Exam 1 Public Health Nursing

A nurse schedules an appointment with a physician who has a practice in the community to learn more about the communitys beliefs regarding childhood immunizations. This is known as: a. Informant interview b. Participant observation c. Secondary analysis d. Windshield survey

ANS: A An informant interview is a method of community data collection that involves directed conversation with selected community members.

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

a.Assessment

Environmental health is important to nurses because chemical, biological, and radiological materials are: a. A major cause of global warming b. Often found in the air, water, and products we use c. Frequently linked to the development of chronic illnesses d. Products that nurses work with on a daily basis

ANS: B Chemical, biological, and radiological pollutants are often found in the air we breathe, the water we drink, and the products we use.

Which intervention is being performed on the individual level? Select all that apply. a. Teaching well-balanced nutrition to a mother with a malnourished child b. Providing a parent age-specific information for immunizations c. Assessing the community for other cases of malnutrition d. Assessing other families on the same street for similar problems

ANS: A, B Teaching well-balanced nutrition and age-specific information about immunizations are the only interventions that focus on individuals. The other examples relate to families and the community.

A major provision of the Social Security Act of 1935 was the establishment of: 1. The Frontier Nursing Service to provide nursing service to rural communities 2. State and local community health services and training of personnel 3. District nursing to provide home health care to sick people 4. Community-based settlement houses

ANS: 2 Title VI of the Social Security Act established state and local community health services and training of personnel.

The basic science applied to understanding the health effects associated with chemical exposures is: a. Toxicology b. Pharmacology c. Chemistry d. Environmental epidemiology

ANS: A Toxicology is the study of the health effects associated with chemical exposures.

In the past, community-oriented nurses have been called: a. District nurses b. Almshouse nurses c. Soldier nurses d.Sisters

ANS: A In the past, community-oriented nurses have been called public health nurses, district nurses, visiting nurses, school nurses, occupational health nurses, and home health nurses.

Epidemiology: a. Is a science that studies the poisonous effects of chemicals b. Explains the association between learning disabilities and exposure to lead-based paint at the cellular level c. Helps nurses understand the strength of the association between exposure and health effects d. Is a method for tracking the prevalence of a disease

ANS: C Epidemiology studies the incidence and prevalence of disease, helping nurses understand the strength of the association between exposure and health effects.

A client eats a nutritious, balanced diet on a daily basis to keep the current state of health. This is described as _____ behavior. a. Illness prevention b. Health promotion c. Health maintenance d. Health protective

ANS: C Health maintenance behavior is directed toward keeping a current state of health.

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

ANS: C Health teaching communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, and practices of individuals, families, systems, and/or communities.

One advantage of health-risk appraisal instruments is that they: a. Are suitable for all age-groups b. Accurately reflect an individuals ability to initiate changes in lifestyle c. Provide support to nurses in counseling individuals about self-care behaviors d. Emphasize environmental factors

ANS: C Health-risk appraisal instruments provide support to nurses in counseling and educating individuals in self-care behaviors.

The Framingham Heart Study was successful in: a. Providing information on the effectiveness of risk-reduction interventions b. Documenting the relationship between social variables and heart disease c. Identifying factors contributing to the development of coronary heart disease d. Demonstrating the effects of mass media in modifying high-risk behavior

ANS: C The Framingham Heart Study identified factors contributing to the development of coronary heart disease and high blood pressure.

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

c.Tertiary prevention

A nurse collects data about seat belt usage by interviewing key informants and observing behaviors in the community. What type of data is being collected? a. Quantitative b. Qualitative c. Focus-groups d. Survey

ANS: B Qualitative data is collected through interviews and observation.

When would a nurse use The Guide to Clinical Preventive Services? a. Conducting group risk appraisal and risk reduction b. Providing recommendations for preventive interventions c. Completing a community wellness inventory d. Improving environmental living conditions and sanitation

ANS: B These include screening tests, counseling, immunizations, and chemoprophylaxis regimens for more than 80 conditions.

An example of an ethical dilemma is: a. Whether or not to set up a community health center in a rural area b. Allocating resources in a natural disaster c. Deciding to withdraw care on a hospice patient d. Applying the principles of Florence Nightingale in Bangladesh

ANS: B When resources are scarce, a dilemma may exist as to how to allocate them.

A social marketing campaign urging community members to avoid driving motorized vehicles after consuming alcohol is implemented in a local community. This intervention is occurring the _____-level of practice. a. Individual/family b. Systems c. Community d. Government

ANS: C Community-level interventions care carried out with the community as a whole.

Neighborhood centers that provided health care and social welfare programs were called: 1. Settlement houses 2. Nursing care centers 3. Nurse-managed clinics 4. Public health services

ANS: 1 Correct by definition. Nursing centers, nurse-managed clinics, and public health services are not necessarily in neighborhoods.

Which of the following trends in health issues in the United States between 1900 and 1955 is accurate? 1. There was a rise in chronic disease such as heart disease and cancer. 2. There was a rise in communicable disease. 3. The crude mortality rate increased dramatically. 4. The life span after diagnosis remained the same.

ANS: 1 Leading causes of death in 1955 were heart disease and cancer, while in 1900 they were pneumonia and tuberculosis. All other answers are false.

A 66-year-old woman is retired and no longer has health insurance through her place of employment. Which of the following programs would be appropriate for her health insurance needs? 1. Medicare 2. Medicaid 3. Social Security 4. Economic Opportunity Act

ANS: 1 The Social Security Act was amended to include health insurance benefits for the elderly, which is addressed through Medicare.

A clinic treating a child for otitis media is an example of: A. Community-based care B. Public health care C. Tertiary health care D. Community-oriented care

Answer: A - In community-based nursing, the nurse focuses on "illness care" of individuals and families across the life span. The aim is to manage acute and chronic health conditions in the community, and the practice is family-centered illness care. Community-based nursing is not a specialty in nursing but, rather, a philosophy that guides care in all nursing specialties.

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

ANS: A Soliciting input from individuals and organizations is a communication competency.

Between 1900 and 1955, the leading causes of mortality were pneumonia, tuberculosis, and diarrhea/enteritis. By mid-century, nurses faced new challenges as the leading causes of death became: 1. Heart disease, cancer, and cerebrovascular disease 2. Influenza 3. Tropical diseases from increased travel abroad 4. Diseases from overcrowded conditions in large cities

ANS: 1 Chronic illness care, long-term illness and disability, and disease prevention became the new challenges for nurses.

Nurses who provided care to people in their homes and provided that care to several people at a time were called: 1. Private duty nurses 2. Visiting nurses 3. Public health nurses 4. Community staff nurses

ANS: 2 Correct by definition

The impact of World War I on public health nursing included which of the following? Select all that apply: 1. Many communicable diseases were eradicated. 2. The depletion of the ranks of public health nurses to the war. 3. The feeling that the greatest patriotic duty was to stay at home. 4. Inadequate funding was the major obstacle to extending nursing services in the community.

ANS: 2, 3, 4 Both World Wars I and II depleted the public health nurse population as nurses went off to war. The feeling of patriotism extended to the idea that patriotic duty could also be served on the home front.

The Elizabeth Poor Law of 1601 is similar to which of the following current laws? 1. Welfare 2. Food Stamps 3. Medicaid 4. Medicare

ANS: 3 The Poor Law guaranteed medical care for poor, blind, and "lame" individuals, similar to Medicaid.

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

c. Assurance

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

d.Policy development

Which of the following programs provided funds for neighborhood health centers, Head Start, and other community action programs? 1. Medicare 2. Medicaid 3. Social Security 4. Economic Opportunity Act

ANS: 4 Funding for neighborhood health centers, Head Start, and other community action programs began in 1964 with the Economic Opportunity Act.

Which example contains the components necessary to form an epidemiologic triangle? a. Pesticides, water, food b. Lead, mercury, soil c. Trichloroethylene, water, infants d. Children under 12, elderly, temperature

ANS: C The epidemiologic triangle consists of an agent (chemical), host (community consisting of several variants), and environment (air, water, soil,

Lillian Wald was the first public health nurse in the United States. Which of the following is her major contribution to public health nursing? 1. Founding the American Nurses Association 2.Establishment of the New York Training Hospital for Nurses 3.Establishment of the Public Health Service 4.Establishment of the Henry Street Settlement that later became the Visiting Nurse Service of New York

ANS:4 Lillian Wald established the Henry Street Settlement.

A nursing student during World War II would likely join which group? 1.The Public Health Service of New York City 2.The Marine Nurse Corps 3.The Frontier Nursing Service 4.The Cadet Nurse Corps

ANS:4 The Bolton Act of 1943 established the Cadet Nurse Corps during World War II, which increased enrollment in schools of nursing at undergraduate and graduate levels.

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

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

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. Primary prevention C. Policy development D. Public transportation

Answer: A - The public health core function of assurance focuses on the responsibility of public health agencies to be sure that activities are appropriately carried out to meet public health goals and plans. This role requires skill in assessment, investigative functions, collaboration, consultation, and cooperation. Assurance also includes assisting communities to implement and evaluate plans and projects.

Ruth Freeman was a leading public health educator, administrator, consultant, author, and leader of the National Health Organization of the twentieth century. Which of the following characterize her philosophy of nursing? 1. Nursing should move from acute care to community-based care. 2. Nurse practitioners should control public health. 3. Nursing is about caring for people, and is also intellectually challenging and offers many professional opportunities. 4. All nurses should seek graduate education to increase their credibility.

ANS: 3 Ruth Freeman felt that nursing was about caring for people and was also intellectually challenging and offered many professional opportunities. She did not specifically espouse the other statements.

An accomplishment for which the Frontier Nursing Service was noted is: 1. Improvement of the care of sick and injured soldiers 2. Establishment of a fee-for-service program for workers at Metropolitan Life Insurance Company 3. Reduction of infant and maternal mortality regardless of environmental conditions 4. Increasing funding for communicable disease treatment

ANS: 3 The Frontier Nursing Service nurses were trained in nursing public health and midwifery and provided care to rural and inaccessible areas, which led to reduced mortality.

Threats to health from communicable diseases, the environment, chronic illness, and the aging process have changed over time. The newer threats to health in the United States that community health nurses are currently faced with include: 1.Diphtheria, cholera, and typhoid fever 2.HIV, AIDS, and bioterrorism 3.Avian flu, tuberculosis, and radiation 4.Polluted water and air

ANS:2 The newer threats to health that public health nurses are involved in are HIV, AIDS, and bioterrorism. Choice #1 lists threats of the past. Avian flu may be a threat, but radiation and tuberculosis are ongoing. Polluted water and air are generally not seen in the United States.

