Unit 4 Test
The nurse is responsible for interviewing an individual concerning a contagious disease exposure report. Which must the nurse do first? a.) Select the specific questionnaire to use during the interview. b.) Review the information provided by the mandated reporter. c.) Develop a trusting nurse-client relationship. d.) Secure confirmation that the exposure actually occurred.
b.) Review the information provided by the mandated reporter. Prior to contacting an individual for an interview, the nurse should first review the information received from the mandated reporter for completeness. Selecting questionnaire, developing trust, and securing confirmation of exposure occur during the actual interview.
Which activity would the community health nurse be involved with at the primary level of prevention? a.) Screening b.) Partner notification c.) Immunization d.) Isolation
c.) Immunization Primary level of prevention activities would include education and immunization. Screening, partner notification, and case and contact investigation are secondary level of prevention activities.
A community health nurse is preparing a presentation for a community center group about crisis. Which of the following concepts about situational crises should be included in the presentation? Select all that apply. A) A situational crisis is a stressful, disrupting event arising from external circumstances that occur suddenly to a person, group, aggregate, or community. B) Situational crises can be predicted, expected, and planned. C) Situational crises are never positive. D) Situational crises often occur without warning. E) Situational crises occur to people because of where they are in time and space.
A, D, E Feedback: A situational crisis is a stressful, disrupting event arising from external circumstances that occur suddenly to a person, group, aggregate, or community. Situational crises often occur without warning. Situational crises occur to people because of where they are in time and space. Situational crises cannot be predicted, expected, or planned. Some situational crises arise from positive events such as significant job promotion or sudden acquisition of great wealth because the change makes increased demands on individuals who must make major life adjustments.
3. A nurse is providing an educational program about testicular self-examination (TSE). Which of the following would be the best learning objective for this program? a. Each participant will state why TSE is important and explain how to do it. b. Each participant will describe how to do TSE and discuss the dangers of testicular cancer. c. 90% of the men will correctly demonstrate testicular self-examination. d. 100% of the men will do a testicular examination correctly on a model.
ANS: C If the goal is to learn TSE, the best goal is for the person to be able to do TSE correctly. Being able to state why it is important is a helpful first step, as is practice on a model, but to be sure the person can really do the procedure, you need to allow practice time and feedback until the person can demonstrate the procedure properly.
14. The leader of an Alzheimers support group surveys the members of the group to determine the best time for the group to meet. Which of the following norms is being supported through this action? a. Group norms b. Task norms c. Maintenance norms d. Reality norms
ANS: C Maintenance norms create group pressure to affirm members and maintain their comfort. Maintenance behaviors include identifying the social and psychological tensions of members and taking steps to support those members at high-stress times. Maintenance norms often refer to things such as scheduling meetings at convenient times and in an accessible and comfortable space.
1. A member of a community weight-loss group has maintained a healthy weight for 2 years through healthy eating and daily exercise. Which of the following steps of the affective domain is this participant demonstrating? a. Analysis b. Application c. Evaluation d. Knowledge
ANS: C Steps in the affective domain have the learner doing the following in this sequence: (1) knowledge: receives the information; (2) comprehension: responds to what is being taught; (3) application: values the information; (4) analysis: makes sense of the information; (5) synthesis: organizes the information; (6) evaluation: adopts behaviors consistent with the new values. In this example, the individual has adopted the behavior and this has resulted in the ability to maintain the value of a healthy weight.
2. A nurse just finished teaching breast self-examination to a large group of women at a professional conference. During the session, she distributed literature and used culturally appropriate visual aids. However, the session was not as effective as it could have been. Which of the following was the most important thing omitted by the nurse? a. Time for audience members to ask questions and clarify the information b. Explanation of why culturally appropriate images are more acceptable c. Opportunity for the women to practice what they learned d. Use of simple language instead of printed material
ANS: C The learner must have opportunities to practice the new skills being learned. Provide practice sessions during the program because many people may not have the time, facilities, motivation, and/or support to practice at home what they have learned.
12. A nurse is meeting to discuss problems and solutions with a group of teenagers who have been newly diagnosed with diabetes. One teenager states, My mom found this particular brand of popcorn that has only 15 carbohydrates in the whole giant bag. Which of the following best describes the group purpose that is being served by the teenagers statement? a. Maintenance function of encouraging everyone to continue the discussion b. Maintenance function of helping everyone feel comfortable talking about food c. Task function of resolving problems about what to nibble during movies d. Task function of sharing information and resources
ANS: D A task function is anything a member does that deliberately contributes to the groups purpose. Members with task-directed abilities are attractive to the group. These traits include strong problem-solving skills, access to material resources, and skills in directing. The teenagers statement shared information about a good resource for the group.
Fomite
inanimate object (contaminated) (Rector, 2018, p.275)
13. A nurse invited all the teenagers who were newly diagnosed with diabetes to a group meeting to discuss issues they all had in common. One teenager replied, I dont know if I want to share all the problems Im having with strangers. Which of the following is the best nurse response? a. Don't share anything with anyone until youre comfortable doing so. b. I can understand what you are saying. c. No one will require you to do anything you dont want to do. d. The purpose of the group is to have a safe place to share problems with others who may be having similar problems.
ANS: D All the responses are empathetic and supportive. However, during the first phase, potential participants do not know whether they can trust one another. The primary task of the leader at this point is to clarify the purpose. Even though a statement such as Dont share anything until youre comfortable is supportive, the response explaining that the purpose is to have a safe place both recognizes what was said and clarifies the purpose of the group.
9. A nurse is planning an educational program about cardiovascular disease. Which of the following would be the optimal time for the nurse to elicit feedback from program participants? a. At the beginning of the program b. At the program midpoint c. Immediately following program completion d. Throughout the program
ANS: D Not only should learners receive feedback, but the educator should also elicit feedback from learners throughout the educational process. On the basis of the feedback that the educator receives from learners, the implementation and presentation of the educational program can be modified.
A neighborhood association group has asked the local nurse in community health for a class on environmental hazards. The nurse in community health has seen good information in the community health text and thinks about getting permission to copy some of the information. The most important thing the nurse should do before using copies of this material is to: a. assess the literacy level of the group. b. see how many plan to attend. c. see whether the group is ready to learn. d. secure a good space for a group meeting.
