POPS Exam 1: NCLEX Review Questions

Public health nursing practice is guided by the community's priorities as identified by community: A. Assessment. B. Diagnosis. C. Interventions. D. Planning.

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

A nursing diagnosis of Increased risk for delayed development, injury, and disease because of inadequate parenting by a primary parent experiencing depression would most likely indicate that the nursing process is being applied at the _______ level of practice and the _______ level of prevention. A. Individual/family + secondary. B. Community + primary. C. Community + secondary. D. Individual/family + primary.

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

A nurse planning a smoking cessation clinic for adolescents in the local middle schools and high schools is providing: A. Community-oriented care. B. Community-based care. C. Secondary care. D. Tertiary care.

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

A nurse manager recognizes that systems theory identifies that there is a social component within an organization that affects the overall functioning of the system. What indicator would demonstrate to the nurse manager that the social needs of an organization are being met? A. Most employees from the organization attend an annual holiday celebration. B. Separate eating areas for each discipline are set up in the cafeteria. C. Nurse managers are planning to move to a centralized area away from the care units. D. The summer softball teams are canceled due to lack of interest.

ANS: A Systems theory focuses on the needs and desires of people who work in the organization. Good attendance at a work-sponsored function indicates that staff enjoy interacting and are meeting social and relationship roles. Separating disciplines does not foster a sense of team. Moving administration away from staff limits interaction and informal conversations that build trust. Lack of participation in sponsored events such as a softball team indicates that staff relationships are not strong, and a social component is not being achieved within the work environment.

When there is evidence that supports a screening for an individual patient but not for the general population, the nurse would expect the United States Preventive Services Task Force Grading to be what? A. No recommendation for or against B. Recommends C. Recommends against D. Strongly recommends

ANS: A The United States Preventive Services Task Force Grading is an example of how evidence is used to make guidelines and determine priority. When there is evidence that supports a screening for an individual patient but not for the general population, there is no recommendation for or against screening the general population. Recommends is the grading when there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial. Recommends against is the grading when there is moderate or high certainty that the intervention has no net benefit or that the harms outweigh the benefits. Strongly recommends is the grading when there is high certainty that the net benefit is substantial.

Local officials have requested a program evaluation of a comprehensive teen sex education program offered in the local schools in preparation for annual budget-planning discussions. The public health nurse determines that the teen pregnancy rate has gradually declined over the years that the program has been in place. The nurse has also identified the evaluation plan that was articulated during the program planning phase. The best tool for demonstrating the efficiency of this program is: A. Cost-benefit analysis. B. Cost-efficiency analysis. C. Relevance assessment. D. School records audit.

ANS: A The efficiency of a program can be evaluated through a formative or summative evaluation. The evaluator may be able to determine whether a given program provides better benefits at a lower cost than a similar program, or whether the benefits to the clients justify the costs of the program (efficiency). Public health programs are usually recognized as having a net positive impact, and appropriate sex education can reduce the incidence of teen pregnancy by altering teen sexual behaviors. To perform a cost-benefit study, the evaluator must decide which costs and which benefits are to be included, how the costs and benefits are to be valued, and what constraints are to be considered (e.g., legal, ethical, social, and/or economic). Health programs involving politically sensitive issues such as teen sex education can benefit from the articulation of measures to determine costs, benefits, and constraints in the program planning phase.

In the middle of the nineteenth century, there was increased national interest in addressing public health problems and improving urban living conditions. Which of the recommendations of the Shattuck Report in Massachusetts represented major innovations in public health during that period (select all that apply)? A. Establishment of state health departments and local health boards in every town. B. Promotion of environmental sanitation and collection of vital statistics. C. Steps to decrease preventable disease and control smoking and alcohol use. D. Targeting of efforts solely on environmental hazards. E. Provision of supplemental food to low-income persons.

