Communities Final

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

C. "Rape isn't about love or even sex; it's about power and control." Intimate partner abuse is about control, not anger. The objective of abuse is to exert power and control over the victim

Which of the following factors would prevent a homeless person from accepting employment adequate to pay for housing? a. Could not complete an employment application because of lack of mailing address b. Hope for a better position than the service positions available c. Lack of adequate resources to pay for other necessities d. Prefer to receive a handout than to have to work

C. Lack of adequate resources to pay for other necessities There are homeless people who are able to function in the workforce. The lack of affordable housing in combination with insufficient income results in people having to spend much of their income on rent and leaves them without adequate resources for other necessities, such as food, clothing, and health care. This situation substantially increases their risk for homelessness.

Which of the following best describes a downstream intervention to solve the problem of homelessness? a. Improved use of community resources b. Increased employment opportunities c. Increased affordable housing d. Improved treatment of mental illness

D. Improved treatment of mental illness Building on McKinlay's "river" metaphor, McKinlay and Marceau (2000) purport that government and private efforts to address homeless health care problems largely focus on "pulling the bodies out of the river of homelessness." Such downstream interventions aimed at treating or alleviating health care problems, such as physical disease and mental illnesses, are worthy and needed. However, these interventions when used alone are far less adequate in alleviating homeless people's social health problems. To improve the social health of the homeless, it is necessary to go upstream and focus on the primary contributors to homelessness itself (i.e., lack of affordable housing, inadequate income, and insufficient services).

Which of the following is a direct result of global warming? a. Decreased prevalence of infectious diseases b. Increased water pollution from soil erosion c. Decreased protection from the ozone layer d. Increased number of parasites and insects

D. Increased number of parasites and insects Global warming is the gradual increase in the average temperature of Earth's near-surface air and oceans since the mid-twentieth century and its projected continuation (Easterling, 2011). Rising global temperatures may enhance the quantity and distribution of parasites, insects, and other disease vectors, potentially increasing the prevalence of a variety of infectious diseases.

Which of the following best explains why the rural population is growing when young persons from rural areas consistently are moving to urban areas to seek employment? a. Adults engaged in all the physically demanding farming tasks have longer life spans than people in urban areas. b. Farm families continue to have a higher birth rate than urban families. c. Many formerly migrant worker Hispanics are settling in rural counties. d. Retirees and other urbanites able to conduct business through telecommunication and travel are moving in.

D. Retirees and other urbanites able to conduct business through telecommunication and travel are moving in. Recent demographic changes in rural areas have also included an influx of retirees and others from urban areas who are able to live in rural areas and conduct business through telecommunication and travel. The other responses do not support the current reason for the increase in the rural population.

A researcher has limited time and funds. Which of the following research designs would be most appropriate? a. Cohort study b. Incidence study c. Longitudinal study d. Retrospective study

D. Retrospective study Because longitudinal, cohort, or incidence studies are costly in terms of resources and staff and often lose subjects over time, a retrospective study may be used because it is faster and less demanding of resources.

Which of the following describes the most important need of every school-aged child with a disability? a. A teacher who understands the child's needs b. An advocate within the school system c. An assessment with comparison with developmental milestones d. An individualized education plan (IEP)

D. An IEP A child should have all of the above items, an advocate in the school nurse, a teacher who understands, an assessment including comparison with developmental milestones, as all of these are components of an IEP with goals, cooperatively developed with the parents, to help the child succeed in school. The IEP describes the goals, as well as any special support needed to help achieve them. The IEP is the most comprehensive answer.

Which of the following best explains why more nurses do not report violence against themselves to authorities? a. Assumption that the nurse somehow "asked for it" by not being cautious enough or alert enough to avoid it b. Assumption that nothing would be done about the situation anyway c. Assumption that nurses can accept anything, from taking blame to being scapegoats for when outcomes are not positive d. Assumption that patients and families cannot be held responsible; being assaulted is part of the job

D. Assumption that patients and families cannot be held responsible; being assaulted is part of the job Workplace violence tends to be higher in some service-oriented work environments, including health care. Such violence is widely believed to be underreported, perhaps in part because of beliefs that it is an expected part of certain jobs.

Which of the following would be true for a county to be defined as having persistent poverty? a. At least 10% of the population has been in poverty for at least the last 10 years. b. At least 10% of the population has been in poverty for at least the last 20 years. c. At least 20% of the population has been in poverty for at least the last 20 years. d. At least 20% of the population has been in poverty for at least the last 30 years.

D. At least 20% of the population has been in poverty for at least the last 30 years. Persistent poverty is defined as counties in which 20% of the population has been in poverty over the last 30 years.

Which of the following would be a source of care if families are employed at a salary above the poverty line, but at too low of an income for health insurance? a. Local health department clinics that provide care on a sliding scale b. Health care providers who donate time and pharmaceutical samples to free clinics c. School health clinics d. The state Children's Health Insurance Program (CHIP)

D. The state Children's Health Insurance Program (CHIP) Although families may be able to get some assistance from any of the listed resources, the CHIP is a publicly subsidized health insurance program for children. It was specifically created for children whose family income is above Medicaid limits but whose families do not receive health insurance through the parents' employment (i.e., the working poor).

On the basis of all the work done by social scientists, approximately how many homeless persons should be expected and tolerated in our society? a. No more than 5% b. No more than 10% c. No more than 15% d. There should not be homeless persons in America.

D. There should not be homeless persons in America. Kozol (1988) argued: "We would be wise to avoid the numbers game. Any search for the 'right number' carries the assumption that we may at last arrived at an acceptable number. There is no acceptable number. Whether the number is 1 million or 4 million, there are too many homeless people in America."

18. What is the usual result of a state or health care organization receiving federal funding for a special health care need?

When funds cease, so does the health care; therefore continuity is lacking. When the funding is no longer provided, the programs cease, which results in lack of continuity of care.

1. When did communities first begin to agree on collective action to stay healthy?

While people were nomads engaging in hunting and gathering Primitive prehistorical societies had health practices to ensure their survival. Isolation and fumigation were used for thousands of years.

Which of the following medications can a school nurse expect to most frequently administer? a. Analgesics and antipyretics b. Antibiotics c. Antitussives d. Anticonvulsants e. Attention-deficit hyperactivity disorder (ADHD) medications

E. ADHD medications Medications used to treat ADHD are the most commonly administered. Medications commonly given in schools include analgesics and antipyretics, antacids, antitussives, anticonvulsants, antiemetics and antidiarrheals, antifungals, antihistamines, and antibiotics.

14. Which method is most consistent with Freire's approach to empowerment?

Encouraging active participation and dialogue in critical reflection Banking education where teachers give information, which learners then regurgitate at exam time, is not useful. Problem-solving education with active participation and ongoing dialogue encourages learners to be critical and reflective about health issues.

3. What is the proper term for those diseases that are always at a consistent level in populations?

Endemic By definition, when diseases are always present in a population they are called endemic.

21. What were the first efforts at improving community health?

Environmental planning of water and sewer systems The first community-wide efforts toward improving health were environmental planning for water and sewer systems.

20. What nurse behavior would be most effective at creating a base for providing culturally effective care?

Exhibiting sensitivity to individual differences resulting from culture and experiences Unfortunately, voicing the need for valuing diversity is not always consistent with behavior. It is often useful to change communication patterns to increase client comfort, although the nurse must sometimes refuse to fulfill client demands. However, it is always crucial to exhibit sensitivity to individual concerns, cultural background, or previous life experiences.

12. What conclusion can be drawn from reviewing how health care costs are spread over a person's lifetime?

Expenditures increase with age. Expenditures increase with age. About one third of costs are incurred during middle age; half during the senior years; and, for those older than 85 years, one third of their lifetime costs occurs during their last year of life.

12. What would a nurse working from a critical theoretical perspective attempt to do in daily practice?

Expose and make explicit social values underlying decisions and the health care system itself Improvements can only be made if societal and personal values are made explicit. Once these values are recognized, they are more easily confronted. Change may be sought toward a more just society.

11. Who pays the majority of the costs for pharmaceutical drugs in the United States today?

Government Government pays 47.8%, insurance companies pay 22.3%, and individuals out of pocket pay 30%.

7. What is the community health nursing definition of health?

Health is families and aggregates choosing actions to ensure safety and well-being. The text stresses that health is not just the result of an individual's choices, but individuals', families', groups', and communities' choices and actions that lead to health.

4. Besides a fresh safe water supply, what other innovation(s) did the Romans introduce?

Hospitals and nursing homes The Romans introduced many health innovations such as fresh water, public physicians, hospitals, surgeries, infirmaries, and nursing homes. Unfortunately, these services were only for the wealthy.

7. In addition to working with a client to change behavior to improve health, what else must be kept in mind according to the Theory of Planned Behavior?

The client's belief about factors that may facilitate or impede the behavior The Theory of Planned Behavior stresses that perceived control is a major factor in whether or not the client performs the behavior.

6. The textbook summarizes a research study of sexually transmitted infections among young adults. What was determined to be a major variable in exposure to infection?

The environment in which the young adults lived The researchers concluded that ecosocial or contextual conditions strongly enhance sexually transmitted disease risk by increasing sexual risk behaviors and likelihood of exposure to infection.

3. Why might health education in the community be more effective than health education in a professional setting such as a hospital or clinic?

The setting is familiar and comfortable to participants. There can be interruptions and distractions anywhere, including in a patient's home. In the community, the setting is familiar and comfortable.

4. What must the nurse do before implementing a comprehensive and entertaining educational program?

Develop an open and trusting relationship with participants. At the core of health education is the development of trusting relationships based on nurturing interactions.

16. Based on statistics, which group is probably more physically active?

A group of highly paid college graduates Research has shown that those with higher levels of education and higher income enjoy physical activity more. Those of mature age, with less education, with less income, and/or living in the southern U.S. states engage in far less activity.

Which of the following are considered core functions of a case manager? (Select all that apply.) a. Assessment and diagnosis of client needs b. Planning and facilitation of client care needs c. Giving direct client care as needed d. Advocating for the client e. Obtaining needed resources and funding for the client f. Submitting appropriate forms to involved agencies for the client

A, B, D There is a consensus in the literature that there are four core functions that delineate case management: assessment, planning, facilitation, and advocacy.

Which of the following describe health hazards to which nurses in hospitals are exposed? (Select all that apply.) a. Anesthetic gases b. Dust c. Heat and chemicals d. Heavy lifting e. Infectious diseases f. Solvents and acids

A, D, E Hospital and other health care workers are exposed to infectious diseases, heavy lifting, radiation, skin disorders, and anesthetic gases. Dust may be a health hazard for those employed in textile and apparel. Launderers and dry cleaners may be exposed to heat and chemicals as a health hazard. Solvents and acids may be a health hazard for those employed in electronics.

Which of the following advanced nurses does not have advanced education in a clinical specialty? a. Clinical nurse leader b. Clinical nurse specialist c. Nurse midwife d. Nurse practitioner

A. Clinical nurse leader All the nurses have advanced education in some aspect of clinical care, such as obstetrics or primary care. However, the clinical nurse leader is a manager of care at some point of care and does not have a clinical specialty.

Which of the following have been identified as part of the core environmental health competencies? (Select all that apply.) a. Assurance b. Assessment c. Policy development d. Management e. Advocacy f. Communication

B, D, F The National Center for Environmental Health, the Centers for Disease Control and Prevention, and the American Public Health Association have established three core competencies for Environmental Health professionals: (1) assessment, (2) management, and (3) communication. Assurance, policy development, and advocacy are not part of the core environmental health competencies.

25. How can a nurse determine a patient's reading level?

Ask, "Do you find it useful to have someone help when you receive written material from your doctor or pharmacy?" Any of the responses might be effective at assessing literacy, but the single question asking how often help might be needed is the fastest and easiest. Nurses are limited in the time available for assessment. One question is easier for a client than a complete assessment tool. Asking about years of education can be dismaying to someone who did not complete many years of formal schooling. Clients may not understand the question when asked to assess their own health literacy.

A nurse eagerly explained to a long-term disabled male client the most recent relevant research related to his care. The client, rather than express appreciation, said, "I prefer to have my care given this way." The nurse explained that research suggested an alternative approach was more clinically effective, but the client said, "I am more comfortable during the day if my care is given this way." Which of the following actions should be taken by the nurse? a. Accept that the client knows what works best b. Ask the nursing supervisor to review the research with the client c. Give evidence-based care according to current research findings d. Negotiate a compromise between patient preferences and research-based approach to care

A. Accept that the client knows what works best A person who lives with a disability commonly becomes an expert at knowing what works best for his or her body. The nurse must ask the client what works best for him or her and what goals the client is pursuing. Research is based on probabilities of effectiveness with large groups, but individuals may have a different unique reaction to any intervention.

A client has been referred to a case management program. Which of the following actions would the nurse most likely take first? a. Admit the client for services. b. Determine the appropriateness for inclusion in the program. c. Contact the physician to determine if services are necessary. d. Contact the most appropriate community agencies for additional assistance.

B. Determine the appropriateness for inclusion in the program. All clients referred for case management must undergo screening to determine their appropriateness for inclusion in the program. Thus, this is the action the nurse must take first. Not all referred clients need the services of a nurse case manager. Often, a nurse can arrange community services or instruct the client and family in the most appropriate follow-up based on client need and program design.

Which gender perceives and reports having better health? a. Females b. Males c. No difference between genders in perceived health status d. Perceived health status varies strongly by individuals more than gender.

B. Males Despite the differences in mortality rates, men tend to perceive themselves to be in better health than women. In the National Health Interview Survey, which asked people to rate their health status, men were more likely to rate their health as excellent or very good as opposed to fair or poor.

Which of the following health problems has been reduced in school-aged and adolescent children? a. Chronic diseases (such as asthma or diabetes) b. Contagious diseases c. Sexually transmitted diseases (STDs) d. Stomach flu (viral gastroenteritis)

B. Contagious diseases Vaccine-preventable deaths (VPD) are at or near record-low levels. According to the Centers for Disease Control and Prevention, many communicable diseases have been reduced by greater than 99% as a result of immunizations. Chronic diseases have been increasing in school-aged and adolescent populations due to the increase in overweight and obesity. STDs and stomach flu have not been greatly reduced in school-aged and adolescent children.

Which of the following federal agencies is responsible for administering most of the federal health-related activities? a. Centers for Disease Control and Prevention (CDC) b. Department of Health and Human Services (DHHS) c. Health Resources and Services Administration (HRSA) d. National Institutes of Health (NIH)

B. DHHS Most health-related activities at the federal level are implemented and administered by the DHHS. The responsibility of the CDC is to keep the public safe and healthy. The responsibility of the HRSA is to improve access to health care services for vulnerable groups in the population. The main responsibility of the NIH is biomedical and health-related research.

Which of the following best describes the current perspective on how communities should treat persons with disabilities (PWDs)? a. Be supportive of PWDs and try to reduce environmental barriers b. Maximize opportunities for PWDs to work and otherwise contribute to community life c. PWDs have civil rights just as other citizens do. d. Recognize that PWDs deserve our support both financially and otherwise

B. Maximize opportunities for PWDs to work and otherwise contribute to community life Contemporary disability policy minimizes disadvantages and maximizes opportunities for PWDs to live productively in their communities. Early American public policy viewed PWDs as "deserving poor" who required governmental protection and provision, with little capacity for self-support or independence.

Which of the following best describes why utilization review departments are becoming case management units? a. Funding is available for case management responsibilities. b. Monitoring service use alone does not improve patient outcomes. c. It facilitates using nurse experts for case management. d. It promotes the current trend of naming "utilization review" units "case management."

B. Monitoring service use alone does not improve patient outcomes. Case management programs evolved from utilization review departments when those departments demonstrated that monitoring service use alone is insufficient for managing patient populations with diverse resource needs. There is not readily available funding for case management responsibilities. Case management involves more than utilization review, so there is a changing role of the nurse associated with the change of the name of the department. Using nurse experts for case management is beneficial, but it is not the reason why these departments transitioned.

One famous study followed a cohort of nurses over their lives, collecting data and health histories as they aged. Which of the following would be the most appropriate categorization of this study? a. Cross-sectional study b. Prospective study c. Retrospective study d. True experiment

B. Prospective study ) Prospective studies monitor a group of individuals to determine if and when disease occurs. A cross-sectional study examines relationships between potential causal factors and disease at a specific time. A retrospective study compares individuals with a particular condition or disease with those who do not have the disease. A true experiment involves both an experimental group who receives an intervention and a control group who does not receive an intervention.

22. How might the approach to home nursing established by Wald and Brewster best be summarized?

"Helping people to help themselves" The nursing service adopted the philosophy of meeting health needs of aggregates including social, economic, and environmental determinants of health. This aggregate approach empowered people of the community. A later director summarized their role as "one of helping people to help themselves."

16. What is the most likely reason that a nurse responsible for teaching spends more time being quiet than giving information?

The nurse is listening to the group's dialogue to identify problems. The exchange of ideas and concerns creates a problem-posing dialogue and identifies root problems or generative themes. The group members themselves create relevant action plans that are congruent with their own reality. Therefore to be effective the nurse must listen to ensure that teaching reflects what the group wants to learn.

7. What is the best way to choose the goals for a particular educational program?

The target audience must determine their needs and priorities. Learners must be involved in determining their own health education needs and priorities. Both the formal and informal leadership would have useful information to share, but the crucial component is input from the target group.

5. What is the advantage of the web of causation model in comparison with the epidemiological triangle model?

The web of causation model shows the relationships among variables. Although it is a more recently created model, the web of causation model is more useful because it illustrates the complexity of relationships among causable variables. It is not easier to understand and use as it has more variables than the three (agent, host, and environment) in the epidemiological model.

9. How does one know if learning has occurred?

There is a long-term change in knowledge and behavior. By definition, learning is an enduring change involving modification of knowledge, behavior, perception, or motivation.

19. What is a flaw in many of the health care bills passed during the last four decades that became obvious in hindsight?

They avoided interfering with the current health care approach and did not improve problems of access or duplication of efforts. Although each bill attempted to meet some problem in health care planning and delivery, none really improved quality, access, and cost issues. Current health care providers and institutions heavily influenced outcomes.

8. Why would some people believe the air within a particular building carries a risk and makes them ill?

They consistently feel worse on workdays and weeks without holidays. As the question discusses risk, the textbook states that the causative factor must precede the problem and that the problem would increase with exposure. Feeling ill only on workdays would imply that some factor in the workplace is responsible.

17. On what basis does the federal government give special funding for health care?

To stay consistent with the societal priorities such as 2020 Health Objectives Allocation of resources is based on societal priorities such as the 2020 Health Objectives.

12. What is the cause of most preventable deaths in the United States?

Tobacco Smoking is the leading cause of preventable deaths, accounting for about one out of every five deaths.

15. Why did local and state governments start to become more involved in controlling disease?

Too many citizens were too upset by local conditions. Community outcry for social reform forced state and local governments to take notice of deplorable conditions and take more responsibility for controlling the spread of bacteria and other microorganisms.

29. What is the Tuskegee Syphilis Study best known for today?

Unethical and racist treatment of uninformed subjects As treatment was knowingly withheld over many years resulting in incredible harm to the subjects and their families, public outrage over unethical, racist, and discriminatory behavior of the researchers continues today.

13. Comparing a surgeon today with a surgeon of Nightingale's time, what would be the primary difference in how they operate on a patient?

Current physicians would carefully scrub between cases. Physicians in Nightingale's time believed in spontaneous generation and were unaware of how diseases spread. Consequently, they did not use sanitary operating procedures.

6. What were the effects of Medicare and Medicaid? Select all that apply.

A previously unseen rise in demand for services occurred. Many persons previously without access now receive health care. Medicare reimbursement rates became the standard for all insurance carriers. Now almost half of all health care costs in the United States are paid by government financing. The enactment of Medicare and Medicaid created an unprecedented demand for services. Medicare reimbursement rates generally became the standard for all insurance carriers.

Which of the following best describes the practical importance of the classifications of metropolitan, micropolitan, and noncare areas? a. Classifications are used for congressional policy-making and funding decisions. b. Metropolitan areas gained importance because of their large population. c. Micropolitan areas are now recognized for their crucial role in society. d. The new system emphasizes the extent of rural (noncare) areas.

A The new core-based statistical areas (CBSA) system includes two categories of counties: (1) metropolitan areas and (2) micropolitan areas. Counties that are neither metropolitan nor micropolitan are called "outside CBSAs," also known as noncare areas. Metropolitan areas contain at least one urbanized area of 50,000 or more people. A micropolitan area contains a cluster of 10,000 to 50,000 persons. Because the metropolitan statistical area classification is used extensively for congressional policy-making and funding decisions, there could be serious ramifications for health care financing within rural market areas.

2. Which factors are included in Pender's model explaining what influences individuals to pursue health promotion activities? Select all that apply.

A belief that one can change one's behaviors, Environmental choices possible, The rewards one believes will result if action is taken, What one's family and peers believe should be done Fear and threat are not aspects of Pender's model. Although fear may cause an initial attempt at change, fear is not a long-term motivator for ongoing action. Pender does include perceived benefits, perceived self-efficacy, interpersonal influences, and available situational (environmental) options as factors that motivate persons to engage in health actions.

19. When William Rathbone created district nursing, who was sent to each district?

A social worker and a nurse A nurse and a social worker were assigned to each district to meet the needs of their communities in nursing, social work, and health education. This plan was widely accepted and very successful.

16. What eventually was helpful in decreasing the incidence of tuberculosis (TB)?

A volunteer organization began a public campaign of education. The National Tuberculosis Association enlisted community support through a campaign of public health education with many voluntary health organizations assisting. Physicians fought being required to maintain surveillance of TB and TB health education. States did have to build large state hospitals for treatment but that did not notably decrease incidence.

Which of the following information must be analyzed to derive an adequate explanation of disease? (Select all that apply.) a. Description of commonalities among those who became ill b. Depiction of the possible pathogen c. Explanation of the health care system in the community d. Portrayal of the geographic area where people became ill e. Review of the methods by which disease can be spread f. Substances that are effective in sanitizing the area described

A, B, D The epidemiological triangle includes the agent (pathogen), host (people who are susceptible and become ill), and environment (the geographic area where people became ill). These three areas allow for an explanation of disease. Explanation of the health care system in the community, review of the methods by which disease can spread, and substances that are effective in sanitizing are not part of examining the epidemiological triangle.

