Final Exam Public Health Nursing

When using the Community Health Promotion Model to address the problem of increasing teenage pregnancy rates in the community, the nurse would use which steps? Select all that apply. a. Identifying interest by community forums b. Building the partnership c. Counseling teenagers about effective birth control methods d. Contacting other cities with similar problems and issues

ANS: A, B The implementation of the Community Health Promotion Model includes identifying interest by community forums and building the partnership.

Time

Future, past, or present oriented

Nurses have worked in the community to improve the health care status of individuals, families, populations, and vulnerable groups. Part of the appeal of this type of nursing is: 1. Working with wealthy contributors who provide the funds 2. Locating the source of disease and curing patients 3. The autonomy of practice and independence in problem solving and decision making 4.Caring for soldiers on the battlefield

ANS: 3 Community health nurses have a long history of autonomous practice, problem solving, and decision making. The other three answers relate to acute care nursing or gathering funding. Community health care nurses did engage in these activities in the nineteenth century, but overall, they have been best known for autonomy of practice.

The increasing knowledge about genetics and genomics will influence nursing practice by changing how: a. Nurses collect and use health histories b. Nursing students complete clinical experiences c. Referrals to other disciplines are made d. Ethical dilemmas are solved

ANS: A Genetics and genomics will change future practice in several areas including: how students are educated, how nurses collect and use health histories, how nurses learn and apply innovative biotechnology, how prevention and health education is provided, administration of new therapies, and public health debates.

What is the best method for preventing hospital-acquired infections? a. Perform good hand washing before and after approaching every patient. b. Prevention is almost impossible due to the high infection rates in hospitals. c. Isolate every patient having surgery. d. Use contact isolation for every patient at risk.

ANS: A Hand washing is the best way to prevent infection.

What is the purpose of providing education across the three levels of prevention? Education: a. Enables clients to attain optimal health b. Identifies and treats health problems early to eliminate disability c. Enables populations to break into individuals d. Teaches people about Healthy People 2010

ANS: A Health education enables clients to attain optimal health, prevent health problems, and identify and treat health problems early to minimize disability. Elimination of a disability may not be possible.

Healthy Communities and Cities is based on which of the following premises? a. When people have the opportunity to work out their own locally defined health problems, they will find sustainable solutions to those problems. b. When the health of a community is improved, the focus will be on life expectancy rather than quality of life. c. When health professionals assume a leadership role, the health of the community will improve. d. When cities recruit enough health professionals to care for those needing medical care, the cities health will improve.

ANS: A Healthy Cities is based on the premise that when people have the opportunity to work out their own locally defined health problems, they will find sustainable solutions to those problems.

A public health nurse collaborates with local community leaders to develop a local campaign educating about the importance of wearing a seat belt. What client system of the integrative model does this describe? a. Community b. Aggregate c. Family d. Individual

ANS: A Interventions to initiate or maintain healthy lifestyles must be multifocal. At the broadest level of care (community), nurses work with community leaders, other community residents, and health professionals to plan programs to promote optimal health for the community and its people.

Which health problem is in need of control in developed countries? a. Hepatitis b. Malaria c. Polio d. Smallpox

ANS: A Malaria, polio, and smallpox are more commonly found in lesser-developed countries.

A nurse applies the ethical principle of non-maleficence when: a. Administering medications using the five rights b. Allowing clients to be active participants in their care c. Providing patient privacy when delivering care d. Referring a client to a physical therapist

ANS: A Non-maleficence requires that one do no harm. It requires that health care professionals act according to the standards of due care, always seeking to produce the least amount of harm possible.

A correctly written objective would be: a. Each member of the Jones family will give an insulin injection to Billy with accurate dosage 100% of the time for 10 consecutive trials. b. Ms. Smith will perform a blood sugar test on herself with an accurate blood sugar reading. c. The community will take their children to receive immunizations within 1 month of the immunization due date. d. Fifty percent of the eligible women seen in the clinic will return for their scheduled mammogram appointment.

ANS: A Objectives are specific, short-term criteria that need to be met as steps toward achieving the long-term goal. They are written as statements of an intended outcome or expected change in behaviors and should be defined in measurable terms.

A nurse discusses with legislators the importance of passing legislation to ban smoking in all public places. This demonstrates the nurses involvement in: a. Policy b. Politics c. Law d. Health policy

ANS: A Politics is the art of influencing others to accept a specific course of action. Therefore political activities are used to arrive at a course of action (the policy).

A nurse is completing an exposure history using the mnemonic I PREPARE. What data would a nurse collect when asking questions about the first P? a. Present work b. Potential exposures c. Personal protective equipment use d. Problems with health

ANS: A Present work is the first P.

Adoption of universal precautions by health care workers is an example of: a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Specific protection

ANS: A Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability.

A nurse demonstrates the leadership behavior of reflecting when: a. Providing feedback on how behavior appears to others b. Introducing new topics to the group c. Verifying information through questions and restatement d. Highlighting important points from the discussion

ANS: A Reflecting involves giving feedback on how behavior appears to others. Advising introduces new topics. Clarifying verifies new information. Summarizing highlights the important points.

A nurse who is involved in identifying individuals with unrecognized health risk factors or asymptomatic disease is using which intervention? a. Screening b. Referral and follow-up c. Surveillance d. Health teaching

ANS: A Screening involves identifying individuals with unrecognized health risk factors or asymptomatic disease.

Which is a disease that was once isolated and rare but is now widespread throughout the world? a. Acquired immunodeficiency syndrome (AIDS) b. Smallpox c. Malaria d. Measles

ANS: A Smallpox has been eradicated; malaria and measles were not isolated and rare throughout the world. AIDS was once isolated and rare, but is now worldwide.

Which core competency of communication is used by nurses engaged in group work? a. Soliciting input from individuals and organizations b. Using simple language when presenting information c. Asking the group to develop the program of interest d. Presenting material to lay audiences only

ANS: A Soliciting input from individuals and organizations is a communication competency.

A nurse is counseling a client who has just learned that she is a carrier of the BRCA-2 gene. What are potential reactions by this client? (Select all that apply) a. Feelings of guilt b. Fear of loss of insurance coverage c. Feelings of anxiety d. Fear for children

ANS: A, C, D Feelings of guilt, anxiety, and fear for future susceptibility for children are all potential reactions this client may have. The Genetic Information Nondiscrimination Act (GINA) protects clients from losing insurance benefits based upon genetic information.

10. A client diagnosed with HPV infection states, "I'm not concerned, I know the warts disappear after a while." The nurse should counsel the client regarding which of the following? (Select all that apply.) a. Link between HPV and cervical cancer b. Status of HPV infection as a reportable disease c. Need to eliminate the warts d. Serious complications of HPV infection for men e. Lack of cure for HPV infection

ANS: A, C, E The complications of HPV infection are especially serious for women. The link between HPV infection and cervical cancer has been established, and this cancer is associated with specific types of the virus. HPV infection is exacerbated during pregnancy and immune-related disorders, a fetus may become infected, and there is no cure. Although the warts will disappear over time, the goal is to eliminate the warts through surgical removal and other treatments to prevent skin-to-skin contact with them.

To analyze the problem of increased adolescent alcohol use in the community, a nurse brings together several groups of people to address the issue. These groups come together at the same time to work on identifying potential causes of the problem, but do not interact during the process. Which model is the nurse applying? a. Delphi technique b. Program planning model c. Community-as-partner model d. Community empowerment model

ANS: B The program planning model is known as the nominal group process. It makes the most of the contributions by various groups with diverse interests, skills, and knowledge. These groups work in the presence of one another but do not interact.

Negative effects:

Can also increase costs High-tech. equipment is expensive, quickly becomes out-dated, often requires highly trained personnel Legal liability Potential for decreased privacy Too much reliance on machines

Assessing Community Health Data collection and interpretation Data gathering Data generation Composite database analysis

Collection of direct data Collection of reported data Community reconnaissance Assessment issues

Technological Trends Positive effects:

Improve health care services Reduce costs (efficient means of delivering care; replacing people with machines) More convenience (time & travel)

Need to increase number of minority nurses

In 2008, minority nurses represented about 22% of the RN population

Demographic Trends:

Increased fertility & decreased mortality "Baby Boom" & Baby Bust" Increasing average age Change in largest minority group (African American to Hispanic) more single parent homes declined mortality

Data collection methods

Informant interviews Participant observation Windshield survey Secondary analysis of existing data Surveys

Cultural Knowledge

Information about organizational elements of diverse cultures and ethnic groups

Evaluating the Intervention for Community Health

Role of outcomes in the evaluation phase

An example of a multilateral organization is: a. United Nations (UN) b. United States Agency for International Development (USAID) c. Project Hope d. Catholic Relief Services

ANS: A A multilateral organization is one that receives funding from multiple governments and nongovernmental sources, which describes the UN. Project Hope and Catholic Relief Services are private voluntary organizations. USAID is funded by one country, the United States.

Nurses who strive to be culturally competent should: a. Respect individuals from different cultures and value diversity. b. Immerse themselves in different cultures. c. Design care for special ethnic groups. d. Give explicit instructions to avoid client decision making.

ANS: A Nurses who strive to be culturally competent respect individuals from different cultures and value diversity. The other answers are false.

Which characteristic is an indicator of community health process? a. Participation and community action b. Live birth rate c. Racial distribution d. Socioeconomic levels

ANS: A Participation and community action are indicators of community health process.

A 5-feet, 6-inch, 25-year-old woman who weighs 120 pounds runs 5 miles a day because it improves her mood and energy level. Which term best describes this example? a. Health promotion b. Illness prevention c. Health maintenance d. Health protection

ANS: A The woman is exercising to improve and promote her health. Health promotion is directed toward achieving a greater level of health.

1. A nurse volunteering at a local homeless shelter notes that many of the clients have acute and chronic illnesses and are in need of primary health care services. The most effective strategy to consider when networking with homeless individuals, families, or populations is to: a. form a community partnership to establish a clinic for homeless persons. b. create a trusting environment and establish a therapeutic relationship. c. collaborate with the local United Way to obtain funding for primary care services. d. dialogue with local clergy to address the unmet primary care need for homeless persons.

ANS: B Nurses need to be able to work with poor and homeless clients to promote, maintain, and restore health. Nurses must be prepared to look at the whole picture: the person, the family, and the community interacting with the environment. In working with the homeless, it is important to create a trusting environment. Trust is essential to the development of a therapeutic relationship with poor or homeless persons. Many clients and families have been disappointed by interactions with health care and social systems. They are now mistrustful and see little hope for change. Establishing a trusting relationship lays the foundation for a more comprehensive assessment of clients' perception of their health care needs and a determination of factors that may contribute to their current health status issues.

When using Anderson and McFarlanes model to complete a community health assessment, a nurse would collect information about the _____ the community. a. Resources available to promote health in b. Interactions among subsystems in c. Physical environment of d. Demographics of

ANS: B A community health assessment must include information about the subsystems and interactions of the total community with the systems external to it.

An example of an agent is: a. Host resistance b. Virus c. Infectiousness d. Bug bite

ANS: B An agent is described by its ability to cause disease and the nature and the severity of the disease.

The United States Department of Health and Human Services (DHHS) is part of which branch of the government? a. Judicial b. Executive c. Legislative d. Health

ANS: B The executive branch includes regulatory departments, one of which is the United States DHHS.

A nurse implements nursing interventions considering the uniqueness of the persons culture. The practice is called cultural: a. Diversity b. Knowledge c. Competence d. Awareness

ANS: C Providing care based on the uniqueness of the clients cultural norms and values is one of the four guiding principles of culturally competent nursing care.

A persons skin color is an example of: a. Multiculturalism b. Ethnicity c. Race d. Culture

ANS: C Race is primarily a social classification that relies on physical markers.

A client comes into the clinic and tells the nurse he goes to an acupuncturist for pain. The nurse says he should take pain medication instead. This would be called cultural: a. Conflict b. Blindness c. Relativism d. Imposition

ANS: D This is an example of cultural imposition, the act of imposing ones cultural beliefs, values, and practices on individuals from another culture.

Stereotyping

Attributing certain beliefs and behaviors about a group to an individual without giving adequate attention to individual differences

Change occurs at several levels. Two key concepts: Community health Partnership for community health

Example: spouse abuse, elder abuse, TB treatment

Implementing for Community Health

Factors influencing implementation Nurse's role Social change process

Cultural Desire

Nurse's intrinsic motivation to provide culturally competent care

Three sources of information about a community:

Other nurse, social workers, or health care providers who are familiar with the dynamics of a given community Community members Your own observations

Community: people and the relationships that emerge among them as they develop and use in common some agencies and institutions and a physical environment

People: the community residents Place: both the geographical and time dimensions Function: the aims and activities of the community

A variety of facilities and providers make up the health care system Example:

Physicians' & dentists' offices, hospitals, managed care organizations, nursing homes, mental health centers, rehabilitation centers, and local, state, and federal official & voluntary agencies

Access: Two-class system:

Private = Those with insurance or who can pay for health care are viewed as receiving superior care Public = Those who depend on public funds Uninsured = working poor who do not qualify for public funds (either make too much money or are illegal immigrants)

Social Organization

Refers to the way in which a cultural group structures itself around the family to carry out role functions

Social & Economic Trends

Rising household incomes Average per-person income is increasing Gap between the richest 25% and the poorest 25% is widening Revised definition of quality health care Economic downturn of 2008 Affordable Care Act

Quality: Institute of Medicine (IOM) reports

To Err Is Human: Building a Safer Health System (IOM, 2000) Keeping Patients Safe: Transforming the Work Environment of Nurses (2003)

A community practice setting is insufficient reason for saying that practice is oriented toward the community client.

When the location of the practice is in the community but the focus of practice is the individual or family, the nursing client remains the individual or family, not the whole community.

Collecting data and monitoring the health status of the population defines which of the core public health functions? a.Assessment b.Prevention c.Assurance d.Policy development

a.Assessment

Providing for the availability of essential personal health services for people who would otherwise not receive health care defines which public health core function? a.Assessment b.Prevention c.Assurance d.Policy development

c. Assurance

6. A community health nurse involved in care management would most likely: a. develop, conduct, and evaluate health teaching programs in primary care. b. manage the staff at a free clinic. c. monitor the health status, resources, and outcomes for an aggregate. d. provide immunizations to migrant workers.

ANS: C Care management is a continuing process in which a case manager establishes systems and monitors the health status, resources, and outcomes for an aggregate—a targeted segment of the population or group.

Which of the following is true about African American nurses in public health? 1.Segregation existed until the 1960s, which made certificate and graduate education more difficult to obtain. 2.Cities were the major areas where they practiced 3. They often belonged to the Frontier Nursing Service. 4.They were recruited heavily as military nurses.

ANS:1 The other statements listed are false.

Cultural Skill

Effective integration of cultural awareness and cultural knowledge to obtain relevant cultural data and meet the needs of culturally diverse clients.

Environmental Control

Relationships between humans and nature

An accomplishment for which the Frontier Nursing Service was noted is: 1. Improvement of the care of sick and injured soldiers 2. Establishment of a fee-for-service program for workers at Metropolitan Life Insurance Company 3. Reduction of infant and maternal mortality regardless of environmental conditions 4. Increasing funding for communicable disease treatment

ANS: 3 The Frontier Nursing Service nurses were trained in nursing public health and midwifery and provided care to rural and inaccessible areas, which led to reduced mortality.

The Elizabeth Poor Law of 1601 is similar to which of the following current laws? 1. Welfare 2. Food Stamps 3. Medicaid 4. Medicare

ANS: 3 The Poor Law guaranteed medical care for poor, blind, and "lame" individuals, similar to Medicaid.

3. A community health nurse is serving as a case manager for premature infants receiving home health care. The case manager arranges for an in-home apnea monitor and daily home visits by a registered nurse who specializes in high-risk pediatrics. The case manager is demonstrating which of the following case manager roles? a. Consultant and coordinator b. Mentor and liaison c. Monitor and reporter d. Standardization monitor and negotiator

ANS: A The case manager is responsible for fulfilling a variety of roles. The nurse is acting as a consultant when working with suppliers to arrange for the apnea monitor. The nurse is acting as a coordinator when arranging for needed heath care services such as daily home visits by a specially trained pediatric registered nurse.

According to Leininger and Watson, the moral ideal of nursing is: a. Caring b. Advocacy c. Responsibility d. Accountability

ANS: A This conceptualization occurred as a response to the technological advances in health care science and the desire of nurses to differentiate nursing practice from medical practice.

An example of an ethical dilemma is: a. Whether or not to set up a community health center in a rural area b. Allocating resources in a natural disaster c. Deciding to withdraw care on a hospice patient d. Applying the principles of Florence Nightingale in Bangladesh

ANS: B When resources are scarce, a dilemma may exist as to how to allocate them.

Which of the following trends in health issues in the United States between 1900 and 1955 is accurate? 1. There was a rise in chronic disease such as heart disease and cancer. 2. There was a rise in communicable disease. 3. The crude mortality rate increased dramatically. 4. The life span after diagnosis remained the same.

ANS: 1 Leading causes of death in 1955 were heart disease and cancer, while in 1900 they were pneumonia and tuberculosis. All other answers are false.

The impact of World War I on public health nursing included which of the following? Select all that apply: 1. Many communicable diseases were eradicated. 2. The depletion of the ranks of public health nurses to the war. 3. The feeling that the greatest patriotic duty was to stay at home. 4. Inadequate funding was the major obstacle to extending nursing services in the community.

ANS: 2, 3, 4 Both World Wars I and II depleted the public health nurse population as nurses went off to war. The feeling of patriotism extended to the idea that patriotic duty could also be served on the home front.

Ruth Freeman was a leading public health educator, administrator, consultant, author, and leader of the National Health Organization of the twentieth century. Which of the following characterize her philosophy of nursing? 1. Nursing should move from acute care to community-based care. 2. Nurse practitioners should control public health. 3. Nursing is about caring for people, and is also intellectually challenging and offers many professional opportunities. 4. All nurses should seek graduate education to increase their credibility.

ANS: 3 Ruth Freeman felt that nursing was about caring for people and was also intellectually challenging and offered many professional opportunities. She did not specifically espouse the other statements.

In 1909, Yssabella Waters published her survey Visiting Nurses in the United States. This document highlighted the fact that: 1.Nurses were trained by Boards of Education. 2.Trained nurses adequately covered less densely populated areas. 3.Visiting nurses services were concentrated in the northeastern quadrant of the nation. 4.Nurses were curing diseases such as tuberculosis and typhoid fever that greatly enhanced their credibility.

ANS: 3 This report emphasized the fact that visiting nurse services were concentrated in the northeast, which underscored the need for rural health.

Which of the following programs provided funds for neighborhood health centers, Head Start, and other community action programs? 1. Medicare 2. Medicaid 3. Social Security 4. Economic Opportunity Act

ANS: 4 Funding for neighborhood health centers, Head Start, and other community action programs began in 1964 with the Economic Opportunity Act.

An intervention by the United States federal government to protect the health of its citizens was the establishment of the Marine Hospital Service, presently known as the Public Health Service. Its purpose was to: 1. Set policy on quarantine legislation for immigrants 2. Establish hospital-based programs to care for the sick at home 3. Establish and promote environmental interventions such as adequate housing and sanitation for urban cities 4. Provide health care for merchant seamen to protect seacoast ports and cities from epidemics

ANS: 4 Providing health care to seamen was an early effort by the federal government to improve public health. Its purpose was to secure its maritime trade and seacoast cities.

5. A case manager employed by a health maintenance organization is charged with discontinuing home health services for a disabled homebound elderly client in an effort to reduce costs. The case manager reviews the client's record and determines that home health services are still indicated for this client. The ethical dilemma faced by the case manager is: a. beneficence. b. justice. c. nonmaleficence. d. veracity.

ANS: A Beneficence—"doing good"—becomes an ethical dilemma when the insurer's goal of containing costs supersedes the case manager's duty to improve health and relieve suffering. This ethical tenet of nursing practice to act in the best interest of the client also involves fidelity to the nurse-client trust relationship. Duty to clients to secure benefits on their behalf and to limit unnecessary expenditures can create dilemmas when the goals are not uniform. Advocacy on this client's behalf with accurate and updated information based on sound assessment, evidence-based practice, and liability risk management could produce a favorable outcome for all parties. The incorrect action would be to do nothing.

2. During a home visit, a case manager for a community health center notes marked pitting edema, shortness of breath, and increased fatigue in a 52-year-old male client who lives alone. The client is admitted to the hospital, where he is diagnosed with congestive heart failure. The case manager works with the hospital's utilization manager to devise a discharge plan. The case manager's most logical next step would be to: a. assess the client; obtain information on the scope of services covered by the benefit plan for the client; if needed services are not covered, seek to identify and arrange for the resources to provide these services. b. call the client, reintroduce himself or herself, and explain his or her role as a case manager for homebound clients. c. discuss with the family their schedule of availability to offer care in the client's home; ensure that the client has daily visits by family members. d. investigate the availability of local support and rehabilitation services for clients with congestive heart failure; contact the client's family.

ANS: A Case management has been described as a set of logical steps and process of interaction within a service network that ensures that a client receives needed services in a supportive, effective, efficient, and cost-effective manner. The National Case Management Task Force defines case management as a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services to meet an individual's needs, using communication and available resources to promote quality cost-effective outcomes. Case management has been defined in the public health nursing literature as the establishment of an appropriate plan of care based on assessment of the client/family and coordination of the necessary resources and services for the client's benefit. Therefore, a critical role of the case manager is to help clients obtain the care they need to achieve a maximum level of health. The nurse needs to understand what the client's insurance covers (broker). If necessary services or equipment is not covered by insurance, the nurse may act as an advocate (facilitator) and connect the client with other resources in the community (coordinator) if available.

7. In case management, it is unlikely that any single professional has the expertise, knowledge, or skills required to achieve success. The synergy produced by all involved parties (client, providers, payers, family/significant others, and community organizations) can result in successful outcomes. These statements relate to the sequential process of: a. collaboration. b. communication. c. cooperation. d. negotiation.

ANS: A Collaboration is achieved through a developmental process carried out in a sequence, yet it is reciprocal among those involved. Teamwork and collaboration require extensive skill sets to achieve successful outcomes. No single professional has the expertise required for all aspects. Synergy among all parties involved is required. Although communication is essential to collaboration, it is not sufficient to create or maintain collaboration.

3. A community-oriented nurse is writing a grant application for funding for a nurse-run clinic serving clients with chronic illnesses. The grant application asks for information regarding program benefits, effectiveness, and efficiency. The most effective tool to obtain this information would be: a. cost studies. b. Mobilizing for Action through Planning and Partnerships (MAPP) model. c. Planning Approach to Community Health (PATCH) method. d. Tracer method.

ANS: A Cost studies are essential to show the value of nursing in the marketplace now and in the future. All cost studies involve three major tasks: financial, research, and statistical. The financial tasks include identifying total program costs. The statistical tasks include identifying appropriate, quantifiable measures for analyzing data. The research tasks include setting up an appropriate study design to answer questions about benefit, efficiency, or effectiveness. Types of cost studies include cost-accounting, cost-benefit, cost-effectiveness, and cost-efficiency studies.

6. Community health nurses conducting health education among populations vulnerable to HIV infection should explain the natural history of the infection, including the fact that HIV infection may go undetected during the primary infection stage because: a. antibody test results are typically negative. b. antibody production by the immune system increases. c. incubation period is prolonged. d. symptoms include myalgias, sore throats, and rash.

ANS: A Individuals may experience flu-like symptoms such as lymphadenopathy, myalgias, sore throat, lethargy, rash, and fever during the primary stage of HIV infection. Results of an antibody test during this phase are usually negative, so the illness often is not recognized as HIV infection. After a variable period of time, commonly 6 weeks to 3 months, HIV antibodies appear in the blood and can be used to confirm the presence of HIV infection

4. A woman comes to the community health center complaining of increasing lower abdominal pain, fever, and abnormal menses for several months. During the assessment, the client indicates that she is aware that her husband has had multiple sex partners in the past 2 years. Appropriate intervention by the nurse would be to: a. arrange to have the client referred for medical evaluation for pelvic inflammatory disease (PID) and appropriate intervention and treatment. b. contact the health department to confirm the spouse's diagnosis of Chlamydia infection to determine the client's exposure, give the client antibiotics, and have her return to the clinic if symptoms worsen. c. provide STD prevention and treatment education and refer the client to the health department for STD screening for gonorrhea and/or Chlamydia infection. d. supply the client with nonsteroidal anti-inflammatory drugs and caution her to call the after-hours call doctor if her symptoms worsen.

