Exam 1 Community Health

5. The local clinic is dedicated to the well adult and child. It has evening hours and offers varied programs for the community. The programs include immunizations and classes on fire safety, health education, and car safety, to name a few. How would the nurse explain the level of prevention used in this setting to your colleagues? A) Primary B) Secondary C) Tertiary D) Quaternary

Ans: A Feedback: When an individual person or a group is considered in good health and shows no signs or symptoms of disease or physical challenges, nurses in interdisciplinary teams and community partnerships are involved in primary prevention. Secondary prevention is a planned effort to minimize the impact of disease and injury once it is realized. Tertiary prevention is the long-term management and treatment of clients with chronic conditions. Quaternary prevention is fabricated.

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

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

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

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

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

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

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

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

21. The nurse works at community clinic that provides various types of health screenings for members of the community. One day, the nurse provides tuberculin tests for a group of new hospital employees. Which type of screening procedure is this? A) Mass screening B) Selective screening C) Multiphasic screening D) Case finding

Ans: B Feedback: Selective screening is performed for specific high-risk populations, such as tuberculin tests for hospital employees. Mass screening is performed on an entire population, such as blood lead level screening, Papanicolaou (Pap) smears, and phenylketonuria of newborns. Multiphasic screening involves a variety of screening tests applied to the same population on the same occasion, such as a series of tests performed on a single blood sample, periodic surveillance of drug therapy, and monitoring the stage of an illness. Case finding is a type of screening ordered by a clinician when searching for illness as part of a client's periodic health examination.

10. The nurse decided to use a learning model based on Skinner with a client with diabetes to improve compliance with dietary and blood glucose assessment requirements. Which would be the best way to implement this program? A) Give rewards for a lower blood sugar level and a food diary that reflects moderate dietary compliance. B) Eliminate the reward and punish the client when she fails to comply with dietary guidelines. C) Demonstrate positive reinforcement by decreasing dietary guidelines and blood sugar parameters. D) Institute a strict timeline to accomplish goals.

Ans: A Feedback: According to Skinner (1953), health behaviors are seen as incremental steps toward a final goal. In the learning model, the nurse establishes and reinforces a goal and rewards the client for partial accomplishment, if necessary. Incremental increases are then made as the pattern of behavior is shaped toward a specific goal. Reinforcement is used to motivate the client to either continue or discontinue a behavior. Giving rewards for a lower blood sugar level and a food diary that reflects moderate dietary compliance is the best example of implementing a learning model of behavior change. Punishment and enforcing a strict timeline do not provide positive reinforcement and thus are not good examples of the learning model. Lowering the requirements of the goal is also not a good example of this model, as the goal should not change.

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

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

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

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

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

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

3. Absenteeism due to illness has increased recently in the local middle school. The increase is noted to be related to exacerbation of asthma symptoms in the student population. Which would be the most effective approach in decreasing absenteeism among this population? A) Develop an asthma education and surveillance program that addresses students, families, and faculty members. B) Develop a policy to exclude students with a diagnosis of asthma from admission to the school. C) Create an asthma prevention plan within the school environment, based in the school nurse's office. D) Create an education program for faculty related to the prevention of exacerbation of asthma systems.

Ans: A Feedback: Community health nurses are focused specifically on modifiable risks of acquiring disease. This requires nurses to analyze trends in risk surveillance data and consider the physical, emotional, and psychosocial challenges people face when confronting disease, physical stressors, and the possibility of premature death. Public health science uses in-depth processes of data collection across the natural history of disease to define trends, and in this way assists nurses and other public health officials in prioritizing the steps needed to minimize risk and improve the quality of care in populations. Only the development of a program that addresses students, families, and faculty members and that takes into account surveillance data is in-depth enough to be effective. The other options do not reflect public health science or approach the problem in a holistic manner.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

13. A 34-year-old client is recovering from a below-the-knee amputation secondary to a motor vehicle accident. The nurse meets with the client to update his care plan, and client states that he knows that he will walk again. He asks for physical therapy schedules and timelines for prosthetics on the basis of his healing process. On the basis of knowledge of the theory of reasoned action, the client's behavior reflects: A) An enhanced ability to meet his goals on the basis of his intention and behaviors B) Goal setting that is unrealistic and irrational based on the client's diagnosis and behaviors C) A depression that will complicate the healing process D) Denial of the injury and part of the healing process

Ans: A Feedback: The theory of reasoned action states that a person's given behavior is primarily determined by his or her intention to perform that behavior (Fishbein & Ajzen, 1975). This intention is determined by the person's attitude toward the behavior (beliefs about the outcomes of the behavior and the value of these outcomes) and the influence of the person's societal environment or subjective norm (beliefs about what others think the person should do). The ability to perform the behavior (a belief that it can be done) is the critical aspect of the change process. The other answers do not reflect the theory of reasoned action.

