. The best description of the nurse's activities is: a. American Red Cross disaster training. b. community preparedness. c. personal preparedness. d. professional preparedness.

ANS: B Preparedness takes place at three levels: personal, professional, and community. The nurse who is professionally prepared is aware of and understands the disaster plans at the workplace and in the community. Preparedness also involves the development of the knowledge one needs to respond to specific types of incidents (chemical, biological, radiological, nuclear, and explosive events, and those involving weapons of mass destruction): how to treat those injured by each, how to use personal protective equipment, and how to work safely near dangerous materials. Nurses who seek greater participation or desire more in-depth understanding of disaster management can become involved with any number of community organizations that are part of the official response team. After receiving formal disaster training nurses can register with national and state registries to provide disaster response when needed. The importance of being adequately trained and properly associated with an official response organization to ensure an orderly, effective, and efficient response cannot be overstated.

The Superfund Amendments and Reauthorization Act (SARA) increased the involvement of the states and their citizens in the cleanup of toxic waste sites and stressed the importance of permanent remedies and innovative treatment technologies. Another important aspect of this federal legislation was that it: a. provided for the appointment of state emergency response commissions. b. increased focus on the human health problems related to hazardous waste sites. c. established a new safety standard of reasonable certainty of no harm that is to be applied to all pesticides used on food. d. reduced the amount of pollution by mandating cost-effective changes in production, operation, and raw materials use.

ANS: B SARA changes included an increase in the size of the trust fund; encouraged greater citizen participation in decision making on how sites should be cleaned up; increased state involvement in every phase of the Superfund program; increased focus on human health problems related to hazardous waste sites; established new enforcement authorities and settlement tools; stressed the importance of permanent remedies and innovative treatment technologies in the cleanup of hazardous waste sites; provided for Superfund actions to consider standards in other federal and state regulations; and established the federal Agency for Toxic Substances and Disease Registry. This act amended the Comprehensive Environmental Response, Compensation, and Liability Act with provisions for a broader community-level involvement and public health mission to address the effects of hazardous waste sites on people.

Many behaviors place any individual—regardless of age, gender, ethnicity, or other characteristics—at greater risk for STDs. The nurse should include primary prevention interventions in all client encounters through the discussion of: a. partner notification. b. safer sex. c. standard precautions. d. STD testing.

ANS: B Sexual abstinence is the best way to prevent STDs; however, for many people it is not realistic. Therefore, education about how to make sexual behavior safer is critical. Safer sexual behavior includes masturbation, dry kissing, touching, fantasy, and vaginal or oral sex with a condom. Nurses should not base assessments on considerations of age, gender, ethnicity, or any other factor, but should discuss safe sex in all client encounters.

A 6-year-old is brought to the emergency department with a full-body rash and fever. During the nursing assessment, which of the following findings would be most relevant to recognizing the case as potential smallpox rather than varicella? a. Fever has responded to acetaminophen, and the child is playful when temperature is not elevated. b. Fever of 101°F was present for several days before the rash appeared. c. Low-grade fever (100°F or less) has been present ever since the rash became obvious. d. Rash is primarily on the trunk of the body.

ANS: B Smallpox is associated with a sudden onset of fever, severe body aches, and occasional abdominal pain and vomiting, as in influenza. The rash, which is centrifugal with same-stage lesions in all areas but most abundant on the face and extremities, follows 2-4 days after the fever begins decreasing. With chickenpox, the rash is centripetal, with lesions most abundant on the trunk or in areas covered by clothing; the rash is present at the onset of symptoms, such as a slight fever with mild constitutional symptoms, and can appear as multiple crops of lesions at various stages of development (maculopapular lesions, vesicular lesions, or granular scabs).

A college health nurse is working with students, faculty, and staff to improve environmental air quality. To address the primary cause of air pollution on campus, the nurse plans a precautionary intervention. Which of the following interventions best demonstrates an appropriate approach? a. Encourage the use of electric cars and scooters on campus b. Increase the use of bicycles, foot-powered scooters, rollerblades, and walking as the primary mode of transportation on campus c. Make the entire campus a no-smoking zone d. Establish a policy to reduce electricity consumption in university buildings by raising the thermostat to 78° in the summer and lowering the thermostat to 70°in the winter

ANS: B The burning of fossil fuels to power automobiles and buses and to generate electricity is the single greatest source of air pollution in the United States. While reducing the use of electricity on campus is helpful, the single biggest source of campus air pollution is the cars and buses used to drive to and around campus. Decreasing their use is also an application of the precautionary principle.

A nurse diabetic educator who recently returned from a professional conference decides to present current best practices and research findings at a gathering of newly diagnosed diabetic clients. In adopting this approach, the nurse may fail to provide health education effectively. This failure would relate to which domain of learning? a. Affective b. Cognitive c. Psychomotor d. Practice

ANS: B The domains of learning are the cognitive, affective, and psychomotor domains. For health education to be effective, the community-oriented nurse must first assess the cognitive abilities of the learner, so that the nurse's expectations and plans are directed to the correct level. Teaching above or below the client's level of understanding may lead to frustration and discouragement.

A clinic-based public health nurse (PHN) has launched an aggressive community health education media campaign to increase the number of fully immunized children within the health district. Which evaluation process would best assess the impact of this strategy at the overall community level? a. Analysis of the immunization clinic appointment rate over the next few months b. Analysis of the trend in childhood immunization rates for the health district c. Assessment of the immunization status of each child who visits the clinic d. Determination of the budgetary impact of the media campaign on the clinic's operations

ANS: B The evaluation of health and behavioral changes can focus on both short-term and long-term effects. Long-term evaluation is geared toward following and assessing the lasting effects of the education program. Long-term evaluation is often the approach used by community health nurses to analyze the effectiveness of an education program for the entire community, not the health status of a specific individual client. Understanding the impact of the educational program in producing change in the community health status allows the health district to make wise choices in addressing the community's needs.