The Frontier Nursing Service was established by Mary Breckinridge to emulate systems of care used in the Highlands of Scotland. Her biggest contribution was: 1.Establishment of the Henry Street Settlement 2.Development of health programs geared toward improving the health care of the rural and often inaccessible populations 3.Blazing a nursing trail through the Rockies, providing nursing care to miners and their families 4.Teaching birth control measures to large numbers of women in the South

ANS:2 Mary Breckenridge developed health programs geared toward improving the health care of the rural and often inaccessible populations in the Appalachian regions of southern Kentucky. Lillian Wald established the Henry Street Settlement.

Early colonial health efforts in the United States included: 1.Establishment of schools of nursing 2.Development of vaccines given to large numbers of people 3.Collection of vital statistics, improved sanitation, and control of communicable diseases introduced through seaports 4.Development of public housing and almshouses

ANS:3 The other choices are events that happened after the colonial period.

Occupational health nursing began as industrial nursing. What was the purpose of this type of nursing? 1.Inventing new machines to streamline production of medical goods 2.Investigating industrial injuries to improve work conditions 3.Working at industrial sites treating work related-injuries 4.Providing care for factory workers and their families

ANS:4 Early occupational health nursing did not provide care for work-related injuries, but instead focused on the care of employees and their families in the home.

Which core function supports the belief that all Americans should receive basic health care services? a. Assessment b. Assurance c. Policy development d. Advocacy

ANS: B Assurance purports that all persons should receive essential personal health services.

Which data source provides information about the function of the community? a. Maps b. Census data c. State departments, business and labor, local library d. Civic groups

ANS: C Function relates to production, distribution, and consumption of goods and services.

A collection of individuals who have in common one or more personal or environmental characteristics is the definition of a(n): a. Community b. Group c. Family d. Aggregate

ANS: D An aggregate is a collection of individuals who have one or more personal or environmental characteristics in common.

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

ANS: C Gaining the learners attention must happen first before learning can take place.

In 1909, Yssabella Waters published her survey Visiting Nurses in the United States. This document highlighted the fact that: 1.Nurses were trained by Boards of Education. 2.Trained nurses adequately covered less densely populated areas. 3.Visiting nurses services were concentrated in the northeastern quadrant of the nation. 4.Nurses were curing diseases such as tuberculosis and typhoid fever that greatly enhanced their credibility.

ANS: 3 This report emphasized the fact that visiting nurse services were concentrated in the northeast, which underscored the need for rural health.

An intervention by the United States federal government to protect the health of its citizens was the establishment of the Marine Hospital Service, presently known as the Public Health Service. Its purpose was to: 1. Set policy on quarantine legislation for immigrants 2. Establish hospital-based programs to care for the sick at home 3. Establish and promote environmental interventions such as adequate housing and sanitation for urban cities 4. Provide health care for merchant seamen to protect seacoast ports and cities from epidemics

ANS: 4 Providing health care to seamen was an early effort by the federal government to improve public health. Its purpose was to secure its maritime trade and seacoast cities.

Which of the following domains would be used to teach a new diabetic how to give an insulin injection? a. Developmental b. Cognitive c. Affective d. Psychomotor

ANS: D The psychomotor domain includes the performance of tasks that require some degree of neuromuscular coordination and emphasizes motor skills.

1. A nurse performing home hospice case management notes the increasing number of hospice clients who 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 larger picture issues such as which of the following?(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

ANS: D, E Case management activities with individual clients and families very often reveal the larger picture of health services and health status of a community. General community weaknesses in the quality and quantity of services often are discovered. The nurse can then intervene at the community level to initiate changes. In this case, the nurse identified a deficiency in the quality of hospice services to individuals who did not have a caregiver in the home environment and the parallel concern of the lack of hospice-related facilities to meet the needs of these clients to achieve a quality dying process.

When a nurse focuses intervention strategies on the structural dimension of community health, they are directed toward: a. Health services b. Primary prevention c. Health promotion d. Secondary prevention

ANS: A Intervention strategies include service use patterns, treatment data from various health agencies, and provider/client ratios.

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

ANS: A Assessment is a core function of public health and refers to systematically collecting data concerning the population, monitoring the population's health status, and making information available on the health of the community. In a community-oriented approach, a nurse would apply both nursing and public health theory. In this case, assessment would be the first step from the perspective of both theories. Because the practice is population focused and community oriented, it would involve the assessment of the community subpopulation of middle school children and the impact of obesity on their overall health status.

5. A case manager employed by a health maintenance organization is charged with discontinuing home health services for a disabled homebound elderly client in an effort to reduce costs. The case manager reviews the client's record and determines that home health services are still indicated for this client. The ethical dilemma faced by the case manager is: a. beneficence. b. justice. c. nonmaleficence. d. veracity.

ANS: A Beneficence—"doing good"—becomes an ethical dilemma when the insurer's goal of containing costs supersedes the case manager's duty to improve health and relieve suffering. This ethical tenet of nursing practice to act in the best interest of the client also involves fidelity to the nurse-client trust relationship. Duty to clients to secure benefits on their behalf and to limit unnecessary expenditures can create dilemmas when the goals are not uniform. Advocacy on this client's behalf with accurate and updated information based on sound assessment, evidence-based practice, and liability risk management could produce a favorable outcome for all parties. The incorrect action would be to do nothing.

2. During a home visit, a case manager for a community health center notes marked pitting edema, shortness of breath, and increased fatigue in a 52-year-old male client who lives alone. The client is admitted to the hospital, where he is diagnosed with congestive heart failure. The case manager works with the hospital's utilization manager to devise a discharge plan. The case manager's most logical next step would be to: a. assess the client; obtain information on the scope of services covered by the benefit plan for the client; if needed services are not covered, seek to identify and arrange for the resources to provide these services. b. call the client, reintroduce himself or herself, and explain his or her role as a case manager for homebound clients. c. discuss with the family their schedule of availability to offer care in the client's home; ensure that the client has daily visits by family members. d. investigate the availability of local support and rehabilitation services for clients with congestive heart failure; contact the client's family.

ANS: A Case management has been described as a set of logical steps and process of interaction within a service network that ensures that a client receives needed services in a supportive, effective, efficient, and cost-effective manner. The National Case Management Task Force defines case management as a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services to meet an individual's needs, using communication and available resources to promote quality cost-effective outcomes. Case management has been defined in the public health nursing literature as the establishment of an appropriate plan of care based on assessment of the client/family and coordination of the necessary resources and services for the client's benefit. Therefore, a critical role of the case manager is to help clients obtain the care they need to achieve a maximum level of health. The nurse needs to understand what the client's insurance covers (broker). If necessary services or equipment is not covered by insurance, the nurse may act as an advocate (facilitator) and connect the client with other resources in the community (coordinator) if available.

7. 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. These statements relate to the sequential process of: a. collaboration. b. communication. c. cooperation. d. negotiation.

ANS: A Collaboration is achieved through a developmental process carried out in a sequence, yet it is reciprocal among those involved. Teamwork and collaboration require extensive skill sets to achieve successful outcomes. No single professional has the expertise required for all aspects. Synergy among all parties involved is required. Although communication is essential to collaboration, it is not sufficient to create or maintain collaboration.

3. A community-oriented nurse is writing a grant application for funding for a nurse-run clinic serving clients with chronic illnesses. The grant application asks for information regarding program benefits, effectiveness, and efficiency. The most effective tool to obtain this information would be: a. cost studies. b. Mobilizing for Action through Planning and Partnerships (MAPP) model. c. Planning Approach to Community Health (PATCH) method. d. Tracer method.

ANS: A Cost studies are essential to show the value of nursing in the marketplace now and in the future. All cost studies involve three major tasks: financial, research, and statistical. The financial tasks include identifying total program costs. The statistical tasks include identifying appropriate, quantifiable measures for analyzing data. The research tasks include setting up an appropriate study design to answer questions about benefit, efficiency, or effectiveness. Types of cost studies include cost-accounting, cost-benefit, cost-effectiveness, and cost-efficiency studies.

4. A nurse providing a tertiary prevention intervention to a population of women who are HIV positive will most likely: a. educate about self-care and the women's rights as employees. b. establish a partnership with a community to initiate a community health center. c. help identify new cases and ensure that clients receive proper treatment. d. teach how to lobby state legislators.

ANS: A Helping clients understand their rights to protect from on-the-job discrimination is part of the nurse-advocate role. Tertiary prevention includes educating women with a chronic disease such as HIV about self-care strategies and health-promotion activities to minimize risky behaviors and poor health outcomes. Enhancing levels of self-esteem and empowerment can prevent feelings of powerlessness and hopelessness, which contribute to vulnerability.

8. Congress passed the Balanced Budget Act of 1997 with provisions intended to ensure the appropriateness of home health services for those who received them; however, the act may have increased health disparities for vulnerable populations such as: a. frail older adults. b. low-income families with newborns. c. poor clients discharged from acute care. d. clients requiring intravenous antibiotics.

ANS: A One objective of the balanced Budget Act of 1997 was to curb the rapid growth of home health spending and financial fraud in the home health industry following a shift of hospital reimbursement methods in 1982 (Tax Equity and Fiscal Responsibility Act) through the adoption of prospective reimbursement for home health services. The act's more stringent regulations regarding which services will be reimbursed and for how long may limit access to care for certain vulnerable groups, such as frail older adults, chronically ill individuals whose care is largely home based, and people who are HIV positive.

6. The nurse engaging in a formative program evaluation would most likely: a. conduct medical record audits for quality assurance. b. make a home visit before a client is discharged from the program. c. participate in a new client evaluation. d. write a policy for risk management.

ANS: A Process evaluation, also referred to as formative evaluation, occurs during program implementation and makes it possible to make midterm corrections to ensure the achievement of program goals. Process evaluation is an ongoing function of examining, documenting, and analyzing the progress of a program. This type of program monitoring can be used to justify continuing the program, because it will address the efficiency and effectiveness of the program in meeting its goals. Quality assurance programs are examples of program evaluation in health care delivery.

3. A community health nurse is serving as a case manager for premature infants receiving home health care. The case manager arranges for an in-home apnea monitor and daily home visits by a registered nurse who specializes in high-risk pediatrics. The case manager is demonstrating which of the following case manager roles? a. Consultant and coordinator b. Mentor and liaison c. Monitor and reporter d. Standardization monitor and negotiator

ANS: A The case manager is responsible for fulfilling a variety of roles. The nurse is acting as a consultant when working with suppliers to arrange for the apnea monitor. The nurse is acting as a coordinator when arranging for needed heath care services such as daily home visits by a specially trained pediatric registered nurse.

