Ch. 16: Program Management, Chapter 16: Program Management, NURS 450 - Ch. 21

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: A. community forums. B. focus groups. C. key informants. D. surveys.

A. community forums.

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

A. community indicators. C. program clients. E. program records.

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

A. conduct medical record audits for quality assurance.

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: A. efficiency. B. progress. C. relevance. D. sustainability.

A. efficiency.

1. Which of the following best describes the steps in program management? A. Assess, plan, implement, evaluate B. Identify, initiate, implement C. Organize, operationalize, mobilize, subsidize D. Substantiate, negotiate, evaluate

ANS: A Assess, plan, implement, evaluate The program management process is similar to the nursing process. Program management consists of assessing, planning, implementing, and evaluating a program. DIF: Cognitive Level: Remember (Knowledge) REF: pp. 276-277

9. A nurse is planning a program to teach cardiac health at the senior citizens center. Which of the following is an effectively written objective for the program? A. By the end of the program each participant will report walking at least 30 minutes a day at least 5 days each week. B. By the end of the program each participant will voice a commitment to walk at least 30 minutes a day. C. By the end of the program each participant will understand the need for physical exercise. D. Each participant will voice a commitment to engage in physical exercise each day.

ANS: A By the end of the program each participant will report walking at least 30 minutes a day at least 5 days each week. Useful program objectives must include a statement of the specific behaviors desired, using an action verb that can be seen and measured. Voicing a commitment is not an outcome action; it is only a verbal agreement. The verb understand is not an action verb that can be seen and measured. Only "will report walking 30 minutes a day at least 5 days each week" has a specific outcome action that can be seen and measured. DIF: Cognitive Level: Apply (Application) REF: p. 283

18. A nurse is conducting program evaluation. Which of the following would be the first action the nurse would take? A. Choose the type of evaluation to be done B. Determine who will be involved in the evaluation C. Identify the goal and objectives for the evaluation D. Obtain answers to specific questions related to the program being evaluated

ANS: A Choose the type of evaluation to be done To do a program evaluation, first choose the type of evaluation you wish to do. Second, identify the goal and objectives for evaluation. Third, decide who will be involved in the evaluation. Fourth, answer the questions related to the type of evaluation. DIF: Cognitive Level: Apply (Application) REF: p. 285

20. Which of the following are elements of the MAPP (Mobilizing for Action Through Planning and Partnership) Program Planning Model? (Select all that apply.) A. Generate shared visions and common values B. Assess priorities in health problems C. Develop a framework for long-range planning D. Choose health priorities

ANS: A, C A. Generate shared visions and common values C. Develop a framework for long-range planning The elements of MAPP include: mobilizing community members and organizations, generating shared visions and common values, developing a framework for long-range planning, conducting needs assessments in four areas: community strengths, local public health system, community health status, and focus of change, and implementing the plan. Assessing priorities in health problems and choosing health priorities are part of other program planning models. DIF: Cognitive Level: Remember (Knowledge) REF: p. 281

7. A community is examining which programs are needed within the community, the populations they will target, and how they will be funded. Which of the following would be the least risky decision for the community to make? A. Choose whichever option is the least expensive of agency resources B. Choose to do nothing C. Choose whatever the agency administration prefers D. Choose whatever the majority of clients prefer

ANS: B Choose to do nothing The need and demand for a program are determined by working with the client. This stage of planning creates options for solving the problem and considers several solutions. Each option for program solution is examined for its uncertainties (risks) and consequences. A "do nothing" decision is always the decision with the least risk to the provider. DIF: Cognitive Level: Apply (Application) REF: p. 279

16. A committee of health care professionals would like to establish a countywide program to improve Hispanic immigrant access to culturally competent health care services. Which of the following persons would be most helpful as a key informant? A. Hospital administrator B. Hispanic community leader C. National expert on cultural competency D. Politician or county official

ANS: B Hispanic community leader Key informants are leaders in the community who are knowledgeable about community needs. In this scenario, the Hispanic leader most likely knows more about the needs of the Hispanic community than the others listed. DIF: Cognitive Level: Apply (Application) REF: p. 280

