Public Health-Test 1-Ch 4,5,6,8,10,11,27,28,31

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

ANS: C In developed countries, nurses are often viewed as one of the strongest advocates of primary health care through nursing's social commitment to health care equality.

1. A nurse is planning a training session for a new group of disability determination workers regarding the leading causes of severe disabilities in U.S. adults. The training should address: a. arthritis, heart disease, and back or spine problems. b. arthritis, lung disease, and back problems. c. back problems, heart disease, and pulmonary disease. d. genetic abnormalities, arthritis, and orthopedic pathology.

ANS: A According to the most recent data from the Survey of Income and Program Participation collected in 2010, approximately 18.7%, or 56.7 million civilian, noninstitutionalized men, women, and children in the United States reported a disability (vision, hearing, ambulating, cognitive, self-care, and/or independent living). 47.5 million U.S adults have a disability. The top three disabilities in the United States are arthritis or rheumatism, back or spine problems, and heart trouble.

2. The relationship between nursing practice, health policy, and politics can best be described as nursing: a. advocacy. b. policy process. c. process. d. profession.

ANS: A Advocacy begins with the art of influencing others (politics) to adopt a specific course of action (policy) to solve a societal problem and is accomplished by building relationships with appropriate policy makers—the individuals or groups that determine a specific course of action to be followed by a government or institution to achieve a desired end (policy outcome). This can be done in many ways. Types of advocacy include actions on behalf of clients served by nursing, especially vulnerable populations; activities of the nursing profession itself; work to develop needed health policies or revise existing policies; and actions related to the community.

6. When conducting an environmental risk assessment, the nurse explores the economic risk and social risk of the family. To capture social risk assessment data, the nurse can best use which of the following? a. Community assessment and ecomap b. Genogram and ecomap c. Genogram and history d. Double ABC-X model

ANS: A An assessment of environmental risk typically includes information about the relationships that the family has with others such as relatives and neighbors and their connections with other social units, the flow of energy in those relationships, and the characteristics of the neighborhood and community in which the family lives. This information can be obtained through the use of assessment tools such as an ecomap and community assessment.

2. Before 1950, the major portion of U.S. health care was funded by out-of-pocket payments by consumers. In the 1950s, a shift was seen to third-party reimbursement, and that trend continues today. Recent trends of third-party reimbursement indicate that the highest portion of third-party health care financing is being carried by: a. combined public sources. b. consumer premiums. c. Medicare. d. private health insurers.

ANS: A By the end of the previous century, health care financing had evolved from a system in which the consumer paid the costs to a system financed primarily by third-party payers, which included private health insurers and local, state, and federal governments. However, recent trends indicate that combined local, state, and federal spending exceeds private health insurance spending in third-party health care financing.

7. The Family and Medical Leave Act (FMLA) of 1993 addressed many issues to support and strengthen the families in our nation without producing an adverse effect on the majority of business employers. Its most significant impact on families was that it: a. enabled individuals to have both a family and a career. b. called for paid adoption leave. c. provided eldercare services. d. provided life insurance benefits.

ANS: A FMLA allows covered employees to take up to 12 weeks of unpaid leave of absence each year for certain family and medical reasons such as their own serious medical illness; the illness of a child, spouse, or parent; and the birth or adoption of a child. Employees' medical benefits remain intact during the unpaid leave, and they are guaranteed that their old position or a similar one will be available to them once they return to work. The most significant impact of FMLA was to ensure that an individual could have both a family and a career and would not have to choose between the two. Americans could now meet the needs of their families while maintaining employment. All women became eligible for unpaid maternity leave on the birth of a child. Many states have legislated longer leave time and more benefits than the minimum required under FMLA for employees in their states. Seven years after the enactment of FMLA, a survey was conducted to understand the impact of such a family policy. Findings from the survey indicated that FMLA had no adverse effect on over two-thirds of business employers and that employees are taking advantage of the FMLA-mandated benefits in increasing numbers.

8. Two of the most significant barriers to practicing family nursing are the narrow definition of family used by health care professionals and social policy makers and: a. lack of consensus on what constitutes a healthy family. b. medical and nursing diagnosis systems. c. nursing's historical ties with the medical model. d. lack of exposure of practicing nurses to family concepts.

ANS: A Family nursing is practiced in all settings. Family nursing consists of nurses and families working together to improve the success of the family and its members in adapting to normative and situational transitions and responding to health and illness. The diverse and changing definitions of "family" present a challenge to society's notion of what constitutes healthy families. Healthy and vital families are essential to the world's future, because families serve as the basic social unit of society.

8. A shift in general approach from a more reactionary, acute care orientation toward a proactive, primary prevention orientation is necessary to achieve not only a more cost-effective but also a more equitable health care system in the United States. From a public health perspective, this strategy is necessary to avoid the need for other less desirable approaches that may compromise access and quality such as: a. rationing of health care. b. secondary prevention. c. managed care expansion. d. regulatory program mandates.

ANS: A Health care reform approaches under consideration to control the use of services and technologies are considered rationing of health care. Rationing of health care in any form implies reduced access to care and potential decreases in acceptable quality of services offered. A provider's refusal to accept Medicare or Medicaid clients is a form of rationing. Like access to care, rationing of health care is a public health issue. Where care is not provided, the public health system and nurses have an ethical obligation to ensure that essential services are available. This is currently being observed in the Katrina Hurricane recovery efforts, in which the health care infrastructure is being severely compromised by the refusal of previous practitioners to reopen their practices in New Orleans because of the impoverished economy. Nursing and public health agencies are stepping into the void left by these practitioners to provide essential services to the population.

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

ANS: A Many factors influence the role of the community-oriented nurse in any given community. A major influence is the community's awareness of those who are disabled and its commitment to addressing their health needs. However, a nurse who becomes aware of and committed to meeting the needs of the physically compromised can use the principles of community-oriented practice to initiate long-term improvement of services in his or her community.

9. 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?

5. A person who is limited in independent living skills, economic self-sufficiency, and self-help ability would meet the definition of: a. developmentally disabled. b. dual-diagnosed. c. impaired. d. physically disabled.

ANS: A The Centers for Disease Control and Prevention (CDC)'s National Center on Birth Defects and Developmental Disabilities defines developmental disability as a long-term impairment that originates during development and up to age 22 years and lasts throughout the person's lifetime. The disability must limit the person in at least three of the following areas: self-help, language, learning, mobility, self-direction, independent living, and economic self-sufficiency.

