Chapter 10
Which concepts are likely to require changes in policy to see a shift in the health of a population? Select all that apply.
Social environment Physical environment Social environment and physical environment are the concepts most likely to require policy change to see a shift. Tobacco use and physical activity can be changed on an individual basis and often do not require policy change. Genetic makeup cannot be changed. The adequacy of a diet can be changed on an individual basis.
Which statement accurately describes governmental health insurance?
Funded through a payroll tax of most working citizens
Which are the key components of public health infrastructure that allow public health organizations at the federal, tribal, state, or local level to deliver public health services? Select all that apply.
A capable and qualified workforce Up-to-date data and information systems Public health agencies capable of assessing and responding to public health needs Rationale: The key components of public health infrastructure include a capable and qualified workforce, up-to-date data and information systems, and public health agencies that are capable of assessing and responding to public health needs. Politically active community members may be helpful but are not a key component. A nurse case manager's optimum education level is debatable. The basic nursing education for case managers required by employers can vary. Some require a baccalaureate degree, and others do not. In some settings, a master's degree is required.
According to Healthy People 2020, what are the components of public health infrastructure that enable a public health organization to deliver public health services at the federal, tribal, state, or local level? Select all that apply.
A capable and qualified workforce Up-to-date data and information systems Public health agencies capable of assessing and responding to public health needs
A health insurance company forms a group to raise money for donations that will be given to specific candidates. Which is the name of this type of group?
A political action committee Rationale: This describes a political action committee, which is organized for the purpose of raising and spending money to elect and defeat candidates. Most political action committees represent business, labor, or ideological interests. A coalition is composed of two or more groups joined to maximize resources, increase their clout, and better their chances of success in achieving a common goal; all of the members in this group are from the same organization. An organization is an organized body of people with a particular purpose; this could be a business, society, association, etc.
Administrative agencies are part of which branch of government?
All three branches
What are the core functions of public health? Select all that apply.
Assurance Assessment Policy development
Which steps should a new graduate nurse take to improve the nursing workforce to ensure more nurses are hired to address public health needs? Select all that apply.
Become politically active Act as a positive role model Keep informed on public health issues Rationale: Nurses are agents of change and can make a difference in public health initiatives and the nursing shortage by becoming politically active and remaining informed on issues. It is important for nurses to be educated on the Title VIII Nursing Workforce Reauthorization Act of 2017 and become active in its implementation. Likewise, being a positive role model/mentor to other nurses will encourage a larger voice through larger numbers. Fundraising for nursing education and using technology to create change, while useful, are not typically a primary means for addressing public health needs.
Which statement accurately describes the Constitution of the United States?
Free speech and freedom of religion are defined in the Bill of Rights. Rationale: The rights guaranteed in the Bill of Rights include free speech and freedom of religion. The Bill of Rights was added after the original articles of the Constitution and was ratified in 1787. The constitution not only set forth the responsibilities of the federal government, but it also provided for individual citizens' rights and freedoms. The Bill of Rights was not guaranteed within the states for 72 years. Originally, it only applied to the laws and actions of the federal government.
Which statement is true of common law? Select all that apply.
Can fill gaps in the law Law made by the courts Interprets the wording of statute law Useful when unforeseen situations arise that aren't covered by statutes Rationale: Common law can fill in gaps in the law. Common law is a law made by the courts, rather than by legislation. Common law interprets the wording of statute law and is useful in situations where circumstances arise that aren't covered by statutes. Common law is a law like those passed by legislation and can result in a court judgment that may award damages, punishment, sanctions, or other remedial actions.
Which is an example of a human rights violation? Select all that apply.
Contaminating water with waste from state-owned facilities Denying access to information and services related to sexual and reproductive rights Failure to prevent starvation Rationale: Human rights violations occur when the government fails to provide the infrastructure, services, and information necessary to promote health, reduce risk, and control disease. Examples of human rights violations include failure to prevent starvation, contaminating water with waste from state-owned facilities, and denying access to information and services related to sexual and reproductive rights. Not having colleges or universities within the vicinity and not having grocery stores with healthful food available would not be considered violations of a community's human rights.
Multiple groups, including the American Nurses Association and the American College of Nurse Practitioners, joined forces to raise funds for a national advertising campaign designed to recruit new nurses into the profession. Which kind of group was formed?
Coalition Rationale: A coalition is an alliance of organizations that join together for combined action. An organization is an organized body of people with a particular purpose, be it a business, society, association, etc. A lobbying group is a group of individuals who attempt to influence business and government leaders to create legislation or conduct an activity that will help a particular organization. A political action committee is an organization that raises money privately to influence elections or legislation, especially at the federal level.
Which example reflects how governmental powers are separated among the branches of government? Select all that apply.
