Community Exam 2 Set 2

What is the primary usefulness of a Program Evaluation and Review Technique (PERT) chart? a. It creates a flowchart of activities in sequence with time estimates. b. It identifies potential program problems and possible solutions. c. It identifies the process needed to achieve a certain result. d. It outlines the steps of the assessment process.

A A PERT chart identifies the program activities, resources to accomplish these activities, and the sequence of those activities. Included is a flowchart designed to estimate the time required to complete specific events necessary, with estimates ranked according to optimistic, most likely, and pessimistic outcomes.

Which of the following data would be more typical of an acute care diagnosis than a community/public health nursing diagnosis? a. A child in the school system admitted for insulin overdose b. Health promotion needs for the neighborhood school c. Mortality and morbidity rates for the city d. Services unavailable in the county

A A diagnosis referring to a need could be based on any of the selections, but community/public health focuses on aggregates, not individuals, and so the child being admitted would have what is more typical of an acute care nursing diagnosis.

A public health agency had enough funds to provide one more health-promotion program during the calendar year. In relation to nutrition and exercise, which of the following would be the best choice? a. Elementary school program for children to which parents are invited b. High school program for those who are involved in athletics c. Young adult programs provided at the YMCA d. Senior citizen programs offered during a free meal

A A healthy lifestyle is easier to maintain when healthful patterns of behavior are learned early in life. Therefore, learning healthy lifestyle behaviors at a young age yields more benefit in years of life

A nurse is reviewing the collected data and discovers some information is not available. Which of the following conclusions will the nurse make? a. There is a data gap. b. There is insufficient information to draw appropriate conclusions. c. Further effort by the team is required. d. Further analysis needs to be performed.

A A lack of information is called a data gap. The nurse may devise a strategy to collect additional data or draw the conclusion that the data gap itself may be informative.

A community/public health nurse was planning a prostate cancer screening in cooperation with the local community hospital. Whom should the nurse be sure to invite? a. Men older than 50 years in the community b. Anyone who had ever been involved with the local community hospital c. Anyone who has a family history of cancer d. Community members from infants to senior citizens

A A screening test is often too expensive to use except for groups at high risk for the disease, which for prostate cancer screening would specifically be men older than 50 years. Women and children do not need screening for prostate cancer. Mass screening is the application of screening tests to large populations and in this case is selective of persons who are at higher risk for the disease.

As nursing students were setting up a health screening at a local community center, they reviewed the need to screen for heart disease and cancer. One student asked, "But colon cancer is prevalent; why aren't we setting up for sigmoidoscopy?" How would the instructor reply? a. "A sigmoidoscopy is expensive to perform and invasive." b. "Can you find adequate privacy for a sigmoidoscopy?" c. "What a great idea. Would you like to help arrange it?" d. "Would you like to administer that test for the screening?"

A A sigmoidoscopy is highly invasive, not cost-effective, and difficult to administer; many clients find this procedure uncomfortable and it has dangerous, although infrequent, side effects.

How might the social planning model best be defined? a. A process of experts engaging in rational, deliberate problem solving b. A process of group meetings that take place until everyone reaches consensus c. A process of collaboration to write grants to fund health care programs d. A process of using democratic decision making through a grassroots approach

A A social planning model is in existence when experts take responsibility for solving problems, sometimes with little community involvement. The community empowerment model uses democratic decision making through a grassroots approach.

A community/public health nurse wanted to use normative-referenced evaluation to determine the effectiveness of an environmental pollution program in the community. After examining the number of asthma-related admissions at the local children's hospital, which of the following actions should the nurse take? a. Compare the admission levels attributable to asthma before and after the implementation. b. Compare the admission levels attributable to asthma with the admission levels attributable to accidents. c. Determine whether the admissions were attributable to asthma or other respiratory problems. d. Determine whether there were zero admissions because of the decreased incidence of asthma after the intervention.

A A zero rate is unrealistic because asthma may have multiple causes; removing one cause might decrease the incidence, but not to zero. In normative-referenced evaluation, measuring goal achievement may involve comparing the population in question with another population. An appropriate approach then would be comparing the population with itself before and after implementation

According to the health-belief model, which factors influence whether a person will engage in a particular health-promoting behavior? a. Feeling susceptible to a severe disease b. Being told to do so by a significant other on a frequent basis c. Believing that high-income persons engage in such behavior d. Viewing posters emphasizing the behavior in an area that the person frequents

A According to the health-belief model, people are motivated by the sense of personal susceptibility to a disease, as well as the perceived severity of a disease.

Which of the following actions should the nurse perform when analyzing collected assessment data? a. Categorizing the data and identifying the implications b. Creating graphs, charts, and maps to display the data c. Determining the aggregates at high risk for specific problems d. Identifying target populations by demographic characteristics

A All of the actions would be performed very early in the process, but the data must first be categorized to identify the inferences that are descriptive of actual or potential health problems.

Which of the following is an example of a phenomenologic community? a. The employees of Delco Manufacturing b. The Miami Valley region c. The village of Yellow Springs d. The United States Census Bureau census tract #1017

A All of the options are examples of geopolitical communities except the staff of a company, which is a phenomenologic community or a community based on relationships, not geopolitical boundaries.

A nurse is initiating program planning. Which of the following actions will the nurse perform first? a. An accurate and thorough assessment of the community b. A confirmation of the formal and informal leaders of the community c. A determination of the budget available for obtaining relevant data d. An analysis of the employer's perspective on potential program needs

A Although all of the actions may need to be performed when a program is planned, programs cannot be planned before a comprehensive accurate and thorough assessment.

A community/public health nurse had a referral to visit a grandmother in her apartment to follow up on blood pressure readings because she was on a new medication. While in the apartment, the nurse took the blood pressure readings of all the adults and children there. What is the nurse attempting to do? a. Perform a case finding. b. Follow the American Heart Association guidelines. c. Give care to all members of the family, regardless of reimbursement. d. Involve the family in the care.

A Although all of the answers are technically true, case finding is defined as an individual or one-to-one screening while present in a setting for another reason. In case finding, screening tests are used to identify previously unrecognized disease in individuals who present to the health care provider for health maintenance checks or for an unrelated complaint.

What is the purpose of outcome attainment? a. Answering the question "Were goals achieved?" b. Clarifying whether agency funds were appropriately expended c. Determining quantity of care given d. Measurement of community living outcomes

A Asking whether goals were achieved is identical with determining outcomes. Outcome attainment concerns measuring whether planned goals were achieved. Synonyms for this activity are performance evaluation, results of effort, and evaluation of effectiveness.

A community/public health nurse is planning the evaluation of a community education program about smoking cessation. Why is it important to complete this evaluation? a. It facilitates additional decision making. b. It clarifies the actual care involved in the service. c. It is required by accrediting agencies. d. It demonstrates that outcomes of the program were met.

A Evaluation yields data, which allow better comprehension and therefore better decisions. The purpose of evaluation is to facilitate additional decision making. The evaluation will help show whether the outcomes of the program have or have not met the goals.

A nurse in a particular community decided that the priority was to decrease the number of teenagers who smoke. Which of the following should the nurse measure first? a. Percentage who currently smoke b. Attitudes toward smoking c. Prior experience with smoking cessation d. Knowledge about the dangers of smoking

A Before the nurse finalizes plans, baseline data on the behavior that is the target of change need to be collected. Although it would be useful to know all of the data mentioned, it is most helpful to know the proportion of teenagers who currently smoke, in order to determine any change. The proportion of the population that engages in smoking can then be compared with the proportion that engages after the intervention.

Which of the following statements best demonstrates an appropriately written behavioral objective? a. "The learner will be able to verbally explain the need for political action." b. "The panel of experts will have discussed knowledge, assumptions, and cultural values." c. "The participant will understand the material presented." d. "The teacher will distribute and collect evaluation forms."

A Behavioral objectives focus on the learner and what the learner demonstrates in terms of knowledge, attitudes, or beliefs. Understanding is not observable, whereas an accurate verbal explanation is observable.

According to the American Nurses Association (ANA) and the American Public Health Association (APHA), the community/public health nurse is responsible primarily for whom? a. The community as a whole b. The employer who is paying the nurse's salary c. The individual for whom the nurse is caring d. The governmental unit that is responsible for its citizens

A Both the ANA and the APHA state that the nurse's primary responsibility is to the community or population as a whole and that nurses must acknowledge the need for comprehensive health program planning to implement this responsibility.

Specificity is the ability of a screening test to accurately identify what aspect of the screening? a. Persons who do not have the disease b. Persons who have the disease c. Persons who need follow-up in relation to the disease d. Persons who were unaware that they had the disease

A By definition, specificity is the ability of a screening test to accurately identify most of the people who do not have the disease. Because no test is 100% accurate, the test results are not always correct.

Stakeholders are defined as persons who a. Have expectations about care to be delivered. b. Have loaned money to the agency. c. Helped write the legislation for health care agency funding. d. Own stock in the agency.

A By definition, stakeholders are interested persons who have expectations about the care but are not directly involved.

The Mississippi River floods a small riverside town. A few citizens decide to stay even after the flood hits the town. Assuming flooding overwhelms city services, which of the following is the most dangerous problem? a. Inability to drink safe water from the flooded city water pipes b. Inability to eat because of food spoilage from lack of electrical service to refrigerators c. Inability to relax, which would result in anxiety and tension d. Inability to sleep because furniture will be wet

A Canned food would be edible. Although anxiety, tension, and sleeplessness may well occur, safe drinking water is the most important immediate physiologic need. Priority would have to be first to obtain safe drinking water for stranded people.

A community/public health nurse employed by the local health department is told by the director to engage in health planning. Which of the following actions will the nurse perform? a. Collecting and analyzing data b. Serving vulnerable populations c. Planning for health care needs of individuals d. Applying the nursing process to community-based care

A Community health planning is a continuous social process by which data about clients are collected and analyzed for the purpose of developing a plan to generate new ideas, meet identified client needs, solve health problems, and guide changes in health care delivery.

Which of the following questions is answered by completing a cost-benefit analysis? a. Can similar outcomes be achieved with less cost? b. Can unlicensed assistive personnel give care equally rapidly? c. Was the care appropriate and given correctly? d. Was the nurse as efficient and as skilled as possible?

A Cost-effective measures determine the cost per unit of outcome, which helps establish conclusions as to whether similar outcomes can be achieved with less cost. Therefore, the question that is being asked is "Can similar outcomes be achieved with less cost?"

A registered nurse flown in to help with a disaster was feeling very tired, irritable, and anxious. In addition, the nurse seemed to be having difficulty concentrating and making decisions. Which of the following is the most likely cause of such feelings? a. The close involvement in the disaster, which has traumatized the nurse as well b. The knowledge that the nurse cannot meet all of the needs of the flood victims c. The realization that the nurse cannot undo the damage of the flood d. The recognition that the nurse is not adequately compensated for working this hard

A Disaster workers also experience distress and need debriefing and support. Many disaster workers report being overwhelmed by the devastation and extent of personal injuries. Some may feel unqualified to cope, particularly after working for 24 to 36 hours without adequate support staff. Care providers also need care and an opportunity to address their own stress issues.

What needs to be done when evaluation data are analyzed? a. Interpreting and judging the data before making any recommendations b. Examining data through the approach that has commonly been used by the agency c. Reviewing the literature and comparing it with current findings d. Using the Omaha System as the guiding framework

A Facts do not speak for themselves but must always be interpreted in context for meaning. Therefore, data used for evaluation must also be interpreted for meaning, and the desirability of the outcomes must be judged. The other responses are not appropriate for use in evaluating data.

To validate change in a population, which of the following should a nurse determine? a. Whether a high proportion of a random sample report change in their health behaviors b. Whether a majority of the population confirm changes in their health behaviors c. Whether each person the nurse individually taught reports a change in health behaviors d. Whether each staff nurse reports that their assigned families demonstrated a change in health behaviors

A Goals are written in terms of percentage of population, not an individual or a family. To study the population, a random sample of 10% to 20% is useful. It is not possible to obtain information from all community members

Which of the following is useful to review in determining whether the goals of the community/public health nurse are appropriate? a. The assessment of community members' health needs b. The focus areas for the nation in Healthy People 2020 c. Goals established by other, similar community/public health agencies d. Goals suggested by the public health research literature

A Healthy People 2020 is a guide to health care planning at the federal level, as well as for states and local communities. When the assessment and planning have been performed in partnership with the community, the health care is more likely to be appropriate. Goals are most appropriate when the nurse has assessed health needs of the aggregate, their readiness to change, and the resources available.

A community/public health nurse determines there are 200 persons in a particular community who are older than age 65, another 300 younger than 21, and about 1500 persons aged 21 to 65. What is that community's dependency ratio? a. 1:3 b. 1:8.5 c. 1:9 d. Cannot be determined from the given data

A If 500 persons are younger than 21 or older than 65 and 1500 persons are aged 21 to 65, the dependency ratio is 1:3. That is, in terms of aggregates, there is 1 dependent person for every 3 who are probably able to care for themselves.

A woman was told that everyone would be getting low-interest loans to rebuild their houses and businesses, and several of her neighbors were starting to rebuild. No one from the government had even come to look at damage to her house yet, which caused her to feel angry and resentful. What is the most likely reason for these feelings? a. She is focusing on her own problems. b. She is grieving over loss of her own property. c. She is suffering from acute posttraumatic stress disorder. d. She does not care about anyone else's damage.

A In the disillusionment phase, there are negative feelings of disappointment because of delays or failures when promises of aid are not fulfilled. People seek help to solve their own personal problems rather than community problems.

A nurse decided to set up a planning group. All of the following groups of people expressed interest in being involved in the planning along with the nursing staff. If the nurse must eliminate one group to keep the size of the group manageable, which of the following groups should the nurse eliminate? a. A convenience selection of local citizens b. Formal and informal leaders of the community c. Those who are probably going to be against the intervention d. The aggregate for which the intervention is going to be implemented

A It is crucial that the target group, caregivers, and formal and informal leaders be involved. It is also helpful to have broad segments of the community to provide a widespread base of support. However, if size must be limited, the involvement of community members who are not leaders (in a position to promote acceptance), who will not be implementing the program, or who will not be affected by the program may be eliminated. The opposition must not be eliminated from the committee.

