Community Health Exam 2

Six characteristics that can help identify a student who may be thinking about drastic violence are:

(1) Venting: having mood swings (2) Vocalizing: threatening others (3) Vandalizing: damaging property (4) Victimizing: seeing himself or herself as a victim (5) Vying: belonging to gangs (6) Viewing: witnessing the abuse of others. By helping to identify students who might be considering school violence, help may be obtained and violent actions may be prevented.

Which is an example of a social determinant of health? a. Ethnicity b. Income c. Gender d. Marital status

b. Income

A group of teenagers with diabetes become upset and angry because they cannot agree on whether or not to have meetings during summer vacation. Which of the following should the nurse do to be effective in helping the teenagers resolve the conflict? a. Admit that it is difficult for everyone to agree on everything; then ask whether the group can try to decide how to agree on the issue. b. Assume adult authority and announce that meetings will be suspended until fall. c. Recognize that most of the teenagers want to have the meetings, but two are being stubborn; ask the two deviant members to leave the group. d. Suggest that the group avoid discussing it further but rather think about it over the next week and try to discuss the situation more rationally next week.

A

A neighborhood association group has asked the local nurse in community health for a class on environmental hazards. The nurse in community health has seen good information in the community health text and thinks about getting permission to copy some of the information. The most important thing the nurse should do before using copies of this material is to: a. assess the literacy level of the group. b. see how many plan to attend. c. see whether the group is ready to learn. d. secure a good space for a group meeting.

A

A nurse established an ongoing group meeting of teenagers with diabetes. In the early stages, the nurse was very directive in arranging location, providing low-carbohydrate drinks and snacks, steering the discussion, and trying to meet all the teenagers' needs. After the group had been meeting for about 3 months, the nurse noticed that the group members no longer simply accepted everything the nurse suggested. Instead, the teenagers began making decisions themselves, and eventually, the nurse no longer controlled the group. Which of the following most likely happened to cause this shift? a. The group became cohesive enough to share leadership tasks. b. Teenagers don't like feeling dependent on adults with power. c. Teenagers often rebel against adult authority. d. The nurse was overwhelmed and lost control of task process.

A

A nurse in community health integrates new slides into a presentation that will be given to a local elementary school group regarding the techniques of proper hand washing. The new slides will repeat essential points during the presentation. This demonstrates the nurse's understanding of what principle? a. Repetition b. Integration c. Participation d. Sequencing

A

A nurse in community health is planning to begin a class to help mothers returning to work better cope with the stresses of multiple roles. The nurse would most likely use: a. an andragogical approach. b. a behavioral approach. c. an operational approach. d. a pedagogical approach.

A

When evaluating an educational program, the nurse discovers that only 25% of community members met the learning objectives. Which of the following parts of the program should be improved? a. Educator b. Content c. Learners d. Objectives

A

Which educational method has been shown to be most effective in fostering treatment adherence? a. Internet based education b. In-person counseling c. Telephone counseling d. Self-directed learning

A

Which of the following statements regarding the Health Belief Model is accurate? a. Cues to action are an important component of the model. b. Multiple methods of education should be used when implementing this model. c. The first stage experienced in this model is the pre-contemplation stage. d. To successfully implement this model, ongoing maintenance of the behavior must be considered.

A

As a community health nurse working with lesbian clients, it is important for the nurse to understand that these clients: a. Are at slightly greater risk for mental illness. b. Will always be at risk for depression. c. Have no problems with psychological disorders. d. Are at no greater risk for psychiatric disorders.

A Correct: Although GLBT individuals do not appear to be any more intrinsically susceptible to mental illness than their straight counterparts, there is some evidence to suggest that they have a slightly higher prevalence of mental illness, possible as a result of "minority stress."

A community health nurse is applying an interactional framework to assess a family's health. Which of the following would the nurse do? A) View them in terms of the family's internal relationships B) Look at them from a life-cycle perspective C) Evaluate the members' changing roles and tasks D) Assess them as a social system relating to other social systems

A Feedback: An interactional framework describes the family as a unit of interacting personalities and emphasizes communication, roles, conflict, coping patterns, and decision-making processes. A developmental framework studies the family from a life-cycle perspective by examining the members' changing roles and tasks in each progressive stage. A structural-functional framework describes the family as a social system relating to other social systems in the environment.

A community health nurse is about to make the first home visit to a family based on a referral from the hospital where the high-risk infant was born to an adolescent mother about 6 days ago. The nurse plans to assess the family and home environment and provide anticipatory guidance. On arrival, the mother sleepily answers the door after the nurse rings the bell and knocks several times. The mother lets the nurse in but is not happy to see the nurse. She gets the infant and places him in the nurse's arms, then sits across the room and turns on the TV. Which response by the nurse would be most appropriate? A) "You must be very tired caring for a newborn baby." B) "I wasn't planning to hold the baby. You should hold him, you are the mother." C) "I need to talk to you, so please turn off the TV." D) "How do you feel being a mother at 17?"

A It is always best to acknowledge a client's feelings, and from the scenario, observations and referral information, being fatigued 6 days after having a baby is very possible. The option about holding the baby is not the best way to respond to the mother or the first comment to make, but holding the baby gives the nurse an opportunity to role model infant interaction and caring and assess his or her cleanliness and clothing appropriateness. However, the nurse may want to say that he or she would like to wash his or her hands before holding the baby. This gives the nurse an additional opportunity to teach and assess another room when washing hands. Asking to turn off the TV might be appropriate after a few moments of introductory conversation. It would be best to ask the mother to turn the TV down because of difficulty hearing her. The nurse will win the mother's favor with this approach better than by asking her to turn off the TV. Asking how she feels being a mother at 17 might be information to gather, but asking it directly as a first comment sounds like a put-down. There are better ways to obtain this information a bit later in the visit.

A community health nurse, visits an 81-year- old newly diagnosed insulin-dependent diabetic who lives alone. The nurse has visited the family three previous times and is visiting early in the morning to observe his client's insulin administration technique. The nurse finds the client depressed over his or her situation one morning. The nurse suggests that together they list positive points about his or her situation and discuss his or her feelings. This is an example of which of the following? A) Strengthening B) Data collection C) Goal-directed questioning D) Measuring family functioning

A The nurse is demonstrating a communication technique called strengthening which is used to assist the family in becoming independent of the nurse's services. Data collection, goal- directed questioning, and measurement of family function are methods used for assessment.

The population nurse is working with an individual who is taking hormone therapy as part of the gender recognition surgery. The nurse would teach the client to increase monitoring for which health problems? (Select all that apply.) a. Heart disease b. Urinary tract infection c. Stroke d. Sexually transmitted infection e. Breast cancer

A & C: increased risk of heart disease and stroke w/ hormone therapy. E: increased risk of BrCA w/ hormone therapy

A patient tells a nurse, "I know all about this already. I read about it on the Internet." The patient then summarizes what he has learned. Because some of this information seems incorrect, what questions would be effective for the nurse to ask? (Select all that apply.) a. Were you able find what you wanted easily on the website? b. Did the website say when the information was updated? c. Did the website state who was responsible for the information? d. Did you enjoy reading the material on the website?

A B C

A nurse is conducting an in-service education session on the Centers for Disease Control and Prevention's (CDC's) updates for preventive services for a group of nurses in community health. The nurse would demonstrate the best understanding of the educational process by integrating which planning strategies? Select all that apply. a. Use of films b. Small group interaction c. Use of games d. Session timing e. Session space

A B C D E

A nurse has been making ongoing visits to a preschool to help the staff teach the children important skills, such as brushing their teeth after meals. Now the nurse is scheduled to teach carbohydrate counting to adults newly diagnosed with diabetes. Which of the following actions will the nurse need to take when teaching this population? (Select all that apply.) a. Appeal to the need for autonomy and choice. b. Emphasize that anyone with diabetes must know this information. c. Explain how to cope with being a guest at a dinner. d. Recognize that this audience will depend on the instructor to set goals for learning.

A C

Which of the following characteristics must a learner possess to successfully master psychomotor learning? (Select all that apply.) a. The necessary ability to perform the skill b. An open mind to learning the new skill c. A sensory image of how to perform the skill d. Opportunities to practice the skill

A C D

Which of the following barriers are specific to the educator? Select all that apply. a. Fear of public speaking b. Low literacy c. Limited experience with the topic d. Lack of motivation e. Lack of experience with gaining participation

A C E

Which of the following things does a nurse who is traveling by automobile to make a home visit need? Select all that apply. A) A full gas tank and well-operating vehicle B) A map that includes the geographic location where the home visit will be made C) A cellular telephone D) A bus schedule E) Exact change Ans:

A, B, C Feedback: A nurse who is traveling by automobile to make a home visit needs the following: a full gas tank and well-operating vehicle, a map that includes the geographic location where the home visit will be made, and a cellular telephone. If the nurse is not using public transportation, the nurse does not need exact change for each bus trip or a bus schedule.

Which of the following are specific safety measures the nurse should apply when making a home visit? Select all that apply. A) Plan to reschedule the visit if you find a large group of people assembled between you and the client's door. B) Immediately leave the home when family members begin to physically fight with one another. C) Enter the residence before you determine that the family you are intending to visit does live there and is home. D) Travel only in pairs for all home visits. E) If someone approaches you and indicates that they want your nursing bag, throw your bag away from where you are and run in the opposite direction. F) Leave an itinerary of your planned travels, the telephone numbers of families you will attempt to visit and your cellular phone number at your base of operation.

A, B, E, F Feedback: It is most important to leave an itinerary of your planned travels, the telephone numbers of families you will attempt to visit, and your cellular phone number at your base of operation. Specific safety measures the nurse should apply when making a home visit include planning to reschedule the visit if you find a large group of people assembled between you and the client's door; immediately leaving the home when family members begin to physically fight with one another; and if someone approaches you and indicates that they want your nursing bag, throw your bag away from where you are and run in the opposite direction. It is not appropriate for the nurse to enter the residence before determining that the family that is to be visited does live there and is home. It is not necessary to travel only in pairs for all home visits.

