Community Health Final

The public health administrator is in the process of hiring a new public health nurse. Which of the following statements made by an applicant would most likely result in the applicant not being hired? a. "I like to be the only person working on a project because individuals in teams have their own ideas and plans and the resulting debate slows progress." b. "I prefer to work in teams because no single person has too much responsibility because the burden is shared." c. "Teamwork is better than work done by individuals because teamwork incorporates different perspectives." d. "Whether teamwork is better than work done by individuals depends on the nature of the work being performed."

a. "I like to be the only person working on a project because individuals in teams have their own ideas and plans and the resulting debate slows progress." An applicant who does not like to work in and with teams would not be appropriate to fill this position. Teamwork is a necessary skill when working as a public health nurse. Working in collaborative partnerships is an essential role of public health nursing. Partnerships and collaboration among groups are much more powerful in making change than the individual client and nurse working alone. Part of the reason is that multiple perspectives are examined in the process of coming to the best solution.

A nurse at a migrant clinic assists clients with completing the application process to receive supplemental food assistance. Which of the following roles of the nurse is being used? a. Advocate b. Case manager c. Outreach worker d. Primary caregiver

a. Advocate As an advocate, the nurse collects, monitors, and analyzes data and discusses with the client which services are needed and whether the client is an individual, a family, or a group. When using the role of case manager, the nurse assists in providing equal access to health care by identifying and alerting the community to gaps in services available. As an outreach worker, the nurse addresses the multiple needs of high-risk populations. Nurses provide direct client care when using the role of primary caregiver.

Which of the following best describes the role of nursing in community health? a. Application of nursing and public health theory in promoting, preserving, and maintaining health of individuals, families, or communities b. Health care provision offered in primary and secondary institutions or in the client's home c. Provision of health care services in institutions located in the community but outside the hospital d. Use of the nursing process and evidence-based practice to meet Healthy People 2020 objectives for community health improvement

a. Application of nursing and public health theory in promoting, preserving, and maintaining health of individuals, families, or communities Nursing practice in community health is the synthesis of nursing theory and public health theory applied to promoting, preserving, and maintaining the health of populations through the delivery of personal health care services to individuals, families, and groups. The focus of practice is health of individuals, families, and groups. Care is provided within the context of preventing disease and disability and promoting and protecting the health of the community as a whole. Healthy People 2020 addresses the role of multiple disciplines in improving the health of the population; thus, it does not use the nursing process or is specific for the nursing profession.

Which of the following best describes the steps in program management? a. Assess, plan, implement, evaluate b. Identify, initiate, implement c. Organize, operationalize, mobilize, subsidize d. Substantiate, negotiate, evaluate

a. Assess, plan, implement, evaluate The program management process is similar to the nursing process. Program management consists of assessing, planning, implementing, and evaluating a program. The other steps are not part of program management. The process of program management, like the nursing process, consists of a rational decision-making system to help nurses determine the complete process of program development, implementation, and evaluation.

A case manager is concerned about his exposure to possible lawsuits. Which of the following are appropriate actions to take to minimize this risk? (Select all that apply.) a. Assure clients they can appeal any decision. b. Carefully document client involvement and reasons for decisions. c. Share client information with the other involved providers and agencies. d. Confirm credentials and capabilities of providers or agencies to give care.

a. Assure clients they can appeal any decision. b. Carefully document client involvement and reasons for decisions. d. Confirm credentials and capabilities of providers or agencies to give care. Elements that reduce risk exposure include clear documentation of the extent of participation in decision making and reasons for decisions; records demonstrating accurate and complete information on interactions and outcomes; use of reasonable care in selecting referral sources—which may include confirming credentials and capabilities of providers and agencies; maintaining good communication with clients; and informing clients of their rights of appeal. In compliance with the Health Insurance Portability and Accountability Act (HIPAA), no nurse is allowed to share information with others without written consent of the client.

A nurse is planning a program to teach cardiac health at the senior citizens center. Which of the following is an effectively written objective for the program? a. By the end of the program each participant will report walking at least 30 minutes a day at least 5 days each week. b. By the end of the program each participant will voice a commitment to walk at least 30 minutes a day. c. By the end of the program each participant will understand the need for physical exercise. d. Each participant will voice a commitment to engage in physical exercise each day.

a. By the end of the program each participant will report walking at least 30 minutes a day at least 5 days each week. Useful program objectives must include a statement of the specific behaviors desired, using an action verb that can be seen and measured. Only "will report walking 30 minutes a day at least 5 days each week" has a specific outcome action that can be seen and measured. Voicing a commitment is not an outcome action; it is only a verbal agreement. The verb understand is not an action verb that can be seen and measured.

Which of the following best explains why every client doesn't receive care from a case manager? a. Case management time is demanding; thus it is restricted to complex cases. b. Many health agencies do not employ case managers. c. Most clients would not benefit from case management. d. Most nurses do not know how to function as case managers.

a. Case management time is demanding; thus it is restricted to complex cases. Case management can be labor intensive, time consuming, and costly. Because of the increasing number of clients with complex problems in nurses' caseloads, the intensity and duration of activities required to support the case management function may soon exceed the demands that the direct caregiver can meet. Health agencies continue to employ more case managers as the cost spent for the care saves the agency money in the long-term. Because case management is labor intensive and costly, it is unrealistic for all clients to have a case manager although additional clients could benefit from case management. Nurses fulfill the roles of advocate, care coordinator, and referral agent which are necessary to function as case managers.

A nurse is conducting program evaluation. Which of the following would be the first action the nurse would take? a. Choose the type of evaluation to be done b. Determine who will be involved in the evaluation c. Identify the goal and objectives for the evaluation d. Obtain answers to specific questions related to the program being evaluated

a. Choose the type of evaluation to be done To do a program evaluation, first choose the type of evaluation you wish to do. After the type of evaluation to be done has been chosen, the nurse will identify the goal and objectives for evaluation, decide who will be involved in the evaluation, and finally, answer the questions related to the type of evaluation.

A nursing committee is responsible for evaluating the process of health care agency in their quality assurance efforts. Which of the following techniques would most likely be used by the committee members? (Select all that apply.) a. Client satisfaction survey data b. Confirmation of credentials of all health care providers employed c. Patient discharge data over the past one year d. Peer review committee audit

a. Client satisfaction survey data d. Peer review committee audit The primary approaches used for process evaluation are the peer review committee and the client satisfaction survey. The techniques used for process evaluation are direct observation, questionnaire, interview, written audit, and videotape of client and provider encounters. Once data are collected to evaluate nursing process standards, the peer review committee reviews the data to identify strengths and weaknesses in the quality of care delivered. Confirming credentials and examine patient discharge data are not typically used for process evaluation.

Which of the following activities are addressed by most public health departments on the federal, state, and local levels? (Select all that apply.) a. Collecting and analyzing various health statistics b. Fining and terminating business at any facility that engages in unsafe commercial practices c. Identifying and planning for high-risk populations d. Planning for and responding to emergencies

a. Collecting and analyzing various health statistics c. Identifying and planning for high-risk populations d. Planning for and responding to emergencies The majority of local, state, and federal public health agencies engage in collecting and analyzing vital statistics, providing health education and information, receiving reports about and investigating and controlling communicable diseases, protecting the environment to reduce the risk to health, providing some health services to particular populations at risk, planning for and responding to natural and human-made disasters and emergencies, identifying public health problems for at-risk and high-risk populations, conducting community assessments to identify community assets and gaps, and partnering with other organizations to develop and implement responses to identified public health concerns. Public health departments do not regulate the practices of businesses; thus, they would not be responsible for fining or terminating businesses.

A child came to school coughing almost constantly. The next day, six other children in the same school room were coughing. Which of the following types of outbreak would the nurse suspect? a. Common source b. Mixed c. Propagated d. Intermittent

a. Common source A common source outbreak refers to a group exposed to a common noxious influence, in this case, the ill child who was attending school. A mixed outbreak is a common source outbreak followed by secondary exposures related to person-to-person contact. Intermittent source cases may be exposed over a period of days or weeks. A propagated outbreak does not have a common source and spreads gradually from person to person over more than one incubation period.

A nurse is employed by a state public health department. Which of the following functions would most likely be completed by this agency? (Select all that apply.) a. Delegating power to engage in certain activities such as quarantine b. Enforcing laws and regulations that protect public health c. Filing birth and death certificates whenever these occur within the state d. Monitoring health status of citizens within its geographic boundaries

a. Delegating power to engage in certain activities such as quarantine b. Enforcing laws and regulations that protect public health d. Monitoring health status of citizens within its geographic boundaries State public health agencies are responsible for monitoring health status and enforcing laws and regulations that protect and improve the public's health. These agencies receive funding from federal agencies for the implementation of public health interventions such as the maternal and child health programs. State agencies distribute federal and state funds to the local public health agencies to implement programs and provide oversight and consultation for local public health agencies. State health agencies also delegate some public health powers, such as the power to quarantine, to local health officers. Local departments file birth and death certificates and often ask for volunteers to assist.