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

ANS: A The Centers for Disease Control and Prevention serve as the national focus for development and application of measures to advance disease prevention and control, environmental health, and health promotion, and for educational activities designed to improve the health of the people of the United States. The mission of the Centers for Disease Control and Prevention is to promote health and quality of life by preventing and controlling disease, injury, and disability.

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

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

8. 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.

7. 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.

1. New discoveries in molecular genetics will have the greatest effect on nursing practice in the area of: a. collection and use of health histories. b. counseling clients. c. identification of gene mutations. d. use of new therapies.

ANS: A The profession of nursing will be impacted by new discoveries in molecular genetics in the areas of education, practice, and public health debates. The practice arena impacts are collection and use of health histories, learning and applying innovative biotechnologies, prevention and health education roles, and administration of new therapies. The collection and use of health history information has the greatest impact on the most nurses. Human disease comes from the collision between genetic variations and environmental factors (i.e., social determinants of health) that are often uncovered in individual health histories. Taking a family history is a useful place to begin when considering a genetic connection and prior to the onset of testing.

2. 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.

7. During an Individuals with Disabilities Education Act (IDEA) screening to detect mental or psychological conditions in young school-age children, a child is identified as having a cognitive disability. The school nurse should now consider this child to be at greatest risk for: a. abuse or neglect. b. age-inappropriate friendships. c. embarrassment. d. physical inactivity.

ANS: A While all individuals with disabilities are at risk for abuse and neglect, children, the elderly, and women are at particular risk. According to the U.S. Department of Health and Human Services, risk factors for the abuse/neglect of disabled children can be stratified to societal factors, such as believing disabled children are asexual or do not feel pain; family or parental factors, which include the child being viewed as different, parents who are embarrassed by their disabled child, or families with inadequate social support or resources; as well as child-related factors, which include being male, having challenging/difficult behaviors, or requiring extensive physical care.

1. Genes that carry genetic instructions for making living organisms are subject to alterations in: (Select all that apply.) a. changes in chromosomal structure. b. changes in deoxyribonucleic acid. c. changes in ribonucleic acid. d. sequences of bases.

ANS: A, B, C, D Alterations in the usual sequence of bases [adenine (A), guanine (G), cytosine (C), and thymine (T)] that form a gene, changes in DNA or chromosomal structures are called mutations. A large number of agents are known to cause mutations. Despite three billion DNA base pairs that must be replicated in each cell division and the large number of mutagens we are exposed to, DNA replication is quite accurate because of the mechanism known as DNA repair that corrects 99.9% of initial errors.

2. The National Coalition of Health Professional Education in Genetics (NCHPEG) created a red-flag tool for determining risk in closely related individuals for the most common diseases that includes: (Select all that apply.) a. close biologic relationship between parents. b. condition occurs in the gender that is least expected. c. ethnic predisposition to certain genetic disorders. d. multiple affected family members. e. onset at an earlier or later than expected age.

ANS: A, B, C, D The genetic red flags developed by the NCHPEG provide an excellent tool to determine if an individual or family might be at risk. The primary red flag for the most common diseases is a large number of affected relatives who are closely related. Some of the red flags are family history of multiple affected family members with the same or related disorders, which may or may not follow an identifiable pattern in the family; onset at an early age; condition occurs in the gender that is least expected to have it; disease occurs in the absence of known risk factors; ethnic predisposition to certain genetic disorders; and a close biological relationship between parents.

1. 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.

1. A nurse is assessing a family's ability to provide home care for their 6 year old, who is a quadriplegic as a result of an automobile accident. The nurse teaches the parents body mechanics and transfer techniques. The nurse also determines the parents' physical ability to safely lift the child. The nurse's actions relate to which of the five interacting variables of Neuman's Systems Model? a. Developmental b. Physiological c. Psychological d. Sociocultural e. Spiritual

ANS: B Neuman's Systems Model, a wellness-oriented model, defines family health in terms of system stability as characterized by five interacting sets of factors: physiological, psychological, sociocultural, developmental, and spiritual. The nurse draws on family strengths and resources to keep the system stable while it adjusts to stress in the face of change. The nurse is answering the question, "Are the parents physically able to transfer the child from bed to wheelchair and from wheelchair to car or shower seat?" This question assesses the physiological variable of family health.

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

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

1. The factors that are frequently cited as having caused the increases in total and per capita health care spending in the United States are well exemplified by which of the following health care events? (Select all that apply.) a. Development of the drug sildenafil (Viagra) b. Increase in hip and knee replacement surgeries c. Increased incidence of ischemic heart disease d. Mandated two-day maternity hospital stays e. Medicare Part D prescription drug plan

ANS: A, B, C, D, E The factors that are frequently cited as having caused increases in total and per capita health care spending in the United States are cost inflation in the production of goods and services; changes in population demography (aging of the population, immigration); increased adoption of medical technology (new procedures, equipment, or pharmaceuticals); increases in the intensity of services, especially when government controlled (legislated programs or mandates); and increases in the incidence of chronic illnesses (ischemic heart disease and obesity). These factors alter the supply of and demand for services to meet identified needs.

4. One of the most significant household changes in the second half of the twentieth century in North America was the increase in men and women living together without marrying. Effects of this trend on the children of cohabitating couples include: a. increased chance of exposure to second-hand smoke. b. decreased chance of parental separation. c. more behavioral and cognitive problems. d. more stable living conditions

ANS: A, C Cohabitating couples in the United States live together for shorter periods of time than cohabiting couples in other countries. Parental separation is five times greater for children born to cohabiting than married parents. The unstable living arrangements for children born outside of marriage remain an important question relative the well-being of these children. The number of transitions is associated with negative child well-being. Many of these children experience about three transition relationships from birth to 3 years of age. The research shows that children in cohabitating relationship have more behavioral and cognitive problems. Researchers also found that cohabitating-parent families spend a greater share of their budgets on alcohol and tobacco than do married, divorced, and never-married single-parent families.