12. A school nurse is administering medications at the school. Which of the following guidelines should be followed? a. A current drug reference should be available in case information is needed b. The nurse should administer medications brought in from home by the child c. Medications cannot be administered without a physician order d. Narcotics and controlled substances should be kept in a locked cabinet

ANS: A A current drug reference should always be available so that it can be consulted for information.

24. Which of the following best explains why the home health nurse would essentially repeat the same information given to the client by the nurse in the hospital? a. Clients find it difficult to learn in the midst of the stress of the acute care setting and often don't remember what the hospital nurse taught. b. Hearing something from a different person, using different words and examples, can help ensure that learning is retained. c. Home health nurses often don't know what hospital-based nurses have already taught. d. Learning depends on receiving information more than once.

ANS: A Although all of the responses are potentially true, the bottom line is that clients may find it difficult to learn while they are hospitalized. Consequently, home care nurses should communicate clearly with discharge planners about the therapeutic plan and medication regimens, as well as what clients have been taught about self-care and symptoms that should be reported to the physician. The nurse should share this same information again, unless the client clearly demonstrates having the knowledge and skills being reviewed.

23. The mother of a high school student newly diagnosed with a condition that will require special health care services is concerned that the student will be required to be home-schooled away from the friends he has developed. Which of the following would be the most appropriate response by the school nurse? a. "Federal legislation requires that the school make provisions for those with various challenges, so your child will be able to remain in school as long as he is able." b. "I realize that this will be a difficult adjustment, but home-schooling has improved over recent decades and the Internet will allow your child to connect with friends." c. "Whether your child can remain in school will depend on state funding for those with disabilities. You might want to contact your congressman on this issue." d. "Your child may remain in school as long as he can manage the course requirements and doesn't flunk out."

ANS: A Federal legislation specifies that children cannot be excluded from schools because of a disability. The school must provide health services that each child needs. Legislation further requires the school district's committee on the disabled to develop individualized education plans (IEPs) for children.

24. A group of nursing students are scheduled to present a program on healthy hearts to various community groups, with a daycare center being the first location. What of the following advice should be given to them by their instructor? a. Base the program on the audience's development and maturity. b. Bring (borrow if necessary) a model of the heart to help explain its functioning. c. Focus on entertaining the learners. d. Have lots of handouts to reinforce the lesson.

ANS: A For younger learners, it is important to keep the lesson to no more than 10 minutes in length, to use plenty of examples, pictures, and stuffed animals in the talk, and to remember the developmental stage of the children when teaching them.

9. A nurse would like to implement a primary prevention effort to decrease the leading cause of death among children and teenagers. Which of the following actions would the nurse most likely take? a. Educate students about injury prevention measures b. Provide free condoms to sexually active students c. Screen for signs and symptoms of cancer d. Invite a guest speaker to talk about living with HIV

ANS: A Injuries are the leading cause of death in children and teenagers; therefore, prevention measures should focus on injury prevention. Because the question asks for primary prevention efforts, the intervention must occur before injury. Common interventions by the school nurse include educational programs reminding children to use their seatbelts or bicycle helmets to prevent injuries. Other classes can be on crossing the street, water safety, and fire safety.

20. Which of the following comments was most likely stated by a home health nurse? a. "Every time I see a client, it costs $80." b. "Health care costs are killing our economy." c. "I can't believe how much clients are charged for things." d. "Medicaid costs are such a large portion of our state's budget."

ANS: A Nurses in many settings are not directly exposed to the financial aspects of health care, although as citizens they should be aware of the overall effects of high health care costs. In home health, nurses must be cost-conscious so that they can accurately explain to clients what Medicare will or will not cover and discuss other financial concerns. In addition, home care nurses must be knowledgeable about which medical supplies are covered.

19. The board of directors is examining various submitted reports concerning its home health agency. Which of the following reports represents an example of benchmarking? a. A report by the administrator regarding how the home health agency's performance compares with that of other local and national home health agencies b. A report by the chief financial officer regarding a cost-benefit analysis related to technological advances c. A report by the chief nursing officer regarding client outcomes d. A report by the medical director regarding implementation of evidence-based practice into standards of care

ANS: A Performance improvement programs are based on measurable data, including benchmarking, which means comparing oneself with national standards and guidelines and with other agencies.

7. The school health nurse has enlisted the assistance of high school role models in the areas of sports and scholarship to provide an antidrug presentation to their peers. Which of the following levels of prevention is being implemented? a. Primary b. Secondary c. Tertiary d. Both primary and secondary

ANS: A Primary prevention interventions by the school nurse include educating children and adolescents about the effects of drugs. In preventing use, students are taught by the school nurse to stay away from drugs such as marijuana, cocaine, crack, heroin, and alcohol.

15. A school nurse suggests to teachers that they have a session on coping strategies and stress management techniques. The nurse also sets up a peer counseling program. Which of the following is the school nurse most likely trying to prevent? a. Adolescent suicides b. Bullying c. Obesity d. Teenagers engaging in violence

ANS: A Suicide is the third leading cause of death in teenagers. To reduce the incidence of suicide in teenagers, the nurse can emphasize coping strategies and stress management techniques and organize a peer assistance program to help teenagers cope with school stresses.

16. A nurse orienting to the home health role states, "I don't understand why we have to collaborate with so many other disciplines this conflicts with the concept of nurses providing all direct care to the client in the home?" Which of the following would be the best response? a. "The nurse still provides direct care for the client; however, interdisciplinary collaboration is necessary to prevent fragmentation of care." b. "Direct nursing care is a concept applied to care in tertiary facilities, such as hospitals, where materials are centrally located in one facility. In home health, this is not possible." c. "Even though home health nursing does not provide as much direct care as other nursing specialties in the community, each discipline contributes to client needs from its special knowledge base." d. "Yes, it does create conflict, but Medicare mandates interdisciplinary collaboration."

ANS: A The responsibilities and functions of other health professions in home care are dictated by Medicare regulations, professional organizations, and state licensing boards. Many of these services can be provided on a consulting basis. The plan of care should be implemented and reinforced by all involved disciplines. Therefore, interdisciplinary collaboration is required in the home health setting. Such collaboration does not conflict with the concept of providing direct care services. Direct care refers to the actual physical aspects of nursing care—anything requiring physical contact and face-to-face interactions. In home care, direct care activities include performing a physical assessment on the client, changing a dressing on a wound, giving medication by injection, inserting an indwelling catheter, or providing intravenous therapy. Direct care also involves teaching clients and family caregivers how to perform a certain procedure or task.

20. A pregnant teen asks the school nurse to provide information on abortion and a list of health care providers who offer such services. If the school nurse has very strong personal beliefs against abortion, which of the following actions should be taken by the nurse? a. Call in another nurse to care for this client. b. Explain, from the nurse's perspective, all the reasons that abortion should be made illegal. c. Offer the student a combination of oral contraceptives to induce spontaneous abortion. d. Provide information on alternatives to abortion and give the client information on adoption agencies.

ANS: A This creates an ethical dilemma for the nurse. If the nurse feels so strongly that he or she cannot work with the situation, another school nurse should be called for help or the student should be referred to other health providers who can provide the care the student needs.

22. Which of the following is a primary requirement for a client to be eligible for home health nursing and Medicare reimbursement of services? a. Must be homebound b. Must be living in a medically underserved area c. Must be indigent d. Must be insured or eligible for Medicare or Medicaid

ANS: A To receive home health services, clients must be homebound. Although home health care is less expensive than hospitalization, it remains much more costly than a traditional visit to a clinic; therefore, those who are not homebound would be expected to receive care at a clinic.

26. Which of the following practices in the home is most crucial? a. Using good handwashing procedures b. Obtaining a puncture-resistant container for family to use for needles c. Putting all contaminated material directly into a trash bag d. Washing all surfaces with disinfectant

ANS: A Universal precautions mean that all blood and body fluids are treated as potentially infectious, especially because many infections are subclinical. The nurse would use extreme care to prevent injuries when handling needles, scalpels, and razors and discard needles and syringes in puncture-resistant containers, use protective coverings if contact with blood and body fluids is expected, put materials contaminated with body fluids in double polyethylene garbage bags, and tell the family to be sure to use detergent in warm water to clean kitchen counters, dishes, and laundry and household disinfectant when cleaning the bathrooms. However, the single most important practice in preventing infections is careful hand washing before and after client care, touching food, or using the bathroom.

1. Which of the following activities are included in the Centers for Disease Control and Prevention's school health program? (Select all that apply.) a. Ensuring a healthy school environment b. Assisting teachers with education related to health c. Encouraging nutritious school meals d. Giving immunizations to students, staff, teachers, and their families

ANS: A, B, C The federal government, through the coordination of the Centers for Disease Control and Prevention, developed a plan that school health programs should follow, including health education, physical education, health services, nutrition services, counseling, psychological and social services, healthy school environment, health promotion for staff, and family/community involvement. Unfortunately schools cannot afford to give immunizations to everyone who might want such a benefit. Education in areas other than health is the responsibility of the teachers, not the nurse.

5. A school nurse describes to teachers the characteristics of an adolescent who may be thinking about drastic violence. Which of the following behaviors would suggest the adolescent was having such problems? (Select all that apply.) a. Being a gang member b. Damaging property c. Leaving the scene if another student is being bullied or hurt d. Mood swings

ANS: A, B, D Six characteristics that can help identify a student who may be thinking about drastic violence are:

4. Which of the following supplies or equipment should a nurse have available in the school health office? (Select all that apply.) a. Cervical spine collars b. Complete emergency kit that fulfills American Hospital Association requirements c. Epinephrine autoinjector kit d. Material for splints

ANS: A, C, D The school nurse needs much equipment to deal with emergencies in the school. Basic necessary equipment includes full oxygen tanks with oxygen masks of different kinds, splints, cervical spine collars, sterile dressings, and an epinephrine autoinjector kit in case a child goes into anaphylactic shock after exposure to an allergen. A hospital-oriented emergency kit would become quickly outdated (medications) and extremely expensive.

