CH FINAL

Twenty people attended a church picnic the previous weekend. By Monday, four individuals exhibited symptoms of food poisoning. On Tuesday, the nurse in community health records the addition of two new cases. The incidence rate would be:

two new cases divided by 16 at risk

How does a significant portion of the population get health information

using the internet, health care professionals, and family & friends.

anthrax (not salmonella) forms spores when infected blood is exposed to the air

True

goal of elimination

remove a disease from a large area

Which would be considered a serious epidemic of influenza?

unable to determine

A

An American takes a long-awaited vacation in sunny Mexico, spending days on the beach eating fresh raspberries from a nearby vendor and drinking bottled water. The tourist may be altering: a. agent-host-environment interaction. b. circadian rhythms. c. herd immunity. d. resistance.

public health actions has been particularly instrumental in reducing childhood infectious diseases in the US

"No shots, no school" legislation, which legally requires children be immunized before school

Analytic Epidemiology differs from descriptive epidemiology, because it searches for:

"how & why" of disease patterns

What is the most frequently used single definition of community

"community of place" or geographic boundaries.

an instructor is reviewing salmonella infections with her class. the following comment indicates that the student needs further review on how it is spread

"it is spread by spores that form once contaminated blood is exposed to the air"

a student complains to the college health nurse that her academic work has been going downhill because of lack of sleep. '"my 3 yr old probably misses her babysitter since she has started going to the daycare center. she hasnt been sleeping well and keeps scratching her bottom. hopefully, she'll adapt to daycare soon. " which of the following information should the nurse provide to the student

"our daughter may have pinworms; let me teach you how to check for this"

A nurse in concerned about the accuracy of the PPD test identifying cases of TB exposure for follow-up chest x-ray. The nurse's concern is addressing the validity measure of:

Sensitivity

What are some strategies to enhance learning needs

1) Audiovisual 2) Brainstorming 3) Case studies 4) demonstrations 5) field trips 6) games 7) group participation 8) guest speakers 9) peer presentations 10) printed materials 11) role plays 12 simulations

What are some ways to develop cultural competence

1) Cultural awareness - self examination and in depth exploration 2)Cultural knowledge - learn about clients world view 3) cultural skill - integrate awareness and knowledge 4) Cultural encounter - engage in cross-cultural interactions 5) cultural desire - intrinsic motivation to provide care

Steps useful in planning an educational program

1) Gain their attention 2) tell the learners the objective 3) ask them to recall knowledge 4) present essential material in clear, organized, simple manner 5) help them apply the information 6) encourage demonstration 7) provide feedback

List the typical steps to follow in developing a health education program

1) Identify a population-specific learning need 2) select one or more learning theories to use in education 3) consider which educational principle most likely increase learning and more feasible 4) examine issue 5) design and implement 6) evaluate its effect

What are the five steps to educational process that builds on understanding of education, learning, and how people learn.

1) Identify educational needs - systemic and thorough assessment 2) establish educational goals (broad and longterm) and objective (specific and short) 3) Select appropriate educational methods 4) skills of the effective communicator 5) Motivational interviewing

What are the three dimensions of community

1) People - residents 2) Place - geographic and time dimensions 3) Function - aims and activities

How can we effectively assess a community?

1) Windshield survey - boundaries, zones, commons, transportation, social serves, street people and animals, condition of areas, race and ethnicity, religion, politics, medic, business industries 2) data collection - gather existing, generate missing data, interpret, and identify strengths and weakness 3) data gathering - demographic 4) Data generation - develop a data that do not exists 5) composite data analysis problems and strengths Page 221 - windshield survey, take public transportation, answer windshield survey questions, plan based on survey

What are the three natures of learning

1) cognitive - memory, recognition, understanding, reasoning, application and problem solving 2) affective - changes in attitude and development of values 3) psychomotor - performance of skill that requires necessary ability, sensory image, and opportunities to practice

What are the three steps in assessing the community?

1) gather relevant existing data and missing data 2) develop a composite database 3) interpret data to identify strengths and problems

What are some steps to assess needs (needs assessment)

1) identify what the client wants to know 2) collect data systemically (readiness to learn) 3) Analyze assessment data that have been collected 4) think about what will increase the client's ability and motivation 5) Assist client to prioritize learning needs.

A

Society bears the burden of infectious disease. That burden includes the effects of morbidity and mortality as well as the staggering: A. economic burden. B. fear burden. C. incidence burden. D. vulnerability burden.

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?

90% (63 / 70)

A city has announced its plans to build a city dump near a community of poor and predominantly African-American citizens. Which of the following principles would the nurse be using when vocalizing opposition for this plan? a. Environmental justice b. Equal rights c. Primary prevention d. Risk protection

A

A community citizen reports to the public health nurse that the city water in one neighborhood has had an unusual taste for the past few months. Which of the following actions should the nurse take first? a. Check the most recent consumer confidence report. b. Consult the Centers for Disease Control and Prevention. c. Notify the Environmental Protection Agency (EPA). d. Place a call to the poison control center.

A

A nurse is attempting to minimize damage following a bioterrorism attack in the community. Which of the following would be the most crucial aspect for the nurse to consider? a.Detecting an increase in people with similar signs and symptoms b. Identifying typical chemical or biological agents c. Identifying factors that put people at risk d. Recognizing areas of vulnerability within an area

A

A nurse is focused on mitigation of disasters at the international level. Which of the following activities would the nurse most likely complete? a. Provide community educational programs and training on how to prepare for disasters. b. Request donations be sent to the affected area. c. Develop a notification procedure to be used by the international disaster relief office. d. Recruit volunteers to be a part of the disaster team that will travel to the afflicted area.

A

A nurse is working with a community during the preparedness stage of disaster management. Which of the following events would the nurse anticipate occurring? a. Heightened inspection and increased security in the community b. Incorporation of provision of pets into local disaster plans c. Purchase of personal protective equipment for all citizens d. Assembly of disaster kits for the home, workplace, and car

A

A nurse, after working two weeks at the site of the largest natural disaster to hit the United States, returns home. Which of the following behaviors would suggest the nurse needs professional assistance? a. The nurse becomes angry when family members quit listening to her ongoing stories about the disaster and the problems there. b. The nurse gives a presentation at the local college about the disaster and describes how health professionals were able to assist the victims who were injured. c. The nurse is moody and feels family demands are not really as important as the other members of her family think they are. d. The nurse is very exhausted and asks to have 3 personal days off from employment responsibilities.

A

From an ethical standpoint, what is the problem with the belief that everyone should receive his or her fair share, that life should always be fair, and that everyone should make his or her own decisions? a. With this belief, the needs of society as a whole are ignored. b. Insufficient resources exist to give everyone a fair share. c. This belief leads to a propensity for some people to like to be taken care of. d. Some people think they deserve more than their fair share.

A

The nurse learns that a family has decided not to accept medical intervention for a health care problem because paying for the care would drastically reduce the family's resources and ability to meet the needs of other family members. Ethically, which of the following actions should be taken by the nurse? a. Appreciate that the family has made the decision that it feels is best and take no further action if it is clear the family has made an informed choice. b. Stress that each individual in society has a right to health care and the family will have to create some way to raise funds for the needed treatment. c. Talk to the media to see whether a campaign to raise funds for the family can be created. d. Try to convince the agency to give the care for free, even if it means economic stress for the agency, because the medical need is obvious.

A

When and by whom was nursing's first code of ethics written? a. 1893, by Lystra Gretter b. 1950, by the ANA House of Delegates c. 1953, by the International Council of Nurses (ICN) d. 2001, by the ANA House of Delegates

A

When does disaster management begin? a. Before the disaster occurs b. During the disaster c. Immediately following the disaster d. During the recovery period

A

Which of the following actions represents the use of secondary prevention to reduce environmental health risks? a. Collecting blood specimens from preschool children to check for lead levels b. Meeting with local government officials to request that the city clean up a hazardous vacant lot c. Referring a child with toxic lead levels to a neurologist d. Teaching parents of a 2-year-old about the dangers of lead-based paint in older homes

A

Which of the following levels of prevention is being used by a nurse who is helping to develop a community-wide disaster management plan? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. All prevention levels

A

Which of the following best defines the word politics? a) A neutral term meaning influence b) The outcome of governmental policies c) A provision of power for making decisions d) The result of legislative action

A Politics is a neutral term meaning the art of influencing others to accept a specific course of action.

Several community-oriented nurses want to explore the problem of obesity in school-age children and assess their community school district health status related to that problem. When gathering information at a national level, they would begin with the: a) Centers for Disease Control and Prevention (CDC) b) Centers for Medicare and Medicaid Services (CMS) c) Health Resources and Services Administration (HRSA) d) National Institute of Nursing Research (NINR)

A The Centers for Disease Control and Prevention (CDC) serves as the national focus for developing and applying disease prevention and control, environmental health, and health promotion and education activities designed to improve the health of the people of the United States.

Which of the following activities is completed by the executive branch of the federal government? a) Administration of policy b) Interpretation of policy c) Proposal of policy d) Passage of policy

A The executive branch administers and regulates policy. The legislative branch proposes policy (as bills) and passes policy (as laws). The judicial branch interprets laws.

A client states to the nurse, "I have heard the Affordable Care Act is supposed to help improve the health care I receive, but so far I have seen no benefits from this legislation." Which of the following statements would be the best reply by the nurse? a) "Maybe you have not directly seen the changes; however, several things have changed in health care because of this bill." a) "It will take years to see any effects from the act because of the delays in implementation of the changes." c) "This legislation will primarily improve care for the elderly and poor populations, so this is why you may not have seen any benefits." d) "The way health care operates at the federal and state levels has changed, so most individuals will not see any direct impact."

A The goal of the Affordable Care Act in 2012 was to improve the health of the nation and access care. Several changes to health care have already been made because of this legislation, and more changes will continue in the future. However, it is possible that unless one has been in a situation where changes have been made, that one may not realize any of the effects of this law.

Three nurses disagree over the appropriate treatment for a woman who is an excellent candidate for hospice care. The first nurse believes that deciding on care rather than cure is the woman's decision and no one else can decide for her. The second nurse says that it is the responsibility of the health care team to do good for the woman, and if the physician thinks there is still a possibility of cure, then the nurses should do everything they can to implement the treatment plan. The third nurse states that it isn't fair for the family members to expend all their resources on the woman, who is probably going to die anyway. Which of the following conclusions can be drawn from this dispute? (Select all that apply.) a. Ethical principles can conflict with one another. b. The nurses are each using different ethical approaches. c. The first nurse is correct because autonomy demands that the woman decide for herself. d. There is no single accepted approach for resolving such disagreements.

A D

B

A Medicare recipient has elected to pay a monthly premium for Medicare that will cover expenses such as laboratory services and equipment. Which of the following best describes this part of Medicare? A. Part A B. Part B C. Part C D. Part D

A

A case management nurse for a locally funded program for special-needs children is increasingly concerned about a recent referral for a 1-year-old child with a congenital illness residing in a poverty-stricken community. The nurse knows that this child may be at higher risk for the most harmful effects of poverty, including: A. developmental delays. B. ear infections. C. frequent colds and infections. D. irritability.

D

A case manager advocates for a client by helping an insurer understand the client's needs and desires and by helping the client understand programs and benefits offered by the insurer. What role is the nurse? a. Arbitrator b. Counselor c. Mediator d. Negotiator

C

A case manager implements a primary prevention activity. Which of the following actions would the nurse most likely complete? a. Advocating for the client whose values conflict with those of the medical service provider b. Collaborating between nursing and occupational health personnel c. Educating a group regarding community services that are available if ever needed d. Resolving conflict between a primary care clinic and a tertiary health care facility

A B D

A case manager is concerned about his exposure to possible lawsuits. Which of the following are appropriate actions to take to minimize this risk? (Select all that apply.) a. Assure clients they can appeal any decision. b. Carefully document client involvement and reasons for decisions. c. Share client information with the other involved providers and agencies. d. Confirm credentials and capabilities of providers or agencies to give care.

D

A case manager is concerned that some of the clients at the neighborhood clinic are getting fewer services because of their financial situations. The case manager is confronting the ethical principle of: a. justice. b. veracity. c. deontology. d. beneficence.

5. A nurse has invited community members to participate as full partners in creating changes to improve the health of the community. Which of the following may be an unexpected consequence of this action?

A change in the distribution or redistribution of power and influence

D

A client expresses concern that health care coverage based on capitation may have negative side effects. Which of the following would most likely be a consequence of capitation? A. Coercing clients to attend health promotion education classes B. Encouraging clients to seek care elsewhere C. Increasing the number of interventions to maximize payment D. Neglecting to order certain tests or treatment to minimize cost to the provider

A

A client is back for his follow-up appointment and says to the nurse, "I know. I know. I drink too much, but the job is so stressful that I need to find a way to unwind at the end of the day. You would too!" The nurse should recognize that this is a primary symptom of addiction known as: A. denial. B. social drug use patterns. C. setting variable. D. coping.

A

A client is using a primary prevention strategy to prevent infectious disease. Which of the following actions is the client most likely taking? a. A client receives a tetanus booster every 10 years. b. A client receives a tetanus booster after stepping on a nail. c. A client receives tetanus immunoglobulin after stepping on a nail. d. A client with tetanus is given antibiotics and is placed on seizure precautions.

A

A client requests help to stop smoking. Which of the following methods would be the best for the nurse to suggest to the client? a. A combination of interventions, beginning with changing the environment b. Acupuncture to reduce the nicotine cravings c. Behavior modification through hypnosis d. Nicotine replacement products

C

A client spends a great deal of his time on the Internet or reading articles related to diabetes and its long-term effects. One day the client asks why the nurse has not suggested a life care plan. Which of the following would be the best response by the nurse? a. "Life care plans are only for young persons who are newly diagnosed." b. "Life care plans are primarily used to determine long-term financial needs for legal reasons." c. "You are receiving appropriate care for your diabetes without serious side effects, so a life care plan isn't really appropriate." d. "I was waiting for you to express interest in having a life care plan."

C

A colonist is working in the public health sector in early colonial America. Which of the following activities would have likely been completed? A. Establishing schools of nursing B. Developing vaccines to administer to large numbers of people C. Collecting vital statistics and improving sanitation D. Developing public housing and almshouses

C

A community health nurse involved in care management would most likely: a. develop, conduct, and evaluate health teaching programs in primary care. b. manage the staff at a free clinic. c. monitor the health status, resources, and outcomes for an aggregate. d. provide immunizations to migrant workers.

B

A community health nurse is working with an uninsured family with two children. The nurse assists the parents in applying for SCHIP benefits and securing an appointment for the children with a community pediatrician that participates in SCHIP. The intervention can best be described as: a. care management. b. case management. c. continuity of care. d. disease management.

C

A community is experiencing an epidemic of the measles. The nurse is trying to determine if this problem is happening in other communities as well. Which of the following resources should the nurse use to answer this question? a. Centers for Disease Control and Prevention Weekly Report b. Communicable Diseases Weekly Report c. Morbidity and Mortality Weekly Report d. Weekly National Report of Communicable Diseases

C

A community mental health nurse is working within the community to help prevent youth violence. Which of the following interventions would most likely be implemented by the nurse? a. Distributing literature that associates violence with a lack of intelligence b. Explaining to youth why youth violence is detrimental to society c. Partnering with associations to provide alternative activities that improve social skills d. Recommending increased funding to prosecute and jail teens associated with violent activity

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 of the following is the most likely explanation for single neighborhood having such a different pattern of illness?

A cultural or ethnic concentration in the neighborhood.

B

A family nurse is working with a married couple that has decided to remain child-free. The nurse recognizes this decision as a: A. biological necessity. B. contemporary family function. C. religious belief decision. D. threat to family survival.

C

A father brings his stepdaughter to the family clinic for an immunization update before the new school year. The nurse notices the interaction between the young girl and her stepfather. The child appears tense and cautious and wraps her arms around herself in a protective manner. The child startles when touched by the stepfather and pulls away. The stepfather is overheard saying, "I'll leave you here if you don't behave and act nice." In this scenario, it would be important for the nurse to explore in her assessment the possibility of: A. child neglect. B. family secrets. C. father-daughter incest. D. impaired family functioning.

WHO definition of community?

A group of people, often living in a defined geographical area, who may share a common culture, values and norms, and are arranged in a social structure according to relationships which the community has developed over a period of time.

B

A home health client has been taking 50 mg of meperidine, a narcotic analgesic, every 4 hours for pain. Which of the following statements made by a nurse to the client's physician indicates a need for further education on narcotics? a. "You need to decrease the time interval between doses to every 3 hours so that my client will maintain pain relief." b. "You need to discontinue that order before my client becomes addicted." c. "You need to increase the meperidine so that my client will achieve adequate pain relief." d. "You need to give my client something in addition to the meperidine."

D

A home health nurse believes a client may be a drug addict. However, the client denies the use of drugs when questioned by the nurse. Which of the following is the most likely cause of the client's denial? a. Confusion resulting from dementia b. History of compulsive lying c. Mental status changes d. Use of addictive drugs

B

A hospice nurse is working with a cancer client and his family. The client's 7-year-old son has developed recent school and peer problems. Understanding the risk for disruption of normal development, the nurse plans to first screen the child for: A. developmental disorders. B. mental health problems. C. parental neglect. D. violence potential.

D

A large industrial plant has recently laid off a significant portion of its workforce because of scalebacks in production. The occupational health nurse proposes education sessions with the remaining employees about effective strategies for managing stress during economic downturns. This suggestion to management is based on the nurse's understanding that increases in aggression and violence at home and work may be triggered by: A. competition. B. unemployment. C. survivor guilt. D. work-related stress.

C

A long-distance truck driver being assessed by a nurse in a community-based clinic states, "I smoke 3 packs of cigarettes a day. I use coffee and diet pills from the drug store to stay awake on the road. That makes it difficult to sleep when I do pull over, so I use a prescription sleeping pill from my doctor to sleep for 4 hours. It's giving me palpitations." The nurse's assessment should include a diagnosis of: A. drug abuse. B. drug addiction. C. substance abuse. D. adverse drug reaction.

D

A male IV drug abuser admits to the nurse that he has no desire to stop using drugs, so rather than lecture him on the dangers of drug addiction, the nurse counsels him on how to sterilize his needles. Which of the following prevention efforts is the nurse attempting to achieve? a. Primary prevention by educating about safe injections b. Primary prevention by avoidance of future legal complications c. Secondary prevention to reduce the risk for infection or other complications d. Tertiary prevention to reduce the transmission of blood-borne diseases

D

A man is addicted to alcohol. In which of the following scenarios is a family member enabling the man to continue drinking? a. The wife asks the nurse to explain why her husband's continued drinking is dangerous. b. The son threatens to leave home because he finds the father's behavior embarrassing. c. The teenage daughter turns to a favorite teacher for emotional support. d. The wife tells her husband's boss that her husband is sick when he is actually inebriated.

C

A man loudly protests his increased property tax bill right after the public health department has made a plea for more funds. "Why," he asks, "should my tax dollars be used to pay for their children to be immunized?" Which of the following would be the best response by the nurse? a. "Immunizations are required by law, and if their parents can't afford it, you and I will have to pay for it." b. "It's just the right thing to do." c. "Only by making sure most kids are immunized can we stop epidemics that might hurt all of us." d. "We're a religious God-fearing community, and we take care of each other."

C

A man who takes a prescribed narcotic for pain on a regular basis reports that he does not like the way the medicine makes him feel. He has tried to change to an alternate analgesic but experienced withdrawal symptoms when he stopped taking the narcotic. Which of the following problems is the man experiencing? a. Drug abuse b. Drug addiction c. Drug dependence d. Substance abuse

D

A mother and her son are in the emergency department. The mother is extremely upset. Earlier, the son had become so angry that he put his hand through a glass window and had to have stitches. The physician suggested a psychiatric consult. Now the mother asks, "Do you think my son is crazy?" Which of the following is the most appropriate response by the nurse? a. "Absolutely not. But a psychiatrist can help your son realize more appropriate ways of displaying anger." b. "Have you had other reasons to think your son is crazy? Perhaps the psychiatrist can reassure you that your son is just an adolescent coping with hormones." c. "Your son is having problems coping with anger. And naturally you're upset. Let the psychiatrist determine whether your son is crazy or not." d. "Your son is having problems with behavior, which is distressing all of you. A psychiatrist may be able to help your son cope with life in a more acceptable way."

A

A nurse considers how the environment outside of the family influences the development of a child when planning care for a family. Which of the following theories is being used by the nurse? a. Bioecological systems theory b. Family systems approach c. Family developmental theory d. Interactionist theory

D

A mother cannot understand why her daughter ran away from home. When the police locate the daughter, she complains of a severe headache, so the police take both of them to the emergency department for assessment. Which of the following potential problems should be assessed by the nurse? a. The daughter's inability to do well in school b. Intimacy problems with the daughter's boyfriend c. The mother's abuse of the daughter over a long period of time d. Sexual abuse by the father

D

A mother confides to the nurse that her live-in boyfriend knocked down her 2-year-old child because he was crying too much. She begs the nurse not to tell anyone because her boyfriend has agreed to take anger management classes. Which of the following actions should be taken by the nurse? a. Abide by the mother's wishes because this information was provided in confidence. b. Arrange for counseling for the boyfriend at the earliest possible availability. c. Encourage the mother to take the child and find alternate housing right away. d. Report the incident to child protective services or other appropriate legal authority.

ABC

A mother is concerned that her daughter may be considering experimentation with drugs and alcohol. Which of the following strategies would the nurse suggest the mother implement? (Select all that apply.) a. Provide opportunities for her daughter to develop her talents. b. Provide realistic feedback to the daughter about her performance at school. c. Encourage her daughter to become involved in extracurricular activities. d. Encourage her daughter to develop new friendships.

C

A movie shows a woman and a man having a contest to see who can drink more shots of whiskey. Who is more likely to "win" the drinking contest when the other passes out and cannot continue? a. If their drinks are the same size, they'll both pass out about the same time. b. If they play fair, they'll probably both vomit before passing out. c. The man will win. d. The woman will win.

A B C D E

A multisystem approach to community disease control would include such interventions as: (select all that apply) Select all that apply. a. community action programs. b. control of vectors. c. improved surveillance systems. d. legislation. e. provision of chemotherapy.

A

A new mother is a full-time college student who lives with her parents, because the baby's father has been imprisoned related to theft and drug abuse. The infant's grandmother, although also employed, cares for the child while the young mother attends classes. Which of the following theoretical frameworks would be most helpful to the nurse when assessing this family's needs? a. Developmental b. Interactional c. Structure-function d. Systems

C

A nurse asks a family member, "What has changed between you and your spouse since your child's head injury?" Which of the following focuses of the family is the nurse assessing? a. The context b. The client c. A system d. A component of society

A

A nurse coordinating care for undocumented minority workers with a high incidence of tuberculosis (TB) conducts a presentation before the local community health board to focus attention on the magnitude of the problem and its potential impact on the local community. The presentation stimulates the community to explore innovative solutions to increase screening for and treatment of TB cases. This scenario is an example of the relationship between: a. advocacy and case management. b. advocacy and continuity of care. c. care management and case management. d. care management and continuity of care.

C

A nurse focuses on the care of the individual while viewing the client's family as a background resource or possible stressor. Which of the following conceptualizations of family does this nurse's view represent? a. Client b. Component of society c. Context d. System

A B D

A nurse functioning in the role of a case manager performs which of the following functions in the care delivery process? Select all that apply. a. Risk analysis b. Data mapping c. Provision of illness care d. Epidemiologic investigation of unexpected illnesses e. Counseling and education

C

A nurse has just met a family and is being doing their family assessment. Which of the following actions should the nurse take before engaging in self-disclosure? a. Confirm the reason for the assessment. b. Demonstrate culture awareness. c. Take time to build trust. d. Understand the family dynamics.

B

A nurse in community health conducting a home visit notices a 4-year-old girl sitting on a stool in an adjoining room. The girl is quiet and withdrawn, rarely makes eye contact, and does not leave the room. The nurse proceeds to ask about the child and attempts to engage the child in conversation. The nurse is assessing for what indicators of child abuse? A. Emotional abuse B. Emotional neglect C. Physical abuse D. Physical neglect

D

A nurse in community health conducts quarterly mental health-promotion and depression-screening programs at the local senior center. The nurse is aware that older adults are at increased risk for developing depression. Using such an intervention also addresses the older adults': A. dependence on their primary care provider. B. normal sensory losses. C. reduced social contacts. D. underutilization of the mental health system.

Nurses in community health often use epidemiology because in the community it is often difficult to control the environment. Which of the following statements demonstrates an epidemiologic strategy for monitoring disease trends?

A nurse in community health investigates a breakout of whooping cough in a local middle school.

A

A nurse in community health is following a pregnant teenager who attends school. The nurse plans to discuss self-care activities that will be important for the teen during her pregnancy. The discussion should include: A. carrying heavy book bags. B. changing to home education. C. decreasing fluid intake to avoid nausea. D. keeping up her grades.

B

A nurse in community health is following an older woman who complains frequently of migraine headaches, backaches, and GI disturbances. During a recent visit, the woman states that her adult son now lives with her. He was recently let go from his job. He enjoys hanging out with his old buddies. When he feels better he will look for a new job. Despite the added burden she really enjoys having her son around again. The nurse should explore this further to determine whether the family is: A. abusive. B. codependent. C. coping. D. estranged.

A

A nurse in community health is working with a parent whose spouse has been called up for active duty in the military reserve. The family is experiencing financial strain due to decreased income. The extended family lives at a distance. The parent is struggling to manage the family in the spouse's absence. The family consists of four children (three preschool and one preteen). In this situation, it would be important for the nurse to further explore the potential for: A. child abuse. B. depression. C. intimate partner abuse. D. parent's resentment of the preteen.

B

A nurse in community health is working with a single parent of three children, ages 4, 6, and 8. The 6-year-old has cerebral palsy. The 4-year-old has asthma. The maternal grandmother lives with the family and has diabetes. The nurse understands the importance of working within the context of the existing family structure and community resources because families are: A. resistive to outside intervention or involvement. B. responsible for providing/managing the care of their members. C. unable to manage the stress of complex health needs. D. restricted in their ability to identify interventions.

D

A nurse in community health working in an inner city clinic with high poverty and unemployment rates recognizes the need for programs for pregnant women because these women often receive late or no prenatal care and deliver: A. at home. B. full term. C. identical twins or triplets. D. low-birthweight babies.

C

A nurse is assessing a young, single pregnant woman. Which of the following findings would be of most concern? a. Elevated blood pressure b. First prenatal visit at 5 months' gestation c. Persistent homelessness d. Positive STD test

C

A nurse is completing a case management advocacy activity which corresponds to the implementation phase of the nursing process. Which of the following activities would the nurse most likely use? a. Asking the client what is most important b. Seeking appropriate referrals for the client c. Assuring the client that his wishes will be supported d. Determining the order in which actions will occur

A

A nurse is completing a tertiary prevention activity in a predominantly poor community, where eating clay (pica) is a common practice. Which of the following actions would the nurse most likely take? a. Assist those who eat large amounts of clay to obtain food stamps after explaining that clay, although filling, does not provide necessary nutrients. b. Initiate early intervention in the school system through education programs designed to focus on healthy food choices. c. Provide laboratory testing and physical assessments to assess for nutritional deficits resulting from clay intake. d. Survey families in the community to determine whether they eat clay and how much clay they eat.

BD

A nurse is concerned about a teenage mother who does not seem to know how to play with an infant. Which of the following behaviors would the nurse want to role-model as good parenting behaviors? (Select all that apply.) a. Allow the baby to cry for 10 or 15 minutes before reacting so that the infant can learn to self-soothe. b. Cuddle and hold the baby while smiling and gazing into the baby's eyes. c. Teach the mother to keep her face about 4 or 5 inches from the baby and to gently blow on the infant's face. d. Sing to baby with different melodies until baby seems to listen and shows a preference for certain tunes.

A

A nurse is concerned about stress related to the heavy caregiving burden assumed by adult children of older clients. Which of the following actions by the nurse demonstrates the use of secondary prevention to limit caregiver stress? a. Asking caregivers how they are doing and suggesting coping strategies b. Encouraging caregivers to periodically leave the house for a couple of hours c. Establishing support groups for caregivers of older parents d. Referring some activities to neighbors and friends

C

A nurse is concerned about the possibility of suicide in a teenage boy. Which of the following characteristics has the boy most likely displayed? a. He has threatened harm to his school peers. b. He is between the ages of 15 and 19. c. He is depressed and has a history of being sexually abused. d. He has been accused of abusing an animal.

D

A nurse is conducting a family assessment. Which of the following behaviors would the nurse recognize as suggestive of a family with problems? a. Before eating, the family prayed, expressing gratitude for their blessings. b. During family play, jokes and laughter were heard. c. Each person had a private room with a door for alone time. d. Most of the conversation was between the father and the eldest daughter.

