Population Health Exam 2

A parent with two school-age children has just finished a family health assessment questionnaire. The parent asks the nurse why one of the questions asks whether there is a neighborhood playground. The nurse's best response would be: A."Don't worry about it. We are going to talk about all this anyway." B."It's important to good health to have adequate recreation resources." C."We want to be able to report any dangerous playground equipment to the city." D."We want to know what kind of neighborhood you're in so we can assess income."

"It's important to good health to have adequate recreation resources." The importance of social risks to family health is gaining increased recognition. A family's health risk increases if they are living in high-crime neighborhoods, communities without adequate recreation or health resources, in communities with major noise pollution or chemical pollution, or in other high-stress environments.

During a family nursing assessment, a parent questions whether God is punishing the family, because one of the children has just been diagnosed with leukemia. The most facilitative response by the nurse would be: A."God is loving and doesn't punish people." B."Tell me more about your family's spiritual beliefs." C."That is not part of my religious belief system, so I don't know." D."Why do you think your family needed to be punished?"

"Tell me more about your family's spiritual beliefs." The focus of the Neuman Systems Model would be to assess the family's ability to adapt to this stressful change. Assessment of spirituality is an important variable in assessing family strengths and weaknesses. The Neuman Systems Model is a wellness-oriented model in which the nurse uses the strengths and resources of the family to maintain system stability while adjusting to stress reactions that may lead to health change and affect wellness. In other words, this model focuses on family wellness in the face of change.

Many families have financial resources that allow them to maintain themselves but limit the quality of their purchasing power. Food high in fat and calories may be affordable, whereas fresh fruits and vegetables may not be affordable. A federal program that attempts to promote healthier diets for vulnerable populations is: A.Medicaid. B.Medicare. C.Supplemental Security Income (SSI). D.Women, Infants, and Children (WIC).

"Tell me more about your family's spiritual beliefs." The focus of the Neuman Systems Model would be to assess the family's ability to adapt to this stressful change. Assessment of spirituality is an important variable in assessing family strengths and weaknesses. The Neuman Systems Model is a wellness-oriented model in which the nurse uses the strengths and resources of the family to maintain system stability while adjusting to stress reactions that may lead to health change and affect wellness. In other words, this model focuses on family wellness in the face of change.

Analytic epidemiology differs from descriptive epidemiology because it searches for: "when" of disease patterns. "where" of disease patterns. "why" of disease patterns. "who" of disease patterns.

"why" of disease patterns. Descriptive epidemiology describes the distribution of disease, death, and other health outcomes in the population according to person, place, and time—the who, where, and when of disease patterns. Analytic epidemiology, on the other hand, searches for the determinants of the patterns observed—the how and why of disease patterns.

Which of the following tools are used in analytic epidemiology? Select all that apply. 1. Cohort study 2. Case-control study 3. Cross-sectional study 4. Clinical trials 5. Community trials

1, 2, 3 Analytic epidemiology deals with the factors that influence the observed patterns of health and disease and increase or decrease the risk of adverse outcomes. Analytic study designs include cohort studies, case-control studies, and cross-sectional studies. In experimental or intervention studies, the investigator initiates a treatment or intervention to influence the risk or course of disease. These studies test whether interventions can prevent disease or improve health. Clinical trials and community trials are examples of experimental studies.

A nurse is conducting an in-service education session on the Centers for Disease Control and Prevention's (CDC's) updates for preventive services for a group of nurses in community health. The nurse would demonstrate the best understanding of the educational process by integrating which planning strategies? Select all that apply. 1. Use of films 2. Small group interaction 3. Use of games 4. Session timing 5. Session space

1, 2, 3, 4, 5 Many factors influence a person's learning needs and the ability to learn, including the learners' demographic, physical, geographical, economic, psychological, social, and spiritual characteristics. Also consider the learner's knowledge, skills, and motivation to learn, as well as what resources are available to support and possibly prevent learning. Resources include printed, audio or visual materials, equipment, agencies, and other individuals. Barriers for the presenter include lack of time, skill and/or confidence, money, space, energy, and organizational support.

Which of the following factors has influenced the implementation of evidence-based practice in health care? Select all that apply. 1. Increased expectations of consumers 2. Advances in technology 3. Nursing shortages 4. Increases in lawsuits 5. Implementation of electronic health records

1, 2, 4 Evidence-based practice is important for all professionals who work in social and health care environments, regardless of the client or the setting with which professionals are dealing, including public health nurses who work with populations. Emphasis on EBP has resulted from increased expectations of consumers, changes in health care economics, increased expectations of accountability, advancements in technology, the knowledge explosion fueled by the Internet, and the growing number of lawsuits occurring when there is injury or harm as a result of practice decisions that are not based on the best available evidence.

Which of the following domains are used in evaluating the strength of evidence? Select all that apply. 1. Quality 2. Quantity 3. Cost effectiveness 4. Consistency 5. Usefulness

1, 2, 4 Grading evidence has been debated so strongly that in 2002; the Agency for Healthcare Research and Quality (AHRQ) commissioned a study to describe existing systems used to evaluate the usefulness of studies and strength of evidence. The report reviewed 40 systems and identified three domains for evaluating systems for the grading of evidence: quality, quantity, and consistency. The quality of a study refers to the extent to which bias is minimized. Quantity refers to the number of studies, the magnitude of the effect, and the sample size. Consistency refers to studies that have similar findings, using similar and different study designs.

Which of the following barriers are specific to the educator? Select all that apply. 1. Fear of public speaking 2. Low literacy 3. Limited experience with the topic 4. Lack of motivation 5. Lack of experience with gaining participation

1, 3, 5 Barriers to learning fall into two broad categories: one concerning the educator and the other concerning the learner. Common educator-related barriers include a fear of public speaking, limited experience with the topic, and lack of experience with gaining participation in the group. Two of the most important learner-related barriers are low literacy and lack of motivation to learn information and make needed behavioral changes.

There are many barriers that affect the actual implementation of evidence-based practice (EBP) in a nursing environment. Which statements reflect the most significant concerns of nurses in the community-focused setting? Select all that apply. 1. EBP requires compliance by the client. 2. EBP requires little support. 3. EBP demands change. 4. EBP questions long-standing nursing practice. 5. Lack of resources

1, 4, 5 Although a community agency may subscribe in theory to the use of EBP, actual implementation may be affected by the realities of the practice setting. Community-focused nursing agencies may lack the resources needed for its implementation in the clinical setting, such as time, funding, computer resources, and knowledge. Nurses may be reluctant to accept findings and feel threatened when long-established practices are questioned. Cost can also be a barrier if the clinical decision or change will require more funds than the agency has available. Compliance can be a barrier if the client will not follow the recommended intervention.

Evidence-based public health utilizes which of the following guidelines? Select all that apply. 1. Decision making for the community served 2. Application of program planning frameworks 3. Judicious use of the Internet for use of evidence 4. Conducting evaluations 5. Disseminating what has been learned

2, 3, 4 Evidence-based public health is defined as a public health endeavor in which there is an informed, explicit, and judicious use of evidence that has been derived from any of a variety of science and social science research and evaluation methods. An expanded definition of evidence-based public health includes making decisions on the basis of the best available evidence, using data and information systems, applying program planning frameworks, engaging the community in decision making, conducting evaluations, and disseminating what has been learned.

Nurses in community health often use epidemiology because in the community it is often difficult to control the environment. Which of the following statements demonstrates an epidemiologic strategy for monitoring disease trends? A nurse in community health conducts an education class for clients newly diagnosed with diabetes. A nurse in community health investigates a breakout of whooping cough in a local middle school. A nurse in community health organizes a health fair at the community health center. A nurse in community health participates on a county school board that addresses student health issues.

A nurse in community health investigates a breakout of whooping cough in a local middle school. Nurses are a key part of the interdisciplinary team in community settings and often use epidemiology to look at health and at disease causation and how to both prevent and treat illness. Nurses use epidemiology in the community to examine factors that affect the individual, family, and population group because it is more difficult to control these factors in the community than in the hospital. Community health nurses who conduct education classes, organize health fairs, and address student health issues are using prevention strategies.

The public health nurse is most likely to use what types of surveillance systems? Select all that apply. A.Active B.Passive C.Sentinel D.Syndronic

A, B Although all of the systems are important, the public health nurse is most likely to use the active or passive systems. A passive system may use the state reportable disease system to complete a community assessment or MAPPS. The active system is used when several schoolchildren become ill after eating lunch in the school cafeteria or at the local hot dog stand, to investigate the possibility of food poisoning, or to follow up the contacts of a newly diagnosed client with tuberculosis or a sexually transmitted infection (STI) at the local homeless shelter.

