Pop Final. May the odds be ever in your favor :)

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

"Be sure to take a 30-minute walk each day." The factors that determine or influence whether disease or other unhealthy results occur are called health risks. The major categories of risk include inherited biological risk, social and physical environmental risk, and behavioral risk. Exercising for 30 minutes a day reduces the risk for many diseases. All the other options are treatment oriented rather than risk avoidance

b

A nurse is determining whether a hospital has the right to require infected patients to be isolated against their will. To which type of law will the nurse refer? a. Common law b. Constitutional law c. Legislation and regulation d. Judicial law

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

"Does your 4-year-old have a booster seat in the car?" Health risk appraisal refers to the process of assessing for the presence of specific factors in each of the categories that have been identified as being associated with an increased likelihood of an illness, such as cancer, or an unhealthy event, such as an automobile accident. Inquiring about why the client came in for the visit, asking about concerns, and physical problems does not address potential health risks that may need to be addressed for the client.

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

"I don't know what to do now that my husband is dead. There is no way I can go back to work and also take care of our three children." A family crisis occurs when the family is not able to cope with an event and becomes disorganized or dysfunctional. When the demands of the situation exceed the resources of the family, a family crisis exists. Only the correct response is the person overwhelmed and unable to conceive of how to cope. In incorrect responses, the survivor is considering the problem and trying to learn how to cope or seek resources to cope.

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

"Where do you shoot with your handguns?" Risk reduction is a complex process that requires knowledge of risks and families' perceptions of the nature of the risk. In this situation, the nurse was asking questions to determine the family's perception of risks associated with owning guns. If the family does not perceive the behavior (having guns in the house) as risky, but rather as necessary for food or sport, the nurse must first educate or persuade the family that others may be more comfortable if certain precautionary measures are taken (such as locks on the guns). Rifles are used for food and sport but handguns are often used in crimes and accidents resulting in death. Asking about how guns are kept safe or locked up does not address the families' perception of the nature of the risk. Asking if any of the hunters killed a deer this year makes the assumption that the family uses the guns for hunting. This perception by the nurse may be inaccurate; it would be more appropriate for the nurse to ask how the guns are used in the home rather than assuming that they are used for deer hunting.

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

-Agency's policies regarding eligibility for services -Family's feelings about the home visit and willingness to continue -Reimbursement policies of third-party payers Although it is not unusual to have only one home visit with a family, often multiple visits are made. The frequency and intensity of home visits vary not only with the needs of the family but also with the eligibility of the family for services as defined by agency policies and priorities. Although the textbook does not directly discuss the issue, the family's willingness to work with the nurse is a factor. Also, the nurse cannot make visits unless the agency is being reimbursed for the nurse's time and expenses, so reimbursement policies of third-party payers are a major influence on the number of visits for which the family may be eligible. The nurse's perception of the time needed to give quality care must unfortunately be secondary to other variables, which can control the time available. While the family's perception of their needs is relevant, it is not the only factor considered when allotting time for visits.

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

-Collaborating with the family to establish goals and a plan for meeting them -Exploring the family's perception of their problems and needs During the beginning phase of the nurse-family interaction, three activities occur—mutual data collection and exploration of needs and problems; mutual establishment of goals; and mutual development of a plan. Assessment of each family member and determining the exact relationship between each member of the family are not part of nurse-family interactions.

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

-Goals must be realistic and feasible. -Ongoing negotiation is central to the process. In contracting, an important aspect is obtaining the family's view of the situation and its needs and problems. Goals must be mutually set and realistic. A pitfall for nurses and clients who are new to contracting is to set overly ambitious goals. Because contracting is a process characterized by ongoing renegotiating, the goals are not static. The family's inability to change "as easily and quickly as they had hoped" does not mean the plan is not workable—only that more time and effort may be necessary. The plan does not need to be the "first priority" for all family members for it to be effective. The plan does need to be mutually set but depending on the situation it may be difficult for this to be the priority for all members of the family. The plan may not be working for a variety of reasons; lack of resources may not be the reason.

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

-The family won't have to travel. -Meeting at home is much more convenient for the family.

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

-The reason for the visit -The cost of the visit and how this may be paid The nurse should include the reason for the visit, how or from whom the referral was obtained, and a brief summary of what is known about the family's situation. The nurse should negotiate a time for the visit, preferably when most family members are available. Clients should be told the fee and possible methods of payment before the nurse assesses the family's willingness for a home visit. If the family does not have a phone, mail can be used to share information. It would be inappropriate for the nurse to share everything that she knows about the family with the family as there may be some information that the family does not need to know. Without visiting the family first, the nurse may not yet know the number of visits that may be planned

c

. A public health nurse found that out of the 70 people who ate the potato salad at a school picnic, 63 developed symptoms of food poisoning. Which of the following best describes the attack rate? a. 63% b. 70% c. 90% d. 100%

1. A resident in a rural community has been diagnosed with asthma. Which of the following providers will most likely provide care to this client? a. Advanced nurse practitioner b. Allergist c. Pediatrician d. Pulmonologist

A

11. A Mexican immigrant mother tells the nurse she is concerned that people in the community will give her daughter mal de ojo. To which of the following folk illnesses is the nurse referring? a. Evil eye b. Fallen fontanel c. Soul loss d. Indigestion

A

3. A migrant farmworker has been injured while working on the farm. Which of the following would provide assistance to care for this injury? a. Emergency department for immediate care b. Migrant Health Act clinics c. OSHA, because the man was injured by farm machinery d. Workers' Compensation, because injury was at work

A

4. A nurse is caring for a migrant farm worker who has been working in the agricultural industry for the past 10 years. When questioned about environmental hazards, the client reports regular exposure to pesticides. Which of the following disorders is the client most at risk to develop? a. Cancer b. Memory loss c. Skin rashes d. Headaches

A

6. In addition to those barriers faced by many residents in rural areas, what additional barrier to health care is a Hispanic migrant farmworker likely to encounter? a. Absence of culturally competent care b. Availability of specialists c. Distance of health care facilities from the place of residence d. High cost of health care

A

ANS: B In approximately 65% to 90% of shaken baby cases, the father or the mother's boyfriend is the perpetrator.

A 6-month-old infant was brought in unresponsive by both parents. X-ray examination showed evidence of shaken baby syndrome. Who is probably responsible? a. The babysitter b. The dad c. The grandparents d. The mom

D

A Hispanic outreach program works with the nurse in community health to train Hispanic health care workers in providing basic services and education within the local Hispanic community. The concept basic to community-oriented nursing practice that is best described by this intervention is: a. community. b. community client. c. community health. d. community partnerships.

b. Part B Medicare Part B is a supplemental (voluntary) program; it provides coverage for services that are not covered by Part A, such as laboratory services, ambulance transportation, prostheses, durable medical equipment, and some supplies. Medicare Part A covers hospital care, home care, and skilled nursing care. Medicare Part C plans are coordinated care plans that include health maintenance organizations, private fee-for-service plans, and medical savings accounts. Medicare Part D provides prescription drug coverage

A Medicare recipient has elected to pay a monthly premium for Medicare that will cover expenses such as durable medical equipment. Which of the following best describes this part of Medicare? a. Part A b. Part B c. Part C d. Part D

b

A bill with the potential to decrease health care services is passed by Congress. Which of the following actions should the nurse take to influence the bills implications? a. Exercise veto power by calling for petitions from health care agencies b. Contact the regulatory agency and participate in public hearings c. Call members of congress to request that they rescind the legislation that was passed d. Discuss the change in services with the administrators at the hospital

a.

A breast cancer screening program screened 8000 women and discovered 35 women previously diagnosed with breast cancer and 20 women with no history of breast cancer diagnosed as a result of the screening. The prevalence proportion would reflect: a. current and past breast cancer events in this population of women. b. newly diagnosed cases of breast cancer in this population of women. c. past breast cancer events in this population of women. the population of women that d. had no evidence of breast cancer.

b.

A business executive develops symptoms of the flu 1 day after returning by air from a cross-Atlantic business trip that ran for 2 consecutive stressful 10-hour days. This individual's development of flu symptoms illustrates the relationship between: a. host and agent. b. host, agent, and environment. c. risk and causality. d. morbidity and disease.

D

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 form 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

ANS: B The first step of the seven-step EBP process is step zero, which involves a curiosity about the interventions that are being applied; this is not described in any of the topic descriptors. Step one requires asking questions in a "PICOT" format; this is not described in any of the topic descriptors. Step two involves searching for the best evidence to answer the question. This is done through evaluating best practices.

A busy school health nurse concerned over the rising incidence of obesity wants to implement evidence-based practice (EBP) but faces barriers because of time constraints. Which of the following actions should the nurse take first? a. Identify students who are obese so that they may be closely monitored for weight control success or failure. b. Evaluate best practices to determine those that have the highest success rates for weight control in children. c. Schedule physician appointments for obese children. d. Develop an obesity management program for children whose body mass index exceeds normal.

bd

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.

ANS: C Spiral fractures are only possible from abuse, as they require a wringing motion to occur. When working with victims of child abuse, the primary obligation of all health care providers is to protect the child. The abuse must be reported as a legal and ethical obligation.

A child of 4 years is seen in the emergency department with a spiral fracture of the right arm. X-ray examination shows previously broken and healed bones. What is your immediate responsibility? a. Call social services to immediately set up foster care for the child b. Provide information about parenting and anger management classes c. Report the child abuse to the local legal authorities d. Try to establish rapport and trust with the child's family

d

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.

A

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

d. Neglecting to order certain tests or treatment to minimize cost to the provider In capitated arrangements, physicians and other practitioners are paid a set amount to provide care to a given client for a set period of time and amount of money. Thus, neglecting to order certain tests or treatment would be a way for the provider to maximize the amount of money received to provide care to members of this group. In a capitated arrangement, the provider would most likely not increase the number of interventions used or coerce clients to attend health promotion classes as both of these strategies would cost the provider more money, and the provider will be receiving a set amount of money to provide care for a given client for a set period of time. It is unlikely that the provider would encourage clients to seek care elsewhere; rather the provider would be conscientious about the number of tests and treatments that are ordered in order to try to contain costs.

A client expresses concern that health care coverage based on capitation may have negative side effects. Which of the following would most likely be a consequence of capitation? a. Coercing clients to attend health promotion education classes b. Encouraging clients to seek care elsewhere c. Increasing the number of interventions to maximize payment d. Neglecting to order certain tests or treatment to minimize cost to the provider

C

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

a. A combination of interventions, beginning with changing the environment The most effective way to get people to stop smoking and prevent relapse involves multiple interventions and continuous reinforcement, and most smokers require several attempts at cessation before they are successful. Making changes to the smoker's environment helps by eliminating cues to smoking, such as ash trays, lighters, and cigarette cases. Acupuncture, behavior modification, and nicotine replacement products may all assist the client in stopping smoking. However, it has been demonstrated that the most effective method involves a combination of strategies.

A client requests help to stop smoking. Which of the following methods would be the best for the nurse to suggest to the client? a. A combination of interventions, beginning with changing the environment b. Acupuncture to reduce the nicotine cravings c. Behavior modification through hypnosis d. Nicotine replacement products

a

A client states to the nurse, I have heard the Affordable Care Act is supposed to help improve the health care I receive, but so far I have seen no benefits from this legislation. Which of the following statements would be the best reply by the nurse? a. Maybe you have not directly seen the changes; however, several things have changed in health care because of this bill. b. It will take years to see any effects from the act because of the delays in implementation of the changes. c. This legislation will primarily improve care for the elderly and poor populations, so this is why you may not have seen any benefits. d. The way health care operates at the federal and state levels has changed, so most individuals will not see any direct impact.

C

A college student goes to the Student Health Center with an extremely swollen neck. The advanced practice nurse determines that he has mumps. His roommate also is experiencing malaise and a sore throat. These two students by definition are considered a: a. A mixed outbreak b. Common source c. Point source d. Propagated outbreak

C

A community health nurse drives through her assigned community before visiting the community groups scheduled for the day. She then drives through the community again that evening before going home. Which of the following best describes the nurse's reason for driving through the community twice in the same day? a. On the second trip, the nurse can carefully confirm the results of the first assessment. b. Repeating the experience ensures that the nurse absorbed all the relevant details. c. Driving through twice allows the nurse to see the community when many residents are at work or at school and then again when most are at home. d. When leaving in the evening, the nurse has more time to write down the results of the earlier assessment.

A D

A community health nurse encourages members of the community to partner and assist in creating health programs. Which of the following best describes the rationale for this action? (Select all that apply.) a. Partnering results in increased effectiveness b. Involving community members results in contributions of time and money into the program c. Having many partners results in increased publicity for the program d. Participating in planning results in having a vested interest in the outcome

A D

A community health nurse has been recently hired to work in an unfamiliar community. Which of the following persons would be effective key informants for the nurse? (Select all that apply.) a. Community's immigrant group activist b. Federal senators and representatives c. Health board members d. Local politicians such as the town mayor

C

A community health nurse has invited several agencies in the community to a meeting to discuss the disaster plan for the community. Which of the following best describes the purpose of this meeting? A. To increase stability in the community B. To improve overall community functioning C. To manage response to disasters in the community D. To enhance communication among agencies in the community

A B

A community health nurse is beginning to work with a newly assigned community. Which of the following would be appropriate actions for the nurse to take to help ensure acceptance? (Select all that apply.) a. Asking those with whom the nurse interacts in the course of daily living their perception of the community (e.g., clerks in grocery stores or pharmacies) b. Attending community events such as festivals or fairs and interacting with participants c. Becoming involved in and contributing to volunteer community organizations d. Completing a comprehensive physical assessment on nearby neighbors

ANS: B Research findings, knowledge from basic science, clinical knowledge, and expert opinion should be considered sources of evidence for EBP. The problem with nursing textbooks is that many are not grounded in evidence-based practice, because the concept is relatively new to the United States (as mentioned in the section of the chapter on historical perspectives of EBP). Scanning the Internet for ideas is helpful only if evidence-based practice sites are accessed, and most Internet sites are not EBP sites.

A community health nurse is determining the best way to address an outbreak of a new infectious disease using evidence-based practice. Which of the following actions would the nurse most likely take? a. Review policies and procedures b. Review outcomes of clinical trials c. Review several nursing textbooks d. Review reputable sites on the Internet

A

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

D

A community health nurse is trying to decrease the incidence of emerging infections caused by drug-resistant organisms. Which of the following actions would be most appropriate for the nurse to implement? A. Lobby for increased use of antibiotics in the treatment and prevention of communicable diseases. B. Notify the Centers for Disease Control regarding any unusual signs and symptoms related to a communicable illness. C. Reinforce the importance of receiving vaccinations according to recommended schedules. D. Teach parents that antibiotics should not be used for treatment of viral infections or for prevention of bacterial infections.

B

A community is experiencing the Honeymoon phase following a disaster. Which of the following is most likely to occur in the community? A. First responders work tirelessly to save others B. Survivors share their stories C. Medical personnel experience exhaustion D. Community organizations rebuild the community

C

A community mental health nurse is implementing a tertiary prevention activity. Which of the following interventions is most likely being completed? A. Disseminating information about mental health to community organizations B. Partnering with school health nurses for early identification of children who have evidence of mental health problems C. Providing case management services that link clients with serious mental illnesses to mental health and community support services D. Screening high-risk clients for the presence of mental disorders

c This diagnosis considers those in a community who may be feeling helpless, hopeless, or frustrated because of an extraordinary event. Financial and physical resources may not be available for rebuilding. Social isolation refers to unacceptable social behavior. Deficient community resources is not an approved diagnosis. Deficient community health may become a problem if sanitary conditions lead to an outbreak of disease.

A community was devastated by a tornado several months ago. What nursing diagnosis would be most appropriate for the nurse to consider? a.Social isolation b.Deficient community resources c.Ineffective community coping d.Deficient community health

b

A community-oriented nurse is interested in studying the hospital discharge data for facilities that typically provide services to members of the community where the nurse practices. The nurse accesses the National Hospital Discharge Survey database of the Department of Health and Human Services (DHHS) to identify data at national, regional, and local levels for comparison purposes. The government health care function being used by the nurse is: a. direct services. b. financing. c. information. d. policy setting.

a

A nurse would like to maximize her autonomy in her parish nursing practice. Which of the following models of parish nursing would most likely be preferred by the nurse? a. Congregation-based model b. Institution-based model c. Teamwork model d. Partnership model

ace

A current challenge for home health care is the issue of family responsibility for the role of caregiver. Which of the following statements reflects underlying factors that contribute to this home health care challenge? Select all that apply. a. Able family members with multiple obligations b. Debilitation of family members c. Number of women working outside the home d. Reimbursement to family e. Social support systems for caregivers

d

A current dramatic trend in nursing in community health involves: a. clinical surveillance. b. shifts in research focus. c. special needs programs. d. vulnerable population shifts.

b

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

c

A faith community nurse is partnering with a local public health department to develop programs for primary, secondary, and tertiary prevention activities. Which of the following should be used as the primary guide for development? a. Contemporary articles in nursing journals b. Evidence-based practice guidelines for treatment of disease c. Healthy People 2020 goals and objectives d. Preferences of partners who are funding the programs

cd

A family is concerned about the medical bills of their father, age 63, who is unemployed and has almost no savings. Which of the following statements by the nurse accurately explain how Medicaid and Medicare would work in this family's situation (Select all that apply.) a. "All your father's medical bills will be paid by whichever program is appropriate." b. "Choose any physician and just show them your Medicare or Medicaid card." c. "Your father must be homebound to qualify for Medicare assistance but less so for Medicaid." d. "Medicare is a federally funded program, but Medicaid is administered by your state."

d

A family member asks a home health nurse to explain the concept of hospice care. Which of the following would the nurse need to include as the fundamental underlying philosophy of hospice? a. Enabling the client to die at home b. Ensuring that the client's living will is upheld c. Placing experts in the position of power of attorney d. Providing comfort measures before death

d

A family shared their concerns, including sexual issues, in strictest confidence with a faith community nurse. When the nurse returned to the church office, the pastor asked why the family wanted to see her. Which of the following statements would be the best response by the nurse? a. "Because you are my supervisor, I will summarize what was said for you." b. "I will include that information in my report to our church's wellness committee." c. "They just wanted me to assess their health needs and make some suggestions." d. "The family had some issues they wanted to discuss in confidence, which I will keep in confidence."

d

A father confides to the parish nurse that his wife has been hurting their 3-year-old daughter. The nurse examines the daughter and finds evidence of physical abuse. In the parish nurse role, which of the following actions should the nurse take first? a. Contact the pastor for guidance in handling this situation. b. Recommend that the family be removed from the faith community. c. Refer the family to pastoral services for counseling. d. Report the findings to child protective services.

ANS: A The text talks about date rape drugs including ketamine, known as Special K. The first priority is to keep oneself safe, so leaving would be prudent. Ideally, the police will allow the report to be made without sharing who reported the potential problem.

A female nursing student is at a fraternity party where alcohol is flowing freely, the music is loud, and people are dancing and talking. Most people seem to be having a great time. What should she do, if anything, when she overhears two men talk about having put Ketamine in a girl's drink? a. First get out of there, then call the campus police and report what was heard b. Nothing, because she had no idea which woman was targeted or even if she drank what was given to her c. Talk to the two men about the dangers and side effects of ketamine d. Watch to see if any young women pass out or are otherwise impaired

a

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.

b

A group of parish nurses affiliated with a number of faith-based communities located in different regions across the state are attending a quarterly meeting. Which of the following statements made by one of them indicates a lack of understanding of parish nursing? a. "I always make sure to have new clients sign a release of information form to obtain their health record from their previous parish nurse." b. "Because I work for and within the church, I am immune from civil laws." c. "The pastor and I work together for the spiritual health of the community." d. "Yes, I am happy to pray with my clients and help them worship."

ANS: B EBP in community-oriented nursing challenges nurses to integrate outcomes of the best evidence into their clinical practice. Current research findings will explicate evidence of most successful interventions. (Randomized clinical trials are the gold standard of research for EBP.) Protocols and opinions often reflect tradition rather than the most current scientific evidence. Although many nursing journals are peer reviewed, many are not and, even if peer reviewed, many are not research based or focused on scientific evidence. Similarly, information from the Internet may or may not be reliable, because the goal of many websites is to sell products rather than to serve as an unbiased source. Determining when the website was last updated would also be helpful in evaluating the site's usefulness.

A health care provider is concerned about the high number of clients with type 2 diabetes mellitus who have poor glucose control. What would be the best reference for the provider to implement evidence-based practice (EBP) in the management of this problem? a. Published protocols b. Current research findings c. Opinions of colleagues d. Nursing journals

B

A nurse is assessing a community's openness to change. Which of the following variables indicate that the community is ready? a. Commitment to current processes and policies b. High social-economic status in the community as a whole c. Long history of dependence on the community health agency and its staff d. Minimal level of social participation by community members

C D

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

b Caregiver role stress can occur when the caregiver(s) is unable to meet obligations or unable to take care of personal needs. Using a respite caregiver once a week gives the family a little time off to accomplish needed tasks. The other observations are not tied to this diagnosis.

A home health care nurse is working with the family of a patient who has Alzheimer disease and requires 24-hour care. What assessment by the nurse indicates the family is meeting an important goal for caregiver role stress? a.Family eats dinner together every night. b.Family uses respite care one night a week. c.Family investigates research trials for patient. d.Family verbalizes exhaustion from caregiving.

a. "Please consider decreasing the time interval between doses to every 3 hours so that my client will maintain pain relief." b. "I'm really concerned my client will become addicted to the codeine." d. "My client needs a prescription for PRN medication for 'breakthrough' pain." It would not be appropriate to ask to decrease the time interval in between doses as the increased use of acetaminophen may be damaging to the client's liver and kidneys. There is no evidence that this client is at risk for developing an addiction. Thus, demanding that this medication be discontinued may be a premature action by the nurse. However, the nurse should monitor the patient closely for signs and symptoms of potential addiction. It would be appropriate to ask the primary care provider for an additional medication in the form of a PRN prescription to possibly assist with the client achieving optimal pain relief rather than changing medications entirely. Although it is a factor, the cost of pain medication isn't a consideration when addressing safe pain management interventions

A home health client has been prescribed acetaminophen with codeine every 4 hours for pain following a hip arthroplasty. Which of the following statements made by a nurse to the client's primary health care provider indicates a need for further education on narcotics related to the goals of safe pain management? (Select all that apply.) a. "Please consider decreasing the time interval between doses to every 3 hours so that my client will maintain pain relief." b. "I'm really concerned my client will become addicted to the codeine." c. "Consider prescribing a different medication so that my client will achieve adequate pain relief." d. "My client needs a prescription for PRN medication for 'breakthrough' pain." e. "This medication is expensive; please prescribe something less costly."

c

A home health nurse asks a client with arthritis to attend a demonstration in which an assistive device is used to put on shoes. Which phase of the nursing process is the nurse's current focus? a. Outcome identification b. Planning c. Implementation d. Evaluation

c

A home health nurse is caring for a client who has right-sided paresis secondary to a stroke. Which of the following would be the best approach for the nurse to take? a. Arrange for private duty nurses to assist the client with daily needs. b. Assist the client with activities of daily living. c. Teach the client to participate in self-care activities. d. Teach the family how to care for the client.

d

A home health nurse is working with a client who requires a catheter insertion and wound care. The nurse is also helping the client and family to develop positive coping skills and identify resources that will help the client to attain a state of optimal functioning. It is important for the nurse to specifically document nursing services provided because of which of the following? a. The agency is required to practice within the guidelines set up by regulatory agencies. b. Each criterion has minimum standards to which the program must adhere. c. Nurses are required to provide supervision of services. d. Reimbursement is dependent on the provision of skilled care.

d

A hospital nurse wants to know why home health nurses often take more time with assessment than nurses do in the hospital. Which of the following is the best explanation for this? a. Home care assessment includes not only the client but the supplies and equipment the family may have available for use. b. The home environment is less organized and equipped for the nurse's use. c. Family members must also be assessed for possible problems that could interfere with the primary client's recovery. d. To be effective, the home health nurse must earn the family's trust and work in partnership with them.

B

A key characteristic of faith community nursing services is to facilitate collaborative health ministries in the faith communities by: A. embracing individuals across the life span. B. respecting diverse traditions of faith. C. requiring statements of faith. D. using a Judeo-Christian theological framework.

C

A large amount of data related to hypertension rates is collected in a community. The data is 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

d

A major emerging public health issue facing nursing in community health is: a. bioterrorism. b. health literacy. c. health ministries. d. welfare reform.

ANS: 2 Title VI of the Social Security Act established state and local community health services and training of personnel.

A major provision of the Social Security Act of 1935 was the establishment of: 1. The Frontier Nursing Service to provide nursing service to rural communities 2. State and local community health services and training of personnel 3. District nursing to provide home health care to sick people 4. Community-based settlement houses

b The case manager in home health care must be a well-versed financial steward and understand what each patient's insurance will cover to maximize the patient's benefit. The home health care nurse serves as a case manager (coordinator) of client care, needed services, and needed supplies in the home setting. The nurse must be well versed as a financial resource manager, who needs to be aware of what is or is not covered on the client's insurance plan.

A nurse is a case manager for a home health care agency. The nurse often orders supplies for patients seen by the agency. What action by the nurse is best? a.Negotiate for cheaper prices from suppliers. b.Investigate what each patient's insurance will cover. c.Refer the patient to the closest supply source. d.Use the same supplier for all patients' needs.

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

A man is currently unemployed and despairs about finding a position A person who is unemployed and despairing of finding employment is at serious economic risk, which is one of the foremost predictors of health problems. Economic risk is determined by the relationship between family financial resources and the demands on those resources. Having adequate financial resources means that a family is able to purchase the necessary services and goods related to health, such as adequate housing, clothing, food, education, and health or illness care. A man who says he needs to eat better and exercise more appears to have adequate resources as he is employed. The man who has a family history of cardiac disease is not displaying any known risk factors related to income. The man who has been laid off still is receiving an income which should assist him in being able to afford the necessary goods and services he needs in the immediate future

b

A man is diagnosed with prostate cancer. Which of the following data should the nurse know to answer the man when he asks, What are the chances Ill survive this thing? a. Attack rate b. Case fatality rate c. Cause-specific morbidity rate d. Crude mortality rate

ANS: A It is a common myth that abusers will stop the abuse on their own. Professional intervention is required to break the cycle of abuse.

A man was crying and saying, "I didn't mean to do it. She just got me so angry I lost control. It will never happen again." The woman said, "It was my fault. I shouldn't have upset him." Then, looking at the nurse, the woman added, "Please don't report this. It will never happen again." What is your response? a. "Abusers don't stop unless intervention occurs. I have to report it." b. "If you're sure it won't happen again, I'll let it go this time." c. "Legally, I'm required to put this in the medical record." d. "The decision is up to the physician, not me."

c. Drug dependence Drug dependence is a state of neuroadaptation (a physiological change in the central nervous system) and alterations in other systems caused by the long-term, regular administration of a drug. People who are dependent on drugs must continue using them to prevent withdrawal symptoms. Drug addiction is a pattern of abuse characterized by an overwhelming preoccupation with the compulsive use of a drug and securing its supply and a high tendency to relapse if the drug is removed. Substance abuse does not apply in this case, because the man is taking a prescribed medication for a legitimate purpose. The term drug abuse is no longer meaningful.

A man who takes a prescribed narcotic for pain on a regular basis reports that he does not like the way the medicine makes him feel. He has tried to change to an alternate analgesic but experienced withdrawal symptoms when he stopped taking the narcotic. Which of the following problems is the man experiencing? a. Drug abuse b. Drug addiction c. Drug dependence d. Substance abuse

b

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."

D Mental health is defined as being able to engage in productive activities and fulfilling relationships with other people, to adapt to change, and to cope with adversity. Mental disorders are conditions characterized by alterations in thinking, mood, or behavior, resulting in distress and/or impaired functioning. Most persons do not get so angry that they become self-destructive (e.g., putting their hand through a glass window and requiring medical attention). The nurse can help the mother accept appropriate assessment and intervention by using positive language and giving hope. With more time the nurse can help the mother deal with feelings of having a "crazy" family member and the effects of such behavior on the whole family.

A mother and her son are in the emergency department. The mother is extremely upset. Earlier, the son had become so angry that he put his hand through a glass window and had to have stitches. The physician suggested a psychiatric consult. Now the mom asks, "Do you think my son is crazy?" Which is the most appropriate response? a. "Absolutely not. But a psychiatrist can help your son realize more appropriate ways of displaying anger." b. "Have you had other reasons to think your son is crazy? Perhaps the psychiatrist can reassure you that your son is just an adolescent coping with hormones." c. "Your son is having problems coping with anger. And naturally you're upset. Let the psychiatrist determine whether your son is crazy or not." d. "Your son is having problems with behavior, which is distressing all of you. A psychiatrist may be able to help your son cope with life in a more acceptable way."

b

A mother brings her child to the nurse's office a few days before the first day of class for the new school year. The mother wants the child to begin school but says, "I'm going to take care of the immunizations tomorrow." The most important action the nurse should take is to: a. conduct a physical examination to determine whether the child is healthy. b. explain to the parent that all required immunizations must be given before the child will be allowed to enter school. c. let the child begin school but ensure that the school keeps the child separated from the other children. d. make sure the child does have an appointment for tomorrow.

ANS: C Although all of these options are good, to determine whether practice is serving the needs of the population, the nurse will need to consult the population served. This means that evidence should be applied with input from the community. For example, decisions related to the services to be offered in a nurse-managed clinic should be made with input from the clinic's advisory board, which should include community leaders and consumers of the clinic's services. Cuban immigrant needs may not be the same as

A nurse executive is implementing evidence-based practice at a community nursing center that serves a large Cuban immigrant population. Which of the following actions would be the most helpful for the nurse? a. Review clinical policies with cultural competency experts from the local university. b. Conduct weekly staff meetings to discuss which methods work best when helping immigrants. c. Invite Cuban immigrants from the community to serve on the center's advisory board. d. Send personnel to conferences and seminars that focus on treating Hispanic immigrants.

a. Provide opportunities for her daughter to develop her talents. b. Provide realistic feedback to the daughter about her performance at school. c. Encourage her daughter to become involved in extracurricular activities. e. Encourage her to discuss her dreams for the future. Prevention guidelines to teach parents and teachers how to increase resiliency in youths include the following strategies: help them develop an increased sense of responsibility for their own success; help them identify their talents; motivate them to dedicate their lives to helping society rather than believing that their only purpose in life is to be consumers; provide realistic appraisals and feedback, stress multicultural competence, and encourage and value education and skills training; and increase cooperative solutions to problems rather than competitive or aggressive solutions. Based on the information provided, there is no reason to suggest the child needs to develop new friendships. Keeping consistent friendships may provide the support the child needs to avoid engaging in these behaviors

A mother is concerned that her daughter may be considering experimentation with drugs and alcohol. Which of the following strategies would the nurse suggest the mother implement? (Select all that apply.) a. Provide opportunities for her daughter to develop her talents. b. Provide realistic feedback to the daughter about her performance at school. c. Encourage her daughter to become involved in extracurricular activities. d. Encourage her daughter to develop new friendships. e. Encourage her to discuss her dreams for the future.

C

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

c. The man will likely win because of an inborn tendency to greater alcohol tolerance. Women are more affected by alcohol than men, because women have less alcohol dehydrogenase activity than men; thus men have an increased tolerance for alcohol. It is also unlikely that they will both "win" at the same time because the alcohol will likely affect the woman factor than the man. The adipose tissue ratio is not a factor in alcohol tolerance. While vomiting may occur, it will not necessarily affect the ability to continue to consume alcohol.

A movie shows a woman and a man having a contest to see who can drink more shots of whiskey. Who is more likely to "win" the drinking contest when and one is unable to continue drinking? a. If their alcohol consumption is the same size, they'll both pass out about the same time. b. Whoever has food in their stomach will probably vomit and be unable to continue drinking. c. The man will likely win because of an inborn tendency to greater alcohol tolerance. d. The woman will likely win due to the tendency to have more adipose tissue

d

A new client has just been released from the hospital after intensive treatment for multiple injuries following a motorcycle accident. Which of the following types of care will he most likely receive? a. Home-based primary care b. Population-focused home care c. Proprietary home care d. Transitional care

C

A new nurse is overwhelmed with the needs of the community. Which of the following should be the first priority of the nurse? a. A problem that affects the most disadvantaged residents in the community b. A problem that is very easy and inexpensive to address c. A problem that is of high concern to the community d. A problem in an area in which the nurse has a great deal of expertise

c

A new role for public health that is used in widespread public emergencies is: a. communicable disease control. b. first responder. c. incident commander. d. professional triage.

ad

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.

C

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

c

A nurse advises a client with osteoporosis to have three servings of milk or dairy products daily. Which of the following levels of prevention is being used by the nurse? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Treatment, but not prevention

A

A nurse at a migrant clinic assists clients with completing the application process to receive supplemental food assistance. Which of the following roles of the nurse is being used? A. Advocate B. Case manager C. Outreach worker D. Primary caregiver

c

A nurse completes a self-assessment of performance as part of the home health nurse's annual evaluation. Which of the following terms best describes this activity? a. Collaboration b. Quality of care c. Performance appraisal d. Resource utilization

D

A nurse educator who teaches at the local community college takes the time to read and understand her community's disaster plans and participates in community mock disasters as a leader of the triage team. The best description of the nurse's activities would be: a. ARC disaster training. b. community preparedness. c. personal preparedness. d. professional preparedness.

a The nurse's priorities may be very different from the community's. For programming to be successful, there must be buy-in from members of the community. Unless programming addresses a need the community thinks is important, it is unlikely to be successful.

A nurse has assessed a community and has found many areas in which health can be improved. As a result, the nurse has multiple ideas for programming. What action by the nurse is best? a.Determine what the community thinks is most important. b.Use vital statistics to determine which is most important. c.See what other communities are focusing programming on. d.Choose the easiest problem to address first.

ANS: A, C Barriers to evidence-based practice exist when the following are limited or lacking: time, access to journal articles, search skills, critical appraisal skills, and an understanding of research terminology. Other barriers include miscommunication about the process; inferior or unavailable research or other evidence; unwillingness of organizations to fund research or make decisions based on evidence; and concern that evidence-based practice will decrease emphasis on individual client needs or the nurse's clinical decisions.

A nurse has decided to increase the evidence base of current nursing practice in an agency. Which of the following describes a barrier that could be encountered by the nurse? (Select all that apply.) a. Colleagues who don't know how to search the literature or critique research b. Dedication to the history and tradition of the agency c. Little or no research published in the clinical area of concern d. Several meta-analyses in the literature with inconsistent results

A

A nurse has invited community members to participate as full partners in creating changes to improve the health of the community. Which of the following may be an unexpected consequence of this action? a. A change in the distribution or redistribution of power and influence b. An increase in awareness of the importance of health c. Continued ongoing interest in community health activities d. Improved family functioning and involvement in health activities

b

A nurse has just received word that Medicaid will reimburse for care provided to a homeless man with schizophrenia who is afraid to come to the clinic to receive health care. Which of the following best describes this type of nursing? a. Community-oriented nursing b. Home health nursing c. Hospice nursing d. Private duty nursing

d

A nurse has only a regular blood pressure cuff when conducting a health screening for all of the residents of a community. Which of the following may be lacking when obtaining blood pressure readings? a. Reliability b. Sensitivity c. Specificity d. Validity

b One of the most important aspects of a community health nurse's role is to be familiar with referral agencies. Awareness of the scope of an agency's influence and services helps the community nurse to pinpoint which agencies are best able to address specific needs. The nurse may have sent this patient to an agency that did not meet his needs. The nurse should ask the patient's opinion about what services are needed. Making another appointment without ensuring that this is the right agency for the patient will not solve the problem. Telling the patient that payment might not be ensured for nonadherence is not therapeutic communication.

A nurse has referred a patient to a community agency. When talking to the patient later, he states that he did not find the agency helpful. What action by the nurse is best? a.Determine what the patient would find helpful. b.Review the agency's mission and scope. c.Make another appointment with the agency. d.Warn the patient that nonadherence affects payment.

ANS: A EBP cannot be applied as a universal remedy without attention to client differences. When EBP is applied at the community level, best evidence may point to a solution that is not sensitive to cultural issues and distinctions and thus may not be acceptable to the community. For example, computer games may be excellent for younger groups but are often poorly suited for older Americans who may face challenges with learning new technology.

A nurse implements an education program that incorporates computer games to reinforce learning for a group of older adults. Although the research demonstrates evidence of improved retention of this information, the nurse experiences exactly the opposite with this group. Which of the following is the most likely cause of such poor outcomes? a. Failure to consider client and setting differences b. Inadequate incorporation of evidence into practice c. Inferior quality of the available research evidence d. Lack of skills when evaluating the evidence

B

A nurse in community health contacts three individuals who have had sexual encounters with an individual recently diagnosed with syphilis. The concept basic to community-oriented nursing practice that is best described by this intervention is: a. community. b. community as client. c. individual as client. d. partnership.

A,C,E

A nurse in community health in California has been working with a 6-year-old child that was rescued from a mudslide. The nurse will observe the child for which of the following stress effects? Select all that apply. a. Bed-wetting episodes b. Desire to return to school c. Fantasies of denial d. Increased playfulness with peers e. Thumb sucking

B

A nurse in community health is invited to work with a coalition of churches to address safety concerns for children in the local community. The nurse provides training in problem-solving skills, manages conflict, facilitates the process, and provides expertise in interpreting data. This nurse has chosen the implementation role of: a. change agent. b. change partner. c. group leader. d. data collector.

c

A nurse in community health may have state-granted personal immunity for particular practice areas such as giving immunizations. If the state legislature has granted personal immunity to nurses employed by public agencies to cover all aspects of their practice, the legal theory that applies is: a. case law. b. respondeat superior. c. sovereign immunity. d. worker's right to know.

c

A nurse in community health that speaks out in a public hearing in support of changes to existing requirements for reporting any long-term effects of structural or organizational changes within the community's health care organizations would be demonstrating: a. legislative action. b. health policy. c. regulatory action. d. regulatory monitoring.

c.

A nurse in community health who teaches a client with asthma to recognize and avoid exposure to asthma triggers and assists the family in implementing specific protection strategies such as removing carpets and avoiding pets is intervening at the level of: a. assessment. b. primary prevention. c. secondary prevention. d. tertiary prevention.

c

A nurse is administering a tuberculosis skin test to a client who has AIDS. Which of the following results should the nurse anticipate when using this screening test? a. Decreased positive predictive value b. Decreased reliability c. Decreased sensitivity d. Decreased specificity

d

A nurse is advocating for the public health department to increase the number of public health nurses that it employs. Which of the following factors should the nurse emphasize? a. Providing disease investigation training b. Providing research opportunities c. Providing leadership experiences d. Providing salaries commensurate with responsibilities

C

A nurse is assessing persons arriving at a shelter following a disaster. Which of the following would be the first action the nurse should take? A. Limit the amount of equipment and medications brought into the shelter. B. Determine if the person has a psychological condition requiring special attention. C. Assess if this type of facility is appropriate for the person. D. Provide medical care for persons as if they were in a hospital.

All the above Income, education, health literacy, where people live or work, early childhood development, social exclusion, family structure, the status and role of women, and vaccination adherence are just some of the social determinants of health recognized worldwide. Communication patterns often are important to assess in culturally diverse individuals, families, and communities, but this is not considered a social determinant of health care.

A nurse is assessing social determinants of health. Which does the nurse include in the assessment? (Select all that apply.) a.Vaccination compliance b.Family structure c.Communication patterns d.Roles for women e.Education

D

A nurse is assessing the status of a community's health. Which of the following will the nurse examine? a. Community awareness b. Health facilities c. Health care manpower d. Vital statistics

D

A nurse is assessing the structure of a community's health. Which of the following data will the nurse examine? a. Health facilities and their staffing patterns b. Health risk profiles of selected aggregates c. Statistics of morbidity and mortality in comparison with similar communities d. Treatment and service use patterns from local health agencies and care providers

A

A nurse is attempting to minimize damage following a bioterrorism attack in the community. Which of the following would be the most crucial aspect for the nurse to consider? A. Detecting an increase in people with similar signs and symptoms B. Identifying typical chemical or biological agents C. Identifying factors that put people at risk D. Recognizing areas of vulnerability within an area

A

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 individuals has the disease. What type of case is the nurse investigating? a. A suspected case b. A confirmed case c. A prolonged case d. An identified case

b OASIS (Outcomes and Assessment Information Set) is a data set of outcome measures for adult home health care clients that is used to track outcome-based quality improvement. Factors that could potentially affect patient safety in the home are particularly important. The other options are not included in this assessment.

