PH Exam 2

assumption 9

public health nursing practice contributes to the achievement of the 10 essential services

Which example contains the components necessary to form an epidemiologic triangle? a. Pesticides, water, food b. Lead, mercury, soil c. Trichloroethylene, water, infants d. Children under 12, elderly, temperature

C The epidemiologic triangle consists of an agent (chemical), host (community consisting of several variants), and environment (air, water, soil,

A nurse collecting morbidity data would refer to which source for applicable information? a. Vital statistics reports b. Birth records c. Death certificates d. Specialized disease registries

D There are many sources of morbidity data (rate of disease incidence), including specialized disease registries. Vital statistics reports, birth records, and death certificates are part of mortality data.

sentinel surveillance systems

Reporting of health events by *health professionals who are selected to represent a geographic area* or a specific reporting group -Can be active or passive Monitoring trends or key health indicators -The sentinel may be a disease, an event, a population Ex: certain providers/agencies in a community may be asked to report the number of cases of influenza seen during a given time to make projections about the severity of the "flu season."

T/F: collaboration is not central to development of a healthy community

false

outcome data

focus on changes in health status. The activities generated by analyses of these data aim to improve public health response systems. Outcome data in this case are the incidence rates (new cases) of influenza among the same population in the same year.

process data

focus on what is done (i.e., services provided or protocols for health care delivery)

secondary prevention

focuses on early identification of individuals or communities experiencing illness, providing treatment, and conducting activities that are geared to prevent worsening health status 1. surveying 2. early detection 3. looking for the prevalence of certain diseases or actions within a group

public policy

government actions affecting all (how it influences the lives of its citizens); all government activities, direct/indirect that can influence the lives of all citizens

confirmed case

have diagnosis with case definition plus lab verification ex. got tested

equity

implies providing accessible services to promote the health of populations most at risk for health problems (e.g., the poor, the young, older adults, minorities, the homeless, and immigrants and refugees)

politics

influencing others to accept a policy

probable case

many factors point to diagnosis but may lack lab verification ex. runny nose and loss of taste (more probable I have COVID)

Multidisciplinary approaches

number of sciences which help explain how pollutants travel through air, water, and soil

types of surveillance systems

passive, active, sentinel, special

assumption 6

public health nurses intervene at 3 levels of practice 1. community (change norms and promote healthy behaviors) 2. system (seeing policies and laws that are in effect) 3. individual (providing education and could be in a group setting; goal= see behavior changes)

assumption 10

public health nursing Practice Is Grounded in a Set of Values and Beliefs

assumption 3

public health nursing practice considers the determinants of health inequities: -age -gender -race -socioeconomic status

assumption 2

public health nursing practice focuses on populations main focus: populations as opposed to individuals

assumption 8

public health nursing practice uses a common set of interventions regardless of practice setting red wedge

assumption 7

public health nursing practice uses the nursing process at all levels of practice 1. assessment 2. diagnosis 3. planning 4. implementation 5. evaluation

appropriate technology

refers to affordable social, biomedical, and health services that are relevant and acceptable to individuals' health, needs, and concerns.

primary health care

refers to meeting the basic health needs of a community by providing readily accessible health services

tertiary prevention

seeks to prevent worsening of crisis

policy

set course of action

health policy

sets actions aimed specifically at healthy outcomes for the individual, group, family, community, or society

suspected case

shows symptoms consistent with outbreak ex. runny nose (suspect I have a cold)

Chemical terrorism

the intentional release of hazardous chemicals into the environment for the purpose of harming or killing (CDC, 2016a; Ryan, 2016).

biological terrorism

the intentional use of microorganisms or toxins derived from living organisms to cause death or disease in humans or the animals and plants on which we depend

Disease surveillance

the ongoing systematic collection, analysis, interpretation, and dissemination of specific health data for use in public health

Epidemiology

the science which helps us understand the strength of association between exposure and health effects

T/F: all systems have feedback loops, where information from one area is fed back to the whole and this feedback provides an opportunity for change or "course correction"

true

T/F: the whole is greater than the sum of the parts- change in one part affects the other parts

true

primary prevention

well populations; prevention of disease; cheapest and effective reaching out to health people and giving them information they need to care for themselves properly

vulnerable populations

those at greater risk for poor health status and healthcare access

The basic science applied to understanding the health effects associated with chemical exposures is: a. Toxicology b. Pharmacology c. Chemistry d. Environmental epidemiology

A Toxicology is the study of the health effects associated with chemical exposures.

toxicology

"the study of poisons" basic science that contributes to our understanding of health effects associated with chemical exposure

point sources of pollution

(identifiable—for example, smokestacks)

non-point sources of pollution

(mobile—for example, cars and trucks)

Surveillance

(n.) a watch kept over a person; careful, close, and disciplined observation

purposes of survelliance

1. Assess public health status. 2. Define public health priorities. 3. Evaluate programs. 4. Stimulate research.

PAHO Healthy Municipalities and Communities Movement (2018)

1. Build a local support group. 2. Know about the Healthy Cities idea. 3. Know the city or community. 4. Gain financial support. 5. Decide where the organization for the project will be located. 6. Develop the proposal. 7. Appoint a project steering committee.

the orange wedge

1. Collaboration 2. Coalition Building 3. Community Organizing

Healthy People 2020 Objectives for Environmental Health

1. Eliminate elevated lead blood levels in children. 2. Minimize risks posed by hazardous sites. 3. Reduce significant pesticide exposures. 4. Reduce the amount of toxic pollutants. 5. Reduce indoor allergen levels. 6. Decrease lead-based paint or related hazards.

Community Health Promotion Model

1. Orient the community to the idea of community health promotion. 2. Build the partnership. 3. Develop a structure in the community for health promotion. 4. Determine who will lead the health promotion work.

3 intervention wheel components

1. Population based (interest or risk) 2. 3 practice levels (community, systems, individual/family) 3. 17 interventions

the red wedge

1. Surveillance 2. Disease and other investigation 3. Outreach 4. Screening

the yellow wedge

1. advocacy 2. social marketing 3. policy development and enforcement

Environmental Exposure by Media

1. air 2. water 3. Waste from industry, pharmaceuticals 4. Storm runoff, erosion, especially due to loss of 80% of the world's forests leading to massive erosion 5. Land and soil 6. Contaminated land designations 7. Highly contaminated 8. Threat designated by the Environmental Protection Agency (EPA) 9. Brownfield site 10. Previously used 11. Now slated for redevelopment 12. Food 13. Pathogenic causes: Escherichia coli, Salmonella; pesticides; genetically modified organisms (GMOs) 14. Environmental causes: pesticides, antibiotics in animals

roles of nurses in environmental health

1. community involvement/public participation 2. individual or population risk assessment 3. risk communication 4. epidemiologic investigations 5. policy development

4 phases of risk assessment

1. determining whether a chemical is known to be associated with neg health effects 2. determining whether a chem has been released into the enviro 3. est how much/what route the chem might enter the human body 4. characterizing risk assessment process taking into account the prev 3 steps

Multidisciplinary approach: key public health professionals

1. food safety specialist 2. sanitarians 3. radiation specialists 4. industrial hygienists

Multidisciplinary approach: Earth sciences that show how pollutants travel

1. geologists 2. meteorologists 3. physicist 4. chemists

the blue wedge

1. health teaching 2. counseling 3. consultation

Environmental health assessments: risk can be categorized as follows-

1. medium (air, water, soil, or food) 2. type (chemical, biological, or radiological) 3. setting (urban, rural, suburban) 4. functional location (home, school, workplace, or community)

important steps and concepts of governmental environmental protection

1. permitting 2. environmental standards 3. compliance 4. monitoring

examples of vulnerable groups

1. poor and homeless 2. pregnant teens 3. migrant workers and immigrants 4. people with mental health problems 5. people who abuse substances 6. people with communicable diseases 7. HIV/AIDS or STIs 8. people who have hepatitis B 9. people who have been incarcerated

the green wedge

1. referral and follow-up 2. case management 3. delegated functions

Models of developing a healthy community

1. successful models (establish priorities after careful assessment and a great deal of community involvement) ex. PAHO Healthy Municipalities and Communities Movement (2018) Community Health Promotion Model--> Institute for Action Research for Community Health/Indiana University (1994)

classifications of cases

1. suspected 2. probable 3. confirmed

Nurses role in providing preventive care for communicable diseases: secondary prevention

1. testing and counseling for HIV 2. post-test counseling 3. partner notification and contact tracing

how many assumptions underly the intervention wheel

10 (made to help or explain the model or framework)

HIV survelliance

2008; confidential reporting of HIV-positive status by name required in all 50 states and the District of Columbia

A school nurse is administering medications at the school. Which of the following guidelines should be followed? a) A current drug reference should be available in case information is needed b) The nurse should administer medications brought in from home by the child c) Medications cannot be administered without a physician order d) Narcotics and controlled substances should be kept in a locked cabinet

A A current drug reference should always be available so that it can be consulted for information.

A nurse considers an audience's ability to read, comprehend, and act on medical instructions while preparing health education materials. Which of the following factors is the nurse considering? a. Health literacy b. Resilience c. Social justice d. Health disparity

A A measure of a patient's ability to read, comprehend, and act on medical instructions is health literacy.Resilience has to do with the factors that allow people to resist the effects of vulnerability. Social justice describes justice with respect to the concepts of egalitarianism and equality. Health disparity refers to the wide variations in health services and health status among certain population groups.

A public health nurse (PHN) uses Assumption 2, "Public health nursing practice focuses on populations," to guide practice. Which of the following would be considered a population of interest? a. Healthy school children b. Homeless individuals c. A person recently diagnosed with diabetes d. Teenage parents

A A population is a collection of individuals who have one or more personal or environmental characteristics in common. Populations of interest are populations that are essentially healthy but could improve factors that promote or protect health; one such population is healthy school children. Homeless individuals and teenage parents would both be considered a population at risk. A person recently diagnosed with diabetes is not a population.

A nurse is completing a disease investigation. Based on the clinical symptoms presented, it is assumed that the individual has measles. However, there has been no laboratory evidence documenting that this individual has the disease. Which of the following types of cases is the nurse investigating? a. A suspected case b. A confirmed case c. A prolonged case d. An identified case

A A suspected case is a clinically compatible case of illness without laboratory confirmation. A confirmed case is a clinically compatible case that is laboratory confirmed by isolation of the organism. A prolonged case and identified case are not types of cases discussed in the text.

A nurse in community health is planning to begin a class to help mothers returning to work better cope with the stresses of multiple roles. The nurse would most likely use: a) an andragogical approach b) a behavioral approach c) an operational approach d) pedagogical approach

A Andragogy is the art and science of teaching adults and individuals with some knowledge about a health-related topic. In the andragogical model, learners influence what they need and want to learn. Learning strategies for children and individuals with little knowledge about a health-related topic are characterized as pedagogy. Various approaches, methods, and tools can be used to evaluate health and behavioral changes. A behavioral or operational approach to educational classes would not be useful in this situation.

One effect of the use of block grants was a: a. reduction of federal expenditures. b. decreased ability of states to spend money on programming. c. guaranteed continuation of programs with demonstrated effectiveness. d. shift from hospital-based to community- based nursing care.

A Block grants enabled financial responsibility to shift from the federal level to the state level, thereby reducing expenditures. Block grants gave additional monies to state and local areas to improve access to care. Block grants have not caused a shift in care from hospital-based to community-based nursing care. Block grants have not guaranteed program continuation.

What information is shared among agencies when they collaborate to implement a quality surveillance system? a. How to use algorithms to identify which events should be investigated? b. Who is to blame for a disease outbreak? c. What shelters will be used and by whom? d. How political action will be necessary to ensure public health?

A Collaboration promotes the development of plans and a directory of emergency responses. How to use algorithms is a key type of information that is shared. Blaming others is not part of collaboration. Determining what shelters will be used and by whom is not the priority for collaboration. How political action will be necessary to ensure public health is not a priority for collaboration.

What levels of practice are encompassed by the Intervention Wheel? a. Communities, individuals and families, and systems b. Assessment, diagnosis, and evaluation c. Primary, secondary, and tertiary d. Communities, populations, and aggregates

A Communities, individuals and families, and systems are the three levels of public healthnursing practice. The other responses do not describe the levels of practice.

The state orders a person newly diagnosed with tuberculosis to be quarantined. Which of the following best describes the type of law that allows the state to do this? a. Constitutional b. Common c. Judicial d. State

A Constitutional law provides overall guidance for selected practice situations. Judicial law is based on court or jury decisions. Common law means that judges are bound by previous decisions unless they are convinced that the older law is no longer relevant or valid. State law is not one of the types of law.

A local health department provides a hypertension screening to all individuals. Which of the following general categories of health care functions is being used? a. Direct services b. Financing c. Information d. Policy setting

A Direct services are actions that provide health care directly to individuals. Financing occurs as the government pays for health care services. Information is used as all branches and levels of government collect, analyze, and disseminate data about health care and health status of the citizens. Policy setting occurs as all branches of government make policy decisions about health care.

What is the purpose of the color-coded wedges on the Intervention Wheel? a. The interventions are grouped together in related wedges. b. The wedges consist of referral information for each wedge. c. The element of health teaching is the predominant feature of each wedge. d. Coalition building must be implemented with each wedge.

A Each wedge consists of related interventions. The other answers describe some of the individual wedges.

A nurse is examining a child in the early stages of HIV infection. Which of the following would the nurse expect to find? a. Failure to thrive and developmental delays b. Kaposi's sarcoma and developmental delays c. Toxoplasmosis and oral candidiasis d. Fatigue and shortness of breath

A Early symptoms of pediatric HIV infection include failure to thrive and developmental delays. Kaposi's sarcoma and oral candidiasis are common opportunistic diseases later in the disease process. Fatigue may be seen in the later stages and is commonly seen inhepatitis and TB.

Which educational method has been shown to be most effective in fostering treatment adherence? a) Internet based education b) In-person counseling c) Telephone counseling d) Self-directed learning

A Educating people through the Internet has been shown to be more effective in fostering treatment adherence than in-person counseling, telephone counseling, or self-directed learning. It is important to be aware that people increasingly are using the Internet as a source of health information. Clients may ask nurses to provide them with information about ways to evaluate the quality and reliability of this information.

The mother of a high school student newly diagnosed with a condition that will require special health care services is concerned that the student will be required to be home-schooled away from the friends he has developed. Which of the following would be the most appropriate response by the school nurse? a) "Federal legislation requires that the school make provisions for those with various challenges, so your child will be able to remain in school as long as he is able." b) "I realize that this will be a difficult adjustment, but home-schooling has improved over recent decades and the Internet will allow your child to connect with friends." c) "Whether your child can remain in school will depend on state funding for those with disabilities. You might want to contact your congressman on this issue." d) "Your child may remain in school as long as he can manage the course requirements and doesn't flunk out."

A Federal legislation specifies that children cannot be excluded from schools because of a disability. The school must provide health services that each child needs. Legislation further requires the school district's committee on the disabled to develop individualized education plans (IEPs) for children.

Which statement about Florence Nightingale's ideas about ethics is correct? a. Nursing is a call to service, and the moral character of persons entering nursing is important. b. Ethical principles are based on the values of the individual nurse. c. Society will dictate the ethical principles to which nurses must adhere. d. Ethics are very important in times of war, such as in the Crimean War, when she set up public health centers

A Florence Nightingale saw nursing as a call to service and viewed the moral character of persons entering nursing as important.

A group of nursing students are scheduled to present a program on healthy hearts to various community groups, with a daycare center being the first location. What of the following advice should be given to them by their instructor? a) Base the program on the audience's development and maturity b) Bring (borrow if necessary) a model of the heart to help explain its functioning c) Focus on entertaining the learners d) Have lots of handouts to reinforce the lesson

A For younger learners, it is important to keep the lesson to no more than 10 minutes in length; to use plenty of examples, pictures, and stuffed animals in the talk; and to remember the developmental stage of the children when teaching them.

HIV transmission can occur through contact with what? a. Contaminated blood b. Insect bites c. Shared eating utensils d. Contaminated toilets

A HIV can be transmitted through exposure to blood. HIV is not transmitted by insect bites, sharing of eating utensils, or toilets.

Which type of hepatitis would likely be found where sanitation is inadequate? a. A b. B c. C d. D

A Hepatitis A would likely be found where sanitation is inadequate. Hepatitis B and C arespread through blood and body fluids. Hepatitis D can only exist in people who are already infected with Hepatitis B.

The school health nurse has enlisted the assistance of high school role models in the areas of sports and scholarship to provide an antidrug presentation to their peers. Which of the following levels of prevention is being implemented? a) Primary b) Secondary c) Tertiary d) Both primary and secondary

A Primary prevention interventions by the school nurse include educating children and adolescents about the effects of drugs. In preventing use, students are taught by the school nurse to stay away from drugs such as marijuana, cocaine, crack, heroin, and alcohol.

7 A's

Awareness Access Availability Affordability Acceptability Appropriateness Adequacy

A unique characteristic of the standards of practice for school nurses is which of the following? a) Alignment with the American Academy of Pediatrics (AAP) guidelines for providing health care to students b) Requirement of bachelor's degrees in nursing and special certification in school nursing c) Restriction on delegation of care to other school personnel d) Use of research findings in the practice of school nursing

A In general, the National Association of School Nurses (NASN) standards align with those developed by the American Academy of Pediatrics (AAP) regarding giving health care to students in the schools. The AAP developed its own ideas about how nurses function in schools based on its assessment of school children's health needs. These guidelines are very similar to those written by the NASN. Additionally, the AAP recommends that the nurse be the head of a health care team that includes a physician (preferably a pediatrician), school counselors, the school psychologist, and members of the school staff including the administrators and teachers.

A public health nurse (PHN) is investigating an outbreak of salmonellosis in a community. Which type of surveillance system is being used? a. Active b. Passive c. Sentinel d. Special

A In the active system, a PHN begins to search for cases through contacts in the community. The nurse names the disease and gathers data about existing cases to try to determine the magnitude of the problem. In the passive system, case reports are sent to local health departments by health care providers. In the sentinel system, trends in commonly occurring diseases or key health indicators are monitored. Special systems are developed for collecting types of data and may be a combination of active, passive, and/or sentinel systems.

