Community Exam 1 Practice Questions

Which correctly defines an adjusted rate? A) Statistical procedure that removes the effects of differences in the composition of a population, such as age, when comparing one with another B) Measure of the probability that people without a certain condition will develop that condition over a period of time C) Measure of the number of people in a given population who have an existing condition at a given point in time D) Detailed rates that are calculated using the number of people in the smaller subgroups of the population in the denominator

Ans: A Feedback: Adjusted rate is the statistical procedure that removes the effects of differences in the composition of a population, such as age, when comparing one with another. Incidence rate is the measure of the probability that people without a certain condition will develop that condition over a period of time. Prevalence rate is the measure of the number of people in a given population who have an existing condition at a given point in time. Specific rates are detailed rates that are calculated using the number of people in the smaller subgroups of the population in the denominator. Often people are divided into subgroups by age and sex, although any characteristic can be used.

The nurse graphs the distribution of influenza cases by the time of onset of influenza. Which would be the result of this work? A) Epidemic curve B) Epidemiologic descriptive study C) Incidence density D) Incidence rate

Ans: A Feedback: An epidemic curve is a graph that plots the distribution of cases by the time of onset of the disease. Epidemiologic descriptive studies are research studies designed to acquire more information about the occurrence and distribution of states of health, such as characteristics of person, place, and time. Incidence density is the use of a person-time denominator in the calculation of rates. A person-day reflects one person at risk for 1 day, and a person-year represents one person at risk for 1 year. Incidence rate is the measure of the probability that people without a certain condition will develop that condition over a period of time.

Who achieved widespread recognition during the Civil War, distributing supplies to wounded soldiers and caring for the casualties with the help of a team of nurses? A) Clara Barton B) Dorothea Dix C) Lemuel Shattuck D) Lillian Wald

Ans: A Feedback: Clara Barton achieved widespread recognition during the Civil War, distributing supplies to wounded soldiers and caring for the casualties with the help of her team of nurses. Dorothea Dix was also an American political activist in the 19th century who became aware of the dreadful conditions in prisons and mental hospitals, and she vigorously lobbied state and federal officials to remedy the situation. Lemuel Shattuck prepared a report for the Massachusetts Sanitary Commission that pointed out that much of the ill health and disability in American cities in 1850 could be traced to unsanitary conditions. Lillian Wald was the founder of public health nursing.

The nurse works to identify epidemiologic transitions in the community. Which is an example of a demographic transition? A) High fertility and high mortality, resulting in slow population growth B) Progressive declines in mortality, as epidemics become less frequent C) High and fluctuating mortality, due to poor health, epidemics, and famine D) Further declines in mortality, increasing life expectancy, and predominance of noncommunicable diseases

Ans: A Feedback: Demographic transitions may progress from low to high levels and include the following: high fertility and high mortality, resulting in slow population growth; improvement in hygiene and nutrition, leading to a decreased burden of infectious disease; declines in mortality and, later, declines in fertility. Epidemiologic transitions include the following: high and fluctuating mortality, due to poor health, epidemics, and famine; progressive declines in mortality, as epidemics become less frequent; and further declines in mortality, increasing life expectancy, and predominance of noncommunicable diseases.

Who is considered the first epidemiologist? A) Hippocrates of Cos B) Aretaeus the Cappadocian C) Claudius Galen D) Susruta

Ans: A Feedback: Hippocrates of Cos was the first to record the relationship of the external environment to the health of individuals and is considered the first epidemiologist. Aretaeus the Cappadocian described pulmonary tuberculosis in detail. Claudius Galen described the four humors, introduced many drugs derived from plants, and was the first to describe smallpox. Susruta was a Brahmin physician who associated malaria with the mosquito.

Over the course of a year, there were 42 cases of institution-associated pneumonia at a hospital. During that time, 3,102 clients were at risk for acquiring this infection, covering a total of 20,411 client-days. Which is the client density in terms of number of cases per 1,000 client-days at this hospital during this time? A) 2.1 B) 13.5 C) 15.2 D) 152

Ans: A Feedback: Incidence density is calculated by dividing the number of new cases occurring during the study period by the person-time units accumulated by subjects during the study period and multiplying the result by the base multiple of 10. In this case, the following equation would result: 42/20,411 = 0.0021 × 1,000 = 2.1 cases per 1,000 client-days.

The nurse wishes to measure the number of cases of staph infections that occur in a hospital over the course of 1 year per total client-days during that year. Which measure should the nurse use? A) Incidence density B) Prevalence rate C) Relative risk ratio D) Specific rate

Ans: A Feedback: Incidence density is the use of a person-time denominator in the calculation of rates. A person-day reflects one person at risk for 1 day, and a person-year represents one person at risk for 1 year. Prevalence rate is the measure of the number of people in a given population who have an existing condition at a given point in time. Relative risk ratio is the ratio of the incidence rate in the exposed group to the incidence rate in the nonexposed group. Specific rates are detailed rates that are calculated using the number of people in the smaller subgroups of the population in the denominator.

A nurse is striving to practice patient-centered care at a hospital. Which action best exemplifies providing patient-centered care? A) Having a client complete a self-reported functional status indicator and then reviewing it with the client B) Explaining to a client the benefits of computer-assisted robotic surgical techniques, which the hospital recently implemented C) Recording a client's signs and symptoms in an electronic health record D) Performing continuous glucose monitoring of a client while the client is in the hospital

Ans: A Feedback: Patient-centered care considers cultural traditions, personal preferences, values, families, and lifestyles. Clients become active participants in their own care, and monitoring health becomes the client's responsibility. To help clients and their healthcare providers make better decisions, the Agency for Healthcare Research and Quality (AHRQ) has developed a series of tools that empower clients and assist providers in achieving desired outcomes, including client-reported functional status indicators. Computer-assisted robotic surgical techniques, electronic health records, and continuous glucose monitoring in the hospital are all technological advances in healthcare, but they do not help the client become a more active participant in his or her care, and thus are not good examples of patient-centered care.

A nurse is interested in exploring initiatives related to health, poverty, and development in Africa. Which organization would most likely be involved in such an initiative? A) Bill and Melinda Gates Foundation B) Living Proof Project C) International Committee of the Red Cross D) Oxfam International

Ans: A Feedback: Philanthropies are organizations that are similar to NGOs but they receive funding through personal endowments. For example, the Bill and Melinda Gates Foundation focuses on health, poverty, and development in Africa, South America, Asia, and Australia. The Living Proof Project supports vaccine and nutrition programs, as well as decreasing the incidence of diseases such as polio, HIV/AIDS, and tropical illnesses. Nongovernmental organizations are private agencies that voluntarily use their resources to address a variety of healthcare initiatives in the United States. The International Committee of the Red Cross is known most for its role in disaster relief. Oxfam International focuses specifically on issues related to hunger and nutritional health.

The hospital board is in the process of developing a policy regarding the use of cell phones within the hospital. After 6 months of a policy being in place and weeks of ongoing evaluation of the policy by individual board members, the board decided to expand the areas where cell phone use is permitted to include all waiting rooms and some client rooms. Which stage of policy-making does this action represent? A) Policy modification B) Policy adoption C) Policy implementation D) Policy assessment

Ans: A Feedback: Policy modification is the step in which a policy that has already been implemented is maintained, changed, or eliminated on the basis of results of policy assessment. Policy adoption is the process of selecting the policy that will be implemented. Policy implementation is the stage in which the selected policy is carried out by using human and financial resources. Policy assessment is the stage in which the implemented policy is evaluated in terms of its compliance with statuary requirements and effectiveness.

Which most accurately defines quality of care? A) Degree to which health services increase the likelihood of desired outcomes and are consistent with current knowledge B) Improvement of what is wrong or unsatisfactory C) Economic approach or analysis tool used to evaluate the effectiveness of a treatment or intervention D) Presence of a variety of ethnic, racial, and cultural backgrounds of the workers in a specific area such as the health sector

Ans: A Feedback: Quality of care is defined by the Institute of Medicine as the degree to which health services for individuals and populations increase the likelihood of desired outcomes and are consistent with current knowledge. Reform is the improvement of what is wrong or unsatisfactory. Cost-benefit is an economic approach or analysis tool used to evaluate the effectiveness of a treatment or intervention. Workforce diversity is the presence of a variety of ethnic, racial, and cultural backgrounds of the workers in a specific area such as the health sector.

Which is the primary method used to measure the existence of states of health or illness in a population during a given time period? A) Rate B) Ratio C) Relative risk ratio D) Sensitivity

Ans: A Feedback: Rate is the primary measurement used to describe the occurrence (quantity) of a state of health in a specific group of people in a given time period. Ratio is a fraction that represents the relationship between two numbers. Relative risk ratio is the ratio of the incidence rate in the exposed group to the incidence rate in the nonexposed group. Sensitivity is the ability of a test to correctly identify people who have a health problem or the probability of testing positive if the health problem is truly present.

In reviewing a study that considered the sensitivity of a particular screening test for HIV, the nurse found 21 true positives, 853 true negatives, 3 false positives, and 5 false negatives. What is the sensitivity of this test? A) 80.8% B) 87.5% C) 93.7% D) 99.6%

Ans: A Feedback: Sensitivity is calculated by dividing the number of true positives by the sum of the number of true positives and false negatives. In this case, the sensitivity would be calculated as follows: 21/21 + 5 = 21/26 = 0.808 = 80.8%.

A nurse is coordinating an initiative in the community to make sure that the healthcare needs of local refugees and asylees are recognized and addressed. Which federal agency should this nurse contact, as it is directly involved with the health and healthcare of refugees and asylees in the United States? A) United States Department of Health and Human Services B) National Institutes of Health C) Agency for Healthcare Research and Quality D) Centers for Disease Control and Prevention

Ans: A Feedback: The United States Department of Health and Human Services is the federal agency that is directly involved with the health and healthcare of U.S. citizens or refugees/asylees. The National Institutes of Health, Agency for Healthcare Research and Quality, and Centers for Disease Control and Prevention are three important organizations in which research is undertaken and used effectively to address key healthcare concerns such as HIV screening and care, address adverse events in hospital settings, and promote measures to decrease the rates of emerging infectious diseases.