7. Health problems exist throughout the world. In the United States, a current health concern is the appearance of new viral strains such as Hantavirus in the Southwest. This is an example of the difference in health care concerns between countries such as: a. United States and Canada. b. Sweden and Indonesia. c. Australia and Japan. d. Bangladesh and Zaire

ANS: B Although health problems exist throughout the world, the health care concerns of less-developed countries differ from those of developed countries. Less-developed nations such as Bangladesh, Zaire, Haiti, Guatemala, most countries in sub-Saharan Africa, and the island nation of Indonesia, have more exotic-sounding health problems like Buruli ulcer, leishmaniasis, schistosomiasis, pediculosis, typhus, yellow fever, and malaria as well as the ongoing problems of measles, mumps, rubella, and polio. Current health concerns for developed nations such as the United States, Canada, Japan, the United Kingdom, Sweden, France, and Australia are problems like hepatitis, the appearance of new viral strains such as hantavirus, and large social yet health-related issues such as terrorism, warfare, violence, and substance abuse. AIDS remains a major global concern for all countries, developed or less developed.

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

ANS: B Being physically disabled places the individual and his or her family at risk for decreased income potential. Persons with low income have less access to health care throughout their lives and are less likely to participate in all levels of prevention. Therefore, they are at greater risk for the onset of disabling conditions and for more rapid progression of disease processes. Those living in poverty could also be at greater risk for disabling conditions resulting from lifestyle choices, such as accidental injuries; tobacco, alcohol and drug use; and inadequate nutrition.

2. Children with chronic health problems face challenges in school because of: a. difficulty gaining access to public school education. b. embarrassment and self-imposed social isolation. c. increased special education costs in public schools. d. psychological distress related to the severity of their disability.

ANS: B Children with chronic health problems often experience embarrassment regarding the demands of their disability and the regimens required to manage it. Having to explain why they must attend to special needs could call unwanted attention to them and their condition. School-age classmates may be reluctant to be close friends with children with chronic illnesses because they may fear that any chronic disease or disability is contagious. Children who receive respect and positive feedback from their families and peers have stronger feelings of self-worth than those who feel socially isolated from others.

7. A public health nurse (PHN) has identified a need to make amendments to an existing law concerning the tuberculosis health assessment of individuals sentenced to serve jail terms on weekends only because of the gap in treatment accountability and potential health risk to the free-living community. To draw attention to this concern, the nurse has several paths to follow, but the amendment of any existing laws would ultimately be decided by which of the following? a. Executive branch of government b. Legislative branch of government c. Local representative d. Senate hearings

ANS: B Each of the government branches at the federal level, in most states, and at the local level plays an important role in developing and implementing health law and public policy. Concerned citizens have many avenues for addressing issues related to needed laws and regulations as well as existing laws and regulations. However, each branch of government has a separate and important function. The legislative branch identifies problems and proposes, debates, passes, and modifies laws to address identified needs.

7. 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.

3. The levels of government responsible for carrying out the five government health care functions of direct services, financing, information, policy setting, and public protection are: a. federal and state. b. federal, state, and local. c. all, but primarily state and local. d. all, but primarily federal and state.

ANS: B Federal, state, and local governments are responsible for carrying out the five core government health care functions. All levels of government provide direct services, but the targeted populations may vary; for example, at the federal level, the focus is on the members and dependents of the military, whereas the states focus on childhood immunizations. The federal government provides funding for health care education and research. The states provide maternal-child health care services through state-level funding for the poor or near poor. Local governments/organizations provide health care services through funding for free clinics that serve the uninsured. All branches and levels of government collect vital statistics and census data, and conduct health surveys. Governments, agencies, and organizations at all levels make health policy. Functions that protect the public, such as monitoring air and water and regulating food, drug, or animal transportation, are carried out at all levels. Affirmation of a woman's right to reproductive privacy occurred at the federal level (Supreme Court). Requiring vaccinations for school entry occurs at the state level.

5. During an assessment of a family of four, the nurse completes a genogram. This assessment tool is effective in identifying: a. behavioral health risk. b. biological health risk. c. nonnormative life events. d. normative age-related risk.

ANS: B One of the most effective techniques for assessing patterns of health and illness in families is construction of a genogram covering three generations of family history. Major illnesses can be listed and patterns can be quickly identified to provide a guide for the health interviewer.

4. A young female client is concerned about her risk for developing ovarian cancer and needs information that might affect her health decisions. She requests that her elderly grandmother be tested for genetic mutations. One significant challenge faced by a family member in responding to such a request is: a. anxiety about the future. b. carrier guilt. c. decreased quality of life. d. fear of blood draws.

ANS: B Genomics has influenced the availability of genetic tests which has implications for families. Individuals, families, and communities need to understand the purpose, limitations, and potential benefits and risks of a test before submitting samples for analysis. Genetic testing is now used to predict the development of genetic disorders, screening populations, confirming diagnoses, prenatal testing, and DNA testing to develop and apply individualized medical treatment. Individuals seeking information that might affect decisions and health may also think that testing results would decrease their quality of life and make them anxious about the future. Family members who have had cancer may refuse genetic testing because their insurance carrier does not reimburse for such testing or their deductibles may be too high for such testing. Additionally, people feel that a positive result may lead to a feeling of guilt about passing along a disease to children and grandchildren. Genetic testing decisions are personal and complex and can be controversial, leading to dissonance in families.

5. A community health nurse is working with a single parent with a special needs child and a child with asthma. The maternal grandmother lives with the family and was recently diagnosed with diabetes. The nurse understands the importance of including the grandmother in her assessment and interventions because families are: a. resistant to outside intervention or involvement. b. involved in the health care of their members. c. unable to manage the stress of complex health needs. d. restricted in their ability to identify interventions.

ANS: B Health care decisions are made within the family, the basic social unit of society. Families are involved in the health care of their members and therefore, are significant participants in the health care team, because they are an ever-present force over the lifetime of care.

1. Health policy can best be defined as a set course of action to: a. administer public health care programs at the federal level for disaster preparedness, response, and recovery. b. obtain a desired health outcome for an individual, family, group, community, or society. c. support publicly funded health care programs at the local, state, and national levels. d. support health care development and research to improve the health status of citizens.

ANS: B Health policy is a set course of action to obtain a desired health outcome, either for individuals, families, groups, communities, or societies. Policies are made not only by governments but also by institutions such as a health department or other health agency, a family, or a professional organization. Politics plays a role in the development of such policies. Politics is found in families, professional and employing agencies, and governments. Therefore, political activities are used to arrive at a course of action (the policy). Policy is a settled course of action to be followed by a government or institution to obtain a desired end.

