Pop Health Review Test 3

A nurse noted that of 18 children in a daycare center room, 5 became ill. Which of the following best describes a host factor that may be associated with this illness and who became ill? a. Some of the children were from very low socioeconomic families. b. Some of the children inhaled car exhaust while playing outside. c. The bacterial cause of the illness was easily removed by hand washing. d. The daycare center room was much warmer on three sides in comparison to the side with the floor to ceiling windows.

A Factors that must be considered as causes of outbreak are categorized as agents, hosts, and environmental factors. Host factors may be age, sex, race, socioeconomic status, genetics, and lifestyle choices. The cause of the illness and exposure to pollutants are considered agent factors, and the difference in temperature in the room is an environmental factor.

Which of the following led to the development of the National Health Quality Improvement Act? a. A very famous movie and television star died as the result of a medical error. b. The number of malpractice claims had increased. c. Media such as films highlighted the reality of current medical care. d. Publicity about a few unfortunate cases caused consumers to become concerned.

B In response to a growing number of malpractice claims in the United States, the National Health Quality Improvement Act of 1986 was established, which encouraged consumers to become informed about their practitioner's practice record and created a national clearinghouse of information on provider malpractice records. The media did not play a role in the creation of the National Health Quality Improvement Act.

Which of the following types of surveillance systems is being used when case reports are routinely sent to local health departments by health care providers and laboratories, where the data are then summarized and forwarded to those responsible for monitoring such reports? a. Active b. Passive c. Sentinel d. Special

B In the passive surveillance system, case reports are sent to local health departments by health care providers or laboratories. The case reports are summarized and forwarded to the state health department, national government, or organizations responsible for monitoring the problem, such as the CDC. In active surveillance, the health department nurse may begin a search for cases through contacts to determine the magnitude of the problem. Sentinel surveillance involves looking for trends. Special surveillance is developed when a particular type of data is sought.

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

B 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. The hospital administrator, national expert on cultural competency, and politician are most likely not as knowledgeable about this immigrant population as the Hispanic community leader.

A nurse attends a conference to learn more about public health surveillance. Why is it so important that the nurse be knowledgeable about this topic? a. Because nurses are employed in public health agencies b. Because nurses are often the first to recognize and respond to a problem c. Because nurses are responsible for ensuring that action is taken when necessary d. Because nurses are typically the ones to interact with the public and the media

B Nurses are often in the forefront of responses to be made in the surveillance process whether working in a small rural agency or a large urban agency; within the health department, school, or urgent care center; or on the telephone performing triage services during a disaster. It is the nurse who sees the event first. Nurses may work in a variety of community agencies, including public health agencies. Nurses will collaborate with others to take action as necessary; it would not be the sole responsibility of the nurse. A wide variety of public health professionals interact with the public and the media, not only nurses.

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.

B Objectives must be precise, behaviorally stated, and measurable. The response that describes mothers receiving nutrition counseling represents a specific, measureable behavior as an objective. Treatment in an acute care setting is not part of a community-oriented care plan. The objective that 95% of children will be immunized by 1 year does not precisely state which children (in a county? in the country?) and does not state which immunizations. (Some are not appropriate to give to children who are only 1 year old.) A 25% reduction by 2015 is a goal, not an objective.

A home-care nurse is encouraging the administration of the agency to increase their quality assurance efforts. Which of the following best describes a negative outcome from this activity? a. An agency deficiency may become visible. b. An individual may be found at fault and then become fearful of being involved. c. Some agency processes may be questioned. d. Employees at the agency will have to commit extra time to complete this process.

B Quality assurance (QA) focuses on the care a client receives within the system and is concerned with the accountability of the provider. A major problem with quality assurance efforts, done by the quality assurance team, is that individuals may be found to be at fault and hence may be fearful of reporting problems or errors. Total quality management/continuous quality improvement are concepts that give direction for managing a system of care, whereas quality assurance focuses on the care a client receives within the system. Continuous quality improvement focuses on processes and possible deficiencies of the organization as a whole so that everyone is involved.

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

D Feasibility means the program's viability, practicality, achievability, or likelihood of success. Everyone involved must be supportive for a program to succeed. What people think about the need for a program, or program feasibility, might differ among health providers, agency administrators, policymakers, and potential clients. Thus, it is important to get all who are involved to support the program.

The pharmacist sent up the wrong medication for the patient. The nurse filled out an incident report when the error was discovered. Which of the following best describes the likely outcome when the quality improvement team reviews the incident report? a. The nurse will receive a commendation for recognition of the error. b. The pharmacist will be disciplined. c. The pharmacist will be reported to the state pharmacy board. d. The CQI team will try to determine how the error occurred.

D In quality improvement, people are asked to help identify problems and seek ways to improve system performance. Providing additional recognition or discipline would not be appropriate steps within the quality improvement process. Ongoing quality improvement focuses on what led to the error occurring.

A child came to school coughing almost constantly. The next day, six other children in the same school room were coughing. Which of the following types of outbreak would the nurse suspect? a. Common source b. Mixed c. Propagated d. Intermittent

A A common source outbreak refers to a group exposed to a common noxious influence, in this case, the ill child who was attending school. A mixed outbreak is a common source outbreak followed by secondary exposures related to person-to-person contact. Intermittent source cases may be exposed over a period of days or weeks. A propogated outbreak does not have a common source and spreads gradually from person to person over more than one incubation period.

The staff was informed that a Quality Improvement Organization (QIO) would be making an unannounced visit in a few hours. Which of the following would the hospital nurse expect the QIO team to examine? a. Records of hospital admissions and scheduled procedures b. Nursing care plans of patients with unexpected problems (infections, falls) c. Discharge paperwork of patients discharged in the past 30 days d. Documentation of adherence to nursing standards of care

A QIOs are directed by the federal government to reduce hospital admissions for procedures that can be performed safely and effectively in an ambulatory surgical setting on an outpatient basis and to reduce inappropriate or unnecessary admissions or invasive procedures by specific practitioners or hospitals. Therefore, the QIO team would examine records to see whether the hospital admissions and all procedures performed were medically necessary. The QIO team would not evaluate nursing care plans, discharge paperwork, or adherence to nursing care standards as that is not the focus of this type of a team. Rather, their focus is on reducing hospital admissions.

following actions should the agency take to help ensure quality care within the institution? a. Ensure appropriate policies and procedures are followed. b. Employ highly recommended and credentialed professionals to give care. c. Use administrative action to ensure that quality care is given to clients. d. Write quality care plans for the most typical problems of clients.