Congress must present a bill to the president before it can become law. The president needs consent of the Senate to appoint Supreme Court justices. Rationale: Congress must present a bill to the president before it can become law, and the president needs the consent of the Senate to appoint Supreme Court justices. Although the president and members of Congress are elected, the judiciary is appointed. The president may nominate any individual to serve on the Supreme Court, but that person must receive confirmation by the Senate. Legislation is prohibited from interfering with the courts' final judgments. Federal courts will refuse to hear a case if they find that it presents a political question
Which is a law that governs society and holds authority derived from the founding documents of a country?
Constitution Rationale: A constitution is the grounding legal and democratic principles upheld by government, and the authority for a constitution is derived from the founding documents of a country. Policies describe how it is ensured that laws and regulations are applied consistently and fairly. Statutes are federal laws enacted by the U.S. Congress that have been passed as bills and must be followed by every state in the country. Regulations are a form of delegated legislation that provide detail on the administration of principles in the law.
In an ideal situation, which document guarantees the basic human rights of the people?
Constitution Rationale: Ideally, the basic human rights of the people will be guaranteed by a nation or state's constitution. A constitution is the grounding legal and democratic principles upheld by government. Policies describe how it is ensured that laws and regulations are applied consistently and fairly. Statutes are written laws passed by the federal government and can't violate a nation's constitution. Common law is unwritten law that is based on custom or court decision; it generally lacks provisions describing the obligation of governments to take active measures to promote and protect human rights.
Which is an example of a common law?
Doctor-patient confidentiality Rationale: A common law is a law based on custom, tradition, and court decisions rather than on written legislation. The doctor-patient confidentiality that binds a medical professional from disclosing what they know about a person's medical condition is an example of a common law. HIPAA is a law. Both mandatory training requirements for employees of nursing facilities and the Clinical Practice Guidelines on the window for tissue plasminogen activator are regulations.
Which is an overarching goal of Healthy People 2020? Select all that apply.
Create social and physical environments that promote good health for all Achieve health equity, eliminate disparities, and improve the health of all age groups Promote quality of life, health development, and health behavior across all life stages Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death The four overarching goals of Healthy People 2020 are (1) to create social and physical environments that promote good health for all; (2) achieve health equity, eliminate disparities, and improve the health of all age groups; (3) promote quality of life, health development, and health behavior across all life stages; and (4) attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. Measuring the impact of prevention activities and encouraging collaborations across communities and sectors are ways that Healthy People establishes benchmarks and monitors progress, but are not overarching goals.
Which enacts statutory laws passed by a legislative body at the state level?
General assembly Rationale: The general assembly executes statutory laws at the state level. Congress enacts statutory laws at the federal level. The state courts insulate against oppressive governance and professional malpractice, fraud, and abuse. Regulatory agencies are used to implement laws administered and enforced by the executive branch.
Which factor has most contributed to social change affecting the development of community health nursing practice?
Health insurance Health insurance is the biggest contributor to social change affecting the development of community health nursing practice. The role of nursing, the environment, and the health of the aggregate patient have also been influenced by health insurance and have had less effect on community health nursing practice.
Which is a strategic plan priority for the Centers for Disease Control and Prevention's (CDC) Strategic Framework? Select all that apply.
Improve health security at home and around the world Strengthen public health and health care collaboration Better prevent the leading causes of illness, injury, disability, and death Rationale: The Strategic Plan Priorities for the CDC's Strategic Framework are to improve health security at home and around the world; strengthen public health and health care collaboration; and better prevent the leading causes of illness, injury, disability, and death. Both achieve health equity, eliminate disparities, and improve the health of all age groups. Creating social and physical environments that promote quality of life, health development, and health behaviors across all life stages are overarching goals of Healthy People 2020.
What key goals of Healthy People 2020 are supported by public health infrastructure? Select all that apply.
Improving health Creating environments that promote health Promoting healthy development and behaviors
What provides the capacity to prepare for and respond to both emergency and ongoing threats to the nation's health?
Infrastructure Rationale: Infrastructure is the foundation for planning, delivering, and evaluating public health, and it provides communities, states, and the Nation the capacity to prevent disease, promote health, prepare for, and respond to both acute threats and chronic challenges to health. A treaty is a formally concluded and ratified agreement between countries. Public policies describe the principles on which social laws are based, such as the institution of wage-and-hour laws. A common law is a law based on custom, tradition, and court decisions, rather than on written legislation.
Which type of policy would institutional goals be categorized under for a community health clinic?
Institutional Institutional policies are rules that govern worksites and identify the institution's goals, operation, and treatment of employees, so goals and policies for the community clinic would fall in this category. Health policies are in response to a goal in health care and a plan for achieving that goal. Public policy works to address specific policy problems and governmental responses to them. Organizational policies are rules that govern organizations and their positions on issues with which the organization is concerned.
