Publi Health Unit 1 NU 485 - Chapter quizzes

1. The minimum requirements for entry into home care practice should be:

A baccalaureate degree in nursing should be the minimum requirement for entry into professional practice in any community health setting, including home care.

1. The Omaha System was initially designed to address the concerns of nurses practicing in the community in the following areas: (Select all that apply.) a. Documentation b. Information management c. Nursing practice d. Telehealth e. Specialty certification

ANS: A, B, C The Omaha System was initially developed to operationalize the nursing process and provide a practical, easily understood, computer-compatible guide for daily use in community settings and is the only American Nurses Association (ANA)-recognized terminology developed inductively by and for nurses who practice in the community.

1. In the middle of the nineteenth century, there was increased national interest in addressing public health problems and improving urban living conditions. Which of the recommendations of the Shattuck Report in Massachusetts represented major innovations in public health during that period? (Select all that apply.) a. Establishment of state health departments and local health boards in every town b. Promotion of environmental sanitation and collection of vital statistics c. Steps to decrease preventable disease and control smoking and alcohol use d. Targeting of efforts solely on environmental hazards e. Provision of supplemental food to low-income persons

ANS: A, B, C The report published in 1850 by the Massachusetts Sanitary Commission called for major innovations, including establishment of a public health infrastructure; environmental sanitation; food, drug, and disease control; well-child care; health education; tobacco and alcohol control; urban planning; and preventive medicine education in medical training programs. This moved public health away from solely targeting environmental hazards to addressing communicable disease, which lay the foundation for an expanded public health role that included the use of PHNs.

2. The ANA Standards of Home Health Nursing Practice is composed of two parts: Standards of Care, which follow the six steps of the nursing process, and Standards of Professional Performance, which include which of the following? (Select all that apply.) a. Quality of care b. Performance appraisal c. Collegiality d. Outcome identification e. Resource use

ANS: A, B, C, E The ANA scope and standards publications, including those for Home Health Nursing and Palliative Nursing, are organized according to the nursing process and contain two sections: the Standards of Care and the Standards of Professional Performance. Both include the six steps of the nursing process: assessment, diagnosis, outcomes identification, planning, implementation, and evaluation; the steps are linked to standards and more specific measurement criteria that are stated in behavioral objectives. The standards address quality of care, performance appraisal, critical thinking skills, education, collegiality, ethics, collaboration, research, and resource use.

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

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

3. The early pioneers in public health nursing were instrumental in the founding of the National Organization for Public Health Nursing (NOPHN) in 1912. This organization served as the dominant force in public health nursing until 1952 and sought to standardize public health nursing education to ensure that nurses received more than hospital-oriented training. Other major accomplishments included what initiatives? (Select all that apply.) a. Collaborated to secure health insurance reimbursement for nursing services, such as postdischarge nursing care at home b. Established public health nursing programs for military outposts in World War I c. Provided matching funds to establish maternal and child health divisions in state health departments d. Responded to the 1918 worldwide influenza pandemic in the United States e. Supported nurse employment through increased grants-in-aid for state programs of home medical care

ANS: A, B, D The NOPHN is credited with upgrading the profession of public health nursing and community-oriented practice through the advancement of an educational model that ensured university-based education in the principles of population-based care; with assisting the U.S. Public Health Service in the development of public health nursing programs for military outposts during World War I in collaboration with the American Red Cross; and with responding to the 1918 worldwide influenza pandemic in the United States by preparing volunteers to care for clients in the community when public health nursing personnel ranks at home were depleted because of the war effort in Europe. The Sheppard-Towner Act of 1921 provided federal matching funds to establish maternal and child health divisions in state health departments. The Federal Emergency Relief Administration supported nurse employment during the 1930s by increasing grants-in-aid for state programs of home medical care.

1. The National Association of School Nurses (NASN) and standards of practice for school nurses set forth which of the following principles? (Select all that apply.) a. School nurses should have a bachelor's degree in nursing and a specialty certification. b. School nursing uses the nursing process. c. Credentialing is recommended but not required. d. American Academy of Pediatrics governs the school nurse's practice. e. School nurses must ensure the safety of the children, including when delegating care.

