CH #1

Providing for the availability of essential personal health services for people who would otherwise not receive health care defines which public health core function? a) Assessment b) Prevention c) Assurance d) Policy development

C

A public health department makes sure that the essential community-oriented health services are available in the community. Which of the following core public health functions is being implemented? a) Policy development b) Assessment c) Assurance d) Scientific knowledge-based care

C Assurance focuses on the responsibility of public health agencies to ensure certain activities have been appropriately carried out to meet public health goals and plans.

Which is responsible for the dramatic increase in life expectancy during the twentieth century? a) Technology increases in the field of medical laboratory research b) Advances in surgical techniques and procedures c) Sanitation and other public health activities d) Use of antibiotics to fight infections

C Improvement in control of infectious diseases through immunizations, sanitation, and other public health activities led to the increase in left expectancy from less than 50 years in 1900 to more than 77 years in 2002.

Which of the following is a basic assumption of public health efforts? a) Health disparities among any groups are morally and legally wrong b) Healthcare is the most important in government planning and funding c) The health of individuals cannot be separated from the health of the community d) The government is responsible for lengthening the life span of Americans

C Public health can be described as what society collectively does to ensure that conditions exist in which people can be healthy.

A public health nurse deals with the examination of a community setting to determine the community's health status. Which of the following activities should be considered in the assessment phase? (Select all that apply.) a) Assisting communities to implement and evaluate plans and projects b) Building constituencies to work with the community c) Collecting, analyzing, and disseminating information d) Evaluating the social, economic, and environmental characteristics e) Questioning the ability of health services to the community

C, D, E

Which of the following best describes community-oriented nursing? a) Focusing on the provision of care to individuals and families b) Providing care to manage acute or chronic conditions c) Giving direct care to ill individuals within their family setting d) Having the goal of health promotion and disease prevention

D By definition, community-oriented nursing has the goal of preserving, protecting, or maintaining health to promote the quality of life.

A public health nurse provides a clinic for HIV-positive citizens in the community. This is an example of: a) Primary prevention b) Secondary prevention c) Tertiary prevention d) Policy making

C

A community-oriented nurse has identified obesity as a problem in the middle school. The next step in a population-focused practice is to make information available about the health of the middle school students. This describes the core public health function of: a) assessment b) assurance c) policy development d) research

A Assessment is a core function of public health and refers to systematically collecting data concerning the population, monitoring the population's health status, and making information available on the health of the community.

Which of the following best describes community-based nursing? a) A philosophy that guides family-centered illness care b) Providing care with a focus on the group's needs c) Giving care with a focus on the aggregate's needs d) A value system in which all clients receive optimal care

A By definition, community-based nursing is nursing that focuses on family-centered illness care to individuals and families in the community.

A nurse planning a smoking cessation clinic for adolescents in the local middle schools and high schools is providing: a) community-oriented care b) community-based care c) secondary care d) tertiary care

A Community-oriented nurses emphasize health promotion, health maintenance, and disease prevention, as well as self-reliance on the part of clients. Regardless of whether the client is a person, family, or group, the goal is to promote health through education about prevailing health problems, proper nutrition, beneficial forms of exercise, and environmental factors such as the safety of food, water, air, and buildings.

Two nurses plan to walk under a huge downtown bridge where various homeless persons live. Why would the nurses go to such an unsafe area? a) To assess the needs of the homeless who live there b) To demonstrate their courage and commitment c) To distribute some of their own surplus clothes to those who can use them d) To share with various churches and other charities what is needed

A In most nursing practices, the client seeks out and requests assistance. In public health nursing, the nurse often reaches out to those who might benefit from a service or intervention, beginning with assessment of needs.

A school nurse teaches three middle school students with asthma conditions techniques to minimize their incidence of bronchial spasms. This is an application of: a) community-based nursing. b) community-oriented nursing. c) institutional nursing. d) public health nursing.

A The goal of community-based nursing (CBN) is to manage acute or chronic conditions while promoting self-care among individuals and families. In CBN the nursing care is family centered, which means that the nurse works to improve the competencies of families to enable them to take better care of themselves. The nurse pays particular attention to the uniqueness of each family and works to plan the most useful interventions. Nurses practicing in the community and many staff public health nurses focus on providing direct care services, including health education, to persons or families outside of institutional settings, either in the home or in a clinic.

A nurse in a clinic that provides direct care services to clients with tuberculosis would be classified as practicing: a) community-based nursing b) community-oriented nursing c) institutional nursing d) public health nursing

A The nurse practicing as a community-based nurse is more likely to give direct care to people than are nurses who practice from a community-oriented framework. A community-oriented framework includes community-oriented nursing and public health nursing. Institutional nursing care is generally delivered in a hospital or nursing home setting.

The state public health agency has received multiple complaints regarding the availability of elder transportation services to a specific county senior center. The state agency assigns a public health nurse to work with the community to evaluate its program for elder transportation services to publicly sponsored eldercare programs. The public health core function applied is: a) assurance b) policy development c) primary prevention d) public transportation

A The public health core function of assurance focuses on the responsibility of public health agencies to be sure that activities are appropriately carried out to meet public health goals and plans. This involves making sure that essential community-oriented health services are available and accessible, especially to vulnerable populations who would otherwise not receive necessary services.

In a federally funded preschool program such as Head Start, nursing services that include conducting developmental-level screening for cognitive and psychomotor development of individual children would most likely be considered community-oriented nursing care when: a) individual results are compared with established standards for children of the same age group b) program characteristics are assessed for their effectiveness in making the school population healthier c) referral is provided for a child identified with delayed psychomotor development d) treatment is initiated for a child with an identified learning disability

A Within federally funded programs for preschool children, from a community-oriented nursing care perspective, nursing services could be provided to individual children by conducting developmental-level screening tests to evaluate each child's level of cognitive and psychomotor development in comparison with established standards for children of the same age. This is population-focused service. A community-based nurse may deliver illness care or direct services to individual children. A public health nurse may assess the program's ability to achieve the overall goal of making its population of children healthier by evaluating the characteristics of the facility, program, and environment for their effectiveness in achieving the goal.

Why are nurses increasingly providing care in clients' homes rather than in hospitals? Select all that apply. a) Home care is less expensive b) It is much more efficient to give care in the home c) Nurses prefer to give home care with individual attention d) People prefer to receive care in their homes rather than in hospitals

A, D An increasing number of clients are receiving care in the home because it is less expensive and clients prefer to receive care in familiar and comfortable settings.

An example of a multilateral organization is: a. United Nations (UN) b. United States Agency for International Development (USAID) c. Project Hope d. Catholic Relief Services

ANS: A A multilateral organization is one that receives funding from multiple governments and nongovernmental sources, which describes the UN. Project Hope and Catholic Relief Services are private voluntary organizations. USAID is funded by one country, the United States.

. A nurse is working at a state health department. Which of the following duties would most likely be completed in this setting? (Select all that apply.) a. Administering the Medicaid program b. Assessing the health needs of the state's citizens c. Employing and supervising school health nurses d. Establishing and maintaining free clinics for HIV-positive drug abusers

ANS: A, B State health departments try to prevent and respond to infectious disease outbreaks. They also are responsible for health care financing and administering Medicaid, providing mental health and professional education, establishing health codes, licensing facilities and personnel, and regulating the insurance industry. State health departments also give direct assistance to local health departments in such areas as ongoing assessment of health needs. DIF: Cognitive Level: Apply (Application) REF: pp. 38, 44

. What do demographic figures suggest about the ways in which the population of the United States is changing? (Select all that apply.) a. Approximately 12% of the U.S. population was born in a different country. b. Hispanics are the largest minority group population. c. Households consisting primarily of intact families continue to grow. d. Mortality for both genders in all age groups declined.

ANS: A, B, D Demographic figures confirm that 12% of the current U.S. population is foreign-born, with most immigrants coming from Latin America and about half as many from Asia. Families make up about 69% of all households, a decline from 81% in 1970. Although African Americans used to be the largest minority group, as of 2003, Hispanics now have that distinction. The population of the United States continues to increase, and mortality for both genders from all age groups has declined. DIF: Cognitive Level: Remember (Knowledge) REF: pp. 34-35

The health priorities in HEALTH21 are based on the concept of: a. Eradication of communicable disease worldwide b. Equality and solidarity with an emphasis on the responsibility for health c. World trade and knowledge sharing about health concerns d. Provisions for the creation of UNICEF

ANS: B HEALTH21 goals are equity and solidarity with an emphasis on the individual's, family's, and community's responsibility for health.

One intervention that has been shown to be effective in improving the health status of a population is: a. Decreasing the number of people who need outside resources b. Increasing in the number of children who can attend school c. Increasing the monetary resources that can be used to treat disease and illness d. Improving the ability to pay debt to more developed countries

ANS: B Health status improvement in children can lead to better education that eventually helps the countrys economic growth.

10. Which of the following best describes why local, state, and federal governmental agencies have started to cooperate and collaborate more closely in the last few years? a. Increased administrative pressures to demonstrate outcomes b. Increased focus on emergency preparedness and response c. Increased taxpayers' complaints and general unhappiness d. Increased pressure to decrease overlap in services

ANS: B Since the tragedy of September 11, 2001, health departments have increasingly focused on emergency preparedness and response. In case of an emergency event, state and local health departments in the affected area will be expected to collect data and accurately report the situation, to respond appropriately to any type of emergency, and to ensure the safety of the residents of the immediate area, while protecting those just outside the danger zone. This goal—to enable public health agencies to anticipate, prepare for, recognize, and respond to terrorist threats or natural disasters—has required an unprecedented level of interstate and federal-local planning and cooperation among these agencies. DIF: Cognitive Level: Understand (Comprehension) REF: p. 45

When utilizing the health care system in the United Kingdom, it is expected that the community health nurse will experience: a. An equal employer-citizen share in cost of health care b. Ownership and operation of the system by the government c. Nurse practitioners as the primary providers of care in the system d. Primary care provided in hospitals

ANS: B The United Kingdom has a tax-supported health system. Services are available to all without cost or for a small fee.

A nurse would anticipate finding signs and symptoms of which disease/disorder when assessing a refugee who fled the genocide in Darfur? a. Tuberculosis b. Post-traumatic stress disorder c. Chronic obstructive pulmonary disorder d. Malnutrition

ANS: B The biopsychological changes seen following genocide include physical stress reactions (cardiovascular, neurological) and mental stress responses, especially post-traumatic stress disorders and depression.

State public health agency responsibilities include: a. conducting community health assessments. b. enforcing public health codes. c. monitoring health status. d. providing expertise that facilitates evidence-based practice.