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

A, B, D The case manager is the architect for the target group's health in the care management delivery process. The building blocks used by the manager include risk analysis, data mapping, data monitoring, epidemiologic investigation of unexpected illnesses, multidisciplinary development of action plans and programs, and identifying case management triggers or events that promote earlier referrals of high-risk clients when prevention can have dramatic results. The case manager builds on the basic functions of the traditional role and adapts new competencies for managing the transition from one part of the system to another or to home.

A traditional quality assurance program goal is to identify problems between the provider and client. Other goals of a traditional QA program are: Select all that apply. A.intervention in problem cases. B.peer review of all cases that are problematic. C.provide feedback regarding interactions between client and provider. D.provide documentation of interactions between client and provider.

A, C Traditional QA programs can fit well with the CQI process. In most health care systems, the overall goal of specific QA approaches is to monitor the process and outcomes of client care. The goals of CQI are as follows: To identify problems between the provider and client through QA methods To intervene in problem cases To provide feedback regarding interactions between the client and provider To provide documentation of interactions between the client and provider Specific approaches are often implemented voluntarily by agencies and provider groups interested in the quality of interactions in their setting. Having peer review of all problematic cases is one step of the audit process for measuring quality.

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

A, C, D Families with strengths, functional families, and resilient families are terms often used to refer to healthy families. Research has been conducted about healthy families, but it is clear that the issues examined all relate to those of relational needs. This means that in healthy families, the basic survival needs are met. The traits ascribed to healthy families are based on attachment and are affectionate in nature.

Which of the following best support the concept of community-oriented nursing practice? Select all that apply. A.Direct nursing care of individuals with tuberculosis (TB) B.Hospice home care for a terminally ill individual and family C.Nursing interventions to stop elder abuse D.Nutrition education programs for teenagers and their families E.Wound care for a homebound individual

A, C, D In community-oriented practice, the nurse and community seek healthful change together. Their common goal involves an ongoing series of health-promoting changes rather than a fixed state. The most effective means of completing healthy changes in the community is through this same partnership. Nurses who have a community orientation are often considered unique because of their target of practice.

The major sources of information for program evaluation are: Select all that apply. A.community indexes. B.media reports. C.program clients. D.program providers. E.program records.

A, C, E Major sources of information for program evaluation are program clients, program records, and community indexes. The program participants, or clients of the service, have a unique and valuable role in program evaluation. Whether the clients, for whom the program was designed, accept the services will determine to a large extent whether the program achieves its goal. Thus their reactions, feelings, and judgments about the program are important to the evaluation.

A nurse in community health in California has been working with a 6-year-old child that was rescued from a mudslide. The nurse will observe the child for which of the following stress effects? Select all that apply. A.Bed-wetting episodes B.Desire to return to school C.Fantasies of denial D.Increased playfulness with peers E.Thumb sucking

A, C, E The effects of disasters on children can be especially disruptive. They can resort to regressive behaviors such as sucking their thumb, wetting their bed, crying, and clinging to parents or have nightmares and fantasies that the disaster never occurred. School-related problems may also develop, and the child may not be able to concentrate or may even refuse to attend school.

Finding resources to implement evidence-based practice (EBP) in community health will continue to be a challenge because of the emphasis on quality care, equal distribution of health care resources, and cost control. Which of the following would demonstrate a creative strategy to implementing EBP? Adopting quality indicators for evaluating websites claiming to contain EBP Avoiding the issue of community politics Creating the role of a knowledge manager Making decisions on behalf of the community

Adopting quality indicators for evaluating websites claiming to contain EBP Although the Internet is one source of evidence data, there may be a lack of quality indicators to evaluate the myriad of websites claiming to contain evidence-based information. It is essential to evaluate the quality of the information on the website, whether it comes from a reputable agency or scholar, and whether the source of the website has a financial interest in the acceptance of the evidence presented.

The problem of the working poor and uninsured places a major burden on the current health care system that affects those families and the community in general. Nurses in community health see this as a major: Select all that apply. A.behavioral issue. B.policy issue. C.health risk issue. D.social issue. E.nursing issue.

B, C, D Economic risk is one of the foremost predictors of health. It is useful to know whether families' resources are adequate to meet their needs. The standard of living they are comfortable with is not the measure of risk. If the main wage earner is employed but receives no medical benefits, and the salary is not sufficient for health promotion or illness-related care, the family may qualify for available government-sponsored programs. This is a major policy issue of concern to nurses.

Which of the following statements are true regarding the health-related vulnerabilities of men? Select all that apply. A.More males die at birth. B.Fewer health services are emphasized for men. C.Men are less likely to be honest about their symptoms. D.More males die from suicide. E.Men do not participate in health care at the same level as women.

B, C, E Although health policies, campaigns, and community health organizations offer services for men, women's health is more often emphasized. Several barriers to men reaching their full health potential have been identified. Men do not participate in health care at the same level as women, apparently because of the traditional masculine gender role learned through socialization (Giorgianni et al, 2013). A study from researchers at Rutgers University found that men who held traditional beliefs about masculinity, such as toughness, bravery, self-reliant, and emotionally restrained, were less likely than women to seek medical help, more likely to choose a male provider, and less likely to be honest about their symptoms (in particular, minimizing their symptoms) (Himmelstein and Sanchez, 2016).

What are the purposes of disease surveillance in public health? Select all that apply. A.Tries to identify terrorist attacks before they occur. B.Provides a means for nurses to monitor disease trends. C.Generates knowledge about disease or outbreak patterns. D.Allows the nurse to advocate for policy changes. E.Reduces morbidity and mortality and improves health through disease trend monitoring.

B, C, E Surveillance is a critical role function for nurses practicing in the community. It is important because it generates knowledge of a disease or event outbreak patterns (including timing, geographic distribution, and susceptible populations). Surveillance provides a means for nurses to monitor disease trends to reduce morbidity and mortality and to improve health. Although surveillance was initially devoted to monitoring and reducing the spread of infectious diseases, it is now used to monitor and reduce chronic diseases and injuries as well as "environmental and occupational exposures" and personal health behaviors. Surveillance systems help nurses and other professionals monitor emerging infections and bioterrorist outbreaks.

Which of the following statements accurately describe the stress reaction phases a community may experience during a disaster response? Select all that apply. A.Disillusionment and reconstruction is most associated with response efforts. B.During the Heroic phase, there is overwhelming need for people to do whatever they can to help others survive the disaster. C.In the Honeymoon phase, survivors may be rejoicing in that their lives and the lives of loved ones have been spared. Disillusionment is the longest phase in the stress reaction process. D.The Disillusionment phase occurs after time elapses and people begin to notice that additional help and reinforcement may not be immediately forthcoming.

B, C, E The first two phases, the Heroic and Honeymoon phases, are most often associated with response efforts. The latter two phases, Disillusionment and Reconstruction, are most often linked with recovery. During the Heroic phase, there is overwhelming need for people to do whatever they can to help others survive the disaster. In the Honeymoon phase, survivors may be rejoicing in that their lives and the lives of loved ones have been spared. Survivors will gather to share experiences and stories. The Disillusionment phase occurs after time elapses and people begin to notice that additional help and reinforcement may not be immediately forthcoming. The last phase, Reconstruction, is the longest. Homes, schools, churches, and other community elements need to be rebuilt and reestablished.

What are the core competencies of the nurse participating in surveillance and investigation activities? Select all that apply. A.Basic patient assessment skills B.Effective communication skills C.Ability to collaborate with community partners D.Advanced-practice nurse with secondary science degree E.Leadership and systems thinking

B, C, E The national core competencies for public health nurses were developed from the work of the Council on Linkages Between Academia and Public Health Practice (2010) and by the Quad Council of Public Health Nursing Organizations (2009). To be a participant in surveillance and investigation activities, the staff nurse must have the following: Analytic assessment skills Ability to provide effective oral and written reports Community dimensions of practice Basic public health science skills Leadership and systems thinking

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

B, D, E The bio/psycho/socio/spiritual approach to family health refers to individual members as well as the family unit as a whole. An individual's health (wellness-illness continuum) affects the entire family's functioning and, in turn, the family's functioning affects the health of individuals. Thus assessments of family health involve simultaneous assessment of individual members and the family system as a whole.

Which of the following social science theories is used by public health nursing to describe how environments and systems outside of the family influence the development of a child over time? A.Life-cycle theory B.Family developmental theory C.Family systems theory D.Bioecological systems theory

Bioecological systems theory The bioecological systems theory describes how environments and systems outside of the family influence the development of a child over time. Family developmental and life-cycle theory provides a framework for understanding normal predicted stresses that families experience as they change and transition over time. The stages of family development are based on the age of the eldest child. Overall family tasks are identified that need to be accomplished for each stage of family development. Nurses use family systems theory to understand how a family is an organized whole as well as composed of individuals.

