COMMUNITY exam 1 questions

Which of the following children is most at risk for being abused? a. A 1-year-old b. A 6-year-old c. A 9-year-old d. A teenager

A 1 YEAR OLD Children under the age of 4 years and children with special needs are at highest risk for abuse.

The Elizabeth Poor Law of 1601 is similar to which current law? a. Welfare b. Food stamps c. Medicaid d. Medicare

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

Which of the following adolescent(s) would receive care from the advanced practice nurse without parental consent? (Select all that apply.) a. A 16-year-old who is living on his own (not with his parents) b. A pregnant adolescent c. An adolescent in an emergency situation d. An adolescent whose diagnosis has a serious prognosis

A 16 YEAR OLD WHO IS LIVING O HIS OWN, A PREGNANT ADOLESCENT, AN ADOLESCENT IN AN EMERGENCY SITUATION Most states have enacted laws allowing health care providers to treat adolescents in certain situations without parental consent. These situations include emergency care, substance abuse, pregnancy, and birth control. All 50 states recognize the "mature minors doctrine." This allows youths 15 years of age and older to give informed medical consent if it is apparent that they are capable of understanding the risks and benefits and if the procedure is medically indicated.

A client has designated someone else to make health care decisions when he or she is unable to do so. Which of the following methods is the client using to make health care decisions? a. An advance directive b. A living will c. A durable medical power of attorney d. The Patient Self-Determination Act

A DURABLE MEDICAL POWER OF ATTORNEY Durable medical power of attorney is the legal way for a client to designate someone else to make health care decisions when he or she is unable to do so.

Which of the following families is at high risk for health problems? a. A man agrees that he needs to eat better and exercise more but also expresses how busy he is at his job. b. A man knows that his grandfather, father, and older brother all died of cardiac disease. c. A man is currently unemployed and despairs about finding a position. d. A man expresses disappointment that, having been laid off as an executive, his new position pays only about two thirds of his original salary.

A MAN IS CURRENTLY UNEMPLOYED AND DESPAIRS ABOUT FINDING A POSITION A person who is unemployed and despairing of finding employment is at serious economic risk, which is one of the foremost predictors of health problems. Economic risk is determined by the relationship between family financial resources and the demands on those resources. Having adequate financial resources means that a family is able to purchase the necessary services and goods related to health, such as adequate housing, clothing, food, education, and health or illness care.

A nurse is drawing a genogram. Which of the following would the nurse use to demonstrate a marriage relationship between two individuals? a. A broken line b. A dashed line c. A solid line d. Two parallel lines

A SOLID LINE Marriage is indicated by a solid line on a genogram.

Which of the following best describes a normative life event that can increase the risk for illness? a. A family is involved in a motor vehicle crash. b. A group of teens experiment with recreational drugs. c. A woman is pregnant with her first child. d. The family wage earner is laid off from his job.

A WOMAN IS PREGNANT WITH HER FIRST CHILD Life events can increase the risk for illness and disability. Normative events are those that are generally expected to occur at a particular stage of development or of the life span. Although pregnancy is a normal condition, it carries risks such as the development of eclampsia or more minor health problems such as constipation and hemorrhoids. Additionally, pregnancy (and the birth that follows) will alter family dynamics and may increase risk for psychological stressors. The events listed in the other options are not normative life events

Which of the following situations would most likely indicate elder abuse? a. A daughter refuses to visit her mother due to work commitments. b. A child runs around a grandparent's house breaking items. c. A young man repeatedly steals money from his grandmother. d. An elderly person demands that the family come for dinner.

A YOUNG MAN REPEATEDLY STEALS MONEY FROM HIS GRANDMOTHER

A nurse wants to establish a program to decrease the death rate among children. Which of the following health problems should be the target of this program? a. Accidents and injuries b. AIDS c. Childhood obesity d. Vaccine-preventable diseases

ACCIDENTS AND INJURIES Injuries are the number one cause of death for children (and young adults up to age 21 years) in the United States. Injuries and accidents are the most important causes of preventable disease, disability, and death among children. Most are preventable. Obesity, although a significant problem, is not a common cause of death in children.

A client explains to the nurse that it is just impossible for her and her husband to continue to have his mother in the home alone during the day while they work because the woman becomes confused and has fallen twice. Which of the following community resources should the nurse recommend? a. Adult day health b. Home health c. Long-term care d. Senior center

ADULT DAY HEALTH Adult day health is for individuals whose mental and/or physical function requires additional health care and supervision. It serves as more of a medical model than the senior center, and individuals typically return home to their caregivers at night. Long-term care would take the client out of the home. Home health would leave the patient for periods of unsupervised time in which the patient could have problems and help would not be available.

Which of the following factor(s) may help determine how many home visits are made to a particular family? (Select all that apply.) a. Agency's policies regarding eligibility for services b. Family's feelings about the home visit and willingness to continue c. Nurse's perception of the amount of time needed to complete required tasks d. Reimbursement policies of third-party payers

AGENCYS POLICIES REGARDING ELIGIBILITY FOR SERVICES, FAMILY FEELINGS ABOUT THE HOME VISIT AND WILLINGNESS TO CONTINUE, REIMBURSEMENT POLICIES OF THIRD PARTY PAYERS Although it is not unusual to have only one home visit with a family, often multiple visits are made. The frequency and intensity of home visits vary not only with the needs of the family but also with the eligibility of the family for services as defined by agency policies and priorities. Although the textbook does not directly discuss the issue, the family's willingness to work with the nurse is a factor. Also, the nurse cannot make visits unless the agency is being reimbursed for the nurse's time and expenses, so reimbursement policies of third-party payers are a major influence on the number of visits for which the family may be eligible. The nurse's perception of the time needed to give quality care must unfortunately be secondary to other variables, which can control the time available

A nurse has completed health risk appraisals with several different families. Which of the following families would be of most concern to the nurse? a. An older couple who has just retired and sold their house, who talk about their new condo in a retirement community. b. Newlyweds who have been saving their money, who want to discuss birth control and family planning in preparation for future pregnancies. c. Parents who come with their child for his pre-kindergarten physical exam and want to be sure all the child's immunizations are up to date. d. A woman who is very pleased with her new position at the hospital and wants to have her pre-employment exam and drug screen.

AN OLDER COUPLE WHO HAS JUST RETIRED AND SOLD THEIR HOUSE WHO TALK ABOUT THEIR NEW CONDO IN A RETIREMENT COMMUNITY Transitions (movement from one stage or condition to another) are times of potential risk for families. Age-related or life-event risks often occur during transitions from one developmental stage to another. Transitions present new situations and demands for families. Moving from the family home to a smaller condo represents a major change in lifestyle. None of the other options represent major transitions. If the event is normative, or anticipated, it is possible for families to prepare for the event and its consequences

A nurse is considering joining the American Public Health Association. What information about this organization should be considered when making this decision? a. APHA focuses on the public health concerns of the medical profession. b. APHA represents concerns of nursing specialty practices. c. APHA provides a forum for nurses to discuss their public health concerns. d. APHA focuses on providing health promotion education to the public.

APHA PROVIDES A FORUM FOR NURSES TO DISCUSS THEIR PUBLIC HEALTH CONCERNS APHA was formed to facilitate interprofessional efforts and promote the "practical application of public hygiene." The Public Health Section within APHA provides nurses with a forum to discuss their concerns and strategies. It also serves as a focus of leadership and policy development for community/public health nursing.

Which of the following interventions would the nurse most likely implement when addressing the problem of asthma among school-aged children? (Select all that apply.) a. Assess schools and day care centers for environmental "friendliness." b. Share nutritional information with all students in the school. c. Develop home and environmental assessment guides. d. Teach all school personnel how to use rescue inhalers.

ASSESS SCHOOLS AND DAY CARE CENTERS FOR ENVIRONMENTAL FRIENDLINESS, DEVELOP HOME AND ENVIRONMENTAL ASSESSMENT GUIDES Population-focused strategies for asthma management include education programs for families of children and adolescents who have asthma, development of home and environmental assessment guides to identify triggers, education and outreach efforts in high-risk populations to aid in case finding (e.g., in areas with low income, high unemployment, and substandard housing, where there is exposure to secondhand smoke), development of community clean air policies (e.g., no burning of leaves, use of smoke-free zones), improved access to care for asthmatic patients (e.g., developing clinic services with consistent health care providers to decrease emergency department use), and assessment of schools and day-care centers for lack of asthma triggers.

Which of the following best describes the use of genomic health care? a. Assists with understanding family relationships b. Assists with determining familial health risks c. Useful in learning about environmental risk factors d. Useful in detecting risk for developing cancer

ASSIST WITH DETERMINING FAMILIAL HEALTH RISKS Genomic health care can give health care providers the tools that they need to use a person's unique genomic information to design and prescribe the most effective treatment for each person and to help clients and families understand some of their health risks that are influenced by their genetic make-up. When nurses obtain a family history and learn about the illnesses and causes of death of biologically related family members, they can then learn about shared genes, environment and lifestyle behaviors that can increase a person's risks for the same diseases that other family members experienced. Genomic health care is broader than detecting risk for developing cancer.

Making sure that essential community-oriented health services are available defines which of the core public health functions? a. Policy development b. Assessment c. Assurance d. Scientific knowledge-based care

ASSURANCE Public health is based on scientific knowledge but is not a core function. The definition does not fit the terms assessment or policy development.

After seeing a public education program on the need for screening colonoscopy and the dangers of colorectal cancer, an older friend asks the nurse, "I'm really scared of getting cancer. What can I do to avoid that kind of cancer?" Which of the following recommendations should be made by the nurse? (Select all that apply.) a. Avoid smoking or much alcohol. b. Choose poultry or fish rather than red or processed meat. c. Eat lots of fruits, vegetables, and fiber each day. d. Try to get at least 8 hours of sleep a night.

AVOID SMOKING OR MUCH ALCOHOL, CHOOSE POULTRY OR FISH RATHER THAN RED OR PROCESSED MEAT, EAT LOTS OF FRUITS VEGGIES AND FIBER EACH DAY Obesity, physical inactivity, smoking, heavy alcohol consumption, a diet high in red or processed meats, and insufficient intake of fruits and vegetables are risk factors for colorectal cancer.

A nurse considers how the environment outside of the family influences the development of a child when planning care for a family. Which of the following theories is being used by the nurse? a. Bioecological systems theory b. Family systems approach c. Family developmental theory d. Interactionist theory

BIOECOLOGICAL SYSTEMS THEORY The bioecological systems theory describes how environments and systems outside of the family influence the development of a child over time.

Which of the following is the best way to ensure good nutrition in infants? a. Breastfeeding only b. Feed them only brand-name baby foods c. Feed them only brand-name cereals d. Feed them only brand-name formulas

BREASTFEEDING ONLY Breastfeeding is the preferred method of infant feeding. Breast milk provides appropriate nutrients and antibodies for the infant. Breastfed infants have fewer illnesses and allergies. Breastfeeding is associated with a lower risk in developing childhood obesity

A nurse is new to the community but wants to begin planning immediately for health promotion programs. Even though the nurse does not yet know the community, which of the following programs would be good to plan first? a. Alcohol and tobacco cessation programs b. Cancer screening programs c. Cardiac health education programs d. Exercise for life programs

CARDIAC HEALTH EDUCATION PROGRAMS Heart disease is one of the most significant public health problems in the United States, responsible for premature mortality and disability. Cardiovascular disease is the leading cause of death in the United States. Good nutrition and exercise programs, while both good health promotion programs, are too narrow in focus to represent the greatest need in the community. Cancer is the second leading cause of death so may be the nurse's second focus.

A nurse wants to establish a program to decrease the death rate among adolescents. Which of the following programs should be developed? a. Anti-alcohol program b. Anti-smoking program c. Careful driving program d. Safe sex program

CAREFUL DRIVING PROGRAM Motor vehicle accidents are the leading cause of death among children and teenagers.