3. A new student's parents had not yet submitted an immunization record, although the nurse had sent a reminder home with the student twice. Which of the following actions should be taken by the nurse to keep the child in school? (Select all that apply.) a. Call the parents or mail another reminder. b. Report the problem to the teacher and the principal. c. Send the child home with a note saying the child cannot return until the immunization record is received. d. Suggest to the parents that if they don't have health care insurance, they may qualify for programs that provide immunizations free.

ANS: A, D There are many problems with children not being immunized or having incomplete vaccination records, especially in families who have moved many times or who may not have a regular physician. The parents may have no idea whether the child has received the required shots. Families may also be without health care insurance to pay for the immunizations, or they may have insurance that does not pay for preventive care. In these cases, they may lack the resources to pay for the immunizations themselves. Therefore, the nurse's role is to be sure parents are aware of the problem, to help them obtain the records if they have been misplaced, and to suggest ways to obtain the injections without charge, even if there is no obvious evidence that lack of funds is the problem. Telling the teacher or principal won't resolve the problem and it is illegal, immoral, and unprofessional to enter false information in a student's record.

15. Which of the following should be the minimum requirement for a nurse to be prepared for home health nursing? a. An RN license and a baccalaureate degree in a health-related field b. A baccalaureate degree in nursing and RN licensure c. An associate's degree in nursing and RN licensure d. Eligibility for certification as a home health nurse

ANS: B A baccalaureate degree in nursing should be the minimum requirement for entry into professional practice in any community health setting.

16. A disaster has occurred in the community. Which of the following actions should be taken by the school nurse? a. Continue activities as much as possible as if nothing had happened b. Continue to assess for shock and stress c. Help teachers discuss the disaster with their class d. Maintain school routines and activities

ANS: B After a disaster, the school nurse has many responsibilities—for instance, continuing to assess the school community for the presence of shock and stress, encouraging parents to minimize how much their children view the disaster coverage on TV, providing grief counseling, continuing to communicate with the children, parents, and school personnel, and following up with assessment of children for anxiety, depression, regression, and posttraumatic stress disorder.

17. Which of the following is the leading cause of children being absent from school because of a chronic illness? a. Allergies b. Asthma c. Diabetes d. Upper respiratory infections

ANS: B Asthma is the leading cause of children being absent from school because of a chronic illness. URIs are an acute problem, not a chronic one.

10. The school nurse has arranged for volunteers to help check each child's hearing and vision. Any child that the volunteers feel did not "pass" will be sent to the nurse for follow-up. The nurse will then send a note to the parents that a physician should be seen. Which of the following levels of prevention is being implemented? a. Primary b. Secondary c. Tertiary d. Both primary and secondary

ANS: B Because secondary prevention involves caring for children when they need health care, this is the largest responsibility for the school nurse. This includes caring for ill or injured students and school employees. It also involves screening and assessing children and referral to appropriate health agencies or providers.

1. Which of the following statements best describes the most essential difference between home health care and acute client care? a. Acute client care is individualized for the client and family. b. Home health care is provided in the client's environment. c. Reimbursement for home health care varies from that of care provided in institutions. d. The focus of acute client care is on community health.

ANS: B Home health differs from other areas of health care in that health care providers practice in the client's environment. All nurses give individualized care to clients.

2. A nurse has just received word that Medicaid will reimburse for care provided to a homeless man with schizophrenia who is afraid to come to the clinic to receive health care. Which of the following best describes this type of nursing? a. Community-oriented nursing b. Home health nursing c. Hospice nursing d. Private duty nursing

ANS: B Home health nursing is provided in the client's environment, regardless of where that may be. "Home" may be a house, apartment, trailer, boarding house, shelter, car, makeshift shelter under a bridge, or cardboard box.

8. Which of the following is a potential advantage of hospital-based home health agencies over other types of home care agencies? a. Administration and management benefits are gained from the expertise of two boards of experts. b. Continuity of care is enhanced. c. Health promotion and illness prevention concerns take precedence over acute care and rehabilitation. d. They are eligible for tax exemptions through affiliated agencies.

ANS: B Hospital-based agencies emerged in response to the recognized need for continuity of care from the acute care setting.

21. Which of the following is most important for school nurses to master in order to prepare for health care delivery in the future? a. Complementary and alternative therapies such as acupuncture b. Computer and technology use c. Psychoanalytical techniques d. Self-defense techniques

ANS: B In the future, school nursing will use telehealth and telecounseling to teach health education. School nurses will use the Internet to work with children and parents.

5. In the agency, one of the nurses spent all available time visiting a group of persons with mental health problems who were trying to remain functional in the community. Which of the following types of assignments did the nurse most likely have? a. Home-based primary care b. Population-focused home care c. Proprietary home care d. Transitional care

ANS: B Population-focused home care is directed toward the needs of specific groups of people, including those with high-risk health needs such as mental health problems, cardiovascular disease, or diabetes, families with infants or young children, and older adults. Such care commonly includes structured regular visits with assessment protocols, focused health education, counseling, and health-related support and coaching.

6. Which of the following best describes services that are offered at a school-based health center? a. Employee care at a discounted cost at the school b. Care to others in the community c. Sex education, birth control, family planning, and care throughout pregnancy d. Referral and networking with other health care services in the community

ANS: B School-based health centers give care not only to students but also to other persons in the community. They may provide social services, daycare, job training, and educational counseling in addition to the medical and nursing care, mental health counseling, and dental care seen in smaller school-based centers.

13. An upset mother calls the school nurse and says, "How dare you say my child has lice? My child is clean and I keep a clean house! You've obviously made an error." Which of the following would be the best response by the nurse? a. "I'm sorry you're upset, but your child cannot return to school until this problem is addressed." b. "Most lice are found in clean hair. Children often share combs. Let me tell you how to fix the problem." c. "You may have been traveling. Lice are often found in motels." d. "I'm sure you're correct one of my volunteers probably made an error. I'll recheck."

ANS: B The nurse must reassure the mother that no insult was intended; in fact, lice are most often found on middle-class children with clean hair. Lice travel easily when children share items such as combs or other property in school. Lice are not life-threatening, and the necessary shampoo and other items to treat lice are widely available over the counter.

3. A school health nurse is requested by the board of education to assist in choosing new playground equipment for an elementary school that meets safety standards. Which of the following best describes the nurse's role in this scenario? a. Case manager b. Consultant c. Counselor d. Health educator

ANS: B The school nurse is the person best able to provide health information to school administrators, teachers, and parent-teacher groups. As a consultant, the school nurse can provide professional information about proposed changes in the school environment and their effect on the health of the children. The nurse also can recommend changes in the school's policies or ask community organizations to help make the children's schools healthier places.

8. Which of the following best describes the primary reason that school health nurses spend so much time on educational programs that teach children the importance of water and fire safety, using a seatbelt in the car, and wearing a helmet when biking or skateboarding? a. Because children won't know if someone doesn't tell them b. Because injuries are the leading cause of death in children and most injuries are preventable c. Because it is a dangerous world and someone has to warn children about the dangers d. Because teaching is easy and more fun than passing out bandages and documenting care

ANS: B The school nurse, as the trusted person at school, is able to quickly give information to help prevent injuries from occurring, since most injuries are preventable. Injuries are the leading cause of death in children and teenagers.

4. At the annual community health fair, the school health nurse displays a science booth that examines the hazards of ineffective hand washing. Which of the following best describes the nurse's role in this scenario? a. Consultant b. Community outreach c. Counselor d. Researcher

ANS: B When participating in community outreach, nurses reach out to residents in the community. One common way this occurs is when nurses are involved in activities such as community health fairs or festivals in the schools.

6. A child has multiple disabilities, and caring for the child has been both expensive and time consuming for the school. Once the child turns 16, which of the following actions should be taken by the nurse? (Select all that apply.) a. As an adult, the child is no longer eligible for school services without charge. b. The school must continue to provide needed appropriate education for the child. c. The school can exclude the child from any extra special activities. d. The school should prepare an updated individualized education plan.

ANS: B, D Educational services must be offered by the schools for all disabled children from birth through age 22 years. Children cannot be excluded from activities because of a disability. The school must always develop an individualized education plan for each child and update it at appropriate intervals. Turning 16 does not make a child an adult.

2. Which of the following best explains why the federal government is beginning to fund school-based health centers? (Select all that apply.) a. These centers help young children avoid becoming addicted to drugs while still in elementary school. b. Attendance and learning are higher in schools with health clinics. c. These centers help keep children in school longer by distributing birth control and thus avoiding pregnancies. d. Many children have no other source of health care services.

ANS: B, D The U.S. government began funding school-based health centers essentially because many school children may not receive health care services otherwise. These are family-centered, community-based clinics run within the schools. Certainly, avoiding pregnancy and drug addiction are among the goals of school-based health centers, but these are not reasons the government began funding them.

17. A nurse completes a self-assessment of performance as part of the home health nurse's annual evaluation. Which of the following terms best describes this activity? a.Collaboration b. Quality of care c. Performance appraisal d. Resource utilization

ANS: C As part of a performance appraisal, the home health nurse evaluates his or her own nursing practice in relation to professional practice standards, scientific evidence, and relevant statutes, rules, and regulations.

13. A home health nurse is caring for a client who has right-sided paresis secondary to a stroke. Which of the following would be the best approach for the nurse to take? a. Arrange for private duty nurses to assist the client with daily needs. b. Assist the client with activities of daily living. c. Teach the client to participate in self-care activities. d. Teach the family how to care for the client.