6. The health policy-making body of the World Health Organization (WHO) released a policy statement on nursing and midwifery in 2013. The important fact for nurses to understand about WHO policy statements is that such statements: a. apply only to underdeveloped countries. b. are guides for in-country initiatives and priorities. c. carry the weight of international law. d. provide mandates for in-country legislatures.

ANS: B In 1946, the WHO was created through a United Nations initiative as a special autonomous organization. The WHO provides services worldwide to promote health, cooperates with member countries in promoting their health efforts, coordinates collaborative activities between countries, and disseminates information on biomedical research and vital international statistics. The World Health Assembly (WHA) is the policy-making arm of the WHO and meets annually. The WHA's health policy work provides policy options for many countries of the world in their development of in-country initiatives and priorities. Although WHA policy statements are very important everywhere, they are guides and not law.

2. One challenge in working with families for healthy outcomes when the following capacity-building practice model occurs when the nurse steps aside in: a. defining the problem. b. designing family interventions. c. evaluating the plan. d. pre-encountering data collection.

ANS: B In a capacity-building model of practice, nurses assume the family has the most knowledge about how their health issues affect the family, supports family decision making, empowers the family to act, and facilitates actions for and with the family. When designing family interventions, nurses will be challenged to help families identify the primary problem confronting them (prioritizing) and stepping aside; accepting the family's priorities as they work in partnership with the family to keep their interventions simple, specific, timely, and realistic.

1. A nurse practitioner is seeking support from a community health and hospital system to open a nurse-managed and nurse-staffed clinic. The nurse provides data demonstrating the role of the clinic in reducing nonurgent emergency department visits and in improving access to services for clients with chronic illness, management of caseloads, and service flow, as well as data showing proposed input and output parameters. This best demonstrates application of the techniques of: a. business cycle modeling. b. cost-effectiveness analysis. c. cost-benefit analysis. d. indirect reimbursement methods.

ANS: B In community health, it is generally believed that interventions have a net positive value such as improving access to services. Nurse-managed clinics provide access to quality care for underserved populations. Nurses can use data to demonstrate the cost-effectiveness and efficiency of their programs without a detailed cost-benefit analysis and gain support from business-oriented health system managers. Efficiency refers to producing maximum output, such as goods or services, using a given set of resources (input), defined in terms of labor, time, and money. Efficiency depends on tasks and process. Effectiveness, on the other hand, refers to the extent to which a health care service meets its intended objective. A cost-effectiveness analysis would allow expression of the net direct and indirect costs and cost savings of a defined outcome in the proposal and planning phases. Cost-benefit analysis would be used to evaluate and demonstrate the effectiveness and efficiency of the program once hard data can be obtained.

6. 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.

6. A middle-aged woman, with a history of breast and ovarian cancer in her family, is concerned that a positive finding for BRACA2 gene may result in loss of her insurance coverage. The nurse should discuss protections under: a. the Affordable Care Act. b. the Genetic Information Nondiscrimination Act (GINA). c. Healthy People 2020. d. the Human Genome Project.

ANS: B The GINA of 2009 protects the public from genetic discrimination by employers or insurers. The act prevents group health plans and health insurers from denying coverage to a healthy individual or charging higher premiums based solely on genetic predisposition to disease. The legislation also prohibits employers from using an individual's genetic information when hiring, firing, or making job placement or promotion decisions.

3. 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.

2. The nurse continues the assessment of a family's ability to provide home care for their 6 year old, who is a quadriplegic as a result of an automobile accident, noting that the parents are in good physical health with no genetic or lifestyle risks, live in a safe neighborhood with caring neighbors, are dealing with grief and stress as they adjust to their child's injury, and are concerned that their insurance benefits may not adequately cover their child's expenses. The family's current health risk appraisal identifies the following risks: a. Biological and life-event risks b. Economic and life-event risks c. Life-event and social risks d. Social risks and biological risks

ANS: B The family is facing a nonnormative life-event risk: their child's sudden significant permanent injury. They are also facing an economic risk, because their financial resources, including their insurance coverage and personal finances, may not be adequate to meet their needs. Currently, they do not have a biological risk in terms of genetics or lifestyle patterns. They also are not facing a social risk such as racial discrimination, pollution, or living in a high crime area.

3. When the community health nurse displays pertinent family information in a family tree format, the family can see the family structure, its members and their relationships over at least three generations and provides a visual source for planning family interventions. This approach also assists the nurse in making clinical judgments relevant to family structure and history. This type of family assessment instrument is referred to as: a. ecomap. b. genogram. c. family developmental task. d. family diagnosis.

ANS: B The genogram displays pertinent family information in a family tree format that shows family members and their relationships over at least three generations. The genogram shows family history and patterns of health-related information, which is a rich source of information for planning interventions. The identified client and his or her family are highlighted on the genogram. Genograms enhance nurses' abilities to make clinical judgments and connect them to family structure and history.

5. 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.

3. The overarching themes conceptualized in the vision for the Human Genome Project embrace the relationship of genomes to: a. biology, chemistry, and medicine. b. biology, health, and society. c. ethics, medicine, and heredity. d. medicine, technology, and ethics.

ANS: B The stated goals of the Human Genome Project were determining the sequence of the three billion chemical pairs that make up human DNA; storing this information in databases; improving tools for data analysis; transferring related technologies to the private sector; and addressing the ethical, legal, and social issues (ELSI) that may arise from the genome mapping project completed in 2003 that identified 25,000 genes in human DNA. The conceptual vision of the team addressed three overarching themes. The first, "genomes to biology," looks at how the study of genomics would affect the future understanding of biology. The second, "genomes to health," helps to explain the underlying mechanisms for human health and disease including gene-gene, gene to environment, and their interactions. The third, "genomes to society," provides the foundation for research to improve the use and interpretation of genetic information and technologies.

2. In the late 1950s, Down syndrome was discovered to be caused by an extra copy of chromosome 21. This early breakthrough best describes: a. double-helix structure. b. genetics. c. genomics. d. mutation carrier.

ANS: B The term genetics is used to mean the study of the function and effect of single genes that are inherited by children from their parents—in other words, the cause of certain diseases, the genetic link. Genomics refers to the study of individual genes in order to understand the structure of the genome, including mapping of genes and sequencing of DNA. Genomics examines the molecular mechanisms and the interplay of genetic and environmental, cultural, and psychological factors of disease. Genomics deals with the functions and interactions of all genes in an organism and is the study of the total DNA structure.