ANS: C Federal public health agencies develop regulations that implement policies formulated by Congress, provide funding to state and territorial health agencies for public health activities, survey the nation's health status and health needs, set practices and standards, provide expertise that facilitates evidence-based practice, coordinate public health activities across state lines, and support health service research. State public health agencies are responsible for monitoring health status and enforcing laws and regulations that protect and improve the public's health. They receive funding from federal agencies to implement public health initiatives. Local public health agencies are responsible for implementing and enforcing local public health codes and ordinances and providing essential public health services to the community. Cognitive Level: Application Associated Chapter Objective: 1 REF: p. 995

Rapid changes in public health are providing a challenge to PHNs because there is neither time nor staff to provide nurses with the on-the-job training needed to acquire the core public health competencies required of the PHN. This resulted in revisions to the American Nurses Association (ANA)'s Scope and Standards of Public Health Nursing Practice in 2005 that established: a. core public health functions as the competency framework. b. Minnesota Department of Health's Intervention Wheel as the practice competencies. c. standards for baccalaureate- and master's-prepared PHNs. d. Quad Council principles as the primary framework for practice.

ANS: C Historically, many of the core public health competencies were provided by PHNs who had learned these skills in the workplace while gaining knowledge through years of practice. Because of rapid changes in public health and limited resources, this approach to competency development can no longer be sustained. In 2007 and again in 2013, the ANA revised the 1999 Scope and Standards of Public Health Practice to reflect the increasing complexity and rapid changes faced by PHNs. The revised standards include standards that must be met by all nurses with baccalaureate degrees, the entry level into public health nursing, as well as standards that must be fulfilled by advanced practice PHNs prepared at the master's level. Cognitive Level: Analysis Associated Chapter Objective: 7 REF: pp. 1002-1003

The introduction of health care technology into lesser-developed countries has led to less-than-satisfactory results because: a. People do not want to use newer technology. b. The cost is so high that they cannot afford to use new technology. c. Other health needs may be more important than using complex technology. d. Technology is too complex for people in lesser-developed countries.

ANS: C It is not generally a lack of desire that is a barrier to use of the new technological systems, but the lack of knowledge about them. It is essential to conduct needs assessments to learn what a community has, what a community wants, and what it can sustain. Well-intended projects have failed because the most basic needs were not met, nor was recognition given to what resources and services the country could sustain.

Which of the following public health nurses most clearly fulfills the responsibilities of this role? a) The nurse who met with several groups to discuss community recreation issues b) The nurse who spend the day attending meeting of various health agencies c) The nurse who talked to several people about their particular health concerns d) The nurse who watched the city council meeting on local cable television

B Any of these descriptions might represent a nurse communicating, cooperating, or collaborating with community residents or groups about health concerns. However, the nurse who spent the day attending meetings of various health agencies is the most representative, because in public health, concerns are broader than recreation, individual concerns are not as important as aggregate priorities, and watching television is less effective than interacting with others.

A nurse is developing a plan to decrease the number of premature deaths in the community. Which of the following interventions would most likely be implemented by the nurse? a) Increase the community's knowledge about hospice care b) Promote healthy lifestyle behavior choices among the community members c) Encourage employers to have wellness centers at each industrial site d) Ensure timely and effective medical intervention and treatment for community members

B Public health approaches could help prevent about 70% of early deaths by influencing the way people eat, drink, drive, engage in exercise, and treat the environment.

Nurses should consider opportunities for population-focused practice that result from the rapid transformation of health care delivery from a medical model to a health promotion/disease prevention model. An example of such opportunity is: a) operator of a nurse practitioner-run urgent care center in a major retail location b) director of clinical services spanning inpatient and community-based settings that provide a wide range of services to the populations seen by the system c) clinical director of a home health agency d) school nurse position in the local high school

B The new focus on populations, coupled with the integration of acute, chronic, and primary care occurring in some health care systems, is likely to create new roles for individuals, including nurses, who will span inpatient and community-based settings and focus on providing a wide range of services to the populations served by the system. Such a role might be director of client care services for the health care system, who has administrative responsibility for a large program area. There will be a demand for individuals who can design programs of preventive and clinical services to be offered to targeted subpopulations and for those who can implement such programs.

Public health nursing is a speciality with a distinct focus and scope of practice and requires a special knowledge base different from other specialty areas of nursing. A public health nurse would first be interested in: a) drug treatments for diabetes b) populations with the highest rate of diabetes c) educational materials for individuals with diabetes d) new technology for diabetic care

B The primary focus that has differentiated public health nursing from other specialties has been the emphasis on the population rather than on individuals or families. The primary goal of public health—the prevention of disease and disability—is achieved by ensuring that conditions exist in which people can remain healthy. Diabetes care and educational materials are provided to individuals and families by a nurse in the community or institutional setting.

Which of the following variables have led to a stronger commitment to population-focused services? Select all that apply. a) Economic turmoil and demand for high-technology care b) Emergence of new or drug-resistant infectious diseases c) Emphasis on overall healthcare needs rather than only on acute care treatment d) Threat of bioterrorism

B, C, D As overall health needs become the focus of care in the U.S., a stronger commitment to population-focused services is emerging. Threats of bioterrorism, anthrax scares, and the emergence of modern-day epidemics have drawn attention to population-focused safety and services.

Public health nursing specialists are interested in which of the following topic(s)? (Select all that apply). a) Educational materials for individuals with HIV/AIDS b) Evaluation of an outreach program for at-risk pregnant teenagers c) Community subpopulations with high rates of type 2 diabetes d) New technologies to monitor diabetes e) Prevalence of hypertension among various age, race, and gender groups

B, C, E Public health specialists often define problems at the population or aggregate level as opposed to the individual level. At the population level, public health specialists are usually concerned with more than one subpopulation and frequently with the health of the entire community.

Which of the following best defines aggregate? a) A large group of persons b) A collection of individuals and families c) A group of persons who share one or more characteristics d) Another name for demographic group

C An aggregate is defined as a collection of people who share one or more personal or environmental characteristics, such as geography or special interest.

The role and goals of the community health nursing practice can best be described as: a) community-based interventions aimed at promoting, preserving, and maintaining the health of populations residing in institutional facilities such as nursing homes b) education of nurses and other staff working in community-based and community-oriented settings to improve the overall effectiveness of their programs to meet client needs c) population-level strategies aimed at promoting, preserving, and maintaining the health of populations through the delivery of personal health care services to individuals, families, and groups in an effort to improve the health of the community as a whole d) activities targeted at improving the health status of clients served by community-based health service agencies such as hospice and home health agencies

C Community health nursing practice is the synthesis of nursing theory and public health theory applied to promoting, preserving, and maintaining the health of populations through the delivery of personal health care services to individuals, families, and groups. The focus of community health nursing practice is the health of individuals, families, and groups and the effect of their health status on the health of the community as a whole (individual to families to groups to community flow).

Making sure that essential community-oriented health services are available defines which of the core public health functions? a) Policy development b) Assessment c) Assurance d) Scientific knowledge-based care

C Public health is based on scientific knowledge but is not a core function. The definition does not fit the terms assessment or policy development.

A registered nurse is seeking a position as a public health nurse. In reviewing the job description, the nurse would expect to find a description of a position that focused on functions such as: a) monitoring pregnant teenagers for symptoms of complications of pregnancy b) offering free hypertension screening and treatment referral at local health fairs to low-income, uninsured, community members c) partnering with local seasonal farmworkers to design a program aimed at preventing illness and injury, and advocating for this population with local political and community leaders d) preventing injury among a population of elderly residents in an assisted living facility and treating residents' chronic illnesses.

C The scope of practice of public health nurses is population focused and community oriented, with a primary emphasis on population-level interventions that target strategies for health promotion and disease prevention. In addition, public health nursing is concerned with the health of all members of a population or community, particularly vulnerable populations, and uses political processes as a major intervention strategy.

In a community clinic that screens and treats individuals for cardiovascular disorders, the nurse practicing public health/population-focused nursing would most likely ascertain: a) a holistic treatment plan b) a specific clinical diagnosis c) individual dietary interventions for cardiovascular disorders d) the prevalence of cardiovascular disorders among various group s

D A public health nurse in a community clinic engaged in population-focused practice would ask the following questions: What is the prevalence rate of the diagnosis or condition among various age, race, and gender groups? Which subpopulations have the highest rates of untreated diagnosis or condition? What programs could reduce the problem of untreated diagnosis/condition and decrease the risk for further morbidity and mortality? Public health nurses are typically concerned with more than one subpopulation, and they often deal with the health of the entire community. Assessment, one of the public health core functions, is a logical first step in examining a community setting to determine its health status.

Which of the following actions would most likely be performed by a public health nurse? a) Asking community leaders what interventions should be chosen b) Assessing the community and deciding on appropriate interventions c) Using data from the main healthcare institutions in the community to determine needed health services d) Working with community groups to create policies to improve the environment

D Although the public health nurse might engage in any of the tasks listed, he or she works primarily with members of the community to carry out core public health functions, including assessment of the population as a whole and engaging in promoting health and improving the environment.

The public health nurse has a clear vision of what needs to be done and where to begin to improve the health of the community. Why would the nurse spend time meeting with community groups to discuss the most important task to be addressed first? a) To increase the group's self-esteem b) To maintain communication links with the groups c) To make the groups feel good about their contribution d) To work with the groups, not for the groups

D Historically, healthcare providers have been accused of providing care for or to a people without actually involving the recipients in the decisions. Public health nursing is a "with the people" - not a "to the people" or "for the people" approach to planning.

In 1988, the Institute of Medicine (IOM) published a report on the future of public health and its mission that defined public health as: a) what public-private partnerships do to treat vulnerable populations b) what the government does to ensure that vital programs are in place c) what the U.S. Public Health Service does to prevent disease, promote health, and deliver service d) what society does collectively to ensure the conditions in which people can be healthy

D In 1988, the IOM's report stated that public health is "what we, as a society, do collectively to assure the conditions in which people can be healthy." Consequently, the mission of public health is "to generate organized community effort to address the public's interest in health by applying scientific and technical knowledge to prevent disease and promote health." This clearly places the emphasis on the desire of the population and community to ensure access to services that foster the health status of the overall community through the equitable distribution of resources addressed to community problems that affect health.

When talking to a women's group at the senior citizens' center, the nurse reminded them that the only way the center would be able to afford to provide transportation services for them would be for them to continue to write letters to their local city council representatives requesting funding for such a service. What was the nurse trying to accomplish through this action? a) Ensure that the women did not expect the nurse to solve their problem b) Demonstrate that the nurse understood the women's concerns and needs c) Express empathy, support, and concern d) Help the women engage in political action

D Public health nurses engage themselves and others in policy development and encourage and assist persons to communicate their needs to those with the power to take action.