A Quality assurance/quality improvement (QA/QI) programs remain the enforcers of standards of care for many agencies that have not elected to engage in a program of CQI. These activities are called assurance activities because they make certain that those policies and procedures are followed so that appropriate quality services are delivered. Without proper policies in place it may be difficult to ensure quality care is provided by the professionals employed by the agency. Administrative action is difficult without having policies in place to support such actions. Policies and procedures provide a broader scope of quality than a written care plan.

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 An unannounced dissemination of a biological agent may easily go unnoticed, and the victims may have left the area of exposure long before the act of terrorism is recognized. Therefore, the first and most important aspect is recognizing that an outbreak has occurred by noting the increase in people presenting with similar signs and symptoms. After the similar signs and symptoms have been detected, the next step is striving to identify the biological or chemical agent. Then the nurse will identify factors that place people at risk, implement measures to control the outbreak, and finally, inform the medical and public communities about treatments, health consequences and preventive measures.

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

A Collaborative practice models involving the community and nurses in joint decision making and specific nursing roles are required. Nurses must remember that collaboration means shared roles and a cooperative effort in which participants want to work together. These participants must see themselves as part of a group effort and share in the process, beginning with planning and including decision making. This means sharing not only the power but also the responsibility for the outcomes of the intervention. By having the community members involved in creating the health change it is likely they will have an increased awareness of the importance of health, an ongoing interest in the health of the community. These things should occur because the community is more educated about its health because of its involvement. Being involved will not necessarily result in improved family functioning so this consequence will most likely not occur.

When does disaster management begin? a. Before the disaster occurs b. During the disaster c. Immediately following the disaster d. During the recovery period

A Disaster management includes the four stages of a disaster: prevention, preparedness, response, and recovery. The first stage of prevention (or mitigation) occurs before the disaster occurs. Disaster management that occurs during the disaster is called response. Recovery occurs following the disaster.

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

B During the Honeymoon phase, survivors rejoice for their survival and may share their experiences and stories. First responders work tirelessly to save others during the Heroic Phase. Medical personnel experience exhaustion during the Disillusionment Phase. The community begins to rebuild during the Reconstruction Phase.

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.

A Mitigation refers to actions to prevent specific disasters from occurring or to reduce the severity of a disaster's effects if it cannot be avoided. Providing community educational programs on disaster preparedness is the only intervention that addresses mitigation. Requesting donations be sent to the affected area occurs during the disaster and is known as the response. Developing a notification procedure would occur as part of the preparedness stage. Depending on the timing of the recruitment, this would be part of either the preparedness or response stage.

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

A Primary prevention takes place before a condition occurs. Primary prevention occurs when one participates in developing a disaster management plan for the community. Secondary prevention occurs with at risk populations and is aimed at early diagnosis and treatment. Tertiary prevention occurs after a problem has already been detected or diagnoses. The development of a plan only addresses primary prevention, not the other levels described.

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

A Such an assignment allows for participant observation or the deliberate sharing in the life of a community. If the nurse lives in the community, activities such as participating in clinical organizations and church life and reading the newspaper give the nurse "observations" of the community's life. The nurse should care about the interventions that are performed regardless of where the nurse lives. The priority is that the nurse is knowledgeable of and can observe the community, the assignment does not have to do with the convenience of the nurse.

A nurse, after working 2 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.

A The fact that the nurse needs to continue to ventilate about the disaster, even after the family has quit listening, would suggest a delayed stress reaction that is not resolving and therefore warrants professional intervention. The nurse presenting at a college about the disaster demonstrates that the nurse is able to engage in conversations about the disaster after it has occurred. It is understandable that the nurse would return exhausted and moody. Indeed, concerns of major importance to family members may seem trivial when compared with problems the disaster victims were confronting.

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

A The program management process is similar to the nursing process. Program management consists of assessing, planning, implementing, and evaluating a program. The other steps are not part of program management. The process of program management, like the nursing process, consists of a rational decision-making system to help nurses determine the complete process of program development, implementation, and evaluation.

A nurse has identified a need to increase the quality assurance efforts within the home care agency. Which of the following has most likely occurred? a. Increased number of client complaints and injuries b. Increased costs of providing care c. Reduced number of incident reports d. Reduced government reimbursement (Medicare and Medicaid)

A The types of problems that may lead to increased quality assurance efforts include client complaints, injury, or death, poor documentation of care, with subsequent denials of reimbursement by third-party payers, lack of or inefficient service, and concerns about client or staff safety. Several factors may influence increased costs of providing care, which may or may not lead to it being a priority of increased quality assurance efforts. An increase in incidence reports, not a decrease, would lead to increased quality assurance efforts. Reduced government reimbursement may lead the agency to consider multiple aspects of care, which may or may not relate a need for increased quality assurance efforts.

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

A To do a program evaluation, first choose the type of evaluation you wish to do. After the type of evaluation to be done has been chosen, the nurse will identify the goal and objectives for evaluation, decide who will be involved in the evaluation, and finally, answer the questions related to the type of evaluation.

How does continuous quality improvement (CQI) differ from quality assurance? a. Quality assurance focuses on client care, whereas CQI focuses on system issues. b. Quality assurance focuses on system issues, whereas CQI focuses on individual client care. c. Quality assurance measures care at one point in time, whereas CQI is an ongoing issue. d. Quality assurance focuses on families, whereas CQI focuses on agency issues.

A Total quality management and continuous quality improvement are concepts that give direction for managing a system of care, whereas quality assurance focuses on the care a client receives within the system. Total quality management and continuous quality improvement focuses on system issues, and quality assurance focuses on individual client care. Quality assurance measures care at multiple points of time. Quality assurance focuses on care of the client, not families, and CQI focuses on management of the system of care.

In January, a nurse is listening to colleagues talk about the increase in depressed patients asking for help from their physicians recently. The incidence of complaints of depression was higher in the last month than in the previous 3 months. Based on this data, which of the following would be the next step for the nurse to take? a. No further action is necessary because depression is known to worsen during the shorter darker days of winter. b. No further action is necessary because this short-term increase may just be a statistical error or even just a mistaken impression by the involved nurses. c. Action should be taken because there must be some cause for this noted increase. d. Action should be taken because this increase may the beginning of an epidemic and should be investigated.

