Community Exam 1

CH. 12 A state public health region reported 39 cases of meningitis in children 15 years of age and younger to date this year. Seven of those children died. The total population of the region is 780,000, of whom 84,000 are children 15 years old and younger. What is the age-specific meningitis death rate for children age 15 years and younger for this region to date this year? a. 0.08/1000 b. 0.46/1000 c. 1/1000 d. 8/1000

a. 0.08/1000 A rate is a measure of the frequency of a health event in a defined population in a specified period of time. A rate is a ratio but not a proportion, because the denominator is a function of both the population size and the dimension of time, whereas the numerator is the number of events. Rates relate to change: moving from one state of being to another, such as from illness to health or from life to death. In this example, seven child deaths divided by the total number of children age 15 years and younger in the population (which is 84,000) = 0.0000833 1000 = 0.0833/1000.

CH. 7 A nurse overhears the doctor saying, "Let's not give the client codeine, he's Asian." The nurse reflects on the comment and determines that the doctor is which of the following? (Select all that apply.) a. Culturally competent b. Prejudiced c. Ethnocentric d. Unable to assess pain based on culture e. Planning care based on racial enzymatic differences

a. Culturally competent e. Planning care based on racial enzymatic differences Biological variations distinguish one racial group from another. These differences may occur in the areas of growth and development, skin color, enzymatic differences, and susceptibility to disease. Research findings suggest that sensitivity to codeine varies with ethnic background. Asian men experience significantly weaker effects from use of the drug than do European men. Asian men are missing an enzyme called CYP2D6 that allows the body to metabolize codeine into morphine, which is responsible for the pain relief provided by codeine. When an individual is missing the enzyme, no amount of codeine will lessen his or her pain, and other pain-reducing medications should be explored.

CH. 10 The role of the nurse who wants to become more active in environmental health could include which of the following? (Select all that apply.) a. Assessing farmworkers for pesticide exposure and providing pesticide risk education b. Conducting epidemiologic investigations as a public health nurse (PHN) c. Developing corporate policy to protect workers from unsafe levels of toxic agents d. Organizing the local community to encourage landlords to remove lead-based paint e. Working as a skilled risk communicator for a local chemical manufacturer

a. Assessing farmworkers for pesticide exposure and providing pesticide risk education b. Conducting epidemiologic investigations as a public health nurse (PHN) c. Developing corporate policy to protect workers from unsafe levels of toxic agents d. Organizing the local community to encourage landlords to remove lead-based paint e. Working as a skilled risk communicator for a local chemical manufacturer Nurses can have a vital role in reducing environmental risk, educating workers and/or the community, and helping to eliminate risks in the local community. As nurses learn more about the environment, opportunities for integration of such work into their practices, educational programs, research, advocacy, and policy work will become evident and will evolve.

CH. 8 Several community-oriented nurses want to explore the problem of obesity in school-age children and assess their community school district's health status related to that problem. When gathering information at a national level, they would begin with the: a. Centers for Disease Control and Prevention. b. Centers for Medicaid and Medicare Services. c. Health Resources and Services Administration. d. National Institute of Nursing Research.

a. Centers for Disease Control and Prevention. The Centers for Disease Control and Prevention serve as the national focus for development and application of measures to advance disease prevention and control, environmental health, and health promotion, and for educational activities designed to improve the health of the people of the United States. The mission of the Centers for Disease Control and Prevention is to promote health and quality of life by preventing and controlling disease, injury, and disability.

CH. 18 Which of the following are the best argument(s) for supporting community-as-client nursing? (Select all that apply.) a. Change for the benefit of the community-client must often occur at several levels. b. Changes in the health of individuals will affect the health of their communities. c. The idea of providing health-related care within the community is not new. d. The impact of the environment on health has long been established. e. Direct hands-on nursing care delivered to individuals or families in community settings is important.

a. Change for the benefit of the community-client must often occur at several levels. b. Changes in the health of individuals will affect the health of their communities. c. The idea of providing health-related care within the community is not new. d. The impact of the environment on health has long been established. The idea that health-related services are provided within a community is not new. At the turn of the century, most persons stayed at home during illnesses. As a result, the practice environment for all nurses (such as community health nurses, PBHs, and visiting nurses) was the home rather than the hospital. These roles continue to exist today. Early textbooks on public health nursing included lengthy descriptions of the home environment and tools for assessing the extent to which that environment promoted the health of the family members. By the 1950s, schools, prisons, industrial settings (occupational health), and neighborhood health centers were added to the list of sites for nursing practice. However, the practice became oriented toward direct-care services to individuals and families and began to lose the community/population focus. Today, direct-care services provided at the individual and family level are defined as community-based nursing practice if the target remains at the direct-care service level and the practice does not address overall community health issues (i.e., common community-related health problems). Presently, there is a resurgence in population-focused health care. Because of the findings from initiatives such as Healthy People 2010 and the World Health Organization's Healthy Communities and Cities, it is now understood that social change related to health behaviors and the use of health policy are more efficient and effective in improving health status overall.

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

a. Documentation b. Information management c. Nursing practice 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. As early as 1970, the nurses, other staff, and administrators of the Visiting Nurse Association (VNA) of Omaha, NE, began addressing nursing practice, documentation, and information management concerns.

CH. 8 State and federal statutes and regulations affect the health care specialties of home health and hospice practice. A primary motivator for nurses to become knowledgeable about these statutes and regulations is their impact on nursing practice in which of the areas below? (Select all that apply.) a. Documentation of client status and progress b. Documentation of services c. Living wills and advance directives d. Resident's rights in long-term care facilities e. Right to death with dignity

a. Documentation of client status and progress b. Documentation of services c. Living wills and advance directives d. Resident's rights in long-term care facilities e. Right to death with dignity State laws specify licensure and certification requirements for home health care and hospice agencies. Compliance with these laws is directly linked to the method of payment for the services. For example, a service must be provided by a licensed and state-certified agency to obtain payment from Medicare. Federal regulations implementing Medicare and Medicaid programs have an enormous effect on much of nursing practice, including documentation practices and recording of visits, client care, status, and progress. Other laws focus on issues such as the right to death with dignity, the rights of residents in long-term care facilities, definitions of death and death pronouncement, and the use of living wills and advance directives.

CH. 9 Factors related to the determinants of health identified in Healthy People 2020 include which of the following? (Select all that apply.) a. Education and literacy b. Genetic endowment c. Gender d. Culture e. Social status

a. Education and literacy b. Genetic endowment c. Gender d. Culture e. Social status The determinants of health identified in Healthy People 2020 influence health status throughout all stages of life and include such things as personal behavior, biology, physical environment, and social environment. Each of these broad areas encompasses multiple factors, and all of the factors listed above influence health status.

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

a. Quality of care b. Performance appraisal c. Collegiality e. Resource use 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.

CH. 8 The relationship between nursing practice, health policy, and politics can best be described as nursing: a. advocacy. b. policy process. c. process. d. profession.

a. advocacy. Advocacy begins with the art of influencing others (politics) to adopt a specific course of action (policy) to solve a societal problem and is accomplished by building relationships with appropriate policy makers—the individuals or groups that determine a specific course of action to be followed by a government or institution to achieve a desired end (policy outcome). This can be done in many ways. Types of advocacy include actions on behalf of clients served by nursing, especially vulnerable populations; activities of the nursing profession itself; work to develop needed health policies or revise existing policies; and actions related to the community.

CH. 10 When a nurse evaluates the completeness and accuracy of information made available to community residents regarding the impact of rezoning of land parcels for industrial use, the nurse can best be described as: a. advocating for ethical choices. b. communicating risk. c. controlling environmental damage. d. volunteering for service on state boards.

a. advocating for ethical choices. Nurses, using sound risk communication skills as trusted communicators, advocate for environmental justice. Ethical issues likely to arise in environmental health decisions are: • Who has access to information and when? • How complete and accurate is the information? • Who is included in the decision making and when? • What and whose values and priorities are given weight in decisions? • How are short-term and long-term consequences considered?