A nurse is developing a community education program about how to prevent sudden infant death syndrome (SIDS). Which of the following information would be included in the presentation? (Select all that apply.) a. Always place a baby on his or her back to sleep. b. Use a semi-firm sleep surface. c. Allow the baby to sleep in a position that provides the most comfort. d. Allow the baby to sleep with a favorite toy or blanket. e. Do not let the baby get too hot during sleep. f. Avoid exposing the baby to cigarette or cigar smoke.

A, E, F Some of the recommendations to reduce the risk of SIDS include: always place a baby on his or her back to sleep, for naps and at night; use a firm sleep surface, covered by a fitted sheet; the baby should not sleep in an adult bed, on a couch, or on a chair alone or with anyone else; keep soft objects, toys, and loose bedding out of the baby's sleep area; do not smoke during pregnancy, and do not smoke or allow smoking around the baby; and do not let the baby get too hot during sleep

Which of the following was suggested by the National Healthcare Disparities Report of 2008 (NHDR) as one reason that there are such disparities in health care outcomes inside the health care system? a. Care provider bias and poor communication exist. b. Funding is inadequate to give appropriate care to persons with disabilities. c. Many people do not seek care until it is almost too late. d. There is a national shortage of care providers.

A. Care provider bias and poor communication exist. The NHDR explains that, within the scope of health care delivery, disparities are due to differences in access to care, provider biases, poor provider-patient communication, poor health literacy, and other factors. This report did not address that there is inadequate funding to provide appropriate care, that people seek care too late, or that there is a national shortage of providers.

Which of the following best explains why many elderly women do not prepare meals or do housework? a. Chronic diseases, especially arthritis and rheumatism, hinder their ability. b. Living in a nursing home does not require them to do so. c. They do not want to; their husbands can share in the work. d. With Social Security, they can afford to pay someone else to do these tasks.

A. Chronic diseases, especially arthritis and rheumatism, hinder their ability. Women are more likely than men to be disabled from chronic conditions. Arthritis and rheumatism, hypertension, and impairment of the back or spine decrease women's activity level. Women are likely to have difficulty performing activities such as walking, bathing or showering, preparing meals, and doing housework. The majority of elderly do not live in nursing homes, but are able to remain in their own homes. It is unlikely that they are not willing to do any work or want to pay someone else to complete these tasks.

As a health advocate, which of the following does the faith community nurse (FCN) need to know? a. Community resources available in the community b. Educational needs of the community c. Recruitment strategies d. Understanding of spirituality

A. Community resources available in the community In the role of health advocate, the FCN facilitates clients' efforts in obtaining needed health services. The FCN uses referral skills and knowledge of community resources to guide individuals as they access available resources. The nurse may, with the client's approval, provide referrals to resources. The FCN recognizes the difficulties encountered by vulnerable populations within the faith community and helps them maneuver the health care maze to access needed resources. Knowing the educational needs of the community is necessary for the FCN to fulfill the role of health educator. As the coordinator of volunteers, the FCN should be aware of how to recruit, train, and direct volunteers to work with the FCN program or health ministry. It is necessary for the FCN to understand spirituality in order to effectively fulfill the role of integrator of health and healing.

Which of the following statements best summarizes all of the changes resulting from attempts to control costs? a. Conflict between providers, patients, employer, and insurance plans raged. b. Costs were controlled, at least temporarily. c. Demand for health care drastically dropped. d. Most employers discontinued their insurance plans for employees.

A. Conflict between providers, patients, employer, and insurance plans raged. All these changes resulted in conflicts among providers, patients, employers, and the insurance plans, particularly when services deemed necessary by the consumer and provider were denied insurance coverage. Everyone blamed everyone else. This did not allow for costs to be controlled, impact the demand for health care, or cause employers to discontinue their insurance plans for employees.

The charge nurse notes that two patients had communicable infectious diseases and were treated appropriately. Which of the following actions should be taken next by the nurse? a. Depends on your state health department's requirements b. Report the two cases to the Centers for Disease Control and Prevention (CDC) c. Report the two cases to your regional health department d. Send the information for inclusion in the Morbidity and Mortality Weekly Report

A. Depends on your state health dept requirements Because state health departments have the responsibility for monitoring and controlling communicable diseases within their respective states, they determine which diseases will be reported within their jurisdiction. Because the state health department requirements will dictate what action is taken next, it may not be necessary to report the cases to the CDC, regional health department, or to the Morbidity and Mortality Weekly Report.

Which of the following levels of government primarily establishes regulations and provides funding for health care? a. Federal government b. Local health departments c. Regional health districts d. State health departments

A. Federal government The federal government has been assuming a larger role in the protection of the population through regulation and funding. Local health departments establish local health codes, fund public hospitals, and provide services to populations at risk who often lack health insurance. State health departments are highly dependent on the federal level of resources and guidance. Regional health districts are not used as a level of government in the United States.

A nurse explained that the elderly are twice as likely to die in a home fire as younger persons and therefore suggested some safety measures. Which of the following strategies would most likely have been suggested by the nurse? a. Have smoke detectors installed in the house b. Invite a family member to sleep in the house at night c. Practice escaping quickly from the house in case of an emergency d. Program your phone so the fire department can be reached by pushing only one button

A. Have smoke detectors installed in the house Community health nurses making home visits can assess their elderly client's home for fire risk and teach fire safety, including the importance of home smoke detectors and fire extinguishers. Inviting family members to spend the night, practicing a quick escape, and programming one's phone for the fire department are irrelevant if a smoke detector is not installed to alert the elderly client that there is a fire in the home.

Which of the following is the most serious complication of women having osteoporosis? a. Hip fracture b. Need to avoid sunlight c. Need to decrease weight-bearing physical activity d. Stooped posture

A. Hip fx The most serious complication of osteoporosis is hip fracture. Approximately 24% of people with hip fractures die of complications within a year.

Which of the following best explains how the Public Health Service (PHS) Act, Title X, has been helpful to families? a. It provides funds for family planning, including contraception. b. It created a child care subsidy to help adults obtain and retain employment. c. It provides housing for low-income families. d. It prevents utility companies from shutting off service and allows for bills to be subsidized.

A. It provides funds for family planning, including contraception. Title X of the PHS Act is the Family Planning Public Service Act, which helped 5 million women obtain family planning services in 2008. Since 1970, federally subsidized family planning funds have been available to clinics and health departments throughout the country. These facilities provide not only access to contraception but also routine preventive health services, education, and counseling. The program is an important part of the public effort to prevent low birth weight through addressing the relationship between lack of family planning and those at greatest risk for low-birth-weight infants (women who are adolescents, single, and/or low income). This program does not provide subsidies for child care or utility payments or housing for low-income families.

Which of the following best describes the screening tests that are completed on all newborns in the United States? a. It varies from state to state, somewhere between 0 and 25 tests. b. It varies from state to state, but all states have a common 26 conditions that are tested. c. Federal legislation mandates 29 tests. d. The number varies greatly by state and by hospital policy.

A. It varies from state to state, somewhere between 0-25 tests Every infant born in the United States is screened shortly after birth for a number of genetic disorders. Newborn screening is state-based so the number of conditions that babies are screened for varies from state to state. All U.S. states and territories currently test for 26 health conditions including phenylketonuria, galactosemia, congenital hypothyroidism, and sickle cell disease

Which of the following statements best describe what happened to the hospitals built or expanded by Hill-Burton Act funds? a. Many such hospitals have consolidated or closed. b. Not needing to expand, hospitals have used the funds to upgrade their facilities. c. They have continued to use such funds to expand. d. When funding ceased, so did hospital expansion.

A. Many such hospitals have consolidated or closed. The Hill-Burton Act authorized federal assistance in construction of hospitals, making hospitals more accessible. However, with the high cost of health care and the decreasing lengths of stay and increasing use of primary care, many hospitals are closing. Because hospitals have closed, they are not further expanding or upgrading facilities.

Which of the following is an appropriate conclusion to draw from research based on network therapy theory? a. Nurses can help at-risk populations access or build support systems. b. Problems in our health care system are worsened by specialization and fragmentation. c. Social class places limitations on access to health care. d. The family is culturally anchored in American beliefs.

A. Nurses can help at-risk populations access or build support systems Network therapy theory involves changing the network of families, be it extended family or friends, who tend to maintain a dysfunctional status quo in the nuclear family. The nurse can help the family replace or expand their network with other resources from the wider system that would be able to provide more support and enhance family functioning

Which of the following best describes the risk for violence among females in the United States today? a. One of top five causes of death from age 1 to 44 years b. One of top 10 causes of death, especially among girls aged 1 to 4 years c. One of the top 10 causes of death, especially among women aged 15 to 24 years d. One of the top 10 causes of death, especially among vulnerable elderly

A. One of top 5 causes of death from 1-44 yo Among all females, homicide ranks in the top five causes of death among ages 1 to 44 years. Homicide is the third leading cause of death among females in the age groups of 1 to 4 and 20 to 29 years, is the fourth leading cause of death in the 5 to 14 year age group, and ranks fifth in the 30 to 34 year age group.

In what way is the U.S. approach to primary health care inconsistent with the World Health Organization (WHO) approach? a. Our primary health care system does not provide universal coverage to all citizens. b. Most U.S. citizens can afford health care through employer insurance plans. c. Tertiary care is preferred over primary care. d. U.S. hospitals make maximum use of the newest and best technology.

A. Our primary health care system does not provide universal coverage to all citizens. As a market-based society, the United States does not focus on primary health care and does not provide coverage to all U.S. citizens. Few managed care models propose universal access or the comprehensive primary health care that WHO, U.S. President Barack Obama, and the late Senator Edward Kennedy advocate.

A client living in the 1920s received health care services. Which of the following would have been the most likely form of payment? a. Patients paid out of their pockets for whatever care the provider charged. b. Public health employees gave care to those who needed it. c. There was little health care to be had, regardless of a person's wealth. d. Workers who belonged to a union had their bills paid by insurance.

A. Patients paid out of their pockets for whatever care the provider charged. Until the 1930s, the predominant method of health care financing was self-payment. Health care providers charged a fee for the services they rendered, and the patient paid the out-of-pocket expense. The assumption was that those who could pay would pay and those who could not pay should receive care and pay what they could. Insurance companies did not exist in the 1920s.

A nurse was becoming very frustrated at the ongoing stream of farmworkers with respiratory problems each spring. Which of the following actions should be taken by the nurse? a. Provide community education on herbicides and other chemicals spread each spring with information on self-protective measures, such as respirators. b. Fight to get farmers to quit spreading chemicals on their fields each spring. c. Suggest that farmers spray water on the fields immediately after the chemicals are spread to reduce dust in the air. d. Tell farm workers to obtain different employment. e. Try to get farmers to reduce the amount of chemicals used on their fields.

A. Provide community education on herbicides and other chemicals spread each spring with information on self-protective measures, such as respirators. Environmental health issues in rural communities, such as pesticide exposure or health hazards from point-source factory emissions, are more effectively assessed and remedied on a community level than on a case-by-case basis. Nurses' involvement in helping people understand health problems in a larger context can be the genesis of change. It is not realistic to have farmers quit or reduce the spreading of chemicals, spray water on their fields after chemical application, or ask them to obtain different employment. Nurses must work with farmers so that they are able to use safe measures when applying the chemicals to their fields.

Which of the following is most likely to provide public health services to Americans residing in a rural community? a. Public health nurse b. Public health physician c. Epidemiologist d. Nurse practitioner

A. Public health nurse In a study of 99 local health departments in three rural states, Rosenblatt and colleagues (2002) found that public health nurses were the core provider of public health services. Many smaller local health departments do not have the economic base to employ other professional public health providers, such as physicians, epidemiologists, sanitarians, and nutritionists at the local level.

Which of the following is accomplished through the use of public policy? a. Solutions to problems of public concern are developed. b. A rational, logical problem-solving decision-making process is implemented. c. Public safety nets for vulnerable populations are created. d. Economic and business management principles are applied

A. Solutions to problems of public concern are developed. The field of public policy involves the study of specific policy problems and governmental responses to them. Political scientists involved in the study of public policy attempt to devise solutions for problems of public concern. The use of public policy may not involve the implementation of a logical problem-solving decision-making process. Public policy addresses more than safety nets for vulnerable populations. Additional principles besides economics and business management are applied through the use of public policy.

Which of the following underlying factors most likely contributes to homelessness? a. Substance abuse b. Unemployment c. Posttraumatic stress syndrome (PTSD) d. Severe mental illness

A. Substance abuse The text states that persons as active agents do make decisions that result in homelessness. These choices result in a shortage of affordable housing, insuf?9?cient income, and scarcity of supportive services as societal conditions that contribute to homelessness rather than cause homelessness. However, these decisions are made in highly contextualized conditions, frequently addiction to alcohol and/or other substances. Substance abuse may in turn lead to unemployment which causes insufficient income. Additionally, PTSD and severe mental illness can cause substance abuse to occur.

A new home health nurse realized that what was being observed and now being said by the client were very inconsistent with what had been documented while the client was hospitalized. Which of the following conclusions should be drawn by the nurse? a. The amount of support available is different from what was stated earlier. b. The client had difficulty distinguishing truth from falsehood. c. The client had to admit the truth when it was obvious to the nurse. d. The family was embarrassed by their living situation

A. The amount of support available is different from what was stated earlier. It is not unusual to find inconsistencies between information the patient provides during hospitalization concerning the amount of physical and emotional support available to the patient in the home and the amount of help actually available to the patient in the home. The nurse validates or modifies the referral information to reflect the actual home situation. The client's perception of support and the actual support provided may be different. Thus, it is unlikely that the client was trying to lie about or was embarrassed by the situation.

People were very concerned about another outbreak of swine flu. All care providers were asked to report, without individual names, any new cases to the public health department for tracking. Which of the following would be most helpful for the local media to report to keep citizens informed? a. The ongoing incidence rate b. The ongoing prevalence of the illness c. How many were hospitalized d. How many had died so far in local hospitals and care facilities

A. The ongoing incidence rate. As only new cases were being reported to the health department, the media could only report the ongoing incidence rate, that is, the number of new cases reported each day.

Which of the following best describes how the federal government determines which projects are awarded special funding for health care? a. Those that are consistent with societal priorities, such as 2020 Health Objectives b. Those that are supported by legislators c. Those that are written by health care organizations that have special needs d. Those that are consistent with the state's long-term health goals

A. Those that are consistent with societal priorities, such as 2020 Health Objectives Allocation of federal resources is based on societal priorities, such as the 2020 Health Objectives. Legislative priority, priority within health care organizations, and priority within individual states are not as important for federal funding as the societal priorities outlined in Healthy People 2020.

Which of the following elderly persons are often the targets of case management? a. Those who are homebound and have multiple complex problems b. Those who live alone without close relatives c. Those who show clear evidence of mental and physical decline d. Those with chronic long-term health problems needing pharmaceutical intervention

A. Those who are homebound and have multiple complex problems Many older people have special, population-specific health care needs. Case management services frequently target the elderly population, specifically homebound individuals or those with complex problems. However, not all older persons require a case manager. The other elderly groups are not the primary target of case management services.

18. Which task will be most helpful in meeting the public health agency's goals?

Actively participate in community agencies' collaborative action plan to meet the community's health goals for the year Although all tasks may be necessary and important, intra-agency cooperation to meet the health goals of the community as a whole is more central to the agency's mission than other choices that meet the needs of individuals or groups rather than the community as a whole.

6. What is the chief determinant of whether a health education program will create change?

Amount of input and participation by learners The lasting effect of cognitive and behavioral changes is determined by learner participation.

23. The Assessment Protocol for Excellence in Public Health (APEX-PH), created by the APHA, ASPH, ASTHO, NACCHO, USCLHO, and CDC, is a voluntary process for what purpose?

An evaluation process involving both community and public organizations The APEX-PH program is a true self-assessment and is intended to be more of a public endeavor involving the community, as well as public organizations.

17. What was the principal outcome of the Hill-Burton Act?

An increase in the number of hospital beds The Hill-Burton Act was also called the Hospital Survey and Construction Act, which was to address the need for better hospital access. Federal aid was given to states for construction of hospitals.

4. Whether caring for an individual, a family, or an aggregate, the nurse can use a systems framework. Which aspect might be more challenging in caring for an aggregate as opposed to caring for an individual?

Analyzing power and decision making within the system Although all aspects can be challenging, it is probably more challenging to recognize the interacting aspects of a large aggregate system in its power distribution, consensus activities, accommodation, and authority within the decision-making process.

11. In a particular community, the rate of new cases of diabetes and the rate of new cases of flu during the month of January were precisely the same. Which disease would have the higher prevalence rate?

As a chronic condition, diabetes would have the higher prevalence rate Diabetes would have the higher prevalence rate because it is a long-term chronic condition that typically does not decrease. Although flu might have a higher incidence rate of new cases, because flu is typically of short duration, the prevalence rate would remain low. Flu is contagious, which could increase the incidence rate but not the prevalence rate.

21. What did large industrial giants do to stop the constant increase in their costs for health insurance for their employees?

Assembled their own health care programs Large industrial giants, such as Kaiser Permanente, decided to assemble their own health care programs. They built hospitals, hired physicians, and provided health care services to their employees. In an effort to market this concept, the phrase health maintenance organization was created. These organizations were designed to provide comprehensive care to employees.

9. What is an appropriate action to take if there is a rumor that some factor in a building was causing the persons employed there to feel ill?

Assess the risk including identifying any toxic substance The media report news; they do not create it without any basis. Researchers are not asked to confirm a preconceived conclusion but to seek what factors are active in a situation. "Group think" is a well-known phenomenon, but one would have to ask what led the communication leaders to believe originally that there was a hazard in the environment. Risk assessment in a questionable situation begins with identifying a possible hazard and describing the risk.

6. What message are public health leaders trying to emphasize to the public?

Assume responsibility for your own health by choosing healthy behaviors Although there are many public health messages in the media, from stop smoking to get a checkup, the primary message currently being emphasized by public health, as well as all the media coverage of the constantly increasing cost for health care, is for each person to take responsibility for his or her own health through choosing healthy lifestyle behaviors

Which of the following situations best describes when a person would most likely be very unhappy and perhaps ill after retirement? (Select all that apply.) a. If their family total income is now less than when he or she was employed b. If the retirement was involuntary c. If the person's self-image was based on job role and status d. If the person has no outside interests or leisure activities e. If his or her spouse did not appreciate input into their schedules or activities f. If the person believes others are now taking credit for his or her achievements

B, C, D, E Retirement can be a happy occasion when it is planned and the person has many activities to which to devote time and energy. Retirement is often a happy occasion when planned and voluntary; however, the opposite may be true if it is involuntary. When older adults retire, they inevitably must cope with a change in social status; this may be difficult for people whose self-concept was based on job status. For retirees who are married, the spouse must also adjust to the changes related to retirement. For elders who have no hobbies or interests, this extra leisure time may be a source of boredom. Family income being less is not necessarily a stressor as many job-related expenses also disappear.

Which of the following actions represent a shift in philosophy at the Centers for Disease Control and Prevention (CDC)? (Select all that apply.) a. Collecting and analyzing health data b. Creating integrated health information systems c. Allocating resources to treat specific diseases d. Encouraging partnerships and strategic alliances e. Creating transaction-based relationships f. Leveraging resources to steer the larger health system

B, D, F Rather than allocating resources, resources will be leveraged to influence the larger health system. Rather than collecting and analyzing health data, they now are creating integrated health information systems. Rather than transaction-based relationships, they now encourage partnerships and strategic alliances.

Which of the following is one legally required to obey? (Select all that apply.) a. Directions to a destination provided by a police officer b. Court decisions related to legislative law c. Delegation of responsibility for a task by a physician d. Executive decisions, such as your employer requirements e. Laws passed by your state or the federal government f. Rules and regulations from agencies, such as the state board of nursing

B, E, F Laws that all must obey include legislative law, regulatory agency rules and regulations, and judiciary rulings regarding the law. Although physicians may delegate a task, a physician cannot delegate responsibility.

9. Why do so many Americans continue to engage in unhealthy behaviors?

Because of the belief that most illnesses can be cured with insurance footing the bill Society sees insurance as an economic shield protecting against all disease and illness. The belief in cure rather than prevention, combined with this financial safety net, encourages society to become a passive participant in health care. The pervasive societal thought is "I don't have to worry; I have insurance."

When using an environmental perspective, which of the following would be the most important question for a nurse to ask when assessing potential health problems? a. "Can you tell me how you have been feeling?" b. "Can you tell me what you do at work?" c. "What brings you here today?" d. "What problems have you been having?"

B. "Can you tell me what you do at work?" Because 25% of worldwide preventable illnesses are caused by poor environmental quality, nurses need to ask critical questions about their clients' work and home environments to help discern the contributions of specific hazards to their health. This can be accomplished by an environmental health history. The other responses do not address a question that would be addressed during an environmental health history.

A nurse has recently learned of the death of a 22-year-old female friend. Which of the following would be the most likely cause of death? a. Complications of childbirth b. Accident or unintentional injury c. Cancer d. Cardiovascular disease

B. Accident or unintentional injury In the adolescent to early adulthood years, the leading cause of death for women is unintentional injuries (i.e., motor vehicle accidents, drug overdose). Complications of childbirth, cancer, and cardiovascular disease are not among the most likely causes of death of a 22-year old female.

Which of the following statements best define epidemiological transition? a. A change from morbidity due to a particular infectious disease to a different infectious disease b. A change from mainly infectious diseases to chronic diseases c. A change in infectious diseases caused by a difference in agent, host, or environment d. A change in life spans of various age groups in a specific country

B. A change from mainly infectious diseases to chronic diseases Many developed countries experienced an epidemiological transition from having an infectious disease profile to having a chronic disease profile and are now plagued by chronic diseases. Once plagued with high rates of infectious disease, developed countries significantly reduce high mortality rates from these diseases through improved sanitation, nutrition, and immunization and improved health care. Most developed countries have a more stable economy and a wide range of industrial and technological development. These countries experience an epidemiological transition. The other statements do not define epidemiological transition.

Which of the following disasters would most likely cause the most long-lasting mental health concerns for its victims? a. For the fourth year in a row a flood hit an area, demolishing several houses, but families heard the warning siren and evacuated in time. b. A forest fire was deliberately set but was not a major concern until the fire suddenly changed direction and people attempting to evacuate at the last minute were burned in their cars. c. A tsunami hit the beach with unbelievable force, water sweeping over the entire harbor, although most boats had been moved to deep water. d. A volcano erupted and lava destroyed the main road to the village where several houses burned, but no one died in the eruption.