A Typically, any unusual increase in incidence should be investigated. But in the majority of cases the increased incidence occurs naturally and/or is predictable when compared with the consistent patterns of previous outbreaks. Many illnesses are seasonal. Seasonal affective disorder (depression) often worsens during the shorter periods of daylight in the winter. The nurse should recognize that depression can be seasonal and not attribute this problem to an error in the data that has been collected. Because this is being recongized as a seasonal problem, there is no need for the nurse to take action. However, the nurse should continue to monitor the data to make sure that this trend does not continue as the weather begins to warm and more hours of daylight occur.

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.

A Useful program objectives must include a statement of the specific behaviors desired, using 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. 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.

The quality improvement team reviews the records of clients on a monthly basis to determine whether protocols for pain assessment were followed. Which of the following best describes the major drawback to the team's approach? a. The client is no longer under the agency's care. b. It is difficult to compare documentation of care to standards of care. c. Records can be inaccurate or incomplete. d. Team members may disagree on whether the standards of care were met.

A With this approach, problems are identified only after clients have been discharged. Although the hope is that better care will be given to future clients, nothing can be done about the clients who received less than optimal care. Using a retrospective audit, it is possible to compare documentation of care to appropriate standards which should be established prior to the review. Records should be complete as it is important for nurses to document the care that they are providing.

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

A, B Eleven core competencies for the nurse and other health providers working in the community have been defined by the Council on Linkages Between Academia and Public Health Practice. Defining variables relevant to current public health problems and obtaining and interpreting information regarding risks and benefits to the community are two of the eleven core competencies. Implementing nursing care focuses on care for individuals and not the community; it is not one of the core competencies. Public health nurses have various roles within the community, they may or may not work for a public health department. It is not within the scope of public health nurses to be responsible to maintain these departments.

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.

A, C 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 plan ning models.

A community health nurse has been recently hired to work in an unfamiliar community. Which of the following persons would be the 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

A, D Informant interviews, which consist of directed talks with selected members of a community about community members or groups and events, are basic to effective data collection. Talking to key informants is a critical part of the community assessment. Key informants are not always those who have a formal title or position. Key informants often have an informal role within the community. Examples of informal key informants would include a member of a minority group who is listened to by other members of the group, a church leader, and a parent who is active and vocal about the school health curriculum. Key informants should be formal or informal leaders within the community. Based on the information provided, it is not known if the federal senators, representatives, and health board members fulfll these roles within the community.

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

B Evaluation begins in the planning phase, when goals and measurable objectives are established and goal-attaining activities are identified. Assessment involves getting to know and understand the community as the client. Implementation involves the work and activities aimed at achieving the goals and objectives. Evaluation is the appraisal of the goals and objectives that have been created.

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

A,B Gaining entry or acceptance into the community is perhaps the biggest challenge in assessment. The nurse is usually an outsider and often represents an established health care system that is neither known nor trusted by community members, who may therefore react with indifference or even active hostility. Entry into the community is critical. Often the nurse can gain entry by taking part in community events, visiting people in formal leadership positions, and clarifying community members' perceptions of health needs. While an activity such as volunteering is a positive action, it is not the most efficient way to become involved in the wider community. Completing physical assessments on individuals is an individual-based, not community-based intervention and would not be anticipated to be performed by the community health nurse.

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,B,D The nurse can list each possible intervention and then consider the resources or barriers to that particular intervention, the expected effect of each choice, the likelihood that the activity will help meet the objective and resolve the problem, whether others can be educated to implement the intervention, and the change process necessary to complete the objective. The primary interest should be the concern of the community, not the nurse's personal interests.

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 The primary reason community partnership is crucial is that community members and professionals who are active participants in a collaborative decision-making process have a vested interest in the success of efforts to improve the health of their community. The significance and effectiveness of partnership in improving community health are supported by a growing body of literature. Community partners do contribute time and money into programs, and most likely will increase the publicity for the program; however, this should not be the primary reason for including them in the partnership. Through the partnership, it is likely that the program will have increased success and better outcomes which should be the primary objective of the nurse.

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

B Disasters create the most devastation in developing countries. The people of low socioeconomic status suffer the most because their houses are less sturdy and they have fewer resources and less means of social security. The climate and location of the country does not relate to its risk of bearing the burden of disasters. Industrialized countries have a higher socioeconomic status and can better address disasters if they occur.

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

B Strategic planning involves the successful matching of client needs, with specific 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. Strategic planning addresses the client, agency, and provider. The other responses address only one of these factors not all three of them which all need to be considered during the strategic planning process.

A home health care agency has major problems but does not want consumers to know about these problems while the agency decides what should be done to improve them. Employees are not told to lie, but they are advised not to share information. Which of the following is the most likely outcome of this situation? a. As long as employees do not share what they know, the community will be uninformed. b. By law, comparative information will be available to the public via the Internet. c. Only a few informed persons will know about the problems. d. Secrecy will prevail unless the local newspaper does an investigative report.

B In 2003 the Home Health Care Quality Initiative (HHQI) was developed by the USDHHS to provide consumers with data on the quality of home health services. Home Health Compare, posted on the Medicare website, is a home health report card available to consumers nationwide. Because the information is available to the public via the internet, the community will be able to view this data at their will.

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 Symptoms of early stress and burnout include minor tremors, nausea, inability to concentrate, difficulty thinking, and problems with memory. Suppressing feelings of guilt, powerlessness, anger, and other signs of stress eventually will lead to symptoms such as irritability, fatigue, headaches, and distortions of bodily functions. It is normal to experience stress, but it must be addressed. The worst thing anyone can do is to deny that it exists. The American Red Cross recommends that the worker get enough sleep and take time away from the disaster (i.e., take breaks). The colleague should deal with his emotions now and not put them off to deal with later. The symptoms that are described relate to early stress and burnout, thus, not multi-tasking or drinking more water are probably not going to help relieve his symptoms.

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

B The client should be defined by biological and psychosocial characteristics, by geographic 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. In order to meet all criteria for defining a client that is to be served by the program, information about the biological and psychosocial characteristics, geographical location, and the problems addressed needs to be included. The incorrect responses do not contain all of this necessary information.