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

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

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

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

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

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

11. The nurse decides to use the health belief model for a wellness walking program for older adults. The walk is to begin each day at 8 PM. Each day a different participant is to start a chain of phone calls to other participants to remind all to attend. The nurse informs the clients in the clinic that walking will improve their overall health and well-being. Two older adults show up the first night and none the second. Which information should the nurse gather to explain the failure of the program? (Select all that apply.) A) The severity of the physical challenge related to the client population B) What stands in the way of taking action toward the goal of health promotion C) The presence or absence of cues needed for the program to achieve success D) The presence or absence of a strong team leader among the participants E) The need to increase persuasion when implementing the program

Ans: A, B, C Feedback: The health belief model, developed by Hochbaum (1956) and Rosenstock (1974), specifies that individual, family, or community health-related behavior depends on (1) the severity of the potential illness or physical challenge, (2) the level of conceivable susceptibility, (3) the benefits of taking preventive action, and (4) what stands in the way of taking action toward the goal of health promotion. This model uses cues as an important way to remind people of healthy behaviors and to promote these actions. A strong team leader and persuasion are not integral parts of the health belief model.

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

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

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

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

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

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

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

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

7. The nurse works in a facility that provides hospice care for clients with cancer diagnoses. The nurse recognizes that the care provided in this facility is tertiary in nature. The nurse develops a plan for the clients that would include the tenets of tertiary prevention. The plan would include: (Select all that apply.) A) Palliative care B) Pain control C) Isolation D) Supportive spiritual development E) Diminished involvement of significant others

Ans: A, B, D Feedback: Tertiary prevention includes rehabilitation and palliative care. Nurses providing this level of care assess disease progression, watch for opportunistic infections, and control pain or other side effects of treatment. Care also includes supporting life choices that bring emotional comfort to clients such as family involvement, decreased isolation, supportive spiritual development, and organized help from communities. Isolation and diminished involvement of significant others do not enhance the client's health and well-being and are not examples of tertiary prevention.

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

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

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

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

16. A 19-year-old client is diagnosed as HIV positive. Which behaviors might be indicators of noncompliance with her drug regimen and require further assessment? (Select all that apply.) A) Depression B) Indifference to self-advocacy in sexual relationships C) Goal-oriented attitude toward treatment plan D) Client's expression of concern for the health and well-being of her children E) Client's expression of concern regarding the ability to pay for her medications

Ans: A, B, E Feedback: In women, there is a relationship between poor self-image, depression, and lack of self-advocacy in sexual relationships (DeMarco, Johnsen, Fukuda, & Deffenbaugh, 2001). From a treatment perspective, depressive symptoms are underdiagnosed and are associated with lower medication adherence, risky behaviors, and poor health outcomes (Sanzero et al., 2005). Goal orientation toward the treatment plan and expressions of concern for her children would tend to indicate compliance, not noncompliance, with her drug regimen.

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

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

19. Secondary HIV prevention or positive prevention is used when caring for African-American women living with HIV by addressing which behavioral risks? (Select all that apply.) A) Interpersonal mistrust B) Alcoholism C) Poor adherence to treatment D) Smoking E) Compromised self-advocacy in sexual relationships

Ans: A, C, E Feedback: Advancing the scientific understanding of secondary HIV prevention (what is called positive prevention) in African-American women by exploring ways to address behavioral risk reduction prevents further transmission of HIV and the serious negative psychological consequences of living with HIV disease. African-American women experience disproportionate levels of (1) interpersonal mistrust and fear of disclosure related to perceived stigma, (2) poor adherence to treatment and other health promotion and disease prevention efforts, (3) delay in seeking care related to mental health comorbidities and addiction recovery issues, and (4) compromised self-advocacy in sexual relationships. Alcoholism and smoking are not behavioral risks associated with African-American women living with HIV.