ANS: A, B, E In reality, the educational preparation of school nurses ranges from associate to master's degrees. However, the NASN, the professional organization for school nurses, recommends that school nurses be registered nurses with a bachelor's degree in nursing and specialty certification as a school nurse. The NASN identifies eight criteria for schools nurses in providing care. One of these criteria is ensuring the safety of the children, including when delegating care. The American Academy of Pediatrics is a physician organization that does not have regulatory power over nursing but has developed guidelines for providing health care to students in schools that compare well with the NASN standards of practice.

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

ANS: A, B, E In the 1890s, the public was interested in limiting disease among all classes of people, partly for religious reasons, partly for charitable reasons, but also because the middle and upper classes were afraid of the diseases that seemed to be brought in by the large communities of European immigrants. Nurses began to establish settlement houses and neighborhood centers, which became hubs for health care and social welfare programs. From the beginning, community health nursing practice included teaching and prevention. Community-oriented interventions led to better sanitation, economic improvements, and better nutrition. These interventions were credited with reducing the incidence of acute communicable diseases. Pioneers in public health nursing like Lillian Wald took advantage of the public's concern and existing practice models to address health care and social problems, which reduced the incidence of acute communicable diseases in immigrant communities.

4. In designing a tertiary prevention intervention to address the leading cause of school absences related to chronic illness, the school nurse should focus on:

ANS: Asthma is the leading cause of children's absence from school as a result of a chronic illness. Children may be hospitalized with an asthma attack or have been recently discharged from the hospital to home. Asthma may be caused by allergic triggers with which the child comes into contact in the school, such as chalk dust, mold/mildew, or pet dander. There may also be concerns about the air quality in the school or specific classroom activities. The nurse can help students with asthma through medication administration, coaching in asthma management, and education of the student, teachers, other children, and parents.

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

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

2. From August through May, an inner city school district provides primary health care services, including mental health and dental care, to children and youth. This is a specific example of which of the following?

ANS: Because many children may not receive health care services other than screening and first aid care from the school nurse, the federal government began funding school-based health centers. School-based health centers are family-centered, community-based clinics run within schools. These clinics provide expanded health services, including mental health and dental care, as well as the more traditional health care services like primary care. They can be small or large and may provide services during the school year, during certain hours throughout the year, or 24/7 all year.

8. Since 1987, the Centers for Disease Control and Prevention (CDC) has funded the federal school health program, which today provides for:

ANS: The federal school health program, an eight-part plan originally developed in 1987 with coordination and funding by the CDC, has led to the development of a comprehensive school health education program that includes the parents and the community in the children's care. By 2001, 20 states had school health programs funded by the CDC. The funding paid for the development of health education plans of study, or curricula that included policies, guidelines, and training for those programs. The states then used these courses to teach schoolchildren. The schools are actively involved in helping children practice problem solving, communication, and other life skills so they can reduce their risk factors.

5. The increased use of telehealth in the school system will be driven largely by:

ANS: The future of school nursing is strong. The amount of health care being given in the schools is increasing. In the future, school nursing will involve telehealth and telecounseling to teach health education. The internet will be used by school nurses to work with children and parents. Teleclinics operated out of the schools will be seen more frequently.

6. A middle school student approaches the school nurse and says, "Can I talk to you about something important?" The school nurse responds affirmatively but should clarify:

ANS: The school nurse may be the person whom children trust to be told important secrets about health. It is important that, as a counselor, the school nurse have a reputation as a trustworthy person to whom children can go when they are in trouble or when they need someone to talk to. Nurses in this situation should tell children that if anything they reveal indicates that they are in danger, the parents, and school officials must be told. However, privacy and confidentiality, as in all health care, are important.

1. The case manager role of the school nurse can best be described as:

ANS: The school nurse's case manager role is to help coordinate the health care of children with complex health problems to ensure that students' health care appointments and visits have the minimum possible negative impact on their educational experience.