A community/public health nurse is planning to implement a new community-based education program. Why is it crucial for the nurse to understand the organizational structure of a community, as well as its leadership? a. The nurse may have to convince the informal leaders of the need for the program before it can be successful. b. The nurse may need to ask the formal leaders to provide leadership for the programs. c. The nurse will want to know political priorities before deciding on any actions to be taken. d. The nurse will want the approval of the elected governing body before making decisions about health programming.

A It is important for the nurse to identify both formal and informal leaders. Informal leaders often have the social power, even though the formal leaders have the authority in decision making. To be successful in any kind of change, the nurse needs a thorough understanding of both the formal and informal leadership dynamics.

Which of the following factors most influences a client's ability to learn from a health education program? a. Client's belief that the information will be useful or enjoyable b. Handouts given to the client c. Nurse's ability to teach d. Setting in which the educational program is given

A Learning depends primarily on emotional readiness, which is reinforced primarily by internal motivation. The learner must be willing to put forth the effort needed to learn. Internal motivation is self-directive and long lasting and is based on the belief that the client's action will be useful or enjoyable.

Which of the following is an appropriate definition of mitigation? a. The actions used to avoid or prevent disaster damage b. The cleaning-up process after a disaster c. The process used to react to a disaster in order to minimize the death rate d. The psychological intervention used to help people cope with a disaster

A Mitigation is a term used in disaster planning that describes actions or processes, or both, that can be used to prevent or reduce the damage caused by a specific disaster event.

What should all nurses know about their community? a. All the medical and social agency resources that may be available b. All of the nursing roles that may need to be fulfilled in a disaster c. The emergency personnel departments in the local area that may need to be recruited d. The nursing actions that may be performed during a disaster as defined by the state's nurse practice act

A Nurses should know in advance all community medical and social agency resources that will be available during a disaster, as well as where equipment and supplies have been stored and their own role and rendezvous site. As a volunteer during a disaster, the nurse in most situations is covered by the Good Samaritan Act of the state.

The nurse is using previously collected data about the incidence and prevalence of lead poisoning in the community as a starting point when conducting a community assessment. What would be the nurse's next step? a. Assessing the community in relation to lead poisoning b. Determining how best to help other personnel decrease the incidence of lead poisoning c. Gathering external resources to help meet the needs of the community d. Working with collaborating agencies to obtain external funding to prevent lead poisoning

A One approach to community assessment is the problem-oriented approach. Using this approach, the nurse assesses a community in relation to a specific topic or health problem. The nurse begins the process with the problem or topic area and then assesses a specific community in relation to that topic. If a particular problem has been identified in previously collected data, the nurse should assess the community in relation to the identified need before gathering resources, working with others, or trying to help colleagues, who may have other priorities.

What must be stressed to all participants attending a health fair? a. A screening program is not a substitute for ongoing health supervision from a health care provider. b. All test results are only tentative, and so participants who receive negative test results may nonetheless be suffering from a disease. c. Results are true today, but disease can develop any time, so participants should attend any future health fairs as well. d. There are many other diseases that may be attacking participants that the health fair did not screen for, and so continued vigilance is necessary.

A Persons who participate in screening programs commonly believe that they have been checked over adequately. Therefore, participants must be advised that a screening program is not a substitute for ongoing health supervision from a health care provider.

The community/public health nurse was enthusiastic about giving care to the community's residents. Which of the following actions should the nurse take when asked to attend a city council meeting? a. Appreciating the opportunity to meet the policy makers in the community b. Clarifying which agenda item was relevant to the agency and its purpose c. Insisting on dedicating the nurse's time toward giving care, not observing politics d. Pointing out that the nurse's caseload was too heavy to waste time in such a way

A Policies are expressions of goals and rules within a community, an expression of values. Policies can mandate, allow, or initiate actions that affect a community's health. Consequently, it is very valuable to meet policy makers and inform them of perhaps unrecognized health needs in the community.

A nurse is determining the quality of care that is provided. Which of the following factors would the nurse examine? a. Adequacy and appropriateness b. Agency mission statements c. Cost-benefit ratios d. Personal feelings about the care

A Quality is measured in terms such as efficiency, appropriateness, and adequacy.

During the aftermath of a disaster, the nurse is assigned to triage incoming injured people. A man shows all the symptoms of a myocardial infarction. What should the nurse do first? a. Give him a red tag so that he is the next person for the physician to treat. b. Give him a green tag because without a cardiac care unit, the man will not survive. c. Allow him to die with dignity by giving him a black tag. d. Provide care for the man until a physician becomes available.

A Red tags are used to identify the most urgent, first-priority injuries. Although his condition is life threatening, survival probability is high, so the man would be a first-priority client. Green tags are used to show third priority and black tags are used for persons who are dying or dead.

Which of the following services implemented by nurses would represent secondary prevention? a. A free diabetes screening held at the local shopping mall b. A post-heart attack exercise program at the local community college c. A "stay beautiful" program stressing safe exercises for pregnant moms d. An elementary school "don't smoke" campaign for students

A Screening, which is aimed at diagnosis and treatment of illness at an early stage, is secondary prevention. Secondary prevention establishes the earliest possible diagnosis and early treatment, even before symptoms are present, to prevent disease progression.

Which audience comment best demonstrates self-efficacy? a. "I believe I can learn to do this." b. "I think the nurse is a real expert in this stuff." c. "Those computer graphics really make it clear how people can do this." d. "Wow. The nurse really expects us to do this."

A Self-efficacy is the belief that the learner is capable of engaging in the desired action. Stating "I believe I can learn to do this" demonstrates the belief by the learner that implementation is possible.

Whether a nurse's plan of care for a community is acceptable is probably determined by which aspect of the plan? a. It was created in coordination with community members. b. It was financially feasible. c. It was politically correct and feasible. d. It was something in which the nurse really believes.

A Stressed throughout Chapter 16 is the importance and need for the community to be involved in the planning. If the community is not involved from the beginning, the program may not be effective. The program is more likely to be successful if the community is involved.

What group or organization defined the term disaster as "a threatening or occurring event," either natural or man-made, "that causes human suffering and creates human needs that victims cannot alleviate without assistance"? a. American Red Cross b. Department of Health and Human Services c. National Office of Disaster Control d. Department of Homeland Security

A The American Red Cross—the voluntary agency historically most involved in disaster relief—so defined the term in 1975.

Knowing that a disaster can occur at any time, staff at a community hospital create a disaster plan that is based on a risk assessment. Which of the following activities should be included in the plan? a. Scheduling periodic mock disasters to practice preparedness b. Developing an ongoing media campaign that stresses the excellence of the employer c. Reviewing all of the hospital policies for consistency and appropriateness d. Sharing stories of problems that have occurred when communities have not been prepared for a disaster

A The Joint Commission (TJC) requires all hospitals to have a disaster plan, hold disaster drills, and regularly evaluate those plans and activities to meet accreditation requirements.

A community/public health nurse was not sure the agency was large enough to fulfill some of its goals. Which of the following should the nurse evaluate in order to reach an accurate conclusion? a. The adequacy of resources, evident in such measures as waiting lists for services b. The financial base of the agency, evident in the agency budget c. The number of cooperative physicians, evident in the agency telephone referral list d. The number of nursing staff, evident in the staffing assignments

A The adequacy of resources is a crucial variable; waiting lists are one appropriate measure of how much care is currently needed but not yet received.

A community/public health nurse plans a program to improve the community's ability to prevent accidents. Which of the following measurements would be the best way to evaluate the outcomes of the nurse's intervention? a. Number of accidents in the subsequent year in comparison with the previous year b. Number of people who attended the educational program c. Number of requests for information received after the program d. Satisfaction level of those who attended the program

A The best evaluation is based on outcomes related to the intervention's purpose—in this case, a decrease in accident rate.

Which of the following statements best demonstrates a client's intention to start exercising on a regular basis? a. "I bought walking shoes and have scheduled a walk before breakfast each day." b. "I exercise when I can find someone to walk with." c. "I need to buy a treadmill or exercise bike so that I don't get fat." d. "I think exercising would reduce my stress and help my appearance."

A The best indicator of whether a client is going to implement a health improvement plan is when the client has moved beyond contemplation and preparation or considering reasons they should engage in the behavior and actually takes action to initiate behavior change, such as buying exercise clothing and scheduling a time to engage in the action.

A community/public health nurse tried to keep the community informed of the progress of the new health programs at all the meetings that the nurse attended. Which of the following would be the reason for the nurse's ongoing communication? a. To avoid community dissatisfaction when expectations are not met b. To be sure that no one blames the nurse when unexpected happenings occur c. To fulfill the responsibility of keeping the community informed d. To be politically and culturally sensitive to the needs of the community

A The more the community/public health nurse is aware of stakeholders' expectations, the fewer surprises there will be later. Dissatisfaction occurs most frequently when expectations are not met. Continued communication allows early identification of misunderstandings, negotiation, and revision of the program to balance the interests of most of the stakeholders. It is not possible to satisfy everyone.

Which comment to the nurse best demonstrates a successful health education program? a. "I'm going to take a 30-minute walk each day." b. "I certainly enjoyed the program, and thank you for the freebies." c. "You gave me so much new information; thank you so much." d. "Wow! I learned many things that I can use in my daily activities."

A The overall goal is to teach a health-promoting activity that can be incorporated into the learner's lifestyle. Assessment of learner outcomes has traditionally been based on achievement of the behavioral objectives. If the objectives are properly written, each objective is measurable. Planning to take a daily walk demonstrates intention to incorporate the program content into personal lifestyle.

What was the result of the prospective payment system legislation? a. Hospital stays were shortened, which placed a greater responsibility on family care. b. Payments to the hospitals and physicians that fulfilled the new rules were higher. c. Nursing staffing was increased to meet the needs of more acutely ill patients. d. Diagnoses were more accurate and complete before clients were admitted to acute care.

A The prospective payment system changed the patterns of hospital billing and thereby altered patterns of inpatient hospital stays. Hospital stays were shortened, and more health service delivery responsibilities were the responsibility of community agencies and family members.

The community/public health nurse was asked why a church was chosen as the site for a recent health fair, because not everyone in the community attended this church. What would be the most likely response by the nurse? a. "It is accessible to most of the residents of the community, it is large and has several restrooms, and it is centrally located." b. "Most residents of the neighborhood either do or should attend the church." c. "I am a member of that church and could reserve the site without charge." d. "The church is community service-oriented, and hosting the screening met its mission."

A Unless mobile vans are used, the site chosen should be accessible, be a public place, have adequate space and restroom facilities, and be acceptable to the majority of the target population.

When a nurse assesses a community, which of the following components is essential to determine first? a. Areas of strength b. Areas of need c. Balance of inputs to outputs d. Openness to intervention

A When assessing, whether individuals or systems, it is essential to determine areas of strength, as well as areas of need. Several chapters in the text emphasize that strengths should be assessed first because strengths are the tools used to address weaknesses.

Which screening tests would be most useful at a health fair at a local YMCA that serves young adults? (Select all that apply.) a. Measurements of blood pressure, blood glucose level, and cholesterol level b. Measurements of height and weight c. Mammography and prostate examination d. Purified protein-derivative skin test (PPD) and review of immunizations e. Stool for occult blood and sigmoidoscopy f. Vision and hearing

A, B On the basis of the age group that would be screened, the blood pressure, cholesterol, and diabetes screening would be most useful. Height and weight measurements are useful for assessing obesity, which is a risk factor for heart disease and stroke, two of the three leading causes of death in Americans. Tests such as mammography, prostate examinations, and stool for occult blood and sigmoidoscopy are more typically used in older populations. PPD, review of immunizations, and vision and hearing screenings are not necessary for a population of young adults.

Which variables must the nurse consider when planning a health fair? (Select all that apply.) a. Cost and convenience of possible screening tests b. Community's culture and support for such screening tests c. Number and type of volunteers available to assist d. The health risks inherent in the target population e. The best photos to use in community advertising f. Needs of the local community-based agencies

A, B, C, D The primary deciding factor is what health risks are present in the target population. Additional variables to be considered include significant health problems in the community; support available from the community, including cultural issues and possible volunteers; and the use of screening tests that are safe, simple to administer, and cost-effective. Although publicity is often very helpful, photographs should not be a primary consideration. Moreover, although the needs of community agencies may be a consideration, it is not of primary concern in the planning of a health fair.

What efforts does the American Nurses Association (ANA) suggest all professional nurses should make? (Select all that apply.) a. Educate students that political options must conceptualize prevention as preferable to treatment in health care. b. Encourage partnerships with consumers and other professionals. c. Increase knowledge and skill in providing preventive services. d. Lobby for legislation to vastly increase sales tax on beer and liquor. e. Require health care providers to serve as role models of healthy lifestyles. f. Support requiring health insurance to pay for preventive health care.

A, B, C, F Box 18-1 lists various efforts that the ANA encourages. These include increasing nurses' knowledge and skill in providing preventive services, encouraging partnerships with consumers and other disciplines in promoting health, supporting health care legislation that holds health insurance plans accountable for preventive care, educating the public to promote the health of the population, and influencing local and national economic and political options toward reconceptualizing health care in preventive ways. The ANA does not support requiring specific actions by health care providers in their private life. Beer and liquor taxes are not discussed in the document.

A nurse was trying to determine what resources might be available to support a screening program for middle-aged adults in the local community. The nurse should be sure to assess which variables? (Select all that apply.) a. Cost and funding sources b. Equipment and personnel to run the screening tests c. Free newspaper publicity d. Local diagnostic and treatment resources e. Temporary personnel who could be hired to assist f. Volunteers to help with the screening

A, B, D, F Practical resources needed to support screening programs include funding, personnel, equipment, volunteers, follow-up diagnostic and treatment services, and support by key community leaders. Temporary employees would not typically be hired. With the low literacy rates, newspapers should not be the only public notification used. Rather, media should include flyers, mass mailings, and notices on community websites and local advertisements on radio and television, as well as in newspapers.