CH. 9 Public health nursing practice is guided by the community's priorities as identified by community: a. assessment. b. diagnosis. c. interventions. d. planning.

a. assessment. Assessing the health status of the populations that make up a community requires ongoing collection and analysis of relevant qualitative and quantitative data. Community assessment includes a comprehensive evaluation of the determinants of health. Data analysis identifies deviations from expected or acceptable rates of disease, injury, death, or disability, as well as risk and protective factors. Community assessment generally results in a lengthy list of community problems and issues. However, communities rarely possess sufficient resources to address the entire list, and priorities must be set after assessing the community's beliefs, attitudes, and opinions, as well as the community's readiness for change.

CH. 1 A community-oriented nurse has identified obesity as a problem in the middle school. The next step in a population-focused practice is to make information available about the health of the middle school students. This describes the core public health function of: a. assessment. b. assurance. c. policy development. d. research.

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

CH. 1 The state public health agency has received multiple complaints regarding the availability of elder transportation services to a specific county senior center. The state agency assigns a public health nurse to work with the community to evaluate its program for elder transportation services to publicly sponsored eldercare programs. The public health core function applied is: a. assurance. b. policy development. c. primary prevention. d. public transportation.

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

The minimum requirements for entry into home care practice should be: a. baccalaureate in nursing. b. baccalaureate in nursing and clinical nurse specialist (CNS) certification. c. master's in nursing. d. master's in nursing and CNS certification.

a. baccalaureate in nursing. Nurses come to home care from a variety of educational and practice backgrounds. Home care nurses should be educated to function at a high level of competency so that they can be relied on not only by their professional colleagues but also by the community. A baccalaureate degree in nursing should be the minimum requirement for entry into professional practice in any community health setting, including home care.

CH. 18 If the community is where nurses practice and apply the nursing process, and the community is the client in that practice, then nurses will want to analyze and synthesize information about: a. boundaries, parts, and dynamic processes of the client community. b. community health status and structure. c. community problems and problem correlates. d. role of the nurse and lay advisors in the community partnership.

a. boundaries, parts, and dynamic processes of the client community. In most definitions, the community includes three factors: people, place, and function. The people are the community members or residents. Place refers to both the geographic and time dimensions, and function refers to the aims and activities of the community. The parts of a community are interdependent, and their function is to meet a wide variety of collective needs. Therefore, the definition of community should also recognize the interaction among systems within the community.

CH. 11 Genes that carry genetic instructions for making living organisms are subject to alterations in: (Select all that apply.) a. changes in chromosomal structure. b. changes in deoxyribonucleic acid. c. changes in ribonucleic acid. d. sequences of bases.

a. changes in chromosomal structure. b. changes in deoxyribonucleic acid. c. changes in ribonucleic acid. d. sequences of bases. Alterations in the usual sequence of bases [adenine (A), guanine (G), cytosine (C), and thymine (T)] that form a gene, changes in DNA or chromosomal structures are called mutations. A large number of agents are known to cause mutations. Despite three billion DNA base pairs that must be replicated in each cell division and the large number of mutagens we are exposed to, DNA replication is quite accurate because of the mechanism known as DNA repair that corrects 99.9% of initial errors.

CH. 7 A nurse is conducting a diabetes self-management group-education session. When participants are asked to remove their shoes, two male clients look at the floor and leave their shoes and socks on their feet. An effective intervention is for the nurse to: a. clarify that no one has to remove his or her shoes unless he or she wants to and continue foot inspection and foot care instruction. b. explain that everyone must learn to do foot inspection to manage their diabetes. c. loudly and slowly repeat the instructions for all participants to remove their shoes. d. stop the group session, pull the two gentlemen aside, and apologize to them.

a. clarify that no one has to remove his or her shoes unless he or she wants to and continue foot inspection and foot care instruction. Exposing one's foot in public is not considered appropriate in all cultures. In some cultures, it is considered rude to display the sole of the foot. In the scenario described, the nurse should give the group permission to comply or not comply with the previous instructions and proceed with the class. Ideally, a nurse should become familiar with the values of the target population(s) before asking anyone to remove an article of clothing in a group setting. Integrating cultural awareness and knowledge allows the nurse to demonstrate cultural skill in meeting the needs of culturally diverse groups.

CH. 1 A community-oriented nurse conducts home visits to new parents to assess the health status of the infant, the parent-child relationship, the parents' knowledge regarding the care of the infant, and the need for health department and social services referrals to support the needs of the new parents and the infant. This can best be described as an example of: a. clinical community health practice. b. community-based practice. c. population-focused practice. d. public health nursing.

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

CH. 11 The National Coalition of Health Professional Education in Genetics (NCHPEG) created a red-flag tool for determining risk in closely related individuals for the most common diseases that includes: (Select all that apply.) a. close biologic relationship between parents. b. condition occurs in the gender that is least expected. c. ethnic predisposition to certain genetic disorders. d. multiple affected family members. e. onset at an earlier or later than expected age.

a. close biologic relationship between parents. b. condition occurs in the gender that is least expected. c. ethnic predisposition to certain genetic disorders. d. multiple affected family members. The genetic red flags developed by the NCHPEG provide an excellent tool to determine if an individual or family might be at risk. The primary red flag for the most common diseases is a large number of affected relatives who are closely related. Some of the red flags are family history of multiple affected family members with the same or related disorders, which may or may not follow an identifiable pattern in the family; onset at an early age; condition occurs in the gender that is least expected to have it; disease occurs in the absence of known risk factors; ethnic predisposition to certain genetic disorders; and a close biological relationship between parents.

CH. 9 A nursing diagnosis of Increased risk for delayed development, injury, and disease because of inadequate parenting by a primary parent experiencing depression would most likely indicate that the nursing process is being applied at the _______ level of practice and the _______ level of prevention. a. individual/family, secondary b. community, primary c. community, secondary d. individual/family, primary

a. individual/family, secondary Based on this nursing diagnosis, one could assume that the level of practice is at the individual/family level (young child who is being parented by a primary parent who is experiencing mental health problems) and at the secondary level of prevention (because the family has an existing identified risk, i.e., a mental health problem).

CH. 11 New discoveries in molecular genetics will have the greatest effect on nursing practice in the area of: a. collection and use of health histories. b. counseling clients. c. identification of gene mutations. d. use of new therapies.

a. collection and use of health histories. The profession of nursing will be impacted by new discoveries in molecular genetics in the areas of education, practice, and public health debates. The practice arena impacts are collection and use of health histories, learning and applying innovative biotechnologies, prevention and health education roles, and administration of new therapies. The collection and use of health history information has the greatest impact on the most nurses. Human disease comes from the collision between genetic variations and environmental factors (i.e., social determinants of health) that are often uncovered in individual health histories. Taking a family history is a useful place to begin when considering a genetic connection and prior to the onset of testing.

CH. 9 When confirmed cases of the mumps, a vaccine-preventable disease, emerged on college campuses in fall 2006, public health nurses (PHNs) conducted outreach at campuses and collaborated with student health officials to increase the number of students with full immunization compliance. This is an example of: a. community-level practice. b. family-level practice. c. individual-level practice. d. systems-level practice.

a. community-level practice. The goal of community-level practice is to improve the knowledge and attitude of the entire community about the importance of immunization and the consequences of not being immunized. These strategies lead to an increase in the percentage of people who obtain recommended immunizations for themselves and their children.

CH. 1 A nurse planning a smoking cessation clinic for adolescents in the local middle schools and high schools is providing: a. community-oriented care. b. community-based care. c. secondary care. d. tertiary care.

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

CH. 7 The nurse is educating her Nigerian client regarding the prenatal services available through the maternal-child health clinic. The client is interested in confirming her pregnancy at this visit but does not see the need for ongoing visits because childbirth is viewed as a natural process in her culture. The nurse negotiates with the client to structure a strategy to achieve a healthy pregnancy outcome that uses the clinic's resources in a manner that is satisfactory to the client. This is an example of: a. cultural accommodation. b. cultural brokering. c. cultural preservation. d. cultural repatterning.

a. cultural accommodation. Culture is defined as a set of beliefs, values, and assumptions about life that are widely held among a group of people and that are transmitted intergenerationally. Culture is important to nurses because it helps them to understand the beliefs and practices clients bring to the clinical setting, their expression of concerns, and the type of health care they are pursuing. Quality of care means that positive health care outcomes are achieved. Failure to focus care according to the client's values and ideas is likely to increase cost and decrease quality. Care that is not culturally competent may lead to increased cost of health care and decrease the opportunity for positive client outcomes. Techniques such as cultural accommodation can ensure that a positive health outcome is achieved while providing for the cost-effective use of limited resources. Failure of clients to keep scheduled appointments with clinics may reflect a cultural preference for the type and frequency of contact with the health care system. Understanding the type of health care service that the client is seeking can ensure that opportunities to negotiate compliance with treatment can occur to the satisfaction of both parties so that precious resources can be managed effectively.