Which of the following is the primary focus of public health nursing? a) Families and groups b) Illness-oriented care c) Individuals within the family unit d) Promotion of quality of life

D The key difference between community-based and community-oriented nursing is that community-based nurses deal primarily with illness-oriented care, whereas community-oriented nurses - or public health nurses - provide healthcare to promote quality of life.

When a business offers wellness incentives to its employees and then notices a decrease in the frequency of physician visits among employees, this is an example of: a. Macroeconomic theory b. Efficiency c. Supply and demand d. Microeconomic theory

ANS: D Microeconomic theory is examining the behaviors of individuals and organizations that result from trade-offs in utility and budget constraints of health care.

A community-oriented nurse conducts home visits to new parents to assess the health status of the infant, the parent-child relationship, the parents' knowledge regarding the care of the infant, and the need for health department and social services referrals to support the needs of the new parents and the infant. This can best be described as an example of: a) clinical community health practice b) community-based practice c) population-focused practice d) public health nursing

A Community-oriented nurses who provide direct care services to individuals, families, or groups are engaging in a clinically oriented practice even when they apply concepts of population-focused, community-oriented strategies along with their direct care clinical strategies.

A clinic treating a child for otitis media is an example of: a) Community-based care b) Public health care c) Tertiary health care d) Community-oriented care

A In community-based nursing, the nurse focuses on "illness care" of individuals and families across the life span. The aim is to manage acute and chronic health conditions in the community, and the practice is family-centered illness care.

Collecting data and monitoring the health status of the population defines which of the core public health functions? a) Assessment b) Prevention c) Assurance d) Policy development

A

Which of the following actions best represents public health nursing? a) Assessing the effectiveness of the large high school health clinic b) Caring for clients in their home following their outpatient surgeries c) Providing care to children and their families at the school clinic d) Administering follow-up care for pediatric clients at an outpatient clinic

A A public health or population-focused approach would look at the entire group of children being served to determine whether available services are effective in achieving the goal of improving the health of the school population.

A registered nurse was employed as a public health nurse. Which question would be most relevant for the nurse to ask? a) "Which groups are at the greatest risk for problems?" b) "Which patients should I see first as I begin my day?" c) "With which physicians will I be most closely collaborating?" d) "With which nursing assistants will I partner the most?"

A Asking which groups are at greatest risk reflects a community-oriented perspective. The other possible responses reflect a focus on individuals.

Which of the following actions demonstrate(s) effective public health nursing practice in the community? (Select all that apply). a) Epidemiologic investigations examine the environment for health hazards b) New services are organized where particular vulnerable populations live c) Partnerships are established with community coalitions d) Staff members are the public health agency continue to increase in number

A, B, C Evidence that public health nurses are practicing effectively in the community would include these: organizing services where people live, work, play, and learn; working in partnerships and with coalitions; and participating in epidemiologic studies.

During the depression of the 1930s, many federal agencies attempted to support the employment of basic nurses by increasing the demand for existing and new nursing services that meet the needs of the increasing ranks of impoverished individuals. Although this facilitated rapid program expansion for recipient public health agencies and gave many nurses a taste of public health, the specialty of public health nursing was negatively affected by: A. Decrease in focus on the community as the unit of service. B. Increase in the scope of fundamental services. C. Increase in field experience. D. Decrease in the need for training and supervision.

A. Decrease in focus on the community as the unit of service.

In the middle of the 19th century, there was an increase national interest in addressing public health problems and improving urban living conditions. Which of the recommendations of the Shattuck report in Massachusetts represented major innovations in public health during that period? Select all that apply. A. Establishment of state health department and local health boards in every town. B. Promotion of environmental sanitation and collection of vital statistics. C. Steps to decrease preventable disease and control smoking and alcohol use. D. Targeting of effort solely on environmental hazards. E. Provision of supplemental food to low-income persons.

ABC

The early pioneers in public health nursing were instrumental in founding the national organization for public health nursing, (NOPHN) in 1912. This organization serves as the dominant force in public health nursing until 1952 and sought to standardize public health nursing education to ensure the nurses receive more than hospital oriented training. Other major accomplishments included what initiatives? Select all that apply. A. Collaborated to secure health insurance reimbursement for nursing services, such as post discharge nursing care at home B. Establish public health nursing programs for military outpost in World War I C. Provided matching funds to establish maternal and Child health the visions in state health departments D. Responded to the 1918 worldwide influenza pandemic in the United States E. Supported nurse employment through increased grandson made for state programs of home medical care

ABD

The poor environmental conditions experience by immigrants in tenement houses in sweatshops were familiar features of urban life across the northeastern United States in the upper Midwest. Which of the following factors assisted community oriented nursing pioneers, such as Lillian Wald, and developing approaches and programs to solve the healthcare and social problems of the times? Select all that apply. A. Community health's focus on teaching and prevention. B. Establishment of settlement houses C. Establishment of the town and country nursing services in large cities. D. Lack of public interest in limiting disease E. Middle and upper-class fear of diseases

ABE

The federal-state-local partnership teams with other organizations to develop and implement responses to identified public health concerns because: a. community health is a shared responsibility. b. health objectives are defined nationally. c. population health is the responsibility of the government. d. public health trends focus on bioterrorism.

ANS: A PHNs partner with multidisciplinary teams of people within public health areas, in other human services and public safety agencies, and in community-based organizations. The health of communities is a shared responsibility that requires a variety of diverse and often nontraditional partnerships. Public health agency staffs include physicians, PHNs, nutritionists, environmental health professionals, health educators, various laboratory workers, epidemiologists, health planners, paraprofessionals who make home visits, and outreach workers. Community-based organizations include the American Red Cross (ARC), free clinics, advocacy groups, Head Start programs, daycare centers, community health centers, hospitals, senior centers, churches, academic institutions, and businesses. Other government agencies include fire/emergency services departments, law enforcement agencies, schools, parks/recreation departments, and elected officials. Cognitive Level: Analysis Associated Chapter Objective: 8 REF: p. 994

The PHN applies knowledge in working with a local school board coalition to develop a helmet safety campaign in the middle and high schools. This best exemplifies which aspect of public health? a. Core Competency b. Core function c. Nursing role d. Standard of practice

ANS: A The core public health competencies are divided into eight domains: analytical assessment skills, basic public health science skills, cultural competency skills, communication skills, community dimensions of practice skills, financial planning and management skills, leadership and systems thinking skills, and policy development/program planning skills. This example demonstrates such competencies as analytical assessment, communication, leadership, and policy skills. Cognitive Level: Application Associated Chapter Objective: 7 REF: pp. 1002-1003

Public health nurses (PHNs) are challenged to respond to public health-related trends of the twenty-first century, which include: a. racial, ethnic, and economic health disparities; rise of drug-resistant pathogens; unequal access to health care; and violence. b. violence, availability of health care for all, and increasing life expectancy. c. health disparities, access issues, and adequate mental health program funding. d. rise of drug-resistant organisms, increased life expectancy, societal violence, and more effective disease surveillance.

ANS: A Twenty-first-century challenges include increasing rates of drug resistance in community-acquired pathogens and societal issues such as welfare reform, economic disparities, racial/ethnic disparities, behavioral influences on health, and unequal access to health care. Cognitive Level: Analysis Associated Chapter Objective: 2 REF: p. 1000

Statistics clearly demonstrate that there are significantly more cases of a disease in one particular neighborhood than in all the rest of the city. Assuming all else is the same, which ofthe following is the most likely explanation for a single neighborhood having such a different pattern of illness? a.A cultural or ethnic concentration in the neighborhood b.The geographical location of the neighborhood within the city c.A statistical fluke without meaning d.The time of year the different statistics were collected throughout the city

ANS: A Although any explanation is possible, the most probable reason is that there is a cultural or ethnic concentration in that particular neighborhood that has a different lifestyle pattern, resulting in different health outcomes

Two women seem to agree on almost everything from favorite music to favorite media stars tothe best way to prepare a meal. Which of the following best explains this similarity in the two women? a.They are both members of the same birth cohort. b.They are close friends. c.They attended the same school. d.They both go the same church

ANS: A Being close friends is probably the result of the similarity rather than the cause. However, being born at about the same time would mean both women have lived through similar social events and media occurrences and therefore would have much in common. Going to the same school or the same church, depending on the size of the institutions, might not result in any personal interaction whatsoever

Which event would be considered the result of bioterrorism? a. Outbreak of smallpox b. Bombed historic buildings c. Explosion of land mines d. Threats of war

ANS: A Bioterrorism is a term used to describe the deliberate release of viruses, bacteria, or other germs (agents) used to cause illness or death in people, animals, or plants.

Which of these statements is true about the disability-adjusted life years (DALYs) in lesser-developed countries? a. Communicable diseases account for the greatest percentage. b. Diarrheal disease and respiratory infections are rampant despite technology. c. Injuries account for most disability. d. Birth control methods are often lacking.

ANS: A Communicable diseases account for the greatest percentage of calculated DALYs in lesser-developed countries.

Implementation of a teen pregnancy prevention program in a high school is shown to decrease the rate of teen pregnancy. This is an example of: a. Effectiveness b. Efficiency c. Microeconomics d. Production

ANS: A Effectiveness refers to the extent to which a health care service meets a stated goal or objective, or how well a program or service achieves what is intended.

An employee is able to receive health insurance from a former employer after changing jobs because of the: a. Health Insurance Portability and Accountability Act (HIPAA) b. Omnibus Budget Reconciliation Act c. Balanced Budget Act of 1997 d. Social Security Act

ANS: A HIPAA is a federal intervention to protect health insurance coverage for workers and families following a job change or loss.

Which characteristic has the greatest effect on health? a. Obesity b. Marital status c. Health insurance d. Age

ANS: A Personal behavior/lifestyle (obesity) has the greatest effect on health. Environmental factors (marital status) and human biology (age) are next followed by the health care system (health insurance).

Which statement regarding poverty and health insurance is true? a. Millions of people in the United States are without health insurance. b. The poor in the United States are as healthy as persons with higher incomes. c. Persons with money or health insurance are less likely to seek health care. d. The poor are more likely to receive health care through private agencies.

ANS: A In the United States, 49.4 million people are without health insurance. The poor in the United States are generally not as healthy as persons with middle or higher incomes. Persons with money and/or health insurance are more likely to seek health care. The poor are less likely to receive health care through private agencies.

Which medication would a nurse administer to a client diagnosed with tuberculosis? a. Isoniazid b. Nevirapine c. Amodiaquine d. Bacille Calmette-Gurin (BCG)

ANS: A Isoniazid is one of several chemotherapeutic medications used to treat tuberculosis. Nevirapine is used to decrease the likelihood of maternal transmission of HIV-AIDS. Amodiaquine is one of several medications used to treat malaria. Bacille Calmette-Gurin is a vaccine that has been promoted as effective in inducing active immunity against tuberculosis.