ANS: A, B, C The report published in 1850 by the Massachusetts Sanitary Commission called for major innovations, including establishment of a public health infrastructure; environmental sanitation; food, drug, and disease control; well-child care; health education; tobacco and alcohol control; urban planning; and preventive medicine education in medical training programs. This moved public health away from solely targeting environmental hazards to addressing communicable disease, which lay the foundation for an expanded public health role that included the use of public health nurses.

Which of the following are the best argument(s) for supporting community-as-client nursing (select all that apply)? A. Change for the benefit of the community-client must often occur at several levels. B. Changes in the health of individuals will affect the health of their communities. C. The idea of providing health-related care within the community is not new. D. The impact of the environment on health has long been established. E. Direct hands-on nursing care delivered to individuals or families in community settings is important.

ANS: A, B, C, D The idea that health-related services are provided within a community is not new. At the turn of the century, most persons stayed at home during illnesses. As a result, the practice environment for all nurses (such as community health nurses, public health nurses, and visiting nurses) was the home rather than the hospital. These roles continue to exist today. Early textbooks on public health nursing included lengthy descriptions of the home environment and tools for assessing the extent to which that environment promoted the health of the family members. By the 1950s, schools, prisons, industrial settings (occupational health), and neighborhood health centers were added to the list of sites for nursing practice. However, the practice became oriented toward direct-care services to individuals and families and began to lose the community/population focus. Today, direct-care services provided at the individual and family level are defined as community-based nursing practice if the target remains at the direct-care service level and the practice does not address overall community health issues (i.e., common community-related health problems). Presently, there is a resurgence in population-focused health care. Because of the findings from initiatives such as Healthy People 2010 and the World Health Organization's Healthy Communities and Cities, it is now understood that social change related to health behaviors and the use of health policy are more efficient and effective in improving health status overall.

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

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

Factors related to the determinants of health identified in Healthy People 2020 include which of the following (select all that apply)? A. Education and literacy. B. Genetic endowment. C. Gender. D. Culture. E. Social status.

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

The Association of Community Health Nurse Educators has called for increased graduate programs to educate public health nurse leaders, educators and researchers to address unmet community and neighborhood needs in such areas as (select all that apply): A. Immigrant and migrant health. B. Natural and human-made disasters. C. Potential bioterrorism. D. Student health. E. Rural health. F. Chronic disease management.

ANS: A, B, C, D, E, F Nurse-managed health centers have provided a range of innovative nursing services, including health promotion and disease/injury prevention to vulnerable populations that lack access to such services when existing organizations have been unable to meet their needs. New populations in communities continue to challenge schools of nursing, health departments, rural health clinics, and migrant health services. Although transfer of official public health services to private control has sometimes reduced professional flexibility and service delivery, in times of workforce shortages having a fully prepared workforce of graduate educated nurses can supplement the public system's ability to respond effectively and meet societal challenges of the time. Well-prepared nurses can seek successful strategies to meet the complex needs of today's vulnerable populations and public health challenges of the future, looking to history for inspiration, explanation, and prediction.

The early pioneers in public health nursing were instrumental in the founding of the National Organization for Public Health Nursing (NOPHN) in 1912. This organization served as the dominant force in public health nursing until 1952 and sought to standardize public health nursing education to ensure that nurses received more than hospital-oriented training. Other major accomplishments included what initiatives (select all that apply)? A. Collaborated to secure health insurance reimbursement for nursing services, such as postdischarge nursing care at home. B. Established public health nursing programs for military outposts in World War I. C. Provided matching funds to establish maternal and child health divisions in state health departments. D. Responded to the 1918 worldwide influenza pandemic in the United States. E. Supported nurse employment through increased grants-in-aid for state programs of home medical care.

ANS: A, B, D The NOPHN is credited with upgrading the profession of public health nursing and community-oriented practice through the advancement of an educational model that ensured university-based education in the principles of population-based care; with assisting the U.S. Public Health Service in the development of public health nursing programs for military outposts during World War I in collaboration with the American Red Cross; and with responding to the 1918 worldwide influenza pandemic in the United States by preparing volunteers to care for clients in the community when public health nursing personnel ranks at home were depleted because of the war effort in Europe. The Sheppard-Towner Act of 1921 provided federal matching funds to establish maternal and child health divisions in state health departments. The Federal Emergency Relief Administration supported nurse employment during the 1930s by increasing grants-in-aid for state programs of home medical care.