B. A forest fire was deliberately set but was not a major concern until the fire suddenly changed direction and people attempting to evacuate at the last minute were burned in their cars. Research has identified four keys to gauging the mental health impact of such events, any two of which may result in severe, lasting, and pervasive psychological effects. The key factors are: (1) extreme and widespread property damage; (2) serious and ongoing financial problems; (3) high prevalence of trauma in the form of injuries, threat to life, and loss of life; and (4) when human intent caused the disaster. Because the fire was deliberately set and lives were lost, that disaster will be more disruptive than disasters when only property was damaged

Which of the following statements best explains why parents and nurses are often concerned about adolescents? a. Adolescents engage in sexual acts without using protection. b. Adolescents engage in very high-risk behaviors. c. Adolescents love driving but are not as skilled as they believe. d. Adolescents often experiment with alcohol or drugs.

B. Adolescents engage in very high-risk behaviors. In their struggle to gain independence and with their sense of immortality, many adolescents engage in risk-taking behaviors, including alcohol and drug abuse, early and unprotected sexual activity, unsafe driving, and participation in delinquent and violent activities that threaten their health. To say adolescents engage in very high-risk behaviors is the inclusive answer, because all other responses name only one problem.

A client has developed pellagra because of a lack of certain B vitamins. Which of the following best describes the classification of the nutritional deficiency? a. Relative risk factor b. Agent factor c. Environment factor d. Host factor

B. Agent factor Nutritional deficiencies are included under agent factors. Although too much of an agent can cause disease (such as obesity related to diabetes), so can too little of an agent. Relative risk indicates the extent of excess risk incurred by exposure relative to nonexposure. Host factors are intrinsic factors and describe one's susceptibility or response influence to the exposure to the agent, such as genetics, age, sex, ethnicity, and human behavior. Environment factors are extrinsic factors and they influence the existence of the agent, exposure, or susceptibility to the agent such as physical environment, biological environment, and socioeconomic environment.

In addition to their homes, where are children most likely to be injured? a. At entertainment sites (theaters, amusement parks) b. At school, especially on playgrounds c. At their part-time job settings d. Transportation (automobiles, school buses)

B. At school, especially on playgrounds Safety on the schoolyard and playground is also important for this age group, because about 200,000 children per year are injured on playgrounds in the United States. Thus, school playgrounds are the most likely place where children are injured. Injuries at entertainment sites, part-time job settings, and through modes of transportation are less likely to occur than injuries at school.

Which of the following nongovernmental groups has been expending millions of dollars to reduce the impact of infectious diseases with profound effect on prevention and treatment for HIV/AIDS, tuberculosis (TB), and malaria? a. Carter Center b. Bill and Melinda Gates Foundation c. Families for Freedom Foundation d. Bradley Foundation

B. Bill and Melinda Gates Foundation The Bill and Melinda Gates Foundation has local, national, and global objectives. Globally, the foundation focuses on reducing extreme poverty, improving health, and increasing public library access. Within Africa, the foundation has had a profound effect on improving access to antiviral medications and prevention and treatment for HIV/AIDS, TB, and malaria. The objectives of the Carter Center are to prevent and resolve conflicts, to enhance freedom and democracy, and improve health. The Families for Freedom Foundation provides education and support to families who are affected by deportation. The Bradley Foundation supports public policy organizations and conservative causes.

Which of the following indicators would be most informative in assessing the health of a newborn? a. Apgar score at birth b. Birth weight and length of gestation c. Mother's education and income from employment d. When the mother began prenatal care at her local clinic

B. Birth wt and length of gestation Birth weight and length of gestation are the most important predictors of infant health. Although maternal education, income, and lack of prenatal factors are factors associated with preterm birth and low birth weight, at the time of birth it is most important to assess the weight of the infant and length of gestation. Using the Apgar score at birth is not as informative of a tool for assessing newborn health as the birth weight and length of gestation.

Which of the following is the most likely reason for adult women to be injured? a. Automobile accidents b. Domestic violence c. Falling d. Stranger violence (theft, rape)

B. Domestic violence Domestic violence is the single largest cause of injury to women between the ages of 15 and 44 years in the United States—more than muggings, car accidents, and rapes combined.

Which of the following best describes the principal factor behind ongoing legislation on the federal level related to health care? a. Change is needed to reflect differences in health needs today. b. Efforts must be put in place to control constantly increasing costs. c. There is a need to focus on the population as a whole. d. Technological breakthroughs should be expanded.

B. Efforts must be put in place to control constantly increasing costs. With the rapid growth of technology and increased demands on the private and public health care subsystems, health care costs have become prohibitive. Cost-effectiveness and cost containment have become critical driving forces as health care delivery system changes are made; however, cost-effectiveness often conflicts with the provision of quality care. The Institute of Medicine (IOM) report Best Care at Lower Costs: The Path to Continuously Learning Health Care in America "presents a vision of what is possible if the nation applies the resources and tools at hand by marshaling science, information technology, incentives, and care culture to transform the effectiveness and efficiency of care—to produce high-quality health care that continuously learns to be better" (2012, p. ix). Since 1999, the IOM has completed many extensive reports examining the status of health care in the United States. Some improvement has been seen in the delivery system, but much more needs to be done. This report addresses these critical concerns again.

Which of the following best describes why a nurse working in a U.S. urban area should be knowledgeable about infectious diseases common to areas of Africa? a. Nurses have an ethical commitment to care for others throughout the world. b. Every infectious disease is just one airplane ride away. c. Infection could occur if a nurse goes out in public. d. Nurses meet people who may originally have been born elsewhere.

B. Every infectious disease is just one airplane ride away. Infectious diseases do not recognize or respect country borders. With rapid international travel, an infected person could easily be in any country in a very short period of time. Problems throughout the globe can threaten human life. Although nurses have an ethical commitment to provide care, infections can occur anywhere, and nurses may care for populations who were originally born outside of the United States, the primary need for the nurse to have this knowledge exists because infectious diseases can spread throughout the world in a very short period of time because of the ease of travel in the world.

A male strong firearms advocate stressed his guns were for self-protection and he wanted all criminals to know his family had loaded guns in their home. Which of the following best explains why a nurse would not support his actions? a. Criminals carry more powerful and illegal guns. b. Guns in the home typically result in dead family members and friends. c. His children may be less careful than the adults in the family. d. Less trained individuals might think the guns were unloaded.

B. Guns in the home typically result in dead family members and friends. Concern about firearms arises when it has been shown that guns kept in the home for self-protection are more likely to kill a family member or a friend than an attacker. Furthermore, the presence of a gun in the home triples the risk for homicide in the home, increases the risk of suicide three to five times, and accidental deaths by four times

Which of the following is the most commonly used illegal drug among children and adolescents in the United States? a. Inhalants b. Marijuana c. Methamphetamine d. Cocaine e. Steroids

B. Marijuana The most commonly used illicit drug among youth in the United States is marijuana. The use of other illegal drugs in high school students includes cocaine (6.8%), inhalants (11.4%), heroin (2.9%), methamphetamine (3.8%), and steroids (3.6%). Inhalants are the most widely abused

Which of the following health problems continues to increase in school-aged and adolescent children? a. Contagious diseases b. Obesity and related problems (diabetes) c. Sexually transmitted diseases (STDs) d. Stomach flu (viral gastroenteritis)

B. Obesity and related problems (Diabetes) Obesity is the fastest rising public health concern in the nation and may overtake tobacco use as the single leading preventable cause of death. The obesity rate has more than doubled in children and tripled in adolescents over the past three decades. More than one third of children and adolescents are considered overweight or obese. Vaccine-preventable deaths (VPD) related to contagious diseases are at or near record-low levels. According to the Centers for Disease Control and Prevention, many communicable diseases have been reduced by greater than 99% as a result of immunizations. STDs and stomach flu have not been increasing in school-aged and adolescent children

Which of the following best describes the first government step in trying to stop constantly rising costs? a. Insurance companies were told to cease adding new members to their plan. b. Payment reimbursement was based on diagnosis and client characteristics rather than on treatment given. c. Physicians were limited to a maximum amount that would be paid for any particular service. d. Reimbursement was based on prospective payment; that is, in advance of admittance for care.

B. Payment reimbursement was based on diagnosis and client characteristics rather than on treatment given. The first efforts to control costs were made by the federal government when Medicare hospital reimbursement was based on a prospective payment system. Payment would be based on a classification system that identified costs according to diagnosis and client characteristics. Restricting insurance companies to add new members to their plan was not part of the first steps to try to stop constantly rising costs.

For which of the following groups is suicide the second leading cause of death? a. People aged 15 to 24 years b. People aged 25 to 34 years c. People aged 35 to 65 years d. People over age 65 years

B. People 25-34 yo For people between the ages of 25 and 34 years, suicide is the second leading cause of death, and it is the third leading cause of death in people aged 15 to 24 years

On which of the following levels of care do most faith community nurses (FCNs) focus? a. Hospice care b. Primary c. Secondary d. Tertiary

B. Primary The FCN practice focuses on health promotion and wellness, which is primary intervention. It holds the spiritual dimension central to health and healing within the context of the faith community.

The nurse could not find a vaccine in the refrigerator. The unopened vaccine vial had been put in a storage cabinet with the other medications. The nurse drew up the appropriate dose in the syringe and then put the vial of vaccine in the refrigerator. Which of the following would be the most likely result? a. The client will have immunity to the disease after the vaccination b. Primary vaccine failure c. Secondary vaccine failure d. The injection will not feel so cold to the client

B. Primary vaccine failure Primary vaccine failure is the failure of a vaccine to stimulate any immune response. It can be caused by improper storage that may render the vaccines ineffective, improper administration route, or exposure of light-sensitive vaccines to light. Secondary vaccine failure is the waning of immunity following an initial immune response, often occurring with immunosuppressed and organ transplant patients in whom the immune memory is essentially destroyed. Although the injection will not feel so cold to the client, the problem that will result is primary vaccine failure

A man walked to the staging area after an earthquake crying that he was hurt. A triage nurse noted he had cuts, abrasions, and an open (bone was seen) fractured arm. Which of the following actions should be taken next? a. Put a green tag on his shirt and he can get in line to wait his turn for medical treatment b. Put a yellow tag on his shirt and then await transport to a medical facility c. Put a black tag on his shirt and give him a chair to rest in until something can be done d. Put a green tag on his shirt and ask him to use his good arm to help others make it to the staging area

B. Put a yellow tag on his shirt and then await transport to a medical facility Green on the triage tag is for the walking wounded or those with minor injuries (e.g., cuts and abrasions) who can wait several hours before they receive treatment; yellow is for those with systemic but not yet life-threatening complications, who can wait 45 to 60 minutes (e.g., simple fractures); red is considered top priority or immediate and is for those with life-threatening conditions but who can be stabilized and have a high probability of survival (e.g., amputations); and black is for the deceased or for those whose injuries are so extensive that nothing can be done to save them (e.g., multiple severe injuries).

What would be an appropriate term for intoxicated drivers, secondhand smoke, urban crowding, noise, and mechanization? a. Risks of living style b. Risks in the built environment c. Personal health risks d. Modern day health risks

B. Risks in the built environment. The built environment is the connection between people, communities, and their surrounding environments that affect health habits and behaviors, interpersonal relationships, cultural values, and customs. Most people live within areas that require almost daily contact with potential health risks and threats, such as intoxicated or impaired drivers, secondhand smoke, urban crowding, noise exposure, unabated traffic, and the stress of increased mechanization.

In which of the following areas would the faith community nurse (FCN) most desire more education to continue in the role? a. Basic community health nursing practice, especially in finding and accessing resources b. Spiritual assessment skills and acquiring theological knowledge c. Use of spirituality in faith healing d. Physical assessment, pathophysiology, and pharmacology

B. Spiritual assessment skills and acquiring theological knowledge Many FCNs find the need for further education to develop spiritual assessment skills, acquire theological knowledge, and learn the nurse's role in healing.

Which of the following would be the best method to increase the positive predictive value of a screening test? a. Test a large population at once b. Test a group at high risk for the health problem c. Use a very sensitive screening test d. Use a very specific screening test

B. Test a group at high risk for the health problem The positive predictive value is affected by what proportion of the tested population has the problem. To increase the positive predictive value, screen populations most at risk for the problem. Testing a large population at once, using a very sensitive or very specific screening test would not increase the positive predictive value of a screening test.

Which of the following best describes the most important factor in legislation? a. The amount of financing and lobbying behind each choice b. The beliefs, attitudes, and values of the policy c. The preferences of the majority of American voters d. The president's ongoing encouragement for one particular choice

B. The beliefs, attitudes, and values of the policy Public policy encompasses the choices made regarding goals, priorities, and how resources are allocated. Policy choices reflect the values, beliefs, and attitudes of those designing the policy. The influence of the president, preferences of Americans, and amount of financing related to the legislation are not as important as the beliefs, attitudes, and values of the policy.

A professional strongly encouraged institutionalization so the parents could focus on care of their other family members. Which of the following suggestions would be appropriate for the nurse to make to the parents? a. As the expert pointed out, institutionalization will reduce family stress. b. The child has a right to an education in the least-restrictive setting. c. The child will eventually adapt to whatever choice the parents make. d. The choice of what to do is entirely the parents'.

B. The child has a right to an education in the least-restrictive setting. It is a given that it is the parents' choice. As an advocate for the child, you can explain that children have a legal right to an appropriate public education based on the child's needs in the least-restrictive setting.

In a community presentation about asthma, a nurse explained the causes of asthma in children, how to observe for "triggers" that lead to an attack, and how to use an inhaler. Which of the following statements best identifies what was omitted from this presentation? a. The nurse did not ask the attendees to disclose if any of them smoke around children. b. The nurse did not address actions that should be taken to improve air quality and only focused on the treatment of asthma. c. The nurse did not address the need to avoid exposure to others who may have a communicable disease. d. The nurse did not review the genetic components related to asthma in families.

B. The nurse did not address actions that should be taken to improve air quality and only focused on the treatment of asthma. By placing responsibility for the cause and cure of health problems exclusively on the individuals, the belief is reinforced that all individuals are free to control their lives. Such a perspective absolves society, government, industry, and business from accountability. Research suggests that changing individual behaviors does not lead to significant reductions in overall morbidity and morality in the absence of basic social, economic, and political changes. Thus, the nurse must include information in the presentation that addresses the need to improve air quality.

3. What happened to health care providers during the Great Depression when so many persons were unemployed?

Both hospitals and physicians went bankrupt. With 25% of the population out of work, the number of patients capable of paying their medical bills was reduced. Because public financing was limited, hospitals, physicians, and other providers went bankrupt.

Which of the following best describes why it is crucial that the faith community nurse (FCN) have at least a baccalaureate degree, as well as several years of experience in clinical practice, in addition to formal education in the role? a. To ensure continued prestige and relatively high salary for the role b. To be autonomous with self-direction and independent decision making c. To enable the FCN to assess the faith community and prioritize its needs d. To function in varied settings from the religious building to the clients' homes

B. To be autonomous with self-direction and independent decision making Incredible diversity and autonomy are found in faith community nursing. The self-direction and independent decision making required by the autonomous roles of the FCN require a highly educated nurse experienced in clinical nursing and community-based nursing practice. Typically, there is not a high salary associated with the role of FCN. The autonomy and independent decision making required in this role allow the nurse to be able to effectively assess the community and function in a variety of settings.

Which of the following best explains how marriage customs have remained unchanged over the last couple decades? a. Lesbian and homosexual adults are adopting children. b. Women are usually responsible for the children following a divorce. c. Single adults are adopting children. d. Women are trying to avoid spinsterhood. e. Women seek to marry at a young age.

B. Women are usually responsible for the children following a divorce. Today, as in the past, when a relationship ends in divorce or separation, more women than men have the responsibility of providing for themselves and their children. Differences today include that many women are delaying marriage and many are not marrying. Single-parent adoptions are legal; single women, including lesbians, are becoming adoptive parents.

Which of the following is the leading cause of death for women in their first trimester? a. Anesthesia b. Ectopic pregnancy c. Hemorrhage d. Pulmonary embolism

B. ectopic pregnancy According to the Centers for Disease Control and Prevention, ectopic pregnancy is the leading cause of maternal death in the first trimester. Historically, the leading cause of maternal death had been pulmonary embolism, followed by pregnancy-induced hypertension, ectopic pregnancy, hemorrhage, stroke, and anesthesia.

26. Why would the nurse continue to ask questions and encourage attendees to contribute examples from their own lives relevant to the discussion?

Because persons learn by doing through active participation One of the key concepts of community organizing practice is the principle of participation, which essentially means that active participation—or learning by doing—results in a greater likelihood of change in behavior and attitude.

1. What was unfortunate about the idea of private health insurance? Select all that apply.

Because providers were paid for any service they gave, it was economically advantageous for them to give as much care as possible. Health care costs increased very rapidly. Health education and health promotion interventions were not included in the idea of health insurance. Patients wanted any and all care that might help, regardless of how expensive it was. There was no limit on what care could be sought and given. The majority of the population was protected. The emphasis was placed on illness care, because providers received a fee only when a service was rendered, and all costs were reimbursed. Insulated from having to pay for health care, consumers demanded complex and technologically advanced services. These demands were a major force rapidly increasing health care costs because people with insurance felt entitled to care, and, after all, there was a guaranteed payer. Medical orientation was on curing at any cost.

9. Which variable has a major influence on a community's health?

Behavior choices made by persons in the community Individual behavior choices and environmental factors are responsible for about 70% of health outcomes. Individual choices are affected through interaction with other individuals and their mutual social and physical environments. Health care providers are responsible for only 10% of the outcome.

5. Why is there such a community health emphasis on heath education programs?

Behavioral change must be voluntary. Health education is designed to predispose, enable, and reinforce voluntary behavior conducive to health.

12. What factors are most responsible for the increasing length of life of Americans over the past 100 years?

Better nutrition and family planning options Average increased life span over the past 100 years can be largely attributed to higher standards of living, better nutrition, a healthier environment, and having fewer children. Public health efforts such as immunization and medical care have also contributed.

24. A nurse works very hard to develop alliances among various community organizations toward improving health in the community. What are actions such as this called?

Building coalitions By definition, the nurse's actions are coalition building. Although collaboration has a very similar meaning, Table 1-5 stresses that collaboration is focused more on enhancing the capacity of an individual or a group. The nurse is establishing cooperative alliances, not yet working with them toward a goal.

11. What nursing interventions did Florence Nightingale use in treating wounded soldiers?

Improvements in food, clothing, and cleanliness Discovering the appalling conditions of the hospital, Florence Nightingale set up diet kitchens and a laundry and provided food, clothing, dressings, and laboratory equipment.

Which of the following strategies have been used to improve the collection of prevalence data for the homeless population? (Select all that apply.) a. Urban Institute study b. Homeless Assistance Report c. Continuum of Care (CoC) concept d. Homeless Information Management System (HMIS) e. Census Bureau f. Education for Homeless Children and Youth program

C, D Two strategies used by the U.S. Department of Housing and Urban Development in the efforts to strengthen the nation's efforts to reduce homelessness, including improvement in collecting prevalence data, are the CoC concept and the HMIS. The Census Bureau and Urban Institute study were historically used to collect data on the homeless population. Data collection improvements have been made since these studies were completed. The Department of Education uses the Education for Homeless Children and Youth program to collect data on homeless youth.

Who may receive benefits under Medicare? (Select all that apply.) a. Federal employees b. Persons aged 55 to 65 years who have bought into the system c. Persons with end-stage renal disease d. Those over 65 years of age, if eligible for Social Security benefits e. Those who are dependents of elderly grandparents, usually because their parents are in prison as a result of drug abuse f. Those with permanent disabilities

C, D, F Medicare pays specified health care services for all people 65 years of age and older who are eligible to receive Social Security benefits. People with permanent disabilities and those with end-stage renal disease are also covered.

A day care center asked the nurse to come because they had several children out as a result of chickenpox. Which of the following statements should the nurse make to the staff? a. "Chickenpox has low infectivity so few children will get sick." b. "Chickenpox has low pathogenicity so the children won't be sick enough to stay home if the parents really need to go to work." c. "Chickenpox has low virulence so the children will be back at the day care center in a week or so." d. "Adults never catch chickenpox, so the staff are safe and may continue working."

C. "Chickenpox has low virulence so the children will be back at the day care center in a week or so." Other considerations for understanding the action of agents include their power to invade and infect large numbers of people (infectivity), their ability to produce disease in those infected with the agent (pathogenicity), and their ability to produce serious disease in their hosts (virulence). When the above concepts are applied, the chickenpox virus has high infectivity, high pathogenicity, and very low virulence

A nurse was teaching a class on good hygiene at a local day care center when one child volunteered, "I have two mommies." Which of the following would be the most appropriate response by the nurse? a. "Don't tell anyone; that's a secret." b. "That's nice—why did you share that?" c. "Yes, some children have two mommies, some have a mommy and a daddy, and some just have daddies. Some people only have one grown-up to love them." d. "Which mommy is your real mommy?"

C. "Yes, some children have two mommies, some have a mommy and a daddy, and some just have daddies. Some people only have one grown-up to love them." The Human Rights Campaign (2009) urges that health professions acknowledge all types of families including gay, lesbian, and even grandparents as heads of family.

A client was admitted to home care and was dismayed to find the nurse discussing such uncomfortable topics as advance directives, living will, and durable power of attorney. Which of the following is the most appropriate response by the nurse? a. "Don't be concerned; this is just routine." b. "I'm sorry, but the state law says I have to ask you to fill out these forms." c. "You get to make decisions about your care, but if, for any reason, you can't do this, these forms will tell us what you want us to do." d. "Your physician asked us to discuss these with you."

C. "You get to make decisions about your care, but if, for any reason, you can't do this, these forms will tell us what you want us to do." Medicare-certified health care agencies must ask patients about advance directives and provide patients with the advance directive form if the patient is interested in completing the document.

Which of the following best describes a food desert? a. The inability to store foods at an acceptable temperature b. The inability to have healthy foods at home c. A neighborhood with little to no access to healthy foods d. A neighborhood that has experienced a recent food-borne illness

C. A neighborhood with little to no access to healthy foods A food desert is a neighborhood with little or no access to healthy foods. There are significant disparities in access to healthy and fresh food supplies, with poor minority families being more likely to live in a food desert. The other responses are not the correct definition of a food desert.