Nursing students were setting up a meeting to finalize plans for a health fair. Of the following people, who must be included? (Select all that apply.) a. All the health care personnel who will be doing the screenings b. Community leaders who are actively involved in neighborhood activities c. Local politicians who will enjoy having their pictures in the media d. Philanthropists who might contribute funds for additional screening tests if their names are publicized e. Staff from the health department that is sponsoring the fair f. Volunteers who will help collect the consent forms and other tasks

A, B, F Although the students might invite anyone, the persons who are most important are those who may help secure needed resources or who will help implement the program. These include health care personnel, volunteers, and community leaders.

The nursing students created a media spot to publicize a free screening for undergraduates to be held at the college. What must the students remember to do? (Select all that apply.) a. Discuss how listeners would benefit by attending. b. Emphasize the program is being given for everyone's benefit. c. Keep the message short, at about 30 seconds or 75 words. d. Require that the ads run late in the evening when most students listen to the radio and watch television. e. Stress the health risks that students face that may be diagnosed at this screening. f. Use lots of visual aids to help listeners visualize the experience.

A, C Such media spots must be short (30 seconds or 75 words) and clarify how listeners will benefit. Fear (stressing the health risks) is not an effective long-term strategy. Visual aids would not be very effective with radio, which is an auditory medium. The screening is not for everyone, but for the college students (not staff or faculty). Although the students can request a late evening advertisement, the channels air public service announcements at whatever time they choose.

Which of the following has resulted from the Steps to a Healthier US program? (Select all that apply.) a. An increase in community-based chronic disease-prevention programs b. An increase in funding for health-promotion programs c. Improvements to include health and preventive practices in daily life d. Improvements in continuing education programs for health professionals e. An increase in availability of online interactive health risk appraisals f. An increase in tax deduction for participating in health-promotion programs

A, C The purpose of Steps to a Healthier US Initiative (2007) was to improve the lives of Americans through community-based chronic disease-prevention programs. Further progress has been made to weave health and preventive practices in all aspects of people's lives, including how they live, where they work, their ability to access clean water and safe food, and how they spend leisure time.

Why should nursing, as a profession, be involved in program planning? (Select all that apply.) a. As a result of time spent in direct contact with clients in the community, nurses possess useful information. b. Nurses have enough political power to create barriers if they are not included in the planning process. c. Nurses, who constitute one third of all health care providers, implement the majority of planned programs. d. Nurses make up a large portion of health care consumers. e. Politically, it is wise to include all professions in planning groups. f. Nurses provide the most expertise of the health care professions.

A, C, D Nurses should be included in program planning because nurses make up more than one third of all health care workers and implement the majority of health care programs. With experience in seeing what works and what does not, nurses can help planning groups avoid problems. Nurses spend a greater amount of time in direct contact with clients. This exposure to the community enables nurses to obtain useful information. In addition, nurses also account for a large portion of health care consumers.

A public health nurse was trying to persuade the largest employer in town to offer workplace health-promotion programs. Which arguments could the nurse offer as benefits of these programs? (Select all that apply.) a. Decreased absenteeism b. Decreased incidence of obesity c. Decreased use of insurance benefits d. Decreased accidents e. Decreased turnover f. Decreased commitment to self-improvement

A, C, D, E There are numerous positive outcomes for employer and employee participation in health-promotion activities. Incentives for employers include reduced rates of employee absenteeism because of improved health status, improved employee productivity, decreased use of medical insurance benefits and workers' compensation for illness and accidents, decreased employee turnover, fewer accidents, and decreased rates of premature morbidity and mortality. Workplace health-promotion programs may not decrease the incidence of obesity or decrease the commitment to self-improvement.

Which of the following are included in the subsystems of Anderson and McFarlane's definition of a community? (Select all that apply.) a. Communication and health/social services b. Demographics and census data c. Economics and recreation d. Physical environment and education e. Politics and government f. Safety and transportation

A, C, D, E, F The eight subsystems are communication, health and social services, economics, recreation, physical environment, education, politics and government, and safety and transportation. Demographics and census data are not subsystems.

Which of the following federal resources supply data that support the objectives and interventions described in Healthy People 2020? (Select all that apply.) a. Centers for Disease Control and Prevention (CDC) b. Dietary Guidelines for Americans c. National Health and Nutrition Examination Survey (NHANES) d. Healthfinder.gov e. National Health Care Survey (NHCS) f. U.S. Public Health Service Office of Disease Prevention and Health Promotion (ODPHP)

A, C, E Numerous federal resources support the objectives and interventions related to Healthy People 2020 and are incorporated into each topic area. These data sources include the CDC, NHANES, and NHCS. The ODPHP coordinates the efforts of public and private sectors to reduce the risks of disease and promotes the nation's health. Links to various data sources can be found within the ODPHP website, but the role of the ODPHP is coordination of efforts to promote health, not data collection. The Dietary Guidelines for Americans and Healthfinder.gov provide information about interventions that can be used to address the Healthy People 2020 objectives.

Which of the following actions should be considered when a nurse provides an educational program to adults? (Select all that apply.) a. Encouraging the learner to share resources with the group during the program b. Focusing on the content that needs to be presented c. Providing a detailed overview of the program before starting the formal education d. Teaching what the learner wants to know before continuing the instruction e. Establishing an ongoing support group for the participants f. Relating the content to life experiences

A, D, F When a nurse is teaching adults, a few of the strategies that should be included are encouraging the learner to share resources with the group during the program, teaching what the learner wants to know before continuing the instruction (otherwise the learner will not be able to focus on instruction if a question is not answered), and relating the content to life experiences. Because the learner's needs should be addressed throughout the program, the focus should not be solely on delivering necessary content. An overview of the program is a good idea before the education is started; however, this does not need to be detailed. An ongoing support group may be appropriate for some participants depending on the nature of the presentation, but it is not necessary for some topics and groups.

What variables are considered in the decision as to which screening tests are to be performed at a health fair? (Select all that apply.) a. A national day dedicated to a specific screening b. Preferences of the local politicians who support such events c. Preferences of the local church, which donated space to be used for the event d. The learning needs of the senior nursing students who are going to be helping e. The sociodemographics of the population that will probably attend f. What donations the nurse or the clinic has received

A, E On a population level, choice of screening test is based on general sociodemographic factors rather than individual risk factors. Age, gender, and ethnicity factors affect the risk status of a population. Hence, population data are an important consideration in the planning of a health fair. The other population-based screenings can be offered in conjunction with national screening days.

Why would a nurse be concerned when a community has relatively closed, rigid boundaries? a. The community does not have an identity. b. The community is probably resistant to change. c. The nurse will not be able to share community resources. d. The nurse may have limited access to the community.

B A closed, rigid system is resistant to change, whereas an open, more flexible system is more receptive to change and to help from the health care delivery system.

When community/public health personnel speak of a community of solution, to what are they referring? a. A community that has resolved its major problems at least temporarily b. The area in which some problems are approached on a wider regional basis c. The fact that communities have to solve their own problems d. The reality that some problems have to be approached on a federal basis

B A community of solution refers to the boundaries within which a problem can be identified, addressed, and solved. Such problems are often beyond one community's boundaries but affect several communities, which must work together to resolve the problem.

Which of the following actions is the most important to perform first in caring for victims of a mass casualty incident? a. Call in all part-time and on-call staff to help care for newly admitted clients. b. Contact surrounding communities for assistance. c. Call the hospital supply store and order extra dressings, intravenous fluids, and other materials. d. Discharge as many hospital patients as possible to make room for disaster victim admissions.

B A mass casualty incident involves 100 or more people, which overwhelms a single institution, help must be summoned immediately, before the patients even arrive.

What might be the implications of knowing where members of the community are employed (i.e., their occupations)? a. How or whether community members worship b. How and when the community members prefer to engage in recreation c. The diseases or injuries for which they may be at risk d. Where residents do their grocery shopping and what they typically buy

C Knowing the occupations may suggest particular diseases and injuries for which employees are at risk.

A nurse used a lifestyle assessment to measure health-promoting lifestyle behaviors of participants at a meeting. Which of the following actions should the nurse take when reviewing the results with each individual? a. Arrange for the client to meet with a lifestyle coach. b. Collaborate with the client in choosing what changes to make. c. Explain ways that the client can engage in new behaviors. d. Tell the client what to do to improve his or her health.

B A plan must involve both the nurse and the client to identify outcomes signifying success from the client's perspective. Only the client can decide what behaviors to attempt to change. The nurse collaborates as a partner to share information. Changing behavior is always the client's decision.

A nurse educator wanted to be certain that the program participants not only learned the content but also had time to practice these new behaviors. Which of the following must the nurse be sure to include in the program? a. Providing positive praise for participation b. Allowing time for role-playing c. Engaging the audience in stress-reduction exercises d. Modeling the appropriate behaviors

B All of the answers are positive teaching behaviors, but to most effectively help the participants change both their attitudes and their behaviors, role-playing provides exploration of attitudes and use of problem-solving skills.

Which of the following is known to be the leading cause of preventable death in the United States? a. Obesity b. Smoking c. Sun exposure d. Second-hand smoke

B Smoking is known to be the leading cause of preventable death in the United States, accounting for 1 per 5 deaths. Obesity rates continue to rise, but obesity is not the leading cause of preventable death. Exposure to the sun and exposure to second-hand smoke also contribute to preventable deaths, but they are not the leading causes

The nurse had a peer evaluation completed in order to improve her teaching expertise. Which of the following best describes this evaluation? a. A summary of the evaluation that the audience completed at the end of the program b. Another nurse observing and providing feedback on the presentation c. Completion of an evaluation of their learning and satisfaction by participants d. Videotaping of the presentation for further review by the nurse and others

B All of the options are possible evaluation mechanisms, but peer evaluation is having a peer—in this case, another professional nurse—observe and give feedback

When a nurse plans educational programs appropriate for a population being served, which of the following actions should the nurse take? a. Bill the employer for the actual cost of the health program. b. Provide feedback and follow-up information to attendees. c. Make handouts available to the audience. d. Incorporate the latest technology into the presentation.

B Although all of the actions should be taken, it is ethically required to provide feedback, education, and appropriate follow-up for identified risks.

Behavioral objectives should be a. Comprehensive and complete. b. Observable, measurable, and clearly communicated. c. Specific and detailed. d. Written on the teaching plan.

B Although all of the responses are consistent with careful planning, the plan will not be workable unless the objectives are measurable and the nurse is able to observe changes in learning, attitudes, or behavior. Because the objectives convey intent to other people, such as external evaluators, they must also be communicable. If clearly stated, the objectives can also be used for evaluation purposes.

A community/public health nurse wants to use key informants to gather additional information. Which of the following actions would be useful to perform first? a. Sending an e-mail message to all community residents b. Conducting a focus group with informal leaders from the community c. Publishing a survey in the local newspaper d. Requesting that children's parents complete a survey

B Although any of these options might be useful, a focus group with the community's leaders would probably yield the most reliable data. Further meetings or focus groups might then concentrate on special at-risk groups.

The director of a public health agency suggested that the community/public health nurse select the target population for a new program. Of the following populations, which would be considered the target population? a. Persons for whom the nurse is most comfortable caring b. Persons for whom some change in health or lifestyle behaviors is desired c. Persons eligible for care according to federal guidelines d. Persons that can afford to pay for their care

B Although clients may be chosen as recipients of care for any of the reasons listed, the target population is typically persons for whom change in health-related behaviors is desired whom the community/public health nurse desires change, whether in lifestyle behaviors or health outcomes.

Which of the following is the most effective way of prioritizing nursing diagnoses? a. Ensuring that the diagnoses are reimbursable by third-party payers b. Determining the degree of community concern about the problem c. Comparing the diagnoses with the agency's mission statement d. Discussing conclusions with another community/public health nurse

B Although the nurse might engage in any of these actions, the most effective way to prioritize nursing diagnoses is to choose the diagnosis most important to the involved aggregate.

A nurse is planning a community-wide program about reducing the risk of developing cardiovascular disease. Which of the following actions should the nurse take first? a. Developing a public education campaign by using public service announcements b. Assessing the extent of the problem in the local community c. Forming partnerships and establishing support with community agencies d. Gathering resource materials and identifying funding sources

B Assessment is always the first step in the nursing process; it is needed to determine the focus of the community program.

Which of the following is a necessary assumption for evaluation to occur? a. Accrediting agencies focus on careful documentation. b. Actions have both intended and unintended results. c. Nursing care is dependent on the reimbursement available. d. People expect professionals to document their care.

B Assumptions are that nurses are accountable for their own action and that nursing actions have results, both intended and unintended.

What was the significance of the National Health Planning and Resources Development Act of 1974? a. It created the program that yielded the first evidence that managed care reduced costs. b. It funded nationwide health planning to improve health care and reduce costs. c. It provided additional federal money to the states to spend on health care. d. It allowed states to take responsibility for planning health care services.

B Before this Act was signed into law, planning was primarily at the state level. The Act provides federal funding to coordinate resources to meet documented needs.

A terrorist releases a poison gas in a crowded subway. This is an example of which of the following? a. Appropriate political action b. Man-made disaster c. Media event d. Natural disaster

B By definition, release of poison gas is a man-made disaster. Man-made disasters include war, chemical and biologic terrorism, transportation accidents, food or water contamination, and building collapse.

Sensitivity is the ability of a screening test to accurately identify what aspect of the screening? a. Persons who do not have the disease b. Persons who have the disease c. Persons with symptoms of the disease d. Persons who now have a diagnosis of the disease

B By definition, sensitivity is the ability of a screening test to accurately identify persons who have the disease. Because no test is 100% accurate, the test results are not always correct; hence screening results are suggestive, not diagnostic.

