final exam review questions

2. A state public health region reported 39 cases of meningitis in children 15 years of age and younger to date this year. Seven of those children died. The total population of the region is 780,000, of whom 84,000 are children 15 years old and younger. What is the age-specific meningitis death rate for children age 15 years and younger for this region to date this year? a. 0.08/1000 b. 0.46/1000 c. 1/1000 d. 8/1000

ANS: A A rate is a measure of the frequency of a health event in a defined population in a specified period of time. In this example, seven child deaths divided by the total number of children age 15 years and younger in the population (which is 84,000) = 0.0000833 × 1000 = 0.0833/1000.

2. 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 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. Which core public health function does this represent? 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.

A nurse planning a smoking cessation clinic for adolescents in the local middle schools and high schools is providing what type of care? a. Community-oriented b. Community-based 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.

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. This can best be described as an example of which type of care? 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.

3. A school nurse notes that 60 children have missed days of high school because of pertussis this past year and this rate has been relatively constant for the past 5 years. The nurse plans to work with the community to increase awareness of the seriousness of this disease for children younger than 6 months of age and to raise and maintain the immunization rates, because in this community the pertussis is: a. endemic. b. epidemic. c. pandemic. d. sporadic.

ANS: A Endemic refers to the constant presence of a disease within a geographic area or a population. Epidemic refers to the occurrence of disease in a community or region in excess of normal expectancy. Pandemic refers to an epidemic occurring worldwide and affecting large populations.

7. One step in the ethical decision-making framework is to place an ethical issue within a meaningful context. What is the rationale for this step? a. Multiple factors affect the formulation and justification of ethical issues and dilemmas. b. The nature of ethical issues and dilemmas determine the specific ethical approach used. c. People cannot make sound ethical decisions if they cannot identify ethical issues and dilemmas. d. Professionals cannot avoid choice and action in applied ethics.

ANS: A Ethical decision-making frameworks use problem-solving processes and provide guides for making sound ethical decisions that can be morally justified. To make these decisions, a person must be able to articulate the ethical issue or dilemma.

2. The community-oriented nurse best exemplifies the application of feminist ethics when the nurse does which of the following? a. Design health care programs that incorporate social justice, respect and equity, and address social and political power. b. Design health care programs for women that respect their dignity and autonomy. c. Ensure that male providers do not use sexist terms with clients, families, and coworkers d. Participate in political action that focuses on women's rights and status in the community.

ANS: A Feminine ethics not only focuses on equity between genders, but also recognizes the social and political powers that help maintain a socially unjust system. The best way to apply feminist ethics for this nurse is to design programs that focus on equity, respect, and social justice and attempt to address the social and political forces.

4. Community health nurses conducting health education among populations vulnerable to HIV infection explain the natural history of the infection, including the fact that HIV infection may go undetected during the primary infection stage because of which issue? 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.

8. What is the underlying reason for the use of universal precautions? a. Blood and body fluids of all clients need to be handled as if they were infected. b. Effective infection control surveillance programs are in place but not reliable. c. Health care settings are reservoirs of infection and precautions prevents spread. d. Health care workers do not always effectively use hand hygiene.

ANS: A The practice of universal precautions is a policy relevant for all health care settings. In 1985, in response to concern regarding the transmission of HIV infection during health care procedures, the Centers for Disease Control and Prevention recommended implementation of a universal precautions policy in all health care settings. This policy requires that all blood and body fluids from all clients be handled as if they were infected with HIV or other bloodborne pathogens.

7. A factor that strongly influences the success of a PHC system is: a. participation of the community members in the design, implementation, and evaluation of the initiative. b. assurance of access to care for every woman and child from pregnancy through childhood. c. each entity's sense of urgency regarding the evaluation of indicators. d. cure orientation of the private sector of health care delivery in the United States.

ANS: A PHC, the focus of the public health system in the United States, is defined as the broad range of services including but not limited to, basic health services, family planning, clean water supply, sanitation, immunization, and nutrition education. It consists of programs designed to be affordable for the recipients of the care and the governments that provide them. The emphasis is on prevention, and the means of providing the care are based on practical, scientifically sound, culturally appropriate, and socially acceptable methods provided at the community level, accessible and acceptable to the community and inviting of community participation.

During the Depression, which of the following created a negative effect on public health nursing? a. Decrease in focus on the community as the unit of service. b. Increase in the scope of fundamental services. c. Increase in field experience requirements for public health. d. Decrease in the need for training and supervision.

ANS: A Some Depression-era federal programs, such as the Works Progress Administration, Relief Nursing Services, and Civil Works Administration (CWA), expanded the need for existing nursing services and created the need for new services in an effort to support employment of basic nurses while meeting the needs of the increasing ranks of impoverished individuals. More than 10,000 nurses were employed by the CWA and assigned to official health agencies. This facilitated rapid expansion of these programs and provided basic nurses with a taste of public health, but it also created a tremendous burden on existing public health staff to provide training and supervision. Basic nursing education focused heavily on the care of individuals, and students received very little training on working with groups and the community as a unit of service. A 1932 survey of public health agencies found that only 7% of nurses employed in public health were adequately prepared to practice in the community, which required considerable agency investment in orientation, training, and supervision.

5. 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, where would the nurses begin their search? 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.

4. The public health nurse is concerned about a possible multi-state outbreak of a foodborne illness. What resource will the nurse consult? a. PulseNet b. Healthy People 2020 c. CDC Yellow Book d. National Healthcare Safety Network

ANS: A The Foodborne Diseases Active Surveillance Network (FoodNet) is a CDC sentinel surveillance system targeting 10 sites across the country and collecting information from laboratories on disease caused by 9 enteric pathogens transmitted commonly through food. This is the resource the nurse would consult if worried about a multi-state outbreak.