In the United States, the system of healthcare has historically given and continues to give stronger support to which types of care? A) Individual care with a focus on cure B) Community care with a focus on cure C) Individual care with a focus on prevention D) Community care with a focus on prevention

Ans: A Feedback: The United States and its system of healthcare have historically given and continue to give stronger support to individual rather than community care and cure rather than prevention.

Which example best illustrates the World Health Organization's definition of health? A) 72-year-old woman with well-managed diabetes who walks 2 miles every day and takes classes at the local community college B) 20-year-old man with no significant history of disease who smokes, works a stressful job, and is sedentary C) 50-year-old woman with no health complaints who is alcoholic, lives alone with little social contact, and is obese D) 98-year-old man with dementia who resides in an assisted living facility

Ans: A Feedback: The World Health Organization defines health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." Although the 72-year-old woman has diabetes, she is managing it well, is physically active, and is effectively developing her mental and social well-being. The 20-year-old man and 50- year-old woman, although they have no known health concerns, do not have healthy lifestyles. The 98-year-old man has a mental condition and there are no indicators of physical or social well-being.

In a healthcare facility, a client is regarded as being healthy if he or she has no diagnosed diseases and is free of any symptoms. Which model of health is in place at this facility? A) Clinical model B) Role performance model C) Adaptive model D) Eudaimonistic model

Ans: A Feedback: The clinical model of health focuses on the elimination of disease or symptoms. For example, some people feel that they are well when they have no symptoms or diagnosed diseases and would not classify themselves as sick otherwise. The role performance model holds that health involves a fit between people and social roles. In the adaptive model, health involves adaptation to the environment. The eudaimonistic model of health holds that health is the actualization or realization of human potential.

Public health nursing is distinguished from other specialties by adherence to eight principles. Which is one of the eight domains of public health nursing practice? A) Analytic assessment skills B) Investigation of disease C) Referral and follow-up D) Case management

Ans: A Feedback: The eight domains of public health nursing practice are as follows: Analytic assessment skills, policy development and program planning skills, communication skills, cultural competency skills, community dimensions of practice skills, public health science skills, financial planning and management skills, and leadership and systems thinking skills. Investigation of disease, referral and follow-up, and case management are all public health nursing interventions but are not domains of public health nursing practice.

In researching cases of West Nile virus in the community, the nurse explores how the interactions among people infected with this virus, mosquitoes, and the environment they share contribute to outbreaks of this disease. Which epidemiologic model is used in this case? A) Epidemiologic triad B) Wheel of causation C) Web of causation D) Natural history

Ans: A Feedback: The epidemiologic triad is the classic model based on the belief that health status is determined by the interaction of the characteristics of the host, agent, and environment, not by any single factor. The wheel of causation de-emphasizes the agent as the sole cause of disease while emphasizing the interplay of physical, biological, and social environments. The web of causation is an epidemiologic model that strongly emphasizes the concept of multiple causation while de-emphasizing the role of agents in explaining illness. Natural history is the course of a disease or condition from the onset to resolution.

Which was the leading cause of death in the United States in 1900? A) Major cardiovascular-renal disease B) Influenza and pneumonia C) Tuberculosis D) Gastritis, duodenitis, enteritis, and colitis

Ans: A Feedback: The leading cause of death in 1900 was major cardiovascular-renal disease followed by influenza and pneumonia; tuberculosis; and gastritis, duodenitis, enteritis, and colitis.

A family member receives Medicaid. Which is most likely to limit access of this person to healthcare? A) Inability to find a provider who accepts Medicaid B) Pre-existing conditions C) Lack of insurance D) Large insurance premiums

Ans: A Feedback: Those covered by Medicaid have insurance but may experience problems accessing primary care due to their inability to find a private physician who accepts Medicaid clients. Out-of-pocket expenses may also be a factor in inability to access care. Preexisting conditions limited access to private insurance before the passage of the Patient Protection and Affordable Care Act of 2010 but should not limit access to healthcare in a client covered by Medicaid. Large insurance premiums would not pertain to Medicaid.

The community health nurse manager works to identify how to manage the local health workforce shortage effectively. Using knowledge of the World Health Organization's (WHO) recommendations, which suggestion should the nurse manager give to the agency? A) Increase the agency's investment in the education and training of new healthcare workers B) Offer incentives to attract workers to thriving urban areas C) Attract men to the health professions D) Provide cures for common health problems to reduce demand for health services

Ans: A Feedback: WHO considers the following as important requirements for the effective management of health workforce shortages: increased investment in education and training; career incentives to attract health workers to rural and disadvantaged areas; attracting women to health professions and addressing retirement; and health promotion and prevention strategies to reduce demand for health services.

Who in the history of epidemiology developed mortality surveillance systems, addressed basic epidemiologic concepts, and is considered the founder of modern statistics? A) William Farr B) John Graunt C) Florence Nightingale D) John Snow

Ans: A Feedback: William Farr is considered the father of modern statistics. John Graunt analyzed weekly reports of births and deaths. Florence Nightingale used statistics to improve public health in England. John Snow performed epidemiologic research on transmission of cholera using natural experiments, mapping, and rates.

The nurse is migrating from a developing nation to a developed nation. This migration ultimately benefits the nurse's home country if the nurse: (Select all that apply.) A) Returns to the home country with advanced practice skills B) Returns to the home country and teach others what was learned C) Shares with the new coworkers nursing practices unique to the nurse's home country D) Earn more money in the position in the new country E) Is safer from exposure to HIV in the new country

Ans: A, B Feedback: Workers who migrate gain new skills in the receiving countries and can return to their native countries revitalized with education and new outlooks on solving the problems— in other words, "brain gain." Those who leave may also come back with the skills to educate other workers. For example, nurses may return with advanced practice nursing skills and become educators in their respective countries. Sharing nursing practices with coworkers in the new job might benefit them and their clients but would not benefit the home country. Earning more money and being safer from exposure to HIV would benefit the nurse, but not the nurse's home country.

Which represent ways nurses can actively engage in policy making? (Select all that apply.) A) Testify at congressional hearings B) Disseminate information on health issues in the media C) Serve as members of governing boards D) Document client symptoms following a physical examination E) Review articles in recent nursing journals

Ans: A, B, C Feedback: In terms of policy making, nurses can 1) provide vital evidence that either supports or opposes a policy, 2) be members of an organization or a group that introduces a specific problem into the national agenda and identifies the goals and tools needed to implement it, and 3) advocate for and disseminate information on health issues through the media. Nurses may also advocate for their clients by testifying at congressional hearings, healthcare summits, and regional forums regarding the need to eliminate disparities in healthcare access among various client demographics. The American Nurses Association works with coalitions and advocates for nurses to serve as members of governing boards in each state, to advance the role and recognition of nurses, to prevent potential declines in quality, and to communicate with the Congress in the prevention of harmful changes in Medicare. Documenting client symptoms and reviewing articles in nursing journals are tasks commonly performed by nurses but are not directly related to policy making.

Personal responsibility for health involves active participation in one's own health through education and lifestyle changes. Which exemplify personal responsibility? (Select all that apply.) A) Reviewing one's own medical records B) Monitoring the positive and negative effects of prescription and over-the-counter medications C) Avoiding tobacco and recreational drug use D) Showing up for scheduled tests and procedures E) Eating the types of foods one most enjoys

Ans: A, B, C, D Feedback: Personal responsibility for health involves active participation in one's own health through education and lifestyle changes. It includes responsibility for reviewing one's own medical records and monitoring both the positive and negative effects of prescription and over-the-counter medications. It means showing up for scheduled tests and procedures and avoiding tobacco and recreational drug use. Eating the types of foods one most enjoys is not necessarily responsible, if one most enjoys foods that do not meet dietary recommendations.

The Department of Health and Human Services has identified several areas for which health disparities exist among various demographic groups and need to be addressed. Which are included among these areas? (Select all that apply.) A) Infant mortality B) Cancer screening C) Cardiovascular disease D) Diabetes E) End-stage renal disease

Ans: A, B, C, D Feedback: The Department of Health and Human Services has identified six areas for which it has oversight and that require effort to reduce disparities. These areas are (1) infant mortality, (2) cancer screening, (3) cardiovascular disease, (4) diabetes, (5) HIV/AIDS, and (6) immunizations. End-stage renal disease is not an area of focus.

Nurses are effective and influential shapers of healthcare policy because of their expertise in: (Select all that apply.) A) Clinical practice B) Administration C) Education D) Political science E) Research

Ans: A, B, C, E Feedback: Nurses' expertise as clinicians, educators, researchers, and administrators lends them much power in public policy. Nurses, as a whole, do not typically have expertise in political science.

The nurse is interested in taking on a role in the state's political decision-making process. Which political skills will the nurse need to be effective in this role? (Select all that apply.) A) Ability to understand others' behaviors B) Social skills C) Diagnostic skills D) Ability to network E) Ability to lie convincingly

Ans: A, B, D Feedback: Healthcare professionals have political skills and active roles in healthcare leadership. These skills include the following: social skills and the ability to understand, interpret, and represent one's own and others' behaviors; the ability, qualifications, and power to influence others and make changes; the ability to develop, connect, and use different social networks; and having a high level of integrity, sincerity, and genuineness.

Which key factors contribute to the rise of noncommunicable diseases in low- and middle-income countries? (Select all that apply.) A) Tobacco use B) Insufficient physical activity C) Unclean water D) High blood pressure E) Lack of contraceptive use

Ans: A, B, D Feedback: Key factors in the rise of noncommunicable diseases include the following: tobacco use, insufficient physical activity, harmful use of alcohol, unhealthy diet, high blood pressure, overweight and obesity, high cholesterol, and cancer-associated infections. Unclean water and lack of contraceptive use are risk factors for communicable diseases, such as Legionnaires' disease and HIV, respectively.

Which risk factor for poor health is associated with low- and middle-income countries? (Select all that apply.) A) Burning of wood and dung for cooking and heat B) Low status of women C) Sedentary lifestyle D) Not wrapping an infant immediately after birth E) Overconsumption of fatty foods

Ans: A, B, D Feedback: Low- and middle-income countries have an increased burden of the risk factor of poverty. Extreme poverty—the inability to meet the basic needs of adequate nutrition, safe drinking water, basic education, and primary health services and the lack of a livelihood that can generate the means to secure these basic needs—is the driving force behind increased mortality. The continuous smoke from the burning of air-polluting solid fuels affects the population's health and in turn affects economic prospects. The continued low status of women, despite years of policy development, increases the risk of disease and disability. Interventions to improve neonatal care at birth in lower-income countries include drying the infant off and wrapping immediately after birth. A sedentary lifestyle and overconsumption of fatty foods are not risk factors associated with low- and middle-income countries but with higher-income countries.

