Ch 1-4 Community Questions
A microscopic approach to the community health problem of childhood obesity would focus on: A. asking an obese child and his or her parent(s) to complete a 24-hour food diary. B. analyzing aggregate Body Mass Indexes (BMIs) of school-age children in a school. C. advocating for a change in health policy related to school lunches. D. exploring changing cultural changes and societal values related to activity.
A A microscopic approach to the conceptualization of the problem of childhood obesity focuses on the individual child. A macroscopic approach focuses on the societal factors that influence health status. Analyzing aggregate BMIs, advocating a change in school lunches, and exploring societal and cultural values related to activity are examples of a macroscopic approach to the community health problem of childhood obesity.
Which of the following "determinants of health" would include predisposition to prostate cancer and a history of depression? A. Biology B. Behaviors C. Social environment D. Physical environment
A Biology refers to an individual's genetic makeup, family history, and physical and mental health problems experienced over the course of life. Behaviors are the individual's responses to internal stimuli and external conditions. Social environment includes interactions and relationships with family, friends, coworkers, and others in the community. The physical environment refers to the things that can be experienced with the senses. Biology is an individual's genetic makeup, family history, and any physical and mental health problems developed in the course of life.
Which of the following theories is based on the assumption that individual needs and related activities are the focus of nursing care? A. Orem's self-care deficit theory B. The health belief model C. Milio's framework D. Critical social theory
A Orem's self-care deficit theory is based on individual self-care needs and explains the level of nursing interventions required to assist clients to obtain optimal health. The health belief model (HBM) evolved from the premise that the world of the perceiver determines action. Milio's framework for prevention (1976) provides a complement to the HBM and a mechanism for directing attention upstream and examining opportunities for nursing intervention at the population level. Critical social theory uses societal awareness to expose social inequalities that keep people from reaching their full potential.
Modern community health nursing requires the nurse to __________, which empowers people to understand and address their health issues and disease. A. practice from a population focus B. adopt a medical model of care C. return to earlier models of prevention D. focus on the individual and family
A Population-focused nursing care includes people in solving their own health problems and focuses resources and health programs in a way to improve the health of entire populations, which include individuals, families, and communities. Adopting a medical model of care and returning to earlier models of prevention will not empower people to understand and address their health issues. Modern community health nurses focus on the population, not the individual and family.
Early public health nurse Lillian Wald and her associates were successful in addressing health and disease in the immigrant community by: A. supporting political activities to improve social and environmental conditions of immigrant families. B. administering bedside nursing care to immigrants and their families. C. teaching the immigrant family members to provide health care in the home. D. obtaining and administering medications to the immigrants and their family members.
A These early public health nurses saw that neither administering bedside clinical nursing, including obtaining and administering medication, nor teaching family members to deliver care in the home adequately addressed the true determinants of health and disease. They resolved that collective political activity should focus on advancing the health of aggregates and improving social and environmental conditions by addressing the social and environmental determinants of health. Wald and her colleagues (1971) impacted the health of the community by organizing the community, establishing school nursing, and taking impoverished mothers to testify in Washington, DC.
When nonindustrial cultures adopt Western customs and transition into urban environments, Western diseases begin to appear. Epidemiologic studies suggest that common risk factors that contribute these health conditions include: (Select all that apply.) A. changes in diet. B. environmental alterations. C. economic changes. D. increased population density. E. occupational hazards.
A, B, D, E Epidemiologic studies suggest that common risk factors that contribute to chronic health conditions are changes in diet (e.g., increases in refined sugar and fats and lack of fiber), environmental alterations (e.g., use of motorized transportation and climate-controlled living and work sites), and occupational hazards. An increase in population and population density also increase mental and behavioral disorders. Economic improvements in nonindustrialized communities would decrease the risk of disease. Economic changes in nonindustrialized communities are not listed as a common risk factor that contributes to chronic health conditions.
A variety of health indicators are used by health providers, policy makers, and community health nurses to measure the health of the community. Indicators that illustrate the health status of a community and may be useful in analyzing health patterns over time include: (Select all that apply.) A. morbidity. B. mortality. C. birth rates. D. life expectancy. E. cancer incidence rates.