D

A nurse is considering applying for a position as a public health nurse. Which of the following would be a reason this position would be appealing? A. Its autonomy and independence B. Its focus on acute care and immediately visible outcomes C. Its collaboration with other health care professionals D. Its flexibility and higher wages

C

A nurse is considering joining the American Public Health Association (APHA). What information about this organization should be considered when making this decision? A. APHA focuses on the public health concerns of the medical profession. B. APHA represents concerns of nursing specialty practices. C. APHA provides a national forum for nurses to discuss their public health concerns. D. APHA focuses on providing health promotion education to the public.

D

A nurse is counseling a woman following a rape. Which of the following feelings is the woman most likely to state she felt while being raped? a. Confusion b. Satisfaction c. Sexual release d. Helplessness

D

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 from Healthy People 2020 D. Services mandated by the state government

B

A nurse is discussing how health care rationing occurs in the United States. Which of the following would most likely be discussed as the criterion that is used to ration health care? A. Clinic operating hours B. Ability to pay for services C. Availability of local provider services D. Transportation availability

C

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 centralized system that provides care in hospitals." 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."

AB

A nurse is helping a client's family prepare to have an intervention that hopefully will encourage the alcoholic father to realize the need for change. Which of the following instructions by the nurse to the client's family members would be most effective? (Select all that apply.) a. "Express your love and your belief that he can change." b. "Point out that his behavior is his choice and his responsibility." c. "Let him know that you understand how much he loves being with his drinking pals and that you agree that their friendship is important." d. "Remind him that entering treatment is better than going to prison."

Which of the following are the major sources of air pollution in the United States? (Select all that apply.) a. Burning of fossil fuels b. Waste incineration c. Industrial plants d. Motor vehicles

A, B, D

B

A nurse is implementing a primary prevention strategy focusing on economics within the community. Which of the following interventions is the nurse most likely completing? A. Applying for a grant to establish a daycare center to serve dependent older adult clients living with working families B. Persuading legislators to pass a bill offering health care financial aid to families at risk C. Screening cocaine addicts for financial assistance eligibility for drug treatment D. Referring clients with renal failure to apply for Medicare

C

A nurse is implementing a primary prevention strategy to address abuse in the community. Which of the following actions is the nurse most likely taking? a. Encouraging others to interfere when they see children hit or hurt in a public place b. Referring caregivers to community respite centers if abuse is beginning to occur c. Lobbying for passage of legislation to outlaw physical punishment in schools d. Screening each pregnant woman privately for intimate partner abuse

B

A nurse is in the termination phase of the nurse-family relationship. Which of the following strategies would the nurse most likely implement? a. Increasing sessions with the nurse b. Making referrals when appropriate c. Providing a formative evaluation of the relationship d. Refusing additional communication with the family

B

A nurse is making an appointment with a family for a nursing visit. Which of the following describes a potential barrier the nurse may encounter? a. The assessment cannot be done unless the extended family is present. b. It may be difficult to find a convenient time for all family members to be present. c. Nurses have limited time to do home visits. d. Families are often scattered over a large area, making access difficult.

C

A nurse is providing care to a child whose parents do not receive health insurance as an employee benefit and who do not have the financial resources to pay for health care out of pocket. Which of the following resources should the nurse recommend to the family? A. A managed care organization B. An emergency department C. Medicaid D. Medicare

A

A nurse is providing care to a pregnant teenager. Which of the following principles is the most important for the nurse to consider when providing care? a. All teen pregnancies are considered high-risk. b. Limited self-care knowledge can lead to pregnancy complications. c. Pregnant teens are likely to receive prenatal care late in the pregnancy. d. Pregnant teens may have limited financial resources to pay for care.

B

A nurse is reviewing the original work of the National Organization for Public Health Nursing. Which of the following accomplishments of today was started within this organization? A. Requiring that public health nurses have a baccalaureate degree in nursing B. Standardizing public health nursing education C. Developing public health nursing competencies D. Opening the Henry Street Settlement

D

A nurse is reviewing with a client the importance of the diabetic diet to maintaining control of blood glucose levels. The client states, "I went to the classes and learned how to count carbohydrates. I have even started to write down what I eat for each meal." Which of the following would be most appropriate response from the nurse? a. "I'm so glad you're beginning to recognize the need to control your blood sugar." b. "Now you just have to make sure you don't give that habit up!" c. "Sounds like you're not ready to really plan your eating yet." d. "That is great. You've started to take action and make changes."

AD

A nurse is screening a client for ATOD problems. Which of the following actions would the nurse most likely complete? (Select all that apply.) a. Assist with identifying help or resources. b. Advise about the need to enter a treatment program. c. Ask about how relationships with family members and friends have been affected. d. Assess amount and pattern of use.

C

A nurse is trying to decrease the risk for depression among older adults. Which of the following interventions should the nurse implement? a. Encourage moving to a nursing home where others of the same age reside. b. Monitor for signs and symptoms of depression. c. Organize an exercise and health promotion program at the local senior citizen center. d. Teach older clients to focus on their strengths rather than their weaknesses.

D

A nurse is trying to maximize the quality of life of her clients while reducing health care costs. Which of the following actions would most likely be completed by the nurse? A. Assisting in cast application for a client who was injured in a skateboard incident B. Irrigating the eyes of a client splashed with chemicals C. Restoring a normal cardiac rhythm following cardiopulmonary resuscitation of a client with a heart condition D. Teaching a high school boy about sexually transmitted infections and proper condom application

B

A nurse is using a case management plan to maximize patient care outcomes. Which of the following describes an important consideration that should be made by the nurse? a. Case management plans should be used only by nurses to manage care. b. Case management plans should be individualized for each client. c. Case managements plans provide additional expense to the client and family. d. Case management plans focus on the natural progression of the disease.

B

A nurse is using the problem identification phase of the case management process. To which of the following phases of the nursing process does this correspond? a. Assessment phase b. Diagnosis phase c. Planning phase d. Implementation phase

D

A nurse is using the provisions of the Family Medical Leave legislation. Which of the following actions is the nurse most likely to take? a. Resigning from employment, but retaining health insurance b. Sharing family information with colleagues c. Providing Medicaid to a family who cannot afford health insurance d. Taking a defined time off of work for family events without fear of job loss

A, B

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 child immunization clinics

B

A nurse is working to ensure long-term positive health outcomes of poor pregnant teens and their children. Which of the following actions would the nurse most likely take? a. Assist teen mothers to learn about their body changes during pregnancy. b. Develop programs that allow teen mothers to complete their education. c. Offer courses in proper care of babies and how to be a parent. d. Monitor pregnant teens to detect early problems with pregnancy.

C

A nurse is working to improve her self-awareness in order to provide better client-centered care to clients living in poverty. Which of the following questions should the nurse ask herself? a. What would I do if I lived in poverty? b. What can be done to get poor people motivated to work? c. How have the media images of poor persons shaped my image of poverty? d. How can community resources assist those living in poverty?

D

A nurse is working with a family to reduce the incidence of home violence. Which of the following actions by the nurse would most likely have a positive effect? a. Being assertive and taking control of decisions because family members cannot be expected to have this ability b. Focusing attention on family weaknesses that need to be fixed before healing can begin c. Pointing out things that victims should do differently to avoid antagonizing the abuser d. Soliciting ideas from the family regarding what they feel will improve their situation

B

A nurse is working with a family who is confronting major challenges to their health. Which of the following approaches would be most helpful for the nurse to use? a. Allowing the family to be noncompliant b. Building on the family's strengths and resilience c. Labeling the family as resistant d. Recognizing that the family is dysfunctional

C

A nurse new to the community evaluates the resources available to a father that has sought help with his escalating abuse and threats of violence to his family. After making the referral, the nurse approaches the local newspaper about running a series on the nature and extent of human abuse in the community. This strategy would: A. advocate for government programs to treat survivors. B. demonstrate the provider's commitment to address the need for services. C. increase awareness of community resources to address violence and abuse. D. increase the number of individuals identified as perpetrators.

C

A nurse organizes care for a family by focusing on the common tasks of family life and considering a longitudinal view of the family life cycle. Which theory is being applied? a. Family systems b. Structural-functional c. Family developmental d. Interactionist

D E

A nurse performing home hospice case management notes the increasing number of hospice clients that lack caregivers in the home environment. The nurse identifies the potential need for a hospice house facility to meet the needs of these clients. The case management process frequently reveals such larger picture issues as: (select all that apply) Select all that apply. a. Community cost concerns b. Community conflict-resolution skills c. Community satisfaction d. Community weaknesses in quality of services e. Community weaknesses in quantity of services

A B D

A nurse requests to meet a newly referred family in their home. Which of the following best explains the rationale for this request? (Select all that apply.) a. The nurse can assess the family environment. b. The family will feel more comfortable. c. Families typically welcome others into their home. d. More family members can typically be involved.

B

A nurse reviews with the client what the client can expect during the next 3 days, as well as how the client should expect to feel each of those days. The client laughs and says, "You've got my care all mapped out." Which of the following tools is the nurse using to determine what will happen when? a. Care planning b. Critical pathway c. Demand management d. Use management

B

A nurse sees the father of a newborn baby push his wife in a wheelchair out onto the patio. The man and woman each smoke a cigarette while the baby sleeps in the mother's arms. Which of the following information should the nurse share with the parents? a. Fetal nicotine syndrome may cause complications in the newborn. b. The sidestream smoke that the baby is exposed to is more dangerous than the mainstream smoke that the parents are inhaling themselves. c. The baby will eventually develop tolerance to tobacco smoke. d. The parents should switch to chewing tobacco as long as the child lives in the home.

D

A nurse was employed by the Marine Hospital Service in 1800. Which of the following interventions would the nurse most likely have completed? A. Setting policy on quarantine legislation for immigrants B. Establishing hospital-based programs to care for the sick at home C. Identifying and improving environmental conditions D. Providing health care for merchant seamen

B

A nurse was shocked when late one night she saw a former high school friend going through a trash bin outside a fast-food restaurant and pulling out half-eaten food. Which of the following is the most likely explanation for a healthy young adult engaging in such behavior? a. He ate his meal but wanted more and had no more money. b. He had full-time employment, but with such a low salary it was inadequate to meet basic expenses. c. A friend had thrown his meal away, and he thought he could find his friend's untouched food. d. He was doing this to fulfill an obligation of fraternity initiation at the college.

B, D

A nurse working with Mary Breckinridge would have likely assisted with: (Select all that apply.) A. establishing the Henry Street Settlement. B. developing health programs geared toward improving the health care of the rural populations. C. blazing a nursing trail through the Rockies, providing nursing care to miners and their families. D. ensuring positive outcomes for pregnancies among women in the Appalachian region.

D

A nurse working with a Hispanic client explains the referral options available for the client to receive a mammogram. One option is free and has limited Spanish language resources. The other option has a nominal fee and comprehensive Spanish language resources. The nurse supports the client's decision to choose the provider that the client feels would best meet her needs. This advocacy role is best described as: a. intercessor. b. mediator. c. obstructer. d. promoter.

A, C

A nurse would like to help members of the community focus on receiving primary preventive health care services. Which of the following interventions should be implemented by the nurse? (Select all that apply.) A. Publicize data on success of health promotion efforts, including cost savings. B. Lobby for decreased reimbursement for secondary and tertiary care services. C. Establish standards for appropriate screenings at specific intervals. D. Encourage members of the military service to engage in appropriate healthy lifestyle behaviors.

A

A nurse would like to increase the accessibility to health care services for mentally ill homeless clients in the community. Which of the following actions should be taken by the nurse? a. Apply for a grant to fund a mobile clinic to take health care to the clients. b. Distribute flyers to the homeless that detail the location of various types of health care services. c. Refer homeless clients to areas that provide temporary housing. d. Solicit donations for food and clothing to be distributed to the homeless.

A

A nurse's Mantoux test is positive for exposure to tuberculosis. Which of the following conclusions should be drawn by the nurse? a. The nurse has been exposed to tuberculosis. b. The nurse has tuberculosis. c. The positive test result probably is due to a problem in the testing process. d. The test is inaccurate and needs to be repeated.

C

A nurse, client, family, and other care providers meet to discuss what will be the best approach to use to continue care. Which of the following best describes why the nurse suggests changing the goal from obtaining appropriate long-term care placement to ensuring that the client's convalescence is beneficial and safe? a. To consider all possible consequences of long-term care placement b. To encourage the group to review the client outcomes in the different settings c. To expand the goal so that different solutions can be generated and considered d. To help the group focus on the critical aspects the client's family considered most important

D

A nursing student during World War II would likely join which group? A. The US Public Health Service B. The Marine Nurse Corps C. The Frontier Nursing Service D. The Cadet Nurse Corps

C

A parent involved in conflict resolution with her teenager says, "I know that some of your friends stay out until midnight, but I think it is best if you are in at 10 o'clock." This statement, a behavior seen in conflict situations, is an example of: a. negotiation. b. cooperation. c. assertiveness. d. aggressiveness.

A

A pregnant teenager has approached a nurse asking about ways to improve the health outcomes for her and her unborn child. Which of the following statements would be most appropriate for the nurse to make? A. "Don't drop out of school." B. "Sign up for childbirth classes." C. "Sign up for the WIC program." D. "Take your prenatal vitamins daily."

10. A new nurse is overwhelmed with the needs of the community. Which of the following should be the first priority of the nurse?

A problem that is of high concern to the community

B, C, D

A public health agency is in the process of obtaining accreditation. Which of the following best describes why the agency would want to achieve accreditation? (Select all that apply.) A. To improve health programming and services B. To improve community relationships C. To improve performance and quality D. To improve management

A

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

B

A public health nurse is compiling information about how to promote early detection of breast cancer in women. Which document would most likely provide useful information about this topic? A. The Future of Public Health B. Healthy People 2020 C. Patient Protection and Affordable Care Act D. Scope and Standards of Public Health Nursing Practice

A

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. Which of the following best describes one main difference between these two types of coverage? A. HMOs provide comprehensive care to members for a fixed fee. B. PPOs designate providers that members can choose. C. PPOs provide one model of care delivery. D. HMOs provide financial incentives to encourage members to select HMO providers.

C

A public health nurse is determining what type of programming should be developed for the community. Which of the following is the most crucial factor that will influence program development? A. Comprehensive assessment and planning done in the community B. Documented needs of the local community C. Federal funding for priority diseases or groups D. Nursing staff's expertise and skills

C

A public health nurse is hosting an informational meeting for young parents about how to balance their multiple responsibilities. Which of the following parents in attendance would be most at risk for abusing his or her own child? a. A new mother who has joined a parents' support group b. A father who is overwhelmed and exhausted by overtime work c. A depressed father who was laid off from work and is missing his work colleagues d. A mother who is missing her career challenges and friends but enjoying being home with her baby

D

A public health nurse is involved in health care reform. Which of the following best explains why the nurse is involved in these efforts? A. To promote the nursing profession B. To increase funding for public health nursing C. To address the concerns of nurses D. To help improve health care access

B

A public health nurse is working with a client who does not have health insurance. Where will the nurse most likely direct the client to in order to receive care? A. Managed care B. Community health center C. Emergency department D. Physician office

D

A public health nurse is working with a low-income population in Massachusetts. Which of the following assumptions can the nurse make about this population? A. They have difficulty accessing health care due to a shortage of primary-care providers. B. They most likely receive health insurance through Medicare. C. They are unable to access health care due to the implementation of the Affordable Care Act. D. They have access to affordable health care insurance.

A

A recent movie release portrays a criminal as a black female drug user whose abusive boyfriend has two children by different women. She lives in the riot-torn inner city of a large metropolitan area. This best demonstrates what type of factor that influences poverty? A. Cultural B. Environmental C. Political D. Social

Which of the following strategies would a nurse expect to be implemented by a typical state environmental agency? (Select all that apply.) a. Acting, through unannounced inspections, to ensure compliance b. Writing permits that help limit toxic hazards c. Monitoring hazardous substances to uphold established standards d. Obtaining and analyzing samples to confirm compliance

A, C, D

B

A school health nurse is asked by a parent group to explain risk factors for alcoholism. Which of the following information should the nurse include? a. Alcoholism is determined primarily by the family environment. b. Alcoholism is determined partly by genetic factors. c. Persons who are alcoholics are usually women. d. Persons born with fetal alcohol syndrome are alcoholics from birth.

B

A school health nurse is conducting drug screening to detect drug use by students before problems develop. Which of the following levels of prevention does this action represent? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Primary and secondary prevention

B

A school health nurse presents a program on preventing teen pregnancy to a group of parents. Following the presentation, which of the following comments by a parent would cause concern? a. "I do not know if my son is sexually active; however, I have decided I'm going to talk to him about it." b. "My daughter is too intelligent to get involved with boys, even if her friends do sleep around." c. "My daughter and I have often discussed sexuality, and when she's ready, I'll pay for her birth control pills. d. "I have spoken to my son about birth control. He says he's not ready to be a father and support a baby. He wants to go to college."

D

A school nurse stops a student in the hall and asks whether the student has been having trouble with her eyes, which look rather red and dry. The female student yawns and says that she hasn't noticed any eye problems. However, she does confess to the school nurse that she has gained 15 pounds since she began smoking "special cigarettes." Which of the following is the student most likely smoking? a. Tobacco b. Crack cocaine c. Ice methamphetamine d. Marijuana

C

A school nurse was caring for an 8-year-old child who had been hurt on the school playground. During the nurse's assessment, the child admitted that her mother was working but didn't make much money so the girl and her mother were living in their car. Based on this information, which of the following would the nurse most likely suspect? a. The child is accident-prone and clumsy. b. The child is being bullied and pushed around by other children. c. The child is more likely to have school absences. d. The child is in need of a vision screening.

B

A school nurse was talking to the teacher of an 8-year-old child who was living with her mother in their car. Which of the following concerns would lead the nurse to talk to the teacher about the child? a. Concern that the child is being mistreated by other children b. Concern that the child has developmental delays c. Concern that the child is given adequate food during lunch d. Concern that the child may need to sit in the front in order to be able to see well

Which of the following is the best brief definition of community?

A social group with common goals within a geographic area

B

A student comes to the college health clinic with typical cold symptoms of fever, sneezing, and coughing, but the nurse also notes small white spots on the inside of the student's cheeks. Which of the following actions should be taken by the college health nurse? a. Inform all students, staff, and faculty of a possible rubella epidemic b. Inform all students, staff, and faculty of a possible measles epidemic c. Reassure the student that it is just a bad cold and will soon pass d. Tell the student to take two acetaminophen and drink lots of fluids

B

A student complains to the college health nurse that her academic work has been going downhill because of lack of sleep. "My 3-year-old probably misses her babysitter since she has started going to the big daycare center. She hasn't been sleeping well and keeps scratching her bottom. Hopefully, she'll adapt to daycare soon." Which of the following information should the nurse provide to the student? a. "Dry skin in winter weather can cause itchiness; try to put on lotion before bedtime." b. "Your daughter may have pinworms; let me teach you how to check for this." c. "Perhaps your child is not developmentally ready for group play." d. "Try to arrange more one-on-one time with your 3-year-old."

D

A student engages in unprotected sex under the influence of alcohol. The student decides to have an HIV test completed the next day. Which of the following results will most likely occur? a. The results will probably be negative for HIV. b. The results will probably be positive for HIV. c. The probability of disease is so low there is no reason to be tested. d. The test results won't be reliable so soon after exposure.

C

A teacher asks the school health nurse to assess a child for neglect. Which of the following assessment findings could indicate neglect? a. Bruises in various stages of healing b. Failure of parent to attend parent-teacher conferences or return teacher phone calls c. Lack of weight gain and wearing dirty clothes d. Lice in the hair

B

A teacher sends a student to the school nurse because the student does not seem to be thinking clearly. The nurse notes that the student is having palpitations, as well as elevated pulse, blood pressure, temperature. Which of the following would most likely cause these symptoms? a. Alcohol b. Ecstasy (MDMA) c. Heroin d. Marijuana

CD

A teenager who has just come in for her prenatal visit appears to be about 6 months pregnant. Which of the following best describe why the teenage girl has waited so long to come in for prenatal care? (Select all that apply.) a. Her friends were suggesting ways to make the problem go away. b. She knew she could not be pregnant because her boyfriend said he used a condom. c. She was afraid her parents would pressure her to terminate the pregnancy. d. She kept hoping the pregnancy would just go away.

C

A woman has just delivered a baby and is lamenting that the baby's father is not with her. She shares with you that he became involved with drugs and is now in prison for theft. The new mother says, "It's so sad. He's clearly no good." Which of the following would be the best response by the nurse? a. "I'm so sorry to hear that. Is your mother able to be with you?" b. "It's good that you and the baby are safe from him." c. "Is there anyone to help you with the baby until the baby's father can be released and encouraged to get treatment for his addiction?" d. "You must hate him for leaving you alone with a new baby!"

Which of the following tools are used in analytic epidemiology?

A) Cohort study B) Case-control study C) Cross-sectional study

A nurse believes new mouth care procedure (MCP) is causing more mouth problems than it 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) consistently seeing mouth inflammation in many of the patients who received the MCP C) documentation from patient records that mouth inflammation in clients did not occur until after the new procedure was implemented

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) drug resistant strains of 'old' disease have evolved

Nurses incorporate epidemiology into their practice and function in epidemiologic roles through (select all that apply):

A) collection, reporting, analysis, and interpretation of data B) environmental risk communication C) documentation on patient charts and records

Epidemiologic studies of diseases conducted by nurses during the twentieth century were influenced by the (select all that apply):

A) declining child mortality rates B) development of new vaccinations

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) health problems for which the specific population is at risk B) whether health care providers are available to follow up on any positive screening results

A nurse is concerned abut 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?

A) sexually active students who had been screened the previous year B) students who claimed to not be sexually active and do not plan to become sexually active C) students who are sexually active but never go 'all the way'

A nurse would like to become involved in political action. Which of the following actions would be most appropriate for the nurse to accomplish this goal? (Select all that apply.) a) Become a member of the state nurses association b) Be friendly with everyone, whether supportive or not of your ideas c) Don't expend time on local activities but ask to be appointed on the state level d) Focus all your efforts on your specialty practice area and your employment site act

A, B A nurse wishing to become politically involved should begin by joining the state nurses association, networking with others involved, and volunteering to serve on committees or in offices. Be friendly and network to increase your knowledge beyond your own workplace or specialty and seek opportunities to share expertise with others.

Which of the following best describes the importance of the World Health Organization (WHO) to the United States? (Select all that apply.) a) Provides daily information on disease occurrences b) Establishes international standards for antibiotics and vaccines c) Creates international legislation regarding international cooperation d) Supports national programs to fight disease

A, B Some WHO services that benefit all countries (including the United States) are providing day-to-day information service on the occurrence of internationally important diseases; publishing the international list of causes of disease, injury, and death; monitoring adverse reactions to drugs; and establishing international standards for antibiotics and vaccines. Individual countries can request assistance with strengthening the delivery of health services, supporting national programs to fight disease, and training health workers—which the United States does not. WHO can suggest but cannot legislate to individual countries.

A nurse is testifying at a committee meeting about a health bill. Which of the following actions should be taken by the nurse? (Select all that apply.) a) Briefly describe personal education, experience, and expertise in the area b) Discuss how the bill affects more than just nurses c) Include factual data and, if possible, statistical information in visual form d) Include the names of famous persons in the media who agree with you

A, B, C Language must be simple and carefully chosen to convey information to listeners and to avoid professional jargon. The nurse must share a bit of personal education, experience, and expertise to be seen as a credible source. The testimony must go beyond just nursing's interest and include accurate, credible data.

Which of the following activities are the responsibility of the Centers for Disease Control and Prevention? (Select all that apply.) a) Conduct research to enhance disease prevention b) Detect and investigate infectious disease problems c) Develop and advocate public health policies d) Publish national goals for promoting health and preventing disease

A, B, C The mission of the CDC is to promote health and quality of life by preventing and controlling disease, injury, and disability. To monitor health, the CDC will detect and investigate health problems, conduct research that will enhance prevention, develop and advocate sound public health policies and other prevention strategies.

Which of the following actions would a nurse take when serving as an advocate for the community? (Select all that apply.) a. Asking questions related to health implications at policy meetings b. Calling the local health department to report problems at the hospital c. Serving as a source of information at public meetings d. Volunteering to serve on health-related committees

A, C, D

Which of the following factors have had an impact on the complex relationship among nursing practice, health policy, and politics? (Select all that apply.) a) Categorical funding b) Death penalty c) Head Start d) Health fairs e) Statutory authority for the profession

A, C, E

A nurse is visiting a state legislator to encourage the legislator to vote for a particular health bill that the state nurses association has endorsed. Which of the following actions would be most important for the nurse to complete? (Select all that apply.) a) Allow the legislator or staff to ask questions b) Be friendly and engage in small talk so that rapport can be established c) Be aware that legislators are well informed; don't insult the legislator by stating information that is obvious d) Have a handout that summarizes all the major points in support of the bill

A, D Legislators might not be well informed about every issue, so they need and want important information. The nurse should allow time for questions or clarification of information shared and have the material on a handout for the legislator's convenience. The nurse should not waste time with small talk but briefly present his or her stand, emphasizing other nurses who support the bill, because numbers count. It is also helpful to invite the legislator to attend nursing conferences or meetings where health issues will be discussed.

B

Which of the following approaches has research suggested is the most effective way to approach drug addiction? a. Criminal justice system b. Harm reduction c. Punishment approach d. Substance abuse education

A nurse is completing a basic health assessment. Which of the following questions should be asked by an environmentally aware nurse? a. "Is anyone else in your family having these symptoms?" b. "Can you tell me about your house or apartment?" c. "What jobs have you held longest?" d. "Where do you live?"

C

A nurse who is explaining to a client why it is important to take medication states, The medication takes a couple of weeks to be effective, but then you should feel better. When the client is next seen, no medication has been purchased. Which of the following is the most likely explanation? a.The nurse emphasized that eventually the client would feel better, but the client needed to feel better immediately so didnt bother with the drug. b.The medication required a trip to the pharmacy, and the client just hadnt had time to obtain the drug yet. c.The medication was too expensive for the clients family. d.The client really hadnt understood why the medication was important.

ANS: A Although any of the answers given is possible, if we look closely at what the nurse stated, there may have been a cultural disconnect based on time orientation. Many nurses are future oriented, whereas many families may place greater value on quality of life and view present time as being more important. When nurses discuss health promotion and disease prevention strategies with persons from a present orientation, they should focus on the immediate benefits these clients would gain rather than emphasizing future outcomes.

18. A nurse explained to a new mother that because she had tested positive for the hepatitis B virus, her newborn son would need the hepatitis B vaccine immediately and then also an immune globulin injection. Wait, said the new mother. Why is my son getting two shots? Which of the following statements would be the best response by the nurse? a. One injection protects your son, while the other encourages his body to build up immunity. b. One shot keeps your son from getting sick, while the other is a typical vaccine to prevent you from accidentally infecting him. c. Since youve already been infected with the virus, your son needs twice as much protection. d. The second shot is just to make sure the first one works.

ANS: A Because infected persons may not have any symptoms, all pregnant women should be tested for HBsAg. If the mother tests positive, her newborn needs hepatitis B immune globulin to provide passive immunity and thus prevent infection. In addition, the newborn is given the hepatitis B vaccine at birth, with two follow-up injections, to build active immunity to the infection.

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

ANS: 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 health care to promote quality of life.

For a bedridden Muslim patient, the nurse rearranges the room and moves the bed so that it faces toward Mecca for the patients daily prayers. Which of the following is the nurse demonstrating through these actions? a.Accommodation b.Awareness c.Brokering d.Imposition

ANS: A Cultural accommodation involves including aspects of the patients religious beliefs and/or folk practices in the traditional health care system to implement essential treatment plans. For this patient, daily prayer in the tradition of Islam is importantfrom the patients perspective, possibly more important than medical treatment.

A nurse is caring for a client of another culture. Which of the following actions would be most appropriate for the nurse to take? a.Alter personal nonverbal behaviors to reflect the cultural norms of the client. b.Keep all behaviors culturally neutral to avoid misinterpretation. c.Rely on friendly gestures to communicate caring for the client. d.Avoid any pretense of prejudice by treating the client in the same way as any other client.

ANS: A Cultural competence in nursing includes adoption of culturally congruent behaviors. Culturally skillful nurses use appropriate touch during conversation, modify the physical distance between themselves and others, and use strategies to avoid cultural misunderstandings while meeting mutually agreed-upon goals. Nurses who strive to be culturally competent respect people from other cultures and value diversity, which helps them to provide more responsive care.

At a local hospital, postpartum care policy requires that nurses observe the mother during infant care to assess the mothers ability to care for the new baby and to promote bonding. A new mother expresses concern that in her country, all infant care is provided by other family members so that the mother can rest and recover. Which of the following actions would be taken by a culturally competent nurse? a.Allow family members to provide the newborns care and assess the mothers knowledge of child care through discussion. b.Reinforce the importance of bonding and that all good mothers gladly assume these responsibilities. c.Explain that the process of postpartum recovery does not require this much rest and require that she provide infant care. d.State that she must abide by hospital policy because documentation of the mothers ability to give the infant care is required for discharge.

ANS: A Culturally competent nursing care focuses on the specific patient, reflects the patients individual beliefs and values, and is provided with sensitivity.