An extensive train derailment occurs in the suburbs of a large metropolitan area. First responders determine that although no fatalities occurred, the derailed cars contain a noxious gas that diffuses readily into the air. The event easily overwhelms the capability of the local responders and hazmat teams are required. The local office of emergency management would coordinate through the emergency operation center to request assistance through which of the following? a. Environmental Protection Agency (EPA) b. Mutual aid agreement c. NIMS d. National Response Plan

ANS: B The first level of disaster response occurs at the locality, with mobilization of entities such as the fire department, law enforcement, public health agencies, and voluntary organizations like the Red Cross. If the disaster warrants significant local attention and overwhelms the capacity of the local responders, then the county or city office of emergency management will coordinate activities through the emergency operation center. Generally localities within a county are signatories to a regional or statewide mutual aid agreement. This agreement provides that the signatories will assist one another with needed personnel, equipment, services, and supplies. Mutual aid agreements are established between facilities and other emergency responding entities within localities, jurisdiction(s), and states; between states; and across borders to ensure seamless service in responding to disaster events, whether caused by people or by nature. When state resources and capabilities are overwhelmed, the governor may request federal assistance under a presidential declaration of disaster or emergency.

A nurse is assigned to teach clients STD prevention information. The nurse updates her teaching plan to incorporate new guidelines from the Centers for Disease Control and Prevention. She includes which of the following as updated information during her next teaching session? a. Always use spermicides with condoms to reduce the risk of contracting chlamydia or gonorrhea. b. Condoms can be effective in preventing infections transmitted by fluids from mucosal surfaces but are not always effective in preventing infections transmitted by skin-to-skin contact. c. Condoms should not be used during oral sex, because they are not effective in preventing transmission of infection. d. When genital ulcers are present, condoms should be used to prevent the spread of infection.

ANS: B The lesions of HSV-2 and HPV infection as well as other lesions capable of transmitting STDs can occur on all parts of the male and female genitalia and rectum. Condoms are effective in reducing transmission via body fluids from the penis and vagina. However, lesions not covered by a male or female condom can still transmit infection even with proper condom use.

A community-oriented nurse understands that the most important use of the principles for effective advocacy is to: a. act as a friend and advocate for the target population served to promote research and data gathering. b. act in the community's best interest, in keeping with community direction, while maintaining diligence, ongoing communication, and confidentiality. c. ensure that public funds are spent only for the priorities stated in the legislation that authorized program funding and promote regulations and legislation. d. give more priority to the opinions and feelings of key community leaders than to data when determining program priorities.

ANS: B The six principles of effective advocacy include acting in the community's best interest, acting in accordance with the community's wishes, keeping the community informed, acting with diligence, maintaining impartiality, and maintaining confidentiality. Bateman's practical framework for advocacy places the advocate's core skills within the context of the six principles of effective advocacy.

Which of the following community health improvement projects uses subjective health perspective? a. Health-promotion project aimed at monitoring an adolescent's compliance with an asthma treatment regimen b. Project aimed at improving flexibility and stamina of residents of an assisted-living facility through participation in a yoga and relaxation program c. Project aimed at teaching clients with diabetes how to maintain glucose control by using a sliding scale for dosing insulin d. Program aimed at improving school performance by teaching high school teachers how to detect drug abuse and screen students for drug use

ANS: B The subjective life process approach involves taking a holistic view of the person's total lifestyle and not judging simply by compliance with a prescribed regimen. The focus is on improving health through lifestyle changes and other health-promoting interventions consistent with the focus of care in a multidimensional client system in the integrative community health promotion model.

A nurse is concerned about the accuracy of the purified protein derivative (tuberculin) test in screening individuals with tuberculosis exposure for follow-up chest radiography. The nurse's concern is related to which aspect of the test's validity? a. Reliability b. Sensitivity c. Specificity d. Variability

ANS: B The validity of a screening test is measured by its sensitivity and specificity. Sensitivity quantifies how accurately the test identifies those individuals with the condition or trait of interest. Sensitivity is calculated as the proportion of persons with the disease that the test correctly identifies as having the disease (true positives). High sensitivity is needed when early treatment is important and when the identification of every case is important. Accurate identification is cost-effective and timely.

A nurse integrates a structured exercise into her classroom presentation on effective handwashing that assists students in demonstrating and modeling good handwashing techniques. The principle followed by an effective educator that is best demonstrated by this approach is: a. create the best learning environment. b. encourage participatory learning. c. organize the learning experience. d. select the learning format.

ANS: B There are six principles that guide the effective educator: send a clear message, select the learning environment, create the best learning experience, organize the learning experience, encourage participatory learning, and provide evaluation and feedback. People learn better when they are actively involved in the learning process. Participation increases motivation, flexibility, and the learning rate.

A community health nurse manager has integrated exposure history elements into the assessment practices of the health department that are relevant to the urban industrial community served. This strategy indicates that the nurse manager is aware of the relationship between: a. community strengths and weaknesses. b. environment and human health/disease. c. toxicology studies conducted by the Environmental Protection Agency and the environment. d. federal and state environmental regulations.