A, B, D, E Some of the more commonly reported health indicators used by health providers, policy makers, and community health nurses to measure the health of the community are life expectancy, infant mortality, age-adjusted death rates, and cancer incidence rates. Birth rates do not provide relative data to measure the health of a community.
Using theory to guide community health nursing practice serves to: (Select all that apply.) A. guide data collection and interpretation in a clear and organized manner. B. provide uniformity in community health nursing practice. C. improve community health nursing practice. D. validate traditional community health nursing beliefs. E. focus the student on factors that are critical to understanding the situation
A, C Theory-based practice guides data collection and interpretation in a clear and organized manner. Although using theory makes it easier to plan standardized care for aggregates, the goal of theory is to improve nursing practice, thereby ensuring quality care. Through the process of integrating theory and practice, the student can focus on factors that are critical to understanding the situation. The lack of uniformity in theory definitions reflects the evolution of thought and the individual differences in the understanding of relationships among theory, practice, and research.
A major limitation of the health belief model is that the burden of action related to health behaviors is exclusively on the aggregate. A. True B. False
B A major limitation of the health belief model is that the burden of responsibility for health behaviors is on the individual client.
A risk factor refers to a(n): A. probability that a specific event will occur in a given time frame. B. exposure that is associated with a disease. C. systematic way of distinguishing the risks posed by potentially harmful exposures. D. proactive process in which individuals participate in behaviors that enable them to react to actual or potential threats to their health.
B A risk factor is an exposure that is associated with incidence of a disease. Risk is the probability that a specific event will occur in a given time frame. A risk assessment is a systematic way of distinguishing the risks posed by potentially harmful exposures. A risk reduction is a proactive process in which individuals participate in behaviors that enable them to react to actual or potential threats to their health.
In which of the following historical ages would people have had an increased risk for contracting salmonella, anthrax, Q fever, or tuberculosis from the proximity of domesticated animals and herds? A. Hunting and gathering stage B. Settled village stage C. Preindustrial cities stage D. Industrial cities stage During the settled village stage of the
B During the settled village stage of the Mesolithic period and Neolithic period, people became sedentary, formed villages, and domesticated herds of animals. They lived in close proximity to the animals and contracted diseases such as salmonella, anthrax, Q fever, and so forth because of cross-contamination of water and food supply. In the hunting and gathering stage, groups may have avoided many contagious diseases because the scattered aggregates were small, nomadic, and separated from other aggregates. In the preindustrial stage, large urban centers formed to support the expanding population. In the industrial cities stage, there was an increase in respiratory diseases such as tuberculosis, pneumonia, and bronchitis and in epidemics of infectious diseases such as diphtheria, smallpox, typhoid fever, typhus, measles, malaria, and yellow fever.
Receiving immunizations, regular health screenings, and physical exams is an example of: A. health promotion. B. health protection. C. secondary prevention. D. health maintenance.
B Health protection refers to behaviors in which the individual engages with the intent to prevent disease, detect disease in early stages, or maximize health. Immunizations and physical examinations are examples. Green and Kreuter (1991) define health promotion as "any combination of health education and related organizational, economic, and environmental supports for behavior of individuals, groups, or communities conducive to health." Secondary prevention refers to early detection and prompt intervention during the period of early disease pathogenesis, such as checking the skin for signs of skin cancer or identifying and treating individuals who have been exposed to contagious diseases. Health maintenance occurs when the individual has changed overt behavior for more than 6 months and strives to prevent relapse.
A smoking cessation class stresses increased lung function, money saved that is not spent on cigarettes, and smelling clean and fresh as benefits to quitting smoking. These support which of the following concepts? A. Perceived barriers B. Decisional balance C. Precontemplation D. Contemplation
B In the transtheoretical model, "decisional balance" describes weighing the benefits of a behavior change against the cost of behavior change. Perceived barriers to action are one's beliefs regarding the tangible and psychological costs of an advised action and include perceived unavailability, inconvenience, expense, difficulty, or time regarding health behaviors. In the precontemplation stage of change, the individual has no intention to take an action toward changing a behavior in the next 6 months. In the contemplation stage, the individual has some intention to take action toward behavior change in the next 6 months.