A nurse performing home hospice case management notes the increasing number of hospice clients that lack caregivers in the home environment. The nurse identifies the potential need for a hospice house facility to meet the needs of these clients. The case management process frequently reveals such larger picture issues as: Select all that apply. 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.

D, E Case management activities with individual clients and families will reveal the larger picture of health services and health status of a community. Through a nurse's case management activities, general community weaknesses in quality and quantity of services often are discovered.

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

Members of a family are self-defined. The members of a family are self-defined. Nurses working with families should ask the people whom they consider to be their family and then include those members in health care planning. The family may range from traditional nuclear and extended family to "postmodern" family structures such as single-parent families, stepfamilies, same-gender families, and families consisting of friends.

According to the Minnesota Model of Public Health interventions, what is the first step of surveillance for the public health nurse? A.Organize the data. B.Analyze the data. C.Interpret and disseminate the data. D.Determine if surveillance is appropriate.

Determine if surveillance is appropriate. The Minnesota Model of Public Health Interventions: Applications for Public Health Nursing Practice (Centers for Public Health Nursing 2001, pp. 15, 16) suggests that surveillance is one of the interventions related to nursing practice in public health. The model provides seven basic steps of surveillance for nurses to follow: Consider whether surveillance as an intervention is appropriate for the situation. Organize the knowledge of the problem, its natural course of history, and its aftermath. Establish clear criteria for what constitutes a case. Collect sufficient data from multiple valid sources. Analyze the data. Interpret and disseminate the data to decision makers. Evaluate the impact of the surveillance system.

Following the attacks of 9/11, a nurse practitioner in a family clinic used opportunities at the clinic staff meetings to speak about her own feelings of loss and guilt. This strategy indicates that the nurse was aware of what phenomenon related to disasters? A.Anxiety B.Effects of stress on individuals C.Sense of urgency D.Scapegoating and blaming

Effects of stress on individuals The stress response of individuals following a disaster may be experienced as rumination about the disaster, immense fear of everything, survivor guilt, sense of great loss, and hesitation to express feelings. Key actions by the nurse can assist others with dealing with the stress, help people cope, allay concerns and fears, identify feelings that they may be experiencing, assist others to think positively and move to the future, and prepare nursing personnel to be effective in a crisis/emergency situation.

A community-oriented nurse convenes a support group for teenage mothers. The nurse understands that this strategy fosters cohesiveness among members and allows the members to learn from one another. What other benefit specific to group teaching will be achieved? Cultural sensitivity Efficiency in client service Learning of new skills Distraction-free surroundings

Efficiency in client service In the education process, one of the important skills for educators to develop in selecting appropriate educational methods is realizing the benefits of group teaching, such as cohesiveness among members, increased number of clients seen, clients learning from one another, and cost effectiveness. Cohesive groups tend to be more productive and able to accomplish their goals; cohesion can be increased as members better understand the experiences of others and identify common ideas and reactions to various issues. Nurses facilitate this process by pointing out similarities, contrasting supportive differences, or helping members redefine differences in ways that make those dissimilarities compatible.

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

Focuses on the interaction of the family with other systems. The major strength of the systems framework is that it views families from both a subsystem and a suprasystem approach. That is, it views the interactions within and between family subsystems as well as the interaction between families and the larger supersystems, such as the community and the world. The major weakness of the systems framework is that the focus is on the interaction of the family with other systems rather than on the individual, which is sometimes more important.

Which educational method has been shown to be most effective in fostering treatment adherence? Internet-based education In-person counseling Telephone counseling Self-directed learning

Internet-based education Educating people through the Internet has been shown to be more effective in fostering treatment adherence than in-person counseling, telephone counseling, or self-directed learning. It is important to be aware that people increasingly are using the Internet as a source of health information. Clients may ask nurses to provide them with information about ways to evaluate the quality and reliability of this information.

A nurse in community health is participating in a community service board strategic team that is currently assessing the community's strengths, the local public mental health system, the community's mental health status, and other variables. This best describes what strategic program planning model used today in the public health arena? Assessment Protocol for Excellence in Public Health (APEXPH) Health Evaluation Data Information System (HEDIS) Mobilizing for Action Through Planning and Partnership (MAPP) Planning Approach to Community Health (PATCH)

Mobilizing for Action Through Planning and Partnership (MAPP) MAPP is the newer approach to program planning in the public health arena. It is a strategic planning model that helps the community health workers be facilitators, as communities establish priorities in their public health issues and identify resources to address the issues. APEXPH addresses the three core competencies of public health: assessment, assurance, and policy development. PATCH is a health education model and HEDIS is not associated with program planning.

The hospital infection control practitioner reports new cases of tuberculosis to the public health department. Of what type of surveillance system is this an example? A.Passive B.Active C.Sentinel D.Special

Passive Surveillance systems in use today are defined as passive, active, sentinel, and special. In the passive system, case reports are sent to local health departments by health care providers (i.e., physicians, nurses) or laboratory reports of disease occurrence are sent to the local health department. In the active system, the nurse, as an employee of the health department, may begin a search for cases through contacts with local health providers and health care agencies. In the sentinel system, trends in commonly occurring diseases or key health indicators are monitored. Special systems are developed for collecting particular types of data; these may be a combination of active, passive, and/or sentinel systems.

An elementary classroom of 28 students has had 13 children who have developed chicken pox over the last 3 weeks. What is the pattern of occurrence? A.Common source outbreak B.Point source outbreak C.Continuous source D.Mixed outbreak

Patterns of occurrence can be identified when investigating a disease or event. These patterns are used to define the boundaries of a problem to help investigate possible causes or sources of the problem. Intermittent or continuous source cases may be exposed over a period of days or weeks, as in the recent food poisonings at a restaurant chain throughout the United States as a result of the restaurant's purchase of contaminated green onions. A common source outbreak refers to a group exposed to a common noxious influence such as the release of noxious gases. In a point source outbreak all persons exposed become ill at the same time, during one incubation period. A mixed outbreak (which was described while investigating a foodborne gastroenteritis caused by a Shigella sonnei virus) is a common source followed by secondary exposures related to person-to-person contact, as in the spreading of influenza.

The community health nurse is aware that lesbian, gay, bisexual, and transgender (LGBT) adults are more likely to experience which of the following conditions? A.Cardiovascular disease B.Poor mental health C.Obesity D.Poverty

Poor mental health Lesbian, gay, bisexual, and transgender (LGBT) adults represent a sometimes hidden special population, in part because of the social stigma associated with homosexuality coupled with the fear of discrimination. Several studies have documented health disparities by sexual orientation in population-based data and have revealed differences in health between LGBT adults and their heterosexual counterparts, including higher risks of poor mental health, smoking, higher risk of disability, and excessive drinking.

What is the purpose of using an algorithm in the surveillance process? A.Tells the nurse who to call in the event of an outbreak. B.Provides the nurse with a step by step plan to identify events needing investigation. C.Provides the nurse with a system for telephone triage in an outbreak. D.It is a visual reminder of the epidemiologic triangle.

Provides the nurse with a step by step plan to identify events needing investigation. A quality surveillance system requires collaboration among a number of agencies and individuals: federal agencies, state and local public health agencies, hospitals, health care providers, medical examiners, veterinarians, agriculture, pharmaceutical agencies, emergency management, and law enforcement agencies, as well as 911 systems, ambulance services, urgent care and emergency departments, poison control centers, nurse hotlines, school, and industry. The type of information shared includes the use of an algorithm to identify which events should be investigated (i.e., using a precise step-by-step plan outlining a procedure that in a finite number of steps helps to identify the appropriate event).

A home health nurse receives a referral to educate an older adult client with diabetes in proper foot care. The nurse's assessment of the client determines that the client has poor eyesight that may affect the client's ability to learn and perform certain skills. Which educational principle is being examined? Cognitive domain Events of instruction Principles of effective instruction Psychomotor domain

Psychomotor domain The psychomotor domain includes the performance of skills that require some degree of neuromuscular coordination and emphasizes motor skills. The cognitive domain includes memory, recognition, understanding, reasoning, application, and problem solving and is divided into a hierarchical classification of behaviors. Education is the establishment and arrangement of events to facilitate learning. Principles that guide the effective educator include message, format, environment, experience, participation, and evaluation.

In the event of a disaster, shelters are generally the responsibility of which of the following entities? A.Centers for Disease Control and Prevention (CDC) B.Federal Emergency Management Agency (FEMA) C.Public Health Service (PHS) D.Red Cross chapter

Red Cross chapter Shelters are generally the responsibility of the local Red Cross chapter, although in massive disasters the military may set up "tent cities" or bring in trailers for the masses who need temporary shelter. Nurses, because of their comfort with delivering aggregate health promotion, disease prevention, and emotional support, make ideal shelter managers and team members. Each person who comes to the shelter is assessed to determine what type of facility is most appropriate. Although initially physical health needs are the priority, especially among older adults and the chronically ill, many of the predominant problems in shelters revolve around stress. The shock of the disaster itself, the loss of personal possessions, the fear of the unknown, living in proximity to total strangers, and even boredom can cause stress.