ANS: B Understanding the relationship between the environment and human health and disease has become more important over the years. The environment is now known to play a role as a determinant of health status, an explanation of disease, an influence on health risk, and a cause of human toxicity and the ever-increasing burden of potentially toxic synthetic chemicals that our bodies carry.

When the association between maternal alcohol use and low birth weight is being studied, the nurse investigator's failure to consider the variable of smoking could introduce bias into the observed association, because smoking has a correlation with both factors. This effect could best be described as: a. causality. b. confounding. c. information bias. d. selection bias.

ANS: B When looking for the existence of statistical association between some factor and a health outcome, the investigator must consider the three general categories of bias. Bias is a systematic error resulting from study design, study execution, or confounding. Bias resulting from the relationship of the outcome and the study factor with some third factor not accounted for in the study design is called confounding. In practice, one can often identify potentially confounding variables and adjust for them in analysis.

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

ANS: B, D 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; maintaining trustworthiness; and advocating for disenfranchised persons within the community.

Vulnerable population groups are those that, in comparison with the population as a whole, have which of the following characteristics? (Select all that apply.) a. Better access to health care services but poor health outcomes b. Greater likelihood of exposure to risk factors c. Multiple risk factors but equal health outcomes d. Worse health outcomes

ANS: B, D Vulnerable populations are defined as those at greater risk for poor health status and health care access. In health care, risk is an epidemiologic term indicating that some people have a higher probability of illness than others. The natural history of disease model explains how certain aspects of physiology and the environment make it more likely that a certain individual will develop a particular health problem. However, not everyone who is at risk develops health problems. Some individuals are more likely to develop the health problems for which they are at risk. A vulnerable population group is a subgroup of the population that is more likely to develop health problems as a result of exposure to risk or to have worse outcomes from these health problems than the rest of the population.

A group's culture is created by the combination of its norms. The nurse supports helpful rules, attitudes, and behaviors in the group because group norms do which of the following? (Select all that apply.) a. Challenge the cohesiveness of the group b. Ensure movement toward the group's purpose and tasks c. Identify message pathways and member participation d. Influence members' perceptions and interpretation of reality e. Maintain the group through various supports to members

ANS: B, D, E Group norms set the standards for group members' behaviors, attitudes, and perceptions. All groups have norms and mechanisms to accomplish conformity. Group norms serve three functions: they ensure movement toward the group's purpose and tasks (task norms), they maintain the group through various supports to members (maintenance norms), and they influence members' perceptions and interpretations of reality (reality norms). Group norms combine to create group culture. Nurses working with groups should not dictate norms but support helpful rules, attitudes, and behaviors within the group. The role of the nurse becomes one of providing accurate information, confirming the possibility/attainability of the group's goals, and encouraging different/positive perspectives.

ANS: C A proportion is a type of ratio in which the denominator includes the numerator. The prevalence proportion is a measure of existing disease in a population at a particular time and is calculated by dividing the number of existing cases by the current targeted population. In this example, 39 cases divided by the total number of children age 15 years and younger in the population (which is 84,000 children) = 0.0004642 ´ 100,000 = 46.42/100,000.

Although infectious disease epidemics are still the major cause of death worldwide, they have subsided in the United States because of improvements in nutrition and sanitation, the discovery of antibiotics, and the development of vaccines. Infectious diseases have not vanished, however, and remain a continuing cause of concern. Healthy People 2020 has a number of objectives aimed at reducing these illnesses because of the morbidity, mortality, and costs associated with infectious diseases. One such costly disease trend related to an increase in the performance of invasive diagnostic and surgical procedures, the use of broad-spectrum antibiotics, and treatment with immunosuppressive drugs is the rise of: a. Escherichia coli 0157:H7. b. multisyndrome effect. c. health care-associated infections. d. severe acute respiratory syndrome.

ANS: C Although infectious diseases may not be the leading cause of death in the United States at the beginning of the twenty-first century, they continue to present varied, multiple, and complex challenges to all health care providers. One trend in the United States is the rise of health care-associated infections. Pennsylvania, the first state in the country to examine the costs of these infections, reported that health care-associated infections led to $2 billion in additional hospital charges and at least 1500 preventable deaths in 2004. Health care-associated infections are acquired during hospitalization or develop within a hospital setting and were previously known as nosocomial or hospital-acquired infections. The performance of invasive diagnostic and surgical procedures, the use of broad-spectrum antibiotics, and treatment with immunosuppressive drugs, along with the original underlying illness, leave hospitalized clients particularly vulnerable to infection by virulent agents carried by other clients and indigenous hospital flora transmitted by health care staff.

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 physician (PCP). Because this nurse is culturally competent with Asian clients, the nurse contacts the client's PCP to discuss replacing this medication with another pain-reducing drug. The nurse's action can best be described as an example of: a. cultural accommodation. b. cultural assessment. c. cultural brokering. d. cultural repatterning.

ANS: C Cultural brokering is an action used by nurses in delivering culturally competent care. Cultural brokering is advocating, mediating, negotiating, and intervening between the client's culture and the biomedical health care culture on behalf of the client.

Which of the following article titles include(s) an example of epidemiologic distribution and determinants? a. Can Operating Room Nurses Measurably Reduce Patient Anxiety? b. Characteristics of Patients Newly Diagnosed with Tuberculosis c. Comparison of Postinsecticide Exposure Incidence of Atopic Dermatitis in Migrant Farmworkers and Land-Owning Farmers in Southwestern Utah d. Postpartum Nurses' Reaction to Rotating Shifts Compared with Assigned Stable Shift

ANS: C Epidemiology investigates the distribution (patterns) and the determinants (factors such as exposure, characteristics, and behaviors) of health events in a population. Distribution addresses "Who, what, where, when, and why?" and determinants address "How did the health event occur?" and "Why are some affected more than others?"