Every 10 years, the U.S. Department of Health and Human Services publishes a national prevention initiative titled Healthy People. One of the new objectives for Healthy People 2020 is to: A. achieve access to preventive services of all Americans. B. improve the nation's ability to prevent, prepare for, respond to, and recover from a major health incident. C. reduce health disparities among Americans. D. increase independence of older Americans.
B One of the new objectives for Healthy People 2020 focuses on preparedness for major health incidents. Achieving access to preventive services of all Americans and reducing health disparities among Americans were goals of Healthy People 2000, and increasing the independence of older Americans was a goal of the original 1979 Healthy People version.
According to the health belief model, the inconvenience of driving to a gym to exercise is an example of a: A. perceived susceptibility. B. perceived barrier. C. perceived benefit. D. cue to action.
B Perceived barriers to action are one's beliefs regarding the tangible and psychological costs of an advised action and include perceived unavailability, inconvenience, expense, difficulty, or time regarding health behaviors. Perceived susceptibility is one's belief regarding the chance of getting a given condition. Perceived benefit is one's belief in the ability of an advised action to reduce the health risk or seriousness of a given condition. Cues to action are strategies or conditions in one's environment that activate readiness to take action.
Disease prevention activities protect people from disease and the effects of disease. An example of primary disease prevention is: A. teaching people with diabetes how to prevent complications. B. administering vaccines to children before kindergarten. C. checking the skin of farm workers for signs of skin cancer. D. identifying and testing individuals exposed to someone with tuberculosis
B Primary prevention activities prevent a problem before it occurs; an immunization is given to prevent a disease before it occurs. Secondary prevention refers to early detection and prompt intervention during the period of early disease pathogenesis, such as checking the skin for signs of skin cancer or identifying and treating individuals who have been exposed to contagious diseases. Aims of tertiary prevention are to keep health problems from getting worse, reduce the effects of disease and injury, and restore individuals to their optimal level of functioning. Examples of tertiary prevention include teaching prevention of complications from disease or referring a patient with a stroke for rehabilitation.
Mary is a nursing student doing her senior project in community health. Part of her assignment is to conduct an activity that illustrates "social health" within a group in her community. The most appropriate activity for Mary to organize would be a: A. neighborhood block party. B. food bank in a local church. C. community yard sale. D. school fundraiser for the school band.
B Social health is a positive interaction among groups with an emphasis on health promotion and illness prevention. The correct choice is a food bank in a local church because a food program alleviates problems with hunger and nutrition that affect health. The other options do not relate to health.
A community health nurse explores a group of teenagers' beliefs about the seriousness of eating disorders and their related susceptibility. The nurse is applying principles from which theory? A. Orem's self-care deficit theory B. The health belief model C. Milio's framework D. Critical social theory
B The health belief model (HBM) offers indicators of the perceived seriousness, perceived susceptibility, and cues to action related to specific health behaviors. Orem's self-care deficit theory is based on individual self-care needs and explains the level of nursing interventions required to assist clients to obtain optimal health. Milio's framework for prevention (1976) provides a complement to the HBM and a mechanism for directing attention upstream and examining opportunities for nursing intervention at the population level. Critical social theory uses societal awareness to expose social inequalities that keep people from reaching their full potential.
During the Renaissance period, much was learned about health and disease. The Elizabethan Poor Law was enacted during this time to: A. govern personal and community hygiene such as contagion, disinfection, and sanitation. B. make local parishes responsible for caring for the poor in the community. C. enforce hygienic codes from Leviticus and establish leper houses. D. legislate social reform, addressing issues such as child welfare and factory management.
B Under the Elizabethan Poor Law, parishes established workhouses to employ the poor. Orphaned and indigent children were considered wards of the parish and were often forced to work long hours and live in substandard housing that negatively affected their health. The Minoans created laws that governed personal and community hygiene. In the Middle Ages, the church enforced hygienic codes from Leviticus and established leper houses. Social reform was legislated by the General Board of Health for England in 1848.