A nurse established an ongoing group meeting of teenagers with diabetes. In the early stages, the nurse was very directive in arranging location, providing low-carbohydrate drinks and snacks, steering the discussion, and trying to meet all the teenagers' needs. After the group had been meeting for about 3 months, the nurse noticed that the group members no longer simply accepted everything the nurse suggested. Instead, the teenagers began making decisions themselves, and eventually, the nurse no longer controlled the group. Which of the following most likely happened to cause this shift? a) The group became cohesive enough to share leadership tasks b) Teenagers don't like feeling dependent on adults with power c) Teenagers often rebel against adult authority d) The nurse was overwhelmed and lost control of task process

A In the beginning, the nurse used an authoritarian style because the nurse was responsible for the group direction. However, as the group matured, continuing an authoritarian style would have resulted in low morale and lack of cohesion. After a group is well established, nurses may best facilitate leadership by relinquishing central control and encouraging group members themselves to determine the norms for their group.

A nurse in community health integrates new slides into a presentation that will be given to a local elementary school group regarding the techniques of proper hand washing. The new slides will repeat essential points during the presentation. This demonstrates the nurse's understanding of what principle? a) Repetition b) Integration c) Participation d) Sequencing

A Incorporating repetitive health behaviors into games helps children retain knowledge and acquire skills. When learners are dependent and entering a totally new content area, they may require more pedagogical experiences. Consider both the age of the learner population and their learning needs as you choose either the pedagogical and andragogical principles for the program. In educational programs for children, provide information that matches the developmental abilities of the group.

A nurse would like to implement a primary prevention effort to decrease the leading cause of death among children and teenagers. Which of the following actions would the nurse most likely take? a) Educate students about injury prevention measures b) Provide free condoms to sexually active students c) Screen for signs and symptoms of cancer d) Invite a guest speaker to talk about living with HIV

A Injuries are the leading cause of death in children and teenagers; therefore, prevention measures should focus on injury prevention. Because the question asks for primary prevention efforts, the intervention must occur before injury. Common interventions by the school nurse include educational programs reminding children to use their seatbelts or bicycle helmets to prevent injuries. Other classes can be on crossing the street, water safety, and fire safety.

A nurse is uncomfortable discussing such topics as sexual behavior and sexual orientation when counseling clients and avoids this topic with clients. Which of the following is the most likely outcome of this avoidance? a. Potential risks and risky behaviors will not be identified. b. Transmission of sexually transmitted infections (STIs) will remain unchanged. c. Clients will develop a trusting relationship with health care providers. d. The nurse will be violating the laws in several states.

A It is important that nurses be able to discuss these topics to help prevent and control STIs. Without discussion of these topics, it is possible that clients will not be aware that they have an STI and may transmit it to others. Thus, the transmission of STDs may increase. A trusting relationship with a health care provider may or may not develop and is not dependent on whether these issues are discussed. There are not laws that mandate nurses to discuss sexual behavior and sexual orientation with clients.

Examples of the benefits of distributive justice are: a. Basic needs, material and social goods, liberties, rights, and entitlements b. Taxes, military service, location of incinerators or power plants c. Entitlement to equal rights and equal treatment d. The right to private property and personal assets

A Justice requires that the distribution of benefits and burdens on a society be fair or equal. the third option refers to egalitarianism, and the last option refers to libertarianism. Taxes, military service, and location of incinerators or power plants are not benefits associated with justice.

A nurse is caring for a population that has experienced a health disparity. Which of the following best describes a health disparity? a. Low childhood immunization rates b. High dropout rates c. Unemployment d. Income below poverty level

A Low childhood immunization rates signify a health disparity. High dropout rates, unemployment, and income below poverty level are social conditions that may lead to health disparities.

A nurse applies the ethical principle of non-maleficence when: a. Administering medications using the five rights b. Allowing clients to be active participants in their care c. Providing patient privacy when delivering care d. Referring a client to a physical therapist

A Non-maleficence requires that one do no harm. It requires that health care professionals act according to the standards of due care, always seeking to produce the least amount of harm possible.

A nurse is assisting an employer who has hired an individual who has been recentlydiagnosed with HIV. Which of the following interventions would be most appropriate for the nurse to implement? a. Educate about how to reduce the risk of breaching the employee's confidentiality. b. Explain how to inform coworkers about avoiding HIV transmission. c. Facilitate obtaining medical insurance coverage for the HIV-infected employee. d. Describe the early signs and symptoms of HIV infection

A Nurses frequently work in the education role, and employers may need assistance in dealing with HIV-infected employees. Disclosing a worker's infection to other workers, terminating employment, and isolating an infected worker are examples of situations that have led to litigation between employees and employers. Thus, the priority will be to protect the employer from litigation.

A nurse becomes actively involved in the development of a health policy in the community. Which of the following describes why this is an important role of the nurse? A. Government and policy have a large impact on nursing and health. B. Policy affects nursing values as set forth by Florence Nightingale. C. Political science is a course of study that parallels nursing. D. Nurses must interpret laws to fit their practice.

A Nurses should be advocates for the health of the population. In order to do this, nurse professionals must have a working knowledge of government, health care law, the policy process, and the political forces that are shaping the future of health care. Policy does not affect nursing values. Political science does not parallel nursing. Nurses are unable to interpret laws to fit their practice.

An occupational health nurse maintains a log of injuries from contaminated sharps. Which of the following describes why the nurse must do this? a. Blood-borne Pathogen Standard b. OSHA c. DOL d. DOD

A OSHA is part of the DOL. The Blood-borne Pathogen Standard became effective in 2002. This act clarified the responsibility of employers to select safer needle devices as they become available and to involve employees in identifying and choosing the devices. The updated standard also required employers to maintain a log of injuries from contaminated sharps. The DOD is not involved in these activities.

A public health nurse (PHN) is reviewing Healthy People 2020 to determine where toprioritize programming for the county health department. Based on Healthy People 2020, which of the following areas would the nurse most likely plan to implement programming? a. Reduce the rate of HIV transmission among adults and adolescents. b. Eliminate sexually transmitted diseases (STDs) from developed countries. c. Reduce deaths from gonorrhea. d. Increase awareness about HIV in the LGBTQ population

A One of the Healthy People 2020 objectives is reducing the number of cases of HIV infection among adults and adolescents. Eliminating STDs from developed countries, reducing deaths from gonorrhea, and increasing awareness about HIV among the LGBTQ population are not addressed by Healthy People 2020.

Which is a feature of public health surveillance? a. Sharing of the results with others b. Defining public health policy c. Evaluating interventions d. Planning national programs

A One of the features of public health surveillance is sharing of the results with others. Defining public health policy, evaluating interventions, and planning national programs are all purposes of surveillance, not features.

A public health nurse (PHN) is developing a measurable outcome health status indicator that can be used at the individual level of practice. Which of the following would the nurse likely use? a. A 50-year-old woman receives annual mammograms. b. School absences in a community decline. c. Teachers have increased awareness of health problems. d. Those in poverty utilize the free mammogram program.

A Outcome health status indicators are used to measure the impact of the interventions on population health. In this case, a 50-year-old woman receiving an annual mammogram will have an impact on the population health when considering those who are receiving the screening. The other examples do not look at population health as an outcome or are not occurring at the individual level.

Pelvic inflammatory disease (PID) is a common complication of which sexually transmitted infection (STI)? a. Gonorrhea b. Syphilis c. Chlamydia d. Herpes

A PID is a common complication of gonorrhea. PID is not a common complication of syphilis, chlamydia, or herpes.

Which of the following is most likely to live in poverty? a. Those who work in high-risk jobs b. Those who have adequate nutrition c. Those who effectively manage stress d. Those who live in single family homes

A People who are poor are more likely to live in hazardous environments that are overcrowded and have inadequate sanitation, work in high-risk jobs, have less nutritious diets, and have multiple stressors.

An example of a point source of air pollution is: a. A smoke stack b. The number of cars and trucks c. How much fossil fuel is consumed in a community d. Ground ozone levels

A Point sources of pollution are identifiable sources of air pollution, such as a smoke stack.

A nurse discusses with legislators the importance of passing legislation to ban smoking in all public places. Which of the following is the nurse becoming involved in? a. Policy b. Politics c. Law d. Health policy

A Politics is the art of influencing others to accept a specific course of action. 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. Law is a system of privileges and processes by which people solve problems based on a set of established rules. Health policy is a set course of action to obtain a desired health outcome for an individual, family, group, community, or society.

Why is it important for nurses to understand the premises of environmental health? a. Nurses should be able to assess risks and advocate for policies that support healthy environments. b. Toxicologists often consult nurses about environmental pollutants. c. Pollutant exposures such as lead are reported by nurses to the Environmental Protection Agency. d. Many Americans live in areas that do not meet current national air quality standards.

A Potential risks to health are concerns for professional nurses. It is the responsibility of the nurse to understand as much as possible about these risks: how to assess them, how to eliminate/reduce them, how to communicate and educate about them, and how to advocate for policies that support healthy environments.

A nurse is completing an exposure history using the mnemonic I PREPARE. What data would a nurse collect when asking questions about the first P? a. Present work b. Potential exposures c. Personal protective equipment use d. Problems with health

A Present work is the first P.

A nurse screens blood product, donor organs, and tissues for the hepatitis C infection. Which of the following best describes this nursing action? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion

A Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Screening blood products, organs, and tissues for infection protects the population from exposure to hepatitis C, which prevents them from contracting the disease. Secondary prevention includes screening for diseases to ensure their early identification, treatment, and follow-up with contact to prevent further spread. Tertiary prevention focuses on chronic care and rehabilitation. Health promotion focuses on the primary prevention activities to promote health and prevent disease.

Resilience refers to the: a. resistance of certain groups to risk factors. b. increased susceptibility to cumulative risk factors among vulnerable groups. c. variability in the effects of stressors according to socioeconomic status. d. increased sensitivity of the very young and the very old to risk factors.

A Resilience refers to how vulnerable populations are able to resist or overcome the effects of the vulnerability. These populations do not succumb to the health risks that impinge on them.

A nurse is involved in identifying individuals with unrecognized health risk factors orasymptomatic disease. Which of the following public health interventions is being applied? a. Screening b. Referral and follow-up c. Surveillance d. Health teaching

A Screening involves identifying individuals with unrecognized health risk factors or asymptomatic disease. Referral and follow-up assist individuals, families, groups, organizations, and/or communities to identify and access necessary resources in order to prevent or resolve problems or concerns. Surveillance describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data. Health teaching communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, behaviors, and practices of individuals, families, systems, and/or communities.

A school nurse suggests to teachers that they have a session on coping strategies and stress management techniques. The nurse also sets up a peer counseling program. Which of the following is the school nurse most likely trying to prevent? a) Adolescent suicides b) Bullying c) Obesity d) Teenagers engaging in violence

A Suicide is the third leading cause of death in teenagers. To reduce the incidence of suicide in teenagers, the nurse can emphasize coping strategies and stress management techniques and organize a peer assistance program to help teenagers cope with school stresses.

A nurse is working with a member of the military. Which of the following describes the department that provides this person with health care services? a. Defense b. Labor c. Agriculture d. Justice

A The Department of Defense (DOD) delivers health care to members of the military, including their dependents and survivors, and to retired members and their families. The DOL houses the Occupational Safety and Health Administration (OSHA), which imposes workplace requirements on industries. The Department of Agriculture houses the Food and Nutrition Service, which oversees a variety of food assistance activities. The Department of Justice (DOJ) provides health services to federal prisoners.

A nurse counsels a client to have the enzyme-linked immunosorbent assay (EIA) testWhich of the following best describes the rationale for this test? a. To indicate the presence of the antibody to HIV b. To reveal whether the client has AIDS c. To isolate the HIV virus d. To confirm HIV after having a positive Western blot

A The EIA is used to indicate the presence of the antibody to HIV. To minimize false positive results, the Western blot is used as a confirmatory test to verify the results. The EIA does not isolate the virus, nor does it reveal whether the individual has symptomatic AIDS.

8. Which of the following statements regarding the Health Belief Model is accurate? a) Cues to action are an important component of the model b) Multiple methods of education should be used when implementing this model c) The first stage experienced in this model is the pre-contemplation staged) d) To successfully implement this model, ongoing maintenance of the behavior must be considered

A The Health Belief Model includes six components that attempt to answer the question of what motivates an individual to do something. These components are perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. The pre-contemplation stage is part of the Transtheoretical Model. Maintenance is part of the Precaution Adoption Process Model.

Which statement about the Intervention Wheel is true? a. It provides a graphic illustration of population-based public health practice. b. It describes in detail the components of public health nursing. c. It demonstrates the practice of community health nurses for policy and lawmakers. d. It is a framework used by all health departments in the United States.

A The Intervention Wheel provides a graphic illustration that gives public health nurses(PHNs) a means to describe the full scope and breadth of their practice. The Wheel wasderived from the practice of PHNs and intended to support their work. It gives PHNs ameans to describe the full scope and breadth of their practice. It serves as a model forpractice in many state and local health departments, but not all.

A nurse provides health services for women and children in the community. Which of the following provides the provisions to offer these services? a. Sheppard-Towner Act b. Public Protection of Maternity andInfancy program c. Early Periodic Screening andDevelopmental Testing (EPSDT) program d. Women, Infants, and Children (WIC)program

A The Sheppard-Towner Act also offered well-child and child-development services, provided adequate hospital services and facilities for women and children, and provided grants-in-aid for establishing maternal and child welfare programs. The Sheppard-Towner Act defined the role of the federal government in creating standards to be followed by states in conducting categorical programs, such as WIC and EPSDT programs

A nurse is working with a family who is unable to find adequate health care coverage for the children in the family. Which of the following pieces of legislation will assist in provision of health care coverage for these children? a. Social Security Act b. Balanced Budget Act c. HIPAA d. ACA

A The Social Security Act provides funds to insure currently uninsured children. The Balanced Budget Act shifted payment in home health care. The HIPAA was intended to help people keep their health insurance when moving from one place to another. The ACA of 2010 provides the opportunity for all to purchase health insurance.

Which federal program created support for older and poor Americans? a. Social Security Act b. Medicare Amendment c. Medicaid Amendment d. Hill-Burton Act

A The Social Security Act sought direct payments to eligible individuals to ensure a minimum level of support for people at risk of problems from inadequate financial resources. The Social Security Act encompasses the Medicare and Medicaid Amendment. The Hill-Burton Act provided funding to assist with building hospitals.

The agency most heavily involved with the health and welfare concerns of United States citizens is the: a. USDHHS. b. PHS. c. Health Resources and Services d. Administration.WHO.

A The USDHHS is the agency most heavily involved with the health and welfare of United States citizens. It touches more lives than any other federal agency. The PHS was the first major federal government action relating to health. The Health Resources and Services Administration is part of the USDHHS. The WHO is concerned with access to health care across the world.

A school district in the Midwest has included health education, physical education, health services, nutrition services, and counseling, psychological, and social services as components of the student health services. Additionally, the district has integrated family/community involvement, staff health promotion, and a commitment to a healthy school environment in its program design. This school district has adopted the school health service program scope of which of the following? a) CDC's Federal School Health Program b) Healthy Schools, Healthy Communities program c) Healthy People 2020 d) School-linked program

A The federal government, through the coordination of the CDC, has developed the Federal School Health Program. The plan includes eight parts: health education; physical education; health services; nutrition services; counseling, psychological, and social services; healthy school environment; health promotion for staff; and family/community involvement.

What was the purpose of the Centers for Disease Control and Prevention (CDC) creating the first list of standard case definitions for notifiable diseases? a. Some diseases were underreported, and others were overreported. b. There was no central office to collect data. c. Some people refused to notify officials when diseases were seen. d. No one knew where to report the information that was collected.

A The initial work was done by the CDC because diseases were overreported or underreported. Before this time, state and local health departments used many different criteria for identifying cases of reportable diseases. There was a central office to collect the data and providers knew that this information needed to be reported, but what was being reported by departments was different.

When a school nurse reports suspected child abuse, there is a breach of confidentiality. Which of the following best describes why this breach is allowed? a. Civil immunity b. Sovereign immunity c. Nurse practice act d. Respondeat superior

A The law mandates that a health professional breach patient confidentiality norms to protect someone who may be in a helpless or vulnerable position. Sovereign immunity states that PHN practice has been granted personal immunity to cover all aspects of their practice. The nurse practice act defines the nurse's scope of practice. The doctrine of respondeat superior says that when a nurse is employed and functioning within the scope of that job, the one responsible for that negligence is the nurse's employer.

A second-grade child with cerebral palsy receives services from a physical therapist and occupational therapist during the child's academic day. The school nurse sets up the schedule to ensure that the therapists' visits do not unnecessarily affect the child's academic day negatively. This role of the school nurse is best described as which of the following? a) Case manager b) Counselor c) Consultant d) Direct caregiver

A The school nurse is expected to function as a case manager, helping to coordinate the health care for children with complex health problems. This may include the child who is disabled or chronically ill, who may be seen by a physical therapist, an occupational therapist, a speech therapist, or another health care provider during the school day. The nurse sets up the schedule for the child's visits so that those appointments do not unnecessarily have a negative effect on the child's academic day. Direct caregiver is the traditional role of the school nurse where immediate nursing care is provided. As a consultant, the school nurse can provide professional information about proposed changes in the school environment and their effect on the health of the children. The school nurse as counselor occurs when children go to the nurse to share important health information.

What is implied by the web of causation model? a. Variables interact resulting in higher probability of illness. b. One disease causes another, especially in vulnerable populations. c. The greater the poverty, the more likely people are to have diseases. d. Immunizations are necessary because vulnerable populations spread disease.

A The web of causation model implies that not only are there more variables, but the variables interact, resulting in higher probability of illness. The relative risk for poor health is greater for vulnerable populations.

A nurse providing care using the idea of servicing citizens, not customers is applying the: a. Ethical tenets of policy development b. Basic concepts of the feminist theory c. Underlying premise of virtue ethics d. Components of distributive justice

A There are three tenets of both policy and ethics. The approach is based on the voice of the community as the foundation on which policy is developed.

According to Leininger and Watson, the moral ideal of nursing is: a. Caring b. Advocacy c. Responsibility d. Accountability

A This conceptualization occurred as a response to the technological advances in health care science and the desire of nurses to differentiate nursing practice from medical practice.

A pregnant teen asks the school nurse to provide information on abortion and a list of health care providers who offer such services. If the school nurse has very strong personal beliefs against abortion, which of the following actions should be taken by the nurse? a) Call in another nurse to care for this client b) Explain, from the nurse's perspective, all the reasons that abortion should be made illegal c) Offer the student a combination of oral contraceptives to induce spontaneous abortion d) Provide information on alternatives to abortion and give the client information on adoption agencies

A This creates an ethical dilemma for the nurse. If the nurse feels so strongly that he or she cannot work with the situation, another school nurse should be called for help or the student should be referred to other health providers who can provide the care the student needs.

