public health question

A nurse is implementing a populationfocused model of home care delivery. Which of the following actions would most likely be taken by the nurse? a. Use an assessment protocol when conducting visits b. Collaborate with other disciplines c. Provide care for a specific population d. Apply highintensity interventions

A Populationfocused home care models of care usually include structured approaches to regular visits with assessment protocols, focused health education, counseling, and healthrelated support and coaching.

The nurse is doing a walkthrough to identify workplace hazards. Which of the following levels of prevention is being implemented? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Assessment

A Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. A walkthrough is part of an assessment, which is part of primary prevention. Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Secondary prevention occurs after a disease process has already begun.

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

A

A nurse is administering medications at school. Which of the following guidelines should be used by the nurse? a. A current drug reference should be available in case information is needed. b. The nurse should administer medications brought by the child. c. Medications cannot be administered without a physician order. d. Narcotics and controlled substances should be kept in a locked cabinet.

A A current drug reference should always be available so it can be consulted for information. All medications should be kept in a locked cabinet. Medications should be in the original container and have the original prescription label on it. The nurse is responsible for giving the medication and is expected by state law to know its action, side effects, and implications.

Which statement about disasters is true? a. They can be natural or humanmade. b. They can be relieved without assistance. c. There is always injury and death when a disaster occurs. d. The timing of a disaster does not influence the types of injuries that will occur.

A A disaster is any natural or humanmade incident that causes disruption, destruction, and/or devastation requiring external assistance. Although natural incidents like earthquakes of hurricanes trigger many disasters, predictable and preventable humanmade factors can further affect the disaster. In the disaster response phase, the incident type and time predict subsequent injuries and illnesses.

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

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

A nurse responds to a humanmade disaster. Which of the following describes what the nurse is responding to? a. Structural collapse b. Communicable disease epidemics c. Mud slides d. Floods

A A structural collapse would be considered a humanmade disaster. Communicable disease epidemics, mud slides, and floods are considered to be natural disasters.

A nurse is completing a disease investigation. Based on the clinical symptoms presented, it is assumed that the individual has measles. However, there has been no laboratory evidence documenting that this individual has the disease. Which of the following types of cases is the nurse investigating? a. A suspected case b. A confirmed case c. A prolonged case d. An identified case

A A suspected case is a clinically compatible case of illness without isolation. A confirmed case is a clinically compatible case that is laboratory confirmed by isolation. A prolonged case and identified case are not types of cases discussed in the text.

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

A Asking the mother about her previous experience with breastfeeding identifies her educational needs. Using the TEACH mnemonic, the first thing the nurse should do is "Tune in": listen before starting to teach; the client's needs should direct the content. Thus, this should be done before the nurse does any demonstration, showing of audiovisual resources, or return demonstration.

Research has shown that Asian men tend to have a greater sensitivity than white Europeans to codeine, and they experience significantly weaker effects from the drug. Which of the following types of cultural variations is being demonstrated? a. Biological variations b. Personal space c. Social organization d. Perception of time

A Biological variations are the physical, biological, and physiological differences that exist between racial groups and distinguish one group from another. Personal space is the physical distance between two individuals during an interaction. Social organization refers to the way in which a cultural group structures itself around the family to carry out role functions. Perception of time is the duration or period between successive events, where some cultures assign greater or lesser emphasis to events that occur in the past, present, or future.

7. A nurse is working in a temporary shelter for victims following a natural disaster. Which condition is the nurse most likely to encounter? a. Stress b. Communicable disease c. Depression d. Injuries requiring first aid

A Causes of stress can be the shock of the disaster itself, loss of personal possessions, fear of the unknown, living in close proximity to total strangers, and boredom. Illnesses requiring first aid and communicable diseases are not the primary concern of the nurse working in the shelter. Immediately following the disaster, it is unlikely that the victims will immediately encounter depression because of the shock of the disaster.

A nurse is pursuing certification as an occupational health nurse. Which organization will provide this certification? a. American Board for Occupational Health Nurses b. Occupational Safety and Health Education and Research Center c. National Institute for Occupational Safety and Health (NIOSH) d. Occupational Safety and Health Administration (OSHA)

A Certification in occupational health nursing is provided by the American Board for Occupational Health Nurses. The Occupational Safety and Health Education and Research Center supports master's and doctoral education with emphases in occupational health nursing, industrial hygiene, occupational medicine, and safety. NIOSH examines potential hazards of new work technologies and practices. OSHA educates employers about occupational health and safety.

What information is shared among agencies when they collaborate to implement a quality surveillance system? a. How to use algorithms to identify which events should be investigated b. Who is to blame for a disease outbreak c. What shelters will be used and by whom d. How political action will be necessary to ensure public health

A Collaboration promotes the development of plans and a directory of emergency responses. How to use algorithms is a key type of information that is shared. Blaming others is not part of collaboration. Determining what shelters will be used and by whom is not the priority for collaboration. How political action will be necessary to ensure public health is not a priority for collaboration.

A public health worker had displayed a competency in disaster medicine and public health. Which of the following describes what the worker has done? a. Communicate effectively with others b. Get involved in the chain of command c. Use a set of preplanned activities for every disaster d. Implement a community assessment

A Communicating effectively with others in a disaster or public health emergency is one of the competencies demonstrated in disaster medicine and public health. Involvement in the chain of command, using a set of preplanned activities for every disaster, and implementing a community assessment are not part of these competencies.

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

A Communities, individuals and families, and systems are the three levels of public health nursing practice. The other responses do not describe the levels of practice.

To meet a client's needs, it is sometimes necessary to integrate into the client's care a culturally relevant practice that lacks scientific utility. Which of the following best describes this action? a. Cultural accommodation b. Cultural awareness c. Cultural preservation d. Cultural repatterning

A Cultural accommodation refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help people of a particular culture to accept nursing strategies, or to negotiate with nurses to achieve satisfying health care outcomes. Cultural awareness refers to the self- examination and indepth exploration of one's own biases, stereotypes, and prejudices as they influence behavior toward other cultural groups. Cultural preservation refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help the clients of a particular culture to retain and preserve traditional values so they can maintain, promote, and restore health. Cultural repatterning refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help clients of a particular culture to change or modify a cultural practice for new or different health care patterns that are meaningful, satisfying, and beneficial.

A PHN is developing a measurable outcome health status indicator that can be used at the individual level of practice. Which of the following would the nurse most likely use? a. A 50yearold woman receives annual mammograms b. School absences in a community decline c. Teachers have increased awareness of health problems d. Those in poverty utilize the free mammogram program

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

A nurse is working with an immigrant population. Which of the following should be the first action taken by the nurse? a. Be aware of one's own culture b. Become familiar with traditional practices of the immigrants c. Try to see things from the immigrant's viewpoint d. Learn to speak the language of the immigrant population

A Cultural competence is one of the core attributes of public health nurses. Nurses come from a variety of cultural backgrounds and have their own cultural traditions. Nurses also bring their biomedical beliefs and values to the practice environment that may differ from the client's own beliefs and values. Because nurses recognize their own culture, they are better able to understand that there are differences among cultures. Being aware of one's own culture should be done before completing the other tasks of increasing familiarity with traditional practices, trying to see things from the other's point of view, or learning to speak the language.

13. A nurse is teaching a group of clients newly diagnosed with diabetes how to give themselves injections. Which of the following formats would be most appropriate for the nurse to use? a. Demonstration b. Health fair c. Lecture d. Nonnative language session

A Demonstration also includes return demonstration. Giving injections can best be learned by seeing the behavior being done. Health fairs target specific populations and are held in a variety of locations. Nonnative language sessions are a way to adapt the health fair to a population that does not speak English. Lecture is a noninteractive method of teaching.

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

A Education is the establishment and arrangement of events to facilitate learning. Education emphasizes the provider's role in providing knowledge and skills. Learning emphasizes the recipient of knowledge and skills. Education does not necessarily result in change, as change is typically not easy for most people. Education is designed to effect changes in the knowledge, skills, and attitudes, not necessarily expertise.

21. An occupational health nurse is assessing slippery floors as a safety hazard in the work setting. Which of the following best describes the type of hazard the nurse is assessing? a. Enviromechanical b. Physical c. Chemical d. Psychosocial

A Enviromechanical agents are those that can potentially cause injury or illness in the workplace. They are related to the work process or to working conditions, and they can cause postural or other strains that can produce adverse health effects when certain tasks are performed repeatedly. Slippery floors are known as enviromechanical hazards. They can cause or potentiate accidents, injuries, strain, or discomfort.

A nurse believes that the best treatment for illness is the use of Western medicine and alternative therapies should not be used for healing. Which of the following best describes what has happened? a. Ethnocentrism b. Cultural imposition c. Racism d. Stereotyping

A Ethnocentrism is the belief that one's own cultural group determines the standards by which another group's behavior is judged. Cultural imposition is the act of imposing one's cultural beliefs, values, and practices on individuals from another culture. Racism is a form of prejudice that occurs through the exercise of power by individuals and institutions against people who are judged to be inferior on the basis of intelligence, morals, beauty, inheritance, and selfworth. Stereotyping is ascribing certain beliefs and behaviors about a given racial and ethnic group to an individual without assessing for individual differences.

A nurse states that the client has exhibited an explicit cultural behavior. Which of the following has the nurse most likely observed? a. Verbal communication b. Body language c. use of titles d. Perception of health and illness

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

11. A public health nurse (PHN) is working with a community during the recovery phase of a disaster. Which of the following attributes would be most important for the nurse to possess? a. Flexibility b. Organization skills c. Personable d. Sense of humor

A Flexibility is key to a successful recovery operation. The role of the PHN in the recovery phase of a disaster is as varied as in the preparedness and response phases, but the PHN's connection to the community puts the PHN in an incredible position of knowledge and awareness on the interprofessional recovery team. The attributes of being organized, personable, and having a sense of humor are not as important as flexibility when dealing with this phase of the disaster.

What is the purpose of providing education across the three levels of prevention? Education: a. enables clients to attain optimal health. b. identifies and treats health problems early to eliminate disability. c. enables populations to break into individuals. d. teaches people about Healthy People 2020.

A Health education enables clients to attain optimal health, prevent health problems, and identify and treat health problems early to minimize disability. Elimination of disability may not be possible. Health education does not teach about the Healthy People 2020 document or break populations into individuals.

A public health nurse (PHN) is investigating an outbreak of salmonellosis in a community. Which type of surveillance system is being used? a. Active b. Passive c. Sentinel d. Special

A In the active system, a PHN begins to search for cases through contacts in the community. The nurse names the disease and gathers data about existing cases to try to determine the magnitude of the problem. In the passive system, case reports are sent to local health departments by health care providers. 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 and may be a combination of active, passive, and/or sentinel systems.

9. Which of the following is most likely to live in poverty? a. Those who work in highrisk jobs b. Those who have adequate nutrition c. Those who effectively manage stress d. Those who live in single family homes

A People who are poor are more likely to live in hazardous environments that are overcrowded and have inadequate sanitation, work in highrisk jobs, have less nutritious diets, and have multiple stressors.

A school nurse reviews the standards of professional practice published by the NASN. Which professional standard will the school nurse rely upon when providing care? a. Interact with interdisciplinary health team members b. Communicate with teachers to effectively manage classrooms c. Teach cardiopulmonary resuscitation to every member of the school staff d. Do research on students at the school

A Interacting with interdisciplinary health team members is one of the criteria for school nurses developed by the NASN. The professional standards rely on nurses to give care based on 11 criteria: (1) develop school health policies and procedures; (2) evaluate their own nursing practice; (3) keep up with nursing knowledge; (4) interact with the interprofessional health care team; (5) ensure confidentiality in providing health care; (6) consult with others to give complete care; (7) use research findings in practice; (8) ensure the safety of children, including when delegating care to other school personnel; (9) have good communication skills; (10) manage a school health program effectively; and (11) teach others about wellness.

11. A nurse is caring for a population that has experienced a health disparity. Which of the following best describes a health disparity? a. Low childhood immunization rates b. High dropout rates c. Unemployment d. Income below poverty level

A Low childhood immunization rates signify a health disparity. High dropout rates, unemployment, and income below poverty level are social conditions that may lead to health disparities.

Which historical event caused dramatic changes in home care nursing? a. Passage of Medicare legislation b. Establishment of Visiting Nurse Associations c. Creation of the Montefiore Hospital Home Care Program d. Provision of funds by the Civil Works Administration

A Medicare introduced regulations for home care practice as well as for reimbursement mechanisms.

8. A riverfront community builds a retaining wall to divert flood water away from the town. Which term describes what has happened? a. Mitigation b. A natural disaster c. Community resilience d. Rapid needs assessment

A Mitigation is defined as actions or measures that can either prevent the occurrence of a disaster or reduce the severity of the effects. A natural disaster, such as an earthquake or hurricane, causes disruption, destruction, and/or devastation requiring external assistance. Community resilience is defined as the sustained ability of a community to withstand and recover from adversity. A rapid needs assessment is based on the traditional model of community assessment where there is a rapid appraisal of a sector or region's population, social systems, and geophysical features.

What is the purpose of NIOSH? a. Examine potential hazards of new work technologies and practices b. Educate employees about environmental risks and hazards c. Develop and maintain a database of workrelated deaths d. Set standards that regulate workers' exposure to potentially toxic substances

A NIOSH examines potential hazards of new work technologies and practices. OSHA educates employees about environmental risks and hazards, develops and maintains a database of work- related deaths, and sets standards that regulate workers' exposure to potentially toxic substances.

A nurse is striving to be culturally competent. Which of the following actions would most likely be taken by the nurse? a. Respect individuals from different cultures and value diversity b. Immerse themselves in different cultures c. Design care for special ethnic groups d. Give explicit instructions to avoid client decision making

A Nurses who strive to be culturally competent respect individuals from different cultures and value diversity. Immersing oneself in a different culture, designing care for special ethnic groups, and giving explicit instructions so the client does not have to make a decision does not demonstrate cultural competence.