ANS: A Nursing assessment should always include taking a comprehensive sexual history to determine an individual's potential risk for STDs. Each sexual partner is potentially exposed to all the STDs of all the persons with whom their partner has been sexually active. PID is a serious infection involving the fallopian tubes and is the most common complication of gonorrhea, but it may also result from chlamydial infections. Symptoms include fever, abnormal menses, and lower abdominal pain. Symptoms can vary among women. PID can cause ectopic pregnancy, and this should be ruled out in all cases. Stillbirth, premature labor, and infertility are also possible complications.

6. The nurse engaging in a formative program evaluation would most likely: a. conduct medical record audits for quality assurance. b. make a home visit before a client is discharged from the program. c. participate in a new client evaluation. d. write a policy for risk management.

ANS: A Process evaluation, also referred to as formative evaluation, occurs during program implementation and makes it possible to make midterm corrections to ensure the achievement of program goals. Process evaluation is an ongoing function of examining, documenting, and analyzing the progress of a program. This type of program monitoring can be used to justify continuing the program, because it will address the efficiency and effectiveness of the program in meeting its goals. Quality assurance programs are examples of program evaluation in health care delivery.

5. The clients most at risk of reactivation of latent infections of tuberculosis (TB) are: a. immunocompromised persons, substance abusers, and those with diabetes. b. individuals previously treated for TB. c. long-term cigarette smokers. d. persons with new-onset asthma or emphysema

ANS: A Reactivation of latent TB infections later in life is common, and the incidence rises in immunocompromised persons, substance abusers, underweight and undernourished individuals, and those with diabetes, silicosis, or gastrectomy.

7. Local officials have requested a program evaluation of a comprehensive teen sex education program offered in the local schools in preparation for annual budget-planning discussions. The public health nurse (PHN) determines that the teen pregnancy rate has gradually declined over the years that the program has been in place. The nurse has also identified the evaluation plan that was articulated during the program planning phase. The best tool for demonstrating the efficiency of this program is: a. cost-benefit analysis. b. cost-efficiency analysis. c. relevance assessment. d. school records audit.

ANS: A The efficiency of a program can be evaluated through a formative or summative evaluation. The evaluator may be able to determine whether a given program provides better benefits at a lower cost than a similar program, or whether the benefits to the clients justify the costs of the program (efficiency). Public health programs are usually recognized as having a net positive impact, and appropriate sex education can reduce the incidence of teen pregnancy by altering teen sexual behaviors. To perform a cost-benefit study, the evaluator must decide which costs and which benefits are to be included, how the costs and benefits are to be valued, and what constraints are to be considered (e.g., legal, ethical, social, and/or economic). Health programs involving politically sensitive issues such as teen sex education can benefit from the articulation of measures to determine costs, benefits, and constraints in the program planning phase.

Which statement about Florence Nightingale's ideas about ethics is correct? a. Nursing is a call to service, and the moral character of persons entering nursing is important. b. Ethical principles are based on the values of the individual nurse. c. Society will dictate the ethical principles to which nurses must adhere. d. Ethics are very important in times of war, such as in the Crimean War, when she set up public health centers.

ANS: A Florence Nightingale saw nursing as a call to service and viewed the moral character of persons entering nursing as important.

Examples of the benefits of distributive justice are: a. Basic needs, material and social goods, liberties, rights, and entitlements b. Taxes, military service, location of incinerators or power plants c. Entitlement to equal rights and equal treatment d. The right to private property and personal assets

ANS: A Justice requires that the distribution of benefits and burdens on a society be fair or equal. the third option refers to egalitarianism, and the last option refers to libertarianism. Taxes, military service, and location of incinerators or power plants are not benefits associated with justice.

In the past, community-oriented nurses have been called: a. District nurses b. Almshouse nurses c. Soldier nurses d.Sisters

ANS: A In the past, community-oriented nurses have been called public health nurses, district nurses, visiting nurses, school nurses, occupational health nurses, and home health nurses.

10. Which of the following are the major sources of information for program evaluation? (Select all that apply.) a. Community indices b. Media reports c. Program clients d. Program providers e. Program records

ANS: A, C, E Both quantitative and qualitative methods may be used to conduct an evaluation. However, the strongest evaluation designs combine both qualitative and quantitative methods. Major sources of information for program evaluation are the program clients (especially user satisfaction information), program records (especially clinical records), and community indices (epidemiologic data).

8. The community planning board is attempting to determine if the clients and health care providers affected by a recent mental health outreach initiative are satisfied that the program interventions have accomplished the program objectives and that clients have benefited from this program. The analysis model that is best designed to provide an estimate of costs to achieve an outcome is: a. cost-benefit analysis. b. cost-effectiveness analysis. c. cost-efficiency analysis. d. Multi-Attribute Utility Technique.

ANS: B An evaluation of program effectiveness may help determine whether both providers and clients are satisfied with program activities, as well as whether the program met its stated objectives. A cost-effectiveness analysis is a subset of a cost-benefit analysis and is designed to provide an estimate of the costs to achieve a given outcome. Such an analysis can answer several questions: Did the program meet its objectives? Were the clients and providers satisfied with the effects of the interventions? Are things better as a result of the interventions? In cost-benefit analysis, both the cost and outcomes are quantitative. In cost-effectiveness analysis, the outcomes are both qualitative (satisfaction) and quantitative (cost).

9. The insurer's risk manager has informed an independently contracted case manager that a liability risk related to experimental treatment and technology was identified in a recent recommendation made by the case manager. Which of the following is the best example of action by a case manager that might be associated with potential liability risk related to experimental treatment and technology? a. Inappropriately recommending that treatment be curtailed when treatment was actually needed b. Failing to apply the contractual definition of "experimental" treatment found in the client's insurance policy c. Substituting the case manager's clinical judgment for that of the insurer's medical director d. Upcoding intensity of care or intervention requirements

ANS: B For case managers, liability concerns exist when three conditions are met: (1) the provider had a duty to treat (i.e., provide reasonable care); (2) a breach of contract occurred through an act of omission; and (3) the act of omission caused injury or damage to the client. Five general areas of risk are liability for managing care, negligent referrals, use of experimental treatment or technology, breach of confidentiality/security, and fraud and abuse. With regard to the use of experimental treatment and technology, the case manager is obligated to apply the contractual definition of "experimental" treatment found in the client's insurance policy (certificate of coverage), because this a legally binding document between the insurer and the insured.

7. A client comes to the local clinic with acute symptoms of fever, nausea, lack of appetite, malaise, and abdominal discomfort. During the course of the assessment, the nurse determines that the client is a health care aide working at a daycare center. These facts are important because: a. acute hepatitis B is self-limiting. b. hepatitis A outbreaks commonly occur in facilities where staff change diapers. c. hepatitis C is a "silent stalker." d. individuals with chronic liver disease are at greater risk for hepatitis A.

ANS: B Hepatitis A virus is most often transmitted through the fecal-oral route. It remains the most frequently reported vaccine-preventable disease. Outbreaks are common in daycare centers where staff must change diapers, among household and sexual contacts of infected individuals, and among travelers to countries were hepatitis A is endemic.

8. Many behaviors place any individual—regardless of age, gender, ethnicity, or other characteristics—at greater risk for STDs. The nurse should include primary prevention interventions in all client encounters through the discussion of: a. partner notification. b. safer sex. c. standard precautions. d. STD testing

ANS: B Sexual abstinence is the best way to prevent STDs; however, for many people it is not realistic. Therefore, education about how to make sexual behavior safer is critical. Safer sexual behavior includes masturbation, dry kissing, touching, fantasy, and vaginal or oral sex with a condom. Nurses should not base assessments on considerations of age, gender, ethnicity, or any other factor, but should discuss safe sex in all client encounters.

3. A nurse is assigned to teach clients STD prevention information. The nurse updates her teaching plan to incorporate new guidelines from the Centers for Disease Control and Prevention. She includes which of the following as updated information during her next teaching session? a. Always use spermicides with condoms to reduce the risk of contracting chlamydia or gonorrhea. b. Condoms can be effective in preventing infections transmitted by fluids from mucosal surfaces but are not always effective in preventing infections transmitted by skin-to-skin contact. c. Condoms should not be used during oral sex, because they are not effective in preventing transmission of infection. d. When genital ulcers are present, condoms should be used to prevent the spread of infection.

ANS: B The lesions of HSV-2 and HPV infection as well as other lesions capable of transmitting STDs can occur on all parts of the male and female genitalia and rectum. Condoms are effective in reducing transmission via body fluids from the penis and vagina. However, lesions not covered by a male or female condom can still transmit infection even with proper condom use

4. When planning a new community health center, a nurse will integrate knowledge of the nursing process and program management. The nurse's initial and most critical step for funding purposes would be: a. finding the lay leaders in the community. b. identifying the target population's health problems and needs. c. outlining the major causes of mortality in the community. d. prioritizing the community's problems.

ANS: B The program management process is parallel to the nursing process and consists of a rational decision making system designed to help nurses know when to make a decision to develop a program (assessment and problem identification); where they want to be at the end of the program (goal setting); how to decide what to do to ensure a successful program (planning); how to develop a plan to go from where they are to where they want to be (implementation); how to know that they are getting there (formative evaluation); and what to measure to know that the program has successful outcomes (summative evaluation). Planning for effective and efficient programs must be based on determination of the needs of populations within the community. Identification of at-risk groups and documentation of the health needs of the targeted population provide the basic justification and rationale for the proposed program plan. Such documentation of needs is essential if funding will be sought to implement the plan. An assessment of health needs may be approached as either a community assessment or a population needs assessment.

2. A community health nurse is conducting a community assessment as part of a program planning initiative and is seeking a tool that is low cost, allows clients to participate in identification of need, and would stimulate community support for the program. The nurse would most likely use which of the following? a. Community forum b. Focus group c. Indicators approach d. Survey

ANS: B There are several types of needs assessment tools, including community forums, focus groups, key informants, indicators approach, survey of existing agencies, and general surveys. Both community forums and focus groups are low-cost tools. The focus group provides clients with the opportunity to participate in identification of needs and can help increase community support for a program. The focus group method has several disadvantages, such as being time consuming to carry out and tending to focus on irrelevant or political "hot button" issues. Leading focus groups requires strong skills in group process to maintain the focus of the group.

A nurse believes everyone is entitled to equal rights and equal treatment in society when applying: a. Distributive or social justice b. Egalitarianism c. Libertarian view of justice d. Communitarianism

ANS: B Egalitarianism is defined as the view that everyone is entitled to equal rights and equal treatment in society.

An orderly process that considers ethical principles, client values, and professional obligations is: a. Accountability b. Ethical decision making c. Moral principles d. Code for Nursing Practice

ANS: B Ethical decision making is defined as an orderly process that considers ethical principles, client values, and professional obligations.

A nurse in the 1960s would have referred to which code of ethics to guide ethical decision making? a. Nightingale Pledge b. Code for Professional Nurses c. Code of Ethics for Nurses with Interpretive Statements d. International Council of Nurses (ICN) Code of Ethics for Nurses

ANS: B Florence Nightingale lived in the 1800s. The Code for Professional Nurses was adopted in 1950, the Code of Ethics for Nurses with Interpretive Statements was adopted in 2001, and the International Council of Nurses (ICN) Code of Ethics for Nurses was adopted in 2000.

Which ethical principle requires doing no harm? a. Respect for autonomy b. Non-maleficence c. Beneficence d. Distributive justice

ANS: B Non-maleficence refers to doing no harm.

Which statement fits the Liberal Democratic Theory of John Rawls? a. Rejection of any idea that societies, states, or collectives of any form can be the bearers of rights or can owe duties. b. Inequalities result from birth, natural endowment, and historic circumstances. c. Everyone has a right to private property. d. Government should be limited.

ANS: B Rawls acknowledges that inequities are inevitable in society, but he tries to justify them by establishing a system in which everyone benefits, especially the least advantaged. This is an attempt to address the inequalities that result from birth, natural endowments, and historic circumstances. The other choices relate to libertarianism.

1. Advantages of community health program planning include ensuring that available resources are used to meet the needs of the population and: a. applying for grants. b. identifying clients and soliciting board members' support. c. identifying resources, activities, and needs. d. increasing the visibility of the program.

ANS: C Community health program planning is population focused and puts the well-being of the public above private interests. Systematic planning for meeting the needs of populations in a community has benefits for clients, nurses, employing agencies, and the community. It ensures that available resources are used to address the actual needs of people in the community, focuses attention on what the organization and health provider are attempting to do for clients, identifies resources and activities that are needed to meet the objectives of client services, reduces role ambiguity by giving responsibility to specific providers to meet program objectives, reduces uncertainty within the program environment, increases the ability of the provider and agency to cope with the external environment and anticipate events, allows for quality decision making, and provides better control over the actual program results. Identifying clients, soliciting board support, applying for grants, and promoting the actual program are steps in the implementation phase of program management.

9. The nurse program manager is determining the direct client care costs as well as the cost of indirect nursing activities for home visits for a home health agency. Analysis of this information along with nursing workload information and client needs can best provide an agency evaluation measure for: a. program decision making. b. cost-effectiveness. c. cost-efficiency. d. perceived value.

ANS: C Cost-efficiency analysis determines the actual cost of performing a number of program services, both direct and indirect, by addressing the productivity of the workforce in achieving specific objectives. The relationship between direct and indirect activities, workforce, caseloads, client needs, and actual costs determines the productivity of the program.

2. A client newly diagnosed with HPV infection, herpes simplex virus 2 (HSV-2) infection, and syphilis asks, "Okay, so how do I get rid of all this stuff?" In developing a plan of care, the nurse recognizes that it is essential to address: a. correct use of condoms to prevent transmission of all STDs. b. cures for each of the STDs identified. c. risk of skin-to-skin contact in transmitting the identified STDs. d. safety of sexual contact in the absence of lesions.

ANS: C The client needs to understand which STDs are transmitted by skin-to-skin contact and which are transmitted by body fluids. The client also needs to understand which infections are curable with antibiotics (syphilis) and which are virus infections that are treatable but not curable (HPV, HSV-2 infections). In HSV-2 infection, although the ability to pass the infection is higher when active lesions are present, some individuals can spread the infection even when they are asymptomatic. HPV transmission occurs through direct contact with the warts that result from HPV, but the virus has also been detected in semen, and exposure to the virus through body fluids is also possible. In addition, the challenge of HPV prevention is that condoms do not necessarily prevent infection because warts can grow in areas that are not covered by barriers such as condoms and skin-to-skin contact may occur.

5. A nurse who is the program director for a new antismoking campaign is developing a written program plan that will include the program's goals, priorities, objectives, budget, and timelines. Before implementation of the program, the written program plan should also address which of the following? a. Cost-benefit analysis b. Perspectives on the program c. Plan for the evaluation process d. Process evaluation

ANS: C When the planning process begins, the plan for evaluating the program should also begin. Everyone who will be involved in implementing a program should be given the opportunity to play a role in planning for program evaluation. Assessment of need is one component of evaluation. Once needs have been established and the program is designed, the nurse must continue plans for program evaluation, such as ongoing process evaluation (formative evaluation) and summative evaluation.

When using the principles of virtue ethics in decision making, a nurse would: a. Provide efficient and effective nursing care. b. Identify the meaningful facts in the situation. c. Seek ethical community support to enhance character development. d. Plan ways to restructure the social practices that oppress women.

ANS: C According to Aristotle, virtues are acquired and include interest in the concept of the good, including benevolence, compassion, trustworthiness, and integrity. One part of the process is seeking ethical community support to enhance character development.

There are two medically indigent clients in the clinic who have come to get their monthly supply of free insulin. There is only enough for one client. Which action does the nurse take first? a. Identify all options. b. Make a decision. c. Gather additional information. d. Act and assess decisions made.

ANS: C One must have all information before looking at options and making a decision.

The steps of the ethical decision making process are similar to the steps of: a. Healthy People 2010 b. Deontology c. The nursing process d. Advocacy

ANS: C The nursing process involves the same basic steps: assessment, diagnosis, planning, implementation, and evaluation.

1. A home health case manager is charged with identifying opportunities for health promotion and illness prevention. The fulfillment of this charge would best be demonstrated when the case manager: a. collaborates with a local chaplain to ensure that the spiritual needs of cancer clients are addressed. b. refers a new diabetic client to a nutrition counselor for dietary teaching. c. teaches a school nurse how to care for a client who will be returning to school and will require new asthma treatments. d. tracks the immunization status of clients and facilitates access to immunization when needed.

ANS: D Case management involves assessment—in this case, screening—and arrangement for delivery of services. Primary prevention includes case management to identify at-risk clients and arrange for services to prevent disease. Through nurse management activities, general community deficiencies in the quality or quantity of health services are often discovered. Case management activities with individual clients and families will reveal the broader picture of health services in and health status of the community. Community assessment, policy development, and assurance activities that frame the core functions of public health actions are often the logical next step in the nurse case manager's practice to intervene at the community level to make changes. Therefore, the core components of case management and the nursing process are complementary. The nursing process function of assessment is complementary to the case management process function of case finding and includes such activities as applying screening tools according to program goals and objectives.

1. A school nurse is teaching a class of sophomores about the relationship between the risk of sexually transmitted disease (STD) and risk-taking behaviors. A key point to include is: a. all STDs are easily preventable with consistent condom use. b. once a young woman is pregnant, she is no longer at risk for most STDs. c. STDs are most likely to be transmitted during a student's initial sexual encounter. d. use of alcohol and drugs makes a student more likely to make decisions that result in exposure to and infection with STDs.

ANS: D Drug use is linked to STD transmission because drugs such as alcohol lower inhibitions and impair judgment about engaging in risky behaviors. Addictions to drugs may cause individuals to acquire the drug or money to purchase the drug by performing sexual favors. This increases both the frequency of sexual contacts and the chances of contracting STDs. Adolescents are particularly at risk. Not all STDs are preventable through condom use. The challenge of preventing human papillomavirus (HPV) infection (genital warts) is that condoms do not necessarily prevent infection because warts may grow in areas that barriers such as condoms do not cover and skin-to-skin contact may occur

9. A population-level tertiary prevention intervention typically carried out by nurses caring for those with communicable disease in the community is: a. HIV test results counseling. b. needle exchange. c. partner notification. d. instruction in standard precautions.

ANS: D Teaching caregivers about infection control in home care is vital. The nurse treating the client with HIV infection in the home environment should teach caregivers about standard precautions. Some clients, families, friends, and others may have concerns about the transmission of HIV infection. Others who may not have concerns about transmission may fail to take adequate precautions or believe myths that they cannot become infected.

8. Members of an extended family are in conflict over the treatment plan for the family's 90-year-old matriarch, who has developed indications of advanced dementia. The case manager is using conflict resolution strategies to allow the parties involved to develop trust, credibility, and distance from the issue at hand, as well as to retain personal dignity. The nurse is demonstrating a knowledge of the strategic process of: a. advocating. b. clarifying. c. cooperating. d. negotiating.

ANS: D Techniques for conflict management involve a range of active communication skills. These skills are directed toward learning all parties' needs and desires, detecting their areas of agreement and disagreement, determining their abilities to collaborate, and assisting in discovering alternatives and activities for reaching the goal of mutual benefit with limited loss. Negotiating is a strategic process used to move conflicting parties toward an outcome and has several stages that allow the parties to develop trust, credibility, and distance from the issue, while retaining personal dignity. All of these factors are important when attempting to move parties toward the creation of new solutions or options through relearning, brainstorming, reflective thinking, and problem-purpose-expansion techniques (systematic problem solving approaches).

4. A community health nurse is the case manager for a homebound client recovering from a hip replacement. The nurse works with the client and his family to prioritize needs and services, and to address these care needs. These activities represent which step in the nursing process? a. Assessment and planning/outcome b. Diagnosis and planning c. Implementation d. Planning/outcome

ANS: D The case management process function of problem prioritizing and planning to address care needs is complementary to the planning/outcome step of the nursing process.

When nurses apply the knowledge and processes of ethics to the examination of ethical problems in health care, they are using: a. Values b. Morality c. Ethics d. Bioethics

ANS: D Bioethics applies the knowledge and processes of ethics to the examination of ethical problems in health care.

The growing multiculturalism of American society can contribute to ethnicity conflicts when: a. Cultural standards are congruent with professional standards. b. Cultural traditions within an ethnic group align with those of the community. c. Ethnic groups overburden the health care system. d. The greater communitys values are jeopardized by specific ethnic values.

ANS: D Callahan offered perspectives on judging diversity and suggests a thoughtful tolerance and some degree of moral persuasion (not coercion) for ethnic groups to alter values so that they are more in keeping with what is normative in American culture.

Which statement about feminist ethics is correct? a. Feminists include only women in their worldview. b. Persons who ascribe to feminist ethics are passive and wish to pursue their ideals through the legislative process. c. Feminists believe that men should not be nurses. d. Womens thinking and moral experiences are important and should be taken into account.

ANS: D Feminist theory ascribes to the idea that womens thinking and moral experiences are important and should be considered.

1. A nurse performing home hospice case management notes the increasing number of hospice clients who lack caregivers in the home environment. The nurse identifies the potential need for a hospice house facility to meet the needs of these clients. The case management process frequently reveals larger picture issues such as which of the following?(Select all that apply.) a. Community cost concerns b. Community conflict resolution skills c. Community satisfaction d. Community weaknesses in quality of services e. Community weaknesses in quantity of services

ANS: D, E Case management activities with individual clients and families very often reveal the larger picture of health services and health status of a community. General community weaknesses in the quality and quantity of services often are discovered. The nurse can then intervene at the community level to initiate changes. In this case, the nurse identified a deficiency in the quality of hospice services to individuals who did not have a caregiver in the home environment and the parallel concern of the lack of hospice-related facilities to meet the needs of these clients to achieve a quality dying process.

The American Red Cross, through its Rural Nursing Service, improved living conditions in villages and isolated farms. Which of the following is an example of the resourcefulness of a nurse of this era? 1.Using hot bricks, salt, or sandbags to substitute for hot water bottles 2.Testing well water for pollutants 3.Teaching school and developing curricula for rural nursing programs 4.Providing post-surgical care

ANS:1 In providing medical care, rural nurses were resourceful in finding alternatives when they did not have medical products that were available in urban areas.

In the late 1800s, local health departments were formed in urban areas for what purpose? 1.To target environmental hazards associated with crowded living conditions and dirty streets and to regulate public baths, slaughterhouses, and pigsties 2.To facilitate interdisciplinary efforts and promote the "practical application of nursing" 3.To provide immunizations to all citizens 4.To provide public health education for nurses who had finished basic "training school" education

ANS:1 Local health departments were formed to handle environmental issues in cities.

During America's Industrial Revolution, the number of jobs for women rapidly increased. Nightingale's successes became known across the United States, and the first nursing schools opened. Which of the following occurred related to public health nursing? 1.Community-oriented nursing began with organizations formed to meet urban health care needs. 2.Nurses were instrumental in the construction of sewers and public water systems. 3.Nurses trained in hospitals worked long hours caring for patients with communicable diseases in a humane way. 4.Nurses closed down almshouses and orphanages.

ANS:1 The visiting nurse became the key to health care in urban areas. Although nurses were involved in interventions to improve sanitation and nutrition, they were not instrumental in their construction. Nurses worked in hospitals, but that was acute care. Almshouses and orphanages were not closed down at this time.

Lina Rogers became the first school nurse. Early school nursing focused on: 1.Investigating causes of absenteeism such as malnourishment and lack of shoes or clothing 2.Teaching school as well as being a nurse 3.Starting the first school of public health 4.Providing medical treatment to enable children to return to school

ANS:1 Early school nursing focused on investigating causes of absenteeism, not providing medical treatment. That was the responsibility of physicians.

Florence Nightingale's contributions to public health included: 1.Caring for the sick, poor, and neglected in institutions and at home 2.Using a population-based approach that led to improvements in environmental conditions 3.Writing the Elizabethan Poor Law to guarantee medical care for all 4.Founding of the district nursing association to provide health care to needy people

ANS:2 During the Crimean War, Nightingale progressively improved the soldiers' health by adopting a population-based approach that used simple epidemiological measures and greatly decreased mortality.

Lillian Wald invented the term public health nursing. Which of the following classes might a person of her day attend? 1.Taking and recording blood pressures accurately 2.Safe and sanitary baby and child care 3.Environmental pollutants and their effects on lung disease 4.Time management: balancing factory work and the home

ANS:2 Lillian Wald provided health care that included educating the community on health care matters.