1. Health People 2020 (HP 2020) is a guidepost for nurses and interdisciplinary teams in community and public health. New focal areas for HP 2020 include: (Select all that apply.) A) Adolescent health B) Diabetes C) Genomics D) Nutrition and weight status E) Social determinants of health

Ans: A, C, E Feedback: Ten new focal areas were added to HP 2020, beyond those included in HP 2010. These include the following: adolescent health; blood disorders and blood safety; dementias, including Alzheimer disease; early and middle childhood; genomics; global health; healthcare-associated infections; health-related quality of life and well-being; lesbian, gay, bisexual, and transgender health; older adults; preparedness; sleep health; and social determinants of health. Diabetes and nutrition and weight status were focal areas that were already included in HP 2010.

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

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

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

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

18. A woman arrives at the clinic for a routine appointment. She has been HIV positive for 3 years and states she is doing well. She currently is involved in a relationship with a man who is HIV positive. She states that she is not consistent with safe sex practices due to her significant other's preferences and feels uncomfortable asking him to wear a condom. Which is the nurse's best response to promote the client's health? A) "You won't become pregnant as long as you are taking your drug cocktail." B) "You will not be protected against other strains of HIV or sexually transmitted infections (STIs)." C) "You will both be safe because you both already have HIV." D) "Let's have you both tested for STIs."

Ans: B Feedback: Although both the woman and her partner are already HIV positive, they can still transmit different strains of HIV to each other, as well as other STIs and can then go on to infect others. Thus, they are not "safe" and the woman should be encouraged to advocate for herself by insisting that her partner wear a condom. The client's drug cocktail will not prevent her from becoming pregnant from unprotected sex. Testing for STIs for the woman and her partner may be appropriate, but not until the client is made to understand the importance of protected sex.

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

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

6. Using the tenets of secondary prevention, the committee seeks to establish an HIV/AIDS clinic. The nurse states that it is important for the location of the clinic to be associated with the local hospital. The committee states that the cost of the clinic associated with the hospital is higher than one that is free standing. Which presents the best rationale for the nurse's suggestion? A) Third-party insurance will reimburse the clinic visits only if the clinic is attached to the hospital. B) The hospital can more easily implement programs of care for the clients. C) The hospital will cover the clients only if the clinic is approved by the hospital governance board. D) The hospital will have a vested interest in the success of the clinic.

Ans: B Feedback: Clients diagnosed with HIV/AIDS need secondary prevention services. To screen effectively for the presence of this condition, a test should be backed by a healthcare infrastructure that can implement programs of care for people who have a verified risk of the disease or physical challenge. The other rationales for placement of the clinic are not based on the tenets of secondary prevention.

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

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

13. The nurse wishes to calculate the probability of persons in your county developing chronic obstructive pulmonary disease over the course of a year. Which measure should the nurse use? A) Incidence density B) Incidence rate C) Relative risk ratio D) Specific rate

Ans: B Feedback: Incidence rate is the measure of the probability that people without a certain condition will develop that condition over a period of time. Incidence density is the use of a person-time denominator in the calculation of rates. A person-day reflects one person at risk for 1 day, and a person-year represents one person at risk for 1 year. Relative risk ratio is the ratio of the incidence rate in the exposed group to the incidence rate in the nonexposed group. Specific rates are detailed rates that are calculated using the number of people in the smaller subgroups of the population in the denominator.

2. The nurse identifies the specific indicators and focal areas needed to establish immunization and well-child clinics in a low-income neighborhood. What actions are needed to meet the health outcomes of the project? A) Identify the need in the community for the clinic on the basis of subjective data. B) Develop a plan to meet the costs and promote the benefits of the project. C) Consider the identified neighborhood's need for healthcare compared with that of other low-income neighborhoods by interviewing the members of the neighborhood. D) Assume that the neighborhood will welcome the institution of a well-child and immunization clinic.

Ans: B Feedback: Knowing how to address the need for change and the actual change at a personal, family, and community level must be based on science—evidence based on rigorous understanding of a problem. Specific actions that can best achieve positive health outcomes can then be determined. Consideration must be given to realistic viability of solutions, costs and benefits, and the degree to which individual people will accept these approaches. Developing a plan to meet the costs and promote the benefits of the project meets these criteria. The other answers are not evidence based.

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

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

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

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

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

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

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

Ans: B Feedback: The report includes the following statistics. Every day, about 800 women die due to complications of pregnancy and childbirth. Children in low-income countries are 16 times more likely (not 2 times more likely) to die before reaching the age of 5 years than children in high-income countries. China, not Zimbabwe, now has a higher life expectancy at birth than 7 out of 10 countries in Eastern Europe. Almost 10%, not 5%, of the world's adult population has diabetes, measured by elevated fasting blood glucose (≥126 mg/dL).

