Practice Questions Test 1
2. The community-oriented nurse best exemplifies the application of feminist ethics when the nurse: a. designs health care programs for the underserved that incorporate social justice, treat men and women with respect and equity, and include community interventions that elevate the status of the underserved in the community. b. designs health care programs for women that respect their dignity and autonomy. c. ensures that male providers do not use sexist terms when counseling clients and their spouses and when dealing with female colleagues. d. participates in political action committees that focus on women's rights and status in the community.
A
3. A nurse is conducting a diabetes self-management group-education session. When participants are asked to remove their shoes, two male clients look at the floor and leave their shoes and socks on their feet. An effective intervention is for the nurse to: a. clarify that no one has to remove his or her shoes unless he or she wants to and continue foot inspection and foot care instruction. b. explain that everyone must learn to do foot inspection to manage their diabetes. c. loudly and slowly repeat the instructions for all participants to remove their shoes. d. stop the group session, pull the two gentlemen aside, and apologize to them.
A
3. A state public health region reported 39 cases of meningitis in children 15 years of age and younger to date this year. Seven of those children died. The total population of the region is 780,000, of whom 84,000 are children 15 years old and younger. What is the age-specific meningitis death rate for children age 15 years and younger for this region to date this year? a. 0.08/1000 b. 0.46/1000 c. 1/1000 d. 8/1000
A
4. A nurse who is ethnocentric in interacting with a client of a different culture: a. most likely has little previous experience with the client's culture and is uncomfortable with people from other cultures. b. is appreciative of the client's cultural beliefs. c. accommodates the client's cultural beliefs when planning care. d. imposes the nurse's value system on the client.
A
5. A community-oriented nurse has identified obesity as a problem in the middle school. The next step in a population-focused practice is to make information available about the health of the middle school students. This describes the core public health function of: a. assessment. b. assurance. c. policy development. d. research.
A
5. Bruising and swelling on a client's face and torso are noticed by a nurse during a prenatal examination. The client's exchange-student husband, who speaks for the client, tells the nurse his wife deserved the bruises. The client looks at the floor and shakes her head in agreement. The nursing student leaves the examination room angry and confused, experiencing what can best be described as: a. culture shock. b. prejudice. c. ignorance. d. racism.
A
5. Several community-oriented nurses want to explore the problem of obesity in school-age children and assess their community school district's health status related to that problem. When gathering information at a national level, they would begin with the: a. Centers for Disease Control and Prevention. b. Centers for Medicaid and Medicare Services. c. Health Resources and Services Administration. d. National Institute of Nursing Research.
A
6. A PHN in a maternal-child health clinic encounters a client from Ethiopia. The clinic typically sees Hispanic clients. The nurse should first conduct: a. general cultural assessment. b. head-to-toe assessment. c. in-depth cultural assessment. d. nonverbal communication assessment.
A
6. During the Depression of the 1930s, many federal agencies attempted to support the employment of basic nurses by increasing the demand for existing and new nursing services that meet the needs of the increasing ranks of impoverished individuals. Although this facilitated rapid program expansion for recipient public health agencies and gave many nurses a taste of public health, the specialty of public health nursing was negatively affected by: a. decrease in focus on the community as the unit of service. b. increase in the scope of fundamental services. c. increase in field experience. d. decrease in the need for training and supervision.
A
6. The WHO initiative Health for All in the 21st Century can best be described as which of the following? a. Social justice initiative b. Primary care initiative c. National initiative d. Environmental initiative
A
6. The state public health agency has received multiple complaints regarding the availability of elder transportation services to a specific county senior center. The state agency assigns a public health nurse to work with the community to evaluate its program for elder transportation services to publicly sponsored eldercare programs. The public health core function applied is: a. assurance. b. policy development. c. primary prevention. d. public transportation.
A
7. A factor that strongly influences the success of a PHC system is: a. participation of the community members in the design, implementation, and evaluation of the initiative. b. assurance of access to care for every woman and child from pregnancy through childhood. c. each entity's sense of urgency regarding the evaluation of indicators. d. cure orientation of the private sector of health care delivery in the United States
A
7. A nurse planning a smoking cessation clinic for adolescents in the local middle schools and high schools is providing: a. community-oriented care. b. community-based care. c. secondary care. d. tertiary care.
A
7. One step in the ethical decision making framework is to place an ethical issue within a meaningful context. The rationale for this step is that: a. multiple factors affect the formulation and justification of ethical issues and dilemmas. b. the nature of ethical issues and dilemmas determine the specific ethical approach used. c. people cannot make sound ethical decisions if they cannot identify ethical issues and dilemmas. d. professionals cannot avoid choice and action in applied ethics.
A
8. A community-oriented nurse conducts home visits to new parents to assess the health status of the infant, the parent-child relationship, the parents' knowledge regarding the care of the infant, and the need for health department and social services referrals to support the needs of the new parents and the infant. This can best be described as an example of: a. clinical community health practice. b. community-based practice. c. population-focused practice. d. public health nursing.
A
8. Virtue ethics is distinctly different from moral justification via theories or principles because the emphasis of virtue ethics is practical reasoning applied to: a. character development. b. consequentialism. c. distributive justice. d. egalitarianism.
A
9. The nurse is educating her Nigerian client regarding the prenatal services available through the maternal-child health clinic. The client is interested in confirming her pregnancy at this visit but does not see the need for ongoing visits because childbirth is viewed as a natural process in her culture. The nurse negotiates with the client to structure a strategy to achieve a healthy pregnancy outcome that uses the clinic's resources in a manner that is satisfactory to the client. This is an example of: a. cultural accommodation. b. cultural brokering. c. cultural preservation. d. cultural repatterning.
A
9. When a nurse evaluates the completeness and accuracy of information made available to community residents regarding the impact of rezoning of land parcels for industrial use, the nurse can best be described as: a. advocating for ethical choices. b. communicating risk. c. controlling environmental damage. d. volunteering for service on state boards.