The National Organization for Public Health Nursing was formed in 1912. Lillian Wald was its first president. The mission was to improve the educational and services standards of the public health nurse and promote public understanding. Which of the following is a contribution of this organization? 1.Requiring that public health nurses have a baccalaureate degree in nursing 2.Standardization of public health nursing education 3.Development of nursing cooperatives 4.Opening of the Henry Street Settlement

ANS:2 The National Organization for Public Health Nursing sought to standardize public health nursing. The Henry Street Settlement was already in existence. The baccalaureate degree in nursing was not developed yet.

Threats to health from communicable diseases, the environment, chronic illness, and the aging process have changed over time. The newer threats to health in the United States that community health nurses are currently faced with include: 1.Diphtheria, cholera, and typhoid fever 2.HIV, AIDS, and bioterrorism 3.Avian flu, tuberculosis, and radiation 4.Polluted water and air

ANS:2 The newer threats to health that public health nurses are involved in are HIV, AIDS, and bioterrorism. Choice #1 lists threats of the past. Avian flu may be a threat, but radiation and tuberculosis are ongoing. Polluted water and air are generally not seen in the United States.

The Frontier Nursing Service was established by Mary Breckinridge to emulate systems of care used in the Highlands of Scotland. Her biggest contribution was: 1.Establishment of the Henry Street Settlement 2.Development of health programs geared toward improving the health care of the rural and often inaccessible populations 3.Blazing a nursing trail through the Rockies, providing nursing care to miners and their families 4.Teaching birth control measures to large numbers of women in the South

ANS:2 Mary Breckenridge developed health programs geared toward improving the health care of the rural and often inaccessible populations in the Appalachian regions of southern Kentucky. Lillian Wald established the Henry Street Settlement.

Early colonial health efforts in the United States included: 1.Establishment of schools of nursing 2.Development of vaccines given to large numbers of people 3.Collection of vital statistics, improved sanitation, and control of communicable diseases introduced through seaports 4.Development of public housing and almshouses

ANS:3 The other choices are events that happened after the colonial period.

Occupational health nursing began as industrial nursing. What was the purpose of this type of nursing? 1.Inventing new machines to streamline production of medical goods 2.Investigating industrial injuries to improve work conditions 3.Working at industrial sites treating work related-injuries 4.Providing care for factory workers and their families

ANS:4 Early occupational health nursing did not provide care for work-related injuries, but instead focused on the care of employees and their families in the home.

Lillian Wald was the first public health nurse in the United States. Which of the following is her major contribution to public health nursing? 1. Founding the American Nurses Association 2.Establishment of the New York Training Hospital for Nurses 3.Establishment of the Public Health Service 4.Establishment of the Henry Street Settlement that later became the Visiting Nurse Service of New York

ANS:4 Lillian Wald established the Henry Street Settlement.

A nursing student during World War II would likely join which group? 1.The Public Health Service of New York City 2.The Marine Nurse Corps 3.The Frontier Nursing Service 4.The Cadet Nurse Corps

ANS:4 The Bolton Act of 1943 established the Cadet Nurse Corps during World War II, which increased enrollment in schools of nursing at undergraduate and graduate levels.

Cultural Conflict

Perceived threat that may arise form a misunderstanding of expectations between clients and nurses when either group is not aware of cultural differences

Race

Primarily a social classification that relies on physical markers such as son color to identify group membership

Cultural Nursing Assessment

Systematic way to identify the beliefs, values, meanings, and behaviors of people while considering their history, life experiences, and the social and physical environments in which they live

Cultural Blindness

Tendency to ignore all differences among cultures, to act as though these differences do not exist, and as a result to treat all people the same (when a person has unique needs)

5. A community-oriented nurse has identified obesity as a problem in the middle school. The next step in a population-focused practice is to make information available about the health of the middle school students. This describes the core public health function of: a. assessment. b. assurance. c. policy development. d. research.

ANS: A Assessment is a core function of public health and refers to systematically collecting data concerning the population, monitoring the population's health status, and making information available on the health of the community. In a community-oriented approach, a nurse would apply both nursing and public health theory. In this case, assessment would be the first step from the perspective of both theories. Because the practice is population focused and community oriented, it would involve the assessment of the community subpopulation of middle school children and the impact of obesity on their overall health status.

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. Cognitive Level: Application Associated Chapter Objective: 7 REF: pp. 1002-1003

7. A nurse planning a smoking cessation clinic for adolescents in the local middle schools and high schools is providing: a. community-oriented care. b. community-based care. c. secondary care. d. tertiary care.

ANS: A Community-oriented nurses emphasize health promotion, health maintenance, and disease prevention, as well as self-reliance on the part of clients. Regardless of whether the client is a person, family, or group, the goal is to promote health through education about prevailing health problems, proper nutrition, beneficial forms of exercise, and environmental factors such as the safety of food, water, air, and buildings.

8. A community-oriented nurse conducts home visits to new parents to assess the health status of the infant, the parent-child relationship, the parents' knowledge regarding the care of the infant, and the need for health department and social services referrals to support the needs of the new parents and the infant. This can best be described as an example of: a. clinical community health practice. b. community-based practice. c. population-focused practice. d. public health nursing.

ANS: A Community-oriented nurses who provide direct care services to individuals, families, or groups are engaging in a clinically oriented practice even when they apply concepts of population-focused, community-oriented strategies along with their direct care clinical strategies.

4. A nurse providing a tertiary prevention intervention to a population of women who are HIV positive will most likely: a. educate about self-care and the women's rights as employees. b. establish a partnership with a community to initiate a community health center. c. help identify new cases and ensure that clients receive proper treatment. d. teach how to lobby state legislators.

ANS: A Helping clients understand their rights to protect from on-the-job discrimination is part of the nurse-advocate role. Tertiary prevention includes educating women with a chronic disease such as HIV about self-care strategies and health-promotion activities to minimize risky behaviors and poor health outcomes. Enhancing levels of self-esteem and empowerment can prevent feelings of powerlessness and hopelessness, which contribute to vulnerability.

6. A recent movie release portrays a female drug user living with her abusive boyfriend, who has two children by different women, in a rundown inner city neighborhood with high levels of poverty and unemployment. This portrayal best describes the influence of which class of factors on societal responses to poverty and homelessness? a. Cultural b. Environmental c. Political d. Social

ANS: A Individual perceptions of poverty and poor persons are rooted in social, political, cultural, and environmental factors. Societal responses to poverty and homeless persons (what actions are taken to assist them) are deeply rooted in history, and that history has helped to shape cultural attitudes. Cultural attitudes affect, and are affected by, the discourses in various media. Portrayals of poor people as lazy and shiftless folk, desperate persons, criminals, and slackers living off of public assistance influence what we believe to be true about poor persons.

Which medication would a nurse administer to a client diagnosed with tuberculosis? a. Isoniazid b. Nevirapine c. Amodiaquine d. Bacille Calmette-Gurin (BCG)

ANS: A Isoniazid is one of several chemotherapeutic medications used to treat tuberculosis. Nevirapine is used to decrease the likelihood of maternal transmission of HIV-AIDS. Amodiaquine is one of several medications used to treat malaria. Bacille Calmette-Gurin is a vaccine that has been promoted as effective in inducing active immunity against tuberculosis.

8. Congress passed the Balanced Budget Act of 1997 with provisions intended to ensure the appropriateness of home health services for those who received them; however, the act may have increased health disparities for vulnerable populations such as: a. frail older adults. b. low-income families with newborns. c. poor clients discharged from acute care. d. clients requiring intravenous antibiotics.

ANS: A One objective of the balanced Budget Act of 1997 was to curb the rapid growth of home health spending and financial fraud in the home health industry following a shift of hospital reimbursement methods in 1982 (Tax Equity and Fiscal Responsibility Act) through the adoption of prospective reimbursement for home health services. The act's more stringent regulations regarding which services will be reimbursed and for how long may limit access to care for certain vulnerable groups, such as frail older adults, chronically ill individuals whose care is largely home based, and people who are HIV positive.

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. Cognitive Level: Analysis Associated Chapter Objective: 8 REF: p. 994

9. A cultural belief and an environmental factor that may increase the risk of potential pesticide exposure for some migrant workers are: a. hot-cold balance and housing. b. cuarentena and distance from health care services. c. need to achieve high productivity and transportation challenges. d. disease causality and proximity to the farm fields.

ANS: A Some migrant workers may not shower when they return from the fields as a result of cultural beliefs about being exposed to cooler water while feeling hot from working. Inadequate housing that lacks showers and/or adequate laundry machines also prevent farmworkers from washing pesticides off themselves and their clothing in a timely manner. This exposes the farmworker and the entire family to the risk of pesticide exposure.

The blueprint or code that is used to construct other components of cells is called the: a. DNA b. Gene c. Chromosome d. Base

ANS: A The DNA is the chemical inside the nucleus of the cell that has the genetic instructions for making living organisms. This can be compared to a blueprint or code that is used to construct other components of cells.

8. When working with the poor or homeless, to develop effective nursing interventions the nurse should evaluate clients and populations in the context of: a. environment. b. improvement in the quality of services. c. human dignity. d. nursing theories.

ANS: A The foundation of nursing theories is the assumption that human beings have inherent dignity and worth. Nursing is based on valuing individuals, promoting health, respecting and restoring dignity, and improving the quality of life of individuals, families, and aggregates. Conflicts in values, beliefs, and perceptions often arise when nurses work with persons from different social, cultural, and economic backgrounds. A lack of agreement between the professional's and the client's perceptions of need can lead to conflict. As a result of this conflict, clients may fail to follow the prescribed treatment protocol. The nurse may then inaccurately interpret the client's behavior as resistance, lack of cooperation, or noncompliance. Nurses should evaluate clients and populations in the context of the environment to develop effective nursing interventions. Care must be multidimensional and should include consideration of biological, psychological, social, political, cultural, environmental, economic, and spiritual factors.

6. A community health nurse directly contacts a mammography clinic to arrange an appointment for a migrant worker with limited English language skills. The nurse communicates with the client through an interpreter to ensure that the appointment is scheduled to meet her needs and that the client understands the procedure to be performed. The role played by the nurse in this encounter with a member of a vulnerable population can best be described as: a. advocacy. b. empowerment. c. partnership. d. social justice.

ANS: A The nurse functions as an advocate when referring clients to other agencies and ensuring that the clients' preferences are accommodated.

6. The state public health agency has received multiple complaints regarding the availability of elder transportation services to a specific county senior center. The state agency assigns a public health nurse to work with the community to evaluate its program for elder transportation services to publicly sponsored eldercare programs. The public health core function applied is: a. assurance. b. policy development. c. primary prevention. d. public transportation.

ANS: A The public health core function of assurance focuses on the responsibility of public health agencies to be sure that activities are appropriately carried out to meet public health goals and plans. This involves making sure that essential community-oriented health services are available and accessible, especially to vulnerable populations who would otherwise not receive necessary services. Assurance also includes assisting communities to implement and evaluate plans and practices.

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. Cognitive Level: Analysis Associated Chapter Objective: 2 REF: p. 1000

7. A nurse case manager identifies a potential health outcomes concern for a 1 year old with special needs living in an impoverished neighborhood, because this child is at increased risk for: a. developmental delays. b. ear infections. c. frequent colds and infections. d. irritability.

ANS: A Young children (0-5 years of age) are at highest risk for the most harmful effects of poverty. Good nutrition during the first years of life is crucial for normal cognitive development. Unfortunately, many children live in poverty during their early childhood years. The brain is directly affected by environmental stimulation during a critical time that extends from the prenatal period through early childhood. Among the risk factors that impede cognitive development in young children are inadequate nutrition, maternal substance abuse, maternal depression, environmental hazards, trauma, and abuse. Unfortunately, poor children often have greater exposure to risk factors such as these. Poverty increases the likelihood of chronic diseases, injuries, traumatic death, developmental delays, poor nutrition, inadequate immunization levels, iron-deficiency anemia, and elevated blood lead levels.

A visitor from Japan comes to the United States for a two-week vacation. This person is known as a: a. Non-immigrant b. Refugee c. Legal immigrant d. Lawful permanent resident

ANS: A A non-immigrant is admitted for a limited duration for a specific purpose.

A nurse working in the 1970s would have applied genetic concepts by: a. Providing genetic counseling to those with genetic disorders b. Educating clients about using genetic testing for risk identification c. Explaining the purposes of the Human Genome Project to clients d. Facilitating referrals for specialized genetic services for clients

ANS: A In the 1970s, nurses working in genetics provided genetic counseling to persons with genetic diseases or risk factors for such disorders. The other activities performed by the nurse did not occur until the 1990s.

A public health nurse uses Assumption 2, Public health nursing practice focuses on populations, to guide practice. Which would be considered a population of interest? a. Healthy school children b. Homeless individuals c. A person recently diagnosed with diabetes d. Teenage parents

ANS: A A population is a collection of individuals who have one or more personal or environmental characteristics in common. Populations of interest are populations that are essentially healthy but could improve factors that promote or protect health; one such population is healthy school children. Homeless individuals and teenage parents would both be considered a population at risk. A person recently diagnosed with diabetes is not a population.

A nurse is providing education to a mother about the importance of having her infant immunized for measles, mumps, and rubella. This immunization will provide what type of immunity? a. Active b. Passive c. Natural d. Acquired

ANS: A Active immunity refers to the immunization of an individual by administration of an antigen (infectious agent or vaccine) and is usually characterized by the presence of an antibody produced by the individual host.

The relationship between nursing practice, health policy, and politics can best be described as nursing: A. advocacy. B. policy process. C. process. D. profession.

ANS: A Advocacy begins with the art of influencing others (politics) to adopt a specific course of action (policy) to solve a societal problem and is accomplished by building relationships with appropriate policy makers—the individuals or groups that determine a specific course of action to be followed by a government or institution to achieve a desired end (policy outcome). This can be done in many ways. Types of advocacy include actions on behalf of clients served by nursing, especially vulnerable populations; activities of the nursing profession itself; work to develop needed health policies or revise existing policies; and actions related to the community.

A nurse schedules an appointment with a physician who has a practice in the community to learn more about the communitys beliefs regarding childhood immunizations. This is known as: a. Informant interview b. Participant observation c. Secondary analysis d. Windshield survey

ANS: A An informant interview is a method of community data collection that involves directed conversation with selected community members.

A nurse is teaching a postpartum mother how to breastfeed her infant. The nurse notes that the mother is alert and agrees that breastfeeding is important to her and beneficial to her baby. The nurse outlines the expectations of breastfeeding for the mother and the baby. Considering the events of instruction, what should the nurse do next? a. Ask the mother about her previous experience with breastfeeding. b. Demonstrate how to position the baby for breastfeeding. c. Show the mother a video about breastfeeding. d. Have the mother demonstrate breastfeeding.

ANS: A Asking the mother about her previous experience with breastfeeding identifies her educational needs. Using the TEACH mnemonic, the first thing the nurse should do is Tune in: listen before starting to teach; the clients needs should direct the content.

Change for the community as client must often occur at several levels because: a. Health problems caused by lifestyle are multidimensional. b. Most individuals can change their habits alone. c. Aggregates are responsible for social change. d. Geographic areas often have health risks that the nurse must identify.

ANS: A Because health problems caused by lifestyle cannot be solved simply by asking individuals to choose healthy habits, change for the community client must often take place at several levels.

Research has shown that Asian men tend to have a greater sensitivity than white Europeans to codeine, and they experience significantly weaker effects from the drug. This is an example of cultural variations of: a. Biological variations b. Space c. Social organization d. Time perception

ANS: A Biological variations are the physical, biological, and physiological differences that exist between racial groups and distinguish one group from another.

Which event would be considered the result of bioterrorism? a. Outbreak of smallpox b. Bombed historic buildings c. Explosion of land mines d. Threats of war

ANS: A Bioterrorism is a term used to describe the deliberate release of viruses, bacteria, or other germs (agents) used to cause illness or death in people, animals, or plants.

One effect of the use of block grants was a: a. Reduction of federal expenditures b. Decreased ability of states to spend money on programming c. Guaranteed continuation of programs with demonstrated effectiveness d. Shift from hospital-based to community-based nursing care

ANS: A Block grants enabled financial responsibility to shift from the federal level to the state level, thereby reducing expenditures.

Which of these statements is true about the disability-adjusted life years (DALYs) in lesser-developed countries? a. Communicable diseases account for the greatest percentage. b. Diarrheal disease and respiratory infections are rampant despite technology. c. Injuries account for most disability. d. Birth control methods are often lacking.

ANS: A Communicable diseases account for the greatest percentage of calculated DALYs in lesser-developed countries.

The levels of practice encompassed by the Intervention Wheel are: a. Communities, individuals and families, and systems b. Assessment, diagnosis, and evaluation c. Primary, secondary, and tertiary d. Communities, populations, and aggregates

ANS: A Communities, individuals and families, and systems are the three levels of public health nursing practice.

After identifying the boundaries of a community, what is the next step the nurse should take in completing a community assessment? a. Gather relevant existing data and generating missing data. b. Plan interventions that benefit the entire community. c. Formulate nursing diagnoses. d. Evaluate the interventions that were used.

ANS: A Community assessment includes gathering relevant existing data and generating missing data.

The state orders a person newly diagnosed with tuberculosis to be quarantined. What type of law allows the state to do this? a. Constitutional b. Common c. Judicial d. State

ANS: A Constitutional law provides overall guidance for selected practice situations.

When a nurse focuses intervention strategies on the structural dimension of community health, they are directed toward: a. Health services b. Primary prevention c. Health promotion d. Secondary prevention

ANS: A Intervention strategies include service use patterns, treatment data from various health agencies, and provider/client ratios.

A nurse applies genetic and genomic knowledge when completing a client assessment by: a. Constructing a pedigree from a collected family history b. Identifying a client who may benefit from genetic counseling c. Referring a client to specialized genetic services d. Incorporating knowledge of genomic risk factors

ANS: A Constructing a pedigree from a collected family history demonstrates assessment in the nursing process. Identification is demonstrated by identifying a client who may benefit from genetic counseling. Referral is demonstrated by referring a client to specialized genetic services. Provision of education, care, and support is demonstrated by incorporating knowledge of genomic risk factors.

To meet a clients needs, it is sometimes necessary to integrate into the clients care a culturally relevant practice that lacks scientific utility. This is known as cultural: a. Accommodation b. Brokering c. Preservation d. Repatterning

ANS: A Cultural accommodation refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help people of a particular culture to accept nursing strategies, or to negotiate with nurses to achieve satisfying health care outcomes.

Which format would be most appropriate for teaching a group of nursing students who are learning to give injections? a. Demonstration b. Health fair c. Lecture d. Nonnative language session

ANS: A Demonstration also includes return demonstration. Giving injections can best be learned by seeing the behavior being done.

When a local health department provides a hypertension screening to all individuals, which general category of health care functions is being used? a. Direct services b. Financing c. Information d. Policy setting

ANS: A Direct services are actions that provide health care directly to individuals.

A public health nurse collaborates with a physicians clinic to increase the number of infants and toddlers who receive lead screening. According to the integrative model, what client system and focus of care are being addressed? a. Aggregate level health promotion b. Aggregate level illness prevention c. Family level illness care d. Individual level health promotion

ANS: A Each succeeding level of the client system is more complex. In this situation, the public health nurse is working with an aggregate of infants and toddlers. The focus of care being addressed is health promotion, focusing on positive measures such as education for healthy living and promotion of favorable environmental conditions as well as periodic examinations, including well-child developmental assessment and health education.

What is the purpose of the color-coded wedges on the Intervention Wheel? a. The interventions are grouped together in related wedges. b. The wedges consist of referral information for each wedge. c. The element of health teaching is the predominant feature of each wedge. d. Coalition building must be implemented with each wedge.

ANS: A Each wedge consists of related interventions. The other answers describe some of the individual wedges.

Which statement about education is true? a. It emphasizes the provider of knowledge and skills. b. It emphasizes the recipient of knowledge and skills. c. It is a process of gaining knowledge and expertise. d. It results in behavioral change.

ANS: A Education is the establishment and arrangement of events to facilitate learning.

A nurse believes that the best treatment for illness is the use of Western medicine and alternative therapies should not be used for healing. This is an example of: a. Ethnocentrism b. Cultural imposition c. Racism d. Stereotyping

ANS: A Ethnocentrism is the belief that ones own cultural group determines the standards by which another groups behavior is judged.

An example of an explicit cultural behavior is: a. Verbal communication b. Body language c. Use of titles d. Perception of health and illness

ANS: A Explicit behaviors are straightforward and do not leave room for misinterpretation of what the person wants to communicate, such as when using verbal communication. Implicit behaviors are less exact and may be difficult to interpret, including body language, use of titles, and perception of health and illness.

The Genetic Information Nondiscrimination Act (GINA): a. Protects individuals from discrimination based on their genetic information b. Allows health insurance companies to deny coverage for pre-existing conditions c. States employers may collect genetic information from employees as needed d. Requires employees to report genetic disorders to their employer

ANS: A GINA was designed to prohibit the improper use of genetic information in health insurance and employment. It protects individuals from discrimination based on their genetic information, prevents denial of coverage based solely on genetic predisposition to disease, and limits disclosure of genetic information.

The Healthy Communities and Cities initiative supports the idea that: a. Healthy cities and communities must be both environmentally and socially sustainable. b. Health public policy is the responsibility of elected officials. c. Physical environments cannot be changed, thus strategies must be developed in order to cope with them. d. The World Health Organization is the primary source of information for cities.

ANS: A Healthy cities and communities must be both environmentally and socially sustainable through a strategy of primary care.

When completing a community assessment, the nurse will: a. Identify community needs and clarify problems. b. Determine the weaknesses of a community. c. Perform the core functions of public health nursing. d. Assess individual needs within a community.

ANS: A In a community assessment, one of the core functions is a logical, systematic approach to identifying community needs, clarifying problems, and identifying community strengths and resources.

A member of the military receives health care services through which department? a. Defense b. Labor c. Agriculture d. Justice

ANS: A The Department of Defense delivers health care to members of the military, including their dependents and survivors, and to retired members and their families.

Multilateral organizations: a. Receive funding from multiple sources b. Control the spread of disease c. Feed the people of the world d. Use nurses as their main source of information

ANS: A Multilateral organizations are those that receive funding from multiple government and nongovernment sources. The other items are specific to the agencies listed, but do not include all of the organizations.

It is important that nurses are involved in health policy because: a. Government and policy have a large impact on nursing and health. b. Policy affects nursing values as set forth by Florence Nightingale. c. Political science is a course of study that parallels nursing. d. Nurses must interpret laws to fit their practice.

ANS: A Nurses should be advocates for the health of the population. In order to do this, nurse professionals must have a working knowledge of government, health care law, the policy process, and the political forces that are shaping the future of health care.

An occupational health nurse maintains a log of injuries from contaminated sharps because of the: a. Bloodborne Pathogen Standard b. Occupational Safety and Health Administration (OSHA) c. Department of Labor (DOL) d. Department of Defense (DOD)

ANS: A OSHA is part of the Department of Labor. The Bloodborne Pathogen Standard became effective in 2002.

A diabetic client reports to the nurse that she has been learning more about controlling her blood sugars by reading information found on the Internet. Which statement by the nurse would be most appropriate? a. Looking at the date the content was posted on the website is important. b. The Internet is an unreliable source of information and should not be used. c. The best sources of information are found on pharmaceutical websites. d. Your physician will provide you better information than the Internet.

ANS: A One of the ways to assess the reliability and validity of Internet sources is to look at its currency, including the dates when the content was posted and updated.

An example of a measurable outcome health status indicator at the individual-level of practice that would be used by a public health nurse is: a. A 50-year-old woman receives annual mammograms b. School absences in a community decline c. Teachers have increased awareness of health problems d. Those in poverty utilize the free mammogram program

ANS: A Outcome health status indicators are used to measure the impact of the interventions on population health. In this case, a 50-year-old woman receiving an annual mammogram will have an impact on the population health when considering those who are receiving the screening. The other examples do not look at population health as an outcome or are not occurring at the individual-level.

An example of a point source of air pollution is: a. A smoke stack b. The number of cars and trucks c. How much fossil fuel is consumed in a community d. Ground ozone levels

ANS: A Point sources of pollution are identifiable sources of air pollution, such as a smoke stack.

Why is it important for nurses to understand the premises of environmental health? a. Nurses should be able to assess risks and advocate for policies that support healthy environments. b. Toxicologists often consult nurses about environmental pollutants. c. Pollutant exposures such as lead are reported by nurses to the Environmental Protection Agency. d. Many Americans live in areas that do not meet current national air quality standards.