The nurse recommends Parents Without Partners to a colleague who is experiencing the challenges of single parenthood in raising a teenager. The nurse is demonstrating an understanding of the group elements of: a. cohesion and task functioning. b. leadership and role structure. c. member interaction and group purpose. d. norms and maintenance.

ANS: C Health-promoting groups may form when people meet in community and health care settings and discover common challenges to their physical and mental well-being. People often make changes with the support of a group that they are unable to make independently. Health-promoting groups like Alcoholics Anonymous and Parents Without Partners improve members' health and deal with specific threats to health.

In the disease-oriented perspective, in which health is objectively defined as the absence of disease and health care is focused on identifying what is not working in a given system and repairing it, health behavior is based on client: a. access to care. b. adjustment of lifestyle. c. compliance with a prescribed regimen. d. response to treatment.

ANS: C In the disease-oriented perspective, health is objectively defined as the absence of disease, and humans are conceptualized as composed of organ systems and cells. Therefore, health care focuses on identifying what is not working in a given system and repairing it. In this paradigm, health behavior is viewed as how the client complies with the recommendations of the health professional.

A child learns at a school safety presentation the importance of wearing a bicycle helmet and requests a helmet for a birthday gift. The parent purchases a helmet like the ones worn by the child's peers. Which of the following statements best describes the relationship of healthy or risky behaviors to lifestyle choices? a. The family is responsible for the health behaviors of children. b. The individual is responsible for health behaviors. c. There is multilevel responsibility for health behaviors. d. The community has a sense of responsibility for health behaviors.

ANS: C In the ecological perspective, individuals ultimately make decisions to engage in healthy or risky behaviors, and lifestyle improvement efforts typically focus on the individual as the target of care. From a public health perspective, however, risky behaviors may have significant implications for the overall health status of the community and contribute to health-related economic losses of the community. Health behaviors have multiple determinants that are both internal and external to the individual, family, community, and society.

A local health department in the Midwest reports cases of certain diseases to the state health department for inclusion in the National Notifiable Diseases Surveillance System (NNDSS). From the perspective of community-level disease monitoring, which of the following 3-year trends in incidence rates for hepatitis A would be of local, state, and national interest? a. 2012 = 2/100,000; 2013 = 3/100,000; 2014 = 1/100,000 b. 2012 = 4/100,000; 2013 = 8/100,000; 2014 = 6/100,000 c. 2012 = 12/100,000; 2013 = 8/100,000; 2014 = 31/100,000 d. 2012 = 16/100,000; 2013 = 24/100,000; 2014 = 9/100,000

ANS: C In this community's report, the incidence of hepatitis A in 2014 was more than double the incidence in 2012. At the community level, a disease may occur in endemic, epidemic, or pandemic proportions. An epidemic is the occurrence of disease in a community or region at a rate in excess of normal expectations. Although people tend to associate large numbers of cases with epidemics, even one case can be termed an epidemic if the disease is considered to have been previously eliminated.

After performing an assessment of a client seeking treatment for hypertension at the local free clinic, the nurse informs the client that the family's children may qualify for enrollment in the state children's health insurance program. The nurse provides the enrollment forms and reviews them with the client, emphasizing how to apply for the benefits. This best exemplifies which principle for intervening with vulnerable populations? a. Carrying out primary prevention b. Setting family-centered, culturally sensitive goals c. Trying to minimize the "hassle factor" d. Using the MAP-IT approach

ANS: C Nurses empower clients by helping them acquire the skills needed to engage in healthy living and to be effective health care consumers. Vulnerable individuals and families may need to go to multiple agencies to find the services for which they qualify, because agencies tend to be specialized instead of comprehensive in their service approach. More agencies are needed that provide comprehensive services with nonrestrictive eligibility requirements. Outreach and case finding are important roles for the nurse in reducing health disparities. One of the principles of intervening with vulnerable populations is to try and minimize the "hassle factor."

Vulnerability is multidimensional, and one of the primary contributors to vulnerability is: a. gender. b. race and ethnicity. c. resource limitations. d. urban or rural residency.

ANS: C Resource limitations are strongly related to health. Lack of adequate social, educational, and economic resources make people more vulnerable and more likely to experience health disparities, and poverty is a primary cause of vulnerability. A correlation has been found between individual indicators of socioeconomic status (e.g., income, education, and occupational status) and a range of health indicators (e.g., morbidity and mortality resulting from various health problems). Not only do individual-level socioeconomic characteristics seem to matter, but population-level characteristics such as income inequality also make a difference. Resource limitations affect the individual's ability to show resilience in the face of problems and crises. Resource limitations may also place individuals and families at risk because of substandard housing, impoverished neighborhoods, and hazardous environments. Although race has been correlated with poor health outcomes, poverty seems to be a key contributing factor for minority populations. Poverty is more likely to affect women and children than other groups.

An example of secondary prevention of infectious disease is: a. malaria chemoprophylaxis. b. Pneumocystis carinii pneumonia chemoprophylaxis for people with AIDS. c. quarantine. d. restaurant inspections.