3. In designing a substance abuse primary prevention education program for the secondary schools in the community, it would be most important for the school nurse to include content related to the latest trend in the use of:

ANS: There has been an increase in the use of "club drugs" such as lysergic acid (LSD), ketamine, gamma hydroxybutyrate (GHB), Rohypnol, and ecstasy (MDMA). The school nurse can teach students about the serious side effects of ecstasy, especially that it causes a very high body temperature, which can lead to death. Teaching students about the dangers of using all drugs is the responsibility of the school nurse. The school nurse can also teach parents and other members of the community about the latest drug use trends, increasing everyone's awareness of these dangerous trends.

9. The Child Nutrition and WIC (Women, Infants, and Children) Reauthorization Act of 2004 designates that each local education agency participating in federal school meal programs have:

ANS: To address obesity and to promote healthy eating and physical activity through changes in school environments, Congress passed the Child Nutrition and WIC Reauthorization Act of 2004 designating that each local education agency (LEA) participating in federal school meal programs, such as the National School Lunch or Breakfast Program, must establish a local school wellness policy.

7. The school nurse plans a health education program on diet and nutrition for adults attending a general equivalency degree (GED) program held at the local high school in the evenings. This best exemplifies which role of the school nurse?

ANS: When performing community outreach, school nurses can participate in community health fairs in the schools, influenza immunization programs, and blood pressure screenings for school staff, among other things. The school nurse can also serve as the liaison for coordinating educational programs in the schools provided by local health charities. School nurses also provide health education to adult learning centers that conduct GED programs, job training, or instruction in English as a second language.

3. A PHN in the local health department assists the community in identifying the health need priorities and the services that can best meet these needs in a cost-effective manner. This is an example of the tertiary prevention public health nursing function of:

Case management is a major tertiary prevention function for PHNs at the community level of practice. Case managers assist clients in identifying the services they need the most at the least cost. They also assist communities and populations in identifying services that will improve the overall community health status.

7. The PHN ensures that a local community coalition for improving school lunches takes the time to listen to each stakeholder's view, develops a common validated language for discussing the initiative, and shares the credit for the success of the initiative. The PHN is adhering to the principles of:

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

8. The federal-state-local partnership teams with other organizations to develop and implement responses to identified public health concerns because:

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

6. If the two major goals of Healthy People 2020 are to be achieved, collaboration is essential for public health nursing practice, and collaboration with existing groups at the local level is encouraged for which of the following reasons?

Public health departments do not have the resources to accomplish these goals independently

9. The PHN applies knowledge in working with a local school board coalition to develop a helmet safety campaign in the middle and high schools. This best exemplifies which aspect of public health?

The core public health competencies are divided into eight domains: analytical assessment skills, basic public health science skills, cultural competency skills, communication skills, community dimensions of practice skills, financial planning and management skills, leadership and systems thinking skills, and policy development/program planning skills. This example demonstrates such competencies as analytical assessment, communication, leadership, and policy skills.

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

a. assessment.

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

a. assurance.

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

a. clinical community health practice.

7. A nurse planning a smoking cessation clinic for adolescents in the local middle schools and high schools is providing:

a. community-oriented care.

6. During the Depression of the 1930s, many federal agencies attempted to support the employment of basic nurses by increasing the demand for existing and new nursing services that meet the needs of the increasing ranks of impoverished individuals. Although this facilitated rapid program expansion for recipient public health agencies and gave many nurses a taste of public health, the specialty of public health nursing was negatively affected by:

a. decrease in focus on the community as the unit of service.

1. Public health nurses (PHNs) are challenged to respond to public health-related trends of the twenty-first century, which include:

a. racial, ethnic, and economic health disparities; rise of drug-resistant pathogens; unequal access to health care; and violence.

3. To promote quality improvement, the documented plan of care for an elderly home care patient should include which of the following?

b. Expected patient outcomes for each identified problem or diagnosis

9. Nurses should consider opportunities for population-focused practice that result from the rapid transformation of health care delivery from a medical model to a health promotion/disease prevention model. An example of such opportunity is:

b. director of clinical services spanning inpatient and community-based settings that provide a wide range of services to the populations seen by the system.

