Exam 1

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The new director of a local public health unit reviews the personnel records of the unit staff and notes that none of the assigned public health nurses (PHNs) has academic training in community and public health nursing. The director's next step should be to: a. recognize that staff members have learned on the job through years of experience and that they will be able to teach their new director basic community and public health principles. b. make arrangements to hire new staff with appropriate formal training. c. realize that with the current nursing shortage the unit should be grateful to have long-term staff. d. review continuing education records to determine if the nurses have received training in community-oriented nursing and ethics, and plan for any needed training.

ANS: D Both the American Nurses Association (ANA) Code of Ethics and the Public Health Code of Ethics state that the professional competency of all public health employees must be assured and address issues of the nurse's accountability to ensure competency in delivery of services to individuals, families, or populations. Cognitive Level: Application Associated Chapter Objective: 5 REF: pp. 130-131

A population-level tertiary prevention intervention typically carried out by nurses caring for those with communicable disease in the community is: a. HIV test results counseling. b. needle exchange. c. partner notification. d. instruction in standard precautions.

ANS: D Teaching caregivers about infection control in home care is vital. The nurse treating the client with HIV infection in the home environment should teach caregivers about standard precautions. Some clients, families, friends, and others may have concerns about the transmission of HIV infection. Others who may not have concerns about transmission may fail to take adequate precautions or believe myths that they cannot become infected. Cognitive Level: Application Associated Chapter Objective: 1, 5 & 6 REF: p. 339

Before 1950, the major portion of U.S. health care was funded by out-of-pocket payments by consumers. In the 1950s, a shift was seen to third-party reimbursement, and that trend continues today. Recent trends of third-party reimbursement indicate that the highest portion of third-party health care financing is being carried by: a. combined public sources. b. consumer premiums. c. Medicare. d. private health insurers.

ANS: A By the end of the previous century, health care financing had evolved from a system in which the consumer paid the costs to a system financed primarily by third-party payers, which included private health insurers and local, state, and federal governments. However, recent trends indicate that combined local, state, and federal spending exceeds private health insurance spending in third-party health care financing. Cognitive Level: Evaluation Associated Chapter Objective: 4 REF: p. 110

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

ANS: A The public health core function of assurance focuses on the responsibility of public health agencies to be sure that activities are appropriately carried out to meet public health goals and plans. This involves making sure that essential community-oriented health services are available and accessible, especially to vulnerable populations who would otherwise not receive necessary services. Assurance also includes assisting communities to implement and evaluate plans and practices. Cognitive Level: Application Associated Chapter Objective: 1 REF: p. 6

Emerging infectious diseases may arise as a result of factors operating singly or in combination, and these factors may include which of the following? (Select all that apply.) a. Environmental changes b. Host behavior c. Improved surveillance d. Microbial adaptation e. Public health infrastructure deterioration

ANS: A, B, D, E Emerging infectious diseases are those for which the incidence has actually increased over the past several decades or has the potential to increase in the near future, and these include both new and known infectious diseases. New viruses may appear as a result of microbial adaptation, activities and behaviors of human hosts, and environmental changes. Relevant environmental changes include such things as weather changes, deforestation, urbanization, and industrialization. Human activities and behaviors that influence the spread of these diseases include increased use of daycare centers, illegal drug use, changing sexual behavior, use of modern modes of transportation, use of air conditioning, immigration, and global travel. Cognitive Level: Analysis Associated Chapter Objective: 6 REF: pp. 293-295

A client comes to the local clinic with acute symptoms of fever, nausea, lack of appetite, malaise, and abdominal discomfort. During the course of the assessment, the nurse determines that the client is a health care aide working at a daycare center. These facts are important because: a. acute hepatitis B is self-limiting. b. hepatitis A outbreaks commonly occur in facilities where staff change diapers. c. hepatitis C is a "silent stalker." d. individuals with chronic liver disease are at greater risk for hepatitis A.

ANS: B Hepatitis A virus is most often transmitted through the fecal-oral route. It remains the most frequently reported vaccine-preventable disease. Outbreaks are common in daycare centers where staff must change diapers, among household and sexual contacts of infected individuals, and among travelers to countries were hepatitis A is endemic. Cognitive Level: Analysis Associated Chapter Objective: 2 & 4 REF: p. 330

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

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

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

ANS: A, B, C, D Alterations in the usual sequence of bases [adenine (A), guanine (G), cytosine (C), and thymine (T)] that form a gene, changes in DNA or chromosomal structures are called mutations. A large number of agents are known to cause mutations. Despite three billion DNA base pairs that must be replicated in each cell division and the large number of mutagens we are exposed to, DNA replication is quite accurate because of the mechanism known as DNA repair that corrects 99.9% of initial errors. Cognitive Level: Analysis Associated Chapter Objective: 1 REF: p. 245

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

ANS: C When a nurse reviews the health history, the nurse observes for any disease that may have a genetic basis and if found, immediately refers the person or family to the appropriate health care provider. The goal of screening is to detect or define risk in low-risk groups and identify those people who should have diagnostic testing. Cognitive Level: Application Associated Chapter Objective: 4 REF: p. 251

ANS: C During the aftermath of a disaster or terrorism event, nurses can feel fear, hopelessness, and loss or bias, hatred, vengeance, and violence toward ethnic or religious groups that may be associated with terrorism. These feeling may compromise their ability to provide care for these groups. Yet the International Council of Nurses' (ICN) Code of Ethics for Nurses (2000) affirms that nurses are ethically bound to provide care to all people. One strategy to use in response to a disaster or terrorism event is to assist in identifying the feelings that nurses or others may be feeling. To accomplish this, the nurse can (1) explain that feelings of fear, helplessness, and loss are a normal reaction to a disruptive situation; (2) work with people and help them think of what they did that helped them overcome fear and helplessness in previous situations; (3) encourage people to talk to others about their fears; (4) encourage others to ask for help and provide resources and referrals; (5) remember that those in the helping professions may find it difficult to seek help; and (6) convene small groups in workplaces with counselors/mental health experts. Cognitive Level: Application Associated Chapter Objective: 8 REF: p. 88

A terrorist bombing at a local church has sent many victims to the local emergency department and resulted in several deaths. Following the event, an emergency department nurse seeks out other nurses who are having difficulty performing their jobs to speak about the event. The nurse is demonstrating the disaster response strategy of: a. allaying public concern and fear. b. assisting victims to think positively and to move to the future. c. identifying feelings that individuals may be experiencing. d. preparing personnel to be effective in a disaster.

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

ANS D. In 1988, the IOM's report stated that public health is "what we, as a society, do collectively to assure the conditions in which people can be healthy." Consequently, the mission of public health is "to generate organized community effort to address the public's interest in health by applying scientific and technical knowledge to prevent disease and promote health." This clearly places the emphasis on the desire of the population and community to ensure access to services that foster the health status of the overall community through the equitable distribution of resources addressed to community problems that affect health. Cognitive Level: Analysis Associated Chapter Objective: 1 REF: p. 6

ANS: A A rate is a measure of the frequency of a health event in a defined population in a specified period of time. A rate is a ratio but not a proportion, because the denominator is a function of both the population size and the dimension of time, whereas the numerator is the number of events. Rates relate to change: moving from one state of being to another, such as from illness to health or from life to death. In this example, seven child deaths divided by the total number of children age 15 years and younger in the population (which is 84,000) = 0.0000833 1000 = 0.0833/1000. Cognitive Level: Application Associated Chapter Objective: 5 REF: p. 262

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

ANS: A Assessment is a core function of public health and refers to systematically collecting data concerning the population, monitoring the population's health status, and making information available on the health of the community. In a community-oriented approach, a nurse would apply both nursing and public health theory. In this case, assessment would be the first step from the perspective of both theories. Because the practice is population focused and community oriented, it would involve the assessment of the community subpopulation of middle school children and the impact of obesity on their overall health status. Cognitive Level: Application Associated Chapter Objective: 1 REF: p. 6

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

ANS: A Community-oriented nurses who provide direct care services to individuals, families, or groups are engaging in a clinically oriented practice even when they apply concepts of population-focused, community-oriented strategies along with their direct care clinical strategies. Cognitive Level: Application Associated Chapter Objective: 3 REF: pp. 15-16

A shift in general approach from a more reactionary, acute care orientation toward a proactive, primary prevention orientation is necessary to achieve not only a more cost-effective but also a more equitable health care system in the United States. From a public health perspective, this strategy is necessary to avoid the need for other less desirable approaches that may compromise access and quality such as: a. rationing of health care. b. secondary prevention. c. managed care expansion. d. regulatory program mandates.

ANS: A Health care reform approaches under consideration to control the use of services and technologies are considered rationing of health care. Rationing of health care in any form implies reduced access to care and potential decreases in acceptable quality of services offered. A provider's refusal to accept Medicare or Medicaid clients is a form of rationing. Like access to care, rationing of health care is a public health issue. Where care is not provided, the public health system and nurses have an ethical obligation to ensure that essential services are available. This is currently being observed in the Katrina Hurricane recovery efforts, in which the health care infrastructure is being severely compromised by the refusal of previous practitioners to reopen their practices in New Orleans because of the impoverished economy. Nursing and public health agencies are stepping into the void left by these practitioners to provide essential services to the population. Cognitive Level: Analysis Associated Chapter Objective: 6 REF: p. 101

Community health nurses conducting health education among populations vulnerable to HIV infection should explain the natural history of the infection, including the fact that HIV infection may go undetected during the primary infection stage because: a. antibody test results are typically negative. b. antibody production by the immune system increases. c. incubation period is prolonged. d. symptoms include myalgias, sore throats, and rash.

ANS: A Individuals may experience flu-like symptoms such as lymphadenopathy, myalgias, sore throat, lethargy, rash, and fever during the primary stage of HIV infection. Results of an antibody test during this phase are usually negative, so the illness often is not recognized as HIV infection. After a variable period of time, commonly 6 weeks to 3 months, HIV antibodies appear in the blood and can be used to confirm the presence of HIV infection. Cognitive Level: Analysis Associated Chapter Objective: 1 REF: p. 321

A woman comes to the community health center complaining of increasing lower abdominal pain, fever, and abnormal menses for several months. During the assessment, the client indicates that she is aware that her husband has had multiple sex partners in the past 2 years. Appropriate intervention by the nurse would be to: a. arrange to have the client referred for medical evaluation for pelvic inflammatory disease (PID) and appropriate intervention and treatment. b. contact the health department to confirm the spouse's diagnosis of Chlamydia infection to determine the client's exposure, give the client antibiotics, and have her return to the clinic if symptoms worsen. c. provide STD prevention and treatment education and refer the client to the health department for STD screening for gonorrhea and/or Chlamydia infection. d. supply the client with nonsteroidal anti-inflammatory drugs and caution her to call the after-hours call doctor if her symptoms worsen.

ANS: A Nursing assessment should always include taking a comprehensive sexual history to determine an individual's potential risk for STDs. Each sexual partner is potentially exposed to all the STDs of all the persons with whom their partner has been sexually active. PID is a serious infection involving the fallopian tubes and is the most common complication of gonorrhea, but it may also result from chlamydial infections. Symptoms include fever, abnormal menses, and lower abdominal pain. Symptoms can vary among women. PID can cause ectopic pregnancy, and this should be ruled out in all cases. Stillbirth, premature labor, and infertility are also possible complications. Cognitive Level: Analysis Associated Chapter Objective: 2 & 3 REF: p. 328 & p. 334

A factor that strongly influences the success of a PHC system is: a. participation of the community members in the design, implementation, and evaluation of the initiative. b. assurance of access to care for every woman and child from pregnancy through childhood. c. each entity's sense of urgency regarding the evaluation of indicators. d. cure orientation of the private sector of health care delivery in the United States.

ANS: A PHC, the focus of the public health system in the U.S., is defined as the broad range of services including but not limited to, basic health services, family planning, clean water supply, sanitation, immunization, and nutrition education. It consists of programs designed to be affordable for the recipients of the care and the governments that provide them. The emphasis is on prevention, and the means of providing the care are based on practical, scientifically sound, culturally appropriate, and socially acceptable methods provided at the community level, accessible and acceptable to the community and inviting of community participation.

A school nurse notes that 60 children have missed days of high school because of pertussis this past year and this rate has been relatively constant for the past 5 years. The nurse plans to work with the community to increase awareness of the seriousness of this disease for children younger than 6 months of age and to raise and maintain the immunization rates, because in this community the pertussis is: a. endemic. b. epidemic. c. pandemic. d. sporadic.