Which health problem is in need of control in developed countries? a. Hepatitis b. Malaria c. Polio d. Smallpox

ANS: A Malaria, polio, and smallpox are more commonly found in lesser-developed countries.

Which statement about the Medicare program is accurate? a. Part A provides coverage for hospitalization. b. Part A requires payment of a monthly premium for coverage. c. Part B provides payment for home health services and extended care facilities. d. Part B is available without cost to all elderly people who have paid social security taxes.

ANS: A Medicare Part A covers hospital care, home care, and skilled nursing care. Medicare Part B is a supplemental program available to all Medicare-eligible persons for a monthly premium.

Multilateral organizations: a. Receive funding from multiple sources b. Control the spread of disease c. Feed the people of the world d. Use nurses as their main source of information

ANS: A Multilateral organizations are those that receive funding from multiple government and nongovernment sources. The other items are specific to the agencies listed, but do not include all of the organizations.

Nurses should be cognizant of microeconomics because: a. Nurses are often the ones to allocate resources to solve a problem. b. Nurses are often involved in federal policy making. c. Nurses should know about microeconomics in order to deliver quality patient care. d. Health care supplies can be very costly and nurses must use them wisely.

ANS: A Nurses often allocate resources, design, plan, coordinate, and evaluate community-based health services.

An example of primary prevention is: a. A smoking cessation program b. Radiation therapy for lung cancer c. Care at a long-term care facility d. Hospice care

ANS: A Primary preventions aim is preventing disease. Radiation therapy, a long-term care facility, and hospice are secondary or tertiary care examples.

When a health care organization's fees for delivery of services are not decided until after they are provided, it is called: a. Retrospective reimbursement b. Prospective reimbursement c. Fee-for-service d. Capitation

ANS: A Retrospective reimbursement is the method whereby fees for the delivery of health care services in an organization are set after services are delivered.

Which is a disease that was once isolated and rare but is now widespread throughout the world? a. Acquired immunodeficiency syndrome (AIDS) b. Smallpox c. Malaria d. Measles

ANS: A Smallpox has been eradicated; malaria and measles were not isolated and rare throughout the world. AIDS was once isolated and rare, but is now worldwide.

8. A nurse is planning to conduct research on patient care outcomes. Which of the following agencies would the nurse use as a resource? a. Agency for Health Care Research and Quality b. Federal Agency for Patient Care Outcomes c. National Center for Nursing Research d. U.S. Agency for Patient Care Effectiveness

ANS: A The Agency for Health Care Research and Quality conducts research on health care systems, health care quality and cost issues, access to health care, and effectiveness of medical treatments. It provides evidence-based information on health care outcomes and quality of care. DIF: Cognitive Level: Apply (Application) REF: p. 42

A public health nurse is counseling a client who is trying to determine if a health maintenance organization (HMO) or preferred provider organization (PPO) will provide the better health care coverage. One main difference between these two types of managed care arrangements is: a. HMOs provide comprehensive care to its members for a fixed fee. b. PPOs designate providers that members can choose. c. PPOs employ physicians as PPO employees. d. HMOs provide financial incentives to encourage members to select HMO providers.

ANS: A The HMO is a provider arrangement whereby comprehensive care is provided to members for a fixed per member per month fee. A PPO uses predetermined rates for services to be delivered to members. HMOs have multiple models of delivery including the staff model, where physicians are HMO employees. PPOs provide financial incentives to encourage members to select PPO providers.

The administration at a local medical center examines the trends in health problems when developing long-range plans for staffing and space allocation. Which of the following sources of information would be most helpful? a.Local data drawn from a professional survey in the city b.The National Health Interview Survey c.The National Hospital Discharge Survey d.The state's vital statistics

ANS: A The National Health Interview Survey and the National Hospital Discharge Survey both provide information on the health status and behaviors of the national population. For many studies, however, the only way to obtain the needed information is to collect the required data in a study specifically designed to investigate a particular question

The intergovernmental organization that focuses its efforts on assisting countries in Latin America is the: a. Pan American Health Organization b. World Bank c. World Health Organization d. United Nations Childrens Fund

ANS: A The Pan American Health Organization serves as a regional field office in Latin America for the World Health Organization.

Which project would most likely receive funding from the World Bank? a. Development of a sanitation system b. Improvement of roads and bridges c. Creation of a national health insurance plan d. Recovery efforts following a hurricane

ANS: A The World Bank lends money to lesser-developed countries so that they might use it to improve the health status of their people. Projects include control and eradication of disease, providing safe drinking water and affordable housing, developing sanitation systems, and encouraging family planning and childhood immunizations.

1. A public health agency is planning to implement the electronic health record. Which of the following is a benefit of this choice? a. Facilitation of interprofessional care b. Improved client compliance with medical regimens c. Cost savings to the agency d. Compliance with JCAHO standards

ANS: A The electronic medical record facilitates interprofessional care in chronic disease management and coordination of referrals; 24-hour availability of records with downloaded laboratory results and up-to-date assessments; incorporation of protocol reminders for prevention, screening, and management of chronic disease; improvement of quality measurement and monitoring; increased client safety; and decline in medication errors. DIF: Cognitive Level: Apply (Application) REF: p. 37

A nurse is examining all of the various factors which can lead to disease. Which of the following models would the nurse most likely use? a.Epidemiologic triangle b.Health promotion c.Levels of prevention d.Natural history of disease

ANS: A The epidemiologic triangle categorizes factors as agent, host, or environment. The model encourages the health care provider to examine all the influences that lead to increased risk. Levels of prevention are actions taken to improve health outcomes. Health promotion addresses health improvement, not the risk for disease

Factors that influence health care costs include (select all that apply): a. Technology and intensity b. Demographics the aging population c. Chronic illness d. Use of the health care system

ANS: A, B, C All but the last option influence health care costs. The fact that individuals have, over time, consumed more health care is not an adequate explanation.

The Quad Council of Public Health Nursing identified eight principles that distinguish the public health nursing specialty from other nursing specialties, including which of the following? (Select all that apply.) a. Collaboration with other professions, organizations, and entities b. Optimal use of available resources c. Population-based unit of care d. Primary obligation to work for the good of individuals and families e. Engagement with clients as an equal partner

ANS: A, B, C, E The tenets (principles) of public health nursing were developed by the Quad Council of Public Health Nursing and integrated into the Scope and Standards of Public Health Nursing Practice of the American Nurses Association (ANA, 2005). These principles distinguish public health nursing from other nursing specialties. The eight principles include population-based unit of care; primary obligation to achieve the "greatest good for the greatest number"; engagement with clients as an equal partner; priority emphasis on primary prevention; focus on strategies that create healthy environmental, social, and economic conditions in which populations may thrive; obligation to reach out to all who might benefit; optimal use of available resources; and collaboration with other professionals, organizations, and entities. Cognitive Level: Synthesis Associated Chapter Objective: 1 REF: p. 998

To manage the public health aspects of a bioterrorist event, nurses need to understand (select all that apply): a. Medical management and public health measures b. The names and descriptions of the agent/disease c. The chemical features of the pathogens d. How to address mental health concerns

ANS: A, B, D Nurses need to understand the names of the pathogens and the disease they cause, the medical management and public health measures (so that accurate information can be disseminated), and how to help people cope with their feelings.

Which of the following provides evidence that the U.S. health care system is in crisis? (Select all that apply.) a. Full-time employees may not have health insurance as a benefit. b. Incompetent or negligent nurses are an ongoing source of medical errors. c. Long work hours and provider fatigue are a major factor in medical errors. d. More punitive measures must be taken to decrease provider errors.

ANS: A, C Although 61% of the non-elderly population continues to obtain health insurance through their employer as a benefit, employment does not guarantee insurance. As a result of the nursing shortage, nurses work longer hours and provider fatigue is a major factor in errors. The Institute of Medicine's (IOM) report To Err Is Human recommends that we stop blaming and punishing individuals for errors and instead begin identifying and correcting system failures by designing safety into the process of care. DIF: Cognitive Level: Understand (Comprehension) REF: p. 37

Which of the following explains why contagious infections are becoming a central focus of public health? (Select all that apply.) a.Americans are fearful of terrorists using biological agents. b.Awareness of human susceptibility to animal diseases has been publicized. c.Drug-resistant strains of "old" diseases have evolved. d.Media coverage exaggerates the dangers of exposure to crowds

ANS: A, C New infectious diseases and new forms of old diseases, such as drug-resistant strains of TB, have emphasized the dangers of infectious diseases. Potential threats from terrorist use of infectious agents have also emphasized infectious diseases

The Millennium Development Goals address (select all that apply): a. Reduction of child mortality b. Eradication of communicable diseases c. Promotion of gender equality and empowerment of women d. Achievement of universal health care access/AIDS, malaria, and other diseases; ensuring environmental sustainability; and developing a global partnership for development.

ANS: A, C The Millennium Development Goals address reduction of child mortality and promotion of gender equality and empower women. Other goals include eradicating extreme poverty and hunger; achieving universal primary education; improving maternal health; combating HIV

Which of the following statements are accurate descriptions of current social and economic trends in the United States? (Select all that apply.) a. Citizens are appreciating the quality of life enjoyed in the United States. b. Enjoying life is not as important as the need to take care of oneself. c. Many families are seeing decreases in family income. d. Massive and unexpected social and economic changes have occurred.

ANS: A, C, D One of the social trends influencing health care is a growing appreciation of the quality of life. The first decade of the twenty-first century has added massive and unexpected changes to health, economic, and social conditions in the form of terrorist attacks, hurricanes, fires, floods, and infectious diseases. In addition to layoffs, outsourcing, and other economic forces, many families are seeing wage decreases. DIF: Cognitive Level: Understand (Comprehension) REF: p. 35

A nurse believes a new mouth care procedure (MCP) is causing more mouth problems than it is helping to avoid. Which of the following must be present for the nurse to go to administration with confidence that the new mouth care procedure (MCP) is causing problems? (Select all that apply.) a.A plausible explanation of how the new MCP could cause harm b.A strong feeling that the MCP is the cause c.Consistently seeing mouth inflammation in many of the patients who have received the MCP d.Documentation from patient records that mouth inflammation in clients did not occur until after the new procedure was implemented

ANS: A, C, D Strength of association is suggested by the fact that patients who did not receive the MCP and patients seen on the floor before the new MCP did not have problems, whereas patients who received the new MCP are having problems. Seeing the problems in many of the patients suggests a consistency. The fact that those who had the procedure more often have worse problems suggests a dose-response relationship. A plausible explanation of how the new procedure could cause harm enhances the biological risk. Feelings alone are not convincing. Astudy should be set up to confirm or dispute the nurse's hypothesis. Although one would hope that previous testing would have been done before the product was released to market, the product could be safe for healthy persons but a risky process for those with compromised immunity or those who are under stress

A PHN in the local health department assists the community in identifying the health need priorities and the services that can best meet these needs in a cost-effective manner. This is an example of the tertiary prevention public health nursing function of: a. case finding. b. case management. c. collaboration. d. provision of direct services.