12. Evaluation is underway for a statewide program to decrease teen injury and death associated with teens who drive while under the influence of alcohol. Which of the following questions would best be used for the summative evaluation of the program? A. Are program participants continuing to attend the programs, and do their satisfaction scores indicate that they are pleased with the program? B. How do statistics for injuries and deaths associated with drunk driving compare for teens in the year following the program? C. How does the amount of alcohol intake by teens compare before and after participants enter into the program? D. What problems are identified as the program is implemented?

ANS: B How do statistics for injuries and deaths associated with drunk driving compare for teens in the year following the program? Summative evaluation is evaluation to assess program outcomes or as a follow-up of the results of the program activities. Two of the options are examples of questions used for formative evaluation. The goal is addressed in the question about statistics; however, the goal was not to decrease drinking of alcohol but to decrease driving when drinking alcohol. DIF: Cognitive Level: Analyze (Analysis) REF: p. 277

4. Which would be an appropriate descriptor that meets all criteria for defining a client to be served by a program? A. All women ages 40 to 50 who have not had a menstrual period for 3 consecutive months B. Immigrants residing in Central County for less than 5 years who have difficulty understanding care instructions because of limited English proficiency C. Pregnant women who have received nutritional counseling but whose nutritional status did not improve D. Children ages 18 months to 5 years old who have been treated for nutritional deficiencies at the Central County Clinic

ANS: B Immigrants residing in Central County for less than 5 years who have difficulty understanding care instructions because of limited English proficiency The client should be defined by biological and psychosocial characteristics, by geographical location, and by the problems to be addressed. For example, in a community with a large number of preschool children who require immunizations to enter school, the client population may be described as all children between 4 and 6 years of age residing in Central County who have not had up-to-date immunizations. This example tells the reader who the client is, what the need is, how large the population is, and where they are located. DIF: Cognitive Level: Analyze (Analysis) REF: pp. 277-278

19. Which of the following programs demonstrates the use of tertiary prevention? A. Developing an in-school clinic that provides birth control counseling and contraception B. Providing a diabetes management program for persons with diabetes mellitus C. Providing cardiovascular fitness evaluations at annual health fairs D. Setting up free blood pressure screenings at popular department stores and supermarkets

ANS: B Providing a diabetes management program for persons with diabetes mellitus The aim of tertiary prevention programs is to reduce complications from disease. Developing an in-school clinic is a primary prevention (pregnancy has not occurred). Fitness evaluations at health fairs and blood pressure screenings are secondary prevention programs (screening identifies conditions early and determines incidence/prevalence). DIF: Cognitive Level: Analyze (Analysis) REF: p. 284

3. Which of the following best describes the purpose of strategic planning? A. To anticipate client needs now and in the future B. To match client needs, provider strengths, and agency resources C. To maximize effective use of agency resources D. To utilize provider strengths and competencies

ANS: B To match client needs, provider strengths, and agency resources Strategic planning involves matching client needs, provider strengths and competencies, and agency resources. Everyone involved can anticipate what will be needed to implement the program, what will occur during implementation, and what the outcomes will be. DIF: Cognitive Level: Understand (Comprehension) REF: p. 277

2. Which of the following best describes the ultimate goal of program planning? A. Avoid unanticipated conflicts in the program development phase B. Provide adequate funding to meet the program's resource requirements C. Ensure that health care services are acceptable, equal, effective, and efficient D. Prevent unnecessary duplication of services

ANS: C Ensure that health care services are acceptable, equal, effective, and efficient Although the other options are aspects of program planning, they address only limited concerns. The comprehensive goal of program planning is to ensure that health care services are acceptable, equal, efficient, and effective. DIF: Cognitive Level: Understand (Comprehension) REF: p. 277