Toward whom is the TLC model targeted? a. Caregivers of older persons with health problems b. Community organizations that offer services for the elderly c. Elderly clients with health problems d. Nurses who care for older clients

CAREGIVERS OF OLDER PERSONS WITH HEALTH PROBLEMS The TLC model is focused toward caregivers (primarily families) in an effort to relieve caregiver burden. Components are T = training in care techniques, safe medication use, recognition of abnormalities, available resources; L = leaving the care situation periodically to obtain respite and relaxation and maintain their normal living needs; and C = care for themselves (the caregiver) through adequate sleep, rest, exercise, nutrition, socialization, solitude, support, financial aid, and health management

A nurse enters a family's home for the first time. Which of the following goals should the nurse have? (Select all that apply.) a. Assessing each family member in detail both physically and psychologically b. Collaborating with the family to establish goals and a plan for meeting them c. Determining the exact relationship between each member of the family d. Exploring the family's perception of their problems and needs

COLLABERATING WITH THE FAMILY TO ESTABLISH GOALS AND A PLAN FOR MEETING THEM, EXPLORING THE FAMILYS PERCEPTION OF THEIR PROBLEMS AND NEEDS During the beginning phase of the nurse-family interaction, three activities occur—mutual data collection and exploration of needs and problems; mutual establishment of goals; and mutual development of a plan.

A nurse notes that the community has an unusually high prevalence of sexually transmitted infections among teens. Which of the following best describes a secondary prevention action the nurse could take? a. Conducting a sexual behavior survey with the adolescents b. Establishing in-school education related to transmission of sexual infections c. Providing free condoms at schools and universities d. Providing follow-up educational programs for those diagnosed with an STI

CONDUCTING A SEXUAL BEHAVIOR SURVEY WITH THE ADOLESCENTS Secondary prevention would include screening for risky behavior. Education and distribution of condoms are both primary prevention measures, and follow-up education for those diagnosed and being treated is tertiary to prevent further problems.

A nurse is working with incarcerated adults who are being released from prison. Which of the following nursing interventions would be most appropriate for the nurse to implement? a. Connect offenders with community-based mental health programs. b. Provide community supervision for mentally ill offenders. c. Advocate for increased prison time to decrease recidivism rates. d. Educate about available state resources.

CONNECT OFFENDERS WITH COMMUNITY BASED MENTAL HEALTH PROGRAMS Connecting offenders with community-based mental health programs at the time of release from prison can decrease recidivism rates, because many incarcerated adults experience major psychiatric disorders. It would be impossible for the nurse to supervise all mentally ill offenders in the community. Increased prison time is not shown to decrease recidivism rates and education about available state resources is not the most important nursing intervention to provide for this population.

A nurse's mother leans forward and says, "My best friend fell the other day and now she's in the hospital. I'm really worried about getting osteoporosis. What do you think I should do?" What should the nurse recommend? (Select all that apply.) a. Ask your doctor for hormone replacement therapy. b. Continue to abstain from alcohol and not use tobacco. c. Eat foods high in calcium such as fortified skim milk. d. Eat lots of green leafy vegetables.

CONTINUE TO ABSTAIN FROM ALCOHOL AND NOT TO USE TOBACCO, EAT FOODS HIGH IN CALCIUM SUCH AS FORTIFIED SKIM MILK It is estimated that one of every two American women older than 50 years will experience an osteoporosis-related fracture in her lifetime. Primary prevention activities include a diet rich in calcium and vitamin D; exposure to sunlight for 20 minutes a day; exercise, especially weight-bearing activities such as walking, running, stair climbing, and weight lifting, to improve bone density; limiting alcohol consumption; and avoiding smoking.

A nurse has just witnessed the signing of an agreement between two parents in which the parents pledge not to yell at each other in the presence of their children. Which of the following is being demonstrated through this action? a. Contracting b. Crisis intervention c. Empowerment d. Strategic planning

CONTRACTING Contracting is making an agreement between those involved in a shared effort by both nurse and family. The premise of contracting is family control. It is assumed that when the family has legitimate control, their ability to make healthful choices is increased.

A nurse working with Mary Breckinridge would have likely assisted with: (Select all that apply.) a. Establishing the Henry Street Settlement b. Developing health programs geared toward improving the health care of the rural populations c. Blazing a nursing trail through the Rockies, providing nursing care to miners and their families d. Ensuring positive outcomes for pregnancies among women in the Appalachian region

DEVELOPING HEALTH PROGRAMS GEARED TOWARD IMPROVING THE HEALTH CARE OF THE RURAL POPULATION , ENSURING POSITIVE OUTCOMES FOR PREGNANCIES AMONG WOMEN IN THE APPALACHIAN REGION Mary Breckinridge developed health programs geared toward improving the health care of the rural and often inaccessible populations in the Appalachian regions of southern Kentucky. Breckinridge introduced the first nurse-midwives into the United States when she deployed FNS nurses trained in nursing, public health, and midwifery. Their efforts led to reduced pregnancy complications and maternal mortality, and to one-third fewer stillbirths and infant deaths in an area of 700 square miles. Lillian Wald established the Henry Street Settlement.

A nurse is appraising health risks. Which of the following questions would most likely be asked by the nurse? a. "Does your 4 year-old have a booster seat in the car?" b. "Have you noticed any physical problems as you go about your daily routine?" c. "What concerns do you have today? d. "Why did you decide to come in for a checkup?"

DOES YOUR 4 YEAR OLD HAVE A BOOSTER SEAT IN THE CAR? Health risk appraisal refers to the process of assessing for the presence of specific factors in each of the categories that have been identified as being associated with an increased likelihood of an illness, such as cancer, or an unhealthy event, such as an automobile accident.

A home health nurse is about to visit a family at their home. However, the nurse is feeling uncomfortable about getting out of her car because a group of young adults across the street are drinking and fighting among themselves. Which of the following actions should be taken by the nurse? a. Call the agency and ask what she should do. b. Call the family, explain the situation, and try to reschedule. c. Fulfill the nurse's commitment to the family and enter the home quickly. d. Drive away and notify the family from a safer location.

DRIVE AWAY AND NOTIFY THE FAMILY FROM A SAFER LOCATION Personal safety is an issue. Home visits are generally very safe; however, as with all worksites, the possibility of violence exists. Therefore, the nurse needs to use caution. If a reasonable question exists about the safety of making a visit, the nurse should not make the visit.

Which of the following best describes where health care dollars in the United States be focused to improve breast cancer cure rates? a. Education for women about breast cancer b. Early detection programs with referral to ongoing access to a care provider c. Primary prevention programs d. Tertiary care through long-term follow-up

EARLY DETECTION PROGRAMS WITH REFERRAL TO ONGOING ACCESS TO A CARE PROVIDER Early detection can promote a cure, whereas late detection typically ensures a poor prognosis. The differences in the outcomes between women of color and white women point to issues associated with early detection, access to health care, and follow-up by a regular care provider.

A woman needs to take some time off from work to care for her invalid mother. Which of the following health policies allows her to take an extended leave from work to care for a family member? a. Personal Responsibility and Work Opportunity Reconciliation Act b. Women's Health Equity Act (WHEA) c. Temporary Assistance for Needy Families (TANF) d. Family and Medical Leave Act (FMLA)

FAMILY AND MEDICAL LEAVE ACT The FMLA provides job protection and continuous health benefits where applicable for eligible employees who need extended leave for their own illness or to care for a family member.

A nurse is implementing Wagner's Chronic Care Model. Which of the following actions would the nurse most likely take? a. Educate a community group about hypertension control. b. Create a budget for chronic disease management. c. Administer immunizations to community members. d. Conduct depression screenings in the community.

EDUCATE A COMMUNITY GROUP ABOUT HYPERTENSION CONTROL Use of electronic health records, provider reminders for key evidence-based care components, interprofessional teams communicating regularly and community health classes to educate people with chronic diseases are various ways the CCM is being implemented. Creating a budget is not a way to use CCM. Administration of immunizations and conducting depression screenings do not address the management of the most common and costly chronic diseases: heart disease, diabetes, stroke, cancer, and arthritis.

A nurse is providing contraceptive counseling to a female client. Which of the following is the most appropriate outcome of this counseling? a. Encourage the individual to choose abstinence. b. Ensure the individual is educated to make an informed choice about reproduction. c. Advocate for increased funding for reproductive services. d. Reduce the health risks of the individual.

ENSURE THE INDIVIDUALS IS EDUCATED TO MAKE AN INFORMED CHOICE ABOUT REPRODUCTION The goal of contraceptive counseling is to ensure that women have appropriate instruction to make informed choices about reproduction. The nurse should provide a nonjudgmental approach during counseling and allow the woman to choose the appropriate contraceptive method. Nurses do advocate for reproductive services for women, but that is not a goal of contraceptive counseling. Reduction in the health risks of the individual is a goal of pre-conceptual counseling.

A community health nurse is planning to implement an intervention to reduce the prevalence of sexually transmitted diseases in the community. Which of the following actions would most likely be taken by the nurse? a. Establish immunization clinics to prevent STDs. b. Educate people with HIV about the mode of transmission. c. Explain to women that HIV is transmitted to women usually by IV drug abuse. d. Develop a STD clinic to increase community access to services.

ESTABLISH IMMUNIZATION CLINICS TO PREVENT STDS The goal of Healthy People 2020 is to promote responsible sexual behaviors, strengthen community capacity, and increase access to quality services to prevent sexually transmitted diseases and their complications. Nursing activities should align with these goals.

A nurse wants to promote improved health for obese children in the community. Which of the following best describes a tertiary prevention measure that the nurse would implement? a. Establish lifestyle improvement programs through local youth organizations. b. Evaluate the food intake of a group of children for a 48-hour period. c. Provide education programs to overweight expectant parents. d. Evaluate the body mass index of children at regularly scheduled well-child exams.

ESTABLISH LIFESTYLE IMPROVEMENT PROGRAMS THROUGH LOCAL YOUTH ORGANIZATIONS Tertiary prevention includes activities aimed to reduce the complications of the disease process. Only lifestyle improvement programs are directed toward preventing problems in children who are already obese. Evaluating food intake and evaluating BMI are types of screening programs (secondary prevention). Providing education programs to overweight expectant parents does not involve children

A nurse is completing an initial home visit with a family. Which of the following actions should be taken first by the nurse? a. Assess the family and the home setting for both strengths and problems. b. Determine the family's expectations of a home visit. c. Establish rapport between the nurse and the family. d. Engage in extended social interaction as would be expected from any guest.

ESTABLISH RAPPORT BETWEEN THE NURSE AND THE FAMILY With the exception of social interaction, all the tasks listed are important. The initial home visit includes the nurse's self-identification and clarification of role, establishing rapport with the family, assessing the situation, and then determining the client's expectations. Although in some senses the nurse is a guest in the home, the nurse is not there for social purposes but to help the family with health concerns. However, without rapport between the nurse and the client, the nurse will be notably less effective at other tasks.

CHAPTER 3 A public health agency is planning to implement the electronic health record. Which of the following is a benefit of this choice? a. Facilitation of interprofessional care b. Improved client compliance with medical regimens c. Cost savings to the agency d. Compliance with JCAHO standards

FACILITATION OF INTERPERFESIONAL CARE The electronic medical record facilitates interprofessional care in chronic disease management and coordination of referrals; 24-hour availability of records with downloaded laboratory results and up-to-date assessments; incorporation of protocol reminders for prevention, screening, and management of chronic disease; improvement of quality measurement and monitoring; increased client safety; and decline in medication errors.