A nurse is completing an OASIS assessment on a patient. What data would be most important for the nurse to assess? a.Presence of grocery stores nearby b.Safety concerns within the home c.Number and kind of pets d.Proximity to a health care facility

B, D, F Suggestions for promoting interaction between an adult and a baby include the following: maintaining a distance of 8 to 10 inches from the baby, smiling, and making eye contact. Talk to the baby, but avoid "baby talk." Singing may also help soothe a baby when fussy (try different melodies to see what the baby prefers). Babies love to play and enjoy "taking walks" and looking at brightly colored objects or toys that make noises.

A nurse is concerned about a young teenage mother who does not seem to know how to play with an infant. What behaviors might the nurse want to role-model as good parenting behaviors? Select all that apply. a. Allowing the baby to cry for 10 or 15 minutes before reacting so that the infant can learn to self-soothe b. Cuddling and holding the baby while smiling and gazing into the baby's eyes c. Teaching the mother to keep her face about 4 or 5 inches from the baby and to gently blow on the infant's face d. Singing to baby with different melodies until baby seems to listen and shows a preference for certain tunes e. Using "baby talk" (goo-goo, gaga) to help the infant recognize verbal sounds f. Walking with the baby while pointing to bright colors and listening to sounds

A Secondary prevention activities involve screening activities that allow for early recognition of problems so that prompt interventions can limit disability. By asking caregivers how they are coping (thus screening), the nurse identifies problems early so that interventions can be employed to limit the extent of stress, thus paving the way for improvement. The other options are either primary or tertiary activities depending on whether the intervention takes place before or after caregiving stress has developed. Also, option 2 could result in negative outcomes for the person needing care (unless a competent substitute is filling in for the primary caregiver).

A nurse is concerned about stress related to the heavy caregiving burden assumed by adult children of older clients. What action by the nurse would use secondary prevention to limit caregiver stress? a. Asking caregivers how they are doing and suggesting coping strategies b. Encouraging caregivers to periodically leave the house for a couple of hours c. Establishing support groups for caregivers of older parents d. Referring some activities to neighbors and friends

b.

A nurse is concerned about the accuracy of the PPD test in identifying cases of TB exposure for follow-up chest x-ray. The nurse's concern is addressing the validity measure of: a. reliability. b. sensitivity. c. specificity. d. variation.

a

A nurse is considering accepting the parish nursing position within his congregation. Which of the following educational preparation is crucial for the nurse to have received? a. Baccalaureate education including community health nursing experience b. Graduate education in community health nursing c. Passing the national certifying exam for parish health nursing d. Worship experiences for the process of ministry

B

A nurse is considering applying for a public health nurse position at a local health department. Which of the following minimum levels of educational preparation should the nurse have obtained? A. Associate degree in nursing B. Baccalaureate degree in nursing C. Master of science degree in nursing D. Training as a licensed practical nurse

A B D

A nurse is deciding which alternative interventions should be implemented. Which of the following factors must be considered by the nurse when making this decision? (Select all that apply.) a. The expected effect or outcome of each possible intervention b. How interested others are in helping in any particular intervention c. The nurse's own interest in implementing each intervention d. The likelihood that the intervention will resolve the problem

a. Supporting an increase in the availability of recreational facilities c. Educating all middle school students about the long-term side effects of drugs and alcohol d. Providing general screenings for substance abuse e. Identifying community-based resources that deal with substance abuse issues Supporting an increase in additional recreational facilities would engage the community members in healthy activities rather than having them potentially turn to substances for relaxation. Providing screenings for substance abuse in the community may assist community members in recognizing the problem sooner. It would be appropriate to educate middle-school students about the long-term side effects of drugs and alcohol since they would be able to understand the information. Early intervention with education is a proven deterrent to substance abuse. Lobbying state legislators for increase in a higher cigarette tax may be beneficial, but this intervention is focused on the state rather than the community where the nurse is working. Identifying local resources where assistance and addition information about substance abuse issues can be found is an appropriate community-based intervention

A nurse is developing a community-based activity aimed at preventing substance abuse in the community. Which of the following interventions would the nurse most likely implement? (Select all that apply.) a. Supporting an increase in the availability of recreational facilities b. Lobbying to state legislators to approve a higher cigarette tax c. Educating all middle school students about the long-term side effects of drugs and alcohol d. Providing general screenings for substance abuse e. Identifying community-based resources that deal with substance abuse issues

a. Health literacy in an important concept in health. If the patient cannot read or comprehend written material, it will be of limited use. The nurse first assesses the patient's ability to read and comprehend written material before choosing the material with which to send him/her home. Patients may or may not realize what they need for discharge, if anything. Giving the patient the same material other patients get does not acknowledge their need for holistic and individualized care.

A nurse is discharging a patient and is planning on what material to give the patient to take home. What action by the nurse is best? a.Assess the patient's ability to read and understand. b.Determine if the patient wants to take written material home. c.Give the patient the same material as other patients get. d.Ask the patient if he/she has a need for written material.

b. Ability to pay for services Because there are not enough health care services available to provide desired services to everyone, the focus has been on reducing costs by controlling the use of services. All of the factors listed affect health care access and therefore affect health care rationing (either directly or indirectly). The primary determinant, however, is the ability to pay for services. Without this ability, services are denied; therefore, those without insurance that is accepted by a provider or institution or who do not have the money to pay out of pocket are unable to obtain services regardless of operating hours, transportation issues, or availability

A nurse is discussing how health care rationing occurs in the United States. Which of the following would most likely be discussed as the criterion that is used to ration health care a. Clinic operating hours b. Ability to pay for services c. Availability of local provider services d. Transportation availability

b

A nurse is employed as a nurse epidemiologist. Which of the following activities would most likely be completed by the nurse? a. Eliciting the health history of a client presenting with an illness b. Evaluating the number of clients presenting with similar diseases c. Performing a physical examination of an ill client d. Providing treatment and health education to a client with a disease

D

A nurse is employed at the state department of public health. Which of the following is a fundamental principle guiding his practice? A. Decisions are made at the federal level, disseminated at the state level, and carried out at the community level. B. Health of populations is only as good as the health of individuals that live and work in the community. C. Oversight of community health departments is the most important function. D. The interaction of the local-state-federal partnership is critical to success.

ABD

A nurse is employed by a state public health department. Which of the following functions would most likely be completed by this agency (Select all that apply.) A. Delegating power to engage in certain activities such as quarantine B. Enforcing laws and regulations that protect public health C. Filing birth and death certificates whenever these occur within the state D. Monitoring health status of citizens within its geographic boundaries

D

A nurse is employed by the American Red Cross and is frequently assigned to fly to a disaster zone. Which of the following should the nurse's family members have readily available? A. Gloves, mask, and other personal protective equipment B. A copy of the nurse's professional license C. A 5-day supply of water D. A disaster/emergency plan

a

A nurse is examining all of the various factors which can lead to disease. Which of the following models would the nurse most likely use? a. Epidemiologic triangle b. Health promotion c. Levels of prevention d. Natural history of disease

d

A nurse is examining the various factors that lead to disease and suggests several areas where nurses could intervene to reduce future incidence of disease. Which of the following models would the nurse most likely use? a. Epidemiologic triangle b. Health promotion c. Levels of prevention d. Web of causality

ANS: A The first step toward implementing evidence-based practice in nursing is recognizing the current status of one's own practice and believing that care based on the best evidence will lead to improved client outcomes. The challenge for the clinician is how to access the evidence and integrate it into practice, thus moving beyond practice based solely on experience, tradition, or ritual.

A nurse is familiar with evidence-based practice (EBP) and wants to implement it into the care of clients. Which of the following would present the biggest challenge? a. Assessing one's current practice and accessing evidence-based resources b. Convincing administration that EBP is beneficial c. Distinguishing EBP from practice based on old standards d. Showing clients that EBP will improve their health outcomes

A

A nurse is focused on mitigation of disasters at the international level. Which of the following activities would the nurse most likely complete? A. Provide community educational programs and training on how to prepare for disasters. B. Request donations be sent to the affected area. C. Develop a notification procedure to be used by the international disaster relief office. D. Recruit volunteers to be a part of the disaster team that will travel to the afflicted area.

C

A nurse is focusing on the process dimension of a community's health. Which of the following interventions will the nurse most likely implement? a. Assessing the health care services available in a community b. Establishing screening programs to diagnosis diseases as early as possible so treatment can begin c. Implementing health promotion activities such as education programs d. Planning for new programs to be developed based on identified needs

a. "Express your belief in him and his ability to change." b. "Point out that his behavior is his choice and his responsibility." e. "Let him know that he is loved by his family and friends. Using FRAMES as a guideline, the nurse would provide Feedback about problems with using drugs, emphasize the person's own personal Responsibility for any changes made, and give Advice on how to change behaviors, including a Menu of options from which to choose while expressing Empathy. Finally, the nurse would provide encouragement and belief that the person can change, hence increasing feelings of self-efficacy. Having the client's family members tell the father that they understand his behavior does not encourage him to realize the need for change. Threatening a future possibility of prison would not provide encouragement to the father and may even challenge him to continue his behavior

A nurse is helping a client's family prepare to have an intervention that hopefully will encourage the alcoholic father to realize the need for change. Which of the following instructions by the nurse to the client's family members would be most effective? (Select all that apply.) a. "Express your belief in him and his ability to change." b. "Point out that his behavior is his choice and his responsibility." c. "Let him know that you understand how much he loves being with his drinking pals." d. "Remind him that entering treatment is better than going to prison." e. "Let him know that he is loved by his family and friends.

A

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

B

A nurse is implementing a primary prevention activity to decrease the incidence of communicable disease. Which of the following actions is the nurse most likely taking? A. Identifying and treating clients in a sexually transmitted disease clinic B. Partnering with schoolteachers to teach and observe hand washing techniques in elementary school children C. Providing case management services that link clients with communicable diseases to health care and community support services D. Performing directly observed therapy (DOT) for clients with active tuberculosis

b. Persuading legislators to pass a bill offering health care financial aid to families at risk Primary prevention occurs before an illness or condition develops. Of the options provided, only persuading legislators to pass a bill offering health care financial aid to families at risk addresses initiating interventions before an illness occurs. Applying for a grant and referring clients with renal failure both demonstrate the use of tertiary prevention as the illness or condition has already developed. Screening cocaine addicts displays the use of secondary prevention as a screening technique is being used to identify the problem as soon as possible.

A nurse is implementing a primary prevention strategy focusing on economics within the community. Which of the following interventions is the nurse most likely completing? a. Applying for a grant to establish a daycare center to serve dependent older adult clients living with working families b. Persuading legislators to pass a bill offering health care financial aid to families at risk c. Screening cocaine addicts for financial assistance eligibility for drug treatment d. Referring clients with renal failure to apply for Medicare

C

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

b The epidemiologist works to develop programs to prevent the development and spread of disease. Studying census data, researching population variables, and designing studies do not fall in this field.

A nurse is interested in epidemiology. What work activity would best fit this role? a.Studying census data to determine common causes of death b.Researching population variables that contribute to disease c.Developing sanitary measures to prevent foodborne illness d.Designing research to determine the connection between pollution and cancer

c

A nurse is investigating a bacterial illness that has caused a health problem in the community. Only some of the people exposed to the bacteria have become ill. Which of the following factors best explains why this would have happened? a. Chemical agent factors b. Environmental factors c. Host factors d. Physical agent factors

D

A nurse is investigating a potential bioterrorism attack. What evidence would a nurse most likely find if a bioterrorism attack occurred? a. A large number of 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 tip d. An unusual illness in a population

C

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

c. Tertiary care is aimed at people who are already experiencing a health alteration, such as those with an infection who need antibiotics. The other options are secondary prevention.

A nurse is orienting to a new job in a home health care agency and is told that most of her patients need tertiary prevention. What activity does the nurse plan to include in the daily routine? a.Household safety checks b.Well-baby checkups c.Antibiotic administration d.Monthly blood pressure assessments

d

A public health nurse employed by the Department of Health is working on a team developing local health policy. The nurse recognizes which of the following about policy development? a. It is based on Socratic method. b. It is important that the policy has been approved by the American Nurses Association. c. It is primarily up to politicians to plan for health care. d. It is very similar to the nursing process.

D

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

a Primary prevention includes activities designed to prevent a disease or condition from occurring in the first place. Examples of primary prevention activities include vaccinations, wellness programs, good nutrition for health, and safer sex programs. Mammograms and physical exams are secondary prevention measures. Medication compliance would be tertiary prevention.

A nurse is planning primary prevention activities. Which activity would the nurse include in this plan? a.Safer sex education for teens b.Mammogram screening c.Medication compliance d.Annual physical exams

C

A nurse is practicing in the community but also has the community as the target of practice. Which of the following best describes the activities of this nurse? a. Providing care to an active caseload of 50 families in the neighborhood b. Inviting all the parents of asthmatic children in the school to meet together for mutual support c. Sharing assessment findings and health goals with every community group that will listen d. Writing articles for the local newspaper highlighting the various programs and services of the local health department

c. Medicaid Medicaid provides coverage for adults with low income and their children. Managed care is a type of private insurance while Medicare is available to persons aged 65 and older. The emergency department would charge a co-pay for care given to both the child and the parents.

A nurse is providing care to a child whose parents do not receive health insurance as an employee benefit and who do not have the financial resources to pay for health care out of pocket. Which of the following resources should the nurse recommend to the family? a. A managed care organization b. An emergency department c. Medicaid d. Medicare

B

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

C

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

d. "That is great. You've started to take action and make changes." There are five stages of change: (1) precontemplation—or resisting that there is a problem, (2) contemplation—or thinking about the problem, (3) preparation—preparing for action and taking some initial steps, (4) action—or making modification in behavior and environment, and (5) maintenance—or preventing relapse. The client prepares for action by learning to recognize the importance of eating and needed changes. Therefore, the nurse should encourage and recognize that the client has begun serious change. This comment by the client demonstrates readiness to take action and needs to be encouraged by the nurse. The incorrect responses are not encouraging replies that would promote the client to continue to move forward with these actions.

A nurse is reviewing with a client the importance of the diabetic diet to maintaining control of blood glucose levels. The client states, "I went to the classes and learned how to count carbohydrates. I have even started to write down what I eat for each meal." Which of the following would be most appropriate response from the nurse? a. "I'm so glad you're beginning to recognize the need to control your blood sugar." b. "Now you just have to make sure you don't give that habit up!" c. "Sounds like you're not ready to really plan your eating yet." d. "That is great. You've started to take action and make changes."

A,E Host, or intrinsic factors are individual variables such as genetics, age, gender, ethnic group, immunization status, and human behavior that impact a person's health. The other options are all extrinsic factors, which pertain to environmental characteristics.

A nurse is studying intrinsic factors that influence the development of asthma in a community. What factors does the nurse assess? (Select all that apply.) a.Socioeconomic status b.Genetics c.Pollution in the area d.Water cleanliness e.Immunization status

d. Teaching a high school boy about sexually transmitted infections and proper condom application Education is primary health care prevention. A proactive investment in disease prevention and health promotion targeted at improving health behaviors and lifestyle has the potential to improve health status and reduce health care costs. Assisting in a cast application, irrigating a client's eyes, and restoring a normal cardiac rhythm are all tertiary prevention methods as a condition has already occurred and the nurse is focusing on restoring health. In order to maximize quality while reducing health care costs, the nurse should focus on primary prevention strategies

A nurse is trying to maximize the quality of life of clients while reducing health care costs. Which of the following actions would most likely be completed by the nurse? a. Assisting in cast application for a client who was injured in a skateboard incident b. Irrigating the eyes of a client splashed with chemicals c. Restoring a normal cardiac rhythm following cardiopulmonary resuscitation of a client with a heart condition d. Teaching a high school boy about sexually transmitted infections and proper condom application

b

A nurse is using analytic epidemiology when conducting a research project. Which of the following projects is the nurse most likely completing? a. Reviewing communicable disease statistics b. Determining factors contributing to childhood obesity c. Analyzing locations where family violence is increasing d. Documenting population characteristics for healthy older citizens

C

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 attach occurring in the community

Teaching a client with gonorrhea how to prevent reinfection and further spread is an example of _____ prevention. a. Primary b. Secondary c. Tertiary d. Primary health care

ANS: B Secondary prevention focuses on early detection and prompt treatment of disease, injury, or disability.

a The role of the registered nurse in home health care is essentially autonomous in that the nurse must be highly proficient in health assessment (physical and psychosocial), be well versed in complex technical and clinical skills, possess strong critical-thinking and clinical reasoning abilities, and demonstrate excellent organizational skills. All choices are important characteristics or abilities of home health care nurses. However, since the nurse working out in the community may not have the resources (personnel or materiel) available in an acute care facility and often must improvise, clinical reasoning would be the most important of the choices provided.

A nurse is wondering if home health care nursing is a good fit. What characteristic or ability does the experienced home health care nurse suggest is most important? a.Clinical reasoning b.Organization c.Assessment skills d.Time management

B

A nurse is working at a local health department. Which of the following would most likely be completed by this agency? A. Enforcement of laws and regulations related to public health nationwide B. Filing of a certificate for any birth or death in a community C. Providing experts in various specialties to answer questions and respond as needed D. Surveying the state's public health needs

B

A nurse is working toward an objective to "Increase to at least 90% the proportion of all pregnant women who receive first trimester prenatal care." During which of the following phases of the nursing process would determination of the objective occur? a. Assessment phase b. Planning phase c. Implementation phase d. Evaluation phase

A

A nurse is working with a community during the preparedness stage of disaster management. Which of the following events would the nurse anticipate occurring? A. Heightened inspection and increased security in the community B. Incorporation of provision of pets into local disaster plans C. Purchase of personal protective equipment for all citizens D. Assembly of disaster kits for the home, workplace, and car

A

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

A

A nurse just accepted a position in community health and has been assigned to a neighborhood very close to where she lives. Which of the following best describes the rationale for this assignment? a. To allow participant observation by the nurse b. To ensure that the nurse would care about her intervention outcomes c. To maximize convenience and minimize commuting time for the nurse d. To save gasoline in these difficult economic times

D

A nurse learns about a huge disaster a few states away. Which of the following actions by the nurse would be most helpful in this situation? A. Contributing funds to any charity that is assisting the victims B. Driving over to the area and volunteering to assist C. Sending clothes and food to the area for distribution D. Training to become a Red Cross disaster volunteer

ANS: D EBP demands changes. It requires incorporating more practice-oriented research and more collaboration between clinicians and researchers. Emphasis should be on decision making using the varied sources of evidence. The environment and climate must be supportive in order to implement EBP.

A nurse manager wants to facilitate incorporation of evidence-based practice (EBP) in the clinical setting. Which of the following would be the best strategy to accomplish this goal? a. Eliminate all protocols and standards that are not evidence based b. Encourage group reflection on the ideals and expectations of nursing care c. Refer agency nurses to Internet sources of research findings d. Support nurses using practice-oriented research findings in decision making

c

A nurse meets with a senator to lobby for passage of a bill to increase funding for interpreter services. With which of the following branches of the government is the nurse working? a. Constitutional branch of government b. Executive branch of government c. Legislative branch of government d. Judicial branch of government

a

A nurse orienting to the home health role states, "I don't understand why we have to collaborate with so many other disciplines; this conflicts with the concept of nurses providing all direct care to the client in the home" Which of the following would be the best response? a. "The nurse still provides direct care for the client; however, interdisciplinary collaboration is necessary to prevent fragmentation of care." b. "Direct nursing care is a concept applied to care in tertiary facilities, such as hospitals, where materials are centrally located in one facility. In home health, this is not possible." c. "Even though home health nursing does not provide as much direct care as other nursing specialties in the community, each discipline contributes to client needs from its special knowledge base." d. "Yes, it does create conflict, but Medicare mandates interdisciplinary collaboration."

B

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

c

A nurse reports that in comparison to all the children in a particular school, the children who are members of the Cub Scouts have 0.3 risk for obesity before entering the sixth grade. Which of the following recommendations would the nurse make to the new parents of two boys who had just moved into this schools neighborhood? a. Discourage the parents from enrolling their sons in Cub Scouts because of the risk. b. Dont say anything about Cub Scouts, because it isnt relevant to nursing care. c. Encourage the parents to enroll their sons in Cub Scouts. d. Share the finding and let the parents draw whatever conclusions they feel appropriate.

B C

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

A nurse is interested in census data. Which federal departments website would be a good place to start? a. Department of Labor b. United States Immunization Survey c. Commerce Department d. World Health Organization

ANS: C The Commerce Department handles the United States Census and population estimates and projections.

b. The sidestream smoke that the baby is exposed to is more dangerous than the mainstream smoke that the parents are inhaling themselves. Sidestream smoke contains higher concentrations of toxic and carcinogenic compounds than mainstream smoke. Sidestream smoke contains higher concentrations of toxic and carcinogenic compounds than mainstream smoke. Fetal alcohol syndrome is a cause of newborn congenital dysfunctions. There is not known tolerance to tobacco smoke. While chewing tobacco doesn't produce smoke, the parents would still be at a considerable health risk from the nicotine.

A nurse sees the father of a newborn baby push his wife in a wheelchair out onto the patio. The man and woman each smoke a cigarette while the baby sleeps in the mother's arms. Which of the following information should the nurse share with the parents? a. Fetal nicotine syndrome may cause complications in the newborn. b. The sidestream smoke that the baby is exposed to is more dangerous than the mainstream smoke that the parents are inhaling themselves. c. The baby will eventually develop tolerance to tobacco smoke. d. The parents should switch to chewing tobacco as long as the child lives in the home.

a.Factory owners c.Community residents d.Local health care providers Stakeholders have a significant interest in a topic. The priority stakeholders the nurse would want to consult for this project include the factory owners, community residents, and health care providers. The stockholders would probably not be consulted. The employees could be a significant stakeholder if the action plan affected employment.

A nurse wants to create a community action plan for health problems related to air pollution from a nearby factory. Which stakeholders does the nurse consult as the priority? (Select all that apply.) a.Factory owners b.Stock shareholders c.Community residents d.Local health care providers e.Factory employees

B D

A nurse wants to determine whether health problems have been improved and interventions have been appropriate and successful over a period of time. Which of the following data should the nurse examine? (Select all that apply.) a. Changes in staffing patterns and assignments in the health agency b. Demographic data c. Education and school statistics d. Environmental factors

C

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

A

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

A

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

B

A nurse wants to volunteer for a community group providing secondary prevention. What activity would the nurse attend? a.Stroke rehabilitation support group b.Blood pressure screening at the mall c.Bicycle safety class at the elementary school d.Drop by nutrition station at the grocery store

B

A nurse was the first on the scene of a disaster and saw people with injuries ranging from minor to serious. Some of those with minor injuries were helping others. Which of the following injured persons would the nurse assist first? A. Those with life-threatening head and chest injuries B. Those who have life-threatening abdominal injuries C. Those who have serious injuries of limbs D. Those who are hurt but still mobile and functioning

c

A nurse wishes to see a bill passed to support funding for the use of interpreters for clients with limited English proficiency. Which of the following would be the best time for the nurse to request support from the local senator, who is not on the committee that is reviewing this bill? a. When the bill is first assigned to a committee b. When the bill is discussed and debated within the committee c. When the bill moves out of committee to be heard by the entire Senate d. When the bill passes the Senate and moves to the House of Representatives

a. Publicize data on success of health promotion efforts. e. Provide transparency to the public regarding service costs and savings Reasons given for the lack of emphasis on prevention in clinical practice and lack of financial investment in prevention include provider uncertainty about which clients should receive services and at what intervals, lack of information about preventive services, negative attitudes about the importance of preventive care, lack of time for delivery of preventive services, delayed or absent feedback regarding success of preventive measures, less reimbursement for these services than for curative services, lack of organization to deliver preventive services, and lack of use of services by the poor and elderly. Considering how health care dollars are spent in the United States, it would not be reasonable to lobby for decreased funding for secondary and tertiary services, as this would result in less care available for individuals. Requiring people to change their lifestyle would be illegal.

A nurse would like to help members of the community focus on receiving primary preventive health care services. Which of the following interventions should be implemented by the nurse? (Select all that apply.) a. Publicize data on success of health promotion efforts. b. Lobby for decreased reimbursement for secondary and tertiary care services. c. Establish standards for appropriate screenings at specific intervals. d. Encourage members of the military service to engage in appropriate healthy lifestyle behaviors. e. Provide transparency to the public regarding service costs and savings.

a

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

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

A

A nurse, after working two weeks at the site of the largest natural disaster to hit the United States, returns home. Which of the following behaviors would suggest the nurse needs professional assistance? A. The nurse becomes angry when family members quit listening to her ongoing stories about the disaster and the problems there. B. The nurse gives a presentation at the local college about the disaster and describes how health professionals were able to assist the victims who were injured. C. The nurse is moody and feels family demands are not really as important as the other members of her family think they are. D. The nurse is very exhausted and asks to have 3 personal days off from employment responsibilities.

ANS: C A lack of computers and Internet access can create a barrier to implementation of EBP in community-based nursing agencies. If these are provided, nurses can quickly access current evidence-based findings and recommendations.

A nursing administrator wants to develop a work environment conducive to the implementation of evidence-based practice (EBP). Which of the following actions would best achieve this goal? a. Conducting market research to determine customer satisfaction with EBP b. Eliciting opinions from nurses on how EBP will affect workload c. Purchasing computers and Internet access for use by employees d. Sending staff to conferences related to incorporation of EBP into practice

c

A nursing staff has successfully screened for diabetes in the community. Which of the following might best persuade the health board to increase funding for diabetic clinics in this community? a. An epidemic of diabetes is now recognized and must be addressed. b. The incidence of diabetes is now higher than previously recognized in the community. c. The prevalence of diabetes is now higher than previously recognized in the community. d. The risk for diabetes in the community could decrease if funding is received.

ANS:4 The Bolton Act of 1943 established the Cadet Nurse Corps during World War II, which increased enrollment in schools of nursing at undergraduate and graduate levels.

A nursing student during World War II would likely join which group? 1.The Public Health Service of New York City 2.The Marine Nurse Corps 3.The Frontier Nursing Service 4.The Cadet Nurse Corps

cd

A parish nurse has been using pastoral activities when providing care to clients. Which of the following interventions is the nurse most likely using (Select all that apply.) a. Helping families plan healthy nutritious meals and get plenty of rest b. Giving health education classes to the congregation c. Using hymns and scripture as a source of guidance and comfort d. Helping identify spiritual strengths that may assist in coping

b

A parish nurse is evaluating health programs that provide holistic care across the life span. Which of the following methods would be the most appropriate approach? a. Bringing families together to plan programs to meet the needs of individuals b. Establishing a wellness committee to assist in the evaluation process c. Matching financial resources with program objectives and goals d. Revisiting assessment data to be certain that planning reflects actual problems observed

b

A parish nurse is implementing a primary prevention measure related to obesity among the school-age members of the church. Which of the following activities is most likely being used by the nurse? a. Establishing a walking program that is sufficiently challenging yet not too strenuous for those who are obese b. Partnering with youth camp cooks to ensure that food is nutritious c. Supervising height and weight measurements taken by clinic assistants d. Working with parents of obese children to implement family lifestyle changes

b

A parish nurse is using the institution-based model to plan care for a client with a chronic illness. Which of the following activities would the nurse most likely implement? a. Bringing in family members to work with the client and nurse in decision making b. Partnering with outlying health care centers for coordinating optimal care c. Pulling from the collective strengths of faith-based community members for social support for the client d. Relying on congregational prayer as a component of healing

C

A particular chronic health problem that adversely affects the aging experience for which it is difficult to estimate the number of individuals affected or the associated cost to manage is: a. iatrogenic drug reactions. b. immobility. c. incontinence. d. intellectual impairment.

a

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. Don't drop out of school. The question specifies the health of both the mother and the child. Socioeconomic conditions improve with education. Because socioeconomic status is inversely related to mortality and morbidity, by becoming better educated, the mother-to-be will be less likely to live a life of poverty and, as a consequence, will enjoy a greater chance of better health for herself and for her child. The priority of the nurse should be to encourage the teenager to stay in school as this choice will provide for the best long-term outcome for the client. Signing up for childbirth classes, the WIC program, and taking prenatal vitamins all address short-term outcomes which are not as important as the future of the teenager raising this child.

A pregnant teenager has approached a nurse asking about ways to improve the health outcomes for her and her unborn child. Which of the following statements would be most appropriate for the nurse to make? a. "Don't drop out of school." b. "Sign up for childbirth classes." c. "Sign up for the WIC program." d. "Take your prenatal vitamins daily."

d

A principal comments to the school nurse that it seems there are a lot more problems with asthma among the students than there were before the school was remodeled a couple of years ago. The nurse investigates the principals observation by reviewing all the school records to determine visits to the health office because of asthma by week and month for the past 5 years. Which of the following best describes the type of study the nurse is conducting? a. Descriptive epidemiological study b. Ecological study c. Prospective cohort study d. Retrospective cohort study

b

A public health nurse has identified the need to make amendments in an existing law concerning the TB health assessment of individuals sentenced to serve jail terms on weekends only, based on the current criminal justice system practices and potential health risk to the free-living community. To raise this concern, the nurse has several paths to follow, but the amendment of any existing laws would ultimately be decided by: a. the executive branch of the government. b. the legislative branch of the government. c. local representatives. d. senate hearings.

D

A public health nurse has reviewed the objectives of Healthy People 2020. Which of the following should be the focus for programming in the community related to communicable diseases? A. Encouraging community members to engage in healthy behaviors B. Identifying high-risk sexual behaviors among community members C. Monitoring the sexual activity of adolescents D. Providing information about the hazards of multiple sexual partners

A

A public health nurse 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

B

A public health nurse traces sexual contacts of clients with sexually transmitted diseases for screening and treatment. Which of the following levels of prevention is being implemented? A. Primary prevention B. Secondary prevention C. Tertiary prevention D. Secondary and tertiary prevention

C

A rape victim said, "He said he loved me; he had been so nice; he said he wanted to show me how much he loved me. And then he...." As you continue to treat her injuries from the rape, what is your response? a. "Anyone can lose control; I'm sure he'll never do it again." b. "I'm not sure he loves you; he may just have wanted easy sex." c. "Rape isn't about love or even sex; it's about power and control." d. "You shouldn't have gone up to his room alone when the two of you had both been drinking."

a

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

b. Alcoholism is determined partly by genetic factors. Research demonstrates that genes are responsible for about half of the risk for abuse of alcohol. Multiple genes play a role in a person's risk for the development of alcoholism. Research has not shown that the family environment is the main risk factor for alcoholism. Alcoholism is more common among men than women. Persons who are born with fetal alcohol syndrome are not alcoholics from birth and are likely to have metabolic or other disturbances.

A school health nurse is asked by a parent group to explain risk factors for alcoholism. Which of the following information should the nurse include? a. Alcoholism is determined primarily by the family environment. b. Alcoholism is determined partly by genetic factors. c. Persons who are alcoholics are usually women. d. Persons born with fetal alcohol syndrome are alcoholics from birth.

b. Secondary prevention One means of secondary prevention is to institute early detection (screening) programs in schools, workplace, and other areas in which people gather to determine the presence of substance abuse. Primary prevention involves education before a problem occurs. Tertiary prevention occurs after the problem has occurred and aims to assist the client to the highest level of functioning. It is not likely for a single intervention to be both primary and secondary in prevention foci.

A school health nurse is conducting drug screening to detect drug use by students before serious problems develop. Which of the following levels of prevention does this action represent? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Primary and secondary prevention

b

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

ANS: B Randomized clinical trials are the gold standard of evidence gathering in EBP.

A school health nurse plans to use evidence-based practice (EBP) to guide the development of health education programs most likely to increase retention of learning in elementary schoolchildren. Which of the following would be the best way to use EBP in this situation? a. Ask other school health nurses what they included in their own education programs. b. Compare and contrast randomized clinical trials related to learning in elementary schoolchildren. c. Develop a series of games to accompany the programs developed to promote health. d. Seek out and examine health education programs for elementary school children on the Internet.

B Teens are often ignorant concerning sexuality and pregnancy and often very embarrassed to discuss such topics. Further, they often believe myths such as they cannot get pregnant the first time they have sex. The earlier their sexual debut, the less likely a birth control method will be used, because younger teens have less knowledge. Teens are more likely to be sexually active if their friends are sexually active. Teens who are knowledgeable and want to be responsible often find it difficult to access birth control. Confidential reproductive health care services may be available for teens, but problems are still associated with transportation, school absences, and costs of care. Parents who do not talk about sexuality with their teens may find them more at risk for sexual permissiveness and pregnancy.

A school health nurse presents a program on preventing teen pregnancy to a group of parents. Following the presentation, what comment by a parent would cause concern? a. "I do not know if my son is sexually active; however, I have decided I'm going to talk to him about it." b. "My daughter is too intelligent to get involved with boys, even if her friends do sleep around." c. "My daughter and I have often discussed sexuality, and when she's ready, I'll pay for her birth control pills. d. "I have spoken to my son about birth control. He says he's not ready to be a father and support a baby. He wants to go to college."

abd

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

c

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

a

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

c

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

ANS: B At the primary prevention level, campaigns to support regular exercise, greater emphasis on school-based physical education programs, and environmental and policy initiatives to create or enhance places for physical activity in communities can make significant contributions to improving the lifestyle of sedentary children. Exercise programs are an example of tertiary prevention. Monitoring BMI in children is an example of secondary prevention. Notifying parents of their children's height-weight scale increases family awareness but does not meet the definition of a preventive measure.

A school nurse is developing a primary prevention strategy for school-aged children. Which of the following interventions would the nurse most likely implement? a. Developing individualized exercise programs for overweight children b. Drafting policy for increases in noncompetitive physical activity programs c. Monitoring body mass index in children to identify elevations before they become difficult to manage d. Notifying parents and/or guardians of their child's height-weight scale in comparison with national norms

C

A school nurse is working with the Parent Teacher Organization (PTO) to improve the health status of preschool students in a lower socioeconomic urban community. Given the demographics of the community, the nurse is aware that this population is at greatest risk for: a. asthma. b. attention deficit disorder (ADD). c. childhood obesity. d. poisoning.

d

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. Marijuana Side effects of marijuana include increased appetite, dry and reddened eyes, and drowsiness. Side effects of crack cocaine and ice methamphetamine are similar and include increased breathing, rapid heart rate, high blood pressure, and increased body temperature. Tobacco use is associated with many chronic diseases but a person smoking tobacco would not necessarily display the student's symptoms.

A school nurse stops a student in the hall and expresses concern that, "Your eyes look rather red and dry." The student yawns and denies eye problems but does mention having gained 15 pounds since smoking "special cigarettes." Which of the following is the student most likely smoking? a. Tobacco b. Crack cocaine c. Ice methamphetamine d. Marijuana

a

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

c

A school nurse wants to decrease the incidence of obesity in elementary school children. Which of the following describes a secondary prevention intervention that the nurse could implement? a. Giving a presentation on the importance of exercise and physical fitness b. Designing a game in which students select healthy food choices c. Weighing students to identify those who are overweight d. Putting students on a diet if they weigh greater than 20% of their ideal weight

C

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

C Many American children are members of the "5H" club—they are hungry, homeless, hugless, hopeless, and without health care.

A school nurse was caring for an 8-year-old child who had been hurt on the school playground. During the nurse's assessment, the child admitted that her mother was working but didn't make much money so the girl and her mother were living in their car. Based on this information, what might the nurse suspect? a. The child is accident-prone and clumsy. b. The child is being bullied and pushed around by other children. c. The child may be a member of the 5H club. d. The child tripped, so perhaps she needs vision screening.

Which assessment made by the community health nurse (CHN) represents the ripple effect? A. The family unit becomes dysfunctional after a death affecting the entire family. B. The care provided by the CHN improves after "getting to know" individual family members. C. Family members take over the physical yard work for an elderly parent with health problems. D. A family member tells the nurse a parent with diabetes often forgets to take prescribed medication.

A. The family unit becomes dysfunctional after a death affecting the entire family.

The nurse manager makes sure that the staff members who work in a local clinic are competent in their job responsibilities. Which of the public health core functions is being demonstrated? a. Assurance b. Assessment c. Prevention d. Policy development

ANS: A Assurance refers to making sure a competent health care workforce is available. Prevention is not a core function, assessment refers to systematic data collection, and policy development refers to the need to provide leadership in developing health policies

B Poverty increases the likelihood of chronic disease, injuries, traumatic death, developmental delays, poor nutrition, inadequate immunization levels, iron deficiency anemia, and elevated blood lead levels. Poverty-stricken children may be hungry and fatigued and have dizziness, irritability, headaches, ear infections, frequent colds, weight loss, inability to concentrate, and increased school absenteeism. Homeless children also experience higher rates of school absenteeism, academic failure, and emotional and behavioral maladjustments. The stress of homelessness can be seen in withdrawal, depression, anxiety, aggression, regression, and self-mutilation. Homeless children may have delayed communication, more mental health problems, and histories of abuse.

A school nurse was talking to the teacher of an 8-year-old child who was living with her mother in their car. What might lead the nurse to talk to the teacher about the child? a. Concern that other children are mistreating the child b. Concern over developmental delays c. Concern that the child is given adequate food during lunch d. Concern that the child may need to sit in the front in order to be able to see well

a

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 nurse is drawing a genogram. Which of the following would the nurse use to demonstrate a marriage relationship between two individuals? a. A broken horizontal line b. An X through a circle c. A solid horizontal line d. A solid vertical line

A solid horizontal line Marriage is indicated by a solid line on a genogram. A broken horizontal line indicates a divorce or separation. An X through a circle or square indicates a death. A solid vertical line indicates offspring and children.

A,C,D

A staff nurse has demonstrated the ability to be competent as a participant surveillance and investigation activities. What skills would you expect that nurse to possess? (select all that apply) a. The ability to identify appropriate data sources b. The ability to communicate effectively using written reports c. The ability to collaborate with community agencies d. The ability to create a budget

ANS: B Concern about firearms arises when it has been shown that guns kept in the home for self-protection are forty-three times more likely to kill a family member or a friend than an attacker. Furthermore, the presence of a gun in the home triples the risk for homicide in the home and increases the risk for suicide fivefold.

A strong firearms advocate stressed his guns were for self-protection and he wanted all criminals to know his family had loaded guns in their home. Why might you not want to applaud his action? a. Criminals carry more powerful and illegal guns. b. Guns in the home typically result in dead family members and friends. c. His children may be less careful than the adults in the family. d. Less trained individuals might think the guns were unloaded.

B The causes of poverty are complex and include decreased earnings, increased unemployment rates, and inadequate education and job skills.

A student nurse was seriously shocked when late one night the she saw a former high school friend going through a trash bin outside a fast-food restaurant and pulling out half-eaten food. What is a likely explanation for a healthy young adult engaging in such behavior? a. He ate his meal but wanted more and had no more money. b. He had full-time employment, but with such a low salary it was inadequate to meet basic expenses. c. A friend had thrown his meal away, and he thought he could find his friend's untouched food. d. He was doing this to fulfill obligation of fraternity initiation at the college.

d

A teacher recommends that surveys to obtain data on drug use be given to high school students when they meet for various school organizations. Which of the following best describes why the nurse would reject this suggestion? a. This method of data collection would result in classification bias. b. This method of data collection would result in confounding bias. c. This method of data collection would result in personal bias. d. This method of data collection would result in selection bias.

C, D, E, F Most young women suspect pregnancy as soon as a period is late. These young women may still delay seeking care, since they falsely hope that the pregnancy will just go away. A teen also may delay seeking care because she wants to keep the pregnancy a secret from her parents, who may pressure her to terminate the pregnancy, or because she does not want to have a gynecological examination. Barriers to care early in the pregnancy also include the real or perceived costs of care, lack of transportation, dislike or fear of the needed exams, and apprehension about the attitude of care providers toward her. Being told that a condom was used doesn't make it so. The girl should know whether a condom was used or not without relying on verbal statements.