ANS: C Secondary prevention interventions related to infectious disease prevent the spread of disease. Primary prevention interventions prevent the occurrence of disease, and tertiary prevention interventions reduce the complications and disabilities of disease through treatment and rehabilitation. Secondary prevention activities center on rapid identification of potential contacts of a reported case. Contacts may be identified as new cases and treated or classified as possibly exposed and given appropriate prophylaxis. Public health laws also assist in secondary prevention because they require investigation of certain disease cases and initiation of preventive measures for individuals affected by a reported case or outbreak of communicable disease. These interventions can include quarantine and can be applied to the entire community if the exposure potential is deemed great enough, as could happen with an outbreak of smallpox or epidemic influenza.

A nurse teaches an asthmatic client to recognize and avoid exposure to asthma triggers and assists the client's family in implementing specific protection strategies in the home, such as removing carpets and avoiding pets. This nurse's activities can best be described as: a. comprehensive assessment. b. primary prevention. c. secondary prevention. d. treatment intervention.

ANS: C Secondary prevention refers to interventions that promote health and prevent complications of an existing disease, injury, or disability. A prevention intervention at this level is aimed at individuals and groups who have been diagnosed with a disease and have discernible pathology (state of prepathogenesis).

A community-oriented nurse wants to design the most effective intervention to reduce CHD morbidity and mortality in a rural area. The program approach should incorporate the strategies of: a. aggregate primary prevention. b. individual-level primary, secondary, and tertiary prevention. c. multilevel intervention with a focus on primary, secondary, and tertiary prevention. d. promotion of optimal health for the individual, family, aggregate, and total community.

ANS: C The Framingham, Alameda, and other studies have shown that effective health promotion must incorporate strategies that deal with all levels in the community—individual, family, aggregate, and total community; that is, they must adopt a multilevel approach. These studies also demonstrate that a program to reduce CHD morbidity and mortality needs to incorporate primary, secondary, and tertiary prevention strategies. An integrated model of community-oriented nursing care reflects the four client systems and multiple foci of care approach.

A client newly diagnosed with HPV infection, herpes simplex virus 2 (HSV-2) infection, and syphilis asks, "Okay, so how do I get rid of all this stuff?" In developing a plan of care, the nurse recognizes that it is essential to address: a. correct use of condoms to prevent transmission of all STDs. b. cures for each of the STDs identified. c. risk of skin-to-skin contact in transmitting the identified STDs. d. safety of sexual contact in the absence of lesions.

ANS: C The client needs to understand which STDs are transmitted by skin-to-skin contact and which are transmitted by body fluids. The client also needs to understand which infections are curable with antibiotics (syphilis) and which are virus infections that are treatable but not curable (HPV, HSV-2 infections). In HSV-2 infection, although the ability to pass the infection is higher when active lesions are present, some individuals can spread the infection even when they are asymptomatic. HPV transmission occurs through direct contact with the warts that result from HPV, but the virus has also been detected in semen, and exposure to the virus through body fluids is also possible. In addition, the challenge of HPV prevention is that condoms do not necessarily prevent infection because warts can grow in areas that are not covered by barriers such as condoms and skin-to-skin contact may occur.

A nurse is working with a disaster medical assistance team as it responds to a disaster. A new team member excitedly insists that its personnel can exceed their 12-hour shifts and do not need breaks. The best intervention on the part of the nurse is to: a. arrange for the team member to be transferred to another unit. b. arrange for the team member to leave duty, return home, and talk with his or her pastor. c. educate the rescuer about necessary stress-management techniques and offer to pair up with the individual so that each can monitor the other's stress level. d. help the team member to call home to speak with his or her family.

ANS: C The nurse needs to be aware that rescue workers are repeatedly exposed to stress and, despite their training in managing such situations, have a higher than normal risk of developing post-traumatic stress syndromes. The nurse can assist the new team member by educating the rescuer about the importance of stress-management and self-management techniques. The nurse could pair up with the new team member so that they could monitor each other's stress responses and could provide guidance in adhering to stress management techniques.

A Public Health Service nurse employed by the Indian Health Service is working with a client diagnosed with cancer. The client uses sweat lodges to "cure the disease." The nurse understands the need for the client to use traditional healing practices. The nurse is integrating her knowledge of the cultural organizing factor of: a. biological variations. b. communication. c. environmental control. d. space.

ANS: C The nurse understands that in the client's culture, disease is often perceived as a disharmony with other forces, and clients may look to hot or cold treatments to resolve or cure a cancerous condition. Clients may use the mind-body-spirit connection to heal from within. Such cultures rely on naturalistic solutions such as herbs, hot and cold treatments, and acupuncture to resolve or cure a cancerous condition.

In an effort to decrease health disparities and improve life expectancy, the Social Security Act was amended in 1998 to provide federal funding to: a. assure access to health care for elderly Americans. b. build hospitals to care for the medically indigent. c. insure children without health insurance. d. provide supplementary income for citizens with disabilities.

ANS: C Title XXI of the Social Security Act, passed in 1998, established the State Children's Health Insurance Program to provide funds to insure currently uninsured children. Legislation enacted subsequently provided for new outreach and case-finding efforts to enroll eligible children in Medicaid.

A nurse has worked for years in an intensive care unit and decides to take a position as a community health nurse directing a local public health unit. Her first assignment is to perform an assessment of the community's migrant farmworker population. The nurse's most appropriate next step is to: a. begin the community assessment using a survey tool proven effective in previous public health unit assessments. b. perform a literature review to study assessment data for similar populations. c. enroll in a community health nursing graduate course to learn community research, measurement, and analysis techniques. d. form a relationship with the farmworkers' community leaders and other key informants.

ANS: C 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.