Which of the following factors is causing nursing to change so quickly? a. Economic issues b. Increases in medical and nursing knowledge c. Legislative issues d. Technology changes

a. Economic issues More than any other single factor, the driving force behind nursing changes is the economy and the increase in managed care to decrease or control health care costs in the United States. Changes in technology and knowledge are not influencing the rapid change in nursing knowledge. Legislative issues are not influencing nursing practice.

An agency has not created a continuous quality improvement program. Which of the following actions should the agency take to help ensure quality care within the institution? a. Ensure appropriate policies and procedures are followed. b. Employ highly recommended and credentialed professionals to give care. c. Use administrative action to ensure that quality care is given to clients. d. Write quality care plans for the most typical problems of clients.

a. Ensure appropriate policies and procedures are followed. Quality assurance/quality improvement (QA/QI) programs remain the enforcers of standards of care for many agencies that have not elected to engage in a program of CQI. These activities are called assurance activities because they make certain that those policies and procedures are followed so that appropriate quality services are delivered. Without proper policies in place it may be difficult to ensure quality care is provided by the professionals employed by the agency. Administrative action is difficult without having policies in place to support such actions. Policies and procedures provide a broader scope of quality than a written care plan.

Which of the following are elements of the MAPP (Mobilizing for Action Through Planning and Partnership) Program Planning Model? (Select all that apply.) a. Generate shared visions and common values. b. Assess priorities in health problems. c. Develop a framework for long-range planning. d. Choose health priorities.

a. Generate shared visions and common values. c. Develop a framework for long-range planning. The elements of MAPP include mobilizing community members and organizations, generating shared visions and common values; developing a framework for long-range planning; conducting needs assessments in four areas: community strengths, local public health system, community health status, and focus of change; and implementing the plan. Assessing priorities in health problems and choosing health priorities are part of other program planning models.

A nurse has identified a need to increase the quality assurance efforts within the home care agency. Which of the following has most likely occurred? a. Increased number of client complaints and injuries b. Increased costs of providing care c. Reduced number of incident reports d. Reduced government reimbursement (Medicare and Medicaid)

a. Increased number of client complaints and injuries The types of problems that may lead to increased quality assurance efforts include client complaints, injury, or death, poor documentation of care, with subsequent denials of reimbursement by third-party payers, lack of or inefficient service, and concerns about client or staff safety. Several factors may influence increased costs of providing care, which may or may not lead to it being a priority of increased quality assurance efforts. An increase in incidence reports, not a decrease, would lead to increased quality assurance efforts. Reduced government reimbursement may lead the agency to consider multiple aspects of care, which may or may not relate a need for increased quality assurance efforts.

In which of the following ways does licensing differ from accreditation? (Select all that apply.) a. Licensing applies to the individual, whereas accreditation applies to a program. b. Licensing is required to practice, whereas accreditation is by choice. c. Licensing is required by state law, whereas accreditation is required by federal law. d. Licensing is required for all professions, whereas accreditation is only available for some.

a. Licensing applies to the individual, whereas accreditation applies to a program. b. Licensing is required to practice, whereas accreditation is by choice. Licensure controls entrance into a profession or occupation and is mandatory to practice. Accreditation is a voluntary or at least a quasi voluntary approach used by institutions or programs. Although there are cost differences between licensure and accreditation, individuals pay for licensure, whereas agencies pay for accreditation. Licensure is based on state law, whereas accreditation is dependent upon professional standards. Licensing relates to individual practice and professions, but accreditation relates too agencies and not individual professions.

In January, a nurse is listening to colleagues talk about the increase in depressed patients asking for help from their physicians recently. The incidence of complaints of depression was higher in the last month than in the previous 3 months. Based on this data, which of the following would be the next step for the nurse to take? a. No further action is necessary because depression is known to worsen during the shorter darker days of winter. b. No further action is necessary because this short-term increase may just be a statistical error or even just a mistaken impression by the involved nurses. c. Action should be taken because there must be some cause for this noted increase. d. Action should be taken because this increase may the beginning of an epidemic and should be investigated.

a. No further action is necessary because depression is known to worsen during the shorter darker days of winter. Typically, any unusual increase in incidence should be investigated. But in the majority of cases the increased incidence occurs naturally and/or is predictable when compared with the consistent patterns of previous outbreaks. Many illnesses are seasonal. Seasonal affective disorder (depression) often worsens during the shorter periods of daylight in the winter. The nurse should recognize that depression can be seasonal and not attribute this problem to an error in the data that has been collected. Because this is being recognized as a seasonal problem, there is no need for the nurse to take action. However, the nurse should continue to monitor the data to make sure that this trend does not continue as the weather begins to warm and more hours of daylight occur.

How does continuous quality improvement (CQI) differ from quality assurance? a. Quality assurance focuses on client care, whereas CQI focuses on system issues. b. Quality assurance focuses on system issues, whereas CQI focuses on individual client care. c. Quality assurance measures care at one point in time, whereas CQI is an ongoing issue. d. Quality assurance focuses on families, whereas CQI focuses on agency issues

a. Quality assurance focuses on client care, whereas CQI focuses on system issues. Total quality management and continuous quality improvement are concepts that give direction for managing a system of care, whereas quality assurance focuses on the care a client receives within the system. Total quality management and continuous quality improvement focuses on system issues, and quality assurance focuses on individual client care. Quality assurance measures care at multiple points of time. Quality assurance focuses on care of the client, not families, and CQI focuses on management of the system of care. em.

The staff was informed that a Quality Improvement Organization (QIO) would be making an unannounced visit in a few hours. Which of the following would the hospital nurse expect the QIO team to examine? a. Records of hospital admissions and scheduled procedures b. Nursing care plans of patients with unexpected problems (infections, falls) c. Discharge paperwork of patients discharged in the past 30 days d. Documentation of adherence to nursing standards of care

a. Records of hospital admissions and scheduled procedures QIOs are directed by the federal government to reduce hospital admissions for procedures that can be performed safely and effectively in an ambulatory surgical setting on an outpatient basis and to reduce inappropriate or unnecessary admissions or invasive procedures by specific practitioners or hospitals. Therefore, the QIO team would examine records to see whether the hospital admissions and all procedures performed were medically necessary. The QIO team would not evaluate nursing care plans, discharge paperwork, or adherence to nursing care standards as that is not the focus of this type of a team. Rather, their focus is on reducing hospital admissions.

A nurse noted that of 18 children in a daycare center room, 5 became ill. Which of the following best describes a host factor that may be associated with this illness and who became ill? a. Some of the children were from very low socioeconomic families. b. Some of the children inhaled car exhaust while playing outside. c. The bacterial cause of the illness was easily removed by hand washing. d. The daycare center room was much warmer on three sides in comparison to the side with the floor to ceiling windows.

a. Some of the children were from very low socioeconomic families. Factors that must be considered as causes of outbreak are categorized as agents, hosts, and environmental factors. Host factors may be age, sex, race, socioeconomic status, genetics, and lifestyle choices. The cause of the illness and exposure to pollutants are considered agent factors, and the difference in temperature in the room is an environmental factor.

The quality improvement team reviews the records of clients on a monthly basis to determine whether protocols for pain assessment were followed. Which of the following best describes the major drawback to the team's approach? a. The client is no longer under the agency's care. b. It is difficult to compare documentation of care to standards of care. c. Records can be inaccurate or incomplete. d. Team members may disagree on whether the standards of care were met.

a. The client is no longer under the agency's care. With this approach, problems are identified only after clients have been discharged. Although the hope is that better care will be given to future clients, nothing can be done about the clients who received less than optimal care. Using a retrospective audit, it is possible to compare documentation of care to appropriate standards which should be established prior to the review. Records should be complete as it is important for nurses to document the care that they are providing

Which of the following are the primary goals of case management? (Select all that apply.) a. To ensure that care coordination occurs across the continuum b. To emphasize evidence-based clinical decision making c. To manage resource use and control expenses d. To stress the advantages and benefits of community-based care

a. To ensure that care coordination occurs across the continuum b. To emphasize evidence-based clinical decision making c. To manage resource use and control expenses The goals in case management are to reduce institutional care while maintaining quality processes and satisfactory outcomes; manage resource use through protocols, evidence-based decision making, guideline use, and disease-management programs; and control expenses by managing care processes and outcomes. Case management involves more aspects of care than only care that occurs in the community. Thus, stressing the advantages and benefits of community-based care is not part of the primary goals of case management.

Which of the following public health nurse applicants is the least qualified for a position of case manager in a rural county? a. A 24-year-old who has a master's degree in public health b. A 34-year-old who will be moving from a large city c. A 44-year-old who was born and raised in the community d. A 54-year-old who, until recently, was a member of the community's school board

b. A 34-year-old who will be moving from a large city Case management competency requires the following knowledge and skills: knowledge of community resources and financing methods; written and oral communication and documentation skills; negotiation and conflict-resolution skills; critical-thinking processes to identify and prioritize problems from the provider and client views; and identification of best resources for the desired outcomes. Because communities are unique, someone new to the area will lack knowledge of community resources and financing methods. There is nothing in the descriptions of the other public health nurses that indicates a lack of current knowledge or skills.