ANS: C Because home health care is often intermittent, and because a reliance on others is not always possible over the long term, a primary objective for the nurse is to facilitate self-care so that clients may remain in their home. This allows clients to have some control over their life and can help prevent hopelessness and a loss of self-esteem. Although assistance may be needed, such assistance should come after helping clients to help themselves.

12. A home health nurse asks a client with arthritis to attend a demonstration in which an assistive device is used to put on shoes. Which phase of the nursing process is the nurse's current focus? a. Outcome identification b. Planning c. Implementation d. Evaluation

ANS: C Implementation is the phase in which the home health nurse implements the interventions identified in the plan of care. If the client is able to use the device, the process can progress to evaluation, in which the nurse will assess the usefulness of the device when incorporated into the client's activities of daily living.

2. Which of the following statements best explains why many school nurses are not able to ensure that all children receive needed health care in the schools? a. There is a shortage of baccalaureate-prepared nurses with national school health nurse certification. b. Most nurses prefer to be employed in hospitals giving direct care. c. Most school districts are unable to afford a nurse in every school. d. School districts and taxpayers see no need for nurses in schools.

ANS: C In Healthy People 2020, objective ECBP-5 states that there should be one nurse for every 750 children in each school (U.S. Department of Health and Human Services, 2010). Most schools have not achieved this objective. In 2006, approximately 40% of the nation's schools met that standard. The new objective is that 44.7% of the country's elementary, middle, junior high, and senior high schools have this many nurses by 2020 (U.S. Department of Health and Human Services, 2010). Having fewer nurses in the schools means that the nurses are expected to perform many different functions. It is therefore possible that they are unable to provide the amount of comprehensive care that the students need (Croghan, 2009).

10. Which of the following best describes why it is more challenging for most nurses to meet the needs of a dying child and his or her family than to meet the needs of a dying adult? a. Children don't understand what it means to die. b. A child's death is harder for anyone to accept. c. Society does not expect death to occur in children. d. Families are not prepared to deal with death.

ANS: C It is true that families are rarely prepared to deal with death. It is also true that children have only a limited understanding of dying. However, the needs of the dying child and family are unique because society does not expect death to occur to the young or to have the child die before the parent.

19. A school nurse has developed a special class for pregnant teens to teach them everything from anticipated body changes to methods for managing common pregnancy-associated problems. The classes also allow the nurse to be in close frequent contact with the students to monitor their health status. Which of the following levels of prevention is being used by the nurse? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Both primary and secondary prevention

ANS: C Many teenage girls who are pregnant attend school; therefore, the school nurse may provide ongoing care to the mother. Although this may appear to be secondary prevention, it is tertiary prevention because adolescent pregnancies are considered to be high risk.

7. Which of the following types of home health agencies emphasizes health promotion and illness prevention? a. Combination agencies b. Hospital-based agencies c. Official agencies d. Proprietary agencies

ANS: C Official or public agencies include those agencies operated by the state, county, city, or other local government units, such as health departments. Nurses employed in these settings provide well-child clinics, immunizations, health education programs, and home visits for preventive health care. Consequently, they include a focus on health promotion and illness prevention as well as giving direct care.

1. According to the American Academy of Pediatrics, which of the following activities are expectations for a school health nurse? a. Ensuring that children with health problems are accepted by their peers b. Driving children home if parents can't pick them up c. Giving emergency care in the school or during school events d. Giving medications as needed if children are ill

ANS: C School nursing responsibilities include making sure that children get the health care they need, including emergency care in the school, keeping track of the state-required vaccinations that children have received, carrying out the required screening of the children based on state law, and ensuring that children with health problems are able to learn in the classroom. The nurse cannot convince children to accept other children as peers, although certainly efforts should be made. HIPAA would not allow individual examples of health problems to be shared, other than providing group statistics.

18. A school nurse is demonstrating the use of a peak flow meter to help children with chronic asthma recognize when they need to use a rescue inhaler. Which of the following levels of prevention is being used by the nurse? a. Primary b. Secondary c. Tertiary d. Both primary and secondary

ANS: C Tertiary prevention includes caring for children with long-term health needs, including asthma and disabling conditions. The nurse is teaching disease management (i.e., when to use an inhaler).

11. Which of the following would be the best way for the school nurse to fulfill his or her responsibilities in an emergency situation? a. Tell all staff to call 911 if the nurse is not in the building. b. Arrange to always be available, even if only by phone. c. Create and share an emergency plan with all teachers and staff. d. Wear a pager so that the nurse can come as soon as humanly possible.

ANS: C The American Health Association recommends that the school nurse create an emergency plan with at least two different staff members identified and responsible for implementing the plan if the nurse is not in the building at the time of the emergency. The plan would include when to call 911 and how to get a child to the hospital via ambulance if needed.

4. Which of the following events led to the emphasis on home care nurses caring for acutely ill clients and the increased demands for extensive documentation? a. Advances in medical technology and pharmacology b. Increased number of lawsuits for substandard care c. Introduction of Medicare d. Social Security Act of the 1930s

ANS: C The combination of preventive services and illness care followed the introduction of Medicare in 1966. The Medicare program emphasized care for more acutely ill people rather than illness prevention and health promotion. The 1997 federal Balanced Budget Act, which implemented the prospective payment system in home care, increased pressure to care for clients with acute illnesses that were likely to improve.

9. Which of the following is the primary focus of hospice care? a. Curing or controlling the client's chronic disease b. Decreasing the waste of acute care (hospital) resources c. Providing palliative care to maintain comfort until death d. Teaching the client and family how to care for themselves

ANS: C The primary goal of hospice care is to help maintain the client's dignity and comfort. Alleviating pain, encouraging the client, family, and friends to communicate with each other about essential sensitive issues, and coordinating care to ensure a comfortable, peaceful death all contribute to palliative care.

22. The principal of a school was upset over a rumor that one of the children had engaged in a violent activity that injured a younger sibling. The principal asked the nurse who the children were so that the involved teachers could both support the injured child and guard other children from the violent child. Which of the following would be the best response by the nurse? a. "I'll get the names to you and the involved teachers immediately." b. "Let me get the parents' consent, and then I'll get you the names." c. "Rumors are often inaccurate let me follow up and see what happened and what needs to be done." d. "Why don't we coordinate a school-wide program on preventing accidents instead?"

ANS: C The school nurse is responsible for maintaining school health office policies, including privacy and safety of health records. The nurse must follow the HIPAA privacy rules while also ensuring the safety of children at school. When a rumor is involved, it is always wise to check its accuracy. If a child was indeed hurt, the nurse needs to make sure both children involved receive (or have already received) appropriate care. The question about having a school-wide program may be appropriate, but this behavior was apparently purposeful, not accidental.

11. When meeting with a client and family, the home health nurse says, "We have discussed your health problems and limitations. Now tell me what level of health and function you hope to achieve." In which of the following phases of the nursing process is the nurse engaging? a. Assessment b. Diagnosis c. Outcome identification d. Planning

ANS: C When discussing health problems and limitations, the nurse was gathering a history as part of the assessment phase. This allowed formulation of a nursing diagnosis. By steering the conversation toward goals, the nurse is now able to work with the client to mutually identify outcomes.

1. Which of the following aspects of a home health agency would most likely be examined during the accreditation process? (Select all that apply.) a. Cost of each service rendered b. Credentials of each employee c. Organizational structure d. Outcomes of care

ANS: C, D Both The Joint Commission (TJC) and the Community Health Accreditation Program (CHAP) of the National League for Nursing (NLN) look at the organizational structure through which care is delivered, the process of care through home visits, and the outcomes of client care, focusing on improved health status. Performance improvement must be ongoing in the agency. It is assumed the credentials of each employee were confirmed before employment.

2. A family is concerned about the medical bills of their father, age 63, who is unemployed and has almost no savings. Which of the following statements by the nurse accurately explain how Medicaid and Medicare would work in this family's situation? (Select all that apply.) a. "All your father's medical bills will be paid by whichever program is appropriate." b. "Choose any physician and just show them your Medicare or Medicaid card." c. "Your father must be homebound to qualify for Medicare assistance but less so for Medicaid." d. "Medicare is a federally funded program, but Medicaid is administered by your state."

ANS: C, D Many physicians will not accept a client on Medicare or Medicaid because of the low reimbursement rates. A deduction from Social Security is made for Medicare premiums, and clients are still responsible for deductibles and copays, so it is misleading to tell the family that all their father's medical bills will be paid. Medicare, for those age 65 and over or disabled, is a federal insurance program administered by the Social Security Administration, whereas Medicaid, based on a client's lack of financial resources, is a federal and state assistance program administered by the state. Medicare will only pay for home health care by skilled professionals while the client is homebound, whereas Medicaid does not necessarily require homebound status and may reimburse for home health aides and other nonskilled supportive services.

14. Which of the following do community-based nurses typically use to organize, sort, and document pertinent client data? a. NANDA b. NIC NOC c. Nursing Diagnosis Taxonomy d. The Omaha System

ANS: D Although all four are recognized nursing taxonomies, in community health, especially home nursing, the Omaha System is typically used. This system was developed by a visiting nurses association in Omaha and based on home nursing documentation needs. The Omaha System is most relevant to home health nursing and is most typically used by home health nurses.

3. A hospital nurse wants to know why home health nurses often take more time with assessment than nurses do in the hospital. Which of the following is the best explanation for this? a. Home care assessment includes not only the client but the supplies and equipment the family may have available for use. b. The home environment is less organized and equipped for the nurse's use. c. Family members must also be assessed for possible problems that could interfere with the primary client's recovery. d. To be effective, the home health nurse must earn the family's trust and work in partnership with them.

ANS: D Although all the responses contain some truth, the primary reason that assessment may take longer for the home health nurse is because when working in a client's home, the nurse is a guest. To be effective, the nurse must earn the trust of the family and establish a partnership with client and family.