A
A nurse is advocating for local leaders to place a newly approved community health clinic in an area of the city that has fewer resources than other areas. The nurse is advocating for the leaders to uphold which of the following ethical principles? A. Distributive justive B. Fidelity C. Respect for autonomy D. Veracity
A
A nurse is using the I PREPARE mneumonic to assess a clients potential environmental exposures. Which of the following questions should the nurse ask when assessing for an "A" in the mnemonic? A. What do you like to do for fun? B. What year was your residence built? C. What jobs have you had in the past? D. What industries are near where you live?
A
1. In the middle of the nineteenth century, there was increased national interest in addressing public health problems and improving urban living conditions. Which of the recommendations of the Shattuck Report in Massachusetts represented major innovations in public health during that period? (Select all that apply.) a. Establishment of state health departments and local health boards in every town b. Promotion of environmental sanitation and collection of vital statistics c. Steps to decrease preventable disease and control smoking and alcohol use d. Targeting of efforts solely on environmental hazards e. Provision of supplemental food to low-income persons
A,B,C
2. Benefits of an electronic health record in the public health system include: (Select all that apply.) a. 24-hour availability of health records. b. ease of referral coordination. c. reduction in medication errors. d. increased privacy. e. consistently reliable internet resources.
A,B,C
1. State and federal statutes and regulations affect the health care specialties of home health and hospice practice. A primary motivator for nurses to become knowledgeable about these statutes and regulations is their impact on nursing practice in which of the areas below? (Select all that apply.) a. Documentation of client status and progress b. Documentation of services c. Living wills and advance directives d. Resident's rights in long-term care facilities e. Right to death with dignity
A,B,C,D,E
1. The role of the nurse who wants to become more active in environmental health could include which of the following? (Select all that apply.) a. Assessing farmworkers for pesticide exposure and providing pesticide risk education b. Conducting epidemiologic investigations as a public health nurse (PHN) c. Developing corporate policy to protect workers from unsafe levels of toxic agents d. Organizing the local community to encourage landlords to remove lead-based paint e. Working as a skilled risk communicator for a local chemical manufacturer
A,B,C,D,E
3. The early pioneers in public health nursing were instrumental in the founding of the National Organization for Public Health Nursing (NOPHN) in 1912. This organization served as the dominant force in public health nursing until 1952 and sought to standardize public health nursing education to ensure that nurses received more than hospital-oriented training. Other major accomplishments included what initiatives? (Select all that apply.) a. Collaborated to secure health insurance reimbursement for nursing services, such as post discharge nursing care at home b. Established public health nursing programs for military outposts in World War I c. Provided matching funds to establish maternal and child health divisions in state health departments d. Responded to the 1918 worldwide influenza pandemic in the United States e. Supported nurse employment through increased grants-in-aid for state programs of home medical care
A,B,D
2. The poor environmental conditions experienced by immigrants in tenement houses and sweatshops were familiar features of urban life across the northeastern United States and the upper Midwest. Which of the following factors assisted community-oriented nursing pioneers, such as Lillian Wald, in developing approaches and programs to solve the health care and social problems of the times? (Select all that apply.) a. Community health's focus on teaching and prevention b. Establishment of settlement houses c. Establishment of the town and country nursing services in large cities d. Lack of public interest in limiting disease e. Middle and upper class fear of diseases
A,B,E
1. The American health care system will continue to evolve and change. Which of the following groupings of health care trends will have the greatest influence on the health care transformation process at the present time? (Select all that apply.) a. Aging of the population and medical technology advances b. Funding levels, political structure, and professional licensure requirements c. Longevity, population diversity, and funding sources d. Managed care, workforce shortages, and level of education of the population
A,C
A nurse manager at a community agency is developing for newly hired nurses. When discussing the differences between community-based and community-oriented nursing, the nurse should include which of the following situations as an example of community-based nursing? (select all) A. A home health nurse performing wound care for a client who is immobile. B. An Occupational health nurse providing classes on body mechanic at a local industrial plant. C. A school nurse teaching a student who has asthma about meds. D. A parish nurse teaching a class on low Na cooking techniques E. A mental health nurse discussing stress management techniques with a support group.
A,C
3. The most important features of the Affordable Health Care for America Act of 2010 that the community-oriented nurse needs to understand to provide resource information to clients are that the Act: (Select all that apply.) a. transforms the health care system from a sick care system to health care system. b. uses piecemeal approach to strengthen the safety net. c. replaces the rational equitable health care system. d. provides insurance reform. e. increases access to affordable health care insurance.
A,D,E
1. A nurse overhears the doctor saying, "Let's not give the client codeine, he's Asian." The nurse reflects on the comment and determines that the doctor is which of the following? (Select all that apply.) a. Culturally competent b. Prejudiced c. Ethnocentric d. Unable to assess pain based on culture e. Planning care based on racial enzymatic differences
A,E
A nurse is preparing an educational program on cultural perspectives in nursing. The nurse should include that which of the following factors are inluenced by an inddividuals culture (select all) A. Nutritional practices B. Family structure C. Health Care Interaction D. Biological variations E. Views about illness
A.B.E
1. In 1925, Mary Breckenridge established the Frontier Nursing Service (FNS) based on a system of care used in the highlands and islands of Scotland. Changes in public support for community and public health nursing and away from individual commitment and private financial support led to innovations in health care delivery in the twentieth century, especially for underserved populations. One of Breckenridge's innovative contributions to health care in the United States was: a. establishment of the Federal Emergency Relief Administration. b. introduction of the first nurse-midwifery training. c. introduction of the nursing process. d. introduction of occupational health nursing.