A nurse is providing pre-conceptual counseling to a young woman. Which of the following supplements would the nurse most likely recommend? a. Iron b. Calcium c. Folic acid d. Vitamin C

FOLIC ACID Research has shown that intake of folic acid can significantly reduce the occurrence of serious and often fatal neural tube defects by 50% to 70%. A recommendation was made that women capable of or planning a pregnancy take 0.4 to 0.8 mg of folic acid daily (USPSTF, 2009)

The nurse and the family have agreed on an ambitious goal to improve family functioning, but as the family later expresses with some dismay, they have not been able to change their behavior as easily and quickly as they had hoped. Which of the following must be remembered throughout this process? (Select all that apply.) a. A reassessment of resources should be done if the plan does not work. b. Individual family members must all be willing to make the plan their first priority. c. Goals must be realistic and feasible. d. Ongoing negotiation is central to the process.

GOALS MUST BE REALISTIC AND FEASIBLE, ONGOING NEGOTIATION IS CENTRAL TO THE PROCESS In contracting, an important aspect is obtaining the family's view of the situation and its needs and problems. Goals must be mutually set and realistic. A pitfall for nurses and clients who are new to contracting is to set overly ambitious goals. Because contracting is a process characterized by ongoing renegotiating, the goals are not static. The family's inability to change "as easily and quickly as they had hoped" does not mean the plan is not workable—only that more time and effort may be necessary.

Which of the following characteristics indicates a man is at a higher risk for developing prostate cancer? a. Being of Caucasian descent b. Has not had a PSA test c. Has a father or brother who has had prostate cancer d. Has benign prostatic hypertrophy (BPH)

HAS A FATHER OR BROTHER WHO HAS HAD PROSTATE CANCER Having a father or brother who has had prostate cancer places a man at higher risk for developing prostate cancer.

An elderly person is in the last stages of dying. Which type of care would be the best for him? a. Home health b. Assisted living c. Nursing home d. Hospice

HOSPICE Hospice would be the best form of care for a person in the last stages of dying.

Which of the following best describes the current research findings related to the use of hormone replacement therapy (HRT)? a. HRT does not prevent heart disease. b. Use of HRT is recommended to prevent osteoporosis. c. When used with complementary therapies, HRT is most effective. d. HRT is a contributing cause of breast cancer.

HRT DOES NOT PREVENT HEART DISEASE HRT does not prevent heart disease. To prevent heart disease women should avoid smoking, reduce fat and cholesterol intake, limit salt and alcohol, maintain a healthy weight, and be physically active.

A nurse is performing a health assessment on a young adult female. Which of the following comments by the client would cause the nurse to be concerned? a. "I can't believe I didn't get that promotion. I thought I was the best candidate." b. "I can't believe they didn't admit me to that graduate program with my good undergraduate grades!" c. "I can't believe how lonely it is around the house since my spouse died." d. "I can't believe how little I care about anything anymore since that diagnosis."

I CANT BELIEVE HOW LITTLE I CARE ABOUT ANYTHING ANYMORE SINCE THAT DIAGNOSIS A number of factors contribute to depression, including being female, having a family history of depression, unemployment, and chronic disease. All the options represent a loss, either potential or actual, but the statement about not caring about anything represents an actual symptom of depression.

A nurse is completing a health risk appraisal with a client. Which of the following comments would cause the nurse to probe further to determine if the family is in crisis? a. "I can't visit my husband in the hospital when I'm at work all day. How can I be sure he's all right?" b. "My husband always handled our finances. Now that he's gone, I'll have to learn how to do this." c. "I don't know what to do now that my husband is dead. There is no way I can go back to work and also take care of our three children." d. "What am I supposed to do now that everything we own is gone? Are there any agencies that can help me?"

I DONT KNOW WHAT TO DO NOW THAT MY HUSBAND IS DEAD. THERE IS NO WAY I CAN GO BACK TO WORK AND ALSO TAKE CARE OF OUR THREE CHILDREN A family crisis occurs when the family is not able to cope with an event and becomes disorganized or dysfunctional. When the demands of the situation exceed the resources of the family, a family crisis exists. In three of the options, the survivor is considering the problem and trying to learn how to cope or seek resources to cope. Only in this option is the person overwhelmed and unable to conceive of how to cope.

CHAPTER 20 A school nurse wants to decrease the rate of obesity among children. Which of the following actions in the community would be most effective? a. Lobby legislators to enact stronger legislation regarding school lunches and snack machines in schools. b. Increase nutrition programs in schools that teach children to make healthy food choices. c. Involve the entire family in the planning and managing of nutrition, especially when a child in the family is obese. d. Provide after-school and summer camps that focus on diet and exercise.

INVOLVE THE ENTIRE FAMILY IN THE PLANNING AND MANAGING OF NUTRITION ESPECIALLY WHEN A CHILD IN THE FAMILY IS OBESE Interventions need to be based on goals of lifestyle changes for the entire family. The goal is to modify the way the family eats, exercises, and plans daily activities. Although it is important to teach nutrition, exercise, and proper food choice, if the family does not, for example, prepare the proper foods from which they can choose, the knowledge of the child is insignificant.

A mother says, "My son wants me to let him buy a car. I must admit, I certainly get tired of driving him around to all his sports and other activities. Do you think I should let him have a car?" Which of the following statements would be the best response by the nurse? a. "Absolutely, it will help him recognize the cost of gas and maintenance." b. "Certainly. Most young men want their own car, and peer pressure can be painful." c. "It depends on whether you trust your son to drive safely." d. "No, adolescent males cannot be trusted with an automobile."

IT DEPENDS ON WHETHER YOU TRUST YOUR SON TO DRIVE SAFELY Motor vehicle-related injuries and violence are the leading causes of morbidity and mortality for adolescents. Males are more likely to take risks, and injury death rates for boys are twice as high as those for girls. Thus, the response by the nurse should take these factors into consideration in response and encourage the mother to individualize her decision for her son.

A nurse is explaining the health care system in the United States to a group of physicians visiting from South America. How would the nurse best describe the current health care system? a. "It is a logical, rational approach to meeting expressed needs while still trying to control costs." b. "It is a system in the process of reform as problems have become increasingly apparent." c. "It is divided primarily into two components: private health care and public health care." d. "It is the best in the world with outstanding research and high-technology care available to all."

IT IS DIVIDED PRIMARILY INTO TWO COMPONENTS: PRIVATE HEALTH CARE AND PUBLIC HEALTH CARE Health care in the United States consists of a personal care system and a public health system, with overlap between the two.

A nurse arrives at a home at the appointment time established with the client over the phone. However, no one answers the door. Finally a child comes out and says, "My mom said she couldn't see you and you should go away." Which of the following actions should be taken by the nurse? a. Demand the child let the nurse into the home to talk to the mother. b. Interview the child as to how the family is doing. c. Leave a card with information on how to get in touch with the nurse . d. Point out that legally once an appointment has been made the mother needs to be seen.

LEAVE A CARD WITH INFORMATION ON HOW TO GET IN TOUCH WITH THE NURSE The contact may be terminated as requested if the nurse determines that either the situation has been resolved or services have been obtained from another source and if the family understands that services are available and how to contact the agency if desired. However, the nurse should leave open the possibility of future contact. Obviously, the nurse cannot force entrance into the home. It would not be appropriate to coerce a child with misinformation or to interview a child about health concerns without a parent being present.

. A nurse would like to learn more about the overall health of a population. Which of the following indicators would the nurse most likely use? a. Life expectancy b. Mortality rate c. Morbidity rate d. Health status

LIFE EXPECTANCY Life expectancy is a measure that is often used to gauge the overall health of a population.

Which of the following nurses is famous for creating public health nursing in the United States? a. Florence Nightingale b. Frances Root c. Lillian Wald d. Mrs. Solomon Loeb

LILLIAN WALD Lillian Wald established the Henry Street Settlement and later emerged as the established leader of public health nursing during its early decades.

A health care provider is working with elderly clients who have ongoing chronic disease. Which of the following strategies can best assist them with healing? (Select all that apply.) a. Advocating for increased support for elderly persons b. Eliminating signs and symptoms of disease c. Managing any chronic diseases to prevent complications and delay deterioration d. Maximizing self-care capacity

MANAGING ANY CHRONIC DISEASES TO PREVENT COMPLICATIONS AND DELAY DETERIORATION, MAXIMIZING SELF CARE CAPACITY With chronic illness, the focus is on healing (a unique process resulting in a shift in the body/mind/spirit system) rather than curing (elimination of the signs and symptoms of disease). Appropriate goals include maximizing self-care capacity, managing chronic diseases effectively, preventing complications, delaying deterioration and decline, and achieving the highest possible quality of life before dying with comfort, peace, and dignity.

How did the Industrial Revolution result in previous caregiving approaches, such as care by families, friends, and neighbors, becoming inadequate? a. Economic and political wars resulted in frequent death and injuries. b. Incredible plagues consistently and constantly swept the European continent. c. Migration and urbanization resulted in increased demand for care. d. Caregivers could easily find other employment, so they demanded to be paid.

MIGRATION AND URBANIZATION RESULTED IN INCREASED DEMAND FOR CARE Care became inadequate because of the social changes in Europe, with great advances in transportation, communication, and other technologies. The increased mobility led to migration and urbanization, which in turn led to increased need for care.

A nurse is implementing a tertiary prevention program to promote health among middle-aged women with diabetes. Which of the following best describes the intervention being implemented by the nurse? a. Developing lifestyle improvement programs for women at risk for diabetes b. Presenting lifestyle management presentations at women's conferences c. Monitoring blood glucose levels closely and modifying diet accordingly d. Screening glucose levels of women at risk for development of diabetes

MONITORING BLOOD GLUCOSE LEVELS CLOSELY AND MODIFYING DIET ACCORDINGLY Tertiary prevention includes activities that are aimed to reduce the complications of the disease process. Only monitoring blood glucose levels is directed toward preventing problems in women who already are diagnosed with diabetes.

A nurse is conducting a family assessment. Which of the following behaviors would the nurse recognize as suggestive of a family with problems? a. Before eating, the family prayed, expressing gratitude for their blessings. b. During family play, jokes and laughter were heard. c. Each person had a private room with a door for alone time. d. Most of the conversation was between the father and the eldest daughter.

MOST OF THE CONVERSATION WAS BETWEEN THE FATHER AND THE ELDEST DAUGHTER Evidence of healthy families can be seen in a variety of observations, including open communication among all members, mutual play with humor, balanced interactions among all members, expressions of a religious core or other value system, and each member being allowed some privacy.

Which statement about eating disorders is correct? a. Individuals with anorexia frequently complain about weight loss. b. Purging is associated with anorexia. c. Most women with bulimia are concerned with the shape and weight of their body. d. Bulimia is considered to have more medical complications than anorexia.

MOST WOMEN WITH BULIMIA ARE CONCERNED WITH THE SHAPE AND WEIGHT OF THEIR BODY Those with bulimia are usually concerned with the shape and weight of their body. Those with anorexia view themselves as normal or overweight, purging is associated with bulimia, and anorexia is considered to have more complications than bulimia.

Which of the following is of the greatest concern for the nurse who works with high school students? a. Alcohol use b. Motor vehicle accidents c. Sports-related injuries d. Unprotected sex

MOTOR VEHICLES ACCIDENTS Motor vehicle-related injuries and violence are the leading causes of morbidity and mortality for adolescents. Thus, this would be the greatest concern for the nurse working with high school students.

During which phase of the home visit does the nurse document what was accomplished? a. Pre-visit phase b. In-home phase c. Termination phase d. Post-visit phase

POST VISIT PHASE A major task of the post-visit phase is documenting the visit and services provided.

Which of the following factors has the largest impact on health disparities among all populations? a. Ethnicity b. Education level c. Lifestyle choices d. Poverty

POVERTY Poverty is a strong and underlying current factor that affects all special groups.

An occupational health nurse is developing an educational program to address the importance of healthy personal health habits. Which of the following topics would be most important for the nurse to address? a. Avoidance of alcohol b. Regular physical exercise c. Daily consumption of calcium-rich foods d. Monthly self-breast and testicular exams

REGULAR PHYSICAL EXERCISE Many family health risks can be reduced by careful attention to diet, exercise, and stress management. Regular physical exercise is effective in promoting and maintaining health and in preventing disease. Physical activity can help to prevent obesity, diabetes, heart disease, cancer, osteoporosis, and depression. Avoidance of alcohol and daily consumption of calcium-rich foods are not recommendations for improving personal health habits.