A nurse says, Im not going to change the way I practice nursing based on where the client is from, because research shows that Western health care technology and research is best. Which of the following is being demonstrated by the nurses statement? a.Ethnocentrism b.Prejudice c.Racism d.Stereotyping

ANS: A Ethnocentrism, a type of cultural prejudice at the cultural population level, is the belief that ones own group determines the standards for behavior by which all other groups are to be judged. For example, some American nurses and providers may think, The way we do it is the only right way to provide this care.

2. A community health nurse is beginning to work with a newly assigned community. Which of the following would be appropriate actions for the nurse to take to help ensure acceptance? (Select all that apply.)

Asking those with whom the nurse interacts in the course of daily living their perception of the community (e.g., clerks in grocery stores or pharmacies) Attending community events such as festivals or fairs and interacting with participants

6. A school nurse asks a class about the ways HIV can be transmitted. Which of the following comments by a student indicates a need for additional teaching? a. I wouldnt sit next to someone with HIV. b. Having unprotected sex with someone who is infected spreads HIV. c. Sharing needles when shooting up drugs spreads HIV. d. Transfusions of blood products that are contaminated can spread HIV.

ANS: A HIV can be transmitted through exposure to blood, semen, vaginal secretions, and breast milk and by sharing needles, syringes, and other equipment used to prepare injectable drugs. It can also be spread by perinatal transmission from mother to child through delivery or breastfeeding and by transfusions of contaminated blood. HIV is not transmitted through casual contact such as touching or hugging someone who has HIV infection. It is not transmitted by insects, coughing, sneezing, office equipment, or sitting next to or eating with someone who has HIV infection. Worldwide, the largest number of HIV infections result from heterosexual transmission.

Which of the following best describes most Americans attitude toward immigrants? a.Ambivalence because there are no clear solutions about how to address their needs b.Strongly negative because immigrants take jobs that native-born Americans could have instead c.Strongly positive because immigrants bring useful job skills and often join previous family members already in the United States d.Strong opposition to further immigration because of the increasing population in the United States

ANS: A Most Americans are ambivalent about immigration, recognizing both the positive and negative aspects involved and realizing that it is a complex issue that has no clear solutions.

When teaching a nutrition class to a student group with a large Hispanic population, the school nurse incorporates foods such as salsa and other healthy dishes familiar to Hispanic students into the presentation. Which of the following best describes the action taken by the nurse? a.Primary prevention b.Secondary prevention c.Tertiary prevention d.Both primary and secondary prevention

ANS: A Primary prevention involves activities such as health teaching to prevent a problem from occurring.

10. A male client visits the clinic office complaining of a yellow, green discharge from his penis. Which of the following STDs has the client most likely contracted? a. Gonorrhea b. Syphilis c. Herpes simplex virus 2 d. Human papillomavirus

ANS: A The symptoms for gonorrhea in a male include a burning sensation when urinating, or a white, yellow-green discharge from the penis. Some men may get swollen or painful testicles. In men, gonorrhea can cause epididymitis, a painful condition of the testicles that if untreated can lead to infertility.

13. Which of the following statements best explains why HSV-2 infection is more challenging for a client than gonorrhea infection? a. HSV-2 is a viral infection that is both chronic and incurable. b. HSV-2 is extremely expensive to treat. c. HSV-2, like HIV, is almost impossible to diagnosis in the early stages. d. Once a person has been treated for HSV-2, the person is immune to further outbreaks.

ANS: A Unlike gonorrhea, there is no cure for HSV-2 infection; it is considered a chronic disease.

11. A Mexican immigrant mother tells the nurse she is concerned that people in the community will give her daughter mal de ojo. To which of the following folk illnesses is the nurse referring? a.Evil eye b.Fallen fontanel c.Soul loss d.Indigestion

ANS: A A common folk illness that a nurse may encounter with the Mexican client is mal de ojo, or evil eye.

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.

ANS: 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.

Which of the following is a basic assumption of public health efforts? a. Health disparities among any groups are morally and legally wrong. b. Health care is the most important priority 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.

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

Staff members have agreed to implement evidence-based practice; they have chosen a specific problem and searched the literature. The group has selected the interventions that seem the easiest to implement. Which of the following actions would the staff take next? a. Assess the quality of the evidence in the literature. b. Decide how best to orient the staff and community to the proposed changes. c. Eliminate all nursing interventions that are not evidence based. d. Choose another specific problem for the next literature search.

ANS: A After the group has chosen the topic and evaluated the literature for approaches that seem feasible, specific interventions are chosen. The quality of the evidence must be assessed before recommending specific changes or writing a protocol to resolve the problem. Grading the strength of evidence or determining the quality, quantity, and consistency of research studies must be done before making recommendations for practice.

24. 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 of the 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.

A registered nurse was just employed as a public health nurse. Which question would be the 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?

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

6. In addition to those barriers faced by many residents in rural areas, what additional barrier to health care is a Hispanic migrant farmworker likely to encounter? a.Absence of culturally competent care b.Availability of specialists c.Distance of health care facilities from the place of residence d.High cost of health care

ANS: A Barriers to health care in general affecting all populations include whether services and professionals are available, affordable, or accessible to rural consumers. For migrant workers, a language barrier and cultural differences often exist between them and other area residents, including health care providers.

25. Two women seem to agree on almost everything from favorite music to favorite media stars to the 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 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 groups needs c. Giving care with a focus on the aggregates needs d. A value system in which all clients receive optimal care:

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

1. 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

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

4. A nurse is caring for a migrant farm worker who has been working in the agricultural industry for the past 10 years. When questioned about environmental hazards, the client reports regular exposure to pesticides. Which of the following disorders is the client most at risk to develop? a.Cancer b.Memory loss c.Skin rashes d.Headaches

ANS: A Chronic exposure to pesticides and chemicals may lead to cancer.

Which of the following is the best way to increase the number of persons who come to their screening test appointments? a. Reminding clients via telephone, e-mail, or mail b. Emphasizing long life and happy family when conditions are caught early and treated successfully c. Pointing out how inexpensive and convenient screening tests are d. Stressing the dangerousness of the condition if not caught early

ANS: A Client reminders and recalls via mail, telephone, or e-mail—or a combination of these strategies—are effective in increasing compliance with screening activities such as those for colorectal and breast cancer.

A nurse has just witnessed the signing of an agreement between two parents in which the parents pledge not to yell at each other in the presence of their children. Which of the following is being demonstrated through this action? a. Contracting b. Crisis intervention c. Empowerment d. Strategic planning

ANS: A Contracting is making an agreement between those involved in a shared effort by both nurse and family. The premise of contracting is family control. It is assumed that when the family has legitimate control, their ability to make healthful choices is increased.

A nurse implements an education program that incorporates computer games to reinforce learning for a group of older adults. Although the research demonstrates evidence of improved retention of this information, the nurse experiences exactly the opposite with this group. Which of the following is the most likely cause of such poor outcomes? a. Failure to consider client and setting differences b. Inadequate incorporation of evidence into practice c. Inferior quality of the available research evidence d. Lack of skills when evaluating the evidence

ANS: A EBP cannot be applied as a universal remedy without attention to client differences. When EBP is applied at the community level, best evidence may point to a solution that is not sensitive to cultural issues and distinctions and thus may not be acceptable to the community. For example, computer games may be excellent for younger groups but are often poorly suited for older Americans who may face challenges with learning new technology.

3. A migrant farmworker has been injured while working on the farm. Which of the following would provide assistance to care for this injury? a.Emergency department for immediate care b.Migrant Health Act clinics c.OSHA, because the man was injured by farm machinery d.Workers' Compensation, because injury was at work

ANS: A Farming and ranching do not often fall under OSHA guidelines, because they are considered small enterprises. Therefore, safety standards are not enforceable, nor is Workers' Compensation insurance usually available for the agricultural industry. Although there are migrant health clinics, they are not always geographically convenient. The only source the nurse can count on using is sending injured workers to emergency departments for immediate care.

A nurse is appraising health risks. Which of the following questions would most likely be asked by the nurse? a. "Does your 4 year-old have a booster seat in the car?" b. "Have you noticed any physical problems as you go about your daily routine?" c. "What concerns do you have today? d. "Why did you decide to come in for a checkup?"

ANS: A Health risk appraisal refers to the process of assessing for the presence of specific factors in each of the categories that have been identified as being associated with an increased likelihood of an illness

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

ANS: 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.

When teaching a nutrition class to a student group with a large Hispanic population, the school nurse incorporates foods such as salsa and other healthy dishes familiar to Hispanic students into the presentation. Which of the following best describes the action taken by the nurse? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Both primary and secondary prevention

ANS: A Primary prevention involves activities such as health teaching to prevent a problem from occurring.

A nurse notes that the community has an unusually high prevalence of sexually transmitted infections among teens. Which of the following best describes a secondary prevention action the nurse could take? a. Conducting a sexual behavior survey with the adolescents b. Establishing in-school education related to transmission of sexual infections c. Providing free condoms at schools and universities d. Providing follow-up educational programs for those diagnosed with an STI

ANS: A Secondary prevention would include screening for risky behavior. Education and distribution of condoms are both primary prevention measures, and follow-up education for those diagnosed and being treated is tertiary to prevent further problems.

23. 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.

Which of the following demographic factors is expected to have the greatest influence on national health care spending? a. The aging population b. Use of diagnosis-related groups to determine reimbursement c. Insurance reform d. An increasing number of people without health insurance

ANS: A The aging population is expected to affect health services more than any other demographic factor. The majority of older adults rely on publicly funded programs. As the baby boom generation ages and retires, federal expenses for Social Security and health care will increase.

14. 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.

A nurse is working with a family member to reduce his health risk. Which of the following recommendations would most likely be made by the nurse? a. "Be sure to take a 30-minute walk each day." b. "Call our office if you have any questions or concerns at all." c. "Come back in 2 weeks for follow-up on your surgery." d. "Continue to take the drug until it is gone, even if you're feeling better earlier."

ANS: A The factors that determine or influence whether disease or other unhealthy results occur are called health risks. The major categories of risk include inherited biological risk, social and physical environmental risk, and behavioral risk. All the other options are treatment oriented rather than risk avoidance. Exercising for 30 minutes a day reduces the risk for many diseases.

A nurse is familiar with evidence-based practice (EBP) and wants to implement it into the care of clients. Which of the following would present the biggest challenge? a. Assessing one's current practice and accessing evidence-based resources b. Convincing administration that EBP is beneficial c. Distinguishing EBP from practice based on old standards d. Showing clients that EBP will improve their health outcomes

ANS: A The first step toward implementing evidence-based practice in nursing is recognizing the current status of one's own practice and believing that care based on the best evidence will lead to improved client outcomes. The challenge for the clinician is how to access the evidence and integrate it into practice, thus moving beyond practice based solely on experience, tradition, or ritual.

A nurse has been successful in creating improvement in a family's health. Which of the following characteristics is most likely displayed by the nurse? a. Skilled at recognizing and strengthening the family's competencies b. Skilled at obtaining referrals and resources for the family c. Skilled at communication and interpersonal relationships d. Skilled at assessing and naming the family's main problems

ANS: A The nurse's approach to the family should be positive and focused on competencies rather than on problems or deficits.

1. A resident in a rural community has been diagnosed with asthma. Which of the following providers will most likely provide care to this client? a.Advanced nurse practitioner b.Allergist c.Pediatrician d.Pulmonologist

ANS: A The providers most often seen by rural adults are general practitioners and advanced practice registered nurses (APRNs). In contrast, urban adults are more likely to seek care from a medical specialist.

A home health nurse who is visiting a family for the first time asks, "Could we review your extended family and other persons or groups with whom you interact each week?" Which of the following provides the best rationale for the nurse asking this question? a. To assess the family's environment and social resources and risks b. To communicate with relevant others as needed c. To determine financial assets available to the family in case of serious need d. To understand the extended family relationships

ANS: A The question by the nurse indicates that she is trying to obtain an ecomap. Ecomaps can provide information about relationships that the family has with others (such as relatives and neighbors), the family's connections with other social units (such as church, school, work, clubs, and organizations), and the flow of energy, positive or negative, in the family. An ecomap represents the family's interactions with other groups and organizations. Environmental or social risk and resources can be assessed from an ecomap.

A nurse has completed health risk appraisals with several different families. Which of the following families would be of most concern to the nurse? a. An older couple who has just retired and sold their house, who talk about their new condo in a retirement community. b. Newlyweds who have been saving their money, who want to discuss birth control and family planning in preparation for future pregnancies. c. Parents who come with their child for his pre-kindergarten physical exam and want to be sure all the child's immunizations are up to date. d. A woman who is very pleased with her new position at the hospital and wants to have her pre-employment exam and drug screen.

ANS: A Transitions (movement from one stage or condition to another) are times of potential risk for families. Age-related or life-event risks often occur during transitions from one developmental stage to another. Transitions present new situations and demands for families. Moving from the family home to a smaller condo represents a major change in lifestyle. None of the other options represent major transitions. If the event is normative, or anticipated, it is possible for families to prepare for the event and its consequences.

7. A child came to school coughing almost constantly. The next day, six other children in the same school room were coughing. Which of the following types of outbreak would the nurse suspect? A. Common source B. Mixed C. Propagated D. Intermittent

ANS: A Common source A common source outbreak refers to a group exposed to a common noxious influence, in this case, the ill child who was attending school. The cause of the illness being spread is obvious. DIF: Cognitive Level: Apply (Application) REF: p. 272

9. In January, a nurse is listening to colleagues talk about the increase in depressed patients asking for help from their physicians recently. The incidence of complaints of depression was higher in the last month than in the previous 3 months. Based on this data, which of the following would be the next step for the nurse to take? A. No further action is necessary because depression is known to worsen during the shorter darker days of winter. B. No further action is necessary because this short-term increase may just be a statistical error or even just a mistaken impression by the involved nurses. C. Action should be taken because there must be some cause for this noted increase. D. Action should be taken because this increase may the beginning of an epidemic and should be investigated.

ANS: A No further action is necessary because depression is known to worsen during the shorter darker days of winter. Typically, any unusual increase in incidence should be investigated. But in the majority of cases the increased incidence occurs naturally and/or is predictable when compared with the consistent patterns of previous outbreaks. Many illnesses are seasonal. Seasonal affective disorder (depression) often worsens during the shorter periods of daylight in the winter. DIF: Cognitive Level: Analyze (Analysis) REF: p. 272

8. A nurse noted that of 18 children in a day care center room, 5 became ill. Which of the following best describes a host factor that may be associated with this illness and who became ill? A. Some of the children were from very low socioeconomic families. B. Some of the children slept during rest time while others only rested. C. The bacterial cause of the illness was easily removed by hand washing. D. The day care center room was much warmer on three sides in comparison to the side with the floor to ceiling windows.

ANS: A Some of the children were from very low socioeconomic families. Factors that must be considered as causes of outbreak are categorized as agents, hosts, and environmental factors. Host factors may be age, sex, race, socioeconomic status, genetics, and lifestyle choices. The cause of the illness is an agent factor, and the difference in temperature in the room is an environmental factor. DIF: Cognitive Level: Apply (Application) REF: p. 272

A nurse recognizes that although a patient speaks English, the patient is from a culture with which the nurse is unfamiliar. Therefore, a cultural assessment should be attempted. Which of the following questions should the nurse ask? (Select all that apply.) a.Can you tell me where your family is from? b.Do you practice a particular religious faith? c.Have you ever been in an American hospital before? d.Is there anything special we need to know about your food preferences?

ANS: A, B In a brief cultural assessment, nurses ask clients about their ethnic background, religious preference, family patterns, cultural values, language, education, politics and health practices. Nurses want to also ask about the clients perception of the health issue and what caused it and how it should be treated as well as the results they expect from the care they get. Such basic data help nurses understand the client from the clients point of view and recognize what is unique about the person, thus avoiding stereotyping.

2. A woman and man who have come to the health clinic begin to argue loudly. You gave me an STD! the man yells. The woman screams back, Not me. I dont have an STD! Which of the following statements would be most appropriate for the nurse to say to them? (Select all that apply.) a. Actually, youre very fortunate to have been tested so you and your partner can begin treatment before more serious damage is done. b. Some STDs may not have any symptoms, so you need to be tested for other conditions and treated if necessary. c. Sometimes the test is inaccurate, so before getting too upset, you should ask to be tested again. d. You may be able to get treatment from your pharmacist so you wont have to be embarrassed like this again.

ANS: A, B, C Often cases of gonorrhea and chlamydia are asymptomatic, so treatment may not be sought and these infections are spread to others through sexual activity. Similarly, during latency, syphilis has no symptoms. It should be noted, however, that STD test results can sometimes be incorrect and the coexistence of other medical conditions may cause a false-positive test result. Having a partner retested, if the results were negative, would also suggest retesting the first person.

Which of the following actions demonstrate(s) effective public health nursing practice in the community? (Select all that apply.) a. Epidemiological 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 at the public health agency continue to increase in number

ANS: 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 epidemiological studies

4. A nurse's family has moved to a rural area to be near her spouse's aging parents. Which of the following would the nurse most likely notice about the family's new environment? (Select all that apply.) a.It is very difficult to obtain continuing education, except for online programs. b.Neighbors seem to expect the nurse to know everything about all health care and illness conditions. c.Neighbors ask questions about health concerns any time they see the nurse, regardless of where they are. d.People come to the health clinic before their situation becomes relatively serious.

ANS: A, B, C Rural people often develop independent and creative ways to cope because of the distance, isolation, and sparse resources they encounter. The boundaries between home and work blur because clients are also neighbors and friends of immediate family members. Nurses are highly regarded by the community and viewed as experts on health and illness. Residents may ask health-related questions and request recommendations whenever they see the nurse. Nurses in rural areas may also be expected to, in general, know something about everything, and this can be a demanding expectation. Some of the challenges are professional isolation, limited opportunities for continuing education, lack of other health personnel or professionals with whom the nurse can interact, heavy workloads, the need to function well in several clinical areas, lack of anonymity, and for some, a restricted social life.

Which of the following factor(s) may help determine how many home visits are made to a particular family? (Select all that apply.) a. Agency's policies regarding eligibility for services b. Family's feelings about the home visit and willingness to continue c. Nurse's perception of the amount of time needed to complete required tasks d. Reimbursement policies of third-party payers

ANS: A, B, D Although it is not unusual to have only one home visit with a family, often multiple visits are made. The frequency and intensity of home visits vary not only with the needs of the family but also with the eligibility of the family for services as defined by agency policies and priorities. Although the textbook does not directly discuss the issue, the family's willingness to work with the nurse is a factor. Also, the nurse cannot make visits unless the agency is being reimbursed for the nurse's time and expenses, so reimbursement policies of third-party payers are a major influence on the number of visits for which the family may be eligible. The nurse's perception of the time needed to give quality care must unfortunately be secondary to other variables, which can control the time available.

An undocumented immigrant comes to a physicians office to receive care. Which of the following services can the client receive? (Select all that apply.) a.Treatment for tuberculosis b.Treatment for Type 2 diabetes c.Immunization for polio d.Physical examination

ANS: A, C Undocumented immigrants or illegal aliens are individuals who have crossed a border into the United States illegally or whose legal permission to stay in the United States has expired. They are eligible only for emergency medical services, immunizations, treatment for the symptoms of communicable diseases, and access to school lunches.

A family asks the nurse to please meet at their home rather than at the clinic. Which of the following best describes why the family prefers to meet in their home? (Select all that apply.) a. The family won't have to travel. b. It is cheaper for the family because of reimbursement requirements. c. Meeting at home is much more convenient for the family. d. The nurse won't be distracted by other clients or responsibilities. e. It would save money for the nurse and the clinic.

ANS: A, C Advantages of a home visit include client convenience and client control, as well as the fact that it facilitates clients who are unable to travel, it allows more individualized services, and it provides a natural relaxed environment for discussion. However, home visits are expensive for the nurse and the nurse's employer because of travel costs and the amount of time spent with just one family. Unfortunately, nurses can be distracted by other tasks regardless of setting. Home visits are cheaper for insurance companies, not for the family.

A nurse has decided to increase the evidence base of current nursing practice in an agency. Which of the following describes a barrier that could be encountered by the nurse? (Select all that apply.) a. Colleagues who don't know how to search the literature or critique research b. Dedication to the history and tradition of the agency c. Little or no research published in the clinical area of concern d. Several meta-analyses in the literature with inconsistent results

ANS: A, C Barriers to evidence-based practice exist when the following are limited or lacking: time, access to journal articles, search skills, critical appraisal skills, and an understanding of research terminology. Other barriers include miscommunication about the process; inferior or unavailable research or other evidence; unwillingness of organizations to fund research or make decisions based on evidence; and concern that evidence-based practice will decrease emphasis on individual client needs or the nurse's clinical decisions.

3. A nurse tells her nursing supervisor that her family is moving from the urban area where they both live to a rural area to be near her spouse's parents, who are becoming less independent. Which of the following suggestions would the nursing supervisor provide to the nurse? (Select all that apply.) a."Community members will probably hold you in higher regard and will look up to you." b."Expect to have less autonomy in a small town than you have working as a nurse in a medical center." c."You may feel like an isolated outsider, because the community may not immediately accept you." d."You will have to be very sensitive about the differences in the rural lifestyle."

ANS: A, C, D Nurses working in rural areas usually have a prestigious status in the community and are viewed as role models. They have greater (not less) independence and autonomy, fewer (not more) resources, and need to have more generalist (not specialized) knowledge and skills.

1. Which of the following best describes why health professionals would be particularly concerned about the health needs of residents in rural areas? (Select all that apply.) a.About 25% of all U.S. residents live in rural settings. b.People in rural areas are especially susceptible to acute illnesses rather than chronic diseases. c.Diagnoses in rural areas are usually for physical injuries, not mental health concerns. d.A high prevalence of poverty exists among rural families.

ANS: A, D About 25% of all U.S. residents live in rural settings. Rural residents are less likely to engage in preventive behavior and they tend to be poorer than their urban counterparts (more than 25% of rural Americans live in or near poverty, and nearly 40% of all rural children are impoverished). Nearly one half of all rural adults suffer from at least one chronic condition. Stress, stress-related conditions, and mental illness are prevalent among populations that have economic difficulties, including rural populations. Often rural health professionals live and practice in a particular community for decades. Consequently, rural respondents tend to know their usual provider of health care.

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.:

ANS: 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. It is not more efficient nor more convenient, since travel time has to be considered. Nurses differ as to their preferred employment setting.

A nurse calls a family to arrange for the first home visit. Which of the following information should the nurse share with the family? (Select all that apply.) a. The reason for the visit b. Everything the nurse knows about the family c. How many visits will be planned d. The cost of the visit and how this may be paid

ANS: A, D The nurse should include the reason for the visit, how or from whom the referral was obtained, and a brief summary of what is known about the family's situation. The nurse should negotiate a time for the visit, preferably when most family members are available. Clients should be told the fee and possible methods of payment before the nurse assesses the family's willingness for a home visit. If the family does not have a phone, mail can be used to share information.

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 public health core function of: A. assessment. B. assurance. C. policy development. D. research

ANS: A. assessment

A state 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 elder care programs. The public health core function applied is: A. assurance. B. policy development. C. primary prevention. D. public transportation.

ANS: A. assurance.

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.

ANS: A. community-based nursing

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.

ANS: A. community-based nursing.

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.

ANS: A. community-oriented care.

In a federally funded preschool program such as Head Start, nursing services that include conducting developmental level screening for cognitive and psycho-motor 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 psycho-motor development. D. treatment is initiated for a child with an identified learning disability.

ANS: A. individual results are compared with established standards for children of the same age group

A Buddhist patient enters the hospital for diagnostic testing just before lunch time. The nurse tells the aide to give a meal tray to the new patient, because no tests will be done until later that evening. The aide gives the patient a meal of Salisbury steak, bread, green beans, and potatoes with brown gravy. The patient eats nothing but a slice of bread and the green beans. Which of the following considerations was omitted by the nurse? a.The patient should not be served any food until a physicians order is obtained. b.The patients Buddhist faith probably requires a vegetarian diet. c.The patient may be too frightened about the tests to want to eat very much. d.The patient may have diabetes or be allergic to some foods.

ANS: B Although it is always wise to check with a patient before sending in food, the meal given to this patient was offensive. Most Buddhists are vegetarians and dont eat meat.

8. Which of the following best explains why some health clinics allow clients to be tested for HIV anonymously with no record of the clients name, address, or contact information? a. Client doesnt actually ever have to be told the results of the test. b. Client may be engaged in illegal activities (drug use). c. Client plans on not paying for the test and collection agencies will not be able to harass them. d. Client wants to be sure care providers dont share results with their family.

ANS: B An advantage of anonymous testing may be that it increases the number of people who are willing to be tested, because many of those at risk are engaged in illegal activities. The anonymity eliminates their concern about the possibility of arrest or discrimination.

21. A mother felt very guilty that her baby was born HIV positive. When the nurse suggested the usual DPT and MMR immunizations, the mother was extremely upset. Dont you know HIV children are immunosuppressed? she exclaimed. Which of the following would be the nurses best response? a. All children have to have these immunizations before they can attend school. b. Being HIV positive, your child is more likely to catch an infection and be very ill if not immunized. c. Im so sorry; I forgot for a moment your child was HIV positive. d. The American Pediatric Association requires all health care providers to offer these immunizations to all parents; it is your choice whether or not to accept them.

ANS: B Because of impaired immunity, children with HIV infection are more likely to get childhood diseases and suffer serious consequences of the diseases. Therefore, DPT, IPV, and MMR vaccines should be given at regularly scheduled times for children infected with HIV. Other immunizations may also be recommended after medical evaluation. Many states do have a no shots, no school law, but exceptions can be made. The APA does recommend immunizations for most children, but this is not the best answer.

A nurse wishes to develop cultural competence. Which of the following actions should the nurse take first? a.Complete a survey of all the various ethnicities represented in the nurses community. b.Consider how the nurses own personal beliefs and decisions are reflective of his or her culture. c.Invite a family from another culture to join the nurse for an event. d.Study the beliefs and traditions of persons living in other cultures.

ANS: B Cultural awareness requires self-examination and an in-depth exploration of ones own beliefs and values as they influence behavior.

A nurse states, The best way to treat a client from another country is to care for them the same way we would want to be cared for. After all, we are all humans with the same wants and needs. What does this statement reflect in relation to culture? a.Awareness b.Blindness c.Knowledge d.Preservation

ANS: B Cultural blindness is the tendency to ignore differences between cultures and to act as if they do not exist. People from different cultures may have different expectations, wants, and needs.

A nurse is about to despair. Earlier in the week, she carefully taught a patient from a different culture exactly how much medication to take and emphasized the importance of taking the correct amount. However, the patient is back in the hospital today with symptoms of an overdose, although the patient denies taking more than the label indicated. Which of the following is the most likely explanation? a.The patient was taking more mediation in the hope of getting well faster. b.The patient was also taking folk medicines that had many of the same effects and perhaps some of the same ingredients as the prescribed medication. c.The patient truly did not understand and thought the dose being taken was correct. d.The patient had a unique response to the medication and should have a smaller dose ordered.

ANS: B For fear of disapproval, a person may not tell the nurse that he or she is using folk medicine as well as Western medication. The two medicines may have cumulative effects that could be dangerous to the client. Nurses who lack cultural knowledge may develop feelings of inadequacy and helplessness because they are often unable to effectively help their clients.

15. Which of the following best describes the characteristic appearance of lesions of human papillomavirus (HPV)? a. Solitary growth with elevated borders and a central depression b. Elevated growths with a cauliflower appearance c. Thin-walled pustules that rupture to form honey-colored crusts d. Vesicles that ulcerate and crust within 1 to 4 days

ANS: B HPV causes genital warts that appear as textured surface lesions, with what is sometimes described as a cauliflower appearance. The warts are usually multiple and vary between 1 and 5 mm in diameter.

19. A client with tuberculosis (TB) asks why the nurse is required to watch the client swallow the medication each day. Which of the following statements is the best response by the nurse? a. Clients with TB are often noncompliant, so if I directly observe, you will be sure to take the drugs that have been ordered. b. This therapy is recommended to make sure that you receive the treatment you need and the infection doesnt become resistant to the drugs. c. This is to make sure you take your medication if your condition becomes so advanced that you do not have enough cerebral oxygenation to remember. d. Tuberculosis medications are very expensive so this method ensures that government money doesnt get wasted on those who will not take the drugs.

ANS: B It is important to be respectful to clients and to consider their perspective and psychological health while also responding truthfully. Directly observed therapy (DOT) programs for TB medication involve the nurse observing and documenting individual clients taking their TB drugs. When clients prematurely stop taking TB medications, there is a risk that the TB will become resistant to the medications. This can affect an entire community of people who are susceptible to this airborne disease. DOT ensures that TB-infected clients receive adequate medication. Thus, DOT programs are aimed at the population level to prevent antibiotic resistance in the community and to ensure effective treatment at the individual level. Many health departments have DOT home health programs to ensure adequate treatment.