B
2. A new group of migrant farmworkers has arrived in a community. The local public health nurse (PHN) realizes that an important step before scheduling clinic services is to: a. consult the public health staff regarding their scheduling preferences. b. learn about the farmworkers' concept of time and their work schedule to determine when and how services can best be scheduled. c. review written materials about the farmworkers' culture of origin. d. visit the farmworker camp and tell the camp leaders when clinic services will be available.
B
2. The most important contribution made by Florence Nightingale to community-oriented nursing was: a. development of the settlement house concept as a strategy to improve urban health standards. b. expansion of the role of nursing to include health-promotion practices. c. founding of the first district nursing association in England. d. introduction of professional schools of nursing in the United States.
B
3. A college health nurse is working with students, faculty, and staff to improve environmental air quality. To address the primary cause of air pollution on campus, the nurse plans a precautionary intervention. Which of the following interventions best demonstrates an appropriate approach? a. Encourage the use of electric cars and scooters on campus b. Increase the use of bicycles, foot-powered scooters, rollerblades, and walking as the primary mode of transportation on campus c. Make the entire campus a no-smoking zone d. Establish a policy to reduce electricity consumption in university buildings by raising the thermostat to 78° in the summer and lowering the thermostat to 70°in the winter
B
3. The Social Security Act of 1935 was designed to prevent the reoccurrence of the problems of the depression. Title VI of this act provided funding for expanded opportunities for health protection and promotion. The most relevant strategy related to this objective for public health nursing was: a. establishment of an FNS. b. provision of funding to support employment and education. c. provision of funding for research and investigation of disease. d. institution of a district nursing model.
B
3. The levels of government responsible for carrying out the five government health care functions of direct services, financing, information, policy setting, and public protection are: a. federal and state. b. federal, state, and local. c. all, but primarily state and local. d. all, but primarily federal and state.
B
4. A state public health region reported 39 cases of meningitis in children 15 years of age and younger to date this year. Seven of those children died. The total population of the region is 780,000, of whom 84,000 are children age 15 years old and younger. Only four cases of meningitis were reported in the public health region during the previous year. No other public health region in the state has an incidence of meningitis that is higher than expected for that region. Based on the information given, the relative frequency of meningitis in the region at this time can best be described as: a. endemic. b. epidemic. c. pandemic. d. sporadic.q
B
4. The U.S. public health system is operated at three distinct levels with collaboration and interface across all levels. The agency that assumes the responsibility for regulating health care and overseeing the health status of Americans is the: a. Department of Homeland Security. b. U.S. Department of Health and Human Services (USDHHS). c. local health department. d. state department of health.
B
5. A community health nurse manager has integrated exposure history elements into the assessment practices of the health department that are relevant to the urban industrial community served. This strategy indicates that the nurse manager is aware of the relationship between: a. community strengths and weaknesses. b. environment and human health/disease. c. toxicology studies conducted by the Environmental Protection Agency and the environment. d. federal and state environmental regulations.
B
5. A community-oriented nurse understands that the most important use of the principles for effective advocacy is to: a. act as a friend and advocate for the target population served to promote research and data gathering. b. act in the community's best interest, in keeping with community direction, while maintaining diligence, ongoing communication, and confidentiality. c. ensure that public funds are spent only for the priorities stated in the legislation that authorized program funding and promote regulations and legislation. d. give more priority to the opinions and feelings of key community leaders than to data when determining program priorities.
B
6. A business executive develops flu-like symptoms 1 day after returning by air from a trans-Atlantic 2-day conference that involved lengthy meetings into the evening. The scenario best illustrates the interaction of: a. host and agent. b. host, agent, and environment. c. risk and causality. d. morbidity and disease.
B
6. The Superfund Amendments and Reauthorization Act (SARA) increased the involvement of the states and their citizens in the cleanup of toxic waste sites and stressed the importance of permanent remedies and innovative treatment technologies. Another important aspect of this federal legislation was that it: a. provided for the appointment of state emergency response commissions. b. increased focus on the human health problems related to hazardous waste sites. c. established a new safety standard of reasonable certainty of no harm that is to be applied to all pesticides used on food. d. reduced the amount of pollution by mandating cost-effective changes in production, operation, and raw materials use.
B
6. The health policy-making body of the World Health Organization (WHO) released a policy statement on nursing and midwifery in 2013. The important fact for nurses to understand about WHO policy statements is that such statements: a. apply only to underdeveloped countries. b. are guides for in-country initiatives and priorities. c. carry the weight of international law. d. provide mandates for in-country legislatures.
B
7. A public health nurse (PHN) has identified a need to make amendments to an existing law concerning the tuberculosis health assessment of individuals sentenced to serve jail terms on weekends only because of the gap in treatment accountability and potential health risk to the free-living community. To draw attention to this concern, the nurse has several paths to follow, but the amendment of any existing laws would ultimately be decided by which of the following? a. Executive branch of government b. Legislative branch of government c. Local representative d. Senate hearings
B
7. Health problems exist throughout the world. In the United States, a current health concern is the appearance of new viral strains such as Hantavirus in the Southwest. This is an example of the difference in health care concerns between countries such as: a. United States and Canada. b. Sweden and Indonesia. c. Australia and Japan. d. Bangladesh and Zaire.
B
7. The Association of Community Health Nurse Educators has called for increased graduate programs to educate PHN leaders, educators, and researchers in such areas as: a. immigrant and migrant health. b. natural and human-made disasters. c. automobile safety for children. d. student health.
B
7. The monitoring and public reporting of air quality in a local community to assist individuals with asthma or other respiratory conditions best illustrates the application of: a. compliance and enforcement. b. environmental epidemiology. c. secondary prevention. d. toxicology.