ANS: B Case management is a major tertiary prevention function for PHNs at the community level of practice. Case managers assist clients in identifying the services they need the most at the least cost. They also assist communities and populations in identifying services that will improve the overall community health status. Cognitive Level: Application Associated Chapter Objective: 3 REF: pp. 1006-1007

The PHN ensures that a local community coalition for improving school lunches takes the time to listen to each stakeholder's view, develops a common validated language for discussing the initiative, and shares the credit for the success of the initiative. The PHN is adhering to the principles of: a. collaboration. b. partnership. c. public health care. d. public health nursing.

ANS: B Changes can be accomplished more easily and effectively by partnerships and collaboration among groups than by the individual client and PHN working alone. The Community Campus Partnerships for Health involved its members and partners in developing nine principles of good practice for community partnerships in 1998. These include agreeing on a mission; values, goals, and measurable outcomes; establishing a relationship characterized by mutual trust, respect, genuineness, and commitment; building on identified strengths and assets but also determining areas for improvement; balancing power and enabling resources to be shared; ensuring clear, open, and accessible communication with ongoing listening and a common validated language; mutually establishing roles, norms, and processes; ensuring feedback to, among, and from all stakeholders; sharing the credit for accomplishments; and taking time for the partnership to develop and evolve. Cognitive Level: Analysis Associated Chapter Objective: 6 REF: p. 994

The PHN serves as a bridge between at-risk populations and the community's health care resources. This role is based on the nurse's responsibility to: a. collect and analyze data on public health programs. b. ensure that all populations have access to affordable, quality health care. c. monitor and assess critical health status indicators. d. provide evidence-based use of resources.

ANS: B Public health's shift from being the primary care provider of last resort to the developing partnerships to meet the health promotion and disease prevention needs of populations has raised concerns about available health care for the uninsured and underinsured. The role of the PHN given this ongoing shift in health care delivery is still being developed in many agencies. PHNs retain responsibility for ensuring that all populations have access to affordable, quality health care services. They accomplish this by advocating for legislation that promotes universal health care, such as increased funding for community health centers and expansion of Medicaid eligibility criteria, and by forming partnerships with hospitals, free clinics, and other organizations to ensure the availability of health care for all populations in the community. Cognitive Level: Analysis Associated Chapter Objective: 4 REF: p. 999

A characterization of the fourth developmental stage of the health services delivery framework is: a. Nurses in the United States being predominantly women b. The expansion of the number and type of health care facilities c. Dependence on technology for patient care d. The discovery and development of pharmacological advances

ANS: C Nurses have become dependent on technologies to monitor client progress, make decisions about care, and deliver care in innovative ways.

Evaluating a smoking cessation program, the gained or increased financial income, the improvements in the community attributable to the program, or costs that would result if the program was not given are examples of: a. Cost-effectiveness analysis b. Cost-benefit analysis c. Supply and demand d. Microeconomic theory

ANS: B Cost-benefit analysis involves the listing of all costs and benefits that are expected to occur from an intervention during a prescribed time.

12. African-American females have a higher mortality rate from breast cancer than White females. This is an example of: a. Projection b. Disparity c. Racism d. A sentinel event

ANS: B Disparities are racial or ethnic differences in the quality of health care, not based on access or clinical needs, preferences, or appropriateness of an intervention. DIF: Cognitive Level: Apply (Application) REF: p. 34

A nurse is employed as a nurse epidemiologist. Which of the following activities would most likely be completed by the nurse? a.Eliciting the health history of a client presenting with an illness b.Evaluating the number of clients presenting with similar diseases c.Performing a physical examination of an ill client d.Providing treatment and health education to a client with a disease

ANS: B Epidemiology differs from clinical medicine, which focuses on the diagnosis and treatment of disease in individuals. Epidemiology monitors the health of the populatio

A nurse is using analytic epidemiology when conducting a research project. Which of the following projects is the nurse most likely completing?a.Reviewing communicable disease statistics b.Determining factors contributing to childhood obesity c.Analyzing locations where family violence is increasing d.Documenting population characteristics for healthy older citizens

ANS: B Epidemiology refers not only to infectious epidemics but also to other health-related events. Analytic epidemiology looks at the etiology (origins or causes) of disease

The allocation of scarce resources within the health care sector and the focus on resource allocation issues related to producing and distributing health care is called: a. Economics b. Health economics c. Economic evaluation of health care d. Microeconomic theory

ANS: B Health economics is the allocation of scarce resources within the health care sector and the focus on resource allocation issues related to producing and distributing health care.

The nursing staff has attempted to screen the entire African-American population in the community for diabetes. Which of the following would provide immediate verification of the success of the nursing staff's efforts? a.An epidemic of diabetes will be recognized. b.The incidence of diabetes will increase in the community. c.The prevalence of diabetes will decrease in the community. d.The risk for diabetes in the community will increase

ANS: B If the screening has been successful, more diabetes will be diagnosed and, hopefully, treated. Thus, the incidence of new cases will increase. Overall, prevalence will also increase, but that is not one of the answer options

In a particular community, several high school students were diagnosed with diabetes mellitusType 2 during the annual high school health fair. Over the next few years, the nursing staff developed and implemented educational programs about the risk factors for diabetes mellitus Type 2 and proper nutrition. Which of the following would be most useful for the nurses to use to determine if they are having any impact? a.The epidemic of diabetes in the high school is gradually ending. b.The incidence of diabetes is slowly decreasing during screening events. c.The prevalence of diabetes is slowly decreasing during screening events. d.The risk for diabetes is slowly increasing over time

ANS: B Incidence rates and incidence proportions are the measure of choice to study etiology because incidence is affected only by factors related to the risk of developing disease and not to survival or cure. Prevalence is a fairly stable number over time, but incidence reacts more quickly to changes in risk factors or intervention programs. If the educational programs are having the desired impact, the incidence of diabetes being diagnosed will decrease in future screenings

Which of the following statistics is used by countries to compare the success of their health care systems? a.Attack rate b.Infant mortality rate c.Cause-specific morbidity rate d.Cause-specific mortality rat

ANS: B Infant mortality is used around the world as an indicator of overall health and availability of health care services

An example of a macroeconomics issue faced by nurses is: a. The evaluation of client access to services b. A health policy that makes the development of a new program possible c. Informing clients and others of the cost of service d. The referral of clients to available services

ANS: B Macroeconomics focuses on the big picture, such as a program, whereas microeconomics focuses on the individual or organization.

5. How does managed care attempt to control costs of care? a. By encouraging families to use the point of service list of individual practice associates b. By requiring families to choose a care provider from the MC network and not allowing access to other services without their provider's permission c. By moving Medicaid-eligible families onto state Medicare enrollment d. By refusing permission for families to use urgent care or emergency department services

ANS: B Managed care is a system in which care is delivered by a specific network of providers. Each provider serves as a gatekeeper who controls access to other providers and services. Cost is reduced because members cannot use specialists or seek hospital or other care without permission from their primary care providers. Thus, those enrolled in Medicaid managed care have restrictions that help keep costs down for government (and for taxpayers). DIF: Cognitive Level: Remember (Knowledge) REF: p. 40

A Medicare recipient has elected to pay a monthly premium for Medicare that will cover expenses, such as laboratory services and equipment. This part of Medicare is called Medicare Part: a. A b. B c. C d. D

ANS: B Medicare Part B is a supplemental (voluntary) program; it provides coverage for services that are not covered by Part A, such as laboratory services, ambulance transportation, prostheses, equipment, and some supplies.

Medicare and Medicaid are: a. Available to any citizen who wishes to enroll b. Two federal programs that provide insurance to special groups c. Private insurance providers d. Funded by the state government

ANS: B Medicare provides insurance for persons over 65, and Medicaid is for low-income and needy children, aged, blind, and/or disabled. Medicare is financed by the federal government. Medicaid is jointly financed by states and the federal government. They are not private insurance providers by definition.

Which of the following actions by Florence Nightingale demonstrates her role as an epidemiologist? a.She convinced other women to join her in giving nursing care to all the soldiers. b.She demonstrated that a safer environment resulted in decreased mortality rate. c.She obtained safe water and better food supplies and fought the lice and rats. d.She met with each soldier each evening to say goodnight, thereby giving psychological support

ANS: B Nightingale examined the relationship between the environment and the recovery of the soldiers. Using simple epidemiological measures, she was able to show that improving environmental conditions and adding nursing care decreased the mortality rates of the soldiers. Nightingale used statistics to document decreased mortality rates when the environmental factors were improved

The first phase of development of the health care system was characterized by: a. The rise in technology b. Epidemics of infectious disease, such as typhoid, influenza, and malaria c. Physicians and nurses who attained their skills in scientifically-based programs d. An expansion of hospital clinics and long-term care facilities

ANS: B Phase one was concerned with epidemics and infectious disease control. Technology is characteristic of phase four, and physicians and nurses attained skills in scientifically based programs in phase two. Phase three included the expansion of hospital clinics and long-term care facilities.

Population health is an approach and perspective that focuses on: a. Control of the spread of the HIV virus worldwide b. The broad range of factors and conditions that influence health c. Community-based care for all citizens d. Prevention and diagnosis of disease worldwide

ANS: B Population health is a holistic approach that considers the total health system.

4. Which of the following best describes ideal primary health care? a. Based on a multidisciplinary group of health care providers that work as a team b. Essential care available to all community members, which encourages self-management c. Focused on health promotion and disease prevention for everyone enrolled in the health center d. Local efforts to meet the Declaration of Alma Ata principles

ANS: B Primary health care is generally defined as essential care made universally accessible to individuals and families in a community with their full participation and at a cost that the community can afford. DIF: Cognitive Level: Understand (Comprehension) REF: p. 39

When a third-party payer establishes the amount of money that will be paid for the delivery of a particular service before offering the service to the client, it is called: a. Retrospective reimbursement b. Prospective reimbursement c. Fee-for-service d. Capitation

ANS: B Prospective reimbursement is the method of paying an organization whereby the third-party payer establishes the amount of money that will be paid for the delivery of a particular service before offering the services to the client.

Public health economics focuses on the: a. Use of resources b. Availability and usage of goods and services related to public health c. Scarcity of resources in the health care industry d. Management and use of monies to improve the health of populations

ANS: B Public health economics focuses on producing, distributing, and consuming goods and services related to public health.