12. Which of the following best explains why chlamydia is a major focus of public health efforts? a. It has more serious long-term outcomes than other STDs b. It can cause problems in infants born to infected mothers c. It is not frequently seen in the United States d. It is so difficult and expensive to treat

ANS: B Like gonorrhea and other STDs, chlamydia can cause neonatal complications in infants born to infected mothers, although it is rather easily treated with antibiotics. Chlamydia does have serious long-term outcomes for the client, but so do syphilis and other STDs. However, unlike syphilis, which in its later stages is rare in the United States, chlamydia is the most common reportable infectious disease in the United States and hence is a major focus of public health.

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

ANS: 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.

20. A nurse is concerned about the prevalence of tuberculosis among migrant farmworkers. Which of the following activities would be best to use when implementing tertiary prevention? a. Administer purified protein derivative (PPD) to contacts of those with tuberculosis. b. Initiate directly observed therapy (DOT) for tuberculosis treatment. c. Provide education about the prevention of tuberculosis to members of the migrant community. d. Use skin tests to screen migrant health workers for tuberculosis infection.

ANS: B Tertiary prevention is carried out among persons already infected with the disease. In this instance DOT ensures compliance with treatment to cure the disease and to prevent worsening or the development of secondary problems.

14. When a nurse discovers that a woman has been treated for cervical cancer, the nurse asks the woman whether she has ever been tested for HIV or other STDs. The woman is offended and asks why the nurse would ask her such a thing. Which of the following statements would be the best response from the nurse? a. Cervical cancer treatments may decrease immunity, so that it is easier to acquire STDs. b. Cervical cancer usually is caused by HPV, and often the presence of one STD is accompanied by other STDs. c. The presence of an STD in women with cervical cancer may lead to congenital defects in offspring. d. The presence of an STD in a woman with a history of cervical cancer has been associated with a relapse of the cancer after treatment.

ANS: B The link between HPV infection and cervical cancer has been established and is associated with specific types of the virus. In 80% to 90% of cases of cervical cancer, evidence of HPV has been found in the tumor. Additionally, HSV-2 infection is linked with the development of cervical cancer. Because the presence of an STD increases the risk for the presence of other STDs, it is essential to screen for this information.

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 spent the day attending meetings 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

ANS: 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 (a one-way form of communication) is less effective than interacting with others

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 spent the day attending meetings 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

ANS: 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 (a one-way form of communication) is less effective than interacting with others.

A school nurse is developing a primary prevention strategy for school-aged children. Which of the following interventions would the nurse most likely implement? a. Developing individualized exercise programs for overweight children b. Drafting policy for increases in noncompetitive physical activity programs c. Monitoring body mass index in children to identify elevations before they become difficult to manage d. Notifying parents and/or guardians of their child's height-weight scale in comparison with national norms

ANS: B At the primary prevention level, campaigns to support regular exercise, greater emphasis on school-based physical education programs, and environmental and policy initiatives to create or enhance places for physical activity in communities can make significant contributions to improving the lifestyle of sedentary children. Exercise programs are an example of tertiary prevention. Monitoring BMI in children is an example of secondary prevention. Notifying parents of their children's height-weight scale increases family awareness but does not meet the definition of a preventive measure.

A nurse wishes to develop cultural competence. Which of the following actions should the nurse take first? a. Complete a survey of all the various ethnicities represented in the nurse's community. b. Consider how the nurse's own personal beliefs and decisions are reflective of his or her culture. c. Invite a family from another culture to join the nurse for an event. d. Study the beliefs and traditions of persons living in other cultures.

ANS: B Cultural awareness requires self-examination and an in-depth exploration of one's own beliefs and values as they influence behavior.

A nurse states, "The best way to treat a client from another country is to care for them the same way we would want to be cared for. After all, we are all humans with the same wants and needs." What does this statement reflect in relation to culture? a. Awareness b. Blindness c. Knowledge d. Preservation

ANS: B Cultural blindness is the tendency to ignore differences between cultures and to act as if they do not exist. People from different cultures may have different expectations, wants, and needs.

A health care provider is concerned about the high number of clients with type 2 diabetes mellitus who have poor glucose control. What would be the best reference for the provider to implement evidence-based practice (EBP) in the management of this problem? a. Published protocols b. Current research findings c. Opinions of colleagues d. Nursing journals

ANS: B EBP in community-oriented nursing challenges nurses to integrate outcomes of the best evidence into their clinical practice. Current research findings will explicate evidence of most successful interventions. (Randomized clinical trials are the gold standard of research for EBP.) Protocols and opinions often reflect tradition rather than the most current scientific evidence. Although many nursing journals are peer reviewed, many are not and, even if peer reviewed, many are not research based or focused on scientific evidence. Similarly, information from the Internet may or may not be reliable, because the goal of many websites is to sell products rather than to serve as an unbiased source. Determining when the website was last updated would also be helpful in evaluating the site's usefulness.

2. 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 population.

1. 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.

Which of the following groups pays the largest amount for health care in the United States today? a. Consumers b. Federal and state government c. Insurance companies and other third-party payers d. Hospitals and health care providers

ANS: B Health care financing has evolved from a time when the most money was expended by consumers, then to a system financed by third-party payers such as insurance companies, and finally, to today, when state and federal government payments (primarily through Medicare and Medicaid) pay more than private insurance companies or consumers.

7. 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.

8. In a particular community, several high school students were diagnosed with diabetes mellitus Type 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.

13. 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 rate

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

An occupational health nurse is developing an educational program to address the importance of healthy personal health habits. Which of the following topics would be most important for the nurse to address? a. Avoidance of alcohol b. Regular physical exercise c. Daily consumption of calcium-rich foods d. Monthly self-breast and testicular exams

ANS: B Many family health risks can be reduced by careful attention to diet, exercise, and stress management. Regular physical exercise is effective in promoting and maintaining health and in preventing disease. Physical activity can help to prevent obesity, diabetes, heart disease, cancer, osteoporosis, and depression. Avoidance of alcohol and daily consumption of calcium-rich foods are not recommendations for improving personal health habits.

Which of the following groups is pressuring clinicians the most to use evidence-based practice (EBP)? a. Administrators b. Insurance companies c. Nurses d. Physicians

ANS: B Much of the pressure to use evidence-based practice comes from third-party payers and is a response to the need to contain costs and reduce legal liability.

3. 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.

Which of the following is most closely correlated with poor health? a. Age and gender (i.e., older males) b. Low socioeconomic status c. Minority race status d. High-risk lifestyle behaviors

ANS: B Poverty is more closely related to health status even when controlling for age, gender, race, education, and lifestyle behaviors.

A nurse was preparing for a home visit to a family where the mother had just been discharged from trauma care after being hit by a drunk driver. The nurse hoped the family was able to care for her. Which of the following comments from the husband would suggest an energized family? a. "I make most of the decisions so the kids don't notice much difference." b. "My daughter is pretty independent; she's active in both sports and theater." c. "My son is old enough to get a job and help pay all these medical bills." d. "My wife taught our daughter how to cook simple meals."

ANS: B Pratt proposed the energized family as being an ideal family type that was most effective in meeting health needs. The energized family is characterized by active contact with a variety of groups and organizations (Boy Scouts, church, sports, theater), flexible role relationships (not if only the daughter is taught how to cook and only the son is expected to get a job), equal power structure (not if the husband makes all the decisions), and a high degree of autonomy by each member (kids know how to be flexible, because parents travel for business frequently).

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 communities 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.

ANS: 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

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.

ANS: 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.

A school health nurse plans to use evidence-based practice (EBP) to guide the development of health education programs most likely to increase retention of learning in elementary schoolchildren. Which of the following would be the best way to use EBP in this situation? a. Ask other school health nurses what they included in their own education programs. b. Compare and contrast randomized clinical trials related to learning in elementary schoolchildren. c. Develop a series of games to accompany the programs developed to promote health. d. Seek out and examine health education programs for elementary school children on the Internet.

ANS: B Randomized clinical trials are the gold standard of evidence gathering in EBP.

A community health nurse is determining the best way to address an outbreak of a new infectious disease using evidence-based practice. Which of the following actions would the nurse most likely take? a. Review policies and procedures b. Review outcomes of clinical trials c. Review several nursing textbooks d. Review reputable sites on the Internet

ANS: B Research findings, knowledge from basic science, clinical knowledge, and expert opinion should be considered sources of evidence for EBP. The problem with nursing textbooks is that many are not grounded in evidence-based practice, because the concept is relatively new to the United States (as mentioned in the section of the chapter on historical perspectives of EBP). Scanning the Internet for ideas is helpful only if evidence-based practice sites are accessed, and most Internet sites are not EBP sites.

12. Which of the following conditions of the rural environment provides increased opportunities for teaching? a.Increased interaction among residents due to neighbors visiting neighbors on the family farms b.Involvement in rural community activities provides more contact with community residents than in urban areas c.Nursing responsibilities in these areas stress the importance of primary, secondary, and tertiary prevention d.Increased illnesses and injuries of rural residents require that they see nurses more often

ANS: B Rural areas have fewer churches, stores, and schools. Thus, nurses may go to the same church, shop at the same stores, and/or have children in the same schools as their clients. There are also fewer organizations, so it is easier to become involved and meet everyone while participating. Visiting neighbors does not increase opportunities for teaching. The fact that nursing responsibilities include all levels of prevention is true of both urban and rural areas. The statement about increased illness and injuries in rural residents is wrong, because although illnesses and injuries are increased, rural residents often do not seek care for these conditions.

After finding several studies related to the clinical problem, a nurse knows the studies must be evaluated. Which of the following characteristics should be present in the literature? a. Federally supported multiagency clinical studies b. Multiple high-quality studies with large sample sizes and consistent findings c. Research studies done by multidisciplinary teams in multiple settings d. Controlled clinical trials

ANS: B The Agency for Healthcare Research and Quality (AHRQ) reviewed 40 systems used to evaluate the quality of studies and strength of evidence. The report identified three domains for evaluating systems that grade the strength of evidence: quality, quantity, and consistency. The quality of a study refers to the extent to which bias is minimized. Quantity refers to the number of studies, the magnitude of the effect, and the sample size. Consistency refers to studies that have similar findings, using similar and different study designs.

A public health nurse is compiling information about how to promote early detection of breast cancer in women. Which document would most likely provide useful information about this topic? a. The Future of Public Health b. Healthy People 2020 c. Patient Protection and Affordable Care Act d. Scope and Standards of Public Health Nursing Practice

ANS: B The Healthy People documents propose a national strategy to improve significantly the health of Americans by preventing or delaying the onset of major chronic illnesses, injuries, and infectious diseases.

12. 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.

A nurse enters a family's home for the first time. Which of the following goals should the nurse have? (Select all that apply.) a. Assessing each family member in detail both physically and psychologically b. Collaborating with the family to establish goals and a plan for meeting them c. Determining the exact relationship between each member of the family d. Exploring the family's perception of their problems and needs

ANS: B, D During the beginning phase of the nurse-family interaction, three activities occur—mutual data collection and exploration of needs and problems; mutual establishment of goals; and mutual development of a plan.

A busy school health nurse concerned over the rising incidence of obesity wants to implement evidence-based practice (EBP) but faces barriers because of time constraints. Which of the following actions should the nurse take first? a. Identify students who are obese so that they may be closely monitored for weight control success or failure. b. Evaluate best practices to determine those that have the highest success rates for weight control in children. c. Schedule physician appointments for obese children. d. Develop an obesity management program for children whose body mass index exceeds normal.

ANS: B The first step of the seven-step EBP process is step zero, which involves a curiosity about the interventions that are being applied; this is not described in any of the topic descriptors. Step one requires asking questions in a "PICOT" format; this is not described in any of the topic descriptors. Step two involves searching for the best evidence to answer the question. This is done through evaluating best practices.

10. A nurse is working with Mexican immigrants. Which of the following behaviors would most likely lead to a positive interaction for the nurse? a.Avoiding touching the client except when necessary as part of the physical examination b.Calling the client by name, socializing before addressing the problem, and being very respectful c.Keeping all interactions direct, to the point, and targeted on the reason for presentation d.Maintaining a non-confrontational relationship by avoiding any disagreement even if the nurse does disagree with what the client is saying

ANS: B The nurse is considered an authority figure who should respect (respeto) the individual, be able to relate to the individual (personalismo), and maintain the individual's dignity (dignidad). Such an approach would be expected for any client, not just with immigrants. Mexican individuals, like those of many cultures, expect to establish some rapport through talking about personal matters (chit-chat) for the first few minutes of an encounter before addressing any problems. Touching as a caring gesture is usually seen as a positive behavior.

22. 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 to know 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.

2. A nurse attends a conference to learn more about public health surveillance. Why is it so important that the nurse be knowledgeable about this topic? A. Because nurses are employed in public health agencies B. Because nurses are often the first to recognize and respond to a problem C. Because nurses are responsible for ensuring that action is taken when necessary D. Because nurses are typically the ones to interact with the public and the media

ANS: B Because nurses are often the first to recognize and respond to a problem Nurses are often in the forefront of responses to be made in the surveillance process whether working in a small rural agency or a large urban agency; within the health department, school, or urgent care center; or on the telephone performing triage services during a disaster. It is the nurse who sees the event first. DIF: Cognitive Level: Apply (Application) REF: p. 268

4. Which of the following types of surveillance is being used when case reports are routinely sent to local health departments by health care providers and laboratories, where the data are then summarized and forwarded to those responsible for monitoring such reports? A. Active surveillance B. Passive surveillance C. Sentinel surveillance D. Special surveillance

ANS: B Passive surveillance It is passive surveillance when case reports are sent to local health departments by health care providers or laboratories. The case reports are summarized and forwarded to the state health department, national government, or organizations responsible for monitoring the problem, such as the CDC. In active surveillance, the health department nurse may begin a search for cases through contacts to determine the magnitude of the problem. Sentinel surveillance involves looking for trends. Special surveillance is developed when a particular type of data is sought. DIF: Cognitive Level: Understand (Comprehension) REF: p. 269

6. Several children were hospitalized for severe vomiting and diarrhea. Which of the following best explains why the nurse would continue to pursue the cause of the illness even after the children have been discharged from the hospital? A. So that the children's families know the public health department cared about them B. So that action could be taken to avoid any such future episodes C. Because the children's parents need to know whom to sue for their medical expenses D. To confirm that the symptoms were due to an infectious disease

ANS: B So that action could be taken to avoid any such future episodes The objectives of an investigation are to control and prevent disease or death by identifying factors that contribute to the occurrence and implementing measures to prevent occurrences. In this case the nurse wanted to make sure children did not become ill again when it could be avoided. DIF: Cognitive Level: Apply (Application) REF: p. 271

3. Which of the following strategies should be used when providing educational programs for children? (Select all that apply.)

b. Use simple words to enhance understanding. c. Use objects to help increase their attention.

3. The public health nurse comes to the hospital to see a client just diagnosed with hepatitis A. The nurse says, Im sorry to bother you when youre not feeling well, but I need to ask you a few questions. Which of the following questions would be most appropriate for the nurse to ask the client? (Select all that apply.) a. Do you know how you got this infection? b. Who lives with you? c. Where are you employed? d. Where do you usually eat?

ANS: B, C The nurse should ask about sexual contacts and ask who (if anyone) lives with the client because the named individuals will need to have immune globulin administered to hopefully prevent the spread of hepatitis A and a community epidemic. The nurse should also ask about the clients place of employment because certain settings warrant special considerations. For example, in restaurants, hospitals, daycare centers, or other institutions, the lack of careful hand-washing by an infected worker can result in contamination of many others.

2. A nurse is caring for Mexican migrant farmworkers. Which of the following conditions are of greatest importance for the nurse to assess? (Select all that apply.) a.Cholera b.Hepatitis c.High blood level of lead d.Malaria

ANS: B, C Poor quality and crowded housing can contribute to such health problems as tuberculosis (TB), gastroenteritis, and hepatitis, as well as exposure to high levels of lead. Tuberculosis (TB) is more prevalent in Mexico than in the United States, and some infected immigrants work as migrant farmworkers. Additionally, TB tends to spread in regions where housing is crowded. Migrant farmworkers have higher rates of TB than most population groups.

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 health care needs rather than only on acute care treatment d. Threat of bio-terrorism:

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

11. Which of the following describes the purpose of surveillance systems today? (Select all that apply.) A. To obtain data used to fight for increased budgets from taxpayers B. To evaluate the effectiveness of public health programs C. To monitor and reduce the incidence of chronic diseases D. To note and help prevent occupational exposure and diseases

ANS: B, C, D B. To evaluate the effectiveness of public health programs C. To monitor and reduce the incidence of chronic diseases D. To note and help prevent occupational exposure and diseases Although surveillance was initially devoted to monitoring and reducing the spread of infectious diseases, it is now used to monitor and reduce chronic diseases and injuries, as well as environmental and occupational exposures. With tight budgets, public health workers must know which programs should be developed and continued based on the most commonly occurring public health problems. Evaluation of the effectiveness of programs requires valid and reliable data. DIF: Cognitive Level: Understand (Comprehension) REF: p. 267

1. In which of the following cases would the school nurse be correct to advise the parents of an HIV-infected child to keep the child home from school? (Select all that apply.) a. The child develops allergies with sneezing. b.The child persists in biting behavior or is unable to control body secretions. c. The nurse is not comfortable with being responsible for the child. d. There is an outbreak of chickenpox in the school.

ANS: B, D Not attending school may be advisable if cases of childhood infections, such as chickenpox or measles, occur in the school, because the immunosuppressed child is at greater risk for suffering complications. Alternative arrangements, such as homebound instruction, might be instituted if a child is unable to control body secretions or displays biting behavior. HIV-positive children are encouraged to obtain routine immunizations, because their immune systems are compromised and they are more susceptible to such infections. To date, no cases of HIV infections being transmitted in a school setting have occurred in the United States. Strong disapproval by parents of well children is an opportunity to teach these persons how HIV is transmitted.

12. A public health department becomes aware of an impending health problem before any problem is reported to the agency. Which of the following has most likely occurred within the community? (Select all that apply.) A. Doctors are feeling rushed as they interact with each patient. B. Emergency departments are notably busier than usual. C. Nurses are calling in ill to the local hospital. D. Pharmacists are discussing the increase in medication purchases.

ANS: B, D B. Emergency departments are notably busier than usual. D. Pharmacists are discussing the increase in medication purchases. Doctors feeling rushed and nurses calling in ill are not unusual events. Syndronic surveillance systems were developed to monitor illness syndromes or events, as seen in such indirect measures as increased numbers of medication purchases, trips to physicians or emergency departments, orders for cultures or x-rays, and rising levels of school or work absenteeism. These may indicate that an epidemic is developing. DIF: Cognitive Level: Analyze (Analysis) REF: p. 271

5. The correctional health nurse is doing a quick assessment on a newly admitted inmate who is HIV positive. Which of the following diseases should the inmate receive screening for immediately? a. Herpes zoster b. Hepatitis B c. Hepatitis C d. Tuberculosis

ANS: D HIV-infected persons who live near one another, such as in correctional facilities, must be carefully screened and deemed noninfectious before admission to such settings. A person with HIV is more susceptible to opportunistic infections, the most common of which is TB.

A nurse working with Mary Breckinridge would have likely assisted with: (Select all that apply.) a. Establishing the Henry Street Settlement b. Developing health programs geared toward improving the health care of the rural populations c. Blazing a nursing trail through the Rockies, providing nursing care to miners and their families d. Ensuring positive outcomes for pregnancies among women in the Appalachian region

ANS: B, D Mary Breckinridge developed health programs geared toward improving the health care of the rural and often inaccessible populations in the Appalachian regions of southern Kentucky. Breckinridge introduced the first nurse-midwives into the United States when she deployed FNS nurses trained in nursing, public health, and midwifery. Their efforts led to reduced pregnancy complications and maternal mortality, and to one-third fewer stillbirths and infant deaths in an area of 700 square miles. Lillian Wald established the Henry Street Settlement.

How did Florence Nightingale help bring about community health nursing? (Select all that apply.) a. She convinced socially prominent wealthy women to volunteer to give care. b. She focused on all soldiers and their environment. c. She interacted with each individual person, assessing his or her needs and acting to meet those needs. d. She kept careful records on what was done and what were the results.

ANS: B, D Nightingale progressively improved the soldiers' health using a population-based approach that improved both environmental conditions and nursing care. Using simple epidemiology measures, she documented a decreased mortality rate to demonstrate the outcomes.

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.

ANS: B. community-based nursing.

Public health nursing is a specialty 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.

ANS: B. populations with the highest rate of diabetes

. A 40-year-old Bosnian, Muslim woman who does not speak English presents to a community health center in obvious pain. She requests a female health care provider. Through physical gestures, the woman indicates that the pain is originating in either the pelvic or genital region. Which of the following interpreters would be the most appropriate in this situation? a.A Bosnian male who is certified as a medical interpreter b.A female from the clients community c.A female who does not know the client d.The clients 20-year-old daughter

ANS: C Although having experience in medical interpretation is important, in many cultures it is inappropriate to have a male interpreter for females. This client has specifically requested a female provider; therefore, one might anticipate that the client will not be as forthcoming with a male interpreter. Regardless of certification and ability, the interpreter cannot interpret information the client may withhold because she feels it inappropriate to discuss private matters in front of a male. This client may also feel it inappropriate to have private matters interpreted by her daughter (especially if they are of a sexual nature or if they involve infidelity). Additionally, to avoid a breach of confidentiality, the nurse should avoid using an interpreter from the same community as the client.

1. Which of the following sexually transmitted diseases can be prevented through immunization? a. Chlamydia b. Gonorrhea c. Hepatitis B d. Herpes

ANS: C At the time of this writing, HBV infection can be prevented by immunization; vaccines for the remaining options are not yet available.

Using the Neuman Systems Model, which of the following questions would the nurse ask a client to assess physiological health? a. "What helps you to cope with situations involving your wife's cancer?" b. "How has your child's illness affected the behavior of your other children?" c. "Tell me about any illnesses your other family members have." d. "Who do you turn to for support outside your immediate family?"

ANS: C Physiological health involves issues related to physical wellness or illness. Other components of health in Neuman's model include psychological health, sociocultural health, developmental health, and spiritual health.

Mexican immigrants who take metamizole (Mexican aspirin) for pain may experience life-threatening agranulocytosis. Which of the following actions would be taken by a nurse who employs cultural repatterning? a.Complete a cultural assessment to identify any other dangerous medications that the client may be taking. b.Put this into perspective by considering that many drugs used in the United States cause agranulocytosis. c.Explain the harmful effects of metamizole and recommend an alternative medication for pain. d.Recognize that taking metamizole is common among persons living in Mexico and accept this as a cultural tradition.

ANS: C Cultural repatterning means that the nurse works with clients to help them reorder, change, or modify their cultural practices when the practice is harmful to them.

9. A nurse is providing education to a client about the use of PrEP. Which of the following statements would the nurse include as part of this teaching? a. Side effects of PrEP include extreme lethargy and joint pain. b. PrEP has been shown to be effective in preventing transmission of the disease from sharing needles. c. The effectiveness of PrEP will depend on your adherence to the medication regimen. d. PrEP will prevent you from contracting HIV and Hepatitis B.

ANS: C Pre-exposure prophylaxis, or PrEP, is a new HIV prevention method for people who do not have the infection but would like to reduce their risk of becoming infected. PrEP requires taking a pill to prevent the HIV virus from getting into the body. It has been shown to be effective for people at very high risk for HIV infection through sex; the results about its effectiveness with injection drug users are not yet available. This prevention method requires strict adherence to taking the medication and having regular HIV testing; it is also used in combination with other HIV prevention methods rather than in isolation (CDC: PrEP, 2012b).

A client is crying softly and saying, What did I do to deserve this punishment, Lord? Which of the following responses by the nurse would be the most appropriate? a.God doesnt punish people. Youre sick just because of bad luck. b.I can call the hospital chaplain to help you talk about these feelings c.What can I do to be helpful to you right now? d.Would you like to confess your sins and repent so this illness will go away?

ANS: C Some clients may view their illness as punishment for misdeeds and may have difficulty accepting care from nurses who do not share their beliefs. Because the nurse may not be a member of the clients religious faith group, an open-ended response showing caring is the most appropriate statement.

7. In the United States, which demographic group has the highest risk for HIV infection? a. African-American homosexual men b. Hispanic IV drug abusers c. White homosexual men d. White lesbians

ANS: C The largest number of new HIV infections in 2009 (11,400) were in white men who had sex with other men (MSM), and this was followed by black MSM (10,800).

20. 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 have the 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.

A nurse gives detailed information on how to apply for Medicaid to a new mother who moved to the United States from Russia about 10 years ago. The nurses next client is an African-American mother of newborn twins who worked until the children were born. The nurse knows the woman is eligible to maintain her insurance after her employment was lost and does not discuss insurance options at all. Which of the following errors is being made by the nurse? a.Covert intentional prejudice b.Covert unintentional prejudice c.Overt intentional prejudice d.Overt unintentional prejudice

ANS: C The nurse may have assumed that the African-American mother knew the available resources and could negotiate for assistance on her own and that the immigrant Russian woman had no experience negotiating government programs and thus needed the nurse to advocate for her and inform her of the programs available to her. The nurse, not knowing the health-seeking behaviors of either client, stereotyped both women and intentionally used her informational power to help one client while denying assistance to the other client.

2. Which of the following provides the best explanation as to why people do not immediately seek medical treatment when they first become ill with HIV? a. They are afraid to get tested for fear results will be positive. b. They avoid the problem (maybe it will go away). c. They dont recognize their symptoms as possibly being due to HIV. d. It is too expensive to get an HIV test.

ANS: C When HIV enters the body, it can cause a flu-like syndrome referred to as a primary infection or acute retroviral syndrome. This may go unrecognized. The symptoms are similar to flu or a bad cold including sore throat, lethargy, rash, fever, and muscle pain. An antibody test at this stage is usually negative. So the person or a medical provider may not recognize the illness as HIV.

A nurse is completing a health risk appraisal with a client. Which of the following comments would cause the nurse to probe further to determine if the family is in crisis? a. "I can't visit my husband in the hospital when I'm at work all day. How can I be sure he's all right?" b. "My husband always handled our finances. Now that he's gone, I'll have to learn how to do this." c. "I don't know what to do now that my husband is dead. There is no way I can go back to work and also take care of our three children." d. "What am I supposed to do now that everything we own is gone? Are there any agencies that can help me?"

ANS: C A family crisis occurs when the family is not able to cope with an event and becomes disorganized or dysfunctional. When the demands of the situation exceed the resources of the family, a family crisis exists. In three of the options, the survivor is considering the problem and trying to learn how to cope or seek resources to cope. Only in this option is the person overwhelmed and unable to conceive of how to cope.

A nursing administrator wants to develop a work environment conducive to the implementation of evidence-based practice (EBP). Which of the following actions would best achieve this goal? a. Conducting market research to determine customer satisfaction with EBP b. Eliciting opinions from nurses on how EBP will affect workload c. Purchasing computers and Internet access for use by employees d. Sending staff to conferences related to incorporation of EBP into practice

ANS: C A lack of computers and Internet access can create a barrier to implementation of EBP in community-based nursing agencies. If these are provided, nurses can quickly access current evidence-based findings and recommendations.

Which of the following families is at high risk for health problems? a. A man agrees that he needs to eat better and exercise more but also expresses how busy he is at his job. b. A man knows that his grandfather, father, and older brother all died of cardiac disease. c. A man is currently unemployed and despairs about finding a position. d. A man expresses disappointment that, having been laid off as an executive, his new position pays only about two thirds of his original salary.

ANS: C A person who is unemployed and despairing of finding employment is at serious economic risk, which is one of the foremost predictors of health problems. Economic risk is determined by the relationship between family financial resources and the demands on those resources. Having adequate financial resources means that a family is able to purchase the necessary services and goods related to health, such as adequate housing, clothing, food, education, and health or illness care.

5. A migrant farmworker presents to the clinic reporting an acute onset of severe abdominal pain, nausea, vomiting, diarrhea, and headache with difficulty concentrating. Which of the following conditions would cause such symptoms? a.Appendicitis b.Bacterial gastroenteritis c.Pesticide poisoning d.Viral illness

ANS: C Although all of these conditions can cause some or all of the symptoms listed, because a migrant farmworker is employed in agriculture, the most probable cause is pesticide poisoning. Acute health effects of pesticide exposure include mild psychological and behavioral deficits such as memory loss, difficulty with concentration, and mood changes, abdominal pain, nausea, vomiting, diarrhea, headache, malaise, skin rashes, and eye irritation.

Which of the following is a basic assumption of public health efforts? a. Health disparities among any groups are morally and legally wrong. b. Health care is the most important priority 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

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

A nurse executive is implementing evidence-based practice at a community nursing center that serves a large Cuban immigrant population. Which of the following actions would be the most helpful for the nurse? a. Review clinical policies with cultural competency experts from the local university. b. Conduct weekly staff meetings to discuss which methods work best when helping immigrants. c. Invite Cuban immigrants from the community to serve on the center's advisory board. d. Send personnel to conferences and seminars that focus on treating Hispanic immigrants.