CH. 7 Bruising and swelling on a client's face and torso are noticed by a nurse during a prenatal examination. The client's exchange-student husband, who speaks for the client, tells the nurse his wife deserved the bruises. The client looks at the floor and shakes her head in agreement. The nursing student leaves the examination room angry and confused, experiencing what can best be described as: a. culture shock. b. prejudice. c. ignorance. d. racism.

a. culture shock. Culture shock is the feeling of helplessness, discomfort, and disorientation experienced by an individual attempting to understand or effectively adapt to a cultural group whose beliefs and values are radically different from those of the individual's own culture. There are cultures in which it is considered acceptable for men to hit their wives and/or children. The nurse can consult with the nursing supervisor or clinic social worker, who can intervene on the client's behalf with the cooperation of a community advocate from the client's culture of origin.

CH. 9 A community-level intervention designed to increase the sense of belonging among older community residents at risk for social isolation was implemented by opening a senior center every other Wednesday at a local church that provided lunch and social programs. At the end of 6 months, the attendees were surveyed to determine their experience with the program, barriers to attendance, expansion of their social networks, and involvement in other community activities. This survey allowed the community health nurse to _______ the program and design program improvements. a. evaluate the effectiveness of b. assess the expansion needs of c. identify problems with d. implement the expansion of

a. evaluate the effectiveness of The evaluation phase of a community-level intervention attempts to determine the effectiveness of the intervention in meeting the desired outcome (decreased social isolation for the elder community population) and in establishing new healthier practices (increased social networking and increased involvement in other community activities) while identifying any emerging barriers (problems) that may interfere with the desired outcome. Very often this can be achieved through a repeat assessment such as a survey of the population receiving the intervention to measure change in attitudes, beliefs, and behaviors.

CH. 18 The community practice nurse is preparing to initiate a community partnership with a neighborhood watch association to address teenager street vandalism. The nurse meets with a local pastor who introduces her to the neighborhood residents she needs to partner with. The role of the pastor in this example is: a. gatekeeper. b. community health worker (CHW). c. professional service provider. d. stakeholder.

a. gatekeeper. Gatekeepers refer to formal or informal community leaders who create opportunities for nurses to meet diverse members of the community. Gatekeepers can confer credibility to the nurse. CHWs are not professional or licensed health care providers but are community members from diverse backgrounds who receive training to do health outreach work. CHWs can assist nurses in doing community health assessments in several ways. They extend the reach of the nurse by being able to do many activities that are part of the community assessment process. Stakeholders refer to anyone with a personal or occupational interest or concern in a community's life. Professional service providers who are community members such as school teachers, public safety officers, and agricultural extension agents play a large part in the overall health of the community.

CH. 7 A PHN in a maternal-child health clinic encounters a client from Ethiopia. The clinic typically sees Hispanic clients. The nurse should first conduct: a. general cultural assessment. b. head-to-toe assessment. c. in-depth cultural assessment. d. nonverbal communication assessment.

a. general cultural assessment. The nurse proceeds with a systematic identification and documentation of the culture care beliefs, meanings, values, symbols, and practices of individuals and groups within a holistic perspective, which includes worldview, life experiences, environmental context, ethnohistory, language, and diverse social structure influences. Cultural assessments should focus on those aspects relevant to the presenting problem, necessary intervention, and participatory education. During initial contacts with clients, nurses should perform a general cultural assessment to obtain an overview. In-depth cultural assessments are conducted over a period of time. This gives the nurse and client time to get to know each other and is especially beneficial to the client because it allows the client to see the nurse in a helping relationship.

CH. 18 A rural community health nurse has made sure that CHWs are involved in the health department's migrant worker outreach program. The nurse believes this intervention strategy is important because the nurse knows that such individuals can be: a. influential with their insider status to engage community members. b. medical professionals within the migrant community. c. natural healers within their community. d. translators to help overcome language barriers.

a. influential with their insider status to engage community members. CHWs can assist nurses in doing community health assessments in several ways. They extend the reach of the nurse by being able to do many activities that are part of the community assessment process. They can also serve as gatekeepers, using their own insider status to engage community members in the assessment process

CH. 7 A nurse who is ethnocentric in interacting with a client of a different culture: a. most likely has little previous experience with the client's culture and is uncomfortable with people from other cultures. b. is appreciative of the client's cultural beliefs. c. accommodates the client's cultural beliefs when planning care. d. imposes the nurse's value system on the client.

a. most likely has little previous experience with the client's culture and is uncomfortable with people from other cultures. Ethnocentrism, an inhibitor to developing cultural competence, is the belief that one's own cultural beliefs are the standards that should be used to judge people from other cultures. Ethnocentric nurses are unfamiliar and uncomfortable with that which is different from their own culture. Their inability to accept different worldviews often leads them to devalue the experiences of others and judge them to be inferior, treating those that are different from themselves with suspicion or hostility. The belief in one's own superiority, or ethnocentrism, may lead to "cultural imposition." Cultural imposition is the act of imposing one's cultural beliefs, values, and practices on individuals from another culture. By developing an approach of "cultural relativism" nurses recognize that clients have different approaches to health care, and that each culture should be judged on its own merit and not on the nurse's personal beliefs. Nurses use "cultural awareness and knowledge" to overcome unfamiliarity and discomfort with cultures outside of their own. Nurses who may have ethnocentric beliefs can avoid inhibiting behaviors/actions such as cultural imposition by developing cultural competence.

CH. 18 The community planning board's evaluation of a community intervention (child immunization campaign) carried out by the health department determined that some progress was made toward the desired outcome (target rate of childhood immunization), but the degree of progress achieved was not sufficient to offset the initial effort in terms of cost and time to launch the campaign. The community determined that the rate gain was not adequate when compared with that achieved through similar initiatives in other communities, which obtained better results by using more efficient strategies. The budget for this program was cut. This community decision best exemplifies which statement about evaluation? a. Evaluation should start in the planning phase of the nursing process. b. Evaluation can have unintended consequences. c. Effectiveness is the only true measure of worthiness. d. The power to design, judge, or institute change is important.

b. Evaluation can have unintended consequences. Evaluation of community health interventions can provide valuable information about an intervention's effectiveness and efficiency in obtaining the desired measurable outcome or its progress to date in reaching that desired outcome. Factors related to costs in money and time should also be addressed to determine if the intervention was worth carrying out. This is especially true given the fact that health care operates in a political environment in which competition for limited resources is a reality. The nurse must also recognize when selecting measurable outcomes in the planning phase that unintended outcomes may result from the intervention that may become evident upon evaluation. The success or failure of the intervention may carry unintended consequences. It may uncover new trends in the community. Finally, the evaluation process should identify whether the intervention was adequate and acceptable to the community. In this case, the change in the outcome measure was not sufficient to be acceptable, and the community's expectations were greater than the results delivered. The community decided to invest its limited resources elsewhere. The issue was not the power to design, judge, or institute change. The results of the intervention were not good enough in the community's eyes. Some of these challenges could have been addressed in the planning stages by exploring alternative approaches that would have ensured a better return on the dollar. This would have built community confidence in health interventions and fed success into the initiative. It may be harder to propose new initiatives when past initiatives produced such unintended consequences.

CH. 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

b. Evaluation of an outreach program for at-risk pregnant teenagers c. Community subpopulations with high rates of type 2 diabetes e. Prevalence of hypertension among various age, race, and gender groups 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.