7. Local officials have requested a program evaluation of a comprehensive teen sex education program offered in the local schools in preparation for annual budget-planning discussions. The public health nurse (PHN) determines that the teen pregnancy rate has gradually declined over the years that the program has been in place. The nurse has also identified the evaluation plan that was articulated during the program planning phase. The best tool for demonstrating the efficiency of this program is: a. cost-benefit analysis. b. cost-efficiency analysis. c. relevance assessment. d. school records audit.

ANS: A The efficiency of a program can be evaluated through a formative or summative evaluation. The evaluator may be able to determine whether a given program provides better benefits at a lower cost than a similar program, or whether the benefits to the clients justify the costs of the program (efficiency). Public health programs are usually recognized as having a net positive impact, and appropriate sex education can reduce the incidence of teen pregnancy by altering teen sexual behaviors. To perform a cost-benefit study, the evaluator must decide which costs and which benefits are to be included, how the costs and benefits are to be valued, and what constraints are to be considered (e.g., legal, ethical, social, and/or economic). Health programs involving politically sensitive issues such as teen sex education can benefit from the articulation of measures to determine costs, benefits, and constraints in the program planning phase.

6. A community health nurse directly contacts a mammography clinic to arrange an appointment for a migrant worker with limited English language skills. The nurse communicates with the client through an interpreter to ensure that the appointment is scheduled to meet her needs and that the client understands the procedure to be performed. The role played by the nurse in this encounter with a member of a vulnerable population can best be described as: a. advocacy. b. empowerment. c. partnership. d. social justice.

ANS: A The nurse functions as an advocate when referring clients to other agencies and ensuring that the clients' preferences are accommodated.

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

ANS: A Asking the mother about her previous experience with breastfeeding identifies her educational needs. Using the TEACH mnemonic, the first thing the nurse should do is Tune in: listen before starting to teach; the clients needs should direct the content.

Which format would be most appropriate for teaching a group of nursing students who are learning to give injections? a. Demonstration b. Health fair c. Lecture d. Nonnative language session

ANS: A Demonstration also includes return demonstration. Giving injections can best be learned by seeing the behavior being done.

A public health nurse collaborates with a physicians clinic to increase the number of infants and toddlers who receive lead screening. According to the integrative model, what client system and focus of care are being addressed? a. Aggregate level health promotion b. Aggregate level illness prevention c. Family level illness care d. Individual level health promotion

ANS: A Each succeeding level of the client system is more complex. In this situation, the public health nurse is working with an aggregate of infants and toddlers. The focus of care being addressed is health promotion, focusing on positive measures such as education for healthy living and promotion of favorable environmental conditions as well as periodic examinations, including well-child developmental assessment and health education.

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

ANS: A Education is the establishment and arrangement of events to facilitate learning.

Which statement about Florence Nightingale's ideas about ethics is correct? a. Nursing is a call to service, and the moral character of persons entering nursing is important. b. Ethical principles are based on the values of the individual nurse. c. Society will dictate the ethical principles to which nurses must adhere. d. Ethics are very important in times of war, such as in the Crimean War, when she set up public health centers.

ANS: A Florence Nightingale saw nursing as a call to service and viewed the moral character of persons entering nursing as important.

What is the purpose of providing education across the three levels of prevention? Education: a. Enables clients to attain optimal health b. Identifies and treats health problems early to eliminate disability c. Enables populations to break into individuals d. Teaches people about Healthy People 2010

ANS: A Health education enables clients to attain optimal health, prevent health problems, and identify and treat health problems early to minimize disability. Elimination of a disability may not be possible.

A public health nurse collaborates with local community leaders to develop a local campaign educating about the importance of wearing a seat belt. What client system of the integrative model does this describe? a. Community b. Aggregate c. Family d. Individual

ANS: A Interventions to initiate or maintain healthy lifestyles must be multifocal. At the broadest level of care (community), nurses work with community leaders, other community residents, and health professionals to plan programs to promote optimal health for the community and its people.

Examples of the benefits of distributive justice are: a. Basic needs, material and social goods, liberties, rights, and entitlements b. Taxes, military service, location of incinerators or power plants c. Entitlement to equal rights and equal treatment d. The right to private property and personal assets

ANS: A Justice requires that the distribution of benefits and burdens on a society be fair or equal. the third option refers to egalitarianism, and the last option refers to libertarianism. Taxes, military service, and location of incinerators or power plants are not benefits associated with justice.

A nurse applies the ethical principle of non-maleficence when: a. Administering medications using the five rights b. Allowing clients to be active participants in their care c. Providing patient privacy when delivering care d. Referring a client to a physical therapist

ANS: A Non-maleficence requires that one do no harm. It requires that health care professionals act according to the standards of due care, always seeking to produce the least amount of harm possible.

A correctly written objective would be: a. Each member of the Jones family will give an insulin injection to Billy with accurate dosage 100% of the time for 10 consecutive trials. b. Ms. Smith will perform a blood sugar test on herself with an accurate blood sugar reading. c. The community will take their children to receive immunizations within 1 month of the immunization due date. d. Fifty percent of the eligible women seen in the clinic will return for their scheduled mammogram appointment.

ANS: A Objectives are specific, short-term criteria that need to be met as steps toward achieving the long-term goal. They are written as statements of an intended outcome or expected change in behaviors and should be defined in measurable terms.

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

ANS: A One of the ways to assess the reliability and validity of Internet sources is to look at its currency, including the dates when the content was posted and updated.

An example of a point source of air pollution is: a. A smoke stack b. The number of cars and trucks c. How much fossil fuel is consumed in a community d. Ground ozone levels

ANS: A Point sources of pollution are identifiable sources of air pollution, such as a smoke stack.

Why is it important for nurses to understand the premises of environmental health? a. Nurses should be able to assess risks and advocate for policies that support healthy environments. b. Toxicologists often consult nurses about environmental pollutants. c. Pollutant exposures such as lead are reported by nurses to the Environmental Protection Agency. d. Many Americans live in areas that do not meet current national air quality standards.

ANS: A Potential risks to health are concerns for professional nurses. It is the responsibility of the nurse to understand as much as possible about these risks: how to assess them, how to eliminate/reduce them, how to communicate and educate about them, and how to advocate for policies that support healthy environments.

A nurse is completing an exposure history using the mnemonic I PREPARE. What data would a nurse collect when asking questions about the first P? a. Present work b. Potential exposures c. Personal protective equipment use d. Problems with health

ANS: A Present work is the first P.

A nurse demonstrates the leadership behavior of reflecting when: a. Providing feedback on how behavior appears to others b. Introducing new topics to the group c. Verifying information through questions and restatement d. Highlighting important points from the discussion

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

The Guide to Clinical Preventive Services provides: a. The most recent recommendations for preventive interventions b. Assistance in interpreting Healthy People 2020 c. A basis for public health nursing practice d. Health risk appraisal instruments

ANS: A The Guide to Clinical Preventive Services provides recommendations for preventive interventions including screening tests, counseling, immunizations, and chemoprophylaxis.

A nurse believes everyone is entitled to equal rights and equal treatment in society when applying: a. Distributive or social justice b. Egalitarianism c. Libertarian view of justice d. Communitarianism

ANS: B Egalitarianism is defined as the view that everyone is entitled to equal rights and equal treatment in society.

A nurse is working with a group of clients with diabetes and is teaching a class about avoiding the long-term effects of diabetes. The nurse begins the class by reviewing the basic physiology of diabetes, which was taught the week before. This nurse is providing effective education by: a. Stimulating recall of prior learning b. Gaining attention c. Presenting the material d. Providing learning guidance

ANS: A The educator should have the learners recall previous knowledge related to the topic of interest.

Examples of modifiable behaviors include: a. Smoking, poor diet, and alcohol consumption b. Cancer, emphysema, and cardiovascular disease c. Walking, running, and aerobic exercise d. Genetic abnormalities

ANS: A The leading causes of death in 2000 were tobacco use, poor diet, physical inactivity, and alcohol consumption. These are modifiable behaviors.

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

ANS: A The step of eliciting performance includes encouraging the learners to demonstrate what they have learned.

A 5-feet, 6-inch, 25-year-old woman who weighs 120 pounds runs 5 miles a day because it improves her mood and energy level. Which term best describes this example? a. Health promotion b. Illness prevention c. Health maintenance d. Health protection

ANS: A The woman is exercising to improve and promote her health. Health promotion is directed toward achieving a greater level of health.

A nurse providing care using the idea of servicing citizens, not customers is applying the: a. Ethical tenets of policy development b. Basic concepts of the feminist theory c. Underlying premise of virtue ethics d. Components of distributive justice

ANS: A There are three tenets of both policy and ethics. The approach is based on the voice of the community as the foundation on which policy is developed.

According to Leininger and Watson, the moral ideal of nursing is: a. Caring b. Advocacy c. Responsibility d. Accountability

ANS: A This conceptualization occurred as a response to the technological advances in health care science and the desire of nurses to differentiate nursing practice from medical practice.

A public health nurse working with a family living in poverty recognizes that they are more likely to be exposed to environmental hazards because they have (select all that apply): a. Limited funds to pay for health care b. Poor nutrition c. Homes located closer to hazardous waste sites d. Less education

ANS: A, B, C Families living in poverty are more likely to experience environmental justice issues such as disproportionate environmental exposures. Sub-standard housing, living closer to hazardous waste sites, working in more hazardous jobs, poorer nutrition, and less access to quality health care all contribute to this issue. Although limited education is related to poverty, it is not discussed as causing an increase in environmental exposure.

When conducting an effective educational program, a nurse would use which basic principle? Select all that apply. a. Use a clear, succinct style. b. Use an active voice. c. Refer to Internet sources. d. Use aids to highlight key points.

ANS: A, B, D Reliable sources must be used, and information found on the Internet is not always reliable.

The ethical tenets that underlie the core function of assessment are (select all that apply): a. Competency: the persons assigned to develop community knowledge are prepared to collect data on groups and populations b. Moral character: the persons selected to develop, assess, and disseminate community knowledge possess integrity c. Service to others over self: a necessary condition of what is good or right policy d. Do no harm: disseminating appropriate information about groups and populations is morally necessary and sufficient

ANS: A, B, D Service to others over self is an ethical tenet of policy development. Competency, moral character, and do no harm are the ethical tenets of assessment.

An orderly process that considers ethical principles, client values, and professional obligations is: a. Accountability b. Ethical decision making c. Moral principles d. Code for Nursing Practice

ANS: B Ethical decision making is defined as an orderly process that considers ethical principles, client values, and professional obligations.