Which programs are funded by the Community Transformation Grant program? (Select all that apply.) A) Tobacco-free living B) Physical activity C) Autism awareness D) Healthy eating E) Managing attention-deficit disorder

Ans: A, B, D Feedback: The Community Transformation Grant program funds programs that promote tobacco- free living, physical activity, healthy eating, services to prevent and control high blood pressure and high cholesterol, social and emotional wellness, and healthy and safe environments. It does not specifically provide funds for autism awareness or managing attention-deficit disorder.

The nurse has been requested to investigate the outbreak of H1N1 in the community. In documenting the outbreak, which should be included in its description? Select all that apply. A) The names of all people who have been infected by the virus B) The geographical area within which the outbreak has occurred C) A brief history of all of the other viral outbreaks that have occurred in the community in recent years D) The time of onset and duration of the outbreak E) The anticipated economic impact of the outbreak on the community

Ans: A, B, D Feedback: The nurse should describe the outbreak according to person, place, and time. A history of other viral outbreaks and the economic impact of the outbreak are not necessary for the nurse to document.

The nurse is in charge of the flu vaccination program in the community. Which actions should the nurse take when planning and evaluating this program? Select all that apply. A) Measure epidemiologic statistics before and after administering the flu shots. B) Plan and evaluate influenza vaccinations regularly. C) Interview clients regarding their perception of the effectiveness of the vaccinations and use these data in planning future vaccinations. D) As new data regarding influenza vaccinations become available, modify the intervention accordingly. E) Evaluate the success of your program by comparing its results with those in other communities.

Ans: A, B, D Feedback: The primary way to demonstrate prevention or control of a health problem is to compare epidemiologic statistics before and after the implementation of the health service. Planning and evaluation are continuous processes. As new data become available, modification in health services may be necessary, and those modifications require evaluation. Evaluation of the program and planning of future interventions should not be based on the clients' perception of its effectiveness, which is likely to not be accurate. Because factors may vary significantly from community to community, it would be more appropriate to compare before and after statistics in your own community rather than statistics with other communities.

The client is a single mother of two who earns minimum wage at a part-time job and never graduated from high school. Which healthcare-related outcomes is the client at increased risk for, based on her circumstances? (Select all that apply.) A) Morbidity B) Mortality C) Genetic disorder D) Difficulty accessing care E) Negative outcomes when receiving care

Ans: A, B, D, E Feedback: Marginalization often occurs in people who live below the poverty level in the United States, and these people frequently are poorly educated. In the chapters that follow, higher rates of morbidity, mortality, difficulty in accessing care, and negative outcomes when receiving care, will be seen as key issues in such populations. This client's circumstances would not increase her risk of experiencing a genetic disorder.

A nurse has just finished providing teaching and care to a child with type 1 diabetes. On the basis of the five dimensions of healthcare identified by the Institute of Medicine, indicators of quality care include that the child: (Select all that apply.) A) Safely self-injected insulin in the office B) Has maintained an appropriate blood glucose level consistently for 6 months C) Was seen by the nurse 2 hours after arriving for a scheduled appointment D) Received care that was identical to that provided to six other clients of various racial backgrounds E) Received instructions directly from the nurse in the office, not via a parent

Ans: A, B, D, E Feedback: The Institute of Medicine lists the following dimensions of healthcare systems that should be considered when quality, cost, and access are examined: 1) safety: avoiding injury and harm from care that is meant to aid clients; 2) effectiveness: assuring that "evidence-based" care is actually delivered, by avoiding overuse of medically unproven care and underuse of medically sound care; 3) client-centeredness: involving clients thoroughly in the decision-making process about their care, thereby respecting their culture, social circumstances, and needs; 4) timeliness: avoiding unwanted delays in treatment; and 5) equality: closing racial, ethnic, gender, and socioeconomic gaps in care and outcomes.

Which public health entities are often regulated by the U.S. federal government? (Select all that apply.) A) Food B) Medications C) School health D) Devices E) Environment

Ans: A, B, D, E Feedback: The federal government plays an important role in the regulation of public health. Public health entities of regulation are often related to (1) food, (2) drugs, (3) devices, (4) occupation health, and (5) the environment through the Department of Health and Human Services. School health is typically regulated by state and local governments, not the federal government.

A nurse is caring for an older client who is struggling to manage her type 2 diabetes mellitus. The nurse should recognize which social determinants of this client's health? (Select all that apply.) A) Household income of $23,000 per year B) Reading level of a third grader C) Medication ineffective due to error in prescription D) Originally from Sudan E) No family in the area

Ans: A, B, D, E Feedback: The social conditions in which people live, their income, social status, education, literacy, home and work environment, support networks, gender, culture, and availability of health services are the social determinants of health. These conditions have an impact on the extent to which a person or community possesses the physical, social, and personal resources necessary to attain and maintain health. A medical error on the part of the client's primary care provider or nurse would not constitute a social determinant of the client's health.

A client receives Medicare, has limited income, and lives in a large city. Which factors are likely to limit the client's ability to access healthcare? (Select all that apply.) A) Inability to afford supplemental insurance B) Living in an urban environment C) High out-of-pocket expenses D) Preexisting conditions E) Lack of in-network providers in her region

Ans: A, C Feedback: The underinsured include older individuals who receive Medicare but cannot afford supplemental insurance or the out-of-pocket expenses associated with Medicare. Those living in a rural area, not an urban area, would be likely to have difficulty finding available healthcare providers. In-network providers would apply to private insurance, not to Medicare.

Which exemplify determinants of health? (Select all that apply.) A) Living in a community with clean, fluoridated water B) Having a death rate of 500 per 100,000 population C) Living in neighborhood with a high crime rate D) Smoking two packs of cigarettes per day E) Having an infant mortality rate of 95 deaths per 1,000 live births

Ans: A, C, D Feedback: Determinants of health are factors that affect outcomes of health status, such as physical environment (living in a community with clean, fluoridated water), social environment (living in a neighborhood with a high crime rate), health behaviors (smoking two packs of cigarettes per day), and individual health, as well as broader factors such as access to health services and overall health policies and interventions. Mortality rates are indicators of health, not determinants of health.

Select the nursing ethical principles established by the American Nurses Association's (ANA) Code of Ethics for Nurses? (Select all that apply.) A) Compassion and respect for the dignity, worth, and uniqueness of every individual B) Primary commitment to the physician C) Promotion and advocacy to protect the client's health, safety, and rights D) Participation in establishing, maintaining, and improving healthcare environments and conditions E) Self-sufficiency and lack of dependence on other healthcare professionals in caring for the client

Ans: A, C, D Feedback: Nursing ethical principles established by the ANA's Code of Ethics for Nurses include the following: 1) compassion and respect for the dignity, worth, and uniqueness of every individual; 2) primary commitment to the client (individual, family, group, or community), not to the physician; 3) promotion and advocacy to protect the client's health, safety, and rights; 4) responsibility and accountability for individual nursing practice by appropriate delegation of tasks to provide optimum care; 5) responsibility to preserve integrity and safety, maintain competence, and continue personal/professional growth; 6) participation in establishing, maintaining, and improving healthcare environments and conditions; 7) participation in the advancement of the profession through contributions to practice, education, administration, and research; 8) collaboration with other healthcare professionals and the public in promoting community, national, and international efforts to meet health needs; and 9) responsibility for articulating values, maintaining integrity, and shaping social policy.

Which steps must take place to improve the U.S. healthcare system, according to Porter? (Select all that apply.) A) Measurement and dissemination of health outcomes must be shared. B) The existing system of delivery of prevention, wellness, screening, and routine health maintenance services must be preserved. C) Care delivery must be reorganized around the availability of physicians. D) Providers must compete for nurses on the basis of the quality of the care provided. E) Clients' involvement in their health must improve and incentives for client involvement should be considered.

Ans: A, E Feedback: Porter lists the following steps that must take place to improve the U.S. healthcare system: 1) measurement and dissemination of health outcomes must be shared; 2) the delivery of prevention, wellness, screening, and routine health maintenance services must be fundamentally restructured (not preserved); 3) care delivery must be reorganized around medical conditions (not around the availability of physicians); 4) a reimbursement program for healthcare professionals as incentives to achieve better outcomes for clients must be established; 5) providers must compete for clients (not nurses) on the basis of the quality of the care provided; 6) all providers must establish electronic medical records; and 7) clients' involvement in their health must improve and incentives for client involvement should be considered.

Which best describes a nongovernmental organization? A) Agency that is based in only one country but provides services to many other countries B) Agency that acquires resources to help others from private rather than public sources C) A group that collects data related to healthcare use across a variety of professional and service parameters D) An organization that uses endowed funds or private fundraising to address the needs of individuals, families, and populations

Ans: B Feedback: A nongovernmental organization is an agency that acquires resources to help others from private rather than public sources. A bilateral agency is one that is based in only one country but provides services to many other countries. Organization for Economic Cooperation and Development is a group that collects data related to healthcare use across a variety of professional and service parameters. A philanthropic organization is one that uses endowed funds or private fundraising to address the needs of individuals, families, and populations.

Who first described pulmonary tuberculosis in detail? A) Hippocrates of Cos B) Aretaeus the Cappadocian C) Claudius Galen D) Susruta

Ans: B Feedback: Aretaeus the Cappadocian described pulmonary tuberculosis in detail. Hippocrates of Cos was the first to record the relationship of the external environment to the health of individuals. Claudius Galen described the four humors, introduced many drugs derived from plants, and was the first to describe smallpox. Susruta was a Brahmin physician who associated malaria with the mosquito.