A home-care nurse is encouraging the administration of the agency to increase their quality assurance efforts. Which of the following best describes a negative outcome from this activity? a. An agency deficiency may become visible. b. An individual may be found at fault and then become fearful of being involved. c. Some agency processes may be questioned. d. Employees at the agency will have to commit extra time to complete this process.

b. An individual may be found at fault and then become fearful of being involved. Quality assurance (QA) focuses on the care a client receives within the system and is concerned with the accountability of the provider. A major problem with quality assurance efforts, done by the quality assurance team, is that individuals may be found to be at fault and hence may be fearful of reporting problems or errors. Total quality management/continuous quality improvement are concepts that give direction for managing a system of care, whereas quality assurance focuses on the care a client receives within the system. Continuous quality improvement focuses on processes and possible deficiencies of the organization as a whole so that everyone is involved.

A nurse is considering applying for a public health nurse position at a local health department. Which of the following minimum levels of educational preparation should the nurse have obtained? a. Associate degree in nursing b. Baccalaureate degree in nursing c. Master of science degree in nursing d. Training as a licensed practical nurse

b. Baccalaureate degree in nursing Educational preparation of nurses in community health should be at least a baccalaureate degree. Nurses need this level of education because of the increasing complexity of better care delivery in public health. A licensed practice nurse would need supervision for a registered nurse and would not be able to practice autonomously in this setting. Those registered nurses who have associate degrees are encouraged to seek further degrees because of the increasing complexity of better care delivery in public health. A master's degree would be even more useful, but for many, advanced education may not be feasible.

Which of the following best describes why planning care for an individual is so challenging in today's health care system? a. Because today's clients have high expectations of the health care system b. Because multiple providers, payers, and settings have to be coordinated c. Because of the new high technology constantly being created and used for client treatment d. Because so many different health care providers are in the acute care setting today

b. Because multiple providers, payers, and settings have to be coordinated Case management practice is complex because of the coordinating activities of multiple providers, payers, and settings throughout a client's continuum of care. The complexities of the system, not the high expectations of the population, new technology, or different providers, is why planning care is so challenging. Coordination of all of these aspects of care, not just one of them, is what makes planning so difficult.

A nurse attends a conference to learn more about public health surveillance. Why is it so important that the nurse be knowledgeable about this topic? a. Because nurses are employed in public health agencies b. Because nurses are often the first to recognize and respond to a problem c. Because nurses are responsible for ensuring that action is taken when necessary d. Because nurses are typically the ones to interact with the public and the media

b. Because nurses are often the first to recognize and respond to a problem Nurses are often in the forefront of responses to be made in the surveillance process whether working in a small rural agency or a large urban agency; within the health department, school, or urgent care center; or on the telephone performing triage services during a disaster. It is the nurse who sees the event first. Nurses may work in a variety of community agencies, including public health agencies. Nurses will collaborate with others to take action as necessary; it would not be the sole responsibility of the nurse. A wide variety of public health professionals interact with the public and the media, not only nurses.

A home health care agency has major problems but does not want consumers to know about these problems while the agency decides what should be done to improve them. Employees are not told to lie, but they are advised not to share information. Which of the following is the most likely outcome of this situation? a. As long as employees do not share what they know, the community will be uninformed. b. By law, comparative information will be available to the public via the Internet. c. Only a few informed persons will know about the problems. d. Secrecy will prevail unless the local newspaper does an investigative report.

b. By law, comparative information will be available to the public via the Internet. In 2003 the Home Health Care Quality Initiative (HHQI) was developed by the USDHHS to provide consumers with data on the quality of home health services. Home Health Compare, posted on the Medicare website, is a home health report card available to consumers nationwide. Because the information is available to the public via the internet, the community will be able to view this data at their will.

A nurse is using a case management plan to maximize patient care outcomes. Which of the following describes an important consideration that should be made by the nurse? a. Case management plans should be used only by nurses to manage care. b. Case management plans should be individualized for each client. c. Case managements plans provide additional expense to the client and family. d. Case management plans focus on the natural progression of the disease.

b. Case management plans should be individualized for each client. Adaptation of the case management care plan to each client's characteristics is a crucial skill for standardizing the process and outcome of care. It links multiple provider interventions to client responses and offers reasonable predictions to clients about health outcomes. Institutions report that sharing case management plans with clients empowers the clients to assume responsibility for monitoring and adhering to the plan of care. Case management plans should link the care that is provided together and involve multiple providers. Case management is part of the standard of care that is provided and does not provide an additional expense to the client, although it may cause an additional expense to the agency. Disease management, not case management, focuses on the natural progression of the disease

A community is examining which programs are needed within the community, the populations they will target, and how they will be funded. Which of the following would be the least risky decision for the community to make? a. Choose whichever option is the least expensive of agency resources. b. Choose to do nothing. c. Choose whatever the agency administration prefers. d. Choose whatever the majority of clients prefer.

b. Choose to do nothing. A "do nothing" decision is always the decision with the least risk to the provider. The need and demand for a program are determined by working with the client. This stage of planning creates options for solving the problem and considers several solutions. Each option for program solution is examined for its uncertainties (risks) and consequences.

The case manager explains to two disagreeing parties that coming to an agreement will save personnel costs for both of them. Which of the following terms best describes this action? a. Assertiveness b. Collaboration c. Cooperation d. Compromising

b. Collaboration In collaborating, an individual attempts to work with others toward solutions that satisfy the needs of both parties. Assertiveness is the ability to present one's own needs. Cooperation is the ability to understand and meet the needs of others. When compromising, an individual attempts to find a mutually acceptable solution that partially satisfies both parties.

A nurse reviews with the client what the client can expect during the next 3 days, as well as how the client should expect to feel each of those days. The client laughs and says, "You've got my care all mapped out." Which of the following tools is the nurse using to determine what will happen when? a. Care planning b. Critical pathway c. Demand management d. Use management

b. Critical pathway Critical paths are tools that name activities to be used in a timely sequence to achieve desired outcomes for care with measurable outcomes. Care planning involves developing a plan of care for an individual. Use management attempts to redirect care and monitors the appropriate use of provider care and treatment services. Demand management seeks to control use by providing clients with correct information to empower themselves to make healthy choices, to use healthy and health-seeking behaviors to improve their health status, and to make fewer demands on the health care system.

A nurse is using the problem identification phase of the case management process. To which of the following phases of the nursing process does this correspond? a. Assessment phase b. Diagnosis phase c. Planning phase d. Implementation phase

b. Diagnosis phase The diagnosis phase of the nursing process is analogous to the identification of the problem in the case management process. It is during this phase that the case manager determines conclusions based on the assessment. During the assessment phase, the nurse develops networks with the target population and disseminates written materials. In the planning phase, the nurse validates and prioritizes problems with all participants. When working through the implementation phase, the nurse contacts providers and negotiates contracts and services.

A public health department becomes aware of an impending health problem before any problem is reported to the agency. Which of the following has most likely occurred within the community? (Select all that apply.) a. Doctors are feeling rushed as they interact with each patient. b. Emergency departments are notably busier than usual. c. Nurses are calling in ill to the local hospital. d. Pharmacists are discussing the increase in medication purchases.

b. Emergency departments are notably busier than usual. d. Pharmacists are discussing the increase in medication purchases. Syndromic surveillance systems were developed to monitor illness syndromes or events, as seen in such indirect measures as increased numbers of medication purchases, trips to physicians or emergency departments, orders for cultures or x-rays, and rising levels of school or work absenteeism. These may indicate that an epidemic is developing. Doctors feeling rushed and nurses calling in ill are not unusual events.

Which of the following is the underlying science or area of study on which public health is based? a. Biostatistics b. Epidemiology c. Medicine d. Social sciences

b. Epidemiology It works across many disciplines and is based on the scientific core of epidemiology. Public health uses biostatistics in its practice. It is not a branch of medicine; it is an organized community approach designed to prevent disease, promote health, and protect populations. Public health is not based on the social sciences, which is the study of society and relationships

Which of the following best describes one of the main problems in ensuring quality for health care in the United States? a. Consumers believe American health care is high-quality and the best in the world. b. Every hospital and health care agency has its own approach to data collection and documentation. c. Finances are the basis of clinical decisions, not quality of care. d. We all agree on what quality is but not on how best to measure it.

b. Every hospital and health care agency has its own approach to data collection and documentation. Very little is known about quality of care in this country because a variety of definitions of quality are used and it is difficult to get comparable data from health care providers and agencies. All consumers, including private citizens, insurance companies, industry, and the federal government, are concerned about achieving the highest quality outcomes at the lowest possible cost. Consumers want more information about quality. Both consumers and providers have a vested interest in improving the quality of the health care system.

A nurse is working at a local health department. Which of the following would most likely be completed by this agency? a. Enforcement of laws and regulations related to public health nationwide b. Filing of a certificate for any birth or death in a community c. Providing experts in various specialties to answer questions and respond as needed d. Surveying the state's public health needs

b. Filing of a certificate for any birth or death in a community Local public health agencies provide and disseminate health information, provide leadership in health planning, provide essential public health and environmental services, analyze statistics on births to monitor community health status, and file a certificate for every birth or death in the community. Enforcement of laws and regulations related to public health nationwide, providing experts in various specialties, and surveying the state's public health needs would all occur at the state level.