2. A community health nurse is trying to increase enrollment in SCHIP. Which of the following interventions would be most effective? a. Explaining the program to children enrolled in public school systems b. Handing out SCHIP applications to uninsured children seen in local hospital emergency departments c. Having a newspaper campaign with information and applications printed in the newspaper d. Sending literature about the SCHIP program home with schoolchildren each year

ANS: B SCHIP builds on Medicaid to provide insurance coverage to low-income, uninsured children who are not eligible for Medicaid. Thus, the population that needs to be targeted for SCHIP is those being seen for medical care who do not have insurance. DIF: Cognitive Level: Apply (Application) REF: p. 37

Supply and demand is illustrated when: a. The demand for nurses in public health is low, but the supply is high b. Few goods or services are available, the price tends to rise c. Supplies are low, nurses must find alternate resources d. Lesser-developed countries receive supplies from other countries

ANS: B Supply and demand is in force when few goods or services are available, and then the price tends to rise.

An example of a philanthropic organization is: a. International Red Cross b. Carnegie Foundation c. Nestl d. Johnson & Johnson

ANS: B The Carnegie Foundation is a philanthropic organization, receiving funding from private endowment funds. The Red Cross is a nongovernmental agency, and Nestl and Johnson & Johnson are private voluntary organizations.

A community health nurse would use the global burden of disease (GBD) to track: a. The number of cases of HIV/AIDS in a country b. Losses from premature death and losses of healthy life that result from disability c. The economic impact of disability on lesser-developed countries d. The rate of disability in industrialized nations

ANS: B The GBD combines losses from premature death and losses of healthy life that result from disability.

Which was considered the first national health insurance plan in the United States? a. HMO Act b. Marine Hospital Service c. Medicare d. Medicaid

ANS: B The Marine Hospital Service was created in 1798 by the federal government to provide medical service for sick and disabled sailors and to protect the nations borders against the importing of disease through seaports.

A man is diagnosed with prostate cancer. Which of the following data should the nurse know to answer the man when he asks, "What are the chances I'll survive this thing?" a.Attack rate b.Case fatality rate c.Cause-specific morbidity rate d.Crude mortality rate

ANS: B The case fatality rate (CFR) is the proportion of persons diagnosed with a particular disorder (i.e., cases) who die within a specified period. The CFR is considered an estimate of the risk for death within that period for a person newly diagnosed with the disease. Persons diagnosed with a particular disease often want to know the probability of surviving. The CFR provides that information

An international agency is most likely to use its funds for: a. Development and installation of technology b. Food relief, worker training, and disaster relief c. Support of dictatorships and corrupt governments d. Funding of local private organizations

ANS: B The lesser-developed countries still receive the greatest amount of financial support from the more developed countries, but most of it goes toward food relief, worker training, and disaster relief instead of health care.

A woman is sitting in a corner of the clinical waiting room, crying audibly. The nurse asks, "What's wrong? Can I help?" The woman responds, "They just told me I have a positive mammogram and I need to see my doctor for follow-up tests. I know I'm going to die of cancer. How can I tell my family?" Which of the following information does the nurse need toknow in order to help the woman cope with this finding? a.The negative predictive value of mammography b.The positive predictive value of mammography c.The reliability of mammography d.The validity of mammography

ANS: B The positive predictive value is the proportion of persons with a positive test who actually have the disease, interpreted as the probability that an individual with a positive test has the disease

Which statement about the reimbursement of health services for nurses is accurate? a. Reimbursement for health care services can be directed only to physicians. b. Nurse practitioners and clinical nurse specialists are reimbursed for Medicare Part B services. c. Nursing care is a separate budget item in determining hospital service costs. d. Nursing care is reimbursed separately from medical care in outpatient settings.

ANS: B This became effective January 1, 1998, under Public Law 105-33.

Roles for nurses related to global health include providing (select all that apply): a. Medications and vaccines for worldwide use b. Direct patient care and facilitating education and health promotional needs of the community c. Knowledge and skill in countries where nursing is an organized profession d. Consultation to auxiliary personnel

ANS: B, C, D Nurses perform many roles related to global health, including providing direct patient care, facilitating education and health promotional needs of the community, providing knowledge and skill in countries where nursing is an organized profession, and providing consultation to auxiliary personnel.

A nurse is concerned about the high incidence of STDs in the community college population and sets up a special STD screening. Which of the following groups of students would be encouraged to attend? (Select all that apply.) a.Sexually active students currently receiving treatment for an STD b.Sexually active students who had been screened the previous year c.Students who claimed to not be sexually active and do not plan to become sexually active d.Students who are sexually active but never "go all the way

ANS: B, C, D Those already diagnosed with the problem are not at risk, because they already have the condition and are no longer at risk for developing it

A nurse is planning to host a health screening at a large urban mall. Which of the following variables will help the nurse determine which screenings should be included? (Select all that apply.) a.Adequate space for persons to lie down after testing until side effects are reduced b.Health problems for which the specific population is at risk c.Whether adequate privacy can be obtained for the invasive or embarrassing procedures d.Whether health care providers are available to follow up on any positive screening results

ANS: B, D The screening tests should be reliable, valid, fast, and inexpensive. They should have few side effects, be minimally invasive, and be capable of detecting enough new cases to warrant the effort and expense. Results should be known immediately. No tests should be used that have negative side effects, are invasive, or cause embarrassment. Ethically, nurses should not screen for any problem unless they can refer those with positive results to a source for follow-up testing and treatment

Which is an example of one of the components of a unit of disability-adjusted life years (DALYs)? a. A woman who lives to be 100 years old b. A woman who contracts HIV after working as a prostitute c. A father with 5 children who dies at the age of 50 from malaria d. A woman who gives birth to a premature infant

ANS: C A male who dies from malaria at age 50 would represent 30 DALYs. Measurement is based on the potential limit for life, which has been set at 82.5 years for women and 80 years for men.

Which antimalarial intervention would be appropriate for client teaching when educating those living in an area of the world where malaria is endemic? a. Receive a dose of IV quinine. b. Avoid direct contact with individuals who have malaria. c. Use insecticide-treated bed nets. d. Apply dichlorodiphenyltrichloroethane (DDT) spray.

ANS: C An effective antimalarial intervention is the use of insecticide-treated bed nets. Malaria is contracted by being bit by an infected mosquito; it cannot be passed by direct person-to-person contact. IV quinine is the drug of choice for treating malaria, not preventing it. Some mosquitoes are resistant to DDT, so this may not be effective.

If the two major goals of Healthy People 2020 are to be achieved, collaboration is essential for public health nursing practice, and collaboration with existing groups at the local level is encouraged for which of the following reasons? a. The federal government is ultimately responsible for the health status of the nation b. The public demands that the government protect the people c. Public health departments do not have the resources to accomplish these goals independently d. State health agencies must take a universal approach to achieving objectives

ANS: C Partnerships and collaboration among groups are much more powerful in making change than the individual client and PHN working alone. Because public health departments do not have the resources to accomplish the Healthy People 2020 goals independently, collaboration is essential to quality public health nursing practice, and collaboration with existing groups at the local level is encouraged. New partnerships are formed related to specific goals. Communities develop coalitions to address selected objectives, based on community needs that include all of the local community stakeholders, such as social service; mental health; educational, recreational, and governmental agencies and institutions; as well as businesses. Cognitive Level: Analysis Associated Chapter Objective: 5 REF: p. 1003

Which is referred to as a lesser-developed country? a. France b. Japan c. Indonesia d. Sweden

ANS: C A country that is not yet stable with respect to its economy and technological development is lesser developed, which describes Indonesia. France, Japan, and Sweden are considered developed countries.

Persons in an auditorium may have been exposed to a disease. If they are infected, it is crucial that they receive immediate treatment and not take the disease home to their families. Which of the following characteristics would be most important to consider when selecting the screening test to be used? a.The negative predictive value b.The positive predictive value c.The sensitivity of the test d.The specificity of the test

ANS: C Because it is most important to identify every case, the sensitivity of the test is crucial. High sensitivity is needed when early treatment is important and when identification of every case is important

This year 600 of 8000 young women ages 17 to 20 years at a university health center tested positive for a sexually transmitted infection (STI). Which of the following terms best describes this data? a.An epidemic b.Incidence c.Prevalence d.Risk

ANS: C Because we do not have baseline data, we have no way to conclude that this is an epidemic with higher-than-normal results from the screening. Incidence refers to new cases, whereas prevalence means all cases. We don't know whether the finding represents the first time a woman was told she had an STI or whether she had previously been diagnosed with the problem. Therefore, we can't say whether these are new cases (incidence), but the results do represent all cases (prevalence). Risk is the probability of developing an STI, but no risk factors are discussed

Which of the following actions would a nurse take to reduce the high incidence of coronary artery disease (CAD) in a community? a.Introduction of a heart-healthy curriculum beginning in the first grade, presentations on diet and exercise for the community at large, and special education sessions for high-risk populations b.Provision of online activities related to prevention of cardiac disease, smoking reduction programs, and blood pressure screenings c.Distribution of handouts, including age-appropriate games, self-assessments, and education on heart-healthy lifestyles; availability of community screenings for hyperlipidemia in persons age 35 and older; and walking programs for those affected with CAD d.Enrollment of clients with CAD into cardiac rehabilitation programs, routine evaluation of effectiveness of CAD treatment regimens, and participation in clinical trials that evaluate interventions for those diagnosed with CAD

ANS: C Education in schools, the community, and high-risk populations focuses only on primary prevention activities. Online activities focus only on primary and secondary prevention. Efforts focused only on those who already have CAD are not primary prevention. Distributinghandouts includes all three levels of prevention to target all members of the population. Targeting all members of the population and implementing all levels of prevention increase the likelihood of positive outcomes for the community as a whole

Conducting a class at a public health clinic on breast self-examination to a group of 50 women is an example of: a. Supply and demand b. Market c. Efficiency d. Effectiveness

ANS: C Efficiency refers to producing maximum output, such as a good or service, or using a given set of resources or inputs, such as labor, time, and available money. Teaching one topic to many people is an example of this.

Nurses can promote efficiency by: a. Evaluating how well a program of service achieves what was intended b. Trying new products provided by sales representatives c. Using time wisely by delegating non-nursing tasks to unlicensed care providers d. Setting up a clinic to look aesthetically pleasing to clients

ANS: C Efficiency relates to producing maximal output given a set of resources. Using time wisely through delegation is the best example of using efficiency.

A woman living in a lesser-developed country is likely: a. At risk for a Vitamin E deficiency b. To have several children c. At risk for death during pregnancy and childbirth d. Viewed as the leader of the family unit

ANS: C Most deaths to women worldwide are related to pregnancy and childbirth. Most of these deaths occur in lesser-developed countries. Common nutritional deficiencies in this population are zinc, iodine, vitamin A, folic acid, and calcium. One of the reasons this problem exists is because women are not seen as valued members of society.