The use of theory in population-focused community health nursing encourages which of the following? (Select all that apply.) A. A reactive approach to care B. A proactive approach to care C. Development of population-focused programs D. Development of individual-focused health protocols for community use
B, C Theory assists the community health nurse in applying upstream thinking, including a proactive approach to population-focused care. A reactive or individual approach prevents progress toward "big picture" initiatives and population-based programs.
Lillian Wald and Mary Brewster's Henry Street Settlement was a model of modern health care. Which of the following services was provided to people living in the Lower East Side of New York City by the Henry Street Settlement nurses? (Select all that apply.) A. Emergency care and first aid B. Home visits to ill mothers and children C. School health services D. Industrial health services to local workers E. Support programs for immigrants
B, C, D, E The Henry Street Settlement was a model comprehensive health care center that provided many services, including home visits to mothers and children, support services for immigrants, the first school health and industrial health programs, and many other services. Emergency care and first aid were not provided services.
Public health efforts focus on prevention and promotion of population health. The local level of the health care system provides direct services to community members through community and personal health services. An example of a health service that targets the larger community, rather than individuals, is: (Select all that apply.) A. providing well-infant care. B. a mobile immunization clinic. C. condemning or repairing unsafe housing. D. encouraging family planning. E. airing a weekly public service announcement to remind women to do breast self-examination.
B, C, E A mobile immunization clinic, repairing unsafe housing, and airing weekly public service announcements all target the larger population of a community. Providing well-infant care and encouraging family planning target individuals.
Which of the following is an example of a modifiable risk factor? (Select all that apply.) A. Air pollution B. Cigarette smoking C. Gender D. Sexual practices E. Diet
B, D, E Modifiable risk factors are those aspects of a person's health risk over which he or she has control. Examples include smoking, leading a sedentary or active lifestyle, the type and amount of food eaten, and the type of activities in which he or she engages. Gender is not changeable. Air pollution can contribute to some disease processes, but it is not considered to be a direct risk factor.
Which of the following is an example of "community health nursing" rather than "community-based nursing"? A. An RN assisting a doctor in a pediatrician's office B. An RN visiting a home-bound patient to monitor for congestive heart failure C. An RN reviewing school clinic records to determine which children are not up to date on their immunizations D. An RN dispensing medications in a nursing home
C "Community health nursing" focuses on groups of people, with the primary responsibility being the population as a whole (as with a school). Care typically focuses on health promotion and illness prevention, such as the nurse who reviews school clinic records to determine which children are not up to date on their immunizations. "Community-based nursing" is setting specific and emphasizes care to individuals, often in homes and ambulatory clinics, and typically addresses acute and chronic health conditions. The other options are examples of nurses providing care to individuals.
It has been estimated that individual behaviors and environmental factors are responsible for what percentage of all premature deaths in the United States? A. 20% B. 40% C. 50% D. 70%
C According to Orleans and Cassidy (2011), 50% of all premature deaths in the United States are a result of individual behaviors and environmental factors. According to Mokdad, Marks, Stroup, and Gerberding (2004), tobacco use leads the list of "actual causes of death" at almost 20% of annual deaths in the United States.
A 22-year-old college student explains to the nurse at the health clinic that she drinks four to five beers when she goes out with friends on Saturday nights. Otherwise, she rarely drinks during the week because of her classes, studying, and part-time job. This would be considered: A. age- and circumstance-appropriate behavior. B. alcoholism. C. binge drinking. D. excessive drinking.
C Binge drinking is defined as drinking five or more drinks on a single occasion for men and four or more for women. Excessive drinking is drinking more than two drinks per day on average for men or more than one drink per day for women. This is considered binge drinking, which is not age- or circumstance-appropriate behavior. Alcoholism is an addiction to alcohol.
Edwin Chadwick's Report on an Inquiry into the Sanitary Conditions of the Laboring Population of Great Britaingreatly contributed to the development of the: A. National Organization for Public Health Nursing. B. American Medical Association. C. General Board of Health for England. D. National Institute.