A teenager who has just come in for her prenatal visit appears to be about 6 months pregnant. What are the most typical reasons that a teenage girl might wait so long to come in for prenatal care? Select all that apply. a. Her friends were suggesting ways to make the problem go away. b. She knew she could not be pregnant because her boyfriend said he used a condom. c. She was afraid her parents would pressure her to terminate the pregnancy. d. She kept hoping the pregnancy would just go away. e. She was scared about the examination and what health care providers do to you. f. She was trying to keep her pregnancy a secret

a

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

4. A nurse's family has moved to a rural area to be near her spouse's aging parents. Which of the following would the nurse most likely notice about the family's new environment? (Select all that apply.) a. It is very difficult to obtain continuing education, except for online programs. b. Neighbors seem to expect the nurse to know everything about all health care and illness conditions. c. Neighbors ask questions about health concerns any time they see the nurse, regardless of where they are. d. People come to the health clinic before their situation becomes relatively serious.

ABC

C

Why would a hospital use surveillance? 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. "Is there anyone to help you with the baby until the baby's father can be released and encouraged to get treatment for his addiction?" The nurse must express concern and empathy and hold out hope for future improvement. To be therapeutic, the nurse must realize that any drug can be abused, that anyone may develop drug dependence, and that drug addiction can be successfully treated. It is inappropriate to assume that the woman wants assistance from her mother. There is no evidence to suggest that the woman or her baby were in danger before he went to prison. Saying "you must hate him" is not appropriate, as it is not the nurse's role to tell the client how she should be feeling.

A woman has just delivered a baby and is lamenting that the baby's father is not with her. She shares with you that he became involved with drugs and is now in prison for theft. The new mother says, "It's so sad. He's clearly no good." Which of the following would be the best response by the nurse while demonstrating empathy? a. "I'm so sorry to hear that. Is your mother able to be with you?" b. "It's good that you and the baby are safe from him." c. "Is there anyone to help you with the baby until the baby's father can be released and encouraged to get treatment for his addiction?" d. "You must hate him for leaving you alone with a new baby!"

ANS: B Working with victims of intimate partner violence (IPV) requires the nurse to establish rapport and trust; deal with issues of confidentiality honestly; provide current information regarding shelters and sources of support; and recognize and accept that clients may "choose" to stay in an abusive relationship.

A woman is in the emergency department for the fifth time this year, each time with more severe injuries. What is your primary responsibility? a. Insist she be discharged to a safe shelter where the perpetrator can't find her b. Provide information regarding safe shelters and sources of support c. Report the assault and battery to the local police department so the perpetrator is arrested for the crime d. Treat the injuries and inform the woman she may be killed if she stays with the perpetrator

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

A woman is pregnant with her first child. Life events can increase the risk for illness and disability. Normative events are those that are generally expected to occur at a particular stage of development or of the life span. Although pregnancy is a normal condition, it carries risks such as the development of eclampsia or more minor health problems such as constipation and hemorrhoids. Additionally, pregnancy (and the birth that follows) will alter family dynamics and may increase risk for psychological stressors. The incorrect responses are not normative life events

b

A woman is sitting in a corner of the clinical waiting room, crying audibly. The nurse asks, Whats wrong? Can I help? The woman responds, They just told me I have a positive mammogram and I need to see my doctor for follow-up tests. I know Im going to die of cancer. How can I tell my family? Which of the following information does the nurse need to know in order to help the woman cope with this finding? a. The negative predictive value of mammography b. The positive predictive value of mammography c. The reliability of mammography d. The validity of mammography

D

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

ANS: A Intimate partner violence (IPV) is the single greatest cause of injury to women between the ages of 15 and 24 years in the United States. Therefore, the nurse must assess for IPV.

A woman was seen in the emergency department with a greenstick broken arm and chest bruises. She explained she fell up a staircase at home while carrying laundry to the bedrooms. Besides assessing for other injuries what must you be sure to do? a. Ask about and educate regarding intimate partner violence b. Assess for use of alcohol or other drugs that might have been a causative factor in the fall c. Get the patient an x-ray examination to determine location and severity of the break d. Immediately apply ice and immobilize in a sling

c

A young woman had been away from home several years before she returned home sick and disheartened. Her mother called a nurse to help. Which of the following behaviors would suggest that the caregiver who arrived was a parish nurse? a. Advanced nursing practice education and skills b. Compassionate, skilled, dedicated touch c. Offered a prayer with the daughter and mother d. Willingness to do whatever was needed by mother or daughter

Which statement is true of the Children's Health Insurance Program (CHIP)? A. Access to health care for low-income children was increased. B. President Obama decreased the overall coverage provided by CHIP in 2009. C. When the CHIP program began, 35% of children in the United States were uninsured. D. The majority of children enrolled in CHIP are from families where the parents do not work.

A. Access to health care for low-income children was increased.

Which role would the community health nurse (CHN) play when caring for families who are dealing with chronic illness in a family member? A. Assist the family with coping strategies. B. Provide the physical care needed by the ill family member. C. Submit paperwork to the insurance company for reimbursement. D. Encourage the family to seek additional visits with the primary care provider.

A. Assist the family with coping strategies.

Virtue ethics is distinctly different from moral justification via theories or principles because the emphasis of virtue ethics is practical reasoning applied to: A. Character development. B. Consequentialism. C. Distributive justice. D. Egalitarianism.

A. Character development. The goal of virtue ethics, one of the oldest ethical theories, is to enable individuals to flourish as human beings. According to Aristotle, virtues are acquired, excellent traits of character that dispose humans to act in accordance with natural good. Examples of such traits in virtue ethics are benevolence, compassion, discernment, trustworthiness, integrity, and conscientiousness.Cognitive Level: AnalysisAssociated Chapter Objective: 3Page Reference: 131

Which of the following sexually transmitted diseases can be prevented through immunization? a. Chlamydia b. Gonorrhea c. Hepatitis B d. Genital Herpes Simplex

ANS: C Hepatitis B infection can be prevented by immunization; vaccines for the remaining options are not yet available. There are not yet vaccines for chlamydia, gonorrhea, or genital herpes simplex.

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

A. Designs health care programs for the underserved that incorporate social justice, treat men and women with respect and equity, and include community interventions that elevate the status of the underserved in the community. Whereas feminism rejects the devaluing of women and their experiences, believes that the oppression of women is morally wrong, and demands social justice and political action, feminist ethics holds a broader worldview advocating just relationships for both men and women, adopts a feminist perspective that facilitates critical thought, and focuses on broad issues such as power, gender, and socioeconomic structures.Cognitive Level: AnalysisAssociated Chapter Objective: 3Page Reference: 132-133

How does the nurse act as an advocate for a 13-year-old who has started smoking? A. Educate the patient about smoking risks. B. Tell the parent that the patient is smoking. C. Say nothing; this will make the patient angry. D. Ask the primary care provider to address the situation.

A. Educate the patient about smoking risks.

Which is an example of secondary prevention in applying the nursing process to care of the family? Which is an example of secondary prevention in applying the nursing process to care of the family? A. Ensure the family has continued access to health care and resources for individual and family health needs. B. Provide health education about immunizations of all family members and education of resources to support the family. C. Assure that the needed resources are available to support long-term care of each family member such as Kelly Autism Program (KAP). D. Use the family genogram to teach the family about predisposition to disease and help the family to develop a health prevention plan.

A. Ensure the family has continued access to health care and resources for individual and family health needs.

Which is the best way to view families in community health nursing? A. Families are components of communities. B. Families should be viewed as individuals requiring care. C. Populations are made up by individuals that need services. D. Communities should be considered extensions of the family.

A. Families are components of communities.

Which is a Healthy People 2020 objective for measurement of access to quality health care? A. Increase the proportion of persons with health insurance. B. Decrease the proportion of persons who have specific ongoing care. C. Decrease the proportion of persons with a usual primary care provider. D. Increase the number of free clinics to prevent long-term health problems.

A. Increase the proportion of persons with health insurance.

Which nurse is credited with establishing principles on how to care for families in the home? A. Lillian Wald B. Clara Barton C. Dorothea Dix D. Mary Breckinridge

A. Lillian Wald

One step in the ethical decision-making framework is to place an ethical issue within a meaningful context. The rationale for this step is that: A. Multiple factors affect the formulation and justification of ethical issues and dilemmas. B. The nature of ethical issues and dilemmas determine the specific ethical approach used. C. People cannot make sound ethical decisions if they cannot identify ethical issues and dilemmas. D. Professionals cannot avoid choice and action in applied ethics.

A. Multiple factors affect the formulation and justification of ethical issues and dilemmas. The historical, sociological, cultural, psychological, economic, political, communal, environmental, and demographic contexts affect the way ethical issues and dilemmas are formulated and justified.Cognitive Level: AnalysisAssociated Chapter Objective: 2Page Reference: 127-129

For which priority conditions should the nurse assess when caring for an adolescent patient who plays video games 10-12 hours daily? A. Obesity B. Scoliosis C. Type 2 diabetes D. Seasonal allergies E. Bipolar depression

A. Obesity C. Type 2 diabetes

The health of a community is measured by the well-being of its people and families. Which circumstances place a community at risk for health issues? Select all that apply. A. Poverty B. Gang violence C. Homelessness D. Low infant birth rates E. Rise in Medicaid services F. Free care clinics for elderly patients

A. Poverty B. Gang violence C. Homelessness D. Low infant birth rates

Which level of prevention is the nurse demonstrating when using a family genogram to teach the family to develop a health prevention plan? A. Primary B. Tertiary C. Secondary D. Preventative

A. Primary

Which is the role of the community health nurse? A. Provide care to communities and populations B. View individuals as components of communities C. Care for individuals discharged from the hospital D. Travel to patients' homes to perform dressing changes

A. Provide care to communities and populations

The nurse identifies that Healthy People 2020 focuses on which health initiatives for adolescents? A. Reduction of obesity B. Wellness checkups in the last 12 months C. Reduce the number of adolescents who start smoking D. Increase the number of teens who accept substance use of others E. Discourage use of birth control mechanisms other than abstinence

A. Reduction of obesity B. Wellness checkups in the last 12 months C. Reduce the number of adolescents who start smoking

The community health nurse (CHN) is reviewing the leading health indicators listed as priorities in Healthy People 2020. Access to quality health care is important to every aspect of family. Which are objectives for the measurement of access to health care? Select all that apply. A. Rise in the number of people with health insurance B. Higher proportion of coverage for preventative services C. Gain in the quantity of people with a primary care provider D. Increase in the number of persons who have a chronic illness E. Increase in physicians caring for a person with a chronic illness F. Decrease in the proportion of persons who have specific ongoing care

A. Rise in the number of people with health insurance B. Higher proportion of coverage for preventative services C. Gain in the quantity of people with a primary care provider

3. A nurse tells her nursing supervisor that her family is moving from the urban area where they both live to a rural area to be near her spouse's parents, who are becoming less independent. Which of the following suggestions would the nursing supervisor provide to the nurse? (Select all that apply.) a. "Community members will probably hold you in higher regard and will look up to you." b. "Expect to have less autonomy in a small town than you have working as a nurse in a medical center." c. "You may feel like an isolated outsider, because the community may not immediately accept you." d. "You will have to be very sensitive about the differences in the rural lifestyle."

ACD

1. Which of the following best describes why health professionals would be particularly concerned about the health needs of residents in rural areas? (Select all that apply.) a. About 25% of all U.S. residents live in rural settings. b. People in rural areas are especially susceptible to acute illnesses rather than chronic diseases. c. Diagnoses in rural areas are usually for physical injuries, not mental health concerns. d. A high prevalence of poverty exists among rural families.

AD

Which of the following trends in health issues in the United States between 1900 and 1955 is accurate? 1. There was a rise in chronic disease such as heart disease and cancer. 2. There was a rise in communicable disease. 3. The crude mortality rate increased dramatically. 4. The life span after diagnosis remained the same.

ANS: 1 Leading causes of death in 1955 were heart disease and cancer, while in 1900 they were pneumonia and tuberculosis. All other answers are false.

A 66-year-old woman is retired and no longer has health insurance through her place of employment. Which of the following programs would be appropriate for her health insurance needs? 1. Medicare 2. Medicaid 3. Social Security 4. Economic Opportunity Act

ANS: 1 The Social Security Act was amended to include health insurance benefits for the elderly, which is addressed through Medicare.

The impact of World War I on public health nursing included which of the following? Select all that apply: 1. Many communicable diseases were eradicated. 2. The depletion of the ranks of public health nurses to the war. 3. The feeling that the greatest patriotic duty was to stay at home. 4. Inadequate funding was the major obstacle to extending nursing services in the community.

ANS: 2, 3, 4 Both World Wars I and II depleted the public health nurse population as nurses went off to war. The feeling of patriotism extended to the idea that patriotic duty could also be served on the home front.

Which of the following programs provided funds for neighborhood health centers, Head Start, and other community action programs? 1. Medicare 2. Medicaid 3. Social Security 4. Economic Opportunity Act

ANS: 4 Funding for neighborhood health centers, Head Start, and other community action programs began in 1964 with the Economic Opportunity Act.

An intervention by the United States federal government to protect the health of its citizens was the establishment of the Marine Hospital Service, presently known as the Public Health Service. Its purpose was to: 1. Set policy on quarantine legislation for immigrants 2. Establish hospital-based programs to care for the sick at home 3. Establish and promote environmental interventions such as adequate housing and sanitation for urban cities 4. Provide health care for merchant seamen to protect seacoast ports and cities from epidemics

ANS: 4 Providing health care to seamen was an early effort by the federal government to improve public health. Its purpose was to secure its maritime trade and seacoast cities.

A visitor from Japan comes to the United States for a two-week vacation. This person is known as a: a. Non-immigrant b. Refugee c. Legal immigrant d. Lawful permanent resident

ANS: A A non-immigrant is admitted for a limited duration for a specific purpose.

A nurse is working in the community with an aggregate/population. Who is the nurse most likely to interact with? a. Students in a county school system b. Christians around the world c. A patient in the intensive care unit at the local hospital d. People who drink coffee

ANS: A A population or aggregate is a collection of individuals who have one or more personal or environmental characteristics in common. Members of a community who can be defined in terms of geography or a special interest can be seen as constituting a population. The clients in the first option share a geographical and special circumstance (school) characteristic. Christians around the world are too large of a geographical space. A patient cannot be an aggregate/population as there is no one to interact with. People who drink coffee share a common interest but may not share a common geographical location to interact.

The relationship between nursing practice, health policy, and politics can best be described as nursing: A. advocacy. B. policy process. C. process. D. profession.

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

What is the purpose of public health core functions? a. Clarifying the role of the government in fulfilling the mission of public health b. Ensuring the safety of populations in receiving quality health care c. Providing community-based individualized care to every person in the United States d. Uniting public and private providers of care in a comprehensive approach to providing health care

ANS: A As defined by the Institute of Medicine in its 1988 report The Future of Public Health, assessment, policy development, and assurance are core functions at all levels of government for the purpose of clarifying the government's role.

A public health nurse (PHN) collects data and monitors the health status of the population. Which of the following core public health functions is the nurse addressing? a. Assessment b. Prevention c. Assurance d. Policy development

ANS: A Assessment consists of systematic data collection and monitoring health status. Prevention is not a core function, assurance is making sure essential services are available, and policy development is needed to provide leadership in developing policies.

Research has shown that Asian men tend to have a greater sensitivity than white Europeans to codeine, and they experience significantly weaker effects from the drug. This is an example of cultural variations of: a. Biological variations b. Space c. Social organization d. Time perception

ANS: A Biological variations are the physical, biological, and physiological differences that exist between racial groups and distinguish one group from another.

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

ANS: A Block grants enabled financial responsibility to shift from the federal level to the state level, thereby reducing expenditures.

The nurse is investigating environmental health problems caused by contaminated ground water. Which type of nursing practice is being implemented? a. Community-oriented b. Community-based c. Policy development d. Tertiary care

ANS: A Community-oriented nursing emphasizes the prevention of disease and disability. Community-based nursing practice is a setting-specific practice whereby care is provided for clients and families where they live, work, and attend school. Policy development seeks to build constituencies that can help bring about change in public policy. Tertiary care focuses on highly specialized medical care.

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

ANS: A Constitutional law provides overall guidance for selected practice situations.

To meet a clients needs, it is sometimes necessary to integrate into the clients care a culturally relevant practice that lacks scientific utility. This is known as cultural: a. Accommodation b. Brokering c. Preservation d. Repatterning

ANS: A Cultural accommodation refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help people of a particular culture to accept nursing strategies, or to negotiate with nurses to achieve satisfying health care outcomes.

When a local health department provides a hypertension screening to all individuals, which general category of health care functions is being used? a. Direct services b. Financing c. Information d. Policy setting

ANS: A Direct services are actions that provide health care directly to individuals.

A nurse examining a child in the early stages of HIV infection would expect to see: a. Failure to thrive and developmental delays b. Kaposis sarcoma and developmental delays c. Toxoplasmosis and oral candidiasis d. Fatigue and shortness of breath

ANS: A Early symptoms of pediatric HIV infection include failure to thrive and developmental delays.

A nurse believes that the best treatment for illness is the use of Western medicine and alternative therapies should not be used for healing. This is an example of: a. Ethnocentrism b. Cultural imposition c. Racism d. Stereotyping

ANS: A Ethnocentrism is the belief that ones own cultural group determines the standards by which another groups behavior is judged.

An example of an explicit cultural behavior is: a. Verbal communication b. Body language c. Use of titles d. Perception of health and illness

ANS: A Explicit behaviors are straightforward and do not leave room for misinterpretation of what the person wants to communicate, such as when using verbal communication. Implicit behaviors are less exact and may be difficult to interpret, including body language, use of titles, and perception of health and illness.

HIV transmission can occur through: a. Exposure to blood b. Insect bites c. Sharing of school supplies d. Toilets

ANS: A HIV can be transmitted through exposure to blood.

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

ANS: A Health risk appraisal refers to the process of assessing for the presence of specific factors in each of the categories that have been identified as being associated with an increased likelihood of an illness, such as cancer, or an unhealthy event, such as an automobile accident

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

ANS: A Hepatitis A would likely be found where sanitation is inadequate.

A nurse is uncomfortable discussing such topics as sexual behavior and sexual orientation when counseling clients. By avoiding this topic with clients: a. Potential risks and risky behaviors will not be identified. b. Transmission of sexually transmitted diseases will decrease. c. Clients will be reluctant to return to care providers. d. The nurse will be violating the laws in most states.

ANS: A It is important that nurses be able to discuss these topics to help prevent and control STDs. Without discussion of these topics, it is possible that clients will not be aware that they have an STD and may transmit it to others.

A nurse is assisting an employer who has hired an individual who has been recently diagnosed with HIV. Which intervention would be most appropriate for the nurse to implement? a. Educate about how to reduce the risk of breaching the employees confidentiality. b. Explain how to inform co-workers 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.

ANS: A Nurses frequently work in the education role, and employers may need assistance in dealing with HIV-infected employees.

It is important that nurses are involved in health policy because: 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.

ANS: 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.

c

Which of the following agencies has the most influence on the health and welfare of U.S. citizens? a. Agency for Healthcare Research and Quality (AHRQ) b. Centers for Disease Control and Prevention (CDC) c. U.S. Department of Health and Human Services (USDHHS) d. World Health Organization (WHO)

Nurses who strive to be culturally competent should: a. Respect individuals from different cultures and value diversity. b. Immerse themselves in different cultures. c. Design care for special ethnic groups. d. Give explicit instructions to avoid client decision making.

ANS: A Nurses who strive to be culturally competent respect individuals from different cultures and value diversity. The other answers are false.

An occupational health nurse maintains a log of injuries from contaminated sharps because of the: a. Bloodborne Pathogen Standard b. Occupational Safety and Health Administration (OSHA) c. Department of Labor (DOL) d. Department of Defense (DOD)

ANS: A OSHA is part of the Department of Labor. The Bloodborne Pathogen Standard became effective in 2002.

A public health nurse is reviewing Healthy People 2020 to determine where to prioritize programming for the county health department. Based on Healthy People 2020, the nurse decides to implement programming to: a. Reduce the rate of HIV transmission among adults and adolescents. b. Eliminate STDs from developed countries. c. Reduce deaths from gonorrhea. d. Increase awareness about HIV in lesbian females.

ANS: A One of the Healthy People 2020 objectives is reducing the number of cases of HIV infection among adults and adolescents.

Pelvic inflammatory disease (PID) is a common complication of: a. Gonorrhea b. Syphilis c. Chancroid d. Herpes

ANS: A PID is a common complication of gonorrhea.

A nurse discusses with legislators the importance of passing legislation to ban smoking in all public places. This demonstrates the nurses involvement in: a. Policy b. Politics c. Law d. Health policy

ANS: 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).

Screening blood products and donor organs and tissue for hepatitis C infection is: a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion

ANS: A Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability.

A local senator has proposed changes to the health care delivery system in the United States. Based on current trends, what is most likely to occur? a. There will be new opportunities provided for public health specialists. b. It will result in isolated care being provided to individuals. c. There will be an increased emphasis in specialty care. d. It will increase the utilization of acute care services.

ANS: A Proposed changes in the health care delivery system will provide new opportunities for public health specialists and result in the creation of new roles within the system. The proposed changes will build an integrated system (not isolated), decrease emphasis on acute care services, and focus on health promotion and disease prevention.

Why is public health nursing considered a nursing specialty? a. It has a distinct focus and scope of practice. b. It requires a master's degree in nursing. c. It is focused on disadvantaged citizens. d. It performs interventions at the acute care level.

ANS: A Public health nursing has a distinct focus and requires a special knowledge base. The other answers are not characteristics of a specialty.

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

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

The agency most heavily involved with the health and welfare concerns of United States citizens is the: a. Unites States Department of Health and Human Services (DHHS) b. Public Health Service c. Health Resources and Services Administration d. World Health Organization

ANS: A The DHHS is the agency most heavily involved with the health and welfare of United States citizens. It touches more lives than any other federal agency.

A member of the military receives health care services through which department? a. Defense b. Labor c. Agriculture d. Justice

ANS: A The Department of Defense delivers health care to members of the military, including their dependents and survivors, and to retired members and their families.

The nurse counsels a client to have the enzyme-linked immunosorbent assay (EIA) test in order to: a. Indicate the presence of the antibody to HIV. b. Reveal whether or not the client has AIDS. c. Isolate the HIV virus. d. Confirm HIV after having a positive Western blot.

ANS: A The EIA is used to indicate the presence of the antibody to HIV.

A public health department is using the mission of public health as described by the Institute of Medicine when planning its health programming. Which of the following activities will most likely be implemented? a. Tracking avian flu outbreaks and doing surveillance in the United States b. Providing a flu shot for an elderly person at the health department c. Keeping track of alternative therapies in use in the United States d. Keeping snake antivenom at the Centers for Disease Control and Prevention in Atlanta

ANS: A The Institute of Medicine's stated mission on public health is "to generate organized community and technical knowledge to prevent disease and promote health." Tracking avian flu outbreaks and doing surveillance applies this concept at a population level. Providing a flu shot for an elderly person only addresses individual care. Keeping track of the use of alternative therapies does nothing to prevent disease or promote health of the population. Keeping snake antivenom is aimed at disease care for an individual, not health promotion or disease prevention.

Population-focused practice concentrates on defining the problems or needs of and implementing solutions for whom? a. Individuals b. Aggregates c. Communities d. Geographical regions

ANS: B Aggregates are a defined population made up of individuals in communities of a specific geographical region. Population-focused practice is implemented with defined populations or subpopulations. This is larger than the scope of individual care but may not address the larger needs of the entire community or geographical region.

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

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

When working with an immigrant population, the first step the nurse should take is: a. Be aware of ones own culture. b. Become familiar with traditional practices of the immigrants. c. Try to see things from the immigrants viewpoint. d. Learn to speak the language of the immigrant population.

ANS: A The first statement is the only one that is correct.

When a school nurse reports suspected child abuse, there is a breach of confidentiality. This breach is allowed because of: a. Civil immunity b. Sovereign immunity c. Nurse practice act d. Respondeat superior

ANS: A The law mandates that a health professional breach patient confidentiality norms to protect someone who may be in a helpless or vulnerable position.

A community health nurse collects data about the number and proportion of persons aged 25 or older with less than a high school education. Which term best describes this type of data? a. Sociodemographic characteristics b. Health status data c. Health risk factors d. Health care resource consumption information

ANS: A The number and proportion of people is a sociodemographic characteristic. Health status includes birth and death rates. Health risk factors discuss proportions of populations who have particular health conditions or health risks. Health care resource consumption refers to spending on health care per capita.

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

ANS: A The nurse's approach to the family should be positive and focused on competencies rather than on problems or deficits.

Which statement about the nursing workforce is true? a. The nursing workforce is overwhelmingly Caucasian. b. The number of minority nurses meets the needs of the countrys demographics. c. The nursing workforce has many unauthorized immigrants. d. Refugees make up a large part of the nursing workforce in some areas.

ANS: A The nursing work force is 81.8% Caucasian. The other statements are false.

1. What is the primary focus to be addressed concerning the improvement of the health of the American people in the twenty-first century? a. Bioterrorism and global health threats b. Delivery of individual care and hygiene c. The need for increased hospital and acute care d. Chronic disease and disability management

ANS: A There are new concerns, and of the most serious are bioterrorism and globally induced infections, such as the avian flu. These threats will divert health care funds and resources from other health care programs to be spent for public safety. The others are not related to public health or are concerns that have been present for many years.

17. A nurse is implementing quality performance standards in a public health department. Which statement best describes the importance of this action? a. Quality performance standards are used to guide improvement in the public health system. b. Quality performance standards rigidly control public health. c. Quality performance standards guide administrators to monitor public health at the national level. d. Quality performance standards can be used as hiring guidelines for nurses.

ANS: A These standards were developed by the Centers for Disease Control and Prevention in 1998. They set the bar for the level of performance that is necessary to deliver essential public health services (PHSs). These standards were developed around the 10 essential PHSs. They focus on the overall public health system rather than on single organizations and describe an optimal level of performance. They are intended to support a process of quality improvement. State and local communities can assess their performance using certain available tools. They are not meant to control public health or be used for hiring guidelines.

Nurses are available to provide health services for women and children due to the provisions of the: a. Sheppard-Towner Act b. Public Protection of Maternity and Infancy program c. Early Periodic Screening and Developmental Testing (EPSDT) program d. Women, Infants, and Children (WIC) program

ANS: A This 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 nurse labels a patient an alcoholic because of his ethnicity. This is called: a. Stereotyping b. Prejudice c. Racism d. Ethnocentrism

ANS: A This is an example of ascribing certain beliefs and behaviors about a given racial and ethnic group to an individual without assessing for individual differences.

A Mexican American mother insists on using special candles to help her daughters ear infection. The nurse asks the mother if she would also give her daughter antibiotics. This is called cultural: a. Accommodation b. Repatterning c. Brokering d. Awareness

ANS: A This means that the nurse supports and facilitates the use of cultural practices with interventions from the biomedical health care system. Cultural accommodation refers to assistive, supportive, facilitative or enabling nurse actions and decisions that help clients of a particular culture accept nursing strategies, or negotiate with nurses to achieve satisfying health care outcomes.

The public health nurse (PHN) compares the rate of teenage pregnancy in various areas of the city. Which of the core functions of public health is the nurse addressing? a. Assurance b. Assessment c. Prevention d. Policy development

ANS: B Assessment refers to systematic data collection, which this nurse is doing for teenage pregnancy. Prevention is not a core function, assurance is making sure essential services are available, and policy development is needed to provide leadership in developing policies.

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

ANS: A Transitions (movement from one stage or condition to another) are times of potential risk for families. Age-related or life-event risks often occur during transitions from one developmentalstage to another. Transitions present new situations and demands for families. Moving from the family home to a smaller condo represents a major change in lifestyle. None of the other options represent major transitions. If the event is normative, or anticipated, it is possible for families to prepare for the event and its consequences.

A large portion of foreign-born residents of the United States: a. Work in service-producing and blue-collar sectors b. Reside in rural areas c. Have language barriers d. Are refugees and non-immigrants

ANS: A Two thirds of the foreign-born population lives in or around major metropolitan areas and works in mainly service-producing and blue-collar sectors. They are also more likely to be poorer. The majority of foreign born are legal immigrants (85%).

19. The public health workforce should demonstrate competency in which of the following competency categories? a. Financial planning and management b. Workforce needs assessment c. Acute care services d. Curriculum development

ANS: A Workforce needs assessment, acute care services, and curriculum developments are not considered categories of core competencies of public health. Rather there are eight categories of competency, which include: (1) analytic/assessment, (2) policy development/program planning, (3) communication, (4) cultural competence, (5) community dimensions of practice, (6) basic public health sciences, (7) financial planning and management, and (8) leadership and systems thinking.

A nurse explained to a new mother that because she had tested positive for the hepatitis B virus, her newborn son would need the hepatitis B vaccine immediately and then also an immune globulin injection. "Wait," said the new mother. "Why is my son getting two shots?" Which of the following statements would be the best response by the nurse? a. "One injection protects your son, while the other encourages his body to build up immunity." b. "One shot keeps your son from getting sick, while the other is a typical vaccine to prevent you from accidentally infecting him." c. "Since you've already been infected with the virus, your son needs twice as much protection." d. "The second shot is just to make sure the first one works."

ANS: A Because infected persons may not have any symptoms, all pregnant women should be tested for HBsAg. If the mother tests positive, her newborn needs hepatitis B immune globulin to provide passive immunity and thus prevent infection. In addition, the newborn is given the hepatitis B vaccine at birth, with two follow-up injections, to build active immunity to the infection. One of the shots provides passive immunity and the other provides active immunity. The active immunity continues to be built up by receiving two follow-up injections weeks later.

A school nurse asks a class about the ways HIV can be transmitted. Which of the following comments by a student indicates a need for additional teaching? a. "I wouldn't sit next to someone with HIV." b. "Having unprotected sex with someone who is infected spreads HIV." c. "Sharing needles when shooting up drugs spreads HIV." d. "Transfusions of blood products that are contaminated can spread HIV."

ANS: A HIV is not transmitted through casual contact such as touching or hugging someone who has HIV infection. It is not transmitted by insects, coughing, sneezing, office equipment, or sitting next to or eating with someone who has HIV infection. HIV can be transmitted through exposure to blood, semen, vaginal secretions, and breast milk and by sharing needles, syringes, and other equipment used to prepare injectable drugs. It can also be spread by perinatal transmission from mother to child through delivery or breastfeeding and by transfusions of contaminated blood. Worldwide, the largest number of HIV infections result from heterosexual transmission

A male client visits the clinic office reporting a yellow-green discharge from his penis. Which of the following STIs has the client most likely contracted? a. Gonorrhea b. Syphilis c. Herpes simplex virus 2 d. Human papillomavirus

ANS: A The symptoms for gonorrhea in a male include a burning sensation when urinating, or a white, yellow-green discharge from the penis. Some men may get swollen or painful testicles. In men, gonorrhea can cause epididymitis, a painful condition of the testicles that if untreated can lead to infertility. Symptoms of syphilis may not appear for several years after contracting the disease. The first stage of syphilis is called primary syphilis when a chancre, a firm, round, small and painless lesion, develops. Signs and symptoms of HSV-2 infection range from no symptoms to painful lesions or blisters around the genitals, rectum, or mouth. Most people with HPV are asymptomatic.

Which of the following statements best explains why HSV-2 infection is more challenging for a client than gonorrhea infection? a. HSV-2 is a viral infection that is both chronic and incurable. b. HSV-2 is extremely expensive to treat. c. HSV-2, like HIV, is almost impossible to diagnosis in the early stages. d. Once a person has been treated for HSV-2, the person is immune to further outbreaks.

ANS: A Unlike gonorrhea, there is no cure for HSV-2 infection; it is considered a chronic disease. Recurrence with HSV-2 is common. The treatment for HSV-2 may be episodic or suppressive for frequent recurrence, which is not expensive to treat. HSV-2 may be asymptomatic but does appear as vesicles, painful ulceration of penis, vagina, labia, perineum, and anus with lesions lasting 5 to 6 weeks.

MULTIPLE RESPONSE 1. What are considered barriers to public health nursing? (Select all that apply.) a. The mindset that the only role for the nurse is at the bedside. b. The structures within which nurses work and the process of role socialization within those structures. c. Few nurses receive graduate-level preparation in the concepts and strategies of the disciplines basic to public health. d. The steady decline in the number of job opportunities in the area. e. The inability to equally distribute the increasing funds.

ANS: A, B, C Barriers exist in thinking that nurses only work in a hospital at the bedside, the process of role socialization in public health which can be a very autonomous profession, and that few nurses have had advanced education in public health. The number of job opportunities continues to increase, but the amount of funding allotted to public health continues to decline.

A client is using a primary prevention strategy to prevent infectious disease. Which of the following actions is the client most likely taking? a. A client receives a tetanus booster every 10 years. b. A client receives a tetanus booster after stepping on a nail. c. A client receives tetanus immunoglobulin after stepping on a nail. d. A client with tetanus is given antibiotics and is placed on seizure precautions.

ANS: A - A client receives a tetanus booster every 10 years. Tetanus boosters given before exposure are a measure of primary prevention because exposure has not yet occurred. If given after exposure (i.e., the client may be infected but disease has not developed), they are considered secondary prevention (similar to the textbook examples of immunoglobulin and rabies immunizations given after exposure). Immunoglobulin would be given if the client had not been previously immunized; however, this again is after exposure, so it is secondary prevention. Because the client has the condition, treatment is aimed at prevention of further injury.

Which of the following is the most probable cause of the increase in new emerging infectious diseases? a. Activities or behavior of humans, including changes in the environment b. Increasing urbanization and growth in new housing materials c. New infectious agents are evolving throughout the world d. Overpopulation in many areas, creating a need to reduce global population

ANS: A - Activities or behavior of humans, including changes in the environment Most of the emergence factors are consequences of activities and behavior of the human hosts and of environmental changes such as deforestation, urbanization, and industrialization. For example, the rise in households with two working parents has increased the number of children in daycare, and with this shift has come an increase in diarrheal diseases such as shigellosis. Urbanization is not a problem, but increasing development into formerly unaffected areas such as rainforests is.

Which of the following best represents an example of infectious disease spreading via a vector? a. Being bitten by an infected mosquito b. Disease spreading from infected mother to infant via the placenta c. A group of partygoers hugging and shaking hands d. Two persons, one of whom is infected, sharing a glass of soda

ANS: A - Being bitten by an infected mosquito Vertical transmission is the passing of infection from parent to offspring via placenta. Horizontal transmission is the person-to-person spread of infection through (among other ways) contact. Common vehicle refers to transportation of the infectious agent from an infected host to a susceptible host via food, water, milk, or other substance. Vectors include mosquitoes, which can transmit the infectious agent by biting the host.

A nurse's Mantoux test is positive for exposure to tuberculosis. Which of the following conclusions should be drawn by the nurse? a. The nurse has been exposed to tuberculosis. b. The nurse has tuberculosis. c. The positive test result probably is due to a problem in the testing process. d. The test is inaccurate and needs to be repeated.

ANS: A - The nurse has been exposed to tuberculosis. An individual who tests positive has been exposed and may be infected, but if that person shows no clinical signs, the person is not diseased. Infection refers to the entry, development, and multiplication of the infectious agent in the susceptible host. Disease is one of the possible outcomes of infection. People with latent TB have no symptoms, are not infectious, and can continue on with life. They may develop active TB. A nurse who interacts with clients may receive INH for a year as a precaution.

Which of the following biological warfare agents poses the greatest bioterrorism threat to a community? a. Anthrax b. Botulism c. Smallpox d. Tularemia

ANS: A - anthrax Because of factors such as the ability to become an aerosol, the resistance to environmental degradation, and a high fatality rate, inhalational anthrax is considered to have an extremely high potential for being the single greatest biological warfare threat.

Which of the following places best describes where the incidence of Vancomycin-resistant Staphylococcus aureus (VRSA) and methicillin-resistant S. aureus (MRSA) is currently rising? a. Areas where people share dressing or bathing facilities b. Daycare centers and schools c. Long-term care facilities d. Senior citizen centers

ANS: A - areas where people share dressing or bathing facilities Vancomycin-resistant Staphylococcus aureus (VRSA) and methicillin-resistant S. aureus (MRSA) remain problems for people who acquire the bacteria in the hospital, but there is a growing incidence of community-acquired MRSA in places where people closely share facilities such as locker rooms, prisons, and other close bathing areas.

1. Which of the following best describes the steps in program management? A. Assess, plan, implement, evaluate B. Identify, initiate, implement C. Organize, operationalize, mobilize, subsidize D. Substantiate, negotiate, evaluate

ANS: A Assess, plan, implement, evaluate The program management process is similar to the nursing process. Program management consists of assessing, planning, implementing, and evaluating a program. DIF: Cognitive Level: Remember (Knowledge) REF: pp. 276-277

9. A nurse is planning a program to teach cardiac health at the senior citizens center. Which of the following is an effectively written objective for the program? A. By the end of the program each participant will report walking at least 30 minutes a day at least 5 days each week. B. By the end of the program each participant will voice a commitment to walk at least 30 minutes a day. C. By the end of the program each participant will understand the need for physical exercise. D. Each participant will voice a commitment to engage in physical exercise each day.

ANS: A By the end of the program each participant will report walking at least 30 minutes a day at least 5 days each week. Useful program objectives must include a statement of the specific behaviors desired, using an action verb that can be seen and measured. Voicing a commitment is not an outcome action; it is only a verbal agreement. The verb understand is not an action verb that can be seen and measured. Only "will report walking 30 minutes a day at least 5 days each week" has a specific outcome action that can be seen and measured. DIF: Cognitive Level: Apply (Application) REF: p. 283

18. A nurse is conducting program evaluation. Which of the following would be the first action the nurse would take? A. Choose the type of evaluation to be done B. Determine who will be involved in the evaluation C. Identify the goal and objectives for the evaluation D. Obtain answers to specific questions related to the program being evaluated

ANS: A Choose the type of evaluation to be done To do a program evaluation, first choose the type of evaluation you wish to do. Second, identify the goal and objectives for evaluation. Third, decide who will be involved in the evaluation. Fourth, answer the questions related to the type of evaluation. DIF: Cognitive Level: Apply (Application) REF: p. 285

A woman and man who have come to the health clinic begin to argue loudly. "You gave me an STI!" the man yells. The woman screams back, "Not me. I don't have an STI!" Which of the following statements would be most appropriate for the nurse to say to them? (Select all that apply.) a. "Actually, you're very fortunate to have been tested, so you and your partner can begin treatment before more serious damage is done." b. "Some STIs may not have any symptoms, so you need to be tested for other conditions and treated if necessary." c. "Sometimes the test is inaccurate, so before getting too upset, you should ask to be tested again." d. "You may be able to get treatment from your pharmacist so you won't have to be embarrassed like this again." e. "Some STIs are spread in ways that are non-sexual in nature."

ANS: A, B, C Often cases of gonorrhea and chlamydia are asymptomatic, so treatment may not be sought and these infections are spread to others through sexual activity. Similarly, during latency, syphilis has no symptoms. It should be noted, however, that STI test results can sometimes be incorrect and the coexistence of other medical conditions may cause a false-positive test result. Having a partner retested, if the results were negative, would also suggest retesting the first person. The pharmacist must receive an order from the primary care provider in order to dispense a prescription.

Congress's legal base for actions in health care include (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 power

ANS: 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.

A nurse is planning a refugee outreach clinic at the neighborhood health center. To provide culturally competent care, the nurse should consider that (select all that apply): a. Their own background, beliefs, and knowledge may be significantly different from those of the people receiving care. b. Language barriers may interfere with efforts to provide assistance. c. Certain risk factors may be present for a given population. d. Certain groups may use non-traditional healing practices.

ANS: A, B, C, D When working with immigrants it is important to be aware of ones own beliefs, realize that language barriers may exist, that different populations experience different risk factors and illnesses, and that non-traditional healing practices may be used.

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

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

The Centers for Disease Control and Prevention 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

ANS: A, B, D The Centers for Disease Control and Prevention implements prevention strategies, detects and investigates health problems, and fosters safe and healthful environments.

20. Which of the following are elements of the MAPP (Mobilizing for Action Through Planning and Partnership) Program Planning Model? (Select all that apply.) A. Generate shared visions and common values B. Assess priorities in health problems C. Develop a framework for long-range planning D. Choose health priorities E. Conducting a needs assessment related to community change

ANS: A, C A. Generate shared visions and common values C. Develop a framework for long-range planning The elements of MAPP include: mobilizing community members and organizations, generating shared visions and common values, developing a framework for long-range planning, conducting needs assessments in four areas: community strengths, local public health system, community health status, and focus of change, and implementing the plan. Assessing priorities in health problems and choosing health priorities are part of other program planning models. DIF: Cognitive Level: Remember (Knowledge) REF: p. 281

The nurse is counseling a female who has recently tested positive for HIV. The nurse educates her that she is responsible to (select all that apply): a. Have regular medical evaluations and follow-ups. b. Donate blood, plasma, body organs, or sperm. c. Inform health care providers about the HIV infection. d. Consider the risk of perinatal transmission.