A neighborhood association group has asked the local nurse in community health for a class on environmental hazards. The nurse in community health has seen good information in the community health text and thinks about getting permission to copy some of the information. The most important thing the nurse should do before using copies of this material is to: a) assess the literacy level of the group b) see how many plan to attend c) see whether the group is ready to learn d) secure a good space for a group meeting

A Two of the most important learner-related barriers are low literacy and lack of motivation to learn information and make needed behavioral changes. Nurses often deal with individuals and populations who are illiterate or who have low literacy levels.One out of every five Americans reads below the fifth-grade level, and one out of every three lacks the literacy needed to understand health care providers. Typically, individuals read three to five grade levels below the last year of school completed. It has been found that most health instructions continue to be written at the 10th grade reading level which is too difficult for almost half of the adult readers in the United States.

When evaluating an educational program, the nurse discovers that only 25% of community members met the learning objectives. Which of the following parts of the program should be improved? a) Educator b) Content c) Learners d) Objectives

A Ultimately, the educator is responsible for the success or failure of the educational process and the development of learner knowledge, skills, and abilities. The educator determines how content can be tailored to the learner. The educator determines the objectives. If evaluation reveals that the learning objectives are not being met, the nurse must determine why the instruction is not effective. The educator is responsible for presenting the material creatively and meaningfully in new ways to increase learner retention and ability to apply the new knowledge.

Which of the following is a characteristic of a vulnerable population? a. Have worse health outcomes and an increased sensitivity to risk factors than the general population b. Have a single risk factor but experience worse health outcomes than the general population c. Have multiple risk factors but equal health outcomes to the general population d. Have worse outcomes with better access to health care than the general population

A Vulnerable population groups are more sensitive to risk factors and have worse health outcomes.Vulnerable populations experience multiple risk factors. Vulnerable populations have worse health outcomes than the general population. Vulnerable populations have more problems accessing health care than the general population.

The school nurse at the intermediate level arranges for a presentation by the trauma educator at the local regional medical center. Bicycle and helmet safety will be the primary topic at the school's open house. This is an example of which of the following school nurse roles? a) Community outreach b) Counselor c) Consultant d) Case manager

A When participating in community outreach, nurses can be involved in community health fairs, reaching others about influenza immunization programs, promoting health education fairs, and coordinating with local charities to provide education to the schools. As a consultant, the school nurse can provide professional information about proposed changes in the school environment and their effect on the health of the children. The school nurse is expected to function as a case manager, helping to coordinate the health care for children with complex health problems. The school nurse as counselor is available to students who need to discuss confidential health matters.

A group of teenagers with diabetes become upset and angry because they cannot agree on whether or not to have meetings during summer vacation. Which of the following should the nurse do to be effective in helping the teenagers resolve the conflict? a) Admit that it is difficult for everyone to agree on everything; then ask whether the group can try to decide how to agree on the issue. b) Assume adult authority and announce that meetings will be suspended until fall. c) Recognize that most of the teenagers want to have the meetings, but two are being stubborn; ask the two deviant members to leave the group. d) Suggest that the group avoid discussing it further but rather think about it over the next week and try to discuss the situation more rationally next week.

A When you respond to conflict by avoiding (suggesting that they avoid further discussion), forcing with power (assuming adult authority), capitulating, or excluding some members (asking the deviant members to leave), the behavior fails to satisfy the concerns of those involved. Open communication and recognition that conflict is inevitable may allow the group to focus on a procedure for fairly resolving the conflict.

A community citizen reports to the public health nurse that the city water in one neighborhood has had an unusual taste for the past few months. Which of the following actions should the nurse take first? A. Check the most recent consumer confidence report. B. Consult the Centers for Disease Control and Prevention. C. Notify the Environmental Protection Agency (EPA). D. Place a call to the poison control center.

A Check the most recent consumer confidence report The consumer confidence report (also known as the right-to-know report) reports the condition of drinking water. Because this is only one citizen, whose sense of taste may be affected by many conditions, it would not be appropriate to overreact by calling in governmental agencies first. Even so, in case one needed to contact an authority, it would be appropriate to start with local governmental agencies such as the city water department rather than federal agencies.

Which of the following actions represents the use of secondary prevention to reduce environmental health risks? A. Collecting blood specimens from preschool children to check for lead levels B. Meeting with local government officials to request that the city clean up a hazardous vacant lot C. Referring a child with toxic lead levels to a neurologist D. Teaching parents of a 2-year-old about the dangers of lead-based paint in older homes

A Collecting blood specimens from preschool children to check for lead levels Secondary prevention refers to actions such as surveillance and screening, which are undertaken so that problems may be detected at early stages.

A city has announced its plans to build a city dump near a community of poor and predominantly African-American citizens. Which of the following principles would the nurse be using when vocalizing opposition for this plan? A. Environmental justice B. Equal rights C. Primary prevention D. Risk protection

A Environmental justice Environmental justice is the goal of campaigns seeking to improve the unequal burden of environmental risks borne by impoverished and minority communities. The Environmental Justice Act would be used in support of the nurse's position.

geographic information systems

A computer system that stores, organizes, analyzes, and displays geographic data. provides a methodology for coding data so that it is related spatially to a place on Earth

A nurse uses the Community Health Promotion Model to address the problem of increasing teenage pregnancy rates in the community. Which of the following steps would be used by the nurse? (Select all that apply.) a. Identifying interest in the topic through use of community forums b. Building a partnership with parents of teenagers to address this problem c. Counseling teenagers about effective birth control methods d. Contacting other cities with similar problems and issues e. Referring teenagers to Planned Parenthood

A, B

What principles were used in the creation of the Healthy Cities movement? (Select all that apply.) a. Primary care b. Equity in health promotion c. Community participation d. High technologic environments e. Relationship building

A, B, C

What are the cornerstones of public health nursing practice? (Select all that apply.) a. Focus on the health of the entire population. b. Reflect community priorities and needs. c. Promote health through strategies driven by epidemiological evidence. d. Are grounded in an ethic of collaboration. e. Provide a framework for ethical decision making.

A, B, C Cornerstones of public health nursing practice focus on the health of the entire population, reflect community priorities and needs, promote health strategies driven by epidemiological evidence, and are grounded in social justice. Nursing is grounded in an ethic of caring.

A public health nurse working with a family living in poverty recognizes that they are more likely to be exposed to environmental hazards because they have (select all that apply): a. Limited funds to pay for health care b. Poor nutrition c. Homes located closer to hazardous waste sites d. Less education

A, B, C Families living in poverty are more likely to experience environmental justice issues such as disproportionate environmental exposures. Sub-standard housing, living closer to hazardous waste sites, working in more hazardous jobs, poorer nutrition, and less access to quality health care all contribute to this issue. Although limited education is related to poverty, it is not discussed as causing an increase in environmental exposure.

A nurse "sets the stage" when assessing members of vulnerable population groups.Which of the following interventions would be completed? (Select all that apply.) a. Creating a comfortable, non-threatening environment b. Providing culturally and linguistically competent assessment c. Collaborating with others as appropriate d. Providing financial and legal advice e. Developing a free clinic in a low-income neighborhood

A, B, C Nurses set the stage by creating a comfortable, non-threatening environment, providing culturally and linguistically competent assessment, and collaborating with others as appropriate. A nurse should not provide financial or legal advice. Developing a free clinic does not "set the stage."

Which of the following activities are included in the Centers for Disease Control and Prevention's school health program? (Select all that apply.) a) Ensuring a healthy school environment b) Assisting teachers with education related to health c) Encouraging nutritious school meals d) Giving immunizations to students, staff, teachers, and their families

A, B, C The federal government, through the coordination of the Centers for Disease Control and Prevention, developed a plan that school health programs should follow, including health education, physical education, health services, nutrition services, counseling, psychological and social services, healthy school environment, health promotion for staff, and family/community involvement. Unfortunately schools cannot afford to give immunizations to everyone who might want such a benefit. Education in areas other than health is the responsibility of the teachers, not the nurse.

A patient tells a nurse, "I know all about this already. I read about it on the Internet." The patient then summarizes what he has learned. Because some of this information seems incorrect, what questions would be effective for the nurse to ask? (Select all that apply.) a) Were you able find what you wanted easily on the website? b) Did the website say when the information was updated? c) Did the website state who was responsible for the information? d) Did you enjoy reading the material on the website?

A, B, C To assess the quality of information, the nurse should attempt to find information about the authors, the purpose of the site (to share information or sell a product?), any available editorial reviews, the date of the material, the design of the site (easy to navigate? well organized?), etc.

According to the Ottawa Charter for Health Promotion, which of the following are included in the areas for health promotion action? (Select all that apply.) a. Creating supportive environments b. Developing personal skills c. Building healthy public policy d. Reorienting health services e. Developing community partnerships

A, B, C, D

Congress's legal base for actions in health care includes which of the following? (Select all that apply.) a. Providing for the general welfare b. Raising funds to support research c. Regulating commerce among the states d. Providing spending powere. Increasing revenue by raising taxes

A, B, C, D The legal base for actions in health care includes providing for the general welfare, regulating commerce among the states, providing spending power, and raising funds to support the military. Increasing revenue is not part of Congress's legal base for actions for health care.

A nurse is conducting an in-service education session on the Centers for Disease Control and Prevention's (CDC's) updates for preventive services for a group of nurses in community health. The nurse would demonstrate the best understanding of the educational process by integrating which planning strategies? (Select all that apply.) a) Use of films b) Small group interaction c) Use of games d) Session timinge- Session space

A, B, C, D, E Many factors influence a person's learning needs and the ability to learn, including the learners' demographic, physical, geographical, economic, psychological, social, and spiritual characteristics. Also consider the learner's knowledge, skills, and motivation to learn, as well as what resources are available to support and possibly prevent learning. Resources include printed, audio or visual materials, equipment, agencies, and other individuals. Barriers for the presenter include lack of time, skill and/or confidence, money, space, energy, and organizational support.

Which of the following are the major sources of air pollution in the United States? (Select all that apply.) A. Burning of fossil fuels B. Waste incineration C. Industrial plants D. Motor vehicles

A, B, D A. Burning of fossil fuels B. Waste incineration D. Motor vehicles Motor vehicles are the greatest single source of air pollution in the United States. The burning of fossil fuels (diesel, industrial boilers, and power plants) and waste incineration are two other major contributors.

Which trends are occurring when providing care for vulnerable populations? (Selectall that apply.) a. Community-based care and interorganizational partnerships b. Outreach and case finding c. Elimination of disparities d. Culturally and linguistically appropriate care e. Increased incidence of acute illnesses

A, B, D Community-based care and interorganizational partnerships, outreach and case finding, and provision of culturally and linguistically appropriate care are all trends to improve care among vulnerable populations.Elimination of disparities is not a trend related to caring for vulnerable populations. Increased incidence of acute illness is not a trend of care provision for vulnerable populations

The ethical tenets that underlie the core function of assessment are (select all that apply): a. Competency: the persons assigned to develop community knowledge are prepared to collect data on groups and populations b. Moral character: the persons selected to develop, assess, and disseminate community knowledge possess integrity c. Service to others over self: a necessary condition of what is good or right policy d. Do no harm: disseminating appropriate information about groups and populations is morally necessary and sufficient

A, B, D Service to others over self is an ethical tenet of policy development. Competency, moral character, and do no harm are the ethical tenets of assessment.

A school nurse describes to teachers the characteristics of an adolescent who may be thinking about drastic violence. Which of the following behaviors would suggest the adolescent was having such problems? (Select all that apply.) a) Being a gang member b) Damaging property c) Leaving the scene if another student is being bullied or hurt d) Mood swings

A, B, D Six characteristics that can help identify a student who may be thinking about drastic violence are (1) Venting: having mood swings; (2) Vocalizing: threatening others; (3) Vandalizing: damaging property; (4) Victimizing: seeing himself or herself as a victim; (5) Vying: belonging to gangs; and (6) Viewing: witnessing the abuse of others. By helping to identify students who might be considering school violence, help may be obtained and violent actions may be prevented.

The CDC accomplishes its mission by: (Select all that apply.) a. Implementing prevention strategies b. Detecting and investigating health problems c. Dictating world health policy d. Fostering safe and healthful environments e. Protecting the population from bioterrorism events

A, B, D The CDC implements prevention strategies, detects and investigates health problems, and fosters safe and healthful environments. The CDC operates within the United States, not worldwide. The Department of Homeland Security is concerned with protecting the population from bioterrorism, not the CDC.

Secondary prevention activities are the largest responsibility of the school nurse and may include which of the following? (Select all that apply.) a) Establishing an emergency plan when a child or staff member needs immediate care b) Giving medications to children during the school day c) Participating in developing an individual education plan (IEP) for students with long-term health needs d) Screening for vision, hearing, height and weight, oral health, TB, and scoliosis e) Teaching standard precautions to all staff

A, B, D, E Secondary prevention involves caring for children when they need care and is the largest responsibility of the school nurse. It may include such activities as caring for ill or injured children or staff (including the development of an emergency plan and appropriate training of staff in standard precautions, first aid, and relevant emergency procedures); screening and assessing children; making appropriate referrals; giving medications; identifying abuse and neglect; communicating with health care providers; preventing suicide and violence; and responding to disasters.

A nurse has been making ongoing visits to a preschool to help the staff teach the children important skills, such as brushing their teeth after meals. Now the nurse is scheduled to teach carbohydrate counting to adults newly diagnosed with diabetes. Which of the following actions will the nurse need to take when teaching this population? (Select all that apply.) a) Appeal to the need for autonomy and choice b) Emphasize that anyone with diabetes must know this information c) Explain how to cope with being a guest at a dinner d) Recognize that this audience will depend on the instructor to set goals for learning

A, C For this audience, the best approach will be to use adult experiences and practical problems as learning motivators—for instance, appealing to adults' sense of autonomy and choice, basing examples on practical adult situations such as cooking meals or eating in restaurants, and discussing how clients can cope with possibly awkward situations such as being a guest at dinner but having diet restrictions.

The nurse is counseling a female who has recently tested positive for HIV. Which of the following will the nurse educate that the client is responsible for? (Select all that apply.) a. Have regular medical evaluations and follow-ups. b. Donate blood and plasma to others who are positive for the disease. c. Inform health care providers about the HIV infection. d. Consider the risk of perinatal transmission. e. Disclose her HIV infection to her employer.

A, C, D A person who is infected with HIV should have regular medical evaluations and follow-up appointments, not donate blood or plasma, inform health care providers about the HIV infection, and consider the risk of perinatal transmission and follow-up with contraceptive use.

Which of the following strategies would a nurse expect to be implemented by a typical state environmental agency? (Select all that apply.) A. Acting, through unannounced inspections, to ensure compliance B. Writing permits that help limit toxic hazards C. Monitoring hazardous substances to uphold established standards D. Obtaining and analyzing samples to confirm compliance

A, C, D A. Acting, through unannounced inspections, to ensure compliance C. Monitoring hazardous substances to uphold established standards D. Obtaining and analyzing samples to confirm compliance The organization and approach to environmental protection vary somewhat among states, but the common essential strategies of prevention and control via the permitting process, establishment of environmental standards, and monitoring, as well as compliance and enforcement, are found in every state.

Which of the following actions would a nurse take when serving as an advocate for the community? (Select all that apply.) A. Asking questions related to health implications at policy meetings B. Calling the local health department to report problems at the hospital C. Serving as a source of information at public meetings D. Volunteering to serve on health-related committees

A, C, D A. Asking questions related to health implications at policy meetings C. Serving as a source of information at public meetings D. Volunteering to serve on health-related committees Advocacy roles of the community-oriented nurse include attending policy meetings to obtain health-related information, holding public meetings (or serving on panels at meetings) to provide health-related information, serving on health-related committees, and informing local media about environmental hazards in the community.

Which of the following characteristics must a learner possess to successfully master psychomotor learning? (Select all that apply.) a) The necessary ability to perform the skill b) An open mind to learning the new skill c) A sensory image of how to perform the skill d) Opportunities to practice the skill

A, C, D Psychomotor learning is dependent on the learners meeting the following three conditions: having the necessary ability including both cognitive and psychomotor ability, having a sensory image of how to carry out the skill, having opportunities to practice the new skill.

Which of the following supplies or equipment should a nurse have available in the school health office? (Select all that apply.) a) Cervical spine collars b) Complete emergency kit that fulfills American Hospital Association requirements c) Epinephrine autoinjector kit d) Material for splints

A, C, D The school nurse needs much equipment to deal with emergencies in the school. Basic necessary equipment includes full oxygen tanks with oxygen masks of different kinds, splints, cervical spine collars, sterile dressings, and an epinephrine autoinjector kit in case a child goes into anaphylactic shock after exposure to an allergen. A hospital-oriented emergency kit would become quickly outdated (medications) and extremely expensive.

Which of the following barriers are specific to the educator? (Select all that apply.) a) Fear of public speaking b) Low literacy c) Limited experience with the topic d) Lack of motivation e) Lack of experience with gaining participation

A, C, E Barriers to learning fall into two broad categories: one concerning the educator and the other concerning the learner. Common educator-related barriers include a fear of public speaking, limited experience with the topic, and lack of experience with gaining participation in the group. Two of the most important learner-related barriers are low literacy and lack of motivation to learn information and make needed behavioral changes.

A new student's parents had not yet submitted an immunization record, although the nurse had sent a reminder home with the student twice. Which of the following actions should be taken by the nurse to keep the child in school? (Select all that apply.) a) Call the parents or mail another reminder b) Report the problem to the teacher and the principal c) Send the child home with a note saying the child cannot return until the immunization record is received d) Suggest to the parents that if they don't have health care insurance, they may qualify for programs that provide immunizations free

A, D There are many problems with children not being immunized or having incomplete vaccination records, especially in families who have moved many times or who may not have a regular physician. The parents may have no idea whether the child has received the required shots. Families may also be without health care insurance to pay for the immunizations, or they may have insurance that does not pay for preventive care. In these cases, they may lack the resources to pay for the immunizations themselves. Therefore, the nurse's role is to be sure parents are aware of the problem, to help them obtain the records if they have been misplaced, and to suggest ways to obtain the injections without charge, even if there is no obvious evidence that lack of funds is the problem. Telling the teacher or principal won't resolve the problem and it is illegal, immoral, and unprofessional to enter false information in a student's record.

health promotion

disease prevention focus on providing community members with a positive sense of health that strengthens their physical, mental, and emotional capacities.