A nurse in community health integrates new slides into a presentation that will be given to a local elementary school group regarding the techniques of proper hand washing. The new slides will repeat essential points during the presentation. This demonstrates the nurse's understanding of what principle? Repetition Integration Participation Sequencing

Repetition Incorporating repetitive health behaviors into games helps children retain knowledge and acquire skills. When learners are dependent and entering a totally new content area, they may require more pedagogical experiences. Consider both the age of the learner population and their learning needs as you choose either the pedagogical and andragogical principles for the program. In educational programs for children, provide information that matches the developmental abilities of the group.

Which of the following systems of surveillance is used to monitor trends in commonly occurring diseases? A.Active B.Passive C.Sentinel D.Syndronic

Sentinel In the sentinel system, trends in commonly occurring diseases or key health indicators are monitored. Special systems are developed for collecting particular types of data; these may be a combination of active, passive, and/or sentinel systems. In the passive system, case reports are sent to local health departments by health care providers (i.e., physicians, nurses) or laboratory reports of disease occurrence are sent to the local health department. In the active system, the nurse, as an employee of the health department, may begin a search for cases through contacts with local health providers and health care agencies.

A nurse in community health is conducting an assessment on a family of four. During the course of the assessment, the nurse collects information about previous generations of the family and siblings. The results are used to create a diagram for the family that displays the family unit across generations. Further discussions occur regarding the patterns of health and illness that relate to biological health risks. The diagram is called: A.an ecomap. B.a family plan. C.a genogram. D.a risk plot.

a genogram. A genogram is a drawing that shows the family unit of immediate interest and includes several generations, using a series of circles, squares, and connecting lines. Basic information about the family, relationships in the family, and patterns of health and illness can be obtained by completing the genogram with the family.

A 3-year smoking cessation program for teens has just concluded. The type of evaluation the staff will conduct is: a formative evaluation. an informal evaluation. an ongoing evaluation. a summative evaluation.

a summative evaluation. Summative evaluations assess program outcomes or are a follow-up of the results of the program activities and look at the end result. Formative evaluations are used to evaluate the progress of a program. An evaluation of program effectiveness may help the nurse evaluator determine both client and provider satisfaction with the program activities, as well as whether the program met its stated objectives.

When applying evidence-based practice (EBP), community-oriented nurses are primarily obligated to ensure that evidence applied to practice is: acceptable to the community. contains cost and reduces legal liability. applied as a universal remedy. limited to research findings.

acceptable to the community. Public health nurses consider EBP as a process to improve practice and outcomes and use the evidence to influence policies that will improve the health of communities.Nursing has a legitimate role to play in interdisciplinary community health practice, and nurses are obligated to ensure that evidence applied to practice is acceptable to the community.

The later years of life for many older adults mark a period of abruptly changing social dynamics over which the older adult has very little control. The nurse should understand that this phenomenon of later life challenges: A.adapting and coping responses. B.intellectual capacity. C.socioeconomic status. D.spiritual awareness.

adapting and coping responses. Eighty-five percent of all elderly people live in homes alone, with spouses or other family or friends. For many families, the caregiving experience is a positive, rewarding, and fulfilling one. Nursing intervention can facilitate good health for older persons and their caregivers and contribute to meaningful family relationships during this period.

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

advocacy and case management.Clients are a part of larger systems: the family, the work environment, and the community. Each system interacts with the client to shape available options through resources, needs, and desires. The practice of advocacy may entail the ability to focus attention on the magnitude of problems caused by diseases affecting a segment of the population. Advocacy often stimulates a community's self-determination to find innovative actions to correct gaps in service.

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

age of the eldest child. Family developmental and life-cycle theory provides a framework for understanding normal predicted stresses that families experience as they change and transition over time. The stages of family development are based on the age of the eldest child. Overall family tasks are identified that need to be accomplished for each stage of family development.

A nurse in community health is planning to begin a class to help mothers returning to work better cope with the stresses of multiple roles. The nurse would most likely use: an andragogical approach. a behavioral approach. an operational approach. a pedagogical approach.

an andragogical approach. Andragogy is the art and science of teaching adults and individuals with some knowledge about a health-related topic. In the andragogical model, learners influence what they need and want to learn. Learning strategies for children and individuals with little knowledge about a health-related topic are characterized as pedagogy. Various approaches, methods, and tools can be used to evaluate health and behavioral changes. A behavioral or operational approach to educational classes would not be useful in this situation.

The nurse in community health identifies an elder abuse problem related to caregiver stress among families. The nurse further identifies a lack of caregiver support services in the local community. The next step in the community-oriented nursing process would be to: A.analyze the community problem. B.establish priorities. C.establish goals and objectives. D.identify intervention activities.

analyze the community problem. After the identification of the community problem(s), the planning phase of the community-oriented nursing process should begin with an analysis of the problem. During the analysis, the nurse seeks to clarify the nature of the problem, its origins and effects, points at which intervention might be undertaken and interested parties/change agents. Analysis often requires identifying direct and indirect contributing factors, outcomes of the problem, and relationships between problems. Once high-priority problems are identified, relevant goals and objectives are developed, followed by the identification of intervention activities.

The nurse has just taught a client newly diagnosed with diabetes how to administer sliding-scale insulin. The most effective way to evaluate learning is to: provide an online test module. ask whether there are any questions. ask for a return demonstration. give a short paper-and-pencil quiz.

ask for a return demonstration. Evaluation is important in the educational process and the nursing process. You will need to evaluate the educator, the process, and the product. Feedback to the educator provides the educator an opportunity to modify the teaching process and to better meet the learner's needs. The educator may ask for verbal feedback, as well as get nonverbal feedback by using return demonstrations to see what learners have mastered and by observing facial expressions when feedback is being given.

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

assertiveness.Assertiveness is the ability to present one's own needs and is a behavior often seen in conflict situations. Negotiating is a strategic process used to move conflicting parties toward an outcome. Cooperation is the ability to understand and meet the needs of others. Aggressiveness is a behavior which may be exhibited in a conflict situation.

A nurse doing a family assessment asks the client, "Have any of your blood relatives had mental illness?" The nurse is asking this question to: A.determine whether the family is stable. B.assess for biological risk factors. C.decide whether this family member needs medication. D.demonstrate open-mindedness about mental illness.

assess for biological risk factors. Healthy People 2020 (US Department of Health and Human Services, 2010) identified the following major categories as being: inherited biological risk, including age-related risks, social and physical environmental risks and behavioral risks as well as health care risks. Although single risk factors can influence outcomes, the combined effect of several risks has greater influence.

A neighborhood association group has asked the local nurse in community health for a class on environmental hazards. The nurse in community health has seen good information in the community health text and thinks about getting permission to copy some of the information. The most important thing the nurse should do before using copies of this material is to: assess the literacy level of the group. see how many plan to attend. see whether the group is ready to learn. secure a good space for a group meeting.

assess the literacy level of the group. Two of the most important learner-related barriers are low literacy and lack of motivation to learn information and make needed behavioral changes. Nurses often deal with individuals and populations who are illiterate or who have low literacy levels.One out of every five Americans reads below the fifth-grade level, and one out of every three lacks the literacy needed to understand health care providers. Typically, individuals read three to five grade levels below the last year of school completed. It has been found that most health instructions continue to be written at the 10th grade reading level which is too difficult for almost half of the adult readers in the United States.

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

assist new parents in communicating with their health plan regarding well-baby coverage. Mediation is an activity in which a third party attempts to provide assistance to those who may be experiencing a conflict in obtaining what they desire. The goal of the nurse advocate as mediator is to help parties understand each other on many levels so that agreement on an action is possible.

When a community health nurse uses evidence-based practice (EBP) to evaluate effectiveness, accessibility, and quality of personal and population-based services, the nurse is addressing the core public health function of: assessment. assurance. policy development. research.

assurance. When a community health nurse uses evidence-based practice (EBP) to evaluate effectiveness, accessibility, and quality of personal and population-based services, the nurse is addressing the core public health function of assurance. Assessment occurs when the nurse uses evidence-based practice for new insights and innovative solutions to health problems. When the nurse develops policies and plans using evidence-based practice that supports individual and community health efforts, the public health function of policy development is being addressed.

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

beneficence.Beneficence can be impaired when excessive attention to cost supersedes or impairs the nurse's duty to provide measures to improve health or relieve suffering. Justice, as an ethical principle for case managers, considers equal distribution of health care with reasonable quality. Veracity, or truth telling, is absolutely necessary to the practice of advocacy and building a trusting relationship with a client. Deontology is not an ethical principle that applies to this situation.