Which of the following best describes how many households with at least one child with a disabling condition would a school nurse working in an elementary school expect to see? a. About 5% b. About 10% c. About 15% d. About 20%

C. About 15% About 15.1% of households with children have at least one child with a special health care need (disabling condition).

Which of the following statements best reflects the model of justice U.S. health care is based on? a. All people are entitled to minimum standards of care. b. All people are responsible to help their neighbors. c. All people have a right to whatever their own efforts allow them to purchase. d. Like firefighting, police protection, libraries, and roads and highways, health care must be supported by tax money for the good of all who need such services.

C. All people have a right to whatever their own efforts allow them to purchase. Market justice has been the dominant model and purports that people are entitled to valued ends (i.e., status, income, and happiness) according to their own individual efforts. Moreover, this model stresses individual responsibility, minimal collective action, and freedom from collective obligations other than respect for another person's fundamental rights. In contrast, under a social justice model, all people are equally entitled to key ends (i.e., access to health care and minimum standards of income). Consequently, all members of society must accept collective burdens to provide a fair distribution of these ends.

Which of the following is the primary task to be accomplished during the initial telephone contact between the home health nurse and the client? a. Make sure that the name, address, telephone, and other data are accurate b. Confirm that the nurse will be a guest in their home so socialization can occur c. Allow the client to give permission and agree to a time for a home visit d. Warn the family that the nurse will always need to immediately see the proof of insurance before proceeding further

C. Allow the client to give permission and agree to a time for a home visit The nurse contacts the client and informs him or her about the service referral. The first telephone contact with the client or family consists of an exchange of essential information, including an introduction by the nurse, identification of the agency that received the referral, and the purpose of the visit. After the initial exchange of information, the nurse informs the client of his or her desire to make the home visit, the client gives permission, and the group sets a mutually acceptable time for the visit. The nurse is a guest in the client's home but not in the usual social sense. Public health nurses who are reimbursed by tax dollars may not require evidence of insurance coverage.

Which of the following is an accurate definition of impairment? a. A disadvantage resulting from a disability that prevents fulfillment of an expected role b. A restriction or inability to perform an activity in a normal manner c. An anatomical, mental, or psychological loss or abnormality d. A defect that affects society on a macro level

C. An anatomical, mental, or psychological loss or abnormality A disability, resulting from an impairment, involves a restriction or inability to perform an activity in a normal manner or within the normal range. An anatomical, mental, or psychological loss or abnormality is an impairment. A handicap is a disadvantage resulting from an impairment or disability that prevents fulfillment of an expected role. In a comparison of these concepts, an impairment affects a human organ on a micro level; disability affects a person on an individual level; and a handicap involves society on a macro level of analysis.

Which of the following best describes the incidence of abuse among pregnant women? a. It is too difficult to determine the actual incidence of abuse among this population. b. It is estimated that approximately 1 out of every 10 women experiences abuse. c. Approximately one out of every six women has been abused by a partner. d. Abuse does not occur among pregnant women.

C. Approx 1 out of every 6 women have been abused by partners Pregnancy does not protect women from the danger of abuse. Indeed, pregnancy may increase stress within the family and provoke the first instances of battering. It is estimated that one in six pregnant women have been abused by a partner

A nurse represents the state professional association. Which of the following actions would the nurse complete in relation to legislation? a. Be prepared to contribute to campaigns of legislators who vote consistently with nursing goals b. Be prepared to confront verbally those on the opposite side of legislative issues c. Be prepared to provide testimony and comment on relevant issues d. Be prepared to visit schools of nursing to present about the current legislative issues

C. Be prepared to provide testimony and comment on relevant issues Although a nurse might do any of the above, the most effective is to provide testimony and comment on issues of importance to nursing. Contributing is dependent on the financial resources of the nurse. Legislators often appreciate volunteer hours spent on campaign tasks as much as sums of money. Giving presentations to schools may be useful, but it may be assumed that most nursing faculty can discuss legislative health issues. Verbal confrontations are not always useful.

Which of the following are examples of the internal structure of the family? a. Ethnicity and race b. Extended family members c. Gender and rank order of birth d. Social class and religion

C. Gender and rank order of birth Internal structure of the family refers to such items as family composition, gender, rank order (by age and sex), subsystems through which the family functions, and boundaries or who is in and who is not in the family system. Extended family members are part of the external structure.

Which of the following best explains why the school nurse and the principal athletic director of the school would frequently be working together? a. As neither are teachers, each is susceptible to job layoffs if the community school tax levy does not pass. b. As support staff to teachers, they have many mutual problems in communicating how they can help teachers be more successful. c. Both are extremely concerned with the typical student's low amount of physical exercise and want to create an intervention plan. d. Both have to create a budget plan and allocate funds for their department for the year.

C. Both are extremely concerned with the typical student's low amount of physical exercise and want to create an intervention plan. Obesity and its prevention or treatment must be of concern to the school nurse. Although many of the underlying causes of obesity are not well understood, several contributing factors have been identified, including reduced access and affordability of nutritious foods, decreased physical activity, and cultural and genetic influences. The nurse and the athletic director would want to cooperate on how to increase physical activity of the students

Which of the following is the most common cause of death among women after age 75? a. Accidents and unintentional injuries b. Cancer c. Cardiovascular disease (CVD) d. Diabetes and its complications

C. CVD About one in four Americans has one or more forms of CVD. One in ten women under age 60 years has some form of CVD; the ratio increases to one in three after age 65 years. CVD continues to be the number one overall killer of women. Accidents and unintentional injuries are the leading cause of death in the adolescent and early adulthood years for women. Cancer is the number one cause among women age 35 to 74. Diabetes and its complications are considered to be the fifth leading cause of death among women age 55 to 74, and the sixth leading cause of death among women age 75 to 84.

A hospital emergency department received a call that multiple casualties were on their way, primarily burns from a large factory fire. Which of the following actions should the hospital take immediately? a. Ask the governor of the state to declare the area a disaster area so state help can be obtained b. Call surrounding hospitals to set up burn units, because there will be too many patients for one hospital to manage c. Call in physicians and nursing staff who are experts in burn care d. Get in touch with the American Red Cross to assist families of the victims

C. Call in physicians and nursing staff who are experts in burn care A multiple casualty event is one in which more than two but fewer than 100 individuals are involved. Until more is known, only staff expert in burn care need be asked for assistance. Only a mass casualty event with 100 or more individuals involved requires community or state involvement.

Which of the following actions would help decrease the total health care costs in the United States? a. Consolidate major health care facilities while expanding neighborhood primary care clinics b. Continue the move to computer-based medical records and other efficiencies in informatics c. Decrease current fraud and abuse d. Streamline and make more consistent all documents needed for third-party reimbursement

C. Decrease current fraud and abuse The billions of dollars spent on health care and struggles for control between providers, consumers, and health care organizations have increased the risk of fraud and abuse. The Federal Bureau of Investigation (FBI) estimates that health care fraud costs the U.S. $80 billion annually (FBI, 2012). Thus, decreasing the fraud and abuse in the system would have the largest impact over any of the other proposed actions.

Which of the following is required for an agency to receive reimbursement for care given from Medicare? a. Application for recognition including signing a contract with the federal government b. Application for reimbursement from Medicare using the appropriate federal forms c. Demonstrating meeting federal quality standards for Medicare-covered services d. Providing specialty care such as physical therapy

C. Demonstrating meeting federal quality standards for Medicare-covered services Certified home health agencies meet federal standards; therefore they are able to receive Medicare payments for services provided to eligible individuals. Not all home health agencies are certified.

Which of the following best describes why some advocacy groups have taken a strong stand against physician-assisted suicide? a. Ethical belief that life is always preferable to death b. Emphasis that there is always hope for a research breakthrough or discovery of a new treatment intervention c. Fear that some persons may be "encouraged" to accept an early death merely because they are not valued by society for their contributions d. Helping someone die is murder, plain and simple

C. Fear that some persons may be "encouraged" to accept an early death merely because they are not valued by society for their contributions Because people have previously been killed because they had a disability, some advocacy groups, such as Not Dead Yet, have taken a strong stance against physician-assisted suicide, fearing it will lead to the early or forced death of people with disability. Ethical and personal beliefs and emphasizing the hope for a new treatment have not been stands taken by advocacy groups against physician-assisted suicide.

Which of the following must be involved for an act to be considered a terrorist act? a. A commitment to a political or religious belief b. An attempt to force compliance with a particular set of religious or political beliefs and behaviors c. Fear, intimidation, and violence d. Violence resulting in plural deaths

C. Fear, intimidation, violence All terrorist acts include three key elements—violence, fear, and intimidation.

A very skilled baccalaureate-prepared clinical nurse was asked to assume a case manager role. Which of the following will be most difficult for the nurse new to this role? a. Having the ability to be a leader and work autonomously b. Obtaining knowledge of community resources c. Gaining knowledge of reimbursement structures and financial strategies d. Getting practice at evaluating patient outcomes

C. Gaining knowledge of reimbursement structures and financial strategies Skills to ensure success in the role of case manager include sound knowledge of reimbursement structures, knowledge of available resources within the community, ability to evaluate patient outcomes, and an understanding of financial strategies. Such a nurse would have to be flexible, be creative, communicate well, and be able to work autonomously. Although the text does not discuss this, the typical baccalaureate program does not include courses in reimbursement and financial implications of clinical decisions.

Which of the following assumptions underlies the Declaration of Alma-Ata? a. Communities should be encouraged to cooperate with national health goals. b. Gross inequalities and disparities will always exist. c. Health is a fundamental human right. d. Public health agencies are responsible to plan and take action to improve health.

C. Health is a fundamental human right The concept of primary health care stresses health as a fundamental human right for individuals, families, and communities; the unacceptability of the gross inequalities and disparities in health status; the importance of community involvement; and the active role of all sectors.

Which of the following groups is the fastest-growing component of the rural population? a. Disabled adults b. Elderly women c. Hispanic children d. Retirees

C. Hispanic children Today, the proportion of Hispanic children is the fastest-growing component of the rural population, regardless of region.

Which of the following best describes how having health insurance has affected lifestyle behaviors? a. Health promotion disease prevention programs are attended because they are reimbursable. b. Health education is widespread, because insurance companies promote such education. c. Medications and medical treatment are relied on for cure. d. Screening is widespread because of insurance sponsorship.

C. Medications and medical treatment are relied on for cure. Funding for behavioral changes is limited, inadequate, or unavailable. Weight loss programs or smoking cessation programs are not reimbursable treatment regimens, although more expensive pharmaceutical interventions are reimbursable. Therefore, it is financially wise not to worry until illness strikes because illness care is reimbursable, whereas preventive health care is not.

Which of the following statements best describes how the United States compares with other countries on infant mortality rate? a. Best of all the industrialized nations b. About in the middle of the industrialized nations c. Near the bottom of the industrialized nations d. Gradually improving among the industrialized nations

C. Near the bottom of the industrialized nations The United States ranks a dismal 27th in infant mortality behind most other industrialized nations, including Japan, Sweden, Spain, Hong Kong, Italy, France, and Canada. Fifty years ago, the United States ranked 12th. The gap in infant mortality between the United States and other nations has occurred in spite of the United States' comparatively high per capita spending on health care and technological advancements.

Which of the following statements best describes why nurses are not more effective in creating political change? a. Nurses are not listened to by politicians. b. Nurses are not perceived as leaders in the health care field. c. Nurses do not act or do not agree on what changes are needed. d. Nurses do not know how to negotiate, communicate, and collaborate to create change.

C. Nurses do not act or do not agree on what changes are needed. Nurses know how to communicate, collaborate, negotiate, and serve as leaders who can make themselves heard. However, the various nursing subgroups do not agree on public policies.

Which of the following best explains why it is difficult to get others interested in environmental health? a. Environmental problems just are not interesting or dramatic. b. It's difficult to get media interested. c. People respond more to an acute crisis than chronic environmental problems. d. People respond more to an individual asking for help than a community asking for help.

C. People respond more to an acute crisis than chronic environmental problems People respond to acute crises with dramatic media coverage (such as hurricanes or earthquakes), but ongoing consistent pressure is needed to ensure day-to-day environmental integrity. Chronic environmental problems are rarely addressed effectively.

One hundred women received notification that their screening tests suggested that they might have a serious health problem. Which of the following actions should the nurse take to ensure that they will complete follow-up testing? a. Compliment them on their willingness to be tested and suggest an immediate appointment before they have too much time to think about the issue. b. Imply that the test could be wrong; the testing materials may not be effective, but the only way to be sure is to be tested further. c. Point out that screening is only suggestive and that not all positive screenings mean they actually have the health problem. d. Reassurance is not therapeutic; reality must be faced. Emphasize the need for immediate treatment.

C. Point out that screening is only suggestive and that not all positive screenings mean they actually have the health problem Not all positive screening results are confirmed with further diagnostic testing. The positive predictive value of a test (proportion of true positive results relative to all positive test results) is usually known for any screening test. Although one could argue that the test could be wrong, it is more therapeutic—because you want people to attend future screenings—to emphasize that screening is only suggestive than to say the screening test is inaccurate.

Which of the following statements best describes how policies in the private sector are different from policies in the public sector? a. Private sector policies are slow, deliberate, and reactive to events. b. Private sector policies are determined by the opinions and feelings of those employed in that sector. c. Private sector policies are based on economics and market trends. d. Private sector policies are based on rational decision making.

C. Private sector policies are based on economics and market trends. Private policy is largely influenced by theories of economics and business management, including consumerism and market trends. Such policies can react quickly and are often proactive. In comparison, public policies are slow and reactive, and economics is just one of many factors involved. Public policies are determined by voting shifts, electoral realignment, and term limits.

Which of the following best describes how the federal government tries to both encourage and support rural health clinics under the Community Health Centers (CHC) program? a. Allowing tax deductions for charitable contributions to rural health clinics (RHCs) b. Donating equipment and supplies to establish such clinics c. Reimbursing both Medicare and Medicaid at a higher rate than otherwise d. Requiring recipients to serve in a rural health clinic for 3 years in exchange for financial assistance while in school

C. Reimbursing both Medicare and Medicaid at a higher rate than otherwise The CHC program, administered by the U.S. Public Health Service, benefits underserved areas and populations. RHCs are designed to improve access to primary care. As an incentive to rural communities to apply for RHCs, Medicare and Medicaid are reimbursed at a higher rate than usual

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

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

A student athlete receives a screening examination before being active in school sports. Which of the following levels of prevention is being used? a. Health prevention b. Primary prevention c. Secondary prevention d. Tertiary prevention

C. Secondary prevention Screening, because it may result in early diagnosis and treatment, is secondary prevention. Primary prevention refers to interventions that occur before the disease develops. Tertiary prevention focuses on limitation of disability and the rehabilitation of those with irreversible disease. Health prevention is not considered to be a level of prevention.

16. In which type of intervention does a community health nurse spend most of the allotted time?

Caring for individuals Although the focus of care is the aggregate, the community health nurse will find the majority of time is spent caring for individuals.

Eight patients were burned in a factory fire. Shortly thereafter, four firefighters were seen with possible smoke inhalation problems. Which of the following best describes how these patients are different from the first patients to arrive? a. Burn patients probably have skin damage, whereas the firefighters have lung damage. b. Burn patients will need extensive care over time, whereas the firefighters can probably stay the night with oxygen treatment and then be discharged. c. The burn patients were direct victims, whereas the firefighters are indirect victims. d. The second set of victims may have scarring, shortness of breath, and persistent hoarseness for the next few days.

C. The burn patients were direct victims, whereas the firefighters are indirect victims. Both sets of victims would have inhaled smoke and have lung damage. The treatment and length of stay would be determined by the amount of damage, which may vary from victim to victim. Both sets of victims, depending on the severity of the burns, may have scarring, shortness of breath, and persistent hoarseness for the rest of their lives. A direct victim is an individual who is immediately affected by the event; the indirect victim may be a family member or friend of the victim or a first responder

Which of the following best describes the recent trends in homelessness? a. The number of homeless individuals in school is decreasing. b. The number of homeless individuals is increasing. c. The number of people in homeless families is increasing. d. The number of people in homeless families is decreasing.

C. The number of people in homeless families is increasing. The U.S. Department of Housing and Urban Development reported the following numbers of people in the total population and subpopulations who used shelters or transitional housing between October 1, 2010, and September 30, 2011: 4,469 individuals, a decrease of 11% since 2007; 537,414 people in families, an increase of 13.5% since 2007. According to the U.S. Department of Education: 1,065,794 homeless students were enrolled during the 2010-2011 school year an increase of 11% over the 3-year period 2008-2009 to 2010-2011.

Which of the following statements best explain the difference in suicide rate according to gender? a. Men are less likely to attempt suicide and less likely to be successful. b. Men are more likely to attempt suicide but less likely to be successful. c. Women are more likely to attempt suicide but less likely to be successful. d. Women are less likely to attempt suicide but more likely to be successful.

C. Women are more likely to attempt suicide but less likely to be successful. Women are more likely to attempt suicide but less likely to be successful. On the other hand, men are less likely to attempt suicide, but are more likely to be successful.

Which of the following steps should the nurse take first when triaging a victim of a disaster? a. Assess mental status b. Assess perfusion c. Assess respirations d. Assess blood pressure

C. assess respirations To assess an individual within the 1-minute guideline, the START system uses three characteristics. First, respirations are checked; then perfusion by pinching the nail bed and observing the reaction; and, last, mental status is checked by asking the individual a question. Assessing blood pressure is not part of the 1-minute guideline

A nurse is trying to determine who would be the most appropriate person to make a health care decision for an adolescent, the adolescent or the parent. Which of the following considerations will the nurse need to make? a. The need for cultural competence b. The need for access to care c. The need for client autonomy d. The need for client privacy and confidentiality

C. need for client autonomy This situation addressed the need for client autonomy. When considering client autonomy, the nurse must consider the following questions. In the specific case, who should make health care decisions for a young client, especially when opposing opinions arise? The client? The parents or guardian? The nurse or other health care professional? At what age does a child become mature enough to participate in such decision making? What laws does any given state have that affect adolescent client autonomy? What should the community health nurse do if he or she believes the client's or parent's decisions are not in the best interest of the client?

23. When Medicare first began reimbursing hospitals based on diagnosis-related groups (DRGs), which might have been less than actual cost, how did hospitals cope?

Charged more for patients whose care was paid by insurance Hospitals developed cost shifting to supplement losses caused by Medicare funding. Because private insurance reimbursements were cost based, hospitals included the loss in their total costs; therefore private insurance paid for covering care to both their enrollees and Medicare patients. By 1985 Medicare paid $0.87 for each hospital dollar and insurance providers paid $1.27.

7. What would be the least expensive approach to treating chronic diseases?

Choose healthy lifestyle behaviors to retain health The five leading causes of death and illness can be positively affected by changes in lifestyle. Healthy lifestyles can modify or even prevent most chronic illnesses.

25. As in other developed countries, what is the primary focus of health care efforts in the United States?

Chronic diseases Whereas diarrhea, starvation, and infectious diseases are major causes of death in developing countries, in developed countries such as the United States, chronic diseases are the primary cause of mortality.

22. What is the most important component of the Planning Approach to Community Health (PATCH) model?

Community participation throughout the process An essential element of the PATCH model is community participation. The idea is that health promotion is a process that enables the population to have more control of its own health.

7. A community health nurse determined exactly how many cases of a particular disease were current in the community. What should the nurse do before determining what interventions should be planned?

Compare the current rate with the previous rate of disease No conclusions can really be drawn from just knowing a number. Only by converting that count to a rate and then comparing the rate with the previous rate, or with the rate in the broader environment or a similar community nearby, can any conclusions be drawn as to whether there is a problem or intervention needed.

15. Which primary prevention would the school nurse choose to address the school's number of unwed pregnancies?

Convince the school board to allow sex education classes to include birth control measures Although all choices would be appropriate actions in a school, only education regarding sexuality and birth control would help prevent future pregnancies.

4. What current emphases are focusing attention on public health? Select all that apply.

Cost containment and managed care models, Fear of bioterrorism within our borders With a current focus on cost containment and organization of health care services under managed care, the emphasis is increasingly on the community and public health. Unfortunately, funding has not increased, and legislation is not focused on public health. However, because bioterrorism is a major current concern and steps are being taken to be able to respond quickly and appropriately to a bioterrorist threat, public health has again become an area of focus.

6. With what endemic infectious disease did people choose to become infected?

Cowpox Those that had an infection of cowpox were thereafter immune from smallpox, which was endemic and killed about 10% of the population.

9. What did Nancy Milio suggest was the most effective way to improve the health of clients?

Create appropriate national health policies The range of available choices is critical in shaping a society's overall health status. Policy decisions in governmental and private organizations shape these choices. Hence, national-level policy making is the best way to impact the health of most Americans rather than continue to concentrate on imparting information in an effort to change individual behaviors.

22. Which kind of study would be most helpful in examining potential risk factors in comparison with disease at a specific time through collecting data regarding current exercise, sleep patterns, and current health status among 12-year-olds?

Cross-sectional study By definition a cross-sectional study examines relationships between potential causal factors and disease at a specific time.

Which of the following nurses used political expertise to influence the federal government to develop a Children's Bureau? a. Clara Barton b. Florence Nightingale c. Lavinia Dock d. Lillian Wald

D Lillian Wald recognized the connection between social conditions and health. She was a driving force behind the federal government's development of the Children's Bureau in 1912. Lavinia Dock was a political activist who waged a campaign for legislation to allow nurses to control the nursing profession. Florence Nightingale was the first nurse to exert political pressure on a government. Clara Barton was responsible for organizing relief efforts during the U.S. Civil War.

Which of the following factors is the single largest threat to child health? a. Child abuse b. Obesity c. Poor nutrition d. Poverty

D. Poverty Poverty is the greatest threat to child health. Children in poverty have less access to nutritious food, shelter, and health care. They are often deprived of advantages such as good schools and may live in substandard housing, have stressful home lives, live surrounded by drugs and crime, and lack positive and nurturing adult role models.

28. Why would large employers decide to self-insure?

To reduce administrative costs charged by insurance companies Some organizations have decided to self-insure their employees. This reduces the administrative cost of insurance, which has been estimated to represent 12.5% of the cost of insurance.

1. What types of data do epidemiologists gather to try to determine which factors may lead to disease? Select all that apply.