C Chadwick's report was published in 1842 and began a move toward legislation resulting in social reform. The General Board of Health for England was established in 1848 as a result of this social reform. The National Organization for Public Health Nursing was formed as an organization for public health nurses. The American Medical Association was formed as an organization for physicians in the mid-1800s. The National Institute is a scientific organization based in Washington, DC.
A man has been smoking for 20 of his 40 years. He smokes a pack of cigarettes daily and states, "My dad smoked two packs a day and lived to be almost 90. Besides, I'm going to die from something anyway, so why quit"? He is in which "stage of change" in the transtheoretical model? A. Contemplation B. Maintenance C. Precontemplation D. Preparation
C In the precontemplation stage of change, the individual has no intention to take an action toward changing a behavior in the next 6 months. In the contemplation stage, the individual has some intention to take action toward behavior change in the next 6 months. In the maintenance stage, the individual has changed overt behavior for more than 6 months. In the preparation stage, the individual intends to take action within the next month and has taken steps toward behavior change.
The belief that health deficits result from an imbalance between the population's health needs and its health-sustaining resources is the premise of which theory? A. Orem's self-care deficit theory B. The health belief model C. Milio's framework D. Critical social theory
C Milio's theory demonstrates upstream conceptualization of understanding the community's health needs and resources; this theory complements the health belief model (HBM). The HBM offers indicators of the perceived seriousness, perceived susceptibility, and cues to action related to specific health behaviors. Orem's self-care deficit theory is based on individual self-care needs and explains the level of nursing interventions required to assist clients to obtain optimal health. Critical social theory exposes people to inequities to help them reach their full potential.
Which of the following nurse leaders formulated the first theory-based conceptual model for nursing care? A. Nancy Milio B. Lillian Wald C. Florence Nightingale D. Dorthea Orem
C Most nursing scholars identify Florence Nightingale as the first nurse theorist. Lillian Wald helped establish community health nursing in the United States. Nancy Milio created the framework for prevention theory. Dorthea Orem conceptualized the self-deficit theory.
Lemuel Shattuck, a Boston bookseller with an interest in public health, published the 1850 book Report of the Massachusetts Sanitary Commission. Which of the following was NOT a recommendation of the report? A. Keeping a record of vital statistics B. Developing well-infant and well-child care programs C. Introducing modern family planning methods in the United States D. Beginning a system of vaccination and health education
C Shattuck recommended major health reform that included keeping vital statistics; providing environmental control; food, drug, and communicable disease control; well-infant, well-child, and school-age child health programs; mental health care; vaccination; and health promotion. His recommendations were not implemented until nearly 19 years later, when a state board of health was formed in Massachusetts. Modern family planning methods were not introduced until the 20th century.
Jennifer is a community health nurse in a large metropolitan area. According to the American Nurses Association's Code of Ethics (2001), community health nurses must align themselves with public health programs that promote and preserve the health of populations by influencing: A. socioeconomic issues. B. psychosocial issues. C. sociocultural issues. D. developmental issues.
C The Code of Ethics of the American Nurses Association (2001) promotes social reform by focusing on health policy and legislation to positively affect accessibility, quality, and cost of health care. Community health nurses must align themselves with public health programs that promote and preserve the health of populations by influencing sociocultural issues, such as human rights, homelessness, violence, and stigma of illness. Directing care toward socioeconomic issues, psychosocial issues, or developmental issues focuses on individuals, families, or groups, which in turn contributes to the health of the total population.
Which of the following entities strives to improve the health of all the public by promoting healthy lifestyles, preventing disease and injury, and protecting the health of communities? A. Managed care organizations (MCOs) B. Medicare C. Public health system D. Affordable Care Act
C The Public health system strives to improve the health of entire populations by promoting healthy lifestyles, preventing disease and injury, and protecting the health of communities. Although MCOs and government financing entities (Medicare and Medicaid) focus on the health of their clients, they do not focus on the community and population in general. The focus of the Affordable Care Act is to mandate health insurance for individuals.