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

The necessary basic preparation for public health nursing is what level of nursing education? a. Associate degree b. Baccalaureate degree c. Master's degree d. Doctor of Nursing Practice

ANS: B A Bachelor of Science in nursing (BSN) is the necessary basic preparation to function as a beginning staff PHN. An Associate degree is not enough for basic preparation. A Master's degree or Doctor of Nursing Practice degree would be part of preparation for advanced practice.

A public health nurse (PHN) has been prepared at the graduate level. Which activity should the practitioner be able to complete? a. Teaching public and community health nursing b. Assessing and intervening successfully at the aggregate level c. Diagnosing and treating disease while having earned prescriptive authority d. Running for political office as experts in public health policy

ANS: B According to the Consensus Conference, specialists should have assessment skills that allow them to intervene at the aggregate level. Public health practitioners have a broad range of practice areas within public health and are not limited to only nursing and medicine.

An example of a behavior that may be defined by culture is: a. Speaking a dialect of a language in a local region b. Standing when an older adult gets on the bus to give him a seat c. Immigrating to the United States seeking work d. An organizational structure of a cultural group

ANS: B Behaviors may be culturally determined as illustrated in the correct response. This behavior is based on the value of respect of elderly people.

An effect of providing care that is not culturally competent is: a. Enhancement of communication b. An increase in the cost of health care c. Achievement of health indicators d. Improvement in client compliance

ANS: B Care that is not culturally competent may increase health care costs and decrease positive client outcomes.

A nurse is implementing community-based nursing care. Which intervention is the nurse most likely to complete? a. Assessing the health needs of a defined community b. Providing care to families in a community c. Promoting the health of an entire community d. Investigating environmental health problems in a community

ANS: B Community-based nursing practice is a setting-specific practice whereby care is provided for families where they live, work, and attend school. The focus is on acute and chronic care and the provision of services. Providing care to families is the only intervention that accurately describes this definition. Assessing the health needs of a community, promoting the health needs of an entire community, and investigating environmental health problems in a community would be considered public health nursing practice.

A nurse advocates and intervenes between the health care system and the clients cultural beliefs on behalf of the client. The nurses action is called cultural: a. Accommodation b. Brokering c. Preservation d. Repatterning

ANS: B Culture brokering is advocating, mediating, negotiating, and intervening between the clients culture and the biomedical health care culture on behalf of clients.

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

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

A client shares that her grandparents immigrated to the United States from Germany. She has disclosed her: a. Multiculturalism b. Ethnicity c. Race d. Culture

ANS: B Ethnicity represents the identifying characteristics of culture, such as race, religion, or natural origin.

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

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

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

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

An example of HIV transmission is: a. Having contact with a HIV-positive individual who is coughing b. An infant receiving breast milk from a HIV-positive mother c. Receiving a mosquito bite while in Africa d. Being near a HIV-positive individual who is sneezing

ANS: B HIV can be transmitted through breast milk.

In comparison with HIV infection in adults, HIV infection in infants and children: a. Has the same signs and symptoms b. Has a shorter incubation period c. Has a longer survival period d. Is detected by using the same tests

ANS: B HIV infection in infants and children has a shorter incubation period.

Needle stick legislation clarified the role of employers to: a. Use Universal Precautions when dealing with all patients. b. Select safer needle devices as they became available. c. Provide needle disposal boxes. d. Incinerate all infectious waste including needles.

ANS: B Health care facilities by law have to select safer needle devices and involve employees in identifying and choosing the devices.

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

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

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

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

States have certain continuing education requirements for persons to renew a nursing license. This type of law is called: a. Constitutional law b. Legislation and regulation c. Judicial and common law d. Police power

ANS: B Licensing is regulated by each states nurse practice act as a function of the board of nursing.

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

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

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 federal agency could this nurse potentially seek funding? a. Centers for Disease Control and Prevention (CDC) b. National Institute of Nursing Research (NINR) c. Department of Health and Human Services (DHHS) d. World Health Organization (WHO)

ANS: B NINR funds the development of the knowledge base of nursing and promotion of nursing services in health care.

One of the main purposes of the Patient Protection and Affordable Care Act was to: a. Create a government-funded insurance program for all Americans. b. Make health insurance affordable for the middle class and small businesses. c. Decrease the rates of chronic disease in the United States. d. Increase the funding for public health agencies.

ANS: B One of the main purposes of this legislation was to make health insurance affordable for middle class families and small businesses with one of the largest tax cuts for health care in history: reducing premiums and out-of-pocket costs. This act does not create a government-funded insurance program nor does it increase funding for public health agencies.

Public health nurse (PHNs) are looking to improve population-focused care in the community. Which activity best describes a key opportunity for the nurses to accomplish this goal? a. Assuming traditional nursing roles b. Influencing public health policy c. Conducting community assessments d. Specializing in community-based nursing practice

ANS: B PHNs must move into positions in which they can influence policy formation. They must assume positions that are not traditionally considered nursing. Conducting community assessments is part of public health nursing practice, not necessarily a key opportunity to improve practice. Specializing in community-based nursing practice is setting-specific and does not relate to a key opportunity to improve population-focused care.

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

ANS: B Pratt proposed the energized family as being an ideal family type that was most effective in meeting health needs. The energized family is characterized by active contact with a variety ofgroups and organizations (Boy Scouts, church, sports, theater), flexible role relationships (not if only the daughter is taught how to cook and only the son is expected to get a job), equal power structure (not if the husband makes all the decisions), and a high degree of autonomy by each member (kids know how to be flexible, because parents travel for business frequently).

18. To better address emerging public health issues, a public health nurse (PHN) plans to complete continuing education in this area. Which content areas should be included in the course that is chosen? a. Leadership b. Ethics c. Communication d. Finance

ANS: B Public health workers should be educated in eight content areas to be able to address emerging public health issues and advances in science and policy: (1) informatics, (2) genomics, (3) cultural competence, (4) community-based participatory research, (5) policy, (6) law, (7) global health, and (8) ethics.

The 1986 Immigration Reform and Control Act had what effect on illegal aliens living in the United States? a. Discriminated against individuals from Southern and Eastern Europe b. Allowed illegal aliens already living in the United States to apply for legal status c. Permitted foreign-born populations to set up communities in or around major metropolitan areas d. Allowed illegal aliens access to green cards that would allow them to work in the United States

ANS: B The 1986 Immigration Reform and Control Act permitted illegal aliens already living in the United States an opportunity to apply for legal status if they met certain requirements.

If a nurse researcher wants to get information on the occurrence of an internationally important disease, where would be a good place to seek this information? a. The United Nations website b. The World Health Organization (WHO) website c. The World Bank website d. The World Health Assembly website

ANS: B The WHO publishes day-to-day information about international occurrence of disease, injury, and death.

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

ANS: B The count drops when the virus is most plentiful in the body.

The United States Department of Health and Human Services (DHHS) is part of which branch of the government? a. Judicial b. Executive c. Legislative d. Health

ANS: B The executive branch includes regulatory departments, one of which is the United States DHHS.

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

ANS: B The process of shifting the responsibility for planning, delivering, and financing programs from the federal level to the states is called devolution. This was a major effort during the Reagan administration.

A nurse utilizes the provisions created by the Ryan White Comprehensive AIDS Resource Emergency Act when performing which intervention? 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

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

What information would be appropriate for a nurse to share when educating IV drug users about sharing equipment? 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 30 seconds. c. Report illegal activities to the authorities and confiscate the needles and syringes. d. Give out needles and syringes to whoever wants them.

ANS: B Using bleach on the needles and syringes is a way to decrease cross contamination.

Which of the following best explains why some health clinics allow clients to be tested for HIV anonymously with no record of the client's name, address, or contact information? a. Client doesn't actually ever have to be told the results of the test. b. Client may be engaged in illegal activities (drug use). c. Client plans on not paying for the test, and collection agencies will not be able to harass them. d. Client wants to be sure care providers don't share results with their family.

ANS: B An advantage of anonymous testing may be that it increases the number of people who are willing to be tested, because many of those at risk are engaged in illegal activities. The anonymity eliminates their concern about the possibility of arrest or discrimination. If testing is anonymous, the client is given an identification code number that is attached to all records of the test results and is not linked to the person's name and address. Demographic data such as the person's sex, age, and race may be collected, but there is no record of the client's name and associated identifying information. Thus, the client is able to know the results of the test while staying anonymous. It would be a violation of HIPAA for the providers to share the results of this test or any other medical information with family members. The follow-up related to payment is not a main concern for the population who is requesting anonymous testing.

A mother felt very guilty that her baby was born HIV positive. When the nurse suggested the usual DPT and MMR immunizations, the mother was extremely upset. "Don't you know HIV children are immunosuppressed?" she exclaimed. Which of the following would be the nurse's best response? a. "All children have to have these immunizations before they can attend school." b. "Being HIV positive, your child is more likely to catch an infection and be very ill if not immunized." c. "I'm so sorry; I forgot for a moment your child was HIV positive." d. "The American Pediatric Association requires all health care providers to offer these immunizations to all parents; it is your choice whether or not to accept them."

ANS: B Because of impaired immunity, children with HIV infection are more likely to get childhood diseases and suffer serious consequences of the diseases. Therefore, DPT, IPV, and MMR vaccines should be given at regularly scheduled times for children infected with HIV. Other immunizations may also be recommended after medical evaluation. Although this child is HIV positive, there is no medical reason why the child should not be immunized. Many states do have a "no shots, no school" law, but exceptions can be made. The APA does recommend immunizations for most children, but this is not the best answer

Which of the following best describes the characteristic appearance of lesions of human papillomavirus (HPV)? a. Solitary growth with elevated borders and a central depression b. Elevated growths with a "cauliflower" appearance c. Thin-walled pustules that rupture to form honey-colored crusts d. Vesicles that ulcerate and crust within 1 to 4 days

ANS: B HPV causes genital warts that appear as textured surface lesions, with what is sometimes described as a cauliflower appearance. The warts are usually multiple and vary between 1 and 5 mm in diameter. The other descriptions are not characteristic of lesions of the human papillomavirus (HPV).

When writing to a legislator to advocate for funds to support advanced practice nursing education, a nurse should remember to (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.

ANS: 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.

A client diagnosed with tuberculosis (TB) asks why the nurse is required to watch the client swallow the medication each day. Which of the following statements is the best response by the nurse? a. "Clients with TB are often noncompliant, so if I directly observe, you will be sure to take the drugs that have been ordered." b. "This therapy is recommended to make sure that you receive the treatment you need and the infection doesn't become resistant to the drugs." c. "This is to make sure you take your medication if your condition becomes so advanced that you do not have enough cerebral oxygenation to remember." d. "Tuberculosis medications are very expensive so this method ensures that government money doesn't get wasted on those who will not take the drugs."

ANS: B It is important to be respectful to clients and to consider their perspective and psychological health while also responding truthfully. Directly observed therapy (DOT) programs for TB medication involve the nurse observing and documenting individual clients taking their TB drugs. When clients prematurely stop taking TB medications, there is a risk that the TB will become resistant to the medications. This can affect an entire community of people who are susceptible to this airborne disease. DOT ensures that TB-infected clients receive adequate medication. Thus, DOT programs are aimed at the population level to prevent antibiotic resistance in the community and to ensure effective treatment at the individual level. Many health departments have DOT home health programs to ensure adequate treatment. The risk to client and the community if the client does not follow the treatment regimen is that the TB will become resistant to these medications. It does not have to do with the possibility of noncompliance by the patient, that the patient will not remember, or related to the cost of the medications.

Which of the following best explains why chlamydia is a major focus of public health efforts? a. It has more serious long-term outcomes than other STDs. b. It can cause problems in infants born to infected mothers. c. It is not frequently seen in the United States. d. It is so difficult and expensive to treat

ANS: B Like gonorrhea and other STDs, chlamydia can cause neonatal complications in infants born to infected mothers. It is treated rather easily with antibiotics. Chlamydia does have serious long-term outcomes for the client, but so do syphilis and other STDs. However, unlike syphilis, which in its later stages is rare in the United States, chlamydia is the most common reportable infectious disease in the United States and hence is a major focus of public health.

A nurse is concerned about the prevalence of tuberculosis among migrant farm workers. Which of the following activities would be best to use when implementing tertiary prevention? a. Administer purified protein derivative (PPD) to contacts of those with tuberculosis. b. Initiate directly observed therapy (DOT) for tuberculosis treatment. c. Provide education about the prevention of tuberculosis to members of the migrant community. d. Use skin tests to screen migrant health workers for tuberculosis infection.

ANS: B Tertiary prevention is carried out among persons already infected with the disease. In this instance, DOT ensures compliance with treatment to cure the disease and to prevent worsening or the development of secondary problems. Administering purified protein derivative (PPD) to contacts of those with tuberculosis is secondary prevention as this is an at-risk population. Providing education about the prevention of tuberculosis to members of the migrant community is a primary prevention strategy as it is aiming to prevent the disease from occurring. Using skin tests to screen migrant health workers for tuberculosis infection is secondary prevention as it is a screening aimed at early detection of the disease.

When a nurse discovers that a woman has been treated for cervical cancer, the nurse asks the woman whether she has ever been tested for HIV or other STDs. The woman is offended and asks why the nurse would ask her such a thing. Which of the following statements would be the best response from the nurse? a. "Cervical cancer treatments may decrease immunity, so that it is easier to acquire STDs." b. "Cervical cancer usually is caused by HPV, and often the presence of one STD is accompanied by other STDs." c. "The presence of an STD in women with cervical cancer may lead to congenital defects in offspring." d. "The presence of an STD in a woman with a history of cervical cancer has been associated with a relapse of the cancer after treatment."

ANS: B The link between HPV infection and cervical cancer has been established and is associated with specific types of the virus. In 80% to 90% of cases of cervical cancer, evidence of HPV has been found in the tumor. Additionally, HSV-2 infection is linked with the development of cervical cancer. Because the presence of an STD increases the risk for the presence of other STDs, it is essential to screen for this information. There is no evidence that the presence of an STD in women with cervical cancer will lead to congenital defects in offspring. The presence of an STD increases the risk for another STD. There is no evidence of relapse of cervical cancer when there is presence of an STD.

A student complains to the college health nurse that her academic work has been going downhill because of lack of sleep. "My 3-year-old probably misses her babysitter since she has started going to the big daycare center. She hasn't been sleeping well and keeps scratching her bottom. Hopefully, she'll adapt to daycare soon." Which of the following information should the nurse provide to the student? a. "Dry skin in winter weather can cause itchiness; try to put on lotion before bedtime." b. "Your daughter may have pinworms; let me teach you how to check for this." c. "Perhaps your child is not developmentally ready for group play." d. "Try to arrange more one-on-one time with your 3-year-old."

ANS: B - "Your daughter may have pinworms; let me teach you how to check for this." Enterobiasis (pinworm infection) is the most common helminthic infection in the United States with about 42 million cases a year. This infection is seen most often among children in institutional settings. Pinworms cause itching, especially around the anus, which can result in a lack of sleep for both child and caregiver.

The tendency to ignore all differences between cultures and to act as though the differences do not exist is defined as cultural: a. Conflict b. Shock c. Blindness d. Imposition

ANS: C Cultural blindness occurs when people state that everyone is treated the same, regardless of their cultural orientation.

When a nurse supports the use of traditional home remedies in conjunction with Western medicine to promote healthy behaviors, the nurse is using cultural: a. Accommodation b. Brokering c. Preservation d. Repatterning

ANS: C Cultural preservation refers to assistive, supportive, facilitative, or enabling nurse actions and decisions that help the clients of a particular culture to retain and preserve traditional values, so they can maintain, promote, and restore health.

A student comes to the college health clinic with typical cold symptoms of fever, sneezing, and coughing, but the nurse also notes small white spots on the inside of the student's cheeks. Which of the following actions should be taken by the college health nurse? a. Inform all students, staff, and faculty of a possible rubella epidemic b. Inform all students, staff, and faculty of a possible measles epidemic c. Reassure the student that it is just a bad cold and will soon pass d. Tell the student to take two acetaminophen and drink lots of fluids

ANS: B - Inform all students, staff, and faculty of a possible measles epidemic Measles is an acute, highly contagious disease that, although considered a childhood illness, is often seen in the United States in adolescents and young adults. Symptoms include fever, sneezing, coughing, conjunctivitis, small white spots on the inside of the cheek (Koplik spots), and a red, blotchy rash beginning several days after the respiratory signs. Measles is serious. Around 10% of measles cases require hospital admission. It can lead to pneumonia and encephalitis, and it can kill. Persons who may have been exposed should be informed that anyone under 18 who has not received both immunization doses should receive measles vaccine.

Which of the following best describes the current goal in relation to communicable diseases? a. To control political borders so diseases cannot spread further b. To exterminate specific infectious agents one by one c. To expand health care facilities to improve infectious disease treatment d. To achieve worldwide immunization to control new cases

ANS: B - To exterminate specific infectious agents one by one The goal of prevention and control programs is to reduce the prevalence of a disease to a level at which it no longer poses a major public health problem. In some cases, diseases may even be eliminated or eradicated. The goal of elimination is to remove a disease from a large geographical area (e.g., a country or region of the world), such as has been done with polio in the Americas. Eradication is the irreversible termination of all transmission of infection by extermination of the infectious agents worldwide, as has been done with smallpox.

Which of the following components of the epidemiologic triangle contributes most to a female client developing a vaginal infection caused by fungi after successful treatment of her strep throat with antibiotics? a. Agent b. Environment c. Host d. Agent and host

ANS: B - environment The antibiotic therapy eliminates a specific pathological agent, but it also may alter the balance of normally occurring organisms in the woman's body, which causes a change in the vaginal environment and allows normally present fungi to proliferate, resulting in a yeast infection.

Which of the following is the number one cause of death worldwide? a. Chronic diseases (heart disease, cancer, stroke) b. Infectious diseases c. Injuries (accidental or purposeful) d. Terrorism

ANS: B - infectious diseases In countries with higher standards of living, where people live longer, chronic diseases—heart disease, cancer, and stroke—are the leading causes of death. Infectious diseases, however, are still the number-one cause of death worldwide.

Which of the following is the most common vector-borne disease worldwide? a. Dengue b. Malaria c. Onchocerciasis (river blindness) d. Yellow fever

ANS: B - malaria Globally, malaria is the most prevalent vector-borne disease, with over 2.4 billion people at risk and more than 275 million cases reported each year. More than 1 million children die of malaria each year. Dengue is the second most common vector-borne disease.

7. A community is examining which programs are needed within the community, the populations they will target, and how they will be funded. Which of the following would be the least risky decision for the community to make? A. Choose whichever option is the least expensive of agency resources B. Choose to do nothing C. Choose whatever the agency administration prefers D. Choose whatever the majority of clients prefer

ANS: B Choose to do nothing The need and demand for a program are determined by working with the client. This stage of planning creates options for solving the problem and considers several solutions. Each option for program solution is examined for its uncertainties (risks) and consequences. A "do nothing" decision is always the decision with the least risk to the provider. DIF: Cognitive Level: Apply (Application) REF: p. 279

16. A committee of health care professionals would like to establish a countywide program to improve Hispanic immigrant access to culturally competent health care services. Which of the following persons would be most helpful as a key informant? A. Hospital administrator B. Hispanic community leader C. National expert on cultural competency D. Politician or county official

ANS: B Hispanic community leader Key informants are leaders in the community who are knowledgeable about community needs. In this scenario, the Hispanic leader most likely knows more about the needs of the Hispanic community than the others listed. DIF: Cognitive Level: Apply (Application) REF: p. 280

12. Evaluation is underway for a statewide program to decrease teen injury and death associated with teens who drive while under the influence of alcohol. Which of the following questions would best be used for the summative evaluation of the program? A. Are program participants continuing to attend the programs, and do their satisfaction scores indicate that they are pleased with the program? B. How do statistics for injuries and deaths associated with drunk driving compare for teens in the year following the program? C. How does the amount of alcohol intake by teens compare before and after participants enter into the program? D. What problems are identified as the program is implemented?

ANS: B How do statistics for injuries and deaths associated with drunk driving compare for teens in the year following the program? Summative evaluation is evaluation to assess program outcomes or as a follow-up of the results of the program activities. Two of the options are examples of questions used for formative evaluation. The goal is addressed in the question about statistics; however, the goal was not to decrease drinking of alcohol but to decrease driving when drinking alcohol. DIF: Cognitive Level: Analyze (Analysis) REF: p. 277

A nurse resigns from a position in a hospital to accept a job in a community setting. After starting the new job, the nurse feels helpless and confused, wondering if this was the right career choice. This nurse is likely experiencing cultural: a. Conflict b. Relativism c. Shock d. Brokering

ANS: C Culture shock can happen to individuals within their own culture when they are having experiences such as starting a new job or career. Culture shock is brought on by anxiety from losing familiar signs and symbols of social interaction. Feelings associated with culture shock are helplessness, discomfort, and disorientation.

4. Which would be an appropriate descriptor that meets all criteria for defining a client to be served by a program? A. All women ages 40 to 50 who have not had a menstrual period for 3 consecutive months B. Immigrants residing in Central County for less than 5 years who have difficulty understanding care instructions because of limited English proficiency C. Pregnant women who have received nutritional counseling but whose nutritional status did not improve D. Children ages 18 months to 5 years old who have been treated for nutritional deficiencies at the Central County Clinic

ANS: B Immigrants residing in Central County for less than 5 years who have difficulty understanding care instructions because of limited English proficiency The client should be defined by biological and psychosocial characteristics, by geographical location, and by the problems to be addressed. For example, in a community with a large number of preschool children who require immunizations to enter school, the client population may be described as all children between 4 and 6 years of age residing in Central County who have not had up-to-date immunizations. This example tells the reader who the client is, what the need is, how large the population is, and where they are located. DIF: Cognitive Level: Analyze (Analysis) REF: pp. 277-278

19. Which of the following programs demonstrates the use of tertiary prevention? A. Developing an in-school clinic that provides birth control counseling and contraception B. Providing a diabetes management program for persons with diabetes mellitus C. Providing cardiovascular fitness evaluations at annual health fairs D. Setting up free blood pressure screenings at popular department stores and supermarkets

ANS: B Providing a diabetes management program for persons with diabetes mellitus The aim of tertiary prevention programs is to reduce complications from disease. Developing an in-school clinic is a primary prevention (pregnancy has not occurred). Fitness evaluations at health fairs and blood pressure screenings are secondary prevention programs (screening identifies conditions early and determines incidence/prevalence). DIF: Cognitive Level: Analyze (Analysis) REF: p. 284

3. Which of the following best describes the purpose of strategic planning? A. To anticipate client needs now and in the future B. To match client needs, provider strengths, and agency resources C. To maximize effective use of agency resources D. To utilize provider strengths and competencies

ANS: B To match client needs, provider strengths, and agency resources Strategic planning involves matching client needs, provider strengths and competencies, and agency resources. Everyone involved can anticipate what will be needed to implement the program, what will occur during implementation, and what the outcomes will be. DIF: Cognitive Level: Understand (Comprehension) REF: p. 277

The public health nurse comes to the hospital to see a client just diagnosed with hepatitis A. The nurse says, "I'm sorry to bother you when you're not feeling well, but I need to ask you a few questions." Which of the following questions would be most appropriate for the nurse to ask the client? (Select all that apply.) a. "Do you know how you got this infection?" b. "Who lives with you?" c. "Where are you employed?" d. "Where do you usually eat?" e. "Are you sexually active?"

ANS: B, C, E The nurse should ask about sexual contacts and ask who (if anyone) lives with the client because the named individuals will need to have immune globulin administered to hopefully prevent the spread of hepatitis A and a community epidemic. The nurse should also ask about the client's place of employment because certain settings warrant special considerations. For example, in restaurants, hospitals, daycare centers, or other institutions, the lack of careful hand-washing by an infected worker can result in contamination of many others. Hepatitis A can be spread through food contaminated by an infected food-handler, contaminated produce, or contaminated water. However, this mode of transmission is not very common in the United States.

The advanced practice nurse explains that the client has an upper respiratory infection (URI) and suggests several measures that might make the client more comfortable. Which of the following best describes why the nurse doesn't just prescribe antibiotics as the client repeatedly requests? (Select all that apply.) a. Antibiotics are expensive, whereas the support measures would be almost free of cost. b. Viral diseases are not affected by antibiotics. c. Clinics cannot afford to continually give antibiotics to anyone who asks for them. d. The more antibiotics are prescribed, the more infectious agents develop resistance to such drugs.

ANS: B, D Antibiotics are not effective against viral diseases, a fact found unacceptable to many clients looking for relief from the misery of a cold or flu. The inappropriate prescribing of antibiotics contributes to the growing problem of infectious agents that have developed resistance to once-powerful antibiotics.

Six students order meals at a local restaurant. Which of the following students are at highest risk for illness? (Select all that apply.) a. The first student asks for a salad with chicken strips and dressing on the side. b. The second student asks for a hamburger, very rare. c. The third student orders a tuna salad sandwich with extra mayonnaise. d. The fourth student orders a breakfast meal with two very soft-poached eggs and toast.

ANS: B, D Escherichia coli O157:H7 can produce a strong cytotoxin that can cause a potentially fatal hemorrhagic colitis. Hamburger is often involved in outbreaks, since the grinding process exposes pathogens on the surface of the whole meat to the interior of the ground meat, effectively mixing the once-exterior bacteria thoroughly throughout the hamburger so that searing the surface no longer suffices to kill all bacteria. Also, hamburger is often made of meat ground from several sources. The best protection against foodborne pathogens is to thoroughly cook food before eating it. Salmonella is also transmitted by undercooked foods such as eggs, poultry, dairy products, and seafood. Consequently, students eating very rare hamburger and undercooked eggs are at high risk.

A nurse will be using an interpreter during a client encounter. What considerations should be made by the nurse? Select all that apply. a. It is appropriate to use family members as interpreters. b. Written materials should be available in the clients primary language. c. Observe the interpreters gestures to assure client understanding. d. The gender, age, and educational level of the interpreter should be evaluated.

ANS: B, D Family members should be used with caution. The clients gestures and non-verbal messages should be observed to assure understanding. Written materials should be available in the clients primary language. The gender, age, educational level, socioeconomic status, religion, and dialect should all be considered when selecting the proper interpreter.

Which patient requires the nurse's immediate intervention? A. 13-year-old whose father owns guns B. 15-year-old who says, "Life isn't worth living" C. 14-year-old who goes out with friends frequently D. 16-year-old who likes to text and recently earned a driver's license

B. 15-year-old who says, "Life isn't worth living"

In which of the following cases would the school nurse be correct to advise the parents of an HIV-infected child to keep the child home from school? (Select all that apply.) a. The child develops allergies with sneezing. b. The child is unable to control body secretions. c. The nurse is not comfortable with being responsible for the child. d. There is an outbreak of chickenpox in the school. e. The child persists in biting behavior.

ANS: B, D, E Not attending school may be advisable if cases of childhood infections, such as chickenpox or measles, occur in the school, because the immunosuppressed child is at greater risk for suffering complications. Alternative arrangements, such as homebound instruction, might be instituted if a child is unable to control body secretions or displays biting behavior. HIV-positive children are encouraged to obtain routine immunizations, because their immune systems are compromised and they are more susceptible to such infections. To date, no cases of HIV infections being transmitted in a school setting have occurred in the United States. Thus, the nurse should not be fearful of providing care to this child.

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

ANS: C A family crisis occurs when the family is not able to cope with an event and becomes disorganized or dysfunctional. When the demands of the situation exceed the resources of the family, a family crisis exists. In three of the options, the survivor is considering the problem and trying to learn how to cope or seek resources to cope. Only in this option is the person overwhelmed and unable to conceive of how to cope

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

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

A person has syphilis with signs and symptoms of rash, sore throat, and muscle and joint pain. This person is experiencing which stage of syphilis? a. Congenital b. Primary c. Secondary d. Tertiary

ANS: C A person with signs and symptoms of a rash, sore throat, and muscle/joint pain is experiencing the secondary stage of syphilis.

How is a population best defined? a. High-risk group b. Those interacting within a school or institutional setting c. Collection of individuals who share at least one common characteristic d. Geographical location within a community

ANS: C A population or aggregate is a collection of individuals who have one or more personal or environmental characteristics in common. High-risk groups, school or institutional setting, and geographical location within the community all describe types of populations, not the definition of population.

Nurses working in hospice and home care settings need to be knowledgeable of health policy to: a. Provide safe nursing care. b. Prevent elder abuse. c. Receive payment for the services provided. d. Influence future legislation.

ANS: 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 that are providing.

A nurse provides for the availability of essential personal health services for people who would otherwise not receive health care. Which of the public health core functions is the nurse addressing a. Assessment b. Prevention c. Assurance d. Policy development

ANS: C Assurance deals with the availability of health services. Prevention is not a core function, assessment refers to systematic data collection, and policy development refers to the need to provide leadership in developing health policies.

A public health department makes sure that the essential community-oriented health services are available in the community. Which of the following core public health functions is being implemented? a. Policy development b. Assessment c. Assurance d. Scientific knowledge-based care

ANS: C Assurance focuses on the responsibility of public health agencies to ensure certain activities have been appropriately carried out to meet public health goals and plans. Policy development seeks to build constituencies that can help bring about change in public policy. Assessment includes activities that involve collecting, analyzing, and disseminating information on both the health status and the health-related aspects of a community or a specific population. Public health is based on scientific knowledge but is not a core function.

A community is concerned about the threat of bioterrorism. Which of the following best describes the basis for this concern? a. Bioterrorism has the potential to dissolve community-based programs. b. This threat could cause the health care system to collapse. c. The threat may divert funds from other public safety health care programs. d. Fear of bioterrorism will increase the need for shelters. NURSINGTB.COM

ANS: C Bioterrorism may have an impact on the availability of resources for public safety health care programs. Because funds are diverted it is possible that community-based programs would be eliminated, the health care system could experience changes, and that there would be an increase in the need for shelter. However, all the remaining options would happen because of the diversion of funds.

A nurse wants to obtain information on the alternative methods of health care her 45-year-old female client uses. Who is the best person to ask about this? a. The husband of the client b. A community leader of the ethnic group c. The client herself d. The religious leader of the ethnic group

ANS: C Clients provide a rich source of information about their own cultures.

Which of the following statements about public health is accurate? a. Prevention of early deaths can be more effectively accomplished by medical treatment than by public health approaches. b. Expenditures and resources for public health have increased in recent years. c. Historically, gains in the health of populations have been related largely to changes in safety, sanitation, and food safety. d. Reform of the medical insurance system is the single change needed to improve the health of Americans.

ANS: C Fielding and Tilson have asserted that most of the increase in life span has been made through improvements in sanitation, clean water supplies, making workplaces safer, improving food and drug safety, immunizing children, and improving nutrition, hygiene, and housing. Medical treatment has not made as significant of an impact on the life span as public health measures. Funding for public health in recent years has been on a gradual decline. Although reform of the medical insurance system may help improve the health of Americans, there are many other factors that will need to be addressed.

While researching various health care services that are provided in prisons, a nursing student learns that these services: a. Are funded by the Department of Defense b. Focus on health promotion interventions c. Must be provided at an adequate level d. Are available to those diagnosed with a chronic illness

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

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

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

16. The public health nurse (PHN) analyzes data related to the number and type of United States Environmental Protection Agency air quality standards that a community failed to meet. This data is an example of using which community health profile indicator? a. Sociodemographic characteristics b. Health status c. Health risk factor d. Functional status

ANS: C Health risk factors discuss proportions of populations who have particular health conditions or health risks; breathing air of poor quality is a risk to health. The number and proportion of people is a sociodemographic characteristic. Health status includes birth and death rates. Functional status refers to reports of good health status by members of the population.

Which statement about race is true? a. In the United States, children of biracial parents are usually assigned the race of the father. b. Ethnicity and race are synonymous terms. c. Individuals may be of the same race but of different cultures. d. No social significance is usually placed on race.

ANS: C It is often a misconception that persons of the same race have the same culture. For example, African Americans may have been born in Africa, the Caribbean, North America, or elsewhere and have very different cultures.

When a nurse is sued for malpractice and goes to court, which type of law is being used? a. Constitutional b. Common c. Judicial d. Institutional

ANS: C Judicial law is based on court or jury decisions.

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

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

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

ANS: C Marriage is indicated by a solid line on a genogram

When working with a client who is HIV positive, the nurse serves as an educator, teaching about the modes of transmission, and serves as a(n): 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

ANS: C Nurses must be role models because many HIV-positive patients are stigmatized.

27. A nurse is using a population focus when providing public health nursing care. Which statement best describes the care that is being provided? a. Priority is given to the highest risk population. b. Direct caregiving is limited to preventive measures, such as administration of immunizations. c. Attention is given to the population or community, regardless of whether they do or do not access the health care system. d. Only populations outside institutional settings are considered.

ANS: C PHNs are concerned with the health of the entire population. Priority is given to the entire population, not just the group at highest risk or those outside of institutional settings. Direct caregiving is not the focus of public health nursing care.

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. This nursing intervention is an example of _____ prevention. a. Primary b. Secondary c. Tertiary d. Primary health care

ANS: C Tertiary prevention includes those interventions aimed at disability limitation and rehabilitation from disease, injury, or disability.

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

ANS: C Personal health habits continue to contribute to the major causes of morbidity and mortality. The pattern of personal health habits and behavioral risk defines individual and family lifestyle risk. The client who doesn't move from the computer desk is creating great stress andstrain on personal physiology and needs to be educated on the benefits of exercise and the risks of cumulative trauma on the body. Multiple health benefits of regular physical activity have been identified; regular physical exercise is effective in promoting and maintaining health and preventing disease

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

ANS: C Physiological health involves issues related to physical wellness or illness. Other components of health in Neuman's model include psychological health, sociocultural health, developmental health, and spiritual health.

A community health nurse visits a homeless shelter that has several clients with tuberculosis who are taking antimicrobial drugs. Supervised drug administration may be done on a daily basis with persons with poor adherence because: a. This type of client does not care about his or her health. b. Homeless people have no access to medications. c. Poor adherence can result in drug resistance. d. The antimicrobials are so powerful, clients must be observed for reactions.

ANS: C Poor adherence has lead to antibiotic resistant strains.

A nurse implements nursing interventions considering the uniqueness of the persons culture. The practice is called cultural: a. Diversity b. Knowledge c. Competence d. Awareness

ANS: C Providing care based on the uniqueness of the clients cultural norms and values is one of the four guiding principles of culturally competent nursing care.

A public health staff nurse (PHN) who has a clear understanding of population-focused practice, would most likely engage in what activity? a. Volunteering for a local community action coalition b. Performing interventions with individuals in the community c. Improving the effectiveness of care provided d. Considering earning a PHN certification

ANS: C Public health staff nurses who have a clear understanding of population-focused care improve their effectiveness and efficiency of practice; have professional satisfaction by seeing how individual care contributes to health at the population level; and appreciate the practice of others who are population-focused specialists. PHN specialists are prepared at the master's level and function in an administrative role.

A persons skin color is an example of: a. Multiculturalism b. Ethnicity c. Race d. Culture

ANS: C Race is primarily a social classification that relies on physical markers.

Segregation is an example of: a. Prejudice b. Cultural imposition c. Racism d. Stereotyping

ANS: C Racism is a form of prejudice that occurs through the exercise of power by individuals and institutions against people who are judged to be inferior in, for example, intelligence, morals, beauty, and self-worth.

A 35-year-old man from Russia comes to the United States seeking asylum because of religious persecution in his native country. This type of immigrant is known as a(n): a. Legal immigrant b. Lawful permanent resident c. Refugee d. Unauthorized immigrant

ANS: C Refugees are people who seek protection in the United States because of fear of persecution in their homeland.

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

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

The practices of physicians, nurses, and other health care providers are differentiated by the: a. Health Resource and Services Administration (HRSA) b. State board of nursing c. Scope of practice d. United States Department of Health and Human Services

ANS: C Scope of practice involves defining nursing, setting its credentials, and then distinguishing between the practices of nurses, physicians, and other health care providers.

Hispanics tend to believe that the needs of the family take priority over those of the individual. This is an example of cultural variations of: a. Communication b. Space c. Social organization d. Environmental control

ANS: C Social organization refers to the way in which a cultural group structures itself around the family to carry out role functions.

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

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

D

In the event of a disaster, shelters are generally the responsibility of which of the following entities? a. Centers for Disease Control & Prevention (CDC) b. Federal Emergency Management Agency (FEMA) c. Public Health Service (PHS) d. Red Cross chapter

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 the United States

ANS: C The DHHS and the new federal agency, the Office of Homeland Security, have provided funds to address serious bioterrorism threats to the people of the United States.

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

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

The public health nurse (PHN) must participate in the essential services of public health. What is one of the essential services of public health nursing? a. Monitoring health status by completing a community assessment b. Diagnosing and investigating health problems in the world c. Informing, educating, and empowering people about health issues d. Working in law enforcement to regulate health and ensure safety

ANS: C The PHN monitors health status in several ways, completing a community assessment is only one way that health status is monitored. The PHN would not diagnose or solve "world" problems, or work in law enforcement. Rather, the PHN would participate with local regulators to protect communities and empower people to address health issues.

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

ANS: C The PHS was created in 1798.

A nurse demonstrates the desire to provide culturally competent care by: a. Relying on a textbook for information about an ethnic group b. Bringing a translator to the local community clinic c. Taking Spanish classes in the evening at a local college d. Judging others using his or her own cultural values

ANS: C The activity that suits the definition of cultural desire is one that a nurse would want to do instead of being directed to do so, referring to the intrinsic motivation of the nurse.

Which intervention is the nurse most likely to implement when addressing one of the primary goals of public health? a. Ensuring that a newly diagnosed 40-year-old hypertensive man takes his medication b. Finding home care for a 70-year-old client recuperating from a hip replacement c. Conducting an infant car seat safety check d. Contacting a local hospice to admit a terminally ill 60-year-old woman

ANS: C The correct answer is concerned with the health of many people, while the other answers address individual interventions. According to the Core Functions Project, all levels of health care, including population-based public health care, must be funded or the goal of health of populations may never be reached.

A nurse is found to be negligent. Because of the doctrine of respondeat superior, the one responsible for that negligence is the: a. Administrator b. Nurses immediate supervisor c. Nurses employer d. Nurse

ANS: 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 nurses employer.

A nurse would like to propose legislation requiring all schools to employ a registered nurse. The first step taken in the legislative process would be: 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

ANS: 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.

Which branch of the government interprets the states rights to grant abortions? a. Executive branch b. Legislative branch c. Judicial branch d. Federal branch

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

ANS: C The most chronic bloodborne infection in the United States is hepatitis C.

A public health nurse (PHN) provides clinic-based services for HIV-positive citizens in the community. Which term best describe this activity? a. Primary prevention b. Health education c. Tertiary prevention d. Policy making

ANS: C This clinic is for clients who already have a disease process; therefore, it is tertiary prevention (preventing deterioration in a patient, a relapse, or disability and dependency by anticipatory nursing and medical care). Primary prevention is using general and specific measures in a population to promote health and prevent the development of disease (incidence) and using specific measures to prevent disease in those who are predisposed to developing a particular condition. Health education would involve providing specific education to this population. Policy making is formulating plans by an organization in order to make decisions.

An example of a bacterial STD is: a. Trichomonas b. HIV c. Syphilis d. Genital warts

ANS: C Trichomonas, HIV, and genital warts are caused by viruses.

In the United States, which group is most affected by a new HIV diagnosis? a. Women having heterosexual relationships b. White IV drug abusers c. Young Black gay and bisexual men d. Men who have sex with other men

ANS: C Although new HIV diagnosis in general has declined, young Black gay and bisexual men are the most affected, with an 94% increase in diagnosis. The largest number of new infections in 2018 was in men who had sex with other men, and this was followed by heterosexual transmission. HIV infections in women are primarily due to heterosexual contact or IV drug use. This information supports the incorrectness of the other options.

A nurse is providing education to a client about the use of PrEP. Which of the following statements would the nurse include as part of this teaching? a. "Side effects of PrEP include extreme lethargy and joint pain." b. "PrEP has been shown to be effective in preventing transmission of the disease from sharing needles." c. "The effectiveness of PrEP will depend on your adherence to the medication regimen." d. "PrEP will prevent you from contracting HIV and hepatitis B."