B
8. A nurse is concerned about the accuracy of the purified protein derivative (tuberculin) test in screening individuals with tuberculosis exposure for follow-up chest radiography. The nurse's concern is related to which aspect of the test's validity? a. Reliability b. Sensitivity c. Specificity d. Variability
B
9. Nurses should consider opportunities for population-focused practice that result from the rapid transformation of health care delivery from a medical model to a health promotion/disease prevention model. An example of such opportunity is: a. operator of a nurse practitioner-run urgent care center in a major retail location. b. director of clinical services spanning inpatient and community-based settings that provide a wide range of services to the populations seen by the system. c. clinical director of a home health agency. d. school nurse position in the local high school.
B
A nurse is caring for a client who is from a different culture than himself. When beginning the cultural assessment, which of the following actions should the nurse take first? A. Determine the clients perception of his current health status. B. Gather data about the clients cultural beliefs C. Determine how the clients culture can affect the effectiveness of nursing actions. D. Gather information about previous client interactions with the health care system.
B
A nurse is conducting health screenings at a statewide health fair and identifies several clients who require referral to a provider. Which of the following statements by a client indicates a barrier to accessing health care? A. I don't drive, and my son is only available to take me places in the mornings. B. I cant take off during the day, and the local after-hours clinic is no longer in operation. C. Only one Dr. in my town is a designated provider by my health maintenance organization. D. I would like to schedule an appointment with the local doctor in my town who speaks English and Spanish.
B
A nurse is reviewing information about the local health department to prepare for an interview. Which of the following services should the nurse expect the local health department to provide? (select all) A. Managing the Women, Infants, and Children program B. Providing education to achieve community health goals. C. Coordinating directives from state personnel D. Reporting communicable diseases to the CDC E. Licensing of RNs
B,C
1. A nurse in Mexico visits a village-based health post in her region to meet with the community volunteer and health committee that operate the health post. They intended to discuss the planning for next year's health promotion initiative and evaluate the recent family planning program. This best demonstrates the aim of the Declaration of Alma-Alta to emphasize which of the following? (Select all that apply.) a. Availability of chemotherapeutic agents b. Development of maternal and child health programs c. Involvement and training of community health workers d. Organized approach to health education e. Promotion and acceptance of traditional medicine
B,C,D,E
1. Public health nursing specialists are interested in which of the following topic(s)? (Select all that apply.) a. Educational materials for individuals with HIV/AIDS b. Evaluation of an outreach program for at-risk pregnant teenagers c. Community subpopulations with high rates of type 2 diabetes d. New technologies to monitor diabetes e. Prevalence of hypertension among various age, race, and gender groups
B,C,E
2. A nurse has been newly appointed as commissioner of the state health department services. The programs the nurse will oversee will most likely include: a. administration of Medicare reimbursement rates and eligibility determination. b. programs involving citizens in the local community, including sanitation and communicable disease contact tracing. c. disaster response, health care financing and administration of programs such as Medicaid, and establishment of health codes. d. monitoring of drugs and over-the-counter products available for sale and use by consumers.
C
2. A registered nurse is seeking a position as a public health nurse. In reviewing the job description, the nurse would expect to find a description of a position that focused on functions such as: a. monitoring pregnant teenagers for symptoms of complications of pregnancy. b. offering free hypertension screening and treatment referral at local health fairs to low-income, uninsured, community members. c. partnering with local seasonal farmworkers to design a program aimed at preventing illness and injury, and advocating for this population with local political and community leaders. d. preventing injury among a population of elderly residents in an assisted living facility and treating residents' chronic illnesses.
C
2. A state public health region reported 39 cases of meningitis in children 15 years of age and younger to date this year. Seven of those children died. The total population of the region is 780,000, of whom 84,000 are children age 15 years old and younger. What is the prevalence proportion of meningitis in this region thus far in the current year? a. 4.1/100,000 b. 5/100,000 c. 46/100,000 d. 50/100,000
C
2. Canada is the leader in promoting a population health framework. Using such a framework, a state health department nurse with budgetary responsibility would determine that funding priorities should focus on: a. chronic disease surveillance and treatment programs. b. pediatric and adolescent primary care and nutrition programs. c. promotion of healthy lifestyles or improvement of social and physical environments. d. well and sick child clinics.
C
3. A nurse has worked for years in an intensive care unit and decides to take a position as a community health nurse directing a local public health unit. Her first assignment is to perform an assessment of the community's migrant farmworker population. The nurse's most appropriate next step is to: a. begin the community assessment using a survey tool proven effective in previous public health unit assessments. b. perform a literature review to study assessment data for similar populations. c. enroll in a community health nursing graduate course to learn community research, measurement, and analysis techniques. d. form a relationship with the farmworkers' community leaders and other key informants.
C
3. The goal of the PHC system is to achieve the objective "Health for All in the 21st Century," set forth by the World Health Organization (WHO). The major barrier to achieving this objective in the United States is that: a. global indicators are not applicable to the United States. b. Healthy People 2020 is not consistent with the Declaration of Alma-Ata. c. PHC is not the primary delivery method for health care in the United States. d. the U.S public health system is not structured to provide PHC.
C
4. A terrorist bombing at a local church has sent many victims to the local emergency department and resulted in several deaths. Following the event, an emergency department nurse seeks out other nurses who are having difficulty performing their jobs to speak about the event. The nurse is demonstrating the disaster response strategy of: a. allaying public concern and fear. b. assisting victims to think positively and to move to the future. c. identifying feelings that individuals may be experiencing. d. preparing personnel to be effective in a disaster.
C
4. Nursing practice is governed by: a. boards of nursing established by the U.S. Department of Health and Human Services. b. nurse practice acts promulgated by federal and state legislative boards. c. nurse practice acts promulgated by state legislatures and operationalized by the state boards of nursing. d. nurse practice acts promulgated by the states in conformity with broad federal guidelines.