ANS: C Although all of these options are good, to determine whether practice is serving the needs of the population, the nurse will need to consult the population served. This means that evidence should be applied with input from the community. For example, decisions related to the services to be offered in a nurse-managed clinic should be made with input from the clinic's advisory board, which should include community leaders and consumers of the clinic's services. Cuban immigrant needs may not be the same as

2. Which of the following best describes a health professional shortage area (HPSA)? a.An area with inadequate health care facilities for residents b.An isolated area of underserved populations within an urban region c.A region with insufficient numbers of health care providers d.A rural region of the United States with a population density of less than 10,000

ANS: C An HPSA is a geographical area that has insufficient numbers of health professionals according to criteria established by the federal government. Often rural areas have a physician, nurse practitioner, or nurse in community health who provides services to residents who live in several counties.

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

ANS: 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

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

ANS: 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.

21. 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.

9. 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.

9. A migrant farmworker brings his daughter into the clinic with severe heat stroke from being out in the sun. The nurse explains the danger signs and stresses staying cool and drinking lots of water. The man seems to know this already. Which of the following best describes the most likely reason that this happened? a.It was a rare occurrence, which probably won't be repeated. b.The daughter either disobeyed her father and went out to play in the sun or just did not realize how hot she was. c.Children may work on small farms because the family may need the additional income. d.The parents were busy working and didn't realize the child was outside so long.

ANS: C Children 12 to 13 years of age can work on a farm with the parents' consent or if the parent works on the same farm. Children younger than 12 years can work on a farm with fewer than 7 full-time workers. Children may need to work for the family's economic survival.

A home health nurse is preparing to terminate the first home visit with teenage parents and their new baby. Which of the following actions will the nurse take before leaving? a. Determine the family's willingness for another home visit b. Establish the purpose of the visit c. Review the family's learning and other accomplishments of the visit d. Review the family record and reason for referral

ANS: C During the termination phase, the nurse reviews the visit with the family, summarizes what has occurred and what has been accomplished, and may make plans for future visits. The other options listed occur during the pre-visit phase.

Which of the following clients would cause the nurse the most concern? a. The client who is currently unemployed but actively seeking a position and frequently walking from one interview to another b. The client who is not employed but spending time at the gym keeping fit and studying the benefits of organic natural uncooked foods c. The client who is employed and often works 12 hours a day without moving from the computer desk d. The client who is employed but always leaves promptly at 5:00 to pick up the children from the day care center

ANS: C Personal health habits continue to contribute to the major causes of morbidity and mortality. The pattern of personal health habits and behavioral risk defines individual and family lifestyle risk. The client who doesn't move from the computer desk is creating great stress and strain on personal physiology and needs to be educated on the benefits of exercise and the risks of cumulative trauma on the body. Multiple health benefits of regular physical activity have been identified; regular physical exercise is effective in promoting and maintaining health and preventing disease.

16. 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. Distributing handouts 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.

10. 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 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

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

Which of the following 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

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

4. 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.

18. 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.

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 of the following best describes a normative life event that can increase the risk for illness? a. A family is involved in a motor vehicle crash. b. A group of teens experiment with recreational drugs. c. A woman is pregnant with her first child. d. The family wage earner is laid off from his job.

ANS: C Life events can increase the risk for illness and disability. Normative events are those that are generally expected to occur at a particular stage of development or of the life span. Although pregnancy is a normal condition, it carries risks such as the development of eclampsia or more minor health problems such as constipation and hemorrhoids. Additionally, pregnancy (and the birth that follows) will alter family dynamics and may increase risk for psychological stressors. The events listed in the other options are not normative life events.

Which of the following nurses is famous for creating public health nursing in the United States? a. Florence Nightingale b. Frances Root c. Lillian Wald d. Mrs. Solomon LoebWhich of the following would have been the focus of a school nurse in the early 20th century? a. Investigating causes of absenteeism b. Teaching school as well as being a nurse c. Promoting nursing as an autonomous practice d. Providing medical treatment to enable children to return to school

ANS: C Lillian Wald established the Henry Street Settlement and later emerged as the established leader of public health nursing during its early decadesANS: A Early school nursing focused on investigating causes of absenteeism, not providing medical treatment. That was the responsibility of physicians.

A nurse is drawing a genogram. Which of the following would the nurse use to demonstrate a marriage relationship between two individuals? a. A broken line b. A dashed line c. A solid line d. Two parallel lines

ANS: C Marriage is indicated by a solid line on a genogram.

26. 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 nurse is implementing risk reduction interventions with a family. Which of the following questions is most important for the nurse to ask? a. "Did any of the hunters in your family kill a deer this year?" b. "How do you keep your rifles safe from curious children?" c. "Where do you shoot with your handguns?" d. "Where do you keep your rifles locked when it is not hunting season?"

ANS: C Risk reduction is a complex process that requires knowledge of risks and families' perceptions of the nature of the risk. In this situation the nurse was asking questions to determine the family's perception of risks associated with owning guns. If the family does not perceive the behavior (having guns in the house) as risky, but rather as necessary for food or sport, the nurse must first educate or persuade the family that others may be more comfortable if certain precautionary measures are taken (such as locks on the guns). Rifles are used for food and sport but handguns are often used in crimes and accidents resulting in death.

17. 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.

7. Which of the following is the most accurate description of a migrant farmworker? a.A person who does farm work as the primary means of employment, although other work may be done when the seasonal work ends b.A person who immigrates to the United States to "follow the crops" in performing seasonal farm work c.A person who moves from place to place to earn money performing seasonal agricultural work d.A person who specializes in the development of rural land for the purpose of farming

ANS: C The Office of Migrant Health of the U.S. Public Health Service defines a migrant farmworker as a person "whose principal employment is in agriculture on a seasonal basis, who has been so employed within the last 24 months, and who establishes for the purpose of such employment a temporary abode." The emphasis is on moving (temporary abode), farm work, and seasonal basis. Not all migrant farmworkers are immigrants.

11. 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 arrives at a home at the appointment time established with the client over the phone. However, no one answers the door. Finally a child comes out and says, "My mom said she couldn't see you and you should go away." Which of the following actions should be taken by the nurse? a. Demand the child let the nurse into the home to talk to the mother. b. Interview the child as to how the family is doing. c. Leave a card with information on how to get in touch with the nurse . d. Point out that legally once an appointment has been made the mother needs to be seen.

ANS: C The contact may be terminated as requested if the nurse determines that either the situation has been resolved or services have been obtained from another source and if the family understands that services are available and how to contact the agency if desired. However, the nurse should leave open the possibility of future contact. Obviously, the nurse cannot force entrance into the home. It would not be appropriate to coerce a child with misinformation or to interview a child about health concerns without a parent being present.

30. 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.

28. 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 citizens living in the community? a. Cross-sectional study b. Ecologic study c. 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.

A nurse is completing an initial home visit with a family. Which of the following actions should be taken first by the nurse? a. Assess the family and the home setting for both strengths and problems. b. Determine the family's expectations of a home visit. c. Establish rapport between the nurse and the family. d. Engage in extended social interaction as would be expected from any guest.

ANS: C With the exception of social interaction, all the tasks listed are important. The initial home visit includes the nurse's self-identification and clarification of role, establishing rapport with the family, assessing the situation, and then determining the client's expectations. Although in some senses the nurse is a guest in the home, the nurse is not there for social purposes but to help the family with health concerns. However, without rapport between the nurse and the client, the nurse will be notably less effective at other tasks.

5. In which of the following situations would the nurse most likely use active surveillance? A. A newspaper wants to know the incidence of asthma in the community. B. A real-time ongoing communication channel is established to monitor a particular symptom. C. Several children become ill with GI upset at one local school. D. The nurse is asked to report the incidence of a specific nonreportable common problem in the community.

ANS: C Several children become ill with GI upset at one local school. In active surveillance, the nurse may begin a search for cases to determine the magnitude of the problem (how widespread it is). An example would be when several school children become ill after eating lunch in the cafeteria or at the local hot dog stand, in which case, active surveillance would be used to investigate the possibility of food poisoning. DIF: Cognitive Level: Apply (Application) REF: p. 269

1. A nurse considered copying last month's surveillance report and changing the date because the number of occurrences per month had not noticeably changed. Which of the following best explains why the nurse should continue to spend time collecting and reporting data that is always nearly the same? A. Because such data are legally required B. Because it is still part of the nurse's responsibilities, even if it is a waste of time C. To determine a local baseline rate and immediately notice any change D. To determine differences among communities in need for state assistance

ANS: C To determine a local baseline rate and immediately notice any change Disease surveillance helps establish baseline (endemic) rates of disease occurrence and patterns of spread. Surveillance makes it possible to initiate a rapid response to an outbreak of a disease or event that can cause a health problem. DIF: Cognitive Level: Apply (Application) REF: pp. 267-268

13. The outpatient health care data show a notable increase in asthma over the numbers treated the previous year. Which of the following actions should the public health nurse take first? (Select all that apply.) A. Analyze educational health programs offered to the public last year. B. Congratulate the public health staff on the success of their asthma awareness program. C. Determine whether there are any other data sources that might confirm or dispute the apparent increase in asthmA. D. Review data with the outpatient clinic staff such as confirming repeat visits versus newly diagnosed cases.

ANS: C, D C. Determine whether there are any other data sources that might confirm or dispute the apparent increase in asthma. D. Review data with the outpatient clinic staff such as confirming repeat visits versus newly diagnosed cases. Before drawing any conclusions, further data should be sought, including confirmation of the current data and their meaning. Data can be inaccurate or collected differently than in the past. What might have led to an increase? Are there other valid sources that might have relevant data? Should surveillance specific to asthma be established? DIF: Cognitive Level: Analyze (Analysis) REF: p. 268

The nurse and the family have agreed on an ambitious goal to improve family functioning, but as the family later expresses with some dismay, they have not been able to change their behavior as easily and quickly as they had hoped. Which of the following must be remembered throughout this process? (Select all that apply.) a. A reassessment of resources should be done if the plan does not work. b. Individual family members must all be willing to make the plan their first priority. c. Goals must be realistic and feasible. d. Ongoing negotiation is central to the process.

ANS: C, D In contracting, an important aspect is obtaining the family's view of the situation and its needs and problems. Goals must be mutually set and realistic. A pitfall for nurses and clients who are new to contracting is to set overly ambitious goals. Because contracting is a process characterized by ongoing renegotiating, the goals are not static. The family's inability to change "as easily and quickly as they had hoped" does not mean the plan is not workable—only that more time and effort may be necessary.

The 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 of the population E. Questioning the availability of health services to the community

ANS: C. Collecting, analyzing, and disseminating information D. Evaluating the social, economic, and environmental characteristics of the population E. Questioning the availability of health services to the community

4. A student asks the nurse at the student health clinic how AIDS is diagnosed. Which of the following statements would be the best response by the nurse? a. A diagnosis of AIDS is made when a screening test called an enzyme-linked immunosorbent assay (ELISA) is confirmed by the Western blot test. b. A diagnosis of AIDS is made when antibodies to HIV are detected about 6 weeks to 3 months following possible exposure. c. A diagnosis of AIDS is made when antibodies to HIV reach peak levels of 1000/ml of blood. d. A diagnosis of AIDS is made when CD4 T lymphocytes drop to less than 200/ml.

ANS: D AIDS is defined as a disabling or life-threatening illness caused by HIV; it is diagnosed in a person with a CD4 T-lymphocyte count of less than 200/ml with or without documented HIV infection. The HIV antibody test (usually the EIA) is the most commonly used screening test for determining whether the antibody to HIV is present but does not confirm AIDS. Positive results with the EIA are tested further with the Western blot test. However, false-negative results are frequent between 6 weeks and 3 months following exposure.

17. Which of the following statements best explains why many health care providers are more afraid of getting hepatitis B than HIV? a. Everyone would assume the person infected with hepatitis B is a drug user. b. Having HBV would mean no further employment in health care. c. The fatality rate is higher and occurs sooner with HBV. d. There is no treatment for HBV, which can be a very serious illness.

ANS: D Both HBV and HIV are blood-borne pathogens. Health care workers may be exposed to either from needle stick injuries and mucous membrane splashes. However, HBV remains alive outside the body for a longer time than does HIV and thus has greater infectivity. The virus can survive for at least 1 week dried at room temperature on environmental surfaces, and therefore infection control measures are crucial in preventing transmission. There is no treatment for hepatitis B, and although some persons never have symptoms and others fight off the disease, many suffer from chronic hepatitis B, a very serious illness. Others may become chronic carriers of the disease.

A family from Mexico comes to the public health department. No one in the family speaks English, and nobody at the health department speaks Spanish. Which of the following actions should be taken by the nurse? a.Attempt communication using an English-Spanish phrase book. b.Call the local hospital and arrange a referral. c.Emphatically state, No hablo Espaol (I dont speak Spanish). d.Obtain an interpreter to translate

ANS: D Communication with the client or family is required for a careful assessment. When nurses do not speak or understand the clients language, they should obtain an interpreter. The nurse must use strategies that will allow effective communication with the client. The client has the right to receive effective care, to judge whether the care was appropriate, and to follow up with appropriate action if the expected care was not received.

The nurse practitioner (NP) discovered that an immigrant client is not taking the penicillin prescribed because his illness is hot and he believes that penicillin, a hot medicine, will not provide balance. Which of the following terms best describes the action taken by the NP when the clients prescription is changed to a different yet equally effective antibiotic? a.Cultural awareness b.Cultural brokering c.Cultural knowledge d.Cultural skill

ANS: D Cultural skill involves the provision of care that is beneficial, safe, and satisfying to the client. The medication change allows the client to retain his cultural beliefs and also satisfies the nurse practitioners need to prescribe an effective antibiotic.

A male nurse had a habit of sitting with the lower part of one leg resting over the knee of his opposite leg when collecting a clients history. He stopped doing this around Muslim clients after being told that Muslims were offended when he exposed the sole of his foot (shoe) to their face. Which of the following was exhibited by the nurse when he changed his behavior? a.Cultural accommodation b.Cultural imposition c.Cultural repatterning d.Cultural skill

ANS: D Cultural skill is the effective integration of cultural knowledge and awareness to meet client needsin this case, the clients need to not be offended by having the bottom of the nurses foot or shoe in view of the clients face. The nurse using cultural skill makes sure nonverbal communication techniques take into consideration the clients use of body language and space. Cultural accommodation involves negotiation with clients to include aspects of their folk practices with the traditional health care system to implement essential treatment plans. Cultural imposition is the process of imposing ones values on others. Cultural repatterning is working with clients to make changes in their health practices if cultural behaviors are harmful or decrease their well-being.

22. A nurse was reading PPD tests 24 hours after another nurse had administered them. Which of the following findings would cause the nurse to interpret the test as positive? a. 15 mm of erythema in a client with HIV infection b. 5 mm of induration in an immigrant from a country where TB is endemic c. A 5-mm ruptured pustule with purulent drainage in a homeless client d. 10 mm of swelling and increased firmness in a client recently released from a correctional facility

ANS: D Erythema alone does not indicate a positive finding. For a PPD test to be positive, induration (swelling with increased firmness) must be present. A diameter of 10 mm induration would be a positive finding in an immigrant from a region with high TB infection. A small pustule in a homeless client undoubtedly is an infection but may not be due to the PPD test.

11. A client is being treated for secondary syphilis. Which of the following signs and symptoms would the nurse anticipate the client would exhibit? a. Chancre at the site of entry b. Jaundice c. Difficulty coordinating muscle movements d. Skin rash without itching

ANS: D Secondary syphilis occurs when the organism enters the lymph system and spreads throughout the body. Signs include skin rash on one or more areas of the body and do not cause itching. Other symptoms may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue.

A health care worker tells a nurse, It does no good to try to teach those Medicaid clients about nutrition because they will just eat what they want to no matter how much we teach them. Which of the following is being demonstrated by this statement? a.Cultural imposition b.Ethnocentrism c.Racism d.Stereotyping

ANS: D Stereotyping occurs when someone attributes certain beliefs and behaviors about a group to an individual without giving adequate attention to individual differences. In this instance, the health care worker makes the assumption that clients with low incomes are not educable. The health care worker is guilty of making another assumption as well: noncompliance among other Medicaid clients the worker has known may have been related to an inability to afford nutritious food.

23. A high school student is planning to volunteer at the hospital after school, so she needs to have a Mantoux test before beginning. Which of the following information should the nurse provide to the new volunteer? a. I will be using tiny tines to administer the TB antigen to the skin on your arm. b.Notify the clinic immediately if you experience any redness or itching at the test site. c. The areas should be kept dry until you return; cover it with plastic wrap when bathing. d. You will need to return in 2 to 3 days to have any reaction interpreted.

ANS: D The Mantoux test is a TB skin test that involves a 0.1-ml injection containing 5 tuberculin units of PPD tuberculin (not tines as in the TB tine test). The site should be examined for a reaction 48 to 72 hours (2 to 3 days) after injection. Only induration should be measured, and the results should be recorded in millimeters.

16. A client who is very upset says to the nurse, But we always used a condom! How could I have genital warts? Which of the following would be the best response by the nurse? a. Are you positive you always used a condom? b. Condoms dont always work. c. The condom might have had a tear in the latex. d. Skin to skin contact to a wart may have occurred outside the area that the condom covers.

ANS: D The challenge of HPV prevention is that condoms do not necessarily prevent infection. Warts may grow where barriers, such as condoms, do not cover, and skin-to-skin contact may occur.

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:

ANS: 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 health care to promote quality of life

3. A client was clearly very relieved when an HIV test came back negative. Thank goodness. Ive had sex several times without a condom, and when one of my friends said he was sick, I think I panicked. Which of the following would be most important to emphasize to the client immediately? a. Abstinence is the only way to be certain you are HIV-free. b. Sex should be restricted to one partner. c. The test could be wrong and the client might still have an HIV infection. d. The test would not cover any recent infection, so if the client has had recent unprotected sex, the test should be repeated in 3 months.

ANS: D The client needs to understand that the test cannot identify infections that may have been acquired within the previous 3 months before the test. Appearance of the HIV antibody can take up to 12 weeks. All persons who have an STD test should be counseled about risk-reduction activities before and after the test is done.

During which phase of the home visit does the nurse document what was accomplished? a. Pre-visit phase b. In-home phase c. Termination phase d. Post-visit phase

ANS: D A major task of the post-visit phase is documenting the visit and services provided.

6. 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 comparing gonorrhea 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 all STIs, 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

The nurse has been reading everything she can find on a particular clinical problem, using both the closest medical library and the Internet. Which of the following would be the most helpful source? a. A journal with a whole issue devoted to research on that clinical problem b. A randomized controlled clinical trial related to that clinical problem c. A researcher who has built a career on studying that clinical problem d. A systematic review related to the clinical problem

ANS: D A systematic review is an approach to identifying, appraising, and synthesizing research evidence to evaluate and interpret all available research that is relevant to a particular research question. Systematic reviews can be accessed from most databases. Systematic reviews require more rigor and contain less opinion of the author than typical reviews of the literature.

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

ANS: 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.

.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 health care institutions in the community to determine needed health services d. Working with community groups to create policies to improve the environment

ANS: 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.

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 health care institutions in the community to determine needed health services d. Working with community groups to create policies to improve the environment

ANS: 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.

8. An employer provides a migrant farm family the day off to visit the health clinic in a nearby community and tells them to take all of the time they need. However, the family arrives at the clinic appearing very stressed. In addition to the health issue, which of the following would most likely be a fear experienced by the family? a.Their personal belongings may be stolen while they are at the clinic. b.Immigration officials will send them back to their home country. c.The clinic personnel will look down on them and be biased against them. d.They weren't getting paid for that day, and continued employment is never certain.

ANS: D Any of the answers might be true; however, most migrant farmworkers are legal residents or U.S. citizens, not illegal immigrants. Many do not have their own transportation and must rely on friends. Migrant farmworkers often have an unpredictable and difficult lifestyle. Many must leave home each year and travel to distant locations to work. They may be uncertain about their work and housing as they go from one possible job to another. An employer telling them to "take all the time they want" could be interpreted as meaning they may no longer be needed, and their next job may be very uncertain.

29. 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 of the 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.

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:

ANS: D By definition, community-oriented nursing has the goal of preserving, protecting, or maintaining health to promote the quality of life. All nurses may focus on individuals and families, give direct care to ill persons within their family setting, and help manage acute or chronic conditions.

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

ANS: D By definition, community-oriented nursing has the goal of preserving, protecting, or maintaining health to promote the quality of life. All nurses may focus on individuals and families, give direct care to ill persons within their family setting, and help manage acute or chronic conditions.

A family from Mexico comes to the public health department. No one in the family speaks English, and nobody at the health department speaks Spanish. Which of the following actions should be taken by the nurse? a. Attempt communication using an English-Spanish phrase book. b. Call the local hospital and arrange a referral. c. Emphatically state, "No hablo Español" (I don't speak Spanish). d. Obtain an interpreter to translate.

ANS: D Communication with the client or family is required for a careful assessment. When nurses do not speak or understand the client's language, they should obtain an interpreter. The nurse must use strategies that will allow effective communication with the client. The client has the right to receive effective care, to judge whether the care was appropriate, and to follow up with appropriate action if the expected care was not received.

A nurse wants to empower the family of a mother who has been newly diagnosed with breast cancer. Which of the following actions would the nurse most likely take? a. Apply for emergency financial assistance on the family's behalf. b. Arrange for community members to assist with child care. c. Invite the mother to join a cancer support group. d. Teach the family how to navigate the health care system.

ANS: D Definitions of empowerment reflect three characteristics of the empowered family seeking help: access and control over needed resources, decision-making and problem-solving abilities, and the ability to communicate and to obtain needed resources. Approaches for helping individuals and families assume an active role in their health care should focus on empowering, rather than giving direct help.

A nurse manager wants to facilitate incorporation of evidence-based practice (EBP) in the clinical setting. Which of the following would be the best strategy to accomplish this goal? a. Eliminate all protocols and standards that are not evidence based b. Encourage group reflection on the ideals and expectations of nursing care c. Refer agency nurses to Internet sources of research findings d. Support nurses using practice-oriented research findings in decision making

ANS: D EBP demands changes. It requires incorporating more practice-oriented research and more collaboration between clinicians and researchers. Emphasis should be on decision making using the varied sources of evidence. The environment and climate must be supportive in order to implement EBP.

A nurse is conducting a health risk appraisal. Which of the following activities is the nurse assessing when using this tool? a. Health promotion activities b. Illness prevention activities c. Risk reduction activities d. Unhealthy activities

ANS: D Health risk appraisal refers to the process of assessing for the presence of specific factors in each of the categories that have been identified as being associated with an increased likelihood of an illness, such as cancer, or an unhealthy event, such as an automobile accident. Therefore, the nurse would assess for unhealthy behavior and activities in the areas of biological and age-related risk, social and physical environment risk, and behavioral risk. Activities to promote health, prevent illness, or reduce risks would be advantageous, not risky.

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 groups 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

ANS: D Historically, health care providers have been accused of providing care for or to 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.

A home health nurse is about to visit a family at their home. However, the nurse is feeling uncomfortable about getting out of her car because a group of young adults across the street are drinking and fighting among themselves. Which of the following actions should be taken by the nurse? a. Call the agency and ask what she should do. b. Call the family, explain the situation, and try to reschedule. c. Fulfill the nurse's commitment to the family and enter the home quickly. d. Drive away and notify the family from a safer location.

ANS: D Personal safety is an issue. Home visits are generally very safe; however, as with all worksites, the possibility of violence exists. Therefore, the nurse needs to use caution. If a reasonable question exists about the safety of making a visit, the nurse should not make the visit.

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

ANS: 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.

27. 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 years ago. 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.

A health care worker tells a nurse, "It does no good to try to teach those Medicaid clients about nutrition because they will just eat what they want to no matter how much we teach them." Which of the following is being demonstrated by this statement? a. Cultural imposition b. Ethnocentrism c. Racism d. Stereotyping

ANS: D Stereotyping occurs when someone attributes certain beliefs and behaviors about a group to an individual without giving adequate attention to individual differences. In this instance, the health care worker makes the assumption that clients with low incomes are not educable. The health care worker is guilty of making another assumption as well: noncompliance among other Medicaid clients the worker has known may have been related to an inability to afford nutritious food.

13. A nurse is implementing a tertiary prevention strategy related to pesticide exposure. Which of the following activities would the nurse complete? a.Observe farmworkers for evidence of unsafe handling of pesticides. b.Provide teaching on how to handle pesticides to avoid or decrease exposure. c.Teach farmworkers how to recognize signs and symptoms of pesticide poisoning. d.Treat a client who has pesticide exposure to prevent complications.

ANS: D Tertiary prevention involves actions taken when a person already has a condition so that complications and worsening of the condition are avoided.

15. 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 event causing another) are often more complex than the epidemiologic triangle conveys. With all the various antecedents identified, the nurse can then decide in which areas interventions are possible.

19. 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.

5. 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.

3. A rural public health nurse is spending time reviewing death certificates. Which of the following best explains the purpose of this activity? A. To ensure that local causes of death are consistent with national causes of death B. To confirm that no local health problems are beginning C. To evaluate effectiveness of health promotion programs D. To obtain mortality data for the local area

ANS: D To obtain mortality data for the local area Mortality data are often the only source of health-related data available for small geographic areas. Vital statistics reports such as death certificates are reviewed. Useful information also comes from administrative data such as discharge reports and billing records. DIF: Cognitive Level: Apply (Application) REF: p. 268

10. Which aspect of a biological agent is probably the most frightening to those exposed? A. Infectivity B. Invasiveness C. Pathogenicity D. Virulence

ANS: D Virulence Infectivity refers to the capacity of an agent to enter a susceptible host and produce infection or disease. Invasiveness is the ability of an agent to get into a susceptible host. Pathogenicity measures the proportion of infected people who develop the disease. Virulence refers to the proportion of people with clinical disease who become severely ill or die. It is assumed people could cope with illness but possible death is truly frightening for most. DIF: Cognitive Level: Understand (Comprehension) REF: p. 272

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 rate of cardiovascular disorders among various groups.

ANS: D. the prevalence rate of cardiovascular disorders among various groups.

A nurse practitioner has established a mobile clinic to vaccinate noninstitutionalized adults against influenza. Which of the following phases of the nursing process is being implemented? a. Assessment b. Planning c. Intervention d. Evaluation

C

Which is an example of an Epidemic?

Adult obesity in the United States

B

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.

The most important predictor of overall mortality:

Age

A collection of individuals who have in common one or more personal and environmental characteristics

Aggregate

B

All adults should be assessed for violence in their primary intimate relationships. The abuse of female partners has the most serious community health ramifications because of the greater prevalence, the more serious long-term emotional and physical consequences, and the greater potential for: A. fleeing to a shelter. B. homicide. C. possessive behavior. D. spontaneous abortion.

C

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."

B

An eighth-grader is brought to the emergency department by a parent for unusual skin blistering and discoloration around the nose and lips. The parent states that the child will not say what caused the injury. The nurse should consider the possible use of: A. crystallized methamphetamine. B. inhalants. C. MDMA (Ecstasy). D. PCP (phencyclidine).

C

An example of secondary prevention for infectious disease prevention is: A. malaria chemoprophylaxis. B. Pneumocystis carinii pneumonia (PCP) chemoprophylaxis for people with AIDS C. quarantine. D. restaurant inspections.

C

An instructor is reviewing Salmonella infections with her class. Which of the following comments indicates that the student needs further review on how Salmonella is spread? a. "Certain pets and farm animals may be Salmonella carriers." b. "It is possible to transmit Salmonella by person-to-person contact." c. "Salmonella may be spread by spores that form once contaminated blood is exposed to the air." d. "Salmonella outbreaks are usually due to contaminated meat, poultry, and eggs."

An epidemiologist wanting to know what caused severe diarrhea and vomiting in several people at a local banquet would be using:

Analytic Epidemiology

In order to have an effective educational programs, what is a core public health principle that must be done?

Asking learners to participate in identifying their learning needs.

This is an inhibitor to developing competence that is a form of prejudice and believe that certain people born in a group are inferior

Racism- skin color, beauty, self-worth

D

At a county board meeting, a nurse reports statistics on drug use in the school. The nurse then requests funding for an after-school recreation program that promotes age-appropriate fun activities and sports. Which of the following objectives is the nurse attempting to meet through this action? a. Help prevent obesity and boredom. b. Offer alternatives to being "on the streets." c. Prevent children from getting in trouble before their parents get home from work. d. Promote healthy lifestyles with physical activity.

D

At a town meeting with public health officials to discuss a communicable disease outbreak, a nurse is asked to explain what is meant by the phrase "a virulent organism." The nurse explains that this means the organism causing the disease is able to do which of the following? a. Bypass normal immunological response mechanisms b. Invade major organ systems c. Produce toxins and poisons that weaken the body d. Produce very severe physical reactions

A community is experiencing the Honeymoon phase following a disaster. Which of the following is most likely to occur in the community? a. First responders work tirelessly to save others b. Survivors share their stories c. Medical personnel experience exhaustion d. Community organizations rebuild the community

B

A new nurse states to a nursing colleague, "But why do I have to be involved in politics? I just want to be the very best clinical nurse I can." Which of the following would be the best response from the nursing colleague? a. "As long as you pay your membership fee to the American Nurses Association, you have participated in the profession's political endeavors." b. "Political action is the way you try to fulfill your ethical responsibilities to clients." c. "You're absolutely right; if you are good clinically, you have fulfilled your obligation." d. "When you've completed your clinical orientation, then you'll have time to be involved in politics."