A committee of health care professionals would like to establish a countywide program to improve Hispanic immigrant access to culturally competent health care services. Which of the following persons would be most helpful as a key informant? a. Hospital administrator b. Hispanic community leader c. National expert on cultural competency d. Politician or county official

b. Hispanic community leader Key informants are leaders in the community who are knowledgeable about community needs. In this scenario, the Hispanic leader most likely knows more about the needs of the Hispanic community than the others listed. The hospital administrator, national expert on cultural competency, and politician are most likely not as knowledgeable about this immigrant population as the Hispanic community leader.

Evaluation is under way for a statewide program to decrease teen injury and death associated with teens who drive while under the influence of alcohol. Which of the following questions would best be used for the summative evaluation of the program? a. Are program participants continuing to attend the programs, and do their satisfaction scores indicate that they are pleased with the program? b. How do statistics for injuries and deaths associated with drunk driving compare for teens in the year following the program? c. How does the amount of alcohol intake by teens compare before and after participants enter into the program? d. What problems are identified as the program is implemented?

b. How do statistics for injuries and deaths associated with drunk driving compare for teens in the year following the program? Summative evaluation is evaluation to assess program outcomes or as a follow-up of the results of the program activities. The goal is addressed in the question about statistics. Two of the options are examples of questions used for formative evaluation (satisfaction and problems with program implementation). The goal was not to decrease drinking of alcohol but to decrease driving when drinking alcohol.

Which would be an appropriate descriptor that meets all criteria for defining a client to be served by a program? a. All women ages 40 to 50 who have not had a menstrual period for 3 consecutive months b. Immigrants residing in Central County for less than 5 years who have difficulty understanding care instructions because of limited English proficiency c. Pregnant women who have received nutritional counseling but whose nutritional status did not improve d. Children ages 18 months to 5 years old who have been treated for nutritional deficiencies at the Central County Clinic

b. Immigrants residing in Central County for less than 5 years who have difficulty understanding care instructions The client should be defined by biological and psychosocial characteristics, by geographic location, and by the problems to be addressed. For example, in a community with a large number of preschool children who require immunizations to enter school, the client population may be described as all children between 4 and 6 years of age residing in Central County who have not had up-to-date immunizations. This example tells the reader who the client is, what the need is, how large the population is, and where they are located. In order to meet all criteria for defining a client that is to be served by the program, information about the biological and psychosocial characteristics, geographical location, and the problems addressed needs to be included. The incorrect responses do not contain all of this necessary information.

A nurse is invited to join the utilization review team to help the agency avoid giving unnecessary care. Which of the following difficulties would the nurse most likely confront as client records are reviewed? a. Alternative care options rather than agency care are often encouraged. b. Not all clients fit the pattern and need more care than guidelines suggest. c. The nurse suggests the agency provide guidelines to professionals giving care. d. The agency is now accountable to its clients and their families.

b. Not all clients fit the pattern and need more care than guidelines suggest. The major disadvantage of utilization review is that not all clients fit the classic picture presented by the criteria used to determine approval or denial of care. Alternative care options are many times not considered as it is assumed that clients fit the criteria that has been established. Utilization review does not provide agency guidelines as to how to provide care. Utilization review focuses on avoiding providing unnecessary care not on accountability to clients and families.

Which of the components of the PDCA model and Donabedian's framework is the most crucial? a. Standard b. Outcome c. Process d. Structure

b. Outcome The PDCA model and Donabedian's framework for evaluating health care programs, using the components of structure, process, and outcome, are useful in developing a quality assurance program. Outcome is the most important ingredient of a program, because it is the key to evaluation of providers and agencies by accrediting bodies, insurance companies, and Medicare and Medicaid through PROs, report cards, and other accrediting agencies. Standard, structure, and process are important parts of the PDCA model, but are not as important as the outcomes

A nurse is implementing a primary prevention activity to decrease the incidence of communicable disease. Which of the following actions is the nurse most likely taking? a. Identifying and treating clients in a sexually transmitted disease clinic b. Partnering with schoolteachers to teach and observe hand washing techniques in elementary school children c. Providing case management services that link clients with communicable diseases to health care and community support services d. Performing directly observed therapy (DOT) for clients with active tuberculosis

b. Partnering with schoolteachers to teach and observe hand washing techniques in elementary school children An example of primary prevention is to educate daycare centers, schools, and the general community about the importance of hand hygiene to prevent transmission of communicable diseases. The goal of primary prevention is to prevent the disease from occurring. Identifying and treating clients is part of secondary prevention, as screening is being completed to determine at the earliest stage possible who has the disease. Providing case management services for those with communicable disease and performing DOT therapy with clients are both examples of tertiary prevention as the populations that the nurse is working with both already have the disease. Through tertiary prevention, the nurse is working to restore their health to the highest level possible.

Which of the following types of surveillance systems is being used when case reports are routinely sent to local health departments by health care providers and laboratories, where the data are then summarized and forwarded to those responsible for monitoring such reports? a. Active b. Passive c. Sentinel d. Special

b. Passive In the passive surveillance system, case reports are sent to local health departments by health care providers or laboratories. The case reports are summarized and forwarded to the state health department, national government, or organizations responsible for monitoring the problem, such as the CDC. In active surveillance, the health department nurse may begin a search for cases through contacts to determine the magnitude of the problem. Sentinel surveillance involves looking for trends. Special surveillance is developed when a particular type of data is sought.

Stakeholders developing a new community-oriented clinic plan want to include a quality assurance (QA) program. Which of the following would be the first step in measuring the structure component? a. Criteria that will be used to measure quality b. Philosophy and objectives of the organization c. Requirements of accrediting agencies d. Standards the QA program wishes to achieve

b. Philosophy and objectives of the organization The philosophy and objectives of an agency define the structural standards of the agency. Identification of standards and criteria for quality assurance begins with writing the philosophy and objectives of the organization. Criteria to measure quality including requirements of accreditors and standards of the QA program are not part of the structural standards of a quality assurance program.

Which of the following programs demonstrates the use of tertiary prevention? a. Developing an in-school clinic that provides birth control counseling and contraception b. Providing a diabetes management program for persons with diabetes mellitus c. Providing cardiovascular fitness evaluations at annual health fairs d. Setting up free blood pressure screenings at popular department stores and supermarkets

b. Providing a diabetes management program for persons with diabetes mellitus The aim of tertiary prevention programs is to reduce complications from disease. Persons with diabetes mellitus already have the disease thus meaning that tertiary prevention would be implemented with this population. Developing an in-school clinic is a primary prevention (pregnancy has not occurred). Fitness evaluations at health fairs and blood pressure screenings are secondary prevention programs (screening identifies conditions early and determines incidence/prevalence).

What did events after September 11, 2001, clearly demonstrate? (Select all that apply.) a. A strong public health structure ready to respond effectively to a crisis b. Public health's need for additional funding and resources c. The unrecognized importance of nurses in lowering health care costs d. Lack of adequate vaccines to meet community's needs

b. Public health's need for additional funding and resources c. The unrecognized importance of nurses in lowering health care costs d. Lack of adequate vaccines to meet community's needs The anthrax exposures after 9/11 alerted policymakers to the weakening public health infrastructure required to respond to bioterrorism events. Unprecedented influenza, tetanus, and childhood vaccine shortages and emerging infections competed with bioterrorism activities for resources. The general public was not informed about how immunizations by nurses improved health and lowered health care cost. For public health services to receive adequate funding, it is necessary for the public and the government to be aware of the benefits provided to a community by nurses. These events showed that the public health system needed to be strengthened in order to operate effectively to keep the public safe.

A public health nurse traces sexual contacts of clients with sexually transmitted diseases for screening and treatment. Which of the following levels of prevention is being implemented? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Secondary and tertiary prevention

b. Secondary prevention Tracing individuals exposed to a client with a sexually transmitted disease is secondary prevention because the nurse is attempting to find those exposed and screen them. Once the exposed persons have been located, screening is another secondary prevention activity. Through tertiary prevention, the nurse is working to restore their health to the highest level possible. If the nurse were to provide care to the clients with sexually transmitted diseases this would be an example of tertiary prevention. The goal of primary prevention is to prevent the disease from occurring. Thus, when providing primary prevention the nurse could provide free condoms for sexually active persons or provide education about ways to prevent the transmission of these diseases.

Several children were hospitalized for severe vomiting and diarrhea. Which of the following best explains why the nurse would continue to pursue the cause of the illness even after the children have been discharged from the hospital? a. So that the children's families know the public health department cared about them b. So that action could be taken to avoid any such future episodes c. Because the children's parents need to know whom to sue for their medical expenses d. To confirm that the symptoms were due to an infectious disease

b. So that action could be taken to avoid any such future episodes The objectives of an investigation are to control and prevent disease or death by identifying factors that contribute to the occurrence and implementing measures to prevent occurrences. In this case the nurse wanted to make sure children did not become ill again when it could be avoided. The further investigation of the illness is not to demonstrate caring on the part of the public health department, rather it assists with learning about what factors contributed to the occurrence. It is unlikely that the parents would sue for a hospitalization for severe vomiting and diarrhea. Also, there is no indication that there would be an individual or agency to sue for the symptoms that the child is experiencing. There is no indication as to what caused these symptoms, thus, the nurse would need to do further investigation to determine if they were related to infectious disease or some other contributing factor.