ANS: A Pertussis (whooping cough) is caused by the bacterium Bordetella pertussis. It is highly contagious and is considered endemic in the United States. Endemic means that the disease is constantly present within a geographic area or population. Vaccination against pertussis, delivered in combination with diphtheria and tetanus vaccination, is a part of the routine childhood immunization schedule. The increase in adolescent and adult pertussis is alarming not because of the increased morbidity—cases are mild or inapparent in these groups—but because these individuals serve as a reservoir of infection for infants, especially those younger than 6 months of age, who are the most vulnerable to pertussis and the most likely to suffer complications resulting in hospitalization and death. Cognitive Level: Synthesis Associated Chapter Objective: 1, 8 REF: pp. 291-292

After hearing about home radon exposure on the news, a man and his wife contact the public health department to inquire about whether or not he should have his home tested. Which stage of the transtheoretical model (TTM) are the man and his wife at in regards to the process of change? a. Preparation b. Contemplation c. Action d. Precontemplation

ANS: A Preparation is the stage where the person intends to do something. Precontemplation is when the person does not plan to change; this may be because the person does not know there is a problem or does not want to do anything about it. In the contemplation stage, the person begins thinking about making a change in the future and examines the pros and cons of doing so. Action occurs when the person actually buys a radon testing kit and uses it in his home. Cognitive Level: Analysis Associated Chapter Objective: 1 & 3 REF: pp. 384-385

The World Health Organization (WHO) developed the Five Keys to Safer Food campaign in 2001 to address the problem of foodborne and waterborne diarrheal diseases worldwide. This campaign emphasizes which of the following practices? a. Keep clean, separate raw and cooked, cook thoroughly b. Never use raw, always cook, buy better c. Wash, cut, cook, and throw away d. Wash, cover, and always refrigerate

ANS: A Protecting the nation's food supply from contamination by virulent microbes is a multifaceted issue that is and will continue to be incredibly costly, controversial, and time-consuming to address. The specter of terrorist threats to the food supply adds an additional layer of complexity. However, much foodborne illness, regardless of the causal agent, can be easily prevented through simple changes in food preparation, handling, and storage. WHO estimates that 2.2 million people, most of them children, die annually from foodborne and waterborne diarrheal diseases in less-developed countries. In 2001, WHO initiated a new campaign entitled Five Keys to Safer Food, a simplified version of an earlier campaign that includes the following elements: keep clean, separate raw and cooked, cook thoroughly, keep food at safe temperatures, and use safe water and raw materials. Cognitive Level: Application Associated Chapter Objective: 3 & 9 REF: p. 307

The clients most at risk of reactivation of latent infections of tuberculosis (TB) are: a. immunocompromised persons, substance abusers, and those with diabetes. b. individuals previously treated for TB. c. long-term cigarette smokers. d. persons with new-onset asthma or emphysema.

ANS: A Reactivation of latent TB infections later in life is common, and the incidence rises in immunocompromised persons, substance abusers, underweight and undernourished individuals, and those with diabetes, silicosis, or gastrectomy. Cognitive Level: Application Associated Chapter Objective: 3 & 4 REF: p. 332

In the community-based participatory research (CBPR) approach, the use of lay community members to promote health within the community is an effective intervention because community members: a. are best at determining the health needs and plan interventions for their community. b. create a passive partnership. c. provide oversight for the health promotion activities. d. relieve local service providers of mundane tasks.

ANS: A The CBPR approach to community assessment allows understanding of sociocultural contexts, systems, and meaning through a collaborative research process. In CBPR, partnerships are active and community members are involved in assessing, planning, implementing, and evaluating change. Both professionals and community residents determine health needs and plan interventions. As residents increase their awareness, they are better able to determine what they want for themselves, their families, and their community and they are more likely to take leadership roles in program development, using health professionals as consultants. Cognitive Level: Analysis Associated Chapter Objective: 2 REF: pp. 388-389

The local public health nurse (PHN) participates in a town board's community assessment process, which identifies teenage pregnancy as a community concern for action. Based on the Healthy People in Healthy Communities MAP-IT model, a logical next step would be: a. coalition building. b. evaluation of outcomes. c. health-risk assessment. d. wellness appraisal.

ANS: A The MAP-IT technique helps the community plan a path to achieve the change that its members want to see in the community. The Healthy People in Healthy Communities MAP-IT process recommends mobilization of individuals and organizations; assessment of the areas of greatest need, resources, and strengths; the planning of an approach; implementation of the plan; and tracking of progress over time. Cognitive Level: Application Associated Chapter Objective: 2 REF: p. 382

An American takes a long-awaited vacation in sunny Mexico, spending days on the beach eating fresh raspberries from a nearby vendor and drinking bottled water. The tourist may be altering: a. agent-host-environment interaction. b. circadian rhythms. c. herd immunity. d. host resistance.

ANS: A The balance among agent, host, and environment is often precarious and may be unintentionally disrupted. Changes in the characteristics of any of these factors may result in disease transmission. Many travelers are at risk for foodborne and waterborne diseases and should be careful to eat only thoroughly cooked foods prepared under reasonable hygienic conditions. Eating foods purchased from street vendors may not be wise. Fruits that can be peeled immediately before eating, such as bananas, are less likely to be a source of infection. Dairy products should be pasteurized and appropriately refrigerated. Only potable water (safe to drink) should be consumed, such as boiled water or bottled water. Other diarrheal diseases may not be related to viral or bacterial infective agents and may be the result of stress, fatigue, schedule changes, and consumption of unfamiliar foods. Cognitive Level: Application Associated Chapter Objective: 2 & 9 REF: p. 290

Primary health care (PHC) differs from primary care in which of the following ways? a. PHC encourages community participation. b. PHC focuses on prevention and cure. c. PHC is defined more narrowly. d. PHC is the primary method of health care delivery in the United States.

ANS: A The definition of PHC is broad, incorporating a comprehensive range of services including public health, prevention, and diagnostic, therapeutic, and rehabilitative services. PHC is the mainstay of the public health system in the United States, with a main focus on prevention instead of cure. The provision of PHC is based on practical, scientifically sound, culturally appropriate, and socially acceptable methods and is carried out at the community level with community participation encouraged. Although endorsed by the United States as a strategy for achieving the goal of health for all in the twenty-first century, it is not the chief means of delivery of health care in the United States.

Virtue ethics is distinctly different from moral justification via theories or principles because the emphasis of virtue ethics is practical reasoning applied to: a. character development. b. consequentialism. c. distributive justice. d. egalitarianism.

ANS: A The goal of virtue ethics, one of the oldest ethical theories, is to enable individuals to flourish as human beings. According to Aristotle, virtues are acquired, excellent traits of character that dispose humans to act in accordance with natural good. Examples of such traits in virtue ethics are benevolence, compassion, discernment, trustworthiness, integrity, and conscientiousness. Cognitive Level: Analysis Associated Chapter Objective: 3 REF: pp. 127-128

One step in the ethical decision making framework is to place an ethical issue within a meaningful context. The rationale for this step is that: a. multiple factors affect the formulation and justification of ethical issues and dilemmas. b. the nature of ethical issues and dilemmas determine the specific ethical approach used. c. people cannot make sound ethical decisions if they cannot identify ethical issues and dilemmas. d. professionals cannot avoid choice and action in applied ethics.

ANS: A The historical, sociological, cultural, psychological, economic, political, communal, environmental, and demographic contexts affect the way ethical issues and dilemmas are formulated and justified. Cognitive Level: Analysis Associated Chapter Objective: 2 REF: p. 124

When a situation exists in which there is potential contact with blood or body fluids, health care workers must always perform hand hygiene and wear gloves, masks, protective clothing, and other indicated personal protective barriers. The underlying reason for requiring these practices, known as universal precautions, is that: a. blood and body fluids of all clients need to be handled as if they were infected. b. effective infection control surveillance programs are in place. c. health care settings are reservoirs of infection. d. health care workers do not effectively use hand hygiene.

ANS: A The practice of universal precautions is a policy relevant for all health care settings. In 1985, in response to concern regarding the transmission of HIV infection during health care procedures, the Centers for Disease Control and Prevention recommended implementation of a universal precautions policy in all health care settings. This policy requires that all blood and body fluids from all clients be handled as if they were infected with HIV or other blood-borne pathogens. Cognitive Level: Analysis Associated Chapter Objective: 10 REF: p. 314

A nurse is teaching a postpartum mother how to breastfeed her infant. The nurse notes that the mother is alert and agrees that breastfeeding is important to her and beneficial to her baby. The nurse outlines the expectations of breastfeeding for the mother and the baby and presents the material. In terms of the sequencing of instruction, what should the nurse do next? a. Ask the mother about her previous experience with breastfeeding b. Demonstrate how to position the baby for breastfeeding c. Have the mother demonstrate breastfeeding d. Show the mother a video about breastfeeding

ANS: A To facilitate skill learning, the nurse should teach and demonstrate the skill. The educator should allow learners to practice and immediately correct any errors in performing the skill. The basic sequence of instruction includes nine steps: gain attention, inform the learner of the objectives, stimulate recall of prior learning, present the material, provide learning guidance, elicit performance, provide feedback, assess performance, and enhance retention and transfer of knowledge. Cognitive Level: Analysis Associated Chapter Objective: 1 & 5 REF: p. 361

The community-oriented nurse best exemplifies the application of feminist ethics when the nurse: a. designs health care programs for the underserved that incorporate social justice, treat men and women with respect and equity, and include community interventions that elevate the status of the underserved in the community. b. designs health care programs for women that respect their dignity and autonomy. c. ensures that male providers do not use sexist terms when counseling clients and their spouses and when dealing with female colleagues. d. participates in political action committees that focus on women's rights and status in the community.

ANS: A Whereas feminism rejects the devaluing of women and their experiences, believes that the oppression of women is morally wrong, and demands social justice and political action, feminist ethics holds a broader worldview advocating just relationships for both men and women, adopts a feminist perspective that facilitates critical thought, and focuses on broad issues such as power, gender, and socioeconomic structures. Cognitive Level: Analysis Associated Chapter Objective: 3 REF: p. 129

At the request of a local housing authority, a PHN conducted a survey at a public housing facility to determine the need for a nurse-managed clinic. When residents and community leaders were asked what services were most needed from the clinic, they listed well-child screening, parenting education, and medication management. The PHN , the local health department, and the community members collaborated in all phases of the project from planning to evaluation to establish a community nursing center at the site. This example best illustrates the application of population-focused community model at which level? a. Aggregate client system level b. Environmental level c. Family client system level d. Individual client system level

ANS: A Within the integrative model of community health promotion, for the needs of this resident population to be met, it was paramount that the nurse understand the perceived problems of both the housing authority and the residents; the services desired by the residents; the resources available at the facility; and the strengths of the aggregate community to participate actively in the assessment, planning, implementation, and evaluation of a community nursing center. Application of a population-focused community model at the aggregate client system level laid the foundation for an active partnership and sustainable and effective intervention. Cognitive Level: Application Associated Chapter Objective: 3 REF: pp. 387-388

Benefits of an electronic health record in the public health system include: (Select all that apply.) a. 24-hour availability of health records. b. ease of referral coordination. c. reduction in medication errors. d. increased privacy. e. consistently reliable internet resources.

ANS: A, B, C Benefits of an electronic record in public health include 24-hour availability of records with downloaded laboratory results and up-to-date assessments; coordination of referrals and facilitation of interprofessional care in chronic disease management; incorporation of protocol reminders for prevention, screening, and management of chronic disease; improvement of quality measurement and monitoring; and increased client safety and decline in medication errors. Drawbacks to new technology include increased legal liability, the potential for decreased privacy, too much reliance on technological advances, and the inconsistent quality of resources available on the Internet and other places.

A group of six nurses is charged by the nurses' manager with evaluating current unit policies. One month later, the manager determines that the group is ineffective because of lack of cohesiveness. Which of the following group concerns or behaviors would be indicative of lack of cohesion? (Select all that apply.) a. Complaints about the degree of member participation b. Dissatisfaction about demands on their schedules c. Complaints about lack of administrative support d. Lack of a work plan for accomplishing the task e. Vying for leadership

ANS: A, B, C, D, E Cohesion is the attraction between individual group members and between each member and the group that allows them to identify themselves as a unit and work toward common goals, endure frustration for the sake of the group, and defend the group against outside criticism. This attraction increases when members feel accepted and liked by others, see similar qualities in one another, and share similar attitudes and values. Members of a highly cohesive group work toward their common goal, identify with the group, are willing to endure frustration to meet their goals, and recognize the needs of individual members. Cognitive Level: Analysis Associated Chapter Objective: 3 REF: p. 369

The factors that are frequently cited as having caused the increases in total and per capita health care spending in the United States are well exemplified by which of the following health care events? (Select all that apply.) a. Development of the drug sildenafil (Viagra) b. Increase in hip and knee replacement surgeries c. Increased incidence of ischemic heart disease d. Mandated two-day maternity hospital stays e. Medicare Part D prescription drug plan

ANS: A, B, C, D, E The factors that are frequently cited as having caused increases in total and per capita health care spending in the United States are cost inflation in the production of goods and services; changes in population demography (aging of the population, immigration); increased adoption of medical technology (new procedures, equipment, or pharmaceuticals); increases in the intensity of services, especially when government controlled (legislated programs or mandates); and increases in the incidence of chronic illnesses (ischemic heart disease and obesity). These factors alter the supply of and demand for services to meet identified needs. Cognitive Level: Synthesis Associated Chapter Objective: 3 REF: p. 118

The American health care system will continue to evolve and change. Which of the following groupings of health care trends will have the greatest influence on the health care transformation process at the present time? (Select all that apply.) a. Aging of the population and medical technology advances b. Funding levels, political structure, and professional licensure requirements c. Longevity, population diversity, and funding sources d. Managed care, workforce shortages, and level of education of the population

ANS: A, C Increases in the number of aging baby boomers as well as the longevity of the elderly, advances in medical technology such as telehealth, and electronic medical record keeping are currently having the greatest impact on the transformation of our health care system. This involves the reallocation of resources, standardization of information transfer, and funding challenges. As a percentage of gross domestic product (GDP), publically funded programs are outpacing the tax and revenue sources for these programs.