6. The WHO initiative Health for All in the 21st Century can best be described as which of the following? a. Social justice initiative b. Primary care initiative c. National initiative d. Environmental initiative

ANS: A The Health for All in the 21st Century initiative is not a single, finite goal, but a strategic process that can lead to progressive improvement in the health of people. In essence, it is a call for social justice and solidarity to improve the economics and infrastructure of nations through a holistic approach to address determinants of health status and increase a community's responsibility for the health of its citizens. This may involve environmental initiatives and health promotion, education, and prevention initiatives aimed at the greater good of the population as a whole instead of serving the interests of individuals or select groups.

5. An American spends several days in Mexicoeating fresh raspberries from a nearby vendor and drinking bottled water. What entity is potentially being altered? a. Agent-host-environment interaction b. Circadian rhythms c. Herd immunity d. Host resistance

ANS: A The balance among agent, host, and environment is often precarious and may be unintentionally disrupted. These three factors are known as the epidemiologic triangle. Changes in the characteristics of any of these factors may result in disease transmission.

Primary health care (PHC) differs from primary care in which of the following ways? a. PHC encourages community participation. b. PHC focuses on prevention and cure. c. PHC is defined more narrowly. d. PHC is the primary method of health care delivery in the United States.

ANS: A The definition of PHC is broad, incorporating a comprehensive range of services including public health, prevention, and diagnostic, therapeutic, and rehabilitative services. PHC is the mainstay of the public health system in the United States, with a main focus on prevention instead of cure. Although endorsed by the United States as a strategy for achieving the goal of health for all in the twenty-first century, it is not the chief means of delivery of health care in the United States.

8. How does virtue ethics differ from other ethical theories or principles? a. It focuses on character development. b. It views consequences as natural occurrences. c. It is core to developing distributive justice. d. It works from the principle of egalitarianism.

ANS: A The goal of virtue ethics, one of the oldest ethical theories, is to enable individuals to flourish as human beings. According to Aristotle, virtues are acquired, excellent traits of character that dispose humans to act in accordance with natural good. Examples of such traits in virtue ethics are benevolence, compassion, discernment, trustworthiness, integrity, and conscientiousness.

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. Which public health core function does the nurse apply in this situation? 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.

2. Benefits of an electronic health record in the public health system include: (Select all that apply.) a. 24-hour availability of health records. b. ease of referral coordination. c. reduction in medication errors. d. increased privacy. e. consistently reliable internet resources.

ANS: A, B, C Benefits of an electronic record in public health include 24-hour availability of records with downloaded laboratory results and up-to-date assessments; coordination of referrals and facilitation of interprofessional care in chronic disease management; incorporation of protocol reminders for prevention, screening, and management of chronic disease; improvement of quality measurement and monitoring; and increased client safety and decline in medication errors.

Which of the following are recommendations of the 1850 Shattuck Report that represented major innovations in public health? (Select all that apply.) a. Establishment of state health departments and local health boards in every town b. Promotion of environmental sanitation and collection of vital statistics c. Steps to decrease preventable disease and control smoking and alcohol use d. Targeting of efforts solely on environmental hazards e. Provision of supplemental food to low-income persons

ANS: A, B, C The report published in 1850 by the Massachusetts Sanitary Commission called for major innovations, including establishment of a public health infrastructure; environmental sanitation; food, drug, and disease control; well-child care; health education; tobacco and alcohol control; urban planning; and preventive medicine education in medical training programs. This moved public health away from solely targeting environmental hazards to addressing communicable disease, which lay the foundation for an expanded public health role that included the use of PHNs.

1. Research articles that include epidemiologic determinants and distribution would include which questions? (Select all that apply.) a. Who is affected most by pesticide exposure? b. Where in the city are lead levels highest? c. How does herbicide runoff affect drinking water? d. What season of the year sees the most trauma? e. Why do children get injured on playgrounds?

ANS: A, B, C, D, E "Who," "what," "when," and "where" questions address epidemiologic distribution. "How" and "why" questions address epidemiologic determinants.

1. 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.

Which are major accomplishments of the National Organization for Public Health Nursing (NOPHN)? (Select all that apply.) a. Collaborated to secure health insurance reimbursement for nursing services, such as postdischarge nursing care at home b. Established public health nursing programs for military outposts in World War I c. Provided matching funds to establish maternal and child health divisions in state health departments d. Responded to the 1918 worldwide influenza pandemic in the United States e. Supported nurse employment through increased grants-in-aid for state programs of home medical care

ANS: A, B, D The NOPHN is credited with upgrading the profession of public health nursing and community-oriented practice through the advancement of an educational model that ensured university-based education in the principles of population-based care; with assisting the U.S. Public Health Service in the development of public health nursing programs for military outposts during World War I in collaboration with the American Red Cross; and with responding to the 1918 worldwide influenza pandemic in the United States by preparing volunteers to care for clients in the community when public health nursing personnel ranks at home were depleted because of the war effort in Europe. The Sheppard-Towner Act of 1921 provided federal matching funds to establish maternal and child health divisions in state health departments. The Federal Emergency Relief Administration supported nurse employment during the 1930s by increasing grants-in-aid for state programs of home medical care.

1. Emerging infectious diseases may arise as a result of factors operating singly or in combination, and these factors may include which of the following? (Select all that apply.) a. Environmental changes b. Host behavior c. Improved surveillance d. Microbial adaptation e. Public health infrastructure deterioration

ANS: A, B, D, E Emerging infectious diseases are those for which the incidence has actually increased over the past several decades or has the potential to increase in the near future, and these include both new and known infectious diseases. New viruses may appear as a result of microbial adaptation, activities and behaviors of human hosts, and environmental changes. Relevant environmental changes include such things as weather changes, deforestation, urbanization, and industrialization. Human activities and behaviors that influence the spread of these diseases include increased use of daycare centers, illegal drug use, changing sexual behavior, use of modern modes of transportation, use of air conditioning, immigration, and global travel.