Several children were hospitalized for severe vomiting and diarrhea. Which of the following best explains why the nurse would continue to pursue the cause of the illness even after the children have been discharged from the hospital? a. So that the children's families know the public health department cared about them b. So that action could be taken to avoid any such future episodes c. Because the children's parents need to know whom to sue for their medical expenses d. To confirm that the symptoms were due to an infectious disease

B The objectives of an investigation are to control and prevent disease or death by identifying factors that contribute to the occurrence and implementing measures to prevent occurrences. In this case the nurse wanted to make sure children did not become ill again when it could be avoided. The further investigation of the illness is not to demonstrate caring on the part of the public health department, rather it assists with learning about what factors contributed to the occurrence. It is unlikely that the parents would sue for a hospitalization for severe vomitting and diarrhea. Also, there is no indication that there would be an individual or agency to sue for the symptoms that the child is experiencing. There is no indication as to what caused these symptoms, thus, the nurse would need to do further investigation to determine if they were related to infectious disease or some other contributing factor.

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 socioeconomic 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

B The ability to change is often directly related to higher socioeconomic status; a perceived need for change; the presence of liberal, scientific, and democratic values; and a high level of social participation by community residents. Not all communities are open to change. Ability to change is often related to the extent to which a community focuses on traditional norms. The more traditional the community, the less likely it is to change. A community that is open to change is likely to be open to changing current processes rather than focusing on traditon. Communities that are open to change typically have a high level of social participation by its residents.

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.

B A "do nothing" decision is always the decision with the least risk to the provider. 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.

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 geographic area d. When the event results in multiple injuries and deaths as well as property damage

B A disaster is any human-made or natural event that causes disruption, destruction, or devastation that cannot be relieved without external assistance. A disaster does not need to involve injuries or deaths. The devastation may not cover a broad area, rather the main concept of the definition of a disaster is that it can not be relieved without assistance.

Evaluation is under way 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?

B Summative evaluation is evaluation to assess program outcomes or as a follow-up of the results of the program activities. The goal is addressed in the question about statistics. Two of the options are examples of questions used for formative evaluation (satisfaction and problems with program implementation). The goal was not to decrease drinking of alcohol but to decrease driving when drinking alcohol.

Which of the components of the PDCA model and Donabedian's framework is the most crucial? a. Standard b. Outcome c. Process d. Structure

B The PDCA model and Donabedian's framework for evaluating health care programs, using the components of structure, process, and outcome, are useful in developing a quality assurance program. Outcome is the most important ingredient of a program, because it is the key to evaluation of providers and agencies by accrediting bodies, insurance companies, and Medicare and Medicaid through PROs, report cards, and other accrediting agencies. Standard, structure, and process are important parts of the PDCA model, but are not as important as the outcomes.

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

B The aim of tertiary prevention programs is to reduce complications from disease. Persons with diabetes mellitus already have the disease thus meaning that tertiary prevention would be implemented with this population. 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).

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.

B The effects on young children can be especially disruptive. They can resort to regressive behaviors such as sucking their thumbs, wetting their beds, crying, and clinging to parents. This regression is normal in response to the event. Regression is a normal response; thus, it is not necessary to recommend psychological counseling or behavior therapy. It would not be appropriate to explain to a 4-year old child that he/she should be "strong".

A nurse is invited to join the utilization review team to help the agency avoid giving unnecessary care. Which of the following difficulties would the nurse most likely confront as client records are reviewed? a. Alternative care options rather than agency care are often encouraged. b. Not all clients fit the pattern and need more care than guidelines suggest. c. The nurse suggests the agency provide guidelines to professionals giving care. d. The agency is now accountable to its clients and their families.

B The major disadvantage of utilization review is that not all clients fit the classic picture presented by the criteria used to determine approval or denial of care. Alternative care options are many times not considered as it is assumed that clients fit the criteria that has been established. Utilization review does not provide agency guidelines as to how to provide care. Utilization review focuses on avoiding providing unnecessary care not on accountability to clients and families.

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

B The nursing students should be prepared to offer a critique of the drill performance and suggest improvements for the next drill—or for an actual disaster. It would be unlikley that the students would be volunteers at the next drill as typically the agencies involved with disaster management are the ones who are coordinating and leading these activities. It is unknown if the student will ever be in the same type of disaster as what they completed the drill for, so their involvement may not change their response in the future. Writing a report and talking about feelings would not be helpful for the agencies to learn what they can do differently if an actual disaster was to occur.

Stakeholders developing a new community-oriented clinic plan want to include a quality assurance (QA) program. Which of the following would be the first step in measuring the structure component? a. Criteria that will be used to measure quality b. Philosophy and objectives of the organization c. Requirements of accrediting agencies d. Standards the QA program wishes to achieve

B The philosophy and objectives of an agency define the structural standards of the agency. Identification of standards and criteria for quality assurance begins with writing the philosophy and objectives of the organization. Criteria to measure quality including requirements of accreditors and standards of the QA program are not part of the structural standards of a quality assurance program.

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

B Triage is the process of separating casualties and allocating treatment on the basis of the victims' potentials for survival. The nurse will determine how seriously hurt individuals are and who should get care first, with the first priority being those who have life-threatening injuries but will probably survive if treated quickly. Although the textbook does not address the issue, because of the limited resources in a disaster situation and the fact that only the nurse is currently available to give care, seriously hurt individuals with head or chest injuries that have only a small chance of surviving are not treated. Those who do not have life-threatening injuries and are mobile and functioning are not given priority during the triage process.

Which of the following best describes one of the main problems in ensuring quality for health care in the United States? a. Consumers believe American health care is high-quality and the best in the world. b. Every hospital and health care agency has its own approach to data collection and documentation. c. Finances are the basis of clinical decisions, not quality of care. d. We all agree on what quality is but not on how best to measure it.

B Very little is known about quality of care in this country because a variety of definitions of quality are used and it is difficult to get comparable data from health care providers and agencies. All consumers, including private citizens, insurance companies, industry, and the federal government, are concerned about achieving the highest quality outcomes at the lowest possible cost. Consumers want more information about quality. Both consumers and providers have a vested interest in improving the quality of the health care system.

Which of the following disasters would implement disaster medical assistance teams (DMATs)? (Select all that apply.) a. Disaster that covers a broad geographic 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

B, C, D A presidentially declared disaster is one that requires implementation of disaster medical assistance teams (DMATs) because the disaster exceeds the capabilities of the involved state(s) to provide a timely and effective response. Such a disaster has the potential to cause a substantial number of deaths or injuries; substantial health and medical problems; or significant damage to the economic and physical infrastructure. The disaster may not cover a broad geographic area. The criteria for use of DMATs is that the disaster exceeds the capabilities of the involved state to provide a timely and effective response. This could occur in a small geographic area.