ANS: C Pre-exposure prophylaxis, or PrEP, is a new HIV prevention method for people who do not have the infection but would like to reduce their risk of becoming infected. PrEP requires taking a pill to prevent the HIV virus from getting into the body. This prevention method requires strict adherence to taking the medication and having regular HIV testing; it is also used in combination with other HIV prevention methods rather than in isolation (CDC: PrEP, 2012b). It has been shown to be effective for people at very high risk for HIV infection through sex; the results about its effectiveness with injection drug users are not yet available. Extreme lethargy and joint pain are not common side effects of PrEP. PrEp provides protection against HIV, not against hepatitis B.

Which of the following provides the best explanation as to why people do not immediately seek medical treatment when they first become ill with HIV? a. They are afraid to get tested for fear that the results will be positive. b. They avoid the problem (maybe it will go away). c. They don't recognize their symptoms as possibly being due to HIV. d. It is too expensive to get an HIV test.

ANS: C When HIV enters the body, it can cause a flu-like syndrome referred to as a primary infection or acute retroviral syndrome. This may go unrecognized. The symptoms are similar to flu or a bad cold including sore throat, lethargy, rash, fever, and muscle pain. An antibody test at this stage is usually negative. So the person or a medical provider may not recognize the illness as HIV. Thus, it is not worthwhile to be tested during this stage of the illness. This information supports the incorrectness of the other options

Which of the following public health actions has been particularly instrumental in reducing childhood infectious diseases in the United States? a. Answering parents' questions about the safety and importance of vaccines today b. Educational campaigns to all health care providers about the importance of immunizations whenever a child is seen c. "No shots, no school" legislation, which legally requires children be immunized before school d. Offering all immunizations to all children free of any charge

ANS: C - "No shots, no school" legislation, which legally requires children be immunized before school Vaccines are one of the most effective methods of preventing and controlling communicable diseases. Hopefully, all nurses answer questions, remind colleagues to think about immunizations whenever a child is seen, and encourage continuing free or low-cost immunization clinics. One of the most effective programs has been the "no shots, no school" legislation, which has resulted in the immunization of most children by the time they enter school.

A man loudly protests his increased property tax bill right after the public health department has made a plea for more funds. "Why," he asks, "should my tax dollars be used to pay for their children to be immunized?" Which of the following would be the best response by the nurse? a. "Immunizations are required by law, and if their parents can't afford it, you and I will have to pay for it." b. "It's just the right thing to do." c. "Only by making sure most kids are immunized can we stop epidemics that might hurt all of us." d. "We're a religious God-fearing community, and we take care of each other."

ANS: C - "Only by making sure most kids are immunized can we stop epidemics that might hurt all of us." Herd immunity is the resistance of a group of people to invasion and spread of an infectious agent because a high proportion of individual members of a group are resistant to the infection. Higher immunization coverage will lead to greater herd immunity, which in turn will block the further spread of the disease.

An instructor is reviewing Salmonella infections with her class. Which of the following comments indicates that the student needs further review on how Salmonella is spread? a. "Certain pets and farm animals may be Salmonella carriers." b. "It is possible to transmit Salmonella by person-to-person contact." c. "Salmonella may be spread by spores that form once contaminated blood is exposed to the air." d. "Salmonella outbreaks are usually due to contaminated meat, poultry, and eggs."

ANS: C - "Salmonella may be spread by spores that form once contaminated blood is exposed to the air." Meat, poultry, and eggs are the foods most often associated with salmonellosis outbreaks. Animals are the common reservoir for the various Salmonella serotypes, although infected humans may also fill this role. Animals are more likely to be chronic carriers. Reptiles such as iguanas have been implicated as Salmonella carriers, along with pet turtles, poultry, cattle, swine, rodents, dogs, and cats. Person-to-person transmission is an important consideration in daycare and institutional settings. Anthrax (not Salmonella) forms spores when infected blood is exposed to air.

Which of the following data would most likely be collected in a syndromic surveillance system? a. Incidence of bioterrorism attacks b. Number of air travelers c. Incidence of school absenteeism d. Number of influenza vaccines administered

ANS: C - Incidence of school absenteeism Syndromic surveillance systems use existing health data in real time to provide immediate analysis and feedback to those charged with investigation and follow-up of potential outbreaks. These systems incorporate factors such as the previously mentioned temporal and geographic clustering and unusual age distributions with groups of disease symptoms or syndromes (e.g., flaccid paralysis, respiratory signs, skin rashes, gastrointestinal symptoms) with the goal of detecting early signs of diseases that could result from a bioterrorism-related attack. Syndromic surveillance systems may include tracking emergency department visits sorted by syndrome symptoms as well as other indicators of illness including school absenteeism and sales of selected over-the-counter medications. In recent years, the tracking of cold medicines used to make crystal methamphetamine has received considerable attention.

A community is experiencing an epidemic of the measles. The nurse is trying to determine if this problem is happening in other communities as well. Which of the following resources should the nurse use to answer this question? a. Centers for Disease Control and Prevention Weekly Report b. Communicable Diseases Weekly Report c. Morbidity and Mortality Weekly Report d. Weekly National Report of Communicable Diseases

ANS: C - Morbidity and Mortality Weekly Report Requirements for disease reporting in the United States are mandated by state rather than federal law. The list of reportable diseases varies by state. State health departments, on a voluntary basis, report cases of selected diseases to the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia. The National Notifiable Diseases Surveillance System (NNDSS) data are collated and published weekly in the Morbidity and Mortality Weekly Report (MMWR).

Which of the following is the most common vector-borne disease in the United States? a. Babesiosis b. Ehrlichiosis c. Lyme disease d. Rocky Mountain spotted fever

ANS: C - lyme disease All four are diseases borne by ticks as the vectors. Lyme disease became a nationally notifiable disease in 1991 and is now the most common vector-borne disease in the United States.

2. Which of the following best describes the ultimate goal of program planning? A. Avoid unanticipated conflicts in the program development phase B. Provide adequate funding to meet the program's resource requirements C. Ensure that health care services are acceptable, equal, effective, and efficient D. Prevent unnecessary duplication of services

ANS: C Ensure that health care services are acceptable, equal, effective, and efficient Although the other options are aspects of program planning, they address only limited concerns. The comprehensive goal of program planning is to ensure that health care services are acceptable, equal, efficient, and effective. DIF: Cognitive Level: Understand (Comprehension) REF: p. 277

8. A nurse checks health department records to compare the number of new teen clients presenting for birth control counseling and management in the 2 months before and after an education intervention program to decrease teen pregnancy. Which of the following steps of the evaluation process is being completed by the nurse? A. Engage stakeholders B. Justify conclusions C. Gather credible evidence D. Focus on the evaluation design

ANS: C Gather credible evidence When the nurse gathers credible evidence, the following information is collected: indicators that will be used, sources of data, quality of the data, quantity of information to be gathered, and the logistics of the data gathering phase. Data gathered should provide credible evidence and should convey a well-rounded view of the program. DIF: Cognitive Level: Apply (Application) REF: p. 283

11. A nurse is completing a summative evaluation of a program designed to decrease obesity in school-age children. Which of the following is the most important question for the nurse to ask? A. Are school-age children satisfied with the program? B. Can parents and guardians support the program requirements? C. Has obesity in school-age children decreased? D. What is the program cost compared with the program benefit?

ANS: C Has obesity in school-age children decreased? Summative evaluation looks at the end result of the program. The major benefit of program evaluation is that it shows whether the program is meeting its purpose. It should answer the following questions: Are the needs for which the program was designed being met? Are the problems it was designed to solve being solved? If the program does not achieve the purpose for which it is designed, important concerns of satisfaction and cost are irrelevant. So if the program purpose is to decrease obesity, the outcome of importance is a decrease in obesity. DIF: Cognitive Level: Apply (Application) REF: p. 277

14. Based on projected increases in the number of older U.S. citizens, a planning committee wants to establish a day care program for the community's older adult population. During which stage is the need for this program being assessed? A. Inactive stage B. Interactive stage C. Preactive stage D. Reactive stage

ANS: C Preactive stage The preactive stage is one in which assessment is based on the projection of a future need. DIF: Cognitive Level: Apply (Application) REF: p. 278

Which of the following symptoms suggests smallpox as opposed to the more common and much less dangerous chickenpox? (Select all that apply.) a. Child appears only mildly ill until late stages in smallpox. b. Lesions appear in various stages in the same area of the body rather than all at once. c. Rash lesions are most abundant on the face and extremities, not on the trunk. d. Rash occurs 2 to 4 days after sudden onset of fever rather than with the fever.

ANS: C, D Symptoms of smallpox include rash lesions on face and extremities, rash that occurs 2 to 4 days after onset of fever, and vesicles that are deep seated.

A nurse is conducting vision screenings on children in the school setting. Which type of nursing practice is the nurse performing? a. Community-oriented b. Public health c. Community health d. Community-based

ANS: D Community-based nursing practice is a setting-specific practice whereby care is provided for clients and families where they live, work, and attend school. Community-oriented nursing emphasizes the prevention of disease and disability. Public health nursing focuses on the care within the whole community. Community health nursing focuses on the health status of individuals and the effect of their health status on the whole community.

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

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

Asians may perceive illness as disharmony with other forces and that medicine is only able to relieve the symptoms rather than cure the disease. They may look to naturalistic solutions and acupuncture to resolve or cure health problems. This is an example of cultural variations of: a. Communication b. Space c. Social organization d. Environmental control

ANS: D Environmental control refers to the ability of individuals to control nature and to influence factors in the environment that affect them.

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

ANS: D Face-to-face visits with legislators are viewed as the most effective means of communication.

12. Which of the following conditions of the rural environment provides increased opportunities for teaching? a. Increased interaction among residents due to neighbors visiting neighbors on the family farms b. Involvement in rural community activities provides more contact with community residents than in urban areas c. Nursing responsibilities in these areas stress the importance of primary, secondary, and tertiary prevention d. Increased illnesses and injuries of rural residents require that they see nurses more often

B

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

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

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

ANS: D It is mandatory to report HIV cases in all states. The information is then sent to the Centers for Disease Control and Prevention (CDC). Some states report HIV infections either by name or by code.

An example of a cultural encounter is: a. Sharing significant assessment findings with members of a racial minority b. Visiting the native land of the clients served at a community health center c. Telephoning the priest at a Latino church to discuss the health issues of a client d. Learning about traditional healing practices from an American Indian client

ANS: D Learning about traditional healing practices is an example of a direct cultural encounter. This occurs when a nurse engages in cross-cultural interactions.

A goal of the Division of Nursing is to: a. Enhance nursing competence in providing high-tech skills b. Apply disease prevention, environmental health, and health promotion concepts c. Provide scholarships for advanced nursing education d. Enhance racial and ethnic diversity in the nursing workforce

ANS: D One of the Division of Nursing goals is to enhance racial and ethnic diversity and cultural competency in the nursing workforce. The other statements apply to other agencies or are false.

Action taken to protect the health, safety, and welfare of citizens, such as requiring immunizations of children before admission to school, is called what kind of power? a. Executive b. Legislative c. Judicial d. Police

ANS: 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.

A public health nurse (PHN) develops and implements local public health policies through partnerships with agencies, organizations, and consumers within the community. Which of the following core public health functions is the nurse addressing? a. Assessment b. Prevention c. Assurance d. Policy development

ANS: D Policy development deals with developing and implementing health policies. Prevention is not a core function, assurance is making sure essential services are available, and assessment refers to systematic data collection.

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

ANS: D TB is most often found in Asian Americans, at 25.6 new TB cases per 100,000 people.

The federal government provides for the protection of the publics health by: a. Interpreting decisions related to womens 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 the borders

ANS: D The United States Constitution gives the federal government the authority to provide for the protection of the publics health. By monitoring the influx of disease at the borders the publics health is being protected.

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

ANS: D The most common reportable infectious disease in the United States is Chlamydia.

A client comes into the clinic and tells the nurse he goes to an acupuncturist for pain. The nurse says he should take pain medication instead. This would be called cultural: a. Conflict b. Blindness c. Relativism d. Imposition

ANS: D This is an example of cultural imposition, the act of imposing ones cultural beliefs, values, and practices on individuals from another culture.

In the Vietnamese culture, individuals may focus on wishes and memories of their ancestors and look to them to provide direction for current situations. This is an example of cultural variations of: a. Communication b. Space c. Social organization d. Time

ANS: D This is the duration or period between successive events, where some cultures assign greater or lesser emphasis to events that occur in the past, present, or future.

Which group should 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

ANS: D Those who have been in close contact with persons who develop hepatitis A should receive immune globulin.

A student asks the nurse at the student health clinic how AIDS is diagnosed. Which of the following statements would be the best response by the nurse? a. "A diagnosis of AIDS is made when a screening test called an enzyme-linked immunosorbent assay (ELISA) is confirmed by the Western blot test." b. "A diagnosis of AIDS is made when antibodies to HIV are detected about 6 weeks to 3 months following possible exposure." c. "A diagnosis of AIDS is made when antibodies to HIV reach peak levels of 1000/ml of blood." d. "A diagnosis of AIDS is made when CD4 T-lymphocytes drop to less than 22 cells/mm."

ANS: D AIDS is defined as a disabling or life-threatening illness caused by HIV; it is diagnosed in a person with a CD4 T-lymphocyte count of less than 22 cells/ml with or without documented HIV infection. The HIV antibody test (usually the EIA) is the most commonly used screening test for determining whether the antibody to HIV is present but does not confirm AIDS. Positive results with the EIA are tested further with the Western blot test. However, false-negative results are frequent between 6 weeks and 3 months following exposure.

A nurse was reading PPD tests 24 hours after another nurse had administered them. Which of the following findings would cause the nurse to interpret the test as positive? a. 15 mm of erythema in a client with HIV infection b. 5 mm of induration in an immigrant from a country where TB is endemic c. A 5-mm ruptured pustule with purulent drainage in a homeless client d. 10 mm of swelling and increased firmness in a client recently released from a correctional facility

ANS: D For a PPD test to be positive, induration (swelling with increased firmness) must be present. A diameter of 10-mm induration would be a positive finding in an immigrant from a region with high TB infection. Erythema alone does not indicate a positive finding. A 5-mm induration is not large enough to indicate a positive finding. A small pustule in a homeless client undoubtedly is an infection but may not be due to the PPD test.

The correctional health nurse is doing a quick assessment on a newly admitted inmate who is HIV positive. Which of the following diseases should the inmate receive screening for immediately? a. Herpes zoster b. Hepatitis B c. Hepatitis C d. Tuberculosis

ANS: D HIV-infected persons, who live near one another, such as in correctional facilities, must be carefully screened and deemed noninfectious before admission to such settings. A person with HIV is more susceptible to opportunistic infections, the most common of which is TB. Hepatitis B and hepatitis C are both transmitted through blood and body fluids which are not as highly contagious as tuberculosis which is transmitted through airborne droplets. Herpes zoster (shingles) is spread by direct contact with fluid from the rash blisters. None of the other options are as directly related to HIV as an opportunistic disease.

A client is being treated for secondary syphilis. Which of the following signs and symptoms would the nurse anticipate the client would exhibit? a. Chancre at the site of entry b. Jaundice c. Difficulty coordinating muscle movements d. Skin rash without itching

ANS: D Secondary syphilis occurs when the organism enters the lymph system and spreads throughout the body. Signs include skin rash on one or more areas of the body and do not cause itching. Other symptoms may include fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. A chancre at the site of entry is a symptom of primary syphilis. Difficulty coordinating movements is a sign of tertiary syphilis. Jaundice is a sign of congenital syphilis.

A high school student is planning to volunteer at the hospital after school, so he or she needs to have a Mantoux test before beginning. Which of the following information should the nurse provide to the new volunteer? a. "I will be using tiny tines to administer the TB antigen to the skin on your arm." b. "Notify the clinic immediately if you experience any redness or itching at the test site." c. "The areas should be kept dry until you return; cover it with plastic wrap when bathing." d. "You will need to return in 2 to 3 days to have any reaction interpreted."

ANS: D The Mantoux test is a TB skin test that involves a 0.1-ml injection containing 5 tuberculin units of PPD tuberculin (not tines as in the TB tine test). The site should be examined for a reaction 48 to 72 hours (2 to 3 days) after injection. Only induration should be measured, and the results should be recorded in millimeters. The Mantoux test involves a 0.1-ml injection not tines as in the TB tine test. Slight redness or itching at the test site may occur, but that should resolve on its own and does not require the client to notify the clinic. The client can engage in normal activities; the site does not need to be kept dry.

A client was clearly very relieved when an HIV test came back negative. "Thank goodness. I've had sex several times without a condom, and when one of my friends said he was sick, I think I panicked." Which of the following would be most important to emphasize to the client immediately? a. Abstinence is the only way to be certain you are HIV free. b. Sex should be restricted to one partner. c. The test could be wrong and the client might still have an HIV infection. d. The test would not cover any recent infection, so if the client has had recent unprotected sex, the test should be repeated in 3 months.

ANS: D The client needs to understand that the test cannot identify infections that may have been acquired within the previous 3 months before the test. Appearance of the HIV antibody can take up to 12 weeks; thus, this test could be negative now, but positive in 3 months. All persons who have an STD test should be counseled about risk reduction activities before and after the test is done. This information supports the incorrectness of the other options.

Which of the following statements best explains why many health care providers are more afraid of getting hepatitis B (HBV) than HIV? a. Everyone would assume the person infected with hepatitis B is a drug user. b. Having HBV would mean no further employment in health care. c. The fatality rate is higher and occurs sooner with HBV. d. There is no treatment for HBV, which can be a very serious illness.

ANS: D Unlike HIV, there is no treatment for hepatitis B, and although some persons never have symptoms and others fight off the disease, many suffer from chronic hepatitis B, a very serious illness. Others may become chronic carriers of the disease. There are multiple populations that have a high prevalence of HBV including injection drug users, persons with STDs or multiple sex partners, immigrants, and refugees and their descendants who came from areas where there is a high endemic rate of HBV, health care workers, clients on hemodialysis, and inmates of long-term correctional institutions. Those who are infected with HBV are still able to work in health care. There is no evidence that the fatality rate is higher or sooner with HBV than with HIV

A client who is very upset says to the nurse, "But we always used a condom! How could I have genital warts?" Which of the following would be the best response by the nurse? a. "Are you positive you always used a condom?" b. "Condoms don't always work." c. "The condom might have had a tear in the latex." d. "Contact may have occurred outside the area that the condom covers."

ANS: D Warts may grow where barriers, such as condoms, do not cover, and skin-to-skin contact may occur. The challenge of HPV prevention is that condoms do not necessarily prevent infection. Thus, even with correct usage and the use of undamaged condoms, transmission may still occur

A community-based HIV/AIDS clinic would be concerned about which aspects of the Public Health Code of Ethics? Select all that apply. A. Autonomy of the professional. B. Confidentiality, when possible. C. Funding. D. Advocacy for disenfranchised persons. E. Respect of only community rights.

B and D

C

Which of the following agencies are responsible for implementing and enforcing local, state, and federal public health codes and ordinances and providing essential public health programs to a community? A. Community health clinics B. Federal health agencies C. Local health agencies D. State health agencies

There is great concern in the nurse's community over three local cases of West Nile virus. Which of the following actions should the nurse take to get the community involved in addressing this problem? a. Ask the state department of health for assistance b. Demand that everyone over age 65 become immunized immediately c. Encourage immunization of all children under 12 d. Have an educational campaign to remove any containers of standing water

ANS: D - Have an educational campaign to remove any containers of standing water Periodic outbreaks of West Nile virus appear to result from a complex interaction of multiple factors, including weather—especially hot, dry summers followed by rain, which influences mosquito breeding sites and population growth. Removing standing water will remove mosquito breeding sites.

Which of the following infectious disease interventions best represents the use of secondary prevention? a. Clients with HIV infection are encouraged to use condoms to protect sexual partners. b. Clients with HIV infection are given medications to improve immunological response. c. Health care workers are encouraged to receive annual vaccinations for influenza. d. Health care workers are required to have a tuberculosis skin test or chest x-ray.

ANS: D - Health care workers are required to have a tuberculosis skin test or chest x-ray. Tuberculosis screening for health care workers is an example of secondary prevention. TB skin tests and chest x-rays are methods of tuberculosis screening. Encouraging clients with HIV to use condoms is an example of primary prevention, because the goal is to prevent exposure to the partner. Encouraging annual influenza vaccinations is also an example of primary prevention. Giving clients with HIV medications is an example of tertiary prevention, because the goal is to reduce complications in those already having the infection.

At a town meeting with public health officials to discuss a communicable disease outbreak, a nurse is asked to explain what is meant by the phrase "a virulent organism." The nurse explains that this means the organism causing the disease is able to do which of the following? a. Bypass normal immunological response mechanisms b. Invade major organ systems c. Produce toxins and poisons that weaken the body d. Produce very severe physical reactions

ANS: D - Produce very severe physical reactions Virulence is the ability to produce a severe pathological reaction.

A student engages in unprotected sex under the influence of alcohol. The student decides to have an HIV test completed the next day. Which of the following results will most likely occur? a. The results will probably be negative for HIV. b. The results will probably be positive for HIV. c. The probability of disease is so low there is no reason to be tested. d. The test results won't be reliable so soon after exposure.

ANS: D - The test results won't be reliable so soon after exposure. It may take up to 6 months after exposure to the HIV virus before an HIV antibody test can test positive, although most infected people will test positive within 3 months. A negative test, therefore, is not a reliable indicator of infection status if exposure is very recent. The incubation period or the time interval between invasion by an infectious agent and the first appearance of signs and symptoms of the disease may be between 10 and 15 years for AIDS.

During an outbreak of hepatitis A, nurses are giving injections of hepatitis A immunoglobulin to selected susceptible persons. Which of the following best describes the type of immunity that will follow the administration of these injections? a. Active immunity b. Long-lasting immunity c. Natural immunity d. Passive immunity

ANS: D - passive community Passive immunity refers to immunization through the transfer of a specific antibody from an immunized individual to a nonimmunized individual, such as the transfer of antibody by administration of an antibody-containing preparation (immune globulin or antiserum). Passive immunity from immune globulin is almost immediate but short-lived. It often is induced as a stopgap measure until active immunity has had time to develop after vaccination.

10. The nurse contacts participants who completed an educational program on breast self-exams to see whether they have any questions and to determine whether they are doing breast self-exams. Which of the following types of evaluation is being implemented by the nurse? A. Final evaluation B. Formative evaluation C. Goal evaluation D. Summative evaluation

ANS: D Summative evaluation Formative evaluation occurs on an ongoing basis while the program exists. In comparison, summative evaluation assesses program outcomes after the program is completed. DIF: Cognitive Level: Apply (Application) REF: pp. 277, 284-285

17. A nurse is conducting a needs assessment but has a limited budget. Which of the following data sources would the nurse most likely eliminate? A. Community forums B. Examination of community indicators C. Focus groups D. Attitude Survey

ANS: D Surveys Attitude scales are probably used most often and are usually phrased in terms of whether a program met its objectives. The client satisfaction survey is an example of an attitude scale often used in the health care delivery system to evaluate the program objectives. Focus groups, community forums, and examination of community indicators are all time consuming and not as directed toward evacuating program goals.

13. A committee concludes that a program's objectives were met and that activities received positive ratings from the community; yet the program will be discontinued because cost was triple the amount anticipated. Which of the following program evaluation measures created a problem? A. Adequacy B. Effectiveness C. Impact D. Sustainability

ANS: D Sustainability The aspects of program evaluation include the following: evaluation of relevance—need for the program; adequacy—program addresses the extent of the need; progress—tracking of program activities to meet program objectives; efficiency—relationship between program outcomes and the resources spent; effectiveness—ability to meet program objectives and the results of program efforts; impact—long-term changes in the client population; and sustainability—enough resources (usually money) to continue the program. DIF: Cognitive Level: Apply (Application) REF: pp. 284-285

A patient eligible to receive benefits from the Patient Protection and Affordable Care Act asks the nurse the cut-off age for dependents to be covered. Which statement made by the nurse is appropriate? A. "There is no age limit to your dependent child receiving benefits." B. "Your dependent child aged 23 years is eligible to receive benefits." C. "Your dependent child can no longer receive benefits on your plan after age 18 years." D. "Your dependent child needs to get a job as soon as possible to receive benefits after age 20 years."

B. "Your dependent child aged 23 years is eligible to receive benefits."

5. After completing a needs assessment, the nurse is confident that he has identified the highest priority health programming need within the community. He presents his ideas at a community interest meeting, and the attendees show essentially no interest in being involved. Knowing that the health problem must be addressed he proceeds with implementation as planned. Which of the following is the most likely outcome of the program? A. Community members will become increasingly positive about the new program. B. Others will recognize the importance of the program and become involved. C. The public health agency will both publicize and expand the program. D. The program will fail because of the community's lack of interest.

ANS: D The program will fail because of the community's lack of interest. The needs to be met for the client population must be identified by both the client and the health provider. If the client population does not recognize the need, the program will usually fail. DIF: Cognitive Level: Apply (Application) REF: pp. 278-279

15. Which of the following methods would be the most interactive approach to assessing a community's need? A. Define needs based on the current health status of the community. B. Examine past needs as identified by the agency as well as the community. C. Project future needs based on current trends. D. Use past and current data to project future needs.

ANS: D Use past and current data to project future needs. Stages used in assessing client need include the following: preactive—projecting a future need; reactive—defining the problem based on past needs identified by the client or the agency; inactive—defining the problem based on the existing health status of the population to be served; and interactive—describing the problem using past and present data to project future population needs. DIF: Cognitive Level: Understand (Comprehension) REF: p. 278

6. A nurse is assessing a community to determine the feasibility of implementing a new program on bike safety for youth in the community. Which of the following aspects should the nurse investigate to make this determination? A. Whether the community, especially agency clients, desire a program B. Whether local politicians support the agency's idea for a program C. Whether agency professionals think a program is needed D. Whether all involved support the need for such a program

ANS: D Whether all involved support the need for such a program What people think about the need for a program, or program feasibility, might differ among health providers, agency administrators, policymakers, and potential clients. Feasibility means the program's viability, practicality, achievability, or likelihood of success. Everyone involved must be supportive for a program to succeed. DIF: Cognitive Level: Apply (Application) REF: pp. 278-279

c

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

A According to the Federal Register in January 2008, for a family of four, the poverty level—defined as the threshold below which families or individuals are considered to be lacking the resources to meet the basic needs for healthy living—is $21,200.

According to the Federal Register, what is the minimum income needed by a family of four to meet the basic needs for healthy living (that is, an income below this amount is considered insufficient to provide the food, shelter and clothing needed to preserve health)? a. $21,200 b. $23,000 c. $25,200 d. $27,000

B

After a house fire, a 4-year-old child begins sucking his thumb and wetting his bed. Which of the following would be the most appropriate action for the nurse to take? A. Explain to the child that it is important to be strong and not act like a baby. B. Explain to the family that this behavior is a normal reaction to disaster. C. Recommend admission for inpatient psychological counseling. D. Recommend behavior therapy as a means to overcome regression.

ANS: B The Agency for Healthcare Research and Quality (AHRQ) reviewed 40 systems used to evaluate the quality of studies and strength of evidence. The report identified three domains for evaluating systems that grade the strength of evidence: quality, quantity, and consistency. The quality of a study refers to the extent to which bias is minimized. Quantity refers to the number of studies, the magnitude of the effect, and the sample size. Consistency refers to studies that have similar findings, using similar and different study designs.

After finding several studies related to the clinical problem, a nurse knows the studies must be evaluated. Which of the following characteristics should be present in the literature? a. Federally supported multiagency clinical studies b. Multiple high-quality studies with large sample sizes and consistent findings c. Research studies done by multidisciplinary teams in multiple settings d. Controlled clinical trials

A B C

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

d

Although a particular congregation's need was obvious, there simply wasn't enough money to support a parish nurse position. Which of the following community groups would have most likely had a need and funds available to contribute to a shared parish nurse position? a. Childcare center b. Community elementary school c. Community high school d. Elderly housing complex

ANS: A, B, C, D, E Pacifism is a belief in peaceful resolution of conflicts and refusal to participate in war. All other factors are universally recognized factors that contribute to violence. These factors are poverty, unemployment, economic dependency; polydrug and alcohol abuse; dysfunctional family and/or social environment and lack of emotional support; media influence (e.g., violent video games, television shows, and movies); access to firearms; political and/or religious ideology; and intolerance and ignorance.

Although violence seems endemic in human society, which causative factors could be reduced if society agreed action was necessary? Select all that apply. a. Access to firearms b. Alcohol and other drug abuse c. Dysfunctional families with lack of emotional support d. Intolerance of those with a different religious ideology e. Media video games, television shows, and movies f. Pacifism as a belief system

ANS: B Working with victims of elder abuse, the nurse must establish rapport and trust; remember that competent adults have the right to make decisions about their own care, including to stay in an abusive situation; and support efforts to create respite programs and support groups for caregivers.

An 80-year-old woman lived with her eldest daughter, the daughter's husband, and their three children. On this visit, the nurse noted the woman looked dehydrated and seemed depressed. Both wrists were red and scabbed. When asked if she was all right, the woman protested she was fine and her daughter took good care of her. What action should you take? a. Begin the paperwork to have the elderly woman put in a nursing home b. Discuss respite care and other stress relief measures with the daughter c. Report the elder abuse to the state Department of Aging d. Review with the total family how to share responsibilities for the woman's care

d. Tertiary prevention to reduce the transmission of blood-borne diseases Tertiary prevention is for people who already have a disease or problem (in this instance, someone already abusing IV drugs) to prevent complications (harm reduction). In this instance, because the client does not plan to stop taking drugs, the nurse is trying to prevent complications related to use of contaminated needles and reduce the transmission of disease through sharing contaminated needles with others. Using the harm reduction model, the nurse should provide education on cleaning needles with bleach between uses and inform the addict about needle exchange programs to decrease the spread of the blood-borne pathogens. This client is already using IV drugs, thus, the nurse will be intervening at the tertiary level of prevention. Secondary and primary prevention strategies would not be appropriate when working with this client who already has a known problem.

An IV drug abuser admits to the nurse he has no desire to stop using drugs, so rather than lecture the individual on the dangers of drug addiction, the nurse provides information how to sterilize his needles. Which of the following prevention efforts is the nurse attempting to achieve? a. Primary prevention by educating about safe injections b. Primary prevention by avoidance of future legal complications c. Secondary prevention to reduce the risk for infection or other complications d. Tertiary prevention to reduce the transmission of blood-borne diseases

D

An academic medical center and a local senior living complex employ a parish nurse. The faith community nurse also holds a faculty position at the university's school of nursing. This nurse is practicing a type of parish nursing known as the: A. advanced practice model. B. clinical specialty model. C. congregation-based model. D. institution-based model.

ANS: 3 The Frontier Nursing Service nurses were trained in nursing public health and midwifery and provided care to rural and inaccessible areas, which led to reduced mortality.

An accomplishment for which the Frontier Nursing Service was noted is: 1. Improvement of the care of sick and injured soldiers 2. Establishment of a fee-for-service program for workers at Metropolitan Life Insurance Company 3. Reduction of infant and maternal mortality regardless of environmental conditions 4. Increasing funding for communicable disease treatment

B

An effective program strategy for health promotion efforts guided by the Healthy People 2020 framework that can be used by the faith community is establishing: A. food pantries. B. health fairs. C. statements of faith. D. volunteer training.

D

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

D

An example of the use of the nursing process within a faith community nursing practice is the: A. contractual agreement. B. evidence of a mature faith. C. polity of the faith community. D. use of health appraisals.

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

An older couple who has just retired and sold their house, who talk about their new condo in a retirement community Transitions (movement from one stage or condition to another) are times of potential risk for families. Age-related or life-event risks often occur during transitions from one developmental stage to another. Transitions present new situations and demands for families. Moving from the family home to a smaller condo represents a major change in lifestyle. The incorrect responses do not represent major transitions. If the event is normative, or anticipated, it is possible for families to prepare for the event and its consequences

A

An underlying current throughout the special population groups with health disparities is: a. poverty. b. aging. c. minority groups. d. children.

b

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

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

c.

Analytic epidemiology differs from descriptive epidemiology because it searches for: a. "when" of disease patterns. b. "where" of disease patterns. c. "why" of disease patterns. d. "who" of disease patterns.

A nurse is working in a community health nursing practice setting. Which intervention is the nurse most likely to implement? a. Administering a flu shot to a client in a physician's office b. Conducting a flu shot clinic at a community center c. Performing a client assessment in a hospital d. Providing supervision of staff in a rehabilitation center

Answer: A Community health nursing practice focuses on the health of individuals, families, and groups and the effect of their health status on the health of the whole community. Administering a flu shot to an individual is the only example that meets this criterion. Performing a client assessment focuses only on individual care, not the community. Providing supervision of staff does not focus on the community. Conducting a flu shot clinic at a community center focuses on protecting the community as a whole and would be considered public health nursing practice.

Which statement about community health nursing practice is correct? a. It focuses on the delivery of personal health services to individuals and families. b. It provides care to protect the health of the whole community. c. It emphasizes the setting where care is provided for clients and families. d. It requires a baccalaureate preparation for practice.

Answer: A Public health nursing provides care to protect the health of the community as a whole. Community-based nursing practice emphasizes the setting where care is provided for clients and families. It is generally assumed that a graduate of any baccalaureate program has the necessary basic preparation to function as a beginning staff PHN; however, this is not a requirement for public health nursing or community health nursing practices.

Which statement describes the consequence of the successful implementation of the Affordable Care Act? a. Americans will pay closer attention to their health status. b. Most of the population will be covered by health insurance. c. Public health departments will need to increase the number of nursing positions. d. The prevalence of obesity will decrease.

Answer: B One consequence of successful implementation of the Affordable Care Act might be that the majority of the population would be covered by insurance and public health agencies will not need to provide direct clinical services in order to assure that those who need them can receive them. The Affordable Care Act will not directly cause Americans to pay closer attention to their health status or decrease the prevalence of obesity.

b

As a result of recent social policy changes, public health agencies have shifted their emphasis from a focus on primary health care services to a focus on core public health activities because of new and re-emerging public health issues. A critical aspect of ensuring the public health system's ability to address these issues is: a. additional regulation. b. adequate funding. c. bioterrorism strategy. d. media coverage.

A

As congregations realize the need for care and care for one another, their individual and corporate relationships with their Creator often are enhanced, thereby increasing their resilience for future crisis situations. The characteristic of faith community nursing philosophy that best endorses this principle is that faith community nurse services: A. Emphasize strengths of individuals, families, and communities B. Focus on the faith community and its ministry C. Focus on the centrality of the spiritual dimension D. Consider health, spiritual health, and healing as an ongoing dynamic process

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

Assists with determining familial health risks Genomic health care can give health care providers the tools that they need to use a person's unique genomic information to design and prescribe the most effective treatment for each person and to help clients and families understand some of their health risks that are influenced by their genetic make-up. When nurses obtain a family history and learn about the illnesses and causes of death of biologically related family members, they can then learn about shared genes and environment and lifestyle behaviors that can increase a person's risks for the same diseases that other family members experienced. Genomic health care involves assessing for health risks based on genetic make-up, not environmental risks or risks posed by relationships or family functioning. Genomic health care is broader than detecting risk for developing cancer.

d. Promote healthy lifestyles with physical activity The nurse is engaging in primary prevention efforts against substance abuse by helping to promote healthy lifestyles and resiliency factors. The purpose of the nurse requesting this funding is to address the problem of substance abuse, not obesity. This program may offer an alternative to children and keep them safe and off the streets; however, the primary objective is to address the overall healthy lifestyle of these youth.

At a county board meeting, a nurse reports statistics related to the increasing problem of substance abuse in the county. The nurse then requests funding for an after-school recreation program that promotes age-appropriate fun activities and sports. Which of the following objectives is the nurse attempting to meet through this action? a. Help prevent obesity and boredom. b. Offer alternatives to being "on the streets." c. Prevent children from getting in trouble before their parents get home from work. d. Promote healthy lifestyles with physical activity

b

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. Researcher

b

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

10. A nurse is working with Mexican immigrants. Which of the following behaviors would most likely lead to a positive interaction for the nurse? a. Avoiding touching the client except when necessary as part of the physical examination b. Calling the client by name, socializing before addressing the problem, and being very respectful c. Keeping all interactions direct, to the point, and targeted on the reason for presentation d. Maintaining a non-confrontational relationship by avoiding any disagreement even if the nurse does disagree with what the client is saying

B

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

B. Act in the community's best interest, in keeping with community direction, while maintaining diligence, ongoing communication, and confidentiality. The six principles of effective advocacy include acting in the community's best interest, acting in accordance with the community's wishes, keeping the community informed, acting with diligence, maintaining impartiality, and maintaining confidentiality. Bateman's practical framework for advocacy places the advocate's core skills within the context of the six principles of effective advocacy.Cognitive Level: AnalysisAssociated Chapter Objective: 6Page Reference: 136-137

Which is a major challenge affecting healthcare needs of families? A. Prescription drug discounts B. Financial burden of healthcare costs C. Lack of understanding of health promotion activities D. Free preventative care services for older adult patients

B. Financial burden of healthcare costs

Which must serve as the entire backdrop for community health nursing? A. Dedicated, well-trained registered nurses B. Focus on aggregates, communities, and populations C. Moving care from the individual level to the family level D. Viewing families as individuals to improve societal health

B. Focus on aggregates, communities, and populations

The community health nurse (CHN) is caring for a young man with a spinal cord injury sustained in a car accident. Which best describes the reasons why it is important to work with families such as this one? A. Scarce resources make it difficult for the family to care for the young man in the family home safely. B. In the family unit, any illness or injury that affects one or more family members will affect the unit as a whole. C. It is important for the family to provide total physical and psychological care to the young man to keep him active. D. While working with the patient and family, the nurse can take over and provide the best physical and psychological care possible.

B. In the family unit, any illness or injury that affects one or more family members will affect the unit as a whole.

Which parenting technique will the nurse teach the parents of an adolescent? A. Criticize the teen's friends if you do not approve of them. B. Initiate open conversations about mental health concerns. C. Limit involvement with teens so they can grow more independent. D. Do not make the teen conform to family expectations, as this can cause rebellion.

B. Initiate open conversations about mental health concerns.

Which behaviors by the community health nurse (CHN) are essential in forming a therapeutic relationship? Select all that apply. A. Be assertive. B. Introduce self by name and title. C. Keep appointments with families. D. Address family members by name and title. E. Bring a positive attitude to every interview. F. Do not explain the reason for the visit to get honest answers.

B. Introduce self by name and title. C. Keep appointments with families. D. Address family members by name and title. E. Bring a positive attitude to every interview.

The nurse is caring for an adolescent with obesity. Which is the primary additional health concern? A. Gastric ulcer B. Type II diabetes C. Substance abuse D. Macular degeneration

B. Type II diabetes

2. A nurse is caring for Mexican migrant farmworkers. Which of the following conditions are of greatest importance for the nurse to assess? (Select all that apply.) a. Cholera b. Hepatitis c. High blood level of lead d. Malaria

BC

D

Before beginning to survey the community to assess its health needs and strengths, the nurse reviews various documents, including local statistical data and the minutes of the previous meeting of the health care agency. Which of the following best explains why the nurse would start with this activity? a. To avoid confronting the community until the nurse is thoroughly oriented b. To become familiar with previous goals and priorities of the agency c. To help get a better understanding of the assigned community d. To save time and effort and perhaps have new insights

ANS: 1 Chronic illness care, long-term illness and disability, and disease prevention became the new challenges for nurses.

Between 1900 and 1955, the leading causes of mortality were pneumonia, tuberculosis, and diarrhea/enteritis. By mid-century, nurses faced new challenges as the leading causes of death became: 1. Heart disease, cancer, and cerebrovascular disease 2. Influenza 3. Tropical diseases from increased travel abroad 4. Diseases from overcrowded conditions in large cities

d

Between 2000 and 2005, 1000 of 10,000 young women ages 17 to 20 years at a university tested positive for a sexually transmitted infection (STI). Of the 1000 diagnosed STIs, 300 were gonorrhea and 500 were chlamydia. Which of the following statements best summarizes these findings? a. The proportion of cases of gonorrhea to all STIs was 300:1300. b. The proportion of cases of gonorrhea to chlamydia was 300:500. c. The proportion of cases of gonorrhea to all STIs was 50%. d. The proportion of STIs to the total population was 100:1000.