5. The PHN serves as a bridge between at-risk populations and the community's health care resources. This role is based on the nurse's responsibility to:

b. ensure that all populations have access to affordable, quality health care.

2. The most important contribution made by Florence Nightingale to community-oriented nursing was:

b. expansion of the role of nursing to include health-promotion practices.

1. In 1925, Mary Breckenridge established the Frontier Nursing Service (FNS) based on a system of care used in the highlands and islands of Scotland. Changes in public support for community and public health nursing and away from individual commitment and private financial support led to innovations in health care delivery in the twentieth century, especially for underserved populations. One of Breckenridge's innovative contributions to health care in the United States was:

b. introduction of the first nurse-midwifery training.

7. The Association of Community Health Nurse Educators has called for increased graduate programs to educate PHN leaders, educators, and researchers in such areas as:

b. natural and human-made disasters.

3. The Social Security Act of 1935 was designed to prevent the reoccurrence of the problems of the depression. Title VI of this act provided funding for expanded opportunities for health protection and promotion. The most relevant strategy related to this objective for public health nursing was:

b. provision of funding to support employment and education.

4. Hospice care would be an appropriate option to discuss with which of the following patients?

c. Patient with metastatic breast cancer who has discontinued chemotherapy and radiation treatment--The criterion for entry into hospice care is that the disease process or condition has progressed to the point that further treatment cannot cure and death within 6 months would not be unexpected.

5. The shift of home care away from its charitable and public health-oriented roots toward current models in use can be attributed to:

c. integration of home care into benefit programs.

6. Medicare regulations, professional organizations, and state licensing boards dictate the responsibilities and functions of health professionals in providing home care, and a variety of specialized services can be included in home care either through direct care service, staff education, or consultation. Because of this need for various knowledge, skills, and perspectives, successful functioning in the provision of services requires:

c. interprofessional teams.

7. In home health care, the use of performance improvement programs, evidence-based practice guidelines, and appropriate communication, documentation, and telehealth technologies are strategies to address the issue of:

c. malpractice risk reduction.

4. State public health agency responsibilities include:

c. monitoring health status.

5. From a historical perspective, the post-Depression shift in the U.S. Congress to the practice of categorical funding that provides federal money for priority diseases or groups has to this day produced a negative effect on the delivery of health care services that can best be described as:

c. national preference service model that neglects emerging problems.

2. A registered nurse is seeking a position as a public health nurse. In reviewing the job description, the nurse would expect to find a description of a position that focused on functions such as:

c. partnering with local seasonal farmworkers to design a program aimed at preventing illness and injury, and advocating for this population with local political and community leaders.

4. The role and goals of the community health nursing practice can best be described as:

c. population-level strategies aimed at promoting, preserving, and maintaining the health of populations through the delivery of personal health care services to individuals, families, and groups in an effort to improve the health of the community as a whole.

4. In 1902, Lillian Wald introduced the concept of school nursing to address the problem of school absenteeism. The primary model for the school nurse program was to work with children in the schools and make home visits for the purpose of:

c. providing and obtaining medical treatment for absent students.

2. Rapid changes in public health are providing a challenge to PHNs because there is neither time nor staff to provide nurses with the on-the-job training needed to acquire the core public health competencies required of the PHN. This resulted in revisions to the American Nurses Association (ANA)'s Scope and Standards of Public Health Nursing Practice in 2005 that established:

c. standards for baccalaureate- and master's-prepared PHNs.

8. The incentives and pressures for cost control and improved health outcomes have promoted the development of technologies that are simpler, more reliable, and:

d. efficient.

3. A public health nurse leader is encountering barriers when trying to shift the public health agency's efforts to a population-focused practice. The reasons peers are not supportive of the proposed shift to a population focus are most likely related to:

d. opinions that nursing should focus on the provision of direct client care and services.

2. A home health nurse is charged with identifying opportunities for health promotion and illness primary prevention. The activity that bests demonstrate this focus is:

d. tracking the immunization status of patients.

1. In 1988, the Institute of Medicine (IOM) published a report on the future of public health and its mission that defined public health as:

d. what society does collectively to ensure the conditions in which people can be healthy.