A public health nurse (PHN) is conducting an assessment of the community's health. Which of the following is being accomplished through this activity? a. Define one problem that will be the focus for a year. b. Assess a social network of interacting individuals usually in a defined territory. c. Minimize the effects of health risks and hazards. d. Intervene at the population level by changing laws and regulations.

B A community is defined as a social network of interacting individuals, usually concentrated in a defined territory. The community assessment generally results in a lengthy list of community problems and issues. Intervention and minimization do not take place during the assessment phase.

The SARS (severe acute respiratory syndrome) outbreak was an epidemic that spread over several countries. Which of the following terms describes what happened? a. Hyperendemic b. Pandemic c. Mixed outbreak d. Holoendemic

B A pandemic refers to the epidemic spread of the problem over several countries or continents. If a problem is considered hyperendemic, there is a persistently (usually) high number of cases. A mixed outbreak is a common source followed by secondary exposures related to person-to-person contact. Holoendemic implies a highly prevalent problem found in a population commonly acquired early in life.

A nurse is working with multiple vulnerable groups. Which of the following would be most sensitive to adverse effects? a. Pregnant teenager living with her parents for financial support b. Poor, older woman with no means of transportation c. 2-year-old boy of underinsured parents d. Recently unemployed father of five

B A poor, older woman with no means of transportation has a combination of risk factors. A pregnant teenager, 2-year-old boy, and recently unemployed father are only displaying one risk factor, not multiple risk factors as the older woman displays.

A set of actions one undertakes on behalf of another is: a. social justice. b. advocacy. c. resilience. d. risk.

B A set of actions one undertakes on behalf of another is advocacy. Social justice describes justice with respect to the concepts of egalitarianism and equality. Resilience refers to how vulnerable populations are able to resist or overcome the effects of the vulnerability. Risk describes that some people have a higher probability of illness than others.

The community leaders in a lesser-developed country decide not to tell the citizens of a small village about a chemical spill at a major industrial facility that could produce harmful effects. Which principle are they violating? a. Policy b. Advocacy c. Caring d. Virtue

B Advocacy requires that the community be properly informed, and this was violated in the above scenario.

A disaster has occurred in the community. Which of the following actions should be taken by the school nurse? a) Continue activities as much as possible as if nothing had happened b) Continue to assess for shock and stress c) Help teachers discuss the disaster with their class d) Maintain school routines and activities

B After a disaster, the school nurse has many responsibilities—for instance, continuing to assess the school community for the presence of shock and stress; encouraging parents to minimize how much their children view the disaster coverage on TV; providing grief counseling; continuing to communicate with the children, parents, and school personnel; and following up with assessment of children for anxiety, depression, regression, and posttraumatic stress disorder.

The nurse gives a very informative and engaging presentation and then gives everyone in the audience a handout that outlines the presentation. Later, the nurse discovers that many of the handouts were thrown away before the audience left the building. Which of the following educational principles has the nurse forgotten? a) Audiences expect PowerPoint or video presentations, not lectures. b) Many Americans do not have a high reading level. c) People want photographs and images, not wordy outlines. d) The nurse gave them too much information too fast for them to want to cope with it all.

B Although visual images are certainly helpful, this does not explain why the handouts were discarded. Most health information is printed at a tenth-grade reading level—yet the average U.S. adult reads at the eighth-grade level and 40% of adults over age 65 read below the fifth-grade level. If people cannot read or understand the material, they discard it.

Which core function supports the belief that all Americans should receive basic health care services? a. Assessment b. Assurance c. Policy development d. Advocacy

B Assurance purports that all persons should receive essential personal health services.

Which of the following is the leading cause of children being absent from school because of a chronic illness? a) Allergies b) Asthma c) Diabetes d) Upper respiratory infections

B Asthma is the leading cause of children being absent from school because of a chronic illness. URIs are an acute problem, not a chronic one.

The school nurse has arranged for volunteers to help check each child's hearing and vision. Any child that the volunteers feel did not "pass" will be sent to the nurse for follow-up. The nurse will then send a note to the parents that a physician should be seen. Which of the following levels of prevention is being implemented? a) Primary b) Secondary c) Tertiary d) Both primary and secondary

B Because secondary prevention involves caring for children when they need health care, this is the largest responsibility for the school nurse. This includes caring for ill or injured students and school employees. It also involves screening and assessing children and referral to appropriate health agencies or providers.

A nurse planned a presentation about the latest trends in disaster planning for the senior nursing students at the local college. However, when the nurse began to share the information, the students were talking to one another and essentially ignoring the nurse. Which of the following actions should be taken by the nurse? a) Ask the students why they are being so rude b) Explain why the information is crucial to their current clinical practice c) Nothing; let the instructor of the course handle the problem. d) Tell a joke to get the students' attention

B Before learning can take place, you need to gain the learner's attention. One way to do this is by convincing the learner that the information about to be presented is important and beneficial to them personally.

Environmental health is important to nurses because chemical, biological, and radiological materials are: a. A major cause of global warming b. Often found in the air, water, and products we use c. Frequently linked to the development of chronic illnesses d. Products that nurses work with on a daily basis

B Chemical, biological, and radiological pollutants are often found in the air we breathe, the water we drink, and the products we use.

A public health nurse is working with a migrant farm worker who has experienced an exposure to a pesticide. When researching pesticides, the nurse looks at the family of the chemical. What similarities are found among chemicals that have been placed in the same family? a. Route of entry into the body b. Actions and associated risks c. Effects that they have on the body d. Potency and toxicity

B Chemicals are grouped so its possible to understand the actions and risks associated with each group.

A public health nurse (PHN) is using collaboration, coalition building, and communityorganizing to develop a new program in the community. Which of the following strategies is the nurse most likely using? a. Providing case management, referral, and follow-up services with individuals b. Carrying out collective action at the systems or community levels of practice c. Conducting a community assessment d. Implementing primary and secondary prevention strategies

B Collaboration, coalition building, and community organizing are the interventions oftencarried out at the systems and community levels of practice. These interventions can be used at all levels of prevention. Providing case management, referral, and follow-up services with individuals represents another group of interventions described by the green wedge. These interventions are not part of conducting a community assessment

A nurse is conducting disease surveillance. Which of the following describes the goal for this action? a. Eradicating a disease before it starts b. Establishing a baseline rate of disease occurrence c. Targeting populations for triage d. Reducing the incidence of heart disease in a community

B Disease surveillance helps establish baseline rates of disease occurrence and patterns of spread to make it possible to initiate a rapid response to an outbreak. Disease surveillance is unable to eradicate a disease before it starts, to target populations for triage, or to reduce the incidence of heart disease in a community. However, disease surveillance does make it possible to initiate a rapid response to an outbreak of a disease or an event that can cause a health problem.

A nurse believes everyone is entitled to equal rights and equal treatment in society when applying: a. Distributive or social justice b. Egalitarianism c. Libertarian view of justice d. Communitarianism

B Egalitarianism is defined as the view that everyone is entitled to equal rights and equal treatment in society.

An orderly process that considers ethical principles, client values, and professional obligations is: a. Accountability b. Ethical decision making c. Moral principles d. Code for Nursing Practice

B Ethical decision making is defined as an orderly process that considers ethical principles, client values, and professional obligations.

A nurse in the 1960s would have referred to which code of ethics to guide ethical decision making? a. Nightingale Pledge b. Code for Professional Nurses c. Code of Ethics for Nurses with Interpretive Statements d. International Council of Nurses (ICN) Code of Ethics for Nurses

B Florence Nightingale lived in the 1800s. The Code for Professional Nurses was adopted in 1950, the Code of Ethics for Nurses with Interpretive Statements was adopted in 2001, and the International Council of Nurses (ICN) Code of Ethics for Nurses was adopted in 2000.

A nurse is examining the route of HIV transmission for a newly diagnosed HIV client.Which of the following would most likely be discovered by the nurse? a. Having contact with an HIV-positive individual who is coughing b. An infant receiving breast milk from an HIV-positive mother c. Receiving a mosquito bite while in Africa d. Being near an HIV-positive individual who is sneezing

B HIV can be transmitted through breast milk. HIV is not transmitted by coughing, sneezing, or mosquito bites.

In comparison with HIV infection in adults, what is true concerning HIV infection in infants and children? a. They present with the same signs and symptoms. b. They have a shorter incubation period. c. They experience a longer survival period. d. They are diagnosed using the same tests.

B HIV infection in infants and children has a shorter incubation period. The physical signs and symptoms in children are different and include failure to thrive, unexplained persistent diarrhea, developmental delays, and bacterial infections such as tuberculosis (TB) and severe pneumonia. Detection is made through different tests in infants of infected mothers than from those who are over 18 months. They do not have a longer survival period.

A nurse supported the passage of needlestick legislation. Which of thefollowing best describes the role of employers because of this legislation? a. Use Universal Precautions when dealingwith all patients b. Select safer needle devices as theybecame available c. Provide needle disposal boxes d. Incinerate all infectious waste, including needles

B Health care facilities by law have to select safer needle devices and involve employees in identifying and choosing the devices. The needlestick legislation did not address the use of Universal Precautions, provision of needle disposal boxes, or incineration of all infectious wastes

A community-oriented nurse convenes a support group for teenage mothers. The nurse understands that this strategy fosters cohesiveness among members and allows the members to learn from one another. What other benefit specific to group teaching will be achieved? a) Cultural sensitivity b) Efficiency in client service c) Learning of new skills d) Distraction-free surroundings

B In the education process, one of the important skills for educators to develop in selecting appropriate educational methods is realizing the benefits of group teaching, such as cohesiveness among members, increased number of clients seen, clients learning from one another, and cost effectiveness. Cohesive groups tend to be more productive and able to accomplish their goals; cohesion can be increased as members better understand the experiences of others and identify common ideas and reactions to various issues. Nurses facilitate this process by pointing out similarities, contrasting supportive differences, or helping members redefine differences in ways that make those dissimilarities compatible.

Which of the following is most important for school nurses to master in order to prepare for health care delivery in the future? a) Complementary and alternative therapies such as acupuncture b) Computer and technology use c) Psychoanalytical techniques d) Self-defense techniques

B In the future, school nursing will use telehealth and telecounseling to teach health education. School nurses will use the Internet to work with children and parents.

A nurse practitioner reports a case of gonorrhea to the local health department. Which type of surveillance system is being used? a. Active b. Passive c. Sentinel d. Special

B In the passive system, case reports are sent to local health departments by health care providers. In the active system, the public health nurse may begin a search for cases through contacts with local health providers and health care agencies. In the sentinel system, trends in commonly occurring diseases or key health indicators are monitored. Special systems are developed for collecting types of data and may be a combination of active, passive, and/or sentinel systems.

At the end of each school term, the school nurse schedules an equipment safety assessment of each school playground in the district. The school nurse uses the guidelines of the U.S. Consumer Protection Safety Commission and prepares a report of the findings for the school board for planning purposes. This intervention by the school nurse is an example of which of the following? a) Community outreach b) Primary prevention c) Secondary prevention d) Tertiary prevention

B Injuries are the leading cause of death in children and teenagers. The school nurse educates children, teachers, and parents about preventing injuries. School nurses also provide information on how to prevent playground injuries. They assess school playgrounds for equipment safety on the basis of the U.S. Consumer Product Safety Commission guidelines.

Public health interventions are implemented with: a. legislators, policy makers, and community leaders. b. individuals and families, communities, and systems. c. children, adolescents, and adults. d. health departments, public health agencies, and visiting nurses' associations.

B It is important to know that public health nurses (PHNs) work with individuals and families, communities, and systems. The other answers may have true parts, but the second option lists the overall groups where PHNs are intervening.

States have certain continuing education requirements for persons to renew a nursing license. Which of the following best describes the type of law that is being used? a. Constitutional law b. Legislation and regulation c. Judicial and common law d. Police power

B Licensing is regulated by each state's nurse practice act as a function of the board of nursing. Constitutional law provides overall guidance for selected practice situations. Judicial law is based on court or jury decisions. Common law means that judges are bound by previous decisions unless they are convinced that the older law is no longer relevant or valid. Police power is state power concerning health care. This power allows states to act to protect the health, safety, and welfare of their citizens.

A nurse is using the technique of motivational interviewing when working with a client. Which of the following statements by the client indicates the client is ready to make the change? a) "I should change." b) "I am willing to change." c) "It's important to change." d) "I want to change."

B Motivational interviewing uses the term "change talk" to refer to statements by the client that he or she is motivated and willing to make change. An easy to use mnemonic is "DARN-CAT" which refers to desire, ability, reason, need, activation, commitment, and taking steps. "I am willing to change" demonstrates activation, a client who is ready, prepared, and willing to make the change. The other statements refer to the client who is preparing to make the change, but not yet ready to implement the change.

A nurse is working with a vulnerable group experiencing multiple risk factors. Which of the following best describes this group? a. Smokers who use chewing tobacco as well as cigarettes b. Substance abusers who test positive for HIV c. Persons with limited access to care because they live in a rural area d. New mothers needing information about baby and child care

B Multiple risk factors are present in substance abusers, including contracting HIV and hepatitis B virus.Homelessness is another risk factor. Vulnerable populations of concern to nurses are persons who are poor or homeless, have special needs, pregnant teens, migrant workers and immigrants, individuals with mental health problems, people who abuse addictive substances, persons who have been incarcerated, people with communicable diseases and those who are at risk, and persons who are HIV positive or have hepatitis B virus or STDs.

A doctoral prepared nurse (PhD) at a university wants to submit a grant to study the impact of a nursing activity on patient outcomes. From which of the following federal agencies could this nurse potentially seek funding? a. Centers for Disease Control and Prevention (CDC) b. National Institute of Nursing Research (NINR) c. USDHHS d. WHO

B NINR funds the development of the knowledge base of nursing and promotion of nursing services in health care. The CDC, USDHHS, and WHO do not provide funding specific to nursing research.

Which ethical principle requires doing no harm? a. Respect for autonomy b. Non-maleficence c. Beneficence d. Distributive justice

B Non-maleficence refers to doing no harm.

A nurse promotes alliances among organizations for a common purpose. Which of the following public health interventions is being implemented? a. Health teaching b. Coalition building c. Surveillance d. Referral and follow-up

B One example of coalition building is promoting alliances among organizations for a common purpose. Referral and follow-up assists individuals, families, groups, organizations, and/or communities to identify and access necessary resources in order to prevent or resolve problems or concerns. Surveillance describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data. Health teaching communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, behaviors, and practices of individuals, families, systems, and/or communities.

Which is considered a nonpoint source of pollution? a. Hazardous waste site b. Animal waste from wildlife c. Chlorine poured down a well d. Stagnant water

B Point source means a single place from which the pollutant is released into the environment, whereas nonpoint source implies a more diffuse source of pollution.

Which problem does a health department usually have the legal authority to investigate? a. Pandemics b. Unusual clusters of illness c. World trends of disease d. Cases of the common cold and pneumonia

B Powers of local government include surveillance of unusual clusters of illness. A health department does not have legal authority to investigate pandemics, world trends of disease, and cases of the common cold and pneumonia.

Nurses role in providing preventive care for communicable diseases: primary prevention

education on how to avoid infection

A person recently returning from overseas is diagnosed with Q fever. Which of the following must occur? a. Reporting must occur on the federal level. b. The case must be reported to the state and local health departments. c. The patient must be isolated immediately. d. The patient's immunization record must be reviewed.

B Q fever is on the notifiable list and must be reported to the state and local health departments. Thus, it needs to be reported, but does not imply immediate isolation or an immunization review.

Which statement fits the Liberal Democratic Theory of John Rawls? a. Rejection of any idea that societies, states, or collectives of any form can be the bearers of rights or can owe duties. b. Inequalities result from birth, natural endowment, and historic circumstances. c. Everyone has a right to private property. d. Government should be limited.

B Rawls acknowledges that inequities are inevitable in society, but he tries to justify them by establishing a system in which everyone benefits, especially the least advantaged. This is an attempt to address the inequalities that result from birth, natural endowments, and historic circumstances. The other choices relate to libertarianism.

An urban school-based clinic is located in a school district where many of the children lack health insurance. The school nurse continues to provide screening, assessment, first aid, and record keeping but can refer students who require additional services to the nurse practitioners that staff the school-based health center (SBHC) on the school grounds. The SBHC is federally funded under which of the following? a) CDC's Federal School Health Program b) The Affordable Care Act c) Healthy People 2010 d) School-linked program

B School-based health centers are family-centered, community-based clinics run within schools under a federally funded program. These clinics give expanded health services, including mental health and dental care, in addition to the more traditional health care services. The Affordable Care Act of 2010 appropriated $200 million to improve and expand services at SBHC. They can vary in size, hours, and days of operation, or administrative model (i.e., school clinic, health center, school-linked program). They are successful because they focus on bringing health care services to children in a community school location and are coordinated with the school health program.

Which of the following best describes services that are offered at a school-based health center? a) Employee care at a discounted cost at the school b) Care to others in the community c) Sex education, birth control, family planning, and care throughout pregnancy d) Referral and networking with other health care services in the community

B School-based health centers give care not only to students but also to other persons in the community. They may provide social services, daycare, job training, and educational counseling in addition to the medical and nursing care, mental health counseling, and dental care seen in smaller school-based centers.

A nurse is teaching a client diagnosed with gonorrhea how to prevent reinfection and further spread. Which of the following describes the action taken by the nurse? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Primary health care

B Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Tertiary prevention focuses on chronic care and rehabilitation. Primary health care refers to the first line of care provided to patients typically by a physician or other health care provider.

A nurse is examining social determinants of health. Which of the following is the nurse looking at? a. Ethnicity b. Income c. Gender d. Marital status

B Social determinants of health are such factors as economic status, education, environmental factors, nutrition, stress, and prejudice that lead to resource constraints, poor health, and health risk. Ethnicity, gender, and marital status are not considered social determinants of health.

If a nurse wanted more information on indoor air quality, which website would be most helpful? a. The National Institutes of Health (NIH) b. The American Lung Association c. Right to Know d. The Occupational Safety and Health Administration (OSHA)

B Sources of information about air quality include the Environmental Protection Agency (EPA) and the American Lung Association.