10. Which of the following are the major sources of information for program evaluation? (Select all that apply.) a. Community indices b. Media reports c. Program clients d. Program providers e. Program records

ANS: A, C, E Both quantitative and qualitative methods may be used to conduct an evaluation. However, the strongest evaluation designs combine both qualitative and quantitative methods. Major sources of information for program evaluation are the program clients (especially user satisfaction information), program records (especially clinical records), and community indices (epidemiologic data).

7. Health education is often used as a strategy in working with vulnerable populations. The benefits of health education can be greatly affected by the individual's or group's: a. cycle of dependency. b. health literacy. c. level of income. d. race and ethnicity.

ANS: B A new concern for public and community health nurses is whether the populations with whom they work have adequate health literacy to benefit from health education. Health literacy is a measure of the client's ability to read, comprehend, and act on medical instructions. It may be necessary to collaborate with an educator, an interpreter, or an expert in health communications to design messages that vulnerable individuals and groups can understand and use.

1. The population group that is likely to be the MOST vulnerable is: a. children with a family history of sickle cell disease and hypertension. b. homeless pregnant teens in a substance abuse program. c. nNative Americans at risk for diabetes. d. overweight children.

ANS: B A vulnerable population group is a subgroup of the population that is more likely to develop health problems as a result of exposure to risk and to have worse outcomes from these health problems than the rest of the population. That is, the interaction among many variables creates a more powerful combination of factors that predispose the person to illness. Vulnerable populations often experience multiple cumulative risks, and they are particularly sensitive to the effects of those risks. Examples of vulnerable populations of concern to nurses are persons who are poor and homeless, people with special needs, pregnant teens, migrant workers and immigrants, individuals with mental health problems, people who abuse addictive substances, persons who have been incarcerated, persons with communicable diseases and those who are risk, and persons who are human immunodeficiency virus (HIV) positive or have hepatitis B virus or sexually transmitted diseases (STDs).

8. The community planning board is attempting to determine if the clients and health care providers affected by a recent mental health outreach initiative are satisfied that the program interventions have accomplished the program objectives and that clients have benefited from this program. The analysis model that is best designed to provide an estimate of costs to achieve an outcome is: a. cost-benefit analysis. b. cost-effectiveness analysis. c. cost-efficiency analysis. d. Multi-Attribute Utility Technique.

ANS: B An evaluation of program effectiveness may help determine whether both providers and clients are satisfied with program activities, as well as whether the program met its stated objectives. A cost-effectiveness analysis is a subset of a cost-benefit analysis and is designed to provide an estimate of the costs to achieve a given outcome. Such an analysis can answer several questions: Did the program meet its objectives? Were the clients and providers satisfied with the effects of the interventions? Are things better as a result of the interventions? In cost-benefit analysis, both the cost and outcomes are quantitative. In cost-effectiveness analysis, the outcomes are both qualitative (satisfaction) and quantitative (cost).

9. The insurer's risk manager has informed an independently contracted case manager that a liability risk related to experimental treatment and technology was identified in a recent recommendation made by the case manager. Which of the following is the best example of action by a case manager that might be associated with potential liability risk related to experimental treatment and technology? a. Inappropriately recommending that treatment be curtailed when treatment was actually needed b. Failing to apply the contractual definition of "experimental" treatment found in the client's insurance policy c. Substituting the case manager's clinical judgment for that of the insurer's medical director d. Upcoding intensity of care or intervention requirements

ANS: B For case managers, liability concerns exist when three conditions are met: (1) the provider had a duty to treat (i.e., provide reasonable care); (2) a breach of contract occurred through an act of omission; and (3) the act of omission caused injury or damage to the client. Five general areas of risk are liability for managing care, negligent referrals, use of experimental treatment or technology, breach of confidentiality/security, and fraud and abuse. With regard to the use of experimental treatment and technology, the case manager is obligated to apply the contractual definition of "experimental" treatment found in the client's insurance policy (certificate of coverage), because this a legally binding document between the insurer and the insured.

9. An unemployed individual with acquired immune deficiency syndrome (AIDS) develops recurrent opportunistic infections that require repeated visits to the health clinic and the purchase of various medications to combat the infections and treat their associated side effects. This best demonstrates how the stress caused by poor health status can be related to: a. barriers to access. b. cascade effects. c. cumulative risk. d. socially based inequity.

ANS: B Poor health status creates stress. Vulnerable populations cope with multiple stressors, and this creates a cascade effect, with chronic stress likely to result. Chronic stress can lead to feelings of hopelessness. Hopelessness results from an overwhelming sense of powerlessness and social isolation that contributes to a continuing cycle of vulnerability. Each factor, such as lack of employment, lack of insurance or underinsurance, the disease process, transportation challenges, limited resources, and complications of treatment can predispose individuals to poor health status. The outcomes of vulnerability reinforce the predisposing factors, which leads to more negative outcomes. This cycle of vulnerability must be broken in order for vulnerable populations to change their health status.

4. When planning a new community health center, a nurse will integrate knowledge of the nursing process and program management. The nurse's initial and most critical step for funding purposes would be: a. finding the lay leaders in the community. b. identifying the target population's health problems and needs. c. outlining the major causes of mortality in the community. d. prioritizing the community's problems.

ANS: B The program management process is parallel to the nursing process and consists of a rational decision making system designed to help nurses know when to make a decision to develop a program (assessment and problem identification); where they want to be at the end of the program (goal setting); how to decide what to do to ensure a successful program (planning); how to develop a plan to go from where they are to where they want to be (implementation); how to know that they are getting there (formative evaluation); and what to measure to know that the program has successful outcomes (summative evaluation). Planning for effective and efficient programs must be based on determination of the needs of populations within the community. Identification of at-risk groups and documentation of the health needs of the targeted population provide the basic justification and rationale for the proposed program plan. Such documentation of needs is essential if funding will be sought to implement the plan. An assessment of health needs may be approached as either a community assessment or a population needs assessment.

2. A community health nurse is conducting a community assessment as part of a program planning initiative and is seeking a tool that is low cost, allows clients to participate in identification of need, and would stimulate community support for the program. The nurse would most likely use which of the following? a. Community forum b. Focus group c. Indicators approach d. Survey

ANS: B There are several types of needs assessment tools, including community forums, focus groups, key informants, indicators approach, survey of existing agencies, and general surveys. Both community forums and focus groups are low-cost tools. The focus group provides clients with the opportunity to participate in identification of needs and can help increase community support for a program. The focus group method has several disadvantages, such as being time consuming to carry out and tending to focus on irrelevant or political "hot button" issues. Leading focus groups requires strong skills in group process to maintain the focus of the group.

When using Anderson and McFarlanes model to complete a community health assessment, a nurse would collect information about the _____ the community. a. Resources available to promote health in b. Interactions among subsystems in c. Physical environment of d. Demographics of

ANS: B A community health assessment must include information about the subsystems and interactions of the total community with the systems external to it.

The community leaders in a lesser-developed country decide not to tell the citizens of a small village about a chemical spill at a major industrial facility that could produce harmful effects. Which principle are they violating? a. Policy b. Advocacy c. Caring d. Virtue

ANS: B Advocacy requires that the community be properly informed, and this was violated in the above scenario.

A public health nurse is working with a migrant farm worker who has experienced an exposure to a pesticide. When researching pesticides, the nurse looks at the family of the chemical. What similarities are found among chemicals that have been placed in the same family? a. Route of entry into the body b. Actions and associated risks c. Effects that they have on the body d. Potency and toxicity

ANS: B Chemicals are grouped so its possible to understand the actions and risks associated with each group.

A nurse in the 1960s would have referred to which code of ethics to guide ethical decision making? a. Nightingale Pledge b. Code for Professional Nurses c. Code of Ethics for Nurses with Interpretive Statements d. International Council of Nurses (ICN) Code of Ethics for Nurses

ANS: B Florence Nightingale lived in the 1800s. The Code for Professional Nurses was adopted in 1950, the Code of Ethics for Nurses with Interpretive Statements was adopted in 2001, and the International Council of Nurses (ICN) Code of Ethics for Nurses was adopted in 2000.

Which of the following is an example of a goal? a. Mr. Williams will look at his stoma without disgust each time his ostomy bag comes off. b. Mr. Williams will be able to independently take care of his ostomy bag within three months. c. Mr. Williams will gather all ostomy supplies correctly each time his ostomy bag needs to be changed. d. Mr. Williams will successfully describe to the nurse how to care for his ostomy when he is asked.

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

Nurses who use Healthy People 2020 as a guide for education: a. Focus on avoiding cigarette smoking and using alcohol in moderation b. Educate clients using primary and secondary levels of prevention c. Use Blooms taxonomy when planning educational objectives d. Design health fairs aimed at individuals

ANS: B Healthy People 2020 focuses on primary and secondary prevention. Understanding the three learning domains is crucial in providing effective health care.

Which behavior would the nurse anticipate when working with an individual with low literacy? a. Asking for additional clarification of materials b. Requesting to read the information later c. Having a high level of motivation d. Being overly dependent on others

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

After evaluating learning needs, what is the next step the nurse should take in developing an educational program? a. Consider any potential barriers to learning. b. Establish goals and objectives for the program. c. Select appropriate materials for the program. d. Assess the dynamics of the group.

ANS: B Instructional objectives need to be evaluated before a teaching program is designed.

How can a community health nurse apply the Ethical Principles for Effective Advocacy? Select all that apply. a. Act in the health care providers best interest. b. Keep the client (group, community) properly informed. c. Maintain client confidentiality. d. Carry out instructions with diligence and competence.

ANS: B Keep the client (group, community) properly informed, maintain client confidentiality, and carry out instructions with diligence and competence are ethical principles for effective advocacy

According to Leavell and Clark, primary prevention consists of: a. Health promotion and rehabilitation b. Health promotion and specific protection c. Early diagnosis and prompt treatment d. Health maintenance and early diagnosis

ANS: B Leavell and Clark stated that primary prevention includes health promotion and specific protection from disease.

Which ethical principle requires doing no harm? a. Respect for autonomy b. Non-maleficence c. Beneficence d. Distributive justice

ANS: B Non-maleficence refers to doing no harm.

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

ANS: B Patriarchal or paternal style is authoritative, winning respect and dependence through parent-like devotion.

Which is considered a nonpoint source of pollution? a. Hazardous waste site b. Animal waste from wildlife c. Chlorine poured down a well d. Stagnant water

ANS: B Point source means a single place from which the pollutant is released into the environment, whereas nonpoint source implies a more diffuse source of pollution.