A client diagnosed with HPV infection states, "I'm not concerned, I know the warts disappear after a while." The nurse should counsel the client regarding which of the following? (Select all that apply.) a. Link between HPV and cervical cancer b. Status of HPV infection as a reportable disease c. Need to eliminate the warts d. Serious complications of HPV infection for men e. Lack of cure for HPV infection

ANS: A, C, E The complications of HPV infection are especially serious for women. The link between HPV infection and cervical cancer has been established, and this cancer is associated with specific types of the virus. HPV infection is exacerbated during pregnancy and immune-related disorders, a fetus may become infected, and there is no cure. Although the warts will disappear over time, the goal is to eliminate the warts through surgical removal and other treatments to prevent skin-to-skin contact with them. Cognitive Level: Synthesis Associated Chapter Objective: 2, 3, 5, & 6 REF: p. 330

The most important features of the Affordable Health Care for America Act of 2010 that the community-oriented nurse needs to understand to provide resource information to clients are that the Act: (Select all that apply.) a. transforms the health care system from a sick care system to health care system. b. uses piecemeal approach to strengthen the safety net. c. replaces the rational equitable health care system. d. provides insurance reform. e. increases access to affordable health care insurance.

ANS: A, D, E The Affordable Health Care for America Act of 2010 requires most Americans to have health insurance coverage, expands Medicaid, subsidizes private coverage for low- and middle-income people, transforms the current system from a sick care system to a true health care system, lowers mortality related to preventable causes, institutes health insurance reform, increases access to affordable health care coverage, and increases support for nursing workforce development programs.

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

ANS: B An epidemic occurs when the rate of disease, injury, or other condition exceeds the usual (endemic) level of that condition. Cognitive Level: Application Associated Chapter Objective: 1 REF: p. 259

In an effort to address West Nile virus, a community increased livestock immunization, began a vector control program, and initiated a community campaign to eliminate standing water reservoirs. This best exemplifies communicable disease control through: a. health education. b. multisystem approach. c. improved public health infrastructure. d. reduction of environmental hazards.

ANS: B Communicable diseases represent an imbalance in the usually harmonious relationship between the human host and the environment. This state of imbalance provides the infectious agent an opportunity to cause illness and death in the human population. Given the many factors that can disrupt the agent-host-environment relationship, a multisystem approach to the control of communicable diseases must be developed. Cognitive Level: Analysis Associated Chapter Objective: 3, 4, & 6 REF: p. 297

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

ANS: B Epidemiologists understand that disease results from complex relationships among causal agents, susceptible persons, and environmental factors. These three elements—agent, host, and environment—are called the epidemiologic triangle. Changes in one of the elements of the triangle can influence the occurrence of disease by decreasing or increasing a person's risk of disease. Cognitive Level: Application Associated Chapter Objective: 3 REF: p. 266

A nurse helping to form a group to deal with ongoing industrial pollution within a community understands that effective groups: a. are larger and comprised of recognized community leaders. b. can have individuals with diverse interests and yet be influential in changing the larger community. c. must include members of all involved parties, including political, corporate, health, and environmental leaders. d. should be small with informal leadership and relationships within the group.

ANS: B Groups of individuals with diverse interests can influence and change the larger social community. Alliances or coalitions unite diverse interest groups who share a common interest in perceived threats to community health, and nurses may work with groups both for community analysis and vehicles for change. Cognitive Level: Application Associated Chapter Objective: 3 & 4 REF: p. 372

A nurse practitioner is seeking support from a community health and hospital system to open a nurse-managed and nurse-staffed clinic. The nurse provides data demonstrating the role of the clinic in reducing nonurgent emergency department visits and in improving access to services for clients with chronic illness, management of caseloads, and service flow, as well as data showing proposed input and output parameters. This best demonstrates application of the techniques of: a. business cycle modeling. b. cost-effectiveness analysis. c. cost-benefit analysis. d. indirect reimbursement methods.

ANS: B In community health, it is generally believed that interventions have a net positive value such as improving access to services. Nurse-managed clinics provide access to quality care for underserved populations. Nurses can use data to demonstrate the cost-effectiveness and efficiency of their programs without a detailed cost-benefit analysis and gain support from business-oriented health system managers. Efficiency refers to producing maximum output, such as goods or services, using a given set of resources (input), defined in terms of labor, time, and money. Efficiency depends on tasks and process. Effectiveness, on the other hand, refers to the extent to which a health care service meets its intended objective. A cost-effectiveness analysis would allow expression of the net direct and indirect costs and cost savings of a defined outcome in the proposal and planning phases. Cost-benefit analysis would be used to evaluate and demonstrate the effectiveness and efficiency of the program once hard data can be obtained. Cognitive Level: Synthesis Associated Chapter Objective: 1 REF: p. 99

Which objective includes all of the critical elements of an educational objective? a. After attending the diabetic education class, the client will prepare a meal plan. b. At the end of self-management training, the client will prepare a daily food plan that meets the 1800-calorie per day American Diabetes Association (ADA) diet guidelines. c. The diabetic client will prepare a list of the five food groups and the number of servings from each group that are necessary for an 1800-calorie diet following ADA guidelines. d. The client and his wife will attend all of the diabetic education classes to learn to prepare meals consistent with ADA diet guidelines.

ANS: B Objectives are specific, short-term criteria that need to be met as steps toward achieving a long-term goal. Objectives are written statements of an intended outcome or expected change in behavior and should define the minimum degree of knowledge or ability needed by the client. They must be stated clearly and defined in measurable terms. Objectives are different from goals, which are broad, long-term, expected outcomes. Cognitive Level: Analysis Associated Chapter Objective: 1 & 5 REF: p. 359

Many behaviors place any individual—regardless of age, gender, ethnicity, or other characteristics—at greater risk for STDs. The nurse should include primary prevention interventions in all client encounters through the discussion of: a. partner notification. b. safer sex. c. standard precautions. d. STD testing.

ANS: B Sexual abstinence is the best way to prevent STDs; however, for many people it is not realistic. Therefore, education about how to make sexual behavior safer is critical. Safer sexual behavior includes masturbation, dry kissing, touching, fantasy, and vaginal or oral sex with a condom. Nurses should not base assessments on considerations of age, gender, ethnicity, or any other factor, but should discuss safe sex in all client encounters. Cognitive Level: Application Associated Chapter Objective: 5 & 6 REF: p. 336

A 6-year-old is brought to the emergency department with a full-body rash and fever. During the nursing assessment, which of the following findings would be most relevant to recognizing the case as potential smallpox rather than varicella? a. Fever has responded to acetaminophen, and the child is playful when temperature is not elevated. b. Fever of 101°F was present for several days before the rash appeared. c. Low-grade fever (100°F or less) has been present ever since the rash became obvious. d. Rash is primarily on the trunk of the body.

ANS: B Smallpox is associated with a sudden onset of fever, severe body aches, and occasional abdominal pain and vomiting, as in influenza. The rash, which is centrifugal with same-stage lesions in all areas but most abundant on the face and extremities, follows 2-4 days after the fever begins decreasing. With chickenpox, the rash is centripetal, with lesions most abundant on the trunk or in areas covered by clothing; the rash is present at the onset of symptoms, such as a slight fever with mild constitutional symptoms, and can appear as multiple crops of lesions at various stages of development (maculopapular lesions, vesicular lesions, or granular scabs). Cognitive Level: Application Associated Chapter Objective: 3 & 7 REF: p. 299

A nurse diabetic educator who recently returned from a professional conference decides to present current best practices and research findings at a gathering of newly diagnosed diabetic clients. In adopting this approach, the nurse may fail to provide health education effectively. This failure would relate to which domain of learning? a. Affective b. Cognitive c. Psychomotor d. Practice

ANS: B The domains of learning are the cognitive, affective, and psychomotor domains. For health education to be effective, the community-oriented nurse must first assess the cognitive abilities of the learner, so that the nurse's expectations and plans are directed to the correct level. Teaching above or below the client's level of understanding may lead to frustration and discouragement. Cognitive Level: Synthesis Associated Chapter Objective: 1 & 5 REF: p. 358

A clinic-based public health nurse (PHN) has launched an aggressive community health education media campaign to increase the number of fully immunized children within the health district. Which evaluation process would best assess the impact of this strategy at the overall community level? a. Analysis of the immunization clinic appointment rate over the next few months b. Analysis of the trend in childhood immunization rates for the health district c. Assessment of the immunization status of each child who visits the clinic d. Determination of the budgetary impact of the media campaign on the clinic's operations

ANS: B The evaluation of health and behavioral changes can focus on both short-term and long-term effects. Long-term evaluation is geared toward following and assessing the lasting effects of the education program. Long-term evaluation is often the approach used by community health nurses to analyze the effectiveness of an education program for the entire community, not the health status of a specific individual client. Understanding the impact of the educational program in producing change in the community health status allows the health district to make wise choices in addressing the community's needs. Cognitive Level: Synthesis Associated Chapter Objective: 6 REF: p. 368

A nurse is assigned to teach clients STD prevention information. The nurse updates her teaching plan to incorporate new guidelines from the Centers for Disease Control and Prevention. She includes which of the following as updated information during her next teaching session? a. Always use spermicides with condoms to reduce the risk of contracting chlamydia or gonorrhea. b. Condoms can be effective in preventing infections transmitted by fluids from mucosal surfaces but are not always effective in preventing infections transmitted by skin-to-skin contact. c. Condoms should not be used during oral sex, because they are not effective in preventing transmission of infection. d. When genital ulcers are present, condoms should be used to prevent the spread of infection.

ANS: B The lesions of HSV-2 and HPV infection as well as other lesions capable of transmitting STDs can occur on all parts of the male and female genitalia and rectum. Condoms are effective in reducing transmission via body fluids from the penis and vagina. However, lesions not covered by a male or female condom can still transmit infection even with proper condom use. Cognitive Level: Analysis Associated Chapter Objective: 5 & 6 REF: p. 330

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

ANS: B The new focus on populations, coupled with the integration of acute, chronic, and primary care occurring in some health care systems, is likely to create new roles for individuals, including nurses, who will span inpatient and community-based settings and focus on providing a wide range of services to the populations served by the system. Such a role might be director of client care services for the health care system, who has administrative responsibility for a large program area. There will be a demand for individuals who can design programs of preventive and clinical services to be offered to targeted subpopulations and for those who can implement such programs. Cognitive Level: Synthesis Associated Chapter Objective: 6 REF: p. 18

A community-oriented nurse understands that the most important use of the principles for effective advocacy is to: a. act as a friend and advocate for the target population served to promote research and data gathering. b. act in the community's best interest, in keeping with community direction, while maintaining diligence, ongoing communication, and confidentiality. c. ensure that public funds are spent only for the priorities stated in the legislation that authorized program funding and promote regulations and legislation. d. give more priority to the opinions and feelings of key community leaders than to data when determining program priorities.

ANS: B The six principles of effective advocacy include acting in the community's best interest, acting in accordance with the community's wishes, keeping the community informed, acting with diligence, maintaining impartiality, and maintaining confidentiality. Bateman's practical framework for advocacy places the advocate's core skills within the context of the six principles of effective advocacy. Cognitive Level: Analysis Associated Chapter Objective: 6 REF: p. 134

Which of the following community health improvement projects uses subjective health perspective? a. Health-promotion project aimed at monitoring an adolescent's compliance with an asthma treatment regimen b. Project aimed at improving flexibility and stamina of residents of an assisted-living facility through participation in a yoga and relaxation program c. Project aimed at teaching clients with diabetes how to maintain glucose control by using a sliding scale for dosing insulin d. Program aimed at improving school performance by teaching high school teachers how to detect drug abuse and screen students for drug use

ANS: B The subjective life process approach involves taking a holistic view of the person's total lifestyle and not judging simply by compliance with a prescribed regimen. The focus is on improving health through lifestyle changes and other health-promoting interventions consistent with the focus of care in a multidimensional client system in the integrative community health promotion model. Cognitive Level: Analysis Associated Chapter Objective: 1 REF: p. 381

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

ANS: B The validity of a screening test is measured by its sensitivity and specificity. Sensitivity quantifies how accurately the test identifies those individuals with the condition or trait of interest. Sensitivity is calculated as the proportion of persons with the disease that the test correctly identifies as having the disease (true positives). High sensitivity is needed when early treatment is important and when the identification of every case is important. Accurate identification is cost-effective and timely. Cognitive Level: Analysis Associated Chapter Objective: 8 & 11 REF: pp. 271-272

A nurse integrates a structured exercise into her classroom presentation on effective handwashing that assists students in demonstrating and modeling good handwashing techniques. The principle followed by an effective educator that is best demonstrated by this approach is: a. create the best learning environment. b. encourage participatory learning. c. organize the learning experience. d. select the learning format.

ANS: B There are six principles that guide the effective educator: send a clear message, select the learning environment, create the best learning experience, organize the learning experience, encourage participatory learning, and provide evaluation and feedback. People learn better when they are actively involved in the learning process. Participation increases motivation, flexibility, and the learning rate. Cognitive Level: Analysis Associated Chapter Objective: 2 & 5 REF: p. 375

There is strong evidence to suggest that poverty can be directly related to poor health outcomes. Poorer health outcomes lead to reduced educational outcomes for children; poor nutrition; low productivity in the adult workforce; and unstable economic growth in the population, community, and nation. These concepts reflect the human capital approach of the branch of economics known as: a. effectiveness and efficiency. b. macroeconomics. c. microeconomics. d. supply and demand.