9. There is strong evidence to suggest that poverty can be directly related to poor health outcomes. Poorer health outcomes lead to reduced educational outcomes for children; poor nutrition; low productivity in the adult workforce; and unstable economic growth in the population, community, and nation. These concepts reflect the human capital approach of the branch of economics known as: a. effectiveness and efficiency. b. macroeconomics. c. microeconomics. d. supply and demand.

ANS: B There are two branches of economics: microeconomics and macroeconomics. Macroeconomics focuses on the "big picture" such as the business cycle and economic growth—the total or aggregate of all individual and organizational behaviors such as growth, expansion, or decline of an aggregate. The aggregate is usually a country or nation. Factors such as levels of income, employment, general price levels, and rate of economic growth are important. Human capital is an important element in macroeconomic theory. Improvement of a human condition like health is a focus for raising and spending money on goods and services because health is valued. This approach also enhances the income-earning ability of people and improves the economy. If the population is healthy, premature morbidity and mortality are lowered, chronic disease and disability are decreased, and economic losses to the nation are reduced. Socioeconomic status is inversely related to mortality and morbidity for almost all diseases.

5. 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.

8. Women with disabilities may be at higher risk for abuse because women with disabilities are: a. less exposed to multiple caretakers. b. less likely to have access to resources. c. more independent. d. socially unattractive.

ANS: B Women and girls with disabilities face many challenges and often have to face "double discrimination." There is worldwide gender discrimination in such areas as access to housing, education, training, employment, and salary equity. Being female also places one at risk for sexual exploitation, abuse, neglect, and violence. Women with disabilities are at increased risk of this type of abuse because of the powerlessness of women in many parts of the world, the lack of resources, and women being undervalued.

1. Contracting with families represents a shared effort by the client(s) and the community health nurse to increase healthful choices. This method of shared effort and active equal involvement of the nurse and family is appropriate for which types of families? (Select all that apply.) a. All families b. Families capable of taking responsibility c. Families oriented toward self-care d. Families seeking ambitious goals e. Families with poor coping skills

ANS: B, C Contracting may not be effective when the nurse is working with families from cultures that expect health care providers to give directive guidance and feedback. Families from cultures outside the United States, as well as some families in the United States, may expect their health care provider to "tell them what to do." Part of the initial nursing assessment should include discussing with family members their expectations and value system before initiating a contract. Also, families must have the competencies and capabilities to participate and take responsibility, must have realistic expectations, and must be willing to renegotiate. Contracting is therefore not for all families.

3. A client's concern about hereditary cancer syndrome can be influenced by the limitations of current testing methods and factors related to: (Select all that apply.) a. absolute risk. b. adoption. c. family size. d. family interest. e. GINA.

ANS: B, C Current methods of testing do not detect all of the mutations that can occur in some diseases including hereditary cancer syndrome-related genes. If a mutation is detected, it does not confirm an absolute risk of cancer but a need for high-risk management. Additionally, an inherited syndrome may not be evident for someone from a small family; someone who is adopted; or someone who is not informed about their family's history of disease or cause of death. Most hereditary cancer syndromes are inherited in an autosomal dominant pattern with variable expression and incomplete penetrance (mutation in one member of the gene pair). Both men and women carry, pass on to children, and inherit these mutations. For mutation carriers, the hereditary cancer syndrome can be mild or more severe. Whether cancer ever develops, the site at which it develops, or the seriousness of the cancer can vary among different people with the same mutation, even within the same family.

1. A nurse conducting a home visit for a child with cerebral palsy observes the child gazing out of the window into the neighborhood. The nurse should provide guidance to the parents regarding: (Select all that apply.) a. adjusting the school schedule to keep the child occupied with studies. b. community attitudes about interacting with children with disabilities. c. opportunities for organized and spontaneous play. d. physical activity needs to avoid obesity.

ANS: B, C, D Greater emphasis has been placed on increasing children's physical activity to avoid childhood obesity, but children with any type of a disability continue to be less physically active and at greater risk of obesity than their healthy peers. This is a result of the relative lack of available opportunities for disabled children to participate in organized and spontaneous play. Additionally, nondisabled children and their parents may have negative attitudes about interacting or playing with disabled children.

1. A nurse is evaluating the outcome of a family with children's action plan to address the incorporation of caregiving needs of the paternal grandfather. Although evaluation includes many tasks, the critical thinking process includes: (Select all that apply.) a. conducting a summative evaluation meeting. b. determining the timeliness of the plan outcome. c. identifying changes in the family story. d. identifying nurse-related barriers. e. making the transition of nurse to family dependence.

ANS: B, C, D Termination, transition, and summative evaluation are tasks of the evaluation process; however, the critical thinking process of evaluation must address whether the plan worked, was it timely, does it need to be revised, whether family barriers or nurse-related barriers existed that interfered with the plan, or figure out if the family story changed. Family barriers include family apathy and indecision. Nurse-related barriers include nurse imposed ideas; negative labeling; overlooking family strengths; and neglecting cultural or gender implications.

1. A nurse in Mexico visits a village-based health post in her region to meet with the community volunteer and health committee that operate the health post. They intended to discuss the planning for next year's health promotion initiative and evaluate the recent family planning program. This best demonstrates the aim of the Declaration of Alma-Alta to emphasize which of the following? (Select all that apply.) a. Availability of chemotherapeutic agents b. Development of maternal and child health programs c. Involvement and training of community health workers d. Organized approach to health education e. Promotion and acceptance of traditional medicine

ANS: B, C, D, E Primary health care in global health is historically based on the Declaration of Alma-Ata (1978). The WHO's and the United Nations Children's Emergency Fund still actively promote primary health care as the strategy for achieving the goal of Health for All in the 21st Century. Several major components are identified for implementation of primary health care: an organized approach to health education that involves professional health care providers and trained community representatives; aggressive attention to environmental sanitation; involvement and training of community health workers; development of maternal and child health programs that include immunization and family planning; initiation of preventive programs aimed at local endemic problems; provision of accessible and affordable services for treatment of common diseases and injuries; availability of chemotherapeutic agents; development of nutrition programs; and promotion and acceptance of traditional medicine. In this example, only three of those components are evident.

1. 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.