Which of the following are the major sources of information for program evaluation (select all that apply)? A. Community indices. B. Media reports. C. Program clients. D. Program providers. E. Program records.

ANS: A, C, E Both quantitative and qualitative methods may be used to conduct an evaluation. However, the strongest evaluation designs combine both qualitative and quantitative methods. Major sources of information for program evaluation are the program clients (especially user satisfaction information), program records (especially clinical records), and community indices (epidemiological data).

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

ANS: B An epidemic occurs when the rate of disease, injury, or other condition exceeds the usual (endemic) level of that condition.

The community planning board is attempting to determine if the clients and health care providers affected by a recent mental health outreach initiative are satisfied that the program interventions have accomplished the program's objectives and that clients have benefited from this program. The analysis model that is best designed to provide an estimate of costs to achieve an outcome is: A. Cost-benefit analysis. B. Cost-effectiveness analysis. C. Cost-efficiency analysis. D. Multi-Attribute Utility Technique.

ANS: B An evaluation of program effectiveness may help determine whether both providers and clients are satisfied with program activities, as well as whether the program met its stated objectives. A cost-effectiveness analysis is a subset of a cost-benefit analysis and is designed to provide an estimate of the costs to achieve a given outcome. Such an analysis can answer several questions: Did the program meet its objectives? Were the clients and providers satisfied with the effects of the interventions? Are things better as a result of the interventions? In cost-benefit analysis both the cost and outcomes are quantitative. In cost-effectiveness analysis the outcomes are both qualitative (satisfaction) and quantitative (cost).

A business executive develops flu-like symptoms 1 day after returning by air from a trans-Atlantic 2-day conference that involved lengthy meetings into the evening. The scenario best illustrates the interaction of: A. Host and agent. B. Host, agent, and environment. C. Risk and causality. D. Morbidity and disease.

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

The most important contribution made by Florence Nightingale to community-oriented nursing was: A. Development of the settlement house concept as a strategy to improve urban health standards. B. Expansion of the role of nursing to include health-promotion practices. C. Founding of the first district nursing association in England. D. Introduction of professional schools of nursing in the United States.

ANS: B Florence Nightingale introduced professional nursing education in 1850s England. She also introduced the concept that individual health depended on community health, which expanded nurses' focus from care of the ill to include a population-based approach, health promotion, and disease prevention. She differentiated "sick nursing" from "health nursing." The latter emphasized that nurses should strive to promote health and prevent illness.

The plan of care for a patient newly diagnosed with diabetes includes health promotion with the tertiary prevention measure of A. avoiding carcinogens. B. foot screening techniques. C. glaucoma screening. D. seat belt use.

ANS: B Foot screening is considered a tertiary prevention measure, one that minimizes the problems with foot ulcers, an effect of diabetic disease and disability. Avoiding carcinogens is considered primary prevention—those strategies aimed at optimizing health and disease prevention in general and not linked to a single disease entity. Glaucoma screening is considered secondary screening—measures designed to identify individuals in an early state of a disease process so that prompt treatment can be started. Seat belt use is considered primary prevention—those strategies aimed at optimizing health and disease prevention in general and not linked to a single disease entity.

A nurse is interviewing at an agency owned by a national religious organization that serves homeless and uninsured patients. A large poster display shows a proposed addition that would add 16 beds to the facility that will be funded from profits of the previous 3 years of operation. The nurse recognizes that the agency is most likely what type of agency? A. For-profit B. Not-for-profit C. Publicly-owned D. Investor-owned

ANS: B Many religious organizations are privately owned and administer not-for-profit health facilities, where profits are returned into the facility for improvements or equipment. For-profit agencies distribute profits to shareholders. Publicly-owned facilities are government supported and not linked to religious organizations. Investor-owned agencies would be for-profit agencies with profits distributed to investors.