Which of the following behaviors results in men being less healthy than women? a. Concentration on sports, hunting, and other dangerous recreational choices b. Employment in stressful positions more so than women c. Preference to spend money on priorities other than health care d. Reluctance to visit physicians

RELUCTANCE TO VISIT PHYSICIANS A major obstacle to improving men's health is their apparent reluctance to consult their primary care provider. Men are not well connected to the health care system. Men do not participate in health care at the same level as women, apparently because of the traditional masculine gender role learned through socialization (Bonhomme, 2007). Only 57% of U.S. men see a doctor, nurse practitioner, or physician assistant compared with 74% of women (AHRQ, 2010)

A home health nurse is preparing to terminate the first home visit with teenage parents and their new baby. Which of the following actions will the nurse take before leaving? a. Determine the family's willingness for another home visit b. Establish the purpose of the visit c. Review the family's learning and other accomplishments of the visit d. Review the family record and reason for referral

REVIEW THE FAMILYS LEARNING AND OTHER ACCOMPLISHMENT OF THE VISIT During the termination phase, the nurse reviews the visit with the family, summarizes what has occurred and what has been accomplished, and may make plans for future visits. The other options listed occur during the pre-visit phase.

A nurse has been successful in creating improvement in a family's health. Which of the following characteristics is most likely displayed by the nurse? a. Skilled at recognizing and strengthening the family's competencies b. Skilled at obtaining referrals and resources for the family c. Skilled at communication and interpersonal relationships d. Skilled at assessing and naming the family's main problems

SKILLED AT RECOGNIZING AND STRENGTHENING THE FAMILYS COMPETENCIES The nurse's approach to the family should be positive and focused on competencies rather than on problems or deficits.

Which of the following will provide the highest benefit to an older adult's well-being? a. Eligibility for Medicare and Social Security b. Higher socioeconomic status, income, and education c. Senior citizen privileges such as senior citizen centers and senior citizen discounts d. Social networks that give support and meaning to life

SOCIAL NETWORKS THAT GIVE SUPPORT AND MEANING TO LIFE Medicare, Social Security, senior privileges, and high socioeconomic status, income, and education are all extremely helpful to older adults. However, social networks that give support and meaning to life are a major factor that can contribute to ongoing health and vitality. One of the biggest dangers is social isolation.

A nurse wants to empower the family of a mother who has been newly diagnosed with breast cancer. Which of the following actions would the nurse most likely take? a. Apply for emergency financial assistance on the family's behalf. b. Arrange for community members to assist with child care. c. Invite the mother to join a cancer support group. d. Teach the family how to navigate the health care system.

TEACH THE FAMILY HOW TO NAVIGATE THE HEALTH CARE SYSTEM Definitions of empowerment reflect three characteristics of the empowered family seeking help: access and control over needed resources, decision-making and problem-solving abilities, and the ability to communicate and to obtain needed resources. Approaches for helping individuals and families assume an active role in their health care should focus on empowering, rather than giving direct help.

A nurse advises a client who has HIV not to donate blood, plasma, or organs. Which of the following levels of prevention is being used? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion

TERTIARY PREVENTION Tertiary prevention includes those interventions aimed at disability limitations and rehabilitation from disease, injury, or disability

Which of the following clients would cause the nurse the most concern? a. The client who is currently unemployed but actively seeking a position and frequently walking from one interview to another b. The client who is not employed but spending time at the gym keeping fit and studying the benefits of organic natural uncooked foods c. The client who is employed and often works 12 hours a day without moving from the computer desk d. The client who is employed but always leaves promptly at 5:00 to pick up the children from the day care center

THE CLIENT WHO IS EMPLOYED AND OFTEN WORKS 12 HOURS A DAY WITHOUT MOVING FROM THE COMPUTER DESK Personal health habits continue to contribute to the major causes of morbidity and mortality. The pattern of personal health habits and behavioral risk defines individual and family lifestyle risk. The client who doesn't move from the computer desk is creating great stress and strain on personal physiology and needs to be educated on the benefits of exercise and the risks of cumulative trauma on the body. Multiple health benefits of regular physical activity have been identified; regular physical exercise is effective in promoting and maintaining health and preventing disease

A family asks the nurse to please meet at their home rather than at the clinic. Which of the following best describes why the family prefers to meet in their home? (Select all that apply.) a. The family won't have to travel. b. It is cheaper for the family because of reimbursement requirements. c. Meeting at home is much more convenient for the family. d. The nurse won't be distracted by other clients or responsibilities. e. It would save money for the nurse and the clinic.

THE FAMILY WONT HAVE TO TRAVEL, MEETING AT HOME IS MUCH MORE CONVENIENT FOR THE FAMILY Advantages of a home visit include client convenience and client control, as well as the fact that it facilitates clients who are unable to travel, it allows more individualized services, and it provides a natural relaxed environment for discussion. However, home visits are expensive for the nurse and the nurse's employer because of travel costs and the amount of time spent with just one family. Unfortunately, nurses can be distracted by other tasks regardless of setting. Home visits are cheaper for insurance companies, not for the family.

A nurse calls a family to arrange for the first home visit. Which of the following information should the nurse share with the family? (Select all that apply.) a. The reason for the visit b. Everything the nurse knows about the family c. How many visits will be planned d. The cost of the visit and how this may be paid

THE REASON FOR THE VISIT, THE COST OF THE VISIT AND HOW THIS MAY BE PAID The nurse should include the reason for the visit, how or from whom the referral was obtained, and a brief summary of what is known about the family's situation. The nurse should negotiate a time for the visit, preferably when most family members are available. Clients should be told the fee and possible methods of payment before the nurse assesses the family's willingness for a home visit. If the family does not have a phone, mail can be used to share information.

A home health nurse who is visiting a family for the first time asks, "Could we review your extended family and other persons or groups with whom you interact each week?" Which of the following provides the best rationale for the nurse asking this question? a. To assess the family's environment and social resources and risks b. To communicate with relevant others as needed c. To determine financial assets available to the family in case of serious need d. To understand the extended family relationships

TO ASSESS THE FAMILY'S ENVIRONMENT AND SOCIAL RESOURCES AND RISKS The question by the nurse indicates that she is trying to obtain an ecomap. Ecomaps can provide information about relationships that the family has with others (such as relatives and neighbors), the family's connections with other social units (such as church, school, work, clubs, and organizations), and the flow of energy, positive or negative, in the family. An ecomap represents the family's interactions with other groups and organizations. Environmental or social risk and resources can be assessed from an ecomap.

If underlying causes were listed on autopsy reports, which of the following would be the most common cause of unnecessary death in the United States? a. Alcohol b. Guns c. Tobacco d. Unprotected sex

TOBACCO Smoking has been identified as the most important preventable cause of morbidity and mortality in the United States.

Which of the following should be the initial consideration made by a nurse who is working with lesbian, gay, bisexual, and transgendered (LGBT) families? a. Understanding of same sex marriage laws within the state b. Understanding of personal feelings of working with members of this community c. Assessment of the family structure within the LGBT family d. Assessment of sexual orientation in a safe environment

UNDERSTANDING OF PERSONAL FEELINGS OF WORKING WITH MEMBERS OF THIS COMMUNITY Nurses have an ethical obligation to provide culturally competent care to LGBT families. Some nurses may feel a degree of discomfort discussing sexual orientation with their patients. However, it is important to overcome this barrier to care for LGBT families. Thus, nurses should provide a safe environment for patients to discuss their sexual orientation.

A nurse is conducting a health risk appraisal. Which of the following activities is the nurse assessing when using this tool? a. Health promotion activities b. Illness prevention activities c. Risk reduction activities d. Unhealthy activities

UNHEALTHY ACTIVITIES Health risk appraisal refers to the process of assessing for the presence of specific factors in each of the categories that have been identified as being associated with an increased likelihood of an illness, such as cancer, or an unhealthy event, such as an automobile accident. Therefore, the nurse would assess for unhealthy behavior and activities in the areas of biological and age-related risk, social and physical environment risk, and behavioral risk. Activities to promote health, prevent illness, or reduce risks would be advantageous, not risky.

A nurse is implementing risk reduction interventions with a family. Which of the following questions is most important for the nurse to ask? a. "Did any of the hunters in your family kill a deer this year?" b. "How do you keep your rifles safe from curious children?" c. "Where do you shoot with your handguns?" d. "Where do you keep your rifles locked when it is not hunting season?"

WHERE DO YOU SHOOT YOUR HANDGUNS? Risk reduction is a complex process that requires knowledge of risks and families' perceptions of the nature of the risk. In this situation the nurse was asking questions to determine the family's perception of risks associated with owning guns. If the family does not perceive the behavior (having guns in the house) as risky, but rather as necessary for food or sport, the nurse must first educate or persuade the family that others may be more comfortable if certain precautionary measures are taken (such as locks on the guns). Rifles are used for food and sport but handguns are often used in crimes and accidents resulting in death.

Which of the following would have been the focus of a school nurse in the early 20th century? a. Investigating causes of absenteeism b. Teaching school as well as being a nurse c. Promoting nursing as an autonomous practice d. Providing medical treatment to enable children to return to school

INVESTIGATING CAUSES OF ABSENTEEISM Early school nursing focused on investigating causes of absenteeism, not providing medical treatment. That was the responsibility of physicians.

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

A BILL THAT PROMOTES UNIVERSAL HEALTH INSURANCE COVERAGE Requiring health care professionals to give care to uninsured persons without charge would quickly bankrupt hospitals, and health professionals could not afford to continue in those roles. Such a law is unfeasible. Social justice refers to providing humane care and social supports for the most disadvantaged members of society. Nurses can be advocates for policy changes to improve social, economic, and environmental factors that predispose vulnerable populations to poor health. Many people do not have health insurance, particularly those who work in jobs where insurance is not offered or costs are too high. Promoting universal health insurance for all would be a step toward providing humane care for those who might not otherwise be able to receive care.

Which of the following best defines aggregate? a. A large group of persons b. A collection of individuals and families c. A group of persons who share one or more characteristics d. Another name for demographic group

A GROUP OF PERSONS WHO SHARE ONE OR MORE CHARACTERISTICS An aggregate is defined as a collection of people who share one or more personal or environmental characteristics, such as geography or special interest.

CHAPTER 1 Which of the following best describes community-based nursing? a. A philosophy that guides family-centered illness care b. Providing care with a focus on the group's needs c. Giving care with a focus on the aggregate's needs d. A value system in which all clients receive optimal care

A PHILOSOPHY THAT GUIDES FAMILY CENTERED ILLNESS CARE By definition, community-based nursing is nursing that focuses on family-centered illness care to individuals and families in the community

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

A PROSPECTIVE PAYMENT SYSTEM FOR HOME HEALTH SERVICES WAS CREATED The Balanced Budget Act of 1997 had some shifts in payment with the stipulations related to home health. In an attempt to curb the rapid growth in spending on home health and financial fraud in that industry, the Health Care Financing Administration (now the Centers for Medicare and Medicaid Services [CMS]) instituted prospective payment for home health services. The Health Insurance Portability and Accountability Act of 1996 was intended to help people keep their health insurance when moving from one place to another as well as provide privacy and security of personal health information. The State Children's Health Insurance Program (SCHIP) was created by Title XXI of the Social Security Act in 1998.

A nurse asks a family member, "What has changed between you and your spouse since your child's head injury?" Which of the following focuses of the family is the nurse assessing? a. The context b. The client c. A system d. A component of society

A SYSTEM When the focus is on the family as a system, the family is viewed as an interactional system in which the whole is more than the sum of its parts. The approach simultaneously focuses on individual members and the family as a whole at the same time. The interactions between family members are the target for nursing interventions.