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

ANS: B, D, E Many health promotion and disease prevention needs are similar across the life span. However, the specific problems encountered and interventions required to deal with the needs of persons with disabilities vary depending on age, the specific disabling condition, and developmental status. Health promotion is a multidimensional concept that applies to all individuals regardless of disability. Both health-promotion and disease-prevention programs for persons with disabilities should focus on preventing the complications from the effects of immobility and the disease process. The complications of immobility and the disease process must be prevented to ensure optimal independent and healthy living, so that the individual with disabilities has the opportunity to lead a productive and happy life.

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

ANS: B, D, E The biological/psychological/sociological/spiritual approach to family health considers individual members as well as the family unit as a whole. An individual's health (along a wellness-illness continuum) affects the functioning of the entire family, and, in turn, the family's functioning affects the health of individuals. Thus assessments of family health involve simultaneous assessment of individual members and the family system as a whole.

2. The interrelationship among individual health, family health, and community health is accurately described by which of the following statements? (Select all that apply.) a. Community is the context for influencing only family health habits. b. Family health habits are developed based on the availability and accessibility of health services. c. Family is a social unit within the community; therefore family influences societal norms more than the health of the individual. d. Health values and beliefs are developed within the family. e. Individual health behaviors are carried out within the family, community, and societal environment.

ANS: B, D, E To achieve the national health objectives for improving the health of the general population, an emphasis must be placed on health promotion and risk reduction. Reducing the risks to segments of the population is a direct way of improving the health of the general population because of the interrelatedness of individual health, family health, and community health. The family is an important environment affecting individual health, because it is within the context of the family that individuals develop health values, health habits, and health-risk preferences. Yet the family is also a social unit within a community and society. In the context of community norms, family health habits are developed based on the availability and accessibility of health services. Societal norms, such as the acceptability of smoking, alcohol abuse, or other risky behaviors, influence the development of family and individual health habits. Individuals, on the other hand, carry out their health behaviors within the context of the family and the community. This complex interrelatedness establishes how individual, family, and community health influence and are influenced by one another. Although posing challenges, this interrelatedness can also bring opportunities by allowing interventions provided at one level to influence the other levels.

2. Canada is the leader in promoting a population health framework. Using such a framework, a state health department nurse with budgetary responsibility would determine that funding priorities should focus on: a. chronic disease surveillance and treatment programs. b. pediatric and adolescent primary care and nutrition programs. c. promotion of healthy lifestyles or improvement of social and physical environments. d. well and sick child clinics.

ANS: C A key to the success of a population health framework is the identification and definition of health issues and of the investment decisions within a population that are guided by evidence about what keeps people healthy. Therefore, a population health approach directs investments that have the greatest potential to influence the health of that population in a positive manner.

8. A major town in Zaire received a gift of retired intensive care unit monitoring equipment from a large specialty hospital in a developed country. Zaire was grateful for the donation because it would increase the technological capability to treat clients in the local hospital. However, over the next year, the monitors remained unused because personnel were not qualified to operate the monitors and no one was available to maintain or repair the equipment. This best explains the relationship between which two concepts? a. Disease prevention and health care planning b. Education and health promotion c. Global health and global development d. Primary health care and primary care

ANS: C Access to services and the removal of financial barriers alone do not account for the use of health care services. The introduction of health care technology from developed nations to less-developed nations has led to less than satisfactory results. Attention must be given to the basic needs of less-developed countries and the resources and services that the country can successfully sustain. When the focus is on the public health needs of less-developed countries, the infrastructures of the countries (economic, industrial, and technological) can be encouraged to grow in a sustainable manner.

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

ANS: C Any state participating in the Medicaid program is required to provide inpatient and outpatient hospital care; laboratory and radiology services; physician services; skilled nursing care at home or in a nursing home for people older than age 21 years; early periodic screening, diagnosis, and treatment for those younger than age 21 years; and, subsequently, family planning. The 1989 amendments required states to provide care for children younger than 6 years of age and to pregnant women with incomes less than 133% of the poverty level. These changes also provided for reimbursement for treatment by pediatric nurse practitioners and family nurse practitioners and thereby increased access to qualified providers.

9. The United States is engaged in a formal agreement with Indonesia to provide economic incentives and assistance in national defense in return for the protection of U.S. private investments in that region. Which bilateral organization is most likely involved in this agreement? a. Carnegie Foundation b. United Nations c. U.S. Agency for International Development d. U.S. Department of Defense

ANS: C Bilateral organizations or agencies operate within a single country and focus on providing direct aid to less-developed countries. All bilateral organizations are influenced by political and historical agendas that determine which countries receive aid. Incentives for engaging in formal arrangements may include economic enhancements for the benefit of both countries, national defense for one or both countries, or enhancement and protection of private investments made by individuals in these nations. The U.S. Agency for International Development is the largest of these and operates totally outside of the United States.

4. The impact of the baby boomer generation on the future of health care can best be described as: a. decrease in demand because they are a healthier group of older adults. b. decrease in demand because they are less likely to use preventive care. c. increase in demand because of increased life expectancy. d. increase in demand because of rates of acute health problems.

ANS: C By the year 2050, individuals age 65 years and older will make up 20% of the population, or one in five Americans. The life expectancy for these individuals is higher, with the number of people age 85 years and older expected to double between 1990 and 2050. Although many older adults are independent and active, because they will live longer they are likely to experience multiple chronic conditions that may become disabling. Older adults are admitted to hospitals three times more often than the general population, and their average length of stay is 3 days longer than the overall average. They visit physicians more often and make up a larger percentage of nursing home residents. Older adults consume a larger proportion of health care resources, including long-term care, hospital care, pharmaceutical products, and chronic disease management services.

3. In evaluation of a program to prevent teen pregnancy, analysis of the net direct and indirect costs, the improvements in the community attributable to the program (such as lower high school dropout rates), and the costs that would result if the program were not implemented (such as the cost of care for low-birth-weight infants) is an example of which of the following? a. Cost-benefit analysis b. Cost-efficiency analysis c. Cost-effectiveness analysis d. Economic growth predictions

ANS: C Cost-effectiveness analysis compares net direct and indirect costs, and cost savings with respect to a defined health outcome. Cost-effectiveness analysis is best used to compare two or more strategies or interventions that have the same health outcome in the community. This comparison can be between two program models or one intervention model and the absence of that intervention.