11. A community health nurse is writing an objective. Which of the following would be most appropriate for the nurse to write? a. Each member of the family will give an insulin injection to the client with accurate dosage 100% of the time for 10 consecutive trials. b. The client will perform a blood sugar test on herself with an accurate blood sugar reading. c. The community will take their children to receive immunizations within 1 month of the immunization due date. d. Fifty percent of the eligible women seen in the clinic will return for their scheduled mammogram appointment.

A Objectives are specific, shortterm criteria that need to be met as steps toward achieving the long- term goal. They are written as statements of an intended outcome or expected change in behaviors and should be defined in measurable terms. The objective "each member of the family will give an insulin injection to the client with accurate dosage 100% of the time for 10 consecutive trials" contains the components of a written objective. "The client will perform a blood sugar test on herself with an accurate blood sugar reading" does not provide any measureable terms. "The community will take their children to receive immunizations within 1 month of the immunization due date" does not provide a measurable percentage of the members of the community. "Fifty percent of the eligible women seen in the clinic will return for their scheduled mammogram appointment" focuses on a longterm goal, rather than a shortterm objective and does not provide a time frame for when this would be measured.

3. Which is a feature of public health surveillance? a. Sharing of the results with others b. Defining public health policy c. Evaluating interventions d. Planning national programs

A One of the features of public health surveillance is sharing of the results with others. Defining public health policy, evaluating interventions, and planning national programs are all purposes of surveillance, not features.

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

A One of the ways to assess the reliability and validity of Internet sources is to look at its currency, including the dates when the content was posted and updated. The Internet has reliable information, but the quality of the information must be assessed. Pharmaceutical websites may have biased information. Physicians are another source of information, but this may or may not be better than what is found on the Internet.

A nurse is providing education to prevent health problems in children. Which of the following levels of prevention is being used? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Assessment

A Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Providing education to prevent health problems in children is part of primary prevention. Secondary prevention includes the screening of children for various illnesses, monitoring their growth and development, and caring for them when they are ill or injured. Tertiary prevention is the continued care of children who need longterm health care services, along with education within the community.

A nurse is employed in home health nursing practice. Which of the following terms best describes the care that is being provided? a. Intermittent nursing care b. Custodial care c. Family caregiving d. Palliative care

A Provision of intermittent skilled visits is a component of home health care nursing. Custodial care refers to the care given in longterm care facilities. Family caregiving may be an important role of keeping the client at home, but it is not a necessary component of home care. Palliative care is an extended continuum of chronic serious illness to acute serious illness during which stabilization and exacerbations may occur.

A nurse uses the leadership behavior of reflecting when providing education to community members about how to lead healthy lifestyles. Which of the following actions is most likely being taken by the nurse? a. Providing feedback on how behavior appears to others b. Introducing new topics to the group c. Verifying information through questions and restatement d. Highlighting important points from the discussion

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

Resilience refers to the: a. resistance of certain groups to risk factors. b. increased susceptibility to cumulative risk factors among vulnerable groups. c. variability in the effects of stressors according to socioeconomic status. d. increased sensitivity of the very young and the very old to risk factors.

A Resilience refers to how vulnerable populations are able to resist or overcome the effects of the vulnerability. These populations do not succumb to the health risks that impinge on them.

A nurse is providing a skilled nursing service. Which of the following best describes the intervention the nurse is performing? a. Teaching the client and family about medication administration b. Consulting with other nurses about the care of a client in the home c. Coordinating services for maximum benefit at minimal cost d. Reviewing nursing assistant charting at the end of each day

A Skilled nursing service is the Medicare term that describes the duties of the registered nurse, and refers to the requirement of nursing judgment. Those services involve assessment, teaching, and selected procedures. Teaching the client and family to implement a therapeutic plan, such as taking medications, is an example of a skilled nursing service. Consultation, coordination, and review of documentation do not fit the definition of a "skilled nursing service."

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

A Soliciting input from individuals and organizations is a communication competency. Various strategies should be used to present the information. The group should assist in determining the topic, but not developing the program. The material should be presented to professional and lay audiences.

26. An occupational health nurse is assessing the need for MSDSs at the worksite. Which of the following items would require an MSDS? a. Hand soap b. Eye goggles c. Aprons d. Earplugs

A The Hazard Communication Standard requires that all worksites with hazardous substances inventory their toxic agents, label them, and provide information sheets, called MSDSs, for each agent. Hand soap is a toxic agent. Eye goggles, aprons, and earplugs are not toxic agents and therefore, do not need an MSDS.

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

A The Intervention Wheel provides a graphic illustration that gives public health nurses (PHNs) a means to describe the full scope and breadth of their practice. The Wheel was derived from the practice of PHNs and intended to support their work. It gives PHNs a means to describe the full scope and breadth of their practice. It serves as a model for practice in many state and local health departments, but not all.

A nurse is working with a family who is unable to find adequate health care coverage for the children in the family. Which of the following pieces of legislation will assist in provision of health care coverage for these children? a. Social Security Act b. Balanced Budget Act c. HIPAA d. ACA

A The Social Security Act provides funds to insure currently uninsured children. The Balanced Budget Act shifted payment in home health care. The HIPAA was intended to help people keep their health insurance when moving from one place to another. The ACA of 2010 provides the opportunity for all to purchase health insurance.

Which federal program created support for older and poor Americans? a. Social Security Act b. Medicare Amendment c. Medicaid Amendment d. HillBurton Act

A The Social Security Act sought direct payments to eligible individuals to ensure a minimum level of support for people at risk of problems from inadequate financial resources. The Social Security Act encompasses the Medicare and Medicaid Amendment. The HillBurton Act provided funding to assist with building hospitals.

A nurse is working with a group of clients diagnosed with diabetes and is teaching a class about avoiding the longterm effects of diabetes. The nurse begins the class by reviewing the basic physiology of diabetes, which was taught the week before. Which of the following principles of effective education is the nurse using? a. Stimulating recall of prior learning b. Gaining attention c. Presenting the material d. Providing learning guidance

A The educator should have the learners recall previous knowledge related to the topic of interest. The principle of gaining attention should have been applied as the program started the week before. Recall should be done before new material is presented and before learning guidance is provided.

A nurse is using the first stage of the Outcomes and Assessment Information Set (OASIS) outcomes analysis. Which of the following best describes what the nurse is doing? a. Comparing an agency's performance to a national sample b. Reporting data on patient care to a national registry c. Stabilizing a client's condition to continue to receive funding d. Documenting client assessment data and findings

A The first stage, outcomes analysis, enables an agency to compare its performance to a national sample, identify factors that may affect outcomes, and identify final outcomes that show improvement in or stabilization of a client's condition. The second stage, outcomes enhancement, enables the agency to select specific client outcomes and determine strategies to improve care.

A nurse has referred a home care client to hospice care. Which of the following best explains the rationale for this referral? a. To provide comfort and peace at a difficult time b. To reduce the cost of care for the terminally ill c. To keep clients at home until the end of life d. To provide care for terminally ill clients expected to live longer than 6 months

A The focus of hospice care is comfort, peace, and a sense of dignity at a very difficult time. Comprehensive services emphasize continuity of care. Hospice care is provided for those with a life expectancy of less than 6 months. Hospice is the only Medicare benefit that includes medications, medical equipment, 24 hours/7 days a week access to care, and support for family members after death. Hospice care does not reduce the cost of care.

What was the purpose of the CDC creating the first list of standard case definitions for notifiable diseases? a. Some diseases were underreported and others were overreported. b. There was no central office to collect data. c. Some people refused to notify officials when diseases were seen. d. No one knew where to report the information that was collected.

A The initial work was done by the CDC because diseases were overreported or underreported. Before this time, state and local health departments used many different criteria for identifying cases of reportable diseases. There was a central office to collect the data and providers knew that this information needed to be reported, but what was being reported by departments was different.

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

A The step of eliciting performance includes encouraging the learners to demonstrate what they have learned. Gaining attention occurs at the beginning of the program. Assessing performance occurs at the end of the program. Enhancing retention and transfer of knowledge occurs as the learners are asked to apply the information to their lives and situations (not to the care of the dolls).

A nurse is triaging victims following a disaster. Which of the following describes the action the nurse would take? a. Allocation of treatment based on the victim's potential for survival b. Assignment of tasks to the appropriate disaster response personnel c. Determination of the level of disaster and agency involvement d. Participation in community preparedness for the disaster response

A The triage process in disaster involves separating the casualties and allocating treatment based on the victim's potential for survival. Assignment of tasks to the appropriate disaster response personnel, determination of the level of disaster and agency involvement, and participation in community preparedness for the disaster response are not part of the triage process.

What is implied by the web of causation model? a. Variables interact resulting in higher probability of illness. b. One disease causes another, especially in vulnerable populations. c. The greater the poverty, the more likely people are to have diseases. d. Immunizations are necessary because vulnerable populations spread disease.

A The web of causation model implies that not only are there more variables, but the variables interact, resulting in higher probability of illness. The relative risk for poor health is greater for vulnerable populations.

A Mexican American mother insists on using special candles to help her daughter's ear infection. The nurse asks the mother if she would also give her daughter antibiotics. Which of the following best describes the action of the nurse? a. Cultural accommodation b. Cultural repatterning c. Culture brokering d. Cultural awareness

A This means that the nurse supports and facilitates the use of cultural practices with interventions from the biomedical health care system. Cultural accommodation refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help clients of a particular culture accept nursing strategies or negotiate with nurses to achieve satisfying health care outcomes. Cultural repatterning refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help clients of a particular culture to change or modify a cultural practice for new or different health care patterns that are meaningful, satisfying, and beneficial. Culture brokering is advocating, mediating, negotiating, and intervening between the client's culture and the biomedical health care culture on behalf of clients. Cultural awareness refers to the self- examination and indepth exploration of one's own biases, stereotypes, and prejudices as they influence behavior toward other cultural groups.

Which school health practice may occur in the future? a. Teaching health education using telehealth and telecounseling b. Using robotic nurses in schools c. Fulfilling the role of both classroom teacher and nurse by nurses d. Developing private practices for treatment of the entire family

A Using telehealth and telecounseling to provide health education is useful for homebound students and their parents. It is unlikely that there will be robotic nurses, that nurses will serve the role of both nurse and classroom teacher, and that private practices will be developed to treat the entire family.

2. Which of the following is a characteristic of a vulnerable population? a. Have worse health outcomes and an increased sensitivity to risk factors than the general population b. Have a single risk factor but experience worse health outcomes than the general population c. Have multiple risk factors but equal health outcomes to the general population d. Have worse outcomes with better access to health care than the general population

A Vulnerable population groups are more sensitive to risk factors and have worse health outcomes. Vulnerable populations experience multiple risk factors. Vulnerable populations have worse health outcomes than the general population. Vulnerable populations have more problems accessing health care than the general population.

An occupational health nurse is educating employees about workrelated hazards. Which of the following hazards would the nurse most likely discuss in the presentation? a. Workplace stress leading to hypertension and cardiovascular disease b. Asbestos, plastics, lead, and solvents leading to dermatitis c. Cement dust and metals leading to bronchitis d. Hormones and nitroglycerine leading to reproductive effects

A Workrelated stress or burnout has been defined as an important problem for many individuals. Responses to negative interpersonal relationships, particularly those with authority figures in the workplace, are often the cause of vague health symptoms and increased absenteeism. Education about stress would be pertinent to all workers, regardless of specific job or setting.

2. A nurse "sets the stage" when assessing members of vulnerable population groups. Which of the following interventions would be completed? (Select all that apply.) a. Creating a comfortable, nonthreatening environment b. Providing culturally and linguistically competent assessment c. Collaborating with others as appropriate d. Providing financial and legal advice e. Developing a free clinic in a lowincome neighborhood

A, B, C Nurses set the stage by creating a comfortable, nonthreatening environment, providing culturally and linguistically competent assessment, and collaborating with others as appropriate. A nurse should not provide financial or legal advice. Developing a free clinic does not "set the stage."

Which statement about the nursing workforce is true? a. The nursing workforce is overwhelmingly white. b. The number of minority nurses meets the needs of the country's demographics. c. The nursing workforce is becoming increasingly diverse with increasing minorities. d. Refugees make up a large part of the nursing workforce in some areas.

A. The nursing workforce is 83% white. Because of the large percentage of white nurses this does not meet the needs of the country's demographics. Unauthorized immigrants and refugees do not make up a part of the nursing workforce.

17. A nurse considers an audience's ability to read, comprehend, and act on medical instructions while preparing health education materials. Which of the following factors is the nurse considering? a. Health literacy b. Resilience c. Social justice d. Health disparity

AA measure of a patient's ability to read, comprehend, and act on medical instructions is health literacy. Resilience has to do with the factors that allow people to resist the effects of vulnerability. Social justice describes justice with respect to the concepts of egalitarianism and equality. Health disparity refers to the wide variations in health services and health status among certain population groups.

A visitor from Japan comes to the United States for a 2week vacation. Which of the following best describes this person? a. Nonimmigrant b. Refugee c. Legal immigrant d. Lawful permanent resident

AA nonimmigrant is admitted for a limited duration for a specific purpose. Refugees are people who seek protection in the United States because of fear of persecution in their homeland. Legal immigrants are people who are not citizens but are legally allowed to live and work in United States, usually because they fulfill labor demands or have family ties. Lawful permanent resident is another name for legal immigrants.

2. Which organizations offer volunteer opportunities in disaster work for nurses? (Select all that apply.) a. ARC b. Citizens Corps c. American Nurses Association d. National Public Health Training Centers e. Sigma Theta Tau International

AB ARC and Citizens Corps offer volunteer opportunities. The American Nurses Association and National Public Health Training Centers offer education and training opportunities. Sigma Theta Tau International is an honor society for nurses.