23. Which of the following clients over 65 years of age meets the criteria for Medicare reimbursement for home health nursing? a. The client who needs assistance with bathing and meal preparation b. The client who needs assistance with house cleaning and meal preparation c. The client who needs sitter services because she wanders from home and becomes lost d. The client whose family members need to learn how to care for his wound

ANS: D Because the nursing service must be considered "skilled," custodial services alone (e.g., sitter services and assistance with ADLs) are not sufficient cause for Medicare reimbursement.

18. Which of the following best describes when the home health nurse must document required Outcome and Assessment Information Set (OASIS-B1) data? a. Before any episode of hospitalization b. After each home health visit c. For all incidences of error or mistake in care d. On first admission to home health care

ANS: D OASIS-B1 data are measured and reported to CMS (1) on admission to home health care, (2) after an episode of hospitalization, (3) at the time of recertification, and (4) on discharge from care or death at home. Data are submitted by each agency to a national databank, and agencies receive both results and comparisons with similar agencies to determine areas needing improvement. The data reported from OASIS determine the payment received by the home health agency for the client's total episode of care.

5. Which of the following best explains why school nurses are involved in helping teachers with the task of teaching children how to practice problem solving, communication, and other life skills? a. Teacher shortages have required nurses to be increasingly involved in teaching life skills. b. Because so many nurses want to be employed in schools, this responsibility was assumed to increase employment opportunities. c. States are requiring nurses to screen and to teach life skills. d. Nurses have been enlisted in this role to help reduce risk factors for future health problems in school children.

ANS: D School health nurses were originally involved in this capacity in 1987 after the CDC began funding schools for HIV-prevention education programs. This program was so successful that it was expanded to include programs to teach children prevention of other chronic illnesses caused in part by risk factors such as poor diet, lack of exercise, and smoking. The schools are actively involved in helping the children practice problem solving, communication, and other life skills so that they can reduce their risk factors for health problems.

25. A family member asks a home health nurse to explain the concept of hospice care. Which of the following would the nurse need to include as the fundamental underlying philosophy of hospice? a. Enabling the client to die at home b. Ensuring that the client's living will is upheld c. Placing experts in the position of power of attorney d. Providing comfort measures before death

ANS: D The hospice philosophy of care means providing comfort measures to an individual before death. Death may occur in the individual's home, in a hospital setting, or in an uncontrolled setting such as the community.

21. Which of the following best describes one of the outcomes of the incentives and pressures for cost control and improved health outcomes? a. Expansion in alternative health care agencies b. Improvements in client teaching materials c. Public pressure to improve health professionals' education d. Development and increased use of telehealth technology

ANS: D The incentives and pressures for cost control and improved health outcomes have increased the development and use of telehealth technology in home care. Simultaneously, technologies have been simplified and their reliability increased, facilitating their safe use in the home.

6. A new client has just been released from the hospital after intensive treatment for multiple injuries following a motorcycle accident. Which of the following types of care will he most likely receive? a. Home-based primary care b. Population-focused home care c. Proprietary home care d. Transitional care

ANS: D Transitional care programs in the home are designed for populations who have complex or high-risk health problems and are making a transition from one level of care to another. Assessment, planning, teaching, making referrals, and following up on referrals foster independence and self-care. Besides intensive teaching about self-care, telephone calls help ensure that the client understands and is able to implement instruction.

14. A school nurse listens as one student talks about another student being upset because his father frequently spanks him with a leather belt that leaves big marks on the student's back. But the student begs the nurse not to tell anyone because he promised the friend that the information would never be shared. Which of the following actions should be taken by the nurse? a. Ask the student if abuse has occurred. b. Call in the named student and ask him to remove his shirt. c. Discuss the conversation with the student's parents. d. Notify the legal authorities.

ANS: D When the nurse identifies a child who may be abused or who receives information from someone else that a child may have been abused, the nurse must contact the appropriate legal authorities and the school's principal. Asking the student about the abuse will not always elicit a truthful answer, because children will protect their parents. A confidential file should be made about the incident; however, the nurse should let the government authorities, usually the state or county child protection department, look into the suspected case. In all cases, the child should be protected from harm, and those who have no right to know that child abuse or neglect is suspected should not be given any information.

A community-oriented nurse convenes a support group for teenage mothers. The nurse understands that this strategy fosters cohesiveness among members and allows the members to learn from one another. What other benefit specific to group teaching will be achieved? a. Cultural sensitivity b. Efficiency in client service c. Learning of new skills d. Distraction-free surroundings

B

A nurse is using the technique of motivational interviewing when working with a client. Which of the following statements by the client indicates the client is ready to make the change? a. "I should change." b. "I am willing to change." c. "It's important to change." d. "I want to change."

B

A nurse planned a presentation about the latest trends in disaster planning for the senior nursing students at the local college. However, when the nurse began to share the information, the students were talking to one another and essentially ignoring the nurse. Which of the following actions should be taken by the nurse? a. Ask the students why they are being so rude. b. Explain why the information is crucial to their current clinical practice. c. Nothing; let the instructor of the course handle the problem. d. Tell a joke to get the students' attention.

B

A nursing student prepares a treatment plan for a client that draws upon the student's understanding of pathophysiology and nursing practice theory learned in the student's coursework. This application of new information used in a different way demonstrates the educational principle of: a. affective domain. b. cognitive domain. c. events of instruction. d. principles of effective education.

B

The nurse gives a very informative and engaging presentation and then gives everyone in the audience a handout that outlines the presentation. Later, the nurse discovers that many of the handouts were thrown away before the audience left the building. Which of the following educational principles has the nurse forgotten? a. Audiences expect PowerPoint or video presentations, not lectures. b. Many Americans do not have a high reading level. c. People want photographs and images, not wordy outlines. d. The nurse gave them too much information too fast for them to want to cope with it all.

B

A nurse is working with a lesbian client. Which statement by the client would indicate a need for further teaching? "Because I am in a homosexual relationship, I ... a. "... should notify my partner(s) if I test positive for any sexually transmitted disease." b. "... do not need to be screened for STDs." c. "... will get a mammogram every two years." d. "... will need to be screened for cervical cancer."

B Correct: This patient does need screening, especially if the relationship is not monogamous.

A community health nurse arrives at a family's home. Which of the following would behaviors by the nurse would be nontherapeutic? A) Maintaining eye contact with the family members B) Paging through paperwork for information C) Sitting on the furniture near the family members D) Placing car keys in the nurse's carryall bag

B Feedback: Community health nurses, like all nurses, need to be aware of their own body language. Fidgeting with car keys during the entire visit, noisily chewing gum, giving minimal eye contact, continuously looking at or paging through paperwork, appearing rushed, and refusing to sit on any of the furniture are behaviors that tell the family a great deal about the nurse, including how he or she feels about being in their home. These actions are nontherapeutic. Sitting on the furniture near family members demonstrates interest in the family. Placing car keys in the carryall bags prevents inadvertent distractions.

Which of the following would a community health nurse use when conducting an outcome evaluation? A) Organization B) Family progress C) Timing D) Performance

B Feedback: Outcome evaluation involves determining the change in the family's health status or progress. Organization and timing are components of the structure-process evaluation. Performance is part of self- evaluation.

Which one of the following is a principle that guides and enhances family nursing practice? A) The nurse should expect that the family will be normal and will not change. B) The nurse should start where the family is at the present time and not the ideal level of functioning. C) The nurse should focus on each family member individually. D) The nurse should evaluate the family based on consistency with traditional family patterns.

B Feedback: When working with families, community health nurses begin at the present, not the ideal level of functioning. This is accomplished after the nurse views the family collectively, not individually. The nurse should expect that what is normal for one family is not necessarily normal for another and that families are constantly changing. The nurse should recognize the validity of family structure variations.

The nurse educator knows that the nursing student has grasped the concept of self- evaluation when the nursing student makes which one of the following statements? A) It is important for the family to evaluate itself. B) It is important for the nurse's growth and effectiveness as a community health nurse. C) Evaluations by others are not helpful. D) Individuals can always see their own strengths or flaws.

B Self-evaluation is important for the nurse's growth and effectiveness as a community health nurse. Self-evaluation is referring to the nurse's growth and not the family's. Sometimes, we cannot see our own strengths or flaws, and evaluations by others are helpful.

A community health nurse determines that it is time for teaching a family about health promotion activities when they say which of the following? A) "Is there a place we can go for the medicine?" B) "It's time we do something about eating right." C) "When are you coming back to visit?" D) "Our grandchildren visit every summer."

B Teaching health promotion activities should begin only after family members express an interest and recognize a need, such as the statement about eating right. Asking about where to get medicine and when the nurse is coming back do not reflect an interest or need. The statement about grandchildren reflects information about the family structure and demographics.

A public health nurse is surveying males in a community to get a sense of the overall health risks present. After reviewing the surveys, approximately 12% identified themselves as gay. The nurse should conclude that this information: a. This coincides with the national averages. b. May have mixed meaning. c. Should not be taken seriously as the nurse really does not know what the respondents meant by their answer. d. Means these men are at much greater risk for psychological and social problems.

B Correct: Homosexuality is culturally defined and what is considered homosexual in one culture may not be in another, even if it involves same-sex sexual activity.

Which of the following strategies should be used when providing educational programs for children? (Select all that apply.) a. Emphasize how to build learning from previous experiences. b. Use simple words to enhance understanding. c. Use objects to help increase their attention. d. Emphasize the importance of the long-term consequences.

B C

A nurse is providing an educational program about testicular self-examination (TSE). Which of the following would be the best learning objective for this program? a. Each participant will state why TSE is important and explain how to do it. b. Each participant will describe how to do TSE and discuss the dangers of testicular cancer. c. 90% of the men will correctly demonstrate testicular self-examination. d. 100% of the men will do a testicular examination correctly on a model.