The nurse wishes to determine how many people in the city die from heart attacks each year per 100,000 population. Which type of rate is the nurse attempting to calculate? A) Age-specific mortality rate B) Cause-specific mortality rate C) Case fatality rate D) Crude mortality rate

Ans: B Feedback: Cause-specific mortality rates indicate the probability of death from a specific cause; the number of deaths from a specific disease is divided by the number of people in the population at midyear and multiplied by 100,000. Age-specific mortality rates indicate the probability of death among those of a specific age group; the number of deaths in the age group is divided by the number of people in that age group in the population at midyear and multiplied by 100,000. In calculating the case fatality rate, the number of people with a specific disease such as lung cancer becomes the subgroup being studied out of the entire population in a designated geographic area. Crude mortality rate is simply the number of deaths occurring in 1 year divided by the midyear population and multiplied by 100,000.

Over the course of a year, there were 42 cases of institution-associated pneumonia at a hospital. During that time, 3,102 clients were at risk for acquiring this infection, with 20,411 client-days. Which is the crude incidence rate of institution-associated pneumonia at this hospital? A) 0.21% B) 1.35% C) 1.52% D) 15.20%

Ans: B Feedback: Crude incidence rate is calculated by dividing the number of occurrences or cases of a health problem by the number of people in the population who are at risk for the health problem. In this case, the following equation would result: 42/3,102 = 0.0135 = 1.35%.

Which occurs in the epidemiologic process that is similar to the implementation phase of the nursing process? A) Data are gathered from reliable sources B) Actions are initiated to carry out the plan C) Actions are evaluated and report prepared D) Further research is conducted if necessary

Ans: B Feedback: During the implementation phase of the epidemiologic process, actions are initiated to implement the plan. During the assessment phase of the epidemiologic process, data are gathered from reliable sources. During the evaluation phase of the epidemiologic process, actions are evaluated, a report is prepared, and further research is conducted if necessary.

National Health Expenditure Accounts are a measure of expenditures on healthcare goods and services in the United States. In the most recent set of estimates, expenditures totaled what percentage of U.S. health spending? A) 2 B) 3 C) 4 D) 5

Ans: B Feedback: Government public health activity constitutes an important service category. In the most recent set of estimates, expenditures totaled $56.1 billion in 2004, or 3% of total U.S. health spending (National Health Expenditures, 2013).

The nurse collects specific data related to risk factors, health indicators, and health outcomes that determine the burden of disease. Which data would the measure known as HALE yield about health indicators and outcomes? A) Average number of years a newborn is expected to live if current mortality rates continue to apply B) Average number of years that a person can expect to live in "full health" by taking into account years lived in less than full health due to disease and/or injury C) Quantifying the burden of disease to a healthy life on the basis of the loss of years related to the burden of disease. The gap in years reflects the current state of health compared with an optimum state of health of a nation. D) Quantifying the burden of acute illness to a healthy life on the basis of the loss of years related to the burden of acute illness. The gap in years reflects the current state of health compared with an optimum state of health of a nation.

Ans: B Feedback: Health-adjusted life expectancy at birth (HALE) is the average number of years that a person can expect to live in "full health" by taking into account years lived in less than full health due to disease and/or injury. Life expectancy at birth is the average number of years a newborn is expected to live if current mortality rates continue to apply. Disability-adjusted life years (DALY) is a measure that quantifies the burden of disease to a healthy life on the basis of the loss of years related to the burden of disease. The gap in years reflects the current state of health compared with an optimum state of health of a nation. Acute illness is not a factor in determining health indicators.

The nurse is locating populations in her region who are exposed to lead-based paint and providing them with information regarding the dangers of lead poisoning. This is an example of which public health intervention? A) Surveillance B) Outreach C) Screening D) Case management

Ans: B Feedback: In the intervention of outreach, the nurse locates populations at risk, provides information, identifies possible actions, and identifies access to services, which is what the nurse is doing in this situation. In the intervention of surveillance, the nurse monitors health events through ongoing, systematic collection, analysis, and interpretation of health data for planning, implementing, and evaluating public health interventions. In the intervention of screening, the nurse identifies individuals with unrecognized risk factors or asymptomatic conditions. In the intervention of case management, the nurse coordinates a plan or process to bring health services and the self-care capabilities of the client together as a common whole in a cost-effective way.

Who was one of the first people to study patterns of disease in populations and analyzed the weekly reports of births and deaths in London, the results of these analyses becoming the precursor of modern vital statistics? A) William Farr B) John Graunt C) Florence Nightingale D) John Snow

Ans: B Feedback: John Graunt analyzed weekly reports of births and deaths. William Farr is considered the father of modern statistics. Florence Nightingale used statistics to improve public health in England. John Snow performed epidemiologic research on transmission of cholera using natural experiments, mapping, and rates.

The hospital board is in the process of developing a policy regarding the use of cell phones within the hospital. At the current meeting, the board has decided to allow use of cell phones only within certain waiting areas within the hospital, and nowhere else. Which stage of policy-making does this action represent? A) Policy formulation B) Policy adoption C) Policy implementation D) Policy assessment

Ans: B Feedback: Policy adoption is the process of selecting the policy that will be implemented. Policy formulation is the stage in which various policy options are identified and explored. Policy implementation is the stage in which the selected policy is carried out by using human and financial resources. Policy assessment is the stage in which the implemented policy is evaluated in terms of its compliance with statuary requirements and effectiveness.

1. The nurse is passionate about research for a cure for pediatric leukemia and has written the state representatives in Congress to urge them to expand federal funding for this research. This behavior is an example of involvement in: A) Policy B) Politics C) Public health D) Equity

Ans: B Feedback: Politics is the process of influencing the allocation of scarce resources, including financial resources, human resources, and time. A policy is a guideline that directs individuals' behavior toward a specific goal or a deliberate course of action chosen by an individual or group to deal with a problem. Public health is what society does collectively to ensure that conditions exist in which people can be healthy. Equity in healthcare refers to care that does not vary in quality because of gender, race, ethnicity, geographic location, or socioeconomic status.

Which most accurately defines "rate"? A) Course of a disease or condition from the onset to resolution B) Primary measurement used to describe either the occurrence or the existence of a specific state of health or illness C) Probability or likelihood that a disease or illness will occur in a group of people who presently do not have the problem D) Characteristic or event that has been shown to increase the probability that a specific disease or illness will develop

Ans: B Feedback: Rate is the primary measurement used to describe either the occurrence or the existence of a specific state of health or illness. Natural history is the course of a disease or condition from the onset to resolution. Risk is the probability or likelihood that a disease or illness will occur in a group of people who presently do not have the problem. A risk factor is a characteristic or event that has been shown to increase the probability that a specific disease or illness will develop.

Which correctly defines sensitivity? A) The ratio of the incidence rate in the exposed group to the incidence rate in the nonexposed group B) Ability of a test to correctly identify people who have a health problem or the probability of testing positive if the health problem is truly present C) Variations measured in hours, days, weeks, or months and commonly used to quantify outbreaks of infectious disease D) Ability of a test to correctly identify people who do not have a health problem or the probability of testing negative if the health problem is truly absent

Ans: B Feedback: Sensitivity is the ability of a test to correctly identify people who have a health problem or the probability of testing positive if the health problem is truly present. Relative risk ratio is the ratio of the incidence rate in the exposed group to the incidence rate in the nonexposed group. Short-term changes are variations measured in hours, days, weeks, or months and are commonly used to quantify outbreaks of infectious disease. Specificity is the ability of a test to correctly identify people who do not have a health problem or the probability of testing negative if the health problem is truly absent.

Demographic characteristics indicate that people in developed countries are living longer, healthier lives, yet tremendous health and social disparities exist. Which describes social determinants of health? A) What society does collectively to ensure the conditions exist in which people can be healthy B) Social conditions in which people live and work C) Context of preventing disease and disability and promoting and protecting the health of the entire community D) Comprehensive management of health information and its secure exchange between consumers, providers, government and quality entities, and insurers

Ans: B Feedback: Social determinants of health are the social conditions in which people live and work. Health information technology is the comprehensive management of health information and its secure exchange between consumers, providers, government and quality entities, and insurers. Public health is what society does collectively to ensure the conditions exist in which people can be healthy. Public health nursing is a population-based practice, defined as a synthesis of nursing and public health within the context of preventing disease and disability and promoting and protecting the health of the entire community.

Which organization publishes and articulates the essentials of public health nursing, including the activities and accountabilities that are characteristics of practice at all levels and settings? A) Association of Community Health Nurse Educators (ACHNE) B) American Nurses Association (ANA) C) American Public Health Association (APHA) D) Association of State and Territorial Directors of Nursing (ASTDN)

Ans: B Feedback: The American Nurses Association (ANA) sets the scope and standards for all professional practice. The publication Public Health Nursing: Scope and Standards of Practice articulates the essentials of public health nursing, including the activities and accountabilities that are characteristic of practice at all levels and settings. The Quad Council of Public Health Nursing Organizations is an alliance of four national nursing organizations that addresses public health nursing issues in the United States, composed of the following: Association of Community Health Nurse Educators (ACHNE), ANA's Congress on Nursing Practice and Economics (CNPE), American Public Health Association (APHA)-Public Health Nursing Section, and Association of State and Territorial Directors of Nursing (ASTDN).

Which type of payment system does the Netherlands have? A) Universal long-term payment system B) Dual-level payment system C) Private health insurance linked to employment D) Free health insurance paid by the government

Ans: B Feedback: The Netherlands has a dual-level healthcare payment system. All primary and acute care is financed from private mandatory insurance. Long-term care for the elderly, the dying, long-term mentally ill, and so on, is covered by money acquired from taxation and is considered a "social insurance."

A high school graduate has decided to pursue a career in public health nursing. Which represents the minimum educational credential that this student will need to obtain entry into public health nursing practice? A) Associate's B) Baccalaureate C) Master's D) Doctorate

Ans: B Feedback: The baccalaureate degree in nursing is the educational credential required for entry into public health nursing practice. Master's level education, with specific expertise in population-focused care, is required for advanced practice or specialist practice. Registered nurses and licensed practical nurses with a diploma or associate's degree may appropriately practice in community settings where care is directed toward the health or illness of individual clients or families rather than populations. A doctorate degree in nursing may be required for academic and research positions associated with public health nursing.

The nurse prepares a presentation about the World Health Organization's World Health Statistics Report for 2013. Which trend is mentioned in this report? A) Children in low-income countries are 2 times more likely to die before reaching the age of 5 years than children in high-income countries. B) Every day 800 women die due to complications of pregnancy and childbirth. C) Zimbabwe now has a higher life expectancy than 7 out of 10 countries in Eastern Europe. D) Almost 5% of the world's adult population has diabetes.

