final questions

d In an institution-based model of faith community nursing, which includes greater collaboration and partnership, the nurse may be in contractual relationships with hospitals, medical centers, long-term care facilities, or educational institutions.

1. An academic medical center and a local senior living complex employ a parish nurse. The faith community nurse also holds a faculty position at the university's school of nursing. This nurse is practicing a type of parish nursing known as the: A. advanced practice model. B. clinical specialty model. C. congregation-based model. D. institution-based model.

b For public health services to meet the demands placed on them for competing resources (services, surveillance, containment, and protection), they must receive adequate funding. It is necessary for the public and the government to be aware of the benefits provided to the community by nurses, such as achieving immunization rates that improve health and lower health care costs (i.e., measles).

1. As a result of recent social policy changes, public health agencies have shifted their emphasis from a focus on primary health care services to a focus on core public health activities because of new and re-emerging public health issues. A critical aspect of ensuring the public health system's ability to address these issues is: A. additional regulation. B. adequate funding. C. bioterrorism strategy. D. media coverage.

b Working with the family in providing care to an individual client is essential. Family is defined by the individual and includes any caregiver or significant person who assists the client in need of care at home. The caregiver is essential in providing the needed maintenance care between the skilled visits of the professional provider.

1. Home health care can be defined as a broad spectrum of health and social services offered in the home environment to recovering, disabled, or chronically ill persons. Participation in providing the needed maintenance care for the home care client is essential by which of the following? A. Chaplain B. Family caregivers C. Home health aides D. Physician

a Individuals may experience symptoms of a flu-like syndrome (i.e., lymphadenopathy, myalgias, sore throat, lethargy, rash, and fever) during the primary infection phase of HIV. An antibody test in this phase is usually negative, so it is often not recognized as HIV.

1. Nurses in community health conducting health education classes for populations vulnerable to HIV/AIDS should explain the natural history of the progression of human immunodeficiency virus (HIV). Of particular importance is the fact that the disease may go undetected during the primary infection phase because: A. antibody tests are typically negative. B. the immune system increases antibody production. C. the incubation period is prolonged. D. symptoms include myalgias, sore throat, and rash.

b Violence is a public health problem that has both emotional and physical effects. Violence is the major cause of premature mortality and lifelong disability, and violence-related morbidity is a significant factor in health care costs. Violent behavior is predictable, and therefore it is preventable, especially with community action.

1. Violence is a major public health problem in our communities that causes premature mortality and lifelong disability. Violence-related morbidity is a significant factor in: A. community deterioration. B. health care costs. C. juvenile delinquency. D. population density.

a If teens return to school, it is important for the nurse to discuss these needs: (1) using the bathroom frequently, (2) carrying and drinking more fluids or snacks to relieve nausea, (3) climbing stairs and carrying heavy book bags, and (4) fitting comfortably behind stationary desks.

A nurse in community health is following a pregnant teenager who attends school. The nurse plans to discuss self-care activities that will be important for the teen during her pregnancy. The discussion should include: A. carrying heavy book bags. B. changing to home education. C. decreasing fluid intake to avoid nausea. D. keeping up her grades.

c In general, people in rural areas have a poorer perception of their overall health and functional status than do urban residents. Rural residents older than 18 years assess their health status less favorably than do urban residents. Studies show that rural adults are less likely to engage in preventive behavior, which increases their exposure to risk.

A nurse in community health is working in a rural setting. In planning for programs to address the population's needs, the nurse should be aware that, in general, rural populations: A. engage in physical activity during leisure time. B. engage in preventive behaviors. C. perceive their overall health as less favorable. D. use seat belts.

a To help abusive families, nurses need to understand that the factors that characterize people who become involved in family violence include upbringing, living conditions, and increased stress. Of these factors, the one most predictably present is previous exposure to some form of violence. As children, abusers were often beaten or saw siblings or parents beaten. They learned that violence is a way to manage conflict. Both men and women who witnessed abuse as children were more likely to abuse their children. Financial solvency and support tended to decrease the incidence of child abuse.

A nurse in community health is working with a parent whose spouse has been called up for active duty in the military reserve. The family is experiencing financial strain due to decreased income. The extended family lives at a distance. The parent is struggling to manage the family in the spouse's absence. The family consists of four children (three preschool and one preteen). In this situation, it would be important for the nurse to further explore the potential for: A. child abuse. B. depression. C. intimate partner abuse. D. parent's resentment of the preteen.

a Each worker represents a host within the worker population group. Certain host factors are associated with increased risk for adverse responses to hazards of the workplace. These include age, gender, health status, work practices, ethnicity, and lifestyle factors. In this example, the factors noted would be the age of the worker and the fact that construction workers work outside with exposure to the elements for long periods.

A recent news article reported the death of a 60-year-old road construction worker on a day with a posted heat advisory. An occupational health nurse would recognize the additional host factors that contributed to this fatality as which of the following? A. Age and work practices B. Gender and lifestyle C. Health status and age D. Work practices and health status

a Cultural attitudes are the beliefs and perspectives that a society values. Perspectives about individual responsibility for health and well-being are influenced by the prevailing cultural attitudes. The media communicate thoughts and attitudes through literature, film, art, television, and newspapers.

A recent movie release portrays a criminal as a black female drug user whose abusive boyfriend has two children by different women. She lives in the riot-torn inner city of a large metropolitan area. This best demonstrates what type of factor that influences poverty? A. Cultural B. Environmental C. Political D. Social

a To prevent TB, the CDC works with public health agencies in other countries to improve screening and reporting of cases and to improve treatment strategies. This includes coordination of treatment for infected individuals who migrate to the United States. Nurses administer tuberculin skin tests and provide education on the importance of compliance to long-term therapy. They may also be involved in directly observed therapy (DOT) and contact investigations of cases in the community.

A strategy that may improve compliance with tuberculosis (TB) treatment is the: A. expansion of directly observed therapy. B. increased tuberculosis testing protocols. C. increased confirmatory testing protocols. D. treatment compliance education.

d The Minnesota Model of Public Health Interventions: Applications for Public Health Nursing Practice (Centers for Public Health Nursing 2001, pp. 15, 16) suggests that surveillance is one of the interventions related to nursing practice in public health. The model provides seven basic steps of surveillance for nurses to follow: 1. Consider whether surveillance as an intervention is appropriate for the situation. 2. Organize the knowledge of the problem, its natural course of history, and its aftermath. 3. Establish clear criteria for what constitutes a case. 4. Collect sufficient data from multiple valid sources. 5. Analyze the data. 6. Interpret and disseminate the data to decision makers. 7. Evaluate the impact of the surveillance system.

According to the Minnesota Model of Public Health interventions, what is the first step of surveillance for the public health nurse? A. Organize the data. B. Analyze the data. C. Interpret and disseminate the data. D. Determine if surveillance is appropriate.

b The epidemiologic model can be used to understand the "relationship" between work and health. In this example, the environmental element, which includes all external conditions that influence the interaction of the host and agents, caused a shift in the work-health interaction that required a change in work practices to avoid heat stroke.

During a recent heat advisory, baggage handlers at the local airport were placed on a 1-hour shift rotation. This work-health interaction demonstrates the theoretical application of which of the following? A. Aggregate populations B. Epidemiologic model C. Host risk factor D. Occupational exposure

d Opportunistic infections may be caused by bacteria, fungi, viruses, or protozoa. The most common opportunistic diseases are Pneumocystis carinii pneumonia and oral candidiasis; other diseases are pulmonary TB, invasive cervical cancer, or recurrent pneumonia. TB can spread rapidly among immunosuppressed individuals. Thus HIV-infected individuals who live near one another, such as in long-term care facilities, correctional facilities, drug treatment facilities, or other settings, must be carefully screened and deemed noninfectious before admission to such settings.

During the last stage of AIDS, many opportunistic infections proliferate in persons with weakened immune systems. HIV-infected individuals who live near one another in long-term care facilities, drug treatment facilities, and prisons should be carefully screened before admission because they are at greater risk for acquiring: A. fungal disease. B. invasive cervical cancer. C. oral candidiasis. D. pulmonary tuberculosis (TB).

b Each client in Medicare-funded home care programs must be under the current care of a doctor of medicine, podiatry, or osteopathy to certify that the client has a medical problem. The physician must certify a plan of treatment before care is provided to the client.

Each client in the Medicare home care program must be under the care of a doctor (medicine, podiatry, or osteopathy). The home health nurse must involve the doctor in developing a plan of care. The role of the doctor in the home health interdisciplinary team is to do which of the following? A. Achieve the optimal level of functioning by teaching B. Certify/recertify the medical necessity and plan of care C. Deal with the social, emotional, and environmental factors that affect well-being D. Provide maintenance, preventive, and restorative treatment for clients

a TQM is a process-driven and customer-oriented philosophy of management that embodies leadership, teamwork, employee empowerment, individual responsibility, and continuous improvement of the system processes that lead to improved outcomes and greater customer satisfaction. QA is concerned with the accountability of the provider and is only one tool in achieving the best client outcomes. CQI focuses on the sources of differences in the ongoing process of health care delivery and seeks to improve the process. Risk management focuses on reducing financial risk.

Given recent vaccine shortages for the flu, the local nurses in community health form a group to evaluate the process of scheduling and operating flu vaccination clinics in the community and review the community's complaints from the previous season. The activity best represents the principle of: A. total quality management (TQM) to achieve continuous quality improvement (CQI). B. quality assurance (QA) to achieve continuous quality improvement (CQI). C. risk management to achieve quality. D. continuous quality improvement (CQI) to achieve total quality management (TQM).

b A new concern for public nurses and nurses in community health is whether the populations with whom they work have adequate health literacy to benefit from health education. 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.

Health education is often used as a strategy in working with vulnerable populations. The benefits of health education can be greatly affected by: A. dependency cycle. B. health literacy. C. income level. D. race and ethnicity.

c Official agencies, operated by the state, county, city, or other local government units such as health departments, are funded primarily by tax revenue (public funding). They are a type of nonprofit home health agency. The home care services provided are reimbursed through Medicare, Medicaid, and private insurance companies.

Nonprofit home health agencies can be reimbursed for home health services through Medicare, Medicaid, and private insurance companies. A major difference between an official agency and a voluntary or private agency is that official agencies receive additional: A. client payments. B. charity support. C. public funding. D. third-party payments.

c In a highly competitive health care environment, certification is expected to become more necessary to ensure the public of competence and quality. Home health nurses can seek professional certification as a generalist, clinical nurse specialist, nursing care manager, nurse in community health, or clinical specialist in community health through the American Nurses Credentialing Center.

