PHN final

When planning a health program, the nurse knows which of the following components are important?SELECT ALL THAT APPLY. 1) Limiting individual rights for the greater public good 2) Actively involving and partnering with the community 3) Performing a skilled and competent assessment 4) Organizing the community to develop and implement the program 5) Sharing conclusions with partners and recipients of interventions

2,3,4,5.

A major plane crash has occurred in a very populated part of town. During the response, a highly respected nurse is designated to be the spokesperson for risk communications to the public. Which techniques should the nurse use?SELECT ALL THAT APPLY. 1) Be honest and closed. 2) Portray dedication and commitment to the population. 3) Meet the needs of the media. 4) Demonstrate competence and expertise. 5) Increase mental noise for the public.

2,3,4.

What type of study is used to examine risk factors for disease using data collected at the same point in time? 1) Cross-examination study 2) Cross-sectional study 3) Cohort study 4) Experimental study

2. A cross-sectional study, also called a survey, examines risk factors and disease using data collected at one point in time.

A nurse refers a child for medical follow-up after suspecting lead exposure. Which step of an exposure risk assessment studies whether a correlation exists between an increase in the quantity of a substance and its harmful effects? 1) Hazard identification 2) Dose-response assessment 3) Exposure assessment 4) Risk characterization

2. Dose-response assessment studies whether a correlation exists between the quantity of a substance and an increase in harmful effects.

While conducting a health screening for low-income senior citizens, the nurse finds most clients have uncontrolled diabetes and hypertension. Some clients explain they are on a fixed income and cannot afford medications. Others tell the nurse they feel fine, so there is no reason to go to the doctor. Which of the following should the nurse do next? 1) Provide clients with pamphlets describing the importance of taking medications and going to the doctor. 2) Host a health fair about controlling diabetes and hypertension through healthy eating and physical activity. 3) Schedule individual health counseling appointments with clients who have uncontrolled diabetes and hypertension. 4) Contact the visiting nurse association to arrange home visits for clients with uncontrolled diabetes and hypertension.

2. Hosting a health fair is an appropriate next step. It is a population-focused, primary prevention intervention that allows clients to choose the information they need and provides the opportunity to ask questions, read posters or brochures, and contact the nurse afterward.

A client newly diagnosed with type 2 diabetes states, "I usually eat out, but I want to figure out how to cook at home so my blood sugar stays under control." The client's statement represents which learning theory? 1) Behaviorism 2) Humanism 3) Cognitivism 4) Constructivism

2. Humanism refers to self-directed learning and encourages the development of personal actions to fulfill one's potential. The client's statement indicates that he knows what he wants to learn.

A large tanker truck overturns on a busy highway and the driver is killed. An unknown liquid substance is covering the roadway. How should first responders initially handle the spill? 1) Evacuate the surrounding area. 2) Find the placard that contains the numerical code. 3) Notify the Hazardous Materials unit of the fire department. 4) Wait to respond to the scene until cleared by the police department.

2. Immediate priorities are to identify the substance and evacuate the immediate area. A plaque containing a numerical code that identifies the chemical or hazardous material being transported is required by the U.S. Department of Transportation. It allows emergency responders to identify the substance in question.

Which correctly defines the term "epidemic" in the 21st century? 1) The description of diseases based on their characteristics. 2) A significant increase in the number of cases of a disease. 3) The number of epidemics occurring across the globe. 4) The increased occurrence of a single disease occurring within a population.

2. In the 21st century, the term epidemic refers to a significant increase in the number of cases of a disease.

While walking through a neighborhood, the nurse asks residents about their health concerns. Several people tell the nurse to talk to Reverend Clay. What term best describes Reverend Clay's role in the community assessment? 1) Facilitator 2) Key informant 3) Representative 4) Gatekeeper

2. Key informant is the best term to describe Reverend Clay's role. This is a person who provides information representing the opinions, assumptions, and perceptions of community members.

The nurse is monitoring illness trends in the community and notes there were 60 cases of varicella during the second week of September. All cases resolved without complications. What term represents this information? 1) Mortality 2) Morbidity 3) Attack rate 4) Recovery trend

2. Morbidity refers to the number of individuals experiencing a similar disability, illness, or disease. The morbidity rate of varicella in the community during the second week of September was 60.

The middle school is experiencing a high rate of absenteeism. The nurse knows the best community health assessment to use is a: 1) Rapid needs assessment 2) Setting-specific assessment 3) Health impact assessment 4) Population-focused assessment

2. Setting-specific assessment focuses on identifying strengths and weaknesses of an organization, or policies and programs within an organization. The nurse's analysis of the school's absenteeism policies, along with program strengths and weaknesses, is the best assessment.