ANS: a
A nurse in community health is planning to begin a class to help mothers returning to work better cope with the stresses of multiple roles. The nurse would most likely use: a. an andragogical approach. b. a behavioral approach. c. an operational approach. d. a pedagogical approach.
ANS: a
Which of the following barriers are specific to the educator?Select all that apply. a. Fear of public speaking b. Low literacy c. Limited experience with the topic d. Lack of motivation e. Lack of experience with gaining participation
ANS: a, c, e
A nursing student prepares a treatment plan for a client that draws upon the student's understanding of pathophysiology and nursing practice theory learned in the student's coursework. This application of new information used in a different way demonstrates the educational principle of: a. affective domain. b. cognitive domain. c. events of instruction. d. principles of effective education.
ANS: b
A home health nurse receives a referral to educate an older adult client with diabetes in proper foot care. The nurse's assessment of the client determines that the client has poor eyesight that may affect the client's ability to learn and perform certain skills. Which educational principle is being examined? a. Cognitive domain b. Events of instruction c. Principles of effective instruction d. Psychomotor domain
ANS: d
Which of the following would the community health nurse identify as a drawback to retrospective reimbursement? A) Spending was limited to the most necessary tests and treatments. B) Services for sickness were encouraged rather than wellness. C) Consumers had to bear the increased accountability for cost containment. D) Payments for services were based on rates calculated from predictions.
B Feedback: Retrospective payment is associated with encouraging sickness care rather than wellness services. Physicians and other providers were rewarded financially for treating illness and providing for additional tests and services. Patients and providers often insisted on expensive or unnecessary tests and treatment. Neither consumers nor providers were accountable for containing costs. Retrospective payment involves reimbursement for a service after it has been rendered with payment of a fee occurring after the fact.
A community health nurse is reviewing the medical records of several families in the community who have experienced varying crises. The nurse identifies which of the following as developmental crises? Select all that apply. A) A windstorm that damaged 20 homes in a community B) Grandpa Jones dying at age 82 years C) A couple getting engaged D) The Smiths getting a divorce E) The Jones experiencing a home invasion F) Seven people dying in an automobile crash
B, C, D Feedback: Developmental crises are periods of disruption that occur at transition points during normal growth and development. Developmental crises, as a rule, do not occur suddenly. They are more evolutionary than revolutionary. Even the advancing, age, illness, or death of a grandparent or parent is a developmental expectation. However, the actual event may occur suddenly. Experiencing damage from a windstorm, a home invasion, or an automobile crash are situational crises.
After teaching a group of students about abuse and families, the instructor determines that the students have an understanding of this issue when they state which of the following? A) Less than 10% of women worldwide reported being physically abused by an intimate partner at some point in their lives. B) A woman's risk of intimate partner violence decreases during pregnancy, but increases once the baby is born. C) Intimate partner violence is a leading cause of morbidity and mortality in women worldwide. D) Intimate partner violence is a private matter and not a public health issue
C Feedback: Intimate partner violence is a leading cause of morbidity and mortality in women worldwide and is a public health issue. It is estimated that between 10% and 52% of women report being physically abused by an intimate partner at some point in their lives worldwide. A woman's risk of intimate partner violence increases during pregnancy with 44% to 48% of all women being abused at least once during the pregnancy.
When discussing the economics of health care with colleagues, the community health nurse addresses macroeconomic theory. Which of the following would the nurse include? A) Quantity of services available B) Consumer's willingness to buy services C) Aggregate perspective of economic stability D) Allocation of the available resources
C Feedback: Macroeconomic theory is concerned with the broad variables that affect the status of the economy as a whole, such as factors affecting aggregate consumptions, production, investment, and international trade. The focus is on the larger view of economic stability and growth, providing a global or aggregate perspective. Microeconomic theory addresses supply (quantity of services available) and demand (consumer's willingness to buy services) and study how allocation and distribution affect consumer demand for goods and services.
An instructor is preparing a class presentation on landmark health legislation. Which of the following would the instructor include as the most significant legislation that attempts to ensure access to health care for Americans? A) Social Security Act B) Hill-Burton Act C) Patient Protection and Affordable Care Act D) Omnibus Budget Reconciliation Act
C Feedback: Patient Protection and Affordable Care Act is expected to provide access to health care for 30 million Americans when fully enacted. The Social Security Act had tremendous consequences for public health with revolutionary welfare insurance and assistance programs, the provision of financial assistance to form state and local health agencies. The Hill-Burton Act (1946), Occupational Health and Safety Act (1970), and the Omnibus Budget Reconciliation Act (1981) are important acts that brought about changes in health care planning, safety, and funding.
Which one of the following statements about primary prevention for family violence is most accurate? A) The cycle of violence within the family cannot be interrupted. B) Persons who have been victims of family violence will repeat the behavior with others. C) Primary prevention includes planned activities undertaken by the nurse to prevent an unwanted event from occurring. D) It is not possible for the community health nurse to foster healthful practices that will counteract unhealthful influences.
C Feedback: Primary prevention includes planned activities undertaken by the nurse to prevent an unwanted event from occurring. The cycle of violence within the family can be interrupted, and persons who have been victims of family violence can learn to use more appropriate coping strategies. It is possible for the community health nurse to foster healthful practices that will counteract unhealthful influences.
Which statement regarding the potential impact of health care reform on community health nursing is most accurate? A) Health care reform does not affect community health nursing. B) Community health nurses know that outcomes research is unnecessary. C) Public health nurses can lead the effort in making health care more accessible to all citizens. D) Community health nurses will only be able to work in public health agencies.
C Feedback: Public health nurses can lead the effort in making health care more accessible to all citizens. Health care reform definitely affects community health nursing. Community health nurses recognize the importance of outcomes research to document the value of nursing interventions with at-risk populations. Community health nursing has important ties to both private and public health agencies.
After describing the Public Health Service to a group of students, which description would indicate the need for additional discussion? A) It offers consultation through national advisory health councils and special advisory committees made up of lay experts. B) The Secretary of Health and Human Services is ultimately responsible for it. C) The Secretary of Health and Human Services is an elected position. D) A major function is to administer grants and contracts with other government agencies.