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

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

12. The committee has established the need for a sick child clinic in an impoverished neighborhood. The demographic data have been collected, and the committee is ready to meet with a group of local businesspeople who are willing to support the project financially. The plan is for the committee and group to combine to facilitate the establishment of the clinic. Using a transtheoretical model, which level of readiness has the committee achieved? A) Contemplation B) Preparation C) Action D) Relapse

Ans: B Feedback: The stages in a transtheoretical model are as follows: precontemplation (no screening programs scheduled and no intention to schedule screening); contemplation (no screening programs scheduled but intent to start a program soon); preparation (no definite screening program but have taken steps to develop a program); action (developed a screening program and intent to sustain the program); maintenance (have had the program for some time and intend to continue); relapse (had a program, do not have a program currently, but intend to have one soon). The committees in this case are in the preparation stage, as they have taken steps to start the clinic but have not actually started it yet.

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

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

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

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

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

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

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

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

15. A 27-year-old client comes from a background of physical and sexual abuse. Violence victimization continued with her partners until recently. She is currently in a support group for victims of abuse. The client's social background places her at risk for: (Select all that apply.) A) Increased safe sex behaviors B) Decreased safe sex behaviors C) Decreased risk for HIV/AIDS D) Increased risk for HIV/AIDS E) Increased risk of depression

Ans: B, D, E Feedback: Trauma such as child sexual abuse, intimate partner violence, adult sexual abuse, and victimization from exposure to violent environments contribute to behaviors associated with increased HIV risk and disease sequelae. Violence victimization increases depressive symptoms, decreases safe sex behaviors, increases the chance of becoming HIV seropositive, and increases the chances of acquiring and being treated for a sexually transmitted infection (STI) within a year's time (Laughon et al., 2007).

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

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

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

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

4. Multiple family units in an underserved neighborhood have children who have not been vaccinated per health guidelines. The nurse researches the problem and establishes a well-child clinic within walking distance to the neighborhood. The clinic is poorly attended. Which would be the nurse's best action to revise the program and improve attendance to the clinic? A) Determine whether the location of the clinic is not conducive to attendance. B) Discuss the problem of attendance at the next community council meeting. C) Interview members of the neighborhood to determine why they do not use the clinic. D) Discuss the problem with the local minister and request him to discuss the clinic at the next prayer service.

Ans: C Feedback: Although the morbidity and mortality data reports are quantitative, it is important to understand that in most cases, perceptions of health or well-being on the part of individuals, families, and communities are subjective. The science of diagnosis and healthcare follow-up may be present, but it is the subjective perceptions of others that often determine a person's willingness to participate in health promotion initiatives. Interviewing members of the neighborhood to determine why they do not use the clinic is the only option that recognizes the need to perceive the subjective perceptions of the neighborhood.

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

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

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

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

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

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

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

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

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

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

9. The nurse conducts a class on the basics of nutrition to a group of obese adults. The nurse counsels the audience, telling them that they need to change their behaviors. By the end of the class, the nurse has lost the audience. To enhance audience participation and learning in the next class, the nurse should: A) Use consistent methods of persuasion B) Offer advice while the participants are passive C) Encourage the group to participate in the decision making D) Encourage the group to continue ambivalent behaviors

Ans: C Feedback: Motivational interviewing, which was developed by Rollnick and Miller (1995), is defined as a "directive, client-centered communication style for eliciting behavior change by helping clients/[groups] to explore and resolve ambivalence." To address behavior change using this method, the motivation comes from the client and is not imposed by a clinician. The client needs to resolve ambivalence to change a behavior with autonomy. Persuasion on the part of the clinician only intensifies resistance. The communication style is therefore one of directing the client to examine and resolve ambivalence. This method does not (1) argue with a group or community by insisting it has a problem that needs to change, (2) offer advice without actively encouraging group-identified choices, (3) give advice while the group is put in a passive role, (4) impose diagnostic labels, or (5) use coercive tactics.