According to the Centers for Disease Control and Prevention (CDC), how should public health professionals use data from the Health-Related Quality of Life (HRQoL) program? 1) Understand factors that influence HRQoL 2) Evaluate population health outcomes 3) Establish evidence-based practice guidelines 4) Reduce morbidity and mortality

2. The CDC recommends that HRQoL should be used to evaluate population health outcomes. HRQoL is one of the main indicators for monitoring health in populations.

The nurse realizes which of the following represents primary prevention at the policy level? 1) Health-Related Quality of Life (HRQoL) screening 2) Public Health Action Plan to Prevent Heart Disease and Stroke 3) eHealth Behavior Program 4) Behavioral Risk Factor Surveillance System (BRFSS)

2. The Public Health Action Plan to Prevent Heart Disease and Stroke represents primary prevention at the policy level. It was developed to guide public health and interested health-care providers in creating primary prevention programs aimed at cardiovascular disease prevention.

The nurse recognizes that the first step in conducting a community health survey is to: 1) Select the target population 2) Define the purpose 3) Write questions 4) Determine the delivery method

2. The first step in conducting a community health survey is to outline the purpose of the study.

In the past 3 months, there has been a 25% increase in the number of motor vehicle-related injuries in Johnson County. What is the best source for the nurse to obtain this information? 1) Johnson County Board of Health 2) Johnson County Memorial Hospital 3) Johnson County Coroner 4) Johnson County Health Department

2. The local hospital is the best source of information. The hospital keeps data on all diagnoses and care provided. Epidemiologists frequently use hospitals as data sources.

The Affordable Care Act helped reduce health disparities by improving access to care. Which of the following actions should be the next priority to eliminate health disparities? 1) Increase availability of personal and public transportation 2) Increase numbers of primary care providers and specialists 3) Increase racial and ethnic diversity among health-care workers 4) Increase medication assistance programs and expand Medicare

2. There is a lack of primary care providers and specialists, especially in rural areas and inner cities.

A parent tells the clinic nurse he does not want his child to get chicken pox. The nurse counsels the parent that receiving the varicella vaccine will enable the child to have which type of immunity against the varicella virus? 1) Active immunity 2) Passive immunity 3) Disease immunity 4) Inherent resistance

2. Vaccination is one form of passive immunity, which develops when the immune system is stimulated to produce antibodies when a synthetic or weakened version of an agent is injected. The varicella vaccine is a weakened form of the varicella virus.

Which health program planning model emphasizes activities and outcomes while decreasing the importance of understanding the rationale for the program choice? 1) CHANGE (Community Health Assessment and Group Evaluation) 2) Logic 3) MAPP (Mobilizing for Action through Planning and Partnerships) 4) PRECEDE (Predisposing, Reinforcing and Enabling Factors, and Causes in Educational Diagnosis and Evaluation)

2. With its emphasis on activities and outcomes, the logic model decreases the importance of understanding the need for rationale for the program choice.

A tornado hits a preschool and grade school in a small community. A nurse is one of the first responders at the scene. Which gold standard should the nurse use for pediatric triage? 1) Healthy People 2020 2) Functional Needs Support Services 3) JumpSTART 4) Model Act

3

How is community-based participatory research (CBPR) most relevant to community nursing? 1) It provides rationale for obtaining community funds. 2) It supports the use of evidence-based practice. 3) It establishes collaboration between community members and public health experts. 4) It provides a framework for population-level nursing interventions.

3. CBPR is most relevant because it engages community members in the assessment process. They are partners in creating activities to improve the health of their communities, and they are also end users of those activities.

What is the most significant influence that the Lillian Wald and Henry Street Settlement had on population-focused nursing? 1) The term "public health nurse" was created. 2) Nurses were allowed to provide care in the home. 3) Public health nursing was formalized. 4) Poverty was identified as a cause of illness.

3. Lillian Wald established public health nursing, which became the foundation for current practice. The formalization of public health nursing was a significant result of her efforts to reform healthcare.

The nurse realizes the built environment is contributing to the increasing prevalence of obesity in a community. Which of the following is an example of modifying the built environment? 1) Providing food vouchers for low-income children 2) Conducting an environmental health risk assessment 3) Writing a grant application to fund safe walking paths 4) Increasing community awareness about obesity

3. Providing safe walking areas changes the built environment by enabling residents to increase physical activity. Grants are a source of funding.