The ability of a screening test to distinguish correctly between persons with and without a disease is known as a. Sensitivity. b. Validity c. Reliability. d. Specificity.

B By definition, validity is the ability of the screening test to distinguish correctly between persons with and those without the disease. Sensitivity is the ability of a screening test to accurately identify persons who have the disease. Reliability is the consistency or reproducibility of test results over time and between examiners. Specificity is the ability of the screening test to identify persons who are normal or without disease and whose test results are correctly negative when those persons are screened.

Of the following disasters, which would probably cause the most suffering? a. A fire during finals' week in a private residential college b. A fire in an Alzheimer disease unit of an extended-care facility c. A fire in an outpatient dermatology clinic at a major urban hospital d. A thunderstorm that downs electrical lines to the local rural hospital

B Certain characteristics of humans influence the severity of the disaster's effect on individuals and communities. For example, the age of a person, preexisting health problems, degree of mobility, and emotional stability all play a part in how someone responds in a disaster situation. Because patients with Alzheimer disease are less cognitively capable and physically less fit, many of them would probably be unable to escape and therefore would be injured or killed.

Which of the following factors can consumers easily evaluate? a. Appropriateness of the selected intervention b. Interpersonal skill of caregivers c. Quality of the care provided d. Effectiveness of the program

B Consumers can judge such factors as accessibility, waiting time, and cost, although not the intricacies, of the health care given. However, the most crucial factor is the interpersonal relationships of the caregivers with the clients.

One of the responsibilities of the community/public health nurse was to teach parenting classes to teenage mothers at high risk for committing child abuse. Which of the following would be an effective approach to helping mothers deal with their infants' behavior without resorting to physical discipline? a. Asking the mothers to listen carefully to the nurse's suggestions b. Asking the mothers to develop a contract to use the techniques discussed c. Asking the mothers to come to a consensus about how to deal with specific problems d. Asking the mothers to self-report abuse of their infants

B Contracts often increase the likelihood that actions will be performed, whereas the other options all have flaws: People other than the nurse may have helpful advice, fear is not the best motivator, and people who are not knowledgeable may not have good ideas, even in a group. Contracts increase commitment to specific actions and therefore increase the likelihood that the appropriate actions will be performed.

Which of the following actions is considered most important by the Centers for Disease Control and Prevention? a. Assisting in recognizing and detaining known terrorists b. Educating health professionals to recognize and treat biochemical hazards c. Establishing and maintaining a database about known biochemical hazards d. Printing and distributing informational materials about known biohazards

B Educating health professionals to recognize and treat biochemical hazards is a priority because there is concern that biologic hazards can be used as terrorist weapons.

A nurse is assisting at a disaster shelter. Which of the following interventions would be most appropriate for the nurse to implement? a. Encouraging everyone in the shelter to guard their own things from possible theft b. Keeping healthy victims busy by assigning them specific duties to perform c. Putting hysterical or panic-stricken victims with adults who can listen to them d. Separating the children from the adults so that the adults can rest while the children play

B Families should be kept together. Panic-stricken or hysterical people should be isolated. Although watching one's things may seem important, stressing that need feeds fear and loss. Survivors may be given tasks to keep them busy and reduce trauma to their self-esteem.

Which natural disaster is the most common worldwide? a. Earthquakes b. Floods c. Hurricane (water)/tornado (over land) d. Volcanic eruption

B Flooding is the most common natural disaster worldwide and also the third leading cause of weather-related deaths in the United States.

Which of the following actions should every nurse take to prepare for a possible local disaster? a. Completing an American Red Cross training program b. Having a personal preparedness kit stored in the home c. Providing volunteer assistance during a disaster in a neighboring community d. Educating the community about the recovery phases after a disaster

B Having personal supplies will allow the nurse to provide self-help, as well as aid others. The American Red Cross has many training programs, such as cardiopulmonary resuscitation (CPR). It is assumed that most nurses have completed programs such as CPR training before graduating from their nursing program. Community education is necessary for preparedness for a disaster; the priority would not be for education about the recovery phases.

Toward which individuals and their families are health education programs primarily aimed? a. Those who are acutely ill and need information to help them recover and avoid further problems b. Those who are healthy and can support each other in maintaining healthy lifestyles c. Those who must cope with an ongoing chronic disease d. Those who have defined health problems and who can support each other in maintaining healthy lifestyles

B Health education focuses on helping healthy groups maintain or improve their health. Patient education describes teaching-learning activities for people with an identified alteration in health.

What is the primary goal of health promotion? a. Discovering people who are at risk and helping them obtain appropriate health care b. Enabling people to exercise control over their own well-being c. Preventing further physiologic damage by early intervention and education d. Reducing specific risks by early diagnosis and treatment

B Health promotion is the process of helping people enhance their well-being and maximize their human potential by changing patterns to promote health rather than simply to avoid illness. The goal of health promotion is to enable people to exercise control over their well-being and ultimately improve their health.

A community/public health nurse was told to focus on teenage smoking. Which of the following actions should be the priority of the nurse? a. Ensuring that smoking is not allowed on school property b. Establishing community-wide programs on the dangers of smoking c. Lobbying to pass laws against teenagers' purchase of cigarettes d. Establishing programs to help adults, especially parents, give up smoking

B In most states, it is already illegal for teenagers to purchase cigarettes, and most schools do not allow smoking on school property. Although focusing on parents would be helpful (because children often copy what their parents do), the most important step is to focus attention on the problem throughout the community. Community attitudes predispose the population to support or work against various policies, services, or behaviors.

Everyone in the emergency shelter told their neighbors what they were doing and how they got away. Which of the following is the most likely reason why these people are sharing their escape stories? a. They are euphoric because they are safe in the shelter. b. They are in the "honeymoon phase," when everyone draws together. c. They are in the reconstruction phase, reviewing just how everything happened. d. They are totally unrealistic, as they clearly had no idea of the extent of the disaster.

B In the "honeymoon phase," there is a drawing together of people who simultaneously experienced the catastrophic event

Which of the following activities represents a challenge when a cost-benefit analysis is performed? a. Calculating all of the indirect, less visible costs b. Placing an appropriate dollar value on the benefits c. Using computer software to calculate the results d. Controlling the variables of cost and benefit

B It is difficult to quantify such qualitative items as benefit value of health care. Not all outcomes can be quantified in terms of dollars.

A nurse would like to facilitate a change within the community. Which of the following actions is the nurse likely to take, in view of Lewin's theory of change? a. Freezing the change by constant persuasion, reinforcement, and use of focus groups b. Increasing driving forces, decreasing restraining forces, or doing both c. Stabilizing change by decree, rules and procedures, or legislation d. Unfreezing the change by using the three techniques described by Lewin

B Lewin described forces that facilitate change (driving forces) or impede change (restraining forces). Driving forces must exceed restraining forces in order for change to occur. Therefore, the nurse may increase driving forces, decrease restraining forces, or attempt to do both.

A local community has experienced a disaster. What should the community do first? a. Call the federal government for immediate funding assistance. b. Implement its emergency operations plan. c. Recruit volunteers who will see what needs to be done and start doing it. d. Try to escape the disaster area.

B Local communities are responsible for safety and welfare of their residents and are required to have an emergency operations plan.

Which fact would suggest to a family that they may want to check building codes and availability of insurance and reconsider the location of their next home? a. The area where they are looking had a huge neighborhood fire after a lightning strike last year, and people are just starting to rebuild. b. The building lot is beautiful but in an area that has had forest fires and all the houses have burned three times in the past 20 years. c. The empty building lot was in a neighborhood of very nice homes, but the home that used to be there was burned when the smoker fell asleep in his bed. d. The home is very historic with features that cannot be replicated at any price today, but the damage from the fireplace fire is still very visible in the main living area.

B Most disasters are infrequent (such as being struck by lightning) and controllable (a person does not have to smoke, particularly in bed), but if such an event is predictable and frequent, action should be taken to avoid a disaster. In this case, it is probably foolish to build in an area where forest fires recur at frequent intervals.

Several people were involved in a local community shooting, and one victim died shortly thereafter. Which person will need the most help immediately after the shooting? a. The police officer who will have to notify the victim's family and follow up with the crime investigation b. The woman who has been living with victim and has never experienced death of a close friend or family member c. The woman who broke up with victim about a month ago and has not forgiven him for moving out of her apartment d. The victim's best friend, who is accustomed to gang shootings and random violence

B Personal variables influence an individual's reaction. Psychological proximity and previous experience influence response. Risk for developing severe consequences is greater if that person is emotionally close to the individual affected or has never before experienced a disaster.

Why is health screening considered a secondary level of prevention? a. It distinguishes between populations at high risk for disease from those at low risk for disease. b. It identifies patients who may need intervention. c. It diagnoses many easily treated diseases. d. It promotes health and well-being.

B Screening is a major secondary level of prevention measure because secondary prevention is aimed at the early detection and treatment of illness. However, because screening tests are imperfect, screening cannot in itself confirm diagnosis or suggest treatment. But screening can suggest whether certain patients require additional intervention.

Which of the following is the most common type of intervention used to improve the health of a community? a. Providing direct care to individuals at high risk for health problems and for their families b. Offering health education and screening programs c. Using media campaigns to raise awareness of the health needs d. Teaching fellow staff professionals about community needs and beliefs

B Several major types of community health intervention programs exist, primarily health-education programs, screening programs, establishing services, policy setting and implementation, increasing community self-help and competence, and increasing power among disenfranchised individuals.

How does summative evaluation help the community/public health nurse? a. Analyzing the data and recognizing gaps b. Determining long-term effect on health c. Improving care as it is being delivered d. Enhancing future offerings of the program

B Summative evaluation takes place after the intervention is complete, even as long as months or years later, to determine whether a long-term effect was accomplished.

Which of the following is the best example of a health-promotion program? a. The nurse collaborated with the local police department to prepare a public safety announcement about the benefits of using one's seat belt. b. The nurse appeared on the local public access television channel each Sunday afternoon to discuss nutrition and exercise options for families. c. The nurse worked with the local school parent-teacher organization to give free bicycle helmets to the students with bicycles. d. The nurse collaborated with the local motorcycle club to make sure all the cyclists who wanted one could obtain a free helmet.

B Teaching good nutrition and encouraging exercise are excellent health-promotion activities. The other choices are all risk reduction or health protection programs.

The President of the United States has declared an area a major disaster area. Which of the following actions will be taken by the American Red Cross? a. Ensuring that privacy and confidentiality of affected families are maintained b. Engaging in mass care, including provision of food, shelter, supplies, health services, and family services c. Establishing a financing loan program for people to rebuild their homes and businesses d. Keeping details of the extent of the disaster confidential

B The American Red Cross was granted a charter in 1905 to act as the primary voluntary national disaster relief agency for the American people if a disaster has been declared by the President. Among the responsibilities of the American Red Cross are damage assessment; mass care, including provision of food,

In what way is the Predisposing, Reinforcing, Enabling, Causes in Educational Diagnosis, and Evaluation (PRECEDE) model helpful when health education programs are implemented? a. It addresses the learning needs of ill individuals. b. It begins with examining an aggregate's general concerns and quality of life. c. It emphasizes the learning needs of families who have an ill member. d. It focuses primarily on environmental resources.

B The PRECEDE model begins with the presence or absence of health problems that are linked to quality-of-life issues, with the question "What are the general concerns of the population?" Such assessment helps ensure that the intervention is based on diagnosis of the community's need.

A nurse is teaching a client how to perform her own insulin injections. Which of the following should the nurse assess first to determine the client's experiential readiness to learn? a. Culture and ethnic background b. Educational ability c. Family structure d. Home environment

B The client's ability to learn can most easily be assessed by determining the client's educational level. Direct questioning related to years of formal education is useful but does not always provide complete and accurate information. Reading ability and learning disabilities should also be considered.

As the flood receded from the town, the Disaster Action Team (DAT) met for debriefing. Why is this debriefing important for the whole community, as well as for the disaster team members? a. The DAT is too tired to keep working and needs to sit and rest a while. b. The DAT has insights that can help modify disaster plans to be used in the future. c. The DAT has to give details of their names and addresses, so formal appreciation for their efforts can be sent. d. The DAT needs some time to just socialize.

B The experience of implementing the disaster plan is extremely useful in knowing which changes need to be made.

The community/public health nurse wanted to most effectively and efficiently determine the health and well-being of the community. Which of the following is the easiest way to determine a community's health? a. Ask the members of the media who report on the community b. Examine epidemiologic statistics of morbidity and mortality c. Review the discharge diagnoses of clients from the community hospital d. Visit the local grocery stores and exercise programs

B The fastest and easiest way to get an overall grasp of the community's health is to examine morbidity and mortality data.

Which of the following citizens trapped in a flood is in most need of supportive intervention by the nurse? a. A handyman who was planning to remodel soon anyway b. The man who had never been in a flood before and did not realize how much damage could be done c. The store owner whose storefront was under water yet again d. The woman whose house and small business were badly damaged but who had flood insurance

B The man who had no previous experience with a flood is psychologically unprepared for the disaster, whereas the other three citizens seem more prepared or do not seem to perceive the disaster as overwhelming.

A community/public health nurse is planning an educational program about healthy choices to prevent heart disease. Which of the following variables will be the primary influence as the nurse selects content for the program? a. Employing agency's preferences b. Needs of the high-risk target group c. Third-party payers' probable coverage of the educational program d. What the nurse feels most comfortable and skilled in teaching

B The nurse certainly must function within the constraints of the health care system, including policies of the employing agency and third-party payers; in a specific planned program, however, the actual content depends on the learning needs of the target group, as determined by a needs assessment.

Which of the following activities would be important for the nurse to complete when planning an educational program? a. Avoid rehearsing the content or it will sound too practiced. b. Come early to set up the audiovisual materials. c. Remind all possible participants that early registration is required. d. Try to get as many free handouts and freebies as possible.