ANS: A Potential risks to health are concerns for professional nurses. It is the responsibility of the nurse to understand as much as possible about these risks: how to assess them, how to eliminate/reduce them, how to communicate and educate about them, and how to advocate for policies that support healthy environments.

A nurse is presenting information to the county health department about potential bioterrorism threats. Which of the agents would the nurse discuss in this presentation? a. Smallpox b. West Nile Virus c. Severe acute respiratory syndrome (SARS) d. Novel influenza A H1N1

ANS: A Susceptibility to smallpox is 100% in the unvaccinated and fatality rate is estimated at 20% to 40% or higher. The agents of highest concern are anthrax, plague, smallpox, botulism, tularemia, and selected hemorrhagic viruses.

Several community-oriented nurses want to explore the problem of obesity in school-age children and assess their community school district's health status related to that problem. When gathering information at a national level, they would begin with the: A. Centers for Disease Control and Prevention. B. Centers for Medicaid and Medicare Services. C. Health Resources and Services Administration. D. National Institute of Nursing Research.

ANS: A The Centers for Disease Control and Prevention serve as the national focus for development and application of measures to advance disease prevention and control, environmental health, and health promotion, and for educational activities designed to improve the health of the people of the United States. The mission of the Centers for Disease Control and Prevention is to promote health and quality of life by preventing and controlling disease, injury, and disability.

A nurse uses the Codes of Ethics developed by the International Council of Nurses and the American Nurses Association when: a. Providing confidential genetic testing for a client b. Advocating for the inclusion of genetic content in a nursing curriculum c. Considering the pros and cons of an ethical dilemma d. Becoming competent in genomics

ANS: A The Codes of Ethics include in this mandate the right that people have to seek and receive genomic heath care that is nondiscriminatory, confidential, private, and that enables those served to make informed decisions.

The agency most heavily involved with the health and welfare concerns of United States citizens is the: a. Unites States Department of Health and Human Services (DHHS) b. Public Health Service c. Health Resources and Services Administration d. World Health Organization

ANS: A The DHHS is the agency most heavily involved with the health and welfare of United States citizens. It touches more lives than any other federal agency.

The Guide to Clinical Preventive Services provides: a. The most recent recommendations for preventive interventions b. Assistance in interpreting Healthy People 2020 c. A basis for public health nursing practice d. Health risk appraisal instruments

ANS: A The Guide to Clinical Preventive Services provides recommendations for preventive interventions including screening tests, counseling, immunizations, and chemoprophylaxis.

Which statement about the Intervention Wheel is true? a. It provides a graphic illustration of population-based public health practice. b. It describes in detail the components of public health nursing. c. It demonstrates the practice of community health nurses for policy and lawmakers. d. It is a framework used by all health departments in the United States.

ANS: A The Intervention Wheel provides a graphic illustration that gives public health nurses a means to describe the full scope and breadth of their practice.

When a nurse understands the significant impact that genetic testing can have on an individual and family, the nurse is meeting a competency identified by the: a. National Coalition of Health Professional Education in Genetics (NCHPEG) b. Centers for Disease Control and Prevention c. American Nurses Association d. International Council of Nurses

ANS: A The NCHPEG identifies one competency of health care professionals as being able to understand that health-related genetic information can have social and psychological implications for individuals and families.

The intergovernmental organization that focuses its efforts on assisting countries in Latin America is the: a. Pan American Health Organization b. World Bank c. World Health Organization d. United Nations Childrens Fund

ANS: A The Pan American Health Organization serves as a regional field office in Latin America for the World Health Organization.

Which project would most likely receive funding from the World Bank? a. Development of a sanitation system b. Improvement of roads and bridges c. Creation of a national health insurance plan d. Recovery efforts following a hurricane

ANS: A The World Bank lends money to lesser-developed countries so that they might use it to improve the health status of their people. Projects include control and eradication of disease, providing safe drinking water and affordable housing, developing sanitation systems, and encouraging family planning and childhood immunizations.

A nurse who uses such data as minutes from a community meeting is using: a. Secondary analysis b. Informant interviews c. A survey d. A windshield survey

ANS: A The data is secondary because it is collected by someone else.

A nurse is working with a group of clients with diabetes and is teaching a class about avoiding the long-term effects of diabetes. The nurse begins the class by reviewing the basic physiology of diabetes, which was taught the week before. This nurse is providing effective education by: a. Stimulating recall of prior learning b. Gaining attention c. Presenting the material d. Providing learning guidance

ANS: A The educator should have the learners recall previous knowledge related to the topic of interest.

When working with an immigrant population, the first step the nurse should take is: a. Be aware of ones own culture. b. Become familiar with traditional practices of the immigrants. c. Try to see things from the immigrants viewpoint. d. Learn to speak the language of the immigrant population.

ANS: A The first statement is the only one that is correct.

When a school nurse reports suspected child abuse, there is a breach of confidentiality. This breach is allowed because of: a. Civil immunity b. Sovereign immunity c. Nurse practice act d. Respondeat superior

ANS: A The law mandates that a health professional breach patient confidentiality norms to protect someone who may be in a helpless or vulnerable position.

Examples of modifiable behaviors include: a. Smoking, poor diet, and alcohol consumption b. Cancer, emphysema, and cardiovascular disease c. Walking, running, and aerobic exercise d. Genetic abnormalities

ANS: A The leading causes of death in 2000 were tobacco use, poor diet, physical inactivity, and alcohol consumption. These are modifiable behaviors.

The main characteristics of partnership are: a. Awareness, flexibility, and distribution of power b. Rights, responsibilities, and consensus c. Commitment, participation, and articulation d. Collaboration, advocacy, and utility

ANS: A The main characteristics of partnership are being informed, flexibility, and negotiated distribution of power.

Which statement about the nursing workforce is true? a. The nursing workforce is overwhelmingly Caucasian. b. The number of minority nurses meets the needs of the countrys demographics. c. The nursing workforce has many unauthorized immigrants. d. Refugees make up a large part of the nursing workforce in some areas.

ANS: A The nursing work force is 81.8% Caucasian. The other statements are false.

Why would a nurse perform a community assessment as part of the Community Health Promotion Model? a. To become more acquainted with the multiple factors that influence health status b. To survey the people in the community about their wants and needs c. To allow special interest groups a say in health policy d. To provide a narrow focus for the committee work

ANS: A The purpose of including a community assessment in the implementation of the Community Health Promotion Model is to become more acquainted with the multiple biological, behavioral, social and physical factors that describe and influence health status of residence. The assessment provides the frame of reference for identifying the communitys strengths, needs, and resources.

During a class on newborn care given at a local health department, a nursing student asks the participants to practice with baby dolls. Which step of promoting effective education is the student using? a. Eliciting performance b. Assessing performance c. Enhancing retention and transfer of knowledge d. Gaining attention

ANS: A The step of eliciting performance includes encouraging the learners to demonstrate what they have learned.

A nurse providing care using the idea of servicing citizens, not customers is applying the: a. Ethical tenets of policy development b. Basic concepts of the feminist theory c. Underlying premise of virtue ethics d. Components of distributive justice

ANS: A There are three tenets of both policy and ethics. The approach is based on the voice of the community as the foundation on which policy is developed.

Nurses are available to provide health services for women and children due to the provisions of the: a. Sheppard-Towner Act b. Public Protection of Maternity and Infancy program c. Early Periodic Screening and Developmental Testing (EPSDT) program d. Women, Infants, and Children (WIC) program

ANS: A This act also offered well-child and child-development services, provided adequate hospital services and facilities for women and children, and provided grants-in-aid for establishing maternal and child welfare programs.

The nurse labels a patient an alcoholic because of his ethnicity. This is called: a. Stereotyping b. Prejudice c. Racism d. Ethnocentrism

ANS: A This is an example of ascribing certain beliefs and behaviors about a given racial and ethnic group to an individual without assessing for individual differences.

The goal of the Healthy Communities and Cities initiative is to: a. Promote health through community participation. b. Reorganize the current health care system. c. Maximize the cost-benefit ratio of health care. d. Improve the quality of care in communities.

ANS: A This leads to addressing the health and quality of life for all through a process that includes diverse citizen participation, mobilization of all sections of the community, and community ownership.

A Mexican American mother insists on using special candles to help her daughters ear infection. The nurse asks the mother if she would also give her daughter antibiotics. This is called cultural: a. Accommodation b. Repatterning c. Brokering d. Awareness

ANS: A This means that the nurse supports and facilitates the use of cultural practices with interventions from the biomedical health care system. Cultural accommodation refers to assistive, supportive, facilitative or enabling nurse actions and decisions that help clients of a particular culture accept nursing strategies, or negotiate with nurses to achieve satisfying health care outcomes.

The basic science applied to understanding the health effects associated with chemical exposures is: a. Toxicology b. Pharmacology c. Chemistry d. Environmental epidemiology

ANS: A Toxicology is the study of the health effects associated with chemical exposures.

A large portion of foreign-born residents of the United States: a. Work in service-producing and blue-collar sectors b. Reside in rural areas c. Have language barriers d. Are refugees and non-immigrants

ANS: A Two thirds of the foreign-born population lives in or around major metropolitan areas and works in mainly service-producing and blue-collar sectors. They are also more likely to be poorer. The majority of foreign born are legal immigrants (85%).

An example of a vertical transmission of a disease is through: a. Breast milk b. Sexual transmission c. Mosquitoes d. Contaminated food

ANS: A Vertical transmission is the passing of infection from parent to offspring via sperm, placenta, milk, or contact in the vaginal canal at birth.

Which intervention is being performed on the individual level? Select all that apply. a. Teaching well-balanced nutrition to a mother with a malnourished child b. Providing a parent age-specific information for immunizations c. Assessing the community for other cases of malnutrition d. Assessing other families on the same street for similar problems

ANS: A, B Teaching well-balanced nutrition and age-specific information about immunizations are the only interventions that focus on individuals. The other examples relate to families and the community.

According to the CDCs Genomic competencies for the public health workforce, all public health workers should be able to (select all that apply): a. Demonstrate basic knowledge of the role that genomics play in disorders. b. Make appropriate referrals to those with more genomic experience. c. Counsel individuals about their genetic susceptibility for particular disorders. d. Recommend appropriate genetic screening tests for clients.

ANS: A, B The CDCs Genomic competencies for the public health workforce apply to all public health professionals. All public health workers should demonstrate basic knowledge and be able to make appropriate referrals. The other statements would not be true of competencies of all public health workers.

A nurse may define a community as a(n) (select all that apply): a. Social group determined by geographic boundaries b. Group of people who share common values and interests c. Group of people defined by their interactions d. Individual with a specific health concern

ANS: A, B, C Community can be defined as many things, including a social group determined by geographical boundaries, a group of people who share common values and interests, and a group of people defined by their interactions.

The cornerstones of public health nursing practice (select all that apply): a. Focus on the health of the entire population b. Reflect community priorities and needs c. Promote health through strategies driven by epidemiological evidence d. Are grounded in an ethic of collaboration

ANS: A, B, C Cornerstones of public health nursing practice focus on the health of the entire population, reflect community priorities and needs, promote health strategies driven by epidemiological evidence, and are grounded in social justice. Nursing is grounded in an ethic of caring

A public health nurse working with a family living in poverty recognizes that they are more likely to be exposed to environmental hazards because they have (select all that apply): a. Limited funds to pay for health care b. Poor nutrition c. Homes located closer to hazardous waste sites d. Less education

ANS: A, B, C Families living in poverty are more likely to experience environmental justice issues such as disproportionate environmental exposures. Sub-standard housing, living closer to hazardous waste sites, working in more hazardous jobs, poorer nutrition, and less access to quality health care all contribute to this issue. Although limited education is related to poverty, it is not discussed as causing an increase in environmental exposure.

What principle(s) were used in the creation of the Healthy Cities movement? Select all that apply. a. Primary care b. Equity in health promotion c. Community participation d. High technologic environments

ANS: A, B, C The Healthy Cities movement was based upon the principles of primary care, equity, health promotion, and community participation.

When delivering safe and effective nursing care, the nurse must consider the significance of which factor(s) in the development of disease? Select all that apply. a. Genetics b. Lifestyle c. Environment d. Technology

ANS: A, B, C The knowledge of human genetics can improve the safety, quality, and effectiveness of care for clients. It is important for nurses to understand the predisposition to disease as well as the impact of behavior and social conditions on overall community health and well-being. Many genetic disorders have an environmental link.

According to the Ottawa Charter for Health Promotion, the areas for health promotion action include (select all that apply): a. Creating supportive environments b. Developing personal skills c. Building healthy public policy d. Reorienting health services

ANS: A, B, C, D Creating supportive environments, developing personal skills, building healthy public policy, and reorienting health services are all areas for health promotion action identified by the Ottawa Charter for Health Promotion in 1986.

Congress's legal base for actions in health care include (select all that apply): a. Providing for the general welfare b. Raising funds to support research c. Regulating commerce among the states d. Providing spending power

ANS: A, B, C, D The legal base for actions in health care includes providing for the general welfare, regulating commerce among the states, providing spending power, and raising funds to support the military.

Which elements of surveillance does a nurse use? Select all that apply. a. Mortality registration b. Epidemic field investigation c. Laboratory reporting d. Individual case investigation

ANS: A, B, C, D There are 10 basic elements of surveillance. Mortality registration, epidemic field investigation, laboratory reporting, and individual case investigation are among them

A nurse is planning a refugee outreach clinic at the neighborhood health center. To provide culturally competent care, the nurse should consider that (select all that apply): a. Their own background, beliefs, and knowledge may be significantly different from those of the people receiving care. b. Language barriers may interfere with efforts to provide assistance. c. Certain risk factors may be present for a given population. d. Certain groups may use non-traditional healing practices.

ANS: A, B, C, D When working with immigrants it is important to be aware of ones own beliefs, realize that language barriers may exist, that different populations experience different risk factors and illnesses, and that non-traditional healing practices may be used.

State and federal statutes and regulations affect the health care specialties of home health and hospice practice. A primary motivator for nurses to become knowledgeable about these statutes and regulations is their impact on nursing practice in which of the areas below? (Select all that apply.) A. Documentation of client status and progress B. Documentation of services C. Living wills and advance directives D. Resident's rights in long-term care facilities E. Right to death with dignity

ANS: A, B, C, D, E State laws specify licensure and certification requirements for home health care and hospice agencies. Compliance with these laws is directly linked to the method of payment for the services. For example, a service must be provided by a licensed and state-certified agency to obtain payment from Medicare. Federal regulations implementing Medicare and Medicaid programs have an enormous effect on much of nursing practice, including documentation practices and recording of visits, client care, status, and progress. Other laws focus on issues such as the right to death with dignity, the rights of residents in long-term care facilities, definitions of death and death pronouncement, and the use of living wills and advance directives.

1. Effects of homelessness on health care outcomes can be devastating and may include which of the following? (Select all that apply.) a. Higher incidence of acute and chronic disease b. Higher risk of physical trauma c. Crisis-oriented health care, usually in emergency departments d. Reduced eligibility for entitlement/assistance programs e. Lack of awareness of care options

ANS: A, B, C, E Homelessness is correlated with poor health outcomes. The incidence of acute and chronic illness, acquired immune deficiency syndrome (AIDS), and trauma is significantly higher among homeless persons. Although homeless persons are at higher risk for physiological problems, they have greater difficulty accessing health care services. Health care is usually crisis oriented and sought in emergency departments, and those who access health care have a hard time following prescribed regimens. Health problems of homeless clients are often directly related to poor preventive health care services. In addition to facing challenges related to self-care, homeless people usually give lower priority to health promotion and health maintenance than to obtaining food and shelter. They spend most of their time trying to survive. Just getting money to buy food is a major challenge. Although some homeless persons are eligible for entitlement programs such as Temporary Assistance for Needy Families (TANF), Women, Infants, and Children (WIC), or Social Security, others must beg for money, sell plasma or blood products, steal, sell drugs, or engage in prostitution. Barriers to treatment include lack of awareness of treatment options, lack of available space in treatment facilities, inability to pay for treatment, lack of transportation, nonsupportive attitudes of service providers, and lack of coordinated services.

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. Cognitive Level: Synthesis Associated Chapter Objective: 1 REF: p. 998

To manage the public health aspects of a bioterrorist event, nurses need to understand (select all that apply): a. Medical management and public health measures b. The names and descriptions of the agent/disease c. The chemical features of the pathogens d. How to address mental health concerns

ANS: A, B, D Nurses need to understand the names of the pathogens and the disease they cause, the medical management and public health measures (so that accurate information can be disseminated), and how to help people cope with their feelings.

When conducting an effective educational program, a nurse would use which basic principle? Select all that apply. a. Use a clear, succinct style. b. Use an active voice. c. Refer to Internet sources. d. Use aids to highlight key points.

ANS: A, B, D Reliable sources must be used, and information found on the Internet is not always reliable.

The ethical tenets that underlie the core function of assessment are (select all that apply): a. Competency: the persons assigned to develop community knowledge are prepared to collect data on groups and populations b. Moral character: the persons selected to develop, assess, and disseminate community knowledge possess integrity c. Service to others over self: a necessary condition of what is good or right policy d. Do no harm: disseminating appropriate information about groups and populations is morally necessary and sufficient

ANS: A, B, D Service to others over self is an ethical tenet of policy development. Competency, moral character, and do no harm are the ethical tenets of assessment.

The Centers for Disease Control and Prevention accomplishes its mission by (select all that apply): a. Implementing prevention strategies b. Detecting and investigating health problems c. Dictating world health policy d. Fostering safe and healthful environments

ANS: A, B, D The Centers for Disease Control and Prevention implements prevention strategies, detects and investigates health problems, and fosters safe and healthful environments.

10. 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.

The Millennium Development Goals address (select all that apply): a. Reduction of child mortality b. Eradication of communicable diseases c. Promotion of gender equality and empowerment of women d. Achievement of universal health care access/AIDS, malaria, and other diseases; ensuring environmental sustainability; and developing a global partnership for development.

ANS: A, C The Millennium Development Goals address reduction of child mortality and promotion of gender equality and empower women. Other goals include eradicating extreme poverty and hunger; achieving universal primary education; improving maternal health; combating HIV

7. Health education is often used as a strategy in working with vulnerable populations. The benefits of health education can be greatly affected by the individual's or group's: a. cycle of dependency. b. health literacy. c. level of income. d. race and ethnicity.

ANS: B A new concern for public and community health nurses is whether the populations with whom they work have adequate health literacy to benefit from health education. Health literacy is a measure of the client's ability to read, comprehend, and act on medical instructions. It may be necessary to collaborate with an educator, an interpreter, or an expert in health communications to design messages that vulnerable individuals and groups can understand and use.

1. The population group that is likely to be the MOST vulnerable is: a. children with a family history of sickle cell disease and hypertension. b. homeless pregnant teens in a substance abuse program. c. nNative Americans at risk for diabetes. d. overweight children.

ANS: B A vulnerable population group is a subgroup of the population that is more likely to develop health problems as a result of exposure to risk and to have worse outcomes from these health problems than the rest of the population. That is, the interaction among many variables creates a more powerful combination of factors that predispose the person to illness. Vulnerable populations often experience multiple cumulative risks, and they are particularly sensitive to the effects of those risks. Examples of vulnerable populations of concern to nurses are persons who are poor and homeless, people with special needs, pregnant teens, migrant workers and immigrants, individuals with mental health problems, people who abuse addictive substances, persons who have been incarcerated, persons with communicable diseases and those who are risk, and persons who are human immunodeficiency virus (HIV) positive or have hepatitis B virus or sexually transmitted diseases (STDs).

2. The nurse case manager in a migrant farmworker clinic assesses this vulnerable population from the perspective of occupational and environmental risks related to: a. contaminated water, applied chemicals, and unfamiliar farm equipment. b. naturally occurring plant substances, pesticides, and fear of injury reporting. c. traffic accidents, weather, lack of worker supervision, and inadequate sewage. d. weather, pesticides, and strict enforcement of occupational regulations.

ANS: B Annually agricultural work ranks in the top four most dangerous occupations in the United States. Migrant farmworkers are exposed to weather because they work outside in the elements, very often for long hours, and typically live in inadequate housing. Exposure to both naturally occurring plant substances and applied chemicals such as pesticides places farmworkers at risk of immediate health problems (contact dermatitis, allergies, and conjunctivitis) and long-term health effects (lung diseases and cancer). Workers may not receive adequate training regarding the use of mechanical equipment, and the equipment may not be properly maintained. The workers' low educational level may impede their ability to comprehend essential training or warnings. In most states, migrant farmworkers are not protected by the same occupational health regulations and worker's compensation benefits as workers in other industries. Workers may fear loss of their jobs if they report injuries and may not be able to afford personal protective equipment.

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. Cognitive Level: Application Associated Chapter Objective: 3 REF: pp. 1006-1007

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. Cognitive Level: Analysis Associated Chapter Objective: 6 REF: p. 994

2. Which of the following best represents the concept of homelessness as crisis poverty? a. Man with chronic alcoholism and drug abuse living in a halfway house b. Recently unemployed man evicted from his apartment c. Teenager living on the streets and abusing drugs d. Woman with schizophrenia who is living in a shelter

ANS: B Crisis poverty is a conception of homelessness that views the homeless as people whose lives are generally marked by hardship and struggle. For this group, homelessness is often transient or episodic. Their homelessness may result from lack of employment opportunities, lack of education, obsolete job skills, and/or domestic violence.

5. A migrant worker comes to the migrant health clinic holding the abdomen and complaining of empacho. The nurse may encounter this complaint when dealing with migrant workers who are: a. natives of Guatemala. b. natives of Mexico. c. natives of Panama. d. newly arrived from Haiti.

ANS: B Four common folk illnesses that a nurse may encounter when working with clients from Mexico are mal de ojo (evil eye), susto (fright), empacho (indigestion), and, for infants, caida de moller (fallen fontanel). Symptoms and folk treatments may vary depending on the individual's or family's place of origin in Mexico. When experiencing a folk illness, the traditional Mexican individual would prefer to seek care from a folk healer. The more common healers are curanderos, herbalists, and espiritualistas. The most common herbs used by the folk healers are chamomile (manzanilla), peppermint (yerba buena), aloe vera, nopales (cactus), and epazote. The nurse needs to ask clients what herbs and other remedies they have tried to help with their symptoms. Use of some herbs with prescribed medication may be contraindicated, and the nurse needs to include that information in client counseling. Any client counseling should incorporate awareness of and sensitivity to the client's culture.

9. An unemployed individual with acquired immune deficiency syndrome (AIDS) develops recurrent opportunistic infections that require repeated visits to the health clinic and the purchase of various medications to combat the infections and treat their associated side effects. This best demonstrates how the stress caused by poor health status can be related to: a. barriers to access. b. cascade effects. c. cumulative risk. d. socially based inequity.

ANS: B Poor health status creates stress. Vulnerable populations cope with multiple stressors, and this creates a cascade effect, with chronic stress likely to result. Chronic stress can lead to feelings of hopelessness. Hopelessness results from an overwhelming sense of powerlessness and social isolation that contributes to a continuing cycle of vulnerability. Each factor, such as lack of employment, lack of insurance or underinsurance, the disease process, transportation challenges, limited resources, and complications of treatment can predispose individuals to poor health status. The outcomes of vulnerability reinforce the predisposing factors, which leads to more negative outcomes. This cycle of vulnerability must be broken in order for vulnerable populations to change their health status.

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.

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. Cognitive Level: Analysis Associated Chapter Objective: 4 REF: p. 999

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.

9. Nurses should consider opportunities for population-focused practice that result from the rapid transformation of health care delivery from a medical model to a health promotion/disease prevention model. An example of such opportunity is: a. operator of a nurse practitioner-run urgent care center in a major retail location. b. director of clinical services spanning inpatient and community-based settings that provide a wide range of services to the populations seen by the system. c. clinical director of a home health agency. d. school nurse position in the local high school.

ANS: B The new focus on populations, coupled with the integration of acute, chronic, and primary care occurring in some health care systems, is likely to create new roles for individuals, including nurses, who will span inpatient and community-based settings and focus on providing a wide range of services to the populations served by the system. Such a role might be director of client care services for the health care system, who has administrative responsibility for a large program area. There will be a demand for individuals who can design programs of preventive and clinical services to be offered to targeted subpopulations and for those who can implement such programs.