An occupational health nurse practitioner's physical assessment of a factory worker identifies an acute-onset pruritic dermatitis extending over the face, hands, neck, and forearms. The nurse's priorities should be to: a. contact factory senior management, educate workers about their exposure, and clean the area. b. contact the Occupational Safety and Health Administration immediately and remove the offending chemical in the work environment. c. immediately evacuate the worker's nearby workspace and treat the worker and other exposed workers. d. treat the client and obtain a comprehensive exposure history; if an on-site environmental exposure is suspected as the cause, screen other at-risk workers and ensure that the environmental risk is identified and eliminated.

ANS: D A careful history should be taken using the I PREPARE (Investigate potential exposures, Present work, Residence, Environmental concerns, Past work, Activities, Referrals and resources, Educate) model. The client should be appropriately treated. If an on-site environmental exposure is suspected, other at-risk workers should be screened and treated as needed. The environmental cause should be resolved, either by removing the offending chemical or reducing it to safer levels. Factory safety policies should be followed, reviewed, and changed if needed. State and federal agencies should be notified as required.

The new director of a local public health unit reviews the personnel records of the unit staff and notes that none of the assigned public health nurses (PHNs) has academic training in community and public health nursing. The director's next step should be to: a. recognize that staff members have learned on the job through years of experience and that they will be able to teach their new director basic community and public health principles. b. make arrangements to hire new staff with appropriate formal training. c. realize that with the current nursing shortage the unit should be grateful to have long-term staff. d. review continuing education records to determine if the nurses have received training in community-oriented nursing and ethics, and plan for any needed training.

ANS: D Both the American Nurses Association (ANA) Code of Ethics and the Public Health Code of Ethics state that the professional competency of all public health employees must be assured and address issues of the nurse's accountability to ensure competency in delivery of services to individuals, families, or populations.

A nurse wishes to become actively involved in disaster management and is extremely interested in providing first aid and delivering aggregate health promotion, disease prevention, and emotional support. It would be ideal for the nurse to train and volunteer as which of the following? a. Community emergency response team member b. Disaster medical assistance team member c. Member of the Medical Reserve Corps d. Red Cross shelter manager

ANS: D Creation and operation of shelters are generally the responsibility of the local Red Cross chapter, although the military may be charged with setting up "tent cities" or mobile home parks for large groups of people needing temporary shelter. Because nurses are comfortable performing tasks such as aggregate health promotion, disease prevention, and provision of emotional support, they make ideal shelter managers and team members. The Red Cross provides training in shelter support and use of appropriate protocols.

A nurse asks a couple who are new parents for their baby's full name. The parents reply that they are only supposed to give the baby its first name. The most appropriate response for the nurse is to: a. tell the couple that they are the child's parents and it is up to them to name their baby. b. explain to the couple the state's bureau of vital statistics deadline for completing the birth certificate. c. give the couple the paperwork and ask when the baby will have a name. d. express interest and ask the couple to share how their new baby will receive its name.

ANS: D 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.

A school nurse is teaching a class of sophomores about the relationship between the risk of sexually transmitted disease (STD) and risk-taking behaviors. A key point to include is: a. all STDs are easily preventable with consistent condom use. b. once a young woman is pregnant, she is no longer at risk for most STDs. c. STDs are most likely to be transmitted during a student's initial sexual encounter. d. use of alcohol and drugs makes a student more likely to make decisions that result in exposure to and infection with STDs.

ANS: D Drug use is linked to STD transmission because drugs such as alcohol lower inhibitions and impair judgment about engaging in risky behaviors. Addictions to drugs may cause individuals to acquire the drug or money to purchase the drug by performing sexual favors. This increases both the frequency of sexual contacts and the chances of contracting STDs. Adolescents are particularly at risk. Not all STDs are preventable through condom use. The challenge of preventing human papillomavirus (HPV) infection (genital warts) is that condoms do not necessarily prevent infection because warts may grow in areas that barriers such as condoms do not cover and skin-to-skin contact may occur.

Campaigns to decrease the inequitable burden of environmental risks on the poor and people of color in the United States strive to apply the ethical principle of: a. societal justice. b. nonmaleficence. c. compliance and enforcement of the Environmental Protection Agency Regulatory Act. d. environmental justice.

ANS: D Environmental health risks notably have disproportionately affected poor people and people of color in the United States. Low-income citizens and people of color are more likely to live near a hazardous waste site, and increased incidence of childhood lead poisoning and increased rates of childhood asthma are seen in these groups. Environmental justice is the principle of assuring that no group is more at risk of harmful exposure than another.

A nurse identifies higher-than-normal levels of lead when screening a 3-year-old child. The nurse works with the local health department to put together a team to address the environmental issues responsible for the child's abnormal lead level. Team members should include the following specialists: a. epidemiologist, pediatric specialist, and sanitarian. b. laboratory specialist, contractor whose bid for lead reduction work is the lowest, and public health lead reduction specialist. c. public health sanitarian, pediatric generalist, and plumbing inspector. d. specially trained housing inspector, pediatric specialist, lead-based paint intervention team, and laboratory specialists to test the child's home and the surrounding neighborhood.

ANS: D Environmental health-risk identification and risk-reduction intervention require a multidisciplinary team. The team members needed to address an elevated lead level in a child include a specially trained housing inspector, a sanitarian familiar with lead health risks, a nurse practitioner and/or physician trained to intervene in cases of pediatric lead exposure, and housing specialists trained to reduce lead-based paint risk in the home.