Nurses come to home health from a variety of educational and practice settings. Based on educational level, nurses are prepared to practice at various levels. To ensure the public of competence and quality in a highly competitive health care environment, it may become necessary for nurses to seek which of the following? A. Accreditation B. Advanced degrees C. Certification D. Specialization

a, b, c, d, e Vulnerability results from the combined effects of limited resources. Limitations in physical resources, environmental resources, personal resources (or human capital), and biopsychosocial resources (e.g., the presence of illness, genetic predispositions) combine to cause vulnerability. Poverty, limited social support, and working in a hazardous environment are examples of limitations in physical and environmental resources. People with preexisting illnesses, such as those with communicable or infectious diseases or those with chronic illnesses such as cancer, heart disease, or chronic airway disease, have less physical ability to cope with stress than those without such physical problems

Which of the following are factors that may contribute to vulnerability? (Select all that apply.) A. Exercise habits B. Crime C. Peeling lead paint D. Social isolation E. Illiteracy

b The spiritual dimension is central to the practice of parish nursing. Nursing embodies the physical, psychological, social, and spiritual dimensions of clients into professional practice. Although parish nursing includes all four, it focuses on intentional and compassionate care, which stems from the spiritual dimension of all humankind.

Which of the following dimensions is an essential component of parish nursing? A. Assertiveness B. Compassion C. Organizational skills D. Fiscal responsibility

a The occupational health nurse role is unique in that the nurse adapts to an agency's needs and to the needs of specific groups of workers (i.e., coal miners, word processors, health care workers). The majority of occupational health nurses work as solo clinicians, but increasingly, additional roles are being included in the specialty practice. In many companies, the occupational health nurse has assumed expanded responsibilities in job analysis, safety, and benefits management. Many occupational health nurses also work as independent contractors or have their own businesses providing occupational health and safety services to industry, as well as consultation. With the current changes in health care delivery and the movement toward managed care, occupational health nurses need increased skills in primary care, health promotion, and disease prevention.

Which of the following is a unique characteristic of the role of the occupational health nurse? A. Adapts to the needs of the agency and specific groups of workers B. Works as a solo clinician and/or independent contractor C. Is interdisciplinary in nature D. Specializes in health promotion and education

c HPSAs tend to have a high proportion of racial minorities and fewer specialists, such as pediatricians, obstetricians, and gynecologists, available to provide care to at-risk populations. There are extreme variations in pregnancy outcomes from one part of the country to another, and even within states.

Within a state, counties designated as Health Professional Shortage Areas (HPSAs) tend to have a high proportion of racial minorities and fewer specialists. This factor may explain conflicting data within a state related to: A. adult immunization rates. B. chronic respiratory illness rates. C. maternal/infant morbidity rates. D. obesity rates.

d The major emerging issues in public health that affect nursing in community health are increased rates of drug-resistant community-acquired pathogens; social issues such as welfare reform; racial and ethnic disparities in health outcomes; behaviorally influenced issues (i.e., chronic disease, violence, substance abuse); emergency preparedness activities and unequal access to health care.

A major emerging public health issue facing nursing in community health is: A. bioterrorism. B. health literacy. C. health ministries. D. welfare reform.

a Young children (newborn to age 5 years) are at greater risk for the most harmful effects of poverty, especially in regard to adequate nutrition and brain development. Other risk factors include maternal substance abuse or depression, exposure to environmental toxins, trauma and abuse, and poor-quality daily care.

A case management nurse for a locally funded program for special-needs children is increasingly concerned about a recent referral for a 1-year-old child with a congenital illness residing in a poverty-stricken community. The nurse knows that this child may be at higher risk for the most harmful effects of poverty, including: A. developmental delays. B. ear infections. C. frequent colds and infections. D. irritability.

d The school nurse gives nursing care related to tertiary prevention when working with children who have long-term or chronic illnesses or with special needs. This may include participation in the development of an individual education plan (IEP); identification of medication, therapy needs, and/or physical, auditory, or visual limitations; and interventions to ensure the appropriate placement of the child in the classroom environment or physical accommodations required, which enhances the child's learning experience.

A child with severe macular degeneration and some hearing loss will be attending the third grade in a local school. A tertiary prevention intervention the school nurse should perform would be which of the following? A. Assess the child's language skills, motor abilities, and social abilities. B. Ensure that a telephone is available for calling emergency personnel or parents. C. Lead educational programs to address coping strategies and stress management techniques. D. Meet with the assigned teachers to discuss classroom seating to enhance the child's learning experience.

d Vulnerable populations are those groups who have an increased risk to develop adverse outcomes. A vulnerable population group is a subgroup of the population, more likely to develop health problems as a result of exposure to risk or to have worse outcomes from a health problem than is the rest of the population. The risks are often cumulative risks from environmental hazards, personal behavior, or biological or genetic makeup.

A city uses the local media (radio, television, and newspapers) to post ratings of air quality on days when the air quality is poor. This notification is directed toward older adults, very young members of the community, and those with chronic breathing problems. These groups are an example of: A. disenfranchised populations. B. disadvantaged populations. C. vulnerability. D. vulnerable populations.

b Hepatitis A virus (HAV) is most often transmitted through the fecal-oral route. It remains one of the most frequently reported vaccine-preventable diseases. Outbreaks are common in day care centers whose staff must change diapers, among household members and sexual contacts of infected individuals, and among travelers to countries where HAV is endemic.

A client presents at 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 day care center. These facts are important because: A. acute hepatitis B is self-limiting. B. hepatitis A outbreaks are common in facilities where staff change diapers. C. hepatitis C is the "silent stalker." D. persons with chronic liver disease are at greater risk for hepatitis A.

d Productive and paid work is an expectation in mainstream American society. Work can be fulfilling and contribute to a sense of well-being; it can also be frustrating and unfulfilling, contributing to stress that may lead to aggression and violence. Some people are frustrated by jobs that are repetitive, boring, and lack stimulation.

A large industrial plant has recently laid off a significant portion of its workforce because of scalebacks in production. The occupational health nurse proposes education sessions with the remaining employees about effective strategies for managing stress during economic downturns. This suggestion to management is based on the nurse's understanding that increases in aggression and violence at home and work may be triggered by: A. competition. B. unemployment. C. survivor guilt. D. work-related stress.

d Although vulnerable populations have always benefited from nursing services, the populations that are most acutely in need of public health services have changed dramatically over the past two decades (i.e., young women and their partners that have risky behaviors and put their pregnancy or children at high risk for injury or abuse).

A current dramatic trend in nursing in community health involves: A. clinical surveillance. B. shifts in research focus. C. special needs programs. D. vulnerable population shifts.

d Pandemic refers to the epidemic spread of the problem over several countries or continents (such as severe acute respiratory syndrome [SARS] outbreak). If a problem is considered hyperendemic, there is a persistently (usually) high number of cases. Sporadic problems are those with an irregular pattern with occasional cases found at irregular intervals. Epidemic means that the occurrence of a disease within an area is clearly in excess of expected levels (endemic) for a given time period.

A disease outbreak of severe acute respiratory syndrome has occurred and has spread over several countries outside the United States. This level of occurrence is said to be: A. hyperendemic. B. sporadic. C. epidemic. D. pandemic.

b Nurses working in rural areas, including those working with migrant farmworkers, have opportunities to use many skills of nursing in community health. One of the first and most important is that of prevention. Given the barriers to receiving health care in rural areas, the ideal situation is to prevent health disruptions whenever possible. Case management and community-oriented primary health care are two effective models to address some of those deficits and resolve rural health disparities.

A district health nurse is assigned to two rural counties in the state. To achieve the best outcomes possible in reducing the health disparities for the large number of frail older clients in the two counties, the nurse should consider using what community-oriented nursing skill? A. Assessment B. Case management C. Geriatrics D. Tertiary prevention

c Incest occurs in all races, religious groups, and socioeconomic classes. A typical pattern is as follows: The daughter involved in the parental incest is usually 9 years of age at the onset and is often the oldest or only daughter. The father seldom uses force. He is more likely to use threats, bribes, intimidations, or misrepresentation of moral standards. These children may have difficulty in social situations and demonstrate avoidance behaviors. They may also attempt to cover or protect their bodies. Therefore the nurse must be aware of these indicators in order to conduct an appropriate assessment and plan appropriate interventions.

A father brings his stepdaughter to the family clinic for an immunization update before the new school year. The nurse notices the interaction between the young girl and her stepfather. The child appears tense and cautious and wraps her arms around herself in a protective manner. The child startles when touched by the stepfather and pulls away. The stepfather is overheard saying, "I'll leave you here if you don't behave and act nice." In this scenario, it would be important for the nurse to explore in her assessment the possibility of: A. child neglect. B. family secrets. C. father-daughter incest. D. impaired family functioning.

c General approaches to quality improvement seek to protect the public by ensuring a level of competency among health care professionals. Examples are credentialing, licensure, accreditation, certification, charter, recognition, and academic degrees. Credentialing is defined as the formal recognition by which individuals or institutions are designated by a qualified agent as having met minimum standards of performance. Licensure is typically viewed as recognition that a person has met a minimal set of standards to practice.

A general approach to quality improvement where a qualified agent designates formal recognition to individuals or institutions that have met minimum standards of performance is best described as: A. accreditation. B. charter. C. credentialing. D. licensing.

a Staff/peer review processes are a specific approach to quality assurance that often use audit tools to determine quality of care. The concurrent audit is a process of audit that evaluates the quality of ongoing care by looking at the nursing process. A retrospective or outcome audit evaluates quality of care following the discharge of a client. Both audits are conducted in nursing peer review.

A government agency is conducting an audit of all active clients in the local hospice program to ensure that hospice criteria for care are being applied appropriately. The type of tool being used in this specific approach to quality assurance is: A. concurrent audit. B. outcome audit. C. retrospective audit. D. peer review.

d Home-based nursing care (home health) is covered by Medicare and other third-party payers as long as the care being delivered is "skilled care" as defined by the home care agency regulations. Skilled nursing services are complex, thereby requiring the knowledge and skill of a registered nurse; the client's condition warrants the skilled intervention; the service cannot be performed by a nonmedical person; and any teaching of a service to a client involves the knowledge of a registered nurse for proper instruction and demonstration.