A school nurse develops emergency plans for students who may need immediate care while at school. Which of the following elements should be included in this plan? (Select all that apply.) a. When to call 911 for local emergency personnel b. Education about standard precautions for staff members c. Role children may play in providing basic first aid d. How to maintain confidentiality and privacy of injured students e. Where the shelter areas are located at the school

ABC According to the American Academy of Pediatrics' (AAP's) and American Heart Association's (AHA's) guidelines, the plan should address when to call 911 for local emergency personnel, education about standard precautions for staff members, and the role that children may play in providing basic first aid. Information related to how to maintain confidentiality and privacy of injured students is not part of the emergency plan. The location of the shelter areas is part of a schoolwide emergency or disaster plan, but not for emergency plans for individual students.

The cornerstones of public health nursing practice include which of the following? (Select all that apply.) a. Focus on the health of the entire population b. Reflect community priorities and needs c. Promote health through strategies driven by epidemiological evidence d. Are grounded in an ethic of collaboration. e. Provide a framework for ethical decision making

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

A nurse is using public surveillance. Which of the following describes the actions involved? (Select all that apply.) a. Estimating the magnitude of an influenza outbreak b. Determining the geographical distribution of gonorrhea cases c. Detecting an epidemic of whooping cough d. Reducing the prevalence of obesity e. Determining the incidence of cardiovascular disease

ABC Estimating the magnitude of the problem, determining geographic distribution of an illness, and detecting epidemics are all uses of public surveillance. Reduction of the prevalence of obesity and determining the incidence of cardiovascular disease are not how public health surveillance is used.

1. Which populations are at greatest risk for disruption after a disaster? (Select all that apply.) a. Singleparent families b. Children c. Substance abusers d. Middleclass families e. Young adults

ABC Singleparent families, children, and substance abusers are all at greater risk for disruption after disaster than a middleclass family or young adults.

A nurse is coordinating care through a highintensity transitional care program. Which of the following best describes the populations that the nurse is working with? (Select all that apply.) a. Adults with cognitive impairments b. Women with highrisk pregnancies c. Older adults with heart failure d. People who are moving from one state to another e. Men who have just experienced divorce

ABC Transitional care ensures the coordination and continuity of health care as clients transfer between different locations and different levels of care in the same location. Highintensity transitional care programs are designed for populations who have complex or highrisk health problems.

Which illegal and unethical activities have occurred in health care systems in the past? (Select all that apply.) a. Inappropriate use of home health services b. Inaccurate billing for services c. Excessive administrative staff d. "Kickbacks" for referrals e. Primary care services provided in the home

ABCD Examples of Medicare fraud and abuse in home health and hospice include inappropriate use of services, excessive payments to administrative staff or owners, "kickbacks" for referrals, and billing for visits and/or medical supplies that are not authorized or provided. The home care nurse must abide by established federal regulations when delivering care to clients.

An occupational health nurse is working in an occupational health and safety program. Which of the following services is the nurse most likely to provide? (Select all that apply.) a. Health/medical surveillance b. Health screening c. Case management d. Job task analysis e. Counseling

ABCD The services provided by onsite occupational health programs range from those focused only on workrelated health and safety problems to a wide scope of services that includes primary health care. An occupational health and safety program may include health/medical surveillance, health screening, case management, and job task analysis.

A staff nurse has demonstrated the ability to be competent as a participant in surveillance and investigation activities. Which of the following skills would you expect that nurse to possess? (Select all that apply.) a. The ability to identify appropriate data sources b. The ability to communicate effectively using written reports c. The ability to collaborate with community agencies d. The ability to create a budget e. The ability to interpret laboratory findings

ABCD The staff nurse must have analytic assessment skills, communication skills, and community dimensions of practice to be a participant in surveillance and investigation. The ability to interpret laboratory findings is not a core competency.

A nurse is planning a refugee outreach clinic at the neighborhood health center. Which of the following considerations should be made by the nurse in order to provide culturally competent care? (Select all that apply.) a. Their own background, beliefs, and knowledge may be significantly different from those of the people receiving care. b. Language barriers may interfere with efforts to provide assistance. c. Certain risk factors may be present for a given population. d. Certain groups may use nontraditional healing practices. e. Introduction of the American culture will be an important part of the encounter.

ABCD When working with immigrants, it is important to be aware of one's own beliefs while realizing that language barriers may exist, that different populations experience different risk factors and illnesses, and that nontraditional healing practices may be used. It would not be appropriate to impose the American culture into the encounter.

Which trends are occurring when providing care for vulnerable populations? (Select all that apply.) a. Communitybased care and interorganizational partnerships b. Outreach and case finding c. Elimination of disparities d. Culturally and linguistically appropriate care e. Increased incidence of acute illnesses

ABD Communitybased care and interorganizational partnerships, outreach and case finding, and provision of culturally and linguistically appropriate care are all trends to improve care among vulnerable populations. Elimination of disparities is not a trend related to caring for vulnerable populations. Increased incidence of acute illness is not a trend of care provision for vulnerable populations.

A school nurse is implementing strategies to prevent violence in the school setting. Which of the following interventions would most likely be used? (Select all that a. Support policies of zero tolerance for weapons on school property b. Facilitate student connectedness to the school community c. Encourage students to lock up and protect their personal property d. Serve as a positive role model e. Encourage students to play club sports outside of school

ABD Supporting policies of zero tolerance for weapons on school property, facilitating student connectedness to the school community, and serving as a positive role model are all strategies that the nurse can use to prevent violence in the school setting. Student connectedness is encouraged if students play sports at school rather than with area clubs. Locking up and protecting personal property is not an effective strategy to prevent violence.

A nurse is using basic educational principles when conducting an effective educational program. Which of the following principles would the nurse most likely be using? (Select all that apply.) a. Use a clear, succinct style b. Use an active voice c. Refer to Internet sources d. Use aids to highlight key points e. Repeat information several times

ABD Using a clear, succinct style, active voice, and using aids to highlight key points are all basic educational principles that should be used by the nurse. Reliable sources must be used, and information found on the Internet is not always reliable. Repeating information is not an education principle.

An occupational health has become a member of the AAOHN. Why would a nurse join this organization? (Select all that apply.) a. To promote the health and safety of workers b. To lobby in Congress for safer work places c. To advance the profession by supporting research d. To promote and provide continuing education in the specialty e. To obtain certification as a specialist in occupational health nursing

ACD The AAOHN is the professional organization for occupational health nurses. It supports the work of the occupational health nurse and advances the specialty by: promoting the health and safety of workers, defining the scope of practice and setting the standards of occupational health nursing practice, developing the code of ethics for occupational health nurses with interpretive statements, promoting and providing continuing education in the specialty, advancing the profession through supporting research, and responding to and influencing public policy issues related to occupational health and safety. A nurse joining the AAOHN would most likely not go to lobby in Congress; rather, AAOHN provides a lobbyist to address pertinent issues. Joining the AAOHN will not assist the nurse in obtaining specialty certification.

3. A nurse responds to a natural disaster. Which of the following is the nurse most likely responding to? a. Transportation accident b. Pollution c. Communicable disease epidemic d. Fire

C A communicable disease epidemic would be considered a natural disaster. Transportations accidents, pollution, and fire are considered humanmade disasters.

17. A nurse is involved in identifying individuals with unrecognized health risk factors or asymptomatic disease. Which of the following public health interventions is being applied? a. Screening b. Referral and followup c. Surveillance d. Health teaching

AScreening involves identifying individuals with unrecognized health risk factors or asymptomatic disease. Referral and followup assists individuals, families, groups, organizations, and/or communities to identify and access necessary resources in order to prevent or resolve problems or concerns. Surveillance describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data. Health teaching communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, behaviors, and practices of individuals, families, systems, and/or communities.

The leading cause of death in children and teenagers is: a. leukemia. b. injuries. c. suicide. d. diabetes.

B

A client shares with the nurse that her grandparents immigrated to the United States from Germany. Which of the following best describes what she has disclosed? a. Multiculturalism b. Ethnicity c. race d. Culture

B Ethnicity represents the identifying characteristics of culture, such as race, religion, or natural origin. Multiculturalism is the blending of diverse cultures. Race is primarily a social classification that relies on physical markers. Culture is a set of beliefs, values, and assumptions about life that are widely held among a group of people and transmitted intergenerationally.

5. A nurse is working with an older person following a disaster. Which of the following emotions of the client should be anticipated by the nurse? a. Anger b. Fear of loss of independence c. Violence d. Regression

B A common reaction of older persons experiencing disaster may be fear of loss of independence. Young children may respond with regression. The community in general may respond will feelings of anger, sorrow, guilt, and perceived blame for the disaster or the outcomes of the disaster. Violence should not be anticipated with any of the populations discussed in the text.

A PHN is conducting an assessment of the community's health. Which of the following is being accomplished through this activity? a. Define one problem that will be the focus for a year b. Assess a social network of interacting individuals usually in a defined territory c. Minimize the effects of health risks and hazards d. Intervene at the population level by changing laws and regulations

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

The SARS (severe acute respiratory syndrome) outbreak was an epidemic that spread over several countries. Which of the following terms describes what happened? a. Hyperendemic b. Pandemic c. Mixed outbreak d. Holoendemic

B A pandemic refers to the epidemic spread of the problem over several countries or continents. If a problem is considered hyperendemic, there is a persistently (usually) high number of cases. A mixed outbreak is a common source followed by secondary exposures related to persontoperson contact. Holoendemic implies a highly prevalent problem found in a population commonly acquired early in life.

A nurse is working with multiple vulnerable groups. Which of the following would be most sensitive to adverse effects? a. Pregnant teenager living with her parents for financial support b. Poor, older woman with no means of transportation c. 2yearold boy of underinsured parents d. Recently unemployed father of five

B A poor, older woman with no means of transportation has a combination of risk factors. A pregnant teenager, 2yearold boy, and recently unemployed father are only displaying one risk factor, not multiple risk factors as the older woman displays.

A set of actions one undertakes on behalf of another is: a. social justice. b. advocacy. c. resilience. d. risk.

B A set of actions one undertakes on behalf of another is advocacy. Social justice describes justice with respect to the concepts of egalitarianism and equality. Resilience refers to how vulnerable populations are able to resist or overcome the effects of the vulnerability. Risk describes that some people have a higher probability of illness than others.

A site that provides primary health care services to children and youths by nurse practitioners in the school setting is a: a. primary care clinic. b. schoolbased health center. c. school health service. d. child health improvement plan.

B A site that provides primary health care services to children and youths by nurse practitioners in the school setting is a schoolbased health center. Primary care clinic refers to care that is typically provided in a physician's office. School health services provide the various types of services that are available in schools. A child health improvement plan is not a setting for health care services to be delivered.

The first industrial nurse is considered to be: a. Betty Moulder. b. Ada Mayo Stewart. c. Lillian Wald. d. Florence Nightingale.

B Ada Mayo Stewart was hired in 1885 by the Vermont Marble Company; she is often considered the first industrial nurse. Betty Moulder provided care of ailing coal miners and their families. Lillian Wald is known as the founder of public health nursing. Florence Nightingale is one of the pioneers of the nursing profession.

A nurse is working in an occupational health setting. Which of the following roles will the nurse most likely have? a. Administrator b. Clinicians/practitioner c. Consultant d. Educator

B An occupational health nurse could be employed in any of these roles. However, the majority of occupational health nurses work as nurse clinicians/practitioners.

A nurse is volunteering on a disaster medical assistant team as a first responder. Which of the following tasks would the nurse be prepared to perform? a. Set up immunization clinics b. Assist in triaging disaster victims c. Provide all the medical care for disaster victims d. Complete a needs assessment of the community

B As a first responder arriving on the scene, the plans for triaging of disaster victims should begin immediately. Setting up immunization clinics would not be a priority following a disaster. In responding to a disaster, it may be impossible to provide all of the medical care for disaster victims. It would not be appropriate to start with completing a needs assessment of the community following a disaster; this should be done before the disaster occurs.

A nurse is unable to provide culturally competent care to a population within the community. Which of the following is an effect of this type of care? a. Enhanced communication b. Increased cost of health care c. Achievement of health indicators d. Improvement in client compliance

B Care that is not culturally competent may increase health care costs and decrease positive client outcomes. Communication is inhibited through care that is not culturally competent. It is not possible to achieve health indicators if culturally competent care is not given. Client compliance decreases if culturally competent care is not provided.

A PHN is using collaboration, coalition building, and community organizing to develop a new program in the community. Which of the following strategies is the nurse most likely using? a. Providing case management, referral, and followup services with individuals b. Carrying out collective action at the systems or community levels of practice c. Conducting a community assessment d. Implementing primary and secondary prevention strategies

B Collaboration, coalition building, and community organizing are the interventions often carried out at the systems and community levels of practice. These interventions can be used at all levels of prevention. Providing case management, referral, and followup services with individuals represents another group of interventions described by the green wedge. These interventions are not part of conducting a community assessment.

A nurse advocates and intervenes between the health care system and the client's cultural beliefs on behalf of the client. Which of the following best describes the nurse's action? a. Cultural accommodation b. Culture brokering c. Cultural preservation d. Cultural repatterning

B Culture brokering is advocating, mediating, negotiating, and intervening between the client's culture and the biomedical health care culture on behalf of clients. Cultural accommodation refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help clients of a particular culture accept nursing strategies or negotiate with nurses to achieve satisfying health care outcomes. Cultural preservation refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help the clients of a particular culture to retain and preserve traditional values, so they can maintain, promote, and restore health. Cultural repatterning refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help clients of a particular culture to change or modify a cultural practice for new or different health care patterns that are meaningful, satisfying, and beneficial.

A nurse is observing behaviors that may be defined by culture. Which of the following is the nurse most likely to observe? a. Speaking a dialect of a language in a local region b. Standing when an older adult gets on the bus to give him a seat c. Immigrating to the United States and seeking work d. An organizational structure of a cultural group

B Culture is a set of beliefs, values, and assumptions about life that are widely held among a group of people and is transmitted intergenerationally. Behaviors may be culturally determined, as illustrated in the correct response. This behavior is based on the value of respect of elderly people. Speaking a particular dialect in a local area would not fit the definition of culture. An organizational structure of a group is not an observable behavior. Immigrating to the United States does not demonstrate culture.