4. A terrorist bombing at a local church has sent many victims to the local emergency department and resulted in several deaths. Following the event, an emergency department nurse seeks out other nurses who are having difficulty performing their jobs to speak about the event. The nurse is demonstrating the disaster response strategy of: a. allaying public concern and fear. b. assisting victims to think positively and to move to the future. c. identifying feelings that individuals may be experiencing. d. preparing personnel to be effective in a disaster.

ANS: C During the aftermath of a disaster or terrorism event, nurses can feel fear, hopelessness, and loss or bias, hatred, vengeance, and violence toward ethnic or religious groups that may be associated with terrorism. These feeling may compromise their ability to provide care for these groups. Yet the International Council of Nurses' (ICN) Code of Ethics for Nurses (2000) affirms that nurses are ethically bound to provide care to all people. One strategy to use in response to a disaster or terrorism event is to assist in identifying the feelings that nurses or others may be feeling. To accomplish this, the nurse can (1) explain that feelings of fear, helplessness, and loss are a normal reaction to a disruptive situation; (2) work with people and help them think of what they did that helped them overcome fear and helplessness in previous situations; (3) encourage people to talk to others about their fears; (4) encourage others to ask for help and provide resources and referrals; (5) remember that those in the helping professions may find it difficult to seek help; and (6) convene small groups in workplaces with counselors/mental health experts.

6. The nurse assesses a client with paraplegia and cataracts. The client holds a full-time job and engages in several hobbies. The nurse documents that the client has: a. dual diagnoses. b. functional limitations and is wheelchair bound. c. visual and physical limitations. d. visual impairment and physical disability.

ANS: C Functional limitations occur when individuals experience difficulty performing basic activities of daily living because of their disability. Examples of functional limitations include difficulty standing, walking, climbing, grasping, and reading. Emphasis is placed on the level of function rather than on the purpose of the activity, so that functional limitation can be associated with the disability.

9. A PHN employed by the state's department of health is working on a team to develop local health policy. The nurse recognizes that policy development focuses on the level of the larger society and adopts strategies that require political actions such as lobbying and testifying. The reason that action in the policy arena comes most easily and naturally to nurses is the fact that the policy process is very similar to which of the following? a. Citizen action committee b. Nursing diagnosis c. Nursing process d. Socratic method

ANS: C Health policy is simply the process of turning health problems into workable action solutions. Thus, the policy process is very similar to the nursing process, but the focus is on the level of the larger society and the adoption of these strategies requires political action. The policy process includes statement of a health care problem, statement of the policy options to address the problem, adoption of a particular policy option, implementation of the policy product, and evaluation of the policy's intended and unintended consequences in solving the original health problem.

3. A nurse contacts a family to arrange an initial home visit. The nurse explains the source of the referral and the purpose of the visit. The husband expresses his concerns about the need for a home visit but agrees to a date and time for the home visit. The nurse reviews the agency's family record and the referral. The nurse has completed which phase(s) of the home visit? a. Initiation phase b. Initiation and postvisit phase c. Initiation and previsit phase d. Previsit phase

ANS: C Home visits allow a more accurate assessment of the family structure, the natural or home environment, and behavior in that environment than do clinic visits. The nurse has completed the initiation phase and the previsit phase. The initiation phase includes clarifying the referral source and the purpose of the visit, and sharing this information with the family. The previsit phase includes initiating contact, establishing shared perceptions, determining the family's willingness to participate, reviewing the record, and scheduling the home visit.

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

ANS: C MSAs are touted as a way of turning health care decision making control over to the individual receiving care. MSAs are tax-exempt accounts available to individuals who work for small companies, usually established through a bank or insurance company, that enable individuals to deposit money into an MSA on a pretax basis. Interest earned is tax free, and unused MSA money can be held in the account from year to year until it is needed to purchase health care services. This transfers to the individual the responsibility for knowledge and decision making regarding health care cost/quality trade-offs.

4. Nursing practice is governed by: a. boards of nursing established by the U.S. Department of Health and Human Services. b. nurse practice acts promulgated by federal and state legislative boards. c. nurse practice acts promulgated by state legislatures and operationalized by the state boards of nursing. d. nurse practice acts promulgated by the states in conformity with broad federal guidelines.

ANS: C State legislatures enact laws that establish boards of nursing. The functions of the board are described by the nurse practice act of each state. The boards of nursing license nurses, oversee training programs, and interpret and enforce statutory law.

8. A nurse seeks the best resource that provides a broad vision of the goals and objectives of many health care stakeholders in our nation and identifies the current national health policy for the United States. The best source for such information would be the: a. American Public Health Association's guidelines. b. website of the Centers for Disease Control and Prevention. c. Healthy People initiatives. d. Pan American Health Organization's mission statement.

ANS: C The Healthy People initiatives began in 1979 with subsequent updates and revisions across multiple decades. Healthy People 2020 builds on earlier versions to identify a national health agenda to attain quality, longer lives free of preventable diseases, disability, injury, and premature death; achieving health equity, eliminating health disparities and improving health for all groups; creating social environments that promote good health for all; and promoting quality of life, healthy development, and healthy behaviors across all life stages.

3. 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.

7. A nurse in a community health clinic reviews a client's health history and includes a family health history across three generations, noting any diseases with a genetic basis. The nurse is detecting or defining risk in low-risk groups for potential referral for diagnostic testing. This is an example of: a. genetic testing. b. primary prevention. c. secondary prevention. d. tertiary prevention.

ANS: C When a nurse reviews the health history, the nurse observes for any disease that may have a genetic basis and if found, immediately refers the person or family to the appropriate health care provider. The goal of screening is to detect or define risk in low-risk groups and identify those people who should have diagnostic testing.

2. 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.

5. Cleft lip and/or palate, a common congenital malformation, is often inherited and influenced by environmental factors, therefore it is referred to as a(n): a. extra chromosome expression. b. gene mutation. c. lifetime exposure phenomenon. d. multifactorial disease.

ANS: D Multifactorial diseases or those caused by gene and environment interaction influence disease risk, health conditions, and the therapies used to treat disease. Multifactorial disorders tend to occur in families and include such common inherited congenital malformations as cleft lip and palate, neural tube defects, and congenital heart disease.

6. Of the four major factors that affect health—personal behavior/lifestyle, environmental factors (physical, social, and economic), human biology, and the health care system—medical services are said to have the least effect. Yet the U.S. health care system remains reactionary, with high-cost, high-technology, and disease-specific "sickness care." These statements support the public health goal of: a. expanding managed care for the underserved. b. expanding secondary prevention in the schools. c. increasing tertiary prevention in skilled nursing facilities. d. preserving and maximizing human capital.