Demographic characteristics, Geographic data, When disease struck the area The person-place-time model suggests epidemiologists examine demographic characteristics of the community (person characteristics), geographic or environmental factors (place), and common time factors (time—or when the disease struck).

What proportion of U.S. citizens are children? a. 12% b. 16% c. 20% d. 24%

D. 24% In 2011, there were 73.9 million U.S. children under the age of 18 years. Children represent about 24% of the country's population, down from a peak of 36% at the end of the mid-1960's baby boom.

A client was quite ill and the family was doing their best. After careful assessment and diagnosis, the home health nurse was setting priorities for care. Which of the following should be the basis for deciding which intervention to implement first? a. Address the problem that is easiest to fix first so the client and family could see some success fairly quickly b. Address the most serious problem first for the client's long-term health c. Address the problem that is partly causing other problems first d. Address the problem that the client and family think should be addressed first

D. Address the problem that the client and family think should be addressed first The plan, including short-term and long-term goals, is developed in consultation with the client and the family. To maximize the plan's success, it is important that the patient and family are involved. If the client expresses a disinterest, the nurse will be limited in possible interventions. Goals are identified that the client is willing to work toward with the nurse's assistance. Thus, it is most important to address the problem that the client and family think should be addressed first. The other problems can be addressed after meeting the immediate needs of the client and family.

How do the policies on children's health in the United States differ from the policies on children's health in other industrialized nations? a. Most industrialized nations, including the United States, have similar policies. b. U.S. policies are more market based and less social justice based. c. U.S. policies are voluntary, whereas in most countries they are required by law. d. Although industrialized nations have policies on children's health, the United States does not.

D. Although industrialized nations have policies on children's health, the United States does not. In the United States, the government's role in promoting or ensuring children's health is more limited than in many other countries. Other countries often have defined policies on children's health; the United States does not. Not only do such policies indicate that children are a priority of the citizenry, but they also help shape the operation of programs and their funding.

Which of the following factors is strongly predictive for homelessness among women veterans? a. Having a previous criminal conviction b. Being a mother c. Having a high school education d. Being unmarried

D. Being unmarried Additional research has demonstrated that being unemployed, disabled, or unmarried strongly predicts homelessness among women veterans. Having a high school education, being a mother, and having a previous criminal conviction are less predictive of homelessness than marital status.

Which of the following best explains how the Civil Rights Act amendments have been helpful to adult women who are employed? a. If both a man and a woman apply for a position, preference must be given to the woman. b. Everyone has permission to apply for any employment position regardless of gender. c. Employers are prohibited from paying different salaries to men and to women for the same position responsibilities. d. Discrimination against pregnant women or conditions involving childbirth or pregnancy is prohibited.

D. Discrimination against pregnant women or conditions involving childbirth or pregnancy is prohibited. There is no affirmative action for gender, and pay scales remain different for men and women. Anyone has always been able to apply for any position; the issue is whether or not you would be chosen. The Civil Rights Act was amended to prohibit discrimination against pregnant women or conditions involving childbirth or pregnancy. This landmark legislation makes it unlawful for employers to refuse to hire, employ, or promote a woman because she is pregnant. In addition, employee benefit plans that continue health insurance, income maintenance during disability or illness, or any other income support program for disabled workers must include disabilities resulting from pregnancy, childbirth, and other related conditions. If employers allow disabled employees to assume lighter or medically restricted assignments, the same considerations must extend to pregnant women.

Which of the following statements best describe why environmental health is more challenging than other variables related to an individual's health? a. Environmental health affects susceptible individuals more than groups. b. Environmental health demands that individuals be willing to change their beliefs. c. Environmental health is dependent on social neighborhoods, as well as geography. d. Environmental health requires social, economic, and political changes to improve.

D. Environmental health requires social, economic, and political changes to improve. Intervening to improve environmental conditions requires basic social, economic, and political changes. Aggregates must work together to create such change. The other responses do not address the multiple dimensions that must be impacted in order to impact change within environmental health.

Which of the following is the most important task to be accomplished during the initial home visit? a. Assess the client and the family b. Discuss social topics c. Educate the client and the family regarding the health problem d. Establish rapport and trust

D. Establish rapport and trust Many clients in need of nursing visits do not trust the health care system and are uncomfortable with the representative from an agency visiting their home. The nurse must build a trust relationship early in the visit or the client will not allow additional visits. Beginning with social topics is often a helpful tool to help establish trust and rapport. After rapport and trust have been established, the nurse can assess the client and family and provide education. Discussion of social topics would not be the primary task to accomplish during any nurse-client interaction.

Which of the following is an example of a nonstochastic theory of aging? a. Cross-link theory b. Error theory c. Free radical theory d. Immunologic theory e. Somatic mutation theory f. Wear and tear theory

D. Immunologic theory All the theories except one are stochastic theories, that is, theories that are based on the assumption that events occur randomly and accumulate over time, which results in aging. The only nonstochastic theory, which views aging as predetermined, is the immunologic theory.

What has research suggested is a barrier to college students eating healthy? a. Lack of access to an exercise facility b. Lack of access to a primary care provider c. Lack of knowledge of the benefits of healthy eating d. Lack of knowledge related to food preparation

D. Lack of knowledge related to food prep Young adults, though identified as underinsured and having limited access to primary care, are identified as a group knowledgeable about the benefits of healthy eating. This age group (20-31) has been identified in numerous national surveys to not regularly engage in healthy eating habits especially eating below the recommended daily servings of fruits and vegetables and a diet high in fast foods. Earlier studies among college students identified the following barriers: cost, stress, lack of knowledge related to food preparation, and peer influence and lack of time to balance busy lives.

Which of the following does the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) service include in its routine screening that may not be included in a typical private physician preschool physical? a. Comprehensive health and developmental history b. Immunizations c. Laboratory testing d. Lead toxicity screenings e. Unclothed physical examination

D. Lead toxicity screenings The EPSDT includes lead paint screening. Medicaid-eligible children are guaranteed access to comprehensive health care services and routine dental examinations. Screening services must include a comprehensive health and developmental history, an unclothed physical examination, plus immunizations and laboratory testing that are age appropriate, as well as lead toxicity screenings. Because these children are very-low income, they probably live in older housing that may have lead paint. Private physicians caring for children with insurance see children of higher income levels who probably live in newer, safer housing

Which of the following best describes what is being discussed in relation to concerns over patients' safety and nurse fatigue? a. All hospitals are now required to report errors made that are a result of low nurse staffing. b. The Centers for Disease Control and Prevention (CDC) is monitoring the incidence of medical errors caused by nurse understaffing. c. The Registered Nurse Safe Staffing Act was passed by Congress in 2013. d. Legislation has been suggested that staffing systems require the input of direct care registered nurses.

D. Legislation has been suggested that staffing systems require the input of direct care registered nurses. The Registered Nurse Safe Staffing Act of 2013 was introduced in Congress to address concerns of inadequate and inappropriate staffing, which threatens patients' safety and the nurses' health. The act would encourage development of staffing systems that require the input of direct care registered nurses, as well as protection for RNs who speak out about patient care issues. This suggested legislation has not been acted on. The CDC is not involved in monitoring medical errors caused by nurse understaffing. Hospitals are not required to report errors that occur due to nurse understaffing.

Which of the following best describes the most common organization for receiving personal health care in the United States today? a. A group of physicians all in a particular specialty group who share an office b. Community health center that includes educational and social services c. Fee for service by a physician in practice by himself or herself d. Managed care organization with capitated payments to providers, both professionals and organizations

D. Managed care organization with capitated payments to providers, both professionals and organizations Managed care has become the dominant paradigm in health care. This model has replaced fee for service by a physician in independent practice or physicians in a group practice, and care in a community health center.

A public health nurse is working in a rural clinic. On the basis of risk, which of the following would be the priority group for care? a. African American adults b. Adolescents c. Elderly women who live alone d. Migrant and seasonal farmworkers (MSFW)

D. Migrant and seasonal farmworkers (MSFW) In general, MSFW may have the poorest health of any aggregate in the United States, and the least access to affordable health care. Eighty-?9?ve percent of the MSFW are Hispanic, Latino, or African American.

Which of the following employment opportunities are among the most dangerous? a. Food processing, textiles, and transportation b. Highway construction, ranching, and public utilities c. Large mechanized factory positions d. Mining, forestry, and fishing

D. Mining, forestry, and fishing Industries with the highest death rates were mining, agriculture, forestry, and fishing, followed by construction, transportation, and public utilities.

Which of the following outcomes for the infant and mother have occurred because of fetal monitoring? a. Improved outcomes for both infant and mother b. No difference for the infant but improved outcomes for the mother c. No difference for the mother but improved outcomes for the infant d. No difference in outcomes for the infant but increased risk for the mother

D. No difference in outcomes for the infant but increased risk for the mother The technology of fetal monitoring has been shown to increase the C-section rate without improving neonatal outcomes. C-sections are risky for the mother as they involve the risks of any major surgery such as hemorrhage, infection, damage to adjacent structures, as well as risks associated with anesthesia. Long-term sequelae for women include pelvic pain, along with formation of adhesions and placental abnormalities that lead to complications in subsequent pregnancies. Improved outcomes both for the mother and infant have not been demonstrated.

Which of the following factors would cause a geographic area to be called a frontier area? a. Arbitrary distinction recognizing the Great Plains, Intermountain areas, and Alaska b. Geographically located in the West, specifically the Great Plains states c. High death rate from use of guns (homicide or suicide) d. Population of fewer than six persons per square mile

D. Population of fewer than six persons per square mile Areas are classified as rural for populations with fewer than 45 persons per square mile and as frontier for geographic areas with fewer than six people per square mile. Many counties of the Great Plains, Intermountain West, and Alaska are designated frontier. Not all mountain areas are rural (the Appalachian mountain area is not), and geographic location alone does not make an area rural.

It has been proposed that a new, better approach to health care be tested with a small group to evaluate its effectiveness. Which of the following best describes why this cannot be done? a. Any employment in the project would be only temporary, so it would be difficult to find professionals to staff the program. b. It is challenging to find appropriate sites located in the target area from which to offer the pilot project service. c. No one wants to accept free services if they include being a guinea pig in a research project. d. Offering a service establishes a precedent and a sense of entitlement, so it is difficult to discontinue the program.

D. Offering a service establishes a precedent and a sense of entitlement, so it is difficult to discontinue the program. Once a direct health care service is offered, it is difficult to discontinue it. Existing programs create tradition by establishing vested interest and a sense of entitlement.

A friend who was raped and beaten appeared to be coping well. However, she recently dropped out of school and shared with the nurse that she is having nightmares where it happens all over again, and these nightmares are becoming impossible to live with. Which of the following would be the concern of the nurse? a. A late psychological reaction of despair and hopelessness b. Depression that no one rescued her and saved her from the traumatic event c. Guilt and concern over what she could possibly have done to invite such an event d. Posttraumatic stress syndrome disorder (PTSD)

D. PTSD PTSD is a psychiatric disorder that can occur after an individual's experiencing or witnessing a life-threatening event. People who suffer from PTSD often relive the experience through nightmares and flashbacks. The social and psychological symptoms can be severe enough, and last long enough, to significantly impair a person's daily life

Which of the following best describes how providers can legally improve their profit under the current reimbursement process? a. Accept more patients and work more hours so former high income is retained b. Order the cheapest generic medications and treatments possible c. Convince patients that they do not want expensive treatments d. Practice conservatively to earn an incentive payment

D. Practice conservatively to earn an incentive payment As a reward for conservative medical practices, health care providers may receive a specified amount of money or a percentage of the agreed reimbursement if services are delivered below the limit set by the third-party payer. Thus, it is the responsibility of the provider to use this conservative practice. Patient care should not be compromised as providers practice conservatively.

When was the idea of national health care insurance first debated in the United States? a. Clinton's 1992 presidential campaign as he attempted to achieve such a plan b. During President Johnson's administration when Medicare and Medicaid were instituted in the 1960s c. President Franklin Roosevelt's attempt to include health insurance in Social Security legislation in the 1930s d. President Theodore Roosevelt advocated such national medical coverage in 1916

D. President Theodore Roosevelt advocated such national medical coverage in 1916 European countries began a social model of health insurance in the early 1900s. President Theodore Roosevelt advocated a similar plan for the United States in 1916. The other attempts mentioned came after Theodore Roosevelt's initial attempt in 1916.

Which of the following best describes an unexpected result of the decrease in funding to traditional public and private forms of health care? a. Emergency departments where patients can't be turned away are overwhelmed with patients needing nonemergency care. b. Grants are increasingly being requested to pay for care. c. More people don't receive needed health care in a timely manner. d. Programs are developed as a result of community efforts.

D. Programs are developed as a result of community efforts Most of the choices are expected consequences of decreased funding. What is unexpected is the increase in the number and type of models being created, as traditional public and private models of health care decline because of funding and shrinking resources. The programs develop in part as the result of community efforts.

Which of the following infections continues to increase in the United States? a. Measles b. Pertussis c. Hepatitis A, B, and C d. Sexually transmitted diseases (STDs)

D. STDs Treatable STDs, such as gonorrhea, chlamydia, and syphilis, are still occurring at significant rates. Gonorrhea had plateaued or declined until 2009 but increased steadily since that time. Reported infections with chlamydia reached an all-time high in 2011

A young woman rolled her wheelchair up the ramp into the clinic to the desk where the intake nurse greeted her. Which of the following should be the nurse's first response? a. "How can I help you?" b. "Who came with you today?" c. Compliment her on her skill with the wheelchair d. Sit so the nurse is on eye level with the young woman

D. Sit so the nurse is on eye level with the young woman Nurses who demonstrate understanding of the issues confronting people with disabilities should approach them on an eye-to-eye level, listening to understand. Moving to eye level should be the first action that the nurse takes before beginning a conversation with the client.

Which of the following best describes how the practice of faith community nurses is different from the practice of other nurse specialists? a. Advanced education is required before attempting such a challenging role. b. Practice setting is in a building dedicated to a purpose other than health care. c. The nurse is a member of the same community where the nurse practices. d. The central focus of the practice is the spiritual dimension.

D. The central focus of the practice is the spiritual dimension. A key element of the philosophical basis of parish nursing is the spiritual dimension, which is central to the practice. All specialties require advanced education and are often practiced in non-health-oriented settings, such as workplaces, schools, or client homes.

A nurse conducted a study of two skin lotions: (1) an inexpensive one and (2) an expensive one. The nurse found that there was a relative risk of 0.7 for skin sores using the inexpensive one and a relative risk of 1.2 using the expensive one. Which skin lotion should the nurse use? a. Impossible to tell from the data given b. It made no difference which lotion was used c. The expensive lotion d. The inexpensive lotion

D. The inexpensive lotion. A risk factor of less than one means the factor is actually protective, so the inexpensive lotion is helpful in preventing skin sores. A risk factor of more than one means the factor increases risk, so using the expensive lotion increases the probability of getting a skin lesion.

Which of the following best describes the proportion of the U.S. population that is made up of persons with a long-lasting condition or disability? a. The number is about 5% and increasing. b. The number is about 10% and stable. c. The proportion is about 15% and stable. d. The proportion is almost 20% and increasing.

D. The proportion is almost 20% and increasing. In 2010, approximately 56.7 million (18.7%) of the 303.9 million civilian noninstitutionalized population aged 5 years and older had a long-lasting condition or disability. Further, it is important for health care policy makers and health care providers to recognize that the prevalence of disability is increasing.

Which of the following best describes what is happening with infectious diseases in the United States? a. There is a continuing decrease in vector-borne infections. b. There is a continuing increase in food-borne and waterborne infections. c. Many airborne diseases are being spread by bioterrorists. d. The rate of infection varies extensively by income and ethnic groups.

D. The rate of infection varies extensively by income and ethnic groups. Probably one of the most profound failures in infectious disease control in the United States and elsewhere is that the successes are not equally distributed in the general population. Infectious diseases continue to be differentially distributed by income and ethnic groups, and the poor and minorities continue to experience the greater burden. There continues to be an increase in vector-borne infections, but there has been a decrease in food-borne and waterborne infections. There is concern that deadly pathogens will be weaponized by terrorists

Which of the following best describes how voluntary health agencies fit into the overall health care system? a. They fill in the gaps between services offered by private and public health systems. b. They primarily serve as sources of financial aid for the underserved. c. They supplement the effort of the public health care system. d. They support research, education, and services for particular groups of patients.

D. They support research, education, and services for particular groups of patients. Voluntary health agencies are committed to specific diseases, organ or body structures, health and welfare of special groups, or particular phases of health. Philanthropic groups support research and programs. These organizations provide major sources of help in preventing disease, promoting health, treating illness, consumer education, and advocacy and research. Unfortunately, there continue to be overlaps among private, voluntary, and public agencies, but without voluntary agencies, fewer services would be available.

Which of the following is the single leading preventable cause of death in the United States? a. Alcohol b. Firearms (guns) c. Overweight and obesity d. Tobacco use

D. Tobacco use Tobacco use is a major problem in this country and is the single leading preventable cause of death in the United States. Overweight and obesity is the second leading cause of preventable death in the United States. Alcohol and firearms (guns) are not leaders in the causes of preventable death in the United States

Which of the following was a major change after Medicare began a prescription drug benefit? a. Number of prescriptions ordered by physicians decreased b. Medications increased without affecting patient care outcomes c. U.S. expenditures on drugs approached the same level as that of other industrialized nations d. Use of drugs and their cost immediately increased

D. Use of drugs and their cost immediately increased As with other health care services, once a funding source has been established, usage and costs increase. Thus, the number of prescriptions ordered increased. For 2006, the United States expenditure for pharmaceuticals was 1.5 times that of other industrialized countries, and these expenditures continue to rise.

Which of the following actions should be taken by a typical community preparing for the expected demographic changes in the United States? a. Build more elementary schools b. Build more high schools c. Build more colleges d. Build more adult condominiums

D. built more adult condominiums The number of children will increase, but the proportion of children as compared with adults has been decreasing since the mid-1960s. Consequently, more housing for adults is needed.

Which of the following has led to the more recent focus on cooperation between the state and the federal level in relation to public health? a. The emphasis of Healthy People 2020 b. The ongoing continued restriction of financial resources c. The new presidential administration's goals d. The threat of bioterrorism

D. the threat of bioterrorism Cooperation between the state and federal levels has been brought to the forefront with efforts to plan for bioterrorism, an event that would necessitate cooperation and sharing. In addition, the state is highly dependent on the federal level for resources and guidance. The administrative goals of the president, emphasis of Healthy People 2020, and restriction of available financial resources have not been the main factor that has led to an increase in cooperation related to public health.

2. What kind of information must be analyzed to derive an adequate explanation of disease? Select all that apply.

Description of commonalities among those who became ill, Depiction of the possible pathogen, Portrayal of the geographic area where people became ill The epidemiological triangle includes the agent (pathogen), host (people who are susceptible and become ill), and environment (the geographic area where people became ill). These three areas allow for an explanation of disease.

Which of the following would be a problem for an older adult with a hearing loss? (Select all that apply.) a. Difficulty in finding a hearing aid that is unobtrusive b. Embarrassment at having to wear a hearing aid c. Hearing is not part of a routine health screening d. Long delays in getting an appointment to see an audiologist or otolaryngologist e. Medicare does not cover the costs of hearing aids f. The adult may withdraw, become isolated, and depressed

E, F In general, Medicare does not cover the costs of hearing aids; Part A covers hospitalization and Part B covers physician and outpatient services, qualified therapies, durable medical equipment, and some home health care services. Consequences of hearing loss may include withdrawal, isolation, and depression. Because of advances in technology, hearing aids are much smaller and less obvious than they previously have been. This leads to less embarrassment and noticeability for those who use them. Because loss of hearing is one of the most common conditions affecting older adults, it should be screened for as a part of routine health screening. There are typically not long delays in seeing a specialist for referral.

3. As in Healthy People 2010, what are the two primary goals of Healthy People 2020? Select the two that apply.

Eliminate health disparities, Increase quality and years of healthy life As published, the two goals are to increase quality and years of healthy life and eliminate health disparities.

4. Which ethical belief would be most helpful in the current health care crisis?

Emphasis should be on social justice and collective responsibility. Public health recognizes the necessity of collective action in keeping the environment safe and in egalitarian tradition and vision. An overinvestment in technology and seeking of cures within the market justice system has stifled the evolution of a health system to protect and preserve the health of the population. Although individual autonomy and freedom of choice are important, so is the recognition of collective responsibility in ensuring social justice, which entitles all people to basic necessities.

11. A nurse found that several professionals resented time spent interacting with and teaching clients. What might be the underlying motivation for resisting client involvement?

Empowering others shifts power from the experts to the community. Successful programs rely on empowering citizens to make decisions about their care. Empowering citizens causes power to shift from health providers to community members. Many prefer to remain in positions of power rather than sharing.

6. What assumption can make Dorothea Orem's theory difficult to use?

That the client is able to control his or her environment Orem's theory is focused on patient-nurse interaction within institutional settings. It assumes that the client can control his or her environment, whereas most persons cannot control work, school, or neighborhood environments.

4. What must be done to evaluate a project once it has been completed? Select all that apply.

Ensure that adequacy and appropriateness of the intervention are measured, Be certain the efficiency and cost benefits are measured, Communicate follow-up recommendations to the community A comprehensive outcome evaluation includes measurement of adequacy, appropriateness, efficiency, and cost-benefit measurements. The intervention will have limited impact unless follow-up recommendations are communicated to the aggregate on completion of the project. Media coverage may or may not be helpful, depending on the project and the intervention. Statistics are useless unless carefully chosen to reflect measurement of objectives. Reports are often shelved without being read, so only those immediately involved should have both input into any report and a copy of the outcome findings.

10. Individual responsibility can be assumed for modifiable risk factors, but what risk factors are least subject to modification?

Environmental exposure An individual may choose to control lifestyle behaviors, nutrition choices, and recreational options. An individual cannot alone control his or her neighborhood, employment setting, or other environmental exposures.

3. What interventions might a nurse choose based on the Health Belief Model to help a client improve his or her lifestyle choices? Select all that apply.

Examine the individual's perceptions of his or her health in relation to current lifestyle behavior choices Review how lifestyle changes can reduce risk and improve the client's life Share statistics regarding the probability of health problems and their seriousness if action is not take Use communication channels to send reminders of action currently needed Unfortunately, although people have to know what to do and how to do it before they can take action, information alone will not motivate people to act. Continued harassment, as in emphasizing how important it is for people to act, also is not motivating. What is effective begins with examining the individual's perceptions of his or her health and current lifestyle choices so education to change perceptions can occur. Sharing information regarding the probability of illness or perceived susceptibility and using communication channels to serve as cues to action may both be motivating. Similarly, reviewing how lifestyle changes can reduce risk and improve life may change the person's perception of the benefits of acting.