2. Which of the following best describes a health professional shortage area (HPSA)? a. An area with inadequate health care facilities for residents b. An isolated area of underserved populations within an urban region c. A region with insufficient numbers of health care providers d. A rural region of the United States with a population density of less than 10,000

C

5. A migrant farmworker presents to the clinic reporting an acute onset of severe abdominal pain, nausea, vomiting, diarrhea, and headache with difficulty concentrating. Which of the following conditions would cause such symptoms? a. Appendicitis b. Bacterial gastroenteritis c. Pesticide poisoning d. Viral illness

C

7. Which of the following is the most accurate description of a migrant farmworker? a. A person who does farm work as the primary means of employment, although other work may be done when the seasonal work ends b. A person who immigrates to the United States to "follow the crops" in performing seasonal farm work c. A person who moves from place to place to earn money performing seasonal agricultural work d. A person who specializes in the development of rural land for the purpose of farming

C

9. A migrant farmworker brings his daughter into the clinic with severe heat stroke from being out in the sun. The nurse explains the danger signs and stresses staying cool and drinking lots of water. The man seems to know this already. Which of the following best describes the most likely reason that this happened? a. It was a rare occurrence, which probably won't be repeated. b. The daughter either disobeyed her father and went out to play in the sun or just did not realize how hot she was. c. Children may work on small farms because the family may need the additional income. d. The parents were busy working and didn't realize the child was outside so long.

C

Which teen does the nurse identify as being at the highest risk for health deviations? A. 18-year-old who does not plan to attend college B. 15-year-old living with two parents of the same gender C. 16-year-old residing in an unsafe inner-city neighborhood D. 17-year-old with asthma who sees a primary care provider every 6 months

C. 16-year-old residing in an unsafe inner-city neighborhood

Which statement best reflects the concept of cohabitation? A. A family group consisting of a mother, father, and children B. A married couple living together in a long-term relationship C. An unmarried couple living together in a long-term relationship that resembles marriage D. Extended family members such as grandparents, aunts, or uncles living with the married or unmarried couple

C. An unmarried couple living together in a long-term relationship that resembles marriage

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

C. Enroll in a community health nursing graduate course to learn community research, measurement, and analysis techniques. Two core functions of community-oriented nursing are assessment and assurance. Both of these core functions have their foundation in the ethical tenets of competency. Nurses assigned to develop community knowledge must be adequately prepared to collect data on groups and populations. The techniques employed differ from those used when caring for individuals. Use of the wrong research techniques leads to wrong assessments, with the potential for developing interventions that harm rather than help the target population.Cognitive Level: SynthesisAssociated Chapter Objective: 4Page Reference: 133-134

Which nursing action is appropriate if an assessment demonstrates that a teenage patient has not met a development goal? A. Teach the patient why developmental goals are important. B. No action is needed as developmental goals are subjective. C. Initiate early referrals that are appropriate to the developmental goal. D. Wait until the following appointment to re-assess whether the goal has been met.

C. Initiate early referrals that are appropriate to the developmental goal.

a.

Clinical medicine and epidemiology differ from each other in the major aspect of: a. practice focus. b. health monitoring. c. determinants of health and disease. d. evaluation of interventions.

B

Communities of faith strive to be caring communities and strongly value the fellowship among members. The faith community nurse recognizes that sharing concerns with pastoral staff and fellow congregants gains valuable support to promote optimal healing. The ethical issue of concern in this matter is: A. group rights. B. individual rights. C. statements of faith. D. virtue ethics.

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

Conducting a sexual behavior survey with the adolescents Secondary prevention would include screening for risky behavior. Education and distribution of condoms are both primary prevention measures, and follow-up education for those diagnosed and being treated is tertiary to prevent further problems.

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

Contracting Contracting is making an agreement between those involved in a shared effort by both nurse and family. The premise of contracting is family control. It is assumed that when the family has legitimate control, their ability to make healthful choices is increased. A family crisis occurs when the family is not able to cope with an event and becomes disorganized or dysfunctional. Making a pledge through contracting is a way to cope with a family crisis. Empowerment reflects a family seeking help with access and control over needed resources, decision-making and problem-solving abilities, and the ability to communicate and to obtain needed resources. The pledge does not address the multiple components of empowerment. Health risk reduction is based on the assumption that decreasing the number or the magnitude of risks will decrease the probability of an undesired event occurring. The pledge does not address multiple health risks.

13. A nurse is implementing a tertiary prevention strategy related to pesticide exposure. Which of the following activities would the nurse complete? a. Observe farmworkers for evidence of unsafe handling of pesticides. b. Provide teaching on how to handle pesticides to avoid or decrease exposure. c. Teach farmworkers how to recognize signs and symptoms of pesticide poisoning. d. Treat a client who has pesticide exposure to prevent complications.

D

8. An employer provides a migrant farm family the day off to visit the health clinic in a nearby community and tells them to take all of the time they need. However, the family arrives at the clinic appearing very stressed. In addition to the health issue, which of the following would most likely be a fear experienced by the family? a. Their personal belongings may be stolen while they are at the clinic. b. Immigration officials will send them back to their home country. c. The clinic personnel will look down on them and be biased against them. d. They weren't getting paid for that day, and continued employment is never certain.

D

The nursing instructor is teaching nursing students about conducting the family interview. Which statement made by a student indicates understanding of the teaching? A. "Interviewing a family is long process that may take more than one day to complete." B. "The family interview begins with a background assessment of how the family is viewed by neighbors." C. "The family interview takes approximately 60 minutes to complete depending on the number of family members in attendance." D. "Family theorists and practitioners suggest that, with experience, the nurse can accomplish a family interview within 15 minutes."

D. "Family theorists and practitioners suggest that, with experience, the nurse can accomplish a family interview within 15 minutes."

The school nurse is teaching a student nurse about pregnancy among teenagers in the United States. Which statement made by the school nurse represents primary prevention measures? A. "Passing out condoms to male students at school may help to prevent pregnancy." B. "Showing the new mother how to provide basic newborn care is essential for success." C. "Routine screenings for pregnancy and sexually transmitted diseases should be done annually." D. "Reproductive education may help students to understand their bodies and prevent pregnancy."

D. "Reproductive education may help students to understand their bodies and prevent pregnancy."

Which statement will the community health nurse (CHN) include in a teaching session on disease prevalence in the United States? A. "The U.S. has the lowest infant mortality rates in the world." B. "Rural areas have a lower neonatal mortality rate compared with larger, urban cities." C. "Incidence of suicide among teenagers and young adults is drastically falling annually." D. "Studies show increased mortality and morbidity associated with cardiac disease, cancer, and diabetes."

D. "Studies show increased mortality and morbidity associated with cardiac disease, cancer, and diabetes."

The nurse is using a genogram to illustrate the family's structure. Which number of generations of family members is usually depicted? A. 2 B. 1 C. 4 D. 3

D. 3

How does the nurse best incorporate a 17-year-old athlete into a plan of care to manage asthma? A. Explain medication regimen to the teen and parent. B. Provide brochures on managing asthma to the patient. C. Refer the teen to a support group for athletes with asthma. D. Ask the teen to demonstrate how to use a spacer for an inhaler.

D. Ask the teen to demonstrate how to use a spacer for an inhaler.

Which is the best way for the community health nurse (CHN) to determine the health of the community? A. Track statistics on teenage pregnancy in the community B. Gather data on the environment to identify toxins in the community C. Identify subpopulations in the community and arrange for home visits D. Compare city data with county data, then county data with state and national data

D. Compare city data with county data, then county data with state and national data

Caring and the ethic of care are core values of community health nursing. This ethical view was developed in the mid-1980s and early 1990s in response to the technical advances in the health care sciences and the desire of nurses to: A. Apply gender-related voices to moral judgment. B. Apply principles of utilitarianism. C. Differentiate distributive justice from beneficence. D. Differentiate nursing practice from medical practice.

D. Differentiate nursing practice from medical practice. The view of caring and the ethic of care that emerged in the mid-1980s and early 1990s was a response to technological advances in science and the desire of nurses to differentiate nursing practice from medical practice. It is closely related to feminist ethics.Cognitive Level: AnalysisAssociated Chapter Objective: 3Page Reference: 131-132

The community health nurse is assessing the family as a system within the context of its environment. Which technique is the nurse using? A. Systems theory B. Network theory C. Transactional model D. Ecological framework

D. Ecological framework

Which statement best defines the concept of sandwich generation? A. Families from a variety of cultures forming one harmonious society B. Family groups greatly influenced by musical genres such as grunge or hip-hop C. Family units from a variety of cultures keeping their individualities in the same society D. Family structures in which adult children care for older parent(s) or provide financial support

D. Family structures in which adult children care for older parent(s) or provide financial support

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

D. Issuance of the ANA's position statement on nursing education in institutions of higher education. In the 1960s, the ANA recommended that all nursing education occur in institutions of higher education; a shift thereby occurred from reliance on inherent ethical tenets and values to the explicit study of ethics and ethical decision-making processes. This, in conjunction with the emergence of the field of bioethics, altered the curriculum content of nursing education programs.Cognitive Level: AnalysisAssociated Chapter Objective: 1Page Reference: 126

As the nurse develops the plan of care, which would be considered under the implementation phase? A. Evaluate for behavioral changes. B. Determine subjective and objective data. C. Plan education on required immunizations. D. Provide information on community resources.

D. Provide information on community resources.

ANS:1 Local health departments were formed to handle environmental issues in cities.

In the late 1800s, local health departments were formed in urban areas for what purpose? 1.To target environmental hazards associated with crowded living conditions and dirty streets and to regulate public baths, slaughterhouses, and pigsties 2.To facilitate interdisciplinary efforts and promote the "practical application of nursing" 3.To provide immunizations to all citizens 4.To provide public health education for nurses who had finished basic "training school" education

ANS: A In the past, community-oriented nurses have been called public health nurses, district nurses, visiting nurses, school nurses, occupational health nurses, and home health nurses.

In the past, community-oriented nurses have been called: a. District nurses b. Almshouse nurses c. Soldier nurses d.Sisters

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

D. Respect for autonomy, in which the nurse recommends to the client an arrangement whereby the caregiver lights the candles when the caregiver is present in the home and removes the matches and candles from the kitchen cabinet. The nurse applies the principle of respect for autonomy. The nurse wants to maintain the client's dignity and quality of life, and to help the client be as independent as possible. But at the same time, the nurse must choose actions that reduce the risk of harm to others.Cognitive Level: ApplicationAssociated Chapter Objective: 3Page Reference: 129-130

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

D. Review continuing education records to determine if the nurses have received training in community-oriented nursing and ethics, and plan for any needed training.

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

Drive away and notify the family from a safer location. Personal safety is an issue. Home visits are generally very safe; however, as with all worksites, the possibility of violence exists. Therefore, the nurse needs to use caution. If a reasonable question exists about the safety of making a visit, the nurse should not make the visit. The home health nurse should be educated about what to do in this situation before it occurs and should not need to call the agency to ask for their advice when faced with this situation. The priority would be to leave the situation before calling the family. The nurse should not place herself in a potentially violent situation by choosing to enter the home

ANS:1 The visiting nurse became the key to health care in urban areas. Although nurses were involved in interventions to improve sanitation and nutrition, they were not instrumental in their construction. Nurses worked in hospitals, but that was acute care. Almshouses and orphanages were not closed down at this time.

During America's Industrial Revolution, the number of jobs for women rapidly increased. Nightingale's successes became known across the United States, and the first nursing schools opened. Which of the following occurred related to public health nursing? 1.Community-oriented nursing began with organizations formed to meet urban health care needs. 2.Nurses were instrumental in the construction of sewers and public water systems. 3.Nurses trained in hospitals worked long hours caring for patients with communicable diseases in a humane way. 4.Nurses closed down almshouses and orphanages.

D

During the assessment phase, the nurse compiles and interprets available data and draws conclusions as to the community's strengths and concerns. Which of the following best describes why the nurse would also conduct interviews with key informants? a. To ensure that others agree with the nurse's plans for interventions b. To confirm the nurse's initial findings and conclusions c. To encourage community partners to feel they "own" the data d. To generate nonstatistical data such as values, beliefs, and perceived needs

D

During which of the following activities is the nurse in community health acting as a partner in change? a. Administering vaccinations to preschoolers b. Analyzing community problems to determine the best interventions c. Establishing an elder-care center for older adults living with family members who work d. Teaching anger management skills to a group of teens in a halfway house

b

Each client in the Medicare home care program must be under the care of a doctor (medicine, podiatry, or osteopathy). The home health nurse must involve the doctor in developing a plan of care. The role of the doctor in the home health interdisciplinary team is to do which of the following? a. Achieve the optimal level of functioning by teaching b. Certify/recertify the medical necessity and plan of care c. Deal with the social, emotional, and environmental factors that affect well-being d. Provide maintenance, preventive, and restorative treatment for clients

ANS:3 The other choices are events that happened after the colonial period.

Early colonial health efforts in the United States included: 1.Establishment of schools of nursing 2.Development of vaccines given to large numbers of people 3.Collection of vital statistics, improved sanitation, and control of communicable diseases introduced through seaports 4.Development of public housing and almshouses

C

Elderly clients should be assessed for signs of abuse. The illegal use of a person for another person's profit is known as: a. neglect. b. incompetence. c. exploitation. d. self-determination.

ANS: C, D, E In the health care field, the most frequent areas for the occurrence of violence are the emergency departments, psychiatric units, geriatric units, and waiting rooms.

In which clinical areas are nurses most at risk for workplace violence? Select all that apply. a. Acute care/intensive care units b. Community health clinics c. Emergency departments d. Geriatric units e. Psychiatric units f. Rehabilitation units

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

Establish rapport between the nurse and the family. The initial home visit includes the nurse's self-identification and clarification of role, establishing rapport with the family, assessing the situation, and then determining the client's expectations. However, without rapport between the nurse and the client, the nurse will be notably less effective at other tasks. Although in some senses the nurse is a guest in the home, the nurse is not there for social purposes but to help the family with health concerns. Building rapport between the nurse and family should occur as the nurse is determining the family's expectations, as well assessing the family and home setting.

B,D,E

Evidence-based public health utilizes which of the following guidelines? (Select all that apply.) A. Decision making for the community served B. Application of program planning frameworks C. Judicious use of the Internet for use of evidence D. Conducting evaluations E. Disseminating what has been learned

C Major depressive disorder is the leading cause of disability in Americans between the ages of 15 and 44 years.

Excluding war, what is the leading cause of disability for Americans 15 to 44 years of age? a. Accidents b. Arthritis c. Major depressive disorder d. Workplace injuries

A

Finding resources to implement evidence-based practice (EBP) in community health will continue to be a challenge because of the emphasis on quality care, equal distribution of health care resources, and cost control. Which of the following would demonstrate a creative strategy to implementing EBP? A. Adopting quality indicators for evaluating websites claiming to contain EBP B. Avoiding the issue of community politics C. Creating the role of a knowledge manager D. Making decisions on behalf of the community

ANS:2 During the Crimean War, Nightingale progressively improved the soldiers' health by adopting a population-based approach that used simple epidemiological measures and greatly decreased mortality.

Florence Nightingale's contributions to public health included: 1.Caring for the sick, poor, and neglected in institutions and at home 2.Using a population-based approach that led to improvements in environmental conditions 3.Writing the Elizabethan Poor Law to guarantee medical care for all 4.Founding of the district nursing association to provide health care to needy people

B

Following the attacks of 9/11, a nurse practitioner in a family clinic used opportunities at the clinic staff meetings to speak about her own feelings of loss and guilt. This strategy indicates that the nurse was aware of what phenomenon related to disasters? a. Anxiety b. Effects of stress on individuals c. Sense of urgency d. Scapegoating and blaming

B

Four months after the disaster of 9/11 at the Pentagon, a local EMS worker complained of extreme exhaustion. The veteran EMS worker also stated that the pace of work at the squad was too slow. The occupational health nurse that is assessing the EMS worker recognizes the symptoms of: a. anger. b. delayed stress reaction. c. inability to concentrate. d. insomnia.

B) Open a senior wellness clinic. Healthy People 2020 identified four goals. Opening a senior wellness clinic focuses on better health, which is in agreement with goal 3, create social and physical environments that promote good health for all. None of the other answers focus on the other goals of Healthy People 2020. Goal 1 is to attain high-quality, longer lives free of preventable disease, disability, injury, and premature death; goal 2 is to achieve health equity, eliminate disparities, and improve the health of all groups; and goal 4 is to promote quality of life, healthy development, and healthy behaviors across all life stages.

Healthy People 2020 has four primary goals. Which community activity would address one of these goals? A) Provide free dental screenings to all school age children. B) Open a senior wellness clinic. C) Overhaul the health insurance system. D) Decrease co-payments of medication prescriptions.

a

Home health agency types, whether official, private and voluntary, combination, hospital based, or proprietary, are similar in terms of which of the following? a. Conditions of participation (COP) for Medicare and Medicaid b. Federal income tax exemption status or accreditation status c. Governance models and administrative structures d. Homemaker services or service contracting practices

b

Home health care can be defined as a broad spectrum of health and social services offered in the home environment to recovering, disabled, or chronically ill persons. Participation in providing the needed maintenance care for the home care client is essential by which of the following? a. Chaplain b. Family caregivers c. Home health aides d. Physician

B

If a person returns from overseas and it is determined that he has cholera, what must occur? a. This is not a disease that is on the notifiable list: nothing need be reported b. The case must be reported to the state and local health departments c. The patient must be isolated immediately d. The patient will probably die, so it is not reportable

C

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

b

In a particular community, several high school students were diagnosed with diabetes mellitus Type 2 during the annual high school health fair. Over the next few years, the nursing staff developed and implemented educational programs about the risk factors for diabetes mellitus Type 2 and proper nutrition. Which of the following would be most useful for the nurses to use to determine if they are having any impact? a. The epidemic of diabetes in the high school is gradually ending. b. The incidence of diabetes is slowly decreasing during screening events. c. The prevalence of diabetes is slowly decreasing during screening events. d. The risk for diabetes is slowly increasing over time.

b

In the agency, one of the nurses spent all available time visiting a group of persons with mental health problems who were trying to remain functional in the community. Which of the following types of assignments did the nurse most likely have? a. Home-based primary care b. Population-focused home care c. Proprietary home care d. Transitional care

d. The wife tells her husband's boss that her husband is sick when he is actually inebriated Enabling is the act of shielding or preventing the addict from experiencing the consequences of the addiction. When someone lies for the abuser, the individual is enabling the abusing behavior to continue. The other options do not demonstrate the behavior of enabling, since none are shielding the abuser from experiencing the consequences of the addiction

In which of the following scenarios is a family member enabling an individual to continue to abuse alcohol? a. The husband asks the nurse to explain why his wife's continued drinking is dangerous. b. The son threatens to leave home because he finds the father's behavior embarrassing. c. The teenage daughter of an alcoholic turns to a favorite teacher for emotional support. d. The wife tells her husband's boss that her husband is sick when he is actually inebriated

a. A business pays for part of health insurance premiums for its employees. c. An employer provides health screenings. e. An employer offers immunizations to all eligible employees Businesses can pay for disease prevention and health promotion services for employees (and sometimes their families) in the form of immunizations, health screenings, and counseling. The business can then deduct these costs as a business expense, which reduces the amount the business owes the government in taxes on their profits. Similarly, when businesses subsidize health insurance for their employees—and families—this is also a business expense, which decreases the amount the business would otherwise pay in taxes. Thus, the government indirectly provides the money, but the business, a part of the private sector, decides how it is used. A business purchasing gifts for its employees and an employer requesting reimbursement for employee transportation costs do not result in tax relief for the business. Rather, the business providing health insurance and health promotion/disease prevention services allows the amount of taxes that the business owes to the government to be reduced.

In which of the following situations would the federal government provide money through tax relief for private enterprise? (Select all that apply.) a. A business pays for part of health insurance premiums for its employees. b. A business purchases gifts for its employees to award them for their service. c. An employer provides health screenings. d. An employer requests reimbursement for employee transportation costs. e. An employer offers immunizations to all eligible employees

A,B,C

In which situation would a nurse use public surveillance? (select all that apply) a. When estimating the magnitude of an influenza outbreak b. When determining the geographical distribution of gonorrhea cases c. When detecting an epidemic of whooping cough d. When reducing the prevalence of obesity

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

Leave a card with information on how to get in touch with the nurse. The contact may be terminated as requested if the nurse determines that either the situation has been resolved or the services have been obtained from another source and if the family understands that services are available and how to contact the agency if desired. However, the nurse should leave open the possibility of future contact. Obviously, the nurse cannot force entrance into the home. It would not be appropriate to coerce a child with misinformation or to interview a child about health concerns without a parent being present

ANS:2 Lillian Wald provided health care that included educating the community on health care matters.

Lillian Wald invented the term public health nursing. Which of the following classes might a person of her day attend? 1.Taking and recording blood pressures accurately 2.Safe and sanitary baby and child care 3.Environmental pollutants and their effects on lung disease 4.Time management: balancing factory work and the home

ANS:4 Lillian Wald established the Henry Street Settlement.

Lillian Wald was the first public health nurse in the United States. Which of the following is her major contribution to public health nursing? 1. Founding the American Nurses Association 2.Establishment of the New York Training Hospital for Nurses 3.Establishment of the Public Health Service 4.Establishment of the Henry Street Settlement that later became the Visiting Nurse Service of New York

ANS:1 Early school nursing focused on investigating causes of absenteeism, not providing medical treatment. That was the responsibility of physicians.

Lina Rogers became the first school nurse. Early school nursing focused on: 1.Investigating causes of absenteeism such as malnourishment and lack of shoes or clothing 2.Teaching school as well as being a nurse 3.Starting the first school of public health 4.Providing medical treatment to enable children to return to school

A

Migrant workers and their families who reside in a specific mobile home park during the summer months would best be classified as a: a. community. b. group. c. setting of practice. d. target population.

ANS: 1 Correct by definition. Nursing centers, nurse-managed clinics, and public health services are not necessarily in neighborhoods.

Neighborhood centers that provided health care and social welfare programs were called: 1. Settlement houses 2. Nursing care centers 3. Nurse-managed clinics 4. Public health services

c

Nonprofit home health agencies can be reimbursed for home health services through Medicare, Medicaid, and private insurance companies. A major difference between an official agency and a voluntary or private agency is that official agencies receive additional: a. client payments. b. charity support. c. public funding. d. third-party payments.

ABCDE

Nurses are reclaiming their tradition of healing and affirming the independent functions of nursing. A heritage of health and healing can also be found in the foundations of faith communities through activities such as: (select all that apply) Select all that apply. A. holding grief groups. B. providing meals to families in crisis. C. sponsoring health fairs. D. visiting the homebound. E. volunteering in community AIDS care groups.

ce

Public health programs are designed with the goal of improving a population's health status. Which of the following apply to public health? Select all that apply. a. It is a branch of medicine. b. It is funded at a local level. c. It is health status monitored at the state level. d. It is implemented at the federal level. e. It is an organized community approach.

c

Nurses come to home health from a variety of educational and practice settings. Based on educational level, nurses are prepared to practice at various levels. To ensure the public of competence and quality in a highly competitive health care environment, it may become necessary for nurses to seek which of the following? a. Accreditation b. Advanced degrees c. Certification d. Specialization

ANS: 3 Community health nurses have a long history of autonomous practice, problem solving, and decision making. The other three answers relate to acute care nursing or gathering funding. Community health care nurses did engage in these activities in the nineteenth century, but overall, they have been best known for autonomy of practice.

Nurses have worked in the community to improve the health care status of individuals, families, populations, and vulnerable groups. Part of the appeal of this type of nursing is: 1. Working with wealthy contributors who provide the funds 2. Locating the source of disease and curing patients 3. The autonomy of practice and independence in problem solving and decision making 4.Caring for soldiers on the battlefield

b.

Nurses in community health often use epidemiology because in the community it is often difficult to control the environment. Which of the following statements demonstrates an epidemiologic strategy for monitoring disease trends? a. A nurse in community health conducts an education class for clients newly diagnosed with diabetes. b. A nurse in community health investigates a breakout of whooping cough in a local middle school. c. A nurse in community health organizes a health fair at the community health center. d. A nurse in community health participates on a county school board that addresses student health issues.

B

Nurses often participate on field assessment teams (surveillance) during a disaster response. These assessments are crucial to best help: a. encourage good intentions of those giving aid. b. match available resources to the population's emergency needs. c. separate casualties and allocate treatment. d. provide compassion and dignity.

ANS: 2 Correct by definition

Nurses who provided care to people in their homes and provided that care to several people at a time were called: 1. Private duty nurses 2. Visiting nurses 3. Public health nurses 4. Community staff nurses

A, B, C, F Groups commonly found among the homeless include persons living in poverty, victims of domestic abuse, people who abuse alcohol or other substances, persons who are mentally ill, and veterans.

Nursing students are offering health screenings at the local homeless shelter. Which persons or groups will the students most likely see? Select all that apply. a. A group of men who smell strongly of body odor and alcohol b. A man some of the students have previously met at the mental health clinic c. A woman who has bruises peeking out from her sweater and skirt d. Persons who just want to come in from the cold weather outside e. A man who is distributing religious tracts and inviting clients to attend services f. A woman and her two children who have been living in their car until it got so cold

ANS:4 Early occupational health nursing did not provide care for work-related injuries, but instead focused on the care of employees and their families in the home.

Occupational health nursing began as industrial nursing. What was the purpose of this type of nursing? 1.Inventing new machines to streamline production of medical goods 2.Investigating industrial injuries to improve work conditions 3.Working at industrial sites treating work related-injuries 4.Providing care for factory workers and their families

B

On the second day after a disaster, a male colleague tells the nurse he has a splitting headache. The nurse notes the colleague is feeling irritable and having difficulty focusing. Which of the following actions should the nurse take in response to the complaint of headache? A. Explain that the headache and problems focusing are probably the result of worry, so he should concentrate on the work at hand and deal with emotions later. B. Explain that he is experiencing signs and symptoms of psychological stress and recommend that he take some time off for a break. C. Explain to the worker that this is a common problem when multitasking under pressure and suggest that he focus on one task at a time. D. Suspect dehydration and encourage the worker to drink more fluids.

b.

One of the basic concepts in epidemiology is the concept of risk. Risk refers to the: a. prevalence of an event occurring. b. probability that an event will occur within a specified time period. c. population most likely to develop a disease. d. rate of development of new cases.

D

One reason that nursing may be slow in developing evidence-based practice (EBP) in the community setting may be the lack of understanding about the links between EBP and: A. evidence gathering. B. research design. C. research funding. D. research use.

c

Persons in an auditorium may have been exposed to a disease. If they are infected, it is crucial that they receive immediate treatment and not take the disease home to their families. Which of the following characteristics would be most important to consider when selecting the screening test to be used? a. The negative predictive value b. The positive predictive value c. The sensitivity of the test d. The specificity of the test

D

Persons often point out that smokers choose to light their cigarettes, alcoholics lift the glass to their mouth, and drug addicts inject or ingest their drugs. Which of the following statements best describes why nurses don't simply focus on helping persons who engage in poor health behaviors to behave appropriately? a. Addicts don't have the willpower to change their behavior. b. It is too rewarding to continue the behavior for a person to be able to change. c. Laws and policies must reward good healthy behaviors and punish unhealthy behaviors to help individuals recognize the importance of change. d. Society must offer healthy choices, offer support, and practice helpful policies.

b

Politics is simply described as: a. the ability to fund a special project. b. the art of influencing others. c. business conducted in the senate. d. interaction between the policymakers and the public.

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

Postvisit phase A major task of the postvisit phase is documenting the visit and services provided. Major tasks of the pre-visit phase are to initiate contact with the family and schedule the home visit. During the in-home phase, the nurse-client relationship is established. During the termination phase, the visit is reviewed with the family and plan for future visits is made

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

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

d. COVID-19 Vaping increases the risk of contracting COVID-19. This is due to the fact that e-cigarettes affect the lungs and immune system, and that makes the user more susceptible to the virus. The seriousness is increased when teens or other uses share the e-cigarettes. Research has found that people who vaped and smoked were five times more likely to develop COVID-19. The other options are potential risks but have not been shown to be so directly associated with vaping.

Research as shown that vaping increases an individual's risk of contracting what disease five-fold? a. Gingivitis b. Mouth cancer c. Oral herpes d. COVID-19

a

Research reveals that people who pray more frequently score lower in physical functioning and score higher in their level of pain. Which of the following conclusions has been drawn from these findings? a. As persons become more disabled, they pray to retain their mental health and obtain comfort. b. Everyone prays more as they get older or become ill. c. Praying decreases physical functioning and increases pain. d. Research findings are sometimes inaccurate due to extraneous variables.

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

Review the family's learning and other accomplishments of the visit During the termination phase, the nurse reviews the visit with the family, summarizes what has occurred and what has been accomplished, and may make plans for future visits. The incorrect options listed occur during the previsit phase.

abde

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

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

d

Several small communities have applied for grant funding from the state department of health to help decrease their teenage pregnancy rate. Which of the following communities should the nurse suggest receive funding first? a. Community Awith 23 single teenage pregnancies in a city of 500 b. Community Bwith 45 single teenage pregnancies in a city of 1000 c. Community Cwith 90 single teenage pregnancies in a city of 2000 d. Community Dwith 90 single teenage pregnancies in a city of 1500

d

Since 2000, home health agencies have been paid by the federal government based on which type of reimbursement? a. Diagnostic-related groups b. Distributive care c. Episodic care d. Prospective payment system

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

Skilled at recognizing and strengthening the family's competencies The nurse's approach to the family should be positive and focused on competencies rather than on problems or deficits. The incorrect responses do not address the strengths of the family, rather they focus on obtaining necessary resources, improving relationships, and assessing for problems.

ANS: D The most dangerous time for the victim is when the victim leaves or attempts to leave the relationship, because it is seen as an erosion of the abuser's control. The victim is more likely to be killed at this time than at any other time in the relationship.

Some of the medical staff thought a woman deserved what she got when she told them she wasn't going to a safe house after discharge. What information should you stress to your colleagues? a. Let's share with her that he has been arrested and is currently in jail for this last assault. b. She feels fearful and helpless and, until her life is clearly threatened, nothing will probably change. c. We need to reinforce that she would be safe in the domestic violence shelter. d. When a woman attempts to leave is often when the abuser kills her.

ANS: A After the group has chosen the topic and evaluated the literature for approaches that seem feasible, specific interventions are chosen. The quality of the evidence must be assessed before recommending specific changes or writing a protocol to resolve the problem. Grading the strength of evidence or determining the quality, quantity, and consistency of research studies must be done before making recommendations for practice.

Staff members have agreed to implement evidence-based practice; they have chosen a specific problem and searched the literature. The group has selected the interventions that seem the easiest to implement. Which of the following actions would the staff take next? a. Assess the quality of the evidence in the literature. b. Decide how best to orient the staff and community to the proposed changes. c. Eliminate all nursing interventions that are not evidence based. d. Choose another specific problem for the next literature search.

a

Statistics clearly demonstrate that there are significantly more cases of a disease in one particular neighborhood than in all the rest of the city. Assuming all else is the same, which of the following is the most likely explanation for a single neighborhood having such a different pattern of illness? a. A cultural or ethnic concentration in the neighborhood b. The geographical location of the neighborhood within the city c. A statistical fluke without meaning d. The time of year the different statistics were collected throughout the city

d. The fact that tobacco smoking causes more premature deaths than any other behavior The most relevant action in this case is making it clear to students that tobacco is a drug—and that smoking cigarettes accounts for one in five deaths in the United States. Smoking is the foremost preventable cause of death in the United States. Because the students are engaging in tobacco use, this is the most important topic to address with them at this time. If the students were not engaging in this behavior, the other topics of commonly used drugs on campus, just "saying no", and overcoming peer pressure may have been just as appropriate.

Students at first-day orientation at the local community college are discussing alcohol and drug abuse with their freshmen advisor. During a break, some students go outside for soft drinks and snacks. Soon after, the advisor walks by and notices several of these students smoking cigarettes. Based on this, which of the following topics of the drug and alcohol orientation would be most important for the advisor to reemphasize after the break? a. A discussion of which drugs are commonly used on campus b. How students can learn to "just say no" when offered drugs or drinks c. How to recognize and overcome peer pressure to continue bad habits d. The fact that tobacco smoking causes more premature deaths than any other behavior

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

Teach the family how to navigate the health care system. Definitions of empowerment reflect three characteristics of the empowered family seeking help: access and control over needed resources, decision-making and problem-solving abilities, and the ability to communicate and to obtain needed resources. Approaches for helping individuals and families assume an active role in their health care should focus on empowering, rather than giving direct help.

ANS: B Most child abuse occurs within the family. Parents and relatives who were abused themselves are most often the perpetrators. Child abuse, like domestic violence, is often a learned transgenerational behavior.

The 7-year-old boy's hands were badly burnt; it was suspected that his mother had forced his hands into boiling hot water after she caught him masturbating. The staff didn't want the mother to be allowed near the boy. What might you say to help the staff interact more objectively with the mother? a. "If we won't let the mom near, who does the child have for support at this painful time?" b. "Most abusers were themselves abused as children and need help to learn how to be a more effective parent." c. "The child may feel responsible; we have to let the mother fix their relationship." d. "We need to encourage the mother to continue parenting him or the boy will become a ward of the state."

ANS:1 In providing medical care, rural nurses were resourceful in finding alternatives when they did not have medical products that were available in urban areas.

The American Red Cross, through its Rural Nursing Service, improved living conditions in villages and isolated farms. Which of the following is an example of the resourcefulness of a nurse of this era? 1.Using hot bricks, salt, or sandbags to substitute for hot water bottles 2.Testing well water for pollutants 3.Teaching school and developing curricula for rural nursing programs 4.Providing post-surgical care

ANS: 3 The Poor Law guaranteed medical care for poor, blind, and "lame" individuals, similar to Medicaid.

The Elizabeth Poor Law of 1601 is similar to which of the following current laws? 1. Welfare 2. Food Stamps 3. Medicaid 4. Medicare

ANS:2 Mary Breckenridge developed health programs geared toward improving the health care of the rural and often inaccessible populations in the Appalachian regions of southern Kentucky. Lillian Wald established the Henry Street Settlement.

The Frontier Nursing Service was established by Mary Breckinridge to emulate systems of care used in the Highlands of Scotland. Her biggest contribution was: 1.Establishment of the Henry Street Settlement 2.Development of health programs geared toward improving the health care of the rural and often inaccessible populations 3.Blazing a nursing trail through the Rockies, providing nursing care to miners and their families 4.Teaching birth control measures to large numbers of women in the South

ANS:2 The National Organization for Public Health Nursing sought to standardize public health nursing. The Henry Street Settlement was already in existence. The baccalaureate degree in nursing was not developed yet.

The National Organization for Public Health Nursing was formed in 1912. Lillian Wald was its first president. The mission was to improve the educational and services standards of the public health nurse and promote public understanding. Which of the following is a contribution of this organization? 1.Requiring that public health nurses have a baccalaureate degree in nursing 2.Standardization of public health nursing education 3.Development of nursing cooperatives 4.Opening of the Henry Street Settlement

A

The Patient Self-Determination Act of 1991 requires that providers receiving Medicare and Medicaid funds give clients written information regarding: a. legal options for treatment choices in the event the person becomes incapacitated. b. patient rights. c. the cost of services. d. patient privacy.

B

The SARS (severe acute respiratory syndrome) outbreak was an epidemic that spread over several countries. By definition, this is considered a: a. Hyperendemic b. Pandemic c. Mixed outbreak d. Holoendemic

a

The administration at a local medical center examines the trends in health problems when developing long-range plans for staffing and space allocation. Which of the following sources of information would be most helpful? a. Local data drawn from a professional survey in the city b. The National Health Interview Survey c. The National Hospital Discharge Survey d. The states vital statistics

a

The board of directors is examining various submitted reports concerning its home health agency. Which of the following reports represents an example of benchmarking? a. A report by the administrator regarding how the home health agency's performance compares with that of other local and national home health agencies b. A report by the chief financial officer regarding a cost-benefit analysis related to technological advances c. A report by the chief nursing officer regarding client outcomes d. A report by the medical director regarding implementation of evidence-based practice into standards of care

d

The broad practice of public health requires a set of skills, knowledge, and attitudes in all disciplines. The baccalaureate level of entry for nursing is currently endorsed to achieve the core competencies of public health because of: a. core public health competencies typically being learned in the workplace. b. encouragement for nurses with an associate's degree to seek further degrees. c. financial planning and management skills learned at the master's level. d. rapid change and limited resources in public health.

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

The client who is employed and often works 12 hours a day without moving from the computer desk Personal health habits continue to contribute to the major causes of morbidity and mortality. The pattern of personal health habits and behavioral risk defines individual and family lifestyle risk. The client who doesn't move from the computer desk is creating great stress and strain on personal physiology and needs to be educated on the benefits of exercise and the risks of cumulative trauma on the body. Multiple health benefits of regular physical activity have been identified; regular physical exercise is effective in promoting and maintaining health and preventing disease. The client who is currently unemployed is demonstrating positive health behaviors by actively seeking employment and walking frequently. The client who spends time at the gym and studies the benefits of organic foods is displaying positive health behaviors by being active and wanting to eat healthy. The client who leaves work to pick up the children at 5:00 is displaying healthy behaviors as he or she is balancing family and work.

B) Policy development and enforcement An example of an intervention for population-based nursing practice is policy development and enforcement. Examples of criteria for public health nursing include focusing on entire population; reflecting community priorities and needs; and promoting health through epidemiologic evidence.

The community health nurse considers specific interventions for population-based nursing practice when developing plans to address the problems identified in the community. Which action is based upon the cornerstones for public health nursing? A) Focus on individual family B) Policy development and enforcement C) Reflect individual priorities and needs D) Promote health through epidemiologic evidence

B

The community health nurse is aware that African-American adults are more likely to be admitted to the hospital for which of the following conditions? a. Newly diagnosed HIV infection b. Diabetic patient with lower extremity wound c. Testicular cancer d. Psychiatric disorders

C) The people in the community need to feel a sense of ownership of the program. The people of the community need to feel a sense of ownership of the program or event, which can come only with their full participation in the decisions regarding planning as well as their assuming some responsibility for implementation. The profession of nursing is one of nurturing, sustaining, and caring for others. It is part of our profession to do for others what they would do for themselves if they were able. Indeed, most nurses interact professionally with people during an altered health state that requires nurses to do for others, but this is not true in community health nursing.

The community health nurse is involved in carrying out the community-based plan. What is the highest priority for the nurse to remember about the people of the community when carrying out the community-based plan? A) The people in the community do not need to assume any responsibility for implementation. B) The community health nurse will care for the individuals in the community. C) The people in the community need to feel a sense of ownership of the program. D) The community health nurses will interact professionally with individuals while carrying out the community plan.

C) Implementation Implementation is the action phase of the nursing process; it is carrying out the community-based plan. Assessment entails looking closely at what is needed or what is wrong; planning involves finding out what to do once the assessment is completed; and evaluation occurs after implementation and determines how well the plan worked to know whether it is working or needs adjustment.

The community health nurse is involved in carrying out the community-based plan. When carrying out this plan, the nurse is utilizing which phase of the nursing process? A) Assessment B) Planning C) Implementation D) Evaluation

B) Secondary Secondary prevention begins after a disease or condition is present. Emphasis is on screening, early diagnosis, and treatment of possible stressors that may adversely affect the community's health. Secondary prevention addresses the current health problem and interventions that will return the person to a pre-injury level. Primary prevention improves the health and well-being of the community, making it less vulnerable to stressors. Health-promotion programs are primary prevention, as are programs that focus on protection from specific diseases. Tertiary prevention focuses on restoration and rehabilitation. Tertiary prevention programs act to return the community to an optimum level of functioning.

The community health nurse is taking care of a client with a minor traumatic brain injury resulting from an automobile accident. The client developed pneumonia and is on IV antibiotics at home. Which level of prevention does this address? A) Primary B) Secondary C) Tertiary D) Chronic care

a

The home health nurse completes an initial assessment on a recently admitted home health client. The nurse should now analyze the assessment data and complete what step in the nursing process that is consistent with the standards of home health practice? a. Diagnosis b. Implementation c. Outcome identification d. Planning

B) Healthy People Dietary Guidelines for Americans is published with the U.S. Department of Agriculture and identifies federally mandated nutrition education activities. Healthy People was launched in 1979; it guides efforts to identify objectives for the nation. Healthy Communities, Worksites, and Schools is a coalition for healthier cities and communities that focuses on ways that communities can adapt the national Healthy People objectives for local use. National Health Information Center is a central health information service for consumers and professionals.