8. A nurse checks health department records to compare the number of new teen clients presenting for birth control counseling and management in the 2 months before and after an education intervention program to decrease teen pregnancy. Which of the following steps of the evaluation process is being completed by the nurse? A. Engage stakeholders B. Justify conclusions C. Gather credible evidence D. Focus on the evaluation design

ANS: C Gather credible evidence When the nurse gathers credible evidence, the following information is collected: indicators that will be used, sources of data, quality of the data, quantity of information to be gathered, and the logistics of the data gathering phase. Data gathered should provide credible evidence and should convey a well-rounded view of the program. DIF: Cognitive Level: Apply (Application) REF: p. 283

11. A nurse is completing a summative evaluation of a program designed to decrease obesity in school-age children. Which of the following is the most important question for the nurse to ask? A. Are school-age children satisfied with the program? B. Can parents and guardians support the program requirements? C. Has obesity in school-age children decreased? D. What is the program cost compared with the program benefit?

ANS: C Has obesity in school-age children decreased? Summative evaluation looks at the end result of the program. The major benefit of program evaluation is that it shows whether the program is meeting its purpose. It should answer the following questions: Are the needs for which the program was designed being met? Are the problems it was designed to solve being solved? If the program does not achieve the purpose for which it is designed, important concerns of satisfaction and cost are irrelevant. So if the program purpose is to decrease obesity, the outcome of importance is a decrease in obesity. DIF: Cognitive Level: Apply (Application) REF: p. 277

14. Based on projected increases in the number of older U.S. citizens, a planning committee wants to establish a day care program for the community's older adult population. During which stage is the need for this program being assessed? A. Inactive stage B. Interactive stage C. Preactive stage D. Reactive stage

ANS: C Preactive stage The preactive stage is one in which assessment is based on the projection of a future need. DIF: Cognitive Level: Apply (Application) REF: p. 278

10. The nurse contacts participants who completed an educational program on breast self-exams to see whether they have any questions and to determine whether they are doing breast self-exams. Which of the following types of evaluation is being implemented by the nurse? A. Final evaluation B. Formative evaluation C. Goal evaluation D. Summative evaluation

ANS: D Summative evaluation Formative evaluation occurs on an ongoing basis while the program exists. In comparison, summative evaluation assesses program outcomes after the program is completed. DIF: Cognitive Level: Apply (Application) REF: pp. 277, 284-285

17. A nurse is conducting a needs assessment but has a limited budget. Which of the following data sources would the nurse most likely eliminate? A. Community forums B. Examination of community indicators C. Focus groups D. Surveys

ANS: D Surveys Surveys tend to be expensive when compared with other methods; therefore the nurse would want to consider other options if on a limited budget. DIF: Cognitive Level: Apply (Application) REF: p. 280

13. A committee concludes that a program's objectives were met and that activities received positive ratings from the community; yet the program will be discontinued because cost was triple the amount anticipated. Which of the following program evaluation measures created a problem? A. Adequacy B. Effectiveness C. Impact D. Sustainability

ANS: D Sustainability The aspects of program evaluation include the following: evaluation of relevance—need for the program; adequacy—program addresses the extent of the need; progress—tracking of program activities to meet program objectives; efficiency—relationship between program outcomes and the resources spent; effectiveness—ability to meet program objectives and the results of program efforts; impact—long-term changes in the client population; and sustainability—enough resources (usually money) to continue the program. DIF: Cognitive Level: Apply (Application) REF: pp. 284-285

5. After completing a needs assessment, the nurse is confident that he has identified the highest priority health programming need within the community. He presents his ideas at a community interest meeting, and the attendees show essentially no interest in being involved. Knowing that the health problem must be addressed he proceeds with implementation as planned. Which of the following is the most likely outcome of the program? A. Community members will become increasingly positive about the new program. B. Others will recognize the importance of the program and become involved. C. The public health agency will both publicize and expand the program. D. The program will fail because of the community's lack of interest.