5. A nurse working in a clinic in an inner city with high poverty and unemployment rates recognizes the need for programs for women because impoverished women are at higher risk for: a. decreased access to social services. b. poorer health status. c. exposure to environmental toxins. d. poorer academic success.

ANS: B The relationship between poverty and health is significant. Poverty presents a formidable obstacle to positive health across the life span. Those in lower income groups have poorer health status, and those with poor health have decreased ability to work and improve their socioeconomic status.

Income level and social networks are examples of: a. Culture b. Development c. Community d. Determinants

ANS: D Determinants are conditions and factors that are important considerations in population health.

When public health nurses conduct an assessment of a communitys health, they a. Define one problem that will be the focus for a year. b. Assess a social network of interacting individuals usually in a defined territory. c. Minimize the effects of health risks and hazards. d. Intervene at the population-level by changing laws and regulations.

ANS: B A community is defined as a social network of interacting individuals, usually concentrated in a defined territory. The community assessment generally results in a lengthy list of community problems and issues. Intervention and minimization do not take place during the assessment phase.

A group of nursing students forms a student nursing association to provide support while they are enrolled in a nursing program. This is known as a community of: a. Place b. Special interest c. Problem ecology d. Function

ANS: B A community of special interest brings members together with common concerns and interests.

The community leaders in a lesser-developed country decide not to tell the citizens of a small village about a chemical spill at a major industrial facility that could produce harmful effects. Which principle are they violating? a. Policy b. Advocacy c. Caring d. Virtue

ANS: B Advocacy requires that the community be properly informed, and this was violated in the above scenario.

Which core function supports the belief that all Americans should receive basic health care services? a. Assessment b. Assurance c. Policy development d. Advocacy

ANS: B Assurance purports that all persons should receive essential personal health services.

An example of a behavior that may be defined by culture is: a. Speaking a dialect of a language in a local region b. Standing when an older adult gets on the bus to give him a seat c. Immigrating to the United States seeking work d. An organizational structure of a cultural group

ANS: B Behaviors may be culturally determined as illustrated in the correct response. This behavior is based on the value of respect of elderly people.

A public health nurse is collecting data about the biological aspects of community health. What data will the nurse collect? a. Race/ethnicity b. Traditional morbidity and mortality rates c. Policy making and social change d. Homicide rates

ANS: B Biological community health is often measured by traditional morbidity and mortality rates, which can be found in The Morbidity and Mortality Weekly Report.

An effect of providing care that is not culturally competent is: a. Enhancement of communication b. An increase in the cost of health care c. Achievement of health indicators d. Improvement in client compliance

ANS: B Care that is not culturally competent may increase health care costs and decrease positive client outcomes.

Environmental health is important to nurses because chemical, biological, and radiological materials are: a. A major cause of global warming b. Often found in the air, water, and products we use c. Frequently linked to the development of chronic illnesses d. Products that nurses work with on a daily basis

ANS: B Chemical, biological, and radiological pollutants are often found in the air we breathe, the water we drink, and the products we use.

A public health nurse is working with a migrant farm worker who has experienced an exposure to a pesticide. When researching pesticides, the nurse looks at the family of the chemical. What similarities are found among chemicals that have been placed in the same family? a. Route of entry into the body b. Actions and associated risks c. Effects that they have on the body d. Potency and toxicity

ANS: B Chemicals are grouped so its possible to understand the actions and risks associated with each group.

A public health nurse uses collaboration, coalition building, and community organizing when: a. Providing case management, referral, and follow-up services with individuals b. Carrying out collective action at the systems or community levels of practice c. Conducting a community assessment d. Implementing primary and secondary prevention strategies

ANS: B Collaboration, coalition building, and community organizing are the interventions often carried out at the systems and community levels of practice. These interventions can be used at all levels of prevention.

When utilizing the Centers for Disease Control and Preventions Healthy Communities Program, a nurse recognizes that a factor that will influence the continuance of this program is: a. Time b. Community participation c. Federal involvement d. Technology

ANS: B Community participation can influence the continuance of the Healthy Communities and Cities movement.

A nurse advocates and intervenes between the health care system and the clients cultural beliefs on behalf of the client. The nurses action is called cultural: a. Accommodation b. Brokering c. Preservation d. Repatterning

ANS: B Culture brokering is advocating, mediating, negotiating, and intervening between the clients culture and the biomedical health care culture on behalf of clients.

A public health nurse (PHN) has identified a need to make amendments to an existing law concerning the tuberculosis health assessment of individuals sentenced to serve jail terms on weekends only because of the gap in treatment accountability and potential health risk to the free-living community. To draw attention to this concern, the nurse has several paths to follow, but the amendment of any existing laws would ultimately be decided by which of the following? A. Executive branch of government B. Legislative branch of government C. Local representative D. Senate hearings

ANS: B Each of the government branches at the federal level, in most states, and at the local level plays an important role in developing and implementing health law and public policy. Concerned citizens have many avenues for addressing issues related to needed laws and regulations as well as existing laws and regulations. However, each branch of government has a separate and important function. The legislative branch identifies problems and proposes, debates, passes, and modifies laws to address identified needs.

A client shares that her grandparents immigrated to the United States from Germany. She has disclosed her: a. Multiculturalism b. Ethnicity c. Race d. Culture

ANS: B Ethnicity represents the identifying characteristics of culture, such as race, religion, or natural origin.

To effectively complete the evaluation phase, the nurse must have: a. Demonstrated the ability to improve the health of the participants b. Developed measureable objectives and goals before implementation c. Encouraged full participation by community members d. Improved the health of the population through the program

ANS: B Evaluation begins in the planning phase, when goals and measurable objectives are established and goal-attaining activities are identified. After implementing the intervention, only the meeting of objectives and effects of the intervening activities have to be assessed.

The levels of government responsible for carrying out the five government health care functions of direct services, financing, information, policy setting, and public protection are: A. federal and state. B. federal, state, and local. C. all, but primarily state and local. D. all, but primarily federal and state.

ANS: B Federal, state, and local governments are responsible for carrying out the five core government health care functions. All levels of government provide direct services, but the targeted populations may vary; for example, at the federal level, the focus is on the members and dependents of the military, whereas the states focus on childhood immunizations. The federal government provides funding for health care education and research. The states provide maternal-child health care services through state-level funding for the poor or near poor. Local governments/organizations provide health care services through funding for free clinics that serve the uninsured. All branches and levels of government collect vital statistics and census data, and conduct health surveys. Governments, agencies, and organizations at all levels make health policy. Functions that protect the public, such as monitoring air and water and regulating food, drug, or animal transportation, are carried out at all levels. Affirmation of a woman's right to reproductive privacy occurred at the federal level (Supreme Court). Requiring vaccinations for school entry occurs at the state level.

Food intoxication is caused by: a. Toxins produced by bacterial growth and chemical contaminants b. Bacterial, viral, or parasitic invasion of food c. Overcooking of meat and produce d. Adding too many spices or ingredients to food

ANS: B Food intoxication is caused by bacterial, viral, or parasitic invasion of food.

When a nurse learns more about the Human Genome Project to better counsel families about the process of genetic testing, the nurse is learning about: a. Genetics b. Genomics c. Genes d. Genetic susceptibility

ANS: B Genomics refers to the study of individual genes to understand the structure of the genome, including the mapping of genes and sequencing the DNA.

Which of the following is an example of a goal? a. Mr. Williams will look at his stoma without disgust each time his ostomy bag comes off. b. Mr. Williams will be able to independently take care of his ostomy bag within three months. c. Mr. Williams will gather all ostomy supplies correctly each time his ostomy bag needs to be changed. d. Mr. Williams will successfully describe to the nurse how to care for his ostomy when he is asked.

ANS: B Goals are broad, long-term expected outcomes. The correct answer describes something that will happen over a long period of time. The other choices describe objectives.

The father of genetics is: a. Charles Darwin b. Gregor Mendel c. James Watson d. Francis Galton

ANS: B Gregor Mendel is considered to be the father of genetics. Charles Darwin expounded on theories of evolution. Francis Galton performed family studies using twins to understand the influence of heredity on various human characteristics. James Watson was the co-discoverer of DNA.

The health priorities in HEALTH21 are based on the concept of: a. Eradication of communicable disease worldwide b. Equality and solidarity with an emphasis on the responsibility for health c. World trade and knowledge sharing about health concerns d. Provisions for the creation of UNICEF

ANS: B HEALTH21 goals are equity and solidarity with an emphasis on the individual's, family's, and community's responsibility for health.

Needle stick legislation clarified the role of employers to: a. Use Universal Precautions when dealing with all patients. b. Select safer needle devices as they became available. c. Provide needle disposal boxes. d. Incinerate all infectious waste including needles.

ANS: B Health care facilities by law have to select safer needle devices and involve employees in identifying and choosing the devices.

Health policy can best be defined as a set course of action to: A. administer public health care programs at the federal level for disaster preparedness, response, and recovery. B. obtain a desired health outcome for an individual, family, group, community, or society. C. support publicly funded health care programs at the local, state, and national levels. D. support health care development and research to improve the health status of citizens.

ANS: B Health policy is a set course of action to obtain a desired health outcome, either for individuals, families, groups, communities, or societies. Policies are made not only by governments but also by institutions such as a health department or other health agency, a family, or a professional organization. Politics plays a role in the development of such policies. Politics is found in families, professional and employing agencies, and governments. Therefore, political activities are used to arrive at a course of action (the policy). Policy is a settled course of action to be followed by a government or institution to obtain a desired end.

One intervention that has been shown to be effective in improving the health status of a population is: a. Decreasing the number of people who need outside resources b. Increasing in the number of children who can attend school c. Increasing the monetary resources that can be used to treat disease and illness d. Improving the ability to pay debt to more developed countries

ANS: B Health status improvement in children can lead to better education that eventually helps the countrys economic growth.

Nurses who use Healthy People 2020 as a guide for education: a. Focus on avoiding cigarette smoking and using alcohol in moderation b. Educate clients using primary and secondary levels of prevention c. Use Blooms taxonomy when planning educational objectives d. Design health fairs aimed at individuals

ANS: B Healthy People 2020 focuses on primary and secondary prevention. Understanding the three learning domains is crucial in providing effective health care.

Immunity is a characteristic of the: a. Agent factor b. Host factor c. Environmental factor d. Epidemiologic triad

ANS: B Immunity refers to species-determined resistance to an infectious agent.

The health policy-making body of the World Health Organization (WHO) released a policy statement on nursing and midwifery in 2013. The important fact for nurses to understand about WHO policy statements is that such statements: A. apply only to underdeveloped countries. B. are guides for in-country initiatives and priorities. C. carry the weight of international law. D. provide mandates for in-country legislatures.

ANS: B In 1946, the WHO was created through a United Nations initiative as a special autonomous organization. The WHO provides services worldwide to promote health, cooperates with member countries in promoting their health efforts, coordinates collaborative activities between countries, and disseminates information on biomedical research and vital international statistics. The World Health Assembly (WHA) is the policy-making arm of the WHO and meets annually. The WHA's health policy work provides policy options for many countries of the world in their development of in-country initiatives and priorities. Although WHA policy statements are very important everywhere, they are guides and not law.

Which behavior would the nurse anticipate when working with an individual with low literacy? a. Asking for additional clarification of materials b. Requesting to read the information later c. Having a high level of motivation d. Being overly dependent on others

ANS: B Individuals with a limited literacy may have a limited vocabulary and general knowledge and do not ask for clarification. They may focus on details and deal in literal or concrete concepts versus abstract concepts. They may select responses on a survey without necessarily understanding them and may be unable to understand math. They may have a low motivation to engage in learning or may drop subtle clues that they cannot read by stating they will look at information later or take it home.

When conducting informant interviews in a small community, the nurse would most likely contact: a. The state department of health for death records b. A local priest for congregation information c. Surrounding communities for crime comparison d. The Centers for Disease Control and Prevention (CDC) for illnesses in the area

ANS: B Informant interviews are methods of directly collecting data. County health department nurses and church officials are often good key informants.

After evaluating learning needs, what is the next step the nurse should take in developing an educational program? a. Consider any potential barriers to learning. b. Establish goals and objectives for the program. c. Select appropriate materials for the program. d. Assess the dynamics of the group.

ANS: B Instructional objectives need to be evaluated before a teaching program is designed.

Public health interventions are implemented with: a. Legislators, policy makers, and community leaders b. Individuals and families, communities, and systems c. Children, adolescents, and adults d. Health departments, public health agencies, and visiting nurses associations

ANS: B It is important to know that public health nurses work with individuals and families, communities, and systems. The other answers may have true parts, but the second option lists the overall groups where public health nurses are intervening.

How can a community health nurse apply the Ethical Principles for Effective Advocacy? Select all that apply. a. Act in the health care providers best interest. b. Keep the client (group, community) properly informed. c. Maintain client confidentiality. d. Carry out instructions with diligence and competence.

ANS: B Keep the client (group, community) properly informed, maintain client confidentiality, and carry out instructions with diligence and competence are ethical principles for effective advocacy

According to Leavell and Clark, primary prevention consists of: a. Health promotion and rehabilitation b. Health promotion and specific protection c. Early diagnosis and prompt treatment d. Health maintenance and early diagnosis

ANS: B Leavell and Clark stated that primary prevention includes health promotion and specific protection from disease.

States have certain continuing education requirements for persons to renew a nursing license. This type of law is called: a. Constitutional law b. Legislation and regulation c. Judicial and common law d. Police power

ANS: B Licensing is regulated by each states nurse practice act as a function of the board of nursing.

A nurse is working in a health department when a patient arrives who has been traveling to South America and has been diagnosed with malaria. The nurse knows: a. The Morbidity and Mortality Weekly Report should be consulted to investigate the rate of malaria in the United States. b. This is a disease that must be reported to the state health department. c. The nurse should take precautions to wear a mask and gown to avoid exposure. d. The patient is very ill and should be sent to the hospital immediately.

ANS: B Malaria is on the list of infectious diseases notifiable at the national level.

A doctoral prepared nurse (PhD) at a university wants to submit a grant to study the impact of a nursing activity on patient outcomes. From which federal agency could this nurse potentially seek funding? a. Centers for Disease Control and Prevention (CDC) b. National Institute of Nursing Research (NINR) c. Department of Health and Human Services (DHHS) d. World Health Organization (WHO)

ANS: B NINR funds the development of the knowledge base of nursing and promotion of nursing services in health care.

Which situation describes the role of a nurse being involved in surveillance? a. Educating clients about influenza immunizations b. Collecting information about occurrence of measles c. Evaluating the effectiveness of a HIV/AIDS prevention program d. Advocating for changes in the national disease reporting requirements

ANS: B Nurses are frequently involved in surveillance by collecting data, making diagnoses, investigating and reporting cases, and providing information to the general public.

Which nursing action demonstrates a nurses involvement in the Community Health Promotion Model? a. Changing public policy b. Establishing a team to conduct evaluation research c. Providing nursing diagnoses for the community d. Revising an objective for Healthy People 2020

ANS: B Nurses may make a contribution to short-term impact evaluation and long-term outcome evaluation to create a knowledge base for community health promotion.

A nurse promotes alliances among organizations for a common purpose. Which public health intervention is being implemented? a. Health teaching b. Coalition building c. Surveillance d. Referral and follow-up

ANS: B One example of coalition building is promoting alliances among organizations for a common purpose.

One of the main purposes of the Patient Protection and Affordable Care Act was to: a. Create a government-funded insurance program for all Americans. b. Make health insurance affordable for the middle class and small businesses. c. Decrease the rates of chronic disease in the United States. d. Increase the funding for public health agencies.

ANS: B One of the main purposes of this legislation was to make health insurance affordable for middle class families and small businesses with one of the largest tax cuts for health care in history: reducing premiums and out-of-pocket costs. This act does not create a government-funded insurance program nor does it increase funding for public health agencies.

When a nurse considers that clients may not want to have genetic testing done because of the impact that it may have on future life decisions, the nurse is incorporating genetics/genomics into practice using: a. Assessment b. Identification c. Referral d. Provision of education, care, and support

ANS: B One of the ways that a nurse uses identification is by identifying ethical, cultural, and societal issues related to genetic and genomic information and technologies. Assessment is not being performed here because the nurse is not assessing a particular clients needs or history. Referral is not taking place, nor is education, care, or support of a patient.

A community that has residents who are very involved in its activities and encourage activities that promote the health of the community displays which condition of community competence? a. Commitment b. Participation c. Articulateness d. Effective communication

ANS: B Participation is an essential condition of community competence defined by active, community-oriented involvement.

A leader controls members through rewards and often keeps members in the dark about the goals and rationale behind prescribed actions. What type of leadership does this describe? a. Democratic b. Patriarchal c. Socialist d. Communication structure

ANS: B Patriarchal or paternal style is authoritative, winning respect and dependence through parent-like devotion.

A nurse is counseling a client whose genetic test results show a genetic susceptibility for breast cancer. The most appropriate statement by the nurse would be: a. You should discuss hormone replacement therapy with your physician. b. You are at an increased risk to develop breast cancer. c. You should have a bilateral mastectomy as soon as possible. d. You should tell all of your siblings and children to get tested.

ANS: B Persons with a genetic susceptibility are at increased risk for developing the disease. Although the client may choose to have a bilateral mastectomy and recommend genetic testing to other family members, the most important thing to relay to the client is that having a genetic susceptibility does not mean that one will automatically have the disease.

Which is considered a nonpoint source of pollution? a. Hazardous waste site b. Animal waste from wildlife c. Chlorine poured down a well d. Stagnant water

ANS: B Point source means a single place from which the pollutant is released into the environment, whereas nonpoint source implies a more diffuse source of pollution.

Population health is an approach and perspective that focuses on: a. Control of the spread of the HIV virus worldwide b. The broad range of factors and conditions that influence health c. Community-based care for all citizens d. Prevention and diagnosis of disease worldwide

ANS: B Population health is a holistic approach that considers the total health system.

A nurse collects data about seat belt usage by interviewing key informants and observing behaviors in the community. What type of data is being collected? a. Quantitative b. Qualitative c. Focus-groups d. Survey

ANS: B Qualitative data is collected through interviews and observation.

Evaluation of individual and group progress toward health goals is important. Which component should be included in the evaluative process? a. Type of teaching strategy used b. Recognition of accomplishments in the group c. Conflict that occurred in the group d. The type of leadership in the group

ANS: B Recognition of accomplishments in the group and of the group is built into the evaluative process.

Rabies post-exposure immunization is an example of which of the following levels of prevention with regard to infectious disease interventions? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Assessment

ANS: B Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability.

Screening school-age children for hearing deficits is an example of: a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion

ANS: B Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability.

If a nurse wanted more information on indoor air quality, which website would be most helpful? a. The National Institutes of Health (NIH) b. The American Lung Association c. Right to Know d. The Occupational Safety and Health Administration (OSHA)

ANS: B Sources of information about air quality include the Environmental Protection Agency (EPA) and the American Lung Association.

An occupational health nurse works with an employer to develop a workplace wellness program for its employees. This intervention is occurring at the _____-level of practice. a. Individual/family b. Systems c. Community d. Government

ANS: B Systems-level of practice consists of changing laws, policies, and practices that influence population-based issues.

A nurse is counseling a client who is considering having genetic testing completed to determine whether she is a carrier of the gene linked to Huntingtons disease. What is the first step the nurse would take when assessing this client? a. Assess vital signs. b. Assess family history of this disorder. c. Assess clients past medical history. d. Assess current medications.

ANS: B Taking a family history is a useful place to begin when considering a genetic connection and prior to the onset of testing.

The 1986 Immigration Reform and Control Act had what effect on illegal aliens living in the United States? a. Discriminated against individuals from Southern and Eastern Europe b. Allowed illegal aliens already living in the United States to apply for legal status c. Permitted foreign-born populations to set up communities in or around major metropolitan areas d. Allowed illegal aliens access to green cards that would allow them to work in the United States

ANS: B The 1986 Immigration Reform and Control Act permitted illegal aliens already living in the United States an opportunity to apply for legal status if they met certain requirements.

An example of a philanthropic organization is: a. International Red Cross b. Carnegie Foundation c. Nestl d. Johnson & Johnson

ANS: B The Carnegie Foundation is a philanthropic organization, receiving funding from private endowment funds. The Red Cross is a nongovernmental agency, and Nestl and Johnson & Johnson are private voluntary organizations.

A community health nurse would use the global burden of disease (GBD) to track: a. The number of cases of HIV/AIDS in a country b. Losses from premature death and losses of healthy life that result from disability c. The economic impact of disability on lesser-developed countries d. The rate of disability in industrialized nations

ANS: B The GBD combines losses from premature death and losses of healthy life that result from disability.

When utilizing the health care system in the United Kingdom, it is expected that the community health nurse will experience: a. An equal employer-citizen share in cost of health care b. Ownership and operation of the system by the government c. Nurse practitioners as the primary providers of care in the system d. Primary care provided in hospitals

ANS: B The United Kingdom has a tax-supported health system. Services are available to all without cost or for a small fee.

If a nurse researcher wants to get information on the occurrence of an internationally important disease, where would be a good place to seek this information? a. The United Nations website b. The World Health Organization (WHO) website c. The World Bank website d. The World Health Assembly website

ANS: B The WHO publishes day-to-day information about international occurrence of disease, injury, and death.

A health educator trying to change a clients attitudes about smoking would be using which of the following domains? a. Cognitive b. Affective c. Psychomotor d. Developmental

ANS: B The affective domain is used to attempt to influence what individuals, families, communities, and populations feel, think, and value.

The biomedical model defines health as the: a. Avoidance of illness b. Absence of disease c. Promotion of healthy behaviors d. Protection from illness and disease states

ANS: B The biomedical model defines health as the absence of disease. It does not explain why populations remain healthy or how health is enhanced.

A nurse would anticipate finding signs and symptoms of which disease/disorder when assessing a refugee who fled the genocide in Darfur? a. Tuberculosis b. Post-traumatic stress disorder c. Chronic obstructive pulmonary disorder d. Malnutrition

ANS: B The biopsychological changes seen following genocide include physical stress reactions (cardiovascular, neurological) and mental stress responses, especially post-traumatic stress disorders and depression.

A nurse cares for the community as the client when focusing on: a. Providing care for aggregates living in the community b. The collective good of the population c. The provision of care for families in the home setting d. Providing health education in the community

ANS: B The community is considered the client when the nursing focus is on the collective good of the population. Providing education is one way the nurse can care for the community as the client; however, the focus of nursing care is larger in scope than only education.

The time interval between invasion by an infectious agent and the first appearance of signs and symptoms of the disease is called: a. Communicable period b. Incubation period c. Infectiousness d. Pathologic reaction

ANS: B The incubation period is the time interval between invasion by an infectious agent and the first appearance of signs and symptoms.

An international agency is most likely to use its funds for: a. Development and installation of technology b. Food relief, worker training, and disaster relief c. Support of dictatorships and corrupt governments d. Funding of local private organizations

ANS: B The lesser-developed countries still receive the greatest amount of financial support from the more developed countries, but most of it goes toward food relief, worker training, and disaster relief instead of health care.

A public health nurse is demonstrating one of the minimum competencies set forth by the National Coalition of Health Professional Education in Genetics (NCHPEG) when: a. Organizing a meeting to discuss the care of cystic fibrosis clients b. Making a referral to a genetics specialist c. Advocating for legislation to support stem cell research d. Educating a client about the results of genetic testing

ANS: B The minimum competencies for health care professionals set forth by NCHPEG are: be able to examine competence of practice, understand the social and psychological implications of health-related genetic information, and know how and when to make referrals to a genetics professional. Making a referral is the only example that is described in these competencies.

A nurse utilizing a disease-oriented approach would: a. Promote a greater level of positive health. b. Teach about common disease processes. c. Provide acute care management of chronic disease. d. Direct care toward disease prevention.

ANS: D Disease prevention, risk appraisal, and disease management are all elements of the disease-oriented approach.

The best response from a nurse when counseling a client who is considering purchasing a genetic testing kit from a vendor advertised on the Internet would be: a. It is illegal to purchase genetic testing kits from Internet vendors. b. It will be important to follow up with a health care provider after receiving your results. c. Many times online vendors experience inaccuracies with their results. d. Internet vendors use the latest technology to perform these tests.

ANS: B The most important aspect of genetic testing is the counseling that occurs with the testing. Purchasing genetic testing kits on the Internet makes it easy for the public to access, but leaves a health care professional out of the testing process. Meeting with a health care professional is important to counsel a client about the implications and indications for such testing.