A home health nurse is working with a client who requires a catheter insertion and wound care. The nurse is also helping the client and family to develop positive coping skills and identify resources that will help the client to attain a state of optimal functioning. It is important for the nurse to specifically document nursing services provided because of which of the following? A. The agency is required to practice within the guidelines set up by regulatory agencies. B. Each criterion has minimum standards to which the program must adhere. C. Nurses are required to provide supervision of services. D. Reimbursement is dependent on the provision of skilled care.

b Children are at risk for disruption of normal development by biological, environmental, and psychosocial factors that impair their mental health, interfere with their education and social interactions, and keep them from realizing their full potential as adults. Children can develop depression or behavior problems in response to an actual or potential loss.

A hospice nurse is working with a cancer client and his family. The client's 7-year-old son has developed recent school and peer problems. Understanding the risk for disruption of normal development, the nurse plans to first screen the child for: A. developmental disorders. B. mental health problems. C. parental neglect. D. violence potential.

b The faith community nurse incorporates faith and health and employs the nursing process in providing services to the faith community as well as to the community served by the faith community. Facilitating collaborative health ministries in the faith communities is an important component of the practice. While the curricula of faith community nursing practice stem from a Judeo-Christian theological framework, parish nursing respects diverse traditions of faith communities and encourages adaptation of the programs to these faith traditions.

A key characteristic of faith community nursing services is to facilitate collaborative health ministries in the faith communities by: A. embracing individuals across the life span. B. respecting diverse traditions of faith. C. requiring statements of faith. D. using a Judeo-Christian theological framework.

b The school nurse may be the person whom children trust to tell important secrets about their health. The school nurse has a reputation as being a trustworthy person to whom the children can go if they are in trouble or when they need to talk to someone. Nurses in this situation should tell the children that if anything they reveal points out that someone is in danger, the parents and school officials must be told.

A middle school student approaches the school nurse and asks, "Can I speak with you about something important?" The school nurse responds affirmatively but should also state which of the following? A. "Anything you tell me will be kept private and confidential." B. "If anything you tell me indicates that someone is in danger, the parents and school officials must be told." C. "It may be best for me to set up an appointment with the school counselor." D. "You can always speak to me if you are in trouble or when you need someone to talk to."

d The components of a quality assurance program are structure, process, outcome, evaluation, interpretation, and action. Outcome is the most important ingredient of a program because it is the key to evaluation of providers and agencies by external agents.

A multidisciplinary quality assurance team has reviewed an organization's stated philosophy and objectives and developed a conceptual model for appraisal that integrates peer review and client satisfaction. The quality assurance program component that should be addressed next would be: A. action. B. process. C. structure. D. outcome.

c Although communicable disease control is a core public health service, the role of public health as incident commander in a widespread public health emergency is a new role. Public health at the federal, state, and local levels was looked to for coordinated leadership and answers to a situation in which experience was limited and answers were uncertain.

A new role for public health that is used in widespread public emergencies is: A. communicable disease control. B. first responder. C. incident commander. D. professional triage.

d Preparedness can take 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. Adequately prepared nurses can serve as leaders and assist others to have a smoother recovery phase.

A nurse educator who teaches at the local community college takes the time to read and understand her community's disaster plans and participates in community mock disasters as a leader of the triage team. The best description of the nurse's activities would be: A. ARC disaster training. B. community preparedness. C. personal preparedness. D. professional preparedness.

b neglect is more difficult to assess than is abuse. Emotional neglect is the omission of basic nurturing, acceptance, and caring essential for healthy personal development. These children are largely ignored or in many cases treated as a nonperson. It is difficult for a neglected child to feel a great deal of self-worth because the parents have not demonstrated that they value the child. Astute observations of children, their homes, and the way they relate to their caregivers can provide clues of neglect.

A nurse in community health conducting a home visit notices a 4-year-old girl sitting on a stool in an adjoining room. The girl is quiet and withdrawn, rarely makes eye contact, and does not leave the room. The nurse proceeds to ask about the child and attempts to engage the child in conversation. The nurse is assessing for what indicators of child abuse? A. Emotional abuse B. Emotional neglect C. Physical abuse D. Physical neglect

d Older adults, because they may depend on others for care, are at risk for abuse and neglect. Healthy aging activities such as physical activity and establishing social networks improve the mental health of older adults. Older adults underutilize the mental health system and are more likely to be seen in primary care or to be the recipient of care in institutions. The nurse can reach them by organizing health-promotion programs through senior settings or other community-based settings.

A nurse in community health conducts quarterly mental health-promotion and depression-screening programs at the local senior center. The nurse is aware that older adults are at increased risk for developing depression. Using such an intervention also addresses the older adults': A. dependence on their primary care provider. B. normal sensory losses. C. reduced social contacts. D. underutilization of the mental health system.

a Advocacy refers to those actions one undertakes on behalf of another. Nurses may function as advocates for vulnerable populations by working for the passage and implementation of policies that lead to improved public health services for these populations.

A nurse in community health directly contacts a mammography clinic to arrange an appointment for a female migrant worker with limited English language abilities. The nurse communicates with the client through an interpreter to ensure that the client's appointment is scheduled to meet her needs and that the client understands the procedure to be performed. This strategy used with vulnerable populations can best be described as: A. advocacy. B. culturally competent care. C. partnership. D. social justice.

a A migrant farmworker is a person whose principal employment is in agriculture on a seasonal basis, who has been employed within the last 24 months, and who establishes for the purpose of such employment a temporary abode. Seasonal farmworkers work cyclically in agriculture but do not migrate. The majority of migrant and seasonal farmworkers are foreign born and predominantly Mexican (75%), coming primarily from the west central states and more recently the states of southern Mexico.

A nurse in community health located in Virginia is conducting an assessment on a Hispanic worker currently working in a local apple orchard for the season. The nurse determines that the worker originates from Florida and is living in temporary housing with other orchard workers. Based on this information, the nurse should integrate the special needs of what vulnerable population? A. Migrant farmworkers B. Seasonal farmworkers C. Underinsured D. Undocumented aliens

d Poor pregnant women are more likely than other women to receive late or no prenatal care and to deliver low-birthweight babies, premature babies, or babies with birth defects.

A nurse in community health working in an inner city clinic with high poverty and unemployment rates recognizes the need for programs for pregnant women because these women often receive late or no prenatal care and deliver: A. at home. B. full term. C. identical twins or triplets. D. low-birthweight babies.

c Referral is an important component of tertiary prevention. Nurses should know about available community resources for abuse victims and perpetrators. If attitudes and resources are inadequate, it is often helpful to work with local radio and television stations and newspapers to provide information about the nature and extent of human abuse as a community health problem. People often do not seek services early in an abusive situation because they simply do not know what is available to them.

A nurse new to the community evaluates the resources available to a father that has sought help with his escalating abuse and threats of violence to his family. After making the referral, the nurse approaches the local newspaper about running a series on the nature and extent of human abuse in the community. This strategy would: A. advocate for government programs to treat survivors. B. demonstrate the provider's commitment to address the need for services. C. increase awareness of community resources to address violence and abuse. D. increase the number of individuals identified as perpetrators.

c Disenfranchisement refers to a feeling of separation from mainstream society. Groups such as the poor, the homeless, and migrant workers are "invisible" to society as a whole and forgotten in health and social planning. Vulnerable populations are at risk for disenfranchisement because their social supports are generally weak, as are their links with formal community organizations.

A nurse participates with a community planning board addressing housing strategies and future community needs. The nurse is aware that the community has a population of homeless families served by local churches. The nurse is also aware that this agricultural community relies on migrant workers during seasonal harvesting of local produce. The nurse is concerned that these disenfranchised populations may be: A. complicated to address. B. costly to serve. C. invisible to the community. D. resilient to the community.

b Title XXI of the Social Security Act provides for the State Children's Health Insurance Program (SCHIP) to provide funds to insure currently uninsured children. The SCHIP program is jointly funded by the Federal and State governments and administered by the states. Using broad Federal guidelines, each state designs its own program, determines who is eligible for benefits, sets the payment levels, and decides upon the administrative and operating procedures. The program is subject to change when states undergo budget reductions

A nurse volunteering at the free clinic in her community informs a client seeking treatment for hypertension that the family's children may qualify for enrollment in the State Children's Health Insurance Program (SCHIP). The nurse's intervention can reduce health disparities for these vulnerable children by making a referral to a program that provides: A. direct financial subsidies for children. B. funds to insure currently uninsured children. C. outreach efforts to enroll eligible children in Medicaid. D. prospective payments for child services.

b Vulnerable populations often are more likely than the general population to suffer from health disparities (i.e., wide variations in health services and health status among certain population groups). The less than adequate care experienced by these groups can be defined by age, gender, race or ethnicity, education or income, disability, geography, or sexual orientation. Disenfranchisement refers to a feeling of separation from mainstream society. The person does not seem to have an emotional connection with any group in particular or with the larger society.

A poor, older Native Alaskan woman lives in a small, remote village near the Canadian border. She has been diagnosed with hypertension and diabetes but rarely makes it to the regional clinic in a distant town for checkups. This woman is most at risk for: A. disenfranchisement. B. health disparities. C. loss of independence. D. resilience.

d The importance of teaching caregivers about infection control in home care is vital. The nurse treating an HIV client in the home environment should teach caregivers about standard precautions. Some clients, families, friends, and other groups may have concerns about transmission of HIV. Others, who may not have concerns about transmission, may not take adequate precautions or may believe myths that they may not become infected.

A population-level tertiary prevention intervention typically performed by nurses and aimed at controlling communicable diseases is: A. HIV test counseling. B. needle-exchange program. C. partner notification. D. standard precautions teaching.

a The federal government, through the coordination of the CDC, has developed the Federal School Health Program. The plan includes eight parts: health education; physical education; health services; nutrition services; counseling, psychological, and social services; healthy school environment; health promotion for staff; and family/community involvement.

A school district in the Midwest has included health education, physical education, health services, nutrition services, and counseling, psychological, and social services as components of the student health services. Additionally, the district has integrated family/community involvement, staff health promotion, and a commitment to a healthy school environment in its program design. This school district has adopted the school health service program scope of which of the following? A. CDC's Federal School Health Program B. Healthy Schools, Healthy Communities program C. Healthy People 2020 D. School-linked program

c Children of migrant farmworkers may need to work for the family's economic survival. Federal law does not protect children from overworking or from the time of day they work outside of school. Therefore children may work until late in the evening or very early in the morning every day of the week. These children may experience constant fatigue and are set up for failure in school.

