Community Health Test 3 evolve

3. The nurse epidemiologist in a local health district receives a report from a local pediatrician that a case of chickenpox has been diagnosed in a second grader at one of the local elementary schools. The nurse proceeds to contact the school to determine whether or not any other children are absent for illness or were recently seen by the school nurse. Other area pediatricians are also contacted to determine whether or not any other cases have been identified. The nurse works with the school to notify parents about what signs and symptoms they should look for and how to manage a child with such symptoms. This is an example of which type of surveillance? a. Active b. Passive c. Sentinel d. Special

ANS: A In an active system of surveillance, the PHN, as an employee of the health department, may begin a search for cases through contacts with the local health providers and health care agencies. The nurse names the disease or event and gathers data about existing cases to try to determine the magnitude of the problem.

8. The federal-state-local partnership teams with other organizations to develop and implement responses to identified public health concerns because: a. community health is a shared responsibility. b. health objectives are defined nationally. c. population health is the responsibility of the government. d. public health trends focus on bioterrorism.

ANS: A PHNs partner with multidisciplinary teams of people within public health areas, in other human services and public safety agencies, and in community-based organizations. The health of communities is a shared responsibility that requires a variety of diverse and often nontraditional partnerships. Public health agency staffs include physicians, PHNs, nutritionists, environmental health professionals, health educators, various laboratory workers, epidemiologists, health planners, paraprofessionals who make home visits, and outreach workers. Community-based organizations include the American Red Cross (ARC), free clinics, advocacy groups, Head Start programs, daycare centers, community health centers, hospitals, senior centers, churches, academic institutions, and businesses. Other government agencies include fire/emergency services departments, law enforcement agencies, schools, parks/recreation departments, and elected officials.

9. The PHN applies knowledge in working with a local school board coalition to develop a helmet safety campaign in the middle and high schools. This best exemplifies which aspect of public health? a. Core Competency b. Core function c. Nursing role d. Standard of practice

ANS: A The core public health competencies are divided into eight domains: analytical assessment skills, basic public health science skills, cultural competency skills, communication skills, community dimensions of practice skills, financial planning and management skills, leadership and systems thinking skills, and policy development/program planning skills. This example demonstrates such competencies as analytical assessment, communication, leadership, and policy skills.

4. The first step in initiating a surveillance strategy is to confirm the: a. existence of the event. b. magnitude of the problem. c. source of the outbreak. d. tentative hypothesis.

ANS: A The first step in conducting an investigation is to confirm that an occurrence/outbreak actually exists and that a supposed event is not a false alarm. The investigator must find out the nature, location, and severity of the problem. Only the investigator can make this determination. The investigator can then verify the diagnosis and develop a case definition to determine the magnitude of the problem.

1. Public health nurses (PHNs) are challenged to respond to public health-related trends of the twenty-first century, which include: a. racial, ethnic, and economic health disparities; rise of drug-resistant pathogens; unequal access to health care; and violence. b. violence, availability of health care for all, and increasing life expectancy. c. health disparities, access issues, and adequate mental health program funding. d. rise of drug-resistant organisms, increased life expectancy, societal violence, and more effective disease surveillance.

ANS: A Twenty-first-century challenges include increasing rates of drug resistance in community-acquired pathogens and societal issues such as welfare reform, economic disparities, racial/ethnic disparities, behavioral influences on health, and unequal access to health care.

1. The Quad Council of Public Health Nursing identified eight principles that distinguish the public health nursing specialty from other nursing specialties, including which of the following? (Select all that apply.) a. Collaboration with other professions, organizations, and entities b. Optimal use of available resources c. Population-based unit of care d. Primary obligation to work for the good of individuals and families e. Engagement with clients as an equal partner

ANS: A, B, C, E The tenets (principles) of public health nursing were developed by the Quad Council of Public Health Nursing and integrated into the Scope and Standards of Public Health Nursing Practice of the American Nurses Association (ANA, 2005). These principles distinguish public health nursing from other nursing specialties. The eight principles include population-based unit of care; primary obligation to achieve the "greatest good for the greatest number"; engagement with clients as an equal partner; priority emphasis on primary prevention; focus on strategies that create healthy environmental, social, and economic conditions in which populations may thrive; obligation to reach out to all who might benefit; optimal use of available resources; and collaboration with other professionals, organizations, and entities.

1. Morbidity data can most easily be located in which of the following sources? (Select all that apply.) a. Environmental surveys b. Hospital discharge reports c. Medical examiners' reports d. Specialized disease registries e. Vital statistics sources

ANS: A, B, D Mortality data can be found in data sources containing vital statistics, which typically include death certificates and coroner/medical examiner reports, and birth certificates. Morbidity data are typically found in reports of notifiable disease; laboratory reports; hospital discharge reports; billing data; outpatient health care data; specialized disease registries; injury surveillance systems; environmental surveys; and sentinel surveillance systems.