C Feedback: The Secretary of Health and Human Services is a cabinet position. Cabinet positions are appointed by the President. The Public Health Service does offer consultation through national advisory health councils and special advisory committees made up of lay experts. The Secretary of Health and Human Services is ultimately responsible for the Public Health Service. A major function of the Public Health Service is to administer grants and contracts with other government agencies.
After a class on important historical influences on community health care, the students are asked to describe the impact of the Shattuck Report. Which response indicates that the students have understood the information? A) "It influenced the speed with which health-focused bills pass the legislature." B) "The report set up the organizational structure of the U.S. Public Health Service." C) "It emphasized sanitary progress forming the basis for current public health practice." D) "It de-emphasized the issues addressed in the Hebrew hygienic code."
C Feedback: The Shattuck Report, a landmark document, made a tremendous impact on sanitary progress addressing public health concepts and methods that form the basis of public health practice today. It had no effect on getting bills passed by the legislation nor was it involved in setting up the organizational structure of the U.S. Public Health Service. The Hebrew hygienic code, probably the first written code, was the prototype for personal and community sanitation.
1. When reporting the identification of a communicable disease and need for investigation, which of the following must be notified first? A) Centers for Disease Control (CDC) B) State health department C) Local health department D) National Reported Disease list
C Feedback: The local health department is the initial point of notification of a communicable disease investigation. Each local health department or agency will investigate the specific disease. The CDC is the federal agency that provides guidance and recommendations for each state health department. The state health department may be the primary agency or the guiding agency for local disease control policies. States use the National Reported Disease list as the guidance for State reportable diseases.
When describing the cycle of violence to a group of students, the instructor includes which of the following as occurring as the cycle continues? A) Frequency of the cycle slows B) Tension-building occurs less often C) Loving reconciliation lasts longer D) Acute battering occurs more often
D Feedback: As the cycle of violence continues, the frequency of the cycle increases, with the tension-building phase and the acute battering incident occurring more often, and elimination of the loving reconciliation phase. Without intervention, this shorter, more violent cycle becomes increasingly risk-filled, for outcomes that may lead to injury or maiming of a partner, incarceration, or death of a partner.
A community health nurse working at the local level is attending an in-service program about health care economics. The nurse asks the presenter, "Why do I need to know this information? My focus is my clients." Which response by the presenter would be most appropriate? A) "You are required to know this information because your agency receives government funding." B) "You might be in management one day and have to deal with cost control and reimbursement." C) "Although it seems foreign to you, it's an important topic that you might have to deal with someday." D) "This knowledge is important to the success of your practice and for the agency's survival."
D Feedback: At the local level (the community health nurse and the employing agency), health care economics is very important for survival. Resourceful use of time, talent, and materials will ensure that the services will be able to continue and that the agency stays viable. Government funding, a future role in management, and dealing with the issue in the future are inappropriate and do not emphasize the importance of the effect of health care economics.
Which of the following would be least appropriate for a community health nurse to include in a plan of care at the secondary prevention level for families who may need to respond in a case of crisis in the future? A) Teaching social problem-solving skills B) Helping women develop assertiveness skills C) Providing parenting classes D) Helping to reestablish as sense of safety
D Feedback: Helping to reestablish a sense of safety would be appropriate at the secondary level of prevention. Teaching social problem-solving skills, helping women develop assertiveness skills, and providing parenting classes are appropriate primary prevention level activities.
Which of the following statements about the core public health functions are true? A) Public health nurses practice as partners with other public health professionals within these core functions. B) Assessment involves the actual provision of services. C) Policy development relates to assessment. D) Assurance means that the public health agency must directly provide the needed services.
A Feedback: Public health nurses practice as partners with other public health professionals within these core functions. Assessment does not involve the actual provision of services (assurance does). Public policy development builds on data from the assessment function. Assurance is the process of translating established policies into services. This function ensures that population-based services are provided, whether by public health agencies or private sources.
Which of the following would the community health nurse identify as an act of sexual exploitation of a child? A) Child pornography B) Child molestation C) Fondling of child's genitals D) Vaginal penetration with an object
A Feedback: Sexual exploitation of children includes conduct or activities related to pornography that depict minors in sexually explicit situations and promotion of prostitution by minors. Sexual assault includes rape, gang rape, incest, sodomy, lewd, or lascivious acts with a child younger than 14 years of age (in most states), oral copulation, fondling of the child's genitals, penetration of the genital or anal opening by a foreign object, and child molestation.
Over the past century, many health-related changes have occurred affecting morbidity and mortality. As community health nurses assess and plan for services in the community, an understanding of which of the following changes would the nurses need to integrate into their plans? Select all that apply. A) High levels of chronic disease B) Shortened life spans C) Increased teen pregnancies D) Abuse of multiple substances E) Increased maternal mortality F) Multidrug-resistant diseases
A, C, D, F Feedback: Issues today include high levels of chronic disease, increase in teen pregnancies, abuse of multiple substances, and multidrug-resistant disease. Shortened life spans and increased maternal mortality were real issues in the 1900s but are significantly different today. With the shortened life span over 100 years ago, people were not living long enough to develop a long history of chronic disease. Maternal mortality was high 100 years ago as prenatal care and the technology of today did not exist.
In preparation for an examination on the history of family violence, a group of students reviews the various laws enacted for protection. The students demonstrate understanding when they identify which of the following as one of the earliest laws enacted? A) Child Abuse Prevention and Treatment Act B) Family Violence Prevention and Services Act C) Keeping Children and Families Safe Act D) Child Abuse Prevention and Treatment and Adoption Reform Act
D Feedback: In 1974, the Child Abuse Prevention and Treatment Act was passed, becoming Public Law 93-247 (PL 93-247). The Child Abuse Prevention and Treatment and Adoption Reform Act of 1978 was followed by the Family Violence Prevention and Services Act of 1984. Later, all three acts were consolidated into the Child Abuse Prevention, Adoption, and Family Services Act of 1988 (Public Law 100-294), and most recently, the Act was amended and reauthorized as the Keeping Children and Families Safe Act.
A community health nurse is developing a plan of care for families in crisis. Which of the following would be most appropriate for the nurse to include? A) Encourage clients to suppress feelings to minimize pain B) Avoid correcting distorted facts to reduce stress C) Allow clients to blame others for the crisis D) Help clients confront crisis
D Feedback: In a crisis, the community health nurse encourages clients to accept help by acknowledging the problem. The nurse should encourage clients to express their feelings openly, assist them in finding facts (distortions create additional tension that may lead to maladaptive responses), and avoid blaming others to promote responsibility for problem solving.