An occupational health nurse works with an employer to develop a workplace wellness program for its employees. Which of the following levels of practice is being implemented? a. Individual b. Systems c. Community d. Government

B Systems level of practice consists of changing laws, policies, and practices that influence population-based issues. The individual level of practice focuses on interventions that involve working with individuals, either singly, or in groups, and with families. Individual level intervention changes knowledge, attitudes, beliefs, practices, and behaviors of individuals. Community level interventions are carried out with the community as a whole. This level of intervention changes community norms, attitudes, awareness, practices, and behaviors. Government is not a level of intervention described by "The Wheel."

Which part of the immunological system suffers the greatest damage resulting from HIV infection? a. Dendrite cells b. CD4+ T-lymphocytes c. Macrophages d. Monocytes

B The CD4+ lymphocytes are severely damaged in HIV infection. In 2008 the case definition for HIV infection was revised to include the HIV classification/staging system based on the number of CD4+ T-lymphocytes. The dendrite cells, macrophages, and monocytes are not as severely damaged as the CD4+ cells are.

A nurse researcher wants to get information on the occurrence of an internationally important disease. Which of the following websites would be the best place to seek this information? a. The United Nations b. The WHO c. The World Bank d. The World Health Assembly

B The WHO publishes day-to-day information about international occurrence of disease, injury, and death. The United Nations deals with human rights, world peace, international security, and the promotion of economic and social advancement of all of the world's people. The World Health Assembly is the WHO's policy-making body. The World Bank provides funding for lesser-developed countries.

How can a community health nurse apply the Ethical Principles for Effective Advocacy? Select all that apply. a. Act in the health care providers best interest. b. Keep the client (group, community) properly informed. c. Maintain client confidentiality. d. Carry out instructions with diligence and competence.

B, C, D Keep the client (group, community) properly informed, maintain client confidentiality, and carry out instructions with diligence and competence are ethical principles for effective advocacy

A nursing student prepares a treatment plan for a client that draws upon the student's understanding of pathophysiology and nursing practice theory learned in the student's coursework. This application of new information used in a different way demonstrates the educational principle of: a) affective domain b) cognitive domain c) events of instruction d) principles of effective education

B The cognitive domain of learning includes memory, recognition, understanding, reasoning, application, and problem solving and is divided into hierarchical classifications of behaviors (i.e., knowledge, comprehension, application, analysis, synthesis, and evaluation). Learners master each level of recognition in order of difficulty. The level of application involves the use of new information in a different way. The affective domain includes changes in attitudes and the development of values. This situation does not demonstrate events of instruction or educational principles.

A nurse is employed by the U.S. Department of Health and Human Services (USDHHS). Which of the following branches of government is the nurse working for? a. Judicial b. Executive c. Legislative d. Health

B The executive branch includes regulatory departments, one of which is the USDHHS. The judicial branch is composed of a system of federal, state, and local courts guided by the opinions of the Supreme Court. The legislative branch is made up of the Senate and the House of Representatives, whose members are elected by the citizens of particular geographic areas. There is not a health branch of the government.

A nurse is applying the steps of surveillance from the Minnesota Model of Public Health Interventions book. Which of the following describes the initial action that the nurse would take? a. Analyze data. b. Consider whether surveillance is appropriate to the situation. c. Evaluate the impact of the surveillance. d. Collect data.

B The first step in this model considers whether surveillance is appropriate. Analyzing data is the fifth step in this model. Evaluation of the impact of the surveillance is the last step of the model. Collecting data is the fourth step in this model.

An upset mother calls the school nurse and says, "How dare you say my child has lice? My child is clean and I keep a clean house! You've obviously made an error." Which of the following would be the best response by the nurse? a) "I'm sorry you're upset, but your child cannot return to school until this problem is addressed." b) "Most lice are found in clean hair. Children often share combs. Let me tell you how to fix the problem." c) "You may have been traveling. Lice are often found in motels." d) "I'm sure you're correct; one of my volunteers probably made an error. I'll recheck."

B The nurse must reassure the mother that no insult was intended; in fact, lice are most often found on middle-class children with clean hair. Lice travel easily when children share items such as combs or other property in school. Lice are not life-threatening, and the necessary shampoo and other items to treat lice are widely available over the counter

When planning, delivering, and financing responsibility for programs is shifted from the federal level to the state level, it is called: a. evolution. b. devolution. c. block granting. d. state administration

B The process of shifting the responsibility for planning, delivering, and financing programs from the federal level to the state level is called devolution. This was a major effort during the Reagan administration. Block grants have increased because of devolution. State administration does not describe this shift of responsibility; rather it describes who is administering the program. Evolution describes how something is gradually developed.

A school health nurse is requested by the board of education to assist in choosing new playground equipment for an elementary school that meets safety standards. Which of the following best describes the nurse's role in this scenario? a) Case manager b) Consultant c) Counselor d) Health educator

B The school nurse is the person best able to provide health information to school administrators, teachers, and parent-teacher groups. As a consultant, the school nurse can provide professional information about proposed changes in the school environment and their effect on the health of the children. The nurse also can recommend changes in the school's policies or ask community organizations to help make the children's schools healthier places.

A middle school student approaches the school nurse and asks, "Can I speak with you about something important?" The school nurse responds affirmatively but should also state which of the following? a) "Anything you tell me will be kept private and confidential." b) "If anything you tell me indicates that someone is in danger, the parents and school officials must be told." c) "It may be best for me to set up an appointment with the school counselor." d) "You can always speak to me if you are in trouble or when you need someone to talk to."

B The school nurse may be the person whom children trust to tell important secrets about their health. The school nurse has a reputation as being a trustworthy person to whom the children can go if they are in trouble or when they need to talk to someone. Nurses in this situation should tell the children that if anything they reveal points out that someone is in danger, the parents and school officials must be told.

Which of the following best describes the primary reason that school health nurses spend so much time on educational programs that teach children the importance of water and fire safety, using a seatbelt in the car, and wearing a helmet when biking or skateboarding? a) Because children won't know if someone doesn't tell them b) Because injuries are the leading cause of death in children and most injuries are preventable c) Because it is a dangerous world and someone has to warn children about the dangers d) Because teaching is easy and more fun than passing out bandages and documenting care

B The school nurse, as the trusted person at school, is able to quickly give information to help prevent injuries from occurring, since most injuries are preventable. Injuries are the leading cause of death in children and teenagers.

When would it be appropriate for a nurse to use a Geographic Information System (GIS)? a. Recording client data collected at a foot clinic b. Determining neighborhoods that have an increased incidence of lead poisoning c. Evaluating effectiveness of a farm safety program d. Scheduling health promotion programs in the community

B The use of a Geographic Information System (GIS) allows the public health nurse to apply the principles of epidemiology into practice. GIS allows nurses to code data so that it is related spatially to a place on earth and is helpful in determining concentrated areas for incidence of disease and illness.

The wide variations in health services and health status between certain population groups are called: a. vulnerable population groups. b. health disparities. c. disadvantaged populations. d. risk markers.

B The wide variations in health services and health status between certain population groups are called health disparities. Vulnerable populations are typically considered to be those who are at greater risk for poor health status and who have poor access to health care. Disadvantaged populations have fewer resources for promoting health and treating illness than does the average person in the United States. Risk describes that some people have a higher probability of illness than others.

Why would a nurse refer to the Code of Ethics for Nurses or the Public Health Code of Ethics? a. To provide answers for ethical dilemmas b. To guide professional practice related to ethics c. To increase moral leadership in ethics d. To find a framework for ethical decision making

B These codes provide general ethical principles and guide personnel in thinking about the underlying ethics of the profession.

A nurse is utilizing the provisions created by the Ryan White HIV/AIDS TreatmentExtension Act. Which of the following interventions is the nurse most likely performing? a. Increasing AIDS awareness in the community b. Determining available health care services for HIV-infected individuals c. Preventing the transmission of AIDS to children from their mothers d. Allowing persons in the final stages of HIV to die with dignity

B This act provides emergency services, services for early intervention and care, and drug reimbursement programs for HIV-infected individuals.

A nurse is educating intravenous (IV) drug users about sharing equipment. Which of the following information would be appropriate for the nurse to include in this education? a. Tell the clients to throw away their equipment after one use. b. Educate the clients on using full-strength bleach on their drug paraphernalia for 30seconds. c. Suggest limiting the number of people who share the equipment. d. Provide clean needles and syringes to whoever wants them.

B Using bleach on the needles and syringes is a way to decrease cross-contamination. This is the last-resort option. People who inject drugs are difficult to reach for health care services, so providing them education is important so that they can protect themselves and others as they most likely will not throw away their equipment or be selective about whom they share their equipment with. Providing needles and syringes does not provide the appropriate education to prevent the spread of disease.

At the annual community health fair, the school health nurse displays a science booth that examines the hazards of ineffective hand washing. Which of the following best describes the nurse's role in this scenario? a) Consultant b) Community outreach c) Counselor d) Researche

B When participating in community outreach, nurses reach out to residents in the community. One common way this occurs is when nurses are involved in activities such as community health fairs or festivals in the schools.

An example of an ethical dilemma is: a. Whether or not to set up a community health center in a rural area b. Allocating resources in a natural disaster c. Deciding to withdraw care on a hospice patient d. Applying the principles of Florence Nightingale in Bangladesh

B When resources are scarce, a dilemma may exist as to how to allocate them

A public health nurse (PHN) is implementing the public health intervention of healthteaching at the systems level of practice. Which of the following interventions is most likely being implemented by the nurse? a. Participating in the "Great American Smokeout" b. Working with a local employer to provide smoking cessation education c. Providing one-on-one counseling to smokers d. Advocating for increased taxes on tobacco products

B Working with a local employer to provide smoking cessation education is the only example of health teaching at the systems level of practice. Participating in the "Great American Smokeout" occurs at the community level and is not health teaching. Providing one-on-one counseling to smokers is health teaching at the individual level of practice. Advocating for increased taxes on tobacco products occurs at the systems level of practice, but it is not health teaching.

A nurse is assessing potential environmental health risks in the community. Which of the following would be the first step that the nurse should take? A. Conduct health risk assessments of randomly selected individuals B. Perform a windshield survey C. Review facility permits and consumer confidence reports D. Survey community members

B Perform a windshield survey Conducting a windshield survey is a useful first step to understanding potential environmental health risks. This provides first-hand information about the community and areas of concern that must be investigated.

Which of the following statements about children and environmental hazards is correct? A. The prevalence of autism is directly related to the increase in environmental toxins. B. Children are more susceptible to environmental toxins because of their smaller size. C. The prevalence of asthma among children has been decreasing. D. Children are more susceptible to cancer if they have a family history of the disease.

B Children are more susceptible to environmental toxins because of their smaller size Because of the smaller size of children, they are exposed to higher doses of pesticide residues in the foods they eat and drink. Autism has increased 1000% since the mid-1980s. However, there is not a direct link to environmental toxins discussed in the text. The prevalence of asthma is at an all time high. Only about 5% of all cancers are strongly associated with heredity.

A nurse wants to find information about environmental threats that are present in the community. Which of the following would be the best source of data for the nurse? A. CINAHL B. National Library of Medicine C. State health department D. Closest local library

B National Library of Medicine Technology helps us understand environmental threats. The National Library of Medicine (NLM) databases are user-friendly and accessible on the Internet. The NLM website provides access to medical databases such as PubMed and GratefulMed, which can be searched for possible environmental linkages to illnesses using key terms.

Which of the following best describes the purpose of local health departments making unannounced inspections of local restaurants? A. To enforce local laws and regulations B. To ensure compliance C. To provide exposure to oversight D. To monitor employee safety

B To ensure compliance Ensuring compliance refers to the process of making certain that permitting requirements are met. Although this activity may be seen as a type of monitoring, the question asks for the purpose, which is to ensure compliance. Enforcement involves penalties such as fines or facility closure.

Which of the following strategies should be used when providing educational programs for children? (Select all that apply.) a) Emphasize how to build learning from previous experiences b) Use simple words to enhance understanding c) Use objects to help increase their attention d) Emphasize the importance of the long-term consequences

B, C When providing educational programs for children, the nurse should use more concrete examples and word choices; use objects or devices to increase attention; incorporate repetitive behaviors into games to help with knowledge retention and acquiring new skills.

assumption 5

emphasis on prevention 1. primary 2. secondary 3. tertiary

Which approach(s) can a nurse use when assessing environmental health risks? Select all that apply. a. Ask legislators to provide a list of environmental pollutants in the area. b. Develop a list of exposures associated with urban, rural, or suburban settings. c. Assess the risk by medium such as air, water, soil, or food. d. Divide the environment into functional locations: home, school, workplace, and community.

B, C, D The 2nd, 3rd, and 4th options are ways a nurse can assess the environment.

A nurse wants to use the principles of risk and outrage to improve an environmental hazard in the community. To accomplish this, which of the following actions would be taken by the nurse? (Select all that apply.) A. Advertise in the media throughout the entire surrounding area. B. Communicate the correct information in a timely fashion. C. Share all the data found on the community assessment. D. Talk to those affected or those worried about the situation.

B, D B. Communicate the correct information in a timely fashion. D. Talk to those affected or those worried about the situation. Sharing all the data would be overwhelming, and much of the data might not be relevant. Using epidemiological statistics would not be meaningful to those without the education or experience to be able to draw an appropriate conclusion. Instead, the correct information must be given in a language the audience—namely, those at risk or worried about the risk—can understand. Use the communication channels the neighborhood residents use and meet at a common meeting place for the community. It is wasteful of resources to advertise in media throughout a wider region or to meet at a central regional facility when only community residents will be interested or involved.

A child has multiple disabilities, and caring for the child has been both expensive and time consuming for the school. Once the child turns 16, which of the following actions should be taken by the nurse? (Select all that apply.) a) As an adult, the child is no longer eligible for school services without charge. b) The school must continue to provide needed appropriate education for the child. c) The school can exclude the child from any extra special activities. d) The school should prepare an updated individualized education plan.

B, D Educational services must be offered by the schools for all disabled children from birth through age 22 years. Children cannot be excluded from activities because of a disability. The school must always develop an individualized education plan for each child and update it at appropriate intervals. Turning 16 does not make a child an adult.

Which of the following best explains why the federal government is beginning to fund school-based health centers? (Select all that apply.) a) These centers help young children avoid becoming addicted to drugs while still in elementary school. b) Attendance and learning are higher in schools with health clinics. c) These centers help keep children in school longer by distributing birth control and thus avoiding pregnancies. d) Many children have no other source of health care services

B, D The U.S. government began funding school-based health centers essentially because many school children may not receive health care services otherwise. These are family-centered, community-based clinics run within the schools. Certainly, avoiding pregnancy and drug addiction are among the goals of school-based health centers, but these are not reasons the government began funding them.

A nurse is writing to a legislator to advocate for funds to support advanced practice nursing education. Which of the following considerations should be made by the nurse? (Select all that apply.) a. Limit the letter to one page in length b. Identify oneself as a nurse c. Provide only factual information d. Share personal knowledge about the issue e. Arrange a face-to-face meeting as soon aspossible

B, D When writing to a legislator, the letter should be a maximum of two pages in length and opinions should be expressed. Additionally, the nurse should identify oneself as a nurse and share knowledge about the issue.

international cooperation

Because health problems transcend international borders, international cooperation is important to ensure health. The principles of primary health care include equity, health promotion, community participation, multisectoral cooperation, appropriate technology, and international cooperation.

A person diagnosed with syphilis presents with signs and symptoms of rash, sore throat, and muscle and joint pain. Which of the following stages of syphilis is the client most likely experiencing? a. Congenital b. Primary c. Secondary d. Tertiary

C A person with signs and symptoms of a rash, sore throat, and muscle/joint pain is experiencing the secondary stage of syphilis. Primary syphilis occurs when the bacteria produce infection in the form of a chancre at the site of entry. Tertiary syphilis usually occurs several years after initial infection and is rare in the United States because the disease is usually cured in its early stages with antibiotics. Congenital syphilis is transmitted transplacentally.

A college student goes to the Student Health Center with an extremely swollen neck where the advanced practice nurse diagnoses the mumps. The student reports that a roommate also is experiencing malaise and a sore throat. Which of the following defines these two students? a. Mixed outbreak b. Common source c. Point source d. Propagated outbreak

C A point source outbreak involves all persons exposed becoming ill at the same time, during one incubation period. A mixed outbreak is a common source followed by secondary exposures related to person-to-person contact. A common source outbreak refers to a group exposed to a common noxious influence such as the release of noxious gases. A propagated outbreak does not have a common source and spreads gradually from person to person over more than one incubation period.

When using the principles of virtue ethics in decision making, a nurse would: a. Provide efficient and effective nursing care. b. Identify the meaningful facts in the situation. c. Seek ethical community support to enhance character development. d. Plan ways to restructure the social practices that oppress women.

C According to Aristotle, virtues are acquired and include interest in the concept of the good, including benevolence, compassion, trustworthiness, and integrity. One part of the process is seeking ethical community support to enhance character development.

A large amount of data related to hypertension rates in a community is collected and analyzed. What is the next step in the surveillance process? a. Collecting data from multiple valid sources b. Evaluating the impact on the surveillance system c. Interpreting the data and disseminating it to decision makers d. Asking political officials to finance a hypertension clinic

C After data is collected and analyzed, the findings must be disseminated. Collection of data is the step described in this scenario and the question asks what must be done next. Evaluating the impact on the surveillance system occurs after dissemination. Dissemination may occur to a broader audience than only political officials.

A nurse who is working in a home care setting attends a local legislative meeting. Which of the following best describes why the nurse needs to be knowledgeable of health policy? a. Provide safe nursing care b. Prevent elder abuse c. Receive payment for the services provided d. Influence future legislation

C Although nurses should be involved in influencing future legislation by contacting their legislators, the best response is that nurses need to be knowledgeable of the current health policies needed so that payment can be received for services they are providing. Health policy does not address safe nursing care provision. Prevention of elder abuse can be part of health policy, but this is not the main reason why nurses should have this knowledge.

A nurse fulfills the environmental health competency of assessment and referral when: a. Advocating for public policy changes b. Understanding policy framework and major pieces of legislation c. Completing an environmental health history d. Describing the scientific principles about environmental health

C Assessment is always an important element of the nursing process. The third option is an example of the assessment phase of the nursing process.

Public health administrators in a community provide a health department to serve an indigent population of immigrants providing translators on certain days of the week. This is an example of: a. Policy b. Quality c. Assurance d. Libertarian philosophy

C Assurance refers to the role of public health in making sure that essential community-oriented health services are available, which may include providing essential personal health services for those who would otherwise not receive them.