A policy that bans alcohol or tobacco use in the workplace is an example of which type of policy?
Institutional policy Rationale: A policy banning alcohol or tobacco use in the workplace is an example of an institutional policy, which governs worksites. Public policies describe the principles upon which social laws are based, such as the institution of wage and hour laws. Health policies reflect the decisions, plans, and actions undertaken to achieve specific healthcare goals within a society. Organizational policies dictate an organization's position on issues that involve them.
Which nurse was instrumental in the development of the Children's Bureau and associating the connection between health and social conditions?
Lillian Wald Rationale: Lillian Wald was a political activist in the early 1900s who recognized the connections between health and social conditions. She was a driving force behind the federal government's development of the Children's Bureau in 1912. Lavinia Dock was a prolific writer and political activist. She waged a campaign for legislation to allow nurses rather than physicians to control the nursing profession. Mary Breckenridge worked to develop nursing in rural Kentucky in the 1920s, establishing the Frontier Nursing Service. Florence Nightingale was asked to establish the first nurse corps to tend to soldiers in the Crimea War in the 1850s.
What agency determines an individual's status for disability benefits?
Social Security Administration
A nurse sends an email to other nurses to ask them to sign a letter that will be sent to a legislator in an attempt to get a clean-air bill passed. What is this activity called?
Lobbying Rationale: This activity is an example of lobbying, which occurs when an individual or group of individuals tries to influence or persuade legislators. Advocacy is when the nurse pleads the patient's cause or acts on the patient's behalf, with a focus on developing the community, system, and individual or family's capacity to plead their own cause or act on their own behalf. Social policy is the branch of public policy that advances social welfare and enhances participation in society. A political action committee is a nonpartisan entity that promotes the election of candidates believed to be sympathetic to their interests.
Which source should the nurse consult to find state election laws and procedures?
Office of lieutenant governor (state capitol) Rationale: The office of lieutenant governor would be the source for state election laws and policies, the legislative information telephone number, and campaign finance reports. The city clerk (city hall) would be an appropriate choice to get information about political jurisdictions for each household address. The secretary of state would be the appropriate source for state government operations and political subdivisions. The county clerk could provide the nurse with information related to local government operations, political subdivisions, the legislative information telephone number, local election laws and procedures, and local campaign finance reports.
The nurse is reviewing documents written with the intent of ensuring laws and regulations are applied consistently and fairly to all parties, including patients and employees. What type of document is the nurse reviewing?
Policies Rationale: Policies describe how it is ensured that laws and regulations are applied consistently and fairly. Statutes are federal laws enacted by the U.S. Congress that have been passed as bills and must be followed by every state in the country. Regulations are a form of delegated legislation that provide detail on the administration of principles in the law. Common law is unwritten law that is based on custom or court decision.
What benefits does the Patient Protection and Affordable Care Act (or Health Care Reform Act) have at the national level? Select all that apply.
Prohibits insurers from dropping policyholders when they get sick Prohibits insurance companies from placing lifetime limits on the dollar value of coverage Prohibits insurers from disallowing coverage for some individuals with preexisting conditions Rationale: The benefits of the Patient Protection and Affordable Care Act (or Health Care Reform Act) at the national level include prohibiting insurers from dropping policyholders when they get sick, prohibiting insurance companies from placing lifetime limits on the dollar value of coverage, and prohibiting insurers from disallowing coverage for some individuals with preexisting conditions. The act establishes high-risk pools to provide health coverage to individuals with preexisting conditions and requires health plans to cover some types of preventative care and screenings without consumer cost-sharing.
What benefit is provided by having a national public health infrastructure?
Provides a framework for addressing social determinants of health The importance of a national public health infrastructure is that it provides a framework for addressing social determinants of health. The emerging issues that have been identified by the public health infrastructure include accreditation of public health agencies, public health systems research, and public health law. Accreditation of public health agencies provides standardization of services and improved performance. Public health systems research is focused on expanding the evidence base for community interventions and for the effective organization, administration, and financing of public health services. Public health laws encompass policies that are being developed to address legal and political challenges resulting from new and re-emerging infectious diseases and increasing levels of chronic disease.
What duties and tasks are performed by the Centers for Medicare and Medicaid Services? Select all that apply.
Providing health insurance Regulating laboratory testing Improving the quality of care Developing coverage policies Providing oversight of the surveying and certifying of nursing home and continuing care providers Activities undertaken by Centers for Medicare and Medicaid Services include improving the quality of care, providing health insurance, developing coverage policies, regulating laboratory testing, and providing oversight of the surveying and certifying of nursing home and continuing care providers. The Centers for Medicare and Medicaid Services do not directly provide health promotion and wellness programs.