Which of the following describes the purpose of surveillance systems today? (Select all that apply.) a. To obtain data used to fight for increased budgets from taxpayers b. To evaluate the effectiveness of public health programs c. To monitor and reduce the incidence of chronic diseases d. To note and help prevent occupational exposure and diseases

B, C, D Although surveillance was initially devoted to monitoring and reducing the spread of infectious diseases, it is now used to monitor and reduce chronic diseases and injuries, as well as environmental and occupational exposures. With tight budgets, public health workers must know which programs should be developed and continued based on the most commonly occurring public health problems. Evaluation of the effectiveness of programs requires valid and reliable data. With limited budgets, suveillance systems are important. The taxpayer money should be used in the most effective and efficient ways possible. This involves monitoring the effectiveness of health programming, not asking for increased budgets from taxpayers.

A public health department becomes aware of an impending health problem before any problem is reported to the agency. Which of the following has most likely occurred within the community? (Select all that apply.) a. Doctors are feeling rushed as they interact with each patient. b. Emergency departments are notably busier than usual. c. Nurses are calling in ill to the local hospital. d. Pharmacists are discussing the increase in medication purchases.

B, D Syndromic surveillance systems were developed to monitor illness syndromes or events, as seen in such indirect measures as increased numbers of medication purchases, trips to physicians or emergency departments, orders for cultures or x-rays, and rising levels of school or work absenteeism. These may indicate that an epidemic is developing. Doctors feeling rushed and nurses calling in ill are not unusual events.

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 in the health agency b. Demographic data c. Education and school statistics d. Environmental factors

B,D To see the outcomes of chosen interventions, the nurse would examine changes in demographics, socioeconomic factors, environmental factors, health status, and/or use of health services. Changing in staffing patterns and education and school statistics would not be impacted by a change in the health problems in the community. Epidemiologic data and trends would be the best sources to examine to evaluate the change.

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.

C Any person who comes to a special needs shelter must be assessed by a nurse to determine whether this type of facility is appropriate. After it has been determined if the facility is appropriate for these people, the nurse can work with them as needed to limit equipment if there is limited space. Assessment of the physical concerns of the people, not the psychological conditions, should be the priamry concern of the nurse. The nurse would not be providing medical care at the shelter, rather, the nurse would provide assessments, referrals, assist the client to meet health care needs, keep client records, ensure emergency communications, and provide a safe environment.

A nurse considered copying last month's surveillance report and changing the date because the number of occurrences per month had not noticeably changed. Which of the following best explains why the nurse should continue to spend time collecting and reporting data that is always nearly the same? a. Because such data are legally required b. Because it is still part of the nurse's responsibilities, even if it is a waste of time c. To determine a local baseline rate and immediately notice any change d. To determine differences among communities in need for state assistance

C Disease surveillance generates knowledge of a disease or event outbreak patterns. Surveillance systems help nurses and other professionals monitor emerging infections and bioterrorist outbreaks. Surveillance provides a means for nurses to monitor disease trends to reduce morbidity and mortality and improve health. Disease surveillance is not part of a legal requirement. There are many useful purposes for surveillance including monitoring for emerging infections and disease trends. The purpose of the monthly surveillance report is not for comparison among communities, rather it is a description of what is happening within the local community.

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 Meeting with all interested community groups is the only way to keep the focus on the community rather than on individuals. Although it is not possible to know the nurse's goals from the nurse's behavior, giving care to select groups does not represent the whole community. Publicizing services increases knowledge but doesn't necessarily help eligible clients access care.

Which of the following organizations would direct nurses' response to a countywide disaster? a. American Red Cross b. Centers for Disease Control and Prevention c. Emergency Management Agency d. The local public health department

C The first level of disaster response occurs at the local level with the mobilization of responders such as the fire department, law enforcement, public health, and emergency services. If the disaster stretches local resources, the county or city emergency management agency (EMA) will coordinate activities through an emergency operations center (EOC). Generally, local responders within a county sign a regional or statewide mutual aid agreement to allow the sharing of needed personnel, equipment, services, and supplies. The American Red Cross may assist with disaster relief efforts, but this would not be the agency that would direct the response by nurses. The Centers for Disease Control and Prevention is a national agency and would most likely not be involved with a county-wide disaster. The local public health department may be involved in responding to the disaster, but this would not be the organization that is responsible for leading the response.

Which of the following best explains why evaluation of client outcomes resulting from nursing intervention is so difficult? a. Client records may not include appropriate data. b. Few tools exist to measure client outcomes. c. Many other factors can also affect client outcomes. d. Measuring client outcomes is extremely time consuming.

C The major problem with outcome evaluation is determining which nursing care activities are primarily responsible for causing changes in client status. In nursing, many uncontrolled factors in the field, such as environment and family relationships, have an effect on client status. Appropriate data should be included in all documentation that is recorded by the nurse. Multiple tools exist to measure client outcomes. With appropriate processes in place, it is not time consuming to measure client outcomes.

The quality improvement team reviews the records of clients on a monthly basis to determine whether protocols for pain assessment were followed. Which of the following best describes this activity? a. Accreditation review b. Concurrent audit c. Retrospective audit d. Utilization review

C The retrospective audit, or outcome audit, evaluates quality of care through appraisal of the nursing process after the client's discharge from the health care system. Accreditation is often linked to governmental regulations that encourage programs to participate in the accrediting process to be reimbursed for services. A concurrent audit is a process audit that evaluates the qulaity of ongoing care by examining the nursing process. Utilization review is used to ensure that care is needed and that the cost is appropriate.

Which of the following information can be gathered by reviewing a community health report card? a. Utilization of health care services in the community b. Demographic information of the community c. Leading causes of morbidity in a community d. Frequency of malpractice claims within a community

C The term community health report card refers to different types of reports, community health profiles, needs assessments, scorecards, quality of life indicators, health status reports, and progress reports. Community health report cards can be a useful tool in efforts to help identify areas where change is needed, to set priorities for action, and to track changes in population health over time. The report card may be used to track leading causes of morbidity and mortality in a community, looking at trends over time to see if public health interventions have improved health care outcomes. Utilization of health care services, demographic information, and frequency of malpractice claims in the community is information that is not found on a community health report card.