B The nurse should visit the site to ensure the cleanliness, temperature, and lighting of the area; arrive early to set up the audiovisual materials; and bring extra supplies such as projector bulb and extension cord. Last-minute attendees should be welcomed. In addition, the nurse should practice the material until it is known forwards and backwards.

A nurse began by asking the audience, "What do you want me to discuss?" All responses were written on the chalkboard and then, as specific points were discussed, the nurse erased the item. However, the nurse often added material that was not requested. Why would the nurse add more content? a. Because the nurse believed the additional information was entertaining and lightened the mood b. Because the nurse knew, on the basis of personal experience, other relevant information that the audience needed c. Because the nurse knew so much about the subject and wanted to give all the details. d. Because the nurse was sure that the audience meant to ask about it

B The presentation should include not only what the audience wants to learn but also what the nurse, on the basis of previous experience, knows would be useful to them.

What is the relationship between sensitivity and specificity? a. The higher the sensitivity, the higher the specificity. b. The higher the sensitivity, the lower the specificity. c. The higher the specificity, the higher the sensitivity. d. The more sensitive a test is, the more specific it becomes.

B The relationship between sensitivity and specificity is inverse. The higher the sensitivity is, the lower the specificity will be, and vice versa. The more sensitive a test, the less specific it becomes.

Which of the following is an essential characteristic of a community? a. A geographic area with defined boundaries b. A particular place over time for common purposes c. A place and beliefs or value systems d. A place or common demographic characteristics

B The three common factors that constitute a community are people, place, and social interaction or common goals.

In preparing to give a presentation on breast self-examination, a nurse went to the American Cancer Society and obtained a variety of handouts to use during the presentation. Which possibly erroneous assumption is the nurse making? a. Handouts are the best technique for emphasizing important points. b. Handouts will be easily read by people in the audience. c. People will appreciate the brochures and freebies such as shower hook reminders. d. People will use the reminders and put them in their bathrooms.

B The use of handouts and other written materials is based on the assumption that the audience can read, but research has shown that approximately 50% of Americans lack basic literacy and math skills

Five years after a major flood, a 52-year-old woman visits the family nurse practitioner (FNP) complaining primarily of inability to sleep but also of trouble concentrating on her job and household tasks and lack of interest in her former hobbies. Which of the following actions should the nurse take next? a. Ask whether she has any other menopausal symptoms such as hot flashes. b. Ask whether she has frequent nightmares or intrusive memories about the flood. c. Suggest ferrous sulfate for anemia, which may be the underlying cause of the symptoms. d. Suggest hot cocoa and relaxation exercises to help the woman sleep and regain her vigor.

B The woman's symptoms suggest posttraumatic stress disorder, but further assessment is needed to confirm the initial diagnosis.

When teaching an educational program to an adult audience, which of the following actions should a nurse take to best meet their educational needs? a. Providing a specific, detailed explanation of each component of the program b. Using various methods of instruction, including lecture, discussion, and visual aids c. Providing an opportunity for participants to express their feelings about the program d. Using a PowerPoint presentation so that the audience can visualize the material

B To best meet the needs of the audience, it is important to use different teaching methods so that each member of the audience can learn by his or her preferred method, whether that is hearing, reading, discussing, or another activity. Thus, the use of only a PowerPoint presentation may not meet the needs of all the members of the audience. In addition, it is helpful to include all three domains of learning, which is usually necessary to incorporate a new health behavior into the learner's life. The best choices include opportunities for learning the material by preferred learning style, expressing feelings, and applying material, which represent the cognitive, affective, and psychomotor aspects.

The nurse distributed written materials with culturally appropriate pictures to the small groups in the audience and began to lecture on the important content before the planned discussion period. However, no one was listening. What should the nurse have done differently? a. Created a more interesting and entertaining lecture b. Withheld the written materials until after the lecture c. Let the audience discuss the material as a whole, not in small groups d. Skipped the lecture and went directly to the discussion period

B Wait to make group assignments and to give handouts for group activity until after you have given the final instructions; otherwise, people will be reading instead of listening to you.

A woman was found to have a blood glucose reading of 320 mg/dL. What should be the nurse's next action? a. Escort the woman to the next screening station and then prepare to test the blood glucose level of the next client. b. Explain the blood glucose reading to the woman and ask whether she has a primary care provider. c. Fill out the form, giving the results accurately for the health department's records. d. Hand the woman culturally appropriate literature on diabetes and the dangers of lack of treatment.

B When a problem is found, the nurse must inform the client and, in collaboration with the client, decide on referrals or how to follow up. After that, the nurse should indeed fill out the appropriate forms, give the client culturally appropriate literature if she seems interested in reading it, and prepare to screen the next client. However, the nurse should not let participants leave the screening until they have secured the number of a health care provider who is appropriate to deal with the identified problems.

Which of the following is one of the goals of Healthy People 2020? a. Decreasing institutionalization and increasing community-based care services b. Achieving health equity, eliminating disparities, and improving the health of all groups c. Creating environments to improve the eating and exercise habits of all people d. Expanding the technology, resources, and medications used to treat chronic illness

B The goals of Healthy People 2020 are to achieve high-quality, longer lives free of preventable disease, disability, injury, and premature death; to achieve health equity, eliminate disparities, and improve the health of all groups; to create social and physical environments that promote good health for all people; and to promote quality of life, health development, and health behaviors across all life stages.

Which of the following are factors in the primary health care model? (Select all that apply.) a. Commitment to a plan of action b. Community participation c. Economics, politics, and environment d. Personal health care services e. Primary health care and personal health services f. Universal access to primary health care clinics

B, C The primary health care model is not focused on primary care or personal health services, which address health care for individuals; instead, it emphasizes community involvement and environmental change.

Which of the following factors would most likely be motivating factors for setting up large community-wide group meetings instead of face-to-face counseling? (Select all that apply.) a. A more comfortable "party" atmosphere would result. b. It would effect more widespread change in the local social norms. c. Cost-effectiveness would be increased. d. The meeting would serve as an environmental cue. e. Most people would rather learn in a group setting. f. People would carpool to the meeting.

B, C, D Benefits of community-wide programs include cost efficiency, ability of the program to serve as an environmental cue, development of an environment of social support, increased ability to evaluate success, and opportunity to reach more people and effect widespread change in social norms.

A nurse is referring a client who needs follow-up care. Which of the following actions should the nurse take? (Select all that apply.) a. Asking whether the client prefers to have the nurse make all the arrangements b. Assessing whether the client meets the eligibility requirements for the receiving agency c. Discussing with the client the payment mechanism for follow-up care d. Determining whether the client is interested in following up at that particular agency e. Arranging for the client to have transportation and child care available f. Contacting several agencies in the area to see whether they are willing to accept a referral

B, C, D The nurse must be sure the client meets eligibility requirements and is interested in the referral. The nurse must be aware of the payment mechanism that will be used for follow-up care so the client can be given names of community resources that are able to provide care on the basis of the source of payment. Contacting agencies about follow-up before the other actions with a client referral are completed is premature. Most agencies cannot provide free transportation and child care for clients to attend a different agency. It would encourage dependency for the nurse to make all the arrangements and then announce to clients what they should do. The client must be actively involved in follow-up care.

Which of the following are framework models currently in use in community health nursing? (Select all that apply.) a. American Nursing Community Health Model (ANCHM) b. Community-as-Partner model c. Mobilization for Action through Planning and Partnerships (MAPP) d. Helvie Energy Framework e. General Ethnographic and Nursing Evaluation Studies in the State (GENESIS) f. The geopolitical phenomenological model

B, C, D, E There is no such model as ANCHM. Geopolitical and phenomenological models are two ways of addressing a community. Community-as-Partner, MAPP, Helvie Energy Framework, and GENESIS are all framework models currently in use in community health nursing.

A community/public health nurse was asked to document the conclusions of the agency's evaluation of its programs. Which of the following actions should the nurse take? (Select all that apply.) a. Include compliments to staff members about their involvement with the programs. b. Be sensitive to local ethnic and cultural groups when discussing behaviors. c. Assume that very powerful and influential persons will read the report. d. Include an executive report for people who will not read a long document. e. Use professional language and include statistical analysis of the findings. f. Word negative findings in a positive way for community residents.

B, C, D, F Evaluation reports need to be written for their audience, which may require more than one format. The nurse must be politically and culturally sensitive. Negative realities can be addressed with positive words. Remember that the most powerful and influential persons in the community may read the report. Consider the perspectives of the community members, and write in a way that does not reinforce cultural stereotypes or blame. Because the report may be long, writing an executive summary is helpful for people who do not have the time to read the whole report.

What is the primary usefulness of a Gantt chart? a. It creates a deadline for each step. b. It describes potential program problems. c. It identifies the process needed to achieve a certain result. d. It outlines the steps of the assessment process.

C A Gantt chart identifies the process needed to achieve a result. Once the final outcome is identified, the major steps necessary to obtain the result are projected backward from results to actions; their timing and sequence are then considered.

Which of the following best describes a group? a. Those who are all living in the same geopolitical area b. Those who are all members of the same phenomenologic community c. Those who engage in repeated face-to-face communication d. Those who respect each other's perspective

C A group consists of two or more people engaged in an interdependent relationship that includes repeated face-to-face communication.

Which of the following would be the best way to determine the health of a community? a. Ask a firefighter which neighborhoods have the fewest fires. b. Ask a realtor which neighborhoods have the most expensive houses. c. Ask people living in the neighborhood if they are happy with where they live. d. Ask the police department which neighborhoods have the lowest crime rates.

C A healthy community is one in which residents are happy with their choice of location and exhibit characteristics that would draw others to the location. Thus, the best way to determine the health of the community is to talk to those living in it.

When assessing a community by using the structural-functional framework, the nurse recognizes that all communities must a. Address financial needs of residents. b. Engage in functions that can be measured. c. Provide for socialization and a sense of identity. d. Require that public safety structures be built.

C All communities fulfill certain functions, including coordination, control, and direction of activities to attain goals, as well as socialization and identity for their members. Providing for both socialization and a sense of identity best address community goals and internal functioning.

Which of the following actions is a nurse most likely to perform in an approach to community health planning with the community empowerment model? a. Motivating bankers and financial advisers to help the community in its development b. Obtaining the best experts available to help the community develop c. Using a grassroots approach and democratic decision making d. Writing grants to obtain money for the community and health care programs

C Although a nurse might well perform all of these actions, the definition of community development is to create progress for the community by actively involving community members. This grassroots approach entails the use of a democratic decision-making process, encourages self-help, relies on voluntary cooperation, and helps develop leadership within the group.

What is the primary reason why entire populations are not surveyed to determine a community's health needs? a. A nurse would not know how to conduct the survey. b. Community members would refuse to answer questions. c. Such a survey would be too expensive and time consuming. d. No community agency would want to be responsible for the results.

C Although a survey of an entire population would be informative, it is typically too impractical in time, cost, and ability to reach all community members.

Which of the following situations is a reason why a community/public health nurse would choose to focus on a particular subgroup instead of on the entire community? a. The subgroup can more easily afford health care services. b. The subgroup has more political power and can influence health funding. c. The subgroup has notably higher statistical risk for experiencing health problems. d. The subgroup knows how to obtain publicity if their needs are not met.

C Although all of the options present good reasons, the community/public health nurse tries to change factors that contribute to the vulnerability to health problems of high-risk groups

A nurse was asked to select an appropriate site for a nursing education program for adults in the community. Which of the following characteristics is most important in choosing the site? a. Location in a building that does not charge rent for use of the space b. Lots of room for participants to stand, walk around the room, and socialize with other participants c. Accessibility to public transportation, location in a physically safe area, and accessibility for disabled participants d. Location next to a police station, fire station, or other community resource

C Although all the criteria would be useful, the most crucial would be an area where prospective participants can get to the meeting while feeling safe doing so. Consequently, the site ideally should be in an area with public transportation, appropriate for people with disabilities, and in a safe (or at least safer) neighborhood

When a community is assessed from a developmental framework, which data must be determined? a. The demographics (such as age) of the persons living in the community b. The emotional maturity of the community's residents c. The history of the community d. The number and quality of daycare centers and schools

C Although all the listed options may be helpful information, the development of a community would most easily be observed in its history. A developmental framework explores the history of a community to determine change and trends. Identifying trends in health status over time helps clarify health outcomes.

Which of the following aspects of a solution to a problem allows the nurse to identify it as the best choice? a. It must be financially reimbursable. b. It must have the support of the clinical agency. c. It must represent the values, beliefs, and perceptions of the involved aggregate. d. It must have the most advantages and the fewest disadvantages.

C Although all these suggestions are extremely important, the most crucial is that the solution fit the community's perspective, beliefs, and values. The community must be motivated to address the issue.

Which demographic factors of a community are important for the nurse to consider when assessing a community? a. Census tract data can be used to determine needed agency staffing. b. Density of housing is associated with contagious infections. c. Ethnicity determines how health is defined and protected. d. Income determines what community services can be financed.

C Although demographic factors (age, race, gender, ethnicity, and density of population) are important for many reasons, the focus of assessment is on promoting and maintaining health. Therefore, health as the community defines it must be understood. Ethnicity determines how the community addresses health problems and attempts to protect the health of its members.

Which of the following is the most crucial environmental influence on health? a. Government in the local community b. Health care system in the local community c. Food, water, and exposure to toxic substances d. Religious and cultural beliefs and values

C An estimated 25% of the preventable illnesses worldwide can be attributed to poor environmental quality (e.g., poor water, sewage disposal, air quality). The government, the health care system, and the value/belief system are sociocultural aspects of the environment whose effects are harder to measure.

A nurse is completing a community assessment by using a systems framework. Which of the following is the key to the success of the assessment? a. Demanding a reasonable budget for assessment expenses b. Telling everyone what he or she is doing so that the listener may have input c. Using a tool to systematically identify, collect, and organize appropriate data d. Allowing at least 2 weeks to collect data to ensure thoroughness

C An organized framework helps the nurse collect appropriate data systematically. The systems model serves as a tool to help the nurse identify, collect, and organize appropriate data, include the critical components and their relationship to each other.