A community health nurse is designated as a "mandated reporter." Which of the following best describes this designation? A) The nurse must witness abuse and neglect before being mandated to report. B) The nurse commands that battered women report the abuse. C) The supervising community health nurse is responsible for reporting only known cases of elder abuse. D) The nurse must report any case of known or suspected abuse and neglect in children or elders.
D Feedback: The abuse or neglect simply needs to be suspected in order for the nurse to report. In most states the nurse can receive a jail sentence and a fine for not reporting suspected abuse. Reporters may never witness the actual abusive event, but they can often see the resulting damage. Each nurse follows through with reporting abuse and neglect cases she or he suspects according to the community's laws.
A community health nurse is engaged in provision of care to clients in a clinic setting at the local health department. This nurse is engaging in which core public health function? A) Clinical B) Assessment C) Policy development D) Assurance
D Feedback: The three core public health functions are assessment, policy development, and assurance. Assessment would involve assessing the community, policy development would involve helping to establish policies that will address the problems assessed, and assurance would involve making sure that the services indicated by policies (following assessment) are available to the community. Clinical is not a core public health function.
During a presentation at a local health department, a community health nurse discusses how society has changed over the past 100 years and the influence that these changes have had on the community's health care needs. Which of the following would the nurse include as a current societal event? A) Large disparity in male/female wages B) Rural to urban migration C) Rampant child labor D) Widespread violence
D Feedback: Today, society is faced with widespread violence and terrorism. Populated urban areas continue to loose people to the suburbs, while 100 years ago, people were leaving rural areas for urban areas. A century ago child labor laws were just forming and child labor was rampant.
A community health nurse is providing a community education program about suicide. Which of the following would the nurse include as a common method used by women? A) Hanging B) Firearms C) Vehicle crash D) Overdose
D Feedback: Women usually choose less violent methods, such as overdosing on medications. Men choose more violent forms of suicide, such as hanging, use of firearms, or vehicle crashes.
Is the following statement TRUE or FALSE? Ebola hemorrhagic fever is a communicable disease used for bioterrorism.
FALSE Ebola hemorrhagic fever is a globally emerging communicable disease. Anthrax and smallpox are infectious diseases associated with bioterrorism.
Is the following statement TRUE or FALSE? Malaria is a disease that has become controlled globally.
FALSE Malaria still presents a global health problem.
A community health nurse suspects Munchausen syndrome by proxy when a child A) experiences "seizures" only when a parent is present, not if a third party is present. B) has stunted growth and shortened limbs that have been noticeable since birth. C) has a noticeable limp when wearing shoes but not in bare feet. D) has periods of "acting out" and misbehaving, especially when there is company.
A Feedback: Experiencing seizures only when a parent is present would be a "red flag" for this syndrome if it were occurring in a child. Stunted growth, limp, or acting out are not associated with Munchausen syndrome by proxy.
When assessing a family in crisis, which of the following would the community health nurse need to do first? A) Assess the nature of the crisis B) Determine client's perception C) Define available supports D) Assess coping abilities
A Feedback: Initially, the nurse must assess the nature of the crisis and the client's response to it. Next, the nurse focuses on the clients' perceptions of the event. Then the nurse determines who is available for support to the individual or family. Finally the nurse assesses the clients' coping abilities.
When describing managed competition as a potential solution to resolve the health care crisis, which of the following would be included? Managed competition would A) promote cost containment and universal access to health care. B) eliminate burdensome government regulations. C) reduce state and federal control over health care delivery. D) discourage consumers from making responsible choices.
A Feedback: Managed competition ideally would promote cost containment and universal access to health care. Governmental regulations and control would still be present as would insurance companies. Managed care would encourage consumers to make responsible choices.
After teaching a community group about the Medicaid program, which of the following would indicate to the nurse that additional teaching is necessary? A) Medicaid has a monthly fee that recipients must pay. B) Medicaid is administered individually by each state. C) Medicaid focuses on preventative services. D) It is possible to be on both Medicare and Medicaid.
A Feedback: Medicaid monies come to the states from the federal government. Each state determines who will receive what kinds of health care services. This makes it a uniquely different program in each state. Medicaid is a free program available to individuals on the basis of financial need and legal residency status. Medicaid has a major focus on preventative services, namely, infant, childhood, and elder immunization programs. Eligibility is determined on the basis of financial need and residency status. Finally, some low-income Medicare eligible people also receive Medicaid.
The nursing student reads the textbook in preparation for a class meeting about primary, secondary, and tertiary prevention related to families in crisis. The student determines which one of the following statements as most accurate regarding the levels of prevention? A) Often people in crisis are temporarily helpless and unable to cope on their own but are receptive to outside influence. B) Secondary prevention interventions include taking action to prevent the unwanted event from occurring. C) Tertiary prevention focuses on moving past the crisis and returning to the precrisis state. D) Primary prevention is the least effective level of intervention in terms of promoting client's health and containing costs.
A Feedback: Often people in crisis are temporarily helpless and unable to cope on their own, but understand the need for outside help and are receptive to other people's suggestions. Primary prevention, not secondary prevention, involves actions that help to prevent an unwanted event from occurring. Tertiary prevention focuses on moving past the crisis, although returning to the precrisis state may not be possible. Primary prevention is the most effective level of intervention in terms of promoting client's health and containing costs.