ANS: B There are two branches of economics: microeconomics and macroeconomics. Macroeconomics focuses on the "big picture" such as the business cycle and economic growth—the total or aggregate of all individual and organizational behaviors such as growth, expansion, or decline of an aggregate. The aggregate is usually a country or nation. Factors such as levels of income, employment, general price levels, and rate of economic growth are important. Human capital is an important element in macroeconomic theory. Improvement of a human condition like health is a focus for raising and spending money on goods and services because health is valued. This approach also enhances the income-earning ability of people and improves the economy. If the population is healthy, premature morbidity and mortality are lowered, chronic disease and disability are decreased, and economic losses to the nation are reduced. Socioeconomic status is inversely related to mortality and morbidity for almost all diseases. Cognitive Level: Synthesis Associated Chapter Objective: 2 REF: pp. 98-99

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

ANS: B When looking for the existence of statistical association between some factor and a health outcome, the investigator must consider the three general categories of bias. Bias is a systematic error resulting from study design, study execution, or confounding. Bias resulting from the relationship of the outcome and the study factor with some third factor not accounted for in the study design is called confounding. In practice, one can often identify potentially confounding variables and adjust for them in analysis. Cognitive Level: Analysis Associated Chapter Objective: 9, 10 & 11 REF: pp. 280-281

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

ANS: B, C, E Public health specialists often define problems at the population or aggregate level as opposed to the individual level. At the population level, public health specialists are usually concerned with more than one subpopulation and frequently with the health of the entire community. Cognitive Level: Synthesis Associated Chapter Objective: 4 REF: p. 12

A community-based HIV/AIDS clinic would be concerned about which aspects of the Public Health Code of Ethics? (Select all that apply.) a. Autonomy of the professional b. Confidentiality, when possible c. Funding d. Advocacy for disenfranchised persons e. Respect of only community rights

ANS: B, D The 12 principles of the Public Health Code of Ethics incorporate the ethical tenets of preventing harm; doing no harm; promoting good; respecting both individual and community rights; respecting autonomy, diversity, and confidentiality when possible; ensuring professional competency; maintaining trustworthiness; and advocating for disenfranchised persons within the community. Cognitive Level: Evaluation Associated Chapter Objective: 5 REF: pp. 131-132

A group's culture is created by the combination of its norms. The nurse supports helpful rules, attitudes, and behaviors in the group because group norms do which of the following? (Select all that apply.) a. Challenge the cohesiveness of the group b. Ensure movement toward the group's purpose and tasks c. Identify message pathways and member participation d. Influence members' perceptions and interpretation of reality e. Maintain the group through various supports to members

ANS: B, D, E Group norms set the standards for group members' behaviors, attitudes, and perceptions. All groups have norms and mechanisms to accomplish conformity. Group norms serve three functions: they ensure movement toward the group's purpose and tasks (task norms), they maintain the group through various supports to members (maintenance norms), and they influence members' perceptions and interpretations of reality (reality norms). Group norms combine to create group culture. Nurses working with groups should not dictate norms but support helpful rules, attitudes, and behaviors within the group. The role of the nurse becomes one of providing accurate information, confirming the possibility/attainability of the group's goals, and encouraging different/positive perspectives. Cognitive Level: Synthesis Associated Chapter Objective: 3 REF: p. 370

ANS: C A proportion is a type of ratio in which the denominator includes the numerator. The prevalence proportion is a measure of existing disease in a population at a particular time and is calculated by dividing the number of existing cases by the current targeted population. In this example, 39 cases divided by the total number of children age 15 years and younger in the population (which is 84,000 children) = 0.0004642 100,000 = 46.42/100,000. Cognitive Level: Application Associated Chapter Objective: 5 REF: p. 262

Although infectious disease epidemics are still the major cause of death worldwide, they have subsided in the United States because of improvements in nutrition and sanitation, the discovery of antibiotics, and the development of vaccines. Infectious diseases have not vanished, however, and remain a continuing cause of concern. Healthy People 2020 has a number of objectives aimed at reducing these illnesses because of the morbidity, mortality, and costs associated with infectious diseases. One such costly disease trend related to an increase in the performance of invasive diagnostic and surgical procedures, the use of broad-spectrum antibiotics, and treatment with immunosuppressive drugs is the rise of: a. Escherichia coli 0157:H7. b. multisyndrome effect. c. health care-associated infections. d. severe acute respiratory syndrome.

ANS: C Although infectious diseases may not be the leading cause of death in the United States at the beginning of the twenty-first century, they continue to present varied, multiple, and complex challenges to all health care providers. One trend in the United States is the rise of health care-associated infections. Pennsylvania, the first state in the country to examine the costs of these infections, reported that health care-associated infections led to $2 billion in additional hospital charges and at least 1500 preventable deaths in 2004. Health care-associated infections are acquired during hospitalization or develop within a hospital setting and were previously known as nosocomial or hospital-acquired infections. The performance of invasive diagnostic and surgical procedures, the use of broad-spectrum antibiotics, and treatment with immunosuppressive drugs, along with the original underlying illness, leave hospitalized clients particularly vulnerable to infection by virulent agents carried by other clients and indigenous hospital flora transmitted by health care staff. Cognitive Level: Application Associated Chapter Objective: 1 REF: p. 314

The 1989 changes to Medicaid Title XIX required states to provide care for children younger than age 6 years and pregnant women with incomes less than 133% of the federal poverty level. These changes also ensured adequate access to qualified providers by: a. adding coverage for the medically indigent. b. reimbursing the costs of early periodic screening, diagnosis, and treatment for those younger than age 21 years. c. reimbursing for treatment by pediatric and family nurse practitioners. d. reimbursing for skilled and intermediate nursing home care.

ANS: C Any state participating in the Medicaid program is required to provide inpatient and outpatient hospital care; laboratory and radiology services; physician services; skilled nursing care at home or in a nursing home for people older than age 21 years; early periodic screening, diagnosis, and treatment for those younger than age 21 years; and, subsequently, family planning. The 1989 amendments required states to provide care for children younger than 6 years of age and to pregnant women with incomes less than 133% of the poverty level. These changes also provided for reimbursement for treatment by pediatric nurse practitioners and family nurse practitioners and thereby increased access to qualified providers. Cognitive Level: Synthesis Associated Chapter Objective: 5 REF: p. 112

The impact of the baby boomer generation on the future of health care can best be described as: a. decrease in demand because they are a healthier group of older adults. b. decrease in demand because they are less likely to use preventive care. c. increase in demand because of increased life expectancy. d. increase in demand because of rates of acute health problems.

ANS: C By the year 2050, individuals age 65 years and older will make up 20% of the population, or one in five Americans. The life expectancy for these individuals is higher, with the number of people age 85 years and older expected to double between 1990 and 2050. Although many older adults are independent and active, because they will live longer they are likely to experience multiple chronic conditions that may become disabling. Older adults are admitted to hospitals three times more often than the general population, and their average length of stay is 3 days longer than the overall average. They visit physicians more often and make up a larger percentage of nursing home residents. Older adults consume a larger proportion of health care resources, including long-term care, hospital care, pharmaceutical products, and chronic disease management services. Cognitive Level: Synthesis Associated Chapter Objective: 3 REF: p. 108

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

ANS: C Community health nursing practice is the synthesis of nursing theory and public health theory applied to promoting, preserving, and maintaining the health of populations through the delivery of personal health care services to individuals, families, and groups. The focus of community health nursing practice is the health of individuals, families, and groups and the effect of their health status on the health of the community as a whole (individual to families to groups to community flow). This is different from public health nursing, which is the synthesis of nursing theory and public health theory applied to promoting and preserving the health of populations. The focus of public health nursing practice is the community as a whole and the effect that the community's health status, including health care resources, has on the health of individuals, families, and groups (community to groups to families to individual flow). Both community health and public health nursing are considered to be community-oriented practices involving free-living (noninstitutionalized) clients. Community-based nursing practice is setting specific, and care is provided to clients where they live (home health or hospice nursing, community-based clinic), work (occupational health nursing), and/or attend school (school nursing). The emphasis of community-based nursing practice is acute and chronic care (illness care) and the provision of comprehensive, coordinated, and continuous services, usually within a specialty area. Cognitive Level: Analysis Associated Chapter Objective: 2 REF: p. 16

In evaluation of a program to prevent teen pregnancy, analysis of the net direct and indirect costs, the improvements in the community attributable to the program (such as lower high school dropout rates), and the costs that would result if the program were not implemented (such as the cost of care for low-birth-weight infants) is an example of which of the following? a. Cost-benefit analysis b. Cost-efficiency analysis c. Cost-effectiveness analysis d. Economic growth predictions

ANS: C Cost-effectiveness analysis compares net direct and indirect costs, and cost savings with respect to a defined health outcome. Cost-effectiveness analysis is best used to compare two or more strategies or interventions that have the same health outcome in the community. This comparison can be between two program models or one intervention model and the absence of that intervention. Cognitive Level: Analysis Associated Chapter Objective: 1 REF: p. 99

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

ANS: C Epidemiology investigates the distribution (patterns) and the determinants (factors such as exposure, characteristics, and behaviors) of health events in a population. Distribution addresses "Who, what, where, when, and why?" and determinants address "How did the health event occur?" and "Why are some affected more than others?" Cognitive Level: Analysis Associated Chapter Objective: 1 REF: p. 258

The nurse recommends Parents Without Partners to a colleague who is experiencing the challenges of single parenthood in raising a teenager. The nurse is demonstrating an understanding of the group elements of: a. cohesion and task functioning. b. leadership and role structure. c. member interaction and group purpose. d. norms and maintenance.

ANS: C Health-promoting groups may form when people meet in community and health care settings and discover common challenges to their physical and mental well-being. People often make changes with the support of a group that they are unable to make independently. Health-promoting groups like Alcoholics Anonymous and Parents Without Partners improve members' health and deal with specific threats to health. Cognitive Level: Application Associated Chapter Objective: 3 & 4 REF: pp. 368-369

In the disease-oriented perspective, in which health is objectively defined as the absence of disease and health care is focused on identifying what is not working in a given system and repairing it, health behavior is based on client: a. access to care. b. adjustment of lifestyle. c. compliance with a prescribed regimen. d. response to treatment.

ANS: C In the disease-oriented perspective, health is objectively defined as the absence of disease, and humans are conceptualized as composed of organ systems and cells. Therefore, health care focuses on identifying what is not working in a given system and repairing it. In this paradigm, health behavior is viewed as how the client complies with the recommendations of the health professional. Cognitive Level: Application Associated Chapter Objective: 1 REF: p. 381

A child learns at a school safety presentation the importance of wearing a bicycle helmet and requests a helmet for a birthday gift. The parent purchases a helmet like the ones worn by the child's peers. Which of the following statements best describes the relationship of healthy or risky behaviors to lifestyle choices? a. The family is responsible for the health behaviors of children. b. The individual is responsible for health behaviors. c. There is multilevel responsibility for health behaviors. d. The community has a sense of responsibility for health behaviors.

ANS: C In the ecological perspective, individuals ultimately make decisions to engage in healthy or risky behaviors, and lifestyle improvement efforts typically focus on the individual as the target of care. From a public health perspective, however, risky behaviors may have significant implications for the overall health status of the community and contribute to health-related economic losses of the community. Health behaviors have multiple determinants that are both internal and external to the individual, family, community, and society. Cognitive Level: Application Associated Chapter Objective: 3 & 4 REF: p. 380

A local health department in the Midwest reports cases of certain diseases to the state health department for inclusion in the National Notifiable Diseases Surveillance System (NNDSS). From the perspective of community-level disease monitoring, which of the following 3-year trends in incidence rates for hepatitis A would be of local, state, and national interest? a. 2012 = 2/100,000; 2013 = 3/100,000; 2014 = 1/100,000 b. 2012 = 4/100,000; 2013 = 8/100,000; 2014 = 6/100,000 c. 2012 = 12/100,000; 2013 = 8/100,000; 2014 = 31/100,000 d. 2012 = 16/100,000; 2013 = 24/100,000; 2014 = 9/100,000

ANS: C In this community's report, the incidence of hepatitis A in 2014 was more than double the incidence in 2012. At the community level, a disease may occur in endemic, epidemic, or pandemic proportions. An epidemic is the occurrence of disease in a community or region at a rate in excess of normal expectations. Although people tend to associate large numbers of cases with epidemics, even one case can be termed an epidemic if the disease is considered to have been previously eliminated. Cognitive Level: Synthesis Associated Chapter Objective: 3 & 5 REF: pp. 291-292

A small business employer desires to control company benefit expenditures by turning health care decision making control over to the employees. The insurance reform mechanism that best addresses the shifting of responsibility, knowledge, and decision making involvement to the individual receiving the care is: a. health spending account. b. managed care. c. medical savings account (MSA). d. prospective payment.