A ruling passed by legislation making it illegal for a child to be unvaccinated against specified health conditions is an example of which type of rule?
Public health law Rationale: A ruling that makes it illegal for a child to be unvaccinated against a specified health condition is an example of a public health law, which typically has three major areas of legal practice: (1) police power, (2) disease and injury prevention, and (3) the law of populations. Regulations are a rule or directive made and maintained by an authority, but it is not illegal if one fails to follow them. Public policies are objectives set by an organization or government. Policies help a government come up with proposed laws (bills). Common law is unwritten law based on custom or court decision; it is not passed by legislation.
Fluoridation of community water supplies is an example of which type of intervention?
Public health law Rationale: Fluoridation of community water supplies is an example of public health law and would fall under the area of practice of disease and injury prevention. A treaty is a formally concluded and ratified agreement between countries. A health policy defines a healthcare goal and a plan for achieving the stated goal. A public health law is the overall body of rules and regulations American industries are required to remain in compliance with. Institutional policies govern worksites.
A group of community health nurses are advocating for a law similar to New York's statute that requires every person in parental relation to a child to have the child vaccinated against childhood diseases such as poliomyelitis, mumps, and measles. For which type of policy should the group lobby?
Public health law Rationale: Requiring parents to immunize their children is public health law (New York State Public Health Law §2164) and should be lobbied for through legislation. Reporting of communicable diseases to state and local health departments, which then report them to the Centers for Disease Control and Prevention, is considered regulation. Health policy is a statement of a decision regarding a goal in health care and a plan for achieving that goal, such as inoculating a population against a disease. Social policy can be defined as the branch of public policy that advances social welfare and enhances participation in society.
Which should the nurse consult to find which bills are currently in process or have been legislated?
State representative or senator office Rationale: A state representative or senator could provide information regarding bills that are in progress or have been legislated. The congressional directory contains short biographies of each member of the Senate and House. Congressional Quarterly Weekly Report contains the congressional terms of service. The government documents section of selected public or university libraries can provide information about congressional committee assignments.
Which statement is true of statutes? Select all that apply.
Statutes are how states define the rules necessary to maintain social order and justice. The authority of a statute is derived from the constitution and founding documents of a state. Statutes develop over time as new laws are adopted and existing laws are amended. Rationale: Bills are developed over time as new laws are adopted and existing laws are amended. Once these bills have passed, they become statutes, which are laws that must be followed by every state in the nation. Amendments are not only allowed but are usually added to a bill before it is submitted for final approval. A committee studies the bill in detail, may receive witnesses, and holds public hearings before recommending amendments. Statutes are used by states to define the rules necessary to maintain social order and justice. It is true that the authority of a statute is derived from the constitution and founding documents of a state; a statute cannot violate the constitution. Statutes are laws; in fact, they are federal laws enacted by the United States Congress that have been passed as bills and must be followed by every state in the country.
Which statement regarding the process by which a bill becomes a law is correct? Select all that apply.
The chief executive must approve a bill that has moved successfully through the legislative process. In 49 of 50 states, a bill must succeed through the House of Representatives and the Senate to become a law. Rationale: A bill that has moved successfully through the legislative process must get the chief executive's approval in the form of a clear endorsement with signature. In 49 of 50 states, a bill must succeed through both the House of Representatives and the Senate to become a law; the exception is Nebraska. Health legislation is very difficult to pass for numerous reasons, including that it is not easily quantified in economic terms and it is often costly to implement. It is always easier to defeat a bill than it is to pass one, so the opposition always has the advantage. If the president chooses to veto a bill, in most cases, Congress can vote to override that veto and the bill becomes a law.
What national healthcare recommendations for routine preventative care have been developed by a federal government body?
Vaccine administration Rationale: The Advisory Committee on Immunization Practices is the only federal government body that provides written recommendations for the routine administration of vaccines for children and adults in the civilian population. The American Congress of Obstetrics and Gynecologists has defined perinatal guidelines. The American Dental Association provides recommendations for preventative dental care. The American Cancer Society provides recommendations for breast cancer screening.
Which statements about The World Health Organization (WHO) are correct? Select all that apply.
WHO works to prevent and treat communicable diseases. WHO is concerned with environmental issues, such as nuclear contamination. Rationale: The WHO is concerned with both the prevention and treatment of communicable diseases and environmental issues. The WHO does not only focus on health conditions affecting adults but emphasizes promoting health throughout the life cycle. Health is no longer defined as the absence of disease or infirmity; it is now described as complete physical, mental, and social well-being. The WHO also targets noncommunicable diseases such as stroke and cancer.