Which client would have been most likely to receive care from the Frontier Nursing Service? a. An injured soldier b. A homebound, elderly male c. A woman in labor d. A child with measles

A WOMAN IN LABOR The Frontier Nursing Service nurses were trained in nursing public health and midwifery and provided care to rural and inaccessible areas, which led to reduced mortality.

A nurse is working at a state health department. Which of the following duties would most likely be completed in this setting? (Select all that apply.) a. Administering the Medicaid program b. Assessing the health needs of the state's citizens c. Employing and supervising school health nurses d. Establishing and maintaining free clinics for HIV-positive drug abusers

ADMINISTERING THE MEDICAID PROGRAM, ASSESSING THE HEALTH NEEDS OF THE STATES CITIZENS State health departments try to prevent and respond to infectious disease outbreaks. They also are responsible for health care financing and administering Medicaid, providing mental health and professional education, establishing health codes, licensing facilities and personnel, and regulating the insurance industry. State health departments also give direct assistance to local health departments in such areas as ongoing assessment of health needs.

A nurse is planning to conduct research on patient care outcomes. Which of the following agencies would the nurse use as a resource? a. Agency for Health Care Research and Quality b. Federal Agency for Patient Care Outcomes c. National Center for Nursing Research d. U.S. Agency for Patient Care Effectiveness

AGENCY FOR HEALTH CARE RESEARCH AND QUALITY The Agency for Health Care Research and Quality conducts research on health care systems, health care quality and cost issues, access to health care, and effectiveness of medical treatments. It provides evidence-based information on health care outcomes and quality of care.

What do demographic figures suggest about the ways in which the population of the United States is changing? (Select all that apply.) a. Approximately 12% of the U.S. population was born in a different country. b. Hispanics are the largest minority group population. c. Households consisting primarily of intact families continue to grow. d. Mortality for both genders in all age groups declined.

APPROX 12% OF THE US POPULATION WAS BORN IN A DIFFERENT COUNTRY, HISPANICS ARE THE LARGEST MINORITY GROUP POPULATION , MORTALITY FOR BOTH GENDERS IN ALL AGE GROUPS DECLINED Demographic figures confirm that 12% of the current U.S. population is foreign-born, with most immigrants coming from Latin America and about half as many from Asia. Families make up about 69% of all households, a decline from 81% in 1970. Although African Americans used to be the largest minority group, as of 2003, Hispanics now have that distinction. The population of the United States continues to increase, and mortality for both genders from all age groups has declined.

Which of the following actions best represents public health nursing? a. Assessing the effectiveness of the large high school health clinic b. Caring for clients in their home following their outpatient surgeries c. Providing care to children and their families at the school clinic d. Administering follow-up care for pediatric clients at an outpatient clinic

ASSESSING THE EFFECTIVENESS OF THE LARGE HIGH SCHOOL HEALTH CLINIC A public health or population-focused approach would look at the entire group of children being served to determine whether available services are effective in achieving the goal of improving the health of the school population.

A nurse is completing a tertiary prevention activity in a predominantly poor community, where eating clay (pica) is a common practice. Which of the following actions would the nurse most likely take? a. Assist those who eat large amounts of clay to obtain food stamps after explaining that clay, although filling, does not provide necessary nutrients. b. Initiate early intervention in the school system through education programs designed to focus on healthy food choices. c. Provide laboratory testing and physical assessments to assess for nutritional deficits resulting from clay intake. d. Survey families in the community to determine whether they eat clay and how much clay they eat.

ASSIST THOSE WHO EAT LARGE AMOUNTS OF CLAY TO OBTAIN FOOD STAMPS AFTER EXPLAINING THAT CLAY ALTHOUGH FILLING DOES NOT PROVIDE NECESSARY NUTRIENTS Tertiary prevention is undertaken to prevent additional health problems when a problem has occurred. Early intervention in the school system is an example of primary prevention. Lab testing and surveying families are screening activities to determine whether a problem is present and to catch it in the early phases; such screening activities are representative of secondary prevention.

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

AT THE CITY'S HOMELESS SHELTER WHICH IS BY POLICY VACANT DURING THE DAY Homeless persons would probably avoid the police station, and many may not wish to go to the medical center—also, there would be transportation issues. The most convenient place for the clients would be the homeless shelter, where transportation and lack of comfort in an unfamiliar place would not be issues. It is helpful to provide comprehensive services in locations where people live and work, including schools, churches, neighborhoods, and workplaces. Thus, for the homeless population the homeless shelter would be an appropriate location.

How did nursing education change in the 1950s? (Select all that apply.) a. Baccalaureate nursing programs typically included public health nursing concepts. b. Diploma schools of nursing continued to expand their student numbers. c. Junior and community colleges began offering nursing programs. d. Nurses were strongly encouraged to have a scientific basis for their practice.

BACCALAUREATE NURSING PROGRAMS TYPICALLY INCLUDED PUBLIC HEALTH NURSING CONCEPTS, JUNIOR AND COMMUNITY COLLEGES BEGAN OFFERING NURSING PROGRAMS In the 1950s public health nursing became a required part of most baccalaureate nursing education programs. In 1952 nursing education programs began in junior and community colleges

A nurse is working with a family member to reduce his health risk. Which of the following recommendations would most likely be made by the nurse? a. "Be sure to take a 30-minute walk each day." b. "Call our office if you have any questions or concerns at all." c. "Come back in 2 weeks for follow-up on your surgery." d. "Continue to take the drug until it is gone, even if you're feeling better earlier."

BE SURE TO TAKE A 30 MINUTE WALK EACH DAY The factors that determine or influence whether disease or other unhealthy results occur are called health risks. The major categories of risk include inherited biological risk, social and physical environmental risk, and behavioral risk. All the other options are treatment oriented rather than risk avoidance. Exercising for 30 minutes a day reduces the risk for many diseases.

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

BE WILLING TO ENTER INTO A LONG TERM RELATIONSHIP WITH FAMILIES Case management is a process that enhances continuity and appropriateness of care. When using case management with vulnerable populations, the nurse can be of greatest benefit if he or she is willing to develop long-term relationships with the families served. This increases trust as well as continuity of care. Care involves a partnership between nurse and client. Nurses who direct and control the client's care cannot establish a trusting relationship and may inadvertently foster a cycle of dependency and lack of personal health control.

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

BEGIN TESTS TO DETERMINE THE CAUSE OF THE BLEEDING WHILE ASKING ABOUT OTHER FAMILY CONCERNS FROM NUTRITION TO SHELTER FOR THE NIGHT It is important to provide comprehensive, family-centered, "one-stop" services. Providing multiple services during a single clinic visit is an example of one-stop services. If social and economic assistance are provided and included in interdisciplinary treatment plans, services can be more responsive to the combined effects of social and economic stressors on the health of special population groups.

A nurse is working with a family who is confronting major challenges to their health. Which of the following approaches would be most helpful for the nurse to use? a. Allowing the family to be noncompliant b. Building on the family's strengths and resilience c. Labeling the family as resistant d. Recognizing that the family is dysfunctional

BUILDING ON THE FAMILYS STRENGTHS AND RESILIENCE The labels of dysfunctional, noncompliant, resistant, or unmotivated all denote families who are not functioning well; however, such labels do not create an environment conducive for positive family change and intervention and should not be used. Families are neither all good nor all bad; families have both strengths and difficulties and have seeds of resilience. Recognizing the family's strengths gives the nurse assets on which to draw in planning care.

9. How does the Department of Agriculture promote the health of U.S. citizens? a. By collecting surplus food left after mechanical harvests and distributing it to the poor b. By inspecting food, so no foodborne illnesses can occur c. By collaborating with others to provide food or food stamps to needy persons d. By providing direct education and grants to dietitians and nutritionists

BY COLLABORATING WITH OTHERS TO PROVIDE FOOD OR FOOD STAMPS TO NEEDY PERSONS The Department of Agriculture collaborates with state and local government welfare agencies to provide food stamps to needy persons to increase their food-purchasing power. Other programs include school breakfast and lunch programs; the Supplemental Food Program for Women, Infants, and Children (WIC); and grants to states for nutrition education training. The Department of Agriculture also engages in plant, product, and animal inspections, but limited funding prevents absolute surety that food is safe to eat.

How does managed care attempt to control costs of care? a. By encouraging families to use the point of service list of individual practice associates b. By requiring families to choose a care provider from the MC network and not allowing access to other services without their provider's permission c. By moving Medicaid-eligible families onto state Medicare enrollment d. By refusing permission for families to use urgent care or emergency department services

BY REQUIRING FAMILIES TO CHOSE A CARE PROVIDER FROM THE MC NETWORK AND NOT ALLOWING ACCESS TO OTHER SERVICES WITHOUT THEIR PROVIDER'S PERMISSION Managed care is a system in which care is delivered by a specific network of providers. Each provider serves as a gatekeeper who controls access to other providers and services. Cost is reduced because members cannot use specialists or seek hospital or other care without permission from their primary care providers. Thus, those enrolled in Medicaid managed care have restrictions that help keep costs down for government (and for taxpayers).

Which of the following statements are accurate descriptions of current social and economic trends in the United States? (Select all that apply.) a. Citizens are appreciating the quality of life enjoyed in the United States. b. Enjoying life is not as important as the need to take care of oneself. c. Many families are seeing decreases in family income. d. Massive and unexpected social and economic changes have occurred.

CITIZENS ARE APPRECIATING THE QUALITY OF LIFE ENJOYED IN THE US, MANY FAMILIES ARE SEEING DECREASES IN FAMILY INCOME, MASSIVE AND UNEXPECTED SOCIAL AND ECONOMIC CHANGES HAVE OCCURRED One of the social trends influencing health care is a growing appreciation of the quality of life. The first decade of the twenty-first century has added massive and unexpected changes to health, economic, and social conditions in the form of terrorist attacks, hurricanes, fires, floods, and infectious diseases. In addition to layoffs, outsourcing, and other economic forces, many families are seeing wage decreases.

A colonist is working in the public health sector in early colonial America. Which of the following activities would have likely been completed? a. Establishing schools of nursing b. Developing vaccines to administer to large numbers of people c. Collecting vital statistics and improving sanitation d. Developing public housing and almshouses

COLLECTING VITAL STATS AND IMPROVING SANITATION The other choices are events that happened after the colonial period.

A nurse focuses on the care of the individual while viewing the client's family as a background resource or possible stressor. Which of the following conceptualizations of family does this nurse's view represent? a. Client b. Component of society c. Context d. System

CONTEXT Family as the context, or structure, has a traditional focus that places the individual first and the family second. In the "family as context" concept, the family serves as either a resource or a stressor to individual health and illness.

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

CASE MANAGEMENT Nurses often function as case managers for vulnerable clients, making referrals and linking them with community services. Case management services are especially important for vulnerable persons because they often do not have the ability or resources to make their own arrangements. Linking clients with health services is accomplished by making appropriate referrals and by following up with clients to ensure that the desired outcomes from the referral were achieved.

A new mother is a full-time college student who lives with her parents, because the baby's father has been imprisoned related to theft and drug abuse. The infant's grandmother, although also employed, cares for the child while the young mother attends classes. Which of the following theoretical frameworks would be most helpful to the nurse when assessing this family's needs? a. Developmental b. Interactional c. Structure-function d. Systems

DEVELOPMENTAL Developmental theory explains and predicts the changes that occur to humans or groups over time. Achievement of family developmental tasks helps individual members accomplish their tasks. In this case the new mother has tasks, whereas her parents have temporarily interrupted their progress in response to their daughter's (and grandchild's) needs.

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

DIRECT CLIENTS TO ENGLISH AS SECOND LANGUAGE COURSES Vulnerability can be reversed by obtaining resources to increase resilience. Although money, food, and clothing meet needs for the short term, they do not help the immigrant develop the power and control to improve health risks over the long term or contribute to lasting resilience. Learning the basic language of the country of residence will give immigrants the ability to communicate and navigate through systems and thus remove barriers that promote disenfranchisement and disadvantaged status.