Which statement fits the Liberal Democratic Theory of John Rawls? a. Rejection of any idea that societies, states, or collectives of any form can be the bearers of rights or can owe duties. b. Inequalities result from birth, natural endowment, and historic circumstances. c. Everyone has a right to private property. d. Government should be limited.

ANS: B Rawls acknowledges that inequities are inevitable in society, but he tries to justify them by establishing a system in which everyone benefits, especially the least advantaged. This is an attempt to address the inequalities that result from birth, natural endowments, and historic circumstances. The other choices relate to libertarianism.

Evaluation of individual and group progress toward health goals is important. Which component should be included in the evaluative process? a. Type of teaching strategy used b. Recognition of accomplishments in the group c. Conflict that occurred in the group d. The type of leadership in the group

ANS: B Recognition of accomplishments in the group and of the group is built into the evaluative process.

Screening school-age children for hearing deficits is an example of: a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion

ANS: B Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability.

If a nurse wanted more information on indoor air quality, which website would be most helpful? a. The National Institutes of Health (NIH) b. The American Lung Association c. Right to Know d. The Occupational Safety and Health Administration (OSHA)

ANS: B Sources of information about air quality include the Environmental Protection Agency (EPA) and the American Lung Association.

A health educator trying to change a clients attitudes about smoking would be using which of the following domains? a. Cognitive b. Affective c. Psychomotor d. Developmental

ANS: B The affective domain is used to attempt to influence what individuals, families, communities, and populations feel, think, and value.

The biomedical model defines health as the: a. Avoidance of illness b. Absence of disease c. Promotion of healthy behaviors d. Protection from illness and disease states

ANS: B The biomedical model defines health as the absence of disease. It does not explain why populations remain healthy or how health is enhanced.

A nurse provides counseling to an obese client about the importance of good nutrition and regular exercise with the intention of helping the client avoid future chronic diseases associated with obesity. What client system and focus of care are being applied in this situation? a. Family level health promotion b. Individual level illness prevention c. Aggregate level illness prevention d. Individual level health promotion

ANS: B The simplest level of the client system is the individual. The focus of care is illness prevention, directed at disease or disability prevention.

When would it be appropriate for a nurse to use a Geographic Information System (GIS)? a. Recording client data collected at a foot clinic b. Determining neighborhoods that have an increased incidence of lead poisoning c. Evaluating effectiveness of a farm safety program d. Scheduling health promotion programs in the community

ANS: B The use of a Geographic Information System (GIS) allows the public health nurse to apply the principles of epidemiology into practice. GIS allows nurses to code data so that it is related spatially to a place on earth and is helpful in determining concentrated areas for incidence of disease and illness.

A 5-feet, 6-inch, 25-year-old female who weighs 120 pounds walks 5 miles a day because she has a long family history of early death from heart attacks and is refraining from a sedentary lifestyle. Which term best describes this example? a. Health promotion b. Illness prevention c. Health maintenance d. Health protection

ANS: B The woman is exercising to prevent an illness that runs in her family. Illness prevention is a behavior directed toward reducing the threat of illness.

Why would a nurse refer to the Code of Ethics for Nurses or the Public Health Code of Ethics? a. To provide answers for ethical dilemmas b. To guide professional practice related to ethics c. To increase moral leadership in ethics d. To find a framework for ethical decision making

ANS: B These codes provide general ethical principles and guide personnel in thinking about the underlying ethics of the profession.

Which data would be useful for a nurse to collect when assessing safety in a community? Select all that apply. a. Number of billboards in the area b. Interviews with health care providers who are familiar with the community c. Observation of community members d. Nurses own observations

ANS: B, C, D Other nurses, social workers, and health care providers, community members, and the nurses own observations are reliable sources of information about the safety of an area

Which approach(s) can a nurse use when assessing environmental health risks? Select all that apply. a. Ask legislators to provide a list of environmental pollutants in the area. b. Develop a list of exposures associated with urban, rural, or suburban settings. c. Assess the risk by medium such as air, water, soil, or food. d. Divide the environment into functional locations: home, school, workplace, and community.

ANS: B, C, D The 2nd, 3rd, and 4th options are ways a nurse can assess the environment.

1. Vulnerable population groups are those that, in comparison with the population as a whole, have which of the following characteristics? (Select all that apply.) a. Better access to health care services but poor health outcomes b. Greater likelihood of exposure to risk factors c. Multiple risk factors but equal health outcomes d. Worse health outcomes

ANS: B, D Vulnerable populations are defined as those at greater risk for poor health status and health care access. In health care, risk is an epidemiologic term indicating that some people have a higher probability of illness than others. The natural history of disease model explains how certain aspects of physiology and the environment make it more likely that a certain individual will develop a particular health problem. However, not everyone who is at risk develops health problems. Some individuals are more likely to develop the health problems for which they are at risk. A vulnerable population group is a subgroup of the population that is more likely to develop health problems as a result of exposure to risk or to have worse outcomes from these health problems than the rest of the population.

6. 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.

ANS: C Care management is a continuing process in which a case manager establishes systems and monitors the health status, resources, and outcomes for an aggregate—a targeted segment of the population or group.

1. Advantages of community health program planning include ensuring that available resources are used to meet the needs of the population and: a. applying for grants. b. identifying clients and soliciting board members' support. c. identifying resources, activities, and needs. d. increasing the visibility of the program.

ANS: C Community health program planning is population focused and puts the well-being of the public above private interests. Systematic planning for meeting the needs of populations in a community has benefits for clients, nurses, employing agencies, and the community. It ensures that available resources are used to address the actual needs of people in the community, focuses attention on what the organization and health provider are attempting to do for clients, identifies resources and activities that are needed to meet the objectives of client services, reduces role ambiguity by giving responsibility to specific providers to meet program objectives, reduces uncertainty within the program environment, increases the ability of the provider and agency to cope with the external environment and anticipate events, allows for quality decision making, and provides better control over the actual program results. Identifying clients, soliciting board support, applying for grants, and promoting the actual program are steps in the implementation phase of program management.

9. The nurse program manager is determining the direct client care costs as well as the cost of indirect nursing activities for home visits for a home health agency. Analysis of this information along with nursing workload information and client needs can best provide an agency evaluation measure for: a. program decision making. b. cost-effectiveness. c. cost-efficiency. d. perceived value.

ANS: C Cost-efficiency analysis determines the actual cost of performing a number of program services, both direct and indirect, by addressing the productivity of the workforce in achieving specific objectives. The relationship between direct and indirect activities, workforce, caseloads, client needs, and actual costs determines the productivity of the program.

5. After performing an assessment of a client seeking treatment for hypertension at the local free clinic, the nurse informs the client that the family's children may qualify for enrollment in the state children's health insurance program. The nurse provides the enrollment forms and reviews them with the client, emphasizing how to apply for the benefits. This best exemplifies which principle for intervening with vulnerable populations? a. Carrying out primary prevention b. Setting family-centered, culturally sensitive goals c. Trying to minimize the "hassle factor" d. Using the MAP-IT approach

ANS: C Nurses empower clients by helping them acquire the skills needed to engage in healthy living and to be effective health care consumers. Vulnerable individuals and families may need to go to multiple agencies to find the services for which they qualify, because agencies tend to be specialized instead of comprehensive in their service approach. More agencies are needed that provide comprehensive services with nonrestrictive eligibility requirements. Outreach and case finding are important roles for the nurse in reducing health disparities. One of the principles of intervening with vulnerable populations is to try and minimize the "hassle factor."

3. Vulnerability is multidimensional, and one of the primary contributors to vulnerability is: a. gender. b. race and ethnicity. c. resource limitations. d. urban or rural residency.

ANS: C Resource limitations are strongly related to health. Lack of adequate social, educational, and economic resources make people more vulnerable and more likely to experience health disparities, and poverty is a primary cause of vulnerability. A correlation has been found between individual indicators of socioeconomic status (e.g., income, education, and occupational status) and a range of health indicators (e.g., morbidity and mortality resulting from various health problems). Not only do individual-level socioeconomic characteristics seem to matter, but population-level characteristics such as income inequality also make a difference. Resource limitations affect the individual's ability to show resilience in the face of problems and crises. Resource limitations may also place individuals and families at risk because of substandard housing, impoverished neighborhoods, and hazardous environments. Although race has been correlated with poor health outcomes, poverty seems to be a key contributing factor for minority populations. Poverty is more likely to affect women and children than other groups.

2. In an effort to decrease health disparities and improve life expectancy, the Social Security Act was amended in 1998 to provide federal funding to: a. assure access to health care for elderly Americans. b. build hospitals to care for the medically indigent. c. insure children without health insurance. d. provide supplementary income for citizens with disabilities.

ANS: C Title XXI of the Social Security Act, passed in 1998, established the State Children's Health Insurance Program to provide funds to insure currently uninsured children. Legislation enacted subsequently provided for new outreach and case-finding efforts to enroll eligible children in Medicaid.

5. A nurse who is the program director for a new antismoking campaign is developing a written program plan that will include the program's goals, priorities, objectives, budget, and timelines. Before implementation of the program, the written program plan should also address which of the following? a. Cost-benefit analysis b. Perspectives on the program c. Plan for the evaluation process d. Process evaluation

ANS: C When the planning process begins, the plan for evaluating the program should also begin. Everyone who will be involved in implementing a program should be given the opportunity to play a role in planning for program evaluation. Assessment of need is one component of evaluation. Once needs have been established and the program is designed, the nurse must continue plans for program evaluation, such as ongoing process evaluation (formative evaluation) and summative evaluation.

When using the principles of virtue ethics in decision making, a nurse would: a. Provide efficient and effective nursing care. b. Identify the meaningful facts in the situation. c. Seek ethical community support to enhance character development. d. Plan ways to restructure the social practices that oppress women.

ANS: C According to Aristotle, virtues are acquired and include interest in the concept of the good, including benevolence, compassion, trustworthiness, and integrity. One part of the process is seeking ethical community support to enhance character development.

A nurse fulfills the environmental health competency of assessment and referral when: a. Advocating for public policy changes b. Understanding policy framework and major pieces of legislation c. Completing an environmental health history d. Describing the scientific principles about environmental health

ANS: C Assessment is always an important element of the nursing process. The third option is an example of the assessment phase of the nursing process.

Public health administrators in a community provide a health department to serve an indigent population of immigrants providing translators on certain days of the week. This is an example of: a. Policy b. Quality c. Assurance d. Libertarian philosophy

ANS: C Assurance refers to the role of public health in making sure that essential community-oriented health services are available, which may include providing essential personal health services for those who would otherwise not receive them.