The community health nurse is trying to locate information about specific programs of the Office of Disease Prevention and Health Promotion. Which program identifies objectives for the nation? A) Dietary Guidelines for Americans B) Healthy People C) Healthy Communities, Worksites, and Schools D) National Health Information Center

C) Healthy Communities, Worksites, and Schools Dietary Guidelines for Americans is published with the U.S. Department of Agriculture and identifies federally mandated nutrition education activities. Healthy People was launched in 1979; it guides efforts to identify objectives for the nation. Healthy Communities, Worksites, and Schools is a coalition for healthier cities and communities that focuses on ways that communities can adapt the national Healthy People objectives for local use. National Health Information Center is a central health information service for consumers and professionals.

The community health nurse is trying to locate information about specific programs of the Office of Disease Prevention and Health Promotion. Which program would help the nurse focus on ways the communities can adapt the national Healthy People objectives for local use? A) Dietary Guidelines for Americans B) Healthy People C) Healthy Communities, Worksites, and Schools D) National Health Information Center

D) National Health Information Center Healthfinder is a gateway Web site to link consumers and professionals to Health and Human Services information from the federal government. Healthy People was launched in 1979; it guides efforts to identify objectives for the nation. Healthy Communities, Worksites, and Schools is a coalition for healthier cities and communities that focuses on ways that communities can adapt the national Healthy People objectives for local use. National Health Information Center is a central health information service for consumers and professionals.

The community health nurse is trying to locate information about specific programs of the Office of Disease Prevention and Health Promotion. Which program would provide referrals services for consumers and professionals? A) Healthfinder B) Healthy People C) Healthy Communities, Worksites, and Schools D) National Health Information Center

A) Office of Disease Prevention and Health Promotion Office of Disease Prevention and Health Promotion (ODPHP), located within the Public Health Service, publishes a tremendous amount of information that is designed to promote health and prevent disease among Americans.

The community health nurse is trying to locate information about ways to promote health and prevent disease among Americans. What government agency within the Public Health Service would the nurse contact to be most helpful in providing this information? A) Office of Disease Prevention and Health Promotion B) Centers for Disease Control and Prevention C) U.S. Department of Health and Human Services D) Health Resources and Services Administration

c.Ethical behavior e.Resource utilization The ANA's Public Health Nursing: Scope and Standards of Practice (2013) requires participation in research, responsible resource utilization, ethical behavior, leadership, and advocacy similar to the standards of practice for all nurses.

The community health nurse knows that which are standards of professional performance for home care nurses according to the ANA? (Select all that apply.) a.Collegiality b.Performance appraisal c.Ethical behavior d.Outcome identification e.Resource utilization

C) Prevention oriented Prevention-oriented attributes should address health improvements that can be achieved through population-based and health service intervention. The objective attribute of drive action includes suggestion of steps that will achieve the proposed targets. Measurable should include a range of measures directed toward improving health outcomes and quality of life. Useful and relevant should be usable by states, localities, and private sector to target schools, communities, worksites, health practices, and other settings.

The community health nurse needs to develop objectives for an upcoming program to improve health. Which type of objective attribute can be achieved through population-based and health service intervention? A) Drive action B) Measurable C) Prevention oriented D) Useful and relevant

B) Policy development and enforcement An example of an intervention for population-based nursing practice is policy development and enforcement. It will be imperative to develop a policy for use and how this policy will be enforced. Focus on the entire population; reflect community priorities and needs; and promote health through epidemiologic evidence do not reach the goal of who and how the center will be utilized.

The community health nurse plans to implement a specific program that will involve use of the new community center that includes a pool and clubhouse. Which would be the best intervention when looking at who and how this center will be utilized? A) Focus on entire population B) Policy development and enforcement C) Reflect community priorities and needs D) Promote health through epidemiologic evidence

A

The faith community nurse role arose out of the challenges faced by families to succeed in meeting the demands of young children, teens, and aging parents as well as which of the following challenges? A. Inadequate training for caregivers B. Increased hospital length of stay C. Lack of consumer demand for health care decisions involvement D. Society's lack of accountability for health care decision making

d

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

C

The gold standard of evidence gathering in evidence-based practice is: A. clinical knowledge and judgment. B. expert opinions. C. randomized clinical trials D. theories of practice.

a.Relieve suffering. b.Support the patient and family. c.Provide grief support. The goals of hospice care include relief of suffering, supporting the family and patient, and providing grief support after the patient dies. Goals do not include keeping patients out of the hospital or lowering medical costs.

The home health care nurse educates patients on which goals of hospice care? (Select all that apply.) a.Relieve suffering. b.Support the patient and family. c.Provide grief support. d.Keep patients out of the hospital. e.Lower medical expenses.

C) Older adults In 1979, the first "health" initiative for the United States (Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention) promoted five goals. These broad goals focused on reducing mortality among targeted age groups—infants, children, adolescents, young adults, and adults—and on increasing the independence of older adults.

The idea of a health program based on unified goals and objectives is central to the Healthy People documents. In 1979, the first "health" initiative for the United States promoted five goals. Which population should the health professional target for increasing their independence? A) Adolescents B) Children C) Older adults D) Young adults

A

The later years of life for many older adults mark a period of abruptly changing social dynamics over which the older adult has very little control. The nurse should understand that this phenomenon of later life challenges: a. adapting and coping responses. b. intellectual capacity. c. socioeconomic status. d. spiritual awareness.

B

The local hospital, health department, and university together planned and implemented a mock casualty drill, with the university's theater and nursing students playing the injured victims. After the drill, which of the following would the nursing students most likely complete? A. Volunteer as leaders in the next casualty drill B. Evaluate the drill and offer recommendations for more effectiveness in the future C. Recognize how to respond to a real disaster in the future D. Write a report on their actions and how they felt during the drill

D

The major factor that has increased Florida's vulnerability to natural disasters in recent decades has been: a. El Niño. b. geography. c. trade winds. d. urbanization.

A) Entire populations An example of criteria for public health nursing includes focusing on the entire population. Examples of interventions for population-based nursing practice include case management, health teaching, and coalition building.

The model for population- and community-based practice is public health nursing. Which is the most important cornerstone criterion for public health nursing? A) Entire populations B) Case management C) Health teaching D) Coalition building

b

The model of care delivered in the home setting which focuses on symptom management at the end of life is known as: a. hospice care. b. palliative care. c. personal care. d. transitional care.

A

The most important causes of preventable disease, disability, and death among children are: a. injuries and accidents. b. maintaining a healthful diet. c. physical activity. d. cardiovascular health.

a

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. Infusion therapy b. Ostomy management c. Renal dialysis d. Chemotherapy Medicare will reimburse for professionally rendered services provided by a licensed health care provider. Grocery shopping would not be covered. If homemaker services are provided to a patient also receiving skilled care, then they too are reimbursed.

The nurse explains to the patient that which services will be covered under medicare? (Select all that apply) a. Infusion therapy b. Ostomy management c. Renal dialysis d. Chemotherapy e. Grocery shopping

ANS: D A systematic review is an approach to identifying, appraising, and synthesizing research evidence to evaluate and interpret all available research that is relevant to a particular research question. Systematic reviews can be accessed from most databases. Systematic reviews require more rigor and contain less opinion of the author than typical reviews of the literature.

The nurse has been reading everything she can find on a particular clinical problem, using both the closest medical library and the Internet. Which of the following would be the most helpful source? a. A journal with a whole issue devoted to research on that clinical problem b. A randomized controlled clinical trial related to that clinical problem c. A researcher who has built a career on studying that clinical problem d. A systematic review related to the clinical problem

d The last step of the nursing process is evaluation. The nurse should evaluate the program to see if interventions had the desired effect. Evaluation could include surveys or looking at financial outcomes, but those are only limited aspects of the process. Planning for next year's event should not occur until after evaluation has been completed.

The nurse has implemented a community-wide immunization program for seasonal influenza. Once the program has ended, what action by the nurse is best? a.Begin planning for next year's program. b.Send mail surveys to participants. c.Determine financial gains or losses. d.Evaluate the program and outcomes.

A

The nurse in community health defines goals and measurable objectives during the planning phase of a community health intervention. This also marks the beginning of the: a. evaluation phase. b. implementation phase. c. needs assessment. d. problem analysis.

A

The nurse in community health identifies an elder abuse problem because of caregiver stress among families in the local community resulting from lack of caregiver support services. The next step in the community-oriented nursing process would be to: a. analyze the community problem. b. establish priorities. c. establish goals and objectives. d. identify intervention activities.

C,D,E Rationale: The ANA's Scope and Standards of Practice for public health nursing requires participation in research, responsible resource utilization, ethical behavior, leadership, and advocacy like the standards of practice for all nurses. Team membership and developing one's own research are not included.

The student nurse learns the ANA's Scope and Standards of Practice for public health nursing include components? (Select all that apply.) a.Team membership b.Developing research c.Ethical behavior d.Responsible resource use e.Advocacy

c

The nurse in community health prepares a community assessment for the local planning commission and presents data that indicate an increase in violence among young children and teens within the community. The nurse projects the cost of care related to violence in ED visits, treatment of stabbing and gunshot wounds, and rehabilitation. The nurse also produces information on school absenteeism, graduation rates, and teenage rape and pregnancy. The planning commission creates a task force to explore the community outlets for child and teen recreation and the current community education programs available to families and students related to violence prevention, negotiation, and mediation. This can best be described as an example of: a. disparities in health care. b. outreach work. c. power of partnerships. d. social issues.

D

The nurse in community health reviews the monthly and year-to-date health service use report for the local community to monitor trends as correlates of the community's health. The nurse is viewing community health through the dimension of: a. partnership. b. process. c. status. d. structure.

b

The nurse in community health serves as a bridge between the at-risk populations and the community's health care resources. This role is based on the nurse's responsibility to: a. collect and analyze data on programs. b. ensure that all populations have access to affordable, quality health care. c. monitor and assess critical health status indicators. d. provide evidence-based use of resources.

A) Bring together the agency and the target population. A unified program requires collaboration and coordination between the agency personnel who will implement the program. Bringing together the agency and the target population will enhance the success of the new program. Implementing a piecemeal approach minimizes the impact of the program. Allowing plenty of time for publicizing the program is crucial to whether people attend and the programs have an impact. Emphasizing the program itself, not the agency involved, will increase the impact of the program.

The nurse in the community wants to implement a new program. To be more certain of success, the nurse should be sure to use which primary step in implementing a unified program? A) Bring together the agency and the target population. B) Use a piecemeal approach to emphasize each piece. C) Emphasize the agency involvement to get everyone excited about the change. D) Widely publicize the program immediately before implementation.

a.Types of housing available c.Recreational facilities d.Health care facilities e.Places of worship A windshield survey is a type of community health assessment. The nurse walks or drives through a neighborhood and notes the type of housing available, the presence and condition of recreational facilities, the presence of health care facilities, and places of worship among other items. Types of cars noted in the neighborhood are not one of the assessments.

The nurse is conducting a windshield survey. What items does the nurse assess? (Select all that apply.) a.Types of housing available b.Cars seen in parking lots c.Recreational facilities d.Health care facilities e.Places of worship

B Although the nurse might assess for any and all of these options, the primary goal would be to assess how much the mother knows and understands about the needs of infants and their development. Such knowledge helps avoid unrealistic expectations and frustrations, which could lead to child abuse.

The nurse was making a postpartum visit to a teenage mother and her month-old infant. What assessment would be most important? a. Assessing for mother's ability to fulfill her own growth and development tasks b. Assessing for mother's knowledge about normal infant growth and development c. Assessing how much the teenager mother's own mother is helping her cope with child care d. Assessing whether the baby's father is being helpful to the mother

B Health problems faced by the homeless often are related directly to poor access to preventive health care services. Proper wound care relies on cleanliness; however, those living on the streets do not typically have ready access to soap and water. The nurse can help by designating a wound room, in which clients can safely carry out wound care activities taught during clinic visits.

The nurse who works at a homeless clinic wants to improve healing of chronic wounds in clients living on the streets. What would be the best action to take to improve client outcomes? a. Providing antibiotics to all homeless persons with chronic, nonhealing wounds b. Offering daily access to a room with soap, water, and bandages c. Handing out free bandaging supplies following each clinic visit d. Performing regular monitoring of the client's wound condition

C

The nurse who works in the community setting must ensure that the application of the best available evidence to improve practice is also: A. accessible and diverse. B. competent and compliant. C. culturally and financially appropriate. D. reasonable and deliverable in a timely fashion.

D) Weekly adult exercise and fitness sessions Primary prevention improves the health and well-being of the community, making it less vulnerable to stressors. Health-promotion programs are primary prevention, as are programs that focus on protection from specific diseases. Usually health promotion is nonspecific and directed toward raising the general health of the total community, such as conducting adult exercise/fitness. Secondary prevention begins after a disease or condition is present. Emphasis is on screening, early diagnosis, and treatment of possible stressors that may adversely affect the community's health. The tine test for tuberculosis, the Denver Developmental Screening Test for developmental delays, and blood pressure assessments are secondary prevention interventions.

The nursing practice model defines intervention as primary, secondary, and tertiary levels of prevention. Which is an example of primary prevention? A) Tine test for tuberculosis B) Denver Developmental Screening Test for developmental delays C) Community blood pressure screenings for elderly clients D) Weekly adult exercise and fitness sessions

b Vulnerable populations have some characteristic that puts them at higher risk for identified health problems. The nurse can best assist vulnerable populations by identifying and working with them to decrease their risks. Researching genetic risks, studying vital statistics, and improving immunizations are all part of the solution, but the overarching priority action is to help the community decrease its risks.

The student studying community health nursing learns that vulnerable populations can be best assisted by which activity? a.Researching their genetic risk for health problems b.Working with the community to decrease health risks c.Studying vital statistics to determine their causes of death d.Making sure the population maintains immunizations

B) Therapy programs for sexually abused children Tertiary prevention focuses on restoration and rehabilitation. Tertiary prevention programs act to return the community to an optimum level of functioning. Adequate shelters for battered women and counseling and therapy programs for sexually abused children are examples of tertiary prevention. Primary prevention improves the health and well-being of the community, making it less vulnerable to stressors. Health-promotion programs are primary prevention, as are programs that focus on protection from specific diseases. Usually health promotion is nonspecific and directed toward raising the general health of the total community, such as immunizations against certain diseases. Secondary prevention begins after a disease or condition is present. Emphasis is on screening, early diagnosis, and treatment of possible stressors that may adversely affect the community's health. The tine test for tuberculosis and breast self-examination assessments are secondary prevention interventions.

The nursing practice model defines intervention as primary, secondary, and tertiary levels of prevention. Which is an example of tertiary prevention? A) Breast self-examinations B) Therapy programs for sexually abused children C) Immunizations against certain diseases D) Tine test for tuberculosis

b

The nursing staff has attempted to screen the entire African-American population in the community for diabetes. Which of the following would provide immediate verification of the success of the nursing staffs efforts? a. An epidemic of diabetes will be recognized. b. The incidence of diabetes will increase in the community. c. The prevalence of diabetes will decrease in the community. d. The risk for diabetes in the community will increase.

c

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"

A

The public health administrator is in the process of hiring a new public health nurse. Which of the following statements made by an applicant would most likely result in the applicant not being hired? A. "I like to be the only person working on a project because individuals in teams have their own ideas and plans and the resulting debate slows progress." B. "I prefer to work in teams because no single person has too much responsibility because the burden is shared." C. "Teamwork is better than work done by individuals because teamwork incorporates different perspectives." D. "Whether teamwork is better than work done by individuals depends on the nature of the work being performed."

a Analytic epidemiology hypothesizes why a disease is occurring in a community and looks at cultural practices, nutrition, and extrinsic factors such as the environment for links. Genetic variables and direct cause of death data are more related to epidemiology.

The public health nurse volunteers for a missionary group caring for Ebola patients in Africa. The nurse is reviewing the data using analytic epidemiology methods. What information does the nurse collect as the priority? a.Cultural norms in burial practices b.Genetic variables in disease acquisition c.Statistics related to incidence and prevalence d.Autopsy data on direct cause of death

B

The recovery phase of a disaster can take a very long time. Nurses need to be aware that despite effective disaster preparedness and response efforts: a. environmental hazards are minimal. b. individuals must ultimately recover on their own. c. the government provides economic support. d. religious organizations must bear the burden of the community.

c

The role/activity of the nurse in community health that was most important during the disasters of September 11, 2001, and the subsequent anthrax bioterrorism attack involved: a. assessment. b. client-level teaching. c. enhanced surveillance activities. d. free and low-cost immunization.

a

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

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

b

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

D

The school nurse is interested in providing an antismoking program in a local middle school and is aware that programs are more effective for this age group when they focus on short-term versus long-term effects of smoking. Besides including health risks and cosmetic effects, the nurse should also consider: a. behavior modification techniques. b. effects on the environment. c. laws regarding tobacco sales to minors. d. social skills instruction to resist pressure to smoke.

d

The state board of nursing has written new regulations to clarify in a more concrete manner what the nurse practice act allows and requires. Which of the following effects will this change have on nurses in this state? a. None, because they are just helpful guidelines for maximum safety b. None, because they just give specifics that may change over time c. Major, because prudent nurses would follow such regulations d. Major, because these rules and regulations have the effect of law and must be obeyed

C A public health nurse works with communities as a larger whole and is concerned with specific target or vulnerable groups within that community. The other options are inaccurate.

The student learns that which is the best definition of a public health nurse? a.Works with the public. b.Works in public areas. c.Works with the greater community. d.Works with public funding.

A,D,E

There are many barriers that affect the actual implementation of evidence-based practice (EBP) in a nursing environment. Which statements reflect the most significant concerns of nurses in the community-focused setting? (Select all that apply.) A. EBP requires compliance by the client. B. EBP requires little support. C. EBP demands change. D. EBP questions long-standing nursing practice. E. Lack of resources

D) Sustainability of the lifestyle change The initial reason for implementing a new program, improvement of health, is often forgotten in the excitement of the new program. Considering that fact, sustainability of the lifestyle change is the primary criteria for evaluating success. How many participate, short-term health improvements, and public marketing are parts of the implementation process but will not affect the long-term health of the participants unless there is sustainability of the program.

There is often an impatience and eagerness associated with new programs, often forgetting the initial reason for implementing the program was to improve health. Considering this, when evaluating the overall effectiveness of the program, the nurse must consider which of the following? A) How many participated in the program B) Short-term health improvements C) Public marketing within the community D) Sustainability of the lifestyle change

c

This year 600 of 8000 young women ages 17 to 20 years at a university health center tested positive for a sexually transmitted infection (STI). Which of the following terms best describes this data? a. An epidemic b. Incidence c. Prevalence d. Risk

ANS:2 The newer threats to health that public health nurses are involved in are HIV, AIDS, and bioterrorism. Choice #1 lists threats of the past. Avian flu may be a threat, but radiation and tuberculosis are ongoing. Polluted water and air are generally not seen in the United States.

Threats to health from communicable diseases, the environment, chronic illness, and the aging process have changed over time. The newer threats to health in the United States that community health nurses are currently faced with include: 1.Diphtheria, cholera, and typhoid fever 2.HIV, AIDS, and bioterrorism 3.Avian flu, tuberculosis, and radiation 4.Polluted water and air

a. Alcohol blood level Approximately 40% to 50% of people seen in trauma centers were drinking at the time of their injuries. Hence, blood alcohol testing should be routinely done for patients admitted to the emergency department for traumatic injuries. Because of the high rate of alcohol involvement in injuries seen in trauma centers, an alcohol blood level would be most important. A cardiac workup, pregnancy test, or STI test would not be the priority

Three female clients were brought to the emergency department by ambulance after a two-car accident at a busy intersection. Which of the following tests should automatically be done under such circumstances? a. Alcohol blood level b. Cardiac workup c. Pregnancy test d. STI tests

c

To achieve the major goals of Healthy People 2020, increasing quality and years of healthy life and eliminating health disparities, the partnership between federal, state, and local agencies is critical, and local community coalitions are encouraged because the: a. federal government is ultimately responsible for the health status of the nation. b. public demands that the government protect the people. c. public health departments do not have the resources to accomplish these goals independently. d. state health department would require a universal approach to achieving objectives.

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

To assess the family's environment and social resources and risks The question by the nurse indicates that she is trying to obtain an ecomap. Ecomaps can provide information about relationships that the family has with others (such as relatives and neighbors), the family's connections with other social units (such as church, school, work, clubs, and organizations), and the flow of energy, positive or negative, in the family. An ecomap represents the family's interactions with other groups and organizations. Environmental or social risk and resources can be assessed from an ecomap. An ecomap does not assess extended family relationships or financial assets. An ecomap is not used as a communication method.

B

To ensure the success of a faith community's health ministry program, the parish nurse must ensure that the wellness committee addresses issues of: A. experiential preparation. B. financing and fundraising. C. referrals. D. retired professionals.

b

To help congregation members better meet their nutritional needs, the parish nurse organized members to participate in activities that focused on fellowship while providing healthy meals to homebound members and serving "healthy heart" church suppers. Which of the following activities is being completed? a. Entitlement programs b. Health ministries c. Partnerships d. Pastoral care practices

D

To maintain effective disaster preparedness, nurses working in the community can play a critical role in providing an updated record of: a. immunizations. b. active tuberculosis (TB) cases. c. WIC enrollees. d. vulnerable populations.

A

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

a.

Twenty people attended a church picnic the previous weekend. By Monday, four individuals exhibited symptoms of food poisoning. On Tuesday, the nurse in community health records the addition of two new cases. The incidence rate would be: a. two new cases divided by 16 at risk. b. two new cases divided by 20. c. six cases divided by 20. d. four cases divided by 16.

D

Two nurses in community health schedule a day to ride through a low-income community to better understand the community and its boundaries, trends, rhythm, stability, and changes that can affect the health of that community. This direct data collection method is often referred to as: a. composite database. b. participant observation. c. secondary analysis. d. windshield survey.

a

Two women seem to agree on almost everything from favorite music to favorite media stars to the best way to prepare a meal. Which of the following best explains this similarity in the two women? a. They are both members of the same birth cohort. b. They are close friends. c. They attended the same school. d. They both go the same church.

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

Understanding of personal feelings of working with members of this community Nurses have an ethical obligation to provide culturally competent care to LGBT families. Some nurses may feel a degree of discomfort discussing sexual orientation with their patients. However, it is important to overcome this barrier to care for LGBT families. Thus, nurses should provide a safe environment for patients to discuss their sexual orientation. After understanding one's own feelings when providing care for this population, it may be important for the nurse to investigate same sex marriage laws and family structure. It is important to provide clients a safe environment to discuss sexual orientation; however, the nurse must be aware of his or her own feelings before beginning this discussion

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

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

B Single motherhood is increasing. A direct correlation exists between lack of education and poverty. Similarly, a direct correlation exists between poverty and poor health outcomes. Poor teens are nearly three times more likely to drop out of school as their nonpoor counterparts. When programs that assist the mother to complete her education are instituted, chances are increased for a better future, which improves health care over the long term across the life span. It is important to keep the pregnant adolescent in school during the pregnancy and have her return as soon as possible after the birth.

What action by the nurse can best ensure long-term positive health outcomes of poor pregnant teens and their children? a. Assisting teen mothers to learn about their body changes during pregnancy b. Developing programs that allow teen mothers to complete their education c. Offering courses in proper care of babies and how to be a parent d. Monitoring pregnant teens to detect early problems with pregnancy

A Accessibility refers to the ability of clients to obtain needed health care services. Although all of these options lead to opportunities for improvement in health, either directly or indirectly, only option 1 (applying for a grant for a mobile clinic) can potentially improve accessibility to a health care clinic. Neighborhood clinics, mobile vans, and home visits can bring health care to people otherwise unable to access care. Coordinating services at a central location often improves client compliance because it reduces the stress of getting to multiple places.

What action can a nurse take that will potentially increase accessibility to health care services for mentally ill homeless clients? a. Applying for a grant to fund a mobile clinic to take health care to the clients b. Distributing flyers to the homeless that detail the location of various types of health care services c. Referring homeless clients to areas that provide temporary housing d. Soliciting donations for food and clothing to be distributed to the homeless

ANS: A, C Plan ahead with the correct address, directions, and information about who will be in the home; tell the office where you will be and check in regularly; carry a cell phone, possibly a pager, and a small amount of money; dress for function and mobility, wear a name tag, and be sure your vehicle is in good repair with a full gas tank and emergency equipment. Carrying a weapon typically results in the weapon being used against you.

What actions should you take to assure your own personal safety when engaging in home visits? Select all that apply. a. Always sit between the client and the exit, and, when in doubt, leave the situation b. Be sure of the correct address and always have a GPS system c. Carry a cell phone and drive in a well-maintained car with a full gas tank d. Have enough money that you can buy your way out of trouble e. Only accept assignments within a few blocks of your own home f. Take self-protection courses such as karate and carry a weapon for your own defense

A, B, C The textbook suggests that the poor be treated like anyone else. Don't prejudge by assuming a poor family cannot pay anything, don't be condescending, and don't call attention to a family's poverty by treating the family differently or separately. Always be supportive. Suggest all programs that might help, such as food banks, churches, and clothing centers. Remember that families are not always able to pay for medications, so free samples are often appreciated. Many families need help to learn how to promote their own health, given their lack of resources.

What advice would you give a new nurse on how to care for very poor families? Select all that apply. a. Be supportive in any way possible. b. Educate the family on how to maximize their health using free resources. c. Offer the family free medication samples whenever possible, keeping in mind the cost of many prescription drugs. d. Recognize the family's poverty and refrain from asking whether they want to make a payment toward their bill. e. Remember to allow the family their pride by not suggesting sources of help that they may not need. f. Try to keep the family separate from your paying clients.

A

When applying evidence-based practice (EBP), community-oriented nurses are primarily obligated to ensure that evidence applied to practice is: A. acceptable to the community. B. contains cost and reduces legal liability. C. applied as a universal remedy. D. limited to research findings.

B

When applying the Minnesota Model of Public Health Interventions: Applications for Public Health Nursing Practice steps of surveillance, what initial action would the nurse take? a. Analyze data b. Consider whether surveillance as an intervention is appropriate to the situation c. Evaluate the impact of surveillance d. Collect data

C The depression rate among older adults is half that of younger people, but the presence of a physical or chronic illness increases rates of depression. Depression rates for older adults in nursing homes range from 15% to 25%; thus encouraging older adults to move to nursing homes would certainly not decrease their risk for depression. Healthy aging activities such as physical activity and establishing social networks improve the mental health of older adults. Older adults underuse the mental health system and are more likely to be seen in primary care or to be recipients of care in institutions. The nurse can reach them by organizing health promotion programs through senior centers or other community-based settings. Telling clients to focus on strengths instead of weaknesses is not helpful—this advice can sound flippant and patronizing if (1) the weaknesses are profound and (2) tools are not given to assist in coping. Monitoring for signs of depression is not an effective approach because this—like most programs currently available for adults, families, and caregivers with health problems—focuses on identifying rather than preventing problems.

What can the nurse do to decrease the risk for depression in older adults? a. Encourage moving to a nursing home where others of the same age reside. b. Monitor for signs and symptoms of depression. c. Organize an exercise and health promotion program at the local senior citizen center. d. Teach older clients to focus on their strengths rather than their weaknesses.

BCD

What did events after September 11, 2001, clearly demonstrate (Select all that apply.) A. A strong public health structure ready to respond effectively to a crisis B. Public health's need for additional funding and resources C. The unrecognized importance of nurses in lowering health care costs D. Lack of adequate vaccines to meet community's needs

C

What does each state do with the information that it receives about notifiable diseases? a. Keeps its own records for surveillance purposes b. Reports the information to the local branch of the WHO c. Transmits the data electronically, weekly, to the CDC d. Does nothing with the information.

D

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

A

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

ANS: C Homicide is the leading cause of death in pregnant women. All pregnant women should be routinely screened for abuse.

What is the leading cause of death for pregnant women? a. Eclampsia b. Hemorrhage c. Homicide d. Infection

A All of these statements are true; thus it is crucial to consider all pregnant teenagers as high-risk obstetric clients. A number of problems (e.g., poverty, late entry into prenatal care, and limited self-care knowledge) can lead to complications of pregnancy, so it is important to treat every teen pregnancy as a special high-risk pregnancy.

What is the most important principle to keep in mind when caring for the pregnant teen? a. All teen pregnancies are considered high-risk. b. Limited self-care knowledge can lead to pregnancy complications. c. Pregnant teens are likely to receive prenatal care late in the pregnancy. d. Pregnant teens may have limited financial resources to pay for care.

B Families with children are the fastest-growing segment of the homeless population.

What is the most rapidly growing group of homeless? a. Adolescents (runaways and "throw-aways") b. Families with children c. Persons in crisis d. Single men

C

What is the purpose of the National Response Framework? A. Create a new branch of government that deals with bioterrorism B. Establish a way for the Red Cross to carry out its mission C. Develop a nationwide all-hazards approach to domestic incident management D. Extend presidential power to act quickly upon weapons of mass destruction

ANS: A Among all females, homicide ranks in the top five causes of death among ages 1 to 34 years. Homicide is the third leading cause of death among females in the age groups of 1 to 4 and 15 to 24 years, is the fourth leading cause of death in the 10- to 14-year age group, and ranks fifth in both the 5- to 9- and 25- to 34-year age groups.

What is the risk for violence for females in the United States today? a. One of top five causes of death from age 1 to 34 years b. One of top ten causes of death, especially among girls aged 1 to 4 years c. One of the top ten causes of death, especially among women aged 15 to 24 years d. One of the top ten causes of death, especially among vulnerable elderly

ANS: C All terrorist acts include three key elements—violence, fear, and intimidation.

What must be involved for an act to be considered a terrorist act? a. A commitment to a political or religious belief b. An attempt to force compliance with a particular set of religious or political beliefs and behaviors c. Fear, intimidation, and violence d. Violence resulting in plural deaths

D

What occurs during 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 their toxins

A

What was the purpose of the CDC creating the first list of standard case definitions for notifiable diseases? a. Some diseases were under-reported and others were over-reported 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

d

What was the significance of the 1979 Surgeon Generals report? a. It planned the goals and priorities for the entire Veterans Administration medical system. b. It vastly increased funding for health promotion activities. c. It identified the use of tobacco as a cause of lung cancer. d. It created national goals for promoting health and preventing disease.

B

When a community health nurse uses evidence-based practice (EBP) to evaluate effectiveness, accessibility, and quality of personal and population-based services, the nurse is addressing the core public health function of: A. assessment. B. assurance. C. policy development. D. research.

d. Between 1945 and 1984 The later part of the 20th Century (1945-1984) ushered in a shift away from acute infectious health problems of previous stages toward chronic health problems such as heart disease, cancer, and stroke

When did medicine in the United States make a shift away from the treatment of acute infection to care of chronic illnesses? a. Between 1890 and 1920 b. Between 1920 and 1940 c. Between 1940 and 1960 d. Between 1945 and 1984

A

When does disaster management begin? A. Before the disaster occurs B. During the disaster C. Immediately following the disaster D. During the recovery period

b

When final health care-related regulations are published, they often lead to changes in practice. After a period of draft review, public comment/hearing, further study if necessary, and then final redrafting, the regulations at both federal and state levels carry the weight of law and are published in the: a. ANA Code of Conduct. b. Code of Regulations. c. Patient Safety Act of 1997. d. Interstate Nurse Licensure Compact.

c

When meeting with a client and family, the home health nurse says, "We have discussed your health problems and limitations. Now tell me what level of health and function you hope to achieve." In which of the following phases of the nursing process is the nurse engaging? a. Assessment b. Diagnosis c. Outcome identification d. Planning

a Stakeholders need to be involved in planning to ensure buy-in from the community. The stakeholders could be community or business leaders. The other actions are important, but if the community leaders are not committed to the plan, the plan is unlikely to work.

When planning interventions for a community, what action by the nurse is best? a.Involve community leaders in planning. b.Create a plan of action addressing priorities. c.Determine what resources are available. d.Attempt to find funding for the plan.

B) Before the program is implemented Before a program is implemented, the manner in which it is to be evaluated must be established. Establishing criteria during or after implementation will not help direct the program. It should be done when promoting health partnerships with school, but not solely in this case, and should always be done before implementing any program no matter where it is implemented.

When should the evaluation plan be established for a community health program? A) During implementation of the program B) Before the program is implemented C) Essential after implementation of the program D) When promoting health partnerships only with schools

ANS: C Youth-related violence is more concentrated in minority communities and inner cities, causing a disproportionate burden on these communities. Children are often not taught peaceful ways of resolving differences and learn by default from what they observe on television and in movies. Consequently, schools have become a common site for violence.

Where is youth violence most likely to occur? a. At home b. At recreational facilities c. In inner-city schools d. Where young adults are employed such as fast-food facilities

ANS: C, D, E The goal of primary prevention is to stop violence, abuse, or neglect before it occurs. Education plays a major part in primary prevention and may include parenting and family wellness and anger management or conflict resolution. Professionals should increase their awareness of violence, identification of cases, and provision of early treatment. The nurse can work in or with the community to educate citizens about the problem of violence, potential causes of violence, and available community services. Screening is secondary prevention, and courses for those already known to be violent are tertiary prevention.

Which actions might public health professionals want to use as primary prevention against widespread community violence? Select all that apply. a. All women seen in prenatal clinics or emergency departments should be asked about abuse b. Assist with courses for prisoners on avoiding violence and resolving conflict c. Classes on parenting and supportive follow-up for new parents d. Courses on anger management and conflict resolution e. Community media campaigns to decrease acceptance of violence f. Screen for elder abuse at every home visit to an elderly client living with his or her family

B,C,D

Which are the objectives of a disease investigation? (select all that apply) a. To enhance the knowledge of the nurse working in public health b. To control and prevent disease and death c. To identify factors that contribute to the disease outbreak/even occurrence d. To implement measures to prevent occurrences

b. The 30-year-old reporting a "weekend cocaine habit" Stimulants, e.g., cocaine or opiates, may produce withdrawal symptoms that are uncomfortable but not life threatening. Detoxification from these drugs does not require direct medical supervision, but medical management of the withdrawal symptoms increases the comfort level. On the other hand, drugs such as alcohol, benzodiazepines, e.g., diazepam, and barbiturates, e.g., secobarbital, can produce life-threatening withdrawal symptoms. These clients should be under close medical supervision during detoxification and should receive medical management of the withdrawal symptoms to ensure a safe withdrawal.

Which client may be able to safely detoxify and manage their withdrawal symptoms with only minimal medical supervision? a. A 50-year-old who uses diazepam to "manage my anxiety" b. The 30-year-old reporting a "weekend cocaine habit" c. A 60-year-old who takes a secobarbital "most nights to help me sleep" d. A 70-year-old who usually drinks "3-4 beers in the evening"

C All these assessment findings are of concern and need attention. However, pregnant homeless women present several challenges. They have higher rates of sexually transmitted diseases, higher incidences of addiction to drugs and alcohol, poorer nutritional status, and higher incidences of poor birth outcomes. Thus being homeless is the most dangerous sign of those listed.

Which finding in a young single pregnant woman would cause you the most concern? a. Elevated blood pressure b. First prenatal visit at 5 months' gestation c. Persistent homelessness d. Positive STD test

B

Which group is most at risk for suicide? a. Adolescents under age 20 b. Men over age 85 c. Females 25 to 45 years of age d. Women over age 65

A B C

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

C Community mental health providers can help prevent a culture of youth violence by creating coalitions and partnerships and providing activities to increase social skills by helping children learn to stop, think, and act.

Which intervention by community mental health nurses is most likely to help prevent youth violence? a. Distributing literature that associates violence with a lack of intelligence b. Explaining to youth why youth violence is detrimental to society c. Partnering with associations to provide alternative activities that improve social skills d. Recommending increased funding to prosecute and jail teens associated with violent activity

A

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) Create social and physical environments that promote health. Healthy People 2000 identified three goals, which were to: 1. increase the span of healthy life for Americans; 2. reduce health disparities among Americans; and 3. achieve access to preventive services for all Americans. Healthy People 2010 identified two broad goals, which are to 1. eliminate health disparities and to 2. increase quality and years of healthy life. Healthy People 2020 identified four goals: 1. attain high-quality, 2. longer lives free of preventable disease, 3. disability, injury, and premature death; 4. achieve health equity, eliminate disparities, and improve the health of all groups; create social and physical environments that promote good health for all; and promote quality of life, healthy development, and healthy behaviors across all life stages.

Which is a goal for Healthy People 2020? A) Create social and physical environments that promote health. B) Increase the span of healthy life for Americans. C) Reduce health disparities among Americans. D) Achieve access to preventive services for all Americans.

A) Collaboration A unified program requires collaboration and coordination between the agency personnel who will implement the program and the program's recipients (the target population). Allowing plenty of time for publicizing the program (and how you perform the mechanics of publicity—how, where, and to whom) can make a crucial difference in whether people attend and what the subsequent impact will be.

Which is the highest priority for success of a unified program between agency personnel who implement a community health program and the target population of program recipients? A) Collaboration B) Agency ownership for program C) Limited time for publicizing the program D) Limited need for coordination between these groups

b. Emergence of new and old communicable and infectious diseases In the 21st century, the emergence of new and the reemergence of old communicable and infectious diseases are occurring as well as larger foodborne disease outbreaks and acts of terrorism. Care for clients continues to move out of the hospital setting and into the community. Chronic disease management will be a challenge for health care providers; however, new guidelines should ease the care provided for these diseases and wouldn't be seen as a challenge. The use of technology will continue to increase, but the need for health care workers will not be decreasing. New health care careers will emerge because of the changes in technology.

Which of the following accurately describes a challenge that will be faced by health care providers in the 21st century? a. Lack of available space to provide care for clients in hospitals b. Emergence of new and old communicable and infectious diseases c. New guidelines for chronic disease management d. Increased use of technology leading to a decreased need for health care workers

b

Which of the following actions by Florence Nightingale demonstrates her role as an epidemiologist? a. She convinced other women to join her in giving nursing care to all the soldiers. b. She demonstrated that a safer environment resulted in decreased mortality rate. c. She obtained safe water and better food supplies and fought the lice and rats. d. She met with each soldier each evening to say goodnight, thereby giving psychological support.

c

Which of the following actions would a nurse take to reduce the high incidence of coronary artery disease (CAD) in a community? a. Introduction of a heart-healthy curriculum beginning in the first grade, presentations on diet and exercise for the community at large, and special education sessions for high-risk populations b. Provision of online activities related to prevention of cardiac disease, smoking reduction programs, and blood pressure screenings c. Distribution of handouts, including age-appropriate games, self-assessments, and education on heart-healthy lifestyles; availability of community screenings for hyperlipidemia in persons age 35 and older; and walking programs for those affected with CAD d. Enrollment of clients with CAD into cardiac rehabilitation programs, routine evaluation of effectiveness of CAD treatment regimens, and participation in clinical trials that evaluate interventions for those diagnosed with CAD

ACD

Which of the following activities are addressed by most public health departments on the federal, state, and local levels (Select all that apply.) A. Collecting and analyzing various health statistics B. Fining or terminating business at any facility that engages in unsafe commercial practices C. Identifying and planning for high-risk populations D. Planning for and responding to emergencies

A B

Which of the following activities are considered to be part of the core competencies for public health professionals? (Select all that apply.) a. Defining variables relevant to current public health problems b. Obtaining and interpreting information regarding risks and benefits to the community c. Implementing nursing care and subsequent evaluation outcomes d. Maintaining public health departments throughout the United States

abc

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

Which of the following activities is completed by the executive branch of the federal government? a. Administration of policy b. Interpretation of policy c. Proposal of policy d. Passage of policy

b. Caffeine Caffeine is in commonly served beverages such as coffee, tea, and soft drinks, as well as in some commonly used pain medications. Beer, cigarettes, and mixed alcoholic beverages are not as culturally acceptable as caffeine, as there are regulations that limit the age that these products can be used.

Which of the following addictive drugs is both legal and culturally acceptable throughout almost all of the United States? a. Beer b. Caffeine c. Cigarettes (nicotine) d. Mixed alcoholic beverages

b. Harm reduction The harm reduction model is a public health approach that recognizes addiction as a health problem and focuses on pragmatic interventions, especially education, to reduce the adverse consequences of drug use and treatment for addicts. Substance abuse education is only one part of the harm reduction model. Using an approach of punishment and the criminal justice system has not been found to be effective based on research.