Which of the following led to the development of the National Health Quality Improvement Act? a. A very famous movie and television star died as the result of a medical error. b. The number of malpractice claims had increased. c. Media such as films highlighted the reality of current medical care. d. Publicity about a few unfortunate cases caused consumers to become concerned.

b. The number of malpractice claims had increased. In response to a growing number of malpractice claims in the United States, the National Health Quality Improvement Act of 1986 was established, which encouraged consumers to become informed about their practitioner's practice record and created a national clearinghouse of information on provider malpractice records. The media did not play a role in the creation of the National Health Quality Improvement Act.

Which of the following describes the purpose of surveillance systems today? (Select all that apply.) a. To obtain data used to fight for increased budgets from taxpayers b. To evaluate the effectiveness of public health programs c. To monitor and reduce the incidence of chronic diseases d. To note and help prevent occupational exposure and diseases

b. To evaluate the effectiveness of public health programs c. To monitor and reduce the incidence of chronic diseases d. To note and help prevent occupational exposure and diseases Although surveillance was initially devoted to monitoring and reducing the spread of infectious diseases, it is now used to monitor and reduce chronic diseases and injuries, as well as environmental and occupational exposures. With tight budgets, public health workers must know which programs should be developed and continued based on the most commonly occurring public health problems. Evaluation of the effectiveness of programs requires valid and reliable data. With limited budgets, surveillance systems are important. The taxpayer money should be used in the most effective and efficient ways possible. This involves monitoring the effectiveness of health programming, not asking for increased budgets from taxpayers.

Which of the following best describes the purpose of strategic planning? a. To anticipate client needs now and in the future b. To match client needs, provider strengths, and agency resources c. To maximize effective use of agency resources d. To utilize provider strengths and competencies

b. To match client needs, provider strengths, and agency resources Strategic planning involves the successful matching of client needs, with specific provider strengths and competencies and agency resources. Everyone involved can anticipate what will be needed to implement the program, what will occur during implementation, and what the outcomes will be. Strategic planning addresses the client, agency, and provider. The other responses address only one of these factors not all three of them which all need to be considered during the strategic planning process.

A client spends a great deal of his time on the Internet or reading articles related to diabetes and its long-term effects. One day the client asks why the nurse has not suggested a life care plan. Which of the following would be the best response by the nurse? a. "Life care plans are only for young persons who are newly diagnosed." b. "Life care plans are primarily used to determine long-term financial needs for legal reasons." c. "You are receiving appropriate care for your diabetes without serious side effects, so a life care plan isn't really appropriate." d. "I was waiting for you to express interest in having a life care plan."

c. "You are receiving appropriate care for your diabetes without serious side effects, so a life care plan isn't really appropriate." Life care plans are typically used for clients experiencing catastrophic illness or adverse events resulting from professional malpractice. Others who benefit from life care planning are those who have sustained injury when younger and whose care requirements have changed as a result of aging. Life care plans are typically used for clients experiencing catastrophic illness or adverse events resulting from professional malpractice, not young persons with a newly diagnosed illness. The life care plan is a customized, medically-based document that provides assessment of all present and future needs (i.e., medical, financial, psychological, vocational, spiritual, physical, and social), including services, equipment, supplies, and living arrangements for a client. These plans may be used by either a plaintiff or defense lawyer to analyze damages. They are also used to set financial rewards, which can be used to pay for care in the future and create a lifetime care plan.

Which of the following Medicaid clients would most likely receive case management? a. An elderly person b. A person receiving rehabilitation following an injury c. A person who has a high-cost chronic disease d. A person with acute illness

c. A person who has a high-cost chronic disease Some states, through their Medicaid programs, are developing disease-management programs for high-cost chronic diseases among their populations, such as asthma and diabetes. An elderly person is most likely receiving Medicare services, not Medicaid services. Additionally, there is not any information that states that the elderly person has a high-cost chronic disease. A person who is receiving rehabilitation following an injury or who has an acute illness does not have a diagnosis that warrants case management, as case management is reserved for those with high-cost chronic diseases.

A nurse is implementing tertiary prevention strategies as part of the quality management process. Which of the following best describes a strategy the nurse would have used? a. All new employees complete a program on fire safety that details what to do in the event of a fire. b. At the yearly employee picnic, teams compete in putting out trash can fires and in racing while carrying mock victims, using safe evacuation techniques. c. After evaluation of response to an actual fire, new procedures implemented in the fire response protocol are distributed to employees. d. Mock fire drills are carried out twice a year to assess response and readiness in the event of a real fire.

c. After evaluation of response to an actual fire, new procedures implemented in the fire response protocol are distributed to employees. Tertiary prevention involves activities that are carried out when evaluation indicates needed improvement. Thus, examining a response to an actual fire (it has already occurred) is an example of tertiary prevention. A program on fire safety is an example of primary prevention. The employee picnic activity and mock fire drills provide for evaluation of competency (screening) and are thus secondary prevention.

A nurse is completing a case management advocacy activity which corresponds to the implementation phase of the nursing process. Which of the following activities would the nurse most likely use? a. Asking the client what is most important b. Seeking appropriate referrals for the client c. Assuring the client that his wishes will be supported d. Determining the order in which actions will occur

c. Assuring the client that his wishes will be supported Assuring the client is a component of the advocacy process that corresponds to the implementation phase. Asking the client what is most important is a way to illuminate values, which occurs in the assessment phase. Seeking appropriate referrals for the client occurs in the assessment phase. Determining the order in which actions will occur is a prioritization of action, which occurs in the planning phase.

Which of the following federal agencies is most influential in public health activities? a. The Agency for Healthcare, Research, and Quality b. Centers for Disease Control and Prevention c. Department of Health and Human Services d. Food and Drug Administration

c. Department of Health and Human Services The U.S. Department of Health and Human Services (USDHHS) and the Environmental Protection Agency (EPA) are the federal agencies that most influence public health activities at the state and local levels. The Agency for Healthcare, Research, and Quality, the Centers for Disease Control and Prevention, and the Food and Drug Administration are all pieces of the broader USDHHS.

The outpatient health care data show a notable increase in asthma over the numbers treated the previous year. Which of the following actions should the public health nurse take first? (Select all that apply.) a. Analyze educational health programs offered to the public last year. b. Congratulate the public health staff on the success of their asthma awareness program. c. Determine whether there are any other data sources that might confirm or dispute the apparent increase in asthma. d. Review data with the outpatient clinic staff such as confirming repeat visits versus newly diagnosed cases.

c. Determine whether there are any other data sources that might confirm or dispute the apparent increase in asthma. d. Review data with the outpatient clinic staff such as confirming repeat visits versus newly diagnosed cases. Before drawing any conclusions, further data should be sought, including confirmation of the current data and their meaning. Data can be inaccurate or collected differently than in the past. What might have led to an increase? Are there other valid sources that might have relevant data? Should surveillance specific to asthma be established? Confirming the data by comparing it to other sources would be the priority. After this has been completed, the next steps would be for the nurse to look at the health programming and community awareness education that has taken place. It would be premature to look at the programming if the initial data obtained is not accurate.

A case manager implements a primary prevention activity. Which of the following actions would the nurse most likely complete? a. Advocating for the client whose values conflict with those of the medical service provider b. Collaborating between nursing and occupational health personnel c. Educating a group regarding community services that are available if ever needed d. Resolving conflict between a primary-care clinic and a tertiary health care facility

c. Educating a group regarding community services that are available if ever needed Primary prevention involves the use of the information exchange process to increase the client's understanding of how to use the health care system. Primary prevention occurs at a point before illness or problem exists. In the remaining options, the client has a problem for which interventions have been employed.

Which of the following best describes the ultimate goal of program planning? a. Avoid unanticipated conflicts in the program development phase. b. Provide adequate funding to meet the program's resource requirements. c. Ensure that health care services are acceptable, equal, effective, and efficient. d. Prevent unnecessary duplication of services.

c. Ensure that health care services are acceptable, equal, effective, and efficient. The comprehensive goal of program planning is to ensure that health care services are acceptable, equal, efficient, and effective. The other options are aspects of program planning, but they address only limited concerns.

A nurse checks health department records to compare the number of new teen clients presenting for birth control counseling and management in the 2 months before and after an education intervention program to decrease teen pregnancy. Which of the following steps of the evaluation process is being completed by the nurse? a. Engage stakeholders b. Justify conclusions c. Gather credible evidence d. Focus on the evaluation design

c. Gather credible evidence When the nurse gathers credible evidence, the following information is collected: indicators that will be used, sources of data, quality of the data, quantity of information to be gathered, and the logistics of the data gathering phase. Data gathered should provide credible evidence and should convey a well-rounded view of the program. Engaging stakeholders includes those who are involved in planning, funding, and implementing the program; those who are affected by the program; and the intended users of its services. When the nurse justifies conclusions, the conclusions of the evaluation should be validated by linking them to the evidence gathered and then appraising them against the values or standards set by the stakeholders. When focusing on the evaluation design, the nurse will describe the purpose for the evaluation, the users who will receive the report, how it will be used, the questions and methods to be used, and any necessary agreements.