C
4. The role and goals of the community health nursing practice can best be described as: a. community-based interventions aimed at promoting, preserving, and maintaining the health of populations residing in institutional facilities such as nursing homes. b. education of nurses and other staff working in community-based and community-oriented settings to improve the overall effectiveness of their programs to meet client needs. c. population-level strategies aimed at promoting, preserving, and maintaining the health of populations through the delivery of personal health care services to individuals, families, and groups in an effort to improve the health of the community as a whole. d. activities targeted at improving the health status of clients served by community-based health service agencies such as hospice and home health agencies.
C
5. From a historical perspective, the post-Depression shift in the U.S. Congress to the practice of categorical funding that provides federal money for priority diseases or groups has to this day produced a negative effect on the delivery of health care services that can best be described as: a. adoption of 2-year associate degree nursing programs. b. exclusion of home-based care from health insurance coverage. c. national preference service model that neglects emerging problems. d. rise in hospital-based care.
C
5. In developed countries, nurses have an important leadership role in primary health care initiatives. Commitment to which of the following best demonstrates nursing's advocacy role in primary health care? a. Equality of health care b. Higher education for nurses c. Provision of direct client care d. Quality of care
C
5. The major factor that drives the current discussions about a Medicare shortfall in the middle of the twenty-first century is: a. diversity of the U.S. health care workforce. b. longevity of the U.S. population. c. percentage of elderly in the U.S. population. d. percentage of foreign-born in the U.S. population.
C
6. The local nurse-managed community health center initiative is providing community-based primary and preventive care as well as specialty care, community screenings, local health assessments, health education, and health care coordination, targeted to medically uninsured individuals regardless of ability to pay. This initiative best describes a system of: a. managed care. b. primary care. c. PHC. d. private health care.
C
7. A Public Health Service nurse employed by the Indian Health Service is working with a client diagnosed with cancer. The client uses sweat lodges to "cure the disease." The nurse understands the need for the client to use traditional healing practices. The nurse is integrating her knowledge of the cultural organizing factor of: a. biological variations. b. communication. c. environmental control. d. space.
C
7. A nurse teaches an asthmatic client to recognize and avoid exposure to asthma triggers and assists the client's family in implementing specific protection strategies in the home, such as removing carpets and avoiding pets. This nurse's activities can best be described as: a. comprehensive assessment. b. primary prevention. c. secondary prevention. d. treatment intervention.
C
8. A community-based hospice nurse has an Asian male client with terminal-stage cancer. The client complains that he is in continuous pain and receives no relief from the codeine prescribed by his primary care physician (PCP). Because this nurse is culturally competent with Asian clients, the nurse contacts the client's PCP to discuss replacing this medication with another pain-reducing drug. The nurse's action can best be described as an example of: a. cultural accommodation. b. cultural assessment. c. cultural brokering. d. cultural repatterning.
C
8. A major town in Zaire received a gift of retired intensive care unit monitoring equipment from a large specialty hospital in a developed country. Zaire was grateful for the donation because it would increase the technological capability to treat clients in the local hospital. However, over the next year, the monitors remained unused because personnel were not qualified to operate the monitors and no one was available to maintain or repair the equipment. This best explains the relationship between which two concepts? a. Disease prevention and health care planning b. Education and health promotion c. Global health and global development d. Primary health care and primary care
C
8. A nurse seeks the best resource that provides a broad vision of the goals and objectives of many health care stakeholders in our nation and identifies the current national health policy for the United States. The best source for such information would be the: a. American Public Health Association's guidelines. b. website of the Centers for Disease Control and Prevention. c. Healthy People initiatives. d. Pan American Health Organization's mission statement.
C
9. A PHN employed by the state's department of health is working on a team to develop local health policy. The nurse recognizes that policy development focuses on the level of the larger society and adopts strategies that require political actions such as lobbying and testifying. The reason that action in the policy arena comes most easily and naturally to nurses is the fact that the policy process is very similar to which of the following? a. Citizen action committee b. Nursing diagnosis c. Nursing process d. Socratic method
C
9. The United States is engaged in a formal agreement with Indonesia to provide economic incentives and assistance in national defense in return for the protection of U.S. private investments in that region. Which bilateral organization is most likely involved in this agreement? a. Carnegie Foundation b. United Nations c. U.S. Agency for International Development d. U.S. Department of Defense
C
A community health nurse is implementing health programs with several populations in the local area. In which of the following situations is a the nurse using primary prevention? A. Performing a home safety check at a clients home B. Teaching healthy nutrition to clients who have HTN C. Providing influenza immunizations to employees at a local preschool. D. Implementing a program to notify individuals exposed to a communicable disease.
C
1. A low-vision client with very early dementia takes pride in her independence. The client, who lives alone in an apartment, tells her nurse she has always enjoyed using fragranced candles. The most appropriate intervention for the nurse is to apply the principle of: a. autonomy, in which the nurse leaves the matches and candles accessible to the client. b. beneficence, in which the nurse maintains the client's dignity and reinforces to the client how pleasant it is to use scented candles. c. nonmaleficence, in which the nurse counsels the client regarding the dangers of the use of candles and matches by someone with low vision. d. respect for autonomy, in which the nurse recommends to the client an arrangement whereby the caregiver lights the candles when the caregiver is present in the home and removes the matches and candles from the kitchen cabinet.
D
1. A nurse asks a couple who are new parents for their baby's full name. The parents reply that they are only supposed to give the baby its first name. The most appropriate response for the nurse is to: a. tell the couple that they are the child's parents and it is up to them to name their baby. b. explain to the couple the state's bureau of vital statistics deadline for completing the birth certificate. c. give the couple the paperwork and ask when the baby will have a name. d. express interest and ask the couple to share how their new baby will receive its name.
D
1. A nurse identifies higher-than-normal levels of lead when screening a 3-year-old child. The nurse works with the local health department to put together a team to address the environmental issues responsible for the child's abnormal lead level. Team members should include the following specialists: a. epidemiologist, pediatric specialist, and sanitarian. b. laboratory specialist, contractor whose bid for lead reduction work is the lowest, and public health lead reduction specialist. c. public health sanitarian, pediatric generalist, and plumbing inspector. d. specially trained housing inspector, pediatric specialist, lead-based paint intervention team, and laboratory specialists to test the child's home and the surrounding neighborhood.