3. A nurse is explaining the health care system in the United States to a group of physicians visiting from South America. How would the nurse best describe the current health care system? a. "It is a logical, rational approach to meeting expressed needs while still trying to control costs." b. "It is a system in the process of reform as problems have become increasingly apparent." c. "It is divided primarily into two components: private health care and public health care." d. "It is the best in the world with outstanding research and high-technology care available to all."

ANS: C Health care in the United States consists of a personal care system and a public health system, with overlap between the two. DIF: Cognitive Level: Apply (Application) REF: p. 39

What would be the best strategy for a government to use to prepare for bioterrorism? a. Threaten lesser-developed countries so they dont develop biological weapons. b. Ban biological weapons worldwide. c. Effectively detect pathogens and manage services. d. Develop antidotes for biological agents.

ANS: C Health care professionals and public health officials need to be able to effectively detect pathogens, manage services, and communicate during a bioterrorism threat.

A nursing staff has successfully screened for diabetes in the community. Which of the following might best persuade the health board to increase funding for diabetic clinics in this community? a.An epidemic of diabetes is now recognized and must be addressed. b.The incidence of diabetes is now higher than previously recognized in the community. c.The prevalence of diabetes is now higher than previously recognized in the community. d.The risk for diabetes in the community could decrease if funding is received

ANS: C If more people are now being diagnosed with diabetes and need support, more ongoing services will be needed for this population. Incidence may go up and down, but prevalence is a fairly stable number

Which of the following statements describes how nursing in the community is more challenging than nursing in an acute care setting? a.There is limited access to information useful to the nurse in giving care in the community. b.More paperwork and forms are required when giving care in the home. c.It is more challenging to control the environment in the community. d.Specialization isn't possible in the community setting

ANS: C In the community, nurses often use epidemiology, since the factors that affect the individual, family, and population group cannot be as easily controlled as in acute care settings. It is essentially impossible to control the environment in the community

A nurse advises a client with osteoporosis to have three servings of milk or dairy products daily. Which of the following levels of prevention is being used by the nurse? a.Primary prevention b.Secondary prevention c.Tertiary prevention d.Treatment, but not prevention

ANS: C Interventions that prevent worsening of a condition are tertiary prevention activities. In this instance, the client already has a health problem (osteoporosis). By advising adequate dairy intake, the nurse aims to ensure that enough calcium is available to limit worsening of the osteoporosis

Which individual would most likely receive Medicaid services? a. An 85-year-old female who has hypertension b. A 25-year-old female who is pregnant c. A 50-year-old male who is blind d. A 70-year-old male who is hearing impaired

ANS: C Medicaid provides financial assistance to states and counties to pay for medical services for the aged poor, the blind, the disabled, and families with dependent children who are below state poverty income levels.

Which service would be covered under Medicare Part A? a. Blood draw to assess PT/INR b. Physical therapy visit c. Stay in skilled nursing facility d. Transportation by an ambulance

ANS: C Medicare Part A covers hospital care, home care, and skilled nursing care.

A person with end-stage kidney failure who is on dialysis is eligible for: a. Medicaid b. Blue Cross c. Medicare d. HMO

ANS: C Medicare is available to anyone on dialysis regardless of age.

A nurse is administering a tuberculosis skin test to a client who has AIDS. Which of the following results should the nurse anticipate when using this screening test? a.Decreased positive predictive value b.Decreased reliability c.Decreased sensitivity d.Decreased specificity

ANS: C Persons with immune deficiencies may have a negative tuberculosis skin test even though they are infected. Sensitivity is the extent to which a test identifies those individuals who havethe condition being examined. AIDS is an acquired immune deficiency; thus, clients with AIDS may have a false-negative response to TB skin tests; that is, they have the disease but the test is not sensitive enough to detect infection in these individuals. Therefore, there is decreased sensitivity with those clients

Which is an example of a service offered at the federal government level? a. Family planning b. Counseling c. Policy making d. Prevention of communicable diseases

ANS: C Policy making is offered at the federal level. Family planning, counseling, and preventing communicable and infectious disease are offered at the state and local levels.

A nurse reports that in comparison to all the children in a particular school, the children who are members of the Cub Scouts have 0.3 risk for obesity before entering the sixth grade. Which of the following recommendations would the nurse make to the new parents of two boys who had just moved into this school's neighborhood? a.Discourage the parents from enrolling their sons in Cub Scouts because of the risk. b.Don't say anything about Cub Scouts, because it isn't relevant to nursing care. c.Encourage the parents to enroll their sons in Cub Scouts. d.Share the finding and let the parents draw whatever conclusions they feel appropriate

ANS: C Relative risk is an estimation of the risk of acquiring a problem for those who are exposed compared with those who are unexposed. As the risk for obesity is less for those that are members of Cub Scouts, joining the group is protective and reduces the incidence among members

A school nurse wants to decrease the incidence of obesity in elementary school children. Which of the following describes a secondary prevention intervention that the nurse could implement? a.Giving a presentation on the importance of exercise and physical fitness b.Designing a game in which students select healthy food choices c.Weighing students to identify those who are overweight d.Putting students on a diet if they weigh greater than 20% of their ideal weight

ANS: C Secondary prevention refers to interventions that increase the probability that a person with a condition will have the condition diagnosed early. Health screenings are the mainstay of secondary prevention. Weighing students and assessing whether the weight is higher than recommended will allow for early intervention so that obesity may be avoided

9. How does the Department of Agriculture promote the health of U.S. citizens? a. By collecting surplus food left after mechanical harvests and distributing it to the poor b. By inspecting food, so no foodborne illnesses can occur c. By collaborating with others to provide food or food stamps to needy persons d. By providing direct education and grants to dietitians and nutritionists

ANS: C The Department of Agriculture collaborates with state and local government welfare agencies to provide food stamps to needy persons to increase their food-purchasing power. Other programs include school breakfast and lunch programs; the Supplemental Food Program for Women, Infants, and Children (WIC); and grants to states for nutrition education training. The Department of Agriculture also engages in plant, product, and animal inspections, but limited funding prevents absolute surety that food is safe to eat. DIF: Cognitive Level: Understand (Comprehension) REF: pp. 43-44

A public health nurse found that out of the 70 people who ate the potato salad at a school picnic, 63 developed symptoms of food poisoning. Which of the following best describes the attack rate? a.63% b.70% c.90% d.100%

ANS: C The attack rate is the proportion of persons exposed to an agent who develop the disease. Because 63 of the 70 persons became ill, the attack rate is 63:70, or 90%

A nurse is investigating a bacterial illness that has caused a health problem in the community. Only some of the people exposed to the bacteria have become ill. Which of the following factors best explains why this would have happened? a.Chemical agent factors b.Environmental factors c.Host factors d.Physical agent factors

ANS: C The epidemiologic triangle includes the agent, host, and environment. The bacteria were the agent so chemical and physical agents are not relevant. The environment was apparently the same for everyone, since all were exposed to the bacteria. Therefore, only differences in host factors can explain why some became ill and some were able to fight off the bacterial infestation

Which of the following types of study should the nurse researcher choose if the goal is to identify the long-term benefits and risks of a particular nursing intervention for senior citizensliving in the community?a.Cross-sectional study b.Ecologic studyc.Clinical trial d.Retrospective analysis

ANS: C The goal of a clinical trial is to evaluate the effectiveness of an intervention. Clinical trials are generally the best way to show causality

Which statement about tuberculosis (TB) is true? a. Meningitis is the leading cause of death from tuberculosis. b. Chemotherapy, if made widely available, could eradicate the disease. c. Many TB cases are associated with HIV. d. The TB bacillus is difficult to isolate.

ANS: C The rise in HIV has lead to an increase in TB because the disease depresses the immune system. Chemotherapy is not always effective, especially in the new drug-resistant strains.

When working with colonias, it is important to remember: a. They have developed roads, transportation, and electrical services. b. They are frequently driven off, only to return to the same area. c. Their settlements have led to an increase in several disease conditions. d. Their contributions have improved the local economy.

ANS: C These settlements have led to an increase in numerous disease conditions associated with poverty, poor sanitation, and overcrowded conditions such as respiratory and diarrheal illnesses.

6. An 80-year-old woman comes to the community health care facility with a large bag of medications. She tells the nurse she can no longer afford these medications because her only income is Social Security. Which statement is the best response by the nurse? a. "Let's go through these medications and see which ones we can delete." b. "You can get these medicines at this clinic for free." c. "Let's see if we can get some help from Medicare to help you pay for these medications." d. "These medications are important. Do your best to pay for them."

ANS: C This elderly patient probably is eligible for benefits through Medicare Part D. Medicare Part D has been added to Medicare to help cover the cost of prescriptions. DIF: Cognitive Level: Analyze (Analysis) REF: p. 40

Between 2000 and 2005, 1000 of 10,000 young women ages 17 to 20 years at a university tested positive for a sexually transmitted infection (STI). Of the 1000 diagnosed STIs, 300 were gonorrhea and 500 were chlamydia. Which of the following statements best summarizes these findings? a.The proportion of cases of gonorrhea to all STIs was 300:1300. b.The proportion of cases of gonorrhea to chlamydia was 300:500. c.The proportion of cases of gonorrhea to all STIs was 50%. d.The proportion of STIs to the total population was 100:1000

ANS: D A proportion is a ratio in which the denominator includes the numerator. If the proportion is small, we can express the number per 1000. The answer of 300:1300 adds the total of the numerator to the denominator, which is unnecessary because the gonorrhea cases were already included in the denominator. In the answer of 300:500, the ratio comparinggonorrhea to chlamydia does not meet the epidemiological definition of proportion (i.e., the denominator must contain the numerator). Although proportions may be expressed as percentages, in the answer of 50% the percentage reflects the number of gonorrhea cases to allSTIs, which doesn't summarize the total STI problem. The answer of 100:1000 correctly summarizes that 1000 of 10,000 (or 100:1000) young women had the problem

A teacher recommends that surveys to obtain data on drug use be given to high school students when they meet for various school organizations. Which of the following best describes why the nurse would reject this suggestion? a.This method of data collection would result in classification bias. b.This method of data collection would result in confounding bias. c.This method of data collection would result in personal bias. d.This method of data collection would result in selection bias

ANS: D Any study is subject to bias resulting from selective choice. There may be a difference between students who choose to belong to an organization and students who choose not to join an organization. Selection bias occurs when selection procedures are not representative ofthe population as a whole. In this instance, the goal is to determine drug use of all students at the school. If only students who join school organizations are selected, those who do not join organizations will not be represented

7. A nurse is determining which health care services must be offered at a local public health clinic. Which of the following factors is most important for the nurse to consider? a. Data available from the most recent community assessment b. Suggestions from community members about what is needed c. Recommendations of Healthy People 2020 d. Services mandated by the state government

ANS: D At the local level, health departments provide care that is mandated by state and federal regulations. DIF: Cognitive Level: Apply (Application) REF: p. 40

Which individual would most likely experience a barrier when accessing health care? a. A 40-year-old female who speaks English b. A 25-year-old female with health insurance c. A 50-year-old male with hypertension d. A 30-year-old male who is unemployed

ANS: D Barriers to accessing care include the inability to afford health care, lack of transportation, physical barriers, communication problems, child care needs, lack of time or information, or refusal of services by providers. The unemployed male is most likely to experience a barrier because of not having a job, which may reduce his access to health insurance and limit his income.