To promote quality improvement, the documented plan of care for an elderly home care patient should include which of the following? a. Listing of community resources available to meet the patient's needs b. Expected patient outcomes for each identified problem or diagnosis c. Formulated nursing diagnosis d. Objective physical assessment data

b. Expected patient outcomes for each identified problem or diagnosis Setting short- and long-term goals provides criteria for evaluation, and increases continuity of care and the potential for improved outcomes.

CH. 10 A college health nurse is working with students, faculty, and staff to improve environmental air quality. To address the primary cause of air pollution on campus, the nurse plans a precautionary intervention. Which of the following interventions best demonstrates an appropriate approach? a. Encourage the use of electric cars and scooters on campus b. Increase the use of bicycles, foot-powered scooters, rollerblades, and walking as the primary mode of transportation on campus c. Make the entire campus a no-smoking zone d. Establish a policy to reduce electricity consumption in university buildings by raising the thermostat to 78° in the summer and lowering the thermostat to 70°in the winter

b. Increase the use of bicycles, foot-powered scooters, rollerblades, and walking as the primary mode of transportation on campus The burning of fossil fuels to power automobiles and buses and to generate electricity is the single greatest source of air pollution in the United States. While reducing the use of electricity on campus is helpful, the single biggest source of campus air pollution is the cars and buses used to drive to and around campus. Decreasing their use is also an application of the precautionary principle.

CH. 8 A public health nurse (PHN) has identified a need to make amendments to an existing law concerning the tuberculosis health assessment of individuals sentenced to serve jail terms on weekends only because of the gap in treatment accountability and potential health risk to the free-living community. To draw attention to this concern, the nurse has several paths to follow, but the amendment of any existing laws would ultimately be decided by which of the following? a. Executive branch of government b. Legislative branch of government c. Local representative d. Senate hearings

b. Legislative branch of government Each of the government branches at the federal level, in most states, and at the local level plays an important role in developing and implementing health law and public policy. Concerned citizens have many avenues for addressing issues related to needed laws and regulations as well as existing laws and regulations. However, each branch of government has a separate and important function. The legislative branch identifies problems and proposes, debates, passes, and modifies laws to address identified needs.

CH. 12 A nurse is concerned about the accuracy of the purified protein derivative (tuberculin) test in screening individuals with tuberculosis exposure for follow-up chest radiography. The nurse's concern is related to which aspect of the test's validity? a. Reliability b. Sensitivity c. Specificity d. Variability

b. Sensitivity The validity of a screening test is measured by its sensitivity and specificity. Sensitivity quantifies how accurately the test identifies those individuals with the condition or trait of interest. Sensitivity is calculated as the proportion of persons with the disease that the test correctly identifies as having the disease (true positives). High sensitivity is needed when early treatment is important and when the identification of every case is important. Accurate identification is cost-effective and timely.

CH. 11 A client's concern about hereditary cancer syndrome can be influenced by the limitations of current testing methods and factors related to: (Select all that apply.) a. absolute risk. b. adoption. c. family size. d. family interest. e. GINA.

b. adoption. c. family size. Current methods of testing do not detect all of the mutations that can occur in some diseases including hereditary cancer syndrome-related genes. If a mutation is detected, it does not confirm an absolute risk of cancer but a need for high-risk management. Additionally, an inherited syndrome may not be evident for someone from a small family; someone who is adopted; or someone who is not informed about their family's history of disease or cause of death. Most hereditary cancer syndromes are inherited in an autosomal dominant pattern with variable expression and incomplete penetrance (mutation in one member of the gene pair). Both men and women carry, pass on to children, and inherit these mutations. For mutation carriers, the hereditary cancer syndrome can be mild or more severe. Whether cancer ever develops, the site at which it develops, or the seriousness of the cancer can vary among different people with the same mutation, even within the same family.

CH. 8 The health policy-making body of the World Health Organization (WHO) released a policy statement on nursing and midwifery in 2013. The important fact for nurses to understand about WHO policy statements is that such statements: a. apply only to underdeveloped countries. b. are guides for in-country initiatives and priorities. c. carry the weight of international law. d. provide mandates for in-country legislatures.

b. are guides for in-country initiatives and priorities. In 1946, the WHO was created through a United Nations initiative as a special autonomous organization. The WHO provides services worldwide to promote health, cooperates with member countries in promoting their health efforts, coordinates collaborative activities between countries, and disseminates information on biomedical research and vital international statistics. The World Health Assembly (WHA) is the policy-making arm of the WHO and meets annually. The WHA's health policy work provides policy options for many countries of the world in their development of in-country initiatives and priorities. Although WHA policy statements are very important everywhere, they are guides and not law.

CH. 11 The overarching themes conceptualized in the vision for the Human Genome Project embrace the relationship of genomes to: a. biology, chemistry, and medicine. b. biology, health, and society. c. ethics, medicine, and heredity. d. medicine, technology, and ethics.

b. biology, health, and society. The stated goals of the Human Genome Project were determining the sequence of the three billion chemical pairs that make up human DNA; storing this information in databases; improving tools for data analysis; transferring related technologies to the private sector; and addressing the ethical, legal, and social issues (ELSI) that may arise from the genome mapping project completed in 2003 that identified 25,000 genes in human DNA. The conceptual vision of the team addressed three overarching themes. The first, "genomes to biology," looks at how the study of genomics would affect the future understanding of biology. The second, "genomes to health," helps to explain the underlying mechanisms for human health and disease including gene-gene, gene to environment, and their interactions. The third, "genomes to society," provides the foundation for research to improve the use and interpretation of genetic information and technologies.

CH. 11 A young female client is concerned about her risk for developing ovarian cancer and needs information that might affect her health decisions. She requests that her elderly grandmother be tested for genetic mutations. One significant challenge faced by a family member in responding to such a request is: a. anxiety about the future. b. carrier guilt. c. decreased quality of life. d. fear of blood draws.

b. carrier guilt. Genomics has influenced the availability of genetic tests which has implications for families. Individuals, families, and communities need to understand the purpose, limitations, and potential benefits and risks of a test before submitting samples for analysis. Genetic testing is now used to predict the development of genetic disorders, screening populations, confirming diagnoses, prenatal testing, and DNA testing to develop and apply individualized medical treatment. Individuals seeking information that might affect decisions and health may also think that testing results would decrease their quality of life and make them anxious about the future. Family members who have had cancer may refuse genetic testing because their insurance carrier does not reimburse for such testing or their deductibles may be too high for such testing. Additionally, people feel that a positive result may lead to a feeling of guilt about passing along a disease to children and grandchildren. Genetic testing decisions are personal and complex and can be controversial, leading to dissonance in families.

CH. 12 When the association between maternal alcohol use and low birth weight is being studied, the nurse investigator's failure to consider the variable of smoking could introduce bias into the observed association, because smoking has a correlation with both factors. This effect could best be described as: a. causality. b. confounding. c. information bias. d. selection bias.

b. confounding. When looking for the existence of statistical association between some factor and a health outcome, the investigator must consider the three general categories of bias. Bias is a systematic error resulting from study design, study execution, or confounding. Bias resulting from the relationship of the outcome and the study factor with some third factor not accounted for in the study design is called confounding. In practice, one can often identify potentially confounding variables and adjust for them in analysis.

CH. 1 Nurses should consider opportunities for population-focused practice that result from the rapid transformation of health care delivery from a medical model to a health promotion/disease prevention model. An example of such opportunity is: a. operator of a nurse practitioner-run urgent care center in a major retail location. b. director of clinical services spanning inpatient and community-based settings that provide a wide range of services to the populations seen by the system. c. clinical director of a home health agency. d. school nurse position in the local high school.

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

CH. 10 A community health nurse manager has integrated exposure history elements into the assessment practices of the health department that are relevant to the urban industrial community served. This strategy indicates that the nurse manager is aware of the relationship between: a. community strengths and weaknesses. b. environment and human health/disease. c. toxicology studies conducted by the Environmental Protection Agency and the environment. d. federal and state environmental regulations.

b. environment and human health/disease. Understanding the relationship between the environment and human health and disease has become more important over the years. The environment is now known to play a role as a determinant of health status, an explanation of disease, an influence on health risk, and a cause of human toxicity and the ever-increasing burden of potentially toxic synthetic chemicals that our bodies carry.