The deliberate release of viruses, bacteria, or other germs with the intent of causing illness or death is: A.event outbreak. B.chemical terrorism. C.biological terrorism. D.surveillance.

biological terrorism. Biological terrorism is the deliberate release of viruses, bacteria, or other germs (agents) used to cause illness or death in people, animals, or plants. Chemical terrorism is the intentional release of hazardous chemicals into the environment for the purpose of harming or killing. Surveillance is a critical role function for nurses practicing in the community. It is important because it generates knowledge of a disease or event outbreak patterns (including timing, geographic distribution, and susceptible populations).

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

case management. Case management is identified as one of the 17 interventions in the scope of practice in community health nursing. Case management is defined as the ability to optimize self-care capabilities of individuals and families and the capacity of systems and communities to coordinate and provide services. Case management, in contrast to the definition of care management, refers to activities implemented with individual clients in a system. Care management includes the concept of disease management.

A nurse in community health is invited to work with a coalition of churches to address safety concerns for children in the local community. The nurse provides training in problem-solving skills, manages conflict, facilitates the process, and provides expertise in interpreting data. This nurse has chosen the implementation role of: A.change agent. B.change partner. C.group leader. D.data collector.

change partner. Content-focused roles often are considered change agent roles, whereas process roles are change partner roles. Change partner roles include enabler-catalyst, teacher of problem-solving skills, and activist advocate. Different roles may be required if the community lacks problem-solving skills or has a history of unsuccessful change efforts. The nurse may have to focus on developing problem-solving capabilities or on making one successful change so that the community becomes empowered to take on the job of promoting change on its own behalf.

A school nurse is working with the Parent Teacher Organization (PTO) to improve the health status of preschool students in a lower socioeconomic urban community. Given the demographics of the community, the nurse is aware that this population is at greatest risk for: A.asthma. B.attention deficit disorder (ADD). C.childhood obesity. D.poisoning.

childhood obesity. Obesity among the youth of the nation has reached epidemic proportions. Many factors contribute to the likelihood that a child will become overweight or obese. Factors include genetics, family eating, and physical activity patterns and time spent inactive while viewing television, playing computer games, or using other electronic devices. The environment in which children live influences obesity.

A nursing student prepares a treatment plan for a client that draws upon the student's understanding of pathophysiology and nursing practice theory learned in the student's coursework. This application of new information used in a different way demonstrates the educational principle of: affective domain. cognitive domain. events of instruction. principles of effective education.

cognitive domain. The cognitive domain of learning includes memory, recognition, understanding, reasoning, application, and problem solving and is divided into hierarchical classifications of behaviors (i.e., knowledge, comprehension, application, analysis, synthesis, and evaluation). Learners master each level of recognition in order of difficulty. The affective domain includes changes in attitudes and the development of values. This situation does not demonstrate events of instruction or educational principles.

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

collaboration.Collaboration is achieved through a developmental process that occurs in a sequence, yet it is reciprocal between those involved. Teamwork and collaboration require extensive skill sets to achieve successful outcomes. No single professional has the expertise required in all aspects. It requires the synergy of all parties involved. The goal of communication in the collaborative development process is to promote respect for, understanding of, and the accuracy of all team members' points of view. Cooperation is the ability to understand and meet the needs of others. Negotiation generally occurs in a situation involving conflict.

A nurse in community health contacts three individuals who have had sexual encounters with an individual recently diagnosed with syphilis. The concept basic to community-oriented nursing practice that is best described by this intervention is: A.community. B.community as client. C.individual as client. D.partnership.

community as client. When the community is the client, the results of nursing interventions should produce changes that affect the community as a whole, such as reducing the spread of sexually transmitted diseases (STDs). Although the nurse may work with individuals, families or other interacting groups, aggregates, institutions, or communities, or within a population, the resulting changes are intended to affect the whole community. The community health nurse is not providing care to an individual in this circumstance. It would be ideal if there were some form of partnership in this intervention.

A nurse in community health seeks a low-cost evaluation method to learn the perspectives of the largest number of persons regarding a proposed local safe haven program for unwanted infants. The best evaluation method to meet the criteria would be: community forums. focus groups. key informants. surveys.

community forums.Community forums have the advantage of being low in cost and capturing the perspectives of a large number of persons. Focus groups and key informant methods limit the number of persons expressing their perspectives. Surveys are expensive and technically demanding.

A Hispanic outreach program works with the nurse in community health to train Hispanic health care workers in providing basic services and education within the local Hispanic community. The concept basic to community-oriented nursing practice that is best described by this intervention is: A.community. B.community client. C.community health. D.community partnerships.

community partnerships. Community partnership is necessary because when there is community partnership lay community members have a vested interest in the success of efforts to improve the health of their community. Most changes must aim at improving community health through active partnerships between community residents and health workers from a variety of disciplines. Partnership, as defined here, is a concept that is as essential for nurses to know and use as are the concepts of community, community as client, and community health.

Migrant workers and their families who reside in a specific mobile home park during the summer months would best be classified as a: A.community. B.group. C.setting of practice. D.target population.

community.In most definitions the concept of community includes people, place/time, and function. Nurses in community health practice regularly need to examine how the personal, geographic, and functional dimensions of community shape their nursing practice with individuals, families, and groups. They can use both a conceptual definition and a set of indicators for the concept of community in their practice. The community is first the setting for practice for the nurse practicing health-promotion and disease-prevention interventions with individuals, families, and groups. Second, the community is the target of practice for the public health nurse whose practice is focused on the broader community rather than on individuals.

A government agency is conducting an audit of all active clients in the local hospice program to ensure that hospice criteria for care are being applied appropriately. The type of tool being used in this specific approach to quality assurance is: concurrent audit. outcome audit. retrospective audit. peer review.

concurrent audit. Staff/peer review processes are a specific approach to quality assurance that often use audit tools to determine quality of care. The concurrent audit is a process of audit that evaluates the quality of ongoing care by looking at the nursing process. A retrospective or outcome audit evaluates quality of care following the discharge of a client. Both audits are conducted in nursing peer review.

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

conduct medical record audits for quality assurance. Quality assurance audits are prime examples of formative program evaluation in health care delivery. The monitoring of program activities—such as hours of services, number of providers used, number of referrals made, and amount of money spent to meet the program objectives—provides an evaluation of the progress of the program. This type of evaluation is an example of formative evaluation of processes, which occurs on an ongoing basis while the program exists. Progress evaluation occurs primarily while implementing the program. The nurse who completes a daily or weekly log of clinical activities (e.g., number of clients seen in the clinic or visited at home, number of phone contacts, number of referrals made, number of community health-promotion activities) is contributing to progress evaluation of the nursing service.

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

contemporary family function. In contemporary times, the traditional functions of families have been modified and new functions added. One of the traditional family functions was to procreate to ensure the survival of the species. Many married couples are electing to be child-free rather than to reproduce.

One specific approach to quality assurance is the use of Total Quality Management (TQM). A district public health department uses this approach and gives much attention to ensuring that studies are used to improve processes, remove management by objectives, and promote self-improvement. The major TQM guideline that would summarize these efforts would be: create, publish, and distribute aims and purposes. create a strong customer-oriented philosophy that is process-driven. eliminate barriers to pride of work/performance. understand the purpose of inspection.

create a strong customer-oriented philosophy that is process-driven. TQM is a process-driven, customer-oriented management philosophy that includes leadership, teamwork, employee empowerment, individual responsibility, and continuous improvement of system processes to yield improved outcomes (Oakland, 2014). Under TQM, quality is defined as customer satisfaction. Quality assurance/quality improvement (QA/QI) is the promise or guarantee that certain standards of excellence are being met in the delivery of care.

A general approach to quality improvement where a qualified agent designates formal recognition to individuals or institutions that have met minimum standards of performance is best described as: accreditation. charter. credentialing. licensing.

credentialing. General approaches to quality improvement seek to protect the public by ensuring a level of competency among health care professionals. Examples are credentialing, licensure, accreditation, certification, charter, recognition, and academic degrees. Credentialing is defined as the formal recognition by which individuals or institutions are designated by a qualified agent as having met minimum standards of performance. Licensure is typically viewed as recognition that a person has met a minimal set of standards to practice.

The nurse who works in the community setting must ensure that the application of the best available evidence to improve practice is also: accessible and diverse. competent and compliant. culturally and financially appropriate. reasonable and deliverable in a timely fashion.

culturally and financially appropriate. Applied to nursing, evidence-based practice includes the best available evidence from a variety of sources, including research studies, evidence from nursing experience and expertise, and evidence from community leaders. Culturally and financially appropriate best practices need to be identified when working with communities instead of individuals. The use of evidence to determine the appropriate use of interventions that are culturally sensitive and cost effective is a must.