A school nurse is asked to assess a 13-year-old child because of excessive drowsiness and inattention in class. The nurse determines that this is a child of migrant workers on a local produce farm. Based on the nurse's knowledge of migrant worker families, the nurse should first explore the child's potential involvement in: A. delinquent behavior. B. drug use. C. field work. D. Migrant Education Program.

a The school nurse is expected to function as a case manager, helping to coordinate the health care for children with complex health problems. This may include the child who is disabled or chronically ill, who may be seen by a physical therapist, an occupational therapist, a speech therapist, or another health care provider during the school day. The nurse sets up the schedule for the child's visits so that those appointments do not unnecessarily have a negative effect on the child's academic day. Direct caregiver is the traditional role of the school nurse where immediate nursing care is provided. As a consultant, the school nurse can provide professional information about proposed changes in the school environment and their effect on the health of the children. The school nurse as counselor occurs when children go to the nurse to share important health information.

A second-grade child with cerebral palsy receives services from a physical therapist and occupational therapist during the child's academic day. The school nurse sets up the schedule to ensure that the therapists' visits do not unnecessarily affect the child's academic day negatively. This role of the school nurse is best described as which of the following? A. Case manager B. Counselor C. Consultant D. Direct caregiver

b The goals of QA and QI are on a continuum of quality, and in public health they are: (1) to continuously improve the timeliness, effectiveness, safety, and responsiveness of programs, and (2) to optimize internal resources to improve the health of the community. Under a continuous quality improvement (CQI) philosophy, QA and QI are but two of the many approaches used to ensure that the health care agency fulfills what the client thinks are the requirements for the service. QA focuses on finding what providers have done wrong in the past (e.g., deviations from a standard of care found through a chart audit). CQI operates at a higher level on the quality continuum but requires the commitment of more organization resources to move in a positive direction. TQM is a process-driven, customer-oriented management philosophy that includes leadership, teamwork, employee empowerment, individual responsibility, and continuous improvement of system processes to yield improved outcomes.

A state health department wants to ensure that the local health departments are delivering quality client care and can demonstrate the degree of excellence attained. The principle that is best defined by this statement is: A. continuous quality improvement (CQI). B. quality assurance (QA). C. risk management. D. total quality management (TQM).

a In general, the National Association of School Nurses (NASN) standards align with those developed by the American Academy of Pediatrics (AAP) regarding giving health care to students in the schools. The AAP developed its own ideas about how nurses function in schools based on its assessment of school children's health needs. These guidelines are very similar to those written by the NASN. Additionally, the AAP recommends that the nurse be the head of a health care team that includes a physician (preferably a pediatrician), school counselors, the school psychologist, and members of the school staff including the administrators and teachers.

A unique characteristic of the standards of practice for school nurses is which of the following? A. Alignment with the American Academy of Pediatrics (AAP) guidelines for providing health care to students B. Requirement of bachelor's degrees in nursing and special certification in school nursing C. Restriction on delegation of care to other school personnel D. Use of research findings in the practice of school nursing

b In a health care environment, a worker with a latex allergy is at higher risk for and more vulnerable to an adverse reaction. The occupational health nurse should carefully screen workers for latex allergies and monitor these workers for optimal health protection. Latex allergies are widely recognized as a health hazard in these environments.

A widely recognized chemical health hazard in health care environments is which of the following? A. Burn-out B. Latex allergy C. Radiation D. Viruses

d Vulnerability results from the combined effects of limited resources. Limitations in physical resources, environmental resources, personal resources (or human capital), and biopsychosocial resources (e.g., the presence of illness, genetic predispositions) combine to cause vulnerability. Poverty, limited social support, and working in a hazardous environment are examples of limitations in physical and environmental resources.

A young adult with a history of prior parental abuse recently has been diagnosed with a stress-related illness. The individual works at a local convenience store, earning a little more than the federal poverty level, but receives no health benefits. This individual is predisposed to the development of: A. poverty. B. resilience. C. risk. D. vulnerability.

c Chlamydia is the most common reportable infectious disease in the United States. Women are often asymptomatic and therefore do not seek treatment, placing them at greater risk for developing pelvic inflammatory disease (PID), a serious infection involving the fallopian tubes (salpingitis).

A young female client visits a local clinic, seeking treatment for a urinary tract infection (UTI). During the assessment, the nurse conducts an extensive sexual history/activity screening to determine the risk for a sexually transmitted disease and potential complication of: A. genital warts. B. herpes simplex virus 1. C. pelvic inflammatory disease (PID). D. primary syphilis.

b The abuse of female partners has the most serious community health ramifications because of the greater prevalence, the greater potential for homicide, the effects on the children in the household, and the more serious long-term emotional and physical consequences. As a woman tries to leave the abusive relationship, the risk for homicide increases, creating a catch-22 scenario. A nurse encountering evidence of severe abuse needs to consider the safety of the woman and her children as the priority.

All adults should be assessed for violence in their primary intimate relationships. The abuse of female partners has the most serious community health ramifications because of the greater prevalence, the more serious long-term emotional and physical consequences, and the greater potential for: A. fleeing to a shelter. B. homicide. C. possessive behavior. D. spontaneous abortion.

a The balance among agent, host, and environment is often precarious and may be unintentionally disrupted. Changes in the characteristics of any of the factors may result in disease transmission. DIF: Cognitive Level: Application

An American takes a long-awaited vacation in sunny Mexico, spending days on the beach eating fresh raspberries from a nearby vendor and drinking bottled water. The tourist may be altering: A. agent-host-environment interaction. B. circadian rhythms. C. herd immunity. D. resistance.

b Effective disaster plans should (1) be written and shared with all who will be involved; (2) train employees in first aid, CPR, and fire brigade procedures; (3) be clear, specific, and comprehensive across all shifts and all work areas; (4) be coordinated with agencies that will respond; (5) be tested at least annually; (6) be evaluated and changed as indicated; (7) include an up-to-date hazard inventory that includes clinical information on exposures and appropriate treatment; (8) provide updated information to the responder agencies as needed; and (9) conduct a response agency worksite walk-through. Representatives of these agencies should visit the worksite and accompany the nurse on a worksite walk-through so that they are familiar with the operations.

An effective industrial disaster plan is a written plan that is shared with all who will be involved, such as the internal first responders, external community-based emergency personnel (transportation, fire, EMS, hospitals), and other key resources in the community. Another factor that influences the effectiveness of an industrial disaster plan is which of the following? A. Addressing activities for work areas that are at greater risk B. Conducting a response agency worksite walk-through C. Testing with a biannual drill D. Training specific employees for fire brigade procedures

b Health fairs are effective strategies for health promotion efforts guided by the Healthy People 2020 framework. These and similar activities promote increased health of the entire community, and they include persons of all ages, encourage enthusiasm, offer fellowship and leisure, and reduce duplication of effort.

An effective program strategy for health promotion efforts guided by the Healthy People 2020 framework that can be used by the faith community is establishing: A. food pantries. B. health fairs. C. statements of faith. D. volunteer training.

c Patterns of occurrence can be identified when investigating a disease or event. These patterns are used to define the boundaries of a problem to help investigate possible causes or sources of the problem. Intermittent or continuous source cases may be exposed over a period of days or weeks, as in the recent food poisonings at a restaurant chain throughout the United States as a result of the restaurant's purchase of contaminated green onions. A common source outbreak refers to a group exposed to a common noxious influence such as the release of noxious gases. In a point source outbreak all persons exposed become ill at the same time, during one incubation period. A mixed outbreak (which was described while investigating a foodborne gastroenteritis caused by a Shigella sonnei virus) is a common source followed by secondary exposures related to person-to-person contact, as in the spreading of influenza.

An elementary classroom of 28 students has had 13 children who have developed chicken pox over the last 3 weeks. What is the pattern of occurrence? A. Common source outbreak B. Point source outbreak C. Continuous source D. Mixed outbreak

c The goal of secondary prevention is to prevent the spread of disease once it occurs. Activities center on rapid identification of potential contacts to a reported case. Primary prevention interventions prevent the occurrence of disease, and tertiary prevention interventions reduce the complications and disabilities through treatment and rehabilitation.

An example of secondary prevention for infectious disease prevention is: A. malaria chemoprophylaxis. B. Pneumocystis carinii pneumonia (PCP) chemoprophylaxis for people with AIDS. C. quarantine. D. restaurant inspections.

d The parish nurse uses the nursing process for assessment, program planning, and evaluation. An example of an assessment intervention would be the use of health risk appraisals, spiritual assessments, and other assessment tools to provide personal health counseling.

An example of the use of the nursing process within a faith community nursing practice is the: A. contractual agreement. B. evidence of a mature faith. C. polity of the faith community. D. use of health appraisals.

c Although migrant workers move from job to job, their health care records typically do not go with them. This leads to fragmented services in such areas as TB treatment, chronic illness management, and immunization. When migrant farmworkers move, they must independently seek out new health services to continue their medications. Also, people with TB may forfeit treatment because they are afraid of immigration authorities.

An undocumented migrant farmworker has been diagnosed with tuberculosis (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 to 12 months. A major challenge that the client may face related to ongoing treatment for TB is: A. affordable care. B. discrimination. C. fragmented services. D. language barriers.

b School-based health centers are family-centered, community-based clinics run within schools under a federally funded program. These clinics give expanded health services, including mental health and dental care, in addition to the more traditional health care services. The Affordable Care Act of 2010 appropriated $200 million to improve and expand services at SBHC. They can vary in size, hours, and days of operation, or administrative model (i.e., school clinic, health center, school-linked program). They are successful because they focus on bringing health care services to children in a community school location and are coordinated with the school health program.

An urban school-based clinic is located in a school district where many of the children lack health insurance. The school nurse continues to provide screening, assessment, first aid, and record keeping but can refer students who require additional services to the nurse practitioners that staff the school-based health center (SBHC) on the school grounds. The SBHC is federally funded under which of the following? A. CDC's Federal School Health Program B. The Affordable Care Act C. Healthy People 2010 D. School-linked program

a Parish nurse services emphasize strengths of individuals, families, and communities. Parish nurses endorse this characteristic in their practice. As congregations realize the need for care and care for one another, their individual and corporate relationships with their Creator often are enhanced. This provides additional coping strengths for future crisis situations within the family and community.