What action can a nurse take on an individual level to reduce pollution in the environment? a. Provide a tax incentive to factories that do not pollute. b. Make laws related to allowed levels of pollution in the area. c. Choose a less-polluting car. d. Move to an area with less pollution.

C Citizens can reduce air pollution by doing their part, which can include choosing less-polluting cars.

A social marketing campaign urging community members to avoid driving motorized vehicles after consuming alcohol is implemented in a local community. Which of the following levels of practice is being demonstrated? a. Individual b. Systems c. Community d. Government

C Community level interventions are carried out with the community as a whole. This level changes community norms, attitudes, awareness, practices, and behaviors. It is directed toward entire populations within the community or occasionally toward populations at risk or populations of interest. Individual level intervention changes knowledge, attitudes, beliefs, practices, and behaviors of individuals. Systems level interventions change organizations, policies, laws, and power structures within communities. Government is not a level of intervention described by "The Wheel."

What does each state do with the information that it receives about notifiable diseases? a. Utilizes the information for surveillance purposes. b. Reports the information to the local branch of the World Health Organization (WHO). c. Transmits the data electronically, weekly, to the Centers for Disease Control and Prevention (CDC). d. Stores the information for state use only.

C Data is transmitted weekly to the CDC through the National Electronic Telecommunications System for Surveillance. States need to transmit the information to the CDC rather than only keeping its own records. The reports are sent to the CDC, not to the WHO.

A nurse uses lecturing as the primary method of educating clients. Which part of the education process is missing? a) Evaluation b) Experience c) Participation d) Understanding

C Educators should include participation. (This is one of the six principles of education.) Merely sitting and listening to someone lecture are not as effective as discussion, even when the presentation is stimulating, interesting, and dynamic.

Epidemiology: a. Is a science that studies the poisonous effects of chemicals b. Explains the association between learning disabilities and exposure to lead-based paint at the cellular level c. Helps nurses understand the strength of the association between exposure and health effects d. Is a method for tracking the prevalence of a disease

C Epidemiology studies the incidence and prevalence of disease, helping nurses understand the strength of the association between exposure and health effects.

The nurse has just taught a client newly diagnosed with diabetes how to administer sliding-scale insulin. The most effective way to evaluate learning is to: a) provide an online test module b) ask whether there are any questions c) ask for a return demonstration d) give a short paper-and-pencil quiz

C Evaluation is important in the educational process and the nursing process. You will need to evaluate the educator, the process, and the product. Feedback to the educator provides the educator an opportunity to modify the teaching process and to better meet the learner's needs. The educator may ask for verbal feedback, as well as get nonverbal feedback by using return demonstrations to see what learners have mastered and by observing facial expressions when feedback is being given.

A nurse is found to be negligent. Because of the doctrine of respondeat superior, who is responsible for the negligence? a. Administrator b. Nurse's immediate supervisor c. Nurse's employer d. Nurse

C The doctrine of respondeat superior says that when a nurse is employed and functioning within the scope of that job, the one responsible for that negligence is the nurse's employer. In some instances, if the agency is found liable, the agency may in turn sue the nurse for negligence.

A man says, "I just can't get myself to leave the house and go for a 30-minute walk each day. I wish I could think of some way to motivate myself." Which of the following would be the best action for the nurse to take? a) Establish a written contract between him and his employer that states walking is required each day b) Recognize the reasons why 30 minutes of walking each day is one of the best health promotion activities he can choose c) Join a group that walks early each morning d) Set up rewards for himself, such as a nice snack after he gets back from walking

C Health behavior is influenced by the groups to which people belong. Having someone else to walk with is an effective way to maintain the behavior.

A nursing student is researching various health care services that are provided in prisons. Which of the following describes these services? a. Funded by the DOD b. Focus on health promotion interventions c. Must be provided at an adequate level d. Are available to those diagnosed with a chronic illness

C Health care services for prisoners are required at an adequate level for all incarcerated individuals. This is administered by the DOJ. Prisoners will receive health care services when diagnosed with chronic illnesses as well as acute illnesses.

A nursing student develops a teaching plan about hand washing to present to a group of elementary school children at the local school. Which of the following public health interventions is being implemented? a. Collaboration b. Surveillance c. Health teaching d. Screening

C Health teaching communicates facts, ideas, and skills that change knowledge, attitudes, values, beliefs, and practices of individuals, families, systems, and/or communities. Collaboration commits two or more persons or organizations to achieve a common goal through enhancing the capacity of one or more of the members to promote and protect health. Surveillance describes and monitors health events through ongoing and systematic collection, analysis, and interpretation of health data. Screening involves identifying individuals with unrecognized health risk factors or asymptomatic disease.

A hospital is using surveillance. Which of the following describes the rationale for this action? a. To protect the public against isolated patients b. To eliminate pathogens from the environment c. To improve quality of care and outcomes d. To decrease the incidence of ventilator-acquired pneumonia

C Hospital surveillance is used to improve quality of care and outcomes. Reduction of the incidence of ventilator-acquired pneumonia is one reason why a hospital uses surveillance, but it does not address the entire issue. Hospital surveillance is unable to eliminate pathogens from the environment and cannot protect the public against isolated patients.

A nurse is providing an educational program about testicular self-examination (TSE). Which of the following would be the best learning objective for this program? a) Each participant will state why TSE is important and explain how to do it b) Each participant will describe how to do TSE and discuss the dangers of testicular cancer c) 90% of the men will correctly demonstrate testicular self-examination d) 100% of the men will do a testicular examination correctly on a model

C If the goal is to learn TSE, the best goal is for the person to be able to do TSE correctly. Being able to state why it is important is a helpful first step, as is practice on a model, but to be sure the person can really do the procedure, you need to allow practice time and feedback until the person can demonstrate the procedure properly.

Which of the following statements best explains why many school nurses are not able to ensure that all children receive needed health care in the schools? a) There is a shortage of baccalaureate-prepared nurses with national school health nurse certification b) Most nurses prefer to be employed in hospitals giving direct care c) Most school districts are unable to afford a nurse in every school d) School districts and taxpayers see no need for nurses in schools

C In Healthy People 2020, objective ECBP-5 states that there should be one nurse for every 750 children in each school (U.S. Department of Health and Human Services, 2010). Most schools have not achieved this objective. In 2006, approximately 40% of the nation's schools met that standard. The new objective is that 44.7% of the country's elementary, middle, junior high, and senior high schools have this many nurses by 2020 (U.S. Department of Health and Human Services, 2010). Having fewer nurses in the schools means that the nurses are expected to perform many different functions. It is therefore possible that they are unable to provide the amount of comprehensive care that the students need (Croghan, 2009).

A nurse is sued for malpractice and goes to court. Which of the following types of law is being used? a. Constitutional b. Common c. Judicial d. Institutional

C Judicial law is based on court or jury decisions. Constitutional law provides overall guidance for selected practice situations. Common law means that judges are bound by previous decisions unless they are convinced that the older law is no longer relevant or valid. Institutional law is not a type of law that has particular importance in the United States

The leader of an Alzheimer's support group surveys the members of the group to determine the best time for the group to meet. Which of the following norms is being supported through this action? a) Group norms b) Task norms c) Maintenance norms d) Reality norms

C Maintenance norms create group pressure to affirm members and maintain their comfort. Maintenance behaviors include identifying the social and psychological tensions of members and taking steps to support those members at high-stress times. Maintenance norms often refer to things such as scheduling meetings at convenient times and in an accessible and comfortable space.

A school nurse has developed a special class for pregnant teens to teach them everything from anticipated body changes to methods for managing common pregnancy-associated problems. The classes also allow the nurse to be in close frequent contact with the students to monitor their health status. Which of the following levels of prevention is being used by the nurse? a) Primary prevention b) Secondary prevention c) Tertiary prevention d) Both primary and secondary prevention

C Many teenage girls who are pregnant attend school; therefore, the school nurse may provide ongoing care to the mother. Although this may appear to be secondary prevention, it is tertiary prevention because adolescent pregnancies are considered to be high risk.

Which nursing action demonstrates advocacy? a. Offering a smoking cessation program b. Screening for hypertension c. Lobbying for health care reform d. Conducting home visits

C Nurses should participate in implementing new directions for health care and help envision these new directions. Nurses can be an important voice in advocating for access to consistent, effective, efficient health care for all.

A public health nurse (PHN) is addressing the problem of obesity at the community level of practice. Which of the following nursing diagnoses would be most appropriate for the nurse to use? a. Alteration in nutrition: More than body requirements b. Need for increased knowledge of proper nutrition c. Families at risk for obesity because of inactivity d. Overweight child related to poor dietary habits

C Nursing diagnoses must be modified to meet the needs of population-focused care in public health nursing practice. Families at risk for obesity because of inactivity is the only nursing diagnosis that addresses a community group that is in need of further intervention. The alteration in nutrition and overweight child nursing diagnoses both address the individual level, not the community level. Need for increased knowledge does not identify the level that is being addressed.

There are two medically indigent clients in the clinic who have come to get their monthly supply of free insulin. There is only enough for one client. Which action does the nurse take first? a. Identify all options. b. Make a decision. c. Gather additional information. d. Act and assess decisions made.

C One must have all information before looking at options and making a decision.

A nurse is using surveillance to collect outcome data. What information would most likely be collected? a. Number of clinic services which use evidence-based protocols b. Proportion of the population vaccinated against influenza c. Incidence of breast cancer in the population d. Probability of a bioterrorism attack occurring in the community

C Outcome data focus on change in health status; incidence rates are one example of this type of information. Process data focus on what is done, such as services provided or protocols for health care delivery. An example of process data is collection of data about the proportion of the eligible population vaccinated against influenza in any 1 year.

A public health nurse (PHN) utilizes the nursing process at all levels of practice. Which of the following demonstrates how this is accomplished? a. Including specific goals for community health nurses b. Developing an accurate nursing diagnosis c. Analyzing the needs of the community, systems, individuals, and families d. Utilizing primary, secondary, and tertiary prevention

C PHNs must customize the nursing process to consider the community, systems, andindividual/family levels of practice. The levels of practice are not used for developingnursing diagnoses or goals. The levels of practice are not demonstrated utilizing the levels of prevention.

A nurse is addressing the problem of air pollution in the community. The first step in the process of controlling the pollution would be: a. Setting standards b. Monitoring c. Permitting d. Compliance

C Permitting is a process by which the government places limits on the amount of pollution emitted into the air or water.

A community health nurse visits a homeless shelter to provide directly observed therapy (DOT) to several clients who have been diagnosed with TB. Which of the following best describes the rationale for this nursing intervention? a. Homeless clients do not care about their health. b. Homeless clients do not have access to medications. c. Poor adherence can result in drug resistance. d. These medications are so powerful, clients must be observed for reactions.

C Poor adherence has led to antibiotic-resistant strains. These clients may care about their health but may have difficulty adhering to the treatment regimen. Medications to treat TB are available to the homeless population. The concern with the antimicrobial treatment is with non-adherence, not with side effects.

A nurse is developing a one-stop service to meet the needs of a vulnerable group. Which of the following would the nurse most likely create? a. Wrap-around services where mental services are linked b. Giving all immunizations on a single clinic visit c. Providing multiple services during a single clinic visit d. Providing free services to the medically indigent

C Providing multiple services during a single clinic visit makes services more responsive to the combined effects of social and economic stressors. Wrap-around services provide comprehensive health as well as social and economic services, so it would include more than the linkage of mental health services.Administering all immunizations or providing free services would not provide a one-stop shop for all needed services.

According to the American Academy of Pediatrics, which of the following activities are expectations for a school health nurse? a) Ensuring that children with health problems are accepted by their peers b) Driving children home if parents can't pick them up c) Giving emergency care in the school or during school events d) Giving medications as needed if children are ill

C School nursing responsibilities include making sure that children get the health care they need, including emergency care in the school; keeping track of the state-required vaccinations that children have received; carrying out the required screening of the children based on state law; and ensuring that children with health problems are able to learn in the classroom. The nurse cannot convince children to accept other children as peers, although certainly efforts should be made. HIPAA would not allow individual examples of health problems to be shared, other than providing group statistics.

The practices of physicians, nurses, and other health care providers are differentiated by which of the following? a. Health Resource and Services Administration (HRSA) b. State board of nursing c. Scope of practice d. USDHHS

C Scope of practice involves defining nursing, setting its credentials, and then distinguishing between the practices of nurses, physicians, and other health care providers. HRSA and USDHHS do not differentiate the practices of health care providers. The state board of nursing only addresses the scope of practice of nursing, not the other health care providers.

Since the Intervention Wheel was first published in 1998, what related event has occurred? a. It has guided national policy. b. It has been used as a tool in deciding licensure issues for State Boards of Nursing. c. It has been incorporated into the public health curricula of many nursing programs. d. It has gained wide acceptance internationally.

C Since being published, the Intervention Wheel has been incorporated into the public/community health coursework of numerous undergraduate and graduate curricula. The Wheel was derived from the practice of PHNs and intended to support their work. It gives PHNs a means to describe the full scope and breadth of their practice. It serves as a model for practice in many state and local health departments. It has been presented internationally but is not used widely at the international level.

A nurse is promoting social justice. Which of the following actions would the nurse most likely take? a. Contacting lawmakers about environmental health issues b. Assisting at homeless shelters c. Advocating for policies to improve social conditions d. Serving on a local coalition to prevent obesity

C Social justice refers to providing equitable care and social supports for the most disadvantaged members of society. Nurses can function as advocates for policy changes to improve social, economic, and environmental factors that predispose vulnerable populations to poor health.

A member of a community weight-loss group has maintained a healthy weight for 2 years through healthy eating and daily exercise. Which of the following steps of the affective domain is this participant demonstrating? a) Analysis b) Application c) Evaluation d) Knowledge

C Steps in the affective domain have the learner doing the following in this sequence: (1) knowledge: receives the information; (2) comprehension: responds to what is being taught; (3) application: values the information; (4) analysis: makes sense of the information; (5) synthesis: organizes the information; (6) evaluation: adopts behaviors consistent with the new values. In this example, the individual has adopted the behavior and this has resulted in the ability to maintain the value of a healthy weight.

A public health nurse (PHN) is implementing interventions at the systems level of practice. Which of the following interventions would be used by the nurse? a. Involve the entire community in solving the health problem. b. Identify health problems in the community. c. Change laws, policies, and practices that influence population-based issues. d. Provide outreach services to populations at risk.

C Systems level practice consists of changing laws, policies, and practices that influencepopulation-based issues. The individual level of practice focuses on interventions thatinvolve working with individuals, either singly, or in groups, and with families isdemonstrated through providing outreach. Community level interventions are carried out with the community as a whole and is demonstrated by involving the entire community in identifying and solving health problems.

A school nurse is demonstrating the use of a peak flow meter to help children with chronic asthma recognize when they need to use a rescue inhaler. Which of the following levels of prevention is being used by the nurse? a) Primary b) Secondary c) Tertiary d) Both primary and secondary

C Tertiary prevention includes caring for children with long-term health needs, including asthma and disabling conditions. The nurse is teaching disease management (i.e., when to use an inhaler).

A nurse works with a group of abused women to enhance their levels of self-esteem.Which of the following levels of prevention is being performed? a. Primary level of prevention b. Secondary level of prevention c. Tertiary level of prevention d. Health promotion

C Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Primary prevention aims to prevent disease and illness before it occurs. Secondary prevention focuses on screening and early detection. Health promotion is not a level of prevention.

The nurse teaches the family of an AIDS client about managing symptomatic illness by preventing deteriorating conditions, such as diarrhea, skin breakdown, and inadequate nutrition. Which of the following best describes the action taken by the nurse? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Primary health care

C Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability. Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability. Primary health care refers to the first line of care provided to patients typically by a physician or other health care provider.

A client is self-employed as a mechanic and has no health insurance coverage. Which of the following best describes the legislation that will assist this client in obtaining health insurance? a. Balanced Budget Act b. Health Insurance Portability and Accountability Act (HIPAA) c. Patient Protection and Affordable Care Act (ACA) d. Social Security Act

C The ACA of 2010 provides the opportunity for all to purchase health insurance. The Balanced Budget Act shifted payment in home health care. The HIPAA was intended to help people keep their health insurance when moving from one place to another. The Social Security Act created the largest federal support program for elderly and poor Americans.

Which of the following would be the best way for the school nurse to fulfill his or her responsibilities in an emergency situation? a) Tell all staff to call 911 if the nurse is not in the building b) Arrange to always be available, even if only by phone c) Create and share an emergency plan with all teachers and staff d) Wear a pager so that the nurse can come as soon as humanly possible

C The American Health Association recommends that the school nurse create an emergency plan with at least two different staff members identified and responsible for implementing the plan if the nurse is not in the building at the time of the emergency. The plan would include when to call 911 and how to get a child to the hospital via ambulance if needed.

Which environmental law sets basic structure for regulating pollutants to United States waters? a. Safe Drinking Water Act b. Toxic Substance Control Act c. Clean Water Act d. Pollution Prevention Act

C The Clean Water Act sets basic structure for regulating pollutants to United States waters.

A nurse is interested in census data. Which federal department's website would be a good place to start? a. Department of Labor (DOL) b. USDHHS c. Commerce Department d. World Health Organization (WHO)

C The Commerce Department handles the United States Census and population estimates and projections. The DOL has information about the consumer price index, employment, and earnings. The USDHHS has information about the national vital statistics and several health-related surveys. The WHO has statistics about world health.

The Office of Homeland Security has a mission to rebuild the crumbling public health infrastructures of each state and provide: a. vaccines for smallpox, anthrax, and plague. b. regulation of nuclear weapons. c. surveillance of bioterrorism threats. d. regulation of foreign nurses entering theUnited States.

C The USDHHS and the federal agency, the Office of Homeland Security, have provided funds to address serious bioterrorism threats to the people of the United States. The Office of Homeland Security does not provide vaccinations, regulation of nuclear weapons, or regulation of foreign nurses entering the United States.

The first major federal government action relating to health was the: a. passage of the Social Security Act. b. creation of the National Institutes of Health (NIH). c. creation of the Public Health Service (PHS). d. creation of Medicare and Medicaid.

C The first major federal governmental action relating to health was the creation in 1798 of the PHS. The Social Security Act was passed in 1935. The NIH was founded in 1887. Medicare and Medicaid were created in 1965

Which question would a nurse ask during the first phase of a risk assessment? a. Has the chemical been released into the environment? b. How much and by which route of entry can the chemical enter the body c. Is the chemical known to be associated with a negative health effect? d. What is the prediction for potential harm?