Which one of the following groups of actions fulfills the three core public health functions in their proper order? A) Counting the number of kindergarten students who are fully immunized, encouraging the school officials to exclude children who are not fully immunized, and offering immunization clinics at the school B) Identifying a source of pollution in the community, educating local residents about precautions that should be taken when the pollution exceeds minimum standards, and asking legislators to apply sanctions to the responsible party for the source of pollution C) Providing prenatal care for pregnant adolescents, determining how many pregnant adolescents currently attend the school, and encouraging school officials to provide an alternative school setting for the pregnant adolescents D) Lobbying for a citywide ban on smoking in public, providing smoking cessation services in the community, and reviewing mortality data to determine the number of people in the community who die each year from lung cancer
A Feedback: The three core public health functions are assessment, policy development, and assurance. Assessment is data collection, the policy development would be based on the assessment, and assuring is the process of translating established policies into services. Counting the number of kindergarten students who are fully immunized would be assessment, encouraging the school officials to exclude children who are not fully immunized would be policy development, and offering immunization clinics at the school would be assurance. Identifying a source of pollution in the community would be assessment, educating local residents about precautions that should be taken when the pollution exceeds minimum standards would be assurance, and asking legislators to apply sanctions to the responsible party for the source of pollution would be policy development. Providing prenatal care for pregnant adolescents would be assurance, determining how many pregnant adolescents currently attend the school would be assessment, and encouraging school officials to provide an alternative school setting for pregnant adolescents would be assurance. Lobbying for a citywide ban on smoking in public would be policy development, providing smoking cessation services in the community would be assurance, and reviewing mortality data to determine the number of people in the community who die each year from lung cancer would be assessment.
When reviewing the trends in communicable diseases for a county, the community health nurse notes that there was an increased incidence of Lyme's disease. The nurse develops a plan for prevention and control integrating the understanding that this disease is most likely transmitted by which mode? A) Vector B) Airborne C) Vehicle-borne D) Direct
A Feedback: In the United States, vector-borne illnesses have received renewed attention with accumulating information about Lyme's disease, transmitted to humans by a tick vector. Airborne transmission occurs through droplet nuclei, such as sneezing or coughing. Indirect or vehicle-borne transmission occurs when the infectious agent is transported via contaminated inanimate objects such as air, water, or food. Direct transmission occurs via the immediate transfer of infectious agents from a reservoir to a new susceptible host such as through touching, biting, kissing, or sexual intercourse.
Which of the following statements accurately describes important steps that a community health nurse must take prior to contacting an individual for an interview regarding communicable disease? Select all that apply. A) Review the information received from the news media reporter for completeness B) Review disease information including the reservoir, incubation period, infectious period, symptoms, and treatment C) Take all appropriate treatments to the interview site D) Investigate only laboratory confirmed communicable diseases E) Eradicate the disease
A, B Feedback: Steps to take prior to contacting an individual regarding communicable disease include reviewing the information received from the reporters for completeness (this refers to the individual reporting the communicable disease to the public health agency and not the news media reporter); clarifying that the disease is suspect or lab confirmed (some infections can be reported if they meet a set of clinical criteria or are part of a larger outbreak for which the case definition has been identified even without laboratory confirmation); review the case definition; review the disease information (including reservoir, incubation period, infectious period, symptoms, and treatment); and identifying the specific questionnaire for the reported disease or using a generic disease investigation form and reviewing the questionnaire. It is not appropriate for the community health nurse to take all treatments to the interview site as the goal of this interview is to assess. Community health nurses may investigate laboratory confirmed or suspected diseases. Eradication of the disease is the last step in investigating a disease, and interviewing an individual regarding communicable disease is one of the first steps in the process of investigation.
Which of the following are appropriate communicable disease prevention interventions that may be implemented by community health nurses? Select all that apply. A) Immunization of children and adults B) Disease investigation and case/contact finding C) Diagnosing cases of communicable diseases D) Prescribing treatment for communicable diseases E) Environmental interventions F) Community Education
A, B, E, F Feedback: Appropriate interventions that may be implemented by community health nurses include immunizations of children and adults, environmental interventions, community education, screening programs, and disease investigation and case/contact finding.
Which of the following would lead a community health nurse to suspect possible child neglect? Select all that apply. A) 15-year-old Lucy misses school once a week to watch her baby sister while mom works. B) 6-year-old Sam plays in the yard with a sweater on when it is 60 degrees outside. C) Twins, Bobby and Billy arrive at school in dirty and smelly clothing most school days. D) 11-year-old Samantha comes to school without lunch or lunch money each day. E) 9-year-old Tommy misses school two or three times a month due to asthma attacks. F) 14-year-old Jennifer watches her neighbor's 2-year-old every Saturday.
A, C, D Feedback: Educational neglect involves Lucy missing school to watch her baby sister and general neglect is evident for the twins and Samantha. Sam may be appropriately dressed based on how hard and long he is playing—he may be comfortable. Although Tommy is missing a number of days of school, he has a legitimate excuse. Fourteen is an appropriate and legal age to babysit.
A group of students are preparing for an examination on the various events serving as landmarks for health care legislation. The students demonstrate understanding of these events by identifying which of the following statements about particular landmark health legislation are true? Select all that apply. A) The Occupational Safety and Health Act provided protection to workers against personal injury or illness resulting from hazardous working conditions. B) The Shepard-Towner Act provided funds to states for hospital construction. C) The Hill-Burton Act provided funds to states for administration of programs to support the health and welfare of mothers and infants. D) The Social Security Act Amendments of 1965 addressed a concern for some version of national health insurance. E) The Omnibus Budget Reconciliation Act attempted to shift more power to states by consolidating categorical grants into four block grants. F) The Patient Protection and Affordable Care Act attempted to ensure the privacy of medical records.
A, D, E Feedback: The Occupational Safety and Health Act provided protection to workers against personal injury or illness resulting from hazardous working conditions. The Hill-Burton Act provided funds to states for hospital construction. The Shepard-Towner Act provided federal funds to states for administration of programs to support the health and welfare of mothers and infants. The Social Security Act Amendments of 1965 addressed a concern for some version of national health insurance. The Omnibus Budget Reconciliation Act attempted to shift more power to states by consolidating categorical grants into four block grants. The Health Insurance Portability and Accountability Act attempted to ensure the privacy of medical records.
Which of the following entities would the community health nurse know are required to report known or suspected cases of reportable diseases in every state in the United States? Select all that apply. A) Physicians, dentists, and nurses B) Laboratory directors C) Any individual who knows of or suspects the existence of a reportable disease D) Medical examiners E) Administrators of schools and child care centers
A, D, E Feedback: In most states, reporting known or suspected cases of a reportable disease is generally considered to be an obligation of physicians, dentists, nurses, and other health professionals; medical examiners; administrators of hospitals, clinics, nursing homes, schools, and child care centers. Some states also require or request reporting from laboratory directors; and any individual who knows of or suspects the existence of a reportable disease.