As congregations realize the need for care and care for one another, their individual and corporate relationships with their Creator often are enhanced, thereby increasing their resilience for future crisis situations. The characteristic of faith community nursing philosophy that best endorses this principle is that faith community nurse services: A. Emphasize strengths of individuals, families, and communities B. Focus on the faith community and its ministry C. Focus on the centrality of the spiritual dimension D. Consider health, spiritual health, and healing as an ongoing dynamic process

b Injuries are the leading cause of death in children and teenagers. The school nurse educates children, teachers, and parents about preventing injuries. School nurses also provide information on how to prevent playground injuries. They assess school playgrounds for equipment safety on the basis of the U.S. Consumer Product Safety Commission guidelines.

At the end of each school term, the school nurse schedules an equipment safety assessment of each school playground in the district. The school nurse uses the guidelines of the U.S. Consumer Protection Safety Commission and prepares a report of the findings for the school board for planning purposes. This intervention by the school nurse is an example of which of the following? A. Community outreach B. Primary prevention C. Secondary prevention D. Tertiary prevention

b Confidentiality is of the utmost importance in parish nursing practice. An individual's right to privacy is an ethical issue. The nurse values client confidentiality while delicately assisting the client and client's family to "share" concerns with pastoral staff and fellow congregants. This sharing gains valuable support to promote optimal healing. The nurse is often the staff member who helps the family to the stage of acceptance of a health concern. How much to share and when to share a concern is indeed a private affair and a part of the important journey of healing.

Communities of faith strive to be caring communities and strongly value the fellowship among members. The faith community nurse recognizes that sharing concerns with pastoral staff and fellow congregants gains valuable support to promote optimal healing. The ethical issue of concern in this matter is: A. group rights. B. individual rights. C. statements of faith. D. virtue ethics.

b By examining specific populations or communities exposed to different ambient environments, environmental epidemiology seeks to clarify the relationship between physical, chemical, and biological factors and human health. Toxicology is the study of health effects associated with chemical exposures. Secondary prevention and compliance and enforcement are not associated with monitoring and public reporting.

The monitoring and public reporting of air quality in a local community to alert individuals with asthma or other respiratory conditions would illustrate: A. compliance and enforcement. B. environmental epidemiology. C. secondary prevention. D. toxicology.

a The interaction between the agent, host, and environment is the platform for determining the contributing factors to emerging and reemerging infectious disease. In some cases, the agent may be the source of change in balance. But in most cases it will be the environment (i.e., weather/climate, deforestation, urbanization, industrialization) or the consequences of the human host's activities or behaviors (illegal drug use, changing sexual behavior, legal and illegal immigration, travel, increase in the number of children in day care, inappropriate use of antibiotics).

Factors that contribute to newly emerging or reemerging infectious disease can be related to microbial adaptation and changes made by the infectious agent. However, most of the emergence factors are related to environmental changes and: A. consequences of human activities/behaviors. B. increase in the number of vectors. C. industrialization and urbanization. D. unpredictable variances in the climate.

b Delayed stress reactions, or those that occur once the disaster is over, include exhaustion and an inability to adjust to a slower pace at work or at home. Workers may be disappointed if family members and friends do not show sufficient interest in what they have been through and if coming back home, in general, does not live up to expectations. Also, they may feel frustration and conflict if their needs seem inconsistent with those of their family and co-workers or if they have left the disaster site thinking that so much more could have been done.

Four months after the disaster of 9/11 at the Pentagon, a local EMS worker complained of extreme exhaustion. The veteran EMS worker also stated that the pace of work at the squad was too slow. The occupational health nurse that is assessing the EMS worker recognizes the symptoms of: A. anger. B. delayed stress reaction. C. inability to concentrate. D. insomnia.

b The stress response of individuals following a disaster may be experienced as rumination about the disaster, immense fear of everything, survivor guilt, sense of great loss, and hesitation to express feelings. Key actions by the nurse can assist others with dealing with the stress, help people cope, allay concerns and fears, identify feelings that they may be experiencing, assist others to think positively and move to the future, and prepare nursing personnel to be effective in a crisis/emergency situation.

Following the attacks of 9/11, a nurse practitioner in a family clinic used opportunities at the clinic staff meetings to speak about her own feelings of loss and guilt. This strategy indicates that the nurse was aware of what phenomenon related to disasters? A. Anxiety B. Effects of stress on individuals C. Sense of urgency D. Scapegoating and blaming

a Homeless people devote a large portion of their time to just trying to survive. Health care is usually crisis oriented and sought in emergency departments. Those who access health care have a hard time following prescribed treatment regimes such as prescribed diets, purchasing prescriptions, or health-promotion or symptom-relief measures.

For the homeless, health care is usually crisis oriented and sought in emergency departments. The most difficult challenge for nurses treating this vulnerable population is to recognize the client's: A. limitations in following treatment protocols. B. limited number of transient treatment facilities. C. transition to persistent poverty. D. use and abuse of tobacco, alcohol, and illicit drugs.

b Understanding that the most likely agents to be used in bioterrorism are easily disseminated, have a potential for high mortality, and are intended to produce major panic and social disruption allows the nurse to fully understand the nature of the threat and plan to participate in an appropriate disaster response to minimize dissemination, activate early treatment, and manage the public's concerns. Disaster-response planning addresses these components.

For the nurse to fully understand the threat associated with the release of biological agents and participate in an appropriate response, the Centers for Disease Control and Prevention (CDC) has stated that the biological agents most likely to be employed are those that both have a potential for high mortality and can be easily disseminated to produce: A. immediately severe symptoms. B. major panic and social disruption. C. multisyndrome effect. D. person-to-person transmission.

a Home health agencies are different in administrative and organizational structures such as funding and governance, but they are similar in terms of the standards they must meet for licensure, certification, and accreditation. Nursing care in home health is covered by Medicare and other third-party payers as long as the care being delivered is skilled care.

Home health agency types, whether official, private and voluntary, combination, hospital based, or proprietary, are similar in terms of which of the following? A. Conditions of participation (COP) for Medicare and Medicaid B. Federal income tax exemption status or accreditation status C. Governance models and administrative structures D. Homemaker services or service contracting practices

c Acquired immunity is the resistance acquired by a host as a result of previous natural exposure to an infectious agent. Having measles once protects against future infection. Acquired immunity may be induced by active or passive immunization. Natural immunity refers to species-determined, innate resistance to an infectious agent. Resistance is the ability of the host to withstand infection, and it may involve natural or acquired immunity. Herd immunity refers to the immunity of a group or community.

Immunity to disease through vaccination is known as: A. natural immunity. B. resistance. C. acquired immunity. D. herd immunity.

a The principles of giving care to families who have experienced violence include the following: intolerance of the violence, respect and caring for all family members, safety as the first priority, absolute honesty, and empowerment. The nurse must use a nurse-family partnership rather than a paternalistic or authoritarian approach.

In giving care to the survivors of violence, the nurse should demonstrate respect and caring for all family members, insist that safety is the first priority, and demonstrate intolerance for violent behavior. Additionally, the nurse should be: A. absolutely honest about what will be reported and what the family can expect. B. authoritarian in approaching the problem. C. cautious in reporting unconfirmed reports of violence. D. sincere in concern for the victims.

b Many workers in health care settings or clinical laboratories are employed as maintenance workers, security guards, aides, or cleaning personnel, who tend not to be well protected from inadvertent exposures, which include contaminated linens in the laundry, soiled equipment, and trash containing contaminated dressings or specimens.

In health care facilities and clinical laboratories, the occupational health nurse needs to be aware of the worker groups that are at risk for exposure to biological agents. Besides the health care workers, worker groups at risk for exposure to biological infectious agents may include which of the following? A. Clerical staff B. Maintenance personnel C. Receptionists D. Chaplains

d Shelters are generally the responsibility of the local Red Cross chapter, although in massive disasters the military may set up "tent cities" or bring in trailers for the masses who need temporary shelter. Nurses, because of their comfort with delivering aggregate health promotion, disease prevention, and emotional support, make ideal shelter managers and team members. Each person who comes to the shelter is assessed to determine what type of facility is most appropriate. Although initially physical health needs are the priority, especially among older adults and the chronically ill, many of the predominant problems in shelters revolve around stress. The shock of the disaster itself, the loss of personal possessions, the fear of the unknown, living in proximity to total strangers, and even boredom can cause stress.

In the event of a disaster, shelters are generally the responsibility of which of the following entities? A. Centers for Disease Control & Prevention (CDC) B. Federal Emergency Management Agency (FEMA) C. Public Health Service (PHS) D. Red Cross chapter

b Sexual abstinence is the best way to prevent STDs. However, for many people, sexual abstinence is not realistic; therefore teaching about how to make sexual behavior safer is critical. Safer sexual behavior includes masturbation, dry kissing, touching, fantasy, and vaginal and oral sex with a condom. Nurses should not base assessments or knowledge on age, gender, ethnicity, or any other factors and should discuss safe sex in all client encounters.

Many behaviors place individuals of all ages, genders, ethnicities, or any other factors at greater risk for sexually transmitted diseases (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.

b Assessment is a major nursing role during a disaster. The acute needs of populations in disaster turn the community assessment into rapid appraisal of a sector or region's population, social systems, and geophysical features. Elements of a rapid needs assessment include determining the magnitude of the incident, defining the specific health needs of the affected population, establishing priorities and objectives for action, identifying existing and potential public health problems, evaluating the capacity of the local response including resources and logistics, and determining the external resource needs for priority actions.

Nurses often participate on field assessment teams (surveillance) during a disaster response. These assessments are crucial to best help: A. encourage good intentions of those giving aid. B. match available resources to the population's emergency needs. C. separate casualties and allocate treatment. D. provide compassion and dignity.

b When a community is provided drinking water by a water supplier (as opposed to individual wells), the water provider is responsible for testing the water according to EPA standards. The results of the testing must be reported to those who purchase the water, in the form of a consumer confidence report (CCR). Nurses should review consumer confidence reports, sometimes referred to as right-to-know reports, to learn what pollutants have been found in the drinking water. Pollution sources are characterized as point sources. A point-source pollutant is released into the environment from a single site, such as a smoke stack, a hazardous waste site, or an effluent pipe into a waterway. Environmental standards are reviewed at the community level. Material Safety Data Sheets provide information about the chemical makeup, the health risks, and any special guidance on safe use and handling of chemicals in the workplace.