C The first phase is determining if a chemical is known to be associated with negative health effects (in animals or humans).

A nurse would like to propose legislation requiring all schools to employ a registered nurse. Which of the following would be the first step taken as the nurse implements the legislative process? a. Introducing the bill to the legislature b. Moving the bill to the other house c. Developing the policy option into a bill d. Hearings, testimony, and lobbying

C The first step in the legislative process is developing the policy option into a bill. This is then followed by introducing the bill to the legislature; hearings, testimony, and lobbying; and the bill moving to the other house.

A nurse investigates the interpretation of a state's right to grant abortions. Which of the following branches of government would the nurse be looking at? a. Executive b. Legislative c. Judicial d. Federal

C The judicial branch interprets laws and their meaning, as in its ongoing interpretation of states' rights to define access to reproductive health services for citizens of the states. The executive branch suggests, administers, and regulates policy. The legislative branchidentifies problems and proposes, debates, passes, and modifies laws to address those problems. The federal branch refers to the top level of government agencies.

A nurse just finished teaching breast self-examination to a large group of women at a professional conference. During the session, she distributed literature and used culturally appropriate visual aids. However, the session was not as effective as it could have been. Which of the following was the most important thing omitted by the nurse? a) Time for audience members to ask questions and clarify the information b) Explanation of why culturally appropriate images are more acceptable c) Opportunity for the women to practice what they learned d) Use of simple language instead of printed material

C The learner must have opportunities to practice the new skills being learned. Provide practice sessions during the program because many people may not have the time, facilities, motivation, and/or support to practice at home what they have learned.

What is the most chronic bloodborne infection in the United States? a. Hepatitis A b. Hepatitis B c. Hepatitis C d. HIV

C The most chronic bloodborne infection in the United States is hepatitis C. Hepatitis A virus is most commonly transmitted through the fecal-oral route. Sources may be water, food, feces, or sexual contact. The hepatitis B virus (HBV) is spread through blood and body fluids and, like HIV, is a bloodborne pathogen. HIV is transmitted through exposure to blood, semen, transplanted organs, vaginal secretions, and breast milk. Although hepatitis B and HIV are both bloodborne pathogens neither are the most chronic infection like hepatitis C.

The steps of the ethical decision making process are similar to the steps of: a. Healthy People 2010 b. Deontology c. The nursing process d. Advocacy

C The nursing process involves the same basic steps: assessment, diagnosis, planning, implementation, and evaluation.

What is the primary cause of vulnerability? a. Race b. Age c. Poverty d. Illness

C The primary cause of vulnerability is poverty. Race, age, and illness may cause populations to be vulnerable, but these factors are not the primary cause.

A nurse is caring for a client who has been diagnosed HIV positive. Which of the following roles of the nurse would be the most important for the nurse to implement? a. Advocate, lobbying for AIDS research b. Counselor, discussing implications of future sexual activity c. Role model, providing supportive care d. Policy maker, addressing laws governing privacy rights of HIV-positive persons

C The priority role of the nurse should be role model, as nurses must be role models because many HIV-positive patients are stigmatized. The need to be an advocate and policy maker does not address the individual needs of the client. The nurse can counsel the client while providing supportive care.

The principal of a school was upset over a rumor that one of the children had engaged in a violent activity that injured a younger sibling. The principal asked the nurse who the children were so that the involved teachers could both support the injured child and guard other children from the violent child. Which of the following would be the best response by the nurse? a) "I'll get the names to you and the involved teachers immediately." b) "Let me get the parents' consent, and then I'll get you the names." c) "Rumors are often inaccurate; let me follow up and see what happened and what needs to be done." d) "Why don't we coordinate a school-wide program on preventing accidents instead?"

C The school nurse is responsible for maintaining school health office policies, including privacy and safety of health records. The nurse must follow the HIPAA privacy rules while also ensuring the safety of children at school. When a rumor is involved, it is always wise to check its accuracy. If a child was indeed hurt, the nurse needs to make sure both children involved receive (or have already received) appropriate care. The question about having a school-wide program may be appropriate, but this behavior was apparently purposeful, not accidental.

Employees working with hazardous chemicals have the right to know about the chemicals they are working with through the creation of the: a. Material Safety Data Sheet b. Consumer Confidence Report c. Hazard Communication Standard d. Environmental Protection Agency

C This standard requires employers to maintain a list of all hazardous chemicals that are used on site.

A nurse is caring for a homeless population. Which of the following characteristics should the nurse anticipate as a need of this population? a. Need more nursing care than other vulnerable groups b. Have no desire to seek medical care c. Have even fewer resources than poor people who have adequate housing d. Are living in despair with no hope or resilience

C Those who are homeless have even fewer resources than poor people who have adequate housing.Homeless and marginally housed people must struggle with heavy demands as they try to manage daily life because their resources are limited. These individuals must cope with finding a place to sleep at night and a place to stay during the day or moving frequently from one residence to another, as well as finding food, before even thinking about health care.

A nurse is caring for a client who has been diagnosed with a bacterial sexually transmitted infection (STI). Which of the following infections does this client most likely have? a. Trichomonas b. HIV c. Syphilis d. Genital warts

C Trichomonas, HIV, and genital warts are caused by viruses. Syphilis is caused by bacteria.

The greatest single source of air pollution in the United States is from: a. Waste incineration b. Power plants c. Motor vehicles d. Molds

C Waste incineration and power plants are major contributors after motor vehicles. Molds contribute to poor indoor air quality.

A nurse practitioner has established a mobile clinic to vaccinate noninstitutionalized adults against influenza. Which of the following phases of the nursing process is being implemented? A. Assessment B. Planning C. Intervention D. Evaluation

C Intervention Giving immunizations is an intervention that will increase the number of people who will be vaccinated. Intervention includes coordinating medical, nursing, and public health actions to meet the client's needs.

A nurse who works at the local hospital asks a public health nurse what might be causing her hands to become very sore and sensitive. Which of the following statements would be the most appropriate response by the public health nurse? A. "Ask the staff in employee health if there have been any other complaints." B. "Call the local health department about any recent problems at the hospital." C. "Check the material safety data sheet on any chemicals you have used recently." D. "See the nurse's health care provider for a complete work-up."

C "Check the material safety data sheet on any chemicals you have used recently."Employees have the right to know about hazardous chemicals with which they work. Employers must maintain a list of all hazardous chemicals used on the premises, along with a material safety data sheet that addresses health risks related to these chemicals, as well as information about safe use and handling.

A nurse is completing a basic health assessment. Which of the following questions should be asked by an environmentally aware nurse? A. "Is anyone else in your family having these symptoms?" B. "Can you tell me about your house or apartment?" C. "What jobs have you held longest?" D. "Where do you live?"

C "What jobs have you held longest?" An exposure history should identify current and past exposures, have a preliminary goal of reducing or eliminating current exposures, and have a long-term goal of reducing adverse health effects. The "I PREPARE" mnemonic consigns the important questions to categories that can be easily remembered. Asking about previous employment helps to answer the "P" of past work.

A nurse wants to help keep the community environment safe. Which of the following is the most appropriate action for the nurse to take? A. Conserve water by bathing less often. B. Downsize to a smaller living space. C. Reduce, reuse, and recycle. D. Replace all his appliances with new energy-efficient ones

C Reduce, reuse, and recycle All citizens can engage in minimizing their impact on the environment by reducing, reusing, and recycling. Although it would be nice to replace all appliances for energy-efficient newer models, most people can't afford that—furthermore, it is an environmental issue to discard the used models. Similarly, downsizing to a smaller living space could help the environment, because the nurse would use less energy, but again, not everyone can afford all the expenses involved in moving. On the other hand, all persons can reduce, reuse, and recycle the individual products they currently consume.

An occupational health nurse at a local factory is using primary prevention strategies to reduce the environmental health risks among the employees. Which of the following activities would the nurse most likely implement? A. Checking radiation detectors to monitor for unsafe levels of radiation exposure B. Irrigating the eyes of an employee who has had a chemical splash to the face C. Teaching new employees who will work outdoors about the signs and symptoms of heat-related illness D. Using spirometry to rule out obstructive or restrictive lung disease for workers who will be wearing mask respirators

C Teaching new employees who will work outdoors about the signs and symptoms of heat-related illness Education is a primary preventive strategy. When examining the sources of environmental health risks in communities and planning intervention strategies, it is important to apply the basic principles of disease prevention.

CDC's Healthy Communities Program

emphasizes policy, systems, and environmental changes. focus is on chronic diseases encourage physical activity and healthy diet discourage tobacco use "tools for community action"

A public health nurse is assisting the community in dealing with the effects of lead paint poisoning. Which of the following activities would the nurse most likely complete? (Select all that apply.) A. Administering medications to those with signs of lead poisoning B. Assessing community members for any health problems C. Setting up a blood screening program with the local health department D. Encouraging local landlords to improve the condition of their housing

C, D C. Setting up a blood screening program with the local health department D. Encouraging local landlords to improve the condition of their housing The nurse's role is to understand the roles of each respective agency and organization, know the public health laws, and work with the community to coordinate services to address the community's needs. Other needed interventions include organizing a blood-lead screening program through the local health department, educating local health providers to encourage them to systematically test children for lead poisoning, and working with local landlords to improve the condition of their housing stock.

A nurse is meeting to discuss problems and solutions with a group of teenagers who have been newly diagnosed with diabetes. One teenager states, "My mom found this particular brand of popcorn that has only 15 carbohydrates in the whole giant bag." Which of the following best describes the group purpose that is being served by the teenager's statement? a) Maintenance function of encouraging everyone to continue the discussion b) Maintenance function of helping everyone feel comfortable talking about food c) Task function of resolving problems about what to nibble during movies d) Task function of sharing information and resources

D A task function is anything a member does that deliberately contributes to the group's purpose. Members with task-directed abilities are attractive to the group. These traits include strong problem-solving skills, access to material resources, and skills in directing. The teenager's statement shared information about a good resource for the group.

A nurse invited all the teenagers who were newly diagnosed with diabetes to a group meeting to discuss issues they all had in common. One teenager replied, "I don't know if I want to share all the problems I'm having with strangers." Which of the following is the best nurse response? a) "Don't share anything with anyone until you're comfortable doing so. b) "I can understand what you are saying." c) "No one will require you to do anything you don't want to do." d) "The purpose of the group is to have a safe place to share problems with others who may be having similar problems."

D All the responses are empathetic and supportive. However, during the first phase, potential participants do not know whether they can trust one another. The primary task of the leader at this point is to clarify the purpose. Even though a statement such as "Don't share anything until you're comfortable" is supportive, the response explaining that "the purpose is to have a safe place" both recognizes what was said and clarifies the purpose of the group.

An acceptable level of emissions or a maximum contaminant level allowed is an example of which environmental protection strategy? a. Controlling pollution b. Waste minimization c. Land use planning d. Environmental standard

D An example of an environmental standard is an acceptable level of emissions or a maximum contaminant level allowed.

law

established rules and privileges (people solve problems based on a set of established rules)

What occurs during an act of biological terrorism? a. The intentional release of hazardous chemicals into the environment b. Environmental and occupational exposure to biological toxins c. Immunity to toxins related to repeated exposures d. An intentional release of viruses, bacteria, or other toxins

D An intentional release of viruses, bacteria, or other toxins would be described as biological terrorism. Chemical terrorism is the intentional release of hazardous chemicals into the environment intended on harming or killing. Surveillance is used to monitor environmental and occupational exposures. Immunity to toxins after repeated exposures does not occur during biological terrorism.

A nurse is working to remove barriers to receiving health care. Which of the following actions is the nurse most likely to support? a. Discrimination against certain groups b. Treatment of pets at the same facility c. Provision of free food at a food bank d. Providing services for a rural population by using a mobile clinic

D Barriers to access are policies and financial, geographic, or cultural features of health care that make services difficult to obtain or so unappealing that people do not want to seek care. Examples of removing barriers include providing extended clinic hours, low-cost or free health services for people who are uninsured or underinsured, transportation, mobile vans, and professional interpreters, which can help improve access to care.

When nurses apply the knowledge and processes of ethics to the examination of ethical problems in health care, they are using: a. Values b. Morality c. Ethics d. Bioethics

D Bioethics applies the knowledge and processes of ethics to the examination of ethical problems in health care.

The growing multiculturalism of American society can contribute to ethnicity conflicts when: a. Cultural standards are congruent with professional standards. b. Cultural traditions within an ethnic group align with those of the community. c. Ethnic groups overburden the health care system. d. The greater communitys values are jeopardized by specific ethnic values.

D Callahan offered perspectives on judging diversity and suggests a thoughtful tolerance and some degree of moral persuasion (not coercion) for ethnic groups to alter values so that they are more in keeping with what is normative in American culture.

A public health nurse (PHN) is conducting a community assessment. Which of the following is the best example of this action? a. Visiting an elderly person at home to assess and evaluate safety and fall risk b. Developing diagnoses to identify nursing interventions at a health clinic c. Evaluating services at an immunization clinic where a translator provides services d. Compiling recent data from the county health department on child abuse cases

D Compiling recent data from the county health department on child abuse cases is an example of community assessment, assessing needs and data within a community. Community assessment does not happen with an individual. Community assessment must be completed before diagnoses can be developed. Evaluation of services is not part of community assessment.

A nurse operates a school-based clinic in a local school where multiple providers and disciplines offer care to children, making it easier for children to access health care. Which of the following best describes this approach? a. Advocacy b. Wrap-around services c. Social justice d. Comprehensive services

D Comprehensive services are health care services that focus on more than one health problem or concern.Stationary or mobile clinics that provide a wide array of health promotion, illness prevention, and illness management services in migrant camps, schools, and local communities are examples of this. Wrap-around services describe a system in which comprehensive health services are available and social and economic services are "wrapped around" these services. Advocacy refers to actions taken on behalf of another. Social justice describes justice with respect to the concepts of egalitarianism and equality.

What information is included in a case definition? a. The precise point of contact b. Laboratory confirmation c. Source of contamination d. Clinical symptoms

D Each case has a unique set of criteria based on what is known about the disease. It may include clinical symptoms, laboratory values, and epidemiologic criteria. The precise point of contact, laboratory confirmation, and source of contamination are not part of a case definition.

An inspection of a facility after a permit is obtained for the purpose of observing whether the plans submitted in the permit application are being implemented as approved is an example of which environmental protection strategy? a. Controlling pollution b. Waste minimization c. Land use planning d. Environmental monitoring

D Environmental monitoring would be an inspection of a facility after a permit is obtained to observe whether the plans submitted in the permit application are being implemented as approved.

A nurse believes additional funding is necessary to support a home- delivered meal program for the elderly. Which of the following would be the best way to share these ideas with a legislator? a. Send an e-mail b. Write a formal letter c. Attend a town hall meeting d. Schedule a face-to-face visit

D Face-to-face visits with legislators are viewed as the most effective means of communication. Sending an e-mail, writing a letter, and attending a town hall meeting are all ways to share ideas with a legislator but are not viewed as the most effective method for sharing.

Which statement about feminist ethics is correct? a. Feminists include only women in their worldview. b. Persons who ascribe to feminist ethics are passive and wish to pursue their ideals through the legislative process. c. Feminists believe that men should not be nurses. d. Womens thinking and moral experiences are important and should be taken into account.

D Feminist theory ascribes to the idea that womens thinking and moral experiences are important and should be considered.

Public health nurses (PHNs) across the United States implement similar types ofinterventions to improve the health of various groups. Which of the following explains why a common set of interventions is used? a. Describe the proper order of implementation. b. Emphasize surveillance as the focus of public health practice. c. Guide practice and generate agency protocols. d. Improve the health status of communities, systems, individuals, and families.

D Interventions are actions taken on behalf of communities, systems, individuals, and families to improve or protect health status. The interventions do not describe a particular order for implementation. Surveillance is only one of the 17 interventions described. PHNs may use any or all of the interventions. No single PHN is expected to perform every intervention at all three levels of practice.

A nurse is working in a public health center. A patient who has been newly diagnosed as HIV positive comes for counseling. By law, which of the following actions must be taken by the nurse? a. Give antiviral medications to the patient. b. Ask the person to name all his or her sexual contacts. c. Refer the patient to the social worker for case management. d. Report the HIV-infected person to the state health department.

D It is mandatory to report HIV cases by name in all states, although not all states require viral load and CD4 counts. There are not laws in place that mandate administration ofmedications, naming of sexual contacts, or referral to case management.

A nurse is planning an educational program about cardiovascular disease. Which of the following would be the optimal time for the nurse to elicit feedback from program participants? a) At the beginning of the program b) At the program midpoint c) Immediately following program completion d) Throughout the program

D Not only should learners receive feedback, but the educator should also elicit feedback from learners throughout the educational process. On the basis of the feedback that the educator receives from learners, the implementation and presentation of the educational program can be modified.

How have nurses historically learned to identify a possible relationship between environmental chemical exposures and their potential harm? a. Extrapolation by toxicologists b. Biomonitoring c. Completing chemistry courses d. Observing signs and symptoms in clients

D Nurses have historically made discoveries related to chemical exposure when people presented with signs and symptoms related to known chemical toxicity. The first two options are modern methods.

The case rate of new tuberculosis (TB) is highest among which ethnicity in the UnitedStates? a. African American b. Native American c. White American d. Asian American

D Of the new cases, 66% are foreign-born persons living in the United States, with Asians and Hispanics being the most common ethnic groups, representing 30% and 28% of national TB cases. The TB rates for African American, Native American, and White American are lower than the Asian and Hispanic populations.

A community coalition monitors the increasing obesity rate of children in their schools. Based on this data, they consider a variety of programming options which may possibly help decrease this trend. What was the purpose of conducting this surveillance? a. Protect the children from diseases that affect obese children. b. Teach parents that obesity will not be tolerated in this community. c. Educate children on surveillance techniques. d. Demonstrate that new clinical and effective protocols need to be developed.

D Ongoing surveillance in a community can lead to new clinical and effective protocols to address an issue. Ongoing surveillance makes it possible to have ongoing monitoring in place to ensure that disease and event patterns improve rather than deteriorate. This surveillance cannot protect children from diseases, teach parents that obesity will not be tolerated, or educate children on surveillance techniques.

A nurse takes action to protect the health, safety, and welfare of citizens, such as requiring immunizations of children before admission to school. Which of the following levels of power is being used? a. Executive b. Legislative c. Judicial d. Police

D Police power is state power concerning health care. This power allows states to act to protect the health, safety, and welfare of their citizens. Executive power comes as the executive branch suggests, administers, and regulates policy. Legislative power occurs as this branch of government identifies problems and proposes, debates, passes, and modifies laws to address those problems. Judicial power occurs as the judicial branch interprets laws and their meaning, as in its ongoing interpretation of states' rights to define access to reproductive health services for citizens of the states.