A breast cancer screening program screened 8000 women and discovered 35 women previously diagnosed with breast cancer and 20 women with no history of breast cancer diagnosed as a result of the screening. The prevalence proportion would reflect: current and past breast cancer events in this population of women. newly diagnosed cases of breast cancer in this population of women. past breast cancer events in this population of women. the population of women that had no evidence of breast cancer.

current and past breast cancer events in this population of women. The prevalence proportion is a measure of existing disease in a population at a particular time (i.e., the number of existing cases divided by the current population). A prevalence proportion is not an estimate of the risk of developing disease, because it is a function of both the rate at which new cases of the disease develop and how long those cases remain in the population. In this example, the prevalence of breast cancer in this population of women is a function of how many new cases develop and how long women live after the diagnosis of breast cancer.

While conducting a community health assessment, a nurse in community health meets with local religious leaders to understand the values, norms, perceived needs, and influence structures within the community. This process of data collection can best be described as: A.data gathering. B.data generation. C.data interpretation. D.problem identification.

data generation. Data generation in a community health assessment is the process of developing data that do not already exist through interaction with community members, individuals, families, and groups. This type of data includes community knowledge and beliefs, values, goals, perceived needs, norms, problem-solving processes, power, leadership, and influence structures. This activity parallels the assessment phase of the nursing process. Data gathering is the process of obtaining existing, readily available data. Data interpretation is conducted in the analysis phase. All of the steps will assist the nurse in problem identification.

Four months after the disaster of 9/11 at the Pentagon, a local EMS worker complained of extreme exhaustion. The veteran EMS worker also stated that the pace of work at the squad was too slow. The occupational health nurse that is assessing the EMS worker recognizes the symptoms of: A.anger. B.delayed stress reaction. C.inability to concentrate. D.insomnia.

delayed stress reaction. Delayed stress reactions, or those that occur once the disaster is over, include exhaustion and an inability to adjust to a slower pace at work or at home. Workers may be disappointed if family members and friends do not show sufficient interest in what they have been through and if coming back home, in general, does not live up to expectations. Also, they may feel frustration and conflict if their needs seem inconsistent with those of their family and coworkers or if they have left the disaster site thinking that so much more could have been done.

A particular chronic health problem that is a serious public health challenge and results in health complications that double medical costs is: A.stroke. B.hypertension. C.diabetes. D.cardiovascular disease.

diabetes. Diabetes is a serious public health challenge for the United States. According to the National Diabetes Statistics Report 2014, one out of every 11 people of the United States population have diabetes (CDC, 2014). People with diabetes are at a higher risk for serious health complication, such as: blindness, kidney failure, heart disease, stroke, and loss of toes, feet, or legs. Due to these health complications, medical costs are twice a high for people with diabetes as those without diabetes. At least 18 of the goals of Healthy People 2020 are related to diabetes.

Local officials have requested a program evaluation of a comprehensive teen sex education program offered in the local schools in preparation for potential budget discussions. A nurse in community health conducts a program evaluation and determines that the teen pregnancy rate has gradually declined over the years that the program has been in place. The community is measuring the program's: efficiency. progress. relevance. sustainability.

efficiency. A program evaluation may be able to determine whether a program provides better benefits at a lower cost than does a similar program or whether the benefits to the clients or number of clients served justifies the costs of the program. This is a measure of the efficiency of a program. A reduction in teen pregnancies can represent significant cost savings to the overall health of the community. The monitoring of program activities—such as hours of services, number of providers used, number of referrals made, and amount of money spent to meet the program objectives—provides an evaluation of the progress of the program. Evaluation of relevance is an important component of the initial planning phase. As money, providers, facilities, and supplies for delivering health care services are more closely monitored, the needs assessment done by the nurse will determine whether the program is needed. Sustainability is the continuation of a program when resources are adequate.

A major evaluation source for a nurse to use to determine the effectiveness of a teen driver safety program is: Centers for Disease Control and Prevention (CDC) reports. epidemiologic data. recent census data. voter registration records.

epidemiologic data. A major source of evaluation is epidemiologic data. Mortality and morbidity data measuring health and illness indicators are probably cited more frequently than any other single index for program evaluation. Incidence and prevalence are valuable indexes used to measure program effectiveness and impact, and these data are readily available on the Internet. Major sources of information for program evaluation are program clients, program records, and community indexes.

The nurse in community health defines goals and measurable objectives during the planning phase of a community health intervention. This also marks the beginning of the: A.evaluation phase. B.implementation phase. C.needs assessment. D.problem analysis.

evaluation phase. 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 accomplishment of objectives and the effects of the intervention activities have to be assessed. The nurse will evaluate whether the objectives were met and whether the intervention activities were effective.

Elderly clients should be assessed for signs of abuse. The illegal use of a person for another person's profit is known as: A.neglect. B.incompetence. C.exploitation. D.self-determination.

exploitation. Neglect refers to a lack of services that are necessary for the physical and mental health of an individual by the individual or a caregiver. Older persons can make independent choices with which others may disagree. Their right to self-determination can be taken from them if they are declared incompetent. Exploitation is the illegal or improper use of a person or their resources for another's profit or advantage. During the assessment process, nurses need to be aware of conflicts between injuries and explanation of cause, dependency issues between client and caregiver, and substance abuse by the caregiver.

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

family demographics. Family demographics is the study of the structure of families and households and the family-related events, such as marriage and divorce, that alter the structure through their number, timing, and sequencing. Nurses must be knowledgeable about family structures, functions, processes, and roles. In addition, nurses must be aware of and understand their own values and attitudes pertaining to their own families, as well as being open to different family structures and cultures.

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

fosters equal family and provider commitment to success. Building the interventions with family-identified problems and strengths allows for equal family and provider commitment to the solutions and ensures more successful interventions. The interactions between family members become the target for nursing interventions (e.g., the direct interactions between the parents, or the indirect interaction between the parents and the child). The systems approach to family always implies that when something happens to one family member, the other members of the family system are affected.

A business executive develops symptoms of the flu 1 day after returning by air from a cross-Atlantic business trip that ran for 2 consecutive stressful 10-hour days. This individual's development of flu symptoms illustrates the relationship between: host and agent. host, agent, and environment. risk and causality. morbidity and disease.

host, agent, and environment. Epidemiologists understand that disease results from complex relationships among causal agents, susceptible persons, and environmental factors. These three elements—agent, host, and environment—are called the epidemiologic triangle. Changes in one of the elements of the triangle can influence the occurrence of disease by decreasing or increasing a person's risk for disease. The associations between risk and causality, morbidity and disease do not demonstrate the relationship to the development of flu.

The nurse in community health is meeting with staff to systematically plan for a new outreach program. Doing so helps them to: assess the needs of potential outreach clients. recognize the special needs of vulnerable people in the area. identify how the problems of similar programs will not be repeated. identify the resources and activities that will help them meet their program objectives.

identify the resources and activities that will help them meet their program objectives. Systematic planning for meeting client needs assists in identifying the resources and activities that are needed to meet the objectives of client services. Today this type of planning is referred to as strategic planning and it involves the successful matching of client needs with specific provider strengths and competencies and agency resources.

The Omaha System is a client classification system developed by the Visiting Nurses Association of Omaha, Nebraska, that has the potential to improve the delivery of care by: improving the description of care. minimizing the assessment required. predicting the outcome. decreasing the communication needs.

improving the description of care. The Omaha System is a comprehensive method for evaluating client care. The components include a classification system for assessing and categorizing client problems, a database, a nursing problem list, and anticipated outcome criteria for the classified problems. It has the potential to improve the delivery of nursing care, documentation, and the descriptions of client care that will enhance nursing assessment, planning, implementation, and evaluation of client care and allow the collection of more pertinent client information (relevant, consistent, and measurable) for more effective and efficient nurse productivity and communication.

The recovery phase of a disaster can take a very long time. Nurses need to be aware that despite effective disaster preparedness and response efforts: A.environmental hazards are minimal. B.individuals must ultimately recover on their own. C.the government provides economic support. D.religious organizations must bear the burden of the community.

individuals must ultimately recover on their own. Recovery is about returning to the new normal with the goal of reaching a level of organization that is as near the level before the disaster as is possible. This is often the hardest part of the disaster. During the recovery period, all involved agencies pull together to restore the institutions and properly rebuild. In the end, all of the nurses and organizations in the world can only provide partnerships with the victims of disaster. Ultimately, it is up to the individuals to recover on their own.

The most common causes of preventable disease, disability, and death among children are: A.injuries and accidents. B.maintaining a healthful diet. C.physical activity. D.cardiovascular health.

injuries and accidents. Injuries and accidents are the most common causes of preventable disease, disability, and death among children. Unintentional injuries are any injuries sustained by accident such as falls, fires, drowning, suffocation, poisoning, sports, recreation, or motor vehicle accidents. Because of their size, growth and development, inexperience, and natural curiosity, children and teens are especially at risk for injury.