CH. 10 The monitoring and public reporting of air quality in a local community to assist individuals with asthma or other respiratory conditions best illustrates the application of: a. compliance and enforcement. b. environmental epidemiology. c. secondary prevention. d. toxicology.

b. environmental epidemiology. Epidemiologic studies enable us to understand the strength of the association between exposures and health effects, such as the relation between air pollution and asthma exacerbation.

CH. 12 A state public health region reported 39 cases of meningitis in children 15 years of age and younger to date this year. Seven of those children died. The total population of the region is 780,000, of whom 84,000 are children age 15 years old and younger. Only four cases of meningitis were reported in the public health region during the previous year. No other public health region in the state has an incidence of meningitis that is higher than expected for that region. Based on the information given, the relative frequency of meningitis in the region at this time can best be described as: a. endemic. b. epidemic. c. pandemic. d. sporadic.

b. epidemic. An epidemic occurs when the rate of disease, injury, or other condition exceeds the usual (endemic) level of that condition.

CH. 8 The levels of government responsible for carrying out the five government health care functions of direct services, financing, information, policy setting, and public protection are: a. federal and state. b. federal, state, and local. c. all, but primarily state and local. d. all, but primarily federal and state.

b. federal, state, and local. Federal, state, and local governments are responsible for carrying out the five core government health care functions. All levels of government provide direct services, but the targeted populations may vary; for example, at the federal level, the focus is on the members and dependents of the military, whereas the states focus on childhood immunizations. The federal government provides funding for health care education and research. The states provide maternal-child health care services through state-level funding for the poor or near poor. Local governments/organizations provide health care services through funding for free clinics that serve the uninsured. All branches and levels of government collect vital statistics and census data, and conduct health surveys. Governments, agencies, and organizations at all levels make health policy. Functions that protect the public, such as monitoring air and water and regulating food, drug, or animal transportation, are carried out at all levels. Affirmation of a woman's right to reproductive privacy occurred at the federal level (Supreme Court). Requiring vaccinations for school entry occurs at the state level.

CH. 11 In the late 1950s, Down syndrome was discovered to be caused by an extra copy of chromosome 21. This early breakthrough best describes: a. double-helix structure. b. genetics. c. genomics. d. mutation carrier.

b. genetics. The term genetics is used to mean the study of the function and effect of single genes that are inherited by children from their parents—in other words, the cause of certain diseases, the genetic link. Genomics refers to the study of individual genes in order to understand the structure of the genome, including mapping of genes and sequencing of DNA. Genomics examines the molecular mechanisms and the interplay of genetic and environmental, cultural, and psychological factors of disease. Genomics deals with the functions and interactions of all genes in an organism and is the study of the total DNA structure.

CH. 12 A business executive develops flu-like symptoms 1 day after returning by air from a trans-Atlantic 2-day conference that involved lengthy meetings into the evening. The scenario best illustrates the interaction of: a. host and agent. b. host, agent, and environment. c. risk and causality. d. morbidity and disease.

b. 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 of disease.

CH. 10 The Superfund Amendments and Reauthorization Act (SARA) increased the involvement of the states and their citizens in the cleanup of toxic waste sites and stressed the importance of permanent remedies and innovative treatment technologies. Another important aspect of this federal legislation was that it: a. provided for the appointment of state emergency response commissions. b. increased focus on the human health problems related to hazardous waste sites. c. established a new safety standard of reasonable certainty of no harm that is to be applied to all pesticides used on food. d. reduced the amount of pollution by mandating cost-effective changes in production, operation, and raw materials use.

b. increased focus on the human health problems related to hazardous waste sites. SARA changes included an increase in the size of the trust fund; encouraged greater citizen participation in decision making on how sites should be cleaned up; increased state involvement in every phase of the Superfund program; increased focus on human health problems related to hazardous waste sites; established new enforcement authorities and settlement tools; stressed the importance of permanent remedies and innovative treatment technologies in the cleanup of hazardous waste sites; provided for Superfund actions to consider standards in other federal and state regulations; and established the federal Agency for Toxic Substances and Disease Registry. This act amended the Comprehensive Environmental Response, Compensation, and Liability Act with provisions for a broader community-level involvement and public health mission to address the effects of hazardous waste sites on people.

CH. 7 A new group of migrant farmworkers has arrived in a community. The local public health nurse (PHN) realizes that an important step before scheduling clinic services is to: a. consult the public health staff regarding their scheduling preferences. b. learn about the farmworkers' concept of time and their work schedule to determine when and how services can best be scheduled. c. review written materials about the farmworkers' culture of origin. d. visit the farmworker camp and tell the camp leaders when clinic services will be available.

b. learn about the farmworkers' concept of time and their work schedule to determine when and how services can best be scheduled. Culturally competent nursing care includes designing services that are culturally appropriate for the specific client and based on the client's cultural norms and values. The concept of time varies depending on a client's culture of origin. When possible, clinic operating times and scheduling policies should respect the community's preferences.

CH. 8 Health policy can best be defined as a set course of action to: a. administer public health care programs at the federal level for disaster preparedness, response, and recovery. b. obtain a desired health outcome for an individual, family, group, community, or society. c. support publicly funded health care programs at the local, state, and national levels. d. support health care development and research to improve the health status of citizens.

b. obtain a desired health outcome for an individual, family, group, community, or society. Health policy is a set course of action to obtain a desired health outcome, either for individuals, families, groups, communities, or societies. Policies are made not only by governments but also by institutions such as a health department or other health agency, a family, or a professional organization. Politics plays a role in the development of such policies. Politics is found in families, professional and employing agencies, and governments. Therefore, political activities are used to arrive at a course of action (the policy). Policy is a settled course of action to be followed by a government or institution to obtain a desired end.

CH. 11 A middle-aged woman, with a history of breast and ovarian cancer in her family, is concerned that a positive finding for BRACA2 gene may result in loss of her insurance coverage. The nurse should discuss protections under: a. the Affordable Care Act. b. the Genetic Information Nondiscrimination Act (GINA). c. Healthy People 2020. d. the Human Genome Project.

b. the Genetic Information Nondiscrimination Act (GINA). The GINA of 2009 protects the public from genetic discrimination by employers or insurers. The act prevents group health plans and health insurers from denying coverage to a healthy individual or charging higher premiums based solely on genetic predisposition to disease. The legislation also prohibits employers from using an individual's genetic information when hiring, firing, or making job placement or promotion decisions.

CH. 12 A state public health region reported 39 cases of meningitis in children 15 years of age and younger to date this year. Seven of those children died. The total population of the region is 780,000, of whom 84,000 are children age 15 years old and younger. What is the prevalence proportion of meningitis in this region thus far in the current year? a. 4.1/100,000 b. 5/100,000 c. 46/100,000 d. 50/100,000

c. 46/100,000 A proportion is a type of ratio in which the denominator includes the numerator. The prevalence proportion is a measure of existing disease in a population at a particular time and is calculated by dividing the number of existing cases by the current targeted population. In this example, 39 cases divided by the total number of children age 15 years and younger in the population (which is 84,000 children) = 0.0004642 100,000 = 46.42/100,000.

CH. 12 Which of the following article titles include(s) an example of epidemiologic distribution and determinants? a. Can Operating Room Nurses Measurably Reduce Patient Anxiety? b. Characteristics of Patients Newly Diagnosed with Tuberculosis c. Comparison of Postinsecticide Exposure Incidence of Atopic Dermatitis in Migrant Farmworkers and Land-Owning Farmers in Southwestern Utah d. Postpartum Nurses' Reaction to Rotating Shifts Compared with Assigned Stable Shift

c. Comparison of Postinsecticide Exposure Incidence of Atopic Dermatitis in Migrant Farmworkers and Land-Owning Farmers in Southwestern Utah Epidemiology investigates the distribution (patterns) and the determinants (factors such as exposure, characteristics, and behaviors) of health events in a population. Distribution addresses "Who, what, where, when, and why?" and determinants address "How did the health event occur?" and "Why are some affected more than others?"