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

DIRECTLY OBSERVING CLIENTS WITH ACTIVE TB AS THEY TAKE THERIR ANTITUBERCULAR MEDICATIONS Tertiary prevention is exemplified when nurses provide directly observed medication therapy for people with active TB.

African-American females have a higher mortality rate from breast cancer than White females. This is an example of: a. Projection b. Disparity c. Racism d. A sentinel event

DISPARITY Disparities are racial or ethnic differences in the quality of health care, not based on access or clinical needs, preferences, or appropriateness of an intervention.

Which of the following variables have led to a stronger commitment to population-focused services? (Select all that apply.) a. Economic turmoil and demand for high-technology care b. Emergence of new or drug-resistant infectious diseases c. Emphasis on overall health care needs rather than only on acute care treatment d. Threat of bioterrorism

EMERGENCE OF NEW DRUG RESISTANT INFECTIOUS DISEASES, EMPHASIS ON OVERALL HEALTH CARE RATHER THAN ONLY ON ACUTE CARE TREATMENT , THREAT OF BIOTERRORISM As overall health needs become the focus of care in the United States, a stronger commitment to population-focused services is emerging. Threats of bioterrorism, anthrax scares, and the emergence of modern-day epidemics have drawn attention to population-focused safety and services.

In comparison with traditional norms, which family functions have become increasingly important in modern American society? (Select all that apply.) a. Conferring appropriate social status b. Educating the younger members c. Ensuring physical and mental health d. Fostering interpersonal relationships and support

ENSURING PHYSICAL AND MENTAL HEALTH, FOSTERING INTERPERSONAL RELATIONSHIPS AND SUPPORT Historically, families have had several functions including financial survival, reproduction, protection from hostile forces, and enculturation, including religious faith, education, conferring social status. Today, however, the more important functions are fostering relationships (emphasizing how people get along and their level of satisfaction) and promoting physical and mental health

Which of the following actions demonstrate(s) effective public health nursing practice in the community? (Select all that apply.) a. Epidemiologic investigations examine the environment for health hazards. b. New services are organized where particular vulnerable populations live. c. Partnerships are established with community coalitions. d. Staff members at the public health agency continue to increase in number.

EPIDEMIOLOGIC INVESTIGATIONS EXAMINE THE ENVIORONMENT FOR HEALTH HAZARDS, NEW SERVICES ARE ORGANIZED WHERE PARTICULAR VULNERABLE POPULATIONS LIVE, PARTNERSHIPS ARE EST WITH COMMUNITY COALITIONS Evidence that public health nurses are practicing effectively in the community would include these: organizing services where people live, work, play, and learn; working in partnerships and with coalitions; and participating in epidemiologic studies

Which of the following best describes ideal primary health care? a. Based on a multidisciplinary group of health care providers that work as a team b. Essential care available to all community members, which encourages self-management c. Focused on health promotion and disease prevention for everyone enrolled in the health center d. Local efforts to meet the Declaration of Alma Ata principles

ESSENTIAL CARE AVAILABLE TO ALL COMMUNITY MEMBERS WHICH ENCOURAGES SELF MANAGEMENT Primary health care is generally defined as essential care made universally accessible to individuals and families in a community with their full participation and at a cost that the community can afford.

Which of the following statements best explains why family functions and structures create unique challenges in family nursing? a. Function and structure change over time. b. Function and structure do not apply to all family units. c. Some clients do not have families. d. Traditional families are rare in society.

FUNCTION AND STRUCTURE CHANGE OVER TIME The functions that families serve evolve and change over time. Some become more important and others less so. Family structures also change over time. The great speed with which changes in family structure, values, and relationships are occurring makes working with families at the beginning of the twenty-first century exciting and challenging.

A nurse organizes care for a family by focusing on the common tasks of family life and considering a longitudinal view of the family life cycle. Which theory is being applied? a. Family systems b. Structural-functional c. Family developmental d. Interactionist

FAMILY DEVELOPMENTAL The family developmental theory focuses on common tasks of family life and provides a longitudinal view of the family life cycle.

Which of the following factors must be considered before deciding on an appropriate plan of action? a. Family agrees to the nurse's plan. b. Family is capable of the required actions. c. Family will learn better coping skills from the nurse's plan. d. Nurse has informed family how to complete the required actions.

FAMILY IS CAPABLE OF THE REQUIRED ACTIONS Family theorists stress that any intervention plan must be developed in collaboration with the family, using and enhancing family strengths and increasing independence of family members. The plan cannot be the nurse's choice alone. Further, the plan must be within the information and skill level of the family, and the family must be committed to the plan and have adequate resources available to implement the plan

Which of the following terms refers to government actions that have a direct or indirect effect on families? a. Family funding b. Family legislation c. Family planning d. Family policy

FAMILY POLICY Government actions that have a direct or indirect effect on families are called family policy.

Which of the following theories views the family as a whole with boundaries that are affected by the environment? a. Family developmental theory b. Structural-functional theory c. Family role theory d. Family systems theory

FAMILY SYSTEMS THEORY The theory that views the family as a whole with boundaries that are affected by the environment is the family systems theory.

A public health nurse is determining what type of programming should be developed for the community. Which of the following is the most crucial factor that will influence program development? a. Comprehensive assessment and planning done in the community b. Documented needs of the local community c. Federal funding for priority diseases or groups d. Nursing staff's expertise and skills

FEDERAL FUNDING FOR PRIORITY DISEASES OR GROUPS Programs are designed to fit funding priorities; thus, the areas supported by Congress determine the categories in which most effort is focused locally.

Which of the following provides evidence that the U.S. health care system is in crisis? (Select all that apply.) a. Full-time employees may not have health insurance as a benefit. b. Incompetent or negligent nurses are an ongoing source of medical errors. c. Long work hours and provider fatigue are a major factor in medical errors. d. More punitive measures must be taken to decrease provider errors.

FULL-TIME EMPLOYEES MAY NOT HAVE HEALTH INSURANCE AS A BENEFIT, LONG WORK HOURS AND PROVIDER FATIGUE ARE A MAJOR FACTOR IN MEDICAL ERRORS Although 61% of the non-elderly population continues to obtain health insurance through their employer as a benefit, employment does not guarantee insurance. As a result of the nursing shortage, nurses work longer hours and provider fatigue is a major factor in errors. The Institute of Medicine's (IOM) report To Err Is Human recommends that we stop blaming and punishing individuals for errors and instead begin identifying and correcting system failures by designing safety into the process of care.

What was the outcome of the Shattuck Report? a. Efforts to control alcohol and drug abuse, as well as tobacco use, were initiated. b. Environmental sanitation efforts became an immediate priority. c. Guidelines for modern public health organizations were eventually developed. d. Local and state governments established boards of health after its publication.

GUIDELINES FOR MODERN PUBLIC HEALTH ORGANIZATIONS WERE EVENTUALLY DEVELOPED It took 19 years for the first of Shattuck's recommendations to be implemented, but his report was the first effort to create a modern public health organization.

A community health nurse is trying to increase enrollment in SCHIP. Which of the following interventions would be most effective? a. Explaining the program to children enrolled in public school systems b. Handing out SCHIP applications to uninsured children seen in local hospital emergency departments c. Having a newspaper campaign with information and applications printed in the newspaper d. Sending literature about the SCHIP program home with schoolchildren each year

HANDING OUT SCHIP APPLICATIONS TO UNINSURED CHILDREN SEEN IN LOCAL HOSPITAL EMERGENCY DEPARTMENTS SCHIP builds on Medicaid to provide insurance coverage to low-income, uninsured children who are not eligible for Medicaid. Thus, the population that needs to be targeted for SCHIP is those being seen for medical care who do not have insurance.

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

HAVE HOMELESS INDIVIDUALS READ THEIR TB SKIN TEST IF NECESSARY AND MAIL IN RESULTS ON A POSTAGE PAID CARD CODED TO PROTECT PRIVACY Homeless people often do not have a way to receive telephone calls. Additionally, they usually face numerous barriers to return to the clinic. These issues often require deviation from strict policies, especially strict policies that are not working. Nurses should develop a way for homeless individuals to read their TB skin test, if necessary, and give them a self-addressed, stamped card they can return by mail with the results.

Why did the Metropolitan Life Insurance Company establish and retain for several years the first community nursing health program for policyholders? a. Creating such a service was the morally correct thing to do. b. Employing nurses directly was less expensive than paying taxes to the city for the same purpose. c. Having the company's nurses make home visits increased worker morale. d. Having public health nurses visit policyholders and their families led to a decline in policyholder deaths, thus lowering costs for the insurance company.

HAVING PUBLIC HEALTH NURSES VISIT POLICYHOLDERS AND THEIR FAMILIES LED TO A DECLINE IN POLICYHOLDER DEATHS THUS LOWERING COSTS FOR THE INSURANCE COMPANIES Metropolitan Life saw an average decline of 7% in the mortality rate of policyholders and almost a 20% decline in the deaths of children. The insurance company attributed this improvement and the associated reduced costs to the visiting nurses.

Which of the following best describes community-oriented nursing? a. Focusing on the provision of care to individuals and families b. Providing care to manage acute or chronic conditions c. Giving direct care to ill individuals within their family setting d. Having the goal of health promotion and disease prevention

HAVING THE GOAL OF HEALTH PROMOTION AND DISEASE PREVENTION By definition, community-oriented nursing has the goal of preserving, protecting, or maintaining health to promote the quality of life. All nurses may focus on individuals and families, give direct care to ill persons within their family setting, and help manage acute or chronic conditions.

A public health nurse is compiling information about how to promote early detection of breast cancer in women. Which document would most likely provide useful information about this topic? a. The Future of Public Health b. Healthy People 2020 c. Patient Protection and Affordable Care Act d. Scope and Standards of Public Health Nursing Practice

HEALTHY PEOPLE 2020 The Healthy People documents propose a national strategy to improve significantly the health of Americans by preventing or delaying the onset of major chronic illnesses, injuries, and infectious diseases.

When talking to a women's group at the senior citizens' center, the nurse reminded them that the only way the center would be able to afford to provide transportation services for them would be for them to continue to write letters to their local city council representatives requesting funding for such a service. What was the nurse trying to accomplish through this action? a. Ensure that the women did not expect the nurse to solve their problem b. Demonstrate that the nurse understood the women's concerns and needs c. Express empathy, support, and concern d. Help the women engage in political action

HELP THE WOMEN ENGAGE IN POLITICAL ACTION Public health nurses engage themselves and others in policy development and encourage and assist persons to communicate their needs to those with the power to take action.

Why are nurses increasingly providing care in clients' homes rather than in hospitals? (Select all that apply.) a. Home care is less expensive. b. It is much more efficient to give care in the home. c. Nurses prefer to give home care with individual attention. d. People prefer to receive care in their homes rather than in hospitals.

HOME CARE IS LESS EXPENSIVE, PEOPLE PREFER TO RECEIVE CARE IN THEIR HOMES RATHER THAN IN HOSPITALS An increasing number of clients are receiving care in the home because it is less expensive and clients prefer to receive care in familiar and comfortable settings. It is not more efficient nor more convenient, since travel time has to be considered. Nurses differ as to their preferred employment setting.

Which statements by a nurse demonstrate understanding of the unique needs of vulnerable groups? (Select all that apply.) a. "I always address the problem that the client believes is the most important." b. "I avoid asking clients for income or financial information, because this is an invasion of privacy." c. "I try to observe the client's cultural traditions as I probe for signs of abuse." d. "I make sure to do a complete assessment, since we often don't know when the person will return to the clinic."