6. What do contemporary historians now suggest has been previously ignored in relation to health care? Select all that apply.

Extensive care giving by female healers in the home, Social and environmental contexts of care Historians have typically ignored the extensive care by women healers, referring to them as marginal amateurs, as well as the major influence of social and environmental contexts on health and medical care that is necessary to place health care in a broader context.

2. What is meant by "thinking upstream"?

Focus on economic, political, and environmental factors "Thinking upstream" means focusing on modifying economic, political, and environmental factors that are the precursors of poor health throughout the world.

12. Why do we not know the incidence or prevalence of gonorrhea?

Gonorrhea is not a reportable condition. The text states that data on many conditions are not available because surveillance is not widely conducted. In other words, there is no responsibility to report cases of most diseases, including gonorrhea. Further morbidity rates are subject to underreporting. Information is only available related to conditions where care providers are required to report that specific condition or where those affected die and mortality data are available.

14. What is a current trend regarding heath care services?

Health care organizations are offering services low in cost and higher in reimbursement. There is a national shift from nonprofit health care to for-profit health care as large for-profit organizations take over smaller community organizations. Because emphasis is on profit, mechanisms of achieving higher reimbursement have been developed. Coding of the patient's illness from the CPT codes results in an increase in reimbursement. Use of computerized medical record programs almost ensures that service can be reimbursed at the highest rate possible. This has changed health care practices to the utilization of services that are low in costs and higher in reimbursement. High-cost services are limited or not offered.

1. A nurse reviewed some handouts before meeting the community residents attending a program on healthful living. What is this nurse's behavior called?

Health promotion Health promotion is any combination of health education and related support for health behaviors. It is not specific protection or disease prevention because no specific disease is being avoided. Although healthful living may indeed improve health, there is nothing to suggest the attendees were not currently healthy.

10. Lemuel Shattuck is well known in the United States for which achievement?

His ideas concerning public health care reform, which were eventually adopted Lemuel Shattuck organized the American Statistical Society and issued a census, which demonstrated high mortality rates. His report of the Massachusetts Sanitary Commission recommended modern public health reforms. However, nothing was actually done about the recommendations for almost two decades. Eventually, however, the merit of his ideas was recognized.

21. What was the name of the district nursing service created in the United States by Lillian Wald and Mary Brewster?

House on Henry Street They established a district nursing service on the Lower East Side of New York City called the House on Henry Street for all the unemployed and homeless immigrants who needed health care. It later evolved into the Visiting Nurse Association of New York City and helped establish public health nursing in the United States.

7. What was one unfortunate consequence of using diagnosis-related groups (DRGs) to determine reimbursement? Select all that apply.

Incentive was to undertreat and underuse health resources. Quality of care was no longer assured. Because costs were contained by both the federal programs and insurance companies, the providers had a strong incentive to undertreat and underuse health resources. The public feared that the quality of care being provided was less to keep costs as low as possible

11. What is the health issue causing the most concern in the United States today?

Increase in obesity The widespread increase in incidence of overweight and obesity has led to calls for population-based measures to address this issue.

2. In giving care to an individual person, why would it be important for the nurse to be knowledgeable about the community?

Individuals and families are strongly influenced by the community and environment around them. It is assumed that community health nurses can read maps—or use a global positioning system in their car—to find client addresses. Although it is indeed important to be an advocate for health care reform and to have information regarding resources available for client services, in the process of giving care, the nurse must particularly be aware of how individuals and families are influenced by the community and environment around them.

4. A nurse was becoming frustrated. She had given her client extensive information on his health problem, but the client continued to be noncompliant in making needed changes. What had the nurse forgotten?

Information, while necessary, will not motivate people to change. Although other priorities may result in delay of change, the fact that the client has returned to the nurse demonstrates interest in changing. Repetition may be helpful, but apparently the nurse has given information on more than one occasion because she believes extensive information has been given. Information alone is rarely enough to motivate a person to act. Information is necessary to know what to do and how to do it before the person chooses to act, but other factors are primarily responsible for motivating people to change their behavior.

14. Which listed factor is most closely associated with morbidity and mortality outcomes?

Insurance status Social political variables such as race-ethnicity, educational status, gender, and income are highly predictive of health status, but the single most relevant factor of those listed is whether or not the person has insurance.

2. Although obtaining information from the aggregates themselves would be optimal, what other source of information might the nurse use to quickly and easily become informed about an aggregate? Select all that apply.

Interview those persons who have previously been involved with the aggregate in some helping role. Review any available records or previously gathered data, Try to find a few key informants and ask for their input. Unfortunately, telephone surveys would probably not be effective because many persons no longer have landlines but rely on cell phones. There would be no easy way to obtain the appropriate telephone numbers. A mail survey would be expensive and time consuming and probably would receive few responses because participants would be asked to think, write, and act to return the survey. Observing without letting persons know they are being observed borders on unethical. However, interviewing persons previously involved and reviewing previously gathered data would be possible.

6. A nurse decided that a high-risk aggregate most needed education about diabetes. What might be the best approach to teaching the group?

Involve participants in small-group activities applying the information Most persons do not enjoy lectures, so the nurse must initiate small-group involvement and participation. Those with less educational experience are more comfortable in informal learning settings.

5. What measure(s) did persons use for self-protection from the Black Death (bubonic plague) in the fourteenth century?

Isolation and quarantine Modern public health practices such as isolation, disinfection, and ship quarantines emerged in response to the bubonic plague.

3. What is the advantage of the ecosocial epidemiology model over both the web of causation model and the epidemiological triangle model? Select all that apply.

It decreases the focus on the individual person., It emphasizes the role of complex political and economic context, Its use suggests possible public policy interventions. The ecosocial approach challenges both the individually focused risk factor approach and molecular epidemiology (sequencing of genes to improve individual susceptibility), as it emphasizes the role of macro-level socioenvironmental factors, especially complex political and economic forces in health and illness.

1. What does Knowles say is especially typical of adult learners? Select all that apply.

Learning draws on the learner's previous life experiences. They need to know why professionals think this knowledge is important. They want information related to current developmental tasks. Knowles suggests all learners want to know why they need to learn material. Material related to previous life experiences, current developmental tasks, or dealing with current challenges is useful and accepted by adult learners. Material chosen by professionals based on what might happen in the future or that ignores barriers such as lack of resources or low self-esteem will not be retained. Active participation through discussion with others helps involve and motivate adult learners.

6. Why do nurses often ask clients how they are sleeping? Select all that apply.

Many adults report sleep problems or occasional lack of sleep. Many important functions occur during sleep. Almost three fourths of all adults report having a sleep problem at least once a week, yet sleep is an essential component of chronic disease prevention and health promotion. Many important functions occur while we sleep such as release of hormones, memory consolidation, and decrease in blood pressure.

24. The most recent planning model, the Mobilizing for Action Through Planning and Partnership (MAPP) model, has three phases. What is the first and perhaps most important phase?

Mobilize the community to become involved The MAPP Model is a planning model that is based on first mobilizing the community; then guiding the community toward a shared vision for long-range planning; and, third, conducting assessments of community strengths, forces of change, health status, and the local health system.

3. What is a weakness among the many nursing theories created throughout the years on the most appropriate ways to approach patient care?

Most nursing theories focus on microscopic individual concerns. Most nursing theories have an extremely narrow focus on individual nurse-patient care situations. This microscopic focus ignores the broader global social macroscopic perspective.

26. What helps explain the increased numbers of advanced practice nurses in primary care?

Most physicians are specialists. Because so many physicians are specialists and there is increasing demand for primary care providers, there are increased opportunities for advanced practice nurses in primary care. Hospitals are decreasing the number of beds, not increasing them.

16. What is the name for the model that demonstrates the progression of disease from prepathogenesis through disease outcome?

Natural history model The natural history of disease model explains disease from prepathogenesis through resolution of the disease process.

4. A nurse involved with a community group told peers that the group was learning networking, negotiating, lobbying, and information seeking. Why isn't the nurse working toward a noticeable improvement in health status for the group? Select all that apply.

Networking, negotiating, lobbying, and information seeking will continue to be useful throughout the participants' life span. There are no immediate solutions to the current health problems in most communities. Nurses use empowerment strategies when helping people develop skills in problem solving, critical thinking, networking, negotiating, lobbying, and information seeking to enhance health. Because health problems have social and political aspects, group members must develop action strategies. Health problems are complex and do not usually have easy and immediate solutions.

27. How do we explain the continued incidence of infectious diseases in the United States today?

No single theory adequately explains why a particular person gets a particular illness at a particular time. Each theory explains some disease under some conditions, but no single theory accounts for all disease. Infectious agents cause disease when a person is susceptible as a result of stress and/or environmental conditions.

16. Which nurse is using a macroscopic rather than microscopic approach?

One who provides testimony to legislators concerning proposed legislation All the choices focus on individual client care except for the nurse who is politically involved as demonstrated by providing testimony relevant to proposed legislation.

17. Which neighborhood would probably be best for someone interested in retaining his or her health?

One with high walkability One's environment is a significant factor. Those living in neighborhoods with high walkability engage in significantly more walking than those living in neighborhoods with low walkability.

6. Under the Theory of Reasoned Action, what is the easiest way to determine whether a person will change his or her behavior?

One's intention to perform a behavior The Theory of Reasoned Action attempts to predict a person's intention to perform or not perform a certain behavior based on the assumption that all behavior is determined by one's behavioral intention.

4. Why do many persons who have Medicare decide to purchase Medigap health insurance policies? Select all that apply.

Patients have to pay a deductible (about $1000) when admitted as a hospital inpatient for care. Medicare Part A does not pay for physician services, hospital outpatient care, and medical equipment. Medicare does not pay for all health care costs of enrollees. There are costs the individual must pay. Consequently, individuals often decide to buy a Medigap policy. Medicare part B (if purchased) pays for physician services, hospital outpatient care, durable medical equipment, and other services including some home health care. The patient does have to pay a deductible, which was almost $1000 in 2010, if admitted as a hospital inpatient. Medicare part A does pay for most inpatient care in hospitals and skilled nursing facilities, hospice care, and some home health care.

2. Historically, how did patients pay for health care?

Patients paid out of their pockets for whatever care the provider charged. Until the 1930s, the predominant method of health care financing was self-payment. Health care providers charged a fee for the services they rendered, and the patient paid the out-of-pocket expense. The assumption was that those who could pay would pay and those who could not pay should receive care and pay what they could.

5. A nurse wanted a screening test that was very sensitive in determining who might have a particular illness. What might be a problem with using such a sensitive test? Select all that apply.

Persons who do not have the illness are told that they might, which leads to anxiety, as well as time and cost of follow-up diagnostic tests. d. Such a test may have lower specificity, so some persons with the disease are told they are disease free and hence do not receive care. The problem with very sensitive tests is that the test picks up almost all people with the disease but also many others who do not have the disease. These "false positives" result in persons needing follow-up diagnostic tests. Additional time, effort, and expense, as well as worry, result until the negative test results are obtained. There is no problem with persons receiving true negative test results and celebrating that knowledge or with persons having their condition correctly diagnosed and treated.

20. Indemnity plans were very much appreciated, but what flaw did they have?

Plans lacked any incentives to contain costs. Indemnity plans paid all the costs of covered services provided to the enrollee. The enrollee enjoyed free choice of provider and services. They preserve the enrollee's right of choice and allow the person to manage his or her own health care. These plans lack incentives for cost containment. Today, cost-sharing efforts (e.g., co-payments, deductible) help contain costs.

19. One hundred women received notification that their screening tests suggested that they might have a serious health problem. How can you reassure these scared women so they will come in for follow-up testing and treatment?

Point out that screening is only suggestive and that not all positive screenings mean they actually have the health problem. Not all positive screening results are confirmed with further diagnostic testing. The positive predictive value of a test (proportion of true positive results relative to all positive test results) is usually known for any screening test. Although one could argue that the test could be wrong, it is more therapeutic—because you want people to attend future screenings—to emphasize that screening is only suggestive than to say the screening test is inaccurate.

25. When was the idea of national health care insurance first debated in the United States?

President Theodore Roosevelt advocated such national medical coverage in 1916. European countries began a social model of health insurance in the early 1900s. President Theodore Roosevelt advocated a similar plan for the United States in 1916.

22. What is the best way for the nurse to be sure that the teaching material and communication channels will be effective?

Pretest the materials with members of the target group to obtain feedback about their acceptability and understandability Pretest the materials to obtain feedback about the understandability and acceptability of the materials with this particular audience. Learning in advance what works and what does not saves time and effort later.

19. What is the primary thrust of philanthropic groups involved in health care?

Primary informational and research activities Philanthropic funding whose services are typically research or disease oriented pays a limited amount of health care. Services are limited to the specific disease or population of interest. Informational and research activities constitute the majority of services provided, although some give direct care or meet ancillary needs such as housing, transportation, or wigs.

26. How was the government successful at containing costs?

Prospective payments were based on diagnosis-related groups (DRGs). Various efforts from, for example, certificate-of-need, peer review, and utilization review were not effective. Prospective payment based on DRGs proved to be effective. The cost reduction that resulted gave rise to the managed care revolution as providers searched for the most cost-effective mechanism of care provision.

24. One famous study followed a cohort of nurses over their lives, collecting data and health histories as they aged. What kind of study is this?

Prospective study Prospective studies monitor a group of individuals to determine if and when disease occurs.

25. A researcher wanted to engage in the best possible research design to obtain reliable information about the possible cause(s) of a disease. Which design would the researcher choose?

Prospective study The most advantageous research design, because it obtains more reliable information and can more easily establish a stronger temporal relationship between presumed causal factors and their effects, is a longitudinal cohort prospective study.

5. What is the primary problem seen in Healthy People 2020's emphasis on choosing healthy lifestyle behaviors, such as daily exercise or healthy food choices?

Public policy emphasizes personal responsibility but ignores social and environmental changes needed for well-being. Although all responses are accurate, the primary problem is the emphasis on personal choices in the Healthy People 2020 objectives. Emphasis on personal choices ignores the need for community responsibility and action that addresses environmental or cultural restraints to health.

2. Many of Nightingale's ideas were absorbed into nursing education in both England and other countries. Which of the following of Nightingale's ideas were forgotten until recently? Select all that apply.

Recognizing the influence of environment on health, Use of statistics and a sound research base As the text remarks, it is interesting to note that the paradigm for nursing education and practice did not incorporate her emphasis on statistics and a sound research base. It is also curious why her writing on health's social and environmental determinants was not consulted until much later.

17. Which action would probably result in the largest change in health care outcomes for Americans?

Redirect a large portion of federal funding from acute care to health promotion activities Of the choices given, health promotion activities would make the largest difference. Increased expenditures on acute care will not notably change the health of the population, whereas funding that addresses health promotion such as education and safe environments would improve the health of the aggregate.

30. Based on public health issues today, what is the major challenge for health care provider education?

Refocusing the curriculum from care of the individual to needs of aggregates There is an obvious need for a primary care curriculum that prepares students to meet the needs of aggregates through community strategies that include understanding of statistical data and epidemiology. Primary health care and health promotion rather than acute care treatment would be emphasized. Such a curriculum would move the focus from the individual to a broader population approach.

9. How did John Snow decrease deaths from cholera?

Removed a source of contaminated water John Snow demonstrated that cholera was transmissible through contaminated water. He removed the pump handle from the contaminated water so an alternate source of water had to be used.

29. What is the issue of major concern among feminists regarding health care?

Reproductive freedom for women Feminists believe that all people are inherently equal and deserve equal opportunities. In health care, feminism focuses on reproductive freedom for women.

7. What was the advantage of creating medical topographies?

Results demonstrated environmental factors related to regional disease. Survey methods were being used to study health problems. The medical topographies illustrated geographic factors related to regional health and disease.

26. Which research design would a researcher with limited time and funds probably choose?

Retrospective study Because longitudinal cohort or incidence studies are costly in terms of resources and staff and often lose subjects over time, a retrospective study may be used because it is faster and less demanding of resources.

23. What did Lillian Wald help create that was very useful for poor children?

School health nursing for school-aged children Wald convinced the New York City Health Commissioner to put a public health nurse into a school. The experiment was so successful that schools adopted nursing on a widespread basis, thereby creating the field of school health nursing.

1. What is the best definition of economics?

Science of allocation of resources Economics represents the science of allocation of resources. Resources are goods or services.

17. What level of prevention does a screening examination, required for each school athlete before being active in school sports, represent?

Secondary prevention Screening, because it may result in early diagnosis and treatment, is secondary prevention.

1. What is most impressive about Lillian Wald's achievements?

She demonstrated how to improve health in communities. Lillian Wald improved health in a community by using diplomacy and neighborhood power. She was elected president of a national nursing organization and created new nursing specialties such as school nursing. However, she is primarily known for her creation of Henry Street House (see Chapter 2 of text), which led to the Visiting Nurses Association and notably improved health in many communities.

16. Because of an interest in social justice, what major event affecting health care occurred in the 1960s?

Social Security Act was amended to create Medicare and Medicaid legislation. The popularity and benefits of employer-provided insurance plans were recognized, as was the reality that some segments of society were being neglected. The 1960s, with a pervasive thrust for social justice, presented the opportunity to move toward universal health care coverage. Titles XVIII and XIX of the Social Security Act created Medicare and Medicaid, respectively.

17. What is the goal of participatory action research?

Social change resulting from stakeholders' strategies The goal of participatory action research is social change. The strategies reached collectively by the involved stakeholders lead to changes within the group and the community.

11. What health-related variable does critical theoretical perspective examine?

Social inequalities Critical theoretical perspective examines social inequalities within the broader political, economic, and social systems of society that keep people from reaching their full potential.

8. How did Edwin Chadwick's ideas help decrease disease in the nineteenth century?

Social reform legislation resulted in changes such as sidewalks. Edwin Chadwick's Report on an Inquiry Into the Sanitary Conditions of the Labouring Population of Great Britain led to legislation for social reform including child welfare, factory management, clean water, sewers, fireplugs, and sidewalks.

20. What is the best way to increase the positive predictive value of a screening test?

Test a group at high risk for the health problem The positive predictive value is affected by what proportion of the tested population has the problem. To increase the positive predictive value, screen populations most at risk for the problem.

14. A nurse had all the details carefully arranged for a project: location, speaker, seating arrangement, refreshments, handouts, visual aids, and students to distribute and collect evaluation sheets. What might be a problem?

Something totally unexpected and unplanned for. Although implementation should follow the plan, the nurse must also prepare for unexpected problems. If the project fails, it is crucial to analyze what went wrong so it can be avoided in the future.

14. What scientific belief or idea eventually changed medical practice and decreased morbidity and mortality?

Specific contagious organisms cause disease. The emergence of the germ theory of disease focused diagnosis and treatment on the individual organism and the individual disease.

16. What would be the proper term for the action of the school health nurse arranging for all the students in the elementary school to receive H1N1 immunizations?

Specific protection Immunizations are a specific protection effort as part of primary prevention.

14. Which research study would determine the attributable risk of a sedentary lifestyle in cardiac disease?

Subtracting the rate of cardiac disease among athletes from the rate of cardiac disease among non athletes Attributable risk is determined by subtracting the rate of disease among nonexposed individuals (such as athletes) from the rate of disease among those exposed (the individuals with a sedentary lifestyle).

6. What responsibility does the ANA Code of Ethics require of the nurse beyond giving excellent care to clients?

Support health legislation to improve accessibility and cost of health care. The ANA Code of Ethics promotes social reform by focusing on health policy and legislation to positively affect accessibility, quality, and cost of health care. The Code does not directly address workplace issues such as work schedules or need for overtime.

21. What is the first and most crucial step according to the Framework for Developing Health Communications?

Target the program to meet the audience's learning needs as they perceive them Understanding the intended audience's learning needs and targeting the program or message to the audience is key to activating effective health education.

18. What group was primarily responsible for the establishment of the first school of public health?

The Rockefeller Foundation Philanthropic foundations influenced many health care efforts. The Rockefeller Sanitary Commission strived for the eradication of hookworm. This model of prevention was so successful that the Rockefeller Foundation established the first school of public health in 1916.

10. What change could most effectively lead to a longer life span in Americans?

The belief that smoking is shameful and disgusting, as well as expensive, becoming the social norm Smoking is responsible for about 20% of all deaths in the United States. Although smoking is an individual's choice, all people are affected by social norms.

5. A patient did not attend the clinic for required follow-up care after his extensive surgery. What might the nurse appropriately conclude?

The health care system is not meeting the client's perceived needs. Although it is easy to blame the patient for being noncompliant or neglecting himself or herself, or to blame the nurse for not "educating" the patient appropriately, it is equally plausible that the health care system is not meeting the client's perceived needs. Clients can have many reasons for not keeping an appointment such as family emergencies, lack of funds, or lack of transportation. Sociocultural and ethnic barriers can also be factors.

15. A nurse did a study of two skin lotions: an inexpensive one and an expensive one. The nurse found that there was a risk factor of 0.7 for skin sores using the inexpensive one and a risk factor of 1.2 using the expensive one. Which one should the nurse use?

The inexpensive lotion A risk factor of less than one means the factor is actually protective, so the inexpensive lotion is helpful in preventing skin sores. A risk factor of more than one means the factor increases risk, so using the expensive lotion increases the probability of getting a skin lesion.

20. Why was the National Health Planning and Resources Development Act of 1974 unsuccessful in its efforts to increase accessibility and acceptability, improve quality, and constrain rising costs?

The law did not affect the current health care delivery system. The 1974 Act was unsuccessful because it grandfathered in the entire health care system. In other words, nothing had to change.

11. What is the primary reason risk reduction is of such importance in the United States today?

The leading causes of death are all related to lifestyle choices. Approximately 50% of annual U.S. deaths occur as a result of modifiable lifestyle factors. The leading causes of death with the highest mortality are all related to lifestyle factors. A change in these factors will also reduce health care expenditures and insurance costs for those persons with insurance. However, unnecessary deaths are even more important.