D
1. In 1988, the Institute of Medicine (IOM) published a report on the future of public health and its mission that defined public health as: a. what public-private partnerships do to treat vulnerable populations. b. what the government does to ensure that vital programs are in place. c. what the U.S. Public Health Service does to prevent disease, promote health, and deliver services. d. what society does collectively to ensure the conditions in which people can be healthy.
D
1. The North American Free Trade Agreement, passed in 1994, allowed increased importation of goods and eased the movement of people throughout the United States, Canada, and Mexico. A health impact of this agreement for southern Texas has included: a. decrease in illegal immigration into the United States as a result of the improved Mexican economy. b. decrease in tuberculosis, cholera, and tetanus as a result of economic development. c. improved nutrition as a result of plentiful fresh vegetables and fruits in local markets. d. increase in respiratory and diarrheal disease as a result of colonias settlements.
D
2. An occupational health nurse practitioner's physical assessment of a factory worker identifies an acute-onset pruritic dermatitis extending over the face, hands, neck, and forearms. The nurse's priorities should be to: a. contact factory senior management, educate workers about their exposure, and clean the area. b. contact the Occupational Safety and Health Administration immediately and remove the offending chemical in the work environment. c. immediately evacuate the worker's nearby workspace and treat the worker and other exposed workers. d. treat the client and obtain a comprehensive exposure history; if an on-site environmental exposure is suspected as the cause, screen other at-risk workers and ensure that the environmental risk is identified and eliminated.
D
3. A public health nurse leader is encountering barriers when trying to shift the public health agency's efforts to a population-focused practice. The reasons peers are not supportive of the proposed shift to a population focus are most likely related to: a. agency colleagues' push for nurses to focus on population initiatives. b. costs associated with staff training and revision of documents. c. lack of support from the agency's funding sources. d. opinions that nursing should focus on the provision of direct client care and services.
D
3. Mortality rates do not accurately describe the health status of populations in the world. The World Health Organization (WHO), in 2009, and World Bank, in 2005, developed an indicator—the global burden of disease—that combines losses from premature death with losses of healthy life that result from disability. The indicator represents: a. costs to the world of treating communicable disease in less-developed countries. b. economic cost of preventable early deaths. c. impact of disability on the international economic forecast. d. years in lost contribution to economic growth.
D
4. Campaigns to decrease the inequitable burden of environmental risks on the poor and people of color in the United States strive to apply the ethical principle of: a. societal justice. b. nonmaleficence. c. compliance and enforcement of the Environmental Protection Agency Regulatory Act. d. environmental justice.
D
4. The new director of a local public health unit reviews the personnel records of the unit staff and notes that none of the assigned public health nurses (PHNs) has academic training in community and public health nursing. The director's next step should be to: a. recognize that staff members have learned on the job through years of experience and that they will be able to teach their new director basic community and public health principles. b. make arrangements to hire new staff with appropriate formal training. c. realize that with the current nursing shortage the unit should be grateful to have long-term staff. d. review continuing education records to determine if the nurses have received training in community-oriented nursing and ethics, and plan for any needed training.
D
5. John Snow played a critical role in the development of modern disease surveillance when he: a. devised a more statistically valid method of analyzing epidemiologic data. b. discovered causal agents for anthrax, tuberculosis, and cholera. c. tracked the incidence of tuberculosis in the tenements of New York City. d. used geographic mapping to demonstrate the connection between water supply and cholera.
D
6. Although nursing has a strong implicit heritage of ethical values and morality, it was not until the 1960s that several seminal events significantly shifted the focus to ethical decision making processes. One of those seminal events was the emergence of the field of bioethics and the other event was: a. adoption of the ANA's Code for Professional Nurses. b. adoption of the American Public Health Association's Public Health Code of Ethics. c. adoption of the International Council of Nurses' Code of Ethics for Nursing. d. issuance of the ANA's position statement on nursing education in institutions of higher education.
D
8. When applying the nursing process to environmental health, the nurse would: a. conduct an assessment focused on the client's presenting problem. b. coordinate interventions with the primary care provider of record. c. examine criteria that are limited to the client's immediate responses. d. include outcome measures that involve mitigation and elimination of the contributing factors.
D
9. Caring and the ethic of care are core values of community health nursing. This ethical view was developed in the mid-1980s and early 1990s in response to the technical advances in the health care sciences and the desire of nurses to: a. apply gender-related voices to moral judgment. b. apply principles of utilitarianism. c. differentiate distributive justice from beneficence. d. differentiate nursing practice from medical practice.
D
9. Case fatality from breast cancer has decreased in recent years, although the incidence of breast cancer has increased. Descriptive epidemiology would use the component of time to explain this change in terms of: a. cyclical patterns. b. event-related clusters. c. point epidemic. d. secular trends
D
A nurse is developing a community health education program for a group of clients who have a new diagnosis of DM. Which of the following learning strategies should the nurse include for clients who auditory learners? A. Showing informational videos B. Providing equipment to practice hands-on skills C. Supplying outlines for note-taking D. Facilitating small group discussions
D
1. Today, an evidence-based nursing practice can best be defined as which of the following? a. Approach to the integration of the best research available, nursing expertise, and the preferences/values of the clients served b. Concept developed by acute care nurses to ensure the quality of care of hospitalized clients and to challenge managed care decisions c. Concept developed in the early twentieth century to help nurses document the scientific basis of their nursing practice d. Framework supporting the use of traditional research as the only basis for making clinical decisions in practice
A
10. After hearing about home radon exposure on the news, a man and his wife contact the public health department to inquire about whether or not he should have his home tested. Which stage of the transtheoretical model (TTM) are the man and his wife at in regards to the process of change? a. Preparation b. Contemplation c. Action d. Precontemplation
A
1. Primary health care (PHC) differs from primary care in which of the following ways? a. PHC encourages community participation. b. PHC focuses on prevention and cure. c. PHC is defined more narrowly. d. PHC is the primary method of health care delivery in the United States.