A nurse is preparing to write a community diagnosis. Which of the following actions must the nurse take? a. Choosing a diagnosis from the 12 functional health patterns b. Choosing from an agency-approved list of NANDA International diagnoses c. Describe a situation and suggest an etiologic component focused on an aggregate d. Use appropriate NANDA International wellness-focused diagnoses

C Any of the options might be chosen; however, to write a community/public health diagnosis, the nurse must maintain the focus on aggregates in a specific environment or community. A diagnosis is a statement that synthesizes assessment data, as well as a label that describes a situation and implies an etiologic component.

What is the first step in beginning a community assessment? a. Choosing persons who live in the community and may share their insights b. Creating a budget of both time and money to devote to assessment c. Defining the community and determining its boundaries or parameters d. Outlining the data needed and determining where they might be found

C Before a community can be assessed, the exact community must be clearly delineated; the nurse accomplishes this by defining the community and determining its boundaries or parameters. This will determine what data the nurse will need to collect.

What do most community/public health nursing diagnoses include? a. The afflicted individual or family, risk factors, and the desired outcome b. The aggregate at high risk and the nurse's decision as to appropriate care c. The target population, the health response desired, and host or environmental factors d. The NANDA International terminology with associated evidence and outcomes

C Community/public health nurses focus not on individuals but on aggregates, and they rarely use NANDA International diagnoses, which focus primarily on acute problems of individuals.

The nurse wanted to determine the community's level of self-esteem and well-being. Which of the following would be the most effective way to systematically and accurately determine the satisfaction level? a. Asking every community member, "What is your level of self-esteem?" b. Asking the employing agency's director, who lives in the community, about satisfaction level c. Distributing self-esteem scales to a random sample of community members d. Observing the clients currently using certain community-based services

C Emotional well-being in a population can be measured by the proportion of members who experience self-esteem and satisfaction with their lives. However, it is not realistic to ask this question of every member of the community. Thus, a random sample surveyed with a tool reliable and valid for an individual should yield an accurate portrayal of the proportion of members who experience positive self-esteem and satisfaction with their lives. This is the best way to get the best assessment of the entire community.

Which federal government entity is responsible for coordinating all federal disaster assistance? a. American Red Cross b. Department of Homeland Security c. Federal Emergency Management Agency (FEMA) d. National Disaster Risk Reduction and Management Council

C FEMA was established in 1979 as the coordinating agency for all available federal disaster assistance. The American Red Cross is a voluntary nongovernmental organization. The Department of Homeland Security is responsible for managing domestic incidents. The National Disaster Risk Reduction and Management Council is part of the Philippine government and is not a federal government agency in the United States.

Care of the spirit, as well as promoting health of the body, is performed very effectively by which professional nursing specialty? a. Church-based nurses b. Community/public health nurses c. Faith community nurses d. Public health nurses

C Faith community nurses (formerly called parish nurses) intentionally focus on care of the spirit as part of the process of promoting holistic health and preventing illness in a faith community

How does formative evaluation help the community/public health nurse? a. Analyzing the data and recognizing gaps b. Determining what to do differently next time c. Improving care as it is being delivered d. Enhancing future offerings of the program

C Formative evaluation occurs during delivery of care and allows the nurse to modify the care currently being given to improve the outcomes for clients.

Why was the publication of Healthy People a landmark document? a. It was the first time that a national plan had been created with funding to implement it. b. It was the first time that evaluation measures based on outcomes to judge effectiveness were created. c. It was the first time that national goals for improving the health of Americans were established. d. It was the first time that universal agreement on federal government priorities was reached.

C Healthy People was instrumental in identifying major health problems and setting national goals for reducing death and disability. However, there were no funds or plans for implementing the goals.

After a disaster, one citizen was most impressed with how much his neighbors went out of their way to help rescue him and take him to the emergency shelter. What is the most likely reason why his neighbors helped him? a. They feared that he would sue them if they did not help him. b. They hoped that, because he was very wealthy, he might give a reward for their help. c. Such help is part of the pattern of behavior during the heroic phase of reaction to a disaster. d. Such behavior is what any American would expect of a neighbor today.

C Helping other people survive is often the first phase of a community's reaction to a disaster.

How was the concept of health defined originally? a. Balance and harmony b. Maximum self-actualization c. Absence of disease d. Total well-being

C Historically, health and illness were viewed as extremes on a continuum; the absence of clinically recognizable disease was equated with the presence of health.

With which of the following populations would collaboration be most important when a school nurse proposes that additional healthy options be added to the school lunch program? a. The staff and teachers b. The children and their parents c. The dietitians and nutritionists d. The school board and administration

C It is very important to develop partnerships with people who are most likely to be affected by the program and promote a sense of cooperation, collaboration, and teamwork in order to be successful.

When is the term mass casualty incident used in a disaster or crisis? a. Fewer than 100 victims, which strains resources b. Man-made disaster events c. More than 100 victims, which overwhelms resources d. Natural disaster events

C In a multiple casualty incident, 2 to 99 people are injured. In a mass casualty incident, a large number people, usually 100 or more, are injured, which significantly overwhelms available emergency medical services, facilities, and resources.

A nurse is planning the evaluation of a mental health screening program in the community. What should be included in the process evaluation of this program? a. Asking whether program goals were adequately met b. Determining whether more people sought follow-up care after the screening c. Determining the number of people who attended and were screened d. Measuring whether the incidence of disease changed

C In process evaluation, investigators examine actual program performance, such as number of people served by the screening. Asking whether program goals were met, determining amount of follow-up care sought, and measuring changes in the incidence of disease are all outcome evaluation measures.

Which of the following would be the best definition of a community? a. People with open boundaries living in a particular area b. People gathered together to solve a particular problem c. People with a sense of belonging or common identity d. People with at least one common demographic characteristic

C In this text, community is defined as an open social system that is characterized by people in a place who have common goals over time. The sense of belonging or common identity is true both of geopolitical and of phenomenologic communities. A population is defined as a collection of individuals who share common characteristics.

In a city where tornadoes have been known to strike, an emergency siren sounds, suggesting to its citizens that an emergency is imminent. What should a community/public health nurse do first? a. Call every family member and tell them to come home immediately. b. Call the local civil defense office for specific instructions for the nurse's agency. c. Follow the disaster plan of the local emergency management agency. d. Start driving to the hospital and prepare to care for the injured.

C On the basis of their employment position, nurses should know their role and specific responsibilities for disaster response. Therefore, the nurse should be prepared to follow the emergency preparedness plan.

Which of the following services implemented by nurses would represent primary prevention? a. A nurse-managed hospital respiratory unit for patients with chronic obstructive pulmonary disease (COPD) and emphysema b. A quit-smoking-now clinic for adults who want to give up the habit c. A "don't smoke" campaign for elementary school students d. A "stay beautiful" campaign for high school female smokers that stresses that smokers have wrinkles about a decade earlier than their chronologic peers

C Only a "don't smoke" campaign for young children would represent action taken before they begin smoking, which is primary prevention. Primary prevention aims to prevent health problems and promote health.

Which of the following services implemented by nurses would represent tertiary prevention? a. A free high-cholesterol screening at the neighborhood grocery store b. A healthy lifestyle exercise and information program for all the employees of the city's largest employer, held at the worksite c. A posthospitalization social support program for persons with chronic severe mental illness and their families d. An exercise and parenting class for new first-time mothers

C Only a social support program for ill persons and their families aims to prevent further disability in both the clients and their families. Tertiary prevention is rehabilitation and prevention of further disability and disease.

What is the purpose of Planned Approach to Community Health (PATCH)? a. To enable assessment by different health institutions in order to maximize resources b. To encourage assessment of high-risk groups so that efforts can be focused c. To engage entire geopolitical communities in assessing their health needs d. To suggest that states cooperate with federal departments to ensure continuity

C PATCH is an attempt to engage entire geopolitical communities in a comprehensive assessment of their health needs, rather than focusing solely on groups at high risk or those served by a specific health institution. It depends on the participation of citizens, the cooperation of several organizations within the community, and the vertical integration of local, state, and federal government resources.

What is the primary reason why every step of an intervention is planned before the intervention is implemented? a. It is required by the nursing process procedure. b. It is the way in which agencies expect to see performance by the nurse. c. It saves time, and the implementation process goes more smoothly. d. It allows the nurse to remember what was going to be done.

C Planning the intervention saves time and helps the implementation process go more smoothly.

A nurse, serving as a volunteer, was helping community residents who had been taken to an emergency shelter for food, clothes, and life necessities. Of the following families, which is in most need of receiving assistance from the nurse? a. A woman who is visiting her father and sees the flood as helpful to finally convince her father to move in with her and her husband b. The couple who believe the flood is God's will and are attempting to determine its meaning for their life c. The man who cannot believe that everything important to him is now lost d. The man who believes the flood is a test of his faith but knows he will be alright

C Professionally, the nurse should concentrate on the victim to whom the disaster is the most overwhelming psychologically.

Which of the following is the best example of a risk reduction program? a. At the senior citizens center, the nurse set up an exercise program for persons in wheelchairs. b. The nurse appeared on the local public access television channel each Sunday afternoon to discuss good parenting skills. c. The nurse worked with the local health maintenance organization (HMO) to make infant car seats available without charge to all first-time pregnant mothers. d. The nurse wrote a weekly local newspaper column on healthy lifestyle behaviors, such as the importance of exercise.

C Providing infant seats helps lower the risks of death or injury from car accidents. The other choices are all health-promotion behaviors.

Which of the following would be a behavior-specific cognition and affect variable according to Pender's model? a. Commitment to a plan of action b. Competing demands (family or work) c. Perceived self-efficacy d. Personal realities such as demographics

C Self-efficacy is a central concept in Pender's health-promotion model with regard to behavior-specific cognition and affect. Other such behavior-specific cognitions and affect variables are perceived benefits, perceived barriers, interpersonal influences, and situational influences

What strategies will a nurse include when planning an educational program for adults that ensures student learning? a. Individual one-on-one tutorials to ensure maximum understanding b. Large group lectures with handouts of main points along with culturally appropriate pictures c. Small peer group discussions on how to apply the new knowledge with prompt feedback d. Use of multimedia technologies such as videotapes and PowerPoint presentations

C Small group discussions help adults become actively involved, often with repetition of the information as they discuss how to apply the knowledge. Individual one-on-one tutorials are extremely expensive. Large group lectures, even with handouts and pictures, still are only effective for low-level cognitive learning, not application. Table 20-1 emphasizes that adults want application of the facts and real-life context.

Which of the following groups created the standards for evaluating effective nursing care with communities? a. The American Association of Colleges of Nursing b. The American Public Health Association c. The Quad Council of Public Health Nursing Organizations d. The National Council of State Boards of Nursing

C The Quad Council of Public Health Nursing Organizations wrote standards, which were most recently published by the American Nurses Association in 2007. An updated version will publish in early 2013.

Because, in relation to physical activity, none of the Healthy People 2010 objectives was met, what does the United States need to do? a. Ensure more tax funding for education of physical education teachers. b. Encourage funding for an increased number of exercise centers. c. Increase programs for teaching and encouraging health-promoting lifestyle choices. d. Require health care providers to serve as role models of appropriate physical activity choices.

C The data highlight the importance of health-promotion programs and the need for individual and community commitment to health-promoting lifestyle changes, particularly in regard to nutrition and physical activity.

Which of the following conclusions would require the nurse to obtain more assessment data? a. A major health problem is identified. b. An identified subpopulation is seen to be at high risk for and vulnerable to medical problems. c. Data that have been collected are incongruent and contradictory. d. Strengths in the community outweigh the areas of weakness.

C The data must be congruent, or data explaining the discrepancies must be found, before inferences about the level of community health can be made.

A community/public health nurse was responsible for setting up a health fair in a very heavily attended inner-city church, with several screenings being given simultaneously. Within the public health agency, what would the nurse call the health fair? a. Case finding b. Community service c. Multiphasic screening d. Unreimbursed care

C The definition of multiphasic screening is the application of multiple screening tests on the same occasion, such as a health fair.

What is the first and most important aspect of managing disasters? a. Evacuating injured persons to medical facilities b. Giving immediate first aid and medical care to the victims c. Planning to prevent such disasters whenever possible d. Rescuing the victims

C The eight principles of disaster management, in order of priority, begin with prevention of the disaster whenever possible.

Lewin's change theory is being applied as the community is addressing improvements in public safety. Which of the following would be one of the first steps in creating change? a. Determining whether anyone else agrees b. Having a careful plan as to what change is desirable c. Making community members aware of the need for change d. Assessing community needs to determine whether change is possible

C The first step is to ensure that the need for change is recognized or felt by people in a position to help create the change. Disequilibria exist or are created, which disrupts the status quo. The stimulus for the perceived need may be within the client or come from an outside force.

The nurse gave each participant a health-risk appraisal tool to determine the health needs of the group as a whole. What other purpose may the tool serve? a. To assess the needs of the broader community b. To demonstrate the necessity of having health education programs c. To motivate participants to consider changing high-risk behaviors d. To provide data for future planning by the nurse's employer

C The health risk appraisal tool helps the nurse obtain data, which is statistically analyzed to determine health risks. However, it may stimulate the individual to engage in the necessary behavioral changes that reduce known health risks. Data about a subgroup should not be considered representative of a wider population.

A public health nurse was asked by a town's community college to offer health education programs for its employees. How would the nurse most effectively determine which programs to offer? a. Asking the administrators which programs they would like b. Performing a complete physical examination on each employee during work time c. Having employees complete a health-risk appraisal form d. Planning a program on the basis of the broader community's demographic data

C The most easy and effective way to determine current needs of the particular aggregate is by having each employee complete a paper-and-pencil form. Because the employer is a community college, literacy should not be a major problem. However, this is a subgroup, the wider community's data might be misleading.