When one case of smallpox occurs in a population in which it was considered to be previously eliminated, it is called: a. Endemic b. An epidemic c. Pandemic d. Infectivity

ANS: B The occurrence of one case of smallpox in a population in which it was considered to be previously eliminated is an epidemic.

When planning, delivering, and financing responsibility for programs is shifted from the federal level to the state level, it is called: a. Evolution b. Devolution c. Block granting d. State administration

ANS: B The process of shifting the responsibility for planning, delivering, and financing programs from the federal level to the states is called devolution. This was a major effort during the Reagan administration.

A nurse provides counseling to an obese client about the importance of good nutrition and regular exercise with the intention of helping the client avoid future chronic diseases associated with obesity. What client system and focus of care are being applied in this situation? a. Family level health promotion b. Individual level illness prevention c. Aggregate level illness prevention d. Individual level health promotion

ANS: B The simplest level of the client system is the individual. The focus of care is illness prevention, directed at disease or disability prevention.

When would it be appropriate for a nurse to use a Geographic Information System (GIS)? a. Recording client data collected at a foot clinic b. Determining neighborhoods that have an increased incidence of lead poisoning c. Evaluating effectiveness of a farm safety program d. Scheduling health promotion programs in the community

ANS: B The use of a Geographic Information System (GIS) allows the public health nurse to apply the principles of epidemiology into practice. GIS allows nurses to code data so that it is related spatially to a place on earth and is helpful in determining concentrated areas for incidence of disease and illness.

A 5-feet, 6-inch, 25-year-old female who weighs 120 pounds walks 5 miles a day because she has a long family history of early death from heart attacks and is refraining from a sedentary lifestyle. Which term best describes this example? a. Health promotion b. Illness prevention c. Health maintenance d. Health protection

ANS: B The woman is exercising to prevent an illness that runs in her family. Illness prevention is a behavior directed toward reducing the threat of illness.

Which nursing diagnosis is written at the community-level? a. Risk of hypertension related to poor diet and sedentary lifestyle b. Risk of obesity among school-age children related to lack of opportunities to engage in physical activity c. Risk of ineffective health maintenance among individuals who do not have access to a primary care provider d. Ineffective coping related to multiple stressors as evidenced by client crying and stating she has no support system

ANS: B There are three parts: risk of, among, and related to. The risk of identifies a specific problem or health risk faced by the community. Among identifies the specific community client with whom the nurse will be working in relation to the identified problem or risk. Related to describes characteristics of the community.

Why would a nurse refer to the Code of Ethics for Nurses or the Public Health Code of Ethics? a. To provide answers for ethical dilemmas b. To guide professional practice related to ethics c. To increase moral leadership in ethics d. To find a framework for ethical decision making

ANS: B These codes provide general ethical principles and guide personnel in thinking about the underlying ethics of the profession.

When would a nurse use The Guide to Clinical Preventive Services? a. Conducting group risk appraisal and risk reduction b. Providing recommendations for preventive interventions c. Completing a community wellness inventory d. Improving environmental living conditions and sanitation

ANS: B These include screening tests, counseling, immunizations, and chemoprophylaxis regimens for more than 80 conditions.

A public health nurse understands that the emergence of new infectious diseases is influenced by the: a. Increased availability of immunizations b. Globalization of food supplies c. Decreased use of child care facilities d. Creation of sanitation systems in third world countries

ANS: B This is one of the many factors that can influence the emergence of infectious diseases.

An example of a vector is: a. Contaminated water b. A tick c. A dirty needle d. An infected person

ANS: B Vectors transmit the infectious agent by biting or depositing the infective material near the host.

West Nile Virus is an example of which of the following types of illness? a. Foodborne b. Vectorborne c. Waterborne d. Zoonoses

ANS: B West Nile virus is carried by a mosquito, which is a vector.

Which method of data collection is being used as a nurse gathers information about the condition of homes, size of lots, neighborhood hangouts, road conditions, and modes of transportation? a. Participant observation b. Windshield survey c. Survey d. Informant interviews

ANS: B Windshield surveys are the motorized equivalent of simple observation.

What would be the best strategy for a government to use to prepare for bioterrorism? a. Threaten lesser-developed countries so they dont develop biological weapons. b. Ban biological weapons worldwide. c. Effectively detect pathogens and manage services. d. Develop antidotes for biological agents.

ANS: C Health care professionals and public health officials need to be able to effectively detect pathogens, manage services, and communicate during a bioterrorism threat.

A public health nurse implements the public health intervention of health teaching at the systems-level of practice by: a. Participating in the Great American Smokeout b. Working with a local employer to provide smoking cessation education c. Providing one-on-one counseling to smokers d. Advocating for increased taxes on tobacco products

ANS: B Working with a local employer to provide smoking cessation education is the only example of health teaching at the systems-level of practice. Participating in the Great American Smokeout occurs at the community level and is not health teaching. Providing one-on-one counseling to smokers is health teaching at the individual-level of practice. Advocating for increased taxes on tobacco products occurs at the systems-level of practice, but it is not health teaching.

1. The community health nurse can serve as an advocate for the vulnerable migrant population by engaging in which of the following actions? (Select all that apply.) a. Becoming culturally and linguistically competent b. Collecting necessary data on migrant workers' lifestyle and health status c. Educating communities about the migrant workers in their areas d. Educating policymakers about successful programs for migrant workers e. Using lay health workers to provide health education in migrant camps

ANS: B, C, D Nurses can serve as social and political advocates for migrant populations. Educating communities regarding these individuals, collecting necessary data on their lives and health, and communicating with legislators and other policymakers at local, state, and national levels are necessary actions that nurses are prepared to undertake.

Roles for nurses related to global health include providing (select all that apply): a. Medications and vaccines for worldwide use b. Direct patient care and facilitating education and health promotional needs of the community c. Knowledge and skill in countries where nursing is an organized profession d. Consultation to auxiliary personnel

ANS: B, C, D Nurses perform many roles related to global health, including providing direct patient care, facilitating education and health promotional needs of the community, providing knowledge and skill in countries where nursing is an organized profession, and providing consultation to auxiliary personnel.

Which data would be useful for a nurse to collect when assessing safety in a community? Select all that apply. a. Number of billboards in the area b. Interviews with health care providers who are familiar with the community c. Observation of community members d. Nurses own observations

ANS: B, C, D Other nurses, social workers, and health care providers, community members, and the nurses own observations are reliable sources of information about the safety of an area

Which approach(s) can a nurse use when assessing environmental health risks? Select all that apply. a. Ask legislators to provide a list of environmental pollutants in the area. b. Develop a list of exposures associated with urban, rural, or suburban settings. c. Assess the risk by medium such as air, water, soil, or food. d. Divide the environment into functional locations: home, school, workplace, and community.

ANS: B, C, D The 2nd, 3rd, and 4th options are ways a nurse can assess the environment.

1. Public health nursing specialists are interested in which of the following topic(s)? (Select all that apply.) a. Educational materials for individuals with HIV/AIDS b. Evaluation of an outreach program for at-risk pregnant teenagers c. Community subpopulations with high rates of type 2 diabetes d. New technologies to monitor diabetes e. Prevalence of hypertension among various age, race, and gender groups

ANS: B, C, E Public health specialists often define problems at the population or aggregate level as opposed to the individual level. At the population level, public health specialists are usually concerned with more than one subpopulation and frequently with the health of the entire community.

1. Vulnerable population groups are those that, in comparison with the population as a whole, have which of the following characteristics? (Select all that apply.) a. Better access to health care services but poor health outcomes b. Greater likelihood of exposure to risk factors c. Multiple risk factors but equal health outcomes d. Worse health outcomes

ANS: B, D Vulnerable populations are defined as those at greater risk for poor health status and health care access. In health care, risk is an epidemiologic term indicating that some people have a higher probability of illness than others. The natural history of disease model explains how certain aspects of physiology and the environment make it more likely that a certain individual will develop a particular health problem. However, not everyone who is at risk develops health problems. Some individuals are more likely to develop the health problems for which they are at risk. A vulnerable population group is a subgroup of the population that is more likely to develop health problems as a result of exposure to risk or to have worse outcomes from these health problems than the rest of the population.

A nurse will be using an interpreter during a client encounter. What considerations should be made by the nurse? Select all that apply. a. It is appropriate to use family members as interpreters. b. Written materials should be available in the clients primary language. c. Observe the interpreters gestures to assure client understanding. d. The gender, age, and educational level of the interpreter should be evaluated.

ANS: B, D Family members should be used with caution. The clients gestures and non-verbal messages should be observed to assure understanding. Written materials should be available in the clients primary language. The gender, age, educational level, socioeconomic status, religion, and dialect should all be considered when selecting the proper interpreter.

When writing to a legislator to advocate for funds to support advanced practice nursing education, a nurse should remember to (select all that apply): a. Limit the letter to one page in length. b. Identify oneself as a nurse. c. Provide only factual information. d. Share personal knowledge about the issue.

ANS: B, D When writing to a legislator, the letter should be a maximum of two pages in length and opinions should be expressed. Additionally, the nurse should identify oneself as a nurse and share knowledge about the issue.

3. The definition of a migrant farmworker includes which of the following? a. Farmer who helps his neighbors on their farms after his own crop fails b. High school student who works part time at his uncle's rose farm c. Teenager who moved with his family ten times in 2 years to work different crops d. Woman who works in the crop fields in the summer and at a grocery store in thewinter

ANS: C According to the Department of Labor, a migrant farmworker is a seasonal farmworker who had to travel to do the farm work and was unable to return to a permanent residence within the same day. A seasonal farmworker returns to his permanent residence, worked in agriculture for at least 25 days or parts of days and did not work year round only in agriculture.

4. The role and goals of the community health nursing practice can best be described as: a. community-based interventions aimed at promoting, preserving, and maintaining the health of populations residing in institutional facilities such as nursing homes. b. education of nurses and other staff working in community-based and community-oriented settings to improve the overall effectiveness of their programs to meet client needs. c. population-level strategies aimed at promoting, preserving, and maintaining the health of populations through the delivery of personal health care services to individuals, families, and groups in an effort to improve the health of the community as a whole. d. activities targeted at improving the health status of clients served by community-based health service agencies such as hospice and home health agencies.

ANS: C Community health nursing practice is the synthesis of nursing theory and public health theory applied to promoting, preserving, and maintaining the health of populations through the delivery of personal health care services to individuals, families, and groups. The focus of community health nursing practice is the health of individuals, families, and groups and the effect of their health status on the health of the community as a whole (individual to families to groups to community flow). This is different from public health nursing, which is the synthesis of nursing theory and public health theory applied to promoting and preserving the health of populations. The focus of public health nursing practice is the community as a whole and the effect that the community's health status, including health care resources, has on the health of individuals, families, and groups (community to groups to families to individual flow). Both community health and public health nursing are considered to be community-oriented practices involving free-living (noninstitutionalized) clients. Community-based nursing practice is setting specific, and care is provided to clients where they live (home health or hospice nursing, community-based clinic), work (occupational health nursing), and/or attend school (school nursing). The emphasis of community-based nursing practice is acute and chronic care (illness care) and the provision of comprehensive, coordinated, and continuous services, usually within a specialty area.

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. Cognitive Level: Application Associated Chapter Objective: 1 REF: p. 995

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. Cognitive Level: Analysis Associated Chapter Objective: 7 REF: pp. 1002-1003

4. Within the impoverished older adult population, the most vulnerable group may be: a. elderly couples living in poverty with serious chronic illnesses. b. elderly men with alcoholism and limited incomes. c. homeless older adults. d. newly widowed, low-income elderly women.

ANS: C Homeless older adults are the most vulnerable of the impoverished older adult population. They have long lived in poverty, have fewer supportive relationships, and are likely to have become homeless as a result of catastrophic events. Life expectancy for homeless older adults is significantly lower than that for older housed adults. Permanent physical deformities, often secondary to poor or absent medical care, are common among homeless older adults. Homeless older adults suffer from untreated chronic conditions, including tuberculosis, hypertension, arthritis, cardiovascular disease, injuries, malnutrition, poor oral health, and hypothermia. As with younger homeless persons, older adults who are homeless must focus their energy on survival, which leaves little time for health promotion activities.

6. An undocumented migrant farmworker has been diagnosed with TB. The local health department initiates treatment by dispensing the first month's supply of medication and educates the client on the need to continue treatment for 6-12 months. A major challenge that the client may face to ongoing treatment for TB is: a. affordable care. b. discrimination. c. fragmented services. d. language barriers.

ANS: C Many factors limit adequate provision of health care services to migrant farmworkers, such as lack of knowledge regarding services, inability to afford care, lack of availability of services, lack of transportation, inconvenient hours of health service facilities, mobility and difficulty in tracking the client, discrimination, lack of documentation, lack of English language skills, and cultural aspects of health care. When migrant families move from job to job, their health records do not typically go with them, which leads to fragmentation of services in such areas as TB treatment, chronic illness management, and immunization.

7. The local hospital emergency department has recently noted an increase in gastroenteritis cases among migrant farmworkers. The local health department is informed of the rise in cases and schedules a case mapping of: a. bars frequented by migrant workers. b. farm fields employing migrant workers. c. housing for migrant workers. d. restaurants frequented by migrant workers.

ANS: C Migrant farmworkers often have trouble finding decent and affordable housing. Housing conditions vary between states and localities. Because housing may be expensive, 50 men may live in one house or three families may live in one trailer. Not only may conditions be crowded, but also housing may lack individual sanitation, bathing, or laundry facilities; provide poor cooking/refrigeration facilities; and lack window screens, fans, or heaters. Infectious diseases caused by poor sanitary conditions at work or home, poor-quality drinking water, and contaminated foods may take the form of acute gastroenteritis and parasite infestations.

5. After performing an assessment of a client seeking treatment for hypertension at the local free clinic, the nurse informs the client that the family's children may qualify for enrollment in the state children's health insurance program. The nurse provides the enrollment forms and reviews them with the client, emphasizing how to apply for the benefits. This best exemplifies which principle for intervening with vulnerable populations? a. Carrying out primary prevention b. Setting family-centered, culturally sensitive goals c. Trying to minimize the "hassle factor" d. Using the MAP-IT approach

ANS: C Nurses empower clients by helping them acquire the skills needed to engage in healthy living and to be effective health care consumers. Vulnerable individuals and families may need to go to multiple agencies to find the services for which they qualify, because agencies tend to be specialized instead of comprehensive in their service approach. More agencies are needed that provide comprehensive services with nonrestrictive eligibility requirements. Outreach and case finding are important roles for the nurse in reducing health disparities. One of the principles of intervening with vulnerable populations is to try and minimize the "hassle factor."

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. Cognitive Level: Analysis Associated Chapter Objective: 5 REF: p. 1003

3. Vulnerability is multidimensional, and one of the primary contributors to vulnerability is: a. gender. b. race and ethnicity. c. resource limitations. d. urban or rural residency.

ANS: C Resource limitations are strongly related to health. Lack of adequate social, educational, and economic resources make people more vulnerable and more likely to experience health disparities, and poverty is a primary cause of vulnerability. A correlation has been found between individual indicators of socioeconomic status (e.g., income, education, and occupational status) and a range of health indicators (e.g., morbidity and mortality resulting from various health problems). Not only do individual-level socioeconomic characteristics seem to matter, but population-level characteristics such as income inequality also make a difference. Resource limitations affect the individual's ability to show resilience in the face of problems and crises. Resource limitations may also place individuals and families at risk because of substandard housing, impoverished neighborhoods, and hazardous environments. Although race has been correlated with poor health outcomes, poverty seems to be a key contributing factor for minority populations. Poverty is more likely to affect women and children than other groups.

8. A community health nurse seeks to enhance the health promotion and health-service-seeking behaviors of the migrant farmworkers in local apple orchards. An evidence-based strategy that would be effective for this mobile population is educating: a. advocacy groups for migrant farmworkers. b. local policymakers. c. migrant lay health workers. d. workers seeking care at the migrant health clinic.

ANS: C The nurse can teach health-promotion strategies and strategies for obtaining health services to members of the migrant community, who, in turn, become empowered as lay health care workers to provide education and outreach to the migrant community as it moves from place to place. Several migrant health programs have recruited migrant workers to serve as outreach workers and lay camp aides to assist in outreach and health education of the workers. Outreach programs succeed because they recognize the diversity of vulnerable groups and the need for flexibility in the provision of services. Because these outreach workers are members of the migrant community, they are trusted and know the culture and the language. Nurses can be a part of the planning and teaching for outreach programs.

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.

4. The migrant clinic's mobile van program provides health education through lay health workers; screening for pesticide illness, tuberculosis (TB), and diabetes; pregnancy testing; and treatment for some acute and chronic illnesses typically seen in this vulnerable population. In dealing with this population's beliefs about disease causality, this program demonstrates the application of the health promotion and disease prevention principle of: a. advocacy. b. cultural competency. c. outreach. d. primary prevention.

ANS: C The same principles of health promotion and prevention apply to migrant farmworkers as to the rest of the U.S. population. However, health promotion and disease prevention as presented by nurses may be difficult concepts for migrant workers to embrace because of their beliefs regarding disease causality, their irregular and episodic contact with the health system, and their lower educational level. Health promotion begins by informing the farmworker family about health topics and the resources available to improve health. Several migrant health programs have recruited migrant workers to serve as outreach workers and lay camp aides to assist in outreach and health education of the workers.

2. A registered nurse is seeking a position as a public health nurse. In reviewing the job description, the nurse would expect to find a description of a position that focused on functions such as: a. monitoring pregnant teenagers for symptoms of complications of pregnancy. b. offering free hypertension screening and treatment referral at local health fairs to low-income, uninsured, community members. c. partnering with local seasonal farmworkers to design a program aimed at preventing illness and injury, and advocating for this population with local political and community leaders. d. preventing injury among a population of elderly residents in an assisted living facility and treating residents' chronic illnesses.

ANS: C The scope of practice of public health nurses is population focused and community oriented, with a primary emphasis on population-level interventions that target strategies for health promotion and disease prevention. In addition, public health nursing is concerned with the health of all members of a population or community, particularly vulnerable populations, and uses political processes as a major intervention strategy.

1. In caring for migrant workers and their families, the nurse should first assess the migrant workers' lifestyle, especially their current: a. communicable diseases. b. educational level. c. housing arrangements. d. pesticide exposure.

ANS: C The way of life of migrant farmworkers and their families is stressful. They often have trouble finding decent and affordable housing. Available housing is often overcrowded and lacking in individual sanitation, bathing or laundry facilities, window screens, and fans or heaters. Housing may be located in hazardous areas next to fields or farm machinery. Housing may be rundown or structurally deficient. Some families may be living in cars or tents when housing is unavailable. All of these factors impact the health status of migrant families and need to be understood by the nurse to direct further assessment.

2. In an effort to decrease health disparities and improve life expectancy, the Social Security Act was amended in 1998 to provide federal funding to: a. assure access to health care for elderly Americans. b. build hospitals to care for the medically indigent. c. insure children without health insurance. d. provide supplementary income for citizens with disabilities.

ANS: C Title XXI of the Social Security Act, passed in 1998, established the State Children's Health Insurance Program to provide funds to insure currently uninsured children. Legislation enacted subsequently provided for new outreach and case-finding efforts to enroll eligible children in Medicaid.

9. To provide effective care and advocacy for individuals, families, and populations living in poverty, nurses must first: a. apply epidemiologic principles for prevention. b. develop resource expertise in the community. c. examine their personal beliefs, values, and experiences. d. understand the federal criteria and guidelines for poverty.

ANS: C To provide effective care and advocacy for individuals, families, and populations living in poverty, nurses need to understand poverty as a concept with historical, social, political, economic, biological, psychological, and spiritual dimensions. Understanding the concepts of poverty and homelessness begins with an examination of one's own beliefs, values, and personal experience.

A nurse is interested in census data. Which federal departments website would be a good place to start? a. Department of Labor b. United States Immunization Survey c. Commerce Department d. World Health Organization

ANS: C The Commerce Department handles the United States Census and population estimates and projections.

Which question would be the most appropriate for the nurse to ask when eliciting information about a clients genetic history? a. Have any of your family members ever completed genetic testing? b. Do any of your family members have a genetic disorder? c. What medical problems have your parents and grandparents experienced? d. What environmental exposures have you had?

ANS: C A clients family medical history is important to obtain in order to consider the clients potential risk for genetic diseases and disorders. The best way to obtain this information is to ask an open-ended question about past medical history of parents and grandparents.

Which is referred to as a lesser-developed country? a. France b. Japan c. Indonesia d. Sweden

ANS: C A country that is not yet stable with respect to its economy and technological development is lesser developed, which describes Indonesia. France, Japan, and Sweden are considered developed countries.

. Which statement regarding mutations is true? a. Mutations in the DNA sequence occur on a regular basis. b. Mutagens are a result of a mutation. c. Environmental factors can be linked to many mutations. d. Spontaneous mutations occur because of environmental exposure.

ANS: C A large number of agents are known to cause mutations. These mutations are attributed to known environmental causes. DNA replication is very accurate, thus, mutations do not occur on a regular basis. Mutagens are the factors that cause mutations. Spontaneous mutations occur naturally during DNA replication.

Which is an example of one of the components of a unit of disability-adjusted life years (DALYs)? a. A woman who lives to be 100 years old b. A woman who contracts HIV after working as a prostitute c. A father with 5 children who dies at the age of 50 from malaria d. A woman who gives birth to a premature infant

ANS: C A male who dies from malaria at age 50 would represent 30 DALYs. Measurement is based on the potential limit for life, which has been set at 82.5 years for women and 80 years for men.

Nurses working in hospice and home care settings need to be knowledgeable of health policy to: a. Provide safe nursing care. b. Prevent elder abuse. c. Receive payment for the services provided. d. Influence future legislation.

ANS: C Although nurses should be involved in influencing future legislation by contacting their legislators, the best response is that nurses need to be knowledgeable of the current health policies needed so that payment can be received for services that are providing.

Which role of the nurse will be most important in the future practice of providing genomic nursing care? a. Direct caregiver b. Educator c. Advocate d. Referral agent

ANS: C Although the nurse will use all of these roles when providing genomic nursing care, the most important role will be that of advocate. Nurses will increasingly provide guidance on policy discussions and ethical issues that relate to confidentiality, privacy, and commercialization. This is the nursing role of advocate.

When writing a community-level diagnosis, Among refers to the: a. Specific problem or health risk faced by the community b. Characteristics of the community c. Community client experiencing the risk or problem d. Likelihood that the problem will be solved

ANS: C Among identifies the specific community client with whom the nurse will be working to address the identified problem.

Which antimalarial intervention would be appropriate for client teaching when educating those living in an area of the world where malaria is endemic? a. Receive a dose of IV quinine. b. Avoid direct contact with individuals who have malaria. c. Use insecticide-treated bed nets. d. Apply dichlorodiphenyltrichloroethane (DDT) spray.

ANS: C An effective antimalarial intervention is the use of insecticide-treated bed nets. Malaria is contracted by being bit by an infected mosquito; it cannot be passed by direct person-to-person contact. IV quinine is the drug of choice for treating malaria, not preventing it. Some mosquitoes are resistant to DDT, so this may not be effective.

A nurse is leading a team responsible for evaluating the health of a community using the Community Health Promotion Model. Based on this model, which step would you expect the nurse to complete? a. Ensuring high technological access before the plan can be implemented b. Soliciting the consent of every member of the community c. Assessing the community d. Restructuring the public health policy in the community

ANS: C Assessing the community is one of the steps in the nine-steps of the Community Health Promotion Model.

A nurse fulfills the environmental health competency of assessment and referral when: a. Advocating for public policy changes b. Understanding policy framework and major pieces of legislation c. Completing an environmental health history d. Describing the scientific principles about environmental health

ANS: C Assessment is always an important element of the nursing process. The third option is an example of the assessment phase of the nursing process.

A group member who has taken on the role of the gatekeeper will: a. Seek and accept the authority or direction of others. b. Guide and direct the group activity. c. Control outsiders access to the group. d. Focus the movement toward the main work of the group.

ANS: C The gatekeeper controls outsiders access to the group.

A public health department makes sure that the essential community-oriented health services are available in the community. Which of the following core public health functions is being implemented? a.Policy development b.Assessment c.Assurance d.Scientific knowledge-based care

ANS: C Assurance focuses on the responsibility of public health agencies to ensure certain activities have been appropriately carried out to meet public health goals and plans. Policy development seeks to build constituencies that can help bring about change in public policy. Assessment includes activities that involve collecting, analyzing, and disseminating information on both the health status and the health-related aspects of a community or a specific population. Public health is based on scientific knowledge, but is not a core function. DIF:Cognitive level: ApplyingREF:p. 14 TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance

Public health administrators in a community provide a health department to serve an indigent population of immigrants providing translators on certain days of the week. This is an example of: a. Policy b. Quality c. Assurance d. Libertarian philosophy

ANS: C Assurance refers to the role of public health in making sure that essential community-oriented health services are available, which may include providing essential personal health services for those who would otherwise not receive them.