CH. 8 A nurse seeks the best resource that provides a broad vision of the goals and objectives of many health care stakeholders in our nation and identifies the current national health policy for the United States. The best source for such information would be the: a. American Public Health Association's guidelines. b. website of the Centers for Disease Control and Prevention. c. Healthy People initiatives. d. Pan American Health Organization's mission statement.

c. Healthy People initiatives. The Healthy People initiatives began in 1979 with subsequent updates and revisions across multiple decades. Healthy People 2020 builds on earlier versions to identify a national health agenda to attain quality, longer lives free of preventable diseases, disability, injury, and premature death; achieving health equity, eliminating health disparities and improving health for all groups; creating social environments that promote good health for all; and promoting quality of life, healthy development, and healthy behaviors across all life stages.

CH. 18 Which action by the community-oriented nurse best illustrates a partnership for health? a. Assisting a school nurse in conducting vision screening of elementary school children b. Developing a volunteer program for teaching parenting skills c. Helping a group of citizens concerned about potential environmental hazards collect relevant health data and develop needed interventions d. Informing a neighborhood council that smoking is its major community health problem

c. Helping a group of citizens concerned about potential environmental hazards collect relevant health data and develop needed interventions Healthy People 2020 cites community partnership as key to meeting program goals. In community-oriented practice, the nurse and the community seek healthy change together. Community members who are equal proactive collaborators in prioritizing, designing, implementing, and evaluating community interventions are much more likely to support and assist in community programs. Programs developed using a community partnership approach (rather than the approach that "I'm the community health expert and I know best") are more effective in identifying and addressing health problems, and such programs are more likely to be sustained over the long term.

CH. 8 A PHN employed by the state's department of health is working on a team to develop local health policy. The nurse recognizes that policy development focuses on the level of the larger society and adopts strategies that require political actions such as lobbying and testifying. The reason that action in the policy arena comes most easily and naturally to nurses is the fact that the policy process is very similar to which of the following? a. Citizen action committee b. Nursing diagnosis c. Nursing process d. Socratic method

c. Nursing process Health policy is simply the process of turning health problems into workable action solutions. Thus, the policy process is very similar to the nursing process, but the focus is on the level of the larger society and the adoption of these strategies requires political action. The policy process includes statement of a health care problem, statement of the policy options to address the problem, adoption of a particular policy option, implementation of the policy product, and evaluation of the policy's intended and unintended consequences in solving the original health problem.

CH. 9 Collaboration is an intervention that would be located where in the Intervention Wheel? a. Red wedge at the individual/family level of practice b. Blue wedge at the community level of practice c. Orange wedge at the community level of practice d. Green wedge at the systems level of practice

c. Orange wedge at the community level of practice The public health interventions are grouped with related interventions, and these wedges are color coordinated. The red wedge includes five interventions: surveillance, disease and health investigation, screening, outreach activities, and case finding. They typically occur in pairs or in sequence, although all can occur independently. The green wedge consists of three interventions: referral and follow-up, case management, and delegated functions; these are often implemented together. Similarly, the blue wedge includes three interventions—health teaching, counseling, and consultation—that are often implemented together. The orange wedge combines three interventions—collaboration, coalition building, and community organizing—which are all types of collective action that are usually carried out at the systems or community level of practice. Similarly, the three yellow wedge interventions—advocacy, social marketing, and policy development and enforcement—are often interrelated when implemented. Interventions in the orange and yellow wedges are typically used at the systems and community levels of practice, whereas those in the red, blue, and green wedges are usually carried out at the individual/family level of practice and to a lesser degree at the community and system levels of practice. Collaboration is a collective action and therefore, must be in an orange wedge.

Hospice care would be an appropriate option to discuss with which of the following patients? a. Patient with stage II lung cancer who is undergoing chemotherapy b. Patient with early Alzheimer's disease whose caregiver needs respite care c. Patient with metastatic breast cancer who has discontinued chemotherapy and radiation treatment d. Patient with severe debilitating osteoporosis

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. This does not mean that the patient will die within the next 6 months, only that if death occurred, it would not have been unexpected. Hospice care services can be provided in the home and/or institutional setting. Multidisciplinary teams have the knowledge, skill, compassion, and experience to address the unique needs of the patient at the end of life as well as the needs of his or her family.

CH. 18 A rural PBH is in the first phase of a community assessment to determine the community health status characteristics of the local county. This initial data gathering should most likely begin with which agency? a. County public health department b. National Centers for Disease Control and Prevention c. State vital statistics bureau d. U.S. Census Bureau

c. State vital statistics bureau Community health is characterized by status, structure, and process dimensions. Status or outcome involves biological, emotional, and social attributes. The biological (or physical) aspect of community health is often measured by traditional morbidity and mortality rates, life expectancy indices, and risk factor profiles. Data gathering is the process of obtaining existing, readily available data. These data describe the demography of the community, but also include the vital statistics, such as mortality and morbidity data. The state bureau of vital statistics would be the best source, especially for rural counties that may not have biostatisticians at the county level. Raw data submitted to the state by the local community would be consolidated at the state level. All states have such bureaus.

CH. 7 A community-based hospice nurse has an Asian male client with terminal-stage cancer. The client complains that he is in continuous pain and receives no relief from the codeine prescribed by his primary care physician (PCP). Because this nurse is culturally competent with Asian clients, the nurse contacts the client's PCP to discuss replacing this medication with another pain-reducing drug. The nurse's action can best be described as an example of: a. cultural accommodation. b. cultural assessment. c. cultural brokering. d. cultural repatterning.

c. cultural brokering. Cultural brokering is an action used by nurses in delivering culturally competent care. Cultural brokering is advocating, mediating, negotiating, and intervening between the client's culture and the biomedical health care culture on behalf of the client.

CH. 7 A Public Health Service nurse employed by the Indian Health Service is working with a client diagnosed with cancer. The client uses sweat lodges to "cure the disease." The nurse understands the need for the client to use traditional healing practices. The nurse is integrating her knowledge of the cultural organizing factor of: a. biological variations. b. communication. c. environmental control. d. space.

c. environmental control. The nurse understands that in the client's culture, disease is often perceived as a disharmony with other forces, and clients may look to hot or cold treatments to resolve or cure a cancerous condition. Clients may use the mind-body-spirit connection to heal from within. Such cultures rely on naturalistic solutions such as herbs, hot and cold treatments, and acupuncture to resolve or cure a cancerous condition.

CH. 18 The most important aspect of the nursing community assessment phase can best be described as: a. analyzing and synthesizing data. b. collecting and gathering data. c. formulating a community nursing diagnosis. d. identifying problem correlates.

c. formulating a community nursing diagnosis. Community assessment is one of the three core functions of public health nursing and is the process of critically thinking about the community. It starts by defining the client in terms of person, place, and function. It is a logical, systematic approach for identifying community needs, clarifying community problems, and identifying community strengths and resources to address these problems. It involves collecting data to obtain usable information about the community and its health. Such data collection may include gathering existing data as well as generating new data. New data might be generated by performing secondary analysis of existing data, conducting surveys, and carrying out community reconnaissance. Both types of data are combined in a composite database that is then analyzed and synthesized to identify trends or themes. The analysis of data generates information about community health problems (needs for action) and community health strengths and abilities that can be drawn upon in tackling these problems. The nurse and the community, in partnership, identify the problems. This is the process of problem analysis, which seeks to clarify the nature of a given problem. The nurse identifies the origins and effects of the problem, the points at which interventions might occur, and the parties that have an interest in the problem or its solution. A community-of-interest focus group that contains both content and process experts, as well as the nurse, should review the information to identify problem correlates (factors that contribute to the problem) and explore the relationship between each factor and the given problem. Active community participation is critical for the data interpretation process, particularly problem identification. A community nursing diagnosis is the end product of assessment and clarifies who gets the care (community defined), states the community problem or risk, and lists the factors contributing to the problem (problem correlates); for example, "Risk of ___ among ____ related to _____."

CH. 8 Nursing practice is governed by: a. boards of nursing established by the U.S. Department of Health and Human Services. b. nurse practice acts promulgated by federal and state legislative boards. c. nurse practice acts promulgated by state legislatures and operationalized by the state boards of nursing. d. nurse practice acts promulgated by the states in conformity with broad federal guidelines.

c. nurse practice acts promulgated by state legislatures and operationalized by the state boards of nursing. State legislatures enact laws that establish boards of nursing. The functions of the board are described by the nurse practice act of each state. The boards of nursing license nurses, oversee training programs, and interpret and enforce statutory law.