I ALWAYS ADDRESS THE PROBLEM THAT THE CLIENT BELIEVERS IS THE MOST IMPORTANT, I TRY TO OBSERVE THE CLIENTS CULTURAL TRADITIONS AS I PROBE FOR SIGNS OF ABUSE Because poverty is a primary cause of vulnerability, the nurse should include questions about the client's financial status. Nurses should not provide financial or legal advice; however, they should make sure to connect clients with someone who can and will help them. Although an assessment must be done, a nurse should only collect data that will actually be used. Focus on what data are needed to help the client that day with the problem the client believes is most important.

Which of the following best describes why local, state, and federal governmental agencies have started to cooperate and collaborate more closely in the last few years? a. Increased administrative pressures to demonstrate outcomes b. Increased focus on emergency preparedness and response c. Increased taxpayers' complaints and general unhappiness d. Increased pressure to decrease overlap in services

INCREASED FOCUS ON EMERGENCY PREPAREDNESS AND RESPONSE Since the tragedy of September 11, 2001, health departments have increasingly focused on emergency preparedness and response. In case of an emergency event, state and local health departments in the affected area will be expected to collect data and accurately report the situation, to respond appropriately to any type of emergency, and to ensure the safety of the residents of the immediate area, while protecting those just outside the danger zone. This goal—to enable public health agencies to anticipate, prepare for, recognize, and respond to terrorist threats or natural disasters—has required an unprecedented level of interstate and federal-local planning and cooperation among these agencies.

CHAPTER 2 A nurse is considering applying for a position as a public health nurse. Which of the following would be a reason this position would be appealing? a. Its autonomy and independence b. Its focus on acute care and immediately visible outcomes c. Its collaboration with other health care professionals d. Its flexibility and higher wages

IT AUTONOMY AND INDEPENDENCE In-patient acute care nurses (not public health nurses) focus on acute care with outcomes known fairly quickly. Unlike in-patient nursing, in which there are other health care professionals and staff with whom to interact, public health nursing is known for its autonomy and independence.

A nurse is making an appointment with a family for a nursing visit. Which of the following describes a potential barrier the nurse may encounter? a. The assessment cannot be done unless the extended family is present. b. It may be difficult to find a convenient time for all family members to be present. c. Nurses have limited time to do home visits. d. Families are often scattered over a large area, making access difficult.

IT MAY BE DIFFICULT TO FIND A CONVENIENT FOR ALL FAMILY MEMBERS TO BE PRESENT It is important to encourage all family members to attend the meeting. However, it can be difficult to find a convenient time for all family members to attend. Many times late afternoon or evening appointments are necessary to accommodate the needs of the family.

How did health care and its delivery change during the 1980s? (Select all that apply.) a. Funding to public health increased as funding for acute hospital care decreased. b. Laws began to be passed that discouraged the use of alcohol, drugs, and tobacco. c. Nurse practitioners were increasingly used to provide care. d. Public health programs suffered reduced political support, financing, and effectiveness.

LAWS BEGAN TO BE PASSED THAT DISCOURAGED THE USE OF ALCOHOL DRUGS AND TOBACCO, NURSE PRACTITIONERS WERE INCREASINGLY USED TO PROVIDE CARE, PUBLIC HEALTH PROGRAMS SUFFERED REDUCED POLITICAL SUPPORT, FINANCING, AND EFFECTIVENESS During the 1980s funding began to shift to meet the costs of acute hospital care, medical procedures, and institutional long-term care. The use of health maintenance organizations was encouraged, and the use of nurse practitioners increased. Consumer and professional advocacy groups urged the passage of laws to prohibit unhealthy practices such as smoking and driving under the influence of alcohol. By the late 1980s, public health had declined in political support, financing, and effectiveness.

An 80-year-old woman comes to the community health care facility with a large bag of medications. She tells the nurse she can no longer afford these medications because her only income is Social Security. Which statement is the best response by the nurse? a. "Let's go through these medications and see which ones we can delete." b. "You can get these medicines at this clinic for free." c. "Let's see if we can get some help from Medicare to help you pay for these medications." d. "These medications are important. Do your best to pay for them."

LETS SEE IF WE CAN GET SOME HELP FROM MEDICARE TO HELP YOU PAY FOR THESE MEDICATIONS This elderly patient probably is eligible for benefits through Medicare Part D. Medicare Part D has been added to Medicare to help cover the cost of prescriptions.

A nurse is in the termination phase of the nurse-family relationship. Which of the following strategies would the nurse most likely implement? a. Increasing sessions with the nurse b. Making referrals when appropriate c. Providing a formative evaluation of the relationship d. Refusing additional communication with the family

MAKING REFERRALS WHEN APPROPRIATE It also includes decreasing contact with the nurse, extending invitations to the family for follow-up, and a summative evaluation meeting for formal closure.

CHAPTER 19 A nurse was preparing for a home visit to a family where the mother had just been discharged from trauma care after being hit by a drunk driver. The nurse hoped the family was able to care for her. Which of the following comments from the husband would suggest an energized family? a. "I make most of the decisions so the kids don't notice much difference." b. "My daughter is pretty independent; she's active in both sports and theater." c. "My son is old enough to get a job and help pay all these medical bills." d. "My wife taught our daughter how to cook simple meals."

MY DAUGHTER IS PRETTY INDEPENDENT; SHE'S ACTIVE IN BOTH SPORTS AND THEATER Pratt proposed the energized family as being an ideal family type that was most effective in meeting health needs. The energized family is characterized by active contact with a variety of groups and organizations (Boy Scouts, church, sports, theater), flexible role relationships (not if only the daughter is taught how to cook and only the son is expected to get a job), equal power structure (not if the husband makes all the decisions), and a high degree of autonomy by each member (kids know how to be flexible, because parents travel for business frequently)

Why were nurses so unprepared for public health nursing in the early twentieth century? a. Community health nursing had not yet been created as a field. b. No one would teach the nurses how to engage in public health activities. c. Nightingale's textbook did not include content on public health nursing. d. Nurses were educated in diploma schools, which focused on hospital nursing.

NURSES WERE EDUCATED IN DIPLOMA SCHOOLS WHICH FOCUSED ON HOSPITAL NURSING Nursing school courses taught in diploma schools of nursing emphasized hospital care of patients; thus, nurses were unprepared for home visiting.

CHAPTER 21 Which of the following is the primary cause of vulnerability to health problems? a. Breakdown of family structures b. Poverty c. Prejudice d. Social isolation

POVERTY People with lower incomes and less education tend to be at higher risk for health problems. Poverty is a primary cause of vulnerabilitY

A nurse is developing a plan to decrease the number of premature deaths in the community. Which of the following interventions would most likely be implemented by the nurse? a. Increase the community's knowledge about hospice care. b. Promote healthy lifestyle behavior choices among the community members. c. Encourage employers to have wellness centers at each industrial site. d. Ensure timely and effective medical intervention and treatment for community members.

PROMOTE HEALTHY LIFESTYLE BEHAVIOR CHOICES AMONG THE COMMUNITY MEMBERS Public health approaches could help prevent about 70% of early deaths by influencing the way people eat, drink, drive, engage in exercise, and treat the environment.

Which of the following is the primary focus of public health nursing? a. Families and groups b. Illness-oriented care c. Individuals within the family unit d. Promotion of quality of life

PROMOTION OF QUALITY OF LIFE The key difference between community-based and community-oriented nursing is that community-based nurses deal primarily with illness-oriented care, whereas community-oriented nurses—or public health nurses—provide health care to promote quality of life.

A nurse was employed by the Marine Hospital Service in 1800. Which of the following interventions would the nurse most likely have completed? a. Setting policy on quarantine legislation for immigrants b. Establishing hospital-based programs to care for the sick at home c. Identifying and improving environmental conditions d. Providing health care for merchant seamen

PROVIDING HEALTH CARE FOR MERCHANT SEAMEN Providing health care to seamen was an early effort by the federal government to improve public health. The purpose of the Marine Hospital Service was to secure its maritime trade and seacoast cities.

. How did Florence Nightingale help bring about community health nursing? (Select all that apply.) a. She convinced socially prominent wealthy women to volunteer to give care. b. She focused on all soldiers and their environment. c. She interacted with each individual person, assessing his or her needs and acting to meet those needs. d. She kept careful records on what was done and what were the results.

SHE FOCUSED ON ALL SOLDIERS AND THEIR ENVIRONMENT, SHE KEPT CAREFUL RECORDS ON WHAT WAS DONE AND WHAT WERE THE RESULTS Nightingale progressively improved the soldiers' health using a population-based approach that improved both environmental conditions and nursing care. Using simple epidemiology measures, she documented a decreased mortality rate to demonstrate the outcomes.

Which of the following is responsible for the dramatic increase in life expectancy during the twentieth century? a. Technology increases in the field of medical laboratory research b. Advances in surgical techniques and procedures c. Sanitation and other public health activities d. Use of antibiotics to fight infections

SANITATION AND OTHER PUBLIC HEALTH ACTIVITIES Improvement in control of infectious diseases through immunizations, sanitation, and other public health activities led to the increase in life expectancy from less than 50 years in 1900 to more than 77 years in 2002.

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

SECONDARY PREVENTION Screening homeless adults and providing medications to those who test positive for TB are examples of secondary prevention. The TB screening identifies infection in early stages. Medications work to prevent infection from developing into disease.

A nurse is determining which health care services must be offered at a local public health clinic. Which of the following factors is most important for the nurse to consider? a. Data available from the most recent community assessment b. Suggestions from community members about what is needed c. Recommendations of Healthy People 2020 d. Services mandated by the state government

SERVICES MANDATED BU THE STATE GOVERNMENT At the local level, health departments provide care that is mandated by state and federal regulations.

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

SHORT LENGTH OF TIME IN THE COMMUNITY Disenfranchisement refers to a feeling of separation from mainstream society. The person does not seem to have an emotional connection with any group in particular or the larger society. For migrant workers who are frequently moving, the short length of time they stay in the community does not allow for the development of social ties. Being a minority group member would not by itself cause disenfranchisement if the minority group member lived in a community with persons from similar ethnic and cultural backgrounds.

A nurse is reviewing the original work of the National Organization for Public Health Nursing. Which of the following accomplishments of today was started within this organization? a. Requiring that public health nurses have a baccalaureate degree in nursing b. Standardizing public health nursing education c. Developing nursing cooperatives d. Opening the Henry Street Settlement

STANDARDIZING PUBLIC HEALTH NURSING EDUCATION The National Organization for Public Health Nursing sought to standardize public health nursing. The Henry Street Settlement was already in existence. The baccalaureate degree in nursing was not developed yet

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

STRONGLY CONSIDER NOT APPLYING BECAUSE THIS POPULATION WILL BE EXPENSIVE TO TREAT Many agencies do not wish to provide services to vulnerable populations. Vulnerable populations are more expensive to treat because they have multiple, cumulative risks and require special service delivery considerations (e.g., to help overcome transportation problems or provide culturally competent care).

In taking a family history, the nurse in community health finds that this is the second marriage for the previously divorced parents and that the male partner is the stepparent to the oldest child. For which of the following aspects of the family assessment is data being gathered? a. Dynamics b. Function c. Structure d. System

STRUCTURE Family structure refers to the characteristics and demographics (gender, age, number) of individual members who make up the family. Structure defines the roles and the positions of family members.

A nurse has just met a family and is being doing their family assessment. Which of the following actions should the nurse take before engaging in self-disclosure? a. Confirm the reason for the assessment. b. Demonstrate culture awareness. c. Take time to build trust. d. Understand the family dynamics.

TAKE TIME TO BUILD TRUST Assessment is interactive. As you are evaluating families, they are evaluating you. Too much disclosure during the early contacts between the family and nurse may scare the family away. Slow the process down, and take time to build trust.

A nurse is using the provisions of the Family Medical Leave legislation. Which of the following actions is the nurse most likely to take? a. Resigning from employment, but retaining health insurance b. Sharing family information with colleagues c. Providing Medicaid to a family who cannot afford health insurance d. Taking a defined time off of work for family events without fear of job loss

TAKING A DEFINED TIME OFF WORK FOR FAMILY EVENTS WITHOUT FEAR OF JOB LOSS The Family Medical Leave legislation allows for a family member to take a defined amount of leave for family events, such as births and deaths, without fear of losing his or her job.