What action can a nurse take on an individual level to reduce pollution in the environment? a. Provide a tax incentive to factories that do not pollute. b. Make laws related to allowed levels of pollution in the area. c. Choose a less-polluting car. d. Move to an area with less pollution.

ANS: C Citizens can reduce air pollution by doing their part, which can include choosing less-polluting cars.

Which group would be likely to demonstrate the most cohesion? a. A group with several leaders b. A group with diverse attitudes and values c. A group with a common goal d. A group with efficient members

ANS: C Cohesion is the attraction between individual members and between each member and the group. Group effectiveness improves as members work together toward group goals while still satisfying the needs of individual members.

Which intervention can be implemented by a nurse when working with a group focused on improving the health of the community? a. Make decisions for the group to move the process along. b. Invite wealthy individuals to participate in the group process. c. Maintain members through recognition and encouragement. d. Teach topics that are of national importance.

ANS: C Maintaining members is an important intervention to facilitate group process.

Which nursing action demonstrates advocacy? a. Offering a smoking cessation program b. Screening for hypertension c. Lobbying for health care reform d. Conducting home visits

ANS: C Nurses should participate in implementing new directions for health care and help envision these new directions. Nurses can be an important voice in advocating for access to consistent, effective, efficient health care for all.

When using the integrative model for community health promotion, the nurse would apply the dimension of client system by: a. Concentrating on individual health behaviors b. Studying client-centered initiatives c. Providing multidimensional nursing care among various levels of clients d. Focusing on health promotion, illness prevention, and illness care

ANS: C Nursing care is targeted toward several levels of clients in the client system.

There are two medically indigent clients in the clinic who have come to get their monthly supply of free insulin. There is only enough for one client. Which action does the nurse take first? a. Identify all options. b. Make a decision. c. Gather additional information. d. Act and assess decisions made.

ANS: C One must have all information before looking at options and making a decision.

A nurse is addressing the problem of air pollution in the community. The first step in the process of controlling the pollution would be: a. Setting standards b. Monitoring c. Permitting d. Compliance

ANS: C Permitting is a process by which the government places limits on the amount of pollution emitted into the air or water.

When a nurse is evaluating the components of an educational program, the nurse is completing a(n): a. Education evaluation b. Educational product c. Process evaluation d. Ongoing evaluation

ANS: C Process evaluation means looking at the components of an educational program.

Which environmental law sets basic structure for regulating pollutants to United States waters? a. Safe Drinking Water Act b. Toxic Substance Control Act c. Clean Water Act d. Pollution Prevention Act

ANS: C The Clean Water Act sets basic structure for regulating pollutants to United States waters.

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

ANS: C The cognitive domain includes memory, recognition, understanding, reasoning, and problem solving.

When implementing a community health education program, which educational principle will the nurse use as a guide? a. Refer to trustworthy sources b. Use an active voice c. Create the best learning environment d. Accentuate the positive

ANS: C The environment must be conducive to learning for educational programs to be effective.

Which question would a nurse ask during the first phase of a risk assessment? a. Has the chemical been released into the environment? b. How much and by which route of entry can the chemical enter the body? c. Is the chemical known to be associated with a negative health effect? d. What is the prediction for potential harm?

ANS: C The first phase is determining if a chemical is known to be associated with negative health effects (in animals or humans).

A group member who has taken on the role of the gatekeeper will: a. Seek and accept the authority or direction of others. b. Guide and direct the group activity. c. Control outsiders access to the group. d. Focus the movement toward the main work of the group.

ANS: C The gatekeeper controls outsiders access to the group.

According to Laffrey, Loveland-Cherry, and Winkler, the health perspective views: a. Health as the absence of disease b. Human lifestyle based on ones prescribed regime c. Humans as complex and interconnected with the environment d. Community education as the role of the registered nurse

ANS: C The health paradigm includes the view that humans are complex and interconnected with the environment.

The steps of the ethical decision making process are similar to the steps of: a. Healthy People 2010 b. Deontology c. The nursing process d. Advocacy

ANS: C The nursing process involves the same basic steps: assessment, diagnosis, planning, implementation, and evaluation.

A woman has attended a weight reduction program for a year and lost 75 pounds. She now attends weekly meetings to keep the weight off. Which term best describes this example? a. Health promotion b. Illness prevention c. Health maintenance d. Health protection

ANS: C The womans weight is being maintained through attending the weight reduction program. Health maintenance focuses on keeping a current state of health.

Employees working with hazardous chemicals have the right to know about the chemicals they are working with through the creation of the: a. Material Safety Data Sheet b. Consumer Confidence Report c. Hazard Communication Standard d. Environmental Protection Agency

ANS: C This standard requires employers to maintain a list of all hazardous chemicals that are used on site.

The greatest single source of air pollution in the United States is from: a. Waste incineration b. Power plants c. Motor vehicles d. Molds

ANS: C Waste incineration and power plants are major contributors after motor vehicles. Molds contribute to poor indoor air quality.

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

ANS: D Before psychomotor learning occurs, the learner must have the necessary ability, a sensory image of how to carry out the skill, and an opportunity to practice the skill.

1. A home health case manager is charged with identifying opportunities for health promotion and illness prevention. The fulfillment of this charge would best be demonstrated when the case manager: a. collaborates with a local chaplain to ensure that the spiritual needs of cancer clients are addressed. b. refers a new diabetic client to a nutrition counselor for dietary teaching. c. teaches a school nurse how to care for a client who will be returning to school and will require new asthma treatments. d. tracks the immunization status of clients and facilitates access to immunization when needed.

ANS: D Case management involves assessment—in this case, screening—and arrangement for delivery of services. Primary prevention includes case management to identify at-risk clients and arrange for services to prevent disease. Through nurse management activities, general community deficiencies in the quality or quantity of health services are often discovered. Case management activities with individual clients and families will reveal the broader picture of health services in and health status of the community. Community assessment, policy development, and assurance activities that frame the core functions of public health actions are often the logical next step in the nurse case manager's practice to intervene at the community level to make changes. Therefore, the core components of case management and the nursing process are complementary. The nursing process function of assessment is complementary to the case management process function of case finding and includes such activities as applying screening tools according to program goals and objectives.

8. Members of an extended family are in conflict over the treatment plan for the family's 90-year-old matriarch, who has developed indications of advanced dementia. The case manager is using conflict resolution strategies to allow the parties involved to develop trust, credibility, and distance from the issue at hand, as well as to retain personal dignity. The nurse is demonstrating a knowledge of the strategic process of: a. advocating. b. clarifying. c. cooperating. d. negotiating.

ANS: D Techniques for conflict management involve a range of active communication skills. These skills are directed toward learning all parties' needs and desires, detecting their areas of agreement and disagreement, determining their abilities to collaborate, and assisting in discovering alternatives and activities for reaching the goal of mutual benefit with limited loss. Negotiating is a strategic process used to move conflicting parties toward an outcome and has several stages that allow the parties to develop trust, credibility, and distance from the issue, while retaining personal dignity. All of these factors are important when attempting to move parties toward the creation of new solutions or options through relearning, brainstorming, reflective thinking, and problem-purpose-expansion techniques (systematic problem solving approaches).

4. A community health nurse is the case manager for a homebound client recovering from a hip replacement. The nurse works with the client and his family to prioritize needs and services, and to address these care needs. These activities represent which step in the nursing process? a. Assessment and planning/outcome b. Diagnosis and planning c. Implementation d. Planning/outcome

ANS: D The case management process function of problem prioritizing and planning to address care needs is complementary to the planning/outcome step of the nursing process.

An acceptable level of emissions or a maximum contaminant level allowed is an example of which environmental protection strategy? a. Controlling pollution b. Waste minimization c. Land use planning d. Environmental standard

ANS: D An example of an environmental standard is an acceptable level of emissions or a maximum contaminant level allowed.

A nurse prepares for a presentation to a group of adults using strategies appropriate for adult learning. This concept is called: a. Authoritarianism b. Learning style c. Pedagogy d. Andragogy

ANS: D Andragogy is a term and model developed by Malcolm Knowles to describe learning strategies for adult learners.

The educational process of selecting appropriate educational methods is similar to which of the following steps of the nursing process? a. Assessment b. Evaluation c. Implementation d. Planning

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

When nurses apply the knowledge and processes of ethics to the examination of ethical problems in health care, they are using: a. Values b. Morality c. Ethics d. Bioethics

ANS: D Bioethics applies the knowledge and processes of ethics to the examination of ethical problems in health care.

The growing multiculturalism of American society can contribute to ethnicity conflicts when: a. Cultural standards are congruent with professional standards. b. Cultural traditions within an ethnic group align with those of the community. c. Ethnic groups overburden the health care system. d. The greater communitys values are jeopardized by specific ethnic values.

ANS: D Callahan offered perspectives on judging diversity and suggests a thoughtful tolerance and some degree of moral persuasion (not coercion) for ethnic groups to alter values so that they are more in keeping with what is normative in American culture.

A nurse utilizing a disease-oriented approach would: a. Promote a greater level of positive health. b. Teach about common disease processes. c. Provide acute care management of chronic disease. d. Direct care toward disease prevention.

ANS: D Disease prevention, risk appraisal, and disease management are all elements of the disease-oriented approach.

Which statement best describes health risk appraisals? a. Data about health practices are collected from families. b. Primary prevention strategies are implemented by using the collected data. c. Identified risks can be easily modified. d. Individual health practices are compared with data from epidemiologic studies.

ANS: D During a health risk appraisal, individuals supply information about their health practices, demographic characteristics, and personal and family medical history for comparison with data from epidemiologic studies. These comparisons are used to predict individuals risk of morbidity and mortality and to suggest areas in which disease risks may be reduced. Health risks appraisals use secondary prevention by screening to prevent or detect disease in its earliest stages.

A potential barrier that a nurse may experience when in the educator role is: a. Working with clients with a low literacy level b. Memorizing the information that is to be taught c. Having a limited vocabulary d. Lacking knowledge about how to gain participation

ANS: D Educators may lack knowledge about how to gain participation. Participation can be fostered by asking open-ended questions, inviting participation, and planning small-group activities whereby a person responds based on the group rather than presenting his own information.

An inspection of a facility after a permit is obtained for the purpose of observing whether the plans submitted in the permit application are being implemented as approved is an example of which environmental protection strategy? a. Controlling pollution b. Waste minimization c. Land use planning d. Environmental monitoring

ANS: D Environmental monitoring would be an inspection of a facility after a permit is obtained to observe whether the plans submitted in the permit application are being implemented as approved.