ANS: D The program will fail because of the community's lack of interest. The needs to be met for the client population must be identified by both the client and the health provider. If the client population does not recognize the need, the program will usually fail. DIF: Cognitive Level: Apply (Application) REF: pp. 278-279

15. Which of the following methods would be the most interactive approach to assessing a community's need? A. Define needs based on the current health status of the community. B. Examine past needs as identified by the agency as well as the community. C. Project future needs based on current trends. D. Use past and current data to project future needs.

ANS: D Use past and current data to project future needs. Stages used in assessing client need include the following: preactive—projecting a future need; reactive—defining the problem based on past needs identified by the client or the agency; inactive—defining the problem based on the existing health status of the population to be served; and interactive—describing the problem using past and present data to project future population needs. DIF: Cognitive Level: Understand (Comprehension) REF: p. 278

6. A nurse is assessing a community to determine the feasibility of implementing a new program on bike safety for youth in the community. Which of the following aspects should the nurse investigate to make this determination? A. Whether the community, especially agency clients, desire a program B. Whether local politicians support the agency's idea for a program C. Whether agency professionals think a program is needed D. Whether all involved support the need for such a program

ANS: D Whether all involved support the need for such a program What people think about the need for a program, or program feasibility, might differ among health providers, agency administrators, policymakers, and potential clients. Feasibility means the program's viability, practicality, achievability, or likelihood of success. Everyone involved must be supportive for a program to succeed. DIF: Cognitive Level: Apply (Application) REF: pp. 278-279

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

B. epidemiologic data.

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? A. Assessment Protocol for Excellence in Public Health (APEXPH) B. Health Evaluation Data Information System (HEDIS) C. Mobilizing for Action Through Planning and Partnership (MAPP) D. Planning Approach to Community Health (PATCH)

C. Mobilizing for Action Through Planning and Partnership (MAPP)

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: A. conduct a survey to determine how many children the fathers have. B. determine whether the fathers have benefited from this type of program before. C. meet with community members to form a planning body. D. provide the fathers with community resources.

C. meet with community members to form a planning body.

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

D. a summative evaluation.

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

D. identify the resources and activities that will help them meet their program objectives.

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: A. efficiency. B. impact. C. relevance. D. sustainability.

D. sustainability.

Nursing students have been assigned to set up a health fair for the homeless population in a large urban setting. Without any funds to pay for space, where should the health fair be located, assuming that all of the following sites are available at no cost? a. At the city's homeless shelter, which is, by policy, vacant during the day b. At a large medical center, where the students could get permission to use an empty clinic in the evening c. At the largest inner-city police station, where there was a large empty space available d. At the local community college, where there are plenty of tables and chairs

a. At the city's homeless shelter, which is, by policy, vacant during the day

A nurse is working as a case manager with a vulnerable population. Which of the following actions should the nurse do when providing care? a. Be willing to enter into a long-term relationship with families. b. Direct and control the client's care because the nurse knows what is most needed. c. Encourage families to become self-sufficient and less dependent on nursing personnel for advice and referrals. d. Rotate assignments periodically to prevent attachment and codependency.

a. Be willing to enter into a long-term relationship with families.

A homeless family brought their father to the public health clinic after he reported bleeding when he went to the bathroom. Which of the following nursing actions would be most appropriate? a. Begin tests to determine the cause of the bleeding while asking about other family concerns from nutrition to shelter for the night. b. Refer the man to a urologist to address the urinary bleeding. c. Suggest that the family take him to an urgent care center immediately. d. Treat the urinary infection and give the man medication to take to prevent the return of infection.

a. Begin tests to determine the cause of the bleeding while asking about other family concerns from nutrition to shelter for the night.