7. What is the major assumption of the health belief model created and used by social psychologists?

The major determinant of preventive health behavior is avoiding disease. The model is based on the assumption that the primary reason people act is disease avoidance. Such avoidance means they perceive themselves as susceptible to a serious disease, there is some cue to action, and there are more benefits than barriers to acting.

3. In what way does the Health Planning Model for care of aggregates differ from the customary nursing process applied to the care of an individual?

The nurse must first decide on and define the aggregate to receive care. Whether caring for an individual, a family, or an aggregate, the nurse must know the demographics of the client and choose which health need has first priority. In caring for aggregates, each participant does not receive an equal number of services, but those services that each participant needs. However, the nurse does have to decide on which aggregate to focus and then carefully define that aggregate.

8. People were very concerned about another outbreak of swine flu. All care providers were asked to report, without individual names, any new cases to the public health department for tracking. What would be most helpful for local media to report to keep citizens informed?

The ongoing incidence rate As only new cases were being reported to the health department, the media could only report the ongoing incidence rate, that is, the number of new cases reported each day.

8. What factor is crucial to plan an effective health education program?

The sociopolitical cultural context of the community's environment Community health education with the community as client is based on practical, relevant, and scientifically sound methods and widely accessible technology. An effective program relates economical, political, and epidemiological factors to internal behavioral and communication factors. Thus the program activities are viewed within a sociopolitical structure especially within the local environmental settings.

9. In trying to determine whether the swine flu outbreak was getting worse, what rate should be carefully observed?

The swine flu incidence rate The incidence rate of new cases would be most useful for detecting short-term acute disease changes, as the swine flu duration is usually relatively short.

4. What is the primary purpose of nursing theory?

To continually improve nursing practice Although nursing theory does serve as a basis for ongoing research, does help demonstrate that nursing is a profession, and may help nurses organize their knowledge, its primary purpose is to improve nursing practice.

13. Which question is the most important to be included in each client's health history?

What kinds of tobacco do you use daily? As smoking is the leading cause of preventable deaths, accounting for about one out of every five deaths, it is crucial that tobacco use be queried in each health history. After asking about tobacco use, the others should also be included in a health history.

3. When would the wheel model of epidemiology be more helpful than the epidemiological triangle model?

When there are multiple causes for a chronic disease The epidemiological triangle model of agent-host-environment is very useful especially with single-cause infectious diseases. However, with the multiple factors involved in chronic diseases, the wheel model is more useful in analyzing and identifying the multiple variables.

13. Which group should be used for determining the community's pregnancy rate?

Women between 15 and 45 years old in the community Although pregnancy is not specifically addressed, the text stresses that only those susceptible to a particular condition should be considered in the denominator. In the case of pregnancy, only women of childbearing age are susceptible.

24. When handed the consent form to sign before treatment could be given, a patient looked at the nurse and said, "I'm sorry; I forgot my glasses today." What should the nurse do?

Wonder if the patient might have difficulty with reading and therefore summarize the content of the form for the client The Institute of Medicine report related that millions of U.S. adults are unable to read and act on health instructions and messages. Among the recommendations is a need for clear communication with clients.

15. What is a "carve-out" service?

A particular service that is offered only by a designated provider or group. Carve-out services might be designated for those who need the services the least. A carve-out service (for example, mental health care) is provided within a standard benefit package but delivered exclusively by a designated provider or group.

8. What assumption inherent in the health belief model (HBM) is problematic?

A person has both free will and access to health resources. The HBM assumes that people have access to health resources, but such resources are not always available to certain groups. Economic, political, and environmental constraints interfere with free choice.

Which of the following groups of persons is most likely to be able to access health care? a. Adults who work in large corporations b. Many employed women c. Older women on fixed incomes d. Young adults, aged 16 to 24 years

A. Adult who work in large corporations Adults who are employed and have health insurance are more likely to have access along with the ability to pay for care. Young adults aged 16 to 24 years often do not have health insurance. Older women on fixed incomes may have difficulty meeting copayments required by Medicare, so they may not have constant access.

In which of the following ways is a hospice nurse different from any other nurse who provides care to a client in the context of their family and home environment? (Select all that apply.) a. Hospice nurses approach care in a holistic fashion. b. Hospice nurses continue to support the family after the client has died. c. Hospice nurses focus more on care and comfort than cure and control. d. Hospice nurses are expert in both physical and psychosocial care. e. Hospice nurses are more skilled at pharmaceutical pain management. f. Some hospice nurses see patients at home and others in institutions.

B, C Nurses who work with the terminally ill seek to enhance the patient's quality of life by focusing on relieving suffering throughout the illness, supporting the patient and family through the dying process, and providing grief support to the family after the patient has died. When the patient becomes terminally ill, the focus shifts from cure to comfort care. Hospice and palliative nursing care is provided in a variety of settings including hospitals, nursing homes, residential homes, and palliative care clinics. Ideally, all nurses approach care holistically and are expert in pain management and both physical and psychosocial care.

1. Why would a patient not do what the nurse instructs after being told several times what needs to be done to get better?

Barriers prevent action. Often the patient is blamed and labeled as being noncompliant. It is more helpful to wonder what barriers interfered with the patient's ability to engage in appropriate action

A nurse wanted a screening test that was very sensitive in determining who might have a particular illness. What might be a problem with using such a sensitive test? (Select all that apply.) a. Many persons have true negative test results. b. Persons who test negative are able to celebrate their healthy state. c. Persons who do not have the illness are told that they might, which leads to anxiety, as well as time and cost of follow-up diagnostic tests. d. Such a test may have lower specificity, so some persons with the disease are told they are disease free and hence do not receive care. e. There is no problem; it is best to use the most sensitive screening test available. f. Persons who have the disease are notified and receive treatment.

C, D The problem with very sensitive tests is that the test picks up almost all people with the disease but also many others who do not have the disease. These "false positives" result in persons needing follow-up diagnostic tests. Additional time, effort, and expense, as well as worry, result until the negative test results are obtained. There is no problem with persons receiving true negative test results and celebrating that knowledge or with persons having their condition correctly diagnosed and treated.

In which of the following clinical areas are nurses most at risk for workplace violence? (Select all that apply.) a. Acute care/intensive care units b. Community health clinics c. Emergency departments d. Geriatric units e. Psychiatric units f. Rehabilitation units

C, D, E In the health care field, the most frequent areas for the occurrence of violence are the emergency departments, psychiatric units, geriatric units, and waiting rooms.

Beyond gathering needed information for future interventions, which of the following purposes is served when the nurse interviews the family? a. Assessing the safety of the immediate environment before further planning can be done b. Establishing a process for the nurse and the family to make decisions c. Engaging in focused planned conversation, which has healing potential in itself d. Focusing on giving compliments to make the family feel good about themselves

C. Engaging in focused planned conversation, which has healing potential in itself The second key element in the interview is the therapeutic conversation. This type of conversation is focused and planned and engages the family. The nurse must listen and remember that even one sentence has the potential to heal or help a family member. Every encounter, whether brief or extended, has "healing potential."

A male nurse is enjoying a very hot summer day at the zoo when he notices a family approaching. An elderly member of the family is moving very slowly and being scolded by another adult, saying "You are not sick. Let's keep moving." The nurse touches the elderly adult who has a flushed face and notices clammy and moist skin. What should the nurse say to the adult? a. "I'm a nurse, and your family member needs to go to the emergency department right now." b. "I'm a nurse, and your family member has heat stroke. I'm calling 911." c. "Take your family member to the air-conditioned restaurant, and have him drink a cold soda immediately." d. "Take your family member to the air-conditioned restaurant, and let your family rest for a while."

D, "Take your family member to the air-conditioned restaurant, and let your family rest for a while." There is not enough evidence to be quite sure what is wrong with the elderly adult, but clearly the elderly person is suffering from being in the hot sun for a period of time. The elderly adult—and probably the rest of the family as well—needs to be moved to a cooler environment and be made to lie down and rest. Drinking chilled water (not soda with caffeine) would also be helpful. In that cooler environment, the nurse can assess the situation to determine whether further action should be taken.

Which of the following best describes how complementary and alternative therapies differ from traditional health care? (Select all that apply.) a. Alternative therapies have been documented as ineffective. b. Complementary medicine is expanding because of paid media coverage. c. Nurses rarely are involved in complementary or alternative therapies. d. Providers vary in training and licensure. e. Reimbursement is often unavailable. f. Alternative therapies lack any research related to their effectiveness.

D, E Alternative or complementary therapies are expanding because of consumer demand, although reimbursement for these services is lagging. The National Center for Complementary and Alternative Medicine is currently researching their effects on health and disease. Training and licensure requirements vary widely. Many nurses have incorporated alternative therapies into their practice and seek more continuing education on such care.

18. What disease would be the best choice for screening if any of the following were possible?

Disease B, which can be controlled if caught early in the disease process There is no point in doing a screening if there is no treatment or if there is a known risk of social stigma and discrimination if it becomes known that the person has the disease. Discussion and disagreement continue as to whether genetic information should be used in family planning. However, it is extremely useful to the individuals concerned and society if screening can lead to early diagnosis and successful control of the disease process.

Parents have requested that their child be brought up to date on appropriate immunizations. After reviewing the child's medical history, the nurse prepares to give the two immunizations. What additional action should be taken by the nurse before administration of the immunization? a. Ask if there is any chance the girl child could be pregnant b. Ask the child if she consents to the immunizations c. Assess whether the child has a fever or other illness that would require the immunization be postponed d. Explain the pros and cons of obtaining immunizations to the parents e. Give the parents the Vaccine Information Statement (VIS)

E. Give the parents the Vaccine Information Statement (VIS) The Centers for Disease Control and Prevention produces VISs that explain the benefits and risks of vaccine to vaccine recipients, their parents, or their legal representatives. Federal law requires that VISs be handed out whenever (before each dose) certain vaccinations are given. Because the parents have previously had the child receive immunizations, they clearly have chosen to continue with immunizations so they do not need to hear the pros and cons of children being immunized. Children cannot give consent, only assent, to procedures. Because the child is a minor, the child's parents make the decisions

Which of the following best describes what proportion of children live in a single-parent family? a. Fewer than 10% b. 11%-15% c. 16%-20% d. 21%-26% e. More than 30%

E. More than 30% In 2012, 34% of all U.S. children lived in single-parent homes

Which of the following sets of symptoms would be unexpected after a disaster? a. Confusion, disorientation, indecisiveness, and memory loss b. Depression, fear, or just numbness c. Fatigue with headaches, nausea, and dizziness d. Irritable, suspicious, argumentative, and inappropriate e. No unusual feelings or behavior

E. No unusual feelings or behavior Common responses to disasters include all sorts of cognitive, emotional, physical, and behavioral symptoms. Therefore, to have no unusual feelings or behavior would indeed be unexpected.

A family came in to discuss a problem with one of their children. Which of the following family behaviors would be concerning to the nurse? a. Each family member made supportive comments about each other. b. Every Sunday the family attends religious services together. c. Family members made humorous comments about their life together. d. The family seemed to rather quickly determine priorities for action. e. The family wanted the nurse to decide what they should do.

E. The family wanted the nurse to decide what they should do. Traits of a healthy family include open communication, ability to establish priorities, being supportive of each other, sharing a religious core, having a sense of humor, and knowing when to seek help. However, healthy families also engage in decision making and do not want others to make decisions for them.

13. What was a major change after Medicare began a prescription drug benefit?

Utilization of drugs and their cost immediately increased. As with other health care services, once a funding source has been established, utilization and costs increase. As one example, physician visits or hospital outpatient visits in which five or more prescriptions were ordered increased from 4% to 7%.

25. After completing a master's degree, a nurse took a course in marketing. Should the agency reimburse the nurse's tuition costs?

Yes, the nurse could use such information in social marketing for the agency. Social marketing tools utilizing marketing principles and technologies are designed to influence the knowledge, attitudes, values, beliefs, and behaviors of populations. Such information would be extremely helpful for agency personnel in improving community health and lifestyle choices.

18. What would be an appropriate response if a nurse were asked, "Why are you so rarely in the department office?"

"I have to be where the people are." One of the underlying premises of community health is to "start where the people are." Therefore, the nurse must spend a great deal of time and effort in the community, interacting with community members.

Which of the following persons would be called chronically homeless? a. A person has been homeless for more than a year b. A person who lives with a roommate when between jobs c. A person who has been staying with friends or family for an extended period of time d. A person has been residing each night in a homeless shelter for almost 3 months

A. A person has been homeless for more than a year The chronically homeless individual is defined as an unaccompanied adult who has been homeless for an extended or numerous periods and has one or more disabling conditions.

10. A newspaper published an article about the athletic banquet at the local high school that had approximately 1000 family members in attendance. Exactly 650 persons became ill within 24 hours, complaining of severe diarrhea, vomiting, and cramping. What is the attack rate?

650:1000 Rates are calculated by the number of people with the problem over the number exposed to the problem. In this case, 650 persons out of the 1000 at the banquet complained of illness. Although this rate could be presented as an attack rate of 65%, 6.5% is incorrect.

4. A nurse was becoming frustrated. It had been 2 weeks, and although the client had verbalized that the best time of day to take a 15-minute walk was early in the morning, the client had not begun to exercise. What had the nurse forgotten? Select all that appl

A decision to act always occurs before action begins. Behavior change is difficult and takes time The Transtheoretical Model is based on the assumption that behavior change takes place over time, progressing through a sequence of stages. The fact that the person had stated the best time to exercise demonstrates the client has moved through precontemplation and contemplation and is preparing to act. The nurse is being rather optimistic in thinking change will occur within 2 weeks. Although being compassionate is helpful, it is not a crucial step in the beginning of the process. Personal resistance to change is probably obvious and does not need further discussion as the patient has moved beyond the stage of analyzing pros and cons to the change.

3. Which is the best definition of health?

A goal and a resource for living Health was originally defined as a lack of illness or disease. More recently, health has been defined as a state of complete physical, mental, and social well-being. Today health's definition is based on the realization that health allows one to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is a goal but also a resource for living.

8. How does community health nursing define community?

A group of persons share a common identity and environment Community health nurses work with both geopolitical groups (within specific geographic boundaries) and phenomenological groups (who have a common identity based on culture, history, or goals). A particular phenomenological group may or may not have been a planned group—that is, a group that came together to resolve a recognized common problem or to meet a common goal. However, of all the choices, a group of persons who share a common identity (phenomenological group) and environment (which implies specific geographic setting) is the broadest and most complete definition.

Which of the following best describes how schools can determine what their school health education priorities should include? (Select all that apply.) a. Provide opportunities for students to practice decision-making skills b. Choose priorities according to which behaviors lead to avoidable problems c. Make priorities consistent with the six topics identified by Healthy People 2020 d. Determine priorities by the education and expertise of the local school nurse e. Select priorities according to parent and student interests f. Decide on priorities based on whatever funding sources are willing to fund

A, B, C Healthy People 2020 sets goals that schools provide health education courses in priority areas. The six behavioral categories or topics identified include the following negative behaviors that often start in childhood or adolescence and persist into adulthood: (1) alcohol and drug use; (2) injury and violence; (3) tobacco use; (4) poor nutrition; (5) lack of physical activity; and (6) sexual behavior that results in sexually transmitted diseases or unwanted pregnancies. These problems and behaviors are preventable and lead to additional problems. In a comprehensive health education program, students should be given the opportunity to practice decision-making and communication skills. Funding may not fit local needs. All school nurses should be competent in teaching related to healthy behaviors or know experts who could assist. The priorities should be based on Healthy People 2020, not on the parent and student interests or on the basis of available funding sources.

Which of the following best describes the term "literally homeless"? (Select all that apply.) a. Lacking a fixed, regular, and adequate nighttime residence b. Lacking a family residence c. Living in a place not typically used for human sleeping d. Living in a temporary living accommodation such as a hotel e. Living full-time in a recreational vehicle f. Sleeping in an extended-care facility or hospital

A, C Literally homeless is described as individuals and families who lack a fixed, regular, and adequate nighttime residence and includes a subset for an individual who resided in an emergency shelter or a place not meant for human habitation and who is exiting an institution where he or she temporarily resided. The term "literally homeless" is not used to describe those lacking a family residence, living in a temporary living accommodation such as a hotel or recreational vehicle, or sleeping in an extended care facility or hospital.

Which of the following describe current legislation acts that limit what managed care organizations (MCOs) are allowed to do? (Select all that apply.) a. Allowing patients to see a specialist without having to obtain approval from their primary care provider b. Allowing patients to go to the emergency department without first telephoning for approval c. Allowing patients the right to choose a physician d. Requiring the MCO to fulfill expectations of the national patients' rights bill e. Requiring the MCO to accept any provider who meets plan requirements f. Requiring the MCO to accept advanced practice nurses as primary care providers

A, B, C In 1999, the House and Senate passed bills that focused on client rights in the managed care environment, but more needs to be done to improve client rights. Client rights issues that are vitally important are information disclosure, physician and provider choice, direct access to specialists, reimbursement for emergency care, and reimbursement denial. As has been discussed, there is still no national patients' bill of rights.

What have been the foci of international nursing research? (Select all that apply.) a. Development of home care or transition from hospital to home b. Diverse clinical experiences c. Educational exchange programs for students and faculty d. How to integrate technology into developing country health care systems e. How to use a career in nursing to change the cultural expectations of gender roles f. The importance of sharing resources with poverty stricken countries

A, B, C Since 1990, international nursing research has focused predominantly on the following three areas: (1) student and faculty educational exchange programs, (2) diverse clinical experiences, and (3) the international development of home care or transition from hospital to home. International nursing research has not focused on integrating technology into the health care systems of developing countries, using a career in nursing to change cultural expectations of gender roles, or the importance of sharing resources.

Which of the following factors results in rural residents having less access to health care than urban dwellers? (Select all that apply.) a. Employment opportunities may be low paying and seasonal. b. There are greater distances to travel and limited choice of health care providers. c. Health care providers prefer to work in higher-paying urban settings. d. Rural residents are less likely to have health insurance. e. Rural persons' economic resources are tied up in land, not easily accessible cash. f. Rural persons believe in self-sufficiency and self-care, not asking others for help.

A, B, C, D A recent Institute of Medicine study reported rural medical access problems in these areas, with some hospital and pharmacy closures; greater distances to travel for physician services; and limited, if any, choice of providers. Rural residents were more likely than urban residents to lack insurance. Two thirds of the persons living in the most rural counties are low-income families. Having economic resources invested in land and believing in self-sufficiency and self-care are not reasons why rural residents have less access to health care than urban dwellers.

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

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

Which of the following do expert rural nurses report as benefits of their work? (Select all that apply.) a. Ability to develop close relationships and give holistic care b. Being able to practice in the community where one lives c. Constant challenges d. Continual growth as an expert generalist e. Higher salary than in urban areas f. Intensity of purpose

A, B, C, D, F Positive aspects of rural nursing include the ability to give holistic care, to know everyone well, and to develop close relationships with the community and with coworkers. Autonomy, professional status, and being valued by the agency and community have been reported components of positive job satisfaction. The rural nurse is a generalist, and generalist is not synonymous with boring. Interviews with rural nurses show that they feel an "intensity of purpose" that makes rural nursing distinctive. Nurses living and practicing in the same place have a strong sense of integration and continuity between practice and community.

Which of the following best describes why for-profit managed care organizations (MCOs) have not begun to move into rural areas to increase the number of persons served? (Select all that apply.) a. High startup and administrative costs are needed. b. A large number of elderly are on Medicare or Medicaid, which results in low reimbursement. c. Managed care has not yet had time to go beyond major population centers. d. MCOs are waiting until federal reimbursements for underserved rural health areas become higher. e. The population is too small and too spread out. f. Rural health areas are too geographically unattractive and lack any recreational possibilities for managers to want to work there.

A, B, C, E MCOs recognize the risks to expanding into rural areas. Risks are probable high startup and administrative costs. Managed care has yet to move into much of rural America because of small dispersed populations, few visits per individual, and large numbers of elderly on Medicare with low-level reimbursements that do not make the aggregate financially attractive to MCOs. It is not likely that federal reimbursements for underserved rural health areas will become higher. The lack of attractive living for managers has not been a reason why MCOs have not moved into rural areas.

Which of the following actions should a nurse take to ensure personal safety when engaging in home visits? (Select all that apply.) a. Always sit between the client and the exit, and, when in doubt, leave the situation b. Be sure of the correct address and always have a GPS system c. Carry a cell phone and drive in a well-maintained car with a full gas tank d. Have enough money that you can buy your way out of trouble e. Only accept assignments within a few blocks of your own home f. Take self-protection courses such as karate and carry a weapon for your own defense

A, C Plan ahead with the correct address, directions, and information about who will be in the home; tell the office where you will be and check in regularly; carry a cell phone, possibly a pager, and a small amount of money; dress for function and mobility, wear a name tag, and be sure your vehicle is in good repair with a full gas tank and emergency equipment. Carrying a weapon typically results in the weapon being used against you.

Which of the following best describes what insurance companies did to decrease their constantly increasing costs? (Select all that apply.) a. Did not cover any illnesses that were diagnosed before the person (or his or her employer) purchased insurance b. Limited coverage to only certain services, eliminating any that were experimental, nontraditional, or too costly c. Reimbursed only the care that was requested by the patient's primary physician d. Limited providing insurance to companies who hired mainly young, healthy persons e. Required preapproval before expensive services were used f. Ceased coverage on any person who used an exorbitant number of services, whenever possible

A, B, C, E, F Insurance companies attempted to reduce unnecessary use by limiting coverage for certain services and people. Restrictions such as the establishment of a gatekeeper that required preauthorization, limited coverage for preexisting illnesses, and exclusion of participants whose use was deemed exorbitant were instituted. Such restrictions increased resentment and resistance and were not very successful.

Which of the following statements best describes what was unfortunate about the original private health insurance plans that were developed? (Select all that apply.) a. Because providers were paid for any service they gave, it was economically advantageous for them to give as much care as possible. b. Health care costs increased very rapidly. c. Health education and health promotion interventions were not included in the idea of health insurance. d. It was immediately seen how much profit could be made by owning or managing an insurance company. e. Patients wanted any and all care that might help, regardless of how expensive it was. f. There was no limit on what care could be sought and given.

A, B, C, E, F The majority of the population was protected. The emphasis was placed on illness care, because providers received a fee only when a service was rendered, and all costs were reimbursed. Insulated from having to pay for health care, consumers demanded complex and technologically advanced services. These demands were a major force rapidly increasing health care costs because people with insurance felt entitled to care, and, after all, there was a guaranteed payer. Medical orientation was on curing at any cost. The profits of owning or managing an insurance company were not immediately seen.