ANS: C MSAs are touted as a way of turning health care decision making control over to the individual receiving care. MSAs are tax-exempt accounts available to individuals who work for small companies, usually established through a bank or insurance company, that enable individuals to deposit money into an MSA on a pretax basis. Interest earned is tax free, and unused MSA money can be held in the account from year to year until it is needed to purchase health care services. This transfers to the individual the responsibility for knowledge and decision making regarding health care cost/quality trade-offs. Cognitive Level: Analysis Associated Chapter Objective: 5 REF: p. 115

The local nurse-managed community health center initiative is providing community-based primary and preventive care as well as specialty care, community screenings, local health assessments, health education, and health care coordination, targeted to medically uninsured individuals regardless of ability to pay. This initiative best describes a system of: a. managed care. b. primary care. c. PHC. d. private health care.

ANS: C Nurse-managed clinics or centers incorporate primary care and public health care; consequently, they provide PHC when the broad range of services focuses on prevention, basic health services, and education and is provided at the community level, typically serving underserved populations.

An example of secondary prevention of infectious disease is: a. malaria chemoprophylaxis. b. Pneumocystis carinii pneumonia chemoprophylaxis for people with AIDS. c. quarantine. d. restaurant inspections.

ANS: C Secondary prevention interventions related to infectious disease prevent the spread of disease. Primary prevention interventions prevent the occurrence of disease, and tertiary prevention interventions reduce the complications and disabilities of disease through treatment and rehabilitation. Secondary prevention activities center on rapid identification of potential contacts of a reported case. Contacts may be identified as new cases and treated or classified as possibly exposed and given appropriate prophylaxis. Public health laws also assist in secondary prevention because they require investigation of certain disease cases and initiation of preventive measures for individuals affected by a reported case or outbreak of communicable disease. These interventions can include quarantine and can be applied to the entire community if the exposure potential is deemed great enough, as could happen with an outbreak of smallpox or epidemic influenza. Cognitive Level: Analysis Associated Chapter Objective: 3 REF: p. 297

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

ANS: C Secondary prevention refers to interventions that promote health and prevent complications of an existing disease, injury, or disability. A prevention intervention at this level is aimed at individuals and groups who have been diagnosed with a disease and have discernible pathology (state of prepathogenesis). Cognitive Level: Analysis Associated Chapter Objective: 4 & 11 REF: p. 269

The major factor that drives the current discussions about a Medicare shortfall in the middle of the twenty-first century is: a. diversity of the U.S. health care workforce. b. longevity of the U.S. population. c. percentage of elderly in the U.S. population. d. percentage of foreign-born in the U.S. population.

ANS: C Seventy-seven million babies were born between the years of 1946 and 1963, giving rise to the often-discussed Baby Boom generation (Centers for Disease Control and Prevention (CDC), 2009). The oldest of these Boomers reached 65 years of age in 2011, and they are expected to live longer than people born in earlier times. The impact on the federal government's insurance program for people 65 years of age and older, Medicare, is expected to be enormous, and this population is expected to double between the years 2000 and 2030, representing 20% of the total population.

A community-oriented nurse wants to design the most effective intervention to reduce CHD morbidity and mortality in a rural area. The program approach should incorporate the strategies of: a. aggregate primary prevention. b. individual-level primary, secondary, and tertiary prevention. c. multilevel intervention with a focus on primary, secondary, and tertiary prevention. d. promotion of optimal health for the individual, family, aggregate, and total community.

ANS: C The Framingham, Alameda, and other studies have shown that effective health promotion must incorporate strategies that deal with all levels in the community—individual, family, aggregate, and total community; that is, they must adopt a multilevel approach. These studies also demonstrate that a program to reduce CHD morbidity and mortality needs to incorporate primary, secondary, and tertiary prevention strategies. An integrated model of community-oriented nursing care reflects the four client systems and multiple foci of care approach. Cognitive Level: Analysis Associated Chapter Objective: 4 REF: pp. 383-384

The goal of the PHC system is to achieve the objective "Health for All in the 21st Century," set forth by the World Health Organization (WHO). The major barrier to achieving this objective in the United States is that: a. global indicators are not applicable to the United States. b. Healthy People 2020 is not consistent with the Declaration of Alma-Ata. c. PHC is not the primary delivery method for health care in the United States. d. the U.S public health system is not structured to provide PHC.

ANS: C The WHO's Declaration of Alma-Ata (1978) identified "Health for All in the Year 2000" as its primary global goal. This was amended in 1998 to "Health for All in the 21st Century." Although the United States, a WHO member nation, has endorsed primary health care as the strategy for achieving the goal of health for all in the twenty-first century, PHC is not the primary delivery method for health care in the United States. This creates a significant barrier to the achievement of that goal, despite the leadership of the U.S. public health system in the Healthy People 2020 initiative.

A client newly diagnosed with HPV infection, herpes simplex virus 2 (HSV-2) infection, and syphilis asks, "Okay, so how do I get rid of all this stuff?" In developing a plan of care, the nurse recognizes that it is essential to address: a. correct use of condoms to prevent transmission of all STDs. b. cures for each of the STDs identified. c. risk of skin-to-skin contact in transmitting the identified STDs. d. safety of sexual contact in the absence of lesions.

ANS: C The client needs to understand which STDs are transmitted by skin-to-skin contact and which are transmitted by body fluids. The client also needs to understand which infections are curable with antibiotics (syphilis) and which are virus infections that are treatable but not curable (HPV, HSV-2 infections). In HSV-2 infection, although the ability to pass the infection is higher when active lesions are present, some individuals can spread the infection even when they are asymptomatic. HPV transmission occurs through direct contact with the warts that result from HPV, but the virus has also been detected in semen, and exposure to the virus through body fluids is also possible. In addition, the challenge of HPV prevention is that condoms do not necessarily prevent infection because warts can grow in areas that are not covered by barriers such as condoms and skin-to-skin contact may occur. Cognitive Level: Synthesis Associated Chapter Objective: 4, 5, & 6 REF: pp. 325-328

A nurse has been newly appointed as commissioner of the state health department services. The programs the nurse will oversee will most likely include: a. administration of Medicare reimbursement rates and eligibility determination. b. programs involving citizens in the local community, including sanitation and communicable disease contact tracing. c. disaster response, health care financing and administration of programs such as Medicaid, and establishment of health codes. d. monitoring of drugs and over-the-counter products available for sale and use by consumers.

ANS: C The public health system at the state level is responsible for standing ready to prevent or respond to disasters, both human caused and natural; overseeing health care financing and the administration of programs such as Medicaid and the State Children's Health Insurance Program; providing mental health and professional education; establishing health codes; licensing facilities and personnel; regulating the insurance industry; and providing direct assistance to local health departments, such as ongoing health needs assessment.

A nurse has worked for years in an intensive care unit and decides to take a position as a community health nurse directing a local public health unit. Her first assignment is to perform an assessment of the community's migrant farmworker population. The nurse's most appropriate next step is to: a. begin the community assessment using a survey tool proven effective in previous public health unit assessments. b. perform a literature review to study assessment data for similar populations. c. enroll in a community health nursing graduate course to learn community research, measurement, and analysis techniques. d. form a relationship with the farmworkers' community leaders and other key informants.

ANS: C Two core functions of community-oriented nursing are assessment and assurance. Both of these core functions have their foundation in the ethical tenets of competency. Nurses assigned to develop community knowledge must be adequately prepared to collect data on groups and populations. The techniques employed differ from those used when caring for individuals. Use of the wrong research techniques leads to wrong assessments, with the potential for developing interventions that harm rather than help the target population. Cognitive Level: Synthesis Associated Chapter Objective: 4 REF: pp. 129-130

Of the four major factors that affect health—personal behavior/lifestyle, environmental factors (physical, social, and economic), human biology, and the health care system—medical services are said to have the least effect. Yet the U.S. health care system remains reactionary, with high-cost, high-technology, and disease-specific "sickness care." These statements support the public health goal of: a. expanding managed care for the underserved. b. expanding secondary prevention in the schools. c. increasing tertiary prevention in skilled nursing facilities. d. preserving and maximizing human capital.

ANS: D Behavior and lifestyle have been shown to have the greatest effect on health, and together with environment and biology accounting for 70% of all illnesses. Yet 97% of health care dollars are spent on secondary and tertiary care. A more proactive investment in disease prevention and health promotion targeted at improving behaviors, lifestyle, and the environment has the potential to improve health status, and thus improve the quality of life while reducing health care costs. The U.S. Department of Health and Human Services has argued that a higher value should be placed on primary prevention with the goal of preserving and maximizing human capital by encouraging health promotion and social practices that result in less disease. Preserving and maximizing human capital will have a profound positive impact on economics in this country. Cognitive Level: Synthesis Associated Chapter Objective: 7 REF: p. 102

A school nurse is teaching a class of sophomores about the relationship between the risk of sexually transmitted disease (STD) and risk-taking behaviors. A key point to include is: a. all STDs are easily preventable with consistent condom use. b. once a young woman is pregnant, she is no longer at risk for most STDs. c. STDs are most likely to be transmitted during a student's initial sexual encounter. d. use of alcohol and drugs makes a student more likely to make decisions that result in exposure to and infection with STDs.

ANS: D Drug use is linked to STD transmission because drugs such as alcohol lower inhibitions and impair judgment about engaging in risky behaviors. Addictions to drugs may cause individuals to acquire the drug or money to purchase the drug by performing sexual favors. This increases both the frequency of sexual contacts and the chances of contracting STDs. Adolescents are particularly at risk. Not all STDs are preventable through condom use. The challenge of preventing human papillomavirus (HPV) infection (genital warts) is that condoms do not necessarily prevent infection because warts may grow in areas that barriers such as condoms do not cover and skin-to-skin contact may occur. Cognitive Level: Application Associated Chapter Objective: 4 & 5 REF: p. 335

An effective community-oriented diabetes program should include: a. access to a certified diabetes educator to teach the client self-management strategies and proper techniques. b. care that incorporates the American Diabetes Association treatment guidelines. c. access to a primary care provider, medication and supplies, and nutritionist consult. d. self-management education, family education, and assurance of affordable clinical care, medication, and testing supplies.

ANS: D From the ecological perspective, community-oriented interventions are directed toward multiple levels of client care: the individual level (self-management) and the environmental level (maximizing environmental resources, including family support and affordable quality care, medication, and testing supplies). Cognitive Level: Analysis Associated Chapter Objective: 1, 3, & 4 REF: pp. 385-386

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

ANS: D In descriptive epidemiology, the components of person, place, and time are used to describe increases or decreases in the frequency of diseases over time. Temporal or spatial patterns that influence long-term changes in morbidity or mortality rates are known as secular trends and may reflect changes in social behavior or practices. Some aspects to be considered are the effects of improved diagnostic capability and changes in survival (case fatality) rather than changes in incidence. The trends in breast cancer have led to a mortality curve that is flatter than the incidence curve. This leads to uncertainty in determining the actual increase in incidence rate, because improved diagnostic capability may explain some but not all of the increase observed. Another area of consideration is changes in case definition or coding of disease in the International Classification of Diseases, because both can produce an artificial change in mortality rates. Cognitive Level: Synthesis Associated Chapter Objective: 5 & 6 REF: p. 275

Although nursing has a strong implicit heritage of ethical values and morality, it was not until the 1960s that several seminal events significantly shifted the focus to ethical decision making processes. One of those seminal events was the emergence of the field of bioethics and the other event was: a. adoption of the ANA's Code for Professional Nurses. b. adoption of the American Public Health Association's Public Health Code of Ethics. c. adoption of the International Council of Nurses' Code of Ethics for Nursing. d. issuance of the ANA's position statement on nursing education in institutions of higher education.

ANS: D In the 1960s, the ANA recommended that all nursing education occur in institutions of higher education; a shift thereby occurred from reliance on inherent ethical tenets and values to the explicit study of ethics and ethical decision making processes. This, in conjunction with the emergence of the field of bioethics, altered the curriculum content of nursing education programs. Cognitive Level: Analysis Associated Chapter Objective: 1 REF: p. 122

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

ANS: D John Snow is considered the father of modern epidemiology because of the methods he used in his groundbreaking work to connect the incidence of cholera with the water supply. Snow showed that households receiving water from one water company, whose intake valve was in an area of the river contaminated by sewage, had a much higher rate of cholera than those receiving water from other companies drawing water from less-contaminated parts of the river. Cognitive Level: Comprehension Associated Chapter Objective: 2 REF: pp. 259-260

The Framingham Heart Study and the Alameda County study are historically important to the development of public health multilevel interventions. Which statement best describes the contribution made by these studies? a. Both focus on urban health risks and interventions to reduce the impact of those risks on the local population b. Both are longitudinal studies that can help community-oriented nurses design interventions to reduce cardiac morbidity and mortality c. Both studies show that young men who cease smoking reduce their risk of coronary disease, even if they develop moderate obesity as they become middle-aged d. Both studies examined personal and environmental factors that influence long-term health outcomes and demonstrate the need for individual and community intervention to reduce morbidity and mortality from preventable disease

ANS: D The Framingham Heart Study examined factors that influence the development of coronary heart disease (CHD). This study led to development of health risk appraisals, predictive risk models, and strategies to reduce CHD risk. The Alameda County study followed a large sample for 4 years to investigate the relationship of social and behavioral factors to mortality. Both studies are highly significant in detecting individual and environmental risk factors for disease and in prompting multilevel community-oriented intervention programs. Cognitive Level: Analysis Associated Chapter Objective: 1 & 3 REF: pp. 383-384

A nurse is working with an established group of parents of children with special needs. Several parents continually express frustration with the health care system and feelings of powerlessness to address their needs. The nurse uses group techniques to validate their experiences and explore options for action. The nurse reacts in this way to conflict within the group because conflict: a. means the group leader must ask the persons causing the conflict to excuse themselves from future meetings. b. means those with the dissenting opinion will change their stand to be more in line with the rest of the group. c. should be avoided. d. supports individual and group growth and change.