A nurse is completing a summative evaluation of a program designed to decrease obesity inschool-age children. Which of the following is the most important question for the nurse toask? a. Are school-age children satisfied with the program? b. Can parents and guardians support the program requirements? c. Has obesity in school-age children decreased? d. What is the program cost compared with the program benefit?

c. Has obesity in school-age children decreased? Summative evaluation looks at the end result of the program. The major benefit of program evaluation is that it shows whether the program is meeting its purpose. It should answer the following questions: Are the needs for which the program was designed being met? Are the problems it was designed to solve being solved? If the program does not achieve the purpose for which it is designed, important concerns of satisfaction and cost are irrelevant. So if the program purpose is to decrease obesity, the outcome of importance is a decrease in obesity. Formative evaluation serves the purpose of assessing if objectives are met or if planned activities are completed. This type of evaluation begins with an assessment of the need for a program and is ongoing as the program is implemented. The considerations of satisfaction, support, and cost are all issues that could be addressed in planning and ongoing assessment of the program.

Which of the following is accomplished through the use of traditional quality assurance? a. Implementation of new techniques to improve outcomes b. Implementation of appropriate interventions for diagnosed problems c. Implementation of change when measured performance does not meet standards d. Implementation of research findings to ensure appropriate clinical treatment

c. Implementation of change when measured performance does not meet standards Traditional approaches to quality assurance are to focus on assessing or measuring performance, to ensure that performance conforms to standards, and to take action to bring about change when care does not meet standards. CQI involves comprehensive data analysis to detect process failures. Thus, implementation of new techniques, interventions, and research findings would require ongoing evaluation of data which is accomplished through CQI not QA.

Which of the following best describes case management? a. A tool of health maintenance organizations b. Targeted toward a specific segment of the population c. Implemented with individual clients d. Used to monitor the health status, resources, and outcomes for an aggregate

c. Implemented with individual clients Case management, in contrast to the definition of care management, involves activities implemented with individual clients in the system. Managed care is a tool of health maintenance organizations. Care management is an enduring process in which a population manager establishes systems and monitors the health status, resources, and outcomes for an aggregate—a targeted segment of the population or a group.

Which of the following information can be gathered by reviewing a community health report card? a. Utilization of health care services in the community b. Demographic information of the community c. Leading causes of morbidity in a community d. Frequency of malpractice claims within a community

c. Leading causes of morbidity in a community The term community health report card refers to different types of reports, community health profiles, needs assessments, scorecards, quality of life indicators, health status reports, and progress reports. Community health report cards can be a useful tool in efforts to help identify areas where change is needed, to set priorities for action, and to track changes in population health over time. The report card may be used to track leading causes of morbidity and mortality in a community, looking at trends over time to see if public health interventions have improved health care outcomes. Utilization of health care services, demographic information, and frequency of malpractice claims in the community is information that is not found on a community health report card

Which of the following agencies are responsible for implementing and enforcing local, state, and federal public health codes and ordinances and providing essential public health programs to a community? a. Community health clinics b. Federal health agencies c. Local health agencies d. State health agencies

c. Local health agencies Local public health agencies are the agencies responsible for implementing and enforcing local, state, and federal public health codes and ordinances and providing essential public health programs to a community. State public heatlh ageencies are reponsible for monitoring health status and enforcing laws and regulations that protect and improve the public's health; they do not provide essential public health programs to the community. Federal health agencies develop regulations that implement policies formulated by Congress. Community health clinics may provide essential public health programs to the community, but are not responsible for implementing and enforcing local, state, and federal public health codes and ordinances.

The nurse suggests use of telehealth to assess how a client is progressing. Which of the following resources must be available for continuing care to be implemented? a. A physician who is willing to use wireless prescriptions and plans of care b. Family permission for the nurse to make home visits c. Long-distance telephone service or a computer with Internet access d. Willingness of the caregiver to drive the client to the nearest clinic

c. Long-distance telephone service or a computer with Internet access Telehealth is an organized health care delivery approach to triage and to provide advice, counseling, and referral for a client's health problem using phones or computers with cameras. The client is usually in the home, and the nurse is at an office, health care facility, or phonebank location. Wireless prescriptions and plans of care are not necessary for a client who is receiving telehealth services. Home visits may not be necessary for a telehealth client. Through the use of telehealth, the need to visit clinics is decreased

Which of the following best explains why evaluation of client outcomes resulting from nursing intervention is so difficult? a. Client records may not include appropriate data. b. Few tools exist to measure client outcomes. c. Many other factors can also affect client outcomes. d. Measuring client outcomes is extremely time consuming.

c. Many other factors can also affect client outcomes. The major problem with outcome evaluation is determining which nursing care activities are primarily responsible for causing changes in client status. In nursing, many uncontrolled factors in the field, such as environment and family relationships, have an effect on client status. Appropriate data should be included in all documentation that is recorded by the nurse. Multiple tools exist to measure client outcomes. With appropriate processes in place, it is not time consuming to measure client outcomes.

Which of the following best describes how public health nurses (PHNs) differed from other health care professions in the early twentieth century? a. PHNs contributed without receiving any salary for doing so. b. PHNs created new settings where health care could be given. c. PHNs gave care to powerless groups. d. PHNs worked outside any organized health care system.

c. PHNs gave care to powerless groups. During this period, public health nurses worked with populations and in settings that were not of interest to other health care disciplines or groups. Much public health service was delivered to the poor and to women and children, who did not have political power or voice. Public health nurses were employed by agencies and received pay for the work that they did. In the early twentieth century, new settings where health care could be delivered were not developed. Public health nurses worked with a variety of partners to begin to include reproductive health, chronic disease prevention, and injury prevention activities.

Based on projected increases in the number of older US citizens, a planning committee wants to establish a day care program for the community's older adult population. During which stage is the need for this program being assessed? a. Inactive stage b. Interactive stage c. Preactive stage d. Reactive stage

c. Preactive stage The preactive stage is one in which assessment is based on the projection of a future need. The stages that are not being described are: reactive — defining the problem based on past needs identified by the client or the agency; inactive — defining the problem based on the existing health status of the population to be served; and interactive — describing the problem using past and present data to project future population needs.

A community mental health nurse is implementing a tertiary prevention activity. Which of the following interventions is most likely being completed? a. Disseminating information about mental health to community organizations b. Partnering with school health nurses for early identification of children who have evidence of mental health problems c. Providing case management services that link clients with serious mental illnesses to mental health and community support services d. Screening high-risk clients for the presence of mental disorders

c. Providing case management services that link clients with serious mental illnesses to mental health and community support services An example of tertiary prevention is the provision of case management services that link clients identified with serious mental illnesses to mental health and community support services. Tertiary prevention aims to restore those with the disease to the highest level of functioning possible. Disseminating information about mental health is an example of primary prevention as the nurse is aiming to prevent a problem before it occurs. Partnering for early identification of children and screening high-risk clients are examples of secondary prevention. Secondary prevention occurs when the nurse conducts screenings and tries to identify diseases at the earliest possible stage.

The quality improvement team reviews the records of clients on a monthly basis to determine whether protocols for pain assessment were followed. Which of the following best describes this activity? a. Accreditation review b. Concurrent audit c. Retrospective audit d. Utilization review

c. Retrospective audit The retrospective audit, or outcome audit, evaluates quality of care through appraisal of the nursing process after the client's discharge from the health care system. Accreditation is often linked to governmental regulations that encourage programs to participate in the accrediting process to be reimbursed for services. A concurrent audit is a process audit that evaluates the quality of ongoing care by examining the nursing process. Utilization review is used to ensure that care is needed and that the cost is appropriate.

In which of the following situations would the nurse most likely use an active surveillance system? a. A newspaper wants to know the incidence of asthma in the community. b. A real-time ongoing communication channel is established to monitor a particular symptom. c. Several children become ill with gastrointestinal (GI) upset at one local school. d. The nurse is asked to report the incidence of a specific non-reportable common problem in the community

c. Several children become ill with gastrointestinal (GI) upset at one local school. In active surveillance, the nurse may begin a search for cases to determine the magnitude of the problem (how widespread it is). An example would be when several school children become ill after eating lunch in the cafeteria or at the local hot dog stand, in which case, active surveillance would be used to investigate the possibility of food poisoning. In the passive surveillance system, case reports are sent to local health departments by health care providers or laboratories. The case reports are summarized and forwarded to the state health department, national government, or organizations responsible for monitoring the problem, such as the CDC. Special surveillance is developed when a particular type of data is sought.