1. Nurses have unique skills that can be applied in which of the following aspects of disaster management? (Select all that apply.) a. Registration as an ARC 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).

Which of the following factors assisted community-oriented nursing pioneers, such as Lillian Wald, in developing approaches and programs to solve the health care and social problems of her times? (Select all that apply.) a. Community health's focus on teaching and prevention b. Establishment of settlement houses c. Establishment of the town and country nursing services in large cities d. Lack of public interest in limiting disease e. Middle and upper class fear of diseases

ANS: A, B, E In the 1890s, the public was interested in limiting disease among all classes of people, partly for religious reasons, partly for charitable reasons, but also because the middle and upper classes were afraid of the diseases that seemed to be brought in by the large communities of European immigrants. Nurses began to establish settlement houses and neighborhood centers, which became hubs for health care and social welfare programs. From the beginning, community health nursing practice included teaching and prevention. Community-oriented interventions led to better sanitation, economic improvements, and better nutrition. These interventions were credited with reducing the incidence of acute communicable diseases. Pioneers in public health nursing like Lillian Wald took advantage of the public's concern and existing practice models to address health care and social problems, which reduced the incidence of acute communicable diseases in immigrant communities.

3. The nurse educates a group of students that which persons would be most at risk of reactivation of latent infections of tuberculosis (TB)? (Select all that apply.) a. Immunocompromised b. Substance abusers c. Individuals previously treated for TB d. Long-term cigarette smokers e. Diabetics

ANS: A, B, E 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.

1. Which of the following groupings of health care trends will have the greatest influence on the health care transformation process? (Select all that apply.) a. Aging of the population and medical technology advances b. Funding levels, political structure, and professional licensure requirements c. Longevity, population diversity, and funding sources d. Managed care, workforce shortages, and level of education of the population

ANS: A, C Increases in the number of aging baby boomers as well as the longevity of the elderly, advances in medical technology such as telehealth, and electronic medical record keeping are currently having the greatest impact on the transformation of our health care system. This involves the reallocation of resources, standardization of information transfer, and funding challenges. As a percentage of gross domestic product (GDP), publically funded programs are outpacing the tax and revenue sources for these programs.

2. 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. Which interventions by the nurse are most appropriate? (Select all that apply.) a. Provide comprehensive STD screening. b. Call the health department to inquire about the spouse. c. Educate the client on ceftriaxone and azythromycin. d. Instruct the client on safer sex practices. e. Perform a serum pregnancy test.

ANS: A, C, D, E Gonorrhea and chlamydia are the two most common STDs today. The CDC guidelines are to treat both infections at the same time with ceftriaxone and azithromycin. However, the patient needs comprehensive STD screening. The client also needs a pregnancy test as STDs can lead to fetal effects (abnormal menses does not rule out a pregnancy). The nurse would educate the client on safer sex practices.

1. 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. Surgical removal and other treatments are often done.

3. The most important features of the Affordable Health Care for America Act of 2010 that the community-oriented nurse needs to understand include which of the following? (Select all that apply.) a. Transforms the health care system from a sick care system to health care system. b. Uses piecemeal approach to strengthen the safety net. c. Replaces the rational equitable health care system. d. Provides insurance reform. e. Increases access to affordable health care insurance.

ANS: A, D, E The Affordable Health Care for America Act of 2010 requires most Americans to have health insurance coverage, expands Medicaid, subsidizes private coverage for low- and middle-income people, transforms the current system from a sick care system to a true health care system, lowers mortality related to preventable causes, institutes health insurance reform, increases access to affordable health care coverage, and increases support for nursing workforce development programs.

6. The local nurse-managed community health center initiative is providing community-based primary and preventive care as well as specialty care, community screenings, local health assessments, health education, and health care coordination, targeted to medically uninsured individuals regardless of ability to pay. What system does this best describe? a. Managed care b. Primary care c. Primary health care d. Private health care

ANS: C Nurse-managed clinics or centers incorporate primary care and public health care; consequently, they provide PHC when the broad range of services focuses on prevention, basic health services, and education and is provided at the community level, typically serving underserved populations.

7. Health problems exist throughout the world. In the United States, a current health concern is the appearance of new viral strains such as Hantavirus in the Southwest. This is an example of the difference in health care concerns between countries such as: a. United States and Canada. b. Sweden and Indonesia. c. Australia and Japan. d. Bangladesh and Zaire.

ANS: B Although health problems exist throughout the world, the health care concerns of less-developed countries differ from those of developed countries. Less-developed nations such as Indonesia include have health problems like Buruli ulcer, leishmaniasis, schistosomiasis, pediculosis, typhus, yellow fever, and malaria as well as the ongoing problems of measles, mumps, rubella, and polio. Current health concerns for developed nations such as Swedenare problems like hepatitis, the appearance of new viral strains such as hantavirus, and large social yet health-related issues such as terrorism, warfare, violence, and substance abuse. AIDS remains a major global concern for all countries, developed or less developed.

3. A state public health region reported 39 cases of meningitis in children 15 years of age and younger to date this year. Seven of those children died. The total population of the region is 780,000, of whom 84,000 are children age 15 years old and younger. Only four cases of meningitis were reported in the public health region during the previous year. No other public health region in the state has an incidence of meningitis that is higher than expected for that region. Based on the information given, the relative frequency of meningitis in the region at this time can best be described as: a. endemic. b. epidemic. c. pandemic. d. sporadic.

ANS: B An epidemic occurs when the rate of disease, injury, or other condition exceeds the usual (endemic) level of that condition.