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

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

3. A PHN in the local health department assists the community in identifying the health need priorities and the services that can best meet these needs in a cost-effective manner. This is an example of the tertiary prevention public health nursing function of: a. case finding. b. case management. c. collaboration. d. provision of direct services.

ANS: B Case management is a major tertiary prevention function for PHNs at the community level of practice. Case managers assist clients in identifying the services they need the most at the least cost. They also assist communities and populations in identifying services that will improve the overall community health status.

7. The PHN ensures that a local community coalition for improving school lunches takes the time to listen to each stakeholder's view, develops a common validated language for discussing the initiative, and shares the credit for the success of the initiative. The PHN is adhering to the principles of: a. collaboration. b. partnership. c. public health care. d. public health nursing.

ANS: B Changes can be accomplished more easily and effectively by partnerships and collaboration among groups than by the individual client and PHN working alone. The Community Campus Partnerships for Health involved its members and partners in developing nine principles of good practice for community partnerships in 1998. These include agreeing on a mission; values, goals, and measurable outcomes; establishing a relationship characterized by mutual trust, respect, genuineness, and commitment; building on identified strengths and assets but also determining areas for improvement; balancing power and enabling resources to be shared; ensuring clear, open, and accessible communication with ongoing listening and a common validated language; mutually establishing roles, norms, and processes; ensuring feedback to, among, and from all stakeholders; sharing the credit for accomplishments; and taking time for the partnership to develop and evolve.

2. A PHN uses the state health department's reportable disease system to complete a community assessment of a rural county with issues of access to primary care services. This can best be described as what type of surveillance system? a. Active b. Passive c. Sentinel d. Special

ANS: B In a passive system of surveillance, health care providers, agencies, or laboratories send case reports to local health departments. The case reports are summarized and forwarded to the state health department, national governmental agency, or organization responsible for monitoring the problem, or to an international organization like the World Health Organization. This system can then be used to derive disease-specific demographic, geographic, and seasonal trends for reported events. These data are useful to a PHN conducting a community assessment or mobilizing for action through planning and partnerships (MAPPS) on a defined community.

5. During an investigation, once the problem has been identified and the initial magnitude delineated in a case definition, the next step is to: a. check the state reportable disease list and request help. b. initiate control measures appropriate to the event/outbreak. c. seek additional cases by interviewing health care agencies. d. develop a tentative hypothesis.

ANS: B Once an event/outbreak has been identified, confirmed, and initially defined, early and continuously changing control measures should be initiated to contain the event and minimize further impact on the public. Then, the investigation can proceed and the proper authorities can be notified or asked for assistance and further consultation.

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

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

5. The PHN serves as a bridge between at-risk populations and the community's health care resources. This role is based on the nurse's responsibility to: a. collect and analyze data on public health programs. b. ensure that all populations have access to affordable, quality health care. c. monitor and assess critical health status indicators. d. provide evidence-based use of resources.

ANS: B Public health's shift from being the primary care provider of last resort to the developing partnerships to meet the health promotion and disease prevention needs of populations has raised concerns about available health care for the uninsured and underinsured. The role of the PHN given this ongoing shift in health care delivery is still being developed in many agencies. PHNs retain responsibility for ensuring that all populations have access to affordable, quality health care services. They accomplish this by advocating for legislation that promotes universal health care, such as increased funding for community health centers and expansion of Medicaid eligibility criteria, and by forming partnerships with hospitals, free clinics, and other organizations to ensure the availability of health care for all populations in the community.

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

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

7. The most common sources of surveillance data are databases maintained by the federal agencies, state health departments, and other organizations with an interest in understanding a specific disease or event. The National Program of Cancer Registries contains morbidity data for the types of cancer found in a state as well as: a. key centers for the specialized treatment of certain cancers. b. links to National Institutes of Health cancer research projects currently being conducted. c. locations of cancer risks and health problems within the state. d. major genetic determinants of cancer by age and sex.

ANS: C A good example of a process in place to collect morbidity data is the National Program of Cancer Registries. This program provides for monitoring the types of cancer found in a state and the locations of the cancer risks and health problems in the state.

6. One of the unique advantages of using data reporting such as a spatial map to analyze and present data is that such a tool provides a graphical way of determining: a. characteristics of the population. b. potential hypothesis. c. priority prevention target areas. d. trends for the spread of the disease.

ANS: C A spatial map is a data-reporting tool that graphically presents the distribution of an event/outbreak in such a way that priority prevention target areas can easily be identified, because it shows graphically what is happening and where it is happening.