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

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

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

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

A nurse is concerned about the accuracy of the purified protein derivative (tuberculin) test in screening individuals with tuberculosis exposure for followup chest radiography. The nurse's concern is related to which aspect of the test's validity? A. Reliability. B. Sensitivity. C. Specificity. D. Variability.

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

When planning a new community health center, a nurse will integrate knowledge of the nursing process and program management. The nurse's initial and most critical step for funding purposes would be: A. Finding the lay leaders in the community. B. Identifying the target population's health problems and needs. C. Outlining the major causes of mortality in the community. D. Prioritizing the community's problems.

ANS: B The program management process is parallel to the nursing process and consists of a rational decision-making system designed to help nurses know when to make a decision to develop a program (assessment and problem identification); where they want to be at the end of the program (goal setting); how to decide what to do to ensure a successful program (planning); how to develop a plan to go from where they are to where they want to be (implementation); how to know that they are getting there (formative evaluation); and what to measure to know that the program has successful outcomes (summative evaluation). Planning for effective and efficient programs must be based on determination of the needs of populations within the community. Identification of at-risk groups and documentation of the health needs of the targeted population provide the basic justification and rationale for the proposed program plan. Such documentation of needs is essential if funding will be sought to implement the plan. An assessment of health needs may be approached as either a community assessment or a population needs assessment.

The Social Security Act of 1935 was designed to prevent the re-occurrence of the problems of the depression. Title VI of this act provided funding for expanded opportunities for health protection and promotion. The most relevant strategy related to this objective for public health nursing was: A. Establishment of a frontier nursing service. B. Provision of funding to support employment and education. C. Provision of funding for research and investigation of disease. D. Institution of a district nursing model.

ANS: B Title VI of the 1935 Social Security Act provided funding for expanded opportunities for health protection and promotion through education and employment of public health nurses. More than 1000 nurses completed educational programs in public health in 1936. Title VI also provided $8 million to assist states, counties, and medical districts in the establishment and maintenance of adequate health services, which included increasing the number of public health nurses with appropriate educational preparation. Title VI also provided $2 million in funding for research and investigation of disease.

When the association between maternal alcohol use and low birth weight is being studied, the nurse investigator's failure to consider the variable of smoking could introduce bias into the observed association, because smoking has a correlation with both factors. This effect could best be described as: A. Causality. B. Confounding. C. Information bias. D. Selection bias.

ANS: B When looking for the existence of statistical association between some factor and a health outcome, the investigator must consider the three general categories of bias. Bias is a systematic error resulting from study design, study execution, or confounding. Bias resulting from the relationship of the outcome and the study factor with some third factor not accounted for in the study design is called confounding. In practice, one can often identify potentially confounding variables and adjust for them in analysis.

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

ANS: B, C, E Public health specialists often define problems at the population or aggregate level as opposed to the individual level. At the population level, public health specialists are usually concerned with more than one subpopulation and frequently with the health of the entire community.

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

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

When teaching a patient with a family history of hypertension about health promotion, the nurse describes blood pressure screening as _____ prevention. A. illness B. primary C. secondary D. tertiary

ANS: C Blood pressure screening is considered secondary prevention. It is a measure designed to identify individuals in an early state of a disease process so that prompt treatment can be started. Illness prevention is considered primary prevention. Primary prevention measures are those strategies aimed at optimizing health and disease prevention in general and not linked to a single disease entity. Tertiary prevention measures are those that minimize the effects of disease and disability.

The most important aspect of the nursing community assessment phase can best be described as: A. Analyzing and synthesizing data. B. Collecting and gathering data. C. Formulating a community nursing diagnosis. D. Identifying problem correlates.