Nurses should review which of the following reports to determine what pollutants have been found in the drinking water of a community? A. Point source report B. Consumer confidence report C. Material Safety Data Sheet D. Environmental standards report

b TQM is a process-driven, customer-oriented management philosophy that includes leadership, teamwork, employee empowerment, individual responsibility, and continuous improvement of system processes to yield improved outcomes (Scott, 2009). Under TQM, quality is defined as customer satisfaction. Quality assurance/quality improvement (QA/QI) is the promise or guarantee that certain standards of excellence are being met in the delivery of care.

One specific approach to quality assurance is the use of Total Quality Management (TQM). A district public health department uses this approach and gives much attention to ensuring that studies are used to improve processes, remove management by objectives, and promote self-improvement. The major TQM guideline that would summarize these efforts would be: A. create, publish, and distribute aims and purposes. B. creating a strong customer-oriented philosophy that is process-driven. C. eliminate barriers to pride of work/performance. D. understand the purpose of inspection.

a Because safe food preparation measures are so important in preventing foodborne disease, the World Health Organization (WHO) has developed the "Ten Golden Rules for Safe Food Preparation." Many foodborne illnesses, regardless of causal organism, can be prevented by simple changes in food preparation, handling, and storage to destroy or denature contaminants and prevent their further spread. Because these measures are so important in preventing foodborne disease, Healthy People 2020 has continued to include an objective directed toward food safety.

Protecting the nation's food supply from contamination by all the virulent microbes is complex, costly, and time consuming. However, much foodborne illness, regardless of causal organisms, can be prevented through simple changes in: A. food preparation, handling, and storage. B. importation regulations. C. pesticide usage. D. animal breeding practices.

d Because of the increased number of home health agencies and increasing costs, the federal government instituted a prospective payment system on October 1, 2000. This system prevents the abuse or fraudulent use of Medicare funding. Nurses in many settings are not directly exposed to the financial aspects of health care. In home health, nurses must be "cost-conscious" so that they can explain to clients what Medicare will or will not cover. It is often difficult for older clients to understand why Medicare will not pay for the nurse to make home visits to take their blood pressure if their condition remains stable. Medicare pays for services only if the client's condition is unstable, the client is homebound, and the client requires skilled, intermittent, and part-time care.

Since 2000, home health agencies have been paid by the federal government based on which type of reimbursement? A. Diagnostic-related groups B. Distributive care C. Episodic care D. Prospective payment system

a Infectious diseases are expensive. The Produce Safety Project at Georgetown University in 2010 suggested that the total cost from foodborne illness could be more than $152 billion.

Society bears the burden of infectious disease. That burden includes the effects of morbidity and mortality as well as the staggering: A. economic burden. B. fear burden. C. incidence burden. D. vulnerability burden.

c The Food Quality Protection Act of 1996 added new provisions related to protection of infants and children from pesticide exposure from multiple sources. The law established a health-based standard of reasonable certainty of "no harm" that prohibits taking into account economic considerations when children are at risk. Other safeguards under the FQPA include the use of an additional tenfold margin of safety when there are adequate data to assess prenatal and postnatal developmental risks, a 15-year renewal process for all pesticides to ensure that they have up-to-date scientific evaluations over time, and a cumulative impact consideration.

The Food Quality Protection Act of 1996 increased the protection of infants and children from pesticide exposure from multiple sources by establishing a new health-based standard of reasonable certainty of "no harm" that: A. considers the cumulative impacts of all pesticides that may share a common mechanism of action. B. establishes a 15-year renewal process for all pesticides. C. prohibits taking into account economic considerations when children are at risk. D. uses an additional tenfold margin of safety when there are adequate data indicating developmental risks.

a The Omaha System is a comprehensive method for evaluating client care. The components include a classification system for assessing and categorizing client problems, a database, a nursing problem list, and anticipated outcome criteria for the classified problems. It has the potential to improve the delivery of nursing care, documentation, and the descriptions of client care that will enhance nursing assessment, planning, implementation, and evaluation of client care and allow the collection of more pertinent client information (relevant, consistent, measurable) for more effective and efficient nurse productivity and communication.

The Omaha System is a client classification system developed by the Visiting Nurses Association of Omaha, Nebraska, that has the potential to improve the delivery of care by: A. improving the description of care. B. minimizing the assessment required. C. predicting the outcome. D. decreasing the communication needs.

d Many of the core public health competencies are provided by nurses who have learned these skills in the workplace while gaining knowledge through years of practice. Rapid changes in public health are providing challenges to nurses, in that neither the time nor the staff is available to provide as much on-the-job training as is needed to learn or upgrade skills and knowledge of staff. The ability to provide a strong public health system is dependent on preparing nurses at the baccalaureate and master's levels.

The broad practice of public health requires a set of skills, knowledge, and attitudes in all disciplines. The baccalaureate level of entry for nursing is currently endorsed to achieve the core competencies of public health because of: A. core public health competencies typically being learned in the workplace. B. encouragement for nurses with an associate's degree to seek further degrees. C. financial planning and management skills learned at the master's level. D. rapid change and limited resources in public health.

c The key questions in an environmental health assessment should cover present and past conditions in work, home, and community environments. In an assessment of environmental exposures, the environment can be divided into functional locations such as home, school, workplace, and community. Nurses can act in the best interest of public health, and use their abilities as educators, advocates, and communicators to affect public policy, laws, and regulations that protect public health. Nurses can serve as a resource for state and federal legislators and their staff.

The community health nurse asks a client, "Have you ever been exposed to any radiation or chemical liquids, dust, mists, or fumes?" The nurse is conducting an: A. environmental advocacy activity. B. environmental compliance activity. C. environmental health assessment. D. environmental risk communication.

c Biological terrorism is the deliberate release of viruses, bacteria, or other germs (agents) used to cause illness or death in people, animals, or plants. Chemical terrorism is the intentional release of hazardous chemicals into the environment for the purpose of harming or killing. Surveillance is a critical role function for nurses practicing in the community. It is important because it generates knowledge of a disease or event outbreak patterns (including timing, geographic distribution, and susceptible populations).

The deliberate release of viruses, bacteria or other germs with the intent of causing illness or death is: A. event outbreak. B. chemical terrorism. C. biological terrorism. D. surveillance.

d OSHA is the federal agency within the U.S. Department of Labor that develops and enforces workplace safety and health regulations. OSHA sets the standards, enforcing them at the federal, state, and local levels. NIOSH is the federal agency within the Centers for Disease Control and Prevention that identifies, monitors, and educates about the incidence, prevalence, and prevention of work-related illnesses and injuries and examines potential hazards of new work technologies and practices. Although NIOSH and OSHA were both created by the same act of Congress, they have discrete functions.

The difference between the Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH) can best be described as which of the following? A. NIOSH enforces workplace safety, and OSHA educates about occupational injury and illness prevention. B. NIOSH monitors work-related injury/illness incidence, prevalence, and prevention, and OSHA governs financial compensation under Workers' Compensation. C. OSHA is part of the Department of Labor, and NIOSH is part of the National Institutes of Health. D. OSHA sets the workplace safety standards, and NIOSH examines potential hazards of new work technologies and practices.

a The beginning of the parish nurse movement coincided with shortening hospital stays, increasing demands on caregivers, inadequate training of caregivers, and family challenges to meet the needs of young children, teens, and aging parents. Parish nurse services were one way to coordinate care and foster continuity of care. The parish nurse services emphasized health promotion and disease prevention and provided the benefits of holistic care through the supportive faith community.

The faith community nurse role arose out of the challenges faced by families to succeed in meeting the demands of young children, teens, and aging parents as well as which of the following challenges? A. Inadequate training for caregivers B. Increased hospital length of stay C. Lack of consumer demand for health care decisions involvement D. Society's lack of accountability for health care decision making

b Palliative care is symptom management with a focus on care coordination and comprehensive support often in specialized inpatient hospice units. Both home-based and inpatient hospice care models share a focus on comfort, pain relief, and mitigation of other distressing symptoms. Hospice care is the care of the dying client and his or her significant others. The Program of All-Inclusive Care for the Elderly (PACE) is a managed care model of integrated health and personal care services. Transitional care programs in the home are designed for populations who have complex or high-risk health problems and are making a transition from one level of care to another.

The model of care delivered in the home setting which focuses on symptom management at the end of life is known as: A. hospice care. B. palliative care. C. personal care. D. transitional care.

d The Resource Conservation and Recovery Act (RCRA) gave the EPA the authority to control the generation, transportation, treatment, storage, and disposal of hazardous waste. The 1984 federal Hazardous and Solid Waste Amendment to this act required phasing out land disposal of hazardous waste. The NEPA established the Environmental Protection Agency (EPA) and a national policy for the environment and provides for the establishment of a Council on Environmental Policy. The EPCRA was enacted to help local communities protect public health safety and the environment from chemical hazards. The PPA focused industry, government, and public attention on reduction of the amount of pollution through cost-effective changes in production, operation, and use of raw materials.

The federal act that grants authority to the Environmental Protection Agency (EPA) which controls the generation, transportation, treatment, storage, and disposal of hazardous waste and ultimately called for the phaseout of land disposal of hazardous waste under a later amendment was the: A. Emergency Planning and Community Right-to-Know Act (EPCRA). B. National Environmental Policy Act (NEPA). C. Pollution Prevention Act (PPA). D. Resource Conservation and Recovery Act (RCRA).

d The amount of health care being given in the schools is increasing. In the future, school nursing will use telehealth and telecounseling to teach health education. School nurses will use the Internet to work with children and parents. The school nurse is responsible for keeping up with the latest changes in health care and health practice so that the health of children in the schools can be enhanced by new trends in health care.

The future of school nursing is very strong and will be further enhanced by the future trend in which of the following? A. Development of an HIV/AIDS health curriculum B. Enhanced use of picture boards C. Improving the air quality of school buildings D. Telehealth and telecounseling

c Individual licensure is a contract between the profession and the state whereby the profession (i.e., State Board of Nursing) is granted control over who can enter into and who exists in the profession. It requires written regulations to define the scope and limits of the profession's practice.

The general approach to quality improvement known as licensure that grants control over who can enter into and who exists in a profession can best be described as a contract between the: A. consumers and the profession. B. legislature and the state board. C. profession and the state. D. public and the professional associations.

d Although deinstitutionalization was noble in conception, it was bankrupt in implementation. Families and communities were not prepared to take on the treatment responsibilities they had to assume, and little education was available. Either care settings such as nursing homes, personal care settings, supervised apartments, rooming houses, single-occupancy hotels, and other similar settings were not available, or people were not educated or prepared to deal with this population.