CH. 9 After consulting with the health department director, a PHN collaborates with a housing advocate service and legal counsel on behalf of the nurse's clients who live in substandard housing under fear of eviction. The nurse is applying the _______ component of the nursing process to a _______ level of practice. a. evaluation, systems b. assessment, community c. implementation, systems d. diagnosis, community

c. implementation, systems Collaboration and advocacy are often collective actions applied at a community or systems level of practice. In this case, the identification of the community problem probably emerged out of practice, rather than from a formal community assessment. The nurse's goals were to enforce the tenant's legal rights and improve their living conditions. The nurse sought advice from a housing advocate service and connected the clients with legal counsel. The nurse also sought political support by consulting with health department officials before implementing the nursing plan.

The shift of home care away from its charitable and public health-oriented roots toward current models in use can be attributed to: a. consolidation of voluntary and official home health agencies. b. expansion of home care to include community health needs. c. integration of home care into benefit programs. d. passage of the Medicare prospective payment system.

c. integration of home care into benefit programs. Home care began changing from its charitable and public health-oriented beginnings when it was added to benefit plans by payers, starting with the Metropolitan Life Insurance Company in the early 1900s; Medicare included it as a benefit for enrollees in 1965. Inclusion of home care benefits began to change the nature of the services provided. Services were focused on individuals with specific functional and health problems who could not be cared for elsewhere, and the care provided became more technical, opening the door for population-focused home care, transitional care, home-based primary care, traditional home health care, and hospice care.

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: a. certified advance practice home health nurses. b. integration of home health aide and homemaker roles. c. interprofessional teams. d. physician certification of the medical problem and plan of care.

c. interprofessional teams. The responsibilities and functions of health professionals in home care are determined by Medicare regulations, professional organizations, and state licensing boards. Many specialized services can be provided in home care, such as enterostomal therapy, podiatric care, pharmaceutical therapy, nutritional counseling, intravenous therapy, respiratory therapy, and psychiatric or mental health services. Many of these services can be provided on a consulting basis, either through staff education or through direct provision of services. This requires the use of an interprofessional team model, so that the specialized knowledge, skills, and perspectives of each team member can be integrated and will be implemented and reinforced by those in all involved disciplines to achieve successful patient outcomes.

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: a. agency accreditation. b. professional performance standards. c. malpractice risk reduction. d. regulatory compliance.

c. malpractice risk reduction. Home health and hospice nurses are at risk for malpractice claims related to the complexity of care, failure to adhere to standards of practice, and other errors. Nurses and their employers need to be proactive by taking responsibility for personal and agency actions. A focus on communication with clients, families, and the health care team; commitment to providing quality care; documentation refresher sessions; performance improvement programs; use of evidence-based practice guidelines; and appropriate use of information technology and telehealth are strategies that can help reduce risks.

CH. 1 A registered nurse is seeking a position as a public health nurse. In reviewing the job description, the nurse would expect to find a description of a position that focused on functions such as: a. monitoring pregnant teenagers for symptoms of complications of pregnancy. b. offering free hypertension screening and treatment referral at local health fairs to low-income, uninsured, community members. c. partnering with local seasonal farmworkers to design a program aimed at preventing illness and injury, and advocating for this population with local political and community leaders. d. preventing injury among a population of elderly residents in an assisted living facility and treating residents' chronic illnesses.

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

CH. 9 The three components of the Intervention Wheel are: a. communities, systems, and individuals/families. b. interventions, color wedges, and levels of practice. c. population base, levels of practice, and public health interventions. d. populations at risk, populations of interest, and levels of practice.

c. population base, levels of practice, and public health interventions. The components of the Intervention Wheel include population base, three levels of practice, and 17 public health interventions. The population-based component includes populations at risk and populations of interest. The three levels of practice include community, systems, and individual/family. The Wheel is colored coded at the intervention level, and the colors (red, blue, green, yellow, and orange) are grouped logically into wedges.

CH. 1 The role and goals of the community health nursing practice can best be described as: a. community-based interventions aimed at promoting, preserving, and maintaining the health of populations residing in institutional facilities such as nursing homes. b. education of nurses and other staff working in community-based and community-oriented settings to improve the overall effectiveness of their programs to meet client needs. c. population-level strategies aimed at promoting, preserving, and maintaining the health of populations through the delivery of personal health care services to individuals, families, and groups in an effort to improve the health of the community as a whole. d. activities targeted at improving the health status of clients served by community-based health service agencies such as hospice and home health agencies.

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

CH. 12 A nurse teaches an asthmatic client to recognize and avoid exposure to asthma triggers and assists the client's family in implementing specific protection strategies in the home, such as removing carpets and avoiding pets. This nurse's activities can best be described as: a. comprehensive assessment. b. primary prevention. c. secondary prevention. d. treatment intervention.

c. secondary prevention. Secondary prevention refers to interventions that promote health and prevent complications of an existing disease, injury, or disability. A prevention intervention at this level is aimed at individuals and groups who have been diagnosed with a disease and have discernible pathology (state of prepathogenesis).

CH. 11 A nurse in a community health clinic reviews a client's health history and includes a family health history across three generations, noting any diseases with a genetic basis. The nurse is detecting or defining risk in low-risk groups for potential referral for diagnostic testing. This is an example of: a. genetic testing. b. primary prevention. c. secondary prevention. d. tertiary prevention.

c. secondary prevention. When a nurse reviews the health history, the nurse observes for any disease that may have a genetic basis and if found, immediately refers the person or family to the appropriate health care provider. The goal of screening is to detect or define risk in low-risk groups and identify those people who should have diagnostic testing.

CH. 18 A community-oriented nurse leader is working with community leaders and interested citizens to improve access to services for the underserved by planning an expansion of the local community health clinic. This is an example of which type of community partnership model? a. Coalition b. Democratic c. Passive d. Community member professional

d. Community member professional Community members who are recognized as community leaders, (whether professionals, pastors, government officials or interested citizens) possess credibility and skills that health professionals often lack. The community member-professional partnership approach specifically emphasizes active participation. Coalitions are formal partnerships in which individuals and organizations serve in defined capacities such as steering committees, advisory committees, and work groups. Coalitions are active partnerships, in which all participants share leadership and decision making to some degree.

CH. 18 Which community attribute is an indicator of a community's health status? a. Mean educational level b. Location of health facilities within the community c. Ratio of police to citizens d. Suicide rate

d. Suicide rate Community health status (or outcome) involves biological, emotional, and social attributes. Biological attributes include morbidity and mortality. The social attributes of health status include crime rates and functional levels. The emotional attributes of health status include consumer satisfaction and mental health indices. The suicide rate is one of the measures used when compiling mental health indices. Educational levels are part of the structure dimension (social indices). The physical attributes of structure include measures of community health services and resources, such as use patterns and provider-to-client ratios.

The incentives and pressures for cost control and improved health outcomes have promoted the development of technologies that are simpler, more reliable, and: a. more acceptable to the patient. b. more expensive. c. more complex. d. efficient.

d. efficient. The increased availability of telehealth coincides with trends described in this and other chapters in this book: an aging population, increased chronic illness and costs, and changes in health care reimbursement. Home health, palliative, and hospice providers face the challenge of managing increasingly complex clients in a highly constrained fiscal environment where patterns of care and reimbursement are based on client need and agency efficiency. Telehealth has emerged as a viable and acceptable way to supplement the delivery of health care economically.

CH. 10 Campaigns to decrease the inequitable burden of environmental risks on the poor and people of color in the United States strive to apply the ethical principle of: a. societal justice. b. nonmaleficence. c. compliance and enforcement of the Environmental Protection Agency Regulatory Act. d. environmental justice.

d. environmental justice. Environmental health risks notably have disproportionately affected poor people and people of color in the United States. Low-income citizens and people of color are more likely to live near a hazardous waste site, and increased incidence of childhood lead poisoning and increased rates of childhood asthma are seen in these groups. Environmental justice is the principle of assuring that no group is more at risk of harmful exposure than another.