A nurse is coordinating care to ensure a comfortable and peaceful death. Which of the following factors should be an important consideration for the nurse? a. The unique stress dying patients often experience b. The cultural values, expectations, and preferences of the family c. The communication style of each family member d. The abilities of the nurse and health care team

B Cultures vary in their beliefs and responses to death. Nurses should know the differences in cultural responses so that they can effectively help people in their time of need. It will be important for the nurse to take cues from the client and the loved ones regarding their needs. The stress experienced by dying patients is different based on the client's culture.

A nurse is conducting disease surveillance. Which of the following describes the rationale for this action? a. To eradicate a disease before it starts b. To establish a baseline rate of disease occurrence and patterns of spread c. To target populations for triage d. To reduce the incidence of heart disease in a community

B Disease surveillance helps establish baseline rates of disease occurrence and patterns of spread to make it possible to initiate a rapid response to an outbreak. Disease surveillance is unable to eradicate a disease before it starts, to target populations for triage, or to reduce the incidence of heart disease in a community. However, disease surveillance does make it possible to initiate a rapid response to an outbreak of a disease or an event that can cause a health problem.

A nurse is working in a community that is experiencing the Honeymoon Phase after a disaster. Which of the following is characteristic of this phase? a. First responders work tirelessly to save others. b. Survivors share their stories. c. Medical personnel experience exhaustion. d. Community organizations rebuild the community.

B During the Honeymoon Phase, survivors rejoice for their survival and may share their experiences and stories. First responders work tirelessly to save others during the Heroic Phase. Medical personnel experience exhaustion during the Disillusionment Phase. The community begins to rebuild during the Reconstruction Phase.

A nurse is developing a goal for a client who is learning how to care for an ostomy. Which of the following would be most appropriate to develop? a. The client will look at his stoma without disgust each time his ostomy bag comes b. The client will be able to independently take care of his ostomy bag within three c. The client will gather all ostomy supplies correctly each time his ostomy bag needs to be changed. d. The client will successfully describe to the nurse how to care for his ostomy when he is asked.

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

3. A nurse uses Healthy People 2020 as a guide when planning health education in the community. Which of the following actions would be taken by the nurse? a. Focus on avoiding cigarette smoking and using alcohol in moderation b. Educate clients using primary and secondary levels of prevention c. Use Bloom's taxonomy when planning educational objectives d. Design health fairs aimed at individuals

B Healthy People 2020 focuses on implementing health promotion in priority areas using primary and secondary prevention. Understanding the three learning domains is crucial in providing effective health care. Health fairs targeted at specific populations can provide a venue for

A nurse practitioner reports a case of gonorrhea to the local health department. Which type of surveillance system is being used? a. Active b. Passive c. Sentinel d. Special

B In the passive system, case reports are sent to local health departments by health care providers. In the active system, the public health nurse 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 and may be a combination of active, passive, and/or sentinel systems.

A nurse is working with an individual who has a low literacy level. Which of the following barriers to learning should the nurse anticipate? a. Asking for additional clarification of materials b. Requesting to read the information later c. Having a high level of anxiety d. Being overly dependent on others

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

A nurse has evaluated the learning needs of a community support group. Which of following steps should the nurse take when developing an educational program for a. Consider any potential barriers to learning b. Establish goals and objectives for the program c. Select appropriate materials for the program d. Assess the dynamics of the group

B Instructional objectives need to be evaluated before a teaching program is designed. The five steps of the educational process are: (1) identifying educational needs, (2) establishing educational goals and objectives, (3) selecting appropriate educational methods, (4) implementing the educational plan, and (5) evaluating the educational process.

Which statement about head lice is true? a. Prevalence of head lice in U.S. schools is nearly 50%. b. Most cases of head lice are found in white, middleclass children. c. Having head lice is associated with living in an unclean home. d. Most incidents of head lice occur in those with dirty hair.

B Lice are mostly found in white, middleclass children as a result of the oval shape of the hair shaft. Prevalence of head lice in U.S. schools ranges from 10% to 40%, being found most commonly in schoolaged children, typically in late summer and autumn. Lice are more often seen in clean hair. The suggestion that lice are associated with unclean homes in poverty areas is incorrect.

A nurse is working with a vulnerable group experiencing multiple risk factors. Which of the following best describes this group? a. Smokers who use chewing tobacco as well as cigarettes b. Substance abusers who test positive for HIV c. Persons with limited access to care because they live in a rural area d. New mothers needing information about baby and child care

B Multiple risk factors are present in substance abusers, including contracting HIV and hepatitis B virus. Homelessness is another risk factor. Vulnerable populations of concern to nurses are persons who are poor or homeless, have special needs, pregnant teens, migrant workers and immigrants, individuals with mental health problems, people who abuse addictive substances, persons who have been incarcerated, people with communicable diseases and those who are at risk, and persons who are HIV positive or have hepatitis B virus or STDs.

Which population is at the greatest risk for experiencing workrelated accidents with subsequent injuries? a. Workers of childbearing age b. Workers with less than 1 year of experience c. Workers with diminished sensory abilities d. Workers with chronic illnesses

B New workers with less than 1 year of experience on the current job are at the greatest risk for experiencing workrelated accidents with subsequent injuries. The highest percentages were in mining; agriculture, forestry, and fishing; construction; and wholesale and retail trade.

An occupational health nurse is assessing workplace hazards. Which of the following would be the best method for the nurse to use? a. Review incident reports b. Walk through the worksite c. Interview key employees d. Read the Standard Industrial Classification (SIC) Code

B One of the best methods an occupational health nurse can use in assessing workplace hazards is to walk through the worksite. Reviewing incident reports, interviewing key employees, and reading the SIC Code do not provide the nurse with as much information as walking through the worksite.

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

B Patriarchal is authoritative, whereas one may control members through rewards and threats. Paternal leaders win respect and dependence through parentlike devotion. Democratic leadership is cooperative in nature and promotes and supports members' involvement in all aspects of decision making and planning. Socialist leadership supports community ownership and involvement of the community.

Which problem does a health department usually have the legal authority to investigate? a. Pandemics b. Unusual clusters of illness c. World trends of disease d. Cases of the common cold and pneumonia

B Powers of local government include surveillance of unusual clusters of illness. A health department does not have legal authority to investigate pandemics, world trends of disease, and cases of the common cold and pneumonia.

A person has returned from overseas and it is determined that he has Q fever. Which of the following must occur? a. This is not a disease that is on the notifiable list; nothing need be reported. b. The case must be reported to the state and local health departments. c. The patient must be isolated immediately. d. The patient will probably die, so it is not reportable.

B Q fever is on the notifiable list and must be reported to the state and local health departments. Thus, it needs to be reported, but does not imply immediate isolation or probable death.

14. A nurse is identifying agents that are part of the epidemiologic triad. Which of the following will the nurse most likely identify? a. Environmental pollution b. Radiation c. Susceptible human beings d. Highrisk groups of individuals

B Radiation is an example of an agent. The agents, factors associated with illness and injury, are occupational exposures that are classified as biological, chemical, enviromechanical, physical, or psychosocial. Environmental pollution is part of the environmental factor in the epidemiologic triad. Susceptible human beings and highrisk groups of individuals are part of the host factor of the epidemiologic triad.

A nurse is planning to evaluate an individual's progress toward a health goal. Which of the following components should be included in the evaluative process? a. Type of teaching strategy used b. Recognition of accomplishments in the group c. Conflict that occurred in the group d. The type of leadership in the group

B Recognition of accomplishments in the group and of the group is built into the evaluative process. The type of teaching strategies used, types of leadership, and conflict are not part of the evaluative process of the group.

27. Which is a requirement of the Superfund Amendment and Reauthorization Act (SARA)? a. Applying stricter rules to determine Superfund sites b. Sharing written disaster plans with key resources in the community c. Authorizing each industry to write their own disaster plan d. Evaluating the effectiveness of a written disaster plan

B SARA requires that written disaster plans be shared with key resources in the community, such as fire departments and emergency departments. SARA does not apply stricter rules, authorize each industry to write their own disaster plan, or evaluate the effectiveness of a written disaster plan.

The nurse is caring for children when they need health care. Which of the following levels of prevention is being used? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion

B Secondary prevention includes the screening of children for various illnesses, monitoring their growth and development, and caring for them when they are ill or injured. Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Tertiary prevention is the continued care of children who need longterm health care services, along with education within the community.

18. A nurse is examining social determinants of health. Which of the following is the nurse looking at? a. Ethnicity b. Income c. Gender d. Marital status

B Social determinants of health are such factors as economic status, education, environmental factors, nutrition, stress, and prejudice that lead to resource constraints, poor health, and health risk. Ethnicity, gender, and marital status are not considered social determinants of health.

Which concepts are used to evaluate client outcomes when using the Omaha System Problem Rating Scale for Outcomes? a. Problem, Intervention, and Outcome b. Knowledge, Behavior, and Status c. Knowledge, Skill, and Attitude

B System Problem Rating Scale for Outcomes uses the concepts of Knowledge, Behavior, and Status.

14. An occupational health nurse works with an employer to develop a workplace wellness program for its employees. Which of the following levels of practice is being implemented? a. Individual b. Systems c. Community d. Government

B Systems level of practice consists of changing laws, policies, and practices that influence populationbased issues. The individual level of practice focuses on interventions that involve working with individuals, either singly, or in groups, and with families. Individual level intervention changes knowledge, attitudes, beliefs, practices, and behaviors of individuals. Community level interventions are carried out with the community as a whole. This level of intervention changes community norms, attitudes, awareness, practices, and behaviors. Government is not a level of intervention described by "The Wheel."

A nurse is using telehealth technology in the home setting. Which of the following best describes the intervention that is being used by the nurse? a. Uses Web TV to teach clients about their health b. Shares health information using electronic communications c. Makes regular visits to clients to check the technology d. Risks violation of the Health Insurance Portability and Accountability Act

B Telehealth includes sharing health information between the client and clinicians using electronic communications. Telehealth may or may not include video technology for live interactions. Telehealth allows for monitoring health status and symptom recognition, providing education, increasing communication, and enabling clients to become active partners in their own care.

Which organization publishes the current scope and standards of home care a. Centers for Medicare and Medicaid Services b. American Nurses Association (ANA) c. Robert Wood Johnson Foundation d. Visiting Nurse Association

B The ANA publishes scope and standards for Home Health Nursing and Hospice and Palliative Nursing. The Centers for Medicare and Medicaid Services control the regulations and reimbursement mechanisms for the majority of home care services. The Robert Wood Johnson Foundation provides grant funding for a variety of projects that support nursing. The Visiting Nurse Association is a home care agency.

1. Which legislation required that schools make allowances to balance educational and health care needs of children with special needs? a. Rehabilitation Act b. Individuals with Disabilities Education Act c. No Child Left Behind d. Education for All Handicapped Children Act

B The Individuals with Disabilities Education Act guarantees educational services. The Rehabilitation Act states that children cannot be excluded from schools because of a handicap. No Child Left Behind states that all children must receive standardized education in a healthy environment. Education for All Handicapped Children states all children should attend school in the least restrictive environment.

The National Association of School Nurses (NASN) recommends which educational preparation for school nurses? a. Licensed practical nursing b. Bachelor of science in nursing (BSN) and certification in school nursing c. School nurse practitioner d. Master of science in nursing with specialization in school nursing

B The NASN recommends that school nurses be registered nurses (RNs) with BSNs and special certification in school nursing. Licensed practical nursing education is insufficient. School nurse practitioner and master of science in nursing with specialization in school nursing exceeds the minimum recommendations for school nurses.

The Refugee Act of 1980 had what effect on refugees who were immigrating into the United States? a. Allowed specific provisions for refugees from Southern and Eastern Europe b. Provided a uniform procedure for refugees to be admitted into the United States c. Permitted refugees to set up communities in or around major metropolitan areas d. Allowed refugees access to "green cards" that would allow them to work in the United States

B The Refugee Act of 1980 provided a uniform procedure for refugees to be admitted into the United States. Refugees were immediately eligible to receive Temporary Assistance for Needy Families, Supplemental Security Income, and Medicaid. This procedure was in effect for all refugees not just those from specific countries. It did not provide "green card" access or permit development of specific communities for refugees.

A bioterrorism attack has occurred in the United States. Which of the following programs would be used to provide large quantities of medications to the American public? a. Cities Readiness Initiative b. Strategic National Stockpile (SNS) c. Public Health Information Network (PHIN) d. Project BioShield

B The SNS has the capacity to provide large quantities of medicine and medical supplies to protect the American public in a public health emergency. The Cities Readiness Initiative aids cities in increasing their capacity to deliver medicines and medical supplies during a public health emergency. The PHIN helps ensure information access and sharing. Project BioShield is a program to develop and produce new drugs and vaccines against potential bioweapons.

6. A health educator is trying to change a client's attitudes about smoking. Which of the following domains would be used? a. Cognitive b. Affective c. Psychomotor d. Developmental

B The affective domain is used to attempt to influence what individuals, families, communities, and populations feel, think, and value. The cognitive domain includes memory, recognition, understanding, reasoning, and problem solving. The psychomotor domain includes the performance of skills that require some degree of neuromuscular coordination and emphasizes motor skills. Developmental domain is not one of the domains of learning.

A nurse is employed in an occupational health setting. Which of the following activities would be a primary role of the nurse? a. Caring for employees and their families b. Providing health promotion and emergency care c. Updating the Material Safety Data Sheets (MSDSs) d. Reporting communicable diseases

B The customary role of the occupational health nurse extends beyond emergency treatment and prevention of illness and injury and also includes the promotion and maintenance of health, overall risk management, care for the environment, and efforts to reduce healthrelated costs in business. The occupational health nurse does not typically care for families of employees, update MSDSs, or report communicable diseases.