A
2. The relationship between nursing practice, health policy, and politics can best be described as nursing: a. advocacy. b. policy process. c. process. d. profession.
A
5. The community practice nurse is preparing to initiate a community partnership with a neighborhood watch association to address teenager street vandalism. The nurse meets with a local pastor who introduces her to the neighborhood residents she needs to partner with. The role of the pastor in this example is: a. gatekeeper. b. community health worker (CHW). c. professional service provider. d. stakeholder.
A
6. Although the definitions of EBP in the literature vary widely, their common thread across all health care disciplines is: a. application of the best available evidence to improve practice. b. definition of what counts as evidence. c. reliance on principles of pathophysiology. d. method of transforming research into practice.
A
7. A rural community health nurse has made sure that CHWs are involved in the health department's migrant worker outreach program. The nurse believes this intervention strategy is important because the nurse knows that such individuals can be: a. influential with their insider status to engage community members. b. medical professionals within the migrant community. c. natural healers within their community. d. translators to help overcome language barriers.
A
7. The local public health nurse (PHN) participates in a town board's community assessment process, which identifies teenage pregnancy as a community concern for action. Based on the Healthy People in Healthy Communities MAP-IT model, a logical next step would be: a. coalition building. b. evaluation of outcomes. c. health-risk assessment. d. wellness appraisal.
A
8. In the community-based participatory research (CBPR) approach, the use of lay community members to promote health within the community is an effective intervention because community members: a. are best at determining the health needs and plan interventions for their community. b. create a passive partnership. c. provide oversight for the health promotion activities. d. relieve local service providers of mundane tasks.
A
9. At the request of a local housing authority, a PHN conducted a survey at a public housing facility to determine the need for a nurse-managed clinic. When residents and community leaders were asked what services were most needed from the clinic, they listed well-child screening, parenting education, and medication management. The PHN , the local health department, and the community members collaborated in all phases of the project from planning to evaluation to establish a community nursing center at the site. This example best illustrates the application of population-focused community model at which level? a. Aggregate client system level b. Environmental level c. Family client system level d. Individual client system level
A
9. If the community is where nurses practice and apply the nursing process, and the community is the client in that practice, then nurses will want to analyze and synthesize information about: a. boundaries, parts, and dynamic processes of the client community. b. community health status and structure. c. community problems and problem correlates. d. role of the nurse and lay advisors in the community partnership.
A
1. Which of the following are the best argument(s) for supporting community-as-client nursing? (Select all that apply.) a. Change for the benefit of the community-client must often occur at several levels. b. Changes in the health of individuals will affect the health of their communities. c. The idea of providing health-related care within the community is not new. d. The impact of the environment on health has long been established. e. Direct hands-on nursing care delivered to individuals or families in community settings is important.
A,B,C,D
1. A community health nurse is revising the agency's nursing protocols to incorporate current EBP clinical practice guidelines. Common barriers to EBP implementation that could be faced include which of the following? (Select all that apply.) a. Disempowerment of nurses in their ability to make clinical decisions b. Experienced nurses' challenging of the need to change long-accepted practices c. Lack of knowledge of how to conduct a systematic review of the research literature d. Unwillingness of clients to accept changes in familiar agency programs e. Urban agency setting with restricted computer resources
A,B,D,E
8. When a public health nurse (PHN) uses evidence-based interventions to evaluate the effectiveness, accessibility, and quality of population-based services within the community, the nurse is addressing the core public health function of: a. assessment. b. assurance. c. policy development. d. research.
B
1. Health policy can best be defined as a set course of action to: a. administer public health care programs at the federal level for disaster preparedness, response, and recovery. b. obtain a desired health outcome for an individual, family, group, community, or society. c. support publicly funded health care programs at the local, state, and national levels. d. support health care development and research to improve the health status of citizens.
B
1. Which of the following community health improvement projects uses subjective health perspective? a. Health-promotion project aimed at monitoring an adolescent's compliance with an asthma treatment regimen b. Project aimed at improving flexibility and stamina of residents of an assisted-living facility through participation in a yoga and relaxation program c. Project aimed at teaching clients with diabetes how to maintain glucose control by using a sliding scale for dosing insulin d. Program aimed at improving school performance by teaching high school teachers how to detect drug abuse and screen students for drug use
B
10. When the association between maternal alcohol use and low birth weight is being studied, the nurse investigator's failure to consider the variable of smoking could introduce bias into the observed association, because smoking has a correlation with both factors. This effect could best be described as: a. causality. b. confounding. c. information bias. d. selection bias.
B
2. Community-oriented nurses use EBP most effectively when they: a. base care on nationally accepted clinical guidelines, informing clients and community groups that the accepted standards of care need to be universally applied. b. base care on nationally accepted clinical guidelines, involve clients in individual care decisions, and include community input when applying evidence in practice. c. make client care decisions using the latest nursing research findings. d. work with physicians to design client care guidelines for community clinics.
B
3. A community-oriented nurse seeks to implement EBP in the community clinic's programs. The best model for the nurse to apply is: a. action research and review. b. community development. c. community research utilization. d. EBP.
B
4. A community-oriented nurse introduces a community partnership group to the Healthy People 2020 information access objective to use electronic personal health management tools. This is an example of: a. meta-analysis of research evidence. b. primary prevention using EBP. c. secondary prevention using EBP. d. tertiary prevention using EBP.