Which statement is discussed in the Code of Ethics for Nurses with Interpretive Statements? a. The profession of nursing is responsible for making political statements and supporting nurse-friendly candidates for office. b. The nurses primary focus is on acute bedside nursing, followed by community health care to promote seamless care. c. The nurse owes duty primarily to the physician to strive to protect health, safety, and the rights of the patient. d. The profession of nursing is responsible for articulating nursing values, for maintaining the integrity of the profession, and for shaping social policy

D Provision 9 of the Code of Ethics for Nurses with Interpretive Statements discusses the need for the nursing profession to address national and global health concerns as well as be involved with shaping policies through political action.

Which statement is true about the origins of the Intervention Wheel? a. A panel of nurses from Iowa, Minnesota, North Dakota, South Dakota, andWisconsin developed and refined the Intervention Wheel. b. It was conceived by a group of international nurses from Norway, Kazakhstan, andJapan. c. It was a result of a qualitative analysis carried out by the State Boards of Nursing. d. It resulted from a grounded theory process carried out by public health consultantsat the Minnesota Department of Health.

D Public health consultants with the Minnesota Department of Health carried out a grounded theory process in response to uncertainty about the contributions of public health nursing to population health level improvement, resulting in the identification of the Intervention Wheel components. It was not developed by a panel of nurses in the Midwest or by a group of international nurses. It was not a qualitative analysis process and the State Boards of Nursing were not involved in its development.

Which of the following best explains why school nurses are involved in helping teachers with the task of teaching children how to practice problem solving, communication, and other life skills? a) Teacher shortages have required nurses to be increasingly involved in teaching life skills b) Because so many nurses want to be employed in schools, this responsibility was assumed to increase employment opportunities c) States are requiring nurses to screen and to teach life skills d) Nurses have been enlisted in this role to help reduce risk factors for future health problems in school children

D School health nurses were originally involved in this capacity in 1987 after the CDC began funding schools for HIV-prevention education programs. This program was so successful that it was expanded to include programs to teach children prevention of other chronic illnesses caused in part by risk factors such as poor diet, lack of exercise, and smoking. The schools are actively involved in helping the children practice problem solving, communication, and other life skills so that they can reduce their risk factors for health problems.

A public health nurse is organizing a multidisciplinary team to address the issue of water pollution in the community. The most likely members that would be invited to address this issue would be: a. Physicians, water sanitation workers, and occupational therapists b. Pharmacologists, radiologists, and epidemiologists c. Nurse practitioners, pharmacologists, and environmentalists d. Geologists, meteorologists, and chemists

D Scientists who study how pollutants travel in air, water, and soil are geologists, meteorologists, and chemists.

A nurse is planning and implementing care for vulnerable populations. Which of the following would be the most appropriate action for the nurse to take? a. Setting up multiple clinics in a wide geographic area b. Advising legal consultants on a variety of issues c. Making laws to protect the homeless d. Teaching vulnerable individuals strategies to prevent illness and promote health

D Teaching vulnerable individuals, families, and groups strategies to prevent illness and promote health is one of the ways nurses provide care for these populations. Setting up clinics, advising legal consultants, and making laws do not address the direct care provision role of the nurse.

The focus of the Division of Nursing is to: a. enhance nursing's competence inproviding high-tech skills. b. apply disease prevention, environmental health, and health promotion concepts. c. provide scholarships for advanced nursing education. d. ensure an adequate supply and distribution of qualified nursing personnel to meet the nation's health needs.

D The Division of Nursing is the key federal focus for nursing education and practice, and it provides national leadership to ensure an adequate supply and distribution of qualified nursing personnel to meet the health needs of the nation. The Division of Nursing does not enhance the competency of the profession. The Division of Nursing does not apply nursing concepts. The Division of Nursing does not provide scholarships.

A nurse is working for the federal government to provide for the protection of the public's health. Which of the following actions would the nurse most likely complete? a. Interpreting decisions related to women's right to privacy b. Setting up immunization clinics for smallpox vaccine c. Regulating nursing at the state level d. Monitoring the influx of disease at theborders

D The United States Constitution gives the federal government the authority to provide for the protection of the public's health. By monitoring the influx of disease at the borders the public's health is being protected. Interpreting decisions does not support the protection of the public's health. Smallpox has been eradicated so it would not be necessary to set up immunization clinics. Regulation of nursing at the state level does not support protection of the public's health by the federal government.

The future of school nursing is very strong and will be further enhanced by the future trend in which of the following? a) Development of an HIV/AIDS health curriculum b) Enhanced use of picture boards c) Improving the air quality of school buildings d) Telehealth and telecounseling

D The amount of health care being given in the schools is increasing. In the future, school nursing will use telehealth and telecounseling to teach health education. School nurses will use the Internet to work with children and parents. The school nurse is responsible for keeping up with the latest changes in health care and health practice so that the health of children in the schools can be enhanced by new trends in health care.

Public health nurses (PHNs) utilize registries to identify children with delayed or missing immunizations. They subsequently follow up with families by phone calls or home visits. Which of the following levels of practice is being implemented? a. Systems b. Community c. Policy d. Individual

D The individual level of practice focuses on interventions that involve working with individuals, either singly, or in groups, and with families. Individual level intervention changes knowledge, attitudes, beliefs, practices, and behaviors of individuals. Community level interventions are carried out with the community as a whole. This level of intervention changes community norms, attitudes, awareness, practices, and behaviors. Systems level interventions change organizations, policies, laws, and power structures within communities. Policy is not a level of intervention described by "The Wheel."

What is the most common reportable infectious disease in the United States? a. Gonorrhea b. Syphilis c. Herpes d. Chlamydia

D The most common reportable infectious disease in the United States is chlamydia.Gonorrhea is the second most commonly reported infectious disease. Syphilis and herpes are not among the most common reportable infectious diseases in the United States.

A home health nurse receives a referral to educate an older adult client with diabetes in proper foot care. The nurse's assessment of the client determines that the client has poor eyesight that may affect the client's ability to learn and perform certain skills. Which educational principle is being examined? a) Cognitive domain b) Events of instruction c) Principles of effective instruction d) Psychomotor domain

D The psychomotor domain includes the performance of skills that require some degree of neuromuscular coordination and emphasizes motor skills. The cognitive domain includes memory, recognition, understanding, reasoning, application, and problem solving and is divided into a hierarchical classification of behaviors. Education is the establishment and arrangement of events to facilitate learning. Principles that guide the effective educator include message, format, environment, experience, participation, and evaluation.

A child with severe macular degeneration and some hearing loss will be attending the third grade in a local school. A tertiary prevention intervention the school nurse should perform would be which of the following? a) Assess the child's language skills, motor abilities, and social abilities b) Ensure that a telephone is available for calling emergency personnel or parents c) Lead educational programs to address coping strategies and stress management techniques d) Meet with the assigned teachers to discuss classroom seating to enhance the child's learning experience

D The school nurse gives nursing care related to tertiary prevention when working with children who have long-term or chronic illnesses or with special needs. This may include participation in the development of an individual education plan (IEP); identification of medication, therapy needs, and/or physical, auditory, or visual limitations; and interventions to ensure the appropriate placement of the child in the classroom environment or physical accommodations required, which enhances the child's learning experience.

passive surveillance systems

Diseases are reported by health care providers -Simple & inexpensive -*Limited by incompleteness* of reporting & variability of quality Case reports or lab reports are sent to the health department -NNDSS is a voluntary system monitored by the CDC

Which of the following groups would be most likely to receive an injection of prophylactic immune globulin for possible exposure to hepatitis A? a. Persons who have had direct contact with blood b. Those who ate at the same restaurant as the person with hepatitis A c. All health care workers d. All those who had household or sexual contact with persons with hepatitis A

D Those who have been in close contact with persons who develop hepatitis A should receive immune globulin. The other groups do not describe populations in direct contact with the person who has hepatitis A.

A nurse is investigating a potential bioterrorism attack. What evidence would a nurse find if a bioterrorism attack occurred? a. Many cases of influenza b. A case of cholera in a local politician following a trip to India c. Dengue fever in a group of students who just returned from a mission trip d. An unusual illness in a population

D Unusual illness in a population should trigger an investigation that may signal a covert bioterrorism attack. Cases of influenza, cholera, and dengue fever in a group would not be considered unexpected illnesses.

A nurse is working with a 17-year-old pregnant cocaine addict who is homeless.Which of the following best describes this client? a. At risk b. A special population c. A Healthy People 2020 target group d. A vulnerable individual

D Vulnerable individuals often have multiple risk factors. Vulnerable populations of concern to nurses are persons who are poor or homeless, have special needs, pregnant teens, migrant workers and immigrants, individuals with mental health problems, people who abuse addictive substances, persons who have been incarcerated, people with communicable diseases and those who are at risk, and persons who are HIV positive or have hepatitis B virus or STDs. Risk is an epidemiological term meaning that some people have a higher probability of illness than others.

A school nurse listens as one student talks about another student being upset because his father frequently spanks him with a leather belt that leaves big marks on the student's back. But the student begs the nurse not to tell anyone because he promised the friend that the information would never be shared. Which of the following actions should be taken by the nurse? a) Ask the student if abuse has occurred b) Call in the named student and ask him to remove his shirt c) Discuss the conversation with the student's parents d) Notify the legal authorities

D When the nurse identifies a child who may be abused or who receives information from someone else that a child may have been abused, the nurse must contact the appropriate legal authorities and the school's principal. Asking the student about the abuse will not always elicit a truthful answer, because children will protect their parents. A confidential file should be made about the incident; however, the nurse should let the government authorities, usually the state or county child protection department, look into the suspected case. In all cases, the child should be protected from harm, and those who have no right to know that child abuse or neglect is suspected should not be given any information.

A nurse wants to have a better understanding of the physiological effects of selected chemicals. Which of the following individuals would provide the most useful information to the nurse? A. Chemist B. Epidemiologist C. Pharmacologist D. Toxicologist

D Toxicologist Toxicology is the basic science that studies the health effects associated with chemical exposures. The other specialists would probably be able to provide some information, but the toxicologist would most likely provide information related to physiological processes.

The nurse is examining blood lead levels in school-age children 1 year after a community-wide education intervention. Which of the following phases of the nursing process is being implemented? A. Assessment B. Diagnosis C. Intervention D. Evaluation

D Evaluation In this instance, the nurse is evaluating the results of the intervention to determine whether goals were reached. If you chose assessment, understand that this would have been done earlier in the process because assessment was needed to determine that a problem existed and that interventions were needed.

A high school student considering a job in the restaurant industry after graduation asks a nurse about workplace safety issues. Which of the following acts would the nurse most likely discuss with the student? A. Chemical Safety Information, Site Security, and Fuels Regulatory Act B. Comprehensive Environmental Response, Compensation, and Liability Act C. Food Quality Protection Act D. Occupational Safety and Health Act

D Occupational Safety and Health Act The Occupational Safety and Health Act (OSHA) was passed to ensure worker and workplace safety in all employment settings, including restaurants. Others may contribute to safety but do not have the full oversight of OSHA.

Health community

Has all of the elements to maintain a good quality of life and to be productive

active surveillance systems

Health agencies contact health providers seeking reports -*Ensures more complete reporting of conditions* -Used in conjunction with specific epidemiologic investigation *PH nursing begins a search for cases through local health providers & health care agencies* -names the disease/event -gathers data -determines magnitude Ex: SARS outbreak

PREPARE

Individual Environmental Exposure History P- present work R- residence E- environmental concerns P- past work A- activities R- referrals and resources E- educate

community participation

Individuals within communities become involved in health promotion through community participation, whereby well-informed and motivated community members participate in planning, implementing, and evaluating health programs.

Indoor Air Quality

Measure of the breathable air inside a habitable structure or conveyance. A measure of the chemical, physical, or biological contaminants in indoor air. in response to non-point sources of pollution

Ottawa Charter (1986)

Places responsibility for health on society rather than only on individuals; used globally as template for health promotion first worldwide action plan for health promotion by the World Health Organization (WHO)

assumption 4

Priorities Identified Through Community Assessment main focus: identification of problems (gaps between needs and services) 7 A's

risk assessment

Process to determine the probability of a health threat associated with an exposure 4 phases

Clean Air Act

Set emission standards for cars, and limits for release of air pollutants in response to non-point sources of pollution

social determinants of health

The conditions in which people are born, grow, live, work, and age, shaped by the distribution of money, power, and resources at global, national, and local levels -poverty and race --> 1. socioeconomic status 2. living conditions 3. geographic location 4. social class 5. education 6. nutrition 7. stress 8. prejudice 9. genetics 10. health services (or lack of) 11. gender substandard housing, hazardous plants and waste sites, hazardous jobs, poor nutrition, less access to healthcare

screening

To test or examine for the presence of something (as a disease)

special surveillance systems

developed for collecting particular types of data and may be a combination of active, passive, and/or sentinel systems

A nurse performs a community assessment as part of the Community Health Promotion Model. Which of the following best describes the rationale for this action? a. Becoming more acquainted with the multiple factors that influence health status b. Surveying the citizens in the community about their wants and needs c. Allowing special interest groups a voice in health policy d. Providing a narrow focus for the committee work

a. Becoming more acquainted with the multiple factors that influence health status

The Healthy Communities and Cities initiative supports what idea? a. Healthy cities and communities must be both environmentally and socially sustainable. b. Healthy public policy is the responsibility of elected officials. c. Physical environments cannot be changed; thus, strategies must be developed in order to cope with them. d. The World Health Organization (WHO) is the primary source of information for cities.

a. Healthy cities and communities must be both environmentally and socially sustainable

What is the goal of the Healthy Communities and Cities initiative? a. Promoting health through community participation b. Reorganizing the current health care system c. Maximizing the cost-benefit ratio of health care d. Improving the quality of care in communities

a. Promoting health through community participation

Healthy Communities and Cities is based on which of the following premises? a. When people can work out their own locally defined health problems, they will find sustainable solutions to those problems. b. When the health of a community is improved, the focus will be on life expectancy rather than quality of life. c. When health professionals assume a leadership role, the health of the community will improve. d. When cities recruit enough health professionals to care for those needing medical care, the cities health will improve.

a. When people can work out their own locally defined health problems, they will find sustainable solutions to those problems.

Developing a healthy community: National Civic League

address root causes (health goes beyond the absence of disease) collaborative and consensus-based systems-level approach defines people and relationships by their skills and abilities

epidemiologic triangle

agent, host, environment ex. agent: lead particles host: child environment: house

A nurse utilizes the Centers for Disease Control and Prevention's (CDC's) Healthy Communities Program. Which of the following factors does the nurse recognize that will influence the continuance of this program? a. Time b. Community participation c. Federal involvement d. Technology

b. Community participation

A nurse is involved in implementing the Community Health Promotion Model. Which of the following best describes the action being taken by the nurse? a. Changing public policy b. Establishing a team to plan and coordinate the work c. Providing nursing diagnoses for the community d. Revising an objective for Healthy People 2020

b. Establishing a team to plan and coordinate the work

Nurses role in providing preventive care for communicable diseases: tertiary prevention

directly observed therapy

A nurse is leading a team responsible for evaluating the health of a community using the Community Health Promotion Model. Based on this model, which of the following steps would you expect the nurse to complete? a. Ensuring high technological access before the plan can be implemented b. Soliciting the consent of every member of the community c. Assessing the community d. Restructuring the public health policy in the community

c. Assessing the community

A nurse was involved in the initial implementation of the Healthy Communities and Cities initiative in the United States. Which of the following problems would have most likely been addressed? a. Reduction to the amount of pollutants released into the environment b. Provision of fire and police protection c. Creation of a coalition to address health disparities d. Elimination of crime and violence from the community

c. Creation of a coalition to address health disparities

Wearing seat belts is required in many communities. Children of a certain age must be restrained in a car seat or seat belt when riding in a car. Which of the following best describes what has happened in this community? a. Unilateral action of lawmakers b. Participation in health fairs c. Healthy public policy d. Media interest in protecting the public

c. Healthy public policy

A nurse is implementing the steps of the Community Health Promotion Model. Which of the following does this most resemble? a. Collaboration process b. WHO's Ottawa Charter c. Nursing process d. CDC's monitoring program

c. Nursing process

Vulnerable populations include

children, wards of the state, prisoners, pregnant women and fetuses, persons who are mentally disabled or otherwise cognitively impaired, and economically or educationally disadvantaged persons.

multisectoral cooperation

coordinated action by all parts of a community, from local government officials to grassroots community members

A nurse is implementing interventions to improve the health of the community. Which of the following approaches would be taken by the nurse? a. A top-down approach with rational-empirical problem solving b. A top-down approach with community practice planned by experts c. A bottom-up approach with facilitation of communication d. A bottom-up-approach with multisectoral planning and action for health

d. A bottom-up-approach with multisectoral planning and action for health

A nurse is designing interventions and evaluating results of Healthy Municipalities and Cities. Which of the following considerations would be made by the nurse? a. Influence of individual actions b. Acute care hospital services in the community c. Social results and endorsement of law makers for policy changes d. Effectiveness of health services, including delivery of preventive services

d. Effectiveness of health services, including delivery of preventive services

A nurse is implementing the Community Health Promotion Model. Which of the following underlying principles should the nurse use to facilitate active participation? a. Individuals should work in groups to complete necessary tasks. b. Individuals participating should represent all segments of the population. c. People will work together if they like the leadership. d. People will participate when they see the issues as worthy of their time

d. People will participate when they see the issues as worthy of their time.

What occurred when the Healthy Communities and Cities concept was brought to the United States? a. The cities chosen for the initial work were Los Angeles and New York City. b. Canada adopted the program at the same time for continuity across borders. c. The same strict guidelines that were implemented in Europe were used. d. Smaller communities and localities were targeted instead of large cities.

d. Smaller communities and localities were targeted instead of large cities.

assumption 1

defining public health nursing practice main focus: health and disease prevention for entire population groups

environmental standards

describe a permitted level of emissions, a maximum contaminant level (MCL), an action level for environmental clean up, or a risk-based calculation required to address health risks

Healthy place

designed and built to improve the quality of life for all people who live, work, worship, learn, and play within their borders—where every person is free to make choices amid a variety of healthy, available, accessible, and affordable options

event

disease