C

A home health nurse receives a referral to educate an older adult client with diabetes in proper foot care. The nurse's assessment of the client determines that the client has poor eyesight that may affect the client's ability to learn and perform certain skills. Which educational principle is being examined? a. Cognitive domain b. Events of instruction c. Principles of effective instruction d. Psychomotor domain

D

A home health nurse is visiting an established client who was referred following hospitalization for a myocardial infarction. The client lives with a spouse and the nurse is assessing the client's knowledge regarding resuming normal activities. The nurse has been trying unsuccessfully to gain information about the client's resumption of sexual activity, but the client consistently changes the subject to questions about medications. This is an example of a(an): a. Nurse-oriented distraction b. Behavioral distraction c. Environmental distraction d. Physical distraction

Behavioral distraction Correct: Rationale: Behavioral distractions consist of behaviors employed by the client to distract the nurse from the purpose of the visit.

A man says, "I just can't get myself to leave the house and go for a 30-minute walk each day. I wish I could think of some way to motivate myself." Which of the following would be the best action for the nurse to take? a. Establish a written contract between him and his employer that states walking is required each day. b. Recognize the reasons why 30 minutes of walking each day is one of the best health promotion activities he can choose. c. Join a group that walks early each morning. d. Set up rewards for himself, such as a nice snack after he gets back from walking.

C

A nurse just finished teaching breast self-examination to a large group of women at a professional conference. During the session, she distributed literature and used culturally appropriate visual aids. However, the session was not as effective as it could have been. Which of the following was the most important thing omitted by the nurse? a. Time for audience members to ask questions and clarify the information b. Explanation of why culturally appropriate images are more acceptable c. Opportunity for the women to practice what they learned d. Use of simple language instead of printed material

C

A nurse uses lecturing as the primary method of educating clients. Which part of the education process is missing? a. Evaluation b. Experience c. Participation d. Understanding

C

The leader of an Alzheimer's support group surveys the members of the group to determine the best time for the group to meet. Which of the following norms is being supported through this action? a. Group norms b. Task norms c. Maintenance norms d. Reality norms

C

The nurse has just taught a client newly diagnosed with diabetes how to administer sliding-scale insulin. The most effective way to evaluate learning is to: a. provide an online test module. b. ask whether there are any questions. c. ask for a return demonstration. d. give a short paper-and-pencil quiz.

C

A couple who are gay have adopted a child. The child's new grandfather says, "I'm worried about the effects of their relationship on my grandchild." How should the population health nurse respond? a. "The child will be adversely affected." b. "Abuse potential is higher among same sex couples." c. "Parenteral attachment to the child is the primary factor in successful parenting." d. "The child will be more likely to be gay as an adult."

C Correct: Children adopted by GLBT individuals tend to develop secure parental attachments and grow up as successfully as children in heterosexual families.

A client who is gay tells the nurse that he has disclosed his sexual preference to a few close friends, but has not come out. How does the nurse interpret this statement? a. This client is confused as to the appropriate terms used for telling others. b. Once you have disclosed, coming out is inevitable. c. The majority of the client's social contacts and family are unaware that he is gay. d. Only the client's friends know he is gay; his family does not.

C Correct: Coming out involves openly living as a gay, lesbian, bisexual, or transgender individual.

A patient who is gay reports that he does not use a condom with his main partner but always uses one when he "goes clubbing." How does the population health nurse document this information? a. Syndemia b. Cisgendering c. Serosorting d. Siliconizing

C Correct: Serosorting is the practice of limiting sexual partners to persons of the same HIV status or use of condoms with HIV discordant or unknown partners.

A couple who are lesbian would like to adopt a child. Which information will the population health nurse provide? a. This adoption will be prohibited by Federal law. b. This adoption will be prohibited by State law in all states. c. Most adoption agencies will accept applications from GLBT persons. d. Sexual orientation is not a significant factor in adoption.

C Correct: While this is a true statement, the percentage of agencies reporting placement of a child with a GLBT family or individual is much lower.

A community health nurse constructs an eco- map for a family based on the understanding that this tool is useful for which reason? A) Family relationships over three or more generations are depicted. B) The ecological system of a family's neighborhood is charted. C) It was originally devised to depict the complexity of the client's story. D) Directions for gathering data about neighborhoods are provided.

C Feedback: An eco-map depicts the complexity of the client's story. Lines are drawn to indicate connections to other systems with arrows signifying the direction of energy or flow of resources, and the absence of lines indicates a lack of connections. The family's neighborhood is one component, but not the central focus of the eco-map. A genogram displays family information about complex family patterns such as family relationships over three or more generations, arrows signify the direction of energy or flow of resources, and absence of lines indicates a lack of connections.

community health nurse to take his or her shopping to purchase some of the food items he or she needs for his or her diet. Which response by the nurse would be most appropriate? A) "I can't, I'm going in a totally different direction." B) "You need to find some other way to get to the store." C) "I'll help you find a way to get to the store." D) "Use the foods you have in the house and shop next week."

C Feedback: The nurse needs to empower the client and helping the client find a way to get to the store promotes the skill of planning so that the client can begin to manage her own needs effectively. Telling the client that the nurse is going in a different direction, telling him or her to find some other way to get to the store, and telling him or her to use the foods in the house are neither therapeutic nor do they promote empowerment.

During a home visit and assessment of an infant and new mother, the nurse determines that the infant looks healthy. The mother asks several questions and listens attentively. One question she asks is whether the nurse is going to visit her again. Which response would be most appropriate? A) "Your baby looks healthy. You should not have any further questions." B) "The agency limits the number of visits I can make; I will let you know." C) "I plan to visit again. What would you like to accomplish at the next visit." D) "I can come weekly for the next 16 weeks, and then a staff nurse will visit."

C Feedback: The response about what the client wants to accomplish together represents a mutual approach, giving power to the client and hints at accomplishing things together on subsequent visits. Noting that the infant looks good and that the mother should not have further questions is closed-ended and nurse- focused and does not promote open communication between the client and the nurse. The option about limiting visits is inaccurate; the nurse has more control over the number of visits than this response implies, unless the visit is part of a special and very limited program. Even then it would not be phrased this way. The final option about 16 weekly visits followed by a staff nurse sounds overwhelming and unrealistic. Very few clients receive this much service from public health agencies.

A community health nurse is attempting to empower a family to become independent. Which of the following would be most appropriate? A) Focus attention on the problem areas B) Do for the family what they cannot C) Emphasize the family's strengths D) Reinforce positive traits

C To help empower families, the community health nurse needs to emphasize the family's strengths. It is the nurse's job to recognize the strengths in families and to help families recognize them as well. Focusing on problem areas portrays a negative view and can undermine the nurse's efforts. Doing for the family what they cannot fosters dependency. Reinforcing positive traits may be appropriate if those positive traits are strengths. Not all positive traits are strengths.

A member of a community weight-loss group has maintained a healthy weight for 2 years through healthy eating and daily exercise. Which of the following steps of the affective domain is this participant demonstrating? a. Analysis b. Application c. Evaluation d. Knowledge

C (Steps in the affective domain have the learner doing the following in this sequence: (1) knowledge: receives the information; (2) comprehension: responds to what is being taught; (3) application: values the information; (4) analysis: makes sense of the information; (5) synthesis: organizes the information; (6) evaluation: adopts behaviors consistent with the new values. In this example, the individual has adopted the behavior and this has resulted in the ability to maintain the value of a healthy weight.)

A nurse invited all the teenagers who were newly diagnosed with diabetes to a group meeting to discuss issues they all had in common. One teenager replied, "I don't know if I want to share all the problems I'm having with strangers." Which of the following is the best nurse response? a. "Don't share anything with anyone until you're comfortable doing so." b. "I can understand what you are saying." c. "No one will require you to do anything you don't want to do." d. "The purpose of the group is to have a safe place to share problems with others who may be having similar problems."

D

A nurse is meeting to discuss problems and solutions with a group of teenagers who have been newly diagnosed with diabetes. One teenager states, "My mom found this particular brand of popcorn that has only 15 carbohydrates in the whole giant bag." Which of the following best describes the group purpose that is being served by the teenager's statement? a. Maintenance function of encouraging everyone to continue the discussion b. Maintenance function of helping everyone feel comfortable talking about food c. Task function of resolving problems about what to nibble during movies d. Task function of sharing information and resources

D

A nurse is planning an educational program about cardiovascular disease. Which of the following would be the optimal time for the nurse to elicit feedback from program participants? a. At the beginning of the program b. At the program midpoint c. Immediately following program completion d. Throughout the program

D

A school nurse is working with a family whose son recently announced that he is gay. The parents were initially angry and now, several weeks later, state to the nurse that this is a fad their son is just "going through." The nurse recognizes this as: a. Acceptance that he is gay. b. A call for help on the parent's behalf. c. A highly irregular occurrence. d. A normal phase of acceptance.

D Correct: Families go through stages similar to the stages of grief. In the denial stage the parents may see their child's professed sexual identity as a "phase" that he or she will grow out of.

The community health nurse staffs a clinic, which serves a large number of homosexual clients. When assessing young lesbian clients, the nurse would want to pay keen attention to physiological changes of which system? a. musculoskeletal b. integumentary c. genitourinary d. respiratory

D Correct: Studies show that smoking is about twice as prevalent in the GLBT population as in the straight population.

Which one of the following has a negative influence on family health and individual health? The level at which a family functions significantly affects the individual's level of health. B) A healthy family fosters individual growth and sustains members during times of crisis. C) Family patterns dictate whether members participate in their own health care. D) Individuals can obstruct the family's health and families can obstruct individual family members' health.

D Feedback: A negative influence on family health and individual health is that individuals can obstruct the family's health and families can obstruct individual family members' health. The level at which a family functions significantly affects the individual's level of health; that a healthy family fosters individual growth and sustains members during times of crisis; and the influence of families that dictate whether members participate in their own health care are all positive influences.