7. In an effort to address West Nile virus, a community increased livestock immunization, began a vector control program, and initiated a community campaign to eliminate standing water reservoirs. Which approach to communicable disease control does this approach exemplify? a. Health education b. Multisystem approach c. Improved public health infrastructure d. Reduction of environmental hazards

ANS: B Communicable diseases represent an imbalance in the usually harmonious relationship between the human host and the environment. This state of imbalance provides the infectious agent an opportunity to cause illness and death in the human population. Given the many factors that can disrupt the agent-host-environment relationship, a multisystem approach to the control of communicable diseases must be developed.

4. The community-oriented nurse who uses the principle of justice would demonstrate that ethical principle best when doing which of the following? a. Learns disaster triage and volunteers for service during local catastrophes. b. Has a permanent "navigation booth" to help people learn how to contact elected officials. c. Takes continuing education on emerging trends in health care such as pharmacogenomics. d. Takes the lead on a committee reviewing and revising nursing home standards.

ANS: B Distributive or social justice refers to the allocation of benefits and burdens to members of society. Benefit refers to basic needs, including material and social goods, liberties, rights, and entitlements. By helping citizens learn to advocate for themselves, they can help force more equal distribution of benefit, including health care, to society. This option also allows the nurse to have an impact on a larger number of community members than the other options do.

7. A public health nurse (PHN) has identified a need to make amendments to an existing health-related law. The nurse knows 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.

5. A business executive develops flu-like symptoms 1 day after returning by air from a trans-Atlantic 2-day conference that involved lengthy meetings. The scenario best illustrates the interaction of: a. host and agent. b. host, agent, and environment. c. risk and causality. d. morbidity and disease.

ANS: B Epidemiologists understand that disease results from complex relationships among causal agents, susceptible persons, and environmental factors. These three elements—agent, host, and environment—are called the epidemiologic triangle. Changes in one of the elements of the triangle can influence the occurrence of disease by decreasing or increasing a person's risk of

3. 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.

The most important contribution made by Florence Nightingale to community-oriented nursing was which of the following? a. Developing the settlement house concept to improve urban health standards b. Expanding the role of nursing to include health-promotion practices c. Founding the first district nursing association in England d. Introducing professional schools of nursing in the United States

ANS: B Florence Nightingale introduced professional nursing education in 1850s England. She also introduced the concept that individual health depended on community health, which expanded nurses' focus from care of the ill to include a population-based approach, health promotion, and disease prevention. She differentiated "sick nursing" from "health nursing." The latter emphasized that nurses should strive to promote health and prevent illness.

1. Health policy can best be defined as a set course of action to do which of the following? a. Administer public health programs 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. Policy is a settled course of action to be followed by a government or institution to obtain a desired end.

6. The health policy-making body of the World Health Organization (WHO) released a policy statement on nursing and midwifery in 2013. What is important for nurses to understand about WHO policy statements? 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.

What was one of Mary Breckenridge's innovative contributions to health care in the United States? a. Establishing the Federal Emergency Relief Administration b. Introducing the first nurse-midwifery training c. Introducing the nursing process d. Establishing occupational health nursing

ANS: B Mary Breckenridge established the Frontier Nursing Service (FNS) in 1925 to provide health programs to rural Appalachia and she introduced the first nurse-midwife training to the United States.

1. The population group that is likely to be the most vulnerable is which of the following? a. Children with a family history of sickle cell disease b. Homeless pregnant teens in a substance abuse program c. Native Americans at risk for diabetes d. Overweight children

ANS: B Populations most vulnerable to risk include poor or homeless persons, pregnant adolescents, migrant workers, severely mentally ill individuals, substance abusers, abused individuals, people with communicable diseases, and people with sexually transmitted diseases.

6. The nurse teaches all clients primary prevention for STDs. Which topic does the nurse include? a. Partner notification b. Safer sex c. Standard precautions d. STD testing

ANS: B Primary prevention activities are those that prevent the onset of diseases or injuries. Teaching safer sex practices are an example of primary prevention.

2. A 6 year old is brought to the emergency department with a full-body rash and fever. During the nursing assessment, which of the following findings would be most relevant to recognizing the case as potential smallpox rather than varicella? a. Fever has responded to acetaminophen, and the child is playful. b. Fever of 101°F was present for several days before the rash appeared. c. Low-grade fever (100°F or less) has been present ever since the rash became obvious. d. Rash is primarily on the trunk of the body.

ANS: B Smallpox is associated with a sudden onset of fever, severe body aches, and occasional abdominal pain and vomiting, as in influenza. The rash, which is centrifugal with same-stage lesions in all areas but most abundant on the face and extremities, follows 2 to 4 days after the fever begins decreasing. With chickenpox, the rash is centripetal, with lesions most abundant on the trunk or in areas covered by clothing; the rash is present at the onset of symptoms, such as a slight fever with mild constitutional symptoms, and can appear as multiple crops of lesions at various stages of development (maculopapular lesions, vesicular lesions, or granular scabs).

The Association of Community Health Nurse Educators has called for increased graduate programs to educate Public Health Nursing leaders, educators, and researchers in such areas as: a. immigrant and migrant health. b. natural and human-made disasters. c. automobile safety for children. d. student health.

ANS: B The Association of Community Health Nurse Educators calls for increased graduate programs to educate PHN leaders, educators, and researchers. Natural disasters (such as floods, hurricanes, and tornados) and human-made disasters (including explosions, building collapses, and airplane crashes) require innovative and time-consuming responses. Preparation for future disasters and potential bioterrorism demands the presence of well-prepared nurses.

4. The agency that assumes the responsibility for regulating health care and overseeing the health status of Americans is which of the following? a. Department of Homeland Security b. U.S. Department of Health and Human Services c. Local Health Department d. State Department of Health

ANS: B The U.S. Department of Health and Human Services (USDHHS) is the agency most heavily involved with the health and welfare concerns of U.S. citizens. The USDHHS is charged with regulating health care and overseeing the health status of Americans.

7. 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.

3. A nurse is assigned to teach clients STD prevention information. What information will the nurse include in the presentation? 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.