ANS: C Community assessment is one of the three core functions of public health nursing and is the process of critically thinking about the community. It starts by defining the client in terms of person, place, and function. It is a logical, systematic approach for identifying community needs, clarifying community problems, and identifying community strengths and resources to address these problems. It involves collecting data to obtain usable information about the community and its health. Such data collection may include gathering existing data as well as generating new data. New data might be generated by performing secondary analysis of existing data, conducting surveys, and carrying out community reconnaissance. Both types of data are combined in a composite database that is then analyzed and synthesized to identify trends or themes. The analysis of data generates information about community health problems (needs for action) and community health strengths and abilities that can be drawn upon in tackling these problems. The nurse and the community, in partnership, identify the problems. This is the process of problem analysis, which seeks to clarify the nature of a given problem. The nurse identifies the origins and effects of the problem, the points at which interventions might occur, and the parties that have an interest in the problem or its solution. A community-of-interest focus group that contains both content and process experts, as well as the nurse, should review the information to identify problem correlates (factors that contribute to the problem) and explore the relationship between each factor and the given problem. Active community participation is critical for the data interpretation process, particularly problem identification. A community nursing diagnosis is the end product of assessment and clarifies who gets the care (community defined), states the community problem or risk, and lists the factors contributing to the problem (problem correlates); for example, "Risk of ___ among ____ related to _____."

A rural public health nurse is in the first phase of a community assessment to determine the community health status characteristics of the local county. This initial data gathering should most likely begin with which agency? A. County public health department. B. National Centers for Disease Control and Prevention. C. State vital statistics bureau. D. U.S. Census Bureau.

ANS: C Community health is characterized by status, structure, and process dimensions. Status or outcome involves biological, emotional, and social attributes. The biological (or physical) aspect of community health is often measured by traditional morbidity and mortality rates, life expectancy indices, and risk factor profiles. Data gathering is the process of obtaining existing, readily available data. These data describe the demography of the community but also include the vital statistics, such as mortality and morbidity data. The state bureau of vital statistics would be the best source, especially for rural counties that may not have biostatisticians at the county level. Raw data submitted to the state by the local community would be consolidated at the state level. All states have such bureaus.

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

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

Advantages of community health program planning include ensuring that available resources are used to meet the needs of the population and: A. Applying for grants. B. Identifying clients and soliciting board members' support. C. Identifying resources, activities, and needs. D. Increasing the visibility of the program.

ANS: C Community health program planning is population focused and puts on the well-being of the public above private interests. Systematic planning for meeting the needs of populations in a community has benefits for clients, nurses, employing agencies, and the community. It ensures that available resources are used to address the actual needs of people in the community, focuses attention on what the organization and health provider are attempting to do for clients, identifies resources and activities that are needed to meet the objectives of client services, reduces role ambiguity by giving responsibility to specific providers to meet program objectives, reduces uncertainty within the program environment, increases the ability of the provider and agency to cope with the external environment and anticipate events, allows for quality decision making, and provides better control over the actual program results. Identifying clients, soliciting board support, applying for grants, and promoting the actual program are steps in the implementation phase of program management.

In 1902, Lillian Wald introduced the concept of school nursing to address the problem of school absenteeism. The primary model for the school nurse program was to work with children in the schools and make home visits for the purpose of: A. Enforcing the department of health's rules and regulations. B. Excluding infectious children from the school environment. C. Providing and obtaining medical treatment for absent students. D. Providing shoes and clothing for students.

ANS: C In New York City in 1897, school medical examination focused on excluding infectious children from school. By 1902, more than 20% of children might be absent from school on any given day because no one focused on providing or obtaining medical treatment for absent children so that they could return to school. The first school nurses made home visits to teach parents and provide followup care to children absent from school.

A quality improvement committee is reviewing discharge surveys. Results show that patients and their families have difficulty finding departments and areas of the hospital. What action by the committee would best address this concern for the organization? A. Continue to review future surveys to monitor the situation. B. Give additional training to the receptionists and switchboard personnel to give better directions. C. Form a multidisciplinary committee to identify options to help travel through the hospital. D. Send a work order to the maintenance department requesting that brighter lights be installed.