A nurse is applying the Minnesota Model of Public Health Interventions: Applications for Public Health Nursing Practice steps of surveillance. Which of the following describes the initial action that the nurse would take? a. Analyze data b. Consider whether surveillance is appropriate to the situation c. Evaluate the impact of the surveillance d. Collect data

B The first step in this model considers whether the surveillance was appropriate. Analyzing data is the fifth step in this model. Evaluation of the impact of the surveillance is the last step of the model. Collecting data is the fourth step in this model.

An occupational health nurse is involved in disaster planning. Which of the following actions would be most appropriate for the nurse to take? a. Assess for possible disasters b. Prevent injuries and death of workers c. Store Medical Data Sheets in a safe place d. Collaborate with government authorities to plan disaster management

B The occupational health nurse is a key player in occupational disasters. The goals of a disaster plan are to prevent or minimize injuries and deaths of workers and residents, minimize property damage, provide effective triage, and facilitate necessary business activities. A disaster plan requires the cooperation of different personnel within the company and community. There are not Medical Data Sheets rather MSDSs.

A nurse is employed in the school setting. Which of the following activities would the nurse most likely perform? a. Care for children who are home sick from school b. Coordinate the health education program of the school c. Facilitate school attendance for students with communicable diseases d. Schedule appointments to specialists for students with chronic disease

B The school nurse's role is comprehensive and often involves coordinating activities, such as coordinating the school health program. A common misperception is that school nurses only put bandages on cuts and soothe children with stomachaches. However, that is not their major role. School nurses give comprehensive nursing care to the children and the staff at the school. At the same time, they coordinate the health education program of the school, consult with school officials to help identify and care for other persons in the school community, and provide leadership in promoting health and safety.

A nurse is examining the future of disaster management. Which of the following should the nurse anticipate? a. Vague and unorganized future due to constant emergence of new disasters b. Increasing sophistication in technology and surveillance c. Lack of involvement by national and state officials d. Decreasing need for public health workers to provide care

B The terrorist event of September 11, 2001, and the anthrax cases have increased the awareness for the need to plan for disasters. Technology and surveillance will continue to advance. Disaster management continues to change and become more organized as learning occurs after each incident, producing progressive best practices. National and state officials are very involved in disaster management. PHNs are particularly critical members of the multidisciplinary disaster health team given their populationbased nursing focus and specialty knowledge in epidemiology and community assessment skills.

Acts of bioterrorism or natural disasters, such as earthquakes, will often have more casualties because: a. they cause the most widespread destruction. b. victims have little time to make evacuation preparations. c. those with chronic conditions cannot escape in time. d. the early warning systems are not effective.

B The use of weapons of mass destruction or natural disasters, such as earthquakes, will often have more casualties because victims have little time to make evacuation preparations. The other answers are false.

The wide variations in health services and health status between certain population groups are called: a. vulnerable population groups. b. health disparities. c. disadvantaged populations. d. risk markers.

B The wide variations in health services and health status between certain population groups are called health disparities. Vulnerable populations are typically considered to be those who are at greater risk for poor health status and who have poor access to health care. Disadvantaged populations have fewer resources for promoting health and treating illness than does the average person in the United States. Risk describes that some people have a higher probability of illness than others.

A nurse is working with a vulnerable population. Which of the following is the nurse most likely working with? a. Families earning more than $50,000/year b. Families earning less than $15,000/year c. Residents of urban areas d. African American physicians

B Vulnerable populations of concern to nurses are persons who are poor or homeless (families earning less than $15,000 per year would be considered poor), persons who have special needs, pregnant teens, migrant workers and immigrants, individuals with mental health problems, people who abuse addictive substances, persons who have been incarcerated, people with communicable diseases and those who are at risk, and persons who are human immunodeficiency virus (HIV) positive or have hepatitis B virus or sexually transmitted diseases (STDs).

Which are categories of classifying interventions according to the Omaha System Intervention Scheme? (Select all that apply.) a. Health education b. Case management c. Treatments and procedures d. Direct care services e. Skilled nursing care

BC The Omaha System Intervention Scheme is comprised of four broad categories of interventions: (1) teaching, guidance, and counseling; (2) treatments and procedures; (3) case management; and (4) surveillance.

A nurse is implementing the Centers for Disease Control and Prevention (CDC) School Health Program within a school. Which components of school health will need to be evaluated? (Select all that apply.) a. Health promotion for students b. Nutrition services c. Counseling, psychological, and social services d. Health education e. Community safety

BCD Components of the CDC School Health Program includes health education, physical education, health services, nutrition services, counseling, psychological, social services, healthy school environment, health promotion for staff, and family/community involvement.

Which are the objectives of a disease investigation? (Select all that apply.) a. Enhance the knowledge of the nurse working in public health b. Control and prevent disease or death c. Identify factors that contribute to the disease outbreak/event occurrence d. Implement measures to prevent occurrences e. Participate in the core functions of public health

BCD The objectives of an investigation are to control and prevent disease or death, identify factors that contribute to the disease outbreak/event occurrence, and implement measures to prevent occurrences. Enhancing the knowledge of the nurse working in public health and participating in the core functions of public health are not objectives of an investigation.

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

BD Family members should be used with caution. The client's gestures and nonverbal messages should be observed to assure understanding. Written materials should be available in the client's primary language. The gender, age, educational level, socioeconomic status, religion, and dialect should all be considered when selecting the proper interpreter. The nurse should face the client during the dialogue, not the interpreter.

A school nurse is coordinating the health care for children with complex health problems. Which of the following roles is being implemented? a. Health educator b. Case manager c. Consultant d. Counselor

BThe nurse may perform the role of case manager for the child who is disabled or chronically ill needing to see many health care providers. The role of case manager is used when coordinating the health care of students with complex health problems. The role of health educator is used when teaching students about the importance of proper nutrition. As a consultant, the school nurse can provide professional information about proposed changes in the school environment and their impact on the health of the children. As a counselor, the school nurse may be the person whom the children trust to tell important secrets about their health.

A PHN is implementing the public health intervention of health teaching at the systems level of practice. Which of the following interventions is most likely being implemented by the nurse? a. Participating in the "Great American Smokeout" b. Working with a local employer to provide smoking cessation education c. Providing oneonone counseling to smokers d. Advocating for increased taxes on tobacco products

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

A school nurse is preparing to administer a prescription medication to a student. Which of the following information is necessary for the nurse to have? a. A copy of the prescription label on bottle b. A small container for the medication c. Signed consent parental consent form d. A signed order from the physician

C A current, signed parental consent form for administering the medication is essential for the student's file. The prescribed drug must have the original prescription label on it and be in the original container so that there are no errors. It is recommended that the physician contacts the school nurse or vice versa, but a signed order from the physician is not necessary.

A nurse is assessing a worker who has had a health reaction to a "safe" low- level exposure. Which of the following most likely describes what has happened? a. An allergic reaction b. A compromised immune system c. Hypersusceptibility d. Malnutrition

C A number of host factors appear to be associated with this hypersusceptibility: light skin, malnutrition, compromised immune system, glucose6phosphae dehydrogenase deficiency, serum alpha1antritrypsin deficiency, chronic obstructive pulmonary disease, sickle cell trait, and hypertension. A worker who has a health reaction to "safe" lowlevel exposures is experiencing hypersusceptibility.

20. A college student goes to the Student Health Center with an extremely swollen neck. The advanced practice nurse determines that he has mumps. His roommate also is experiencing malaise and a sore throat. Which of the following defines these two students? a. Mixed outbreak b. Common source c. Point source d. Propagated outbreak

C A point source outbreak involves all persons exposed becoming ill at the same time, during one incubation period. A mixed outbreak is a common source followed by secondary exposures related to persontoperson contact. A common source outbreak refers to a group exposed to a common noxious influence such as the release of noxious gases. A propagated outbreak does not have a common source and spreads gradually from person to person over more than one incubation period.

A home care agency has applied for accreditation from the Joint Commission. What is the next step the agency will take? a. Attend a conference to learn more about the accreditation process b. Schedule a site visit with the Joint Commission c. Complete a selfstudy of the agency d. Improve methods of documentation of client visits

C After applying for accreditation, a lengthy selfstudy must be completed that addresses all aspects of the agency's operation. Following completion of the selfstudy, an accreditation team schedules a site visit. Attending a conference to learn more about accreditation should be done before applying. A site visit with the Joint Commission occurs after the selfstudy has been reviewed. Improving methods of documentation of client visits should be addressed before applying for accreditation.

A nurse is assessing persons arriving at an alternate care center following a disaster. Which of the following actions should the nurse take first? a. Assess the amount of equipment and medications needed for each client b. Determine if the client has a psychological condition requiring special attention c. Assess whether this type of facility is appropriate for the client d. Determine if the client has a support system to assist with additional care needs

C Alternate care centers may be used to shelter patients with medical needs designated as "non- ambulatory care/hospital overflow" e.g., care of nonambulatory patients with less intense medical needs. After determination of the appropriateness of the facility, the nurse can then provide medical care as needed. It should not be necessary to initially determine if the client has a psychological condition or limit the amount of equipment or medications.

A school nurse is providing health information to school administrators, teachers, and parentteacher groups. Which of the following roles is being implemented? a. Health educator b. Case manager c. Consultant d. Counselor

C As a consultant, the school nurse provides health information to various school groups. The role of case manager is used when coordinating the health care of students with complex health problems. The role of health educator is used when teaching students about the importance of proper nutrition. As a counselor, the school nurse may be the person whom the children trust to tell important secrets about their health.

A nurse tells a coworker that she has been working on a regular basis with a group that demonstrates cohesion. Which of the following groups is the nurse most likely to describe? a. A group with several leaders b. A group with diverse attitudes and values c. A group with a common goal d. A group with efficient members

C Cohesion is the attraction between individual members and between each member and the group. Group effectiveness improves as members work together toward group goals while still satisfying the needs of individual members. A group with several leaders may have difficulty obtaining cohesion if each of the leaders has a different idea. Common attitudes and values among the group members will be important for the group to obtain cohesion. Efficiency does not play a role in developing cohesion.

19. An occupational health nurse has conducted a walkthrough assessment and has identified potential hazards in the workplace. The nurse recognizes that it will be easiest to modify exposure to which hazard? a. Bacteria b. Aerosols c. Noise d. Burnout

C Controlling physical agents, such as noise, can usually be accomplished through engineering strategies and personal protective equipment. It is much harder to change biological agents (bacteria), chemical agents (aerosols), and psychosocial agents (burnout).

The tendency to ignore all differences between cultures and to act as though the differences do not exist is defined as: a. cultural conflict. b. culture shock. c. cultural blindness. d. cultural imposition.

C Cultural blindness occurs when people state that everyone is treated the same, regardless of their cultural orientation. Cultural conflict is a perceived threat that may arise from a misunderstanding of expectations when nurses are unable to respond appropriately to another individual's cultural practice because of unfamiliarity with the practice. Culture shock is the feeling of helplessness, discomfort, and disorientation experienced by an individual attempting to understand or effectively adapt to a cultural group whose beliefs and values are radically different from the individual's culture. Cultural imposition is the act of imposing one's cultural beliefs, values, and practices on individuals from another country.

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

C Cultural desire refers to the nurse's intrinsic motivation to want to engage in the elements necessary to provide culturally competent care. The activity that suits the definition of cultural desire is one that a nurse would want to do instead of being directed to do so, referring to the intrinsic motivation of the nurse. Relying on a textbook for information, bringing a translator, and judging others do not demonstrate the definition of cultural desire as they are not demonstrating the intrinsic motivation of the nurse.

A nurse supports the use of traditional home remedies in conjunction with Western medicine to promote healthy behaviors. Which of the following is being demonstrated by the nurse? a. Cultural accommodation b. Cultural awareness c. Cultural preservation d. Cultural repatterning

C Cultural preservation refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help the clients of a particular culture to retain and preserve traditional values, so they can maintain, promote, and restore health. Cultural accommodation refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help clients of a particular culture accept nursing strategies or negotiate with nurses to achieve satisfying health care outcomes. Cultural awareness refers to the selfexamination and indepth exploration of one's own biases, stereotypes, and prejudices as they influence behavior toward other cultural groups. Cultural repatterning refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help clients of a particular culture to change or modify a cultural practice for new or different health care patterns that are meaningful, satisfying, and beneficial.

26. A nurse resigns from a position in a hospital to accept a job in a community setting. After starting the new job, the nurse feels helpless and confused, wondering if this was the right career choice. Which of the following terms best describes how the nurse is feeling? a. Cultural conflict b. Cultural relativism c. Culture shock d. Culture brokering

C Culture shock can happen to individuals within their own culture when they are having experiences such as starting a new job or career. Culture shock is brought on by anxiety from losing familiar signs and symbols of social interaction. Feelings associated with culture shock are helplessness, discomfort, and disorientation. Cultural conflict is a perceived threat that may arise from a misunderstanding of expectations when nurses are unable to respond appropriately to another individual's cultural practice because of unfamiliarity with the practice. Cultural relativism recognizes that clients have different approaches to health, and that each culture should be judged on its own merit and not on the nurse's personal beliefs. Culture brokering is advocating, mediating, negotiating, and intervening between the client's culture and the biomedical health care culture on behalf of clients.

What does each state do with the information that it receives about notifiable a. Uses the information for surveillance purposes b. Reports the information to the local branch of the World Health Organization c. Transmits the data electronically, weekly, to the Centers for Disease Control and Prevention (CDC) d. Does nothing with the information

C Data is transmitted weekly to the CDC through the National Electronic Telecommunications System for Surveillance. States need to transmit the information to the CDC rather than only keeping its own records. The reports are sent to the CDC, not to the WHO.

22. An occupational health nurse refers an employee to an employee assistance program. Which of the following problems would most likely be addressed? a. Obesity b. Smoking c. Alcohol abuse d. Lack of exercise

C Employee assistance programs are designed to address personal problems such as marital/family issues, substance abuse, or financial difficulties. These issues are addressed because they affect the employee's productivity. These efforts are costeffective for businesses.

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

C Gaining the learner's attention must happen first before learning can take place. The following steps of implementation include telling the learners the objectives of the instruction, asking learners to recall previous knowledge, presenting the essential materials, helping the learners apply the information, encouraging learning to demonstrate what they have learned, and providing feedback to help learners improve their knowledge and skills.