Nurses 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. Which is an example of such opportunity? a. Operator of a nurse practitioner-run urgent care center in a major retail location b. Director of clinical services providing a wide range of services to 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 community-oriented nurse using the principles for effective advocacy would do which of the following? a. Share data on a caseload medically indigent with philanthropic organizations. b. Follow the clients' wishes and directions tenaciously in all related activities. c. Monitor spending allocated by the state or local authorities for proper disbursement. d. Use the opinions and ideas of key community leaders first to drive policy creation and program development.

ANS: B The six principles of effective advocacy include acting in the client's best interests; acting in accordance with the client's wishes and instructions; keeping the client properly informed; carrying out instructions with diligence and competence; acting impartially and offering frank, independent advice; and maintaining client confidentiality. Following a client's wishes tenaciously fits the description of these principles.

7. A nurse is concerned about the accuracy of the purified protein derivative (tuberculin) test in screening individuals with tuberculosis exposure for follow-up chest radiography. The nurse's concern is related to which aspect of the test's validity? a. Reliability b. Sensitivity c. Specificity d. Variability

ANS: B The validity of a screening test is measured by its sensitivity and specificity. Sensitivity quantifies how accurately the test identifies those individuals with the condition or trait of interest. Sensitivity is calculated as the proportion of persons with the disease that the test correctly identifies as having the disease (true positives). High sensitivity is needed when early treatment is important and when the identification of every case is important.

The Social Security Act of 1935 was designed to prevent the reoccurrence of the problems of the depression. Title VI of this act provided funding for expanded opportunities for health protection and promotion. The most relevant strategy of Title VI of the Social Security Act (1935) related to public health nursing was funding which of the following? a. The Frontier Nursing Service b. Employment and education of nurses c. Research and investigation of disease d. The district nursing model

ANS: B Title VI of the 1935 Social Security Act provided funding for expanded opportunities for health protection and promotion through education and employment of public health nurses (PHNs). More than 1,000 nurses completed educational programs in public health in 1936. Title VI also provided $8 million to assist states, counties, and medical districts in the establishment and maintenance of adequate health services, which included increasing the number of PHNs with appropriate educational preparation. Title VI also provided $2 million in funding for research and investigation of disease, but this did not have the far reaching results as the increase in public health nurses.

9. When the association between maternal alcohol use and low birth weight is being studied, the nurse investigator's failure to consider the variable of smoking could introduce bias into the observed association, because smoking has a correlation with both factors. This effect could best be described as: a. causality. b. confounding. c. information bias. d. selection bias.

ANS: B When looking for the existence of statistical association between some factor and a health outcome, the investigator must consider the three general categories of bias. Bias is a systematic error resulting from study design, study execution, or confounding. Bias resulting from the relationship of the outcome and the study factor with some third factor not accounted for in the study design is called confounding. In practice, one can often identify potentially confounding variables and adjust for them in analysis.

6. Which is an example of secondary prevention of infectious disease? a. Malaria chemoprophylaxis b. Immunizations c. Quarantine d. Restaurant inspections

ANS: C Secondary prevention interventions related to infectious disease prevent the spread of disease. Primary prevention interventions prevent the occurrence of disease, and tertiary prevention interventions reduce the complications and disabilities of disease through treatment and rehabilitation. Secondary prevention activities center on rapid identification of potential contacts of a reported case. Contacts may be identified as new cases and treated or classified as possibly exposed and given appropriate prophylaxis. Public health laws also assist in secondary prevention because they require investigation of certain disease cases and initiation of preventive measures for individuals affected by a reported case or outbreak of communicable disease. These interventions can include quarantine and can be applied to the entire community if the exposure potential is deemed great enough, as could happen with an outbreak of smallpox or epidemic influenza.

1. A nurse in Mexico collaborates with the health committee that operates a village-based health post. They intended to discuss the planning for next year's health promotion initiative and evaluate the recent family planning program. This best demonstrates the aim of the Declaration of Alma-Alta to emphasize which of the following? (Select all that apply.) a. Availability of chemotherapeutic agents b. Development of maternal and child health programs c. Involvement and training of community health workers d. Organized approach to health education e. Promotion and acceptance of traditional medicine

ANS: B, C, D, E Primary health care in global health is historically based on the Declaration of Alma-Ata (1978). The WHO's and the United Nations Children's Emergency Fund still actively promote primary health care as the strategy for achieving the goal of Health for All in the 21st Century. Several major components are identified for implementation of primary health care: an organized approach to health education that involves professional health care providers and trained community representatives; aggressive attention to environmental sanitation; involvement and training of community health workers; development of maternal and child health programs that include immunization and family planning; initiation of preventive programs aimed at local endemic problems; provision of accessible and affordable services for treatment of common diseases and injuries; availability of chemotherapeutic agents; development of nutrition programs; and promotion and acceptance of traditional medicine. In this example, only three of those components are evident.

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. A community-based HIV/AIDS clinic would be concerned about which aspects of the Public Health Code of Ethics? (Select all that apply.) a. Autonomy of the professional b. Confidentiality, when possible c. Funding d. Advocacy for disenfranchised persons e. Respect of only community rights

ANS: B, D The 12 principles of the Public Health Code of Ethics incorporate the ethical tenets of preventing harm; doing no harm; promoting good; respecting both individual and community rights; respecting autonomy, diversity, and confidentiality when possible; ensuring professional competency; maintaining trustworthiness; and advocating for disenfranchised persons within the community.

2. A state health department nurse with budgetary responsibility for a population health framework would allocate priority funding to which activity? a. Chronic disease surveillance and treatment programs b. Pediatric and adolescent primary care and nutrition programs c. Promoting healthy lifestyles or improvement of social and physical environments d. Well and sick child clinics

ANS: C A key to the success of a population health framework is the identification and definition of health issues and of the investment decisions within a population that are guided by evidence about what keeps people healthy. Therefore, a population health approach directs investments that have the greatest potential to influence the health of that population in a positive manner. The activities that promote healthy lifestyles and improve social and physical environments would best illustrate this concept.