Ans: B Feedback: The report includes the following statistics. Every day, about 800 women die due to complications of pregnancy and childbirth. Children in low-income countries are 16 times more likely (not 2 times more likely) to die before reaching the age of 5 years than children in high-income countries. China, not Zimbabwe, now has a higher life expectancy at birth than 7 out of 10 countries in Eastern Europe. Almost 10%, not 5%, of the world's adult population has diabetes, measured by elevated fasting blood glucose (3126 mg/dL).

A client reluctantly came to the clinic only after his daughter insisted that he do so. The nurse finds that he has type 2 diabetes. When the nurse explains that he has a serious condition, the client brushes it off and says, "I can still work and provide for my family. I'm not sick." Which model of health has this client adopted? A) Clinical model B) Role performance model C) Adaptive model D) Eudaimonistic model

Ans: B Feedback: The role performance model holds that health involves a fit between people and social roles. For example, some people, even if they have symptoms of disease, would classify themselves as unhealthy only if they could not fulfill their roles in life, such as mother or worker. The clinical model of health focuses on the elimination of disease or symptoms. In the adaptive model, health involves adaptation to the environment. The eudaimonistic model of health holds that health is the actualization or realization of human potential.

Why has there been an increase in the number of acute and chronically ill people residing in the community who need professional nursing care? A) Shorter length of stay in long-term care facilities B) Increase in ambulatory surgery C) Decrease in the use of outpatient clinics D) Increase in length of stay in emergency departments

Ans: B Feedback: The shorter length of stay in acute care (not long-term care) facilities, as well as the increase in ambulatory surgery and outpatient clinics, has resulted in more acute and chronically ill people residing in the community who need professional nursing care.

In researching an outbreak of malaria in the developing nation where the nurse currently works, the nurse decides to not focus on the role of mosquitoes in transmitting the disease but on how the physical environment of the community, biological aspects of the community, and social customs interact to affect the prevalence of this disease. Which epidemiological model is the nurse using? A) Epidemiologic triad B) Wheel of causation C) Web of causation D) Natural history

Ans: B Feedback: The wheel of causation de-emphasizes the agent as the sole cause of disease while emphasizing the interplay of physical, biological, and social environments. The epidemiologic triad is the classic model based on the belief that health status is determined by the interaction of the characteristics of the host, agent, and environment, not by any single factor. The web of causation is an epidemiologic model that strongly emphasizes the concept of multiple causation while de-emphasizing the role of agents in explaining illness. Natural history is the course of a disease or condition from the onset to resolution.

The community health nurse in a low-income country is working to decrease the incidence of diarrheal illnesses. Which intervention would most likely best address this problem? A) Providing fuel alternatives to burning wood and dung B) Providing sanitized drinking water C) Education regarding contraception use D) Distribution of and education on the daily use of insecticide-treated bed nets

Ans: B Feedback: Unclean water remains a major problem in reducing diarrheal illness and waterborne and water-related illnesses and their health consequences. Educating families on the daily use of insecticide-treated bed nets would address malaria, as malaria is spread predominantly by mosquitoes, but there is no indication that malaria is the culprit here. Diarrheal illnesses are not directly related to burning wood or dung or to sexual intercourse.

Select the great public health achievements in the United States in the 20th century. (Select all that apply.) A) Elimination of common infectious diseases B) Recognition of tobacco as a health hazard C) Fluoridation of drinking water D) Healthier mothers and babies E) Decline in the percentage of obese and overweight people

Ans: B, C, D Feedback: Great public health achievements in the United States in the 20th century include the following: control (not elimination) of common infectious diseases; recognition of tobacco as a health hazard; fluoridation of drinking water; and healthier mothers and babies. The percentage of overweight and obese people increased over the course of the 20th century and continues to increase today.

Why is there an increasing use of home monitoring devices? (Select all that apply.) A) Rising number of people with acute conditions B) Increased need to deliver healthcare to medically underserved populations C) Advances in technology to assess clients' conditions in their home D) Performing assessments in real time using Internet video systems E) Decline in the number of older adults

Ans: B, C, D Feedback: Home monitoring devices are becoming necessities, due in part to the aging population, the rising number of people with chronic (not acute) conditions, and the need to increase healthcare delivery to medically underserved populations. Advances in technology, specifically medical devices, sensors, and high-speed telecommunication networks, have made it possible to assess clients' conditions remotely in their homes, either by storing information for later access or by performing assessments in real time using Internet video systems. The number of older adults in the United States is increasing, not declining.

Which core functions of the government address the health of its citizens? (Select all that apply.) A) Providing healthcare directly to its citizens B) Assessing healthcare problems C) Developing healthcare policy that provides access to services D) Building state-of-the-art hospitals E) Ensuring delivery of healthcare services and achievement of desired outcomes

Ans: B, C, E Feedback: A government has three core functions in addressing the health of its citizens: (1) it assesses healthcare problems, (2) intervenes by developing relevant healthcare policy that provides access to services, and (3) ensures that services are delivered and outcomes achieved. Although some government agencies, such as the U.S. Department of Veterans Affairs, do provide healthcare directly to citizens, this is not a core function of the government. Building state-of-the-art hospitals is not a core function of government, either.

The nurse applies a cost-benefit analysis to the healthcare model. Which costs are the primary concerns of the client? (Select all that apply.) A) Total payment for the service B) Out-of-pocket payment C) Suffering and pain D) Actual and direct cost of providing a service E) Psychological costs

Ans: B, C, E Feedback: Clients are interested in their own out-of-pocket payment, as well as the psychological costs, suffering, and pain, which are difficult to quantify yet have long-lasting negative effects. The total payment for the service is usually what matters to the payer. The providers are usually concerned with the actual and direct cost of providing a service.

The nurse is assigned to prepare the yearly goals for the community health agency in a developing nation. Which goals, on the basis of the United Nations' Millennium Development Goals for improving global health, should the nurse include? (Select all that apply.) A) Initiate an afterschool sports program at every school in the nation to increase physical activity among children. B) Distribute a mosquito bed net to every home in the nation. C) Provide 1 million free allergy shots to people at highest risk. D) Increase the number of girls who attend primary schools by 100%. E) Provide training on prevention of postpartum hemorrhage to all healthcare workers.

Ans: B, D, E Feedback: The United Nations Millennium Development Goals and Targets include the following: eradicate extreme hunger and poverty; achieve universal primary education; promote gender equality and empower women; reduce child mortality; improve maternal health; halt and reverse the spread of HIV/AIDS, malaria, and other diseases; ensure environmental sustainability; and develop a global partnership for development. Increasing physical activity among children and allergy prevention are not among the United Nations' Millennium Development Goals for improving global health.

Which goals are part of the Patient Protection and Affordable Care Act (ACA), which was passed in 2010? (Select all that apply.) A) Shifting the focus of the healthcare delivery system from prevention to treatment B) Reducing the costs and improving the efficiency of healthcare C) Allowing insurers to deny healthcare coverage on the basis of preexisting conditions D) Expanding health insurance coverage E) Expanding healthcare access to children

Ans: B, D, E Feedback: Through the Patient Protection and Affordable Care Act (ACA), the Obama administration's goals in improving the overall healthcare system and the quality of care include but are not limited to the following: 1) expanding health insurance coverage, 2) shifting the focus of the healthcare delivery system from treatment to prevention (not from prevention to treatment), and 3) reducing the costs and improving the efficiency of healthcare. Additionally, the ACA expanded healthcare access to children. Through the ACA, youth are allowed to remain on their parents' healthcare plan to the age of 26, insurers are no longer allowed to exclude children from coverage because of preexisting conditions, and access has been expanded through state-based health insurance exchanges for uninsured families.

Which statements regarding the relationship between politics and healthcare are true? (Select all that apply.) A) Politics has a limited effect on healthcare. B) The government should be interested in health matters when a problem affects a specific group or a whole population. C) Politics has only negative effects on healthcare. D) Republicans and Democrats generally agree on healthcare policies. E) Political solutions can be achieved at both the federal and state levels.

Ans: B, E Feedback: Politics interferes with every aspect of healthcare in the United States. In reference to a political issue, the government should be interested in problems that affect a specific group or a whole population. There are many examples of the positive role that governments play through policies and legislations, including providing equal opportunity through universal provision of education, healthcare, and often housing and nutrition programs. There is little agreement between the two major U.S. political parties (Democrats and Republicans) when it comes to whom, how, what, and when healthcare should be provided and who should pay for it. Solutions can be achieved by working at either the federal or the state level.

19. Which best describes a multilateral agency? A) Is based in only one country but provides services to many other countries B) Is responsible for the health and welfare of citizens nationally C) Receives funding from both governmental and nongovernmental sources D) Acquires resources to help others from private rather than public sources

Ans: C Feedback: A multilateral agency is one that receives funding from both governmental and nongovernmental sources. A bilateral agency is one that is based in only one country but provides services to many other countries. The Department of Health and Human Services is a U.S. agency responsible for the health and welfare of citizens nationally. A nongovernmental organization (NGO) is an agency that acquires resources to help others from private rather than public sources.

The nurse recently learned that more than 100 infants and children in the community have received vaccinations at the health clinic in the past month. These data are an example of which health indicator? A) Morbidity and mortality B) Risk factors C) Health service coverage D) Health system resources

Ans: C Feedback: According to the World Health Organization statistical information system, health indicators may be placed into four categories: morbidity and mortality, risk factors, health service coverage, and health system resources. Health service coverage data identify uptake of specific services known to improve or promote health and well-being, such as reproductive health services, infant and child health and immunization, HIV, and tuberculosis care. Morbidity and mortality are measured by life expectancy at birth and health-adjusted life expectancy at birth. Risk factors focus on nutrition and health behaviors and environmental factors such as clean drinking water and burning of solid fuels. Health system resources focus on the capacity and supply of healthcare providers.