After a mock disaster drill, the nurse participates in a "hot wash" of the exercise in which participants from all units speak about successes, problem solving, failures, and unanticipated challenges or obstacles faced during the mock disaster drill. This activity best addresses the public health workforce competency of: a. describing the agency chain of command. b. identifying the limits of one's own knowledge, skill, and authority. c. recognizing unusual events that might indicate an emergency. d. writing after-action reports, updating implementation plans, and implementing changes.

ANS: D Federal agencies and professional organizations have outlined competencies for public health professionals at all points of the disaster management cycle. One competency speaks to the ability to evaluate drills, exercises, or actual events. As valuable components of preparedness, mass casualty drills and exercises can help rescuers develop the necessary coordination, skills, and confidence to operate effectively and efficiently across disciplines and agencies. Special emphasis is placed on the after-action reporting once the exercise is over, which ultimately allows improvement of the overall all-hazards disaster response plan. Such sessions may be referred to as debriefings, hot washes, or postings. Participation in these sessions develops the critical skill of evaluation that allows for process improvement.

An effective community-oriented diabetes program should include: a. access to a certified diabetes educator to teach the client self-management strategies and proper techniques. b. care that incorporates the American Diabetes Association treatment guidelines. c. access to a primary care provider, medication and supplies, and nutritionist consult. d. self-management education, family education, and assurance of affordable clinical care, medication, and testing supplies.

ANS: D From the ecological perspective, community-oriented interventions are directed toward multiple levels of client care: the individual level (self-management) and the environmental level (maximizing environmental resources, including family support and affordable quality care, medication, and testing supplies).

When applying the nursing process to environmental health, the nurse would: a. conduct an assessment focused on the client's presenting problem. b. coordinate interventions with the primary care provider of record. c. examine criteria that are limited to the client's immediate responses. d. include outcome measures that involve mitigation and elimination of the contributing factors.

ANS: D If the nurse suspects that the client's health problem is being influenced by environmental factors, the nurse should follow the nursing process and note the environmental aspects of the problem in every step of the nursing process. For instance, in goal setting, the nurse should include outcome measures that relate to mitigation and elimination of the environmental factors.

Case fatality from breast cancer has decreased in recent years, although the incidence of breast cancer has increased. Descriptive epidemiology would use the component of time to explain this change in terms of: a. cyclical patterns. b. event-related clusters. c. point epidemic. d. secular trends.

ANS: D In descriptive epidemiology, the components of person, place, and time are used to describe increases or decreases in the frequency of diseases over time. Temporal or spatial patterns that influence long-term changes in morbidity or mortality rates are known as secular trends and may reflect changes in social behavior or practices. Some aspects to be considered are the effects of improved diagnostic capability and changes in survival (case fatality) rather than changes in incidence. The trends in breast cancer have led to a mortality curve that is flatter than the incidence curve. This leads to uncertainty in determining the actual increase in incidence rate, because improved diagnostic capability may explain some but not all of the increase observed. Another area of consideration is changes in case definition or coding of disease in the International Classification of Diseases, because both can produce an artificial change in mortality rates.

Although nursing has a strong implicit heritage of ethical values and morality, it was not until the 1960s that several seminal events significantly shifted the focus to ethical decision making processes. One of those seminal events was the emergence of the field of bioethics and the other event was: a. adoption of the ANA's Code for Professional Nurses. b. adoption of the American Public Health Association's Public Health Code of Ethics. c. adoption of the International Council of Nurses' Code of Ethics for Nursing. d. issuance of the ANA's position statement on nursing education in institutions of higher education.

ANS: D In the 1960s, the ANA recommended that all nursing education occur in institutions of higher education; a shift thereby occurred from reliance on inherent ethical tenets and values to the explicit study of ethics and ethical decision making processes. This, in conjunction with the emergence of the field of bioethics, altered the curriculum content of nursing education programs.

John Snow played a critical role in the development of modern disease surveillance when he: a. devised a more statistically valid method of analyzing epidemiologic data. b. discovered causal agents for anthrax, tuberculosis, and cholera. c. tracked the incidence of tuberculosis in the tenements of New York City. d. used geographic mapping to demonstrate the connection between water supply and cholera.

ANS: D John Snow is considered the father of modern epidemiology because of the methods he used in his groundbreaking work to connect the incidence of cholera with the water supply. Snow showed that households receiving water from one water company, whose intake valve was in an area of the river contaminated by sewage, had a much higher rate of cholera than those receiving water from other companies drawing water from less-contaminated parts of the river.

A population-level tertiary prevention intervention typically carried out by nurses caring for those with communicable disease in the community is: a. HIV test results counseling. b. needle exchange. c. partner notification. d. instruction in standard precautions.

ANS: D Teaching caregivers about infection control in home care is vital. The nurse treating the client with HIV infection in the home environment should teach caregivers about standard precautions. Some clients, families, friends, and others may have concerns about the transmission of HIV infection. Others who may not have concerns about transmission may fail to take adequate precautions or believe myths that they cannot become infected.

The Framingham Heart Study and the Alameda County study are historically important to the development of public health multilevel interventions. Which statement best describes the contribution made by these studies? a. Both focus on urban health risks and interventions to reduce the impact of those risks on the local population b. Both are longitudinal studies that can help community-oriented nurses design interventions to reduce cardiac morbidity and mortality c. Both studies show that young men who cease smoking reduce their risk of coronary disease, even if they develop moderate obesity as they become middle-aged d. Both studies examined personal and environmental factors that influence long-term health outcomes and demonstrate the need for individual and community intervention to reduce morbidity and mortality from preventable disease

ANS: D The Framingham Heart Study examined factors that influence the development of coronary heart disease (CHD). This study led to development of health risk appraisals, predictive risk models, and strategies to reduce CHD risk. The Alameda County study followed a large sample for 4 years to investigate the relationship of social and behavioral factors to mortality. Both studies are highly significant in detecting individual and environmental risk factors for disease and in prompting multilevel community-oriented intervention programs.