Using the Neuman Systems Model, which of the following questions would the nurse ask a client to assess physiological health? a. "What helps you to cope with situations involving your wife's cancer?" b. "How has your child's illness affected the behavior of your other children?" c. "Tell me about any illnesses your other family members have." d. "Who do you turn to for support outside your immediate family?"

TELL ME ABOUT ANY ILLNESS YOUR OTHER FAMILY MEMBERS HAVE Physiological health involves issues related to physical wellness or illness. Other components of health in Neuman's model include psychological health, sociocultural health, developmental health, and spiritual health.

A nursing student during World War II would likely join which group? a. The Public Health Service of New York City b. The Marine Nurse Corps c. The Frontier Nursing Service d. The Cadet Nurse Corps

THE CADET NURSE CORPS The Bolton Act of 1943 established the Cadet Nurse Corps during World War II, which increased enrollment in schools of nursing at undergraduate and graduate levels.

chapter 18 The following people enter the health clinic together: an unmarried man and his year-old son, an unmarried woman with a year-old daughter, and the man's married brother, who is separated from his wife. During the assessment it is determined that both men work and contribute to the household, where all of them live. Which of the following best describes the "family"? a. The group consists of three families: the man and his son, the woman and her daughter, and the brother, who is married even though he and his wife are separated. b. There are two families involved: first, the unmarried man and woman and their two children, and second, the brother, who is married even though he and his wife are separated. c. There is no family here, only three adults sharing resources between themselves and two biologically related children. d. The family includes whoever the adults state are family members.

THE FAMILY INCLUDES WHOEVER THE ADULTS STATE ARE FAMILY MEMBERS Nurses working with families should ask an adult member to identify all those considered to be family members and then include those members in health care planning. A "family" may range from the traditional nuclear model with extended family to such "postmodern" family structures as single-parent families, stepfamilies, same-gender families, and families consisting of friends.

The hospital-based nurse has worked with a client at some length regarding appropriate diet. Based on the family systems theory, which of the following will most likely occur when the client returns home? a. The family member who prepares food will probably suggest the newly discharged member eat the meals everyone in the family enjoys. b. The family member who prepares food will probably try to modify family meals without obvious change for the family as a whole. c. The family member who prepares food will probably prepare meals based on the diet plan for all the family. d. The family member who prepares food will probably prepare special meals for the newly discharged member.

THE FAMILY MEMBER WHO PREPARES FOOD WILL PROBABLY PREPARE MEALS BASED ON THE DIET PLAN FOR ALL THE FAMILY Family systems typically maintain stable patterns, although families do change constantly in response to stresses. Change in one part of the family affects the total system. It is not realistic to expect the whole family to change eating patterns immediately based on the needs of one family member. However, if family members are supportive, they will want to try to help the ill member. Because of the rapid change and stress in American society, preparing different sets of meals is not very realistic. Therefore, the member who prepares the meals will probably compromise by trying to meet the ill member's needs without making drastic changes in the overall eating patterns of the family

The nurse is told that a healthy, functional family consisting of a 25-year-old man and a 24-year-old woman, who are expecting their first child, would appreciate a nurse coming to their apartment for anticipatory guidance in preparing themselves and their apartment for the baby. Based on that statement, which of the following assumptions can the nurse safely make about the family? a. The family is lacking a strong support system. b. The family's basic needs are being met. c. The couple's in-laws are unavailable to share their expertise about child care. d. The married couple is excited about their first baby.

THE FAMILYS BASIC NEEDS ARE BEING MET In functional, healthy, or resilient families, the basic survival needs are met. Healthy families exist based on attachment and affection. There is nothing in the example to suggest that they are married, that their income is low, or that they lack other resources or support systems.

Which of the following is a basic assumption of public health efforts? a. Health disparities among any groups are morally and legally wrong. b. Health care is the most important priority in government planning and funding. c. The health of individuals cannot be separated from the health of the community. d. The government is responsible for lengthening the life span of Americans.

THE HEALTH OF INDIVIDUALS CANNOT BE SEPARATED FROM THE HEALTH OF THE COMMUNITY Public health can be described as what society collectively does to ensure that conditions exist in which people can be healthy.

The nurse often has to make resource allocation decisions. Which of the following best describes the criterion the nurse should use in such cases? a. The specific moral or ethical principle related to the situation b. The cheapest, most economical approach c. The most rational probable outcome d. The needs of the aggregate rather than a few individuals

THE NEED OF THE AGGREGATE RATHER THAN A FEW INDIVIDUALS Although all of the choices represent components of a decision that the nurse might consider, the dominant needs of the population outweigh the expressed needs of one or a few people.

A nurse requests to meet a newly referred family in their home. Which of the following best explains the rationale for this request? (Select all that apply.) a. The nurse can assess the family environment. b. The family will feel more comfortable. c. Families typically welcome others into their home. d. More family members can typically be involved.

THE NURSE CAN ASSESS THE FAMILY ENVIRONMENT, THE FAMILY WILL FEEL MORE COMFORTABLE, MORE FAMILY MEMBERS CAN TYPICALLY BE INVOLVED Advantages to meeting in the family home include the fact that it allows the nurse to see the everyday family environment and observe typical family interactions. Also, more family members can be present, and families are often more comfortable in their own environment. However, a disadvantage to meeting in the family's home is that family members may view this as an intrusion into the only place they feel safe from outside observation; thus, the nurse must be highly skilled in guiding the interactions and setting limits.

Which of the following public health nurses most clearly fulfills the responsibilities of this role? a. The nurse who met with several groups to discuss community recreation issues b. The nurse who spent the day attending meetings of various health agencies c. The nurse who talked to several people about their particular health concerns d. The nurse who watched the city council meeting on local cable television

THE NURSE WHO SPENT THE DAY ATTENDING MEETING OF VARIOUS HEALTH AGENCIES Any of these descriptions might represent a nurse communicating, cooperating, or collaborating with community residents or groups about health concerns. However, the nurse who spent the day attending meetings of various health agencies is the most representative, because in public health, concerns are broader than recreation, individual concerns are not as important as aggregate priorities, and watching television (a one-way form of communication) is less effective than interacting with others.

Why did American citizens become interested in establishing government-controlled boards of health? a. They were afraid of infectious diseases such as yellow fever. b. The government could force the poverty-stricken to accept care. c. Such boards could tax and thereby ensure adequate funds to pay for care. d. Such a system would allow for accurate records of births and deaths.

THEY WERE AFRAID OF INFECTIOUS DISEASE SUCH AS YELLOW FEVER Threat of disease, especially yellow fever, led to public interest in establishing government-sponsored, or official, boards of health.

Two nurses plan to walk under a huge downtown bridge where various homeless persons live. Why would the nurses go to such an unsafe area? a. To assess the needs of the homeless who live there b. To demonstrate their courage and commitment c. To distribute some of their own surplus clothes to those who can use them d. To share with various churches and other charities what is needed

TO ASSESS THE NEEDS OF THE HOMELESS WHO LIVE THERE In most nursing practices, the client seeks out and requests assistance. In public health nursing, the nurse often reaches out to those who might benefit from a service or intervention, beginning with assessment of needs.

A public health nurse is involved in health care reform. Which of the following best explains why the nurse is involved in these efforts? a. To promote the nursing profession b. To increase funding for public health nursing c. To address the concerns of nurses d. To help improve health care access

TO HELP IMPROVE HEALTH CARE ACCESS Public health nurses have been involved in health care reform for several years. An emphasis of reform is that health promotion and disease prevention appear to yield reduction in costs and illness/injury incidence while increasing years of healthy life.

The public health nurse has a clear vision of what needs to be done and where to begin to improve the health of the community. Why would the nurse spend time meeting with community groups to discuss the most important task to be addressed first? a. To increase the group's self-esteem b. To maintain communication links with the groups c. To make the groups feel good about their contribution d. To work with the groups, not for the groups

TO WORK WITH THE GROUPS NOT FOR THE GROUPS Historically, health care providers have been accused of providing care for or to people without actually involving the recipients in the decisions. Public health nursing is a "with the people"—not a "to the people" or "for the people"—approach to planning.

Which of the following principles has been used by the American Nurses Association (ANA) when encouraging health care reform? a. High-technology interventions to reduce nursing time, effort, and medical errors must be expanded. b. Nurses must be recognized and rewarded for health promotion efforts. c. Nursing research into patient care outcomes must be expanded and funded. d. Universal access to essential health services should be available for all citizens.

UNIVERSAL ACCESS TO ESSENTIAL HEALTH SERVICES SHOULD BE AVAILABLE FOR ALL CITIZENS The ANA's position is based on the belief that health care is a basic human right. Thus, a restructured health care system must ensure universal access to a standard package of essential health care services for all citizens and residents.

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

VULNERABLE POPULATIONS Vulnerable populations are groups (aggregates) with an increased risk to develop adverse health outcomes. Families are a subgroup of populations.

A registered nurse was just employed as a public health nurse. Which question would be the most relevant for the nurse to ask? a. "Which groups are at the greatest risk for problems?" b. "Which patients should I see first as I begin my day?" c. "With which physicians will I be most closely collaborating?" d. "With which nursing assistants will I partner the most?"

WHICH GROUPS ARE AT THE GREATEST RISK FOR PROBLEMS? Asking which groups are at greatest risk reflects a community-oriented perspective. The other possible responses reflect a focus on individuals

The nurse in community health needs to conduct a family assessment within a commune but is uncertain how to proceed because family lines appear blurred. The best way to determine the family of a mother and her child is to ask the woman which of the following questions? a. "How many children do you have, and who is the father of each?" b. "Is there a register of families who are members of this commune?" c. "Tell me about your significant other." d. "Who are the members of your and your child's family?"

WHO ARE THE MEMBERS OF YOUR AND YOUR CHILDS FAMILY? The members of a family are self-defined. The family includes whoever the woman says are family members. The nurse should include all those members in health care planning.

Which of the following must be firmly established before beginning a family assessment? (Select all that apply.) a. Why the data are needed b. How best to interview each individual in the family c. The most convenient time for you to visit the family d. The rationale or purpose of the visit

WHY THE DATA ARE NEEDED, THE MOST CONVENIENT TIME FOR YOU TO VISIT THE FAMILY, THE RATIONALE OR PURPOSE OF THE VISIT Assessment of families requires an organized plan, including the purpose of seeing the family, which family members can be present, what you are assessing and why, and how will you obtain the necessary data. It can be assumed that the nurse would already know agency policies. It is more informative to interview the family as a whole so that you can observe family interaction (rather than focusing on interviewing each individual). Therefore, the preferred time to visit is when most family members will be available. Similarly, it is more informative to see the family in their home setting than to establish a different site for the visit.

Which of the following actions would most likely be performed by a public health nurse? a. Asking community leaders what interventions should be chosen b. Assessing the community and deciding on appropriate interventions c. Using data from the main health care institutions in the community to determine needed health services d. Working with community groups to create policies to improve the environment

WORKING WITH THE COMMUNITY GROUPS TO CREATE POLICIES TO IMPROVE THE ENVIRONMENT Although the public health nurse might engage in any of the tasks listed, he or she works primarily with members of the community to carry out core public health functions, including assessment of the population as a whole and engaging in promoting health and improving the environment.

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

YOU WILL LIKE WORKING WITH HISPANIC IMMIGRANTS BECAUSE THEY HAVE CLOSE KNIT FAMILY STRUCTURES Assumptions are not helpful. Each person and family should be assessed individually. No two people or groups are alike. Any stereotype, positive or negative, can be problematic. Even though Hispanic groups, as a whole, do have close-knit family structures, by assuming that all Hispanics are this way, staff members are less likely to be open to the possibility of issues such as family violence.