B
8. The community planning board's evaluation of a community intervention (child immunization campaign) carried out by the health department determined that some progress was made toward the desired outcome (target rate of childhood immunization), but the degree of progress achieved was not sufficient to offset the initial effort in terms of cost and time to launch the campaign. The community determined that the rate gain was not adequate when compared with that achieved through similar initiatives in other communities, which obtained better results by using more efficient strategies. The budget for this program was cut. This community decision best exemplifies which statement about evaluation? a. Evaluation should start in the planning phase of the nursing process. b. Evaluation can have unintended consequences. c. Effectiveness is the only true measure of worthiness. d. The power to design, judge, or institute change is important.
B
9. Randomized controlled trials are often inappropriate for evaluating many public health interventions. The most common approach to establishing evidence in public health is the use of: a. blinded studies. b. case-control studies. c. expert opinion. d. research synthesis.
B
1. A community-based HIV/AIDS clinic would be concerned about which aspects of the Public Health Code of Ethics? (Select all that apply.) a. Autonomy of the professional b. Confidentiality, when possible c. Funding d. Advocacy for disenfranchised persons e. Respect of only community rights
B,D
4. In 1902, Lillian Wald introduced the concept of school nursing to address the problem of school absenteeism. The primary model for the school nurse program was to work with children in the schools and make home visits for the purpose of: a. enforcing the department of health's rules and regulations. b. excluding infectious children from the school environment. c. providing and obtaining medical treatment for absent students. d. providing shoes and clothing for students.
C
1. Which action by the community-oriented nurse best illustrates a partnership for health? a. Assisting a school nurse in conducting vision screening of elementary school children b. Developing a volunteer program for teaching parenting skills c. Helping a group of citizens concerned about potential environmental hazards collect relevant health data and develop needed interventions d. Informing a neighborhood council that smoking is its major community health problem
C
1. Which of the following article titles include(s) an example of epidemiologic distribution and determinants? a. Can Operating Room Nurses Measurably Reduce Patient Anxiety? b. Characteristics of Patients Newly Diagnosed with Tuberculosis c. Comparison of Postinsecticide Exposure Incidence of Atopic Dermatitis in Migrant Farmworkers and Land-Owning Farmers in Southwestern Utah d. Postpartum Nurses' Reaction to Rotating Shifts Compared with Assigned Stable Shift
C
2. A rural PBH is in the first phase of a community assessment to determine the community health status characteristics of the local county. This initial data gathering should most likely begin with which agency? a. County public health department b. National Centers for Disease Control and Prevention c. State vital statistics bureau d. U.S. Census Bureau
C
4. A community-oriented nurse wants to design the most effective intervention to reduce CHD morbidity and mortality in a rural area. The program approach should incorporate the strategies of: a. aggregate primary prevention. b. individual-level primary, secondary, and tertiary prevention. c. multilevel intervention with a focus on primary, secondary, and tertiary prevention. d. promotion of optimal health for the individual, family, aggregate, and total community.
C
5. In the disease-oriented perspective, in which health is objectively defined as the absence of disease and health care is focused on identifying what is not working in a given system and repairing it, health behavior is based on client: a. access to care. b. adjustment of lifestyle. c. compliance with a prescribed regimen. d. response to treatment.
C
5. When nurses work with communities, "best practices"—the application of the best available evidence to improve practice—must also be: a. accessible and diverse. b. competent and compliant. c. culturally and financially appropriate. d. reasonable and deliverable in a timely fashion.
C
6. A child learns at a school safety presentation the importance of wearing a bicycle helmet and requests a helmet for a birthday gift. The parent purchases a helmet like the ones worn by the child's peers. Which of the following statements best describes the relationship of healthy or risky behaviors to lifestyle choices? a. The family is responsible for the health behaviors of children. b. The individual is responsible for health behaviors. c. There is multilevel responsibility for health behaviors. d. The community has a sense of responsibility for health behaviors.
C
6. The most important aspect of the nursing community assessment phase can best be described as: a. analyzing and synthesizing data. b. collecting and gathering data. c. formulating a community nursing diagnosis. d. identifying problem correlates.
C
7. Examples of the application of EBP to improve public health nursing can be found in research projects designed to test the effectiveness of public health nursing interventions related to the core functions and essential services of public health. These projects are associated with: a. Agency on Healthcare Research and Quality. b. Cochrane Database of Systematic Reviews. c. the Intervention Wheel. d. U.S. Preventive Services Task Force.
C
A nurse is preparing an education program on disease transmission for employees at a local day care facility. When discussing the epidemiological triangle, the nurse should include which of the following factors as agents? (select all) A. Resource availability B. Ethnicity C. Toxins D. Bacteria E. Altered immunity
C,D
2. An effective community-oriented diabetes program should include: a. access to a certified diabetes educator to teach the client self-management strategies and proper techniques. b. care that incorporates the American Diabetes Association treatment guidelines. c. access to a primary care provider, medication and supplies, and nutritionist consult. d. self-management education, family education, and assurance of affordable clinical care, medication, and testing supplies.
D
3. The Framingham Heart Study and the Alameda County study are historically important to the development of public health multilevel interventions. Which statement best describes the contribution made by these studies? a. Both focus on urban health risks and interventions to reduce the impact of those risks on the local population b. Both are longitudinal studies that can help community-oriented nurses design interventions to reduce cardiac morbidity and mortality c. Both studies show that young men who cease smoking reduce their risk of coronary disease, even if they develop moderate obesity as they become middle-aged d. Both studies examined personal and environmental factors that influence long-term health outcomes and demonstrate the need for individual and community intervention to reduce morbidity and mortality from preventable disease
D
3. Which community attribute is an indicator of a community's health status? a. Mean educational level b. Location of health facilities within the community c. Ratio of police to citizens d. Suicide rate
D
4. A community-oriented nurse leader is working with community leaders and interested citizens to improve access to services for the underserved by planning an expansion of the local community health clinic. This is an example of which type of community partnership model? a. Coalition b. Democratic c. Passive d. Community member professional
D