4. State public health agency responsibilities include: a. conducting community health assessments. b. enforcing public health codes. c. monitoring health status. d. providing expertise that facilitates evidence-based practice.

ANS: C Federal public health agencies develop regulations that implement policies formulated by Congress, provide funding to state and territorial health agencies for public health activities, survey the nation's health status and health needs, set practices and standards, provide expertise that facilitates evidence-based practice, coordinate public health activities across state lines, and support health service research. State public health agencies are responsible for monitoring health status and enforcing laws and regulations that protect and improve the public's health. They receive funding from federal agencies to implement public health initiatives. Local public health agencies are responsible for implementing and enforcing local public health codes and ordinances and providing essential public health services to the community.

2. Rapid changes in public health are providing a challenge to PHNs because there is neither time nor staff to provide nurses with the on-the-job training needed to acquire the core public health competencies required of the PHN. This resulted in revisions to the American Nurses Association (ANA)'s Scope and Standards of Public Health Nursing Practice in 2005 that established: a. core public health functions as the competency framework. b. Minnesota Department of Health's Intervention Wheel as the practice competencies. c. standards for baccalaureate- and master's-prepared PHNs. d. Quad Council principles as the primary framework for practice.

ANS: C Historically, many of the core public health competencies were provided by PHNs who had learned these skills in the workplace while gaining knowledge through years of practice. Because of rapid changes in public health and limited resources, this approach to competency development can no longer be sustained. In 2007 and again in 2013, the ANA revised the 1999 Scope and Standards of Public Health Practice to reflect the increasing complexity and rapid changes faced by PHNs. The revised standards include standards that must be met by all nurses with baccalaureate degrees, the entry level into public health nursing, as well as standards that must be fulfilled by advanced practice PHNs prepared at the master's level.

6. If the two major goals of Healthy People 2020 are to be achieved, collaboration is essential for public health nursing practice, and collaboration with existing groups at the local level is encouraged for which of the following reasons? a. The federal government is ultimately responsible for the health status of the nation b. The public demands that the government protect the people c. Public health departments do not have the resources to accomplish these goals independently d. State health agencies must take a universal approach to achieving objectives

ANS: C Partnerships and collaboration among groups are much more powerful in making change than the individual client and PHN working alone. Because public health departments do not have the resources to accomplish the Healthy People 2020 goals independently, collaboration is essential to quality public health nursing practice, and collaboration with existing groups at the local level is encouraged. New partnerships are formed related to specific goals. Communities develop coalitions to address selected objectives, based on community needs that include all of the local community stakeholders, such as social service; mental health; educational, recreational, and governmental agencies and institutions; as well as businesses.

1. Disease surveillance, a critical role function for the public health nurse (PHN), can best be defined as the ongoing, systematic collection, analysis, interpretation, and dissemination of specific health data relevant to public health. The nurse's knowledge and understanding of surveillance systems is critical to: a. detecting epidemics and pandemics. b. facilitating planning and policy changes. c. improving the quality and usefulness of the data collected. d. understanding the relationship between epidemiologic principles.

ANS: C Surveillance is a critical role for the nurses practicing in the community. A comprehensive understanding and knowledge of surveillance systems and how they work will help nurses improve the quality and the usefulness of the data collected for the purpose of making decisions about needed community services, community actions, and public health programming.

8. Collaboration among local, state, and federal agencies; health care providers, agencies, and organizations; and other community-based services that address issues of safety and welfare in a community is critical to the success of a quality surveillance program. The public health practice domain that best describes the ability to collaborate effectively is: a. communication. b. analytical assessment skills. c. community dimensions of practice. d. policy and program development.

ANS: C The Core Competencies for public health are divided into eight practice domains: analytical assessment skills, policy/program development, communication, cultural competency, community dimensions of practice, basic public health sciences, financial planning/management, and leadership. The practice domain for community dimensions of practice addresses the establishment and maintenance of links during an investigation; collaboration with partners; and development, implementation, and evaluation of an assessment to define a problem.

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

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

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

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

9. Disease and event surveillance systems exist to help improve the health of the public through the systematic and ongoing collection, distribution, and use of health-related data. A PHN utilizes the data in available surveillance systems to make a presentation to a community planning committee that is interested in the problem of childhood obesity. This use of the data for facilitating community planning is a good example of helping the community to: a. avert a health care epidemic. b. evaluate prevention and control measures. c. identify cases for fact finding. d. manage endemic health problems.

ANS: D A nurse can contribute to surveillance systems and can best use the data collected through such systems to help manage endemic health problems and those that are emerging, such as evolving infectious diseases and bioterrorist (human-created) health problems.

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

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

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

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

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

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

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

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

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

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