B

A nurse is assessing potential environmental health risks in the community. Which of the following would be the first step that the nurse should take? a. Conduct health risk assessments of randomly selected individuals b. Perform a windshield survey c. Review facility permits and consumer confidence reports d. Survey community members

B

A nurse was the first on the scene of a disaster and saw people with injuries ranging from minor to serious. Some of those with minor injuries were helping others. Which of the following injured persons would the nurse assist first? a. Those with life-threatening head and chest injuries b. Those who have life-threatening abdominal injuries c. Those who have serious injuries of limbs d. Those who are hurt but still mobile and functioning

B

After a house fire, a 4-year-old child begins sucking his thumb and wetting his bed. Which of the following would be the most appropriate action for the nurse to take? a.Explain to the child that it is important to be strong and not act like a baby. b. Explain to the family that this behavior is a normal reaction to disaster. c. Recommend admission for inpatient psychological counseling. d. Recommend behavior therapy as a means to overcome regression.

B

How can nurses know whether they have been effective in assessing the community and planning and implementing appropriate interventions? a. Ask community leaders for their opinion of the interventions. b. Examine the morbidity and mortality rate of the community. c. Reassess the community to determine whether obvious needs have been met. d. Systematically survey community residents regarding their perception.

B

On the second day after a disaster, a male colleague tells the nurse he has a splitting headache. The nurse notes the colleague is feeling irritable and having difficulty focusing. Which of the following actions should the nurse take in response to the complaint of headache? a. Explain that the headache and problems focusing are probably the result of worry, so he should concentrate on the work at hand and deal with emotions later. b. Explain that he is experiencing signs and symptoms of psychological stress and recommend that he take some time off for a break. c. Explain to the worker that this is a common problem when multitasking under pressure and suggest that he focus on one task at a time. d. Suspect dehydration and encourage the worker to drink more fluids.

B

The local hospital, health department, and university together planned and implemented a mock casualty drill, with the university's theater and nursing students playing the injured victims. After the drill, which of the following would the nursing students most likely complete? a. Volunteer as leaders in the next casualty drill b. Evaluate the drill and offer recommendations for more effectiveness in the future c. Recognize how to respond to a real disaster in the future d. Write a report on their actions and how they felt during the drill

B

Which of the following best defines a disaster? a. Any event that results in multiple deaths b. Devastation that cannot be relieved without assistance c. Devastation that covers a broad geographical area d. When the event results in multiple injuries and deaths as well as property damage

B

Which of the following best describes countries that bear the greatest burden of disasters? a. Arid regions that are prone to drought b. Developing countries with limited resources c. Industrialized countries with much to lose d. Water-boundary regions that are prone to floods and hurricanes

B

Which of the following best describes the purpose of local health departments making unannounced inspections of local restaurants? a. To enforce local laws and regulations b. To ensure compliance c. To provide exposure to oversight d. To monitor employee safety

B

Which of the following is considered the most important goal in nursing today? a. Adapting to technological advances such as electronic medical records b. Demonstrating caring as the basis of nursing practice c. Distinguishing nursing care from medical care d. Seeking evidence-based outcomes to demonstrate nursing's contribution to care

B

Which of the following statements about children and environmental hazards is correct? a. The prevalence of autism is directly related to the increase in environmental toxins. b. Children are more susceptible to environmental toxins because of their smaller size. c. The prevalence of asthma among children has been decreasing. d. Children are more susceptible to cancer if they have a family history of the disease.

B

nurse wants to find information about environmental threats that are present in the community. Which of the following would be the best source of data for the nurse? a. CINAHL b. National Library of Medicine c. State health department d. Closest local library

B

A mother brings her child to the nurse's office a few days before the first day of class for the new school year. The mother wants the child to begin school but says, "I'm going to take care of the immunizations tomorrow." The most important action the nurse should take is to: a) conduct a physical exam to determine whether the child is healthy b) explain to the parent that all required immunizations must be given before the child will be allowed to enter school c) let the child begin school but ensure that the school keeps the child separated from the other children d) make sure the child does have an appointment for tomorrow

B Community-oriented nursing practice interacts with many legal aspects of nursing in community health. Nurses employed by health departments or boards of education may deliver school and family health nursing, a specialty area of practice with its own legal aspects. School health legislation establishes a minimum of services that must be provided to children in public and private schools. Children must have immunizations against certain communicable diseases before entering school.

A nurse is determining whether a hospital has the right to require infected patients to be isolated against their will. To which type of law will the nurse refer? a) Common law b) Constitutional law c) Legislation and regulation d) Judicial law

B Constitutional law provides the right to intervene in a reasonable manner to protect the health, safety, and welfare of the citizenry. State power concerning health care is called police power. This power allows states to act to protect the health, safety, and welfare of their citizens. The state must show that it has a compelling interest in taking actions, especially actions that might infringe on individual rights. The state can isolate an individual to prevent an epidemic, even though this infringes on individual rights. The community's rights are deemed more important than the individual's rights when there is a threat to the health of the public.

A public health nurse has identified the need to make amendments in an existing law concerning the TB health assessment of individuals sentenced to serve jail terms on weekends only, based on the current criminal justice system practices and potential health risk to the free-living community. To raise this concern, the nurse has several paths to follow, but the amendment of any existing laws would ultimately be decided by: a) the executive branch of the government b) the legislative branch of the government c) local representatives d) senate hearings

B Each of the government branches at the federal, state, and local levels plays an important role in developing and implementing health law and public policy. Concerned citizens have many avenues to address issues related to required laws and regulations as well as existing laws and regulations. However, each branch of government has separate and important functions. The legislative branch identifies problems, proposes debates, and passes and modifies laws to address identified problems.

3. A nurse is providing an educational program about testicular self-examination (TSE). Which of the following would be the best learning objective for this program?

c. 90% of the men will correctly demonstrate testicular self-examination.

Which of the following statements best describes the law in relation to clinical practice by nursing students? a) Students are considered certified until licensure is obtained b) Students are expected to meet the same standard of care as the professional nurse c) Students are not legally liable for errors because they practice under the license of their instructor d) Students have a scope of practice determined by the nurse practice act

B Nursing students need to be aware that the same laws and rules that govern the professional nurse apply to them as well. Students are expected to meet the same standard of care as that met by any licensed nurse practicing under the same or similar circumstances. Although it is true that students cannot practice outside the scope of practice determined by the nurse practice act, they also cannot perform the tasks and responsibilities of the licensed practitioner within the scope of practice until they have received adequate knowledge; therefore, the scope of practice for the student is determined by the instructor, based on the student's level of education.

A bill with the potential to decrease health care services is passed by Congress. Which of the following actions should the nurse take to influence the bill's implications? a) Exercise veto power by calling for petitions from health care agencies b) Contact the regulatory agency and participate in public hearings c) Call members of congress to request that they rescind the legislation that was passed d) Discuss the change in services with the administrators at the hospital

B Once a bill is passed and becomes law, it is too late to influence congressional members to change their vote; however, it is not too late to influence the outcome of the vote because the nurse can influence how the law is regulated. An agency typically writes the regulations that control how the law is implemented in more specific detail. Often this process can be just as important as lobbying against a bill because it shapes the final implementation of the law.

Politics is simply described as: a) the ability to fund a special project b) the art of influencing others c) business conducted in the senate d) interaction between the policymakers and the public

B Politics is the art of influencing others to accept a specific course of action. Therefore, political activities are used to arrive at a course of action (the policy).

When final health care-related regulations are published, they often lead to changes in practice. After a period of draft review, public comment/hearing, further study if necessary, and then final redrafting, the regulations at both federal and state levels carry the weight of law and are published in the: a) ANA Code of Conduct b) Code of Regulations c) Patient Safety Act of 1997 d) Interstate Nurse Licensure Compact

B Revisions made to proposed regulations are based on public comment and public hearing. Depending on the amount and content of the public reaction, final regulations are prepared, or the area and issues are studied further. Final regulations are published in the Code of Regulations at the state and federal level and carry the force of law. When regulations become effective, health care practice is changed to conform to the new regulations. Monitoring administrative regulations is essential for the professional nurse, who can influence regulations by attending the hearings, providing comments, testifying, and engaging in lobbying aimed at individuals involved in the writing of the regulations. Concrete written suggestions for revision submitted to these individuals are frequently persuasive and must be acknowledged by government in publishing the final rules.

Which of the following describes the significance of the passage of The Public Health Threats and Emergencies Act? (Select all that apply.) a) It funded ongoing activities of the public health system b) It led to improved water quality and food safety guidelines c) It included funding for public health activities d) It validated that the public health system was prepared for terrorism

B, C The Public Health Threats and Emergencies Act was the first federal law to comprehensively address the public health system's preparedness for bioterrorism and other infectious disease outbreaks and signaled the beginning of renewed interest in public health as the protector for entire communities.

Which of the following disasters would implementation of disaster medical assistance teams (DMATs)? (Select all that apply.) a. Disaster that covers a broad geographical area b. Disaster that is beyond the coping capabilities of the affected state c. Disaster that may result in substantial health and medical problems d. Disaster that may cause a large number of deaths and/or injuries

B, C, D

A nurse wants to use the principles of risk and outrage to improve an environmental hazard in the community. To accomplish this, which of the following actions would be taken by the nurse? (Select all that apply.) a. Advertise in the media throughout the entire surrounding area. b. Communicate the correct information in a timely fashion. c. Share all the data found on the community assessment. d. Talk to those affected or those worried about the situation.

B, D

A community health nurse has invited several agencies in the community to a meeting to discuss the disaster plan for the community. Which of the following best describes the purpose of this meeting? a. To increase stability in the community b. To improve overall community functioning c. To manage response to disasters in the community d. To enhance communication among agencies in the community

C

A man entered the emergency department bleeding profusely and screaming, "I've got to see a doctor right now! I've got a right to see a doctor! I'm hurt. You have to take care of me!" Which of the following premises would ethically justify such a demand for immediate attention? a. All hospitals receive federal money and all capable employed adults pay taxes, so all adults have a right to what their tax money has purchased. b. Saving an individual's life improves society and upholds tradition. c. Our society believes that all persons should be treated equally and that basic needs, such as not dying if death can be avoided, should be met. d. The man has a property right to his own body, and the government is responsible to ensure that property rights are protected.

C

A nurse didn't know what to do when faced with a particular ethical dilemma because an option that would have a good outcome didn't seem possible. The nurse decided to talk to the agency supervisor and decide what action to take. Which of the following best describes the nurse's actions? a. Appropriate, because the supervisor is responsible for the nurse's choices b. Intelligent, because the supervisor has access to resource persons (clergy, physicians, administrators) who might know of options the nurse hadn't considered c. Justified, because this provides an opportunity to discuss the issue but the nurse maintains responsibility for the decision d. Wise, because the supervisor would be more knowledgeable concerning agency priorities and traditional practices

C

A nurse is assessing persons arriving at a shelter following a disaster. Which of the following would be the first action the nurse should take? a. Limit the amount of equipment and medications brought into the shelter. b. Determine if the person has a psychological condition requiring special attention. c. Assess if this type of facility is appropriate for the person. d. Provide medical care for persons as if they were in a hospital.

C

A nurse who works at the local hospital asks a public health nurse what might be causing her hands to become very sore and sensitive. Which of the following statements would be the most appropriate response by the public health nurse? a. "Ask the staff in employee health if there have been any other complaints." b. "Call the local health department about any recent problems at the hospital." c. "Check the material safety data sheet on any chemicals you have used recently." d. "See the nurse's health care provider for a complete work-up."

C

An occupational health nurse at a local factory is using primary prevention strategies to reduce the environmental health risks among the employees. Which of the following activities would the nurse most likely implement? a. Checking radiation detectors to monitor for unsafe levels of radiation exposure b. Irrigating the eyes of an employee who has had a chemical splash to the face c. Teaching new employees who will work outdoors about the signs and symptoms of heat-related illness d. Using spirometry to rule out obstructive or restrictive lung disease for workers who will be wearing mask respirators

C

How are ethics and public policies similar? a. Both are abstract principles that often differ in actual practice. b. Both are best achieved by persons in high political office who can effect change. c. Both strive for the public good. d. Both use general principles in making decisions.

C

Some nurses are debating about the appropriate action to take in relation to a particular family. One member of the family is ill, and the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, "But it doesn't have to be an either/or situation. Perhaps each family member could take a turn calling in sick just 2 or 3 days. That way they could all take a turn at helping and yet not upset their employers. Wouldn't that be fair?" Which of the following ethical approaches is being used by this nurse? a. Communitarianism b. Deontological ethics c. Principlism d. Utilitarianism

C

Some nurses are debating about the appropriate action to take in relation to a particular family. One member of the family is ill, and the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, "It's not up to us; it's the family's decision. They know what is best for them." Which of the following ethical approaches is being used by this nurse? a. Communitarianism b. Deontological ethics c. Principlism d. Utilitarianism

C

Some nurses are debating about the appropriate action to take in relation to a particular family. The father is ill, and the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, "It is a wife's responsibility to care for an ill husband." Which of the following ethical approaches is being used by this nurse? a. Consequentialism b. Communitarianism c. Deontological ethics d. Principlism

C

The staff cannot reach an agreement on what is the right thing to do in relation to a specific patient. Which of the following approaches should the nurse use in personally deciding what is right? a. Do whatever will not get the nurse in trouble with employer b. Do whatever is supported by an ethical expert, such as the hospital chaplain c. Do whatever the nurse would recommend to anyone in a similar situation d. Do whatever the nurse supervisor would feel comfortable reporting to administration

C

What is the purpose of the National Response Framework? a. Create a new branch of government that deals with bioterrorism b. Establish a way for the Red Cross to carry out its mission c. Develop a nationwide all-hazards approach to domestic incident management d. Extend presidential power to act quickly upon weapons of mass destruction

C

What is the relationship between ethics and a community health nursing practice? a. Ethics and actual nursing practice are not related. b. Knowing ethics allows nurse to recognize the source of most problems. c. Ethics is constantly involved in nurses' clinical decisions. d. Although ethics is important, political and legal responsibilities are more important in practice.

C

Which of the following is the first and most crucial step in the ethical decision-making process? a. Assess the context or environment in which the decision must be made. b. Consider the various ethical principles or theories. c. Identify the ethical concerns. d. Make a decision and act on it.

C

Which of the following older adults is most in need of psychological support? a. The older adult who keeps asking if loans will be available for him to rebuild b. The older adult who keeps asking if he can go back home yet c. The older adult who keeps lamenting the loss of his family photos d. The older adult who keeps talking about how expensive his home theater was and how he will never be able to afford to replace it

C

Which of the following organizations would direct nurses' response to a county-wide disaster? a. American Red Cross b. Centers for Disease Control and Prevention c. Emergency Management Agency d. The local public health department

C

nurse wants to help keep the community environment safe. Which of the following is the most appropriate action for the nurse to take? a. Conserve water by bathing less often. b. Downsize to a smaller living space. c. Reduce, reuse, and recycle. d. Replace all his appliances with new energy-efficient ones.

C

Which of the following agencies has the most influence on the health and welfare of U.S. citizens? a) Agency for Healthcare Research and Quality (AHRQ) b) Centers for Disease Control and Prevention (CDC) c) U.S. Department of Health and Human Services (USDHHS) d) World Health Organization (WHO)

C As the agency to which most health care legislation is delegated, the USDHHS is the agency most heavily involved with the health and welfare of citizens. The AHRQ and CDC are divisions of the USDHHS. WHO's policy-making body provides policy options and guides but not laws. In the textbook, only the USDHHS is discussed regarding its responsibility for Medicare and Medicaid through the Centers for Medicare and Medicaid Services (CMS).

Who is responsible for determining the scope of practice for registered nurses? a) American Nurses Association b) Federal legislators c) State legislators d) U.S. Department of Health and Human Services

C Health care practitioners are subject to the laws of the state in which they practice. The state nurse practice acts define the practice of professional nursing, identify the scope of nursing practice, set educational qualifications, and determine legal titles. The nurse practice act is governed by legislators in each state.

A nurse in community health may have state-granted personal immunity for particular practice areas such as giving immunizations. If the state legislature has granted personal immunity to nurses employed by public agencies to cover all aspects of their practice, the legal theory that applies is: a) case law b) respondeat superior c) sovereign immunity d) worker's right to know

C In some states, the legislature has granted personal immunity to nurses employed by public agencies to cover all aspects of their practice under the legal theory of sovereign immunity.

A nurse wishes to see a bill passed to support funding for the use of interpreters for clients with limited English proficiency. Which of the following would be the best time for the nurse to request support from the local senator, who is not on the committee that is reviewing this bill? a) When the bill is first assigned to a committee b) When the bill is discussed and debated within the committee c) When the bill moves out of committee to be heard by the entire Senate d) When the bill passes the Senate and moves to the House of Representatives

C Once the bill is passed by committee and moves out of committee to be heard by all senators, it will be important to contact this senator, who will then be in a position to act on it. The nurse would not want to wait until after the vote has been taken in the Senate because it would then be too late for the senator to act.

Which of the following statements best describes why the federal government has become involved in health care? a) The states asked the federal level to become involved b) Because of rising costs to the states, the federal budget needed to be used to pay for necessary services c) The Constitution gives the federal government the power to promote the general welfare d) This step was necessary to standardize care on a national level

C One of the first constitutional challenges to a federal law passed by Congress was in the area of health and welfare in 1937. The Supreme Court (judicial branch) reviewed the legislation in question and determined, through interpretation of the Constitution, that such federal governmental action was within the powers of Congress to promote the general welfare.

Which of the following statements by a client indicates a lack of understanding regarding an appropriate reason to sue for malpractice? a) "Because the health care workers didn't turn my mother every 2 hours, she developed bedsores." b) "I received permanent nerve damage because they would not remove a cast that was too tight." c) "My daughter wasn't given a call light, and for a whole shift no one checked on her condition." d) "They amputated the wrong leg during surgery."

C Professional negligence, or malpractice, is defined as an act (or failure to act) that leads to injury. All of the choices specify an injury, except for "My daughter wasn't given a call light, and for a whole shift no one checked on her condition," in which case the care was substandard but no injury resulted.

Which of the following laws established programs for provision of health services for women and children and supported community-oriented nursing practice? a) Early Periodic Screening and Developmental Testing (EPSDT) Initiative b) Healthy People 2000 Initiative c) Sheppard-Towner Act d) State Child Health Improvement Act (SCHIP)

C The Sheppard-Towner Act of 1921 played an important role in the development of public health policy, public health nursing, and social welfare policy. Of particular importance was the fact that it established standards for programs to serve women and children and made nurses available to provide these services in the community setting.

A community-oriented nurse is interested in studying the hospital discharge data for facilities that typically provide services to members of the community where the nurse practices. The nurse accesses the National Hospital Discharge Survey database of the Department of Health and Human Services (DHHS) to identify data at national, regional, and local levels for comparison purposes. The government health care function being used by the nurse is: a) direct services b) financing c) information d) policy setting

C The federal, state, and local governments carry out four health care functions, which fall into the general categories of direct services, financing, information, and policy setting. Collecting vital statistics, including mortality and morbidity data, gathering census data, and conducting health care status surveys are government functions that relate to the role of the government to provide information.

A nurse meets with a senator to lobby for passage of a bill to increase funding for interpreter services. With which of the following branches of the government is the nurse working? a) Constitutional branch of government b) Executive branch of government c) Legislative branch of government d) Judicial branch of government

C The legislative branch of government is composed of the Senate and the House of Representatives. The legislative branch identifies problems and proposes and then debates, passes, and modifies laws to address those problems.

A nurse in community health that speaks out in a public hearing in support of changes to existing requirements for reporting any long-term effects of structural or organizational changes within the community's health care organizations would be demonstrating: a) legislative action b) health policy c) regulatory action d) regulatory monitoring

C The regulatory process, although it may not be as visible as the legislative process, can also be used to shape laws and dramatically affect health policy. Because regulations flow from legislation, they have the force of law. The legislative process begins with ideas (policy options) that are developed into bills. At each level of government, the executive branch can and, in most cases, must prepare regulations for implementing policy and new programs. These regulations are detailed, and they establish, fix, and control standards and criteria for carrying out certain laws.

A public health nurse is assisting the community in dealing with the effects of lead paint poisoning. Which of the following activities would the nurse most likely complete? (Select all that apply.) a. Administering medications to those with signs of lead poisoning b. Assessing community members for any health problems c. Setting up a blood screening program with the local health department d. Encouraging local landlords to improve the condition of their housing

C,D

A study that uses information on current health status, personal characteristics, and potential risk factors or exposures all at once is called:

Cross-sectional

John Snow is called the "Father of Epidemiology" because of his work with:

Cholera

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?

Community D - with 90 single teenage pregnancies in a city of 1500

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?"

Case Fatality Rate

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 citizens living in the community?

Clinical Trial

The type of epidemiologic study that is used to describe a group of persons enrolled in study who share some characteristic of interest and who are followed over a period of time to observe some health outcome is a(n):

Cohort Study

B

Which of the following groups is most at risk for suicide? a. Adolescents under age 20 b. Men over age 85 c. Females 25 to 45 years of age d. Women over age 65

Voters have recently decided to have fluoride added to the city water system. Epidemiologists waning to study the effect of fluoride on dental caries would be conducting a(n):

Community trial

6. A community health nurse has been recently hired to work in an unfamiliar community. Which of the following persons would be effective key informants for the nurse? (Select all that apply.)

Communitys immigrant group activist Local politicians such as the town mayor

In which situation does the nurse need to be aware of the potential for selection bias?

Considering how the participants will enter the study

This is an inhibitor to developing competence with tendency to ignore all differences among cultures, to act as thou these differences do not exists, and as a result treats people all the same

Cultural blindness

This is an inhibitor to developing competence where one impose's one's values on other

Cultural imposition - ignoring western medicine

This is an inhibitor to developing competence where there's feeling oh hopelessness, discomfort, and disorientation experienced by individual attempting to understand or adapt to another culture

Culture Shock

A high school student considering a job in the restaurant industry after graduation asks a nurse about workplace safety issues. Which of the following acts would the nurse most likely discuss with the student? a. Chemical Safety Information, Site Security, and Fuels Regulatory Act b. Comprehensive Environmental Response, Compensation, and Liability Act c. Food Quality Protection Act d. Occupational Safety and Health Act

D

A nurse is asked to meet with a family who recently emigrated from Botswana (Africa). After the clinical doctor tells the husband the wife's diagnosis of breast cancer, the family thanks the physician and starts to leave. Ethically, which of the following is the nurse's most important action? a. Emphasizing that the family must set up a surgical appointment for the wife immediately b. Assessing the family's current living situation, including insurance and other assets c. Educating the family concerning the usual treatment and the prognosis of breast cancer d. Interviewing the family concerning their perspective of the threat to the family's well-being

D

A nurse is employed by the American Red Cross and is frequently assigned to fly to a disaster zone. Which of the following should the nurse's family members have readily available? a. Gloves, mask, and other personal protective equipment b. A copy of the nurse's professional license c. A 5-day supply of water d. A disaster/emergency plan

D

A nurse learns about a huge disaster a few states away. Which of the following actions by the nurse would be most helpful in this situation? a. Contributing funds to any charity that is assisting the victims b. Driving over to the area and volunteering to assist c. Sending clothes and food to the area for distribution d. Training to become a Red Cross disaster volunteer

D

A nurse wants to have a better understanding of the physiological effects of selected chemicals. Which of the following individuals would provide the most useful information to the nurse? a.Chemist b.Epidemiologist c.Pharmacologist d.Toxicologist

D

A physician refuses to order pain medication for a drug addict who has been severely injured in a car accident. When reminded by nurses that pain medication has not been ordered, the physician merely replies that the patient's suffering from the pain of his injuries will build character and that the addicted patient needs to get off drugs. Which of the following ethical theories is the physician using (or misusing)? a. Consequentialism b. Communitarianism c. Deontological ethics d. Virtue ethics

D

Some nurses are debating about the appropriate action to take in relation to a particular family. One member of the family is ill, and the other family members have chosen to continue working rather than take time off to care for the ill family member. One nurse states, "The whole family is being affected and will fall apart if they don't focus on their family's needs first before anything else." Which of the following ethical approaches is being used by this nurse? a. Communitarianism b. Deontological ethics c. Principlism d. Utilitarianism

D

The nurse is examining blood lead levels in school-age children 1 year after a community-wide education intervention. Which of the following phases of the nursing process is being implemented? a. Assessment b. Diagnosis c. Intervention d. Evaluation

D

Which of the following is the dominant issue in ethical debate around an issue such as continuing or withdrawing treatment in acute health care? a. Doing what is best for the community b. Doing what is best for the family c. Obeying legal mandates d. Upholding ethical principles

D

Which of the following would confirm that the nurse's advocacy has been truly successful or effective? a. Audiences agree with the nurse who is serving as advocate. b. Legislators discuss appropriate legislation to better allocate resources. c. People verbalize that the disenfranchised should be better treated. d. Systematic social changes are made to improve quality of life.

D

A public health nurse employed by the Department of Health is working on a team developing local health policy. The nurse recognizes which of the following about policy development? a) It is based on Socratic method b) It is important that the policy has been approved by the American Nurses Association c) It is primarily up to politicians to plan for health care d) It is very similar to the nursing process

D Health policy is simply the process of turning health problems into workable action solutions. Thus, the policy process is very similar to the nursing process, but the focus is on the level of the larger society, and the adoption strategies require political action.

What was the significance of the 1979 Surgeon General's report? a) It planned the goals and priorities for the entire Veterans Administration medical system b) It vastly increased funding for health promotion activities c) It identified the use of tobacco as a cause of lung cancer d) It created national goals for promoting health and preventing disease

D The 1979 Surgeon General's report began a focus on preventing disease and promoting health for all Americans. It was a national effort with all levels of government, as well as other interested parties, involved.

A nurse is advocating for the public health department to increase the number of public health nurses that it employs. Which of the following factors should the nurse emphasize? a) Providing disease investigation training b) Providing research opportunities c) Providing leadership experiences d) Providing salaries commensurate with responsibilities

D Through the input of the Division of Nursing's National Advisory Council for Nursing Education and Practice (NACNEP), the Division of Nursing sets policy for nursing nationally. A few of the factors indicated by the NACNEP that need to be in place to support the public health nurse role are: competitive salaries commensurate with responsibilities, experience in health promotion and prevention, long-term trusting relationships in the community, and a commitment to social justice and eliminating health disparities.

The state board of nursing has written new regulations to clarify in a more concrete manner what the nurse practice act allows and requires. Which of the following effects will this change have on nurses in this state? a) None, because they are just helpful guidelines for maximum safety b) None, because they just give specifics that may change over time c) Major, because prudent nurses would follow such regulations d) Major, because these rules and regulations have the effect of law and must be obeyed

D When the legislature passes a law and delegates its oversight to an agency, it gives that agency the power to make regulations. Because regulations flow from legislation, they have the force of law. Whether prudent or not, nurses are obligated to practice consistent with these regulations.

B

Which of the following groups pays the largest amount for health care in the United States today? A. Consumers B. Federal and state government C. Insurance companies and other third-party payers D. Hospitals and health care providers

A nurse reports that in comparison to all the children in a particular school, the children who are members of the Cub Scouts have a 0.3 risk for obesity before entering the 6th 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?

Encourage the parent to enroll their sons in Cub Scouts.

A nurse is administering a TB skin test to a client who has AIDS. Which of the following results should the nurse anticipate when using this screening test?

Decreased sensitivity

5. Which of the following activities are considered to be part of the core competencies for public health professionals? (Select all that apply.)

Defining variables relevant to current public health problems Obtaining and interpreting information regarding risks and benefits to the community

4. A nurse wants to determine whether health problems have been improved and interventions have been appropriate and successful over a period of time. Which of the following data should the nurse examine? (Select all that apply.)

Demographic data Education and school statistics

The factors, exposures, characteristics, and behaviors that determine patterns of disease are described using:

Determinants

A nurse is using Analytic Epidemiology when conducting a research project. Which of the following projects is the nurse most likely completing?

Determining factors contributing to childhood obesity

An example of Primary Prevention:

Diet + Exercise

8. A community health nurse drives through her assigned community before visiting the community groups scheduled for the day. She then drives through the community again that evening before going home. Which of the following best describes the nurses reason for driving through the community twice in the same day?

Driving through twice allows the nurse to see the community when many residents are at work or at school and then again when most are at home.

Which of the following actions would a nurse take to reduce the high incidence of coronary artery disease in a community?