A nurse who is providing diabetes screening at a community clinic discovers that a new client has type 2 diabetes mellitus. The nurse provides counseling, refers the client to an endocrinologist for initial assessment and treatment, arranges for the client to see someone regarding financial assistance, contacts the mobile van to arrange transportation, and sets up a follow-up appointment. Which of the following types of service do these actions represent? a. Case management b. Client advocacy c. Holistic care d. Wrap-around services

a. Case management

A community health nurse would like to implement an intervention to increase lasting resilience among new immigrants. Which of the following actions should be taken by the nurse? a. Direct clients to English-as-second-language courses. b. Give immigrant clients money to help them get settled. c. Identify areas in the city where housing is less expensive. d. Solicit donations for food, clothing, and other needs.

a. Direct clients to English-as-second-language courses

Which of the following bills would the nurse lobbyist, who believes strongly in social justice, encourage legislators to support? a. A bill that establishes policies requiring all persons to pay the same cost for services regardless of income b. A bill that promotes universal health insurance coverage c. A bill that requires all health care providers to give care to uninsured persons without charge d. A bill that requires health care workers to report undocumented immigrants who present for treatment

b. A bill that promotes universal health insurance coverage

Nurses at a homeless clinic are concerned that homeless clients rarely return to have the nurses assess the findings of their tuberculosis (TB) skin tests. Which of the following is the most appropriate policy for the clinic to have regarding the screening test findings? a. Call all homeless clients 48 hours after TB skin testing to remind them to return to the clinic for test interpretation. b. Have homeless individuals read their TB skin test, if necessary, and mail in results on a postage-paid card coded to protect privacy. c. Re-administer the TB skin test if the client returns later than scheduled for test interpretation. d. Routinely refer all homeless clients for chest x-rays.

b. Have homeless individuals read their TB skin test, if necessary, and mail in results on a postage-paid card coded to protect privacy.

Which of the following is the primary cause of vulnerability to health problems? a. Breakdown of family structures b. Poverty c. Prejudice d. Social isolation

b. Poverty

A nurse offers homeless clients yearly tuberculosis (TB) screening and free treatment for those who test positive for TB. Which of the following levels of prevention is being used? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Secondary and tertiary prevention

b. Secondary prevention

A staff member is orienting a new nurse to a health clinic that serves primarily vulnerable populations. Which of the following statements indicates a need for additional staff education? a. "If a client who does not speak English comes in, you must obtain an interpreter right away." b. "We try to take care of as many problems as possible in one visit, so when you interview the client ask about additional concerns." c. "You will like working with Hispanic immigrants because they have close-knit family structures." d. "You will need to assist the client by scheduling any referral or follow-up appointments around their work schedules."

c. "You will like working with Hispanic immigrants because they have close-knit family structures."

A community health nurse is implementing a tertiary prevention activity related to tuberculosis. Which of the following interventions is the nurse most likely completing? a. Administration of skin tests to identify persons who have been infected with tubercle bacilli b. Assessing for signs and symptoms of active tuberculosis c. Directly observing clients with active tuberculosis as they take their antitubercular medications d. Interpretation of tuberculosis skin test findings

c. Directly observing clients with active tuberculosis as they take their antitubercular medications

Which of the following statements best describes an outcome of the Balanced Budget Act of 1997? a. Additional funding was provided to the State Children's Health Insurance Program (SCHIP). b. Individuals were able to keep their health insurance when moving from one place to another. c. Patient privacy and security of health information was enhanced. d. A prospective payment system for home health services was created.

d. A prospective payment system for home health services was created.

Which of the following factors predisposes many migrant farmworkers to disenfranchisement? a. Being a minority group member b. Inability to attend religious services because of work requirements c. Previous experiences of physical abuse d. Short length of time in the community

d. Short length of time in the community

A large financial grant was being offered to whichever health facility wanted to accept the responsibility for giving care to local vulnerable populations. Which of the following actions would most likely be taken by the local medical centers? a. Agree to collaboratively apply for the funds in a cooperative proposal. b. Individually compete eagerly for the additional funds now available. c. Reach out enthusiastically to this previously underserved population group. d. Strongly consider not applying, because this population will be expensive to treat.

d. Strongly consider not applying, because this population will be expensive to treat.

Which of the following terms is used to describe aggregates who are at high risk for having poor health outcomes because of limited resources? a. Disadvantaged families b. Multi-problem families c. Resilient populations d. Vulnerable populations

d. Vulnerable populations