A community health nurse primarily works with mothers and their high-risk children, often referring them to various voluntary agencies for services. Which of the following would be examples of voluntary health agencies? Select all that apply. A) American Diabetes Association B) The U.S. Public Health Service C) The National Institutes of Health D) Women, Infant, and Children Program (WIC) E) National Society for Autistic Children F) Planned Parenthood Federation of America
A, E, F Feedback: The American Diabetes Association, National Society for Autistic Children, and Planned Parenthood Federation are examples of voluntary agencies supported by nonfederal funds and are nonprofit organizations. The U.S. Public Health Service, the National Institutes of Health, and the WIC program are federal agencies or receive federal funds to operate; thus they are not voluntary agencies.
15. A nurse established an ongoing group meeting of teenagers with diabetes. In the early stages, the nurse was very directive in arranging location, providing low-carbohydrate drinks and snacks, steering the discussion, and trying to meet all the teenagers needs. After the group had been meeting for about 3 months, the nurse noticed that the group members no longer simply accepted everything the nurse suggested. Instead, the teenagers began making decisions themselves, and eventually, the nurse no longer controlled the group. Which of the following most likely happened to cause this shift? a. The group became cohesive enough to share leadership tasks. b. Teenagers dont like feeling dependent on adults with power. c. Teenagers often rebel against adult authority. d. The nurse was overwhelmed and lost control of task process.
ANS: A In the beginning, the nurse used an authoritarian style because the nurse was responsible for the group direction. However, as the group matured, continuing an authoritarian style would have resulted in low morale and lack of cohesion. After a group is well established, nurses may best facilitate leadership by relinquishing central control and encouraging group members themselves to determine the norms for their group.
8. Which of the following statements regarding the Health Belief Model is accurate? a. Cues to action are an important component of the model. b. Multiple methods of education should be used when implementing this model. c. The first stage experienced in this model is the pre-contemplation stage. d. To successfully implement this model, ongoing maintenance of the behavior must be considered.
ANS: A The Health Belief Model includes six components that attempt to answer the question of what motivates an individual to do something. These components are perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. The pre-contemplation stage is part of the Transtheoretical Model. Maintenance is part of the Precaution Adoption Process Model.
10. When evaluating an educational program, the nurse discovers that only 25% of community members met the learning objectives. Which of the following parts of the program should be improved? a. Educator b. Content c. Learners d. Objectives
ANS: A Ultimately, the educator is responsible for the success or failure of the educational process and the development of learner knowledge, skills, and abilities. The educator determines how content can be tailored to the learner. The educator determines the objectives. If evaluation reveals that the learning objectives are not being met, the nurse must determine why the instruction is not effective. The educator is responsible for presenting the material creatively and meaningfully in new ways to increase learner retention and ability to apply the new knowledge.
11. A man says, I just cant get myself to leave the house and go for a 30-minute walk each day. I wish I could think of some way to motivate myself. Which of the following would be the best action for the nurse to take? a. Establish a written contract between him and his employer that states walking is required each day. b. Recognize the reasons why 30 minutes of walking each day is one of the best health promotion activities he can choose. c. Join a group that walks early each morning. d. Set up rewards for himself, such as a nice snack after he gets back from walking.
ANS: C Health behavior is influenced by the groups to which people belong. Having someone else to walk with is an effective way to maintain the behavior.
16. A group of teenagers with diabetes become upset and angry because they cannot agree on whether or not to have meetings during summer vacation. Which of the following should the nurse do to be effective in helping the teenagers resolve the conflict? a. Admit that it is difficult for everyone to agree on everything; then ask whether the group can try to decide how to agree on the issue. b. Assume adult authority and announce that meetings will be suspended until fall. c. Recognize that most of the teenagers want to have the meetings, but two are being stubborn; ask the two deviant members to leave the group. d. Suggest that the group avoid discussing it further but rather think about it over the next week and try to discuss the situation more rationally next week.
ANS: A When you respond to conflict by avoiding (suggesting that they avoid further discussion), forcing with power (assuming adult authority), capitulating, or excluding some members (asking the deviant members to leave), the behavior fails to satisfy the concerns of those involved. Open communication and recognition that conflict is inevitable may allow the group to focus on a procedure for fairly resolving the conflict.
4. A patient tells a nurse, I know all about this already. I read about it on the Internet. The patient then summarizes what he has learned. Because some of this information seems incorrect, what questions would be effective for the nurse to ask? (Select all that apply.) a. Were you able find what you wanted easily on the website? b. Did the website say when the information was updated? c. Did the website state who was responsible for the information? d. Did you enjoy reading the material on the website?
ANS: A, B, C To assess the quality of information, the nurse should attempt to find information about the authors, the purpose of the site (to share information or sell a product?), any available editorial reviews, the date of the material, the design of the site (easy to navigate? well organized?), etc.
1. A nurse has been making ongoing visits to a preschool to help the staff teach the children important skills, such as brushing their teeth after meals. Now the nurse is scheduled to teach carbohydrate counting to adults newly diagnosed with diabetes. Which of the following actions will the nurse need to take when teaching this population? (Select all that apply.) a. Appeal to the need for autonomy and choice. b. Emphasize that anyone with diabetes must know this information. c. Explain how to cope with being a guest at a dinner. d. Recognize that this audience will depend on the instructor to set goals for learning.
ANS: A, C For this audience, the best approach will be to use adult experiences and practical problems as learning motivatorsfor instance, appealing to adults sense of autonomy and choice, basing examples on practical adult situations such as cooking meals or eating in restaurants, and discussing how clients can cope with possibly awkward situations such as being a guest at dinner but having diet restrictions.
2. Which of the following characteristics must a learner possess to successfully master psychomotor learning? (Select all that apply.) a. The necessary ability to perform the skill b. An open mind to learning the new skill c. A sensory image of how to perform the skill d. Opportunities to practice the skill
ANS: A, C, D Psychomotor learning is dependent on the learners meeting the following three conditions: having the necessary ability including both cognitive and psychomotor ability, having a sensory image of how to carry out the skill, having opportunities to practice the new skill.