ANS: C Successful organizations respect the input of all disciplines when searching for solutions for problems. Continuing to gather data delays solving a problem. There is no indication that verbal directions will solve the problem; additional measures may be required. Merely providing additional light may not solve the problem—multi-language signs or even remodeling may be identified by the committee as being needed.

The three components of the Intervention Wheel are: A. Communities, systems, and individuals/families. B. Interventions, color wedges, and levels of practice. C. Population base, levels of practice, and public health interventions. D. Populations at risk, populations of interest, and levels of practice.

ANS: C The components of the Intervention Wheel include population base, 3 levels of practice, and 17 public health interventions. The population-based component includes populations at risk and populations of interest. The three levels of practice include community, systems, and individual/family. The Wheel is colored coded at the intervention level, and the colors (red, blue, green, yellow, and orange) are grouped logically into wedges.

Interrelated concepts to professional nursing a nurse manager would consider when addressing concerns about the quality of health promotion include A. culture. B. development. C. evidence. D. nutrition.

ANS: C The interrelated concepts to professional nursing include evidence, health care economics, health policy, and patient education. Culture is a patient attribute concept. Development is a patient attribute concept. Nutrition is a health and illness concept.

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

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

A hospital organization is applying for Magnet status to show excellence in nursing practice. What components would indicate that the hospital is meeting Magnet principles? (Select all that apply.) A. The education budget for nursing has been cut to provide for new laboratory equipment. B. On average, 40% of new nurses are leaving within 1 year of hire. C. Nurses are active participants on all major hospital committees. D. Quality improvement projects are planned and evaluated by nurses. E. Patient care outcome data are reported in the annual executive board meeting.

ANS: C, D To gain Magnet status, an organization must show that nurses are active participants in the organization administrative structure, fully involved in quality improvement projects, and are recognized as a valuable resource.

Which community attribute is an indicator of a community's health status? A. Mean educational level. B. Location of health facilities within the community. C. Ratio of police to citizens. D. Suicide rate.

ANS: D Community health status (or outcome) involves biological, emotional, and social attributes. Biological attributes includes morbidity and mortality. The social attributes of health status include crime rates and functional levels. The emotional attributes of health status include consumer satisfaction and mental health indices. The suicide rate is one of the measures used when compiling mental health indices. Educational levels are part of the structure dimension (social indices). The physical attributes of structure include measures of community health services and resources, such as use patterns and provider-to-client ratios.

John Snow played a critical role in the development of modern disease surveillance when he: A. Devised a more statistically valid method of analyzing epidemiologic data. B. Discovered causal agents for anthrax, tuberculosis, and cholera. C. Tracked the incidence of tuberculosis in the tenements of New York City. D. Used geographic mapping to demonstrate the connection between water supply and cholera.

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

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

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

Promotion of the creation of immunization registries that combine immunization information from different sources into a single electronic record to provide official immunization records for schools, daycare centers, health departments, and clinics is a goal of: A. Community-level practice. B. Family-level practice. C. Individual-level practice. D. Systems-level practice.

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

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

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

A community-oriented nurse leader is working with a community partnership to improve access to services for the underserved by planning an expansion of the local community health clinic. This nursing intervention strategy is focused on which of the following community health dimensions? A. Environment. B. Health status. C. Process. D. Structure.

ANS: D The nursing intervention strategy is a component of the nursing process applied at the community level through community partnership. The intervention strategy is part of the planning phase. The intervention identified would relate to the structure dimension of community health. Structure is the dimension of community health defined in terms of services and resources.

The nurse in a newly opened community health clinic is developing a program for the individuals considered at greatest risk for poor health outcomes. The group is considered the A. global community. B. sedentary society. C. unmotivated population. D. vulnerable populations.

ANS: D Vulnerable populations refers to groups of individuals who are at greatest risk for poor health outcomes. The entire world is the global community. Sedentary refers to the lifestyles of people worldwide who have epidemic rates of obesity and many other related chronic diseases. Unmotivated population refers to the individuals who have not demonstrated interest in changing.