People in the community are feeling insecure and vulnerable because the neighborhood is considering closing one of the local elementary schools. Which of the following actions should a nurse take? a. Ask the formal leader of the group to speak out against the closure. b. Ask the informal leader to offer a rationale for the closure. c. Offer help and support for those involved. d. Offer to write legislators opposing the decision.

C The nurse must recognize that change is threatening and anxiety provoking, and so individuals will need help and support while they experience the proposed change. Asking other people to take a leadership role to speak out against the closure would not be appropriate. Writing to legislators may be effective, but it is not the best action when trying to work with people who are feeling vulnerable and insecure.

A family is supporting each other in the emergency shelter after a flood. The nurse overhears the conversation. Which family member most needs the other family members to listen and understand? a. An 11-year-old girl, who lost her teddy bear collection and is crying b. A 45-year-old adult, who keeps telling everyone that at least he still has his job and that they can cope with this c. A 43-year-old woman, who keeps saying, "Without our family pictures, we've lost our history" d. A 16-year-old boy, who has lost his favorite hunting rifle and seems angry

C The nurse should concentrate on the victim whose perception of the disaster is the most overwhelming. Losing one's personal history would be the most overwhelming loss both psychologically and objectively.

Which of the following is an example of the relationship between demographic factors and health needs? a. Persons with high incomes typically have nutritional problems resulting from diet choices. b. Low educational level is associated with more health promotion behaviors. c. Religion may suggest beliefs concerning use of contraception, health care, and food choices. d. Being the majority population group, young adult men help determine which service agencies are most needed.

C The religion of the community members may suggest their beliefs about contraception, abortion, living will, circumcisions, organ donations, and so on.

Of the following families, which is most likely to need the most support to recover from the loss of electricity? a. The family who moved into their motor home with its generator b. The family who was away on vacation at the time c. The family who was without electricity for 2 weeks d. The family who was without electricity for 3 days

C The scope and severity of the disaster have a major effect on a person's ability to cope. In general, people without electricity for longer periods of time have a more difficult time. Consequently, 2 weeks is more difficult than a few days to be without a major utility.

How might the social action approach be summarized? a. A process of experts engaging in rational, deliberate problem solving b. A process of group meetings that take place until everyone reaches consensus c. A process in which groups seek redistribution of power or basic change in organizational policies d. A process in which groups work together to write several grants to get money for health care programs

C The social action approach is a process in which direct, often confrontational action is undertaken to redistribute power, resources, or decision making in the community, to effect a change in the basic policies of formal organizations, or both.

Considering the health-belief model, which statement suggests that the person is going to begin a new healthy habit? a. "If I could be asleep while they did the colonoscopy, it might be alright." b. "I did have a cousin who was treated for breast cancer." c. "Both my mother and father died of heart problems." d. "Because my employer was paying for the health screening, I thought I might go."

C The statement "Both my mother and father died of cardiac problems" suggests both susceptibility ("my parents") and severity ("died").

A health screening was held, and the nurse reported the number and names of persons with positive test results to the agency director. What, however, is even more important than reporting this information? a. Being sure that each client had identification so that no false names could be used b. Keeping legal documentation of both negative and positive results c. Telling the person with positive test results where they might go for treatment d. Using the cheapest screening approach possible

C There is no purpose in determining who receives positive test results unless there is some plan for treatment of those persons. Referral and treatment resources must be included as part of the intervention. The nurse must provide information about how and where to go for help

A community/public health nurse is using the social action model to facilitate change in the community. Which of the following aspects of this model may make the nurse feel uncomfortable? a. Admitting that the nurse may not know the best approach b. Cooperating with a large number of community agencies c. Confronting power brokers directly d. Sharing decision making with other people

C This approach requires direct confrontation to obtain redistribution of power, resources, or decision making, which may be uncomfortable for anyone.

Which of the following is the typical research design used for evaluation in a community/public health agency? a. Analysis of variance b. Multiple regression analysis c. Time series design or other quasi-experimental method d. True experiment with randomization and control

C Time series design is very useful because it allows pretest and posttest results to be compared in order to demonstrate that change did (or did not) occur. Later evaluations indicate whether the change was lasting. Because nurses cannot manipulate variables or use control groups, only quasi-experimental methods, not random clinical trials, can be used.

A disaster is occurring in a community. Which of the following actions should the nurse take first? a. Calling all members of the nurse's family together at their home b. Immediately driving to the hospital in preparation for giving care to victims c. Remaining in place until the situation has stabilized d. Contacting the emergency operations center to receive instructions

C While a disaster is occurring, professionals are usually advised to remain in place until the situation has stabilized before attempting to provide care. Phone lines may be nonoperable, and roads may not be open for traffic. The priority is to remain in place, and the next step will be to contact the emergency operations center if necessary.

Which of the following situations will cause difficulties when a nurse tries to persuade a community to accept a particular intervention? a. The solution is oriented to the future, not the present. b. Powerful groups in the community may not be committed to this intervention. c. The intervention is inconsistent with cultural, ethnic, or religious beliefs. d. The intervention may need more tax dollars than have currently been funded.

C Although any of these situations could cause a community to reject a proposed intervention, any intervention that is inconsistent with beliefs and values will be immediately rejected.

A volunteer explained to a nurse that a certain client did not wish to fill out the information/consent form. What should the nurse explain to the client as to why the form was required? (Select all that apply.) a. "The agency requires such forms to document personnel time." b. "The information serves as data for duplicating the screening in the future." c. "You may wish to keep these data so that they are available for needed follow-up." d. "The form is needed for student education; the data are collated to determine community-wide needs." e. "Consent is needed before any tests, particularly invasive ones, are administered." f. "The data are used for program evaluation so that more such screenings may be available."

C, E, F Easy-to-use forms are typically used to document the data for counseling, instruction, and referral information. They provide test results for the participant and future providers, as well as for program evaluation. Consent is legally required before invasive screening measures such as blood measurements. It is hoped that students will use general sociodemographic variables such as age, gender, and ethnicity rather than a biased sample from one screening for determining community-wide needs. Agencies would assign personnel, so they would not need patients to fill out forms to confirm personnel activity.

The intervention that a nurse and a planning group proposed was not accepted, primarily because of poor timing and lack of funds. Which of the following is helpful for the nurse to remember? a. At least an effort was made to intervene. b. The situation will probably not get worse. c. The communities can function without the proposed program. d. There are always other options that might meet the same goals.

D A problem can almost always be solved in more than one way.

Any screening test must absolutely be a. Accurate in its conclusion. b. Capable of being administered in a quiet area. c. Equally effective with both children and adults. d. Inexpensive and easy to perform.

D A screening test by definition must be less expensive than treatment later in the disease process. It must also be inexpensive enough to be given to large numbers of persons at a cost that health agencies or their clients can afford. The tests are held throughout the community, not in medical centers with many resources, and so they must be easy and fairly quick to perform.

nurse was assessing the neighborhood near the health agency. The nurse drove around observing the condition of the buildings, sidewalks, and the people in the community. Which of the following best describes the actions of the nurse? a. A drive-through b. A neighborhood observation c. A quick overview d. A windshield survey

D A walk- or drive-through is frequently referred to as a windshield survey. This is one way that the nurse can get a "feel" for the community that cannot be obtained from just reading about it.

In the United States, which of the following is the most crucial influence in the sociocultural environment? a. The community in which a person grows and develops b. Family's values and beliefs c. Health care provider from whom care is sought as needed d. Socioeconomic class, education, and occupation

D All of the options influence health and illness, as well as the individual's lifestyle. However, higher education and socioeconomic class are associated with greater participation in health-promotion activities and, therefore, better lifestyle choices overall.

Which of the following definitions of health is most typically used in nursing today? a. Ability to interact and adapt to the environment b. Ability to perform required social roles c. Ability to stay free from disease d. Ability to maximize human potential

D Although all are accepted definitions, the most contemporary definition of health has emphasized the relationship between health and wellness. Wellness is the process of moving toward maximizing human potential.

Which of the following characteristics would be most indicative of a healthy community? a. Excellent private schools and superb fire and police systems b. A United Way that receives large donations each year c. An extensive array of services offered by private physicians d. Clean air and water and a sense of community cohesion

D Although all items sound positive, a sense of community cohesion in a safe community (clean air and water) would be most helpful to its residents.

A local employer was concerned about rapidly increasing health care costs. The nurse did an assessment and found that most of the employees smoked heavily. Which of the following suggestions should the nurse make to the employer as the most effective approach to decrease smoking among the employees? a. Lobby area legislators to increase the tax on cigarette sales. b. Offer a smoking cessation program at the workplace. c. Talk to the employees in small groups and ask them to quit smoking. d. Work with interested employees to create a "no tobacco products" environment.

D Although all of the actions could be performed and probably would be helpful, the most effective way to change behavior is to restructure the environment so that the behavior is not possible. Information alone is insufficient to effect large-scale, community-wide behavioral change, as the widespread dissemination of information on the health risks of obesity clearly demonstrates. Environmental restructuring makes it more difficult to engage in the high-risk behavior and improves and optimizes the healthful conditions (air) existing in the environment.

The community/public health nurse was excited about creating a program for prenatal education and care for single teenage mothers. Before writing an application for a grant to fund the program, what should the nurse determine? a. Agency's policies about writing grants for such a program b. Number of single teenage mothers in the local high schools c. Whether local teenagers are interested in receiving such a service d. Whether anyone else in the area is offering such a service

D Although community/public health nursing interventions may be directed toward establishing new services, the nurse must first be sure that a proposed service is not duplicating services already existing in the community.

How can nurses best help expand availability of health education programs? a. Being entrepreneurs and asking patients to pay what they think the educational program was worth b. Suggesting to their friends and neighbors that they lobby local health organizations to provide such health education programs c. Teaching health education programs as unpaid volunteers in the community d. Working politically to influence public policy regarding funding health education programs

D Although nurses can volunteer, join other people in requesting health education programs, or teach such programs as nurse entrepreneurs, the best way to expand the availability of such programs is to influence public policy regarding development and funding of health education programs. Although it is not clearly stated in Chapter 20 (all the answers are recommended in the text), the book as a whole emphasizes the importance of political action for more extensive influence.

The public health clinic was planning its once-a-month dental clinic in the community with a visiting volunteer dentist. Which of the following would be the most important task in preparation for this clinic? a. Plan to be there that day to assist with client flow. b. Sterilize all the dental equipment. c. Tell everyone to make an appointment to decrease waiting time. d. Use multiple strategies to publicize the clinic in the community.

D Although planning, being present, and having necessary supplies are important, the crucial task is to inform community residents who might be interested. Establishing such a clinic means decreasing barriers to care (lack of access), and using every means to let people know about it is a cue to action.

Which of the following facts is a drawback of the community empowerment model? a. Bankers and other money people are very busy and often uninterested. b. Grants, although beautifully written, may not get funded. c. It is hard to persuade experts to volunteer their time. d. It is the slowest approach and takes the longest to obtain results.

D Although the community empowerment model may have the longest-lasting effects, it does take considerable time and effort to implement, because democratic decision making is a slow process.

Which of the following actions must the nurse take when confirming the diagnosis before final decisions are made? a. Ensuring that it is a diagnosis used in the Omaha diagnosis system b. Checking to see whether the diagnosis is reimbursable c. Prioritizing the diagnosis within the agency's mission d. Validating the diagnosis/conclusion with the community or client

D Although the nurse might engage in any of these actions, the most important action is to validate the conclusions with the involved aggregate.

Some nursing students were taking blood pressure measurements at one spot in the large room where many of the health screening stations were set up. A student pulled aside her instructor and said, "This man's blood pressure is 220/160. Whom should I call to get him to treatment immediately?" What should be the instructor's first action? a. Ask the gentleman if he has health insurance. b. Call a local ambulance. c. Follow up with previously determined emergency plans. d. Check the reliability of the findings.

D Although the nurse should have prepared emergency plans for extremely dangerous client findings, and indeed the gentleman may need to be conveyed to a hospital, the first step should be to repeat the blood pressure measurement and confirm the reliability of the findings. Reliability refers to the consistency or reproducibility of test results over time and between examiners.

Why is documentation of evaluation so crucial? a. It helps explain why nurses have limited time to provide direct client care. b. It helps keep administrators informed of what the staff is doing before staff evaluation time. c. It helps the nurse better understand the evaluation and the findings. d. It helps provide a baseline against which to study trends and make program decisions.

D Among other reasons, documentation is necessary to provide a baseline from which to detect changes in outcomes. Such documentation also provides a basis for deciding whether programs should be continued and how they might be modified.

The nurse is planning to present an educational program. Which of the following is important for the nurse to remember? a. Having many handouts so that the audience can remember what was said b. Ordering a microphone so that everyone in the room can hear easily c. Using pictures and posters of professionals demonstrating the needed behaviors d. Using many different methods of presentation with multimedia art

D As members of a media society, most audiences expect a smooth, professional presentation with the use of many different media. Handouts alone may be unsuccessful, because not all Americans are literate. Reading levels must always be considered. Demonstrations by professionals may be unsuccessful unless their ethnic and cultural backgrounds are similar to those of the audience. Lecture is considered the least effective way of conveying information.

A client received positive results on a screening test. What does this result mean for the client? a. The client does not have the disease. b. The client has the disease and needs immediate treatment. c. The client has a laboratory finding confirming disease. d. The client will need further testing and follow-up.

D Because test results are sometimes falsely positive, the client cannot be assumed to have the disease. Rather, the client will need further testing to confirm the diagnosis and then receive appropriate treatment.

Which of the following personal beliefs best demonstrates the meaning of self-efficacy? a. "You are capable of continued growth and development." b. "You are responsible for your own health and well-being." c. "You can improve your own health and well-being by using imagery." d. "You can influence your environment and circumstances."

D By definition, self-efficacy is the belief that a person can influence his or her environment and circumstances.