Which statement about feminist ethics is correct? a. Feminists include only women in their worldview. b. Persons who ascribe to feminist ethics are passive and wish to pursue their ideals through the legislative process. c. Feminists believe that men should not be nurses. d. Womens thinking and moral experiences are important and should be taken into account.

ANS: D Feminist theory ascribes to the idea that womens thinking and moral experiences are important and should be considered.

It is important for a nurse to recognize group norms because they: a. Allow for creativity and variety among group members b. Influence members perception of community c. Are helpful in evaluating the effectiveness of the group d. Maintain the group through various supports to members

ANS: D Group norms serve to maintain the group through various supports to members.

How have nurses historically learned to identify a possible relationship between environmental chemical exposures and their potential harm? a. Extrapolation by toxicologists b. Biomonitoring c. Completing chemistry courses d. Observing signs and symptoms in clients

ANS: D Nurses have historically made discoveries related to chemical exposure when people presented with signs and symptoms related to known chemical toxicity. The first two options are modern methods.

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

ANS: D Nurses working with established groups should know that this type of group has membership ties and an existing structure that has proven to be successful.

Which statement is discussed in the Code of Ethics for Nurses with Interpretive Statements? a. The profession of nursing is responsible for making political statements and supporting nurse-friendly candidates for office. b. The nurses primary focus is on acute bedside nursing, followed by community health care to promote seamless care. c. The nurse owes duty primarily to the physician to strive to protect health, safety, and the rights of the patient. d. The profession of nursing is responsible for articulating nursing values, for maintaining the integrity of the profession, and for shaping social policy.

ANS: D Provision 9 of the Code of Ethics for Nurses with Interpretive Statements discusses the need for the nursing profession to address national and global health concerns as well as be involved with shaping policies through political action.

A public health nurse is organizing a multidisciplinary team to address the issue of water pollution in the community. The most likely members that would be invited to address this issue would be: a. Physicians, water sanitation workers, and occupational therapists b. Pharmacologists, radiologists, and epidemiologists c. Nurse practitioners, pharmacologists, and environmentalists d. Geologists, meteorologists, and chemists

ANS: D Scientists who study how pollutants travel in air, water, and soil are geologists, meteorologists, and chemists.

Which community-based risk-reduction intervention resulted in equally favorable health risk changes for both control and treatment groups? a. Framingham Heart Study b. Stanford Heart Disease Prevention Program c. North Karelia Study d. Minnesota Heart Health Program

ANS: D The Minnesota Heart Health Program resulted in equally favorable health risk changes for both control and treatment groups.

When applying the integrative model for community health promotion, a nurse assesses a neighborhood for accessibility and adequacy of care to provide treatment for medical conditions. What client system does this describe? a. Individual b. Family c. Aggregate d. Community

ANS: D The community focus includes the nurse assessing the community for accessibility and adequacy of care to provide treatment for medical conditions.

Florence Nightingale's contributions to public health included: 1.Caring for the sick, poor, and neglected in institutions and at home 2.Using a population-based approach that led to improvements in environmental conditions 3.Writing the Elizabethan Poor Law to guarantee medical care for all 4.Founding of the district nursing association to provide health care to needy people

ANS:2 During the Crimean War, Nightingale progressively improved the soldiers' health by adopting a population-based approach that used simple epidemiological measures and greatly decreased mortality.

Lillian Wald invented the term public health nursing. Which of the following classes might a person of her day attend? 1.Taking and recording blood pressures accurately 2.Safe and sanitary baby and child care 3.Environmental pollutants and their effects on lung disease 4.Time management: balancing factory work and the home

ANS:2 Lillian Wald provided health care that included educating the community on health care matters.

The National Organization for Public Health Nursing was formed in 1912. Lillian Wald was its first president. The mission was to improve the educational and services standards of the public health nurse and promote public understanding. Which of the following is a contribution of this organization? 1.Requiring that public health nurses have a baccalaureate degree in nursing 2.Standardization of public health nursing education 3.Development of nursing cooperatives 4.Opening of the Henry Street Settlement

ANS:2 The National Organization for Public Health Nursing sought to standardize public health nursing. The Henry Street Settlement was already in existence. The baccalaureate degree in nursing was not developed yet.

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

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

Change for the community as client must often occur at several levels because: a. Health problems caused by lifestyle are multidimensional. b. Most individuals can change their habits alone. c. Aggregates are responsible for social change. d. Geographic areas often have health risks that the nurse must identify.

ANS: A Because health problems caused by lifestyle cannot be solved simply by asking individuals to choose healthy habits, change for the community client must often take place at several levels.

Which characteristic is an indicator of community health process? a. Participation and community action b. Live birth rate c. Racial distribution d. Socioeconomic levels

ANS: A Participation and community action are indicators of community health process.

Which characteristic is an indicator of community health structure? a. Infant mortality rate b. Effective communication c. Crime rate d. Emergency room utilization

ANS: D The structure of the community is defined in terms of services and resources.

In the late 1800s, local health departments were formed in urban areas for what purpose? 1.To target environmental hazards associated with crowded living conditions and dirty streets and to regulate public baths, slaughterhouses, and pigsties 2.To facilitate interdisciplinary efforts and promote the "practical application of nursing" 3.To provide immunizations to all citizens 4.To provide public health education for nurses who had finished basic "training school" education

ANS:1 Local health departments were formed to handle environmental issues in cities.

Which of the following is true about African American nurses in public health? 1.Segregation existed until the 1960s, which made certificate and graduate education more difficult to obtain. 2.Cities were the major areas where they practiced 3. They often belonged to the Frontier Nursing Service. 4.They were recruited heavily as military nurses.

ANS:1 The other statements listed are false.

During America's Industrial Revolution, the number of jobs for women rapidly increased. Nightingale's successes became known across the United States, and the first nursing schools opened. Which of the following occurred related to public health nursing? 1.Community-oriented nursing began with organizations formed to meet urban health care needs. 2.Nurses were instrumental in the construction of sewers and public water systems. 3.Nurses trained in hospitals worked long hours caring for patients with communicable diseases in a humane way. 4.Nurses closed down almshouses and orphanages.

ANS:1 The visiting nurse became the key to health care in urban areas. Although nurses were involved in interventions to improve sanitation and nutrition, they were not instrumental in their construction. Nurses worked in hospitals, but that was acute care. Almshouses and orphanages were not closed down at this time.

Lina Rogers became the first school nurse. Early school nursing focused on: 1.Investigating causes of absenteeism such as malnourishment and lack of shoes or clothing 2.Teaching school as well as being a nurse 3.Starting the first school of public health 4.Providing medical treatment to enable children to return to school

ANS:1 Early school nursing focused on investigating causes of absenteeism, not providing medical treatment. That was the responsibility of physicians.

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

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

A nurse who is involved in identifying individuals with unrecognized health risk factors or asymptomatic disease is using which intervention? a. Screening b. Referral and follow-up c. Surveillance d. Health teaching

ANS: A Screening involves identifying individuals with unrecognized health risk factors or asymptomatic disease.

. When implementing interventions at the systems-level of practice, the public health nurse would: a. Involve the entire community in solving the health problem. b. Identify health problems in the community. c. Change laws, policies, and practices that influence population-based issues. d. Provide outreach services to populations at risk.

ANS: C Systems-level practice consists of changing laws, policies, and practices that influence population-based issues.

A nurse plans on implementing a community-wide influenza immunization program. Which factor should the nurse consider when implementing this program? a. The number of community members who have already received the immunization b. The existence of formal groups in the community c. Public policy that mandates influenza immunization for certain populations d. The communitys readiness to participate in the program

ANS: D The factors that influence implementation in the community are the nurses chosen roles, the type of health problem selected as the focus for intervention, the communitys readiness to take part in problem solving, and characteristics of the social change process.

Public health nurses utilize registries to identify children with delayed or missing immunizations. They subsequently follow up with families by phone calls or home visits. This is an example of ____-level of practice. a. Systems b. Community c. Policy d. Individual/family

ANS: D The individual/family-level of practice focuses on interventions that involve working with individuals, either singly, or in groups, and with families.

Nurses have worked in the community to improve the health care status of individuals, families, populations, and vulnerable groups. Part of the appeal of this type of nursing is: 1. Working with wealthy contributors who provide the funds 2. Locating the source of disease and curing patients 3. The autonomy of practice and independence in problem solving and decision making 4.Caring for soldiers on the battlefield

ANS: 3 Community health nurses have a long history of autonomous practice, problem solving, and decision making. The other three answers relate to acute care nursing or gathering funding. Community health care nurses did engage in these activities in the nineteenth century, but overall, they have been best known for autonomy of practice.

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

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

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

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

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

ANS: A Communities, individuals and families, and systems are the three levels of public health nursing practice.

After identifying the boundaries of a community, what is the next step the nurse should take in completing a community assessment? a. Gather relevant existing data and generating missing data. b. Plan interventions that benefit the entire community. c. Formulate nursing diagnoses. d. Evaluate the interventions that were used.

ANS: A Community assessment includes gathering relevant existing data and generating missing data.

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

ANS: A Each wedge consists of related interventions. The other answers describe some of the individual wedges.

When completing a community assessment, the nurse will: a. Identify community needs and clarify problems. b. Determine the weaknesses of a community. c. Perform the core functions of public health nursing. d. Assess individual needs within a community.

ANS: A In a community assessment, one of the core functions is a logical, systematic approach to identifying community needs, clarifying problems, and identifying community strengths and resources.

An example of a measurable outcome health status indicator at the individual-level of practice that would be used by a public health nurse is: a. A 50-year-old woman receives annual mammograms b. School absences in a community decline c. Teachers have increased awareness of health problems d. Those in poverty utilize the free mammogram program

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

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

ANS: A The Intervention Wheel provides a graphic illustration that gives public health nurses a means to describe the full scope and breadth of their practice.

A nurse who uses such data as minutes from a community meeting is using: a. Secondary analysis b. Informant interviews c. A survey d. A windshield survey

ANS: A The data is secondary because it is collected by someone else.

The main characteristics of partnership are: a. Awareness, flexibility, and distribution of power b. Rights, responsibilities, and consensus c. Commitment, participation, and articulation d. Collaboration, advocacy, and utility

ANS: A The main characteristics of partnership are being informed, flexibility, and negotiated distribution of power.

A nurse may define a community as a(n) (select all that apply): a. Social group determined by geographic boundaries b. Group of people who share common values and interests c. Group of people defined by their interactions d. Individual with a specific health concern

ANS: A, B, C Community can be defined as many things, including a social group determined by geographical boundaries, a group of people who share common values and interests, and a group of people defined by their interactions.