The nurse works to identify epidemiologic transitions in the community. Which exemplifies an epidemiologic transition? A) High fertility and high mortality, resulting in slow population growth B) Improvement in hygiene and nutrition, leading to a decreased burden of infectious disease C) High and fluctuating mortality, due to poor health, epidemics, and famine D) Mortality declines and, later, fertility declines

Ans: C Feedback: An example of an epidemiologic transition is high and fluctuating mortality, due to poor health, epidemics, and famine. Demographic transitions may progress from low to high levels and include the following: high fertility and high mortality, resulting in slow population growth; improvement in hygiene and nutrition, leading to a decreased burden of infectious disease; mortality declines and, later, fertility declines.

Which is the primary way that U.S. federal government has encouraged improved information management in the healthcare system? A) Publishing of guidelines for increased efficiency in filing client records B) Tax deductions for the installation of new telephone systems C) Reimbursement and bonuses for physicians and hospitals for adopting electronic health records D) Grants for hiring office managers trained in health information technology

Ans: C Feedback: As established in the American Recovery and Reinvestment Act, physicians who adopt and use electronic health records (EHRs) meaningfully can be reimbursed for their services up to $44,000 over 5 years. Similarly, hospitals that effectively utilize EHRs earn an incentive of $2 million through a one-time bonus. The other answers are not true.

City A has a population of people who are exposed to HIV, whereas City B has a population of people who are considered nonexposed to HIV. There were 3,267 new HIV cases in a given year for City A, with a population (exposed) of 10,000,000. There were only 5 new HIV cases in the same year for City B, with a population (nonexposed) of 150,000. Which is the attributable risk of HIV occurring in City A in terms of cases per 100,000 population? A) 3.33 B) 13.55 C) 29.34 D) 32.67

Ans: C Feedback: Attributable risk is calculated by subtracting the incidence rate in a nonexposed population from the incidence rate in an exposed population. In this case, we first need to calculate the individual incidence rates for City A and City B and then subtract to find the attributable risk for City A. The incidence rate for City A is calculated as follows: 3,267/10,000,000 = 0.0003267 × 100,000 = 32.67 cases per 100,000 population. The incidence rate for City B is calculated as follows: 5/150,000 = 0.0000333 × 100,000 = 3.33 cases per 100,000 population. The attributable risk for HIV occurring in City A, then, is calculated as follows: 32.67 - 3.33 = 29.34 cases per 100,000 population.

Which characterizes physicians in France? A) Physicians are evenly distributed between rural and urban areas B) About 40% of physicians are women C) Physician visits can take 15 to 30 minutes D) Physicians see about 15 clients a day

Ans: C Feedback: Characteristics of physicians in France include that physicians are unevenly distributed between rural and urban areas; about 50% of physicians are women; physician visits can take 15 to 30 minutes; and physicians see about 10 clients per day.

The nurse is measuring the occurrence of chronic obstructive pulmonary disease being investigated in the entire population. Which rate does this represent? A) Adjusted B) Attack C) Crude D) Incidence

Ans: C Feedback: Crude rate is the measurement of the occurrence of the health problem or condition being investigated in the entire population. Adjusted rate is the statistical procedure that removes the effects of differences in the composition of a population, such as age, when comparing one with another. Attack rate is the incidence or occurrence rate. Incidence rate is the measure of the probability that people without a certain condition will develop that condition over a period of time.

Which was a duty performed by district nurses in Liverpool, England, in 1865? A) Use epidemiologic knowledge and methods B) Encourage community organization C) Report facts to and ask questions of physicians D) Assist physicians with surgery in the newly constructed hospitals

Ans: C Feedback: Duties of district nurses in Liverpool, England, in 1865 included the following: Investigate new referrals as soon as possible; report to the superintendent situations in which additional food or relief would improve recovery; report neglect of clients by family or friends to the superintendent; assist physicians with surgery in the home; maintain a clean, uncluttered home environment and tend fires for heat; teach the client and family about cleanliness, ventilation, giving of food and medications, and obedience to the physician's orders; set an example for "neatness, order, sobriety, and obedience"; hold family matters in confidence; avoid interference with the religious opinions and beliefs of clients and others; report facts to and ask questions of physicians; and refer the acutely ill to hospitals and the chronically ill, poor without family to infirmaries. Using epidemiologic knowledge and methods and encouraging community organization are principles of public health today, not duties of district nurses in England in 1865. Nurses at that time assisted physicians with surgery in the home, not in newly constructed hospitals.

Which represents the correct order of the three stages of the natural history of disease? A) Pathological onset, manifestation of clinical disease, presymptomatic B) Presymptomatic, pathological onset, manifestation of clinical disease C) Pathological onset, presymptomatic, manifestation of clinical disease D) Manifestation of clinical disease, presymptomatic, pathological onset

Ans: C Feedback: Epidemiologic research has established the natural history of most illnesses. This refers to the course of a disease or condition from the onset to resolution. It includes (1) the pathological onset stage, (2) the presymptomatic stage, and (3) the manifestation of clinical disease.

The community health nurse knows that early attempts to understand illness and disease focused on the study of the experiences of individual people. Using this knowledge, how would the nurse define epidemiology to a group of nursing students? A) An outbreak that occurs when there is an increased incidence of a disease beyond that which is normally found in the population B) Model based on the belief that health status is determined by the interaction of the characteristics of the host, agent, and environment C) Study of the distribution and determinants of states of health and illness in human populations D) Epidemiologic model that strongly emphasizes the concept of multiple causation while de-emphasizing the role of agents in explaining illness

Ans: C Feedback: Epidemiology is the study of the distribution and determinants of states of health and illness in human populations. An epidemic is an outbreak that occurs when there is an increased incidence of a disease beyond that which is normally found in the population. The epidemiologic triad is a model based on the belief that health status is determined by the interaction of the characteristics of the host, agent, and environment. The web of causation is an epidemiologic model that strongly emphasizes the concept of multiple causation while de-emphasizing the role of agents in explaining illness.

Who used statistics to improve public health in England? A) William Farr B) John Graunt C) Florence Nightingale D) John Snow

Ans: C Feedback: Florence Nightingale used statistics to improve public health in England. William Farr is considered the father of modern statistics. John Graunt analyzed weekly reports of births and deaths. John Snow performed epidemiologic research on transmission of cholera using natural experiments, mapping, and rates.

A nurse works predominantly with clients who are active military personnel. Which publically funded program provides health benefits to this population? A) Medicare B) Medicaid C) TRICARE D) CHIP

Ans: C Feedback: Funding for the healthcare system in the United States comes primarily from privately owned health insurance companies. Exceptions include programs that are publically funded, such as Medicare, Medicaid, TRICARE (civilian health benefits for military personnel, retirees, and dependents), Children's Health and Insurance Program (CHIP), and Veterans Health Administration.

The nurse manager at a healthcare facility in a developing nation regularly loses nurses to positions in developed nations. According to the World Health Organization, which action would be appropriate for the nurse manger to take to address this problem? A) Lobby for local legislation that prevents migration of healthcare workers. B) Encourage the facility to build workforce capacity within the country. C) Institute HIV prevention measures and treatment for health workers. D) Treat expatriate workers with the same dignity and respect as all healthcare workers.

Ans: C Feedback: HIV protection and treatment, as well as plans for emergency preparedness, are paramount if workers are to feel safe in their environments. Migration is a human right, so lobbying for antimigration legislation would not be appropriate. Because the facility is losing its native healthcare workers, not gaining expatriate workers from other nations, encouraging the facility to build workforce capacity in the nurse's own country, and treating expatriate workers with dignity would not address the problem.

The International Council of Nurses (ICN) is a federation of more than 130 national nurses associations, representing more than 13 million nurses worldwide. In which area is the International Council of Nurses particularly active? A) Basic nursing practice B) Secondary healthcare C) Women's health D) Safe immunization programs

Ans: C Feedback: ICN is particularly active in international classification of nursing practice; advanced (not basic) nursing practice; entrepreneurship; HIV/AIDS, tuberculosis, and malaria; women's health; primary (not secondary) healthcare; family health; and safe water (not safe immunization programs).

Who prepared a report for the Massachusetts Sanitary Commission that pointed out that much of the ill health and disability in American cities in 1850 could be traced to unsanitary conditions? A) Clara Barton B) Dorothea Dix C) Lemuel Shattuck D) Lillian Wald

Ans: C Feedback: Lemuel Shattuck prepared a report for the Massachusetts Sanitary Commission that pointed out that much of the ill health and disability in American cities in 1850 could be traced to unsanitary conditions. Clara Barton achieved widespread recognition during the Civil War, distributing supplies to wounded soldiers and caring for the casualties with the help of her team of nurses. Dorothea Dix was also an American political activist in the 19th century who became aware of the dreadful conditions in prisons and mental hospitals, and she vigorously lobbied state and federal officials to remedy the situation. Lillian Wald was the founder of public health nursing

A hurricane recently struck a nurse's hometown, and the nurse on behalf of the hospital is coordinating local relief efforts with nongovernmental organizations (NGOs). Which organization should this nurse most expect to work with in this situation? A) Bill and Melinda Gates Foundation B) Living Proof Project C) International Committee of the Red Cross D) Oxfam International

Ans: C Feedback: Nongovernmental organizations are private agencies that voluntarily use their resources to address a variety of healthcare initiatives in the United States. The International Committee of the Red Cross is known most for its role in disaster relief. Oxfam International focuses specifically on issues related to hunger and nutritional health. Philanthropies are organizations that are similar to NGOs but receive funding through personal endowments. For example, the Bill and Melinda Gates Foundation focuses on health, poverty, and development in Africa, South America, Asia, and Australia. The Living Proof Project supports vaccine and nutrition programs, as well as decreasing the incidence of diseases

A nurse successfully persuades an obese client to perform a weekly weigh-in at home using a digital scale and record the weight in a log. This strategy is an example of: A) Telehealth B) Health information technology C) Personal responsibility for health D) Evidence-based nursing

Ans: C Feedback: Personal responsibility for health involves active participation in one's own health through education and lifestyle changes. In this case, the client makes a positive change in lifestyle by monitoring body weight weekly. Telehealth is the use of electronic information and telecommunications technologies to support long-distance clinical healthcare, client and professional health-related education, public health, and health administration. Health information technology (HIT) is defined as the comprehensive management of health information and its exchange between consumers, providers, government, and insurers in a secure manner. Evidence-based nursing is the integration of the best evidence available with clinical expertise and the values of the client to increase the quality of care.