What action can a nurse take on an individual level to reduce pollution in the environment? a. Provide a tax incentive to factories that do not pollute. b. Make laws related to allowed levels of pollution in the area. c. Choose a less-polluting car. d. Move to an area with less pollution.

ANS: C Citizens can reduce air pollution by doing their part, which can include choosing less-polluting cars.

A nurse wants to obtain information on the alternative methods of health care her 45-year-old female client uses. Who is the best person to ask about this? a. The husband of the client b. A community leader of the ethnic group c. The client herself d. The religious leader of the ethnic group

ANS: C Clients provide a rich source of information about their own cultures.

Which group would be likely to demonstrate the most cohesion? a. A group with several leaders b. A group with diverse attitudes and values c. A group with a common goal d. A group with efficient members

ANS: C Cohesion is the attraction between individual members and between each member and the group. Group effectiveness improves as members work together toward group goals while still satisfying the needs of individual members.

A social marketing campaign urging community members to avoid driving motorized vehicles after consuming alcohol is implemented in a local community. This intervention is occurring the _____-level of practice. a. Individual/family b. Systems c. Community d. Government

ANS: C Community-level interventions care carried out with the community as a whole.

The tendency to ignore all differences between cultures and to act as though the differences do not exist is defined as cultural: a. Conflict b. Shock c. Blindness d. Imposition

ANS: C Cultural blindness occurs when people state that everyone is treated the same, regardless of their cultural orientation.

When a nurse supports the use of traditional home remedies in conjunction with Western medicine to promote healthy behaviors, the nurse is using cultural: a. Accommodation b. Brokering c. Preservation d. Repatterning

ANS: C Cultural preservation refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help the clients of a particular culture to retain and preserve traditional values, so they can maintain, promote, and restore health.

A nurse resigns from a position in a hospital to accept a job in a community setting. After starting the new job, the nurse feels helpless and confused, wondering if this was the right career choice. This nurse is likely experiencing cultural: a. Conflict b. Relativism c. Shock d. Brokering

ANS: C Culture shock can happen to individuals within their own culture when they are having experiences such as starting a new job or career. Culture shock is brought on by anxiety from losing familiar signs and symbols of social interaction. Feelings associated with culture shock are helplessness, discomfort, and disorientation.

A nurse surveys the school nurses in a community to determine their roles in the schools because this data is not available. The nurse is engaging in the process of data: a. Collection b. Gathering c. Generation d. Interpretation

ANS: C Data generation is the process of developing data that do not already exist by interacting with community members or groups. This data includes information about a communitys knowledge and beliefs, values and sentiments, goals and perceived needs, norms, problem-solving processes, power, leadership, and influence structures.

Epidemiology: a. Is a science that studies the poisonous effects of chemicals b. Explains the association between learning disabilities and exposure to lead-based paint at the cellular level c. Helps nurses understand the strength of the association between exposure and health effects d. Is a method for tracking the prevalence of a disease

ANS: C Epidemiology studies the incidence and prevalence of disease, helping nurses understand the strength of the association between exposure and health effects.

The wearing of seat belts is required in many communities. Children of a certain age must be restrained in a car seat or seat belt when riding in a car. This is an example of: a. Unilateral action of lawmakers b. Participation in health fairs c. Healthy public policy d. Media interest in protecting the public

ANS: C Examples of healthy public policy are seat belt legislation, nonsmoking policies, and immunization policies for school-age children.

Which data source provides information about the function of the community? a. Maps b. Census data c. State departments, business and labor, local library d. Civic groups

ANS: C Function relates to production, distribution, and consumption of goods and services.

A nurse is implementing an educational program about the importance of being physically active. Which step would the nurse complete first? a. Provide learning guidance b. Present the stimulus c. Gain the learners attention d. Ask learners to recall prior learning

ANS: C Gaining the learners attention must happen first before learning can take place.

An example of a multifactorial disorder is: a. Measles b. Hepatitis B c. Eczema d. Type I diabetes

ANS: D Disorders that are influenced by multiple factors including genetics/genomics, environment, lifestyle, and other factors are considered to be multifactorial.

While researching various health care services that are provided in prisons, a nursing student learns that these services: a. Are funded by the Department of Defense b. Focus on health promotion interventions c. Must be provided at an adequate level d. Are available to those diagnosed with a chronic illness

ANS: C Health care services for prisoners are required at an adequate level for all incarcerated individuals. This is administered by the Department of Justice. Prisoners will receive health care services when diagnosed with chronic illnesses as well as acute illnesses.

A client eats a nutritious, balanced diet on a daily basis to keep the current state of health. This is described as _____ behavior. a. Illness prevention b. Health promotion c. Health maintenance d. Health protective

ANS: C Health maintenance behavior is directed toward keeping a current state of health.

A PHN employed by the state's department of health is working on a team to develop local health policy. The nurse recognizes that policy development focuses on the level of the larger society and adopts strategies that require political actions such as lobbying and testifying. The reason that action in the policy arena comes most easily and naturally to nurses is the fact that the policy process is very similar to which of the following? A. Citizen action committee B. Nursing diagnosis C. Nursing process D. Socratic method

ANS: C Health policy is simply the process of turning health problems into workable action solutions. Thus, the policy process is very similar to the nursing process, but the focus is on the level of the larger society and the adoption of these strategies requires political action. The policy process includes statement of a health care problem, statement of the policy options to address the problem, adoption of a particular policy option, implementation of the policy product, and evaluation of the policy's intended and unintended consequences in solving the original health problem.

A nursing student develops a teaching plan about hand washing to present to a group of elementary school children at the local school. Which public health intervention is being implemented? a. Collaboration b. Surveillance c. Health teaching d. Screening

ANS: C Health teaching communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, and practices of individuals, families, systems, and/or communities.

One advantage of health-risk appraisal instruments is that they: a. Are suitable for all age-groups b. Accurately reflect an individuals ability to initiate changes in lifestyle c. Provide support to nurses in counseling individuals about self-care behaviors d. Emphasize environmental factors

ANS: C Health-risk appraisal instruments provide support to nurses in counseling and educating individuals in self-care behaviors.

The introduction of health care technology into lesser-developed countries has led to less-than-satisfactory results because: a. People do not want to use newer technology. b. The cost is so high that they cannot afford to use new technology. c. Other health needs may be more important than using complex technology. d. Technology is too complex for people in lesser-developed countries.

ANS: C It is not generally a lack of desire that is a barrier to use of the new technological systems, but the lack of knowledge about them. It is essential to conduct needs assessments to learn what a community has, what a community wants, and what it can sustain. Well-intended projects have failed because the most basic needs were not met, nor was recognition given to what resources and services the country could sustain.

Which statement about race is true? a. In the United States, children of biracial parents are usually assigned the race of the father. b. Ethnicity and race are synonymous terms. c. Individuals may be of the same race but of different cultures. d. No social significance is usually placed on race.

ANS: C It is often a misconception that persons of the same race have the same culture. For example, African Americans may have been born in Africa, the Caribbean, North America, or elsewhere and have very different cultures.

When a nurse is sued for malpractice and goes to court, which type of law is being used? a. Constitutional b. Common c. Judicial d. Institutional

ANS: C Judicial law is based on court or jury decisions.

Which intervention can be implemented by a nurse when working with a group focused on improving the health of the community? a. Make decisions for the group to move the process along. b. Invite wealthy individuals to participate in the group process. c. Maintain members through recognition and encouragement. d. Teach topics that are of national importance.

ANS: C Maintaining members is an important intervention to facilitate group process.

A woman living in a lesser-developed country is likely: a. At risk for a Vitamin E deficiency b. To have several children c. At risk for death during pregnancy and childbirth d. Viewed as the leader of the family unit

ANS: C Most deaths to women worldwide are related to pregnancy and childbirth. Most of these deaths occur in lesser-developed countries. Common nutritional deficiencies in this population are zinc, iodine, vitamin A, folic acid, and calcium. One of the reasons this problem exists is because women are not seen as valued members of society.

Which information is important for the nurse to know about preventing and controlling parasitic infections? a. The medication to prescribe to treat these infections b. The nature and symptoms of all parasitic illnesses c. What specimens to collect and how and when to collect them d. Public policy about parasitic infections

ANS: C Nurses need to be cognizant about what specimens to collect, how and when to collect, and what laboratory techniques to use.

Which nursing action demonstrates advocacy? a. Offering a smoking cessation program b. Screening for hypertension c. Lobbying for health care reform d. Conducting home visits

ANS: C Nurses should participate in implementing new directions for health care and help envision these new directions. Nurses can be an important voice in advocating for access to consistent, effective, efficient health care for all.

When using the integrative model for community health promotion, the nurse would apply the dimension of client system by: a. Concentrating on individual health behaviors b. Studying client-centered initiatives c. Providing multidimensional nursing care among various levels of clients d. Focusing on health promotion, illness prevention, and illness care

ANS: C Nursing care is targeted toward several levels of clients in the client system.

Which nursing diagnosis would a public health nurse use when addressing the problem of obesity at the community-level of practice? a. Alteration in nutrition: More than body requirements b. Need for increased knowledge of proper nutrition c. Families at risk for obesity because of inactivity d. Overweight child related to poor dietary habits

ANS: C Nursing diagnoses must be modified to meet the needs of population-focused care in public health nursing practice. Families at risk for obesity because of inactivity is the only nursing diagnosis that addresses a community group that is in need of further intervention.

The most common vector-borne disease in the United States is: a. Malaria b. Yellow fever c. Lyme disease d. Rocky Mountain spotted fever

ANS: C Over 15,000 cases of Lyme disease are reported per year. Malaria is most common worldwide.

A nurse is addressing the problem of air pollution in the community. The first step in the process of controlling the pollution would be: a. Setting standards b. Monitoring c. Permitting d. Compliance

ANS: C Permitting is a process by which the government places limits on the amount of pollution emitted into the air or water.

When a nurse is evaluating the components of an educational program, the nurse is completing a(n): a. Education evaluation b. Educational product c. Process evaluation d. Ongoing evaluation

ANS: C Process evaluation means looking at the components of an educational program.

A public health nurse utilizes the nursing process at all levels of practice by: a. Including specific goals for community health nurses b. Developing an accurate nursing diagnosis c. Analyzing the needs of the community, system, and individuals and families d. Utilizing primary, secondary, and tertiary prevention

ANS: C Public health nurses must customize the nursing process to consider the community, systems, and individual/family levels of practice.

Segregation is an example of: a. Prejudice b. Cultural imposition c. Racism d. Stereotyping

ANS: C Racism is a form of prejudice that occurs through the exercise of power by individuals and institutions against people who are judged to be inferior in, for example, intelligence, morals, beauty, and self-worth.

A 35-year-old man from Russia comes to the United States seeking asylum because of religious persecution in his native country. This type of immigrant is known as a(n): a. Legal immigrant b. Lawful permanent resident c. Refugee d. Unauthorized immigrant

ANS: C Refugees are people who seek protection in the United States because of fear of persecution in their homeland.

Requirements for disease reporting in the United States are mandated by: a. The Centers for Disease Control and Prevention (CDC) b. Federal laws c. State laws and regulations d. The World Health Organization (WHO)

ANS: C Requirements for disease reporting in the United States are mandated by state laws and regulations.

The practices of physicians, nurses, and other health care providers are differentiated by the: a. Health Resource and Services Administration (HRSA) b. State board of nursing c. Scope of practice d. United States Department of Health and Human Services

ANS: C Scope of practice involves defining nursing, setting its credentials, and then distinguishing between the practices of nurses, physicians, and other health care providers.

Since the Intervention Wheel was first published in 1998, it has: a. Guided national policy b. Been used as a tool in deciding licensure issues for State Boards of Nursing c. Been incorporated into the public health curricula of many nursing programs d. Gained wide acceptance internationally

ANS: C Since being published, the Intervention Wheel has been incorporated into the public/community health coursework of numerous undergraduate and graduate curricula.

Hispanics tend to believe that the needs of the family take priority over those of the individual. This is an example of cultural variations of: a. Communication b. Space c. Social organization d. Environmental control

ANS: C Social organization refers to the way in which a cultural group structures itself around the family to carry out role functions.

Nursing practice is governed by: A. boards of nursing established by the U.S. Department of Health and Human Services. B. nurse practice acts promulgated by federal and state legislative boards. C. nurse practice acts promulgated by state legislatures and operationalized by the state boards of nursing. D. nurse practice acts promulgated by the states in conformity with broad federal guidelines.

ANS: C State legislatures enact laws that establish boards of nursing. The functions of the board are described by the nurse practice act of each state. The boards of nursing license nurses, oversee training programs, and interpret and enforce statutory law.

. When implementing interventions at the systems-level of practice, the public health nurse would: a. Involve the entire community in solving the health problem. b. Identify health problems in the community. c. Change laws, policies, and practices that influence population-based issues. d. Provide outreach services to populations at risk.

ANS: C Systems-level practice consists of changing laws, policies, and practices that influence population-based issues.

The nurse teaches food handlers to wash utensils after contact with raw meat. This prevention focuses on the: a. Agent b. Host c. Environment d. Food handler

ANS: C Teaching food handlers to wash utensils after contact with raw meat is a prevention that focuses on the environment.

The nurse provides footwear and gloves to leprosy clients to prevent trauma to their insensitive and deformed hands and feet. This is an example of ____ prevention. a. A primary level of b. A secondary level of c. A tertiary level of d. Primary health care

ANS: C Tertiary prevention reduces complications through treatment and rehabilitation.

Which environmental law sets basic structure for regulating pollutants to United States waters? a. Safe Drinking Water Act b. Toxic Substance Control Act c. Clean Water Act d. Pollution Prevention Act

ANS: C The Clean Water Act sets basic structure for regulating pollutants to United States waters.

The Office of Homeland Security has a mission to rebuild the crumbling public health infrastructures of each state and provide: a. Vaccines for smallpox, anthrax, and plague b. Regulation of nuclear weapons c. Surveillance of bioterrorism threats d. Regulation of foreign nurses entering the United States

ANS: C The DHHS and the new federal agency, the Office of Homeland Security, have provided funds to address serious bioterrorism threats to the people of the United States.

The Framingham Heart Study was successful in: a. Providing information on the effectiveness of risk-reduction interventions b. Documenting the relationship between social variables and heart disease c. Identifying factors contributing to the development of coronary heart disease d. Demonstrating the effects of mass media in modifying high-risk behavior

ANS: C The Framingham Heart Study identified factors contributing to the development of coronary heart disease and high blood pressure.

A nurse seeks the best resource that provides a broad vision of the goals and objectives of many health care stakeholders in our nation and identifies the current national health policy for the United States. The best source for such information would be the: A. American Public Health Association's guidelines. B. website of the Centers for Disease Control and Prevention. C. Healthy People initiatives. D. Pan American Health Organization's mission statement.

ANS: C The Healthy People initiatives began in 1979 with subsequent updates and revisions across multiple decades. Healthy People 2020 builds on earlier versions to identify a national health agenda to attain quality, longer lives free of preventable diseases, disability, injury, and premature death; achieving health equity, eliminating health disparities and improving health for all groups; creating social environments that promote good health for all; and promoting quality of life, healthy development, and healthy behaviors across all life stages.

The first major federal government action relating to health was the: a. Passage of the Social Security Act b. Creation of the National Institutes of Health (NIH) c. Creation of the Public Health Service (PHS) d. Creation of Medicare and Medicaid

ANS: C The PHS was created in 1798.

A nurse demonstrates the desire to provide culturally competent care by: a. Relying on a textbook for information about an ethnic group b. Bringing a translator to the local community clinic c. Taking Spanish classes in the evening at a local college d. Judging others using his or her own cultural values

ANS: C The activity that suits the definition of cultural desire is one that a nurse would want to do instead of being directed to do so, referring to the intrinsic motivation of the nurse.

The cognitive domain includes: a. Changes in attitudes and the development of values b. The performance of skills c. Memory, recognition, understanding, reasoning, and problem solving d. Memorization of one set of skills before moving on to the next

ANS: C The cognitive domain includes memory, recognition, understanding, reasoning, and problem solving.

A community that demonstrates commitment would most likely support the development of a: a. Community club to facilitate community involvement b. Childrens recreation program c. Curb-side recycling program and community-based education about recycling d. Cooperative agreement with a neighboring city to share needed services

ANS: C The commitment condition of community competence defined by Cottrell refers to the affective and cognitive attachment to a community, that is worthy of substantial effort to sustain and enhance. Creating a recycling program as well as associated education enhances both the cognitive and affective domains of the community.

A nurse involved in the initial implementation of the Healthy Communities and Cities initiative in the United States would have likely addressed which problem? a. Reduction to the amount of pollutants released into the environment b. Provision of fire and police protection c. Creation of a coalition to address health disparities d. Elimination of crime and violence from the community

ANS: C The concept of a healthy community or city is based on the belief that the health of the community is largely influenced by the environment in which people live and that health problems have multiple causes: social, economic, political, environmental, and behavioral. Creation of a coalition engages residents in addressing the problem which is impacted by multiple factors. The initial activities focused on the problems of diverse populations.

A nurse is found to be negligent. Because of the doctrine of respondeat superior, the one responsible for that negligence is the: a. Administrator b. Nurses immediate supervisor c. Nurses employer d. Nurse

ANS: C The doctrine of respondeat superior says that when a nurse is employed and functioning within the scope of that job, the one responsible for that negligence is the nurses employer.

When implementing a community health education program, which educational principle will the nurse use as a guide? a. Refer to trustworthy sources b. Use an active voice c. Create the best learning environment d. Accentuate the positive

ANS: C The environment must be conducive to learning for educational programs to be effective.

Which example contains the components necessary to form an epidemiologic triangle? a. Pesticides, water, food b. Lead, mercury, soil c. Trichloroethylene, water, infants d. Children under 12, elderly, temperature

ANS: C The epidemiologic triangle consists of an agent (chemical), host (community consisting of several variants), and environment (air, water, soil,

Which question would a nurse ask during the first phase of a risk assessment? a. Has the chemical been released into the environment? b. How much and by which route of entry can the chemical enter the body? c. Is the chemical known to be associated with a negative health effect? d. What is the prediction for potential harm?

ANS: C The first phase is determining if a chemical is known to be associated with negative health effects (in animals or humans).

A nurse would like to propose legislation requiring all schools to employ a registered nurse. The first step taken in the legislative process would be: a. Introducing the bill to the legislature b. Moving the bill to the other house c. Developing the policy option into a bill d. Hearings, testimony, and lobbying

ANS: C The first step in the legislative process is developing the policy option into a bill. This is then followed by introducing the bill to the legislature; hearings, testimony, and lobbying; and the bill moving to the other house.

One of the main goals of the Human Genome Project was: a. Providing physicians with a national database for information related to genetic disorders b. Developing new medications that can be used in genetics research c. Addressing ethical, legal, and social issues related to this research d. Improving the ability to accurately test for genetic disorders

ANS: C The goals of the Human Genome Project were to determine the sequences of the base pairs in human DNA; improve tools for data analysis; transfer related technologies to the private sector; and address the ethical, legal, and social issues that may arise.

According to Laffrey, Loveland-Cherry, and Winkler, the health perspective views: a. Health as the absence of disease b. Human lifestyle based on ones prescribed regime c. Humans as complex and interconnected with the environment d. Community education as the role of the registered nurse

ANS: C The health paradigm includes the view that humans are complex and interconnected with the environment.

Which branch of the government interprets the states rights to grant abortions? a. Executive branch b. Legislative branch c. Judicial branch d. Federal branch

ANS: C The judicial branch interprets laws and their meaning, as in its ongoing interpretation of states rights to define access to reproductive health services for citizens of the states.

A nurse who reads the local community newspaper is using which method to gather data about the community? a. Informant interview b. Survey c. Participant observation d. Windshield survey

ANS: C The nurse is deliberately sharing in the life of the community.

What are the critical attributes in the definition of community? a. Families, groups, and health organizations b. Health needs, geographical boundaries, and target population c. People, place, and functions d. Populations and health resources

ANS: C The people are community members or residents; place refers to geographic and time dimensions; and function refers to the aims and activities of the community.

A nurse is providing information to a local newspaper about the presence of infectious diseases in the United States. Which statement by the nurse is accurate? a. It is the goal of the World Health Organization to prevent the transmission of the plague by avoiding direct contact with inflicted individuals. b. Rabies is easily spread by contact with animals. c. Polio has been eliminated in the United States since 1994. d. The onset of tularemia is characterized by a distinct skin lesion often called a bulls-eye lesion.

ANS: C The plague is a vector-borne disease and cannot be spread by direct contact with inflicted individuals. Rabies is a rare event because of the widespread vaccination of dogs in the 1950s. The Americas were certified as polio free in 1994. The onset of Lymes disease is characterized by a bulls-eye lesion.

Which statement about tuberculosis (TB) is true? a. Meningitis is the leading cause of death from tuberculosis. b. Chemotherapy, if made widely available, could eradicate the disease. c. Many TB cases are associated with HIV. d. The TB bacillus is difficult to isolate.

ANS: C The rise in HIV has lead to an increase in TB because the disease depresses the immune system. Chemotherapy is not always effective, especially in the new drug-resistant strains.

The steps of the Community Health Promotion Model resemble the: a. Collaboration process b. WHOs Ottawa Charter c. Nursing process d. CDCs monitoring program

ANS: C The steps of the Community Health Promotion Model are very similar to the nursing process. The steps include assessment, planning, implementation, and evaluation.

A woman has attended a weight reduction program for a year and lost 75 pounds. She now attends weekly meetings to keep the weight off. Which term best describes this example? a. Health promotion b. Illness prevention c. Health maintenance d. Health protection

ANS: C The womans weight is being maintained through attending the weight reduction program. Health maintenance focuses on keeping a current state of health.

When working with colonias, it is important to remember: a. They have developed roads, transportation, and electrical services. b. They are frequently driven off, only to return to the same area. c. Their settlements have led to an increase in several disease conditions. d. Their contributions have improved the local economy.

ANS: C These settlements have led to an increase in numerous disease conditions associated with poverty, poor sanitation, and overcrowded conditions such as respiratory and diarrheal illnesses.

Which strategy would be the most appropriate for a public health nurse to use to increase the immunization coverage of infants and toddlers? a. Read the Mortality and Morbidity Weekly Report to learn about vaccinations. b. Require that children have all their immunizations before going to public school. c. Track children known to be at risk for underimmunization. d. Lead teams of health care workers to enforce laws related to immunizations.

ANS: C This is a function of public health nurses who work in health departments where immunizations are given and tracked.

Employees working with hazardous chemicals have the right to know about the chemicals they are working with through the creation of the: a. Material Safety Data Sheet b. Consumer Confidence Report c. Hazard Communication Standard d. Environmental Protection Agency

ANS: C This standard requires employers to maintain a list of all hazardous chemicals that are used on site.

A community health nurse investigates an outbreak of pinworm at a local day care center. What suggestions would the nurse give to the day care workers? a. Close the day care until all surfaces are cleaned. b. No action is necessary because it is easily treated with oral vermicides. c. Using good hand washing is important to prevent the transmission. d. Every child in the day care should be treated because they all are probably infected.

ANS: C Transmission is through the fecal-oral route, so good hand washing after toileting is essential.

The greatest single source of air pollution in the United States is from: a. Waste incineration b. Power plants c. Motor vehicles d. Molds

ANS: C Waste incineration and power plants are major contributors after motor vehicles. Molds contribute to poor indoor air quality.

3. A public health nurse leader is encountering barriers when trying to shift the public health agency's efforts to a population-focused practice. The reasons peers are not supportive of the proposed shift to a population focus are most likely related to: a. agency colleagues' push for nurses to focus on population initiatives. b. costs associated with staff training and revision of documents. c. lack of support from the agency's funding sources. d. opinions that nursing should focus on the provision of direct client care and services.

ANS: D Barriers to implementing population-focused care include lack of understanding of the public health nurse role and its relationship to other roles in nursing, such as direct care and services; workplace role socialization that determines what roles are appropriate and inappropriate or accessible and inaccessible for nurses; and lack of comprehensive training at the graduate level in the disciplines basic to public health such as epidemiology, biostatistics, community development, service administration, and policy formation.