5. A hospital is using surveillance. Which of the following describes the rationale for this action? a. To protect the public against isolated patients b. To eliminate pathogens from the environment c. To improve quality of care and outcomes d. To decrease the incidence of ventilatoracquired pneumonia

C Hospital surveillance is used to improve quality of care and outcomes. An example is an infection that occurs in patients who had procedures at that facility. Reduction of the incidence of ventilator- acquired pneumonia is one reason why a hospital uses surveillance, but it does not address the entire issue. Hospital surveillance is unable to eliminate pathogens from the environment and cannot protect the public against isolated patients.

Which population would have been the focus of care for an occupational health nurse in the early 1900s? a. Injured workers b. All workers c. Families d. The community

C In the early days of occupational health nursing, the nurse's work was holistic and centered on the family. The care provided by Betty Moulder and Ada Mayo Stewart focused on both ill workers and their families.

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

C It is often a misconception that persons of the same race have the same culture. For example, African Americans may have been born in Africa, the Caribbean, North America, or elsewhere and have very different cultures. In the United States, children of biracial parents are usually assigned the race of the mother. Ethnicity is a contrasting term to race. Race is a characteristic that allows for some groups to be separated, treated as superior, and given access to power and other valued resources, while others are treated as inferior and have limited access to power and resources.

A nurse identifies a child who may be abused or receives information from a teacher that a child may have been abused. Which of the following actions must the nurse a. Call the police immediately to take the child to a safe place b. Contact the parents and ask about it c. Contact the legal authorities as well as the school's principal d. Examine the child to see if the abuse really occurred

C It is the law in most states for child abuse or suspected child abuse to be reported. When a nurse identifies a child who may be abused, or receives information from a teacher about potential abuse, the nurse must contact the appropriate legal authorities as well as the school's principal. A confidential file should be made about the incident. In all cases, the child must be protected from harm, and those who have no right to know that child abuse or neglect is suspected should not be given any information.

Which statement about chemical agents is accurate? a. Chemicals are not ordinarily found in the body tissues of the general population. b. Most chemicals have been studied to determine the effects of exposure on humans. c. Chronic exposure to lowlevel doses of workplace chemicals below standards constitutes a potential health risk. d. Human effects of chemical exposure are associated with single agents rather than with the interaction of agents.

C It is true that chronic exposure to lowlevel doses of workplace chemicals below standards constitutes a potential health risk. Most chemicals have not been studied epidemiologically to determine the effects of exposure on humans. As a consequence of general environmental contamination with chemicals from work, home, and community activities, a variety of chemicals have been found in the body tissues of the general population. Predicting human responses to chemical exposures are complicated because multiple chemicals often combine and interact to create a new chemical agent.

A nurse is working with a group focused on improving the health of the community. Which of the following interventions should be used by the nurse? a. Make decisions for the group to move the process along b. Invite business leaders to participate in the group process c. Maintain members through recognition and encouragement d. Teach topics that are of national importance

C Maintaining members is an important intervention to facilitate group process. The topics that are taught should be of importance to the group. The group should be part of the decisionmaking process. The membership of the group should be maintained, inviting new members to the group may hinder the processes of the group.

Which types of industries are noted for high degrees of hazards associated with the work? a. Data entry, animal rescue, and hospice b. Engineering, science, and laboratories c. Manufacturing, mining, and agriculture d. Aeronautics, plastics, and nursing

C Manufacturing, mines, construction, and agriculture are noted for their high degree of hazards associated with their work. However, no worksite is free of occupational health and safety hazards.

A PHN is addressing the problem of obesity at the community level of practice. Which of the following nursing diagnoses would be most appropriate for the nurse to use? a. Alteration in nutrition: More than body requirements b. Need for increased knowledge of proper nutrition c. Families at risk for obesity because of inactivity d. Overweight child related to poor dietary habits

C Nursing diagnoses must be modified to meet the needs of populationfocused care in public health nursing practice. Families at risk for obesity because of inactivity is the only nursing diagnosis that addresses a community group that is in need of further intervention. The alteration in nutrition and overweight child nursing diagnoses both address the individual level, not the community level. Need for increased knowledge does not identify the level that is being addressed.

A PHN utilizes the nursing process at all levels of practice. Which of the following demonstrates how this is accomplished? a. Including specific goals for community health nurses b. Developing an accurate nursing diagnosis c. Analyzing the needs of the community, systems, individuals, and families d. Utilizing primary, secondary, and tertiary prevention

C PHNs must customize the nursing process to consider the community, systems, and individual/family levels of practice. The levels of practice are not used for developing nursing diagnoses or goals. The levels of practice are not demonstrated utilizing the levels of prevention.

When a nurse is evaluating the components of an educational program. Which of the following best describes the action that is being taken by the nurse? a. Shortterm evaluation b. Educational product c. Process evaluation d. Longterm evaluation

C Process evaluation means looking at the components of an educational program. The educational product is the outcome of the educational process. Shortterm evaluation evaluates the immediate effects of a health program. Longterm evaluation is geared toward following and assessing the status of an individual, family, community, or population over time.

A home care nurse is employed by a proprietary agency. What does this mean? a. The agency is exempt from federal income taxes. b. The agency is governed by a board of directors. c. The agency is a profitmaking agency. d. The agency is reimbursed primarily by tax funds.

C Proprietary agencies are profitmaking agencies. Proprietary agencies are freestanding, forprofit agencies that are required to pay taxes. Many are part of large chains and now dominate the home care industry.

A nurse is developing a onestop service to meet the needs of a vulnerable group. Which of the following would the nurse most likely create? a. Wraparound services where mental services are linked b. Giving all immunizations on a single clinic visit c. Providing multiple services during a single clinic visit d. Providing free services to the medically indigent

C Providing multiple services during a single clinic visit makes services more responsive to the combined effects of social and economic stressors. Wraparound services provide comprehensive health as well as social and economic services, so it would include more than the linkage of mental health services. Administering all immunizations or providing free services would not provide a onestop shop for all needed services.

10. Which was the first legislation that specifically required certain prevention programs for workers? a. Occupational Safety and Health Act b. NIOSH c. Mine Safety and Health Act d. SIC Code

C The Mine Safety and Health Act was enacted in 1968. It was the first legislation that specifically required certain prevention programs for workers. The Occupational Safety and Health Act established OSHA and NIOSH to carry out the Act's purpose of ensuring "safe and healthful working conditions for working men and women." NIOSH examines potential hazards of new work technologies and practices. The SIC Code did not require certain protection programs for workers.

21. A city council discusses how former city laws promoted segregation in the community years ago. Which of the following was being demonstrated when segregation occurred? a. Prejudice b. Cultural imposition c. Racism d. Stereotyping

C Racism is a form of prejudice that occurs through the exercise of power by individuals and institutions against people who are judged to be inferior in, for example, intelligence, morals, beauty, and selfworth. Prejudice is the emotional manifestation of deeply held beliefs about a group. Cultural imposition is the act of imposing one's cultural beliefs, values, and practices on individuals from another country. Stereotyping is ascribing certain beliefs and behaviors about a given racial and ethnic group to an individual without assessing for individual differences.

A nurse in the occupational health arena is implementing a secondary prevention strategy. Which of the following best describes the action that was taken by the a. Providing education on safety in the workplace to prevent injury b. Working with chronically diabetic workers to ensure appropriate medications c. Screening for hearing loss resulting from noise levels in the plants d. Ensuring that a person with cardiovascular disease attends a rehab program

C Secondary prevention occurs after a disease process has already begun—screening for hearing loss. Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability—working with chronically diabetic workers and ensuring that a person with cardiovascular disease attends rehab. Primary prevention is aimed at prevention of a disease before it occurs—providing education on safety in the workplace to prevent injury.

A nurse is promoting social justice. Which of the following actions would the nurse most likely take? a. Contacting lawmakers about environmental health issues b. Assisting at homeless shelters c. Advocating for policies to improve social conditions d. Serving on a local coalition to prevent obesity

C Social justice refers to providing equitable care and social supports for the most disadvantaged members of society. Nurses can function as advocates for policy changes to improve social, economic, and environmental factors that predispose vulnerable populations to poor health.

Hispanics tend to believe that the needs of the family take priority over those of the individual. Which of the following types of cultural variations is being demonstrated? a. Communication b. Personal space c. Social organization d. Environmental control

C Social organization refers to the way in which a cultural group structures itself around the family to carry out role functions. Communication is the means by which culture is shared (verbal and nonverbal). Personal space is the physical distance between two individuals during an interaction. Environmental control refers to the person's relationship with nature and to plan and direct factors in the environment that affect them.

A PHN is implementing interventions at the systems level of practice. Which of the following interventions would be used by the nurse? a. Involve the entire community in solving the health problem b. Identify health problems in the community c. Change laws, policies, and practices that influence populationbased issues d. Provide outreach services to populations at risk

C Systems level practice consists of changing laws, policies, and practices that influence population- based issues. The individual level of practice focuses on interventions that involve working with individuals, either singly, or in groups, and with families is demonstrated through providing outreach. Community level interventions are carried out with the community as a whole and is demonstrated by involving the entire community in identifying and solving health problems.

A nurse works with a group of abused women to enhance their levels of self- esteem. Which of the following levels of prevention is being performed? a. Primary level of prevention b. Secondary level of prevention c. Tertiary level of prevention d. Health promotion

C Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Primary prevention aims to prevent disease and illness before it occurs. Secondary prevention focuses on screening and early detection. Health promotion is not a level of prevention.

The nurse provides direct care services to a stroke victim to avoid complications. Which of the following levels of prevention is being implemented? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Assessment

C Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Thus, direct care for a stroke victim is focusing on limiting disability and encouraging rehabilitation. Primary prevention focuses on preventing the disease before it occurs. Secondary prevention focuses on early detection and screening. Assessment is not a level of prevention.

An employer offers a limited duty program after an employee has experienced a cumulative trauma injury. Which of the following levels of prevention is being implemented? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Assessment

C Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability—limited duty program after injury. Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Secondary prevention occurs after a disease process has already begun.

A nurse is providing ongoing care to a pregnant teenager. Which of the following levels of prevention is being used? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion

C Tertiary prevention is the continued care of children who need longterm health care services, along with education within the community. Ongoing care to a pregnant teenager is part of tertiary prevention. Secondary prevention includes the screening of children for various illnesses, monitoring their growth and development, and caring for them when they are ill or injured. Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability.

A client is selfemployed as a mechanic and has no health insurance coverage. Which of the following best describes the legislation that will assist this client in obtaining health insurance? a. Balanced Budget Act b. Health Insurance Portability and Accountability Act (HIPAA) c. Patient Protection and Affordable Care Act (ACA) d. Social Security Act

C The ACA of 2010 provides the opportunity for all to purchase health insurance. The Balanced Budget Act shifted payment in home health care. The HIPAA was intended to help people keep their health insurance when moving from one place to another. The Social Security Act created the largest federal support program for elderly and poor Americans.

What is the purpose of the National Incident Management System (NIMS)? a. Create a new branch of government that deals with bioterrorism b. Establish a way for the Red Cross to carry out its mission c. Develop a nationwide allhazards approach to domestic incident management d. Extend presidential power to act quickly upon acts of bioterrorism

C The National Response Framework is a unified, alldiscipline, allhazards approach to domestic incident management. It is built upon scalable, flexible, and adaptable coordinating structures to align key roles and responsibilities linking all levels of government and organizations. The Homeland Security Act of 2002 created a new branch of government that deals with bioterrorism, the U.S. Department of Homeland Security. The NIMS did not impact the Red Cross or extend presidential power to act upon bioterrorism.

11. A nurse has discovered that a client should be receiving Meals on Wheels. Which of the following steps of the nursing process is the nurse performing? a. Diagnosis b. Planning c. Assessment d. Implementation

C The Standards of Care and the Standards of Professional Performance both include the six steps of the nursing process: (1) assessment, (2) diagnosis, (3) outcomes identification, (4) planning, (5) implementation, and (6) evaluation. As a nurse performs an assessment, the nurse recognizes the current needs of the client.

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

C The cognitive domain includes memory, recognition, understanding, reasoning, and problem solving. The affective domain includes changes in attitudes and the development of values. The psychomotor domain includes the performance of skills that require some degree of neuromuscular coordination and emphasizes motor skills. Memorization of skills is only one part of the cognitive domain

A nurse is implementing a community health education program at a local church. Which of the following educational principles should the nurse implement when providing this education? a. Refer to trustworthy sources b. Use an active voice c. Create the best learning environment d. Accentuate the positive health behaviors of the participants

C The environment must be conducive to learning for educational programs to be effective. The environment should be free of distractions and consistent with the message. The other strategies may assist with the educational program, but are not one of the major educational principles discussed in the textbook.

A nurse is trying to facilitate interprofessional collaboration. Which of the following actions should be taken by the nurse? a. Understand who is in charge of the client's care b. Make appropriate referrals c. Recognize what other professionals do and how they view their roles d. Request assistance when performing complex skills

C The factors for successful interprofessional functioning include the categories of knowledge, skill, and attitudes with subheadings including the understanding of the roles of each professional.

A group member has taken on the role of the "gatekeeper." Which of the following actions would most likely be taken by this member? a. Seek and accept the authority or direction of others b. Guide and direct the group activity c. Control outsiders' access to the group d. Focus the movement toward the main work of the group

C The gatekeeper controls outsiders' access to the group. The follower seeks and accepts the authority or direction of others. The leader guides and directs group activity. The task specialist focuses or directs movement toward the main work of the group.

A community health nurse is using the Omaha System. Which of the following best describes the rationale for using this system? a. To define each health care provider's role b. To use nursing diagnoses in community health nursing practice c. To foster collaborative practice d. To provide practitioners a method for communication

C The goals of developing the Omaha System were to develop a structured and comprehensive system that could be both understood and used by members of various disciplines and to foster collaborative practice. Therefore, the Omaha System was designed to guide practice decisions, sort and document pertinent client data uniformly, and provide a framework for an agencywide, multidisciplinary clinical information management system capable of meeting the daily needs of clinicians, managers, and administrators.