9. Healthy People 2020 has a number of objectives aimed at reducing which trend in infectious diseases? a. Identification of multi-state outbreak of Escherichia coli 0157:H7 b. The failure of the multisystem approach to containing diseases c. A rapid and serious rise in health care-associated infections d. Emergence of a new strain of severe acute respiratory syndrome

ANS: C Although infectious diseases may not be the leading cause of death in the United States at the beginning of the twenty-first century, they continue to present varied, multiple, and complex challenges to all health care providers. One trend in the United States is the rise of health care-associated infections. Health care-associated infections are acquired during hospitalization or develop within a hospital setting and were previously known as nosocomial or hospital-acquired infections. The performance of invasive diagnostic and surgical procedures, the use of broad-spectrum antibiotics, and treatment with immunosuppressive drugs, along with the original underlying illness, leave hospitalized clients particularly vulnerable to infection by virulent agents carried by other clients and indigenous hospital flora transmitted by health care staff.

2. A client newly diagnosed with 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 which topic 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 Among other things, clients need to understand how STDs are transmitted, including by body fluids and through skin-to-skin contact. HSV2 can be transmitted in the absence of skin lesions.

9. The United States is engaged in a formal agreement with Indonesia to provide economic incentives and assistance in national defense in return for the protection of U.S. private investments in that region. Which bilateral organization is most likely involved in this agreement? a. Carnegie Foundation b. United Nations c. U.S. Agency for International Development d. U.S. Department of Defense

ANS: C Bilateral organizations or agencies operate within a single country and focus on providing direct aid to less-developed countries. All bilateral organizations are influenced by political and historical agendas that determine which countries receive aid. Incentives for engaging in formal arrangements may include economic enhancements for the benefit of both countries, national defense for one or both countries, or enhancement and protection of private investments made by individuals in these nations. The U.S. Agency for International Development is the largest of these and operates totally outside of the United States.

4. 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.

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.

4. A terrorist bombing at a local church has sent many victims to the local emergency department and resulted in several deaths. Following the event, an emergency department nurse seeks out other nurses who are having difficulty performing their jobs to speak about the event. The nurse is demonstrating the disaster response strategy of: a. allaying public concern and fear. b. assisting victims to think positively and to move to the future. c. identifying feelings that individuals may be experiencing. d. preparing personnel to be effective in a disaster.

ANS: C During the aftermath of a disaster or terrorism event, nurses can feel fear, hopelessness, and loss or bias, hatred, vengeance, and violence toward ethnic or religious groups that may be associated with terrorism. These feeling may compromise their ability to provide care for these groups. Yet the International Council of Nurses' (ICN) Code of Ethics for Nurses (2000) affirms that nurses are ethically bound to provide care to all people. One strategy to use in response to a disaster or terrorism event is to assist in identifying the feelings that nurses or others may be feeling. To accomplish this, the nurse can: (1) explain that feelings of fear, helplessness, and loss are a normal reaction to a disruptive situation; (2) work with people and help them think of what they did that helped them overcome fear and helplessness in previous situations; (3) encourage people to talk to others about their fears; (4) encourage others to ask for help and provide resources and referrals; (5) remember that those in the helping professions may find it difficult to seek help; and (6) convene small groups in workplaces with counselors/mental health experts.

9. 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.

The primary impetus for the school nurse program established by Lilian Wald was to work with children in the schools and make home visits for the purpose of: a. enforcing the department of health's rules and regulations. b. excluding infectious children from the school environment. c. providing and obtaining medical treatment for absent students. d. providing shoes and clothing for students.

ANS: C In New York City in 1897, school medical examinations focused on excluding infectious children from school. By 1902, more than 20% of children might be absent from school on any given day because no one focused on providing or obtaining medical treatment for absent children so that they could return to school. The first school nurses made home visits to teach parents and provide follow-up care to children absent from school.

5. Commitment to which of the following best demonstrates nursing's advocacy role in primary health care initiatives in developed countries? a. Equality of health care b. Higher education for nurses c. Provision of direct client care d. Quality of care

ANS: C In developed countries, nurses are often viewed as one of the strongest advocates of primary health care through nursing's social commitment to health care equality.

1. A local health department in the Midwest reports cases of certain diseases to the state health department for inclusion in the National Notifiable Diseases Surveillance System (NNDSS). From the perspective of community-level disease monitoring, which of the following 3-year trends in incidence rates for hepatitis A would be of local, state, and national interest? a. 2016 = 2/100,000; 2017 = 3/100,000; 2018 = 1/100,000 b. 2016 = 4/100,000; 2017 = 8/100,000; 2018 = 6/100,000 c. 2016 = 12/100,000; 2017 = 8/100,000; 2018 = 31/100,000 d. 2016 = 16/100,000; 2017 = 24/100,000; 2018 = 9/100,000

ANS: C In this community's report, the incidence of hepatitis A in 2018 was more than double the incidence in 2016. At the community level, a disease may occur in endemic, epidemic, or pandemic proportions. An epidemic is the occurrence of disease in a community or region at a rate in excess of normal expectations. Although people tend to associate large numbers of cases with epidemics, even one case can be termed an epidemic if the disease is considered to have been previously eliminated.

2. A nurse is among the first responders to a disaster. What action by the nurse takes priority? a. Arranging for shelter for disaster providers b. Beginning community assessment as soon as possible c. Beginning disease surveillance and planning health education 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.

6. A nurse teaches an asthmatic client to recognize and avoid exposure to asthma triggers and assists the client's family in implementing specific protection strategies in the home, such as removing carpets and avoiding pets. This nurse's activities can best be described as: a. comprehensive assessment. b. primary prevention. c. secondary prevention. d. treatment intervention.