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.

3. Deinstitutionalization of chronically ill individuals from publicly funded psychiatric hospitals had the unintended consequence of: a. moving clients to readily available community-based care. b. shortening hospital stays in mental health facilities. c. increasing the funding for community-based services. d. increasing the number of homeless persons.

ANS: D Deinstitutionalization of chronically mentally ill individuals from public psychiatric hospitals increased the number of homeless persons. The intent was to move clients from public psychiatric hospitals to community-based treatment centers. However, adequate community-based services were not funded. Few of the intended community mental health centers were ever built.

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.

What intervention would be the most appropriate for the nurse to use when trying to develop community partnerships? a. Involve only the community residents. b. Use nurses as the source of information and leadership. c. Rely on the power of local officials. d. Include a variety of disciplines.

ANS: D Community partnerships occur when community residents and health workers come from a variety of disciplines.

1. In 1988, the Institute of Medicine (IOM) published a report on the future of public health and its mission that defined public health as: a. what public-private partnerships do to treat vulnerable populations. b. what the government does to ensure that vital programs are in place. c. what the U.S. Public Health Service does to prevent disease, promote health, and deliver services. d. what society does collectively to ensure the conditions in which people can be healthy.

ANS: D In 1988, the IOM's report stated that public health is "what we, as a society, do collectively to assure the conditions in which people can be healthy." Consequently, the mission of public health is "to generate organized community effort to address the public's interest in health by applying scientific and technical knowledge to prevent disease and promote health." This clearly places the emphasis on the desire of the population and community to ensure access to services that foster the health status of the overall community through the equitable distribution of resources addressed to community problems that affect health.

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.

Which is an example of a public health nurse conducting a community assessment? a. Visiting an elderly person at home to assess and evaluate safety and fall risk b. Developing diagnoses to identify nursing interventions at a health clinic c. Evaluating services at an immunization clinic where a translator provides services d. Compiling recent data from the county health department on child abuse cases

ANS: D Compiling recent data from the county health department on child abuse cases is an example of community assessment, assessing needs and data within a community.

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.

Which approach should a nurse take when implementing interventions to improve the health of a community? a. A top-down approach with rational-empirical problem solving b. A top-down approach with community practice planned by experts c. A bottom-up approach with facilitation of communication d. A bottom-up approach with multi-sectoral planning and action for health

ANS: D A bottom-up approach with multi-sectoral planning and action for health incorporates community participation. A bottom-up approach uses broad-based community problem solving that includes health professionals, local officials, service providers, and other community members, including those at risk for health problems.

Which statement would be most appropriate for the nurse to make when assisting a family in compiling a family health history? a. When you have completed this history, it will not need to be updated. b. Looking back at two generations of biological relatives will be sufficient. c. The purpose of completing a family history is to decrease genetic susceptibility. d. A family history is a useful tool when considering your future health risks.

ANS: D A family history is a useful tool to help families know about their health risks and prevent disease in themselves and their close relatives. It is recommended that families develop a three generation history and update it on a regular basis. Completion of a family history will not decrease genetic susceptibility; rather it will make families more aware of what that susceptibility may be.

A collection of individuals who have in common one or more personal or environmental characteristics is the definition of a(n): a. Community b. Group c. Family d. Aggregate

ANS: D An aggregate is a collection of individuals who have one or more personal or environmental characteristics in common.

An acceptable level of emissions or a maximum contaminant level allowed is an example of which environmental protection strategy? a. Controlling pollution b. Waste minimization c. Land use planning d. Environmental standard

ANS: D An example of an environmental standard is an acceptable level of emissions or a maximum contaminant level allowed.

A nurse prepares for a presentation to a group of adults using strategies appropriate for adult learning. This concept is called: a. Authoritarianism b. Learning style c. Pedagogy d. Andragogy

ANS: D Andragogy is a term and model developed by Malcolm Knowles to describe learning strategies for adult learners.

The educational process of selecting appropriate educational methods is similar to which of the following steps of the nursing process? a. Assessment b. Evaluation c. Implementation d. Planning

ANS: D Assessment would be identifying educational needs, evaluation would be evaluating educational process, and implementation would be implementing the educational plan. Planning is similar to selecting appropriate educational methods.

While collecting a medical history, a client reports having a family history positive for Huntingtons disease. However, the client states he does not want to have genetic testing performed. The nurse recognizes that one reason a client may refuse genetic testing is because of the: a. Impact it may have on obtaining health insurance in the future b. Legal consequences that may result c. Inaccuracy of the results that are obtained d. Decreased quality of life that may occur if the results are positive

ANS: D Barriers to genetic testing are: some individuals do not have an insurance carrier that reimburses for genetic testing, a high-deductible insurance policy, and feelings that testing may decrease the quality of life and increase anxiety for the future if the results were positive. Others may also feel guilty about passing along a disease to children and grandchildren.

A nurse is teaching a client about how to complete a dressing change of a wound. The nurse knows that what conditions must be met before learning will occur? a. Must be able to memorize the instructions, relay this information to a partner, and demonstrate the dressing change b. Must master the dressing change at the time it is taught, repeat the demonstration for the nurse, and teach another person c. Must be able to speak the language of the nurse, have time to practice the dressing change, and master the dressing change in a short time d. Must have the necessary ability, a sensory image of how to carry out the dressing change, and an opportunity to practice the dressing change

ANS: D Before psychomotor learning occurs, the learner must have the necessary ability, a sensory image of how to carry out the skill, and an opportunity to practice the skill.

Which religious organization would be contacted to provide food to starving people in a lesser-developed country? a. International Red Cross b. Church World Service c. Maryknoll Missionaries d. Catholic Relief Services

ANS: D Catholic Relief Services alleviates suffering and provides assistance to people in need affected by war, starvation, famine, drought, and national disasters without regard to race, religion, or nationality. The Red Cross is not a religious organization, and the Church World Service and Maryknoll Missionaries do other things besides providing food.

Which statement best describes health risk appraisals? a. Data about health practices are collected from families. b. Primary prevention strategies are implemented by using the collected data. c. Identified risks can be easily modified. d. Individual health practices are compared with data from epidemiologic studies.

ANS: D During a health risk appraisal, individuals supply information about their health practices, demographic characteristics, and personal and family medical history for comparison with data from epidemiologic studies. These comparisons are used to predict individuals risk of morbidity and mortality and to suggest areas in which disease risks may be reduced. Health risks appraisals use secondary prevention by screening to prevent or detect disease in its earliest stages.

A potential barrier that a nurse may experience when in the educator role is: a. Working with clients with a low literacy level b. Memorizing the information that is to be taught c. Having a limited vocabulary d. Lacking knowledge about how to gain participation

ANS: D Educators may lack knowledge about how to gain participation. Participation can be fostered by asking open-ended questions, inviting participation, and planning small-group activities whereby a person responds based on the group rather than presenting his own information.

Asians may perceive illness as disharmony with other forces and that medicine is only able to relieve the symptoms rather than cure the disease. They may look to naturalistic solutions and acupuncture to resolve or cure health problems. This is an example of cultural variations of: a. Communication b. Space c. Social organization d. Environmental control

ANS: D Environmental control refers to the ability of individuals to control nature and to influence factors in the environment that affect them.

An inspection of a facility after a permit is obtained for the purpose of observing whether the plans submitted in the permit application are being implemented as approved is an example of which environmental protection strategy? a. Controlling pollution b. Waste minimization c. Land use planning d. Environmental monitoring

ANS: D Environmental monitoring would be an inspection of a facility after a permit is obtained to observe whether the plans submitted in the permit application are being implemented as approved.

A nurse believes additional funding is necessary to support a home-delivered meal program for the elderly. The best way to share these ideas with a legislator is to: a. Send an e-mail. b. Write a formal letter. c. Attend a town hall meeting. d. Schedule a face-to-face visit.

ANS: D Face-to-face visits with legislators are viewed as the most effective means of communication.

It is important for a nurse to recognize group norms because they: a. Allow for creativity and variety among group members b. Influence members perception of community c. Are helpful in evaluating the effectiveness of the group d. Maintain the group through various supports to members

ANS: D Group norms serve to maintain the group through various supports to members.

Public health nurses use a common set of interventions to: a. Describe the proper order of implementation. b. Emphasize surveillance as the main focus of public health practice. c. Guide practice and generate agency protocols. d. Improve the health status of communities, systems, individuals, and families.

ANS: D Interventions are actions taken on behalf of communities, systems, individuals, and families to improve or protect health status.

An example of a cultural encounter is: a. Sharing significant assessment findings with members of a racial minority b. Visiting the native land of the clients served at a community health center c. Telephoning the priest at a Latino church to discuss the health issues of a client d. Learning about traditional healing practices from an American Indian client

ANS: D Learning about traditional healing practices is an example of a direct cultural encounter. This occurs when a nurse engages in cross-cultural interactions.

When caring for a client with methicillin-resistant S. aureus (MRSA), the community health nurse should know: a. Persons with MRSA usually have a chronic illness. b. MRSA is a hospital-acquired infection and not often seen in the community. c. VRE (vancomycin-resistant Staphylococcus aureus) follows MRSA. d. MRSA is becoming more common in the community.

ANS: D MRSA is being seen more and more in the community with outbreaks frequently associated with school athletic programs and prison populations.

How have nurses historically learned to identify a possible relationship between environmental chemical exposures and their potential harm? a. Extrapolation by toxicologists b. Biomonitoring c. Completing chemistry courses d. Observing signs and symptoms in clients

ANS: D Nurses have historically made discoveries related to chemical exposure when people presented with signs and symptoms related to known chemical toxicity. The first two options are modern methods.

An established group requests a teaching and learning session on hypertension. What can the nurse expect with this type of group? a. The group membership will change from week to week. b. The members all have the same interests. c. They prefer lectures rather than demonstrations. d. The group already has operating methods that have been successful.

ANS: D Nurses working with established groups should know that this type of group has membership ties and an existing structure that has proven to be successful.

A goal of the Division of Nursing is to: a. Enhance nursing competence in providing high-tech skills b. Apply disease prevention, environmental health, and health promotion concepts c. Provide scholarships for advanced nursing education d. Enhance racial and ethnic diversity in the nursing workforce

ANS: D One of the Division of Nursing goals is to enhance racial and ethnic diversity and cultural competency in the nursing workforce. The other statements apply to other agencies or are false.

When implementing the Community Health Promotion Model, which underlying principle should the nurse use in order to facilitate active participation? a. Individuals should work in groups to complete necessary tasks. b. Individuals participating should represent all segments of the population. c. People will work together if they like the leadership. d. People will participate when they see the issues as worthy of their time.

ANS: D People participate when they feel a sense of community and see their involvement in the issues as relevant and worthy of their time.

Action taken to protect the health, safety, and welfare of citizens, such as requiring immunizations of children before admission to school, is called what kind of power? a. Executive b. Legislative c. Judicial d. Police

ANS: D Police power is state power concerning health care. This power allows states to act to protect the health, safety, and welfare of their citizens.

Which statement is discussed in the Code of Ethics for Nurses with Interpretive Statements? a. The profession of nursing is responsible for making political statements and supporting nurse-friendly candidates for office. b. The nurses primary focus is on acute bedside nursing, followed by community health care to promote seamless care. c. The nurse owes duty primarily to the physician to strive to protect health, safety, and the rights of the patient. d. The profession of nursing is responsible for articulating nursing values, for maintaining the integrity of the profession, and for shaping social policy.

ANS: D Provision 9 of the Code of Ethics for Nurses with Interpretive Statements discusses the need for the nursing profession to address national and global health concerns as well as be involved with shaping policies through political action.

Which statement is true about the origins of the Intervention Wheel? a. A panel of nurses from Iowa, Minnesota, North Dakota, South Dakota, and Wisconsin developed and refined the Intervention Wheel. b. It was conceived by a group of international nurses from Norway, Kazakhstan, and Japan. c. It was a result of a qualitative analysis carried out by the State Boards of Nursing. d. It resulted from a grounded theory process carried out by public health consultants at the Minnesota Department of Health.

ANS: D Public health consultants with the Minnesota Department of Health carried out a grounded theory process in response to uncertainty about the contributions of public health nursing to population health-level improvement, resulting in the identification of the Intervention Wheel components.

A public health nurse is organizing a multidisciplinary team to address the issue of water pollution in the community. The most likely members that would be invited to address this issue would be: a. Physicians, water sanitation workers, and occupational therapists b. Pharmacologists, radiologists, and epidemiologists c. Nurse practitioners, pharmacologists, and environmentalists d. Geologists, meteorologists, and chemists

ANS: D Scientists who study how pollutants travel in air, water, and soil are geologists, meteorologists, and chemists.

An example of a successful campaign against which of the following communicable diseases was carried out during the 1960s and 1970s? a. Tetanus b. Measles c. Pertussis d. Smallpox

ANS: D Smallpox was virtually eliminated throughout the world as a result of immunization.

Which community-based risk-reduction intervention resulted in equally favorable health risk changes for both control and treatment groups? a. Framingham Heart Study b. Stanford Heart Disease Prevention Program c. North Karelia Study d. Minnesota Heart Health Program

ANS: D The Minnesota Heart Health Program resulted in equally favorable health risk changes for both control and treatment groups.

The federal government provides for the protection of the publics health by: a. Interpreting decisions related to womens right to privacy b. Setting up immunization clinics for smallpox vaccine c. Regulating nursing at the state level d. Monitoring the influx of disease at the borders

ANS: D The United States Constitution gives the federal government the authority to provide for the protection of the publics health. By monitoring the influx of disease at the borders the publics health is being protected.

The ability of an agent to produce a severe pathologic reaction is known as: a. Antigenicity b. Invasiveness c. Toxicity d. Virulence

ANS: D The ability of an agent to produce a severe pathologic reaction is known as virulence.

When applying the integrative model for community health promotion, a nurse assesses a neighborhood for accessibility and adequacy of care to provide treatment for medical conditions. What client system does this describe? a. Individual b. Family c. Aggregate d. Community

ANS: D The community focus includes the nurse assessing the community for accessibility and adequacy of care to provide treatment for medical conditions.

When the Healthy Communities and Cities concept was brought to the United States: a. The cities chosen for the initial work were Los Angeles and New York City. b. Canada adopted the program at the same time for continuity across borders. c. The same strict guidelines that were implemented in Europe were used. d. Smaller communities and localities were targeted instead of large cities.

ANS: D The concept of Healthy Communities was used to incorporate localities that were not necessarily cities.

A nurse who is designing interventions and evaluating results of Healthy Municipalities and Cities should consider the: a. Influence of individual actions b. Acute care hospital services in the community c. Social results and endorsement of law makers for policy changes d. Effectiveness of health services including delivery of preventive services

ANS: D The effectiveness of health services, including the delivery of preventive services, should be considered when designing interventions and evaluating the results of Healthy Municipalities and Cities.

A nurse plans on implementing a community-wide influenza immunization program. Which factor should the nurse consider when implementing this program? a. The number of community members who have already received the immunization b. The existence of formal groups in the community c. Public policy that mandates influenza immunization for certain populations d. The communitys readiness to participate in the program

ANS: D The factors that influence implementation in the community are the nurses chosen roles, the type of health problem selected as the focus for intervention, the communitys readiness to take part in problem solving, and characteristics of the social change process.

A nurse implements the principles of the Personalized Health Care Initiative in practice by: a. Educating clients that multiple factors influence the development of disease b. Counseling clients about the results of genetic testing c. Lobbying for legislation to support genetic research d. Protecting clients from discrimination based on the results of genetic testing

ANS: D The goals of the Personal Health Care Initiative are to link clinical and genomic information to support personalized health care, protect individuals from discrimination-based or unauthorized use of genetic information, ensure the accuracy and clinical validity of genetic tests performed for medical application purposes, and develop common policies for access to genomic databases for federally-sponsored programs.

Public health nurses utilize registries to identify children with delayed or missing immunizations. They subsequently follow up with families by phone calls or home visits. This is an example of ____-level of practice. a. Systems b. Community c. Policy d. Individual/family

ANS: D The individual/family-level of practice focuses on interventions that involve working with individuals, either singly, or in groups, and with families.

The key to achieving the goals of Health for All in the 21st Century (HEALTH21) is the worldwide: a. Cure of communicable disease b. Technological development of all nations c. Availability of health care insurance d. Implementation of primary health care

ANS: D The major key to attaining Health for All by the Year 2000 was the worldwide implementation of primary health care; this has extended into the next century with the document HEALTH21. The World Health Assembly in 1977 stated that all citizens of the world should enjoy a level of health that would permit them to lead a socially and economically productive life.

A nurse is trying to increase participation in a free colorectal screening program for middle-aged adults who lack health insurance. Which implementation mechanism would be most effective? a. Small interacting groups b. Health policy c. Lay advisors d. Mass media

ANS: D The mass media (newspapers, television, and radio) represent an impersonal and formal type of communication and are useful in providing information quickly to a large number of people.

Which of the following domains would be used to teach a new diabetic how to give an insulin injection? a. Developmental b. Cognitive c. Affective d. Psychomotor

ANS: D The psychomotor domain includes the performance of tasks that require some degree of neuromuscular coordination and emphasizes motor skills.

Which characteristic is an indicator of community health structure? a. Infant mortality rate b. Effective communication c. Crime rate d. Emergency room utilization

ANS: D The structure of the community is defined in terms of services and resources.

In the Vietnamese culture, individuals may focus on wishes and memories of their ancestors and look to them to provide direction for current situations. This is an example of cultural variations of: a. Communication b. Space c. Social organization d. Time

ANS: D This is the duration or period between successive events, where some cultures assign greater or lesser emphasis to events that occur in the past, present, or future.

Worldwide, the most frequent cause of death from a single agent is: a. AIDS b. Malaria c. Hepatitis d. Tuberculosis

ANS: D Tuberculosis strikes nearly 3 million people each year. One third of the worlds population harbors the pathogen.

Personal safety is a prerequisite for effective community-oriented practice. Personal safety should be a consideration throughout the process.

An awareness of the community and common sense are the two best guidelines for judgment.

Identifying Community Problems Planning the Community Health

Analyzing problems Problem priorities Criteria Establishing goals and objectives Identifying intervention activities

A nurse planning a smoking cessation clinic for adolescents in the local middle schools and high schools is providing: A. Community-oriented care B. Community-based care C. Secondary care D. Tertiary care

Answer: A - Community-oriented nurses emphasize health protection, maintenance, and promotion and disease prevention, as well as self-reliance among clients. Regardless of whether the client is a person, a family, or a group, the goal is to promote health through education about prevailing health problems, proper nutrition, beneficial forms of exercise, and environmental factors such as safe food, water, air, and buildings.

A clinic treating a child for otitis media is an example of: A. Community-based care B. Public health care C. Tertiary health care D. Community-oriented care

Answer: A - In community-based nursing, the nurse focuses on "illness care" of individuals and families across the life span. The aim is to manage acute and chronic health conditions in the community, and the practice is family-centered illness care. Community-based nursing is not a specialty in nursing but, rather, a philosophy that guides care in all nursing specialties.

A state agency has received multiple complaints regarding the availability of elder transportation services to a specific county senior center. The state agency assigns a public health nurse to work with the community to evaluate its program for elder transportation services to publicly sponsored elder care programs. The public health core function applied is: A. Assurance B. Primary prevention C. Policy development D. Public transportation

Answer: A - The public health core function of assurance focuses on the responsibility of public health agencies to be sure that activities are appropriately carried out to meet public health goals and plans. This role requires skill in assessment, investigative functions, collaboration, consultation, and cooperation. Assurance also includes assisting communities to implement and evaluate plans and projects.

Community as client requires that the improved health of the community remains the overall goal of nursing intervention.

Change to benefit the community client often must occur at several levels ranging from individual to society as a whole.

Community as Client and Partner in Nursing Practice

Direct clinical care and be a part of population-focused community health practice. Improved health of the community remains the overall goal of nursing intervention.

Health Workforce Trends

Not enough primary care providers move to community-based care By 2016, expecting 587,000 new nursing positions 55% of surveyed nurses intend to retire between 2011 and 2020

Community Health: has three common characteristics: status, structure, and process

Status: involves physical (i.e., morbidity and mortality rates), emotional (i.e., client satisfaction), and social (i.e., crime rates) components Structure: services and resources in a community Process: effective community functioning or problem solving

Primary health care (PHC) is broader than primary care

The setting for PHC is within all communities of a country and involves all aspects of society (World Health Organization, 1978)

A public health nurse provides a clinic for HIV-positive citizens in the community. This is an example of: a.Primary prevention b.Secondary prevention c.Tertiary prevention d.Policy making

c.Tertiary prevention

Public health nurses who develop and implement local public health policies through partnerships with agencies, organizations, and consumers within the community are using which core public health function? a.Assessment b.Prevention c.Assurance d.Policy development

d.Policy development

Between 1900 and 1955, the leading causes of mortality were pneumonia, tuberculosis, and diarrhea/enteritis. By mid-century, nurses faced new challenges as the leading causes of death became: 1. Heart disease, cancer, and cerebrovascular disease 2. Influenza 3. Tropical diseases from increased travel abroad 4. Diseases from overcrowded conditions in large cities

ANS: 1 Chronic illness care, long-term illness and disability, and disease prevention became the new challenges for nurses.

Neighborhood centers that provided health care and social welfare programs were called: 1. Settlement houses 2. Nursing care centers 3. Nurse-managed clinics 4. Public health services

ANS: 1 Correct by definition. Nursing centers, nurse-managed clinics, and public health services are not necessarily in neighborhoods.

Cultural brokering

Advocating, mediating, negotiating, and intervening between the client's culture and the biomedical health care culture on behalf of clients.

Cultural Shock

Feeling of hopelessness, discomfort, and disorientation experienced by an individual attempting to understand or effectively adapt to another cultural group that differs in practices, values, and beliefs. Results from the anxiety caused by losing familiar sights, sounds, and behaviors.

Racism

Form of prejudice and refers to the belief that persons who are born into a particular group are inferior, for example, in intelligence, morals, beauty, or self-worth

Prejudice

Having a deeply held reaction, often negative, about another group or person

Cultural Accommodation

Nurse supports and facilitates clients in their use of cultural practices when such cultural practices are not harmful to clients.

Cultural Preservation

Nurse supports and facilitates the use of scientifically supported cultural practices from a person's culture along with those from the biomedical health care system (Acupuncture)

Cultural Repatterning

Nurse works with clients to help them reorder, change, or modify their cultural practices when these practices are harmful to them

Space

Physical area persons need between themselves and others to feel comfortable

Biological Variations

Physical, biological, and physiological differences that distinguish one racial group from another

Cultural Encounter

Process that permits nurses to seek opportunities to engage in cross-cultural interactions

Ethnocentrism

Type of cultural prejudice at the population level, is the belief that one's own group determines the standards for behavior by which all other groups are to be judged

Cultural Competence

(in nurses) A combination of culturally congruent behaviors, practice attitudes, and policies that allow nurses to work effectively in cross-cultural situations.

A 66-year-old woman is retired and no longer has health insurance through her place of employment. Which of the following programs would be appropriate for her health insurance needs? 1. Medicare 2. Medicaid 3. Social Security 4. Economic Opportunity Act

ANS: 1 The Social Security Act was amended to include health insurance benefits for the elderly, which is addressed through Medicare.

Nurses who provided care to people in their homes and provided that care to several people at a time were called: 1. Private duty nurses 2. Visiting nurses 3. Public health nurses 4. Community staff nurses

ANS: 2 Correct by definition

A major provision of the Social Security Act of 1935 was the establishment of: 1. The Frontier Nursing Service to provide nursing service to rural communities 2. State and local community health services and training of personnel 3. District nursing to provide home health care to sick people 4. Community-based settlement houses

ANS: 2 Title VI of the Social Security Act established state and local community health services and training of personnel.

Cultural Awareness

Self-examination and in-depth exploration of one's own beliefs and values as they influence behavior. Nurses that are culturally aware are able to learn about the cultural dimensions of clients, understand their own behavior and how it helps or hinders the delivery of competent care to persons from cultures other than their own, recognize that health is expressed differently across cultures and that culture influences an individual's responses to health, illness, death, and disease

Culture

Set of beliefs, values, and assumptions about life that is widely held among a group of people and that is transmitted across generations

Ethnicity

Shared feeling of peoplehood among a group of individuals. reflects cultural membership and is based on individuals sharing similar cultural patterns (beliefs, values, customs, behaviors, traditions) that, over time, create a common history that is resistant to change