The goal of deinstitutionalization was to improve the quality of life for people with mental disorders by providing services in the communities where they lived rather than in large institutions. At what program level did this change in locus of care fail? A. Assessment level B. Design level C. Evaluation level D. Implementation level

a The population group at the greatest risk for experiencing work-related accidents with subsequent injuries is new workers with less than 1 year of experience on the current job, because of characteristics such as risk taking, lack of knowledge, and lack of familiarity with the new job. Older workers may be at increased risk in the workplace because of diminished sensory abilities, the effects of chronic illnesses, and delayed reaction times. A third population group that may be very susceptible to workplace exposure is women in their child-bearing years.

The greatest risk for experiencing work-related accidents with subsequent injuries is to which of the following? A. New workers with less than 1 year of experience on the current job B. Older workers with 2 years of experience on the job C. Women over 50 years of age with 3 years of experience on the current job D. Workers with safe, low-level exposure on the job

b Death rates for working-age adults are higher in the most rural and the most highly populated urban areas. The highest death rates for children and young adults occur in the most rural counties. Residents of rural areas have the highest death rates resulting from unintentional injuries in general and motor vehicle injuries in particular.

When using the health measure of death rates for working-age adults, the nurse could expect to find the highest rates in which areas? A. Large metropolitan areas B. Most rural and highly populated urban areas C. Most rural and suburban areas D. Small suburban and all urban areas

a The nursing process is the theoretical framework used by the ANA, which notes that the nursing process is the essential methodology by which client goals are identified and achieved. Their scope and standards publications, including those for Home Health Nursing and Hospice and Palliative Nursing, are organized according to the nursing process and contain two sections: the Standards of Care and the Standards of Professional Performance (ANA, 2007; HPNA/ANA, 2007). Both include the six steps of the nursing process: assessment, diagnosis, outcomes identification, planning, implementation, and evaluation; the steps are linked to standards and more specific measurement criteria that are stated in behavioral objectives. The standards address quality of care, performance appraisal, education, collegiality, ethics, collaboration, research, and resource use.

The home health nurse completes an initial assessment on a recently admitted home health client. The nurse should now analyze the assessment data and complete what step in the nursing process that is consistent with the standards of home health practice? A. Diagnosis B. Implementation C. Outcome identification D. Planning

a Surveillance systems in use today are defined as passive, active, sentinel, and special. In the passive system, case reports are sent to local health departments by health care providers (i.e., physicians, nurses) or laboratory reports of disease occurrence are sent to the local health department. In the active system, the nurse, as an employee of the health department, may begin a search for cases through contacts with local health providers and health care agencies. In the sentinel system, trends in commonly occurring diseases or key health indicators are monitored. Special systems are developed for collecting particular types of data; these may be a combination of active, passive, and/or sentinel systems.

The hospital infection control practitioner reports new cases of tuberculosis to the public health department. Of what type of surveillance system is this an example? A. Passive B. Active C. Sentinel D. Special

c Housing conditions greatly vary among states and localities. When housing costs are high, 50 farmworkers may live in one house, or three families may share one trailer. Some may live in cars or tents if necessary. Housing may lack individual sanitation, bathing, or laundry facilities. Poor-quality and crowded housing can contribute to such health problems as tuberculosis (TB), gastroenteritis, and hepatitis.

The local hospital emergency department has recently experienced an increase in gastroenteritis cases among migrant farmworkers. The local health department is informed of this rise in cases and schedules a case mapping of local: A. bars frequented by migrant workers. B. farm fields employing migrant workers. C. housing for migrant workers. D. restaurants frequented by migrant workers.

d The urbanizing and the overcrowding of cities have increased the danger from natural disasters because communities have been built in areas that are vulnerable to disasters, such as in known hurricane, flood, and tornado zones. Increases in population and developing for habitation of areas vulnerable to natural disasters have led to major increases in insurance payouts in the United States in every decade. Projections suggest that by 2050, at least 46% of the world's population will live in areas vulnerable to natural floods, earthquakes, and severe storms.

The major factor that has increased Florida's vulnerability to natural disasters in recent decades has been: A. El Niño. B. geography. C. trade winds. D. urbanization.

d Focus on prevention. Use every opportunity to teach about preventive health care. A single client visit may focus on an acute health problem such as influenza, but it may also include health education about diet and exercise, counseling for smoking cessation, and a follow-up appointment for immunizations once the influenza is over. The shift away from hospital-based care includes a renewed commitment to the public health services that vulnerable populations need to prevent illness and promote health, such as reductions of environmental hazards and violence and assurance of safe food and water.

The most critical strategy that can be used by nurses in community health to improve the health status of migrant workers that spend only a few months in a geographic location is to: A. conduct a comprehensive assessment and formulate a plan for treatment. B. establish a long-term trust relationship to prevent disappointment. C. schedule appointments for appropriate immunizations for the children. D. use every opportunity to teach about preventive health care.

b Rough handling by caregivers can lead to bruises and bleeding into body tissues because of the fragility of older adult clients' skin and vascular systems. It is often difficult to determine whether the injuries of older adults result from abuse, falls, or other natural causes. Careful assessment through both observation and discussion can help determine the cause of injuries so that proper plans for interventions can be made.

The nurse at the adult day care center notices bruises on the wrists of a 90-year-old client. Besides the physical assessment of the client, the nurse should: A. confront the daughter when she arrives to pick the father up. B. discuss the findings with the caregivers to determine the cause of the injuries. C. educate the staff about indications of elder abuse. D. make a referral to the primary care provider for follow-up.

b Attendance at school may be inadvisable if cases of childhood infections are in the school, since the immunosuppressed child is at greater risk for suffering complications. Alternative arrangements, such as homebound instruction, might be instituted if a child is unable to control body secretions or displays biting behavior.

The nurse in community health is aware that HIV-infected children should attend school, because the benefit of attendance far outweighs the risk of transmitting or acquiring infections. School attendance should be reconsidered when there is evidence of: A. availability of homebound instruction. B. cases of measles. C. lack of handicapped access. D. prejudice of teachers and/or students.

c Partnerships and collaborations between groups are much more powerful in making change than are an individual client and nurse working alone. Nurses can facilitate an appropriate community response by providing information in a manner that stimulates community action to address specific problems at a population level to ultimately improve the health care status of the community.

The nurse in community health prepares a community assessment for the local planning commission and presents data that indicate an increase in violence among young children and teens within the community. The nurse projects the cost of care related to violence in ED visits, treatment of stabbing and gunshot wounds, and rehabilitation. The nurse also produces information on school absenteeism, graduation rates, and teenage rape and pregnancy. The planning commission creates a task force to explore the community outlets for child and teen recreation and the current community education programs available to families and students related to violence prevention, negotiation, and mediation. This can best be described as an example of: A. disparities in health care. B. outreach work. C. power of partnerships. D. social issues.

b Nurses in community health retain responsibility for ensuring that all populations have access to affordable, quality health care services. Despite the shift in focus in recent years from a direct service model, nurses in community health may provide direct services to populations that are underserved/not served and conduct case management activities to link at-risk populations to appropriate community services.

The nurse in community health serves as a bridge between the 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 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.

c The monitoring of communicable diseases is one of the most important roles for nursing during disasters. During the September 11, 2001, airplane attacks and the October 2001 anthrax attacks, nurses at the federal, state, and local levels immediately implemented active enhanced surveillance activities. Information about communicable diseases seen at the local level was passed on to the state public health agency and finally the CDC. At each step, the data were analyzed for evidence of unusual disease trends.

The role/activity of the nurse in community health that was most important during the disasters of September 11, 2001, and the subsequent anthrax bioterrorism attack involved: A. assessment. B. client-level teaching. C. enhanced surveillance activities. D. free and low-cost immunization.

c Violence that begins in pregnancy may continue for several years after, with increasing severity. Variations by ethnicity have also been observed during this postpartum period: intimate partner violence may peak at 3 months postpartum among African-American and Hispanic/Latino new mothers and at 18 months for white mothers. The nurse should look for physical signs of abuse, as well as for controlling or intrusive partner behavior.

The nurse must ask about violence at each prenatal and postpartum visit, especially with vulnerable populations such as teenagers, as well as observe for signs of violence on each visit. The nurse should be aware that the peak for postpartum intimate partner violence may be observed at various times according to ethnic group, such as: A. 6 months for white mothers. B. 10 months for white mothers. C. 3 months for African-American and Hispanic/Latino mothers. D. 12 months for African-American and Hispanic/Latino mothers.

c Organizational culture refers to the norms and patterns of behavior that are sanctioned within a particular organization that set guidelines for the types of work behaviors that will enable employees to succeed within a particular organization or department. In this example, the new CFO has reset the expectations related to working overtime and weekends to beat deadlines. These factors and the employees' response to them must be assessed if strategies for influencing the health and safety of workers are to be effective.

The occupational health nurse is aware that several employees from the accounting/finance departments are complaining about exhaustion, anxiety, and heartburn and notes an increase in absenteeism for these departments. On further exploration, the nurse learns that a new chief financial officer (CFO) has been in place for 1 month. The new CFO is demanding higher productivity and turnaround with expectations of working overtime and weekends to "get the job done" ahead of deadlines. The occupational health nurse, using the epidemiologic model, recognizes this as a psychological agent that can best be described as which of the following? A. Employment conditions B. Nonfatal violence C. Organizational culture D. Shift work

c Primary prevention of HCV infection includes screening blood products and donor organs and tissue; risk-reduction counseling and services, including obtaining the sexual and injection drug use (IDU) history; and infection control practices.

The primary prevention of hepatitis C virus (HCV) includes: A. counseling and follow-up of infected clients. B. routine testing for health care workers. C. screening of blood products. D. testing of high-risk individuals.

d Records are an important part of the communication structure of the health care organization. Accurate and complete records are required by law and must be kept by all agencies, both governmental and nongovernmental. In most states, the state departments of health stipulate the kinds of records to be kept and their content requirements for community agencies. Records provide complete information about the client (whether a family, group, population, or community), indicate the extent and quality of the services being given, resolve legal issues in malpractice suits, and provide information for education and research.