Which of the following approaches has research suggested is the most effective way to approach drug addiction? a. Criminal justice system b. Harm reduction c. Punishment approach d. Substance abuse education

a. Consumers are influenced by advertising for specific health care agents or procedures. c. Education and specialization of personnel have increased. e. Hospital stays are much shorter Since the 1980s, the United States has been in a period of limited resources, with an emphasis on containing costs, restricting growth in the health care industry, and reorganizing care delivery. Results have included shorter hospital stays and substitution of one set of personnel (such as nurse practitioners) for another set (physicians). Such trends are made more challenging by increased direct marketing to consumers. Also with increased knowledge has come increased education and specialization. Shorter hospital stays continue to occur so there is a focus on expanding care in the community, not in acute care hospitals. Containment of costs is a major focus; however, creation of new payment methods has not been part of this conversation

Which of the following are some major differences in health care today, as compared with the first half of the 20th century? (Select all that apply.) a. Consumers are influenced by advertising for specific health care agents or procedures. b. The emphasis is on the continued expansion of health care facilities, especially acute care hospitals. c. Education and specialization of personnel have increased. d. The need to create new ways to pay for health care is a central focus. e. Hospital stays are much shorter

cd

Which of the following aspects of a home health agency would most likely be examined during the accreditation process (Select all that apply.) a. Cost of each service rendered b. Credentials of each employee c. Organizational structure d. Outcomes of care

D

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

B

Which of the following best defines a disaster? A. Any event that results in multiple deaths B. Devastation that cannot be relieved without assistance C. Devastation that covers a broad geographical area D. When the event results in multiple injuries and deaths as well as property damage

a

Which of the following best defines the word politics? a. A neutral term meaning influence b. The outcome of governmental policies c. A provision of power for making decisions d. The result of legislative action

B

Which of the following best describes countries that bear the greatest burden of disasters? A. Arid regions that are prone to drought B. Developing countries with limited resources C. Industrialized countries with much to lose D. Water-boundary regions that are prone to floods and hurricanes

C

Which of the following best describes how public health nurses (PHNs) differed from other health care professions in the early twentieth century? A. PHNs contributed without receiving any salary for doing so. B. PHNs created new settings where health care could be given. C. PHNs gave care to powerless groups. D. PHNs worked outside any organized health care system.

d

Which of the following best describes one of the outcomes of the incentives and pressures for cost control and improved health outcomes? a. Expansion in alternative health care agencies b. Improvements in client teaching materials c. Public pressure to improve health professionals' education d. Development and increased use of telehealth technology

b

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

A

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

a

Which of the following best describes the primary difference between parish nursing and all other nursing positions? a. Affiliation with a church or congregation b. Incorporation of spiritual aspects into nursing care c. Provision of holistic nursing care d. Residence within the community of service

D

Which of the following best describes the primary reason life spans have notably lengthened over the past 100 years? A. Advances in hospital care and procedures B. Advances in medicine and medical research C. Advances in nursing practice D. Advances in public health

b

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

A

Which of the following best describes the role of nursing in community health? A. Application of nursing and public health theory in promoting, preserving, and maintaining health of individuals, families, or communities B. Health care provision offered in primary and secondary institutions or in the client's home C. Provision of health care services in institutions located in the community but outside the hospital D. Use of the nursing process and evidence-based practice to meet Healthy People 2020 objectives for community health improvement

d

Which of the following best describes when the home health nurse must document required Outcome and Assessment Information Set (OASIS-B1) data? a. Before any episode of hospitalization b. After each home health visit c. For all incidences of error or mistake in care d. On first admission to home health care

B

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

a

Which of the following best describes why it is helpful to be a member of a faith community? a. Belief and traditions help with coping. b. Members can ask others in the group for help. c. It is a social outlet. d. Members are able to get others to contribute to the causes they support.

c

Which of the following best describes why it is more challenging for most nurses to meet the needs of a dying child and his or her family than to meet the needs of a dying adult? a. Children don't understand what it means to die. b. A child's death is harder for anyone to accept. c. Society does not expect death to occur in children. d. Families are not prepared to deal with death.

C. Legally, emergency departments must see clients even if clients can't pay People on Medicaid frequently have no primary care provider and may not be able to pay for their care. Although physicians can choose clients based on their ability to pay, emergency departments are required by law to evaluate every client regardless of ability to pay. Emergency department co-payments are modest and are frequently waived if the client is unable to pay. Thus, low out-of-pocket costs provide incentives for Medicaid clients and the uninsured to use emergency departments for primary care services. Limited physician office hours over the weekend does make it difficult for low-income persons to access care through a primary care provider; however, this is not influenced by a government decision. The government does not require Medicaid clients to use the emergency department when their primary care provider is unavailable, rather the policies of the emergency department to see all clients regardless of ability to pay may inadvertently encourage them to use this service. The paperwork at a physician's office that needs to be completed by a Medicaid client is not any different than any other client receiving care at the office

Which of the following best explains how the government unintentionally encourages low-income persons to use emergency departments as their primary care provider? a. A huge amount of paperwork is required when Medicaid clients go to a physician's office. b. Government regulations require Medicaid clients to use emergency departments when their primary health care provider is unavailable. c. Legally, emergency departments must see clients even if clients can't pay. d. Physicians' limited office hours make them unavailable during evenings and weekends.

a. Clients may have preexisting conditions not covered by insurance. b. Many physicians won't accept Medicaid clients. c. Medicaid won't pay for certain medical interventions. The primary reasons for delay, difficulty, or failure to access care include inability to afford health care and a variety of insurance-related reasons, including the insurer not approving, covering, or paying for care; the client having preexisting conditions; and physicians refusing to accept the insurance plan. Practical problems such as lack of childcare, transportation, long waiting periods, and communication issues also interfere. Noncompliance is not a primary reason why Medicaid clients have poor outcomes. There is no research to confirm that Medicaid recipients are reluctant to seek medical care. Rather there are usually other compounding factors that interfere with the client following the regimen or accessing other needed health care services which result in the poor health outcomes.

Which of the following best explains why clients who have Medicaid have poor health outcomes? (Select all that apply.) a. Clients may have preexisting conditions not covered by insurance. b. Many physicians won't accept Medicaid clients. c. Medicaid won't pay for certain medical interventions. d. Medicaid recipients are noncompliant with their health care providers' recommendations. e. There is a general hesitancy among those eligible to seek health care.

d

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.

bd

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.

a

Which of the following best explains why the home health nurse would essentially repeat the same information given to the client by the nurse in the hospital? a. Clients find it difficult to learn in the midst of the stress of the acute care setting and often don't remember what the hospital nurse taught. b. Hearing something from a different person, using different words and examples, can help ensure that learning is retained. c. Home health nurses often don't know what hospital-based nurses have already taught. d. Learning depends on receiving information more than once.

A C D

Which of the following best supports the concept of community-oriented nursing practice? Select all that apply. a. Direct nursing care of individuals with tuberculosis (TB) b. Hospice home care for a terminally ill individual and family c. Nursing interventions to stop elder abuse d. Nutrition education programs for teenagers and their families e. Wound care for a homebound individual

ANS: B Much of the pressure to use evidence-based practice comes from third-party payers and is a response to the need to contain costs and reduce legal liability.

Which of the following groups is pressuring clinicians the most to use evidence-based practice (EBP)? a. Administrators b. Insurance companies c. Nurses d. Physicians

d. Advances were made in sewage disposal, and water and milk quality. Environmental conditions influencing health began to improve with major advances in water purity, sanitary sewage disposal, milk quality, and urban housing quality. The health problems of this era were no longer mass epidemics but individual acute infections or traumatic episodes. The education of health care providers did move into universities during this time period; however, this is not the reason why there was an increased focus on infections and trauma. Health care was paid for primarily by individuals during this time period so there was not an increase in the amount of money available to pay for health care. The outcomes of hospital care improved because of the advances that were being made in technology, not because health care providers were focusing more on infections and trauma.

Which of the following caused health care providers to begin to focus on individual infections and trauma in the 1900s in the United States? a. Education of health care providers moved into universities. b. People finally had enough money to pay for medical care. c. The improved outcomes of hospital care were recognized. d. Advances were made in sewage disposal, and water and milk quality

C

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

A

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

d

Which of the following clients over 65 years of age meets the criteria for Medicare reimbursement for home health nursing? a. The client who needs assistance with bathing and meal preparation b. The client who needs assistance with house cleaning and meal preparation c. The client who needs sitter services because she wanders from home and becomes lost d. The client whose family members need to learn how to care for his wound

a

Which of the following comments was most likely stated by a home health nurse? a. "Every time I see a client, it costs $80." b. "Health care costs are killing our economy." c. "I can't believe how much clients are charged for things." d. "Medicaid costs are such a large portion of our state's budget."

d. Prospective payment scale based on the medical diagnosis As a result of rising health costs, Congress passed a law in 1983 that mandated an end to cost-plus reimbursement and instituted a prospective payment system (PPS) for inpatient hospital services to shift the cost incentives away from the providing of more care and toward more efficient services. The basis for prospective reimbursement is the 468 diagnosis-related groups (DRGs). There is not a Medicare panel that determines the actual cost of services. Payments are determined in advance based on DRGs and are not determined by the budget of the federal government. Hospital and health care provider feedback do not influence the prospective reimbursement; rather, the third-party payer establishes the amount of money that will be paid for the delivery of a particular service before offering the services to the client.

Which of the following criterion is now used for deciding the amount of the reimbursement before care is provided? a. A proportion of actual cost arbitrarily decided by the Medicare panel b. The federal budget constraints for the current fiscal year c. Hospital and health care provider feedback and political persuasion d. Prospective payment scale based on the medical diagnosis

a. The aging population The aging population is expected to affect health services more than any other demographic factor. The majority of older adults rely on publicly funded programs. As the Baby Boom generation ages and retires, federal expenses for Social Security and health care will increase. The use of diagnosis-related groups to determine reimbursement started in 1983 and is not expected to have a great influence on national health care spending at this time. Insurance reform is not a demographic factor. Due to the Affordable Care Act, the number of people without health insurance is decreasing.

Which of the following demographic factors is expected to have the greatest influence on national health care spending? a. The aging population b. Use of diagnosis-related groups to determine reimbursement c. Insurance reform d. An increasing number of people without health insurance

B

Which of the following dimensions is an essential component of parish nursing? A. Assertiveness B. Compassion C. Organizational skills D. Fiscal responsibility

B,C,D

Which of the following disasters would implementation of disaster medical assistance teams (DMATs) (Select all that apply.) A. Disaster that covers a broad geographical area B. Disaster that is beyond the coping capabilities of the affected state C. Disaster that may result in substantial health and medical problems D. Disaster that may cause a large number of deaths and/or injuries

d

Which of the following do community-based nurses typically use to organize, sort, and document pertinent client data? a. NANDA b. NIC NOC c. Nursing Diagnosis Taxonomy d. The Omaha System

A,B,D

Which of the following domains are used in evaluating the strength of evidence? (Select all that apply.) A. Quality B. Quantity C. Cost effectiveness D. Consistency E. Usefulness

c

Which of the following events led to the emphasis on home care nurses caring for acutely ill clients and the increased demands for extensive documentation? a. Advances in medical technology and pharmacology b. Increased number of lawsuits for substandard care c. Introduction of Medicare d. Social Security Act of the 1930s

A,B,D

Which of the following factors has influenced the implementation of evidence-based practice in health care? (Select all that apply.) A. Increased expectations of consumers B. Advances in technology C. Nursing shortages D. Increases in lawsuits E. Implementation of electronic health records

D

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

A

Which of the following factors is causing nursing to change so quickly? A. Economic issues B. Increases in medical and nursing knowledge C. Legislative issues D. Technology changes

C

Which of the following federal agencies is most influential in public health activities? A. The Agency for Healthcare, Research, and Quality B. Centers for Disease Control and Prevention C. Department of Health and Human Services D. Food and Drug Administration

b. Federal and state government Combined state and federal governments paid the most for health care in 2018. Health care financing has evolved from a time when the most money was expended by consumers, then to a system financed by third-party payers such as insurance companies, and finally, to today, when state and federal government payments (primarily through Medicare and Medicaid) pay more than private insurance companies or consumers. From 1960 to 2018, the percentage of third-party public insurance payments increased and the percent of out-of-pocket payments declined

Which of the following groups pays the largest amount for health care in the United States today a. Consumers b. Federal and state government c. Insurance companies and other third-party payers d. Hospitals and health care providers

d. A 30-year-old male who is unemployed Barriers to accessing care include the inability to afford health care, lack of transportation, physical barriers, communication problems, childcare needs, lack of time or information, or refusal of services by providers. The unemployed male is most likely to experience a barrier because of not having a job, which may reduce his access to health insurance and limit his income. Those who speak English as a second language and have health insurance even with co-pay requirements should both find it easier to access health insurance than someone who is unemployed since the inability to afford health care is a primary barrier. Medical diagnoses, such as having hypertension, do not present a barrier to accessing health care.

Which of the following individuals would most likely experience a barrier when accessing health care a. A 40-year-old female who speaks English as a second language b. A 25-year-old female with co-pay health insurance c. A 50-year-old male with hypertension d. A 30-year-old male who is unemployed

A C

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

D

Which of the following is a core competency required of public health nurses? A. Knowledge in the use of high-technology diagnostics B. Knowledge of the implementation of electronic medical records C. Skill in the physical assessment of complex clients D. Skill in developing policy and planning programs

b

Which of the following is a potential advantage of hospital-based home health agencies over other types of home care agencies? a. Administration and management benefits are gained from the expertise of two boards of experts. b. Continuity of care is enhanced. c. Health promotion and illness prevention concerns take precedence over acute care and rehabilitation. d. They are eligible for tax exemptions through affiliated agencies.

a

Which of the following is a primary requirement for a client to be eligible for home health nursing and Medicare reimbursement of services? a. Must be homebound b. Must be living in a medically underserved area c. Must be indigent d. Must be insured or eligible for Medicare or Medicaid

b. Paranoia is a known side effect of marijuana use. Marijuana's diverse reactions include anxiety, disorientation, and paranoia. The risks of marijuana are not being discussed as much as in the past. Today's marijuana is stronger than ever before, and people can become addicted. The Substance Abuse and Mental Health Services Administration (SAMHSA) says "approximately 1 in 10 people who use marijuana will become addicted." The rate increases to 1 in 6 if the youth is under age 18. Marijuana use has known effects on fetal development.

Which of the following is an accurate concern about the marijuana? a. Strength of most available marijuana is weaker than in the past. b. Paranoia is a known side effect of marijuana use. c. Marijuana has no effect on a fetus. d. Psychological and physiological dependence are seldom experience with marijuana use

b. Low socioeconomic status Poverty is more closely related to health status even when controlling for age, gender, race, education, and lifestyle behaviors. The rate of uninsured remained higher among people with lower incomes and lower among those with higher incomes. Households of three with less than $20,000 annual income are at the highest risk for being uninsured. Socioeconomic status has the closest correlation to health status; thus, age, gender, minority race status, and high-risk lifestyle behaviors do not have the closest correlation.

Which of the following is most closely correlated with poor health? a. Age and gender (i.e., older males) b. Low socioeconomic status c. Minority race status d. High-risk lifestyle behaviors

b

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

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

D

Which of the following is the best brief definition of community? a. A geographic area or political division under common leadership b. A group sharing a common bond such as a profession or occupation c. A group working together to confront a common problem d. A social group with common goals within a geographic area

A

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

ANS: A Client reminders and recalls via mail, telephone, or e-mail—or a combination of these strategies—are effective in increasing compliance with screening activities such as those for colorectal and breast cancer.

Which of the following is the best way to increase the number of persons who come to their screening test appointments? a. Reminding clients via telephone, e-mail, or mail b. Emphasizing long life and happy family when conditions are caught early and treated successfully c. Pointing out how inexpensive and convenient screening tests are d. Stressing the dangerousness of the condition if not caught early

b

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

c

Which of the following is the primary focus of hospice care? a. Curing or controlling the client's chronic disease b. Decreasing the waste of acute care (hospital) resources c. Providing palliative care to maintain comfort until death d. Teaching the client and family how to care for themselves

B

Which of the following is the underlying science or area of study on which public health is based? A. Biostatistics B. Epidemiology C. Medicine D. Social sciences

ANS:1 The other statements listed are false.

Which of the following is true about African American nurses in public health? 1.Segregation existed until the 1960s, which made certificate and graduate education more difficult to obtain. 2.Cities were the major areas where they practiced 3. They often belonged to the Frontier Nursing Service. 4.They were recruited heavily as military nurses.

c

Which of the following laws established programs for provision of health services for women and children and supported community-oriented nursing practice? a. Early Periodic Screening and Developmental Testing (EPSDT) Initiative b. Healthy People 2000 Initiative c. Sheppard-Towner Act d. State Child Health Improvement Act (SCHIP)

A

Which of the following levels of prevention is being used by a nurse who is helping to develop a community-wide disaster management plan? A. Primary prevention B. Secondary prevention C. Tertiary prevention D. All prevention levels

c. Health economics Economics is the science concerned with the use of resources; health economics is concerned with how scarce resources affect the health care industry. Insurance resources, health care rationing, and medical technology are important components of health economics but by themselves do not provide the broad understanding called for in this question.

Which of the following must a nurse be knowledgeable about to make decisions regarding the most cost-effective way to allocate health care resources? a. Insurance resources b. Health care rationing c. Health economics d. Medical technology

B

Which of the following objectives is most appropriate for the development of a community-oriented nursing care plan? a. All monitored patients will receive abortive therapy for lethal dysrhythmias within 3 minutes of dysrhythmia recognition. b. Of mothers receiving nutrition counseling, 80% will identify five sources of calcium by the end of class. c. 95% of children will be immunized by 1 year of age. d. There will be a 25% reduction in health disparities by 2015.

C

Which of the following older adults is most in need of psychological support? A. The older adult who keeps asking if loans will be available for him to rebuild B. The older adult who keeps asking if he can go back home yet C. The older adult who keeps lamenting the loss of his family photos D. The older adult who keeps talking about how expensive his home theater was and how he will never be able to afford to replace it

C

Which of the following organizations would direct nurses' response to a county-wide disaster? A. American Red Cross B. Centers for Disease Control and Prevention C. Emergency Management Agency D. The local public health department

a. Managed care plan The concept of managed care is that costly care could be reduced if consumers had access to education and health promotion. Fee-for-service payment encourages more services to be given. Reimbursement, whether prospective or retrospective, is based on the same criteria, but managed care integrates the financing and the delivery of health care.

Which of the following payment systems tries to keep clients healthy through education and health promotion, with the goal of reducing the need for professional health care intervention and therefore also lowering cost? a. Managed care plan b. Fee-for-service payment c. Prospective reimbursement d. Retrospective reimbursement

a

Which of the following practices in the home is most crucial? a. Using good handwashing procedures b. Obtaining a puncture-resistant container for family to use for needles c. Putting all contaminated material directly into a trash bag d. Washing all surfaces with disinfectant

c

Which of the following principles is central to the role of the parish nurse? a. Advanced nursing practice education and skills b. Faith consistent with the community and its leadership c. Spiritual dimension of care d. Willingness to serve anyone in need

c. Stay in skilled nursing facility Medicare Part A covers hospital care, home care, and skilled nursing care. Medicare Part B covers "medically necessary" services, such as health care provider services, outpatient care, home health, and other medical services such as diagnostic services and physiotherapy.

Which of the following services would be covered under Medicare Part A? a. Blood draw to assess PT/INR b. Physical therapy visit c. Stay in skilled nursing facility d. Transportation by an ambulance

b

Which of the following should be the minimum requirement for a nurse to be prepared for home health nursing? a. An RN license and a baccalaureate degree in a health-related field b. A baccalaureate degree in nursing and RN licensure c. An associate's degree in nursing and RN licensure d. Eligibility for certification as a home health nurse

C

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

B,C,E

Which of the following statements accurately describe the stress reaction phases a community may experience during a disaster response? Select all that apply. a. Disillusionment and reconstruction is most associated with response efforts. b. During the Heroic phase, there is overwhelming need for people to do whatever they can to help others survive the disaster. c. In the Honeymoon phase, survivors may be rejoicing in that their lives and the lives of loved ones have been spared. d. Disillusionment is the longest phase in the stress reaction process. e. The Disillusionment phase occurs after time elapses and people begin to notice that additional help and reinforcement may not be immediately forthcoming.

c

Which of the following types of study should the nurse researcher choose if the goal is to identify the long-term benefits and risks of a particular nursing intervention for senior citizens living in the community? a. Cross-sectional study b. Ecologic study c. Clinical trial d. Retrospective analysis

b. Methadone blocks the effects of heroin and reduces the craving. Methadone, when administered in moderate or high daily doses, produces a cross-tolerance to other narcotics, thereby blocking their effects and decreasing the craving for heroin. The advantages of methadone are that it is long acting and effective when taken orally, it does not produce a "high," it is inexpensive, and it has few known side effects. The main effect of this medication is that it decreases the craving for heroin; it is not a drug that clients come to prefer nor does it prevent further dependence on drugs.

Which of the following statements accurately describes why methadone is used to treat heroin addiction? a. Addicts come to prefer methadone instead of heroin. b. Methadone blocks the effects of heroin and reduces the craving. c. Methadone prevents further dependence on drugs. d. Methadone gives an enjoyable high, so addicts continue treatment.

B C E

Which of the following statements are true regarding the health-related vulnerabilities of men? Select all that apply. a. More males die at birth. b. Fewer health services are offered to men. c. Men often put work ahead of their health needs. d. More males die from suicide. e. Men often incur more work related injuries than women.

c

Which of the following statements best describes how clients and parish nurses typically perceive spiritual health? a. It exists at the point that cure is attained. b. It has a tangential relation to well-being. c. It is part of an ongoing dynamic process. d. It is usually unchanging across the life span.

b

Which of the following statements best describes the law in relation to clinical practice by nursing students? a. Students are considered certified until licensure is obtained. b. Students are expected to meet the same standard of care as the professional nurse. c. Students are not legally liable for errors because they practice under the license of their instructor. d. Students have a scope of practice determined by the nurse practice act.

b

Which of the following statements best describes the most essential difference between home health care and acute client care? a. Acute client care is individualized for the client and family. b. Home health care is provided in the client's environment. c. Reimbursement for home health care varies from that of care provided in institutions. d. The focus of acute client care is on community health.

c

Which of the following statements best describes why the federal government has become involved in health care? a. The states asked the federal level to become involved. b. Because of rising costs to the states, the federal budget needed to be used to pay for necessary services. c. The Constitution gives the federal government the power to promote the general welfare. d. This step was necessary to standardize care on a national level.

c

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

Which of the following statements by a client indicates a lack of understanding regarding an appropriate reason to sue for malpractice? a. Because the health care workers didnt turn my mother every 2 hours, she developed bedsores. b. I received permanent nerve damage because they would not remove a cast that was too tight. c. My daughter wasnt given a call light, and for a whole shift no one checked on her condition. d. They amputated the wrong leg during surgery.

b

Which of the following statements by a parish nurse exhibits a lack of understanding of the concept of pastoral care? a. "By working with my clients to help them identify their spiritual strengths, I am drawing on pastoral care aspects of practice." b. "To incorporate pastoral care, I should involve the pastor in ministering to the members of the congregation." c. "I use pastoral care when I emphasize the spiritual dimension of nursing when providing care." d. "When I lend support to my clients during times of joy, as well as during their times of sorrow, this illustrates an important aspect of pastoral care."

c

Which of the following statements describes how nursing in the community is more challenging than nursing in an acute care setting? a. There is limited access to information useful to the nurse in giving care in the community. b. More paperwork and forms are required when giving care in the home. c. It is more challenging to control the environment in the community. d. Specialization isnt possible in the community setting.

d

Which of the following statements suggests that faith community nursing is a nationally recognized specialty of nursing? a. Academic programs now offer a clinical specialty in parish nursing. b. Faith community nurses are increasingly receiving salaries for their efforts. c. Faith community nursing is being adapted in other countries and to non-Christian faiths. d. Scope and standards of faith community practice have been developed and revised.

b

Which of the following statistics is used by countries to compare the success of their health care systems? a. Attack rate b. Infant mortality rate c. Cause-specific morbidity rate d. Cause-specific mortality rate

acd

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. Capitation In payment by capitation, practitioners are paid a set amount to provide care to a given client or group of clients for a set period of time. In the fee-for-service payment system, which is like the retrospective reimbursement, the practitioner determines the costs of providing a service, delivers the service to a client, submits a bill for the delivered service to a third-party payer, and is paid by the third-party payer. Rationing implies reduced access to care and potential decreases in the acceptable quality of services offered

Which of the following terms describes when a nurse practitioner receives a set monthly payment to take care of a group of clients regardless of the services needed and provided? a. Capitation b. Fee for service c. Rationing d. Retrospective reimbursement

c

Which of the following types of home health agencies emphasizes health promotion and illness prevention? a. Combination agencies b. Hospital-based agencies c. Official agencies d. Proprietary agencies

D

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

c

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. Lifestyle choices Personal biology and behavior (or lifestyle), environmental factors and policies (including physical, social, health, cultural, and economic environments), social networks, living and working conditions, and the healthcare system—medical services are said to have the least effect. Behavior and lifestyle have been shown to have the greatest effect on longevity, with the environment and biology accounting for the greatest effect on the development of all illnesses

Which of the four main factors that affect health, is the most important? a. Environment b. Human biology c. Lifestyle choices d. Health care system

d. A 24-year-old man who works part-time at a small business Young adults (ages 19 to 25 years) account for a disproportionately large share of the uninsured, largely due to their low incomes. The elderly person would be eligible for Medicare, and the 2-year-old is probably eligible for Medicaid. The man who works at the large corporation probably has health insurance, because most large businesses provide it.

Which person is most likely to be uninsured? a. An 82-year-old woman with chronic medical problems b. A 2-year-old whose mother is on welfare c. A 50-year-old business man who works for a large corporation d. A 24-year-old man who works part-time at a small business

B

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

D

Which source would a nurse use to collect morbidity data? a. Vital statistics reports b. Birth records c. Death certificates d. Specialized disease registries

C

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

B

While conducting a community health assessment, a nurse in community health meets with local religious leaders to understand the values, norms, perceived needs, and influence structures within the community. This process of data collection can best be described as: a. data gathering. b. data generation. c. data interpretation. d. problem identification.

c

Who is responsible for determining the scope of practice for registered nurses? a. American Nurses Association b. Federal legislators c. State legislators d. U.S. Department of Health and Human Services

ANS: D Notably, approximately 30% of female murder victims are killed by an intimate partner.

Who is usually the perpetrator of female homicide? a. A person trying to engage in rape with the woman fighting back b. A person who wanted money and she refused to give it to him c. A stranger d. An intimate partner

ANS: D Hate crimes are crimes based on an individual's race, sexual orientation, religious beliefs, ethnic background, or national origin. Hate crimes may include rape, sexual or physical assault, harassment, attacks on homes or on places of worship, and vandalism. Because hate crimes attack an individual's identity, the emotional effects are compounded.

Why are hate crimes involving violence often considered worse than other crimes involving violence? a. Because hate crimes can't be avoided because one can't change one's race or religious or sexual orientation b. Because hate crimes often are committed by groups rather than individuals c. Because more damage is typically done in a hate crime than in a typical assault and battery d. Because the crime is personal, attacking the victim's identity

B

Why does a nurse conduct surveillance? a. To eradicate a disease before it starts b. To establish a baseline rate of disease occurrence and patterns of spread c. To target populations for triage d. To reduce the incidence of heart disease in a community

ANS: D Workplace violence tends to be higher in some service-oriented work environments, including health care. Such violence is widely believed to be underreported, perhaps in part because of beliefs that it is an expected part of certain jobs.

Why don't more nurses report violence against them to authorities? a. Assumption that the nurse somehow "asked for it" by not being cautious enough or alert enough to avoid it b. Assumption that nothing would be done about the situation anyway c. Assumption that nurses can accept anything, from taking blame to being scapegoats for when outcomes are not positive d. Assumption that patients and families can't be held responsible; being assaulted is part of the job

D Homeless persons have the same problems accessing care as do others in poverty (e.g., lack of money, lack of insurance, lack of transportation). Therefore health care of homeless persons is usually crisis oriented and sought in emergency departments, where the cost of service is high but is not refused as it often is in clinics.

Why is health care of the homeless so expensive to the community? a. Health conditions of the homeless require increased preventive services. b. Homeless clients typically make more clinic visits for multiple health problems. c. Homeless people spread contagious diseases to those they pass on the street. d. Most care to homeless people takes place in hospital emergency departments.

ANS: C Gangs are responsible for as much as 80% of all crime in many communities. These crimes include illegal alien smuggling, armed robbery, assault, auto theft, drug and weapon trafficking, identity theft, and murder.

Why should all citizens care about young people joining gangs? a. Gangs are beginning to be seen in suburban areas. b. Gangs are responsible for destroying lives and property in inner cities. c. Gangs commit as much as 80% of all crime in many communities. d. Gangs help give the young person protection, respect, and sense of belonging.

A nurse makes the suggestion that the 2-week shift rotations should be set up so that the next rotation in shifts is later rather than earlier. Which of the following is the nurse attempting to prevent through this suggestion? a. Anxiety, depression, and exhaustion b. Family turmoil c. Physical illnesses d. Sleeping disorders

a

A nurse who works for a hospital in employee health notes that several nurses from one unit have missed work after contracting a communicable disease from a patient. Which of the following best describes the host factor? a. Each sick nurse b. The communicable disease c. The hospital d. The patient

a

A recent news article reported the death of a 60-year-old road construction worker on a day with a posted heat advisory. An occupational health nurse would recognize the additional host factors that contributed to this fatality as which of the following? a. Age and work practices b. Gender and lifestyle c. Health status and age d. Work practices and health status

a

An employee in a laboratory drops a flask, resulting in a chemical splash into the employee's eyes, which in turn results in burns to the eyes. Which of the following would be considered the agent? a. The chemical b. The employee c. The flask d. The laboratory

a

The greatest risk for experiencing work-related accidents with subsequent injuries is to which of the following? a. New workers with less than 1 year of experience on the current job b. Older workers with 2 years of experience on the job c. Women over 50 years of age with 3 years of experience on the current job d. Workers with safe, low-level exposure on the job

a

Which of the following groups should the occupational health nurse devote the most time to regarding education and follow-up evaluation? a. New workers employed less than 1 year b. Older workers with chronic illnesses c. Older workers with diminished hearing d. Women in their childbearing years

a

Which of the following hospital employees are most at risk for being exposed to and possibly developing active drug-resistant TB? a. Housekeeping staff b. Medical staff c. Nursing staff d. Ward clerks

a

Which of the following is a unique characteristic of the role of the occupational health nurse? a. Adapts to the needs of the agency and specific groups of workers b. Works as a solo clinician and/or independent contractor c. Is interdisciplinary in nature d. Specializes in health promotion and education

a

Which of the following describes how occupational health nursing differs from other nursing specialties (Select all that apply.) a. It is autonomous, because the occupational nurse works independently. b. The major focus is on the environment. c. Nurses focus on health promotion and disease prevention. d. Nursing care is given in the community.

ab

An occupational health nurse should be aware of which of the following trends in the marketplace (Select all that apply.) a. A majority of new jobs will be in service-oriented employment. b. Employees will often have compressed work weeks, shift work, and reduced job security. c. A majority of positions will still be held by males. d. Many employees will be older and suffer chronic health problems.

abd

A widely recognized chemical health hazard in health care environments is which of the following? a. Burn-out b. Latex allergy c. Radiation d. Viruses

b

An effective industrial disaster plan is a written plan that is shared with all who will be involved, such as the internal first responders, external community-based emergency personnel (transportation, fire, EMS, hospitals), and other key resources in the community. Another factor that influences the effectiveness of an industrial disaster plan is which of the following? a. Addressing activities for work areas that are at greater risk b. Conducting a response agency worksite walk-through c. Testing with a biannual drill d. Training specific employees for fire brigade procedures

b

An occupational health nurse is working with the manager to change the assignment of an employee from working with heavy metal to using machinery to assist with loading and unloading boxes at the truck dock. Which of the following best explains the rationale for this change? a. To prevent injury b. To limit disability c. To provide primary prevention d. To provide tertiary prevention

b

An occupational health nurse periodically conducts spirometry testing of employees who work around hazardous gases. Which of the following levels of prevention is being implemented? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Tertiary care prevention

b

During a recent heat advisory, baggage handlers at the local airport were placed on a 1-hour shift rotation. This work-health interaction demonstrates the theoretical application of which of the following? a. Aggregate populations b. Epidemiologic model c. Host risk factor d. Occupational exposure

b

In health care facilities and clinical laboratories, the occupational health nurse needs to be aware of the worker groups that are at risk for exposure to biological agents. Besides the health care workers, worker groups at risk for exposure to biological infectious agents may include which of the following? a. Clerical staff b. Maintenance personnel c. Receptionists d. Chaplains

b

The occupational health nurse continually reminds employees to wear their safety goggles and ear plugs. Which of the following levels of prevention is being implemented? a. Both secondary and tertiary prevention b. Primary prevention c. Secondary prevention d. Tertiary prevention

b

Which of the following best describes the mission of OSHA? a. To create an inspection system to avoid preventable loss of life b. To ensure safe and healthful working conditions c. To establish rules for employee safety d. To share factory illness and injury rates with the public

b

Which of the following statements best describes how workers' compensation legislation has changed employer behavior? a. Employers have improved safety of working conditions because safety data is now public information. b. Companies have improved safety of working conditions because worker's compensation insurance premiums are now based on previous claims. c. Employers were legally required to implement safety changes. d. Companies have become more involved in the legislative process.

b

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

b. "My daughter is pretty independent; she's active in both sports and theater." Pratt proposed the energized family as being an ideal family type that was most effective in meeting health needs. The energized family is characterized by active contact with a variety of groups and organizations (Boy Scouts, church, sports, theater), flexible role relationships, equal power structure, and a high degree of autonomy by each member. Flexible role relationships are not being demonstrated if only the daughter is taught how to cook and only the son is expected to get a job. Equal power structure is not being displayed if the husband makes all the decisions

An occupational health nurse wants to know the NAICS code of a prospective employer. Which of the following best explains why the nurse would be interested in this information (Select all that apply.) a. To assess how others have rated the company in relation to employment there b. To compare the prospective employer's injury rate with similar employers' rates c. To learn more about the usual processes and products of the company as well as typical hazards d. To learn how employees feel about the employer

bc

Changes in the workforce will pose new challenges to protecting worker health and safety. Which of the following trends will influence business strategies to increase health status, employment longevity, and satisfaction of workers? Select all that apply. a. Expanded younger workforce b. Female workforce increasing c. Increase in minority workers d. Job shifts to manufacturing e. More racially diverse workforce

bce

Which of the following are the primary reasons that employers have increasingly focused on ensuring a healthy and safe environment for workers (Select all that apply.) a. To fulfill their ethical and moral responsibility b. To avoid the cost of liability suits, workers' compensation, etc. c. To maintain good public relations d. To meet legislated standards and avoid significant penalties for noncompliance

bd

A nurse keeps ongoing documentation of all the clients seen at the community health clinic. The nurse enters the demographic data and the primary diagnoses into the computer to have a comprehensive perspective of the clinic's clients. Which of the following best explains why the nurse is collecting this data? a. This data will be useful in a research study the nurse is conducting. b. This data will provide evidence of clinic resources being wasted on minor health problems. c. This data will help identify patterns in the risk factors associated with a particular subgroup. d. This data can be used to show trends that can be included in the next grant proposal for further funding.

c

An occupational health nurse is removing a foreign body from a patient's eye. Which of the following levels of prevention is being implemented? a. Injury prevention b. Primary prevention c. Secondary prevention d. Tertiary prevention

c

In which of the following settings have nurses most often reported being the victims of violence, especially by patients and their families? a. Acute care inpatient settings b. Community clinics and physicians' offices c. Emergency departments and psychiatric units d. In homes during home health visits

c

The occupational health nurse is aware that several employees from the accounting/finance departments are complaining about exhaustion, anxiety, and heartburn and notes an increase in absenteeism for these departments. On further exploration, the nurse learns that a new chief financial officer (CFO) has been in place for 1 month. The new CFO is demanding higher productivity and turnaround with expectations of working overtime and weekends to "get the job done" ahead of deadlines. The occupational health nurse, using the epidemiologic model, recognizes this as a psychological agent that can best be described as which of the following? a. Employment conditions b. Nonfatal violence c. Organizational culture d. Shift work

c

Which of the following interventions regarding worker safety would be the least effective? a. Using job rotation and workplace monitoring b. Designing equipment so that employee exposure to hazards is minimized c. Having employees use safety measures and personal protective equipment d. Designing the environment to encourage employees to follow workplace procedures

c

Which of the following would most likely be one of the first steps taken in employer disaster planning? a. All employees are invited to attend sessions on disaster planning. b. Employers stress the importance of disaster drills and encourage active participation. c. Exhaustive inventory of chemicals and industrial hazards is completed. d. Written disaster plans are distributed to each employee and each worksite.

c

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

c. "Tell me about any illnesses your other family members have." Physiological health involves issues related to physical wellness or illness. Other components of health in Neuman's model include psychological health, sociocultural health, developmental health, and spiritual health. Asking about coping and support addresses psychological health, not physiological health. Inquiring about the behavior of the other children addresses developmental health.

Which of the following explains why some occupational health specialists are very concerned about chemicals in the workplace (Select all that apply.) a. All chemicals are inherently dangerous to humans. b. Chemicals are often used when natural substances are equally effective. c. Effects of chemicals can be cumulative. d. Interactions of chemicals are typically unknown.

cd

A nurse is completing a health history on a client during a routine physical exam. Which of the following questions, which is often omitted, should be asked by the nurse? a. "How is your family doing" b. "What problems have you been having" c. "What health concerns do you have today" d. "Where do you work and what do you do there"

d

A nurse is interviewing a person who has stated on her entry health form that she is retired. Which of the following is the most crucial question for the nurse to ask? a. "Have you had any problems since leaving your employment" b. "How do you spend your time now" c. "What has retirement been like for you" d. "Where were you previously employed and what did you do there"

d

An occupational health nurse sees the various injuries and diseases that persons can acquire from employment. Which of the following recommendations would the nurse most likely provide about safety in the workplace? a. Find employment in physical labor; at least your body will be in good condition. b. Professional positions are the safest choice for employment. c. White collar positions provide the least risk for injury. d. There is no "safe" occupation or profession.

d

As the single occupational health employee at a company, a nurse is busy with safety programs and first aid when employees are hurt. However, the nurse still finds time to walk through the entire facility once a day. Which of the following best explains the rationale for this action by the nurse? a. To document employee efficiency and effectiveness at their jobs b. To look for evidence of personal protective equipment being torn or destroyed c. To observe whether employees are taking their rest periods as scheduled and drinking adequate fluids during the day d. To observe effectiveness of safety education and equipment

d

The difference between the Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH) can best be described as which of the following? a. NIOSH enforces workplace safety, and OSHA educates about occupational injury and illness prevention. b. NIOSH monitors work-related injury/illness incidence, prevalence, and prevention, and OSHA governs financial compensation under Workers' Compensation. c. OSHA is part of the Department of Labor, and NIOSH is part of the National Institutes of Health. d. OSHA sets the workplace safety standards, and NIOSH examines potential hazards of new work technologies and practices.

d

The occupational health nurse makes certain all employees have and know how to use personal protective equipment (PPE). Which of the following factors will most likely determine how effective the PPE is in keeping employees safe? a. Comfort level of the PPE b. Effectiveness of the nurse's teaching c. Knowledge level of the employee d. Psychosocial norms of the setting

d

The occupational health nurse suggests that an employee work only half-days for three weeks and then return to full-time employment. Which of the following best describes the rationale for this suggestion? a. To provide an example to other employees to ensure future cooperation with safety measures b. To enforce an economic penalty for not obeying nurse's instructions regarding safety measures c. To ensure that all employees keep their positions during an economic downturn d. To continue employment and income with limited duty as a rehabilitation effort after an injury

d

Which of the following is the most common disabling condition when measured by days away from work? a. Bruises b. Cuts and lacerations c. Mental illnesses d. Sprains and strains

d

Which of the following is the primary reason that large companies are becoming more involved in their employees' personal health and well-being? a. It is an ethical and moral responsibility. b. It improves public relations within the community. c. It allows managers to better understand their employees. d. It provides a cost savings to the company.

d