ANS: C Secondary prevention usually encompasses interventions designed to increase the probability that a person with a disease will have that condition diagnosed at a stage when treatment is likely to result in cure. However, nurses often use health education interventions when caring for individuals with a diagnosed health problem with the aim of preventing further complications or exacerbations.

5. What is the major factor driving current discussions about a Medicare shortfall in the middle of the twenty-first century? a. Diversity of the U.S. health care workforce b. Longevity of the U.S. population c. Percentage of elderly in the U.S. population d. Percentage of foreign-born in the U.S. population

ANS: C Seventy-seven million babies were born between the years of 1946 and 1963, giving rise to the often-discussed Baby Boom generation (Centers for Disease Control and Prevention (CDC), 2009). The oldest of these Boomers reached 65 years of age in 2011, and they are expected to live longer than people born in earlier times. The impact on the federal government's insurance program for people 65 years of age and older, Medicare, is expected to be enormous. Medicare spending is expected to grow nearly 8% between 2021 and 2026.

4. What entity governs nursing practice? 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 created by state legislatures and operationalized by state boards of nursing. d. Nurse practice acts written 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.

8. 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. What is the best source for this information? 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.

3. What is the major barrier to achieving the "Health for All in the 21st Century in the United States? a. Global indicators are not applicable to the United States. b. Healthy People 2020 is not consistent with the Declaration of Alma-Ata. c. Primary Health Care is not the primary delivery method for health care in the United States. d. The U.S public health system is not structured to provide PHC.

ANS: C The WHO's Declaration of Alma-Ata (1978) identified "Health for All in the Year 2000" as its primary global goal. This was amended in 1998 to "Health for All in the 21st Century." Although the United States, a WHO member nation, has endorsed primary health care as the strategy for achieving the goal of health for all in the twenty-first century, Primary Health Care is not the primary delivery method for health care in the United States. This creates a significant barrier to the achievement of that goal, despite the leadership of the U.S. public health system in the Healthy People 2020 initiative.

1. A state public health region reported 39 cases of meningitis in children 15 years of age and younger to date this year. Seven of those children died. The total population of the region is 780,000, of whom 84,000 are children age 15 years old and younger. What is the prevalence proportion of meningitis in this region thus far in the current year? a. 4.1/100,000 b. 5/100,000 c. 46/100,000 d. 50/100,000

ANS: C The prevalence proportion is a measure of existing disease in a population at a particular time and is calculated by dividing the number of existing cases by the current targeted population. In this example, 39 cases divided by the total number of children age 15 years and younger in the population (which is 84,000 children) = 0.0004642 × 100,000 = 46.42/100,000.

2. A nurse has been newly appointed as commissioner of the state health department services. The programs the nurse will oversee will most likely include which of the following? a. Administration of Medicare reimbursement rates and eligibility determination b. Programs involving the local community, including sanitation and communicable disease contact tracing c. Disaster response, health care financing and administration of programs such as Medicaid, and establishment of health codes d. Monitoring drugs and over-the-counter products available for sale and use by consumers.

ANS: C The public health system at the state level is responsible for standing ready to prevent or respond to disasters, both human caused and natural; overseeing health care financing and the administration of programs such as Medicaid and the State Children's Health Insurance Program; providing mental health and professional education; establishing health codes; licensing facilities and personnel; regulating the insurance industry; and providing direct assistance to local health departments, such as ongoing health needs assessment.

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 which functions? 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. The other options might be specific interventions a public health nurse could implement as part of broader programming.

Categorical Congressional funding has had which effect on health care? a. Positive by adoption of 2-year associate degree nursing programs b. Negative leading to exclusion of home-based care from health insurance coverage c. Negative as the national preference service model neglects emerging problems d. Positive due to the sharp rise in hospital-based care and technological resources

ANS: C The shift in the U.S. Congress to categorical funding provides federal money for priority diseases or groups rather than a comprehensive community health program. Thus local health departments designed programs to fit the funding priorities, which led to duplication of services among official health agency programs and a silo approach to program planning. When funding is directed by national preferences (silo programming), the ability of public health departments to respond to local and emerging problems is seriously impaired, because funding is earmarked for those national preferences only.

3. A nurse takes a new position as a community health nurse. Her first assignment is to perform an assessment of the community's migrant farmworker population. What is the most appropriate step for the nurse to take first? a. Begin the community assessment using a survey tool proven effective in previous assessments. b. Perform a literature review to study assessment data for similar populations. c. Enroll in a college course to learn community research, measurement, and analysis techniques. d. Form a relationship with the farmworkers' community leaders and other key informants.

ANS: C Two core functions of community-oriented nursing are assessment and assurance. Both of these core functions have their foundation in the ethical tenets of competency. Nurses assigned to develop community knowledge must be adequately prepared to collect data on groups and populations. The techniques employed differ from those used when caring for individuals. Use of the wrong research techniques leads to wrong assessments, with the potential for developing interventions that harm rather than help the target population.

8. A nurse is leading an effort to get desperately needed medical supplies and equipment to an impoverished and war-torn country. Materiel is being gathered according to the recipient country's stated needs. Before shipping the equipment, what would the nurse do? a. Consult with the country's leaders on what they are able to sustain. b. Determine if any prohibitions exist on delivery of medical goods. c. Enlist the help of an NGO to provide security services for the delivery. d. Provide funding to keep the medical equipment in working order.

ANS: C Without global health diplomacy and collaboration, much donated materiel is wasted because it requires resources the receiving country does not have, so it becomes unsustainable. For example, x-ray machines may not be used because of a lack of technicians to use them or because of a lack of electricity. The nurse would determine if the receiving country will be able to use the donations.

A public health nurse leader is encountering barriers when trying to shift the public health agency's efforts to a population-focused practice. Which of the following is most likely to be the rationale for the lack of support? a. 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 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.