A hospital nurse is providing care to a patient with acute coronary syndrome. This represents which level of prevention? 1) Primary 2) Secondary 3) Tertiary 4) Quaternary

3. Tertiary prevention includes treating and rehabilitating patients in a hospital or acute care setting.

Which of the following recommendations identified by Healthy People 2020 and shared by WHO Commission on Social Determinants of Health policies could the community health nurse implement at individual, family, and community levels? 1) Disseminate evidence-based interventions to address health inequalities. 2) Improve daily living conditions for all, especially the very young. 3) Reduce barriers to ensure access to effective health-care and prevention services. 4) Support community development at the local level to establish partnerships.

3. The community health nurse can work at individual, family, and community levels to reduce barriers to ensure access to health care. This can be accomplished through health promotion, screening, referrals, community partnerships, advocacy, and additional public health nursing core competencies.

The nurse is preparing a health education program for young adults regarding sexually transmitted infections (STIs). What should the nurse do first? 1) Obtain condoms to distribute during the program. 2) Create an objective related to abstinence and STI prevention. 3) Assess the cultural and religious beliefs of the young adults. 4) Identify sexually active individuals.

3. The nurse should assess the cultural and religious beliefs of the young adults first. Assessment is always the first step in the nursing process.

Which of the following statements reflects an understanding of cultural humility? 1) I need to take a look at your abdomen to complete your physical exam. 2) I read that you might be uncomfortable with being touched. 3) How can I approach the physical exam to make you the most comfortable? 4) Are you comfortable with my examining your abdomen?

3. This statement is the best example of cultural humility. It is an inquisitive and respectful approach to assessing an individual's wishes that allows for an open-ended answer.

The public health nurse knows the single most preventable cause of morbidity and mortality in the United States is: 1) Poor nutrition 2) Lack of physical activity 3) Alcohol use 4) Tobacco use

4

Which of the following is an example of a selective prevention intervention? 1) A public service announcement explaining the risks of drunk driving 2) A billboard advertisement for a smoking cessation hotline 3) A weight loss guide for an obese client in the prehypertensive stage 4) A colonoscopy on a 45-year-old man whose father died of colon cancer

4

Healthy People 2030 has identified seven Foundational Principles that explain the thinking that guides our actions. Which of the following is not included in the list of principles? 1) The health and well-being of communities and the entire population are essential to a fully functioning, equitable society. 2) Working toward the population's full potential for health and well-being is a component of decisionmaking and policy formulation across all sectors. 3) Achieving health and well-being for all provides valuable benefits to society, including lower health costs and more prosperous and engaged individuals and communities. 4) Investing to maximize the health and well-being of the nation is costly and would not be an efficient use of resources.

4. Investing to maximize the health and well-being of the nation is a critical and efficient use of resources.

To provide population-focused care grounded in public health science, the public health nurse must have knowledge of: 1) Florence Nightingale's Notes on Nursing 2) Cultural differences 3) Healthy People 2020 4) Epidemiology and biostatistics

4. Public health nurses must have a solid understanding of epidemiology and biostatistics, which are foundations of public health science.

According to the World Health Organization, which of the following accounts for unfair and avoidable differences in health status within and between countries? 1) Social capital 2) Social justice 3) Social gradient 4) Social determinants

4. Social determinants account for the unfair and avoidable differences in health status seen within and between countries.

Which type of secondary data is essential in a community assessment? 1) Mortality rate 2) Disease prevalence 3) Injury rate 4) Sociodemographics

4. Sociodemographic data are essential because they best describe the population. Census data provide numbers of people and households in a community and information related to age, gender, marital status, occupation, income, education, and race/ethnicity.

Which of the following contributed to the expansion of public health nursing in the early 1930s? 1) Medicaid 2) Medicare 3) World War II 4) Social Security Act

4. The Social Security Act increased funding for public health nurses.

What is the primary reason public health nurses conduct community assessments? 1) To develop a strategic plan for health promotion activities 2) To prioritize health problems in a community 3) To prevent the spread of communicable diseases 4) To create interventions to ensure a population's health

4. The primary purpose for conducting a community health assessment is to ensure the health of a community or population through policy development, program planning, and interventions.

A nurse is volunteering with a nongovernmental organization (NGO) to provide disaster relief to a small community in Haiti after a major earthquake. What is the most important step in preparing for her assignment? 1) Pack a bag and plan on being out of the country for at least 2 weeks. 2) Pack favorite nonperishable food items to hand out to people. 3) Pack antidiarrheal medications because diarrhea is a common problem affecting people after any natural disaster. 4) Start reviewing available cultural information on the people of Haiti.