Which of the following describes the principal problem with early efforts at ensuring quality of care? a. No one knows how to measure quality of care. b. Professionals resisted and sabotaged such efforts. c. Standards emphasized structure, not process. d. There were no standards as to what represented quality care.

c. Standards emphasized structure, not process. Early efforts such as the National Health Quality Improvement Act of 1986 emphasized structure rather than process or outcome of care; hence, they did not really address the root issues of quality. Health care professionals are concerned with providing high quality care. Standards and measures are both in place to evaluate quality

An agency is beginning to implement a general approach for quality improvement. Which of the following activities would the agency most likely implement? a. Customer satisfaction is assessed through the use of surveys provided to the client after each appointment. b. The health maintenance organization (HMO) provides incentives to personnel who complete in-house programs on customer service. c. The institution has received accreditation through The Joint Commission. d. The total quality improvement (TQI) team meets to examine how to make the registration process more efficient

c. The institution has received accreditation through The Joint Commission. General approaches to quality improvement seek to protect the public by ensuring a level of competency among health care professionals. Examples are credentialing, licensure, accreditation, certification, charter, recognition, and academic degrees. Customer satisfaction may play a role in achieving one of these general approaches for quality improvement, but is not one of the major approaches. Making the registration process more efficient may assist in achieving one of these general approaches, but is not one of the major approaches.

A nurse considered copying last month's surveillance report and changing the date because the number of occurrences per month had not noticeably changed. Which of the following best explains why the nurse should continue to spend time collecting and reporting data that is always nearly the same? a. Because such data are legally required b. Because it is still part of the nurse's responsibilities, even if it is a waste of time c. To determine a local baseline rate and immediately notice any change d. To determine differences among communities in need for state assistance

c. To determine a local baseline rate and immediately notice any change Disease surveillance generates knowledge of a disease or event outbreak patterns. Surveillance systems help nurses and other professionals monitor emerging infections and bioterrorist outbreaks. Surveillance provides a means for nurses to monitor disease trends to reduce morbidity and mortality and improve health. Disease surveillance is not part of a legal requirement. There are many useful purposes for surveillance including monitoring for emerging infections and disease trends. The purpose of the monthly surveillance report is not for comparison among communities, rather it is a description of what is happening within the local community.

A nurse, client, family, and other care providers meet to discuss what will be the best approach to use to continue care. Which of the following best describes why the nurse suggests changing the goal from obtaining appropriate long-term care placement to ensuring that the client's recovery is beneficial and safe? a. To consider all possible consequences of long-term care placement b. To encourage the group to review the client outcomes in the different settings c. To expand the goal so that different solutions can be generated and considered d. To help the group focus on the critical aspects the client's family considered most important

c. To expand the goal so that different solutions can be generated and considered One problem with seeking solutions is stating the problem in such a narrow fashion that only one possible outcome is acceptable. To avoid this, the nurse may restate the problem. By expanding the goal, different solutions can be generated. Clients and advocates may feel limited in their options if they generate solutions before completely analyzing the problems, needs, desires, and consequences. Changing the goal allows other possibilities, which may or may not include long-term care, to be considered. The client outcomes in different settings are not being addressed at this time. Examining the aspects that the family feels is most important can better be considered by broadening the goal.

What is the primary goal of total quality management? a. To confirm the high standards desired in patient care b. To discover and correct errors in task completion c. To focus on the client and teamwork d. To enable organizations to publicize their quality approach to patient care

c. To focus on the client and teamwork Total quality management is a management philosophy that includes a focus on client, continuous quality improvement, and teamwork. Under TQM, quality is defined as customer satisfaction. Quality assurance is the promise or guarantee that certain standards of excellence are being met for the client in the delivery of care. QI is defined as a structured approach to improving performance

A wealthy factory owner says, "I don't care about the poor. I just want the best care available for me and my family. Why should I care whether other people get health care or not?" Which of the following would be the most appropriate response by the nurse? a. "If your employees are ill, who will do the work in your factory?" b. . "You might catch a contagious disease from one of your employees." c. "You have a moral obligation to help those less fortunate." d. "Your personal insurance and tax costs will go up if your employees have to use community resources when they're ill."

d. "Your personal insurance and tax costs will go up if your employees have to use community resources when they're ill." Because the speaker's primary concern is apparently money, an appropriate response must show that the factory owner will lose money if he doesn't support the health of others in the community. Everyone - consumers, providers, and those who pay the health care bills - benefits if people stay healthy. The focus should be on the larger community and not only on the work needing to be done at the factory.

Which of the following best describes the primary reason life spans have notably lengthened over the past 100 years? a. Advances in hospital care and procedures b. Advances in medicine and medical research c. Advances in nursing practice d. Advances in public health

d. Advances in public health A person born today can expect to live 30 years longer than someone born in 1900. Medical care accounts for 5 years of that increase, but public health is responsible for the additional 25 years, through prevention efforts brought about by changes in social policies, community actions, and individual and group behavior changes. Advances in medical care only accounts for 5 of the additional 30 years that longevity has increased. Hospital and nursing care are not specifically noted when discussing the increase in life span.

The nurse admits uncertainty over how to address the needs of a group of clients. The long-term nurse in the area suggests that the nurse review published evidence-based clinical guidelines. How can the nurse know these guidelines are reliable? a. Because the agency supports their use. b. Because the guidelines have been published. c. Because the long-term nurse trusts them. d. Because they are based on research and expert opinion.

d. Because they are based on research and expert opinion. Evidence-based practice guidelines are protocols or statements of recommended practice developed by professional organizations and based on scientific clinical data and research as well as expert opinion from extensive clinical experience. Such guidelines help a clinician in decision making. Scientific data is what makes these guidelines reliable, not the support of an agency, the fact that they were published, or that they are trusted by the nurse.

A case manager advocates for a client by helping an insurer understand the client's needs and desires and by helping the client understand programs and benefits offered by the insurer. What role is the nurse? a. Arbitrator b. Systems allocator c. Mediator d. Negotiator

d. Negotiator Negotiating is a strategic process used to move conflicting parties toward an outcome. Parties must see the possibility of achieving an agreement and the costs of not achieving an agreement. As a systems allocator, the nurse distributes limited health care resources according to a plan or rationale. Mediating is the process of assisting parties to understand each other's concerns and to determine their conclusion of the issues. The mediator has no authority to decide, whereas an arbitrator is legally allowed to suggest an appropriate outcome.

Which of the following best describes the primary problem that can result from health care today being given by many different care providers? a. Clients are not sure which provider to see first. b. Health care providers have to make referrals to other providers. c. Clients sometimes are not sure who their primary provider is. d. Overuse, underuse, or gaps in care may result.

d. Overuse, underuse, or gaps in care may result. A particularly challenging problem is the fragmenting of services, which can result in overuse, underuse, gaps in care, and miscommunication. Clients who have a primary care provider typically know who that provider is and recognize that this is the provider that should be seen first. The referral system is not a primary problem with health care being given by various providers. It is the fragmentation of services that causes the problems within the system.

The management team of the Central County Community Health Agency wants to analyze the cost of homebound client services. Which of the following records are most likely to provide useful data? a. Clinical records b. Financial records c. Morbidity and mortality records d. Provider service records

d. Provider service records The provider service records include information about the numbers of clinic clients seen daily, home visits made daily, transportation and mileage, the provider's time spent with the client, and the amount and kinds of supplies used. The provider service record is completed on a daily basis by each provider and is summarized monthly and annually to indicate trends in health care activities and costs relative to personnel time, transportation, maintenance, and supplies. A clinical record is the client health record. This would contain health information for a single client, would not generally include clinic costs, and would be an inefficient source because it identifies service to only one individual. Financial records include extraneous items for the clinic as a whole. Extracting specific data will not be as easy, because they will be from the provider service record. Morbidity and mortality records would not be suitable in this instance.

A public health nurse has reviewed the objectives of Healthy People 2020. Which of the following should be the focus for programming in the community related to communicable diseases? a. Encouraging community members to engage in healthy behaviors b. Identifying high-risk sexual behaviors among community members c. Monitoring the sexual activity of adolescents d. Providing information about the hazards of multiple sexual partners

d. Providing information about the hazards of multiple sexual partners Healthy People 2020 lists communicable disease as an area of focus including levels of human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), and sexually transmitted infections. One method to reduce the risk of acquiring a communicable disease is by the public health nurse providing information on the hazards of multiple sexual partners and street drug use. Encouraging ―healthy behaviors‖ is not specific to the prevention of communicable diseases. Monitoring the sexual activity of adolescents only addresses one segment of the population, and monitoring does not provide an active intervention for the nurse to complete to influence the problem. Identification of high-risk behaviors is part of the assessment of the community and may assist the nurse in knowing what programs to develop, but this would not assist in decreasing the rates of communicable disease.

Which of the following is a core competency required of public health nurses? a. Knowledge in the use of high-technology diagnostics b. Knowledge of the implementation of electronic medical records c. Skill in the physical assessment of complex clients d. Skill in developing policy and planning programs

d. Skill in developing policy and planning programs The core public health competencies are divided into the following eight domains: (1) analytic assessment skills; (2) basic public health sciences skills; (3) cultural competency skills; (4) communication skills; (5) community dimensions of practice skills; (6) financial planning and management skills; (7) leadership and systems thinking skills; (8) policy development/program planning skills. The incorrect competencies are better suited for tertiary facilities such as hospitals.