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?

C 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. Formative evaluation serves the purspoe of assessing if objectives are met or if planned activities are completed. This type of evaluation begins with an assessment of the need for a program and is ongoing as the program is implemented. The considerations of satisfaction, support, and cost are all issues that could be addressed in planning and ongoing assessment of the program.

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.

C When doing a windshield survey as part of community assessment, the nurse should observe two times: one during the day when people are at work and children are at school and a second time in the evening after work is done and school is out. It is likely that different things are occurring in the community when the nurse drives through the community at different times. Therefore, it is likely that the nurse will learn more about the community by doing this and not necessarily confirm previous findings. If the nurse was interested in writing down the results of the findings, the nurse could use public transportation or ride in a car with another nurse driving for more efficient documentation of her findings, this would not necessarily occur by the nurse driving through the community in the evening.

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 Choice of priority must depend on the community's awareness of the problem—and their motivation to improve it. Other bases for choosing include determining which individuals would be most affected, what benefits to the community would result, what might happen if the problem is not resolved, how much it might cost to address the problem, and how much support for or opposition to the problem seem likely based on community values and priorities. Rather than examining the issues from the perspective of the most disadvantaged residents, the nurse should look at the problem which affects the most individuals in the community who may or may not be disadvantaged. The cost of the problem will need to be addressed, but if the problem is not a priority to the community the agency may be wasting money addressing a problem that the community does not care to solve. If the nurse is unfamiliar with interventions to solve the probem, the nurse should collaborate with others to solve the problem. The priority should be the needs of the community, not the needs of the nurse.

Which of the following describes the principal problem with early efforts at ensuring quality of care? a. No one knows how to measure quality care. b. Professionals resisted and sabotaged such efforts. c. Standards emphasized structure, not process. d. There were no standards as to what represented quality care.

C Early efforts such as the National Health Quality Improvement Act of 1986 emphasized structure rather than process or outcome of care; hence, they did not really address the root issues of quality. Health care professionals are concerned with providing high quality care. Standards and measures are both in place to evaluate quality.

An agency is beginning to implement a general approach for quality improvement. Which of the following activities would the agency most likely implement? a. Customer satisfaction is assessed through the use of surveys provided to the client after each appointment. b. The health maintenance organization (HMO) provides incentives to personnel who complete in-house programs on customer service. c. The institution has received accreditation through The Joint Commission. d. The total quality improvement (TQI) team meets to examine how to make the registration process more efficient.

C General approaches to quality improvement seek to protect the public by ensuring a level of competency among health care professionals. Examples are credentialing, licensure, accreditation, certification, charter, recognition, and academic degrees. Customer satisfaction may play a role in achieving one of these general approaches for quality improvement, but is not one of the major approaches. Making the registration process more efficient may assist in achieving one of these general approaches, but is not one of the major approaches.

In which of the following situations would the nurse most likely use an active surveillance system? a. A newspaper wants to know the incidence of asthma in the community. b. A real-time ongoing communication channel is established to monitor a particular symptom. c. Several children become ill with gastrointestinal (GI) upset at one local school. d. The nurse is asked to report the incidence of a specific nonreportable common problem in the community.

C In active surveillance, the nurse may begin a search for cases to determine the magnitude of the problem (how widespread it is). An example would be when several school children become ill after eating lunch in the cafeteria or at the local hot dog stand, in which case, active surveillance would be used to investigate the possibility of food poisoning. In the passive surveillance system, case reports are sent to local health departments by health care providers or laboratories. The case reports are summarized and forwarded to the state health department, national government, or organizations responsible for monitoring the problem, such as the CDC. Special surveillance is developed when a particular type of data is sought.

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 Older adults react deeply to the loss of personal possessions because of the high sentimental value attached to the items. Family photos are a part of family history and are not replaceable. This type of a loss warrants psychological support. Homes and electronic equipment can be replaced, so the older adult may be able to eventally access loans to rebuild his home and replace his equipment. Because these things are replaceable, it is likely that that the older adult will be able to better cope with these losses than with something that is irreplaceable. Depending on the loss of the older adult, he/she may have a need for relocation rather than returning home.

A nurse is implementing tertiary prevention strategies as part of the quality management process. Which of the following best describes a strategy the nurse would have used? a. All new employees complete a program on fire safety that details what to do in the event of a fire. b. At the yearly employee picnic, teams compete in putting out trash can fires and in racing while carrying mock victims, using safe evacuation techniques. c. After evaluation of response to an actual fire, new procedures implemented in the fire response protocol are distributed to employees. d. Mock fire drills are carried out twice a year to assess response and readiness in the event of a real fire.

C Tertiary prevention involves activities that are carried out when evaluation indicates needed improvement. Thus, examining a response to an actual fire (it has already occurred) is an example of tertiary prevention. A program on fire safety is an example of primary prevention. The employee picnic activity and mock fire drills provide for evaluation of competency (screening) and are thus secondary prevention.

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. Define roles, responsibilities, and relationships critical to effective emergency preparedness d. Extend presidential power to act quickly upon weapons of mass destruction

C The National Response Framework, a successor to the National Response Plan, "helps define the roles, responsibilities, and relationships critical to effective emergency planning, preparedness, and response to any emergency or disaster." The NRF serves as a guide for conducting a nationwide all-hazards response that is flexible and adaptable and that links all levels of the government with nongovernmental organizations and the private sector. The U.S. Department of Homeland Security was developed in 2002 to develop and coordinate the implementing of a comprehensive national strategy to secure the United States from terrorist threats or attacks. Eventually, the NRF was developed within this department. The National Response Framework helps to provide a linkage for the Red Cross to other organizations, but does not assist with it carrying out its mission. The NRF does not change presidential power.

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.

C The comprehensive goal of program planning is to ensure that health care services are acceptable, equal, efficient, and effective. The other options are aspects of program planning, but they address only limited concerns.

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

C The level of community preparedness for a disaster is only as good as the people and organizations in the community make it. Although natural disasters cannot be prevented, much can be done to minimize further increases in accidents, death, and destruction after impact. A concise, realistic, and well-rehearsed disaster plan is essential for managing the response to disaster. Open, clear, and ongoing communication among involved workers and organizations is critical. A disaster planning meeting among community agencies would not impact the stability or functioning of the community. The communication among the agencies that are present may be improved; however, the group is meeting for a specific purpose so the overall communication may not change, and there may be agencies that are not represented at the meeting.