ANS: D The groups to which people belong influence health behavior. Through participation with others, meaning is confirmed, confounded, contradicted, or compromised. This is how social reality is created. Nurses frequently use groups to help individuals within a community. When conflict occurs in a group, the resulting tension can help move the group toward its goals. Group members are most effective and productive when conflict is acknowledged and individual concerns are expressed in a manner that respects other members of the group. Effective groups promote collaboration and support expression and resolution of conflict. Cognitive Level: Application Associated Chapter Objective: 3 & 4 REF: pp. 373-374

A low-vision client with very early dementia takes pride in her independence. The client, who lives alone in an apartment, tells her nurse she has always enjoyed using fragranced candles. The most appropriate intervention for the nurse is to apply the principle of: a. autonomy, in which the nurse leaves the matches and candles accessible to the client. b. beneficence, in which the nurse maintains the client's dignity and reinforces to the client how pleasant it is to use scented candles. c. nonmaleficence, in which the nurse counsels the client regarding the dangers of the use of candles and matches by someone with low vision. d. respect for autonomy, in which the nurse recommends to the client an arrangement whereby the caregiver lights the candles when the caregiver is present in the home and removes the matches and candles from the kitchen cabinet.

ANS: D The nurse applies the principle of respect for autonomy. The nurse wants to maintain the client's dignity and quality of life, and to help the client be as independent as possible. But at the same time, the nurse must choose actions that reduce the risk of harm to others. Cognitive Level: Application Associated Chapter Objective: 3 REF: p. 126

Caring and the ethic of care are core values of community health nursing. This ethical view was developed in the mid-1980s and early 1990s in response to the technical advances in the health care sciences and the desire of nurses to: a. apply gender-related voices to moral judgment. b. apply principles of utilitarianism. c. differentiate distributive justice from beneficence. d. differentiate nursing practice from medical practice.

ANS: D The view of caring and the ethic of care that emerged in the mid-1980s and early 1990s was a response to technological advances in science and the desire of nurses to differentiate nursing practice from medical practice. It is closely related to feminist ethics. Cognitive Level: Analysis Associated Chapter Objective: 3 REF: p. 128

ANS: C Access to services and the removal of financial barriers alone do not account for the use of health care services. The introduction of health care technology from developed nations to less-developed nations has led to less than satisfactory results. Attention must be given to the basic needs of less-developed countries and the resources and services that the country can successfully sustain. When the focus is on the public health needs of less-developed countries, the infrastructures of the countries (economic, industrial, and technological) can be encouraged to grow in a sustainable manner. Cognitive Level: Synthesis Associated Chapter Objective: 5 REF: p. 72

A major town in Zaire received a gift of retired intensive care unit monitoring equipment from a large specialty hospital in a developed country. Zaire was grateful for the donation because it would increase the technological capability to treat clients in the local hospital. However, over the next year, the monitors remained unused because personnel were not qualified to operate the monitors and no one was available to maintain or repair the equipment. This best explains the relationship between which two concepts? a. Disease prevention and health care planning b. Education and health promotion c. Global health and global development d. Primary health care and primary care

In developed countries, nurses are often viewed as one of the strongest advocates of primary health care through nursing's social commitment to health care equality. Cognitive Level: Analysis Associated Chapter Objective: 3 REF: p. 67

In developed countries, nurses have an important leadership role in primary health care initiatives. Commitment to which of the following best demonstrates nursing's advocacy role in primary health care? a. Equality of health care b. Higher education for nurses c. Provision of direct client care d. Quality of care

ANS: D The global burden of disease indicator utilizes the unit of disability-adjusted life-year (DALY). This unit measures the combined time lived with a disability and time lost as a consequence of premature death. The time lost because of premature mortality is calculated using standard expected years of life based on gender, whereas the reduction in physical capacity as a result of morbidity (disability) is measured using a six-point scale from 0 (perfect health) to 1 (death) that reflects the degree of dependence of the young and older adults on the adults in the population. The DALY represents life-years lost that could have contributed to the economic growth of a family or country as a consequence of premature death, disability, or loss of caregiver potential productivity/contribution. Cognitive Level: Analysis Associated Chapter Objective: 7 REF: p. 75

Mortality rates do not accurately describe the health status of populations in the world. The World Health Organization (WHO), in 2009, and World Bank, in 2005, developed an indicator—the global burden of disease—that combines losses from premature death with losses of healthy life that result from disability. The indicator represents: a. costs to the world of treating communicable disease in less-developed countries. b. economic cost of preventable early deaths. c. impact of disability on the international economic forecast. d. years in lost contribution to economic growth.

ANS: D The colonias (colonies) are settlements of workers along borders in California, Arizona, New Mexico, and Texas. More than 40,000 Texans live in colonias along the southern Texas border. Environmental conditions in the colonias, such as lack of roads, transportation, water or electrical services, and access to primary care, have resulted in increased preventable infectious diseases (amebiasis, respiratory, and diarrheal diseases), environmental health hazards, and injuries associated with determinants of poverty, poor sanitation, and overcrowded conditions. Cognitive Level: Evaluation Associated Chapter Objective: 10 REF: p. 65

The North American Free Trade Agreement, passed in 1994, allowed increased importation of goods and eased the movement of people throughout the United States, Canada, and Mexico. A health impact of this agreement for southern Texas has included: a. decrease in illegal immigration into the United States as a result of the improved Mexican economy. b. decrease in tuberculosis, cholera, and tetanus as a result of economic development. c. improved nutrition as a result of plentiful fresh vegetables and fruits in local markets. d. increase in respiratory and diarrheal disease as a result of colonias settlements.

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

ANS: A Advocacy begins with the art of influencing others (politics) to adopt a specific course of action (policy) to solve a societal problem and is accomplished by building relationships with appropriate policy makers—the individuals or groups that determine a specific course of action to be followed by a government or institution to achieve a desired end (policy outcome). This can be done in many ways. Types of advocacy include actions on behalf of clients served by nursing, especially vulnerable populations; activities of the nursing profession itself; work to develop needed health policies or revise existing policies; and actions related to the community. Cognitive Level: Analysis Associated Chapter Objective: 5 REF: p. 183

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

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

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

ANS: A Culture is defined as a set of beliefs, values, and assumptions about life that are widely held among a group of people and that are transmitted intergenerationally. Culture is important to nurses because it helps them to understand the beliefs and practices clients bring to the clinical setting, their expression of concerns, and the type of health care they are pursuing. Quality of care means that positive health care outcomes are achieved. Failure to focus care according to the client's values and ideas is likely to increase cost and decrease quality. Care that is not culturally competent may lead to increased cost of health care and decrease the opportunity for positive client outcomes. Techniques such as cultural accommodation can ensure that a positive health outcome is achieved while providing for the cost-effective use of limited resources. Failure of clients to keep scheduled appointments with clinics may reflect a cultural preference for the type and frequency of contact with the health care system. Understanding the type of health care service that the client is seeking can ensure that opportunities to negotiate compliance with treatment can occur to the satisfaction of both parties so that precious resources can be managed effectively. Cognitive Level: Application Associated Chapter Objective: 1 REF: p. 159

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

ANS: A Culture shock is the feeling of helplessness, discomfort, and disorientation experienced by an individual attempting to understand or effectively adapt to a cultural group whose beliefs and values are radically different from those of the individual's own culture. There are cultures in which it is considered acceptable for men to hit their wives and/or children. The nurse can consult with the nursing supervisor or clinic social worker, who can intervene on the client's behalf with the cooperation of a community advocate from the client's culture of origin. Cognitive Level: Application Associated Chapter Objective: 3 REF: p. 158

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

ANS: A Ethnocentrism, an inhibitor to developing cultural competence, is the belief that one's own cultural beliefs are the standards that should be used to judge people from other cultures. Ethnocentric nurses are unfamiliar and uncomfortable with that which is different from their own culture. Their inability to accept different worldviews often leads them to devalue the experiences of others and judge them to be inferior, treating those that are different from themselves with suspicion or hostility. The belief in one's own superiority, or ethnocentrism, may lead to "cultural imposition." Cultural imposition is the act of imposing one's cultural beliefs, values, and practices on individuals from another culture. By developing an approach of "cultural relativism" nurses recognize that clients have different approaches to health care, and that each culture should be judged on its own merit and not on the nurse's personal beliefs. Nurses use "cultural awareness and knowledge" to overcome unfamiliarity and discomfort with cultures outside of their own. Nurses who may have ethnocentric beliefs can avoid inhibiting behaviors/actions such as cultural imposition by developing cultural competence. Cognitive Level: Comprehension Associated Chapter Objective: 3 REF: p. 157

Today, an evidence-based nursing practice can best be defined as which of the following? a. Approach to the integration of the best research available, nursing expertise, and the preferences/values of the clients served b. Concept developed by acute care nurses to ensure the quality of care of hospitalized clients and to challenge managed care decisions c. Concept developed in the early twentieth century to help nurses document the scientific basis of their nursing practice d. Framework supporting the use of traditional research as the only basis for making clinical decisions in practice

ANS: A Evidence-based practice (EBP) was originally adopted by physicians as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual clients. Evidence-based public health is a public health endeavor in which there is informed, explicit, and judicious use of evidence that has been derived using any of a variety of scientific and social science research and evaluation methods. In 2005, Sigma Theta Tau International defined evidence-based nursing as an integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families, and communities who are served. External evidence includes research and other evidence while internal evidence includes the nurse's clinical experiences and client's preferences. Cognitive Level: Application Associated Chapter Objective: 1 REF: p. 343

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

ANS: A Exposing one's foot in public is not considered appropriate in all cultures. In some cultures, it is considered rude to display the sole of the foot. In the scenario described, the nurse should give the group permission to comply or not comply with the previous instructions and proceed with the class. Ideally, a nurse should become familiar with the values of the target population(s) before asking anyone to remove an article of clothing in a group setting. Integrating cultural awareness and knowledge allows the nurse to demonstrate cultural skill in meeting the needs of culturally diverse groups. Cognitive Level: Synthesis Associated Chapter Objective: 1 & 5 REF: pp. 154-155

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

ANS: A Nurses, using sound risk communication skills as trusted communicators, advocate for environmental justice. Ethical issues likely to arise in environmental health decisions are: • Who has access to information and when? • How complete and accurate is the information? • Who is included in the decision making and when? • What and whose values and priorities are given weight in decisions? • How are short-term and long-term consequences considered? Cognitive Level: Analysis Associated Chapter Objective: 6 REF: p. 236

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

ANS: A The Centers for Disease Control and Prevention serve as the national focus for development and application of measures to advance disease prevention and control, environmental health, and health promotion, and for educational activities designed to improve the health of the people of the United States. The mission of the Centers for Disease Control and Prevention is to promote health and quality of life by preventing and controlling disease, injury, and disability. Cognitive Level: Application Associated Chapter Objective: 2 REF: p. 173

Although the definitions of EBP in the literature vary widely, their common thread across all health care disciplines is: a. application of the best available evidence to improve practice. b. definition of what counts as evidence. c. reliance on principles of pathophysiology. d. method of transforming research into practice.

ANS: A The definition of EBP has evolved over the years and across health professions. The current understanding of EBP has identified this term as an approach to integrating all health professions. The underlying principle is that high-quality care is based on evidence rather than on tradition or intuition. Although definitions of EBP vary widely in the literature, the common thread across disciplines is the application of the best available evidence to improve practice. Cognitive Level: Analysis Associated Chapter Objective: 1, 2, & 7 REF: p. 345

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

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

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

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

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

ANS: A The nurse proceeds with a systematic identification and documentation of the culture care beliefs, meanings, values, symbols, and practices of individuals and groups within a holistic perspective, which includes worldview, life experiences, environmental context, ethnohistory, language, and diverse social structure influences. Cultural assessments should focus on those aspects relevant to the presenting problem, necessary intervention, and participatory education. During initial contacts with clients, nurses should perform a general cultural assessment to obtain an overview. In-depth cultural assessments are conducted over a period of time. This gives the nurse and client time to get to know each other and is especially beneficial to the client because it allows the client to see the nurse in a helping relationship. Cognitive Level: Application Associated Chapter Objective: 1 REF: pp. 161-163

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

ANS: D If the nurse suspects that the client's health problem is being influenced by environmental factors, the nurse should follow the nursing process and note the environmental aspects of the problem in every step of the nursing process. For instance, in goal setting, the nurse should include outcome measures that relate to mitigation and elimination of the environmental factors. Cognitive Level: Application Associated Chapter Objective: 3 REF: p. 239

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

ANS: A The profession of nursing will be impacted by new discoveries in molecular genetics in the areas of education, practice, and public health debates. The practice arena impacts are collection and use of health histories, learning and applying innovative biotechnologies, prevention and health education roles, and administration of new therapies. The collection and use of health history information has the greatest impact on the most nurses. Human disease comes from the collision between genetic variations and environmental factors (i.e., social determinants of health) that are often uncovered in individual health histories. Taking a family history is a useful place to begin when considering a genetic connection and prior to the onset of testing. Cognitive Level: Application Associated Chapter Objective: 3 REF: p. 243

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

ANS: A, B, C, D The genetic red flags developed by the NCHPEG provide an excellent tool to determine if an individual or family might be at risk. The primary red flag for the most common diseases is a large number of affected relatives who are closely related. Some of the red flags are family history of multiple affected family members with the same or related disorders, which may or may not follow an identifiable pattern in the family; onset at an early age; condition occurs in the gender that is least expected to have it; disease occurs in the absence of known risk factors; ethnic predisposition to certain genetic disorders; and a close biological relationship between parents. Cognitive Level: Synthesis Associated Chapter Objective: 4 REF: pp. 251-253

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

ANS: A, B, C, D, E Nurses can have a vital role in reducing environmental risk, educating workers and/or the community, and helping to eliminate risks in the local community. As nurses learn more about the environment, opportunities for integration of such work into their practices, educational programs, research, advocacy, and policy work will become evident and will evolve. Cognitive Level: Synthesis Associated Chapter Objective: 5 & 6 REF: p. 238

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

ANS: A, B, C, D, E State laws specify licensure and certification requirements for home health care and hospice agencies. Compliance with these laws is directly linked to the method of payment for the services. For example, a service must be provided by a licensed and state-certified agency to obtain payment from Medicare. Federal regulations implementing Medicare and Medicaid programs have an enormous effect on much of nursing practice, including documentation practices and recording of visits, client care, status, and progress. Other laws focus on issues such as the right to death with dignity, the rights of residents in long-term care facilities, definitions of death and death pronouncement, and the use of livingwills and advance directives. Cognitive Level: Synthesis Associated Chapter Objective: 5 REF: p. 179

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

ANS: A, B, C, D, E The determinants of health identified in Healthy People 2020 influence health status throughout all stages of life and include such things as personal behavior, biology, physical environment, and social environment. Each of these broad areas encompasses multiple factors, and all of the factors listed above influence health status.