A nurse is assigned to provide community outreach to a small town that was partially destroyed by a tornado 3 years earlier and has been rebuilt. The first client is a family who lost their home and their best friend in the tornado. The best intervention would include: a. assessment of the family's home environment to rule out safety issues. b. avoidance of discussion of the disaster of 3 years ago. c. consideration that the family will have worked through the emotional aftermath by now. d. support of the family in preparing a personal disaster response plan.

ANS: D The approach of relief activities needs to shift from short-term aid to long-term support. Promoting individual, family, and community preparedness increases safety in the event of disaster and can help children and adults feel empowered. This builds on the resilience of the individual, family, and/or community. Individuals and families still need to be assessed for indications of mental distress (case finding) and referred to a mental health professional if the need exists. Open discussions of the family's response to the slow process of recovery or long-term results of living under adverse conditions can uncover lingering mental distress or exacerbations of chronic conditions that require attention. During the initial stages of recovery environmental safety issues should have been addressed.

The major factor that has led to sharply increased insurance payouts following disasters in the United States in recent decades has been: a. El Niño. b. geography. c. technology. d. human development.

ANS: D The cost in more developed countries is higher because of the extent of material possessions and complex infrastructures, including technology. In the United States, increases in population and development in areas vulnerable to natural disasters, especially coastal areas, have led to sharply increased insurance payouts.

The emergency support functions of the National Response Framework (NRF) and the National Incident Management System (NIMS) provide: a. authority to step in and take control of state, local, and voluntary organizations during disasters. b. command and control for American Red Cross and Disaster Medical Assistance teams. c. oversight of federal and state response operations, with minimal interaction with other organizations. d. written approach, protocol, and common language for responders from federal agencies and other voluntary organizations.

ANS: D The first level of disaster response is carried out by the locality (office of emergency management). Through mutual aid agreements, localities can arrange for additional support from surrounding communities (emergency operations center). When the response needs exceed the capability of the localities and state-level resources or capabilities, then the governor may request assistance under a presidential declaration of disaster or emergency. The way the federal government offers assistance is through the NRF. The NRF was written to approach a domestic incident in a unified, well-coordinated manner that enables all responding entities to work together more effectively and efficiently. All member organizations of the responding teams, including all relevant branches of the federal government, are assigned functions that are listed in the plan as emergency support functions. When large disasters require the services of a variety of emergency responding units with personnel coming from different parts of the country, the challenge of working together in unison may require the use of the NIMS, which provides all responders with a protocol and common language for working together. The importance of interoperable communication equipment is stressed by the NIMS.

The highest priority for a nurse who is among the first responders to a disaster is: a. arranging for shelter for disaster providers. b. beginning community assessment as soon as possible to ensure a rapid recovery. c. beginning surveillance and planning needed health education for disaster survivors. d. immediately developing plans for effective triage and client management.

ANS: D The first priority when responding to a disaster is to immediately plan for, coordinate, and carry out effective triage. Disaster response includes community assessment, surveillance, health education, and coordination of shelter arrangements. However, the first task is to provide care for life-threatening injuries and conditions.

A nurse is working with an established group of parents of children with special needs. Several parents continually express frustration with the health care system and feelings of powerlessness to address their needs. The nurse uses group techniques to validate their experiences and explore options for action. The nurse reacts in this way to conflict within the group because conflict: a. means the group leader must ask the persons causing the conflict to excuse themselves from future meetings. b. means those with the dissenting opinion will change their stand to be more in line with the rest of the group. c. should be avoided. d. supports individual and group growth and change.

ANS: D The groups to which people belong influence health behavior. Through participation with others, meaning is confirmed, confounded, contradicted, or compromised. This is how social reality is created. Nurses frequently use groups to help individuals within a community. When conflict occurs in a group, the resulting tension can help move the group toward its goals. Group members are most effective and productive when conflict is acknowledged and individual concerns are expressed in a manner that respects other members of the group. Effective groups promote collaboration and support expression and resolution of conflict.

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 fragranced candles. The most appropriate intervention for the nurse is to apply the principle of: a. autonomy, in which the nurse leaves the matches and candles accessible to the client. b. beneficence, in which the nurse maintains the client's dignity and reinforces to the client how pleasant it is to use scented candles. c. nonmaleficence, in which the nurse counsels the client regarding the dangers of the use of candles and matches by someone with low vision. d. respect for autonomy, in which the nurse recommends to the client an arrangement whereby the caregiver lights the candles when the caregiver is present in the home and removes the matches and candles from the kitchen cabinet.

ANS: D The nurse applies 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.

Caring and the ethic of care are core values of community health nursing. This ethical view was developed in the mid-1980s and early 1990s in response to the technical advances in the health care sciences and the desire of nurses to: a. apply gender-related voices to moral judgment. b. apply principles of utilitarianism. c. differentiate distributive justice from beneficence. d. differentiate nursing practice from medical practice.

ANS: D The view of caring and the ethic of care that emerged in the mid-1980s and early 1990s was a response to technological advances in science and the desire of nurses to differentiate nursing practice from medical practice. It is closely related to feminist ethics

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