7. The nurse gives a very informative and engaging presentation and then gives everyone in the audience a handout that outlines the presentation. Later, the nurse discovers that many of the handouts were thrown away before the audience left the building. Which of the following educational principles has the nurse forgotten? a. Audiences expect PowerPoint or video presentations, not lectures. b. Many Americans do not have a high reading level. c. People want photographs and images, not wordy outlines. d. The nurse gave them too much information too fast for them to want to cope with it all.
ANS: B Although visual images are certainly helpful, this does not explain why the handouts were discarded. Most health information is printed at a tenth-grade reading levelyet the average U.S. adult reads at the eighth-grade level and 40% of adults over age 65 read below the fifth-grade level. If people cannot read or understand the material, they discard it.
4. A nurse planned a presentation about the latest trends in disaster planning for the senior nursing students at the local college. However, when the nurse began to share the information, the students were talking to one another and essentially ignoring the nurse. Which of the following actions should be taken by the nurse? a. Ask the students why they are being so rude. b. Explain why the information is crucial to their current clinical practice. c. Nothing; let the instructor of the course handle the problem. d. Tell a joke to get the students attention.
ANS: B Before learning can take place, you need to gain the learners attention. One way to do this is by convincing the learner that the information about to be presented is important and beneficial to them personally.
5. A nurse is using the technique of motivational interviewing when working with a client. Which of the following statements by the client indicates the client is ready to make the change? a. I should change. b. I am willing to change. c. Its important to change. d. I want to change.
ANS: B Motivational interviewing uses the term change talk to refer to statements by the client that he or she is motivated and willing to make change. An easy to use mnemonic is DARN-CAT which refers to desire, ability, reason, need, activation, commitment, and taking steps. I am willing to change demonstrates activation, a client who is ready, prepared, and willing to make the change. The other statements refer to the client who is preparing to make the change, but not yet ready to implement the change.
3. Which of the following strategies should be used when providing educational programs for children? (Select all that apply.) a. Emphasize how to build learning from previous experiences. b. Use simple words to enhance understanding. c. Use objects to help increase their attention. d. Emphasize the importance of the long-term consequences.
ANS: B, C When providing educational programs for children, the nurse should use more concrete examples and word choices; use objects or devices to increase attention; incorporate repetitive behaviors into games to help with knowledge retention and acquiring new skills.
6. A nurse uses lecturing as the primary method of educating clients. Which part of the education process is missing? a. Evaluation b. Experience c. Participation d. Understanding
ANS: C Educators should include participation. (This is one of the six principles of education.) Merely sitting and listening to someone lecture are not as effective as discussion, even when the presentation is stimulating, interesting, and dynamic.
Which of the following statements about Health Care Rationing is most accurate? A) It will not occur in the United States because of our country's values. B) A danger of rationing is compromising quality and effectiveness. C) Rationing in health care has never been practiced. D) Advances in knowledge and technological capabilities will eliminate the need for rationing in the future.
B Feedback: A danger of rationing is compromising quality and effectiveness. Rationing is already practiced in this country to some extent and for many years. Advances in knowledge and technological capabilities compound rationing decisions.
While visiting a family in their home, a community health nurse hears a parent screaming who says, "Everything you do is wrong. Can't you do anything right ever?" The nurse suspects which of the following? A) Neglect B) Emotional abuse C) Sexual abuse D) Physical abuse
B Feedback: Emotional abuse involves psychological mistreatment or neglect and may involve verbal abuse such as statements like, "Everything you do is wrong. Can't you do anything right?" Neglect occurs when physical, emotional, medical, educational resources necessary for healthy growth and development are withheld or unavailable. Sexual abuse involves acts of sexual assault or sexual exploitation of a minor. Physical abuse is intentional harm that results in pain, physical injury, or death.
When seeking employment, a community health nurse decides to focus the search on official health care agencies, based on the understanding that these agencies are A) voluntary. B) tax supported. C) proprietary. D) privately funded.
B Feedback: Official health care agencies, later called public health agencies, are tax supported; thus, they must provide services determined by the federal, state, or local government. Voluntary or private agencies are privately funded. Proprietary health services are privately owned and managed and may be for profit or nonprofit.
Which of the following statements best describes the difference between the function of public sector health care agencies and private sector health care agencies? A) Public sector health care agencies are more likely to pilot or subsidize demonstration projects. B) Private sector health care agencies are more likely to promote health legislation. C) Public sector health care agencies are more likely to generate new research and innovation. D) Private sector health care agencies usually focus on needs that are met.
B Feedback: Private sector health agencies are more likely to promote health legislation, whereas public sector health care agencies are more likely to be responsible for carrying out health legislation. Private sector health care agencies (not public) are more likely to pilot or subsidize demonstration projects and generate new research and innovation. Private sector health care agencies strive to detect unmet needs rather than met needs.
Which of the following statements best describes the difference between the function of public sector health care agencies and private sector health care agencies? A) Private sector health services are complementary and supplementary to government health agencies. B) Public sector health care agencies usually meet the needs of people with special needs. C) Private sector health agencies usually are constrained in developing innovations in health care. D) Public health sector agencies generally satisfy the health care needs of a community.
B Feedback: Private sector health services are complementary and supplementary to government health agencies, but this is not a difference between the two types of agencies. Private sector health care agencies usually meet the needs of people with special needs (rather than public sector health care agencies that focus on the entire population within their jurisdiction). Private sector health care agencies are less constrained than public sector health care agencies in developing innovations in health care. A part of the reason for the development of private sector health care agencies is the impatience or dissatisfaction with government (public health) programs.
After teaching a class about family and domestic violence directed toward children as a community health problem, which of the following if stated by the class indicates to the instructor that the teaching was effective? A) Family violence is new and occurs as a result of our fast-paced technological society. B) Family violence has occurred in most countries for centuries as children have been thought of as the property of their parents. C) Family violence occurs mostly in the urbanized areas of the United States mostly in the urbanized areas where exposure to crime is more prevalent. D) Family violence is decreasing in industrialized countries in the world as a result of more public awareness.
B Feedback: The history of family and domestic violence is long. For centuries, children were thought of as the property of their parents, and any treatment doled out by the parents was their prerogative. It is only fairly recently in history (early 1900s) that groups have become concerned and begun to do something about family violence. Family violence is brought to the attention of officials more frequently today than in yesteryear, especially in urban areas where more people live, but it occurs throughout the world—in urban, rural, and remote areas with no signs of decreasing. Family violence in the United States occurs mostly in the urbanized areas where exposure to crime is more prevalent. Family violence is decreasing in industrialized countries in the world as a result of more public awareness.