The purpose of record keeping in public health agencies is to maintain complete information on clients served and the extent and quality of service provided to those clients. The records also provide information for education and research. Another important use of the records is to: A. determine raises for personnel. B. explain cost overruns. C. foster independence in clinical practice. D. resolve legal issues in malpractice suits.

b Recovery is about returning to the new normal with the goal of reaching a level of organization that is as near the level before the disaster as is possible. This is often the hardest part of the disaster. During the recovery period all involved agencies pull together to restore the institutions and properly rebuild. In the end, all of the nurses and organizations in the world can only provide partnerships with the victims of disaster. Ultimately, it is up to the individuals to recover on their own.

The recovery phase of a disaster can take a very long time. Nurses need to be aware that despite effective disaster preparedness and response efforts: A. environmental hazards are minimal. B. individuals must ultimately recover on their own. C. the government provides economic support. D. religious organizations must bear the burden of the community.

a When participating in community outreach, nurses can be involved in community health fairs, reaching others about influenza immunization programs, promoting health education fairs, and coordinating with local charities to provide education to the schools. As a consultant, the school nurse can provide professional information about proposed changes in the school environment and their effect on the health of the children. The school nurse is expected to function as a case manager, helping to coordinate the health care for children with complex health problems. The school nurse as counselor is available to students who need to discuss confidential health matters.

The school nurse at the intermediate level arranges for a presentation by the trauma educator at the local regional medical center. Bicycle and helmet safety will be the primary topic at the school's open house. This is an example of which of the following school nurse roles? A. Community outreach B. Counselor C. Consultant D. Case manager

c State health departments play a key role in implementing the Healthy People 2020 objectives by setting the goals using the objectives as a framework. Knowing that health departments do not have the resources to accomplish these goals independently, collaboration is essential to quality nursing practice and is encouraged at the local level with existing groups. Communities establish coalitions to address selected objectives, based on community needs, to include all of the local community stakeholders. The public health team includes the local, state, and federal agencies and the private sector, each with its own variable reason (stakeholders) for participation, yet striving for an agreed-upon goal of increasing the health status of the nation.

To achieve the major goals of Healthy People 2020, increasing quality and years of healthy life and eliminating health disparities, the partnership between federal, state, and local agencies is critical, and local community coalitions are encouraged because the: A. federal government is ultimately responsible for the health status of the nation. B. 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 department would require a universal approach to achieving objectives.

b The faith community nurse is called on to partner with potential supporters in finding funds. The nurse is accountable for money spent and for fundraising, whether the position is salaried or voluntary. Educational and promotional materials, equipment, travel time, continuing education, and malpractice insurance are selected areas that must be included in a budget of the parish nurse. If these materials are not budget items, services may be limited. The nurse must communicate the importance of these areas and the associated funding to the faith community and the wellness committee to ensure the success of any program.

To ensure the success of a faith community's health ministry program, the parish nurse must ensure that the wellness committee addresses issues of: A. experiential preparation. B. financing and fundraising. C. referrals. D. retired professionals.

d When calamity strikes, disaster workers must know what kinds of populations they are attempting to assist. Accurate information regarding the location of a retirement village, nursing home, childcare center, rehabilitation center, individuals cared for in the home who are dependent on critical medical equipment, or locations with special populations is crucial.

To maintain effective disaster preparedness, nurses working in the community can play a critical role in providing an updated record of: A. immunizations. B. active tuberculosis (TB) cases. C. WIC enrollees. D. vulnerable populations.

b Diseases such as polio, diphtheria, pertussis, and measles, which previously occurred in epidemic proportions, are now controlled by routine childhood immunization, but they have not been eradicated. Despite the availability of free vaccines, many infants and toddlers, who are the most vulnerable to these potentially severe diseases, are not receiving scheduled immunizations by their second year. Recent "no shots, no school" legislation has increased the number of children fully immunized by the time they enter school. Increasing the rate of full immunization can provide the general public the protection of herd immunity, which is helpful in controlling communicable disease exposure through immigration, endemic (pertussis), and epidemic (influenza) outbreaks.

To reach the desired goal of maximizing the full immunization rates for preventable communicable disease and increasing herd immunity levels, it is crucial for the nurse to: A. assume that the primary care physician has provided all appropriate immunizations. B. check an individual's immunization status at each and every visit. C. support parents who are reluctant to immunize their children. D. understand the difficulties in obtaining and maintaining immunization schedules.

a In 1985, in response to concerns regarding the transmission of HIV infection during health care procedures, the Centers for Disease Control and Prevention (CDC) recommended a Universal Precautions policy for all health care settings. This strategy requires that all blood and body fluids from all clients be handled as if infected with HIV or other blood-borne pathogens.

Universal Precautions is a policy for all health care settings, where potential contact with blood or other body fluids exists, and requires that health care workers always perform hand hygiene and wear gloves, masks, protective clothing, and other indicated personal protective barriers. The underlying strategy for this policy requires that: A. blood and body fluids of all clients be handled as if infected. B. health care workers effectively use hand hygiene. C. health care settings are reservoirs of infection. D. effective infection control surveillance programs are in place.

a Vulnerable populations often experience multiple cumulative risks, and they are particularly sensitive to the effects of those risks. Risks come from environmental hazards (e.g., lead exposure from lead-based paint from peeling walls or that which has been used in toy manufacturing or melamine added to milk supplies), social hazards (e.g., crime, violence), personal behavior (e.g., diet, exercise habits, smoking), or biological or genetic makeup (e.g., congenital addiction, compromised immune status).

Vulnerable populations may be exposed to more than one hazard at a time. This is known as: A. cumulative risk. B. disenfranchised populations. C. resilience. D. underserved populations.

b A quality surveillance system requires collaboration among a number of agencies and individuals: federal agencies, state and local public health agencies, hospitals, health care providers, medical examiners, veterinarians, agriculture, pharmaceutical agencies, emergency management, and law enforcement agencies, as well as 911 systems, ambulance services, urgent care and emergency departments, poison control centers, nurse hotlines, school, and industry. The type of information shared includes the use of an algorithm to identify which events should be investigated (i.e., using a precise step-by-step plan outlining a procedure that in a finite number of steps helps to identify the appropriate event).

What is the purpose of using an algorithm in the surveillance process? A. Tells the nurse who to call in the event of an outbreak B. Provides the nurse with a step by step plan to identify events needing investigation C. Provides the nurse with a system for telephone triage in an outbreak D. It is a visual reminder of the epidemiologic triangle

a Understanding ethics is essential for nurses making their own choices, in describing issues and options within groups, and in advocating for ethical choices. Ethical issues likely to arise in environmental health decisions are the following: · Who has access to information and when? · How complete and accurate is the available information? · Who is included in the decision making and when? · What and whose values and priorities are given weight in decisions? · How are short-term and long-term consequences considered?

When a community health nurse evaluates the completeness and accuracy of information made available to community residents regarding the impact of rezoning land parcels for industrial use, the nurse is: A. advocating for ethical choices. B. communicating risk. C. controlling environmental damage. D. volunteering for service on state boards.

a If the community health nurse suspects that a client's health problem is being influenced by environmental factors, the nurse should follow the nursing process and note the environmental aspects of the problem in every step of the nursing process. In the evaluation stage, the nurse should examine criteria that include the immediate and long-term responses of the client, as well as the recidivism of the problem for the client. Consideration of laws and policies in the community occurs in the planning phase. Examining the relationship between the disease and the environmental factors occurs in the diagnosis phase and coordinating actions to meet the needs of the client is a step in the intervention phase.

When applying the nursing process to environmental health, the community health nurse would examine criteria that include the immediate and long-term responses of the client to the planned interventions. Another important factor to consider in the evaluation process would be: A. recidivism of the problem for the client. B. consideration of community policy and laws. C. relationship between the disease and the environmental factors. D. coordination of actions to meet the client's needs.

d If the community health nurse suspects that a client's health problem is being influenced by environmental factors, the nurse should follow the nursing process and note the environmental aspects of the problem in every step of the nursing process. For instance, in goal setting, the nurse would include outcome measures that mitigate and eliminate the environmental factors.

When applying the nursing process to environmental health, the community health nurse would: A. conduct a focused assessment on the presenting problem. B. coordinate interventions with the physician only. C. examine criteria that include only the client's immediate response. D. include outcome measures that mitigate and eliminate the environmental factors.

a Rural and urban residencies are not opposing lifestyles. Rather, they are a rural-urban continuum ranging from living on a remote farm, to a village or small town, to a larger town or city, to a large metropolitan area with a core inner city.

When determining whether a geographic area is rural or urban, the nurse should recognize that: A. rural and urban areas, by relative nature, occur on a continuum. B. rural regions have fewer than six persons per square mile. C. rural residents feel isolated. D. rural areas are recreational, retirement, or resort communities.

a Toxicology is the basic science that studies the health effects associated with chemical exposure. Epidemiology, an applied use in environmental health, helps us understand the strength of association between exposures and health effects in human populations. Environmental epidemiology is the study of the effect on human health of physical, chemical, and biological factors in the external environment. To understand how and when humans may be exposed to hazardous chemicals, radiation, and biochemical contaminants, earth sciences are used to help explain how pollutants travel in air, water, and soil. Therefore environmental health requires a multidisciplinary approach to assess and decrease environmental health risks. This may involve geologists, meteorologists, chemists, food safety specialists, sanitarians, radiation specialists, industrial hygienists, housing inspectors, clinical specialists, laboratory workers, and/or remediation specialists. This may also involve interagency cooperation (i.e., health department, department of environmental protection, housing department, public/private laboratories, tertiary care facilities, department of agriculture, transportation department).

Which of the following statements best explains the need for geologists, meteorologists, and chemists on the multidisciplinary team in environmental health? A. Earth sciences explain how pollutants travel in air, water, and soil. B. Earth sciences help us understand the strength of the association between exposures and health effects in human populations. C. Earth scientists study the negative effects of chemical exposure. D. Earth scientists work with the community to coordinate services to meet the community's needs.

c In the sentinel system, trends in commonly occurring diseases or key health indicators are monitored. Special systems are developed for collecting particular types of data; these may be a combination of active, passive, and/or sentinel systems. In the passive system, case reports are sent to local health departments by health care providers (i.e., physicians, nurses) or laboratory reports of disease occurrence are sent to the local health department. In the active system, the nurse, as an employee of the health department, may begin a search for cases through contacts with local health providers and health care agencies.

Which of the following systems of surveillance is used to monitor trends in commonly occurring diseases? A. Active B. Passive C. Sentinel D. Syndronic