Based on projected increases in the number of older US 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

C The preactive stage is one in which assessment is based on the projection of a future need. The stages that are not being described are: 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.

What is the primary goal of total quality management? a. To confirm the high standards desired in patient care b. To discover and correct errors in task completion c. To focus on the client and teamwork d. To enable organizations to publicize their quality approach to patient care

C Total quality management is a management philosophy that includes a focus on client, continuous quality improvement, and teamwork. Under TQM, quality is defined as customer satisfaction. Quality assurance is the promise or guarantee that certain standards of excellence are being met for the client in the delivery of care. QI is defined as a structured approach to improving performance.

Which of the following is accomplished through the use of traditional quality assurance? a. Implementation of new techniques to improve outcomes b. Implementation of appropriate interventions for diagnosed problems c. Implementation of change when measured performance does not meet standards d. Implementation of research findings to ensure appropriate clinical treatment

C Traditional approaches to quality assurance are to focus on assessing or measuring performance, to ensure that performance conforms to standards, and to take action to bring about change when care does not meet standards. CQI involves comprehensive data analysis to detect process failures. Thus, implementation of new techniques, inteventios, and research findings would require ongoing evaluation of data which is accomplished through CQI not QA.

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

C When the emphasis is on the process dimension—usually the level of intervention of the nurse in community health—the best strategy is usually health promotion, such as various primary prevention strategies. The other responses represent the structure dimension of the community. Structure is defined as the services and resources within the community. This includes service use patterns, treatment data from various health agencies, and provider-to-client ratios.

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

C 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. Engaging stakeholders includes those who are involved in planning, funding, and implementing the program; those who are affected by the program; and the intended users of its services. When the nurse justifies conclusions, the conclusions of the evaluation should be validated by linking them to the evidence gathered and then appraising them against the values or standards set by the stakeholders. When focusing on the evaluation design, the nurse will describe the purpose for the evaluation, the users who will receive the report, how it will be used, the questions and methods to be used, and any necessary agreements.

The outpatient health care data show a notable increase in asthma over the numbers treated the previous year. Which of the following actions should the public health nurse take first? (Select all that apply.) a. Analyze educational health programs offered to the public last year. b. Congratulate the public health staff on the success of their asthma awareness program. c. Determine whether there are any other data sources that might confirm or dispute the apparent increase in asthma. d. Review data with the outpatient clinic staff such as confirming repeat visits versus newly diagnosed cases.

C, D Before drawing any conclusions, further data should be sought, including confirmation of the current data and their meaning. Data can be inaccurate or collected differently than in the past. What might have led to an increase? Are there other valid sources that might have relevant data? Should surveillance specific to asthma be established? Confirming the data by comparing it to other sources would be the priority. After this has been completed, the next steps would be for the nurse to look at the health programming and community awareness education that has taken place. It would be premature to look at the programming if the initial data obtained is not accurate.

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

D Disaster kit assembly for the home, workplace, and car, especially by nurses, occurs during the preparedness phase. Heightened inspection and increased security is part of the mitigation phase. Individuals should make plans for the provision of their pets through their own personal disaster planning; this would not be part of the community disaster planning. It would not be appropriate or feasible for the nurse to purchase personal protective equipment for all citizens.

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. Donating 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

D Disaster workers must know what kinds of populations they are attempting to assist. Thus, formal training related to disaster management and response would be important for the nurse to complete. Without having formal training and having official sponsorship, volunteers may not be able to be used. Lack of information or inaccurate information regarding the scope of the disaster and its initial effects can contribute to the misuse of resources. Often too many volunteers who lack official sponsorship convene at the site of disaster and are disappointed when their help cannot be used. Similarly, well-meaning people may send clothes and food to disaster sites. The unneeded contributions of food and clothing add to the stress of coping with the disaster, particularly if refrigeration and storage are not available. Although contributing to an organization like the American Red Cross is to be encouraged and commended, many fraudulent scam charities may pop up claiming to collect funds for the victims.

A nurse is assessing the structure of a community's health. Which of the following data will the nurse examine? a. The community's commitment to health 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

D Community health, when viewed from the structure of the community, is usually defined in terms of community characteristics, as well as services and resources. Indicators used to measure community health services and resources include service use patterns, treatment data from various health agencies, and provider/client ratios. The community's commitment to health is part of the process dimension of the community. Health risk profiles and vital statistics are part of the status dimension of the community.

A rural public health nurse is spending time reviewing death certificates. Which of the following best explains the purpose of this activity? a. To ensure that local causes of death are consistent with national causes of death b. To confirm that no local health problems are beginning c. To evaluate effectiveness of health promotion programs d. To obtain mortality data for the local area

D Mortality data are often the only source of health-related data available for small geographic areas. Vital statistics reports, such as death certificates, are reviewed. Useful information also comes from administrative data such as discharge reports and billing records. It is not necessary that the local causes of death are consistent with national causes, rather it is important the nurse be aware of the major causes of mortality in the community so that the needs of the community can be addressed. Mortality data can occasionally be used to evaluate the effectiveness of health promotion programs, but this would not be the primary purpose of reviewing death certificates. Other data can be used to detect the start of local health problems. Analyzing death certificates as the only means of examining local health problems would provide the nurse with data that is not current.

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.

D The interactive approach to assessing the needs of the community includes describing the problem using past and present data to project future population needs. Projecting a future need describes the preactive stage. The reactive stage defines the problem based on past needs identified by the client or the agency. The inactive stage involves defining the problem based on the existing health status of the population to be served.

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

D According to WHO, a community is "A group of people, often living in a defined geographical area, who may share a common culture, values and norms, and are arranged in a social structure according to relationships which the community has developed over a period of time. Members of a community gain their personal and social identity by sharing common beliefs, values and norms which have been developed by the community in the past and may be modified in the future." The correct answer includes aspects of people, place, and function or aims. In addition to sharing geographic boundaries and leadership, a community also has common values and interests. In addition to sharing a common bond, members within a community have to interact with one another. A group working together to confront a common problem only addresses the aspect of function; it does not address people or place

A wealthy factory owner says, "I don't care about the poor. I just want the best care available for me and my family. Why should I care whether other people get health care or not?" Which of the following would be the most appropriate response by the nurse? a. "If your employees are ill, who will do the work in your factory?" b. "You might catch a contagious disease from one of your employees." c. "You have a moral obligation to help those less fortunate." d. "Your personal insurance and tax costs will go up if your employees have to use community resources when they're ill."