Distribution of handouts, including age-appropriate games, self-assessments, and education on hear-healthy lifestyles; availability of community screenings for hyperlipidemia in persons age 35 and older; and walking programs for those affected with CAD

B

During a group counseling session for perpetrators of intimate partner violence, which of the following statements made by a client indicates a lack of insight into his violent behavior? a. "I have been taking out my frustrations with work on my girlfriend." b. "I love my girlfriend and didn't want to hurt her; it was an accident." c. "It might be a good idea for me to temporarily leave the house when I feel myself becoming angry." d. "When I drink alcohol, I become more abusive toward my girlfriend."

D

During an outbreak of hepatitis A, nurses are giving injections of hepatitis A immunoglobulin to selected susceptible persons. Which of the following best describes the type of immunity that will follow the administration of these injections? a. Active immunity b. Long-lasting immunity c. Natural immunity d. Passive immunity

What is the difference between education and learning?

Education is an activity initiated by one or more agents designed to effect knowledge, skill, & attitude. Learning the recipient of knowledge and skills and the person in whom a change is to occur. (Learning involves CHANGE - which is difficult for many people)

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?

Epidemiologic Triangle

This is an inhibitor to developing competence that is a type of prejudice at the population level and it is a belief that one own group determines the standards for behavior by which all other groups are to be judged.

Ethnocentrism - ex. the way american nurses care is the best

A nurse is employed as a Nurse Epidemiologist. Which of the following activities would most likely be completed by the nurse?

Evaluating the number of clients presenting with similar diseases.

B, D

How did Florence Nightingale help bring about community health nursing? (Select all that apply.) A. She convinced socially prominent wealthy women to volunteer to give care. B. She focused on all soldiers and their environment. C. She interacted with each individual person, assessing his or her needs and acting to meet those needs. D. She kept careful records on what was done and what were the results.

A

Factors that contribute to newly emerging or reemerging infectious disease can be related to microbial adaptation and changes made by the infectious agent. However, most of the emergence factors are related to environmental changes and: a. consequences of human activities/behaviors. b. increase in the number of vectors. c. industrialization and urbanization. d. unpredictable variances in the climate.

B D E

Family health can be defined as a dynamic, changing, relative state of well-being that includes the biological, psychological, sociological, cultural, and spiritual factors of a family system. This family health approach would best include which of the following underlying principles? Select all that apply. A. Assessment of the individual's health does not determine the overall family system's health. B. Family functioning affects the health of individuals. C. Family system assessment specifically addresses the individual's health. D. The individual's health affects family functioning. E. Simultaneous assessment of individual family members and the family system as a whole is important to family health.

When studying chronic disease, the multifactorial etiology of illness is considered. what does this imply?

Focus should be on the factors or combinations and levels of factors contributing to disease.

A

For a nurse to develop a therapeutic attitude toward the treatment of alcohol, tobacco, and other drug (ATOD) problems in the community, the nurse must realize drug addiction can be successfully treated, anyone may develop drug dependence, and: A. any drug can be abused. B. illegal drugs are the category of abused drugs. C. prescription drugs rarely cause dependence. D. over-the-counter (OTC) drugs are "good drugs."

A

For the homeless, health care is usually crisis oriented and sought in emergency departments. The most difficult challenge for nurses treating this vulnerable population is to recognize the client's: A. Limitations in following treatment protocols. B. limited number of transient treatment facilities. C. transition to persistent poverty. D. use and abuse of tobacco, alcohol, and illicit drugs.

B

For the nurse to fully understand the threat associated with the release of biological agents and participate in an appropriate response, the Centers for Disease Control and Prevention (CDC) has stated that the biological agents most likely to be employed are those that both have a potential for high mortality and can be easily disseminated to produce: A. immediately severe symptoms. B. major panic and social disruption. C. multisyndrome effect. D. person-to-person transmission.

What is the goal in health promotion and education?

Helping clients change behaviors

A nurse is assessing a communitys openness to change. Which of the following variables indicate that the community is ready?

High social-economic status in the community as a whole

A nurse is investigating a bacterial illness that has caused a health problem in the community. Only some of the people exposed o the bacteria have become ill. Which of the following factors best explains why this would have happened?

Host factors

A business executive develops symptoms of the flu 1 day after returning by air from a cross-Atlantic business trip that ran for 2 consecutive stressful 10 hour day. This individual's development of flu symptoms illustrates the relationship between:

Host, Agent, Environment

B, C, D

How did health care and its delivery change during the 1980s? (Select all that apply.) A. Funding to public health increased as funding for acute hospital care decreased. B. Laws began to be passed that discouraged the use of alcohol, drugs, and tobacco. C. Nurse practitioners were increasingly used to provide care. D. Public health programs suffered reduced political support, financing, and effectiveness.

A, C

How did nursing education change in the 1950s? (Select all that apply.) A. Baccalaureate nursing programs typically included public health nursing concepts. B. Diploma schools of nursing continued to expand their student numbers. C. Junior and community colleges began offering nursing programs. D. Nurses were strongly encouraged to have a scientific basis for their practice.

C

How did the Industrial Revolution result in previous caregiving approaches, such as care by families, friends, and neighbors, becoming inadequate? A. Economic and political wars resulted in frequent death and injuries. B. Incredible plagues consistently and constantly swept the European continent. C. Migration and urbanization resulted in increased demand for care. D. Caregivers could easily find other employment, so they demanded to be paid.

B

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

C

Indiscriminate use of "good drugs" has caused more health problems from adverse reactions, drug interactions, dependence, addiction, and overdoses than has the use of "bad drugs." The high-risk population group that most experiences the negative consequences identified above is: A. adolescents. B. injection drug users. C. older adults. D. pregnant women.

Which of the following statistics is used by countries to compare the success of their health care systems?

Infant Mortality Rate

C

Immunity to disease through vaccination is known as: a. natural immunity. b. resistance. c. acquired immunity. d. herd immunity.

4. A nurse is focusing on the process dimension of a communitys health. Which of the following interventions will the nurse most likely implement?

Implementing health promotion activities such as education programs

A

In applying the developmental theory, a family nurse determines the developmental stage of the family based on: A. age of the eldest child. B. family strengths. C. individual growth patterns. D. overall tasks of the family.

A

In case management, it is unlikely that any single professional has the expertise, knowledge, or skills required to achieve success. The synergy produced by all involved parties (client, providers, payers, family/significant others, and community organizations) can result in successful outcomes. This statement relates to the sequential process of: a. collaboration. b. communication. c. cooperation. d. negotiation.

C D

In comparison with traditional norms, which family functions have become increasingly important in modern American society? (Select all that apply.) a. Conferring appropriate social status b. Educating the younger members c. Ensuring physical and mental health d. Fostering interpersonal relationships and support

A

In giving care to the survivors of violence, the nurse should demonstrate respect and caring for all family members, insist that safety is the first priority, and demonstrate intolerance for violent behavior. Additionally, the nurse should be: A. absolutely honest about what will be reported and what the family can expect. B. authoritarian in approaching the problem. C. cautious in reporting unconfirmed reports of violence. D. sincere in concern for the victims.

C

In taking a family history, the nurse in community health finds that this is the second marriage for the previously divorced parents and that the male partner is the stepparent to the oldest child. For which of the following aspects of the family assessment is data being gathered? a. Dynamics b. Function c. Structure d. System

A, C

In which of the following situations would the federal government provide money through tax relief for private enterprise? (Select all that apply.) A. A business pays for part of health insurance premiums for its employees B. A business purchases gifts for its employees to award them for their service C. An employer provides health screenings and immunizationsd. D. An employer requests reimbursement for employee transportation costs

CD

It is estimated that one in 15 males becomes a father during his teen years. The nurse should be aware that many young men facing paternity have specific challenges such as: (select all that apply) Select all that apply. A. acting as though they are interested when they are disinterested. B. avoiding prenatal care involvement. C. desiring and needing to be involved with their children. D. being rejected by the young woman's family. E. rejecting their role as a father.

Which of the following statements describes how nursing in the community is more challenging than nursing in an acute care setting?

It is more challenging to control the environment in the community.

What is the relationship of public health nurse and community

It is the setting for practice and the target of practice

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?

Tertiary Prevention

Name some historic public health nurse leaders in US

Lilian Wald - established nurse settlement that became henry street settlement, also wrote a book, established public health nursing program for life insurance policy holders, provided funding of red cross, and arranged nurses to wear insignia. Jessie Sleet (scales) - african american nurse studied TB among african-americans in NY Ada Mayo Stweart - provided obstetrics, sickness, and post surgical AND WORK RELATED INJURIES Lina Rogers - first school nurse

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?

Local data drawn from a professional survey in the city

most common vector-borne disease in the US

Lyme

An example of Secondary Prevention:

Mammogram

BDE

Marijuana (Cannabis sativa or C. indica) is the most widely used illicit drug in the United States. The nurse should be aware that marijuana has which of the following characteristics? Select all that apply. A. Decreases appetite B. May lead to tolerance C. Is highly toxic D. Has little quality control E. Is a safe therapeutic agent

B

Methadone maintenance for heroin addiction is a harm reduction strategy because it reduces deviant behavior and introduces addicted persons to the health care system. What is a disadvantage to the use of Methadone? A. Methadone is inexpensive. B. Methadone carries a risk of overdose. C. Methadone prevents relapse. D. Methadone is long acting and effective orally.

Which of the following best describes the use of genomic health care? a. Assists with understanding family relationships b. Assists with determining familial health risks c. Useful in learning about environmental risk factors d. Useful in detecting risk for developing cancer

NS: B Genomic health care can give health care providers the tools that they need to use a person's unique genomic information to design and prescribe the most effective treatment for each person and to help clients and families understand some of their health risks that are influenced by their genetic make-up. When nurses obtain a family history and learn about the illnesses and causes of death of biologically related family members, they can then learn about shared genes, environment and lifestyle behaviors that can increase a person's risks for the same diseases that other family members experienced. Genomic

Which of the following should be the initial consideration made by a nurse who is working with lesbian, gay, bisexual, and transgendered (LGBT) families? a. Understanding of same sex marriage laws within the state b. Understanding of personal feelings of working with members of this community c. Assessment of the family structure within the LGBT family d. Assessment of sexual orientation in a safe environment

NS: B Nurses have an ethical obligation to provide culturally competent care to LGBT families. Some nurses may feel a degree of discomfort discussing sexual orientation with their patients. However, it is important to overcome this barrier to care for LGBT families. Thus, nurses should provide a safe environment for patients to discuss their sexual orientation.

Public health professionals refer to 3 levels of prevention as tied to specific stages in the:

Natural history of disease

They are leaders of health promotion through health education. They educate clients across all levels and the work with individuals, family, groups, and communities

Nurses

11. Which of the following objectives is most appropriate for the development of a community-oriented nursing care plan?

Of mothers receiving nutrition counseling, 80% will identify five sources of calcium by the end of class.

D

Of the four main factors that affect health, which is the least important? A. Environment B. Human biology C. Lifestyle choices D. Health care system

What are the levels of prevention

Primary: no occurrence secondary: treatment for disease tertiary: person had disease and preventing from getting it again

1. A community health nurse encourages members of the community to partner and assist in creating health programs. Which of the following best describes the rationale for this action? (Select all that apply.)

Participating in planning results in having a vested interest in the outcome Partnering results in increased effectiveness

during an outbreak of hepatitis A, nurses are giving injections of Hep A Ig to selected susceptible persons. Which of the following best describes the type of immunity that will follow the administration of these injections

Passive immunity

Vocational rehabilitation of a person with a neuromuscular disease is an example of:

Tertiary Prevention:

A nurse is working toward an objective to Increase to at least 90% the proportion of all pregnant women who receive first trimester prenatal care. During which of the following phases of the nursing process would determination of the objective occur?

Planning phase

An outbreak of a GI illness from a food borne pathogen is an example of a(n):

Point Epidemic

To understand the causes of health and disease, Epidemiology studies:

Populations

The proportion of persons with positive test results who actually have a disease, interpreted as the probability that an individual with a positive test result has the disease, is the:

Positive Predictive Value

This is an inhibitor to developing competence that have deeply held reaction, often negative, about another group or person

Prejudice ex having brown skin

Examples of learning formats

Presentation - large group and short attention span Demonstration - showing how to perform a task small informal group - sharing experiences Health fair - displays and posters Nonnative language sessions

A screening for diabetes revealed 20 previously diagnosed diabetics and 10 probable new cases, which were later confirmed, for a total of 30 cases. This is called:

Prevalence

This year 600 of 8,000 young women ages 17 to 20 years at a university health center tested positive for a STD. Which of the following terms best describes this data?

Prevalence

What is the prime aim of public health nurse leaders?

Prevent disease and preserve, promote, restore, and protect health for the community and population within Promote physical and mental health and prevent disease, injury, and disability.

As a result of an outbreak of influenza in a community, a nurse encourages members of the community to receive the influenza vaccine. Which level of prevention is being used?

Primary Prevention

Immunizations for measles is an example of:

Primary Prevention

An example of an attack rate is the:

Proportion of people becoming ill after eating at a fast food restaurant.

A

Protecting the nation's food supply from contamination by all the virulent microbes is complex, costly, and time consuming. However, much foodborne illness, regardless of causal organisms, can be prevented through simple changes in: a. food preparation, handling, and storage. b. importation regulations. c. pesticide usage. d. animal breeding practices.

An example of Tertiary Prevention:

Rehabilitative job training

Screening for hearing defects is an example of:

Secondary Prevention

A principal comments to the school nurse that it seems there are a lot more problems with asthma among students than there were before the school was remodeled a couple years ago. 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 he following best describes the type of study the nurse is conducting?

Retrospective Cohort Study

The probability an event will occur within a specified period of time is called:

Risk

When a nurse examines birth and death certificates during an epidemiologic investigation, what data category is being used?

Routinely collected data

Which is an example of an agent in the Epidemiologic triangle?

Salmonella

A nurse in community health who teaches a client with asthma to recognize and avoid exposure to asthma triggers and assists the family in implementing specific protection strategies, such as removing carpets and avoiding pets is intervening at the level of:

Secondary Prevention

A nurse is practicing in the community but also has the community as the target of practice. Which of the following best describes the activities of this nurse?

Sharing assessment findings and health goals with every community group that will listen

Which of the following actions by Florence Nightingale demonstrates her role as an epidemiologist?

She demonstrated that a safer environment resulted in decreased mortality rate.

B D

Six students order meals at a local restaurant. Which of the following students are at highest risk for illness? (Select all that apply.) a. The first student asks for a salad with chicken strips and dressing on the side. b. The second student asks for a hamburger, very rare. c. The third student orders a tuna salad sandwich with extra mayonnaise. d. The fourth student orders a breakfast meal with two very soft-poached eggs and toast.

3. Persons often point out that smokers choose to light their cigarettes, alcoholics lift the glass to their mouth, and drug addicts inject or ingest their drugs. Which of the following statements best describes why nurses dont simply focus on helping persons who engage in poor health behaviors to behave appropriately?

Society must offer healthy choices, offer support, and practice helpful policies.

This is an inhibitor to developing competence that attributes certain beliefs and behaviors about a group to an individual without giving adequate attention to individual differences

Stereotyping "all asians are hard working"

D

Which of the following individuals 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

10. When evaluating an educational program, the nurse discovers that only 25% of community members met the learning objectives. Which of the following parts of the program should be improved?

a. Educator

D

Students at first-day orientation at the local community college are discussing alcohol and drug abuse with their freshmen advisor. During a break, some students go outside for soft drinks and snacks. Soon after, the advisor walks by and notices several of these students smoking cigarettes. Based on this, which of the following topics of the drug and alcohol orientation would be most important for the advisor to reemphasize after the break? a. A discussion of which drugs are commonly used on campus b. How students can learn to "just say no" when offered drugs or drinks c. How to recognize and overcome peer pressure to continue bad habits d.The fact that tobacco smoking causes more deaths than any other behavior in the United States

What does the pneumonic TEACH stand for?

T-tune in E - Edit information A - act on each teaching C - clarify often H - honor the client as a partner

Key goal of public health nurse?

Teach people to promote health, prevent illness, and manage chronic illness.

During which of the following activities is the nurse in community health acting as a partner in change?

Teaching anger management skills to a group of teens in a halfway house

C

The Elizabethan Poor Law of 1601 is similar to which current law? A. Welfare B. Food stamps C. Medicaid D. Medicare

B D

The advanced practice nurse explains that the client has an upper respiratory infection (URI) and suggests several measures that might make the client more comfortable. Which of the following best describes why the nurse doesn't just prescribe antibiotics as the client repeatedly requests? (Select all that apply.) a. Antibiotics are expensive, whereas the support measures would be almost free of cost. b. Viral diseases are not affected by antibiotics. c. Clinics cannot afford to continually give antibiotics to anyone who asks for them. d. The more antibiotics are prescribed, the more infectious agents develop resistance to such drugs.

B

The nurse at the adult day care center notices bruises on the wrists of a 90-year-old client. Besides the physical assessment of the client, the nurse should: A. confront the daughter when she arrives to pick the father up. B. discuss the findings with the caregivers to determine the cause of the injuries. C. educate the staff about indications of elder abuse. D. make a referral to the primary care provider for follow-up.

B

The case manager explains to two disagreeing parties that coming to an agreement will save personnel costs for both of them. Which of the following terms best describes this action? a. Assertiveness b. Collaboration c. Cooperation d. Compromising

BC

The community health nurse performs an assessment of violence by observing which of the following community characteristics? Select all that apply. A. Presence of social support networks B. Crime rates C. Levels of unemployment D. Presence of physical disabilities in individuals E. Presence of family violence

C

The current-day definition of family refers to two or more individuals who depend on one another for emotional, physical, and/or financial support. Which of the following is the most important principle to support this broader definition? A. Families are defined by genetic ties. B. Family names are needed to confer status. C. Members of a family are self-defined. D. Traditional family functions have been redefined.

3. A nurse is deciding which alternative interventions should be implemented. Which of the following factors must be considered by the nurse when making this decision? (Select all that apply.)

The expected effect or outcome of each possible intervention How interested others are in helping in any particular intervention The likelihood that the intervention will resolve the problem

A

The family nurse conducts the family nursing assessment with the family as a unit. Using a systematic process, family problems are identified and family strengths are emphasized as building blocks for interventions. Which of the following best completes the statement to demonstrate the importance of assessment to outcomes? Integrating the extended families: A. fosters equal family and provider commitment to success. B. facilitates outcomes-oriented family nursing research. C. decreases the need for nurse contact and intervention. D. removes barriers to needed services to achieve success.

D

The family systems theory encourages nurses to view both the individual clients as participating members of a whole family. What is the major weakness of the systems framework? A. Views families from both a subsystem and a suprasystem approach B. Defines the direction of interactions C. Views the family as an agent of change D. Focuses on the interaction of the family with other systems

D

The following people enter the health clinic together: an unmarried man and his year-old son, an unmarried woman with a year-old daughter, and the man's married brother, who is separated from his wife. During the assessment it is determined that both men work and contribute to the household, where all of them live. Which of the following best describes the "family"? a. The group consists of three families: the man and his son, the woman and her daughter, and the brother, who is married even though he and his wife are separated. b. There are two families involved: first, the unmarried man and woman and their two children, and second, the brother, who is married even though he and his wife are separated. c. There is no family here, only three adults sharing resources between themselves and two biologically related children. d. The family includes whoever the adults state are family members.

D

The goal of deinstitutionalization was to improve the quality of life for people with mental disorders by providing services in the communities where they lived rather than in large institutions. At what program level did this change in locus of care fail? A. Assessment level B. Design level C. Evaluation level D. Implementation level

B

The harm reduction approach to substance abuse focuses on health promotion and disease prevention. A primary prevention strategy that can be used by the nurse to address substance abuse under this approach is to: A. assess for recreational drug use. B. destroy the myth of good drugs versus bad drugs. C. encourage children to "just say no." D. refer to an addiction treatment program.

B

The hospital-based nurse has worked with a client at some length regarding appropriate diet. Based on the family systems theory, which of the following will most likely occur when the client returns home? a. The family member who prepares food will probably suggest the newly discharged member eat the meals everyone in the family enjoys. b. The family member who prepares food will probably try to modify family meals without obvious change for the family as a whole. c. The family member who prepares food will probably prepare meals based on the diet plan for all the family. d. The family member who prepares food will probably prepare special meals for the newly discharged member.

In a particular community several high school students were diagnosed wit diabetes mellitus type 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 DMII and proper nutrition. Which of the following would be most useful for the nurses to use to determine if they are having any impact?

The incidence of diabetes is slowly decreasing during screening events.

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?

The incidence of diabetes will increase in the community.

B

Which of the following addictive drugs is both legal and culturally acceptable throughout almost all of the United States? a. Beer b. Caffeine c. Cigarettes (nicotine) d. Mixed alcoholic beverages

D

The nurse in community health needs to conduct a family assessment within a commune but is uncertain how to proceed because family lines appear blurred. The best way to determine the family of a mother and her child is to ask the woman which of the following questions? a. "How many children do you have, and who is the father of each?" b. "Is there a register of families who are members of this commune?" c. "Tell me about your significant other." d. "Who are the members of your and your child's family?"

A

The nurse in community health uses information about family structure, household composition, marriage, divorce, birth, death, adoption, and other family life events to forecast and predict stresses and developmental changes experienced by families and identify possible solutions to family challenges. This best describes the study of: A. family demographics. B. family functions. C. family health. D. family resilience.

A

The nurse is evaluating a new home health client for ongoing management at home following back surgery for a traumatic injury. The client has been receiving a morphine-based drug for long-term pain management over the past 6 months. The nurse's assessment should include a plan for addressing the client's: A. drug dependence. B. drug addiction. C. substance abuse. D. opiate addiction.

B

The nurse is making a postpartum visit to a teenage mother and her month-old infant. Which of the following assessments would be most important? a. Assessing for mother's ability to fulfill her own growth and development tasks b. Assessing for mother's knowledge about normal infant growth and development c. Assessing how much the teenage mother's own mother is helping her cope with child care d. Assessing whether the baby's father is being helpful to the mother

B

The nurse is told that a healthy, functional family consisting of a 25-year-old man and a 24-year-old woman, who are expecting their first child, would appreciate a nurse coming to their apartment for anticipatory guidance in preparing themselves and their apartment for the baby. Based on that statement, which of the following assumptions can the nurse safely make about the family? a. The family is lacking a strong support system. b. The family's basic needs are being met. c. The couple's in-laws are unavailable to share their expertise about child care. d. The married couple is excited about their first baby.

C

The nurse must ask about violence at each prenatal and postpartum visit, especially with vulnerable populations such as teenagers, as well as observe for signs of violence on each visit. The nurse should be aware that the peak for postpartum intimate partner violence may be observed at various times according to ethnic group, such as: A. 6 months for white mothers. B. 10 months for white mothers. C. 3 months for African-American and Hispanic/Latino mothers. D. 12 months for African-American and Hispanic/Latino mothers.

C

The nurse suggests use of telehealth to assess how a client is progressing. Which of the following resources must be available for continuing care to be implemented? a. A physician who is willing to use wireless prescriptions and plans of care b. Family permission for the nurse to make home visits c. Long-distance telephone service or a computer with Internet access d. Willingness of the caregiver to drive the client to the nearest clinic

B

The nurse who works at a homeless clinic wants to improve healing of chronic wounds in clients living on the streets. Which of the following would be the best action to take to improve client outcomes? a. Provide antibiotics to all homeless persons with chronic, nonhealing wounds b. Offer daily access to a room with soap, water, and bandages c. Hand out free bandaging supplies following each clinic visit d. Perform regular monitoring of the client's wound condition

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 to know in order to help the wan cope with this finding?

The positive predictive value of mammography

A nursing staff has successfully screened for diabetes in the community. Which o the following might best persuade the health board to increase funding for diabetic clinics in this community?

The prevalence of diabetes is now higher than previously recognized in the community.

Between 2000 and 2005, 100 of 100,000 young women ages 17 to 20 years at a university tested positive for an STD. Of the 1,000 diagnosed, 300 were Gonorrhea and 500 were Chlamydia. Which of the following statements best summarizes these findings?

The proportion of STDs to the total population was 100 : 1000

Two women seem to agree on almost everything from favorite music to favorite media stars to the best way to prepare a meal. Which of the following best explains this similarity in the two women?

They are both members of the same birth cohort.

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?

The sensitivity of the test

B

The wife of an abusive husband reports to the nurse that her husband has been increasingly more abusive over the past year. Which of the following should be the first action that is taken by the nurse? a. Arrange for the couple to attend marital counseling. b. Develop a plan for the wife's escape if the violence starts again. c. Teach the client how to avoid initiating her husband's anger. d. Work with the client on development of self-esteem.

D

There is great concern in the nurse's community over three local cases of West Nile virus. Which of the following actions should the nurse take to get the community involved in addressing this problem? a. Ask the state department of health for assistance b. Demand that everyone over age 65 become immunized immediately c. Encourage immunization of all children under 12 d. Have an educational campaign to remove any containers of standing water

Who are the vulnerable population?

This group who have an increased risk for developing health outcomes. - poor and homeless persons -pregnant adolescents -migrant workers/immigrants -severely mentally ill -substance abusers -abused/victims of violence -person with communicable disease -people with HIV, Hep B, and STD

How to start assessing a community?

This involves getting to know and understanding the community as a client. Nurse should define their client in terms of 1) Place 2) people, 3) function : What are the geographic boundaries Which people are members of this community What characteristics do they have in common

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?

This method of data collection would result in selection bias

A

Three women were brought to the emergency department by ambulance after a two-car accident at a busy intersection. Which of the following tests should automatically be done under such circumstances? a. Alcohol blood level b. Cardiac workup c. Pregnancy test d. STD tests

7. A nurse just accepted a position in community health and has been assigned to a neighborhood very close to where she lives. Which of the following best describes the rationale for this assignment?

To allow participant observation by the nurse

6. During the assessment phase, the nurse compiles and interprets available data and draws conclusions as to the communitys strengths and concerns. Which of the following best describes why the nurse would also conduct interviews with key informants?

To generate nonstatistical data such as values, beliefs, and perceived needs

B

To reach the desired goal of maximizing the full immunization rates for preventable communicable disease and increasing herd immunity levels, it is crucial for the nurse to: A. assume that the primary care physician has provided all appropriate immunizations. B. check an individual's immunization status at each and every visit. C. support parents who are reluctant to immunize their children. D. understand the difficulties in obtaining and maintaining immunization schedules.

9. Before beginning to survey the community to assess its health needs and strengths, the nurse reviews various documents, including local statistical data and the minutes of the previous meeting of the health care agency. Which of the following best explains why the nurse would start with this activity?

To save time and effort and perhaps have new insights

A nurse is assessing the structure of a communitys health. Which of the following data will the nurse examine?

Treatment and service use patterns from local health agencies and care providers

A

Universal Precautions is a policy for all health care settings, where potential contact with blood or other body fluids exists, and requires that health care workers always perform hand hygiene and wear gloves, masks, protective clothing, and other indicated personal protective barriers. The underlying strategy for this policy requires that: a. blood and body fluids of all clients be handled as if infected. b. health care workers effectively use hand hygiene. c. health care settings are reservoirs of infection. d. effective infection control surveillance programs are in place.

what should you do when you do not understand the client's language

Use an interpreter

A nurse has only a regular BP 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?

Validity

B

Violence is a major public health problem in our communities that causes premature mortality and lifelong disability. Violence-related morbidity is a significant factor in: A. community deterioration. B. health care costs. C. juvenile delinquency. D. population density.

15. A nurse is assessing the status of a communitys health. Which of the following will the nurse examine?

Vital statistics

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?

Web of Causality

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?

Weighing students to identify those who are overweight

A, B, D

What do demographic figures suggest about the ways in which the population of the United States is changing? (Select all that apply.) A. Foreign-born immigrant population is increasing. B. Hispanics are the largest minority group population. C. Leading causes of death are from infectious diseases. D. Mortality for both genders in all age groups declined.

A C D

What terms are used to describe healthy families? Select all that apply. A. Families with strengths B. Dysfunctional C. Functional families D. Resilient families E. Resistant families

C

What was the outcome of the Shattuck Report? A. Efforts to control alcohol and drug abuse, as well as tobacco use, were initiated. B. Environmental sanitation efforts became an immediate priority. C. Guidelines for modern public health organizations were eventually developed. D. Local and state governments established boards of health after its publication.

B

When acting as a mediator, the nurse advocate would: a. choose a new health plan for a client with limited funds. b. assist new parents in communicating with their health plan regarding well-baby coverage. c. provide health education to teens who need knowledge about sexually transmitted diseases. d. set up a doctor's appointment for an illiterate adult.

When does the community become the client?

When nursing focus is on collective of common good of the population instead of the individual health.

C

Which client would have been most likely to receive care from the Frontier Nursing Service? A. An injured soldier B. A homebound, elderly male C. A woman in labor D. A child with a broken femur

C

Which of the following Medicaid clients would most likely receive case management? a. An elderly person b. A person receiving rehabilitation following an injury c. A person who has a high-cost chronic disease d. A person with acute illness

B

Which of the following accurately describes a challenge that will be faced by health care providers in the 21st century? A. Lack of available space to provide care for clients in hospitals B. Emergence of new and old communicable and infectious diseases C. New guidelines for chronic disease management D. Increased use of technology leading to a decreased need for health care workers

A, C

Which of the following are some major differences in health care today, as compared with the first half of the 20th century? (Select all that apply.) A. Consumers are influenced by advertising for specific health care agents or procedures. B. The emphasis is on the continued expansion of health care facilities, especially acute care hospitals. C. Education and specialization of personnel have increased. D. The need to create new ways to pay for health care is a central focus.