4. When a disaster occurs, the immediacy of the situation can result in nongovernmental organizations (NGOs) rushing to provide assistance without taking into account the culture of the people in distress. The absence of ritual can add to the stress of the survivors in the short and long term. It is important to understand a number of key cultural issues including: 1) linguistic affiliation, especially in countries where the population speaks more than one language, 2) social stratification and presence of a formal or informal class system, 3) gender roles, 4) marriage, kinship, and family, 5) religious beliefs, and 6) etiquette.

Nurses at a local hospital created a program to lower blood glucose levels among individuals with type 2 diabetes by 25% within 2 months. Using the Plan-Do-Study-Act cycle, place the following actions in the correct order: Conclude the program is a success and expand it to the entire hospital. Decide to start the program on 3 North beginning the first of the month. Start the program with the first set of patients. Examine results to determine if the program worked.

Deciding when and where to start the program is part of the first step in the cycle (Plan).3) Starting the program on the first set of patients represents the second step (Do).4) Examining the results of the program is the third step (Study).1) The final step, Act, is to decide whether the program worked. The nurses concluded the program was successful, and it was expanded to the entire hospital.

Two nurses plan to conduct a study on diabetes and need access to patients' electronic medical records (EMRs). What is the most ethical way for the nurses to obtain access to the EMRs? 1) Send a proposal to the Institutional Review Board (IRB). 2) Send a written request to the IT department. 3) Obtain consent from patients whose EMRs will be accessed. 4) Use medical record numbers as identifiers to maintain privacy.

The IRB is a committee that formally reviews all research involving human subjects to ensure the protection of participants' human rights. It is unethical to conduct research involving human subjects without IRB approval.

A nurse is caring for a client in the emergency room. The client survived a bomb explosion in a train station and has lost an arm as a result of being thrown by the blast wind. How should the nurse document this injury? 1) Primary 2) Secondary 3) Tertiary 4) Quaternary

The client had a traumatic amputation (loss of an arm), which is a tertiary injury. Tertiary injuries result from the victim being thrown by the blast wind. Fractures, amputations, and brain injuries are examples of tertiary injuries

Which is the primary purpose of the Patient Protection and Affordable Care Act (ACA) of 2010? 1) Mandate health coverage for all Americans 2) Enforce consumer protection in the health-care system 3) Improve access to affordable health coverage 4) Provide universal health care to all citizens

The purpose of the ACA is to increase access to affordable health coverage for everyone, provide ways to bring down health-care costs, and improve the quality of care by improving health outcomes.

A person without adequate shelter—for example, someone who is living in a vehicle or squatting in abandoned buildings—is experiencing which of the following? 1) Primary homelessness 2) Secondary homelessness 3) Tertiary homelessness 4) Quaternary homelessness

1

Which of the following are benefits of public health accreditation?SELECT ALL THAT APPLY. 1) Increased transparency 2) Stronger management processes 3) Identification of organizational strengths 4) Increased use of quality improvement information in decisionmaking

1,2,4

Identify the goals of a rapid assessment.SELECT ALL THAT APPLY. 1) Understand immediate needs after a disaster or adverse event. 2) Determine possible courses of action to help those in need. 3) Collect past data to assist in developing a plan. 4) Identify resource requirements. 5) Start the process immediately after the disaster or event (usually within one week).

1,2,4,5

Which components should be included in an environmental exposure assessment?SELECT ALL THAT APPLY. 1) A work history. 2) A health history. 3) An environmental history. 4) An exposure history. 5) A family history.

1,3,4

The public health nurse plans to educate the community about incidence rates of different cancers. Which of the following cancers are increasing in the United States?SELECT ALL THAT APPLY. 1) Pancreas 2) Breast 3) Liver 4) Esophagus 5) Melanoma of the skin

1,3,4,5

Which of the following are types of cohort studies?SELECT ALL THAT APPLY. 1) Prospective 2) Descriptive 3) Retrospective 4) Historical 5) Hypothetical

1,3,4. A prospective cohort study follows a group of people over a specific period of time. A retrospective cohort study is one in which the investigator uses previous data to present current findings related to the variables of interest. A historical study is a combination of prospective and retrospective methods to create a data set.