A physician receives a set amount of money to provide care to a given group of clients for a set period of time. This is an example of: a. Retrospective reimbursement b. Prospective reimbursement c. Fee-for-service d. Capitation

ANS: D Capitation describes the practice of paying physicians and other practitioners a set amount to provide care to a given client or group of clients for a set period of time and amount of money. This is similar to prospective reimbursement for health care organizations.

Which religious organization would be contacted to provide food to starving people in a lesser-developed country? a. International Red Cross b. Church World Service c. Maryknoll Missionaries d. Catholic Relief Services

ANS: D Catholic Relief Services alleviates suffering and provides assistance to people in need affected by war, starvation, famine, drought, and national disasters without regard to race, religion, or nationality. The Red Cross is not a religious organization, and the Church World Service and Maryknoll Missionaries do other things besides providing food.

Income level and social networks are examples of: a. Culture b. Development c. Community d. Determinants

ANS: D Determinants are conditions and factors that are important considerations in population health.

An example of managed care is: a. Medicare b. Medicaid c. Medical savings accounts d. Health maintenance organizations

ANS: D Health maintenance organizations and preferred provider organizations are types of managed care.

Nurses working with aggregates would apply the macroeconomic theory because they are concerned with the: a. Factors that determine prices and affect resource allocation b. Positive effect of competitiveness on health care costs c. Supply, demand, and costs of services available to their clients d. Policies to support programs to improve the health of the community

ANS: D Macroeconomics focuses on the big picture, which is policy, whereas microeconomics focuses on the individual or organization.

A principal comments to the school nurse that it seems there are a lot more problems with asthma among the students than there were before the school was remodeled a couple of yearsago. The nurse investigates the principal's observation by reviewing all the school records to determine visits to the health office because of asthma by week and month for the past 5 years. Which of the following best describes the type of study the nurse is conducting? a.Descriptive epidemiological study b.Ecological study c.Prospective cohort study d.Retrospective cohort study

ANS: D Retrospective cohort studies rely on existing records to define a cohort that is classified as having been exposed or unexposed at some time in the past. In this case, the issue is whether there is some health risk in the new building addition that is increasing frequency of visits to the school nurse because of asthma

An example of a successful campaign against which of the following communicable diseases was carried out during the 1960s and 1970s? a. Tetanus b. Measles c. Pertussis d. Smallpox

ANS: D Smallpox was virtually eliminated throughout the world as a result of immunization.

11. Which of the following principles has been used by the American Nurses Association (ANA) when encouraging health care reform? a. High-technology interventions to reduce nursing time, effort, and medical errors must be expanded. b. Nurses must be recognized and rewarded for health promotion efforts. c. Nursing research into patient care outcomes must be expanded and funded. d. Universal access to essential health services should be available for all citizens.

ANS: D The ANA's position is based on the belief that health care is a basic human right. Thus, a restructured health care system must ensure universal access to a standard package of essential health care services for all citizens and residents. DIF: Cognitive Level: Understand (Comprehension) REF: p. 47

The key to achieving the goals of Health for All in the 21st Century (HEALTH21) is the worldwide: a. Cure of communicable disease b. Technological development of all nations c. Availability of health care insurance d. Implementation of primary health care

ANS: D The major key to attaining Health for All by the Year 2000 was the worldwide implementation of primary health care; this has extended into the next century with the document HEALTH21. The World Health Assembly in 1977 stated that all citizens of the world should enjoy a level of health that would permit them to lead a socially and economically productive life.

Which person is most likely to be uninsured? a. An 82-year-old woman with chronic medical problems b. A 2-year-old whose mother is on welfare c. A 50-year-old businessman who works for a large corporation d. A 32-year-old man who works part-time at a small business

ANS: D The typical uninsured person is one who works at a low-paying job, part-time or temporary, or at a small business. The elderly person would be eligible for Medicare, and the 2-year-old is probably eligible for Medicaid. The man who works at the large corporation probably has health insurance, since most large businesses provide it.

A nurse is examining the various factors that lead to disease and suggests several areas where nurses could intervene to reduce future incidence of disease. Which of the following models would the nurse most likely use? a.Epidemiologic triangle b.Health promotion c.Levels of prevention d.Web of causality

ANS: D The web of causality model recognizes the complex interrelationships of many factors interacting to increase or decrease the risk for disease. Causal relationships (one thing or eventcausing another) are often more complex than the epidemiologic triangle conveys. With all thevarious antecedents identified, the nurse can then decide in which areas interventions are possible

Worldwide, the most frequent cause of death from a single agent is: a. AIDS b. Malaria c. Hepatitis d. Tuberculosis

ANS: D Tuberculosis strikes nearly 3 million people each year. One third of the worlds population harbors the pathogen.

A nurse has only a regular blood pressure cuff when conducting a health screening for all of the residents of a community. Which of the following may be lacking when obtaining blood pressure readings? a.Reliability b.Sensitivity c.Specificity d.Validity

ANS: D Validity is the accuracy of a test or measurement, or how closely it measures what it claims to measure. With only one regular BP cuff, the nurse cannot obtain accurate measurements on those who are extremely obese or extremely thin. A thigh cuff and a pediatric cuff would allow the nurse to obtain accurate—that is, valid—measurements

Several small communities have applied for grant funding from the state department of health to help decrease their teenage pregnancy rate. Which of the following communities should the nurse suggest receive funding first? a.Community A—with 23 single teenage pregnancies in a city of 500 b.Community B—with 45 single teenage pregnancies in a city of 1000 c.Community C—with 90 single teenage pregnancies in a city of 2000 d.Community D—with 90 single teenage pregnancies in a city of 1500

ANS: D Without doing any actual math, it should be fairly obvious that 23:500, 45:1000, and 90:2000 are all about the same proportion but that 90:1500 is a larger proportion. Doing the math, the pregnancy rates of A, B, and C are 45-46:1000, whereas the rate in Community D is 60:1000

Jennifer is a nurse in a family medicine clinic. Today she is assessing Jose, a 4-year-old who is being seen for an earache. The type of nursing Jennifer practices is: a) community-oriented nursing. b) community-based nursing. c) public health nursing. d) tertiary health nursing.

B In community-based nursing, the nurse focuses on "illness care" of individuals and families across the life span. The aim is to manage acute and chronic health conditions in the community, and the practice is family-centered illness care. Community-based nursing is not a specialty in nursing but, rather, a philosophy that guides care in all nursing specialties. Community-oriented nursing has as its primary focus the health care either of the community or populations as in public health nursing (PHN) or of individuals, families, and groups in a community.

The most important contribution made by Florence Nightingale to community-oriented nursing was: A. Development of the settlement house concept is a strategy to improve urban health standards. B. Expansion of the role of nursing to include health-promotion practices. C. Founding the first district nursing Association in England. D. Introduction of professional schools of nursing in the United States.

B. Expansion of the role of nursing to include health-promotion practices.

In 1925, Mary Breckinridge established the frontier nursing service (FNS) based on the system of care used in the highlands and islands of Scotland. Changes in public support for community and public health nursing and away from individual commitment and private financial support lead to innovations in healthcare delivery in the 20th century, especially for underserved population's. One of Breckenridge's innovative contributions to healthcare in the United States was: A. Establishment of the federal emergency relief administration. B. Introduction of the first nurse-midwifery training. C. Introduction of the nursing process. D. Introduction of occupational health nursing.

B. Introduction of the first nurse-midwifery training.

The Association of community health nurse educators has called for increased graduate programs to educate PHN leaders, educators, and researchers in areas such as: A. Immigrant and migrant health. B. Natural and human-made disasters. C. Automobile safety for children. D. Student health.

B. Natural and human-made disasters.

The Social Security act of 1935 was designed to prevent the reoccurrence of the problems of the depression. Title VI of this act provided funding for expanded opportunities for health protection and promotion the most relevant strategy related to the subject for public health nursing was: A. Establishment of an FNS. B. Provision of funding to support employment and education. C. Provision of funding for research and investigation of disease. D. Institution of a district nursing model.

B. Provision of funding to support employment and education.

From a historical perspective, the post-depression shift in the US Congress to the practice of categorical funding that provides federal money for priority diseases are grouped as to this day produced a negative affect on the delivery of healthcare services that can best be described as: A. Adoption of two-year associate degree nursing programs. B. Exclusion of home-based care from health insurance coverage. C. National preference service model that neglects emerging problems. D. Rise in hospital-based care.

C. National preference service model that neglect submerging problems.

In 1902, Lillian Wald introduce the concept of school nursing to address the problem school absenteeism. The primary model for the school nurse program was to work with children in the schools and make home visits for the purpose of: A. Enforcing the department of health rules and regulations. B. Excluding infectious children from the school environment. C. providing and obtaining medical treatment for absent students. D. Providing shoes and clothing for students.

C. Providing and obtaining medical treatment for absent students.

Public health nurses who develop and implement local public health policies through partnerships with agencies, organizations, and consumers within the community are using which core public health function? a) Assessment b) Prevention c) Assurance d) Policy development

D

A public health nurse leader is encountering barriers when trying to shift the public health agency's efforts to a population-focused practice. The reasons peers are not supportive of the proposed shift to a population focus are most likely related to: a) agency colleagues' push for nurses to focus on population initiative b) costs associated with staff training and revision of documents c) lack of support from the agency's funding sources d) opinions that nursing should focus on the provision of direct client care and services

D Barriers to implementing population-focused care include lack of understanding of the public health nurse role and its relationship to other roles in nursing, such as direct care and services; workplace role socialization that determines what roles are appropriate and inappropriate or accessible and inaccessible for nurses; and lack of comprehensive training at the graduate level in the disciplines basic to public health such as epidemiology, biostatistics, community development, service administration, and policy formation.

The nurse often has to make resource allocation decisions. Which of the following best describes the criterion the nurse should use in such cases? a) The specific moral or ethical principle related to the situation b) The cheapest, most economical approach c) The most rational probable outcome d) The needs of the aggregate rather than a few individuals

D Although all of the choices represent components of a decision that the nurse might consider, the dominant needs of the population outweigh the expressed needs of one or a few people.