Which of the following descriptions characterizes a problem with the use of case descriptions as an evaluation method? a. They lack statistical documentation, despite telling about an interesting event. b. They have to be repeated in order to verify that no other factor could have changed the outcomes. c. They are not considered "good" research. d. They cannot prove that the nursing intervention led to the specific health outcomes.

D Case studies cannot prove that the nursing intervention led to the specific health outcomes. However, if the change occurred shortly after the implementation and there were no other community changes that might have contributed simultaneously to the change, it is justified to suggest the implementation had an effect on the change.

How might the goals of communities best be summarized? a. Ensuring that the community's history is remembered b. Encouraging socialization with persons outside the community c. Maximizing availability of financial and other resources d. Promoting survival and maximizing the well-being of members

D Communities must survive and ensure that the needs of community members are met, including the need for well-being.

A nurse is planning to involve the community in the evaluation process. Why is this a critical part of evaluation? a. The nurse has completed her ethical, legal, and political responsibilities. b. The agency retains state approval and national accreditation. c. The community does not feel ignored by the agency. d. The interventions helped community members make appropriate lifestyle changes.

D Community involvement is crucial to ensure that the interventions were effective for people affected by them.

A man continued to state that the flood was not that bad, the town can rebuild, and no real damage was done. From his statements, what can be concluded? a. He has totally recovered and thinks everyone else has as well. b. He is having a strong emotional response but is overcompensating. c. He is psychotic and needs medication. d. He is still in denial, and the disaster has not really registered yet.

D Denial is the first stage of emotional response to a disaster. Victims will deny the magnitude of the problem or understand the problem but seem unaffected emotionally.

The community/public health nurse charted the number of persons who came in to be taught breast self-examination. The nurse noted that during the past 3 days, there was a sudden increase in the number of women coming in. Which of the following is the most likely reason for the increase? a. The increased number is probably just a coincidence. b. The local nursing school hosted a women's health fair. c. The American Heart Association had just started its annual publicity campaign. d. The media had publicized a famous woman's diagnosis of breast cancer.

D Even though the local nursing school hosted a health fair, some other factor (probably a new, one-time-only, external cue) had emphasized the importance of the behavior and made women aware of their susceptibility to and the severity of breast cancer. Only a very famous person's problems would be a current media event that would create enough attention to cause a sudden great increase. External cues to action influence decisions related to health care behavior. A publicity campaign by the American Heart Association may increase the public's cue to action in relation to heart disease, but it would not likely be a factor relevant to the risk for breast cancer

Of the following communities, which had a poor reaction to a disaster? a. Chicago, which, after a large fire, now requires all buildings to be made of fireproof brick b. Hilo, Hawaii, which, after the downtown was again destroyed by a tsunami, created an oceanfront park and moved small businesses farther up the mountain c. Los Angeles, which is in the process of strengthening highway resistance to earthquake damage d. Settersville, which, after a tornado flattened downtown, decided to appeal for state funds to rebuild, and which, if no funds are forthcoming, will simply cease to exist as a town

D Healthy cities that are susceptible to particular disasters on a frequent basis try to establish prewarning, or control, measures that can reduce the impact of disasters. Thus, a healthy community is one that plans to minimize damage and strengthens structural resources. An unhealthy community might just give up.

Which of the following events might help document the importance of a health screening to the neighborhood? a. Absenteeism caused by illness at the local factory decreased. b. Morbidity statistics related to heart disease decreased over the next year. c. The incidence and prevalence of hypertension fell precipitously. d. The incidence and prevalence of hypertension rose precipitously.

D If a screening program is effective, the incidence and prevalence of the disease being screened will appear to increase because screening will result in the early detection of previously unrecognized illness.

One of the adults at a health education program introduced a rather unorthodox suggestion, claiming, "I saw it on the Internet." Which of the following criteria is most important for laypeople to use in deciding whether to accept information on the Internet? a. The author of the information has written several books on the topic, all of which are for sale. b. The content of the site is supported by an international pharmaceutical company. c. The site is frequently referred to in magazine and TV advertisements. d. The site is maintained and frequently updated by a federal health agency.

D In an Internet site, the authorship should be based on credentials and clinical reputation, preferably peer reviewed. The information should be written by staff at a reputable organization, preferably based on research, frequently updated, and not biased by being financially supported by companies or people attempting to sell products.

Which of the following would be the focus of a nurse who is using an epidemiologic framework to assess a community? a. Interviewing health care professionals concerning the community b. Researching findings from epidemiologic studies c. Learning about the health of the community's population d. Discovering groups among the community residents who are most at risk

D In an epidemiologic framework, investigators examine the health of the community and suggest targeting programs toward the groups most at risk for illness or disability. Different aggregates have different health needs.

Which of the following is an example of a criterion-referenced evaluation? a. Comparing the population with regard to the factor of interest before and after the intervention b. Comparing the population with another population with regard to the factor of interest c. Determining whether the objective is appropriate for the program d. Determining whether the objective was reached at the desired level

D In criterion-referenced evaluation, an investigator measures the extent to which objectives are reached. Comparing the population with regard to various factors is an example of normative-referenced evaluation. Determining the appropriateness of the objective does not match the definition of criterion- or normative-referenced evaluation; rather, it addresses specific program evaluation.

Which group of persons is least likely to be considered a vulnerable group at high risk for medical problems? a. Homeless women and children b. Intravenous drug users c. Pregnant single teenage girls d. Single adolescent boys

D In examining person-related factors, the nurse looks particularly for vulnerable aggregates and risky behavior. Homeless persons, intravenous drug users, and pregnant single teenage girls are all at high risk for medical problems. As a group, single adolescent boys do not have a condition that makes them vulnerable to illness.

Which of the following criteria must be met in order for an educational program to receive third-party reimbursement? a. It must be provided to a geriatric population. b. It must be given by an advanced nurse practitioner. c. It must occur in a rural, underserved area. d. It must be prescribed by a physician for an ill client.

D Insurance companies pay for illness, not wellness, and so they will pay for patient teaching regarding an existing illness only when it is prescribed by a physician.

Which of the following is a very practical and feasible way of obtaining comprehensive community health data? a. Completing a comprehensive survey with community residents b. Performing a windshield survey c. Requesting community residents respond to an Internet survey d. Using data already collected and available on the Internet

D Many sources of demographic and epidemiologic data already collected, and often available on the Internet, may be used. It is not feasible or financially possible for the nurse to do a comprehensive community assessment in isolation. Performing a windshield survey does not allow the nurse to collect comprehensive health data about the community. Requesting community residents respond to an Internet survey can be a very time-consuming process for the nurse to undertake, especially when there are already data collected and available.

Floods have hit a small town on the Mississippi many times. The last time, a levee broke, and there was extensive property damage, as well as several deaths. What should be the first preparation that the nurse should make before another flood hits? a. Create child care centers. b. Establish morgue facilities. c. Plan for a parking area for rescue workers. d. Practice the nurse's personal family response plan.

D Nurses should establish their own family disaster response plans to protect their family and homes and still be able to respond to their community's need.

In a state where a disaster occurred, which of the following actions should the governor take first? a. Touring the disaster area with the media b. Encouraging community members to volunteer c. Publicizing the disaster and asking the national government for funding d. Opening the state's Emergency Operations Center

D One state agency is usually designated as the emergency management agency for all state-coordinated efforts. The state governor will open the state's Emergency Operations Center to coordinate state agencies' disaster relief efforts. The Emergency Management Agency advises the governor when the state has exhausted its resources or if the disaster is such that the state does not have adequate resources to respond.

Which of the following would be the best question for a nurse to ask to determine whether an educational intervention had any effect? a. "Are you interested in any other topics for me to teach?" b. "Did you find this program useful to you?" c. "Do you understand the material I presented?" d. "How are you going to apply these ideas at home?"

D Only "How are you going to apply these ideas at home?" will elicit responses that demonstrate whether the learner understood what was said and is willing to use the information in his or her life. It is also an excellent discussion question. Assessment of learner outcomes has traditionally been based on achievement of the behavioral objectives.

Which of the following events illustrates how the suprasystem affects a community as a system? a. A group of concerned citizens points out the rising number of homeless persons in the community. b. A subgroup of the community demands that housing for homeless persons be built. c. Homeless persons decide to picket in front of the city government building. d. The state legislature passes a law that all communities must build some housing for homeless persons.

D Only if the state dictates a legal requirement to a local community is it an instance of the suprasystem's directly affecting the (community) system.

A nurse is planning to examine program outcomes. Which of the following would be the most important question to ask? a. Was the agency adequately funded? b. What organizational process was used? c. What techniques were used? d. What were the end effects on clients?

D Outcomes focus on the end results of the care, such as "Did change occur?" or "What are actual effects on clients?"

For whom are patient education programs very helpful? a. Adults and families who can learn to avoid health problems b. Adults and families, who will all be clients in the future c. People who wish to learn how best to use the health care system d. People with an identified health problem

D Patient education describes teaching-learning activities for people with an identified alteration in health. Health education focuses on helping healthy groups maintain or improve their health.

Which of the following groups should be included in any planning group to ensure that weaknesses are addressed and counterarguments are known? a. Administrators from the local hospital or hospitals b. Administrators of the health care agency c. Leaders in the community d. Those initially expected to resist the proposal

D People who are against the proposal are the most helpful in knowing what arguments will be used and what weaknesses are apparent in the proposal. It is always possible that they may become involved and become supporters.

Which of the following factors has a direct correlation with the health and well-being of the community? a. The number of hospitals and other health agencies in the community b. The number of physicians who practice in the community c. The government funding level of the community d. The poverty level of the community

D Standard of living (level of poverty) is associated with health status.

Why are results of screening tests referred to as presumptive? a. If the test result is positive, it may be assumed that the disease is present. b. The test results lead to recognition of symptoms. c. The tests detect previously unrecognized signs and symptoms. d. Because screening test results have less than 100% accuracy, referral for further tests is necessary.

D Test results are presumptive because the tests are fallible and thus further testing is necessary to confirm or rule out possible disease. Tests yield occasional inaccurate positive and inaccurate negative results.

Which of the following would be the most effective mechanism to use when collaborating with others to have an extensive and lasting impact on health outcomes? a. Broadly disseminating health-related information to inform citizens b. Encouraging the creation of more health programs on client lifestyle modification c. Increasing funding to health agencies for more health education programs d. Influencing improved health policies and legislation for healthier communities

D The American Nurses Association (ANA) suggests that nursing's role in prevention includes supporting health care legislation and influencing local and national economic and political options (i.e., affecting health policies and legislation).

In an earthquake, the roads and underground pipes were all destroyed. Fires and explosions began to occur from the broken leaking gas lines. Which of the following would be used to describe the fire? a. A man-made disaster b. The cause of the earthquake c. The primary agent d. The secondary agent

D The earthquake was the primary agent that caused the damage; the fires were secondary agents that resulted from damage by the primary agent. In this incident, primary agents include falling buildings, heat, wind, rising water, chemical and biologic agents, and smoke; secondary agents include bacteria and viruses that produce contamination or infection after the primary agent has caused injury or destruction. Primary and secondary agents vary according to the type of disaster

Why is the perspective of third-party payers and administrators an issue when cost-benefit analysis is performed? a. Administrators do not focus equally on costs and benefits. b. Administrators are not experts in cost-benefit analyses. c. Administrators lack understanding of health care benefits used in such analyses. d. Administrators ignore the client perspective of time, energy, and money.

D The perspective is that of the provider or the payer, not that of the client. Client time, energy, and money are typically not considered in the cost-benefit analysis. This oversight is an issue because what might be least expensive for an agency can be extremely expensive for a family.

After obtaining data from a health-risk appraisal tool, a nurse met with a client for follow-up. Which of the following actions should the nurse take first after summarizing the information? a. Create a reward system to reinforce healthful behaviors. b. Design a behavior change plan acceptable to the client. c. Establish an implementation time frame. d. Identify and reinforce client strengths.

D The process begins with summarizing information and then proceeds to identification and reinforcement of strengths. Then goals, outcome measures, a plan, reward system, and time frame are created. Good nursing practice always builds on client strengths rather than focusing just on weaknesses.

A local community hospital offers weekly hypertension screenings at the community center. A community/public health nurse was asked by a community member about when the health department would be offering a hypertension screening at the center. Which of the following would be the best response from the community/public health nurse? a. "When the public health department receives additional grant funding." b. "When the residents of the neighborhood request free screenings." c. "When the community/public health nurse has extra time." d. "When the community hospital stops offering screenings."

D When planning to offer a screening, the nurse must assess for significant health problems in the community, gather support from the community, and consider all the details. If screening resources are already available at a community center, there is no reason for the public health department to offer such a screening. Currently, the local hospital is meeting their needs for screening.

Why might citizens be concerned about disasters, especially terrorism, even before they occur? a. Charities will be trying to collect money for the victims by using personal stories. b. Financial costs of a disaster or terrorist attack increase citizens' taxes. c. Laws have been passed requiring preparation for disaster education for laypeople. d. There have been an increased number of terrorist activities throughout the world.

D Worldwide, there have been an increased number of terrorist activities that have been widely publicized using various forms of media.

After a severe tornado hit the center of town, the American Red Cross set up an emergency shelter. The Emergency Operations Center was established. What would a nurse member of the Disaster Action Team most likely be asked to do? (Select all that apply.) a. Debrief all the professionals assisting at the shelter. b. Establish a personal family disaster response plan. c. Appear on the local radio and TV stations to encourage citizens to stay calm. d. Ride in a helicopter and assess the amount of damage done to the community. e. Assign people who come to the shelter a space and give them emotional support. f. Triage injured people, set up morgue facilities, and help with immediate first aid.

E, F Nurses who are members of the disaster action team will be assigned a shelter and asked to assess needs and provide support. During the disaster, injured people are triaged, morgue facilities are established, and rescue activities are organized. Although a personal family disaster response plan is an excellent idea, the plan should be prepared before a disaster hits. Debriefing occurs during the recovery phase, not immediately after the disaster hits.