CH. 7 A nurse asks a couple who are new parents for their baby's full name. The parents reply that they are only supposed to give the baby its first name. The most appropriate response for the nurse is to: a. tell the couple that they are the child's parents and it is up to them to name their baby. b. explain to the couple the state's bureau of vital statistics deadline for completing the birth certificate. c. give the couple the paperwork and ask when the baby will have a name. d. express interest and ask the couple to share how their new baby will receive its name.

d. express interest and ask the couple to share how their new baby will receive its name. Dealing effectively with immigrant populations includes learning about how the community deals with common events and what their traditional practices are. In some cultures, it is not the parents but their spiritual leader or a more senior family member who gives a baby its name. Nurses should engage in cultural encounters to learn about a client's culture and practices.

CH. 10 When applying the nursing process to environmental health, the nurse would: a. conduct an assessment focused on the client's presenting problem. b. coordinate interventions with the primary care provider of record. c. examine criteria that are limited to the client's immediate responses. d. include outcome measures that involve mitigation and elimination of the contributing factors.

d. include outcome measures that involve mitigation and elimination of the contributing factors. If the nurse suspects that the client's health problem is being influenced by environmental factors, the nurse should follow the nursing process and note the environmental aspects of the problem in every step of the nursing process. For instance, in goal setting, the nurse should include outcome measures that relate to mitigation and elimination of the environmental factors.

CH. 11 Cleft lip and/or palate, a common congenital malformation, is often inherited and influenced by environmental factors, therefore it is referred to as a(n): a. extra chromosome expression. b. gene mutation. c. lifetime exposure phenomenon. d. multifactorial disease.

d. multifactorial disease. Multifactorial diseases or those caused by gene and environment interaction influence disease risk, health conditions, and the therapies used to treat disease. Multifactorial disorders tend to occur in families and include such common inherited congenital malformations as cleft lip and palate, neural tube defects, and congenital heart disease.

CH. 1 A public health nurse leader is encountering barriers when trying to shift the public health agency's efforts to a population-focused practice. The reasons peers are not supportive of the proposed shift to a population focus are most likely related to: a. agency colleagues' push for nurses to focus on population initiatives. b. costs associated with staff training and revision of documents. c. lack of support from the agency's funding sources. d. opinions that nursing should focus on the provision of direct client care and services.

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

CH. 12 Case fatality from breast cancer has decreased in recent years, although the incidence of breast cancer has increased. Descriptive epidemiology would use the component of time to explain this change in terms of: a. cyclical patterns. b. event-related clusters. c. point epidemic. d. secular trends.

d. secular trends. In descriptive epidemiology, the components of person, place, and time are used to describe increases or decreases in the frequency of diseases over time. Temporal or spatial patterns that influence long-term changes in morbidity or mortality rates are known as secular trends and may reflect changes in social behavior or practices. Some aspects to be considered are the effects of improved diagnostic capability and changes in survival (case fatality) rather than changes in incidence. The trends in breast cancer have led to a mortality curve that is flatter than the incidence curve. This leads to uncertainty in determining the actual increase in incidence rate, because improved diagnostic capability may explain some but not all of the increase observed. Another area of consideration is changes in case definition or coding of disease in the International Classification of Diseases, because both can produce an artificial change in mortality rates.

CH. 9 The intervention used to influence the knowledge, attitudes, values, beliefs, behaviors, and practices of the population of interest is referred to as: a. advocacy. b. coalition building. c. consultation. d. social marketing.

d. social marketing. Social marketing utilizes commercial marketing principles and technologies in programs designed to influence the knowledge, attitudes, values, beliefs, behaviors, and practices of the population of interest. Recent examples of the use of these techniques are antismoking campaigns, campaigns for refunding of the State Children's Health Insurance Program, and campaigns to address the needs of uninsured/underinsured populations.

CH. 10 A nurse identifies higher-than-normal levels of lead when screening a 3-year-old child. The nurse works with the local health department to put together a team to address the environmental issues responsible for the child's abnormal lead level. Team members should include the following specialists: a. epidemiologist, pediatric specialist, and sanitarian. b. laboratory specialist, contractor whose bid for lead reduction work is the lowest, and public health lead reduction specialist. c. public health sanitarian, pediatric generalist, and plumbing inspector. d. specially trained housing inspector, pediatric specialist, lead-based paint intervention team, and laboratory specialists to test the child's home and the surrounding neighborhood.

d. specially trained housing inspector, pediatric specialist, lead-based paint intervention team, and laboratory specialists to test the child's home and the surrounding neighborhood. Environmental health-risk identification and risk-reduction intervention require a multidisciplinary team. The team members needed to address an elevated lead level in a child include a specially trained housing inspector, a sanitarian familiar with lead health risks, a nurse practitioner and/or physician trained to intervene in cases of pediatric lead exposure, and housing specialists trained to reduce lead-based paint risk in the home.

CH. 9 Promotion of the creation of immunization registries that combine immunization information from different sources into a single electronic record to provide official immunization records for schools, daycare centers, health departments, and clinics is a goal of: a. community-level practice. b. family-level practice. c. individual-level practice. d. systems-level practice.

d. systems-level practice. The goal of systems-level practice is to change the laws, policies, and practices that influence immunization rates, such as promoting the creation of population-based immunization registries and improving clinic and provider practices.

A home health nurse is charged with identifying opportunities for health promotion and illness primary prevention. The activity that bests demonstrate this focus is: a. collaborating with the chaplain to address the spiritual needs of a hospice patient. b. educating a school nurse on the care regime of a returning student newly diagnosed with asthma. c. referring a newly diagnosed diabetic patient to the nutritionist for dietary teaching. d. tracking the immunization status of patients.

d. tracking the immunization status of patients. Immunizations prevent disease, a function of primary prevention. Patients requiring home health care may be more at risk of complications of diseases like influenza and pneumonia. Keeping immunizations current is a critical aspect of health promotion and illness primary prevention for these patients. Home health nursing involves the same primary prevention focus in the care of aggregates as does other community-oriented nursing. It also requires a focus on secondary and tertiary prevention in the care of individuals in collaboration with the family and other caregivers.

CH. 10 An occupational health nurse practitioner's physical assessment of a factory worker identifies an acute-onset pruritic dermatitis extending over the face, hands, neck, and forearms. The nurse's priorities should be to: a. contact factory senior management, educate workers about their exposure, and clean the area. b. contact the Occupational Safety and Health Administration immediately and remove the offending chemical in the work environment. c. immediately evacuate the worker's nearby workspace and treat the worker and other exposed workers. d. treat the client and obtain a comprehensive exposure history; if an on-site environmental exposure is suspected as the cause, screen other at-risk workers and ensure that the environmental risk is identified and eliminated.

d. treat the client and obtain a comprehensive exposure history; if an on-site environmental exposure is suspected as the cause, screen other at-risk workers and ensure that the environmental risk is identified and eliminated. A careful history should be taken using the I PREPARE (Investigate potential exposures, Present work, Residence, Environmental concerns, Past work, Activities, Referrals and resources, Educate) model. The client should be appropriately treated. If an on-site environmental exposure is suspected, other at-risk workers should be screened and treated as needed. The environmental cause should be resolved, either by removing the offending chemical or reducing it to safer levels. Factory safety policies should be followed, reviewed, and changed if needed. State and federal agencies should be notified as required.

CH. 12 John Snow played a critical role in the development of modern disease surveillance when he: a. devised a more statistically valid method of analyzing epidemiologic data. b. discovered causal agents for anthrax, tuberculosis, and cholera. c. tracked the incidence of tuberculosis in the tenements of New York City. d. used geographic mapping to demonstrate the connection between water supply and cholera.

d. used geographic mapping to demonstrate the connection between water supply and cholera. John Snow is considered the father of modern epidemiology because of the methods he used in his groundbreaking work to connect the incidence of cholera with the water supply. Snow showed that households receiving water from one water company, whose intake valve was in an area of the river contaminated by sewage, had a much higher rate of cholera than those receiving water from other companies drawing water from less-contaminated parts of the river.

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

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