B

Which of the following best describes a principle of care that the nurse should abide by when working with abusive families? a. Confront the abuser and shame him into penitence and a desire to change. b. Demonstrate respect for all family members, including the abuser. c. Exclude the abuser from family meetings because the abuser is the one creating problems. d. Notify the abuser's clergyman, boss, and others who can exert pressure for change.

C (Case management, in contrast to the definition of care management, involves activities implemented with individual clients in the system.)

Which of the following best describes case management? a. A tool of health maintenance organizations b. Targeted toward a specific segment of the population c. Implemented with individual clients d. Used to monitor the health status, resources, and outcomes for an aggregate

B

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

C

Which of the following best describes the cost of health care in the United States? A. Health care costs are kept low, and the indicators of health are among the best worldwide. B. Health care costs are low which has resulted in poor health outcomes. C. Health care costs are the highest in the world, but the indicators of health are not the best worldwide. D. Health care costs and indicators of health are the highest in the world.

B

Which of the following best describes the current goal in relation to communicable diseases? a. To control political borders so diseases cannot spread further b. To exterminate specific infectious agents one by one c. To expand health care facilities to improve infectious disease treatment d. To achieve worldwide immunization to control new cases

D

Which of the following best describes the goal or priority of the nurse advocate? a. To gain organizational and governmental support for the promotion of nursing objectives b. To improve community service needs identified by research findings c. To integrate evidence-based practice guidelines in the provision of community nursing service d. To promote the client's rights and self-determination

D

Which of the following best describes the primary problem that can result from health care today being given by many different care providers? a. Clients are not sure which provider to see first. b. Health care providers have to make referrals to other providers. c. Clients sometimes are not sure who their primary provider is. d. Overuse, underuse, or gaps in care may result.

B

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

B

Which of the following best describes why planning care for an individual is so challenging in today's health care system? a. Because today's clients have high expectations of the health care system b. Because multiple providers, payers, and settings have to be coordinated c. Because of the new high technology constantly being created and used for client treatment d. Because so many different health care providers are in the acute care setting today

C

Which of the following best explains how the government unintentionally encourages low-income persons to use emergency departments as their primary-care provider? A. A huge amount of paperwork is required when Medicaid clients go to a physician's office. B. Government regulations require Medicaid clients to use emergency departments when their primary health care provider is unavailable. C. Legally, emergency departments must see clients even if clients can't pay. D. Physicians' limited office hours make them unavailable during evenings and weekends.

A, B, C

Which of the following best explains why clients who have Medicaid have poor health outcomes? (Select all that apply.) A. Clients may have preexisting conditions not covered by insurance. B. Many physicians won't accept Medicaid clients. C. Medicaid won't pay for certain medical interventions. D. Medicaid recipients are noncompliant with their health care providers' recommendations.

A

Which of the following best explains why every client doesn't receive care from a case manager? a. Case management time is demanding; thus it is restricted to complex cases. b. Many health agencies do not employ case managers. c. Most clients would not benefit from case management. d. Most nurses do not know how to function as case managers.

A

Which of the following best represents an example of infectious disease spreading via a vector? a. Being bitten by an infected mosquito b. Disease spreading from infected mother to infant via the placenta c. A group of partygoers hugging and shaking hands d. Two persons, one of whom is infected, sharing a glass of soda

A

Which of the following biological warfare agents poses the greatest bioterrorism threat to a community? a. Anthrax b. Botulism c. Smallpox d. Tularemia

D

Which of the following caused health care providers to begin to focus on individual infections and trauma in the 1900s in the United States? A. Education of health care providers moved into universities. B. People finally had enough money to pay for medical care. C. The improved outcomes of hospital care were recognized. D. Advances were made in sewage disposal, and water and milk quality.

B

Which of the following components of the epidemiologic triangle contributes most to a female client developing a vaginal infection caused by fungi after successful treatment of her strep throat with antibiotics? a. Agent b. Environment c. Host d. Agent and host

D

Which of the following criterion is now used for deciding the amount of the reimbursement before care is provided? A. A proportion of actual cost arbitrarily decided by the Medicare panel B. The federal budget constraints for the current fiscal year C. Hospital and health care provider feedback and political persuasion D. Prospective payment scale based on the medical diagnosis

C

Which of the following data would most likely be collected in a syndromic surveillance system? a. Incidence of bioterrorism attacks b. Number of air travelers c. Incidence of school absenteeism d. Number of influenza vaccines administered

A

Which of the following demographic factors is expected to have the greatest influence on national health care spending? A. The aging population B. Use of diagnosis-related groups to determine reimbursement C. Insurance reform D. An increasing number of people without health insurance

BCD

Which of the following factors may lead to increased violence? (Select all that apply.) a. Adequate social support b. Feelings of powerlessness c. Violence shown in the media d. Living in a crowded environment

B

Which of the following factors must be considered before deciding on an appropriate plan of action? a. Family agrees to the nurse's plan. b. Family is capable of the required actions. c. Family will learn better coping skills from the nurse's plan. d. Nurse has informed family how to complete the required actions.

D

Which of the following infectious disease interventions best represents the use of secondary prevention? a. Clients with HIV infection are encouraged to use condoms to protect sexual partners. b. Clients with HIV infection are given medications to improve immunological response. c. Health care workers are encouraged to receive annual vaccinations for influenza. d. Health care workers are required to have a tuberculosis skin test or chest x-ray.

C

Which of the following is a common factor typically found in those who abuse others? a. Fear and belief that others are "out to get them" b. Poor self-esteem and unawareness of alternatives c. Previous observations of violent behaviors to manage conflict d. Difficulty keeping commitments

B

Which of the following is an accurate concern about the use of marijuana? a. Marijuana has painful withdrawal symptoms. b. Marijuana may damage the respiratory tract. c. Marijuana can often reduce pain but physicians refuse to prescribe it. d. Marijuana quickly leads to psychological and physiological dependence.

B

Which of the following is most closely correlated with poor health? A. Age and gender (i.e., older males) B. Low socioeconomic status C. Minority race status D. High-risk lifestyle behaviors

C

Which of the following is the leading cause of disability for Americans 15 to 44 years of age? a. Accidents b. Arthritis c. Major depressive disorder d. Workplace injuries

C

Which of the following is the most common vector-borne disease in the United States? a. Babesiosis b. Ehrlichiosis c. Lyme disease d. Rocky Mountain spotted fever

B

Which of the following is the most common vector-borne disease worldwide? a. Dengue b. Malaria c. Onchocerciasis (river blindness) d. Yellow fever

B

Which of the following is the most likely reason for a man to rape a woman? a. Because the woman was asking for it b. For power and control c. Provoked by the woman's dress and behavior d. Sexual pleasure and release

A

Which of the following is the most probable cause of the increase in new emerging infectious diseases? a. Activities or behavior of humans, including changes in the environment b. Increasing urbanization and growth in new housing materials c. New infectious agents are evolving throughout the world d. Overpopulation in many areas, creating a need to reduce global population

B

Which of the following is the most rapidly growing group of homeless? a. Adolescents b. Families with children c. Persons in crisis d. Single men

B

Which of the following is the number one cause of death worldwide? a. Chronic diseases (heart disease, cancer, stroke) b. Infectious diseases c. Injuries (accidental or purposeful) d. Terrorism

A B C

Which of the following is the primary goal of case management? (Select all that apply.) a. To ensure that care coordination occurs across the continuum b. To emphasize evidence-based clinical decision making c. To manage resource use and control expenses d. To stress the advantages and benefits of community-based care

C

Which of the following is the top risk factor for intimate partner homicide? a. There is a gun in the house. b. The husband has made threats against wife before. c. The wife has previously called 911 because of husband's beating her. d. The woman's young daughter also lives with them.

C

Which of the following must a nurse be knowledgeable about to make decisions regarding the most cost-effective way to allocate health care resources? A. Insurance resources B. Health care rationing C. Health economics D. Medical technology

A C D

Which of the following must be firmly established before beginning a family assessment? (Select all that apply.) a. Why the data are needed b. How best to interview each individual in the family c. The most convenient time for you to visit the family d. The rationale or purpose of the visit

C

Which of the following nurses is famous for creating public health nursing in the United States? A. Florence Nightingale B. Frances Root C. Lillian Wald D. Mrs. Solomon Loeb

A

Which of the following payment systems tries to keep clients healthy through education and health promotion, with the goal of reducing the need for professional health care intervention and therefore also lowering cost? A. Managed care plan B. Fee-for-service payment C. Prospective reimbursement D. Retrospective reimbursement

A

Which of the following persons is most likely to be assaulted? a. A young man b. A young woman c. An older man d. An older woman

A

Which of the following places best describes where the incidence of Vancomycin-resistant Staphylococcus aureus (VRSA) and methicillin-resistant S. aureus (MRSA) is currently rising? a. Areas where people share dressing or bathing facilities b. Daycare centers and schools c. Long-term care facilities d. Senior citizen centers

A, C

Which of the following provides evidence that the US health care system is in crisis? (Select all that apply.) A. Health insurance is an expensive benefit for employers to provide. 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.

C

Which of the following public health actions has been particularly instrumental in reducing childhood infectious diseases in the United States? a. Answering parents' questions about the safety and importance of vaccines today b. Educational campaigns to all health care providers about the importance of immunizations whenever a child is seen c. "No shots, no school" legislation, which legally requires children be immunized before school d. Offering all immunizations to all children free of any charge

B

Which of the following public health nurse applicants is the least qualified for a position of case manager in a rural county? a. A 24-year-old who has a master's degree in public health b. A 34-year-old who will be moving from a large city c. A 44-year-old who was born and raised in the community d. A 54-year-old who, until recently, was a member of the community's school board

B

Which of the following racial groups experiences the highest incidence of poverty? a. Non-Hispanic Whites b. Blacks c. Hispanics d. Asians

C

Which of the following services 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

D

Which of the following social science theories is used by public health nursing to describe how environments and systems outside of the family influence the development of a child over time? A. Life cycle theory B. Family developmental theory C. Family systems theory D. Bioecological systems theory

2. Which of the following characteristics must a learner possess to successfully master psychomotor learning? (Select all that apply.)

a. The necessary ability to perform the skill c. A sensory image of how to perform the skill d. Opportunities to practice the skill

B

Which of the following statements accurately describes why methadone is used to treat heroin addiction? a. Addicts come to prefer methadone instead of heroin. b. Methadone blocks the effects of heroin and reduces the craving. c. Methadone prevents further dependence on drugs. d. Methadone gives an enjoyable high, so addicts continue treatment.

A, C, D

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. People often spend a considerable amount of their own money on complementary therapies. D. The gap between the richest and poorest is widening.

D

Which of the following statements best describes why health care of the homeless is so expensive to the community? a. Health conditions of the homeless require increased preventive services. b. Homeless clients typically make more clinic visits for multiple health problems. c. Homeless people spread contagious diseases to those they pass on the street. d. Most care to homeless people takes place in hospital emergency departments.

C

Which of the following statements best explains the primary reason why violence is so high among young African-American men? a. Men tend to be more violent than women. b. They are young and thus lack maturity. c. Unemployment is higher in this population. d. Violent tendencies are transferred genetically along racial lines.

A

Which of the following statements best explains why family functions and structures create unique challenges in family nursing? a. Function and structure change over time. b. Function and structure do not apply to all family units. c. Some clients do not have families. d. Traditional families are rare in society.

B

Which of the following statements by a parent indicates a need for increased learning regarding appropriate (nonabusive) discipline of a child? a. "I have stopped using a switch on my child, and I am learning to count to 10 before reacting." b. "I never spank or hit; I yell at them to stop being stupid, and if they don't, I tell them no one is ever going to love them if they act like that." c. "I use time-outs when my child acts out or is naughty. Sometimes my child doesn't cope well with this, but I am persistent." d. "When my child misbehaves, I distract him and focus his attention on other things. If he throws a tantrum, I have been known to just pick him up and leave from wherever we are."

D

Which of the following statements is the best explanation as to why some countries are more violent than others? a. Civilized societies are less violent than primitive societies. b. Geographical differences are the primary factor. c. Population differences are the main determinant—for example, having more males than females. d. Violence is a learned behavior controlled or allowed by social norms.

A

Which of the following statements, made by a caregiver of an older client, should alert the nurse to assess for evidence of elder abuse? a. "Mom is always into something and can't seem to stay still, so I've been giving her half a Valium to get her to relax so I can get some rest." b. "Mom wanted to stay at her home, but we were scared for her safety, so we moved some of her personal things into our home and brought her to live with us." c. "She has not been having incontinence problems since we have been taking her to the toilet every 2 to 3 hours when she is awake." d. "We have to feed Mom baby food now because she has trouble chewing and swallowing regular food."

C D

Which of the following symptoms suggests smallpox as opposed to the more common and much less dangerous chickenpox? (Select all that apply.) a. Child appears only mildly ill until late stages in smallpox. b. Lesions appear in various stages in the same area of the body rather than all at once. c. Rash lesions are most abundant on the face and extremities, not on the trunk. d. Rash occurs 2 to 4 days after sudden onset of fever rather than with the fever.

A

Which of the following terms describes when a nurse practitioner receives a set monthly payment to take care of a group of clients regardless of the services needed and provided? A. Capitation B. Fee for service C. Rationing D. Retrospective reimbursement

D

Which of the following terms refers to government actions that have a direct or indirect effect on families? a. Family funding b. Family legislation c. Family planning d. Family policy

D

Which of the following theories views the family as a whole with boundaries that are affected by the environment? a. Family developmental theory b. Structural-functional theory c. Family role theory d. Family systems theory

A

Which of the following would have been the focus of a school nurse in the early 20th century? A. Investigating causes of absenteeism B. Teaching school as well as being a nurse C. Promoting nursing as an autonomous practice D. Providing medical treatment to enable children to return to school

D

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 business man who works for a large corporation D. A 24-year-old man who works part-time at a small business

A

Why did American citizens become interested in establishing government-sponsored boards of health? A. They were afraid of infectious diseases such as yellow fever. B. The government could force the poverty-stricken to accept care. C. Such boards could tax and thereby ensure adequate funds to pay for care. D. Such a system would allow for accurate records of births and deaths.

D

Why did the Metropolitan Life Insurance Company establish and retain for several years the first community nursing health program for policyholders? A. Creating such a service was the morally correct thing to do. B. Employing nurses directly was less expensive than paying taxes to the city for the same purpose. C. Having the company's nurses make home visits increased worker morale. D. Having public health nurses visit policyholders and their families led to a decline in policyholder deaths, thus lowering costs for the insurance company.

D

Why were nurses so unprepared for public health nursing in the early 20th century? A. Public health nursing had not yet been created as a field. B. No one would teach the nurses how to engage in public health activities. C. Nightingale's textbook did not include content on public health nursing. D. Nurses were educated in diploma schools, which focused on care of hospitalized clients.

a client is using a primary prevention strategy to prevent infectious disease. which of the following actions is the client most likely taking

a client receives a tetanus booster every 10 years

15. A nurse established an ongoing group meeting of teenagers with diabetes. In the early stages, the nurse was very directive in arranging location, providing low-carbohydrate drinks and snacks, steering the discussion, and trying to meet all the teenagers' needs. After the group had been meeting for about 3 months, the nurse noticed that the group members no longer simply accepted everything the nurse suggested. Instead, the teenagers began making decisions themselves, and eventually, the nurse no longer controlled the group. Which of the following most likely happened to cause this shift?

a. The group became cohesive enough to share leadership tasks.

16. A group of teenagers with diabetes become upset and angry because they cannot agree on whether or not to have meetings during summer vacation. Which of the following should the nurse do to be effective in helping the teenagers resolve the conflict?

a. Admit that it is difficult for everyone to agree on everything; then ask whether the group can try to decide how to agree on the issue.

1. A nurse has been making ongoing visits to a preschool to help the staff teach the children important skills, such as brushing their teeth after meals. Now the nurse is scheduled to teach carbohydrate counting to adults newly diagnosed with diabetes. Which of the following actions will the nurse need to take when teaching this population? (Select all that apply.)

a. Appeal to the need for autonomy and choice. c. Explain how to cope with being a guest at a dinner.

Nursing students have been assigned to set up a health fair for the homeless population in a large urban setting. Without any funds to pay for space, where should the health fair be located, assuming that all of the following sites are available at no cost? a. At the city's homeless shelter, which is, by policy, vacant during the day b. At a large medical center, where the students could get permission to use an empty clinic in the evening c. At the largest inner-city police station, where there was a large empty space available d. At the local community college, where there are plenty of tables and chairs

a. At the city's homeless shelter, which is, by policy, vacant during the day

A nurse is working as a case manager with a vulnerable population. Which of the following actions should the nurse do when providing care? a. Be willing to enter into a long-term relationship with families. b. Direct and control the client's care because the nurse knows what is most needed. c. Encourage families to become self-sufficient and less dependent on nursing personnel for advice and referrals. d. Rotate assignments periodically to prevent attachment and codependency.

a. Be willing to enter into a long-term relationship with families.

A homeless family brought their father to the public health clinic after he reported bleeding when he went to the bathroom. Which of the following nursing actions would be most appropriate? a. Begin tests to determine the cause of the bleeding while asking about other family concerns from nutrition to shelter for the night. b. Refer the man to a urologist to address the urinary bleeding. c. Suggest that the family take him to an urgent care center immediately. d. Treat the urinary infection and give the man medication to take to prevent the return of infection.

a. Begin tests to determine the cause of the bleeding while asking about other family concerns from nutrition to shelter for the night.

A nurse who is providing diabetes screening at a community clinic discovers that a new client has type 2 diabetes mellitus. The nurse provides counseling, refers the client to an endocrinologist for initial assessment and treatment, arranges for the client to see someone regarding financial assistance, contacts the mobile van to arrange transportation, and sets up a follow-up appointment. Which of the following types of service do these actions represent? a. Case management b. Client advocacy c. Holistic care d. Wrap-around services

a. Case management

8. Which of the following statements regarding the Health Belief Model is accurate?

a. Cues to action are an important component of the model.

A community health nurse would like to implement an intervention to increase lasting resilience among new immigrants. Which of the following actions should be taken by the nurse? a. Direct clients to English-as-second-language courses. b. Give immigrant clients money to help them get settled. c. Identify areas in the city where housing is less expensive. d. Solicit donations for food, clothing, and other needs.

a. Direct clients to English-as-second-language courses

4. A patient tells a nurse, "I know all about this already. I read about it on the Internet." The patient then summarizes what he has learned. Because some of this information seems incorrect, what questions would be effective for the nurse to ask? (Select all that apply.)

a. Were you able find what you wanted easily on the website? b. Did the website say when the information was updated? c. Did the website state who was responsible for the information?

Invasiveness

ability of a bacterial pathogen to rapidly spread through tissue

infectivity

ability of a biological agent to enter and grow in the host

Resistance

ability of the host to withstand infection; natural or acquired immunity

Pathogenicity

ability to cause disease

A nurse is told that a screening test has high specificity. This means that the test:

accurately identifies those without the trait

which of the following is the most probable cause of the increase in new emerging infectious diseases

activities or behavior of humans, including changes in the environment

which of the following biological warfare agents poses the greatest bio-terrorism threat to a community

anthrax

Which statement is true about mortality rates? Mortality rates:

are informative only for fatal diseases

A nurse offers homeless clients yearly tuberculosis (TB) screening and free treatment for those who test positive for TB. Which of the following levels of prevention is being used? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Secondary and tertiary prevention

b. Secondary prevention

best describes where the incidence of Vancomycin-resistant staph and MRSA is currently rising

areas where people share dressing or bathing facilities

5. A nurse is using the technique of motivational interviewing when working with a client. Which of the following statements by the client indicates the client is ready to make the change?

b. "I am willing to change."

Which of the following bills would the nurse lobbyist, who believes strongly in social justice, encourage legislators to support? a. A bill that establishes policies requiring all persons to pay the same cost for services regardless of income b. A bill that promotes universal health insurance coverage c. A bill that requires all health care providers to give care to uninsured persons without charge d. A bill that requires health care workers to report undocumented immigrants who present for treatment

b. A bill that promotes universal health insurance coverage

4. A nurse planned a presentation about the latest trends in disaster planning for the senior nursing students at the local college. However, when the nurse began to share the information, the students were talking to one another and essentially ignoring the nurse. Which of the following actions should be taken by the nurse?

b. Explain why the information is crucial to their current clinical practice.

Nurses at a homeless clinic are concerned that homeless clients rarely return to have the nurses assess the findings of their tuberculosis (TB) skin tests. Which of the following is the most appropriate policy for the clinic to have regarding the screening test findings? a. Call all homeless clients 48 hours after TB skin testing to remind them to return to the clinic for test interpretation. b. Have homeless individuals read their TB skin test, if necessary, and mail in results on a postage-paid card coded to protect privacy. c. Re-administer the TB skin test if the client returns later than scheduled for test interpretation. d. Routinely refer all homeless clients for chest x-rays.

b. Have homeless individuals read their TB skin test, if necessary, and mail in results on a postage-paid card coded to protect privacy.

7. The nurse gives a very informative and engaging presentation and then gives everyone in the audience a handout that outlines the presentation. Later, the nurse discovers that many of the handouts were thrown away before the audience left the building. Which of the following educational principles has the nurse forgotten?

b. Many Americans do not have a high reading level.

Which of the following is the primary cause of vulnerability to health problems? a. Breakdown of family structures b. Poverty c. Prejudice d. Social isolation

b. Poverty

best represents an example of infectious disease spreading via a vector

bitten by an infected mosquito

A staff member is orienting a new nurse to a health clinic that serves primarily vulnerable populations. Which of the following statements indicates a need for additional staff education? a. "If a client who does not speak English comes in, you must obtain an interpreter right away." b. "We try to take care of as many problems as possible in one visit, so when you interview the client ask about additional concerns." c. "You will like working with Hispanic immigrants because they have close-knit family structures." d. "You will need to assist the client by scheduling any referral or follow-up appointments around their work schedules."

c. "You will like working with Hispanic immigrants because they have close-knit family structures."

A community health nurse is implementing a tertiary prevention activity related to tuberculosis. Which of the following interventions is the nurse most likely completing? a. Administration of skin tests to identify persons who have been infected with tubercle bacilli b. Assessing for signs and symptoms of active tuberculosis c. Directly observing clients with active tuberculosis as they take their antitubercular medications d. Interpretation of tuberculosis skin test findings

c. Directly observing clients with active tuberculosis as they take their antitubercular medications

1. A member of a community weight-loss group has maintained a healthy weight for 2 years through healthy eating and daily exercise. Which of the following steps of the affective domain is this participant demonstrating?

c. Evaluation

11. A man says, "I just can't get myself to leave the house and go for a 30-minute walk each day. I wish I could think of some way to motivate myself." Which of the following would be the best action for the nurse to take?

c. Join a group that walks early each morning.

14. The leader of an Alzheimer's support group surveys the members of the group to determine the best time for the group to meet. Which of the following norms is being supported through this action?

c. Maintenance norms

2. A nurse just finished teaching breast self-examination to a large group of women at a professional conference. During the session, she distributed literature and used culturally appropriate visual aids. However, the session was not as effective as it could have been. Which of the following was the most important thing omitted by the nurse?

c. Opportunity for the women to practice what they learned

6. A nurse uses lecturing as the primary method of educating clients. Which part of the education process is missing?

c. Participation

This is an inhibitor to developing competence where a perceived threat may arise from misunderstanding of expectations between clients and nurses from either group

cultural conflict

A breast cancer screening program screened 8000 women and discovered 35 women previously diagnosed with breast cancer and 20 women with no history of breast cancer diagnosed as a result of the screening. The prevalence proportion would reflect:

current and past breast cancer events in this population of women.

13. A nurse invited all the teenagers who were newly diagnosed with diabetes to a group meeting to discuss issues they all had in common. One teenager replied, "I don't know if I want to share all the problems I'm having with strangers." Which of the following is the best nurse response?

d. "The purpose of the group is to have a safe place to share problems with others who may be having similar problems."

Which of the following statements best describes an outcome of the Balanced Budget Act of 1997? a. Additional funding was provided to the State Children's Health Insurance Program (SCHIP). b. Individuals were able to keep their health insurance when moving from one place to another. c. Patient privacy and security of health information was enhanced. d. A prospective payment system for home health services was created.

d. A prospective payment system for home health services was created.

Which of the following factors predisposes many migrant farmworkers to disenfranchisement? a. Being a minority group member b. Inability to attend religious services because of work requirements c. Previous experiences of physical abuse d. Short length of time in the community

d. Short length of time in the community

A large financial grant was being offered to whichever health facility wanted to accept the responsibility for giving care to local vulnerable populations. Which of the following actions would most likely be taken by the local medical centers? a. Agree to collaboratively apply for the funds in a cooperative proposal. b. Individually compete eagerly for the additional funds now available. c. Reach out enthusiastically to this previously underserved population group. d. Strongly consider not applying, because this population will be expensive to treat.

d. Strongly consider not applying, because this population will be expensive to treat.

12. A nurse is meeting to discuss problems and solutions with a group of teenagers who have been newly diagnosed with diabetes. One teenager states, "My mom found this particular brand of popcorn that has only 15 carbohydrates in the whole giant bag." Which of the following best describes the group purpose that is being served by the teenager's statement?

d. Task function of sharing information and resources

9. A nurse is planning an educational program about cardiovascular disease. Which of the following would be the optimal time for the nurse to elicit feedback from program participants?

d. Throughout the program

Which of the following terms is used to describe aggregates who are at high risk for having poor health outcomes because of limited resources? a. Disadvantaged families b. Multi-problem families c. Resilient populations d. Vulnerable populations

d. Vulnerable populations

Virulence

degree/extent of pathogenicity

the concern is the interval between

exposure and disease

Descriptive Epidemiology refers to the:

distribution of disease, death, and other health outcomes in the population according to person, place, and time --> who, where, when of disease patterns

there is great concern in the nurse's community over three local cases of west nile virus. which of the following actions should the nurse take to get the community involved in addressing this problem

have an educational campaign to remove any containers of standing water

which of the following components of the epidemiologic triangle contributes most to a female client developing a vaginal infection caused by fungi after successful treatment of her strep throat with antibiotics

environment

which of the following infectious diseases interventions best represents the use of secondary prevention

health care workers are required to have a tb test or chest xray

What is the prime cause for health problems when we view things from broad perspective

health disparities poverty has direct effect on health and well-being across lifespan

which of the following would most likely be collected in a syndromic surveillance system

incidence of school absenteeism

IID-27

increase the percentage of persons aware they have a chronic hepatitis C infection

number 1 cause of death worldwide

infectious diseases

a student comes to the college health clinic with the typical cold symptoms of fever, sneezing, coughing, but the nurse also notes small white spots on the inside of the student's cheeks

inform all students, staff, and faculty of a possible measles epidemic

eradication

irreversible termination of infection transmission

most common vector-borne disease worldwide

malaria

a man loudly protests his increased property tax bill right after the public health department has made a plea for more funds. "why" he asks, "should my tax dollars be used to pay for their children to be immunized?" which of the following would be the best response by the nurse

only by making sure most kids are immunized can we stop epidemics that might hurt all of us

Clinical medicine and epidemiology differ rom each other in the major aspect of:

practice focus.

acquired immunity

previous natural exposure to an infectious agent; active or passive

One of the basic concepts in epidemiology is the concept of risk. Risk refers to the:

probability that an event will occur within a specified time period

at a ton meeting with public health officials to discuss a communicable disease outbreak, a nurse is asked to explain what is meant by the phrase "a virulent organism". the nurse explains that this means the organism causing the disease is able to do which of the following

produce very severe physical reactions

IID-24

reduce chronic hepatitis B virus infections in infants and young children (Perinatal infections)

goal of prevention

reduce prevalence to level of no public threat

Healthy People 2020 Immunization and Infectious Diseases (IID-4)

reduce, eliminate, maintain elimination of cases of vaccine-preventable diseases; reduce invasive pneumococcal infections

the nurse is trying to determine if a disease occurrence needs to be reported to the state health department. which of the following resources should the nurse use to answer this question?

state health dept website

The interaction between an agent, a host, and the environment is called:

the Epidemiologic Triangle

Antigenicity

the ability of the agent to induce antibody production in the host

Toxicity

the degree to which a substance is biologically harmful.

a nurse mantoux test is positive for exposure to TB. which of the following conclusions should be drawn by the nurse

the nurse has been exposed to TB

a student engages in unprotected sex under the influence of alcohol. the student decides to have an HIV test completed the next day. which of the following results will most likely occur

the test results wont be reliable so soon after exposure

which of the following best describes the current goal in relation to communicable diseases

to exterminate specific infectious agents one by one

Explain community based practice nursing

when location of practice is the community, the focus of practice is the individuals or the family and the nurse is practicing in the community setting