Which of the following statements is NOT true about the "thinking upstream" model of community health nursing practice? A. It is a conceptual model to assist the nurse in community health planning. B. It helps to focus the time, energy, and programmatic resources available to community health nursing clients. C. It focuses the nurse on short-term, individual-based nursing interventions. D. It focuses the nurse on long-term, "bigger picture" issues related to community health practice, such as social justice or power.
C The upstream model uses the analogy of a river flowing upstream toward the bigger picture to focus community health nursing practice. This differentiates population-focused and individual-focused nursing interventions. The community health nurse needs to have a "critical eye" for the bigger picture to focus time, energy, and resources and provide quality care.
The community health nurse is teaching a prenatal class and includes the societal cost of fetal alcohol syndrome in one of the educational sessions. The nurse is demonstrating an understanding of: A. Orem's self-care deficit theory. B. the health belief model. C. Milio's framework. D. critical theoretical perspective.
D Critical theoretical perspective exposes people to inequities to help them reach their full potential. Orem's self-care deficit theory is based on individual self-care needs and explains the level of nursing interventions required to assist clients to obtain optimal health. The health belief model (HBM) evolved from the premise that the world of the perceiver determines action. Milio's framework for prevention (1976) provides a complement to the HBM and a mechanism for directing attention upstream and examining opportunities for nursing intervention at the population level.
What discovery by Edward Jenner resulted in one of the greatest medical advances of the 18th century? A. The benefits of isolation in the control of communicable disease such as bubonic plague B. The discovery that cholera was transmissible through contaminated water C. The identification of modern epidemiologic principles, such as agent-host-environment D. The development of the smallpox vaccination that resulted in immunity after inoculation with the cowpox virus
D Edward Jenner's observation of a decline in the incidence of smallpox among people who worked with cows lead to his investigation of the connection between cowpox and smallpox and the development of the smallpox vaccination that prevented the disease in humans. At the time, the incidence of smallpox among the general population was 95%, and the death rate was 10%. Isolation and other epidemiologic principles were not recognized as beneficial in controlling communicable disease until modern times. John Snow demonstrated in 1854 that cholera was transmissible through contaminated water.
The first visiting nurse in the United States was: A. Lillian Wald. B. Mary Brewster. C. Florence Nightingale. D. Francis Root.
D Francis Root was an 1877 graduate nurse sent by the Women's Board of the New York City Mission to provide care to sick individuals in their homes. This was considered an innovation in nursing care in the United States and the precursor to modern visiting nurses' associations. Lillian Wald and Mary Brewster established a district nursing service in New York City in 1893. Florence Nightingale began her work in the mid-19th century and is credited with establishing "modern nursing."
What is the most common chemical dependence in the United States? A. Alcohol B. Cocaine C. Marijuana D. Nicotine
D Nicotine addiction is the most common form of chemical dependence in the United States. Smokers who try to quit experience withdrawal symptoms, including anxiety, irritability, and difficulty concentrating. Alcohol use is very common in our society, but it is not the most common form of chemical dependence. Cocaine and marijuana are not the most common forms of chemical dependence in the United States.
Which of the following was NOT a public health service provided by the Romans? A. A supervisor of the public baths B. Street cleaners C. Supervision of the sale of food D. Housing for the indigent population
D Public health services provided by the Romans included a water board to maintain the aqueducts, a supervisor of the public baths, street cleaners, and supervision of the sale of food. Housing for the indigent population was not a public service provided by the Romans; in fact, inhabitants of the Roman slums did not share in public health amenities, and their health suffered accordingly.
Which of the following "determinants of health" refers to factors that are experienced with the senses-things that can be seen, touched, heard, and smelled? A. Biology B. Behaviors C. Social environment D. Physical environment
D The physical environment refers to the things that can be experienced with the senses. The physical environment can affect health negatively or positively. Biology is an individual's genetic makeup, family history, and any physical and mental health problems developed in the course of life. Behaviors are the individual's responses to internal stimuli and external conditions. Social environment includes interactions and relationships with family, friends, coworkers, and others in the community.