8. 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.

1. A school nurse is teaching students about the relationship between the risk of sexually transmitted disease (STD) and risk-taking behaviors. Which key point will the nurse include? 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 risky decisions.

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.

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.

6. One seminal event that significantly shifted nursing's focus to ethical decision making was the emergence of the field of bioethics. In conjunction with bioethics, what other event occurred to shape this agenda? a. Adopting the ANA's Code for Professional Nurses b. Adopting the American Public Health Association's Public Health Code of Ethics c. Promoting the International Council of Nurses' Code of Ethics for Nursing d. Returning ethics courses to nursing programs in institutions of higher education

ANS: D In the 1960s, the ANA recommended that all nursing education occur in institutions of higher education; a shift thereby occurred from reliance on inherent ethical tenets and values from religiously based programs to the explicit study of ethics and ethical decision-making processes. This, in conjunction with the emergence of the field of bioethics, altered the curriculum content of nursing education programs.

1. What is a potential, unanticipated public health issue arising from international trade agreements? a. Decrease in illegal immigration across borders seeking health care. b. Decrease in contagious diseases a result of economic development. c. Improved nutrition as a result of increased amounts of healthy foods. d. Increase in foodborne disease when sanitary conditions differ between countries.

ANS: D International trade agreements, such as NAFTA, can have unanticipated health effects on the involved countries. One example would be an increase in foodborne diseases when food is imported from a country where sanitation and food regulations are less developed than in the other countries.

4. John Snow played a critical role in the development of modern disease surveillance when he did which of the following? a. Devised a more statistically valid method of analyzing epidemiologic data b. Discovered causal agents for anthrax, tuberculosis, and cholera c. Tracked the incidence of tuberculosis in the tenements of New York City d. Used geographic mapping to demonstrate the connection between water supply and cholera

ANS: D John Snow is considered the father of modern epidemiology because of the methods he used in his groundbreaking work to connect the incidence of cholera with the water supply. Snow showed that households receiving water from one water company, whose intake valve was in an area of the river contaminated by sewage, had a much higher rate of cholera than those receiving water from other companies drawing water from less-contaminated parts of the river.

8. Case fatality from breast cancer has decreased in recent years, although the incidence of breast cancer has increased. Descriptive epidemiology would use the component of time to explain this change in terms of: a. cyclical patterns. b. event-related clusters. c. point epidemic. d. secular trends.

ANS: D Long-term patterns of morbidity or mortality rates (i.e., over years or decades) are called secular trends. Secular trends may reflect changes in social behavior or health practices.

5. 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. Which description of the nurse's activities is accurate? a. American Red Cross disaster training b. Community preparedness c. Personal preparedness d. Professional preparedness

ANS: D 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.

7. Which of the following is a population-level tertiary prevention intervention for those with HIV in the community? a. HIV test results counseling b. Needle exchange c. Partner notification d. Standard precautions education

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.

3. What emergency support functions do 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 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.

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. Which intervention by the nurse is best? 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 and more in control. This builds on the resilience of the individual, family, and/or community.

1. A low-vision client with very early dementia takes pride in her independence. The client, who lives alone in an apartment, tells her nurse she has always enjoyed using scented candles. Which is the most appropriate intervention for the nurse? a. Leave the matches and candles accessible to the client. b. Maintain the client's dignity by stating that she is capable of using them for now. c. Counsel the client of the dangers of her using candles and matches. d. Collaborates with the client to give the candles and matches to a family member who brings them during visits.

ANS: D The best action is for the nurse to apply the principle of respect for autonomy. The nurse wants to maintain the client's dignity and quality of life, and to help the client be as independent as possible. But at the same time, the nurse must choose actions that reduce the risk of harm to others.

3. The nurse analyzing data from reports of the global burden of disease would learn about which of the following topics? a. Costs to the world of treating communicable disease in less-developed countries. b. Economic cost of preventable early deaths. c. Impact of disability on the international economic forecast. d. Years in lost contribution to economic growth.

ANS: D The global burden of disease indicator utilizes the unit of disability-adjusted life-year (DALY). This unit measures the combined time lived with a disability and time lost as a consequence of premature death. The time lost because of premature mortality is calculated using standard expected years of life based on gender, whereas the reduction in physical capacity as a result of morbidity (disability) is measured using a six-point scale from 0 (perfect health) to 1 (death) that reflects the degree of dependence of the young and older adults on the adults in the population. The DALY represents life-years lost that could have contributed to the economic growth of a family or country as a consequence of premature death, disability, or loss of caregiver potential productivity/contribution.

9. Caring and the ethic of care were developed in the mid-1980s and early 1990s in response to and the desire of nurses to do which of the following? a. Apply gender-related voices to moral judgment. b. Apply principles of utilitarianism. c. Differentiate distributive justice from beneficence. d. Differentiate nursing practice from medical practice.

ANS: D The view of caring and the ethic of care that emerged in the mid-1980s and early 1990s was a response to technological advances in science and the desire of nurses to differentiate nursing practice from medical practice. It is closely related to feminist ethics. It posits that caring is the foundation of nursing.

6. The nurse demonstrating disaster-related recovery competencies would do which of the following? a. Determine local mental health resources. b. Establish a mass medication distribution center. c. Restock personal preparedness supplies. d. Write and distribute an after-action report.

ANS: D There are competencies for all phases of the disaster response cycle. Recovery competencies include after-action participation, disaster plan modifications, and coordinating efforts to address the psychosocial and public health impact.

5. 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 inquires as to the client's employment and job duties. Which response would the nurse view as most important? a. Identifies as bi-sexual. b. Is a strict pesco-vegetarian. c. Occasionally uses intravenous drugs. d. Works in a daycare center and changes diapers.

ANS: D This patient has symptoms of hepatitis A. 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.