Which of the following are included in the Standards of Public Health Nursing Practice?SELECT ALL THAT APPLY. 1) Integration of research into practice 2) Treatment of communicable illness 3) Collaboration 4) Environmental inspection 5) Application of public health policies

1,3,5

A nursing instructor overhears two students quizzing each other for an upcoming community health exam. One student asks the other to give an example of a fomite. Which of the following is considered a fomite? 1) A paper tissue carrying rhinovirus 2) A mosquito carrying a parasite 3) A human ill with H1N1 influenza 4) A raccoon carrying the rabies virus

1. A fomite is a mode of transmission of infectious disease. It is an inanimate object. An infected person or host touches the object and sheds the infectious agent onto the object. The agent is transmitted to the next person who touches that object. The paper tissue carrying rhinovirus is a fomite.

What is the most commonly reported sexually transmitted infection (STI) in the United States? 1) Chlamydia 2) Pelvic inflammatory disease 3) Gonorrhea 4) Syphilis

1. Chlamydia is the most commonly reported STI in the United States. In 2010, the incidence rate of chlamydia was 426 per 100,000. The rate in women was double that of men.

Which of the following goals would be included in a community action plan? 1) The prevalence of obesity will decrease by 5% in 12 months. 2) The client's body mass index (BMI) will be normal within 6 months. 3) Of the surveys sent, 75% will be completed and returned. 4) Patient satisfaction scores will improve by the end of the year.

1. Developing a community action plan is the final step in the CHANGE model. This requires developing a project period with annual objectives. The goal of a 5% decrease in the prevalence in obesity over 12 months is observable, measurable, time limited, and population focused.

A nurse is working in the emergency department of a large urban hospital. The nurse is responsible for managing the emergency response and disaster management team. The hospital is just returning to normal functioning after caring for victims of a building explosion. Which priority action should the nurse take next? 1) Schedule a quality improvement meeting with key staff members to discuss what went well and what needs to be addressed. 2) Address the staff and congratulate them on meeting the objectives. 3) Plan a training seminar for new staff to review emergency response protocols. 4) Contact the public relations department to schedule interviews with key members of the senior staff.

1. Directly after an emergency or disaster, the nurse's priority is to schedule a quality improvement meeting with key members of the staff to evaluate efforts after the emergency or disaster.

A school nurse requests that the school board institute a policy requiring nutrition education to be added to the district's curriculum. The president of the school board asks about the goals and costs of the program. Which evaluation criterion is the president asking about? 1) Efficiency 2) Effectiveness 3) Feasibility 4) Equity

1. Efficiency is an evaluation of the cost of the program in relation to the achievement of policy goals.

Which agency differs from other public health agencies due to its ability to apply evidence-based findings directly to individuals' daily lives? 1) Centers for Disease Control and Prevention (CDC) 2) World Health Organization (WHO) 3) State Health Department 4) Community partners

1. The CDC is distinguished from peer agencies by its ability to apply research to individuals' daily lives.

A 35-year-old client is talking to the nurse at the community clinic. She states, "My lungs aren't right. I can't catch my breath, and I can't stop coughing. I have two cats and live in an apartment over by the train station. I keep telling my boyfriend he can't smoke in the apartment, but he won't go outside. He's so stubborn." Which of the following is the client regularly exposed to? 1) Chemical, biological, and physical agents 2) Biological and physical agents; psychosocial factors 3) Chemical and physical agents; psychosocial factors 4) Chemical biological agents and anatomical agents

1. The client is exposed to secondhand smoke and its chemical agents, which are carcinogens. The dander of the two cats is a biological agent. Living near the train station exposes the client to noise, a physical agent.

During a windshield survey of the community, the nurse notices a high number of fast food restaurants and is concerned about obesity in the population. Which of the following most closely represents the determinants of health that were observed? 1) Upstream 2) Downstream 3) Midstream 4) Host

1. Upstream determinants include social relations, neighborhoods and communities. Fast food restaurants in the neighborhood represent upstream determinants of health.

Which primary data collection methods does the nurse use with the CHANGE approach to community assessment?SELECT ALL THAT APPLY. 1) Conducting a mirror survey 2) Administering surveys to individuals 3) Using PhotoVoice 4) Doing a walkability audit 5) Examining voting records

2,3,4

Identify the main environmental drivers that make up the list of diseases associated with the environment (cardiovascular problems, diarrheal conditions, and lower respiratory diseases).SELECT ALL THAT APPLY. 1) Soil quality 2) Ambient air pollution 3) Household air pollution 4) Water 5) Hygiene

2,3,4,5

The public health nurse knows climate change most likely will increase the incidence of which of the following?SELECT ALL THAT APPLY. 1) Alzheimer disease 2) Salmonellosis 3) Asthma and allergic diseases 4) Post-traumatic stress disorder (PTSD) 5) Legionnaire disease

2,3,4,5