ANS: D Behavior and lifestyle have been shown to have the greatest effect on health, and together with environment and biology accounting for 70% of all illnesses. Yet 97% of health care dollars are spent on secondary and tertiary care. A more proactive investment in disease prevention and health promotion targeted at improving behaviors, lifestyle, and the environment has the potential to improve health status, and thus improve the quality of life while reducing health care costs. The U.S. Department of Health and Human Services has argued that a higher value should be placed on primary prevention with the goal of preserving and maximizing human capital by encouraging health promotion and social practices that result in less disease. Preserving and maximizing human capital will have a profound positive impact on economics in this country.

4. 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.

4. 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.

1. 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.

4. During a home visit, a nurse teaches a husband who is recovering from a stroke and his wife how to modify their home environment to prevent falls. This education represents: a. primary prevention. b. secondary prevention. c. secondary and tertiary prevention. d. tertiary prevention.

ANS: D Health-risk reduction is based on the assumption that decreasing the number of risks or the magnitude of risk will result in a lower probability of an undesired event. After a stroke, clients are often unstable when ambulating. Tertiary prevention includes assessing the home to prevent further complications from preventable injuries.

8. 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.

6. 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.

8. Government programs that support family health through the promotion of healthy lifestyles affect the health of individuals, family health, and overall community health. The best example of a government-sponsored program that can promote health and prevent illness for middle-income, subsistence-level families is: a. Medicaid. b. Medicare. c. nongovernmental organization. d. Women, Infants, and Children (WIC).

ANS: D Not all families have access to health insurance. For families at the poverty level, programs such as Medicaid are available to pay for illness care as well as health promotion and risk reduction/prevention. An increasing number of middle-income individuals are without health benefits. These people often do not have enough income to purchase health care but earn too much money to qualify for public assistance programs. These families may have access to illness care services but typically do not have access to preventive care. Such families are at a subsistence level and do not have the purchasing power for preventive care or nutritious foods like fruits and vegetables. Nutritious diets are important to preventing illness and promoting health. The WIC program of the U.S. Department of Agriculture is a government-sponsored nutrition program. Women, infants, and children from families living at a subsistence level may meet the eligibility criteria for this nutrition program. Women who participate in WIC programs during pregnancy have healthier babies. Infants and children who participate in the WIC program are more linked to the health care system than children who are not WIC participants. Children who participate in the WIC program receive both preventive and curative care more often than children who do not participate in the program.

1. When applying the bioecologic systems theory to families, a major assumption of this model is: a. families experience disequilibrium when they transition from one stage to another stage. b. focusing on the interaction of the system with other systems rather than the individual. c. maintaining stability through adaptation to internal and external stressors. d. what happens outside the family is as equally important as what happens inside the family.

ANS: D The bioecologic systems theory of Bronfenbrenner is designed around the principles of nature and nurture and those principles can be applied to families. The family is at the center of the concentric circles representing microsystems, mesosystems, exosystems, macrosystems, and chronosystems. One assumption of this model is that what happens outside the family is equally as important as what happens inside the family, providing a more holistic view of interactions between family and society, but not addressing how families cope or adapt to the interactions with these systems. The other statements apply to family development/lifecycle theory and family systems theory.

7. One major challenge in the development of social policies that affect families is related to: a. absence of any federal family policies. b. indirect negative effects on families. c. attempts at welfare reform. d. ongoing debate as to what constitutes a family.

ANS: D The challenges of social policy for families are numerous. Given the ongoing debate as to what constitutes a family, social policy may specify a definition that is inconsistent with the family's own definition, such as same-sex partnerships and/or marriage, legal definition of a parent, reproductive and fertility issue (surrogacy rights), care of older adults, health care proxy, teen request for confidential services.

1. The North American Free Trade Agreement, passed in 1994, allowed increased importation of goods and eased the movement of people throughout the United States, Canada, and Mexico. A health impact of this agreement for southern Texas has included: a. decrease in illegal immigration into the United States as a result of the improved Mexican economy. b. decrease in tuberculosis, cholera, and tetanus as a result of economic development. c. improved nutrition as a result of plentiful fresh vegetables and fruits in local markets. d. increase in respiratory and diarrheal disease as a result of colonias settlements.

ANS: D The colonias (colonies) are settlements of workers along borders in California, Arizona, New Mexico, and Texas. More than 40,000 Texans live in colonias along the southern Texas border. Environmental conditions in the colonias, such as lack of roads, transportation, water or electrical services, and access to primary care, have resulted in increased preventable infectious diseases (amebiasis, respiratory, and diarrheal diseases), environmental health hazards, and injuries associated with determinants of poverty, poor sanitation, and overcrowded conditions.

3. Mortality rates do not accurately describe the health status of populations in the world. The World Health Organization (WHO), in 2009, and World Bank, in 2005, developed an indicator—the global burden of disease—that combines losses from premature death with losses of healthy life that result from disability. The indicator represents: a. costs to the world of treating communicable disease in less-developed countries. b. economic cost of preventable early deaths. c. impact of disability on the international economic forecast. d. years in lost contribution to economic growth.

ANS: D The global burden of disease indicator utilizes the unit of disability-adjusted life-year (DALY). This unit measures the combined time lived with a disability and time lost as a consequence of premature death. The time lost because of premature mortality is calculated using standard expected years of life based on gender, whereas the reduction in physical capacity as a result of morbidity (disability) is measured using a six-point scale from 0 (perfect health) to 1 (death) that reflects the degree of dependence of the young and older adults on the adults in the population. The DALY represents life-years lost that could have contributed to the economic growth of a family or country as a consequence of premature death, disability, or loss of caregiver potential productivity/contribution.

1. 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.

9. 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.

6. The nurse working with the family of a child recently diagnosed with juvenile diabetes asks the parents about any changes in their relationship since the child's diagnosis. This family nursing approach can best be described as treating the family as a: a. client. b. component of society. c. context. d. system.

ANS: D When the family is approached as a system, the focus is on the family unit and the family is viewed as an integrated system in which the whole is more than the sum of its parts. The interactions among family members become the target for nursing interventions. The systems approach always assumes that when something happens to one family member, the other members of the family system are affected, and vice versa. This includes interactions among parents and children as well as interactions between parents.