The cornerstones of public health nursing practice (select all that apply): a. Focus on the health of the entire population b. Reflect community priorities and needs c. Promote health through strategies driven by epidemiological evidence d. Are grounded in an ethic of collaboration

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

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

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

When public health nurses conduct an assessment of a communitys health, they a. Define one problem that will be the focus for a year. b. Assess a social network of interacting individuals usually in a defined territory. c. Minimize the effects of health risks and hazards. d. Intervene at the population-level by changing laws and regulations.

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

A group of nursing students forms a student nursing association to provide support while they are enrolled in a nursing program. This is known as a community of: a. Place b. Special interest c. Problem ecology d. Function

ANS: B A community of special interest brings members together with common concerns and interests.

A public health nurse is collecting data about the biological aspects of community health. What data will the nurse collect? a. Race/ethnicity b. Traditional morbidity and mortality rates c. Policy making and social change d. Homicide rates

ANS: B Biological community health is often measured by traditional morbidity and mortality rates, which can be found in The Morbidity and Mortality Weekly Report.

A public health nurse uses collaboration, coalition building, and community organizing when: a. Providing case management, referral, and follow-up services with individuals b. Carrying out collective action at the systems or community levels of practice c. Conducting a community assessment d. Implementing primary and secondary prevention strategies

ANS: B Collaboration, coalition building, and community organizing are the interventions often carried out at the systems and community levels of practice. These interventions can be used at all levels of prevention.

To effectively complete the evaluation phase, the nurse must have: a. Demonstrated the ability to improve the health of the participants b. Developed measureable objectives and goals before implementation c. Encouraged full participation by community members d. Improved the health of the population through the program

ANS: B Evaluation begins in the planning phase, when goals and measurable objectives are established and goal-attaining activities are identified. After implementing the intervention, only the meeting of objectives and effects of the intervening activities have to be assessed.

When conducting informant interviews in a small community, the nurse would most likely contact: a. The state department of health for death records b. A local priest for congregation information c. Surrounding communities for crime comparison d. The Centers for Disease Control and Prevention (CDC) for illnesses in the area

ANS: B Informant interviews are methods of directly collecting data. County health department nurses and church officials are often good key informants.

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

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

A nurse promotes alliances among organizations for a common purpose. Which public health intervention is being implemented? a. Health teaching b. Coalition building c. Surveillance d. Referral and follow-up

ANS: B One example of coalition building is promoting alliances among organizations for a common purpose.

A community that has residents who are very involved in its activities and encourage activities that promote the health of the community displays which condition of community competence? a. Commitment b. Participation c. Articulateness d. Effective communication

ANS: B Participation is an essential condition of community competence defined by active, community-oriented involvement.

An occupational health nurse works with an employer to develop a workplace wellness program for its employees. This intervention is occurring at the _____-level of practice. a. Individual/family b. Systems c. Community d. Government

ANS: B Systems-level of practice consists of changing laws, policies, and practices that influence population-based issues.

A nurse cares for the community as the client when focusing on: a. Providing care for aggregates living in the community b. The collective good of the population c. The provision of care for families in the home setting d. Providing health education in the community

ANS: B The community is considered the client when the nursing focus is on the collective good of the population. Providing education is one way the nurse can care for the community as the client; however, the focus of nursing care is larger in scope than only education.

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

ANS: D Compiling recent data from the county health department on child abuse cases is an example of community assessment, assessing needs and data within a community.

To analyze the problem of increased adolescent alcohol use in the community, a nurse brings together several groups of people to address the issue. These groups come together at the same time to work on identifying potential causes of the problem, but do not interact during the process. Which model is the nurse applying? a. Delphi technique b. Program planning model c. Community-as-partner model d. Community empowerment model

ANS: B The program planning model is known as the nominal group process. It makes the most of the contributions by various groups with diverse interests, skills, and knowledge. These groups work in the presence of one another but do not interact.

Which nursing diagnosis is written at the community-level? a. Risk of hypertension related to poor diet and sedentary lifestyle b. Risk of obesity among school-age children related to lack of opportunities to engage in physical activity c. Risk of ineffective health maintenance among individuals who do not have access to a primary care provider d. Ineffective coping related to multiple stressors as evidenced by client crying and stating she has no support system

ANS: B There are three parts: risk of, among, and related to. The risk of identifies a specific problem or health risk faced by the community. Among identifies the specific community client with whom the nurse will be working in relation to the identified problem or risk. Related to describes characteristics of the community.

Which method of data collection is being used as a nurse gathers information about the condition of homes, size of lots, neighborhood hangouts, road conditions, and modes of transportation? a. Participant observation b. Windshield survey c. Survey d. Informant interviews

ANS: B Windshield surveys are the motorized equivalent of simple observation.

A public health nurse implements the public health intervention of health teaching at the systems-level of practice by: a. Participating in the Great American Smokeout b. Working with a local employer to provide smoking cessation education c. Providing one-on-one counseling to smokers d. Advocating for increased taxes on tobacco products

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

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

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

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

ANS: C Community health nursing practice is the synthesis of nursing theory and public health theory applied to promoting, preserving, and maintaining the health of populations through the delivery of personal health care services to individuals, families, and groups. The focus of community health nursing practice is the health of individuals, families, and groups and the effect of their health status on the health of the community as a whole (individual to families to groups to community flow). This is different from public health nursing, which is the synthesis of nursing theory and public health theory applied to promoting and preserving the health of populations. The focus of public health nursing practice is the community as a whole and the effect that the community's health status, including health care resources, has on the health of individuals, families, and groups (community to groups to families to individual flow). Both community health and public health nursing are considered to be community-oriented practices involving free-living (noninstitutionalized) clients. Community-based nursing practice is setting specific, and care is provided to clients where they live (home health or hospice nursing, community-based clinic), work (occupational health nursing), and/or attend school (school nursing). The emphasis of community-based nursing practice is acute and chronic care (illness care) and the provision of comprehensive, coordinated, and continuous services, usually within a specialty area.

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

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

When writing a community-level diagnosis, Among refers to the: a. Specific problem or health risk faced by the community b. Characteristics of the community c. Community client experiencing the risk or problem d. Likelihood that the problem will be solved

ANS: C Among identifies the specific community client with whom the nurse will be working to address the identified problem.

Public health nurses use a common set of interventions to: a. Describe the proper order of implementation. b. Emphasize surveillance as the main focus of public health practice. c. Guide practice and generate agency protocols. d. Improve the health status of communities, systems, individuals, and families.

ANS: D Interventions are actions taken on behalf of communities, systems, individuals, and families to improve or protect health status.

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

ANS: C Assurance focuses on the responsibility of public health agencies to ensure certain activities have been appropriately carried out to meet public health goals and plans. Policy development seeks to build constituencies that can help bring about change in public policy. Assessment includes activities that involve collecting, analyzing, and disseminating information on both the health status and the health-related aspects of a community or a specific population. Public health is based on scientific knowledge, but is not a core function. DIF:Cognitive level: ApplyingREF:p. 14 TOP: Nursing process: Assessment MSC: NCLEX: Health Promotion and Maintenance

A nurse surveys the school nurses in a community to determine their roles in the schools because this data is not available. The nurse is engaging in the process of data: a. Collection b. Gathering c. Generation d. Interpretation

ANS: C Data generation is the process of developing data that do not already exist by interacting with community members or groups. This data includes information about a communitys knowledge and beliefs, values and sentiments, goals and perceived needs, norms, problem-solving processes, power, leadership, and influence structures.

Which nursing diagnosis would a public health nurse use when addressing the problem of obesity at the community-level of practice? a. Alteration in nutrition: More than body requirements b. Need for increased knowledge of proper nutrition c. Families at risk for obesity because of inactivity d. Overweight child related to poor dietary habits

ANS: C Nursing diagnoses must be modified to meet the needs of population-focused care in public health nursing practice. Families at risk for obesity because of inactivity is the only nursing diagnosis that addresses a community group that is in need of further intervention.

A public health nurse utilizes the nursing process at all levels of practice by: a. Including specific goals for community health nurses b. Developing an accurate nursing diagnosis c. Analyzing the needs of the community, system, and individuals and families d. Utilizing primary, secondary, and tertiary prevention

ANS: C Public health nurses must customize the nursing process to consider the community, systems, and individual/family levels of practice.

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

ANS: C Since being published, the Intervention Wheel has been incorporated into the public/community health coursework of numerous undergraduate and graduate curricula.

A community that demonstrates commitment would most likely support the development of a: a. Community club to facilitate community involvement b. Childrens recreation program c. Curb-side recycling program and community-based education about recycling d. Cooperative agreement with a neighboring city to share needed services

ANS: C The commitment condition of community competence defined by Cottrell refers to the affective and cognitive attachment to a community, that is worthy of substantial effort to sustain and enhance. Creating a recycling program as well as associated education enhances both the cognitive and affective domains of the community.

A nurse who reads the local community newspaper is using which method to gather data about the community? a. Informant interview b. Survey c. Participant observation d. Windshield survey

ANS: C The nurse is deliberately sharing in the life of the community.

What are the critical attributes in the definition of community? a. Families, groups, and health organizations b. Health needs, geographical boundaries, and target population c. People, place, and functions d. Populations and health resources

ANS: C The people are community members or residents; place refers to geographic and time dimensions; and function refers to the aims and activities of the community.

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

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

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

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

What intervention would be the most appropriate for the nurse to use when trying to develop community partnerships? a. Involve only the community residents. b. Use nurses as the source of information and leadership. c. Rely on the power of local officials. d. Include a variety of disciplines.

ANS: D Community partnerships occur when community residents and health workers come from a variety of disciplines.

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

ANS: D Public health consultants with the Minnesota Department of Health carried out a grounded theory process in response to uncertainty about the contributions of public health nursing to population health-level improvement, resulting in the identification of the Intervention Wheel components.

A nurse is trying to increase participation in a free colorectal screening program for middle-aged adults who lack health insurance. Which implementation mechanism would be most effective? a. Small interacting groups b. Health policy c. Lay advisors d. Mass media

ANS: D The mass media (newspapers, television, and radio) represent an impersonal and formal type of communication and are useful in providing information quickly to a large number of people.

The American Red Cross, through its Rural Nursing Service, improved living conditions in villages and isolated farms. Which of the following is an example of the resourcefulness of a nurse of this era? 1.Using hot bricks, salt, or sandbags to substitute for hot water bottles 2.Testing well water for pollutants 3.Teaching school and developing curricula for rural nursing programs 4.Providing post-surgical care

ANS:1 In providing medical care, rural nurses were resourceful in finding alternatives when they did not have medical products that were available in urban areas.