D Because the speaker's primary concern is apparently money, an appropriate response must show that the factory owner will lose money if he doesn't support the health of others in the community. Everyone - consumers, providers, and those who pay the health care bills - benefits if people stay healthy. The focus should be on the larger community and not only on the work needing to be done at the factory.

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.

D Change for the benefit of the community client often must occur at several levels, ranging from the individual to society as a whole. Lifestyle-induced health problems cannot be solved simply by asking or encouraging individuals to choose health-promoting habits. Society also must provide healthy choices. Most individuals cannot change their habits alone; they require the support of family members, friends, community health care systems, and relevant social policies. Change in society is helpful for addicts to change their behavior. Many times certain aspects of society limit an individuals ability to make change on their own. Laws and policies within society must support individuals to make healthy lifestyle choices.

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

D Content-focused roles often are considered change agent roles, whereas process roles are called change partner roles. Change partner roles include those of enabler-catalyst, teacher of problem-solving skills, and activist agent. Teaching anger management skills to a group of teens in a halfway house demonstrates the use of a change partner role of teacher of problem-solving skills. Change agent roles stress gathering and analyzing facts and implementing programs. The nurse establishing an elder-care center is acting as a change agent. The nurses administering vaccinations and analyzing community problems are carrying out other nursing roles.

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 Data generation is the process of developing data that do not already exist, through interaction with community members, individuals, families, or groups. Such information might include the community's knowledge and beliefs, values and sentiments, and goals and perceived needs. Such data are collected by interviews and observation. Interviews with key informants provide data; the purpose is not to ensure agreement with the nurse's plan or confirm findings. The key informants are formal or informal leaders within the community and although they may have information to share about the community, it may not be important that they feel that they "own" the data.

The nurse admits uncertainty over how to address the needs of a group of clients. The long-term nurse in the area suggests that the nurse review published evidence-based clinical guidelines. How can the nurse know these guidelines are reliable? a. Because the agency supports their use. b. Because the guidelines have been published. c. Because the long-term nurse trusts them. d. Because they are based on research and expert opinion.

D Evidence-based practice guidelines are protocols or statements of recommended practice developed by professional organizations and based on scientific clinical data and research as well as expert opinion from extensive clinical experience. Such guidelines help a clinician in decision making. Scientific data is what makes these guidelines reliable, not the support of an agency, the fact that they were published, or that they are trusted by the nurse.

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.

D Perspectives on the program, or what people think about the need for a program, might differ among health providers, agency administrators, policymakers, and potential clients. These groups are considered the stakeholders in the program. Collecting data on the opinions and attitudes of all persons, whether directly or indirectly involved with the program, is necessary to determine if the program is feasible, if there is a need to redefine the problems, or if a new program should be developed or an existing program expanded or modified. If a new or changed program is to be successful, it must not only be available, but also be accessible and acceptable to the people who will use it. If community members do not accept the programming, it is unlikely that they will become increasingly positive about it or invite others to become involved. The public health agency could attempt to publicize and expand the program, but without the acceptance of the community it will most likely fail.

The nurse contacts participants who completed an educational program on breast self-examinations to see whether they have any questions and to determine whether they are doing breast self-examinations. 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

D Summative evaluation assesses program outcomes after the program is completed. Formative evaluation occurs on an ongoing basis while the program exists. Goal evaluation and final evaluation are not types of formal evaluation that are addressed in the textbook.

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. Surveys

D Surveys tend to be expensive when compared with other methods; therefore the nurse would want to consider other options if on a limited budget. Focus groups, community forums, and examination of community indicators are all low cost; however, they can all be time consuming.

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

D The aspect of program evaluation is sustainability—enough resources (usually money) to continue the program. Otheraspects of program evaluation include: adequacy — program addresses the extent of the need; effectiveness — ability to meet program objectives and the results of program efforts; impact —l ong-term changes in the client population.

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

D The nurse and the nurse's family are best protected by having the skills and knowledge to cope with a disaster, including details such as where families will reunite in the event of an emergency. The nurse should have his/her own copy of the professional license. It is recommended that a 3-day supply of water (1 gallon per person per day) be part of an emergency planning kit. Gloves, mask, and other personal protective equipment are recommended for the professional nurse to have available as an emergency supply

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

D The nurse uses previously gathered data because it saves time and effort. Many sources of data are readily available and useful for secondary analysis. Being familiar with the community before the assessment is important, however, being thoroughly oriented is not necessary. The nurse should become familiar with the community, not the goals and priorities of the agency. It is helpful for the nurse to better understand the community, but the main reason is to save time and avoid duplication of data that may already exist.

The management team of the Central County Community Health Agency wants to analyze the cost of homebound client services. Which of the following records are most likely to provide useful data? a. Clinical records b. Financial records c. Morbidity and mortality records d. Provider service records

D The provider service records include information about the numbers of clinic clients seen daily, home visits made daily, transportation and mileage, the provider's time spent with the client, and the amount and kinds of supplies used. The provider service record is completed on a daily basis by each provider and is summarized monthly and annually to indicate trends in health care activities and costs relative to personnel time, transportation, maintenance, and supplies. A clinical record is the client health record. This would contain health information for a single client, would not generally include clinic costs, and would be an inefficient source because it identifies service to only one individual. Financial records include extraneous items for the clinic as a whole. Extracting specific data will not be as easy, because they will be from the provider service record. Morbidity and mortality records would not be suitable in this instance.

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 The status of community health involving biological indicators is often measured by traditional morbidity and mortality rates, life-expectancy indices, and risk-factor profiles. Vital statistics are measures of community health status. Health care manpower (e.g., nurses, physicians) and health facilities (e.g., hospitals, clinics) are measures of community health structure. Community awareness is a measure of the process.

Which aspect of a biological agent is probably the most frightening to those exposed? a. Infectivity b. Invasiveness c. Pathogenicity d. Virulence

D Virulence refers to the proportion of people with clinical disease who become severely ill or die. It is assumed people could cope with illness but possible death is truly frightening for most. Infectivity refers to the capacity of an agent to enter a susceptible host and produce infection or disease. Invasiveness is the ability of an agent to get into a susceptible host. Pathogenicity measures the proportion of infected people who develop the disease.