When planning for a home visit, which of the following would be most helpful to ensure a successful home visit? A) Documentation in a timely manner B) Summarizing the main visit points C) Providing incidental teaching D) Scheduling an appropriate visit time

D Feedback: As part of planning the community health nurse would contact the family to set up an appropriate time for the visit. Documenting in a timely manner ensures successful evaluation. Providing incidental teaching and summarizing the main visit points help to ensure successful implementation.

When a community health nurse is conducting a family assessment on an assigned family, which of the following would be most appropriate? A) Use quantitative data only to maintain and preserve objectivity B) Interview one family member to avoid confusion and repeated information C) Use a checklist format, completing the tool in the family's presence D) Make several visits and accumulate data from all family members

D Feedback: Completing a family assessment takes time. It is better to keep notes from several visits with the family and observe the family as a group during some family activity. The nurse should not use obtrusive questionnaire techniques or take notes in the family's presence. Quantitative data will give a one-sided view of family data. It is best to interview all family members over time. The nurse should collect both quantitative and qualitative data, which will provide a rich family assessment.

When assessing a family, which of the following would lead the nurse to question the health of a family? A) Role relationships are inflexible. B) Coping is actively attempted. C) Family members communicate regularly. D) The family lacks regular links with the broader community.

D Feedback: In a healthy family, role relationships are structured effectively so that they can change with changing family needs. Active coping, regular family communication, and regular links with the broader community reflect a healthy family.

Which of the following would be most appropriate for the community health nurse to do first when planning an initial home visit to a family? A) Obtain the basic supplies that will be needed B) Gather appropriate educational materials C) Contact the family via telephone D) Review the referral information

D Feedback: The first step is to obtain the referral and review it to gather information about the possible needs of the family and the reason for the visit. Once this is done, then the nurse would obtain the basic supplies and education materials that might be needed and contact the family to arrange the visit.

While making a family health visit, an older relative who is visiting has been drinking and becomes verbally abusive and increasingly loud. Which action by the community health nurse would be best? A) Continue the visit with caution B) Suggest the relative go in another room and take a nap C) Ask the sober family members to take the visitor home D) Terminate the visit, making plans for another visit

D Terminating the visit is the best choice. It appears the problem is escalating, and the nurse's safety should always come first. Continuing the visit puts the nurse and possibly the other family members at risk. Making a suggestion to go into another room and take a nap may agitate the relative and make a deteriorating situation worse. Making a suggestion for a family member to take the visitor home may agitate the relative and make a deteriorating situation worse. Additionally, this is the client's home and the suggestion should be the client's.

A community health nurse is collecting data about the family's demographics. Which of the following would the nurse include? Select all that apply. A) Dietary patterns B) Housing C) Climate D) Socioeconomic status E) Education of members F) Ethnicity

DEF Family demographics refer to such descriptive variables as a family's composition, its socioeconomic status, and the ages, education, occupation, ethnicity, and religious affiliations of members. Dietary patterns, housing, and climate are variables assessed with the physical environment.

A home health nurse visits a client who was referred following hospitalization for severe malnutrition related to gastroesophageal reflux disease (GERD) and a large hiatal hernia. Resolution measure? The client: a. Related the importance of taking a daily vitamin. b. Gained two pounds in the past month. c. Will relate the importance of maintaining diet high in nutrient quality. d. Can state the side effects of her medications.

Gained two pounds in the past month. Correct: A resolution measure focuses on the degree to which an existing problem has been resolved.

A home health nurse is working with a client who has several open wounds. Soiled bandages from dressing changes, and equipment used for this client should be: a. Disposed of in the same manner as the client's garbage. b. Brought to the local landfill so as not to mix with the client's regular waste. c. Handled in the same manner as if the client were in a clinical setting. d. Handled as regular garbage, but marked as "Hazardous Waste."

Handled in the same manner as if the client were in a clinical setting. Correct: Rationale: The nurse should adhere to the agency's standards of practice, incorporate universal precautions for preventing the spread of blood borne diseases, and educate clients and family members in infection control measures, including universal precautions.

A hospice client has decided to remain in his own home until death. The client requires 24/7 nursing care and during the first overnight care by hospice nursing staff, they realize that the client's home is infested with cockroaches. The hospice nurse should: a. Help the family make arrangements for pest control measures immediately. b. Refuse to visit the home until the situation is taken care of. c. Tell the client's family that the client does not qualify for hospice services because of the condition in the home. d. Make an immediate referral for social services and move the client to a long-term care facility.

Help the family make arrangements for pest control measures immediately. Correct: The need for balance in the area of risk and safety affects both nurse and client. The nurse must decide what level of risk is acceptable without unduly jeopardizing the safety of the client or the nurse's own safety. The nurse might need to weigh the relative risks of changing a potentially hazardous environment versus the disruption to the client's life that will result from the change. This is a situation that requires action on the nurse's part, but not a situation that is without a solution.

A referral to the home health agency has been made. As the nurse makes plans to see the client, several steps need to be accomplished. Choose the nurse's initial step in this process. a. Prioritize client needs b. Implement the visit c. Make a preliminary assessment d. Make nursing hypotheses

Make a preliminary assessment Correct: Before the home visit, the nurse conducts a preliminary assessment to review existing information about the client and his or her situation.

A patient has been hospitalized with a femur fracture that has not healed as expected. As discharge comes closer the family inquires about the possibility of home health care visits. What information should the nurse provide? (Select all that apply.) a. The client must first pass the OASIS screen before home health visits are certified. b. The client must first pass HHRG screening before home health visits are certified. c. Qualification requires that the client is homebound. d. Since the client requires physical therapy placement in a long term care facility is necessary. e. The client must be eligible for Social Security benefits to be eligible for Medicare reimbursement of services.

Qualification requires that the client is homebound. Correct: One of the requirements of home health care is that the client is homebound. The client must be eligible for Social Security benefits to be eligible for Medicare reimbursement of services. Correct: Social Security benefits are required in order for the client to be eligible for Medicare.

A home health nurse is completing an initial visit to a client. Which information is the most important to document? a. The objectives developed by the nurse prior to the visit b. The client's physical assessment c. Referrals made to outside agencies d. Discharge summary

The client's physical assessment Correct: The nurse should document the actual (not preliminary) assessment of client health status and the health needs identified as well as the interventions employed to address these needs.

A home health nurse is evaluating the effectiveness of the visits to a particular client. Which statement reflects evaluation of a health promotion/illness prevention measure? a. The client's mobility and range of motion measurements after physical therapy sessions. b. The number of times the client attended health education classes. c. The client's blood pressure measurements after initiating treatment for hypertension. d. The client's weight after nutrition therapy was instituted.

The number of times the client attended health education classes. Correct: Evaluative criteria for health promotion/illness prevention measures reflect health promotion or the absence of specific health problems. Monitoring the number of times the client attended health education classes would indicate that the client's interest in activities that promote health or healthy lifestyles.

A home health nurse is making a visit to a client whose dwelling does not have running water. The best way for the nurse to practice standard precautions in this case would be to: a. Have the client meet the nurse at the closest health agency. b. Use waterless hand cleaner before, during, and after the visit. c. Make a referral to social services, as this client should not be living in a home without running water. d. Only perform non-invasive procedures or assessments.

Use waterless hand cleaner before, during, and after the visit. Correct: The primary infection control measure in any setting is adequate hand washing before and after giving any direct care to clients. Hands should be thoroughly washed with soap and running water, or a waterless cleanser used if no water is available.

A home health nurse is making an initial visit to a new client. The nurse had developed a preliminary assessment prior to the visit to the client, who was referred after hospitalization for a total hip replacement. The client lives alone. What is the next step in the home visit? The nurse will: a. Evaluate the home for any mobility concerns (i.e., stairs, carpets, uneven sidewalk, etc.). b. Validate the information collected prior to the visit. c. Refer the client to physical therapy. d. Monitor the client's progress in mobility.

Validate the information collected prior to the visit. Correct: The first task in implementing the home visit is to validate the accuracy of the preliminary assessment.

Which statement is true about mortality rates? Mortality rates: a. Are informative only for fatal diseases b. Provide information about existing disease in the population c. Are calculated using a population estimate at year-end d. Reveal the risk of getting a particular disease

a. Are informative only for fatal diseases

An example of a health disparity is: a. Childhood immunization rates b. High dropout rates c. Unemployment d. Income below poverty level

a. Childhood immunization rates

John Snow is called the "father of epidemiology" because of his work with: a. Cholera b. Malaria c. Polio d. Germ theory

a. Cholera

A mental health nurse working in the 1960s received additional education to provide care for the severely mentally ill in the community because of which legislation? a. Community Mental Health Centers Act b. Stewart B. McKinney Homeless Act c. National Health Planning and Resource Development Act d. Patient Protection and Affordable Care Act

a. Community Mental Health Centers Act

Which trends are occurring among vulnerable populations? Select all that apply. a. Community-based care and interorganizational partnerships b. Outreach and case finding c. Elimination of disparities d. Culturally and linguistically appropriate care

a. Community-based care and interorganizational partnerships b. Outreach and case finding d. Culturally and linguistically appropriate care

A study that uses information on current health status, personal characteristics, and potential risk factors or exposures all at once is called: a. Cross-sectional b. Ecological c. Case-control d. Cohort

a. Cross-sectional

Which is a characteristic of a vulnerable population? a. Have worse health outcomes and an increased sensitivity to risk factors than the general population b. Have a single risk factor but experience worse health outcomes than the general population c. Have multiple risk factors but equal health outcomes than the general population d. Have worse outcomes with better access to health care than the general population

a. Have worse health outcomes and an increased sensitivity to risk factors than the general population

A nurse considers an audience's ability to read, comprehend, and act on medical instructions while preparing health education materials. Which factor is the nurse considering? a. Health literacy b. Ethnicity c. Medical training d. Disparity

a. Health literacy

A screening for diabetes revealed 20 previously diagnosed diabetics and 10 probable new cases, which were later confirmed, for a total of 30 cases. This is called: a. Prevalence b. Incidence c. Attack d. Morbidity

a. Prevalence

As a result of an outbreak of influenza in a community, a nurse encourages members of the community to receive the influenza vaccine. Which level of prevention is being used? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Multifactorial prevention

a. Primary prevention

Immunization for measles is an example of: a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion

a. Primary prevention

An example of tertiary prevention is: a. Rehabilitative job training b. Parenting education c. Testicular self-examination d. Family counseling

a. Rehabilitative job training

When a nurse examines birth and death certificates during an epidemiologic investigation, what data category is being used? a. Routinely collected data b. Data collected for other purposes but useful for epidemiologic research c. Original data collected for specific epidemiologic studies d. Surveillance data

a. Routinely collected data

Which federal program created support for older and poor Americans? a. Social Security Act b. Medicare Amendment c. Medicaid Amendment d. Hill-Burton Act

a. Social Security Act

What is implied by the web of causation model? a. Variables interact resulting in higher probability of illness. b. One disease causes another, especially in vulnerable populations. c. The greater the poverty, the more likely people are to have diseases. d. Immunizations are necessary because vulnerable populations spread disease.

a. Variables interact resulting in higher probability of illness.