The Patient Self-Determination Act of 1990 requires that providers receiving Medicare and Medicaid funds give clients written information regarding: a.legal options for treatment choices in the event the person becomes incapacitated. B.patient rights. C.the cost of services. D.patient privacy.

legal options for treatment choices in the event the person becomes incapacitated. The Patient Self-Determination Act of 1990 (PL 103-43) requires that providers receiving Medicare and Medicaid funds give clients written information regarding their legal options for treatment choices if they become incapacitated. A routine discussion of advance medical directives can help ease the difficult discussions faced by health care professionals, family, and clients. The nurse can assist an individual to complete a values history instrument. These instruments ask questions about specific wishes regarding different medical situations.

Nurses often participate in field assessment teams during a disaster response. These assessments are crucial to best help: A.encourage good intentions of those giving aid. B.match available resources to the population's emergency needs. C.separate casualties and allocate treatment. D.provide compassion and dignity.

match available resources to the population's emergency needs. Assessment is a major nursing role during a disaster. The acute needs of populations in disaster turn the community assessment into rapid appraisal of a sector or region's population, social systems, and geophysical features. Elements of a rapid needs assessment include determining the magnitude of the incident, defining the specific health needs of the affected population, establishing priorities and objectives for action, identifying existing and potential public health problems, evaluating the capacity of the local response including resources and logistics, and determining the external resource needs for priority actions.

A nurse in community health has determined that there is a need for a program for teenage fathers who want to learn about child care. The next step in the program management process would be to: conduct a survey to determine how many children the fathers have. determine whether the fathers have benefited from this type of program before. meet with community members to form a planning body. provide the fathers with community resources.

meet with community members to form a planning body. The program management process is like the nursing process. Program management consists of assessing, planning, implementing, and evaluating a program. One is applied to a program, whereas the other is applied to clients. Following the assessment, planning for the program should occur.

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

monitor the health status, resources, and outcomes for an aggregate. Care management is an enduring process in which a care manager establishes systems and monitors the health status, resources, and outcomes for an aggregate or a targeted segment of the population or a group. Care management strategies include use management, critical paths, disease management, demand management, and case management.

One member of an older couple has just retired. This is considered a: A.developmental stage that will help the family with stress reduction. B.nonnormative event that will have psychological impact on the family. C.normative event and can increase the family's risk for illness. D.normative event and will have little effect on the family' well-being.

normative event and can increase the family's risk for illness. Life events can increase the risk for illness. Normative events are those that are generally expected to occur at a particular stage of development or the life span. If the event is normative, families may be able to identify needed resources, make plans to cope with the change, learn new skills, and prepare for the event and its consequences. This kind of anticipatory preparation can increase the family's coping ability and decrease stress and negative outcomes. However, when the event is nonnormative, or unexpected, families have little or no time to prepare and the outcome can be increased stress, crisis, or even dysfunction.

A multidisciplinary quality assurance team has reviewed an organization's stated philosophy and objectives and developed a conceptual model for appraisal that integrates peer review and client satisfaction. The quality assurance program component that should be addressed next would be: action. process. structure. outcome.

outcome. The components of a quality assurance program are structure, process, outcome, evaluation, interpretation, and action. Outcome is the most important ingredient of a program because it is the key to evaluation of providers and agencies by external agents.

A disease outbreak of severe acute respiratory syndrome has occurred and has spread over several countries outside the United States. This level of occurrence is said to be: A.hyperendemic. B.sporadic. C.epidemic. D.pandemic.

pandemic. Pandemic refers to the epidemic spread of the problem over several countries or continents (such as severe acute respiratory syndrome [SARS] outbreak). If a problem is considered hyperendemic, there is a persistently (usually) high number of cases. Sporadic problems are those with an irregular pattern with occasional cases found at irregular intervals. Epidemic means that the occurrence of a disease within an area is clearly in excess of expected levels (endemic) for a given time period.

An underlying current throughout the special population groups with health disparities is: A.poverty. B.aging. C.minority groups. D.children.

poverty. Health disparities present political implications and influence government actions. Certain groups have been recognized as experiencing health disparities and have become a priority for policy efforts. Poverty is a strong and underlying current throughout all of the special groups.

Clinical medicine and epidemiology differ from each other in the major aspect of: practice focus. health monitoring. determinants of health and disease. evaluation of interventions.

practice focus. Epidemiology is the study of populations to monitor the health of the population, understand the determinants of health and disease in communities, and investigate and evaluate interventions to prevent disease and maintain health. Epidemiology focuses on populations, whereas clinical medicine focuses on the diagnosis and treatment of disease in individuals. Epidemiology studies populations to determine the causes of health and disease in communities and to investigate and evaluate interventions that will prevent disease and maintain health. Epidemiologic methods are used extensively to determine to what extent the goals of Healthy People 2020 (US Department of Health and Human Services, 2010) have been met and to monitor the progress of those objectives not fully met at present.

One of the basic concepts in epidemiology is the concept of risk. Risk refers to the: prevalence of an event occurring. probability that an event will occur within a specified time period. population most likely to develop a disease. rate of development of new cases.

probability that an event will occur within a specified time period. Risk refers to the probability that an event will occur within a specified time period. A population at risk is the population of persons for whom there is some finite probability (even if small) of that event occurring. Incidence rates and proportions measure the rate of new case development in a population and provide an estimate of the risk of disease.

The general approach to quality improvement known as licensure that grants control over who can enter into and who exists in a profession can best be described as a contract between the: consumers and the profession. legislature and the state board. profession and the state. public and the professional associations.

profession and the state. Individual licensure is a contract between the profession and the state whereby the profession (i.e., State Board of Nursing) is granted control over who can enter into and who exists in the profession. It requires written regulations to define the scope and limits of the profession's practice.

A nurse educator who teaches at the local community college takes the time to read and understand her community's disaster plans and participates in community mock disasters as a leader of the triage team. The best description of the nurse's activities would be: A.ARC disaster training. B.community preparedness. C.personal preparedness. D.professional preparedness.

professional preparedness. The nurse who is professionally prepared is aware of and understands the disaster plans at the workplace and in the community. Adequately prepared nurses can serve as leaders and assist others to have a smoother recovery phase.

Nursing interventions and approaches for helping individuals and families to assume an active role in their care should focus on empowerment rather than on enabling. The underlying principle to empowerment is: A.client dominance. B.decreased competence. C.professional dominance. D.professional-client partnership.

professional-client partnership. Empowerment's underlying assumption is one of partnership between the professional and the client, as opposed to one in which the professional is dominant. Families are assumed to be either competent or capable of becoming competent. For families to become active participants, they need to feel a sense of personal competence and a desire for and willingness to take action.

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

promoter. The nurse advocate makes the client's rights the priority. The goal of promoter for the client's autonomy and self-determination may result in a high degree of client independence in decision making. Mediation is an activity in which a third party attempts to provide assistance to those who may be experiencing a conflict in obtaining what they desire. The nurse advocate does not exhibit roles of intercessor or obstructer in this situation.

A state health department wants to ensure that the local health departments are delivering quality client care and can demonstrate the degree of excellence attained. The principle that is best defined by this statement is: continuous quality improvement (CQI). quality assurance (QA). risk management. total quality management (TQM).

quality assurance (QA). The goals of QA and QI are on a continuum of quality, and in public health they are: (1) to continuously improve the timeliness, effectiveness, safety, and responsiveness of programs, and (2) to optimize internal resources to improve the health of the community. Under a continuous quality improvement (CQI) philosophy, QA and QI are but two of the many approaches used to ensure that the health care agency fulfills what the client thinks are the requirements for the service. QA focuses on finding what providers have done wrong in the past (e.g., deviations from a standard of care found through a chart audit). CQI operates at a higher level on the quality continuum but requires the commitment of more organization resources to move in a positive direction. TQM is a process-driven, customer-oriented management philosophy that includes leadership, teamwork, employee empowerment, individual responsibility, and continuous improvement of system processes to yield improved outcomes.

The gold standard of evidence gathering in evidence-based practice is: clinical knowledge and judgment. expert opinions. randomized clinical trials. theories of practice.

randomized clinical trials. A hierarchy of evidence, ranked in order of decreasing importance and use, has been accepted by many health professionals. The double-blind randomized controlled trial (RCT) generally ranks as the highest level of evidence. Some nurses would argue that this hierarchy ignores evidence gained from clinical experience. However, the definition of evidence-based nursing presented above indicates that clinical expertise as evidence, when used with other types of evidence, is used to make clinical decisions.