A community health nurse is revising the agency's nursing protocols to incorporate current EBP clinical practice guidelines. Common barriers to EBP implementation that could be faced include which of the following? (Select all that apply.) a. Disempowerment of nurses in their ability to make clinical decisions b. Experienced nurses' challenging of the need to change long-accepted practices c. Lack of knowledge of how to conduct a systematic review of the research literature d. Unwillingness of clients to accept changes in familiar agency programs e. Urban agency setting with restricted computer resources

ANS: A, B, D, E Barriers to adopting EBP in the community setting can include miscommunication among nursing leaders about the implementation process; inferior quality of available research or other types of evidence; inability to assess and use evidence; unwillingness of organizations to fund research and make decisions based on research or other evidence; the nurse's ability to make clinical decisions; and certain realities of the practice setting, such as lack of resources for implementation in the setting (time, funding, computer resources, and knowledge), reluctance to accept findings, and resistance to changing long-standing practices. The use of EBP clinical guidelines is one way for nurses to provide evidence-based nursing care in an efficient manner. Clinical practice guidelines usually are developed by groups of experts in the field who have reviewed the evidence (systematic review) and made recommendations based on the best available evidence. This overcomes the need for knowledge on the part of those in practice setting on how to conduct a systematic review of the research literature. Cognitive Level: Synthesis Associated Chapter Objective: 5 REF: p. 346

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

ANS: A, E Biological variations distinguish one racial group from another. These differences may occur in the areas of growth and development, skin color, enzymatic differences, and susceptibility to disease. Research findings suggest that sensitivity to codeine varies with ethnic background. Asian men experience significantly weaker effects from use of the drug than do European men. Asian men are missing an enzyme called CYP2D6 that allows the body to metabolize codeine into morphine, which is responsible for the pain relief provided by codeine. When an individual is missing the enzyme, no amount of codeine will lessen his or her pain, and other pain-reducing medications should be explored. Cognitive Level: Evaluation Associated Chapter Objective: 4, 5 & 6 REF: p. 143

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

ANS: B Culturally competent nursing care includes designing services that are culturally appropriate for the specific client and based on the client's cultural norms and values. The concept of time varies depending on a client's culture of origin. When possible, clinic operating times and scheduling policies should respect the community's preferences. Cognitive Level: Application Associated Chapter Objective: 1 & 5 REF: p. 154

Community-oriented nurses use EBP most effectively when they: a. base care on nationally accepted clinical guidelines, informing clients and community groups that the accepted standards of care need to be universally applied. b. base care on nationally accepted clinical guidelines, involve clients in individual care decisions, and include community input when applying evidence in practice. c. make client care decisions using the latest nursing research findings. d. work with physicians to design client care guidelines for community clinics.

ANS: B EBP uses interventions based on the best available evidence from a variety of sources, including research studies, evidence from nursing experiences and expertise, and evidence from community leaders. EBP also addresses client preferences and values, including clients in decisions, and focuses on developing true partnerships in which power and decision making are shared between health care providers and the community to make culturally and financially appropriate interventions. Cognitive Level: Application Associated Chapter Objective: 3 REF: p. 343

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

ANS: B Each of the government branches at the federal level, in most states, and at the local level plays an important role in developing and implementing health law and public policy. Concerned citizens have many avenues for addressing issues related to needed laws and regulations as well as existing laws and regulations. However, each branch of government has a separate and important function. The legislative branch identifies problems and proposes, debates, passes, and modifies laws to address identified needs. Cognitive Level: Analysis Associated Chapter Objective: 1 REF: p. 177

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

ANS: B Epidemiologic studies enable us to understand the strength of the association between exposures and health effects, such as the relation between air pollution and asthma exacerbation. Cognitive Level: Application Associated Chapter Objective: 1 & 2 REF: p. 222

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

ANS: B Federal, state, and local governments are responsible for carrying out the five core government health care functions. All levels of government provide direct services, but the targeted populations may vary; for example, at the federal level, the focus is on the members and dependents of the military, whereas the states focus on childhood immunizations. The federal government provides funding for health care education and research. The states provide maternal-child health care services through state-level funding for the poor or near poor. Local governments/organizations provide health care services through funding for free clinics that serve the uninsured. All branches and levels of government collect vital statistics and census data, and conduct health surveys. Governments, agencies, and organizations at all levels make health policy. Functions that protect the public, such as monitoring air and water and regulating food, drug, or animal transportation, are carried out at all levels. Affirmation of a woman's right to reproductive privacy occurred at the federal level (Supreme Court). Requiring vaccinations for school entry occurs at the state level. Cognitive Level: Application Associated Chapter Objective: 2 REF: pp. 170-171

A community-oriented nurse seeks to implement EBP in the community clinic's programs. The best model for the nurse to apply is: a. action research and review. b. community development. c. community research utilization. d. EBP.

ANS: B Nurses have an important role to play in developing and using clinical guidelines for community practices. The use of a community development model will ensure that the community's perspective is included. Nurses active in the EBP movement should devote attention to understanding how best to incorporate clinical practice guidelines into a community-oriented practice. Nurses must use caution in adopting EBP in a prescriptive manner in different community environments. When EBP is applied at the community level, best evidence may point to a solution that is not sensitive to cultural issues or distinctions and thus may not be acceptable to the community. Ethical practice in communities requires attention to community differences. Cognitive Level: Synthesis Associated Chapter Objective: 4 & 6 REF: p. 352

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

ANS: B Genomics has influenced the availability of genetic tests which has implications for families. Individuals, families, and communities need to understand the purpose, limitations, and potential benefits and risks of a test before submitting samples for analysis. Genetic testing is now used to predict the development of genetic disorders, screening populations, confirming diagnoses, prenatal testing, and DNA testing to develop and apply individualized medical treatment. Individuals seeking information that might affect decisions and health may also think that testing results would decrease their quality of life and make them anxious about the future. Family members who have had cancer may refuse genetic testing because their insurance carrier does not reimburse for such testing or their deductibles may be too high for such testing. Additionally, people feel that a positive result may lead to a feeling of guilt about passing along a disease to children and grandchildren. Genetic testing decisions are personal and complex and can be controversial, leading to dissonance in families. Cognitive Level: Analysis Associated Chapter Objective: 5 REF: pp. 245-247

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

ANS: B Health policy is a set course of action to obtain a desired health outcome, either for individuals, families, groups, communities, or societies. Policies are made not only by governments but also by institutions such as a health department or other health agency, a family, or a professional organization. Politics plays a role in the development of such policies. Politics is found in families, professional and employing agencies, and governments. Therefore, political activities are used to arrive at a course of action (the policy). Policy is a settled course of action to be followed by a government or institution to obtain a desired end. Cognitive Level: Comprehension Associated Chapter Objective: 4 REF: p. 168

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

ANS: B In 1946, the WHO was created through a United Nations initiative as a special autonomous organization. The WHO provides services worldwide to promote health, cooperates with member countries in promoting their health efforts, coordinates collaborative activities between countries, and disseminates information on biomedical research and vital international statistics. The World Health Assembly (WHA) is the policy-making arm of the WHO and meets annually. The WHA's health policy work provides policy options for many countries of the world in their development of in-country initiatives and priorities. Although WHA policy statements are very important everywhere, they are guides and not law. Cognitive Level: Analysis Associated Chapter Objective: 2 REF: p. 172

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

ANS: B SARA changes included an increase in the size of the trust fund; encouraged greater citizen participation in decision making on how sites should be cleaned up; increased state involvement in every phase of the Superfund program; increased focus on human health problems related to hazardous waste sites; established new enforcement authorities and settlement tools; stressed the importance of permanent remedies and innovative treatment technologies in the cleanup of hazardous waste sites; provided for Superfund actions to consider standards in other federal and state regulations; and established the federal Agency for Toxic Substances and Disease Registry. This act amended the Comprehensive Environmental Response, Compensation, and Liability Act with provisions for a broader community-level involvement and public health mission to address the effects of hazardous waste sites on people. Cognitive Level: Analysis Associated Chapter Objective: 4 REF: p. 235

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

ANS: B The GINA of 2009 protects the public from genetic discrimination by employers or insurers. The act prevents group health plans and health insurers from denying coverage to a healthy individual or charging higher premiums based solely on genetic predisposition to disease. The legislation also prohibits employers from using an individual's genetic information when hiring, firing, or making job placement or promotion decisions. Cognitive Level: Synthesis Associated Chapter Objective: 1 & 5 REF: p. 248

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

ANS: B The burning of fossil fuels to power automobiles and buses and to generate electricity is the single greatest source of air pollution in the United States. While reducing the use of electricity on campus is helpful, the single biggest source of campus air pollution is the cars and buses used to drive to and around campus. Decreasing their use is also an application of the precautionary principle. Cognitive Level: Synthesis Associated Chapter Objective: 1 & 6 REF: p. 226

When a public health nurse (PHN) uses evidence-based interventions to evaluate the effectiveness, accessibility, and quality of population-based services within the community, the nurse is addressing the core public health function of: a. assessment. b. assurance. c. policy development. d. research.

ANS: B The core public health functions of assessment, assurance, and policy development can be addressed through EBP interventions. The core function of assurance can be carried out by monitoring health status to identify community health problems, enforcing laws and regulations that protect health and ensure safety, ensuring the provision of health care that is otherwise unavailable, ensuring a competent public health and personal health workforce, and utilizing EBP to evaluate effectiveness. To successfully implement an EBP, nurses must be knowledgeable about the research and current evidence; have the ability to interpret the meaning of the evidence; be willing to change personal viewpoints about quality and credibility of evidence; and the practice environment must be willing to embrace EBP. Cognitive Level: Analysis Associated Chapter Objective: 3 REF: p. 353

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

ANS: B The stated goals of the Human Genome Project were determining the sequence of the three billion chemical pairs that make up human DNA; storing this information in databases; improving tools for data analysis; transferring related technologies to the private sector; and addressing the ethical, legal, and social issues (ELSI) that may arise from the genome mapping project completed in 2003 that identified 25,000 genes in human DNA. The conceptual vision of the team addressed three overarching themes. The first, "genomes to biology," looks at how the study of genomics would affect the future understanding of biology. The second, "genomes to health," helps to explain the underlying mechanisms for human health and disease including gene-gene, gene to environment, and their interactions. The third, "genomes to society," provides the foundation for research to improve the use and interpretation of genetic information and technologies. Cognitive Level: Analysis Associated Chapter Objective: 2 REF: p. 244

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

ANS: B The term genetics is used to mean the study of the function and effect of single genes that are inherited by children from their parents—in other words, the cause of certain diseases, the genetic link. Genomics refers to the study of individual genes in order to understand the structure of the genome, including mapping of genes and sequencing of DNA. Genomics examines the molecular mechanisms and the interplay of genetic and environmental, cultural, and psychological factors of disease. Genomics deals with the functions and interactions of all genes in an organism and is the study of the total DNA structure. Cognitive Level: Application Associated Chapter Objective: 1 REF: p. 243

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

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

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

ANS: B Understanding the relationship between the environment and human health and disease has become more important over the years. The environment is now known to play a role as a determinant of health status, an explanation of disease, an influence on health risk, and a cause of human toxicity and the ever-increasing burden of potentially toxic synthetic chemicals that our bodies carry. Cognitive Level: Analysis Associated Chapter Objective: 1 REF: p. 227

A community-oriented nurse introduces a community partnership group to the Healthy People 2020 information access objective to use electronic personal health management tools. This is an example of: a. meta-analysis of research evidence. b. primary prevention using EBP. c. secondary prevention using EBP. d. tertiary prevention using EBP.