8. What is the primary cause of vulnerability? a. Race b. Age c. Poverty d. Illness

C The primary cause of vulnerability is poverty. Race, age, and illness may cause populations to be vulnerable, but these factors are not the primary cause.

A nurse is conducting an occupational health assessment. Which of the following best describes the rationale for this assessment? a. It is required by OSHA. b. It is required by NIOSH. c. It helps to identify agent and host factors that place employees at risk. d. It helps to educate workers about potential hazards.

C The purpose of this assessment is to become knowledgeable of the work processes and the materials, the requirements of various jobs, the presence of actual or potential hazards, and the work practices of employees. This assessment allows the nurse to identify agents and host factors that place employees at risk. An occupational health assessment is not required by any organization.

A child's parents have requested that their child be exempt from obtaining the required immunizations for a religious reason. What action should a school nurse take related to this request in order to be compliant with the law? a. Deny entry into school for children without the required immunizations b. Educate the parents about the need for immunizations c. Be aware of the state laws regarding acceptable reasons for exemption d. Allow the student to attend school without the immunizations

C The state mandates the rules about having immunizations that the nurse must follow. Thus, it is the responsibility of the school nurse to be aware of the laws in the state regarding acceptable reasons for immunization exemption.

15. A nurse is assessing host factors as part of the epidemiologic triad. Which of the following factors would the nurse most likely assess? a. Crowding b. Shift work c. Worker's family d. Chemical exposure

C The worker's family is considered a part of the host factor. Crowding and shift work are environmental factors, and chemical exposure is the agent factor.

A nurse is caring for a homeless population. Which of the following characteristics should the nurse anticipate as a need of this population? a. Need more nursing care than other vulnerable groups b. Have no desire to seek medical care c. Have even fewer resources than poor people who have adequate housing d. Are living in despair with no hope or resilience

C Those who are homeless have even fewer resources than poor people who have adequate housing. Homeless and marginally housed people must struggle with heavy demands as they try to manage daily life because their resources are limited. These individuals must cope with finding a place to sleep at night and a place to stay during the day or moving frequently from one residence to another, as well as finding food, before even thinking about health care.

A large amount of data related to hypertension rates is collected in a community. The data is analyzed. Which of the following describes the next step in the surveillance process? a. Collecting data from multiple valid sources b. Evaluating the impact on the surveillance system c. Interpreting the data and disseminating it to decision makers d. Asking political officials to finance a hypertension clinic

CAfter data is collected and analyzed, the findings must be disseminated. Collection of data is the step described in this scenario and the question asks what must be done next. Evaluating the impact on the surveillance system occurs after dissemination. Dissemination may occur to a broader audience than only political officials.

2. Medicarecertified home health agencies place emphasis on _____ care. a. chronic b. distributive c. intermittent d. primary

CAs part of the Conditions of Participation, Medicarecertified home health agencies must place an emphasis on intermittent care. Home care services that are provided must be intermittent and provide a skilled service. Primary care refers to the care that is often provided in a physician's office. Medicarecertified agencies provide care following an acute hospitalization or medical change; they do not provide longterm care for chronic illnesses.

A nurse is using surveillance to collect outcome data. What information would most likely be collected? a. Number of clinic services which use evidencebased protocols b. Proportion of the population vaccinated against influenza c. Incidence of breast cancer in the population d. Probability of a bioterrorism attack occurring in the community

COutcome data focus on change in health status; incidence rates are one example of this type of information. Process data focus on what is done, such as services provided or protocols for health care delivery. An example of process data is collection of data about the proportion of the eligible population vaccinated against influenza in any 1 year.

A school nurse is teaching a group of teenagers about the dangers of using "club drugs." The nurse provides information that which drug may cause a very high body temperature leading to death? a. Gamma hydroxybutyrate (GHB) b. Rohypnol c. Alcohol d. Ecstasy

D A very high body temperature can lead to death when taking ecstasy. GHB, Rohypnol, and Ecstasy are known as "club drugs."

What occurs during biological terrorism? a. The intentional release of hazardous chemicals into the environment b. Environmental and occupational exposure to biological toxins c. Immunity to toxins related to repeated exposures d. An intentional release of viruses, bacteria, or other toxins

D An intentional release of viruses, bacteria, or other toxins would be described as biological terrorism. Chemical terrorism is the intentional release of hazardous chemicals into the environment for the purpose of harming or killing. Surveillance is used to monitor environmental and occupational exposures. Immunity to toxins after repeated exposures does not occur during biological terrorism.

18. A nurse prepares for a presentation to a group of adults using strategies appropriate for adult learning. Which of the following concepts is being applied? a. Authoritarianism b. Learning style c. Pedagogy d. Andragogy

D Andragogy is a term and model developed by Malcolm Knowles to describe learning strategies for adult learners. In pedagogy the teacher assumes full responsibility for making decisions about what will be learned, and how and when it will be learned. In authoritarianism the leader controls group movement and progress through interpersonal power. Learning style refers to how someone learns best.

12. A nurse is using the educational process of selecting appropriate educational methods when planning a community health program. Which of the following steps of the nursing process does this action most resemble? a. Assessment b. Evaluation c. Implementation d. Planning

D Assessment would be identifying educational needs, evaluation would be evaluating educational process, and implementation would be implementing the educational plan. Planning is similar to selecting appropriate educational methods.

A nurse is working to remove barriers to receiving health care. Which of the following actions is the nurse most likely to support? a. Discrimination against certain groups b. Treatment of pets at the same facility c. Provision of free food at a food bank d. Providing services for a rural population by using a mobile clinic

D Barriers to access are policies and financial, geographic, or cultural features of health care that make services difficult to obtain or so unappealing that people do not want to seek care. Examples of removing barriers include providing extended clinic hours, lowcost or free health services for people who are uninsured or underinsured, transportation, mobile vans, and professional interpreters, which can help improve access to care.

A nurse is teaching a client about how to complete a wound dressing change. Which of the following conditions must be met before learning will occur? a. Must be able to memorize the instructions, relay this information to a partner, and demonstrate the dressing change b. Must master the dressing change at the time it is taught, repeat the demonstration for the nurse, and teach another person c. Must be able to speak the language of the nurse, have time to practice the dressing change, and master the dressing change in a short time d. Must have the necessary ability, a sensory image of how to carry out the dressing change, and an opportunity to practice the dressing change

D Before psychomotor learning occurs, the learner must have the necessary ability, a sensory image of how to carry out the skill, and an opportunity to practice the skill. This is the only option that contains all of the necessary requirements of the learner.

An employee has come into contact with a biological agent. Which of the following considerations should be made by the nurse? a. The biological agent may cause accidents in the work environment. b. The biological agent is commonly found in the agriculture industry. c. The biological agent may potentiate stress in the workplace. d. The biological agent indicates exposure to bacteria, viruses, fungi, or parasites.

D Biological agents are living organisms whose excretions or parts are capable of causing human disease, usually by an infectious process. Biological hazards are common in workplaces such as health care facilities and clinical laboratories where employees are potentially exposed to a variety of infectious agents, including viruses, fungi, and bacteria.

Community preparedness is being used to plan for a disaster. Which of the following tasks is being implemented? a. Assembling emergency supplies b. Understanding the workplace disaster plan c. Taking a disaster training course d. Developing an evacuation plan to remove individuals from danger

D Community preparedness involves developing an evacuation plan to remove individuals from danger. Assembling emergency supplies is an example of individual preparedness. Understanding the workplace disaster plan is an example of preparedness in the workplace within the community. Taking a disaster training course is an example of professional preparedness.

A PHN is conducting a community assessment. Which of the following is the best example of this action? a. Visiting an elderly person at home to assess and evaluate safety and fall risk b. Developing diagnoses to identify nursing interventions at a health clinic c. Evaluating services at an immunization clinic where a translator provides services d. Compiling recent data from the county health department on child abuse cases

D Compiling recent data from the county health department on child abuse cases is an example of community assessment, assessing needs and data within a community. Community assessment does not happen with an individual. Community assessment must be completed before diagnoses can be developed. Evaluation of services is not part of community assessment.

10. A nurse operates a schoolbased clinic in a local school where multiple providers and disciplines offer care to children, making it easier for children to access health care. Which of the following best describes this approach? a. Advocacy b. Wraparound services c. Social justice d. Comprehensive services

D Comprehensive services are health care services that focus on more than one health problem or concern. Stationary or mobile clinics that provide a wide array of health promotion, illness prevention, and illness management services in migrant camps, schools, and local communities are examples of this. Wraparound services describe a system in which comprehensive health services are available and social and economic services are "wrapped around" these services. Advocacy refers to actions taken on behalf of another. Social justice describes justice with respect to the concepts of egalitarianism and equality.

A nurse is participating in the preparedness stage of disaster management. Which of the following describes what is happening? a. Heightened inspection and increased security in the community b. Incorporation of provision of pets into local disaster plans c. Purchase of personal protective equipment for all citizens d. Assembly of disaster kits for the home, workplace, and car

D Disaster kit assembly for the home, workplace, and car, especially by nurses, occurs during the preparedness phase. Heightened inspection and increased security in the community is part of the prevention activities. Purchase of personal protective equipment for all citizens and incorporation of provision of pets into local disaster plans are not realistic plans for preparedness.

What information is included in a case definition? a. The precise point of contact b. Laboratory confirmation c. Source of contamination d. Clinical symptoms

D Each case has a unique set of criteria based on what is known about the particular disease. It may include clinical symptoms, laboratory values, and epidemiologic criteria. The precise point of contact, laboratory confirmation, and source of contamination are not part of a case definition.

A nurse is working for a public health department as the community health educator. Which of the following is a potential barrier that a nurse may experience? a. Working with clients with a low literacy level b. Memorizing the information that is to be taught c. Having a limited vocabulary d. Lacking knowledge about how to gain participation

D Educators may lack knowledge about how to gain participation. Participation can be fostered by asking openended questions, inviting participation, and planning smallgroup activities whereby a person responds based on the group rather than presenting his own information. Clients with low literacy levels and limited vocabularies are considered to be a learnerrelated barrier, not a barrier of the educator. Memorizing the information to teach may cause problems with the presentation but would not be a barrier for the educator.

Asians may perceive illness as disharmony with other forces and that medicine is only able to relieve the symptoms rather than cure the disease. They may look to naturalistic solutions and acupuncture to resolve or cure health problems. Which of the following types of cultural variations is being demonstrated? a. Communication b. Personal space c. Social organization d. Environmental control

D Environmental control refers to the ability of individuals to control nature and to influence factors in the environment that affect them. Communication is the means by which culture is shared (verbal and nonverbal). Personal space is the physical distance between two individuals during an interaction. Social organization refers to the way in which a cultural group structures itself around the family to carry out role functions.

24. A nurse recognizes the importance of group norms when planning community health education. Which of the following provides the best explanation for why this is important? a. Allow for creativity and variety among group members b. Influence members' perception of community c. Are helpful in evaluating the effectiveness of the group d. Maintain the group through various supports to members

D Group norms serve to maintain the group through various supports to members. They are the standards that guide, control, and regulate individuals and communities. They suggest what a group believes is important, what it finds acceptable or objectionable, or what it perceives as of no consequence. Group norms may limit the creativity and variety among the group members. Members' perception of the community could be influenced by group norms, but this is not why this consideration should be made when planning community health education. Group norms are not used to evaluate the effectiveness of the group.

12. The most disabling occupational condition reported in 2011 was/were: a. cuts and punctures. b. fractures. c. bruises. d. sprains and strains.

D In 2011, sprains and strains were by far the most frequent disabling conditions, accounting for 38% of the cases of days away from work.

An established group requests a teaching and learning session on hypertension. Which of the following should the nurse expect with this type of group? a. The group membership will change from week to week. b. The members all have the same interests. c. They prefer lectures rather than demonstrations. d. The group already has operating methods that have been successful.

D Nurses working with established groups should know that this type of group has membership ties and an existing structure that has proven to be successful. An established group would have a stable group membership. Learning occurs better in all groups with demonstrations instead of lectures. In an established group, they may be together because of a common interest, but may not share all of the same interests.

What is the purpose of OSHA? a. Educate occupational health and safety professionals b. Identify and research occupational health and safety hazards c. Distribute research findings relevant to occupational health and safety d. Educate employers about occupational health and safety

D OSHA educates employers about occupational health and safety. NIOSH identifies and researches occupational health and safety hazards, distributes research finding relevant to occupational health and safety, and educates occupational health and safety professionals.

1. Official agencies are financed primarily by: a. charities. b. individual clients. c. thirdparty payers. d. tax funds.

D Official agencies are financed primarily by tax funds. These agencies are typically operated by state, county, city, or other local government units, such as health departments.

A community coalition monitors the increasing obesity rate of children in their schools. Based on this data, they consider a variety of programming options which may possibly help decrease this trend. What was the purpose of conducting this surveillance? a. Protect the children from diseases that affect obese children b. Teach parents that obesity will not be tolerated in this community c. Educate children on surveillance techniques d. Demonstrate that new clinical and effective protocols need to be developed

D Ongoing surveillance in a community can lead to new clinical and effective protocols to address an issue. Ongoing surveillance makes it possible to have ongoing monitoring in place to ensure that disease and event patterns improve rather than deteriorate. This surveillance cannot protect children from diseases, teach parents that obesity will not be tolerated, or educate children on surveillance techniques.

In the Vietnamese culture, individuals may focus on wishes and memories of their ancestors and look to them to provide direction for current situations. Which of the following types of cultural variations is being demonstrated? a. Communication b. Personal space c. Social organization d. Perception of time

D Perception of time is the duration or period between successive events, where some cultures assign greater or lesser emphasis to events that occur in the past, present, or future. Communication is the means by which culture is shared (verbal and nonverbal). Personal space is the physical distance between two individuals during an interaction. Social organization refers to the way in which a cultural group structures itself around the family to carry out role functions.