Which population is most likely to be affected by poverty? a. Women b. Men c. Two-parent families d. Adoptive families

a. Women

Which is an example of an epidemic? a. "Bird" flu in China b. Adult obesity in the United States c. An isolated case of smallpox in Africa d. The nursing shortage in the United States

b. Adult obesity in the United States

A set of actions one undertakes on behalf of another is: a. Social justice b. Advocacy c. Linguistically appropriate health care d. A waiver

b. Advocacy

The most important predictor of overall mortality is: a. Race b. Age c. Gender d. Income

b. Age

An epidemiologist wanting to know what caused severe diarrhea and vomiting in several people at a local banquet would be using: a. Descriptive epidemiology b. Analytic epidemiology c. Distribution d. Determinants

b. Analytic epidemiology

Nurses incorporate epidemiology into their practice and function in epidemiologic roles through (select all that apply): a. Policy making and enforcement b. Collection, reporting, analysis, and interpretation of data c. Environmental risk communication d. Documentation on patient charts and records

b. Collection, reporting, analysis, and interpretation of data c. Environmental risk communication d. Documentation on patient charts and records

In which situation does the nurse need to be aware of the potential for selection bias? a. Determining the population to be studied b. Considering how the participants will enter the study c. Studying cause and effect relationships d. Documenting results of the study

b. Considering how the participants will enter the study

Epidemiologic studies of diseases conducted by nurses during the twentieth century were influenced by the (select all that apply): a. Increasing rate of poverty b. Declining child mortality rates c. Overcrowding in major cities d. Development of new vaccinations

b. Declining child mortality rates d. Development of new vaccinations

The wide variations in health services and health status between certain population groups are called: a. Priority population groups b. Health disparities c. Disadvantaged populations d. Risk markers

b. Health disparities

The differential vulnerability hypothesis refers to the: a. Resistance of certain groups to risk factors b. Increased susceptibility to cumulative risk factors among vulnerable groups c. Variability in the effects of stressors according to socioeconomic status d. Increased sensitivity of the very young and the very old to risk factors

b. Increased susceptibility to cumulative risk factors among vulnerable groups

An outbreak of a gastrointestinal illness from a food-borne pathogen is an example of a(n): a. Attack rate b. Point epidemic c. Secular trend d. Event-related cluster

b. Point epidemic

Which vulnerable group would be most sensitive to adverse effects? a. Pregnant teenager living with her parents for financial support b. Poor, older woman with no means of transportation c. Two-year-old boy of underinsured parents d. Recently unemployed father of five

b. Poor, older woman with no means of transportation

The probability an event will occur within a specified period of time is called: a. Rate b. Risk c. Epidemiology d. Epidemic

b. Risk

Which is an example of an agent in the epidemiologic triangle? a. Human population distribution b. Salmonella c. Genetic susceptibility d. Climate

b. Salmonella

Screening for hearing defects is an example of: a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion

b. Secondary prevention

An example of a vulnerable group experiencing multiple risk factors is: a. Smokers who use chewing tobacco as well as cigarettes b. Substance abusers who test positive for human immunodeficiency virus (HIV) c. Persons with limited access to care because they live in a rural area d. New mothers needing information about baby and child care

b. Substance abusers who test positive for human immunodeficiency virus (HIV)

A nurse is told that a screening test has high specificity. This means that the test: a. Provides precise and consistent readings b. Accurately identifies those with the condition or trait c. Accurately identifies those without the trait d. Has a high level of false positives

c. Accurately identifies those without the trait

How can nurses promote social justice? a. By contacting lawmakers about environmental health issues b. By assisting at homeless shelters c. By advocating for policies to improve social conditions d. By serving on a local coalition to prevent obesity

c. By advocating for policies to improve social conditions

The type of epidemiologic study that is used to describe a group of persons enrolled in a study who share some characteristic of interest and who are followed over a period of time to observe some health outcome is a(n): a. Case control study b. Cross-sectional study c. Cohort study d. Experimental study

c. Cohort study

Voters have recently decided to have fluoride added to the city water system. Epidemiologists wanting to study the effect of fluoride on dental caries would be conducting a(n): a. Ecological study b. Double-blind study c. Community trial d. Screening

c. Community trial

An example of primary prevention is: a. Pap smear b. Blood pressure screening c. Diet and exercise d. Physical therapy

c. Diet and exercise

When studying chronic disease, the multifactorial etiology of illness is considered. What does this imply? a. Genetics and molecular structure of disease is paramount. b. Single organisms that cause a disease, such as cholera, must be studied in more detail. c. Focus should be on the factors or combinations and levels of factors contributing to disease. d. The recent rise in infectious disease is the main focus.

c. Focus should be on the factors or combinations and levels of factors contributing to disease.

A nurse caring for a homeless population recognizes that those who are homeless: a. Need more nursing care than other vulnerable groups b. Have no desire to seek medical care c. Have even fewer resources than poor people who have adequate housing d. Are living in despair with no hope or resilience

c. Have even fewer resources than poor people who have adequate housing

A client is self-employed as a mechanic and has limited health insurance coverage. This client is considered: a. Poor b. Near poor c. Medically indigent d. Uninsured

c. Medically indigent

Public health professionals refer to three levels of prevention as tied to specific stages in the: a. Epidemiologic triangle b. Web of causation c. Natural history of disease d. Surveillance process

c. Natural history of disease

A nurse operates a school-based clinic in a local school, making it easier for children to access health care. This is an example of: a. Case finding b. Wrap-around services c. Outreach d. Comprehensive services

c. Outreach

The proportion of persons with positive test results who actually have a disease, interpreted as the probability that an individual with a positive test result has the disease, is the: a. Sensitivity b. Specificity c. Positive predictive value d. Negative predictive value

c. Positive predictive value

What is the primary cause of vulnerability? a. Race b. Age c. Poverty d. Illness

c. Poverty

A nurse is developing a one-stop service to meet the needs of a vulnerable group. Which is an example of this type of service? a. Wrap-around services where mental services are linked b. Giving all immunizations on a single clinic visit c. Providing multiple services during a single clinic visit d. Providing free services to the medically indigent

c. Providing multiple services during a single clinic visit

Which is an example of a priority population group? a. People earning more than $100,000/year b. People earning less than $100,000/year c. Residents of remote rural areas of Canada d. African American physicians

c. Residents of remote rural areas of Canada

A nurse works with a group of abused women to enhance their levels of self-esteem. Which level of prevention is being performed? a. Primary level of prevention b. Secondary level of prevention c. Tertiary level of prevention d. Health promotion

c. Tertiary level of prevention

Vocational rehabilitation of a person with a neuromuscular disease is an example of: a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion

c. Tertiary prevention

A 17-year-old pregnant cocaine addict who is homeless is considered: a. At risk b. A special population c. A Healthy People 2020 target group d. A vulnerable individual

d. A vulnerable individual

The factors, exposures, characteristics, and behaviors that determine patterns of disease are described using: a. Descriptive epidemiology b. Analytic epidemiology c. Distribution d. Determinants

d. Determinants

An example of secondary prevention is: a. Rehabilitation b. Avoidance of high-risk behaviors c. Immunization d. Mammogram

d. Mammogram

To understand the causes of health and disease, epidemiology studies: a. Individuals b. Families c. Groups d. Populations

d. Populations

An example of an attack rate is the: a. Number of cases of cancer recorded at a medical center b. Number of people who died of cholera in India in a given year c. Number of beef cattle inoculated against mad-cow disease on a farm d. Proportion of people becoming ill after eating at a fast-food restaurant

d. Proportion of people becoming ill after eating at a fast-food restaurant

Which demonstrates the removal of a barrier to health care? a. Discrimination against certain groups b. Treatment of pets at the same facility c. Provision of free food at a food bank d. Providing services for a rural population by using a mobile clinic

d. Providing services for a rural population by using a mobile clinic

Which is the most appropriate action for a nurse when planning and implementing care for vulnerable populations? a. Setting up multiple clinics in a wide geographic area b. Advising legal consultants on a variety of issues c. Making laws to protect the homeless d. Teaching vulnerable individuals strategies to prevent illness and promote health

d. Teaching vulnerable individuals strategies to prevent illness and promote health

The interaction between an agent, a host, and the environment is called: a. Natural history of disease b. Risk c. Web of causality d. The epidemiologic triangle

d. The epidemiologic triangle

Which would be considered a serious epidemic of influenza? a. 50 cases b. 100 cases c. 500 cases d. Unable to determine

d. Unable to determine