ANS: B Using resources such as the Healthy People 2020 information access objectives, nurses can identify evidence-based prevention strategies to implement at the community level in their nursing practice and improve clients' understanding of EBP by fostering access to these electronic personal health tools. Cognitive Level: Synthesis Associated Chapter Objective: 4 & 6 REF: p. 351 & p. 352

Randomized controlled trials are often inappropriate for evaluating many public health interventions. The most common approach to establishing evidence in public health is the use of: a. blinded studies. b. case-control studies. c. expert opinion. d. research synthesis.

ANS: B What counts as evidence has been argued in the public health literature. Randomized controlled trials, the gold standard in other areas of EBP, are often inappropriate for evaluating public health interventions because subjects cannot be randomly assigned to treatment and control groups. In public health, a case-control study is most appropriate. Cognitive Level: Application Associated Chapter Objective: 2 & 5 REF: p. 347

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

ANS: B, C Current methods of testing do not detect all of the mutations that can occur in some diseases including hereditary cancer syndrome-related genes. If a mutation is detected, it does not confirm an absolute risk of cancer but a need for high-risk management. Additionally, an inherited syndrome may not be evident for someone from a small family; someone who is adopted; or someone who is not informed about their family's history of disease or cause of death. Most hereditary cancer syndromes are inherited in an autosomal dominant pattern with variable expression and incomplete penetrance (mutation in one member of the gene pair). Both men and women carry, pass on to children, and inherit these mutations. For mutation carriers, the hereditary cancer syndrome can be mild or more severe. Whether cancer ever develops, the site at which it develops, or the seriousness of the cancer can vary among different people with the same mutation, even within the same family. Cognitive Level: Evaluation Associated Chapter Objective: 4 & 5 REF: p. 246

Examples of the application of EBP to improve public health nursing can be found in research projects designed to test the effectiveness of public health nursing interventions related to the core functions and essential services of public health. These projects are associated with: a. Agency on Healthcare Research and Quality. b. Cochrane Database of Systematic Reviews. c. the Intervention Wheel. d. U.S. Preventive Services Task Force.

ANS: C A systematic review of the literature was conducted on three levels of practice and 17 interventions identified in the Intervention Wheel. The sources were rated by members of a practitioner panel and consensus was achieved on the outcomes of the review. These findings were field tested and subsequently critiqued by a national panel of experts providing examined evidence for the use of the model and its relationship to the core functions and essential services of public health. Cognitive Level: Application Associated Chapter Objective: 3 & 6 REF: pp. 351-352

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

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

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

ANS: C Cultural brokering is an action used by nurses in delivering culturally competent care. Cultural brokering is advocating, mediating, negotiating, and intervening between the client's culture and the biomedical health care culture on behalf of the client. Cognitive Level: Synthesis Associated Chapter Objective: 6 REF: pp. 159-160

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

ANS: C Health policy is simply the process of turning health problems into workable action solutions. Thus, the policy process is very similar to the nursing process, but the focus is on the level of the larger society and the adoption of these strategies requires political action. The policy process includes statement of a health care problem, statement of the policy options to address the problem, adoption of a particular policy option, implementation of the policy product, and evaluation of the policy's intended and unintended consequences in solving the original health problem. Cognitive Level: Analysis Associated Chapter Objective: 4 & 5 REF: p. 179

When nurses work with communities, "best practices"—the application of the best available evidence to improve practice—must also be: a. accessible and diverse. b. competent and compliant. c. culturally and financially appropriate. d. reasonable and deliverable in a timely fashion.

ANS: C Nurses in community-oriented practice need to identify culturally and financially appropriate interventions when implementing EBP in work with communities. The use of evidence to determine appropriate interventions that are both culturally sensitive and cost-effective is a necessity to ensure acceptance by the community and appropriate allocation of limited resources. Cognitive Level: Analysis Associated Chapter Objective: 1 & 3 REF: p. 343

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

ANS: C State legislatures enact laws that establish boards of nursing. The functions of the board are described by the nurse practice act of each state. The boards of nursing license nurses, oversee training programs, and interpret and enforce statutory law. Cognitive Level: Application Associated Chapter Objective: 3 REF: p. 177

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

ANS: C The Healthy People initiatives began in 1979 with subsequent updates and revisions across multiple decades. Healthy People 2020 builds on earlier versions to identify a national health agenda to attain quality, longer lives free of preventable diseases, disability, injury, and premature death; achieving health equity, eliminating health disparities and improving health for all groups; creating social environments that promote good health for all; and promoting quality of life, healthy development, and healthy behaviors across all life stages. Cognitive Level: Analysis Associated Chapter Objective: 7 REF: p. 171

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

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

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

ANS: C The nurse understands that in the client's culture, disease is often perceived as a disharmony with other forces, and clients may look to hot or cold treatments to resolve or cure a cancerous condition. Clients may use the mind-body-spirit connection to heal from within. Such cultures rely on naturalistic solutions such as herbs, hot and cold treatments, and acupuncture to resolve or cure a cancerous condition. Cognitive Level: Synthesis Associated Chapter Objective: 4 & 5 REF: p. 145

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

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

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

ANS: D A careful history should be taken using the I PREPARE (Investigate potential exposures, Present work, Residence, Environmental concerns, Past work, Activities, Referrals and resources, Educate) model. The client should be appropriately treated. If an on-site environmental exposure is suspected, other at-risk workers should be screened and treated as needed. The environmental cause should be resolved, either by removing the offending chemical or reducing it to safer levels. Factory safety policies should be followed, reviewed, and changed if needed. State and federal agencies should be notified as required. Cognitive Level: Analysis Associated Chapter Objective: 3 & 6 REF: p. 224

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

ANS: D Dealing effectively with immigrant populations includes learning about how the community deals with common events and what their traditional practices are. In some cultures, it is not the parents but their spiritual leader or a more senior family member who gives a baby its name. Nurses should engage in cultural encounters to learn about a client's culture and practices. Cognitive Level: Application Associated Chapter Objective: 2 REF: p. 155

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

ANS: D Environmental health risks notably have disproportionately affected poor people and people of color in the United States. Low-income citizens and people of color are more likely to live near a hazardous waste site, and increased incidence of childhood lead poisoning and increased rates of childhood asthma are seen in these groups. Environmental justice is the principle of assuring that no group is more at risk of harmful exposure than another. Cognitive Level: Application Associated Chapter Objective: 1 & 6 REF: p. 220

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

ANS: D Environmental health-risk identification and risk-reduction intervention require a multidisciplinary team. The team members needed to address an elevated lead level in a child include a specially trained housing inspector, a sanitarian familiar with lead health risks, a nurse practitioner and/or physician trained to intervene in cases of pediatric lead exposure, and housing specialists trained to reduce lead-based paint risk in the home. Cognitive Level: Analysis Associated Chapter Objective: 2 & 5 REF: p. 222

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

ANS: D Multifactorial diseases or those caused by gene and environment interaction influence disease risk, health conditions, and the therapies used to treat disease. Multifactorial disorders tend to occur in families and include such common inherited congenital malformations as cleft lip and palate, neural tube defects, and congenital heart disease. Cognitive Level: Analysis Associated Chapter Objective: 3 REF: pp. 247-248

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

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

Bilateral organizations or agencies operate within a single country and focus on providing direct aid to less-developed countries. All bilateral organizations are influenced by political and historical agendas that determine which countries receive aid. Incentives for engaging in formal arrangements may include economic enhancements for the benefit of both countries, national defense for one or both countries, or enhancement and protection of private investments made by individuals in these nations. The U.S. Agency for International Development is the largest of these and operates totally outside of the United States. Cognitive Level: Application Associated Chapter Objective: 9 REF: p. 69

The United States is engaged in a formal agreement with Indonesia to provide economic incentives and assistance in national defense in return for the protection of U.S. private investments in that region. Which bilateral organization is most likely involved in this agreement? a. Carnegie Foundation b. United Nations c. U.S. Agency for International Development d. U.S. Department of Defense

The Health for All in the 21st Century initiative is not a single, finite goal, but a strategic process that can lead to progressive improvement in the health of people. In essence, it is a call for social justice and solidarity to improve the economics and infrastructure of nations through a holistic approach to address determinants of health status and increase a community's responsibility for the health of its citizens. This may involve environmental initiatives and health promotion, education, and prevention initiatives aimed at the greater good of the population as a whole instead of serving the interests of individuals or select groups. Cognitive Level: Application Associated Chapter Objective: 2 REF: p. 64

The WHO initiative Health for All in the 21st Century can best be described as which of the following? a. Social justice initiative b. Primary care initiative c. National initiative d. Environmental initiative

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

ANS: A Community-oriented nurses emphasize health promotion, health maintenance, and disease prevention, as well as self-reliance on the part of clients. Regardless of whether the client is a person, family, or group, the goal is to promote health through education about prevailing health problems, proper nutrition, beneficial forms of exercise, and environmental factors such as the safety of food, water, air, and buildings. Cognitive Level: Application Associated Chapter Objective: 2 REF: p. 16

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

ANS C. The scope of practice of public health nurses is population focused and community oriented, with a primary emphasis on population-level interventions that target strategies for health promotion and disease prevention. In addition, public health nursing is concerned with the health of all members of a population or community, particularly vulnerable populations, and uses political processes as a major intervention strategy. Cognitive Level: Synthesis Associated Chapter Objective: 2 REF: p. 10

ANS: B, C, D, E Primary health care in global health is historically based on the Declaration of Alma-Ata (1978). The WHO's and the United Nations Children's Emergency Fund still actively promote primary health care as the strategy for achieving the goal of Health for All in the 21st Century. Several major components are identified for implementation of primary health care: an organized approach to health education that involves professional health care providers and trained community representatives; aggressive attention to environmental sanitation; involvement and training of community health workers; development of maternal and child health programs that include immunization and family planning; initiation of preventive programs aimed at local endemic problems; provision of accessible and affordable services for treatment of common diseases and injuries; availability of chemotherapeutic agents; development of nutrition programs; and promotion and acceptance of traditional medicine. In this example, only three of those components are evident. Cognitive Level: Synthesis Associated Chapter Objective: 1 REF: p. 67

A nurse in Mexico visits a village-based health post in her region to meet with the community volunteer and health committee that operate the health post. They intended to discuss the planning for next year's health promotion initiative and evaluate the recent family planning program. This best demonstrates the aim of the Declaration of Alma-Alta to emphasize which of the following? (Select all that apply.) a. Availability of chemotherapeutic agents b. Development of maternal and child health programs c. Involvement and training of community health workers d. Organized approach to health education e. Promotion and acceptance of traditional medicine

The U.S. public health system is operated at three distinct levels with collaboration and interface across all levels. The agency that assumes the responsibility for regulating health care and overseeing the health status of Americans is the: a. Department of Homeland Security. b. U.S. Department of Health and Human Services (USDHHS). c. local health department. d. state department of health.

ANS: B The USDHHS is the agency most heavily involved with the health and welfare concerns of U.S. citizens. The USDHHS is charged with regulating health care and overseeing the health status of Americans.

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

ANS: D Barriers to implementing population-focused care include lack of understanding of the public health nurse role and its relationship to other roles in nursing, such as direct care and services; workplace role socialization that determines what roles are appropriate and inappropriate or accessible and inaccessible for nurses; and lack of comprehensive training at the graduate level in the disciplines basic to public health such as epidemiology, biostatistics, community development, service administration, and policy formation. Cognitive Level: Synthesis Associated Chapter Objective: 5 REF: pp. 17-18

ANS: C A key to the success of a population health framework is the identification and definition of health issues and of the investment decisions within a population that are guided by evidence about what keeps people healthy. Therefore, a population health approach directs investments that have the greatest potential to influence the health of that population in a positive manner. Cognitive Level: Application Associated Chapter Objective: 2 REF: p. 67

Canada is the leader in promoting a population health framework. Using such a framework, a state health department nurse with budgetary responsibility would determine that funding priorities should focus on: a. chronic disease surveillance and treatment programs. b. pediatric and adolescent primary care and nutrition programs. c. promotion of healthy lifestyles or improvement of social and physical environments. d. well and sick child clinics.

ANS: B Although health problems exist throughout the world, the health care concerns of less-developed countries differ from those of developed countries. Less-developed nations such as Bangladesh, Zaire, Haiti, Guatemala, most countries in sub-Saharan Africa, and the island nation of Indonesia, have more exotic-sounding health problems like Buruli ulcer, leishmaniasis, schistosomiasis, pediculosis, typhus, yellow fever, and malaria as well as the ongoing problems of measles, mumps, rubella, and polio. Current health concerns for developed nations such as the United States, Canada, Japan, the United Kingdom, Sweden, France, and Australia are problems like hepatitis, the appearance of new viral strains such as hantavirus, and large social yet health-related issues such as terrorism, warfare, violence, and substance abuse. AIDS remains a major global concern for all countries, developed or less developed. Cognitive Level: Application Associated Chapter Objective: 6 REF: p. 64

Health problems exist throughout the world. In the United States, a current health concern is the appearance of new viral strains such as Hantavirus in the Southwest. This is an example of the difference in health care concerns between countries such as: a. United States and Canada. b. Sweden and Indonesia. c. Australia and Japan. d. Bangladesh and Zaire.

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