Which statement is true about the origins of the Intervention Wheel? a. A panel of nurses from Iowa, Minnesota, North Dakota, South Dakota, and Wisconsin developed and refined the Intervention Wheel. b. It was conceived by a group of international nurses from Norway, Kazakhstan, and c. It was a result of a qualitative analysis carried out by the State Boards of Nursing. d. It resulted from a grounded theory process carried out by public health consultants at the Minnesota Department of Health.

D Public health consultants with the Minnesota Department of Health carried out a grounded theory process in response to uncertainty about the contributions of public health nursing to population health level improvement, resulting in the identification of the Intervention Wheel components. It was not developed by a panel of nurses in the Midwest or by a group of international nurses. It was not a qualitative analysis process and the State Boards of Nursing were not involved in its development.

19. A nurse is responding to a disaster. Which of the following is the priority of the disaster response? a. Clean up the environment b. Handle the stress reaction of the victims c. Bring in as many aid workers and nurses as possible d. Reestablish sanitary barriers and focus on basic needs

D Reestablishing sanitary barriers and focusing on water, food, waste disposal, vector control, shelter, and safety are the first goals. After this has been established, the nurse can address the cleanup of the environment, the stress reactions of the victims, and the need to bring in additional workers.

6. A nurse experiences a stress reaction while working with the survivors of a disaster. Which of the following best describes what has happened? a. The nurse makes decisions to assist with care coordination of the survivors. b. The nurse tells the supervisor of the disaster the details of the care that was provided. c. The nurse cries after returning home at the end of the day. d. The nurse refuses to follow orders.

D Symptoms that may signal a need for stress management assistance include the following: being reluctant or refusing to leave the scene until the work is finished; denying needed rest and recovery time; feelings of overriding stress and fatigue; engaging in unnecessary risktaking activities; difficulty communicating thoughts, remembering instructions, making decisions, or concentrating; engaging in unnecessary arguments; having a limited attention span; and refusing to follow orders.

A nurse is planning and implementing care for vulnerable populations. Which of the following would be the most appropriate action for the nurse to take? a. Setting up multiple clinics in a wide geographic area b. Advising legal consultants on a variety of issues c. Making laws to protect the homeless d. Teaching vulnerable individuals strategies to prevent illness and promote health

D Teaching vulnerable individuals, families, and groups strategies to prevent illness and promote health is one of the ways nurses provide care for these populations. Setting up clinics, advising legal consultants, and making laws do not address the direct care provision role of the nurse.

A nurse is developing and coordinating an emergency response plan for a community. With which of the following organizations would the nurse collaborate? a. American Red Cross (ARC) b. National Disaster Medical System (NDMS) c. Centers for Disease Control and Prevention (CDC) d. Emergency Management Agency (EMA)

D The EMA is responsible for developing and coordinating emergency response plans in a defined area. The ARC works with communities in the preparedness, response, and recovery phases of a disaster. The CDC studies the effect that disasters have on population health and continuously develops new prevention strategies. The NDMS provides nurses the opportunity to work on specialized disaster response teams.

A nurse is using the Omaha System Problem Classification Scheme. Which of the following situations is the nurse most likely experiencing? a. Measuring client outcomes b. Collaborating with other professionals c. Providing health education d. Organizing a comprehensive assessment

D The Omaha System Problem Classification Scheme is used to organize a comprehensive assessment according to four priority domains. It's simple and concrete terms are used to organize a comprehensive assessment, an important standard of nursing practice. It does not measure client outcomes, promote collaboration with other professionals, or provide health education.

After conducting a comprehensive client assessment, the nurse would organize information about the client's medication regimen into which domain of the Omaha System Problem Classification Scheme? a. Environmental b. Psychosocial c. Physiological d. Healthrelated behaviors

D The Omaha System Problem Classification Scheme uses four domains to organize client information. The Healthrelated behaviors domain includes information related to patterns of activity that maintain or promote wellness, promote recovery, and decrease the risk of disease. The environmental domain includes material resources and physical surroundings both inside and outside the living area. The psychosocial domain includes patterns of behavior, emotion, communication, relationships, and development. The physiological domain includes functions and processes that maintain life.

13. PHNs utilize registries to identify children with delayed or missing immunizations. They subsequently follow up with families by phone calls or home visits. Which of the following levels of practice is being implemented? a. Systems b. Community c. Policy d. Individual

D The individual level of practice focuses on interventions that involve working with individuals, either singly, or in groups, and with families. Individual level intervention changes knowledge, attitudes, beliefs, practices, and behaviors of individuals. Community level interventions are carried out with the community as a whole. This level of intervention changes community norms, attitudes, awareness, practices, and behaviors. Systems level interventions change organizations, policies, laws, and power structures within communities. Policy is not a level of intervention described by "The Wheel."

7. The nurse is teaching a new diabetic client how to give himself an insulin injection. Which of the following domains would be used? a. Developmental b. Cognitive c. Affective d. Psychomotor

D The psychomotor domain includes the performance of tasks that require some degree of neuromuscular coordination and emphasizes motor skills. Developmental domain is not one of the domains of learning. The cognitive domain includes memory, recognition, understanding, reasoning, and problem solving. The affective domain is used to attempt to influence what individuals, families, communities, and populations feel, think, and value.

19. A nurse is collecting morbidity data. Which of the following would be the source that the nurse would use? a. Vital statistics reports b. Birth records c. Death certificates d. Specialized disease registries

D There are many sources of morbidity data (rate of disease incidence), including specialized disease registries. Vital statistics reports, birth records, and death certificates are part of mortality data.

A client comes into the clinic and tells the nurse he goes to an acupuncturist for pain. The nurse says he should take pain medication instead. Which of the following best describes the action taken by the nurse? a. Cultural conflict b. Cultural blindness c. Cultural relativism d. Cultural imposition

D This is an example of cultural imposition—the act of imposing one's cultural beliefs, values, and practices on individuals from another culture. Cultural conflict is a perceived threat that may arise from a misunderstanding of expectations when nurses are unable to respond appropriately to another individual's cultural practice because of unfamiliarity with the practice. Cultural blindness occurs when people state that everyone is treated the same, regardless of their cultural orientation. Cultural relativism recognizes that clients have different approaches to health, and that each culture should be judged on its own merit and not on the nurse's personal beliefs.

A nurse is investigating a potential bioterrorism attack. Which of the following evidence would a nurse find if a bioterrorism attack occurred? a. A large number of cases of influenza b. A case of cholera in a local politician following a trip to India c. Dengue fever in a group of students who just returned from a mission trip d. An unusual illness in a population

D Unusual illness in a population should trigger an investigation that may signal a covert bioterrorism attack. Cases of influenza, cholera, and dengue fever in a group would not be considered unexpected illnesses.

6. A nurse is working with a 17yearold pregnant cocaine addict who is homeless. Which of the following best describes this client? a. At risk b. A special population c. A Healthy People 2020 target group d. A vulnerable individual

D Vulnerable individuals often have multiple risk factors. Vulnerable populations of concern to nurses are persons who are poor or homeless, have special needs, pregnant teens, migrant workers and immigrants, individuals with mental health problems, people who abuse addictive substances, persons who have been incarcerated, people with communicable diseases and those who are at risk, and persons who are HIV positive or have hepatitis B virus or STDs. Risk is an epidemiological term meaning that some people have a higher probability of illness than others.

PHNs across the United States implement similar types of interventions to improve the health of various groups. Which of the following explains why a common set of interventions is used? a. Describe the proper order of implementation b. Emphasize surveillance as the main focus of public health practice c. Guide practice and generate agency protocols d. Improve the health status of communities, systems, individuals, and families

DInterventions are actions taken on behalf of communities, systems, individuals, and families to improve or protect health status. The interventions do not describe a particular order for implementation. Surveillance is only one of the 17 interventions described. PHNs may use any or all of the interventions. No single PHN is expected to perform every intervention at all three levels of practice.

A school nurse is demonstrating community outreach in practice. Which of the following interventions is most likely being used by the nurse? a. Coordinating health care of students with complex health problems b. Teaching students about the importance of proper nutrition c. Providing direct care to ill and injured students d. Participating in a community health fair

DWhen participating in community outreach, nurses are involved in community health fairs, using that opportunity to teach others. The role of case manager is used when coordinating the health care of students with complex health problems. The role of health educator is used when teaching students about the importance of proper nutrition. The role of direct caregiver is used when providing direct care to ill and injured students.

22. The nurse labels a patient an alcoholic because of his ethnicity. Which of the following best describes this action by the nurse? a. Stereotyping b. Prejudice c. Racism d. Ethnocentrism

a Stereotyping is ascribing certain beliefs and behaviors about a given racial and ethnic group to an individual without assessing for individual differences. Prejudice is the emotional manifestation of deeply held beliefs about a group. Racism is a form of prejudice that occurs through the exercise of power by individuals and institutions against people who are judged to be inferior in, for example, intelligence, morals, beauty, and selfworth. Ethnocentrism is the belief that one's own cultural group determines the standards by which another group's behavior is judged.

A large portion of foreignborn residents of the United States: a. work in serviceproducing and bluecollar sectors. b. reside in rural areas. c. have a high school education. d. are refugees and nonimmigrants.

a Twothirds of the foreignborn population lives in or around major metropolitan areas and works in mainly serviceproducing and bluecollar sectors. They are also more likely to be poorer. The majority of foreign born are legal immigrants (85%). More than 54% of the foreignborn adults in the labor force have completed high school, which would not be considered a large portion.

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

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

18. A nurse promotes alliances among organizations for a common purpose. Which of the following public health interventions is being implemented? a. Health teaching b. Coalition building c. Surveillance d. Referral and followup

b One example of coalition building is promoting alliances among organizations for a common purpose. Referral and followup assists individuals, families, groups, organizations, and/or communities to identify and access necessary resources in order to prevent or resolve problems or concerns. Surveillance describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data. Health teaching communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, behaviors, and practices of individuals, families, systems, and/or communities.

A social marketing campaign urging community members to avoid driving motorized vehicles after consuming alcohol is implemented in a local community. Which of the following levels of practice is being demonstrated? a. Individual b. Systems c. Community d. Government

c Community level interventions are carried out with the community as a whole. This level changes community norms, attitudes, awareness, practices, and behaviors. It is directed toward entire populations within the community or occasionally toward populations at risk or populations of interest. Individual level intervention changes knowledge, attitudes, beliefs, practices, and behaviors of individuals. Systems level interventions change organizations, policies, laws, and power structures within communities. Government is not a level of intervention described by "The Wheel."

A nurse implements nursing interventions considering the uniqueness of the person's culture. Which of the following best describes this action? a. Cultural diversity b. Cultural knowledge c. Cultural competence d. Cultural awareness

c Providing care based on the uniqueness of the client's cultural norms and values is one of the three guiding principles of culturally competent nursing care. Cultural diversity refers to the degrees of variation represented among populations based on lifestyle, ethnicity, race, interest, across place, and place of origin across time. Cultural knowledge refers to the process of searching for and obtaining a sound educational understanding about culturally diverse groups. Cultural awareness refers to the selfexamination and indepth exploration of one's own biases, stereotypes, and prejudices as they influence behavior toward other cultural groups.

A nurse is working with a population that exhibits a large amount of diversity. The nurse recognizes that skin color of individuals within this population is an example a. multiculturalism. b. ethnicity. c. race d. culture.

c Race is primarily a social classification that relies on physical markers. Multiculturalism is the blending of diverse cultures. Ethnicity is the shared feeling of peoplehood among a group of individuals and relates to cultural factors, such as nationality, geographic region, culture, ancestry, language, beliefs, and traditions. Culture is a set of beliefs, values, and assumptions about life that are widely held among a group of people and transmitted intergenerationally.

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

c Since being published, the Intervention Wheel has been incorporated into the public/community health coursework of numerous undergraduate and graduate curricula. The Wheel was derived from the practice of PHNs and intended to support their work. It gives PHNs a means to describe the full scope and breadth of their practice. It serves as a model for practice in many state and local health departments. It has been presented internationally, but is not used widely at the international level.

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

cClients provide a rich source of information about their own cultures. The client would be the preferred person to collect this information instead of the husband, community leader, or religious leader.

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

cHealth teaching communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, and practices of individuals, families, systems, and/or communities. Collaboration commits two or more persons or organizations to achieve a common goal through enhancing the capacity of one or more of the members to promote and protect health. Surveillance describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data. Screening involves identifying individuals with unrecognized health risk factors or asymptomatic disease

A 35yearold man from Russia comes to the United States seeking asylum because of religious persecution in his native country. Which of the following best describes this type of immigrant? a. Legal immigrant b. Lawful permanent resident c. Refugee d. Unauthorized immigrant

cRefugees are people who seek protection in the United States because of fear of persecution in their homeland. Legal immigrants are people who are not citizens but are legally allowed to live and work in United States, usually because they fulfill labor demands or have family ties. Lawful permanent resident is another name for legal immigrants. Unauthorized immigrants may have crossed a border into the United States illegally, or their legal permission to stay in the United States may have expired.

A nurse has experienced a cultural encounter. Which of the following best describes what has happened? a. Sharing significant assessment findings with members of a racial minority b. Visiting the native land of the clients served at a community health center c. Telephoning the priest at a Hispanic church to discuss the health issues of a client d. Learning about traditional healing practices from an American Indian client

d Cultural encounter refers to the process that permits nurses to seek opportunities to directly engage in crosscultural interactions with clients of diverse cultures to modify existing beliefs about a specific cultural group and possibly avoid stereotyping. Learning about traditional healing practices is an example of a direct cultural encounter. This occurs when a nurse engages in cross- cultural interactions. Sharing significant assessment findings demonstrates the nurse sharing information, not an engagement with the population. When visiting a native land, there may not be interaction with any other culture. Telephoning a priest at a Hispanic church does not demonstrate an interaction, but rather the nurse calling the priest to accomplish a nursing task.