The nurse contacts participants who completed an educational program on breast self-examinations to see whether they have any questions and to determine whether they are doing breast self-examinations. Which of the following types of evaluation is being implemented by the nurse? a. Final evaluation b. Formative evaluation c. Goal evaluation d. Summative evaluation

d. Summative evaluation Summative evaluation assesses program outcomes after the program is completed. Formative evaluation occurs on an ongoing basis while the program exists. Goal evaluation and final evaluation are not types of formal evaluation that are addressed in the textbook.

A nurse is conducting a needs assessment but has a limited budget. Which of the following data sources would the nurse most likely eliminate? a. Community forums b. Examination of community indicators c. Focus groups d. Surveys

d. Surveys Surveys tend to be expensive when compared with other methods; therefore the nurse would want to consider other options if on a limited budget. Focus groups, community forums, and examination of community indicators are all low cost; however, they can all be time consuming.

A committee concludes that a program's objectives were met and that activities received positive ratings from the community; yet the program will be discontinued because cost was triple the amount anticipated. Which of the following program evaluation measures created a problem? a. Adequacy b. Effectiveness c. Impact d. Sustainability

d. Sustainability The aspect of program evaluation is sustainability—enough resources (usually money) to continue the program. Other aspects of program evaluation include: adequacy — program addresses the extent of the need; effectiveness — ability to meet program objectives and the results of program efforts; impact —long-term changes in the client population.

A community health nurse is trying to decrease the incidence of emerging infections caused by drug-resistant organisms. Which of the following actions would be most appropriate for the nurse to implement? a. Lobby for increased use of antibiotics in the treatment and prevention of communicable diseases. b. Notify the Centers for Disease Control regarding any unusual signs and symptoms related to a communicable illness. c. Reinforce the importance of receiving vaccinations according to recommended schedules. d. Teach parents that antibiotics should not be used for treatment of viral infections or for prevention of bacterial infections.

d. Teach parents that antibiotics should not be used for treatment of viral infections or for prevention of bacterial infections. The widespread, often inappropriate, use of antimicrobial drugs has resulted in loss of effectiveness for some infections. Clients and health care providers are responsible for the inappropriate use of antibiotics. The nurse can influence this trend by objecting to inappropriate use of antibiotics by providers and by educating individuals, families, health care providers, and the community about the dangers of misuse and overuse of antibiotics. Lobbying for increased use of antibiotics would not assist in decreasing the amount of drug-resistant organisms. Notifying the Centers for Disease Control or increasing the percentage of children who are vaccinated will not effect the increased development of drug-resistant organisms.

The pharmacist sent up the wrong medication for the patient. The nurse filled out an incident report when the error was discovered. Which of the following best describes the likely outcome when the quality improvement team reviews the incident report? a. The nurse will receive a commendation for recognition of the error. b. The pharmacist will be disciplined. c. The pharmacist will be reported to the state pharmacy board. d. The CQI team will try to determine how the error occurred.

d. The CQI team will try to determine how the error occurred. In quality improvement, people are asked to help identify problems and seek ways to improve system performance. Providing additional recognition or discipline would not be appropriate steps within the quality improvement process. Ongoing quality improvement focuses on what led to the error occurring.

A nurse is employed at the state department of public health. Which of the following is a fundamental principle guiding his practice? a. Decisions are made at the federal level, disseminated at the state level, and carried out at the community level. b. Health of populations is only as good as the health of individuals that live and work in the community. c. Oversight of community health departments is the most important function. d. The interaction of the local-state-federal partnership is critical to success.

d. The interaction of the local-state-federal partnership is critical to success. In the United States, the local-state-federal partnership includes federal agencies, the state and territorial public health agencies, and the local public health agencies. Their effective interaction is critical to the effective use of both financial and personnel resources to address the health of populations. Nurses working in all of these agencies work together to identify, develop, and implement interventions that will improve and maintain the nation's health. Decisions can be made and implemented at the federal, state, and local levels. The health of individuals and populations is influenced by the health policies that are in place. The state agency may provide some oversight of local health departments, but that is not its primary purpose

After completing a needs assessment, the nurse is confident that he has identified the highest priority health programming need within the community. He presents his ideas at a community interest meeting, and the attendees show essentially no interest in being involved. Knowing that the health problem must be addressed he proceeds with implementation as planned. Which of the following is the most likely outcome of the program? a. Community members will become increasingly positive about the new program. b. Others will recognize the importance of the program and become involved. c. The public health agency will both publicize and expand the program. d. The program will fail because of the community's lack of interest

d. The program will fail because of the community's lack of interest Perspectives on the program, or what people think about the need for a program, might differ among health providers, agency administrators, policymakers, and potential clients. These groups are considered the stakeholders in the program. Collecting data on the opinions and attitudes of all persons, whether directly or indirectly involved with the program, is necessary to determine if the program is feasible, if there is a need to redefine the problems, or if a new program should be developed or an existing program expanded or modified. If a new or changed program is to be successful, it must not only be available, but also be accessible and acceptable to the people who will use it. If community members do not accept the programming, it is unlikely that they will become increasingly positive about it or invite others to become involved. The public health agency could attempt to publicize and expand the program, but without the acceptance of the community it will most likely fail.

A rural public health nurse is spending time reviewing death certificates. Which of the following best explains the purpose of this activity? a. To ensure that local causes of death are consistent with national causes of death b. To confirm that no local health problems are beginning c. To evaluate effectiveness of health promotion programs d. To obtain mortality data for the local area

d. To obtain mortality data for the local area Mortality data are often the only source of health-related data available for small geographic areas. Vital statistics reports, such as death certificates, are reviewed. Useful information also comes from administrative data such as discharge reports and billing records. It is not necessary that the local causes of death are consistent with national causes, rather it is important the nurse be aware of the major causes of mortality in the community so that the needs of the community can be addressed. Mortality data can occasionally be used to evaluate the effectiveness of health promotion programs, but this would not be the primary purpose of reviewing death certificates. Other data can be used to detect the start of local health problems. Analyzing death certificates as the only means of examining local health problems would provide the nurse with data that is not current.

Which of the following best describes the goal or priority of the nurse advocate? a. To gain organizational and governmental support for the promotion of nursing objectives b. To improve community service needs identified by research findings c. To integrate evidence-based practice guidelines in the provision of community nursing service d. To promote the client's rights and self-determination

d. To promote the client's rights and self-determination In today's practice, the nurse advocate makes the client's rights the priority. Thus, the goal of advocacy is to promote self-determination in a constituency or client group. Integrating evidence-based practice is part of the role of the nurse as a researcher. Gaining organizational and government support and improving community service needs identified by research are not roles of the nurse as an advocate. In the advocate role, the nurse promotes the self-determination of the group

Which of the following best describes the goal or priority of the nurse advocate? a. To gain organizational and governmental support for the promotion of nursing objectives b. To improve community service needs identified by research findings c. To integrate evidence-based practice guidelines in the provision of community nursing service d. To promote the client's rights and self-determination

d. To promote the client's rights and self-determination In today's practice, the nurse advocate makes the client's rights the priority. Thus, the goal of advocacy is to promote self-determination in a constituency or client group. Integrating evidence-based practice is part of the role of the nurse as a researcher. Gaining organizational and government support and improving community service needs identified by research are not roles of the nurse as an advocate. In the advocate role, the nurse promotes the self-determination of the group.

Which of the following methods would be the most interactive approach to assessing a community's need? a. Define needs based on the current health status of the community. b. Examine past needs as identified by the agency as well as the community. c. Project future needs based on current trends. d. Use past and current data to project future needs.

d. Use past and current data to project future needs. The interactive approach to assessing the needs of the community includes describing the problem using past and present data to project future population needs. Projecting a future need describes the preactive stage. The reactive stage defines the problem based on past needs identified by the client or the agency. The inactive stage involves defining the problem based on the existing health status of the population to be served.

Which aspect of a biological agent is probably the most frightening to those exposed? a. Infectivity b. Invasiveness c. Pathogenicity d. Virulence

d. Virulence Virulence refers to the proportion of people with clinical disease who become severely ill or die. It is assumed people could cope with illness but possible death is truly frightening for most. Infectivity refers to the capacity of an agent to enter a susceptible host and produce infection or disease. Invasiveness is the ability of an agent to get into a susceptible host. Pathogenicity measures the proportion of infected people who develop the disease.

A nurse is assessing a community to determine the feasibility of implementing a new program on bike safety for youth in the community. Which of the following aspects should the nurse investigate to make this determination? a. Whether the community, especially agency clients, desire a program b. Whether local politicians support the agency's idea for a program c. Whether agency professionals think a program is needed d. Whether all involved support the need for such a program

d. Whether all involved support the need for such a program Feasibility means the program's viability, practicality, achievability, or likelihood of success. Everyone involved must be supportive for a program to succeed. What people think about the need for a program, or program feasibility, might differ among health providers, agency administrators, policymakers, and potential clients. Thus, it is important to get all who are involved to support the program.