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

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

12. Incidence rates for groups exposed to a secondhand smoke are compared with the incidence rates for people who are not exposed to secondhand smoke. This will measure the: A) Incidence density B) Prevalence rate C) Relative risk ratio D) Specific rate

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

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

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

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

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

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

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

17. A 32-year-old African-American client is diagnosed with HIV. She is at her 6-month appointment following diagnosis and treatment. The client states that she has not revealed her diagnosis to her boyfriend because she is afraid that he will leave. She expresses feelings of anger because she must put her feelings and illness aside or be abandoned. The client's behaviors reflect: A) Denial of her disease process B) Noncompliance with her drug regimen C) Inability to advocate for herself D) Fear of financial insolvency

Ans: C Feedback: The concept of "silencing the self" has been used to explain how gender roles negatively influence self-advocacy behaviors in women. Women tend to silence their voice in relationships to maintain connections with others, even if that means they will subsequently suffer physically, psychologically, or socially. According to Jack (1991), women are reinforced culturally to (1) care for others' needs before their own, (2) abide by designated societal rules of behavior, (3) refrain from directly expressing their feelings and needs, and (4) outwardly maintain compliance, while feeling hostility inwardly, because of their silencing behaviors. Silencing the self is relevant to the proposed study because it is a concept that is identified and understood in the context of relationships with others, that is, a relational concept. There is no evidence that Carlene is denying her disease process, not complying with her drug regimen, or is fearful of financial insolvency.

20. A 43-year-old African-American client is HIV positive. She has a personal history of abuse, which ended when her husband died 2 years ago. When counseling the client about adherence to her treatment plan, the nurse finds her intelligent and goal oriented. In addition to her need for education and follow-up regarding her HIV diagnosis and treatment, which associated condition should the nurse most consider when caring for this client? A) Cardiac tamponade B) Chronic obstructive pulmonary disease C) Posttraumatic stress disorder D) Cirrhosis of the liver

Ans: C Feedback: When providing physical care to clients with HIV and working to decrease communicability using the ecological model, consider the client's mental health symptoms, severity/frequency of the effects from significant trauma, such as posttraumatic stress disorder, substance use and abuse, and addiction. Cardiac tamponade, chronic obstructive pulmonary disease, and cirrhosis of the liver are not typically associated with either HIV or a history of abuse.

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

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

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

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

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

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

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

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

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

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

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

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

14. A 47-year-old client and three members of his neighborhood have had their homes robbed and belongings scattered. The client contacts the police and, with their assistance, develops a neighborhood watch. The watch is organized and 24 families have been recruited to participate. The watch will be active throughout vacation months and as needed. This organization is representative of: A) Transtheoretical model B) Theory of reasoned action C) Social learning D) Relapse prevention model

Ans: D Feedback: The relapse prevention model has been used specifically with issues that relate to adherence. For example, communities interested in crime prevention may be aware that in certain months of the year there is an increase in violent crime. They would then create a community campaign to promote nonviolence by increasing law enforcement presence and improving faith-based support. Social learning/social cognitive theory is a behavior change approach affected by environmental influences, personal factors, and attributes of the behavior itself. The theory of reasoned action states that a person's given behavior is primarily determined by his or her intention to perform that behavior (Fishbein & Ajzen, 1975). The transtheoretical model, developed by Prochaska and DiClemente (1983), is a sequential approach to behavior change that involves timely readiness of the learner.

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

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

8. An immigrant from Guatemala, age 47, is admitted to the coronary care unit with congestive heart failure. This is the fourth admission for this client, and the physician believes that the client's inability to adhere to his diet and medication regimen is the reason for his frequent admissions. The physician refers the client to the local community health nurse, on discharge from the hospital. Which would be most appropriate for the nurse to include in this client's plan of care? A) Insisting that the client adhere to his diet B) Developing culturally relevant and gender-sensitive interventions C) Teaching the family to adapt their cultural dietary plans to the client's diagnosis D) Assessing the client's financial needs and obtaining financial assistance as needed

Ans:B Feedback:The development of culturally relevant and gender-sensitive interventions that demonstrate positive outcomes in health and well-being is the focus of prevention efforts. Approaching individuals and groups about behavior change must incorporate knowledge of diverse client perspectives and include the use of counseling skills and motivational interviewing. To address behavior change using motivational interviewing, the motivation comes from the client and is not imposed by a clinician. The client needs to resolve ambivalence to change a behavior with autonomy. Persuasion on the part of the clinician only intensifies resistance. Thus, the nurse should not insist that the client adhere to his diet, which does not reflect the client's cultural needs as a Hispanic male. Teaching the family to adapt their cultural dietary plans to the client's diagnosis addresses only one of the client's needs. Assessing the client's financial needs and obtaining financial assistance is the role of the social worker, not the nurse.