A group of families are attending a local community group for a class on Internet safety and children. Which of the following statements by the group indicates effective teaching? A) "It's not so much the time they spend but the sites they use." B) "We'll move the computer to the family room so we can easily observe the child's internet use." C) "We'll set the Internet browser feature to medium." D) "The firewall program that we have from 2 years ago should still be good."
B Feedback: To promote Internet safety with children, the computer should be placed in a high traffic area in the home so that others can easily observe what is going on. Parents need to monitor the time as well as the sites that the child uses. The Internet security browser should be set to high. With the advances in technology, a firewall program that is 2 years old may not be adequate to protect the child. However, it would be better than no firewall program at all.
When discussing elder abuse with a senior citizen group, which of the following would the community health include? A) Older men experienced abuse at a higher rate than elderly women. B) Types of elder abuse include physical abuse, emotional abuse, neglect, and exploitation. C) The majority of cases of elder abuse are perpetrated by persons unknown to the victim. D) Elders with dementia are less likely to be abused since they have less social interactions.
B Feedback: Types of elder abuse include physical abuse, emotional abuse, neglect, and exploitation. Older women experienced abuse at a higher rate than elderly men. The perpetrators of elder abuse may be either known or unknown to the elder. Some elders are especially vulnerable to elder abuse.
Which of the following statements about the international health organization is most accurate? A) PAHO is completely separate from the WHO. B) UNICEF promotes child and maternal health and welfare globally. C) WHO focuses primarily on developing countries. D) WHO and UNICEF are agencies of the United Nations.
B Feedback: United Nations International Children's Emergency Fund (UNICEF) promotes child and maternal health and welfare globally. The Pan American Health Organization (PAHO) is the oldest continually functioning international health organization in the world and predates the World Health Organization (WHO). Initially, the PAHO was independent from the WHO but is now the WHO regional office for the Americas and receives part of its funding from WHO. WHO focuses on the promotion of health worldwide, not just developing countries. The United States Agency for International Development (USAID) focuses on developing countries. WHO and UNICEF are both agencies of the United Nations.
Which of the following most well describes a public health care agency? A) The agency most often has a very specific focus. B) The agency is responsible for promoting and protecting the health of all within their jurisdiction. C) The agency only employs nurses and environmental health practitioners. D) The agency is able to perform its work independently with complete autonomy.
B Feedback: Unlike private organizations that tend to have a specific focus, government health agencies exist to accomplish a broad goal of protecting and promoting the health of the total population under their jurisdiction. Public health requires interdisciplinary and interorganizational collaboration.
A community health nurse is presenting a program about hepatitis prevention and risk reduction to a local community group. The nurse determines that the group has understood the program when they identify which method as the major mode of transmission for hepatitis B? A) Oral-fecal route B) Exposure to contaminated blood C) Airborne droplet nuclei D) Infected rodents, such as mice and rats
B Feedback: Hepatitis B can occur in certain high-risk groups, including injected drug users, heterosexuals with multiple partners, and homosexual men. Hepatitis A is transmitted by the fecal-oral route. TB is transmitted by airborne droplet nuclei. Hantavirus is transmitted via infected rodents.
As part of a community wide education program, a community health nurse is developing a teaching plan about Medicare. Which of the following would the nurse include in the plan? Select all that apply. A) It is a state health insurance program for elderly and the disabled. B) Medicare Part A covers medically necessary hospitalization, home care, hospice services, and limited-skilled nursing services. C) Medicare Part D covers prescription drug costs. D) Medicare Part A is supplementary and voluntary. E) Medicare beneficiaries can make changes to their coverage at any time.
B, C Feedback: Medicare is a federal health insurance program and covers citizens and some legal aliens who are over 65 years old (not a State program). It also covers people with permanent disabilities or chronic renal disease at any age. Medicare Part A covers medically necessary hospitalization, home care, hospice services, and limited-skilled nursing service. Prescriptions are covered under Medicare Part D. Medicare Part B is supplementary and voluntary. Medicare beneficiaries can make changes to their coverage during open enrollment periods.
Which of the following would a community health nurse expect to assess in a perpetrator of intimate partner violence? A) Occasional marijuana use B) High academic achievement C) Belief in male dominance D) Desire for complacency
C Feedback: Characteristics of perpetrators of intimate partner violence include a belief in strict gender roles, such as male dominance, heavy alcohol and drug use, low academic achievement, and desire for power and control in relationships
Which of the following statements about trends and issues influencing health care economics and community health services delivery are true? Select all that apply. A) The United States has the most cost effective health care system in the world. B) One explanation for the high cost of US Health Care System is the need to practice defensive medicine by ordering excessive tests and x-rays. C) In the United States, the health-related quality of life is lower than for most other countries. D) The United States ranks first among all WHO countries on a measure of how respectfully clients are treated. E) In a survey published in 2009, most US physicians identified that their health care system worked well.
B, C, D Feedback: The United States has one of the least cost effective health care systems in the world. One explanation for the high cost of US Health Care System is the need to practice defensive medicine by ordering excessive tests and x-rays. In the United States, the health-related quality of life is lower than for most other countries. The United States ranks first among all WHO countries on a measure of how respectfully clients are treated. In a survey published in 2009, most US physicians did not identify that their health care system worked well.
A community health nurse assesses a child during a home visit. Which of the following would lead the nurse to suspect that the child is a victim of sexual abuse? A) Bruising of the arms and back B) Evidence of numerous dental caries C) Complaints of pain on urination D) Burns on the hands and feet
C Feedback: A sign of sexual abuse would be complaints of pain on urination or defecation. Bruising on the arms and back and burns on the hands and feet would suggest physical abuse. Numerous dental caries may suggest neglect.
Vector
nonhuman carriers—such as mosquitoes, ticks, and lice—that transmit organisms from one host to another. (Rector, 2018, p.275)
Direct Transmission
occurs by immediate transfer of infectious agents from a reservoir to a new host. (Rector, 2018, p.272)
Indirect Transmission
occurs when the infectious agent is transported within contaminated inanimate materials such as air, water, or food. (Rector, 2018, p.275)