Which rate measures the number of people in a given population who have influenza at a given point in time? A) Adjusted B) Incidence C) Prevalence D) Specific

Ans: C Feedback: Prevalence rate is the measure of the number of people in a given population who have an existing condition at a given point in time. Adjusted rate is the statistical procedure that removes the effects of differences in the composition of a population, such as age, when comparing one with another. Incidence rate is the measure of the probability that people without a certain condition will develop that condition over a period of time. Specific rates are detailed rates that are calculated using the number of people in the smaller subgroups of the population in the denominator. Often people are divided into subgroups by age and sex, although any characteristic can be used.

Which risk factor is associated with overall health? A) Allergy B) Traumatic injury C) Air pollution D) Down syndrome

Ans: C Feedback: Risk factor categories found to be associated with overall health include childhood and maternal undernutrition; other nutrition-related risk factors and inactivity; additive substances; sexual and reproductive health; and environmental risks (such as air pollution). Allergy, traumatic injury, and Down syndrome are not risk factors for overall health.

The nurse meets with a group of fellow nurses. They discuss the number of children who have died in hot cars and how likely they are to gain support from their state legislators to address the problem. The nurses are currently in which step of the policy- making process? A) Policy formulation B) Policy adoption C) Setting an agenda D) Policy assessment

Ans: C Feedback: Setting an agenda, the first step in the policy-making process, involves considering the significance of the problem, the political support for addressing the problem, and the ability to perceive the viability of proposed alternative solutions for the problem. After the agenda is set, the policy can be formulated. Once formulated, the policy must be adopted or agreed upon before it can be implemented. Only after being implemented can the policy be assessed or evaluated in terms of its effectiveness. The final step is modifying the policy on the basis of the results of the assessment.

Which is a Healthy People 2020 goal? A) Decrease the incidence of preventable disease, disability, injury, and premature death B) Reduce health inequity, decrease disparities, and improve the health of certain groups C) Create social and physical environments that promote good health for all D) Promote healthy development and healthy behaviors for the geriatric stage of life

Ans: C Feedback: The Healthy People 2020 goals are as follows: attain high-quality, longer lives free of preventable disease, disability, injury, and premature death (not just to decrease the incidence of these); achieve health equity, eliminate disparities, and improve the health of all groups; create social and physical environments that promote good health for all; and promote healthy development and healthy behaviors across every stage of life, not just older adults.

Which is characteristic of the German healthcare system? A) Health insurance payments based on risk, not income B) Ambulatory care provided by centralized nonprofit hospitals C) An average hospital stay of 9 days D) Nurse practitioners operating independently

Ans: C Feedback: The average length of hospital stay in Germany has decreased in recent years from 14 to 9 days, still considerably longer than the 5- to 6-day average in the United States. Health insurance coverage is maintained by all citizens sharing in the effort to have an insurance pool, and payment is based on income, not risk. Currently, physicians in private practice provide ambulatory care, and centralized nonprofit hospitals offer the majority of inpatient care. Nurses in the German healthcare system, called sisters, are mostly diploma-educated individuals working with a physician.

Public health nursing is distinguished from other specialties by adherence to eight principles. Which is one of the eight domains of public health nursing practice? A) Policy development and individual planning skills B) Individual dimensions of practice skills C) Financial planning and management skills D) Leadership and individual critical thinking skills

Ans: C Feedback: The eight domains of public health nursing practice are as follows: Analytic assessment skills, policy development and program planning skills, communication skills, cultural competency skills, community dimensions of practice skills, public health science skills, financial planning and management skills, and leadership and systems thinking skills.

The nurse explores all of the possible factors that contribute to coronary artery disease in the community as links in multiple interrelated chains. Which epidemiologic models is the nurse using? A) Epidemiologic triad B) Wheel of causation C) Web of causation D) Natural history

Ans: C Feedback: The web of causation is an epidemiologic model that strongly emphasizes the concept of multiple causation while de-emphasizing the role of agents in explaining illness. The epidemiologic triad is the classic model based on the belief that health status is determined by the interaction of the characteristics of the host, agent, and environment, not by any single factor. The wheel of causation de-emphasizes the agent as the sole cause of disease while emphasizing the interplay of physical, biological, and social environments. Natural history is the course of a disease or condition from the onset to resolution.

Public health nursing is distinguished from other specialties by adherence to eight principles. Which are domains of public health nursing practice? (Select all that apply.) A) Intuitive assessment skills B) Community organization skills C) Communication skills D) Cultural competency skills E) Product marketing skills

Ans: C, D Feedback: The eight domains of public health nursing practice are as follows: Analytic assessment skills, policy development and program planning skills, communication skills, cultural competency skills, community dimensions of practice skills, public health science skills, financial planning and management skills, and leadership and systems thinking skills.

The parish community health nurse is assigned to prepare the goals for a 6-month mission trip to a developing nation. Which challenge to the Millennium Development Goals should the nurse consider? A) Child mortality has increased 21% since 1990. B) The percentage of people living on less than $0.25 a day rose from 22% in 1990 to 47% in 2010. C) The number of children out of school worldwide increased from 57 million to 102 million. D) 870 million people still do not consume enough food to meet their nutritional energy requirements.

Ans: D Feedback: 870 million people still do not consume enough food to meet their nutritional energy requirements. Child mortality has dropped 41% since 1990, not increased 21%. Extreme poverty is falling in every region. The percentage of people living on less than $.25 a day fell from 47% in 1990 to 22% in 2010. The number of children out of school worldwide decreased from 102 million to 57 million.

Which best describes a philanthropic organization? A) Agency that is based in only one country but provides services to many other countries B) Agency that acquires resources to help others from private rather than public sources C) A group that collects data related to healthcare use across a variety of professional and service parameters D) An organization that uses endowed funds or private fundraising to address the needs of individuals, families, and populations

Ans: D Feedback: A philanthropic organization is one that uses endowed funds or private fundraising to address the needs of individuals, families, and populations. A bilateral agency is one that is based in only one country but provides services to many other countries. A nongovernmental organization is one that acquires resources to help others from private rather than public sources. Organization for Economic Cooperation and Development is a group that collects data related to healthcare use across a variety of professional and service parameters.

Which best describes a risk factor? A) Course of a disease or condition from the onset to resolution B) Primary measurement used to describe either the occurrence or the existence of a specific state of health or illness C) Probability or likelihood that a disease or illness will occur in a group of people who presently do not have the problem D) Characteristic or event that has been shown to increase the probability that a specific disease or illness will develop

Ans: D Feedback: A risk factor is a characteristic or event that has been shown to increase the probability that a specific disease or illness will develop. An outbreak is a course of a disease or condition from the onset to resolution. Rate is a primary measurement used to describe either the occurrence or the existence of a specific state of health or illness. Risk is the probability or likelihood that a disease or illness will occur in a group of people who presently do not have the problem.

Which is the fastest growing healthcare expenditure in the United States? A) Healthcare technology B) Hospital care C) Outpatient treatment and surgery D) Prescription medications

Ans: D Feedback: Although hospital care accounts for the largest share of healthcare spending, prescription drugs are the fastest growing healthcare expenditure.

You have heard rumors in the hospital where you work of an Ebola outbreak in your community and you would like to investigate it further. Which of the following should be your first step in the investigation? A) Identify the names of the people infected by the virus B) Formulate and test hypotheses as to the most probable causative factors C) Implement a plan for control of the outbreak D) Establish the existence of the outbreak

Ans: D Feedback: Because you have only heard rumors, you should first establish the existence of the outbreak before identifying those infected, formulating and testing hypotheses, and implementing a plan for control of the outbreak.

Which best exemplifies a bilateral agency? A) The United Nations B) The World Health Organization (WHO) C) The World Bank D) The U.S. Agency for International Development (USAID)

Ans: D Feedback: Bilateral agencies and organizations conduct their services within one specific country. USAID is a good example in the United States. It is a committed initiative that works with developing countries to enhance systems to fortify the health and welfare of international populations. Multilateral agencies and organizations receive funding from both governmental and nongovernmental sources. Examples of multilateral agencies include the United Nations and the WHO. The World Bank is another multilateral organization. Its major goal is to lend money to countries in need of developing their infrastructure on a variety of fronts.

Which occurs in the epidemiologic process that is similar to the diagnosis phase of the nursing process? A) Data are gathered from reliable sources B) Healthcare needs and assets are identified C) Goals and objectives for care are established D) A tentative hypothesis is formulated

Ans: D Feedback: During the diagnosis phase of the epidemiologic process, a tentative hypothesis is formulated. During the assessment phase of the epidemiologic process, data are gathered from reliable sources. During the diagnosis phase of the nursing process, healthcare needs and assets are identified and goals and objectives for care are established.

The community health nurse works in a low-income country. The nurse's primary concern is to decrease the incidence of malaria. Which intervention should the nurse pursue? A) Fuel alternatives to burning wood and dung B) Sanitized drinking water C) Education regarding contraception use D) Distribution of and education on the daily use of insecticide-treated bed nets

Ans: D Feedback: Educating families on the daily use of insecticide-treated bed nets in regions where malaria is highly endemic would be the appropriate intervention, as malaria is spread predominantly by mosquitoes. Malaria is not related to burning wood or dung, water quality, or sexual intercourse.

A nurse is coordinating a plan to bring vaccinations in a cost-effective way to a rural community that currently lacks access to them. This is an example of which public health intervention? A) Surveillance B) Outreach C) Screening D) Case management

Ans: D Feedback: In the intervention of case management, the nurse coordinates a plan or process to bring health services and the self-care capabilities of the client together as a common whole in a cost-effective way. In the intervention of surveillance, the nurse monitors health events through ongoing, systematic collection, analysis, and interpretation of health data for planning, implementing, and evaluating public health interventions. In the intervention of outreach, the nurse locates populations at risk, provides information, identifies possible actions, and identifies access to services. In the intervention of screening, the nurse identifies individuals with unrecognized risk factors or asymptomatic conditions.