One reason that nursing may be slow in developing evidence-based practice (EBP) in the community setting may be the lack of understanding about the links between EBP and: evidence gathering. research design. research funding. research use.

research use. EBP represents a cultural change in practice. It provides an environment to improve both nursing practice and client outcomes. Several factors have been identified in the literature that support implementation of EBP or that will need to be overcome for nursing and other disciplines to successfully implement EBP. These factors include knowledge of research and current evidence and the ability to interpret evidence, among other factors. Gathering of evidence, research design, and funding are not associated with the slower development of EBP for nursing.

The purpose of recordkeeping in public health agencies is to maintain complete information on clients served and the extent and quality of service provided to those clients. The records also provide information for education and research. Another important use of the records is to: determine raises for personnel. explain cost overruns. foster independence in clinical practice. resolve legal issues in malpractice suits.

resolve legal issues in malpractice suits. Records are an important part of the communication structure of the health care organization. Accurate and complete records are required by law and must be kept by all agencies, both governmental and nongovernmental. In most states, the state departments of health stipulate the kinds of records to be kept and their content requirements for community agencies. Records provide complete information about the client (whether a family, group, population, or community), indicate the extent and quality of the services being given, resolve legal issues in malpractice suits, and provide information for education and research.

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

responsible for providing/managing the care of their members. Health care decisions are made within the family, the basic social unit of society. Families are responsible for providing and managing the care of family members. Families are significant members of health care teams because they are an ever-present force over the lifetime of care. Families are more responsible than ever for assisting in the health care of ill family members.

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

secondary prevention. Primary prevention refers to interventions that promote health and prevent the occurrence of disease, injury, or disability. Interventions at this level are aimed at individuals and groups who are susceptible to disease but have no discernable pathology (state of prepathogenesis). In this case, the client has already has asthma, so the nurse teaches the client to recognize and avoid exposure to asthma triggers. This is an example of secondary prevention. Health screenings are at the core of secondary prevention. Tertiary prevention includes interventions aimed at limiting disability and interventions that enhance rehabilitation from disease, injury, or disability. Assessment is a component of epidemiology.

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

sensitivity. Validity of a screening test is measured by sensitivity and specificity. Sensitivity quantifies how accurately the test identifies those with the condition or trait. Sensitivity represents the proportion of persons with the disease whom the test correctly identifies as positive (true positives). High sensitivity is needed when early treatment is important and when identification of every case is important. Reliability is the consistency of repeating a measure and is affected by variation in results. Specificity indicates how accurately the test identifies those without the condition or trait.

A nurse in community health decides to form a contract with a family. The contract states that the family will designate one night as a family night. The nurse is most likely using the contract to: A.make sure the family does what is expected. B.encourage the family to put plans in writing. C.let the family know that this is a legal agreement. D.shift the responsibility so that it becomes a shared effort.

shift the responsibility so that it becomes a shared effort. Contracting involves a shift in responsibility and control toward a shared effort by the client and professional as opposed to an effort by the professional alone. The premise of contracting is family control. It is assumed that when the family has legitimate control, its ability to make healthful choices is increased. Contracting is a strategy aimed at formally involving the family in the nursing process and jointly defining the roles of both the family members and the health professional.

The school nurse is interested in providing an anti-smoking program in a local middle school and is aware that programs are more effective for this age group when they focus on short-term versus long-term effects of smoking. Besides including health risks and cosmetic effects, the nurse should also consider: A.behavior modification techniques. B.effects on the environment. C.laws regarding tobacco sales to minors. D.social skills instruction to resist pressure to smoke.

social skills instruction to resist pressure to smoke. Anti-smoking programs directed toward children and teenagers are more successful if the focus is on short-term effects rather than long-term effects. Developmentally, children and teenagers cannot visualize the future to imagine the consequences of smoking. Teaching should include how advertising puts pressure on people to smoke.

The nurse in community health reviews the monthly and year-to-date health service use report for the local community to monitor trends as correlates of the community's health. The nurse is viewing community health through the dimension of: partnership. process. status. structure.

structure. Community health has three dimensions: status, structure, and process. Measures of community health services and resources include service use patterns, treatment data, and provider-to-client ratios. Community health in terms of status, or outcome, is the most well-known and accepted approach; it involves biological, emotional, and social parts. The view of community health as the process of effective community functioning or problem solving is well established. In population-centered practice, the nurse and community seek healthful change together.

A nurse in community health becomes aware that a teen smoking cessation program offered at the health department is a demonstration project. In evaluating this program, the nurse would be concerned with the program's: efficiency. impact. relevance. sustainability.

sustainability. A program can be continued if there are resources for it. Programs funded as a demonstration project or through outside sources require ongoing funding to survive after the initial funding or time frame for the demonstration project has ended. If the reason for the evaluation is to examine the efficiency of a program, it may occur on an ongoing basis as a formative evaluation. If the evaluation of impact is the goal, long-term effects such as changes in morbidity and mortality must be investigated. Evaluation of relevance is an important component of the initial planning phase. As money, providers, facilities, and supplies for delivering health care services are more closely monitored, the needs assessment done by the nurse will determine whether the program is needed.

Given recent vaccine shortages for the flu, the local nurses in community health form a group to evaluate the process of scheduling and operating flu vaccination clinics in the community and review the community's complaints from the previous season. The activity best represents the principle of: total quality management (TQM) to achieve continuous quality improvement (CQI). quality assurance (QA) to achieve continuous quality improvement (CQI). risk management to achieve quality. continuous quality improvement (CQI) to achieve total quality management (TQM).

total quality management (TQM) to achieve continuous quality improvement (CQI). Total quality management provides direction for managing a system of care, whereas continuous quality improvement using quality assurance and quality improvement focuses on the care a client receives within the system. TQM is a process-driven, customer-oriented management philosophy that includes leadership, teamwork, employee empowerment, individual responsibility, and continuous improvement of system processes to yield improved outcomes. CQI focuses on the sources of differences in the ongoing process of health care delivery and seeks to improve the process. Risk management focuses on reducing financial risk.

A nurse in community health is conducting a parenting class for prospective parents that will focus on the development of new skills, identification of needed resources, planning, and other preparations for the arrival of a newborn. This intervention is addressing a potential risk associated with: A.biology. B.behavior. C.environment. D.transitions.

transitions. Transitions, or the movement from one stage or condition to another, are times of potential risk for families. Age-related or life event risks often occur during transitions from one developmental stage to another. They require families to learn new skills; change behaviors, schedules, or patterns of communication; identify needed resources; and make plans.

Twenty people attended a church picnic the previous weekend. By Monday, four individuals exhibited symptoms of food poisoning. On Tuesday, the nurse in community health records the addition of two new cases. The incidence rate would be: two new cases divided by 16 at risk. two new cases divided by 20. six cases divided by 20. four cases divided by 16.

two new cases divided by 16 at risk. An incidence rate quantifies the rate of development of new cases in a population at risk, whereas an incidence proportion indicates the proportion of the population at risk that experiences the event over some period of time (Rothman, 2012). The population at risk is considered to be persons without the event or outcome of interest but who are at risk of experiencing it. People who already have the disease or outcome of interest are excluded from the population at risk for this calculation because they already have the condition and are no longer at risk of developing it.

The major factor that has increased the danger of natural disasters is: A.El Niño. B.geography. C.trade winds. D.urbanization.

urbanization. The urbanizing and the overcrowding of cities have increased the danger from natural disasters because communities have been built in areas that are vulnerable to disasters, such as in known hurricane, flood, and tornado zones. Increases in population and developing for habitation of areas vulnerable to natural disasters have led to major increases in insurance payouts in the United States in every decade. Projections suggest that by 2050, at least 46% of the world's population will live in areas vulnerable to natural floods, earthquakes, and severe storms.

To maintain effective disaster preparedness, nurses working in the community can play a critical role in providing an updated record of: A.immunizations. B.active tuberculosis (TB) cases. C.WIC enrollees. D.vulnerable populations.

vulnerable populations.When calamity strikes, disaster workers must know what kinds of populations they are attempting to assist. Accurate information regarding the location of a retirement village, nursing home, childcare center, rehabilitation center, individuals cared for in the home who are dependent on critical medical equipment, or locations with special populations is crucial.

Two nurses in community health schedule a day to ride through a low-income community to better understand the community and what factors affect the health of that community. This direct data collection method is often referred to as: A.composite database. B.participant observation. C.secondary analysis. D.windshield survey.

windshield survey. Five useful methods of data collection are informant interviews, participation observation, windshield survey, secondary analysis of existing data, and surveys. Windshield surveys are the motorized equivalent of simple observation. While driving a car or riding public transportation, the nurse can observe many dimensions of a community's life and environment through the windshield. A basic method is participant observation, the deliberate sharing, if conditions permit, in the life of a community. In secondary analysis, the nurse uses previously gathered data, such as minutes from community meetings.