Which best exemplifies a public health goal in the United States? A) To restore the ability of an 80-year-old to perform activities of daily living after a stroke B) To lobby for legislation that ensures the accessibility to health insurance on the basis of one's health C) To develop treatments to address symptoms related to chemotherapy D) To establish a free exercise program at a community center to promote fitness in a low-income neighborhood with high obesity rates

Ans: D Feedback: It is important to review several key components of the function public health serves through key initiatives, including a national consensus on goals, provision of systems of health insurance based on risk, not necessarily health, and the role of nongovernmental disease prevention and health promotion. In the United States, public healthcare includes disease prevention and health promotion based on science and cultural relevance. It is not focused on the health of the individual person but of the larger population. The goal of public healthcare is to keep populations healthy through a larger "reach" than connection at the individual level.

Who was the best known epidemiologist of the 19th century and used population data and personal observations to investigate the epidemic of cholera that occurred from 1848 through 1854? A) William Farr B) John Graunt C) Florence Nightingale D) John Snow

Ans: D Feedback: John Snow performed epidemiologic research on transmission of cholera using natural experiments, mapping, and rates. William Farr is considered the father of modern statistics. John Graunt analyzed weekly reports of births and deaths. Florence Nightingale used statistics to improve public health in England.

Which most accurately describes how disease patterns have changed from 1900 to the present? A) Morbidity and mortality from infectious diseases have increased. B) Morbidity and mortality from unintentional injuries have decreased. C) Morbidity and mortality from chronic degenerative conditions have decreased. D) Morbidity and mortality from noninfectious diseases have increased.

Ans: D Feedback: Primarily as a result of improved public health practices in the early 20th century, life expectancy in the United States, the United Kingdom, and European countries, as well as in other developed countries, rose. With it, a change in the patterns of disease occurred. No longer are infectious diseases the leading causes of death; the morbidity and mortality from noninfectious diseases and chronic degenerative conditions have increased.

The community health nurse addresses an outbreak of viral spinal meningitis in the community. Referring to Leavell and Clark's natural history of disease model, which example of tertiary prevention might the nurse consider in this situation? A) Initiate vaccinations for all people who have not yet been infected. B) Familiarize yourself with the signs and symptoms of the disease so that you can provide early diagnosis and treatment of it. C) Encourage any who think they might have symptoms of the disease to come to the community health clinic to be assessed as soon as possible, to prevent associated disabilities. D) Refer clients who have experienced neurological deficits because of the disease to a neurologist to begin rehabilitation.

Ans: D Feedback: Primary prevention measures specific to the disease can be implemented at this stage to prevent the onset in a population of well people. The period of pathogenesis begins when there are biological, psychological, or other responses within the host. Secondary prevention measures that focus on early diagnosis and prompt treatment, limiting resulting disabilities, are implemented during the early stages of the disease. Tertiary prevention follows with rehabilitation measures that enable the individual to function at his or her maximum capability.

A nurse performs a variety of tasks as part of the nurse's position at a hospital. Which task best exemplifies public health? A) Reading current nursing journals and integrating the latest research into daily practice B) Instructing a client on how to best care for a suture site at home C) Participating in a videoconference call with a client who lives in a remote area D) Facilitating a community-wide smoking cessation program one month out of the year

Ans: D Feedback: Public health is what society does collectively to ensure the conditions exist in which people can be healthy. A community-wide smoking cessation program is a great example of a public health intervention, in that it involves the collective effort of society to improve the health of its members. Reading and applying the latest nursing research is an example of evidence-based nursing. Instructing a client on how to best care for a suture site at home is an example of personal responsibility for health, but it is not focused on the health of the greater community. Participating in a videoconference call with a client who lives in a remote area is an example of patient-centered care and of an effective implementation of technology, but it is not particularly related to public health.

The nurse is conducting research on the relative risk of acquiring lung cancer as a result of being exposed to secondhand smoke. The nurse is studying two different groups. Group A includes 400 adults who do not smoke but are exposed to secondhand smoke in their home on a daily basis. Group B includes 400 adults who do not smoke and are not exposed to secondhand smoke in their home. Over the course of 10 years, 20 subjects in Group A are diagnosed with lung cancer, whereas only 2 subjects in Group B are diagnosed with lung cancer. Which is the relative risk ratio that would result from this study? A) 0.5 B) 1 C) 5 D) 10

Ans: D Feedback: Relative risk ratio compares the incidence rate of a group exposed to a certain risk factor with the incidence rate of a group not exposed to the risk factor. It is calculated by dividing the incidence rate in the exposed group by the incidence rate in the nonexposed group. In this case, we need to first calculate the separate incidence rates for Group A and Group B and then divide to find the relative risk ratio. The incidence rate for Group A is calculated as follows: 20/400 = 0.05 × 1,000 = 50 cases per 1,000 population. The incidence rate for Group B is calculated as follows: 2/400 = 0.005 × 1,000 = 5 cases per 1,000 population. The relative risk ratio, then, is calculated as follows: 50/5 = 10.

The nurse wishes to compare the number of persons aged 40 to 49 years who die each year with the midyear population of persons in this age range, per 100,000 population. Which type of rate is the nurse attempting to calculate? A) Adjusted B) Incidence C) Prevalence D) Specific

Ans: D Feedback: Specific rates are detailed rates that are calculated using the number of people in the smaller subgroups of the population in the denominator. Often people are divided into subgroups by age and sex, although any characteristic can be used. Adjusted rate is the statistical procedure that removes the effects of differences in the composition of a population, such as age, when comparing one with another. Incidence rate is the measure of the probability that people without a certain condition will develop that condition over a period of time. Prevalence rate is the measure of the number of people in a given population who have an existing condition at a given point in time.

The nurse is working through an ethical dilemma using a decision-making process developed by the Ohio Nurses Association. After identifying the existence of the ethical dilemma, the next step in this process is to: A) Clarify personal values and moral position B) Determine options on the basis of consideration of benefits and risks C) Make a responsible decision about actions or recommendations D) Gather and analyze relevant information

Ans: D Feedback: The Ohio Nurses Association (2006) developed a process to guide nurses in working through ethical dilemmas. This process includes the following steps, in order: 1) Identifying the existence of the ethical dilemma (conflict in values); 2) gathering and analyzing relevant information—including identification of stakeholders, interdisciplinary team members, and other sources of relevant information; 3) clarifying personal values and moral position, including the moral perspectives of other "players" in the scenario; 4) determining options on the basis of careful consideration of alternatives' benefits and risks; 5) making responsible decisions about actions or recommendations, in collaboration with other interested parties; and 6) evaluating the impact of the action and outcomes.

Which country spends the most on healthcare? A) Canada B) England C) Japan D) United States

Ans: D Feedback: The United States spends more on healthcare than does any other industrialized country.

Which represents the correct order of events in the policy-making process? A) 1) Policy formulation, 2) policy assessment, 3) policy adoption, 4) policy implementation, 5) policy modification, 6) setting an agenda B) 1) Setting an agenda, 2) policy formulation, 3) policy assessment, 4) policy modification, 5) policy adoption, 6) policy implementation C) 1) Policy formulation, 2) setting an agenda, 3) policy implementation, 4) policy modification, 5) policy assessment, 6) policy adoption D) 1) Setting an agenda, 2) policy formulation, 3) policy adoption, 4) policy implementation, 5) policy assessment, 6) policy modification

Ans: D Feedback: The correct order of events in the policy-making process is as follows: 1) setting an agenda, 2) policy formulation, 3) policy adoption, 4) policy implementation, 5) policy assessment, 6) policy modification. An agenda must be set before a policy is formulated; this phase involves considering the significance of the problem, the political support for addressing the problem, and the ability to perceive the viability of proposed alternative solutions for the problem. After the agenda is set, the policy can be formulated. Once formulated, the policy must be adopted or agreed upon before it can be implemented. Only after being implemented can the policy be assessed or evaluated in terms of its effectiveness. The final step is modifying the policy on the basis of the results of the assessment.

Which is the focus of Smith's eudaimonistic model? A) Elimination of disease or symptoms B) A fit between people and social roles C) Adaptation to the environment D) Actualization or realization of human potential

Ans: D Feedback: The focus of the eudaimonistic model is the actualization or realization of human potential. The focus of the clinical model is elimination of disease or symptoms. The focus of the role performance model is a fit between people and social roles. The focus of the adaptive model is adaptation to the environment.

A nurse in the Canadian healthcare system is concerned because a client has been denied a surgical procedure that the nurse believes is essential to the client's recovery. Who should the nurse expect will have the most power to reverse this decision? A) Nurse practitioner B) Physicians C) Private insurance company D) Health administrator

Ans: D Feedback: The most powerful individuals in the Canadian healthcare system are not physicians but health administrators, who put an emphasis on cost efficiency and social responsibility. Private insurance exists to cover services not covered under Medicare, such as vision needs, dental services, and pharmaceuticals for nonelderly people. This type of private insurance is acquired through employment contributions and represents a small portion of total health expenditures (15%). Nurses and nurse practitioners are important to the care of individuals and communities but play a lesser role in the administration of public healthcare.

A community health nurse visits a village in Chad. The nurse has just finished assessing a 10-year-old girl who reports always being hungry. She lives in a home with her mother and father, who both work. She says she's never been to a healthcare provider before. Which level of poverty should the nurse most suspect in this girl and her family? A) Middle B) Moderate C) Relative D) Extreme

Ans: D Feedback: Unlike the moderately and relatively poor, the extremely poor cannot access healthcare and are chronically hungry. "Middle" is not a level of poverty.

A client visits the office of an independent nurse practitioner to have routine blood work done. The client returns 1 week later for a follow-up visit to discuss the results and formulate a new treatment plan. On the basis of the client's insurance plan, the client is only obligated to pay $15 copay for this service. The total payment that the client's insurance company provides the practitioner is $180, which covers the $80 fee for a 15- minute visit and the $100 cost of laboratory services. On the basis of the nurse's current client load, $40 of the $80 fee for the visit covers overhead and the remaining $40 is profit. In terms of cost-benefit analysis, which is the actual financial cost to the nurse for providing this service? A) $100 B) $15 C) $180 D) $140

Ans: D Feedback: Using cost-benefit analysis, the cost to the provider is the actual and direct cost of providing a service, which in this case would be $100 for the laboratory services plus $40 for office overhead, which equals $140. Clients are interested in their own out-of- pocket payment, which in this case would be $15. The actual total payment for the service is usually what matters to the payer or insurance company, which in this case is $180.