Which of the following current issues are leading the World Health Organization (WHO) to reconsider its initial definition of health? (Select all that apply.) a. Environmental issues such as industrial toxins or carcinogenic commercial products b. Global, not local, problems such as spread of antibiotic-resistant bacteria c. Need to move from containment and treatment to social intervention d. Pressure from industrialized nations to emphasize chronic diseases rather than infectious diseases e. Realization that government actions influence the basic human right of health f. Worldwide pandemics such as human immunodeficiency virus (HIV) and swine flu, which require a different approach

A, B, C, E, F WHO is refocusing as it attempts to deal with environmental issues of nuclear contamination and industrial toxins, and the exploration of carcinogenic commercial products (such as tobacco). Globally, WHO is trying to eliminate antibiotic-resistant bacteria and the HIV pandemic. HIV has changed the paradigm from traditional containment and treatment to a more comprehensive approach of social intervention. There is a realization that health is a basic human right and health problems are linked to government action and affect human rights. The WHO is not emphasizing the chronic diseases faced by industrialized nations.

Which of the following strategies would most likely increase attendance at a clinic aiming to improve men's health in the community? (Select all that apply.) a. Employing male nurses b. Having male-friendly space for socialization c. Having evening and weekend hours d. Having male-accepted nibbles and drinks (pretzels and light beer) e. Including lectures on male health each evening f. Providing male-accepted and respected activities such as poker

A, B, C, F Data demonstrated that usage of male clinics was highest with informal evening clinics directed by male nurses. Based on the social rather than medical model, Australian clinics promote well-being among older males by providing them with accepted and respected activities, as well as providing a male-friendly space for socialization. The room in which staff members see men has decor geared toward men. The data did not demonstrate that having male-accepted nibbles and drinks or including lectures on male health each evening were effective in increasing attendance at the clinic.

Which of the following created the original expansion of home health care agencies? (Select all that apply.) a. Changes that decreased reimbursement for hospital-based care b. Cost containment in a managed care environment c. Meeting clients' preference for care in their homes, not institutions d. Offering new career opportunities for nurses who are tired of hospital nursing e. The requirement of third-party payers for care to be given in homes f. So they could serve as a profitable revenue source

A, B, C, F Numerous factors generated the growth of home health services, including the increasing costs of hospital care and the subsequent introduction of the prospective payment system. Providing home care services contributes to cost containment in a managed care environment. This cost containment is accomplished through timely hospital discharges by providing nursing services in the home setting and supporting clients at home rather than in skilled facilities. Home care is also popular with consumers, who prefer to receive care in their own homes rather than in an institution. The increasing number of home health agencies indicates that these agencies are profitable endeavors and provide hospitals with an additional revenue source.

Which of the following factors are necessary to assume there might be a cause-effect relationship between a particular variable A and a specific illness? (Select all that apply.) a. It is easy to understand how the variable A could lead to the illness. b. Research studies consistently demonstrate a relationship between variable A and the illness. c. The illness is frequently seen without the presence of variable A. d. The more of variable A present, the sicker the person becomes. e. Variable A is always found after the person becomes ill. f. Variable A is never found in the presence of other illnesses

A, B, D There are six criteria for assuming possible causation including strength of the association, dose-response relationship, temporally correct relationship, biological plausibility, consistency among studies, and specificity. Only the "easy-to-understand," consistent research studies and the increased dose leading to increased illness are consistent with those six criteria.

Which of the following disasters are considered NA-TECH (natural-technological) disasters? (Select all that apply.) a. Constant rain led to mud slides, and whole neighborhoods were buried. b. An earthquake caused structural collapse of bridges and highways in the area. c. People stampeded out of the overcrowded arena, trampling people who had fallen. d. River flooding resulted in overflow of the sewage plant and contaminated drinking water throughout the city. e. The tsunami washed out all the power and telephone lines throughout the downtown area of the city. f. Volcanic eruption covered the town with ash, making it difficult to breathe.

A, B, D, E Disasters are identified as natural, man-made, or a combination of both. A NA-TECH disaster is a natural disaster that creates or results in a widespread technological problem. Examples of NA-TECH disasters would include whole neighborhoods being buried by mudslides, earthquakes causing structural collapse of roadways or bridges, river flooding resulting in an overflow of the sewage plant and contaminated drinking water, and a tsunami washing out all of the power and telephone lines. People stampeding out of a crowded arena does not involve a disaster that results in a widespread technological problem, nor does a volcanic eruption that makes it hard to breathe

A son did not know what to get his mother for her birthday. She refused most gifts, saying they were just something more for her to take care of. Assuming the mother did not have these, which of the following would be a very helpful gift? (Select all that apply.) a. Purchase a new front door with a large peephole so she can see who is ringing the doorbell b. Arrange for Social Security check to be deposited directly into the bank c. Add bars on all the house windows for added security d. Buy a shredder for the mother to use on all personal documents e. Install caller ID on her telephone f. Have strong deadbolts installed on all outside doors

A, B, D, E, F Measures can be taken to lessen the risk of crime happening to the elderly person. In the home, safety measures include making sure that door and window locks are strong. The elder should note who is at the door before opening the door. The elder can get caller ID service for the telephone; if no number or individual is identified, the elder may choose not to answer the call. Identity theft is on the increase, and elderly individuals are particularly vulnerable. To avoid this problem, Social Security and monthly pension checks should be deposited directly into a bank account. Any information that is sent to the home with credit card offers, personal information, and so forth should be shredded so that the information cannot be used illegally. Bars on doors and windows need to be installed with caution, because they may increase the risk of harm in the event public officials need to access the home as a result of fire or need to gain access to assist the elderly person who may be injured from a fall or may be ill.

Which of the following best describe why it is crucial that nurses who focus on the care of individual patients also be able to work with families? (Select all that apply.) a. Anytime a person is ill, his or her whole family is affected. b. By understanding the family, understanding of the individual is improved. c. Families often are very demanding if they feel their loved one isn't receiving the best care possible. d. Individuals depend on their families for care and support. e. Most important decisions are made by families as a whole, not individuals. f. Risks caused by genetics or environment affect the whole family, not just the individual.

A, B, D, F Reasons that it is important for nurses to work with families include that the family is a resource in giving care to its members and working together on health promotion and wellness activities; any dysfunction (illness, injury, separation) that affects one family member will affect the whole family; the nurse can often identify a health problem that involves risks for the entire family. Finally, understanding the whole family helps the nurse understand and provide more holistic care to the individual.

A community health nurse is assigned to cover a school health office when the school's nurse is ill. A child is waiting for the nurse's arrival, saying a particular medication is needed. Which of the following can the nurse expect to find in the school health office? (Select all that apply.) a. A nursing policy book with standing orders and nursing protocols b. Medications clearly labeled with student name, as well as typical medication information (e.g., name, dose) c. Approval from the student's teacher for the student to see the nurse for the medication each day d. The student's written assent for the medication to be administered when requested e. Written request from a health care provider for that student to receive that medication f. Written request from the student's parents for the specific medication to be administered

A, B, E, F The guidelines from the National Association of School Nurses indicate that medications should be in containers that are properly labeled with all appropriate student and medication information, accompanied by a written request from the health care provider and parent or guardian, and administered without violating standing orders or nursing protocols. The nurse would not typically find an approval from the student's teacher for the student to see the nurse each day for a medication or a student's assent for the medication to be administered. The parents and health care provider are responsible for the written request for the medication to be administered.

Which of the following factors make family nursing particularly challenging? (Select all that apply.) a. The health care system primarily focuses on care of individuals. b. Insurance reimbursement focuses on illness care and treatment of individuals. c. Family members are not always consistent in what they tell the nurse. d. More variables to be considered when completing an assessment e. Number of chronic comorbidities f. Most theories focus on intervention with individuals.

A, B, F Families have challenging health care needs that are not usually addressed by the health care system. Instead, the health care system most frequently addresses the individual. Traditionally, nursing has relied heavily, if not solely, on theoretical frameworks from the disciplines of psychology or social psychology, which target individuals.

Which of the following clients may be eligible for hospital-based, disease-specific case management support? (Select all that apply.) a. Those who have high-cost conditions b. Those with physicians who request such intervention for their patients c. Those who may be maintained in a stable condition in their home environment d. Those who have access to private insurance plans e. Those who have requested such services f. Those whose hospital has a collaborative agreement with a home health nursing agency

A, C Case management services are often provided for individuals who are identified as having medical conditions that are high-cost or high-volume acute and chronic illnesses such as congestive heart failure. The goal is to keep these clients as healthy as possible and stable in their home environment. Doing so will decrease the frequency and length of hospital stays and therefore decrease health care costs.

An elderly woman shared that she had six different physicians, each focusing on one particular health problem. Which of the following would be of immediate concern for the home health nurse? (Select all that apply.) a. Whether the client has a family physician who was coordinating her care b. Whether the physicians communicate with each other c. If each physician was prescribing medications, what drug interactions might be occurring? d. Were all these health care providers licensed physicians? e. Who was helping her with transportation to all these physicians? f. Would all these physician visits add up to more than what Medicare would reimburse the client?

A, C The client needs a family physician or a nurse case manager who is coordinating her care and ensuring that the medications are not having interaction effects. A pharmacist might also do this, but the client may be using several different pharmacies. Errors associated with preventable adverse drug events occur most often at the stages of prescribing and monitoring (i.e., the same medication[s], or different medications for the same condition, being prescribed by different health providers).

Which of the following best describes why there are more long-term consequences (such as death) to a driver injured in a truck accident in a rural area than a driver injured in a truck accident in an urban area? (Select all that apply.) a. Rural drivers are more likely to speed over long distances than urban drivers. b. Rural drivers are not as skilled with vehicles as urban drivers, so they are more severely injured in a crash. c. The urban driver is taken immediately for care, whereas the rural driver might be injured on an isolated field and not found by anyone for hours. d. Urban drivers are more likely to use their seat belts than rural drivers. e. Urban drivers are probably rushed to an emergency department, whereas the rural driver lives far away from emergency services, often over bad roads and possibly through severe weather. f. Urban drivers trade their vehicles in rather frequently, whereas rural drivers keep their vehicles for as long as they can make them run, so the vehicles are much less roadworthy

A, C, D, E Getting patients from the place of injury to the trauma center within the "golden hour" is frequently not possible in rural areas because distance, terrain, climatic conditions, and communication methods produce barriers. Some rural facilities are more than 1 hour away by air from the nearest trauma center or tertiary care hospital. Driving at high speeds, driving long distances, driving in winter conditions, not using seat belts, and consuming alcohol have been cited as contributing to greater levels of injury deaths and disability by rural residents in the West. There is no evidence to suggest that rural drivers are not as skilled as urban drivers or that their vehicles are less roadworthy.

Which of the following variables create differences from school to school regarding the health services that are available? (Select all that apply.) a. Community resources b. National statistics on health problems c. School leadership preferences d. State legislative requirements e. Students' needs f. Teacher preferences

A, C, D, E School health services goals and objectives vary from state to state, community to community, and school to school. These differences reflect wide variations in state regulation, student needs, community resources, funding sources, and school leadership preferences. The national statistics on health problems and teacher preferences do not create differences among schools in regards to health services that are available.

A woman admitted, "I did fall once, but it was an accident that I'm sure won't happen again." Which of the following responses would be most appropriate for the nurse? (Select all that apply.) a. "Are you getting lots of calcium and vitamin D? Are you drinking milk or taking calcium pills?" b. "Do you have a couple glasses of wine each evening to relax you before you go to bed?" c. "Do you live in a one-story house and are your floors even without rugs to trip you up?" d. "Let me give you some balance and leg muscle exercises to practice at home each day." e. "Remember that if you start to fall, fall sideways if you can to minimize injury." f. "Review what medications you are taking."

A, C, D, F Simple exercises that strengthen leg muscles and exercises that can improve balance are recommended to be done daily. Adequate amounts of calcium and vitamin D, obtaining a bone density test, and taking medications that are available for slowing bone loss are activities that can help prevent falls. Seniors can also improve their environment to reduce their risk of falling by checking floor surfaces and curb heights; identifying weather-related problems before venturing outside; wearing supportive, low-heeled shoes; making sure that rooms are well lit; and ensuring that safety equipment is installed in bathrooms and stairwells. In the event of a fall, if the senior remembers to fall forward or backward or to land on their hands to break a fall, it will lessen the risk of hip fracture. Uneven surfaces such as sidewalks, curbs, or floor elevations; wet or slippery ground; and climbing up on household items not intended for climbing can result in loss of footing or loss of traction. Drinking alcoholic beverages increases the risk of falling because alcohol slows reflexes and response time; causes dizziness, sleepiness, or light-headedness; and alters balance. Medications such as blood pressure pills, heart medicines, diuretics, and tranquilizers may increase the risk of falling

Which of the following activities are consistent with the conclusions of the report Crossing the Quality Chasm? (Select all that apply.) a. Increased emphasis on evidence-based practice b. Improved reimbursement schedules that allow primary care providers to spend more time with each individual client c. Increased attention to patients' needs for health education and self-management d. Increased communication, cooperation, and collaboration between various components of the health care system e. Increased use of information technology (electronic medical records and data management) f. Improved organization of the health care system

A, C, E The report suggested the following changes: need for evidence-based planned care; reorganization of practices to meet needs of patients who require more time; attention to patients' need for information and behavioral change; ready access to clinical expertise needed; and supportive information systems. Current trends, which reflect these suggestions, are the focus on evidence-based care; more patient education; need for accepting self-management responsibility; and expansion of electronic medical records and other information technologies. Health care may be improving its organization, but it is not an obvious trend with obvious change, nor are reimbursement schedules allowing care providers more time to spend with clients. Cost containment is decreasing the time care providers can spend with clients.

In comparison with mental health care in urban areas, which of the following best describes how mental health care in rural areas differs? (Select all that apply.) a. Access to care is more limited or not available at all locally. b. Cost for treatment is typically reimbursed at a lower rate. c. Depression is frequently not recognized or is not treated. d. Ethnic and racial disparities exist. e. Primary health care professionals accept responsibility for mental health treatment. f. The suicide rate is notably higher.

A, C, E, F In rural areas adjacent to a small city, suicide rates were 31% higher than suburban rates and 43% higher in rural areas that were not adjacent to small cities. Decreased access to mental health services for treatment of depression may contribute to these higher rates. Because of the lack of qualified mental health care providers, rural residents often receive services from primary care providers. Ethnic and racial disparities exist whether in urban or rural health care.

A family member tells the nurse that she is worried about her grandmother driving. Which of the following would be most appropriate for the nurse to suggest? (Select all that apply.) a. Avoid rush hour traffic. b. Buy and drive a very large heavy car. c. Do not converse with any passengers. d. Drive more slowly. e. Drive only during daylight. f. Leave the radio turned off.

A, C, E, F Some interventions older adults could implement are limiting their driving to daylight hours, planning their trips to avoid rush hour, not listening to the radio, and avoiding talking with passengers. Purchasing a large, heavy car and driving more slowly are not appropriate actions to assist an elderly person with driving.

Which of the following strategies would be most helpful to implement with adolescent males at a high school? (Select all that apply.) a. A short required course on how to be a good parent b. Assistance in learning how to control emotions and behaviors c. Classes in male physiology, self-screenings, and influence of nutrition and exercise d. Encouragement to be involved in organized team sports involving both genders e. Recognition of reality factors such as the need to be employed after school hours f. Interpersonal communication with a male school nurse

A, C, F Some suggestions that may improve male health are information about how their bodies function, what is normal, what is abnormal, what action to take, and the contributions of proper nutrition and exercise; self-care instruction, including testicular and genital self-examination; help with fathering; and recognition that feelings of confusion and uncertainty in a time of rapid social change are normal and that they may mark the onset of healthy adaptation to change. Male nurses can be extremely effective in such an endeavor. Providing assistance in learning how to control emotions and behaviors, encouraging the involvement in organized team sports, and the recognition of reality factors would not be the most important strategies to implement with adolescent males?

Which of the following best describes the advantage of the ecosocial epidemiology model over both the web of causation model and the epidemiological triangle model? (Select all that apply.) a. It decreases the focus on the individual person. b. It demonstrates the usefulness of molecular epidemiology in disease prevention. c. It emphasizes the role of complex political and economic context. d. It is more useful in public policy campaigns in explaining what people need to do to protect themselves. e. It reflects the current emphasis on ecology and the environment. f. Its use suggests possible public policy interventions.

A, C, F The ecosocial approach challenges both the individually focused risk factor approach and molecular epidemiology (sequencing of genes to improve individual susceptibility), because it emphasizes the role of macro-level socioenvironmental factors, especially complex political and economic forces in health and illness. Molecular epidemiology, the use of public policy campaigns, and the relationship between ecology and the environment are not advantages of the use of the ecosocial approach.

An epidemiologist is gathering data to determine which factors may lead to disease. Which of the following data will be gathered? (Select all that apply.) a. Demographic characteristics b. Disease characteristics c. Geographic data d. Health protection measures taken e. Length of the disease process f. When disease struck the area

A, C, F The person-place-time model suggests epidemiologists examine demographic characteristics of the community (person characteristics), geographic or environmental factors (place), and common time factors (time—or when the disease struck). Disease characterstics, health protection measures taken, and length of the disease process are not used when determining which factors may lead to disease.

Which of the following conclusions were made when Congress asked for a report on the federal government's quality enhancement process on the care the federal government gave? (Select all that apply.) a. A clear responsibility at the federal level is to lead by example. b. Computerized clinical data have enabled practice guidelines to be written. c. Federally sponsored education and training programs have a strong impact. d. Quality assurance information has been consistent and useful in improvement. e. The quality of federal health care was very good. f. Writing regulations influences nonfederal health care providers and organizations.

A, C, F The report Leadership by Example concluded that there is a lack of consistent performance measurement, the information is not useful, computerized clinical data are missing, and the approach to gathering data is not systematic. The federal government is the largest purchaser of care because it gives direct care to specified groups and requires conforming to regulations for those accepting Medicare and Medicaid funds. Sponsored research, education, and training also have an impact. The report concluded that the federal government must accept leadership both by example and by coordinating improvement in health care quality.

Which of the following critical issues in health care were addressed by The Health Insurance Portability and Accountability Act (HIPAA) of 1996? (Select all that apply.) a. Portability of insurance coverage b. COBRA, maintaining coverage for those who lose their jobs c. Insurance companies having a total monopoly in a certain geographic area d. Insurance companies setting limits on coverage of longer than 12 months e. Insurance companies charging seriously ill persons more than healthy persons f. Insurance companies paying the same for mental health coverage as for physical illnesses

A, D The HIPAA of 1996 addressed insurance issues. Critical were the portability of coverage and preexisting conditions. Insurers cannot set limits on coverage longer than 12 months. COBRA was established through the Consolidated Omnibus Budget Reconciliation Act of 1985. The McCarren-Ferguson Act of 1945 gave states the exclusive right to regulate health insurance plans. The Mental Health Parity and Addictions Equity Act of 2008 mandated that insurance companies must provide the same coverage for mental health as for physical illness. Health Care Reform legislation prevents insurance companies from charging seriously ill persons more than healthy persons.

Which of the following best describes how a case manager identifies people who would benefit from case management services? (Select all that apply.) a. Evidence-based criteria b. Families who express doubt that the patient is receiving adequate care c. Patient having setbacks from treatment d. Referrals from health care providers or agencies e. Risk identification from data management f. Use of health risk screening tools

A, D, E, F A variety of tools are used to identify people who would benefit from case management services. These include health risk screening tools, evidence-based criteria, risk stratification through data management, and referrals from hospitals and health care providers.

Which of the following guiding rules or principles would most likely be followed by a nurse caring for persons with disabilities? (Select all that apply.) a. Adopt the client's priorities b. Change care according to the most recent research findings c. Care for the disability and then for the whole person d. Know community resources thoroughly e. Support the client's decisions f. When in doubt, listen

A, D, E, F Data from interviews conducted with nurses who provide care to persons with disabilities revealed principles such as do not assume anything; adopt the client's perspective; listen and learn from the client; gather data from the perspective of the client and family; care for the client and the family, not the disability; be well informed about community resources; and become an advocate by letting clients choose.

Which of the following screenings are typically administered in the school setting? (Select all that apply.) a. Blood pressure b. Chest x-ray c. Cholesterol and blood glucose d. Height and weight e. Scoliosis f. Visual and hearing acuity

A, D, E, F Height, weight, vision, and hearing screenings are provided at most schools. Scoliosis or postural screening should be done to identify spinal deviations and intervene early to prevent related secondary problems. The detection of high blood pressure during childhood is important in identifying children who have hypertension and who will benefit from early intervention and follow-up. Screenings in schools must be relatively fast, easy, and noninvasive. Blood work is invasive and cannot be done without parental consent. It is also expensive because test strips must be purchased. Due to the equipment needed, it is not typical that chest x-rays or cholesterol and blood glucose screenings are administered in the school setting.

Which of the following best describes the purposes of professional societies such as the American Nurses Association (ANA)? (Select all that apply.) a. Providing control and oversight of the occupation b. Creating licensing laws to control entry into the profession c. Determining appropriate requirements for education into the profession d. Establishing standards for practice e. Protecting the interests of the practitioners f. Safeguarding the public trust

A, D, E, F Professional societies seek to further a particular profession, the interests of persons engaged in that profession, and the public interest. Their roles are to maintain control and oversight of the occupation—such as by writing standards for practice—as well as safeguarding the public trust. Licensure and educational standards are responsibilities of individual states.

Which of the following functions are responsibilities of the states?? (Select all that apply.) a. Delegating power to localities and holding them accountable for results b. Creating managed health organizations to decrease state health care costs c. Establishing and managing local health departments d. Licensure of professional health care providers e. Overseeing all insurance programs f. Providing access to necessary health services

A, D, E, F State governments focus particularly on financing and delivery of services and oversight of insurance. The state is responsible for addressing the mission of public health—assessment, policy development, and assurance—throughout the state. Tasks include assessment of health needs based on statewide data collection; establishment of statewide health objectives; and delegating power to localities as appropriate and holding them accountable. States license health professionals as part of the statewide effort to develop and maintain essential personnel. Creating managed health organizations and establishing and managing local health departments are not a main responsibility of the state.

A nurse was excited about being the only staff member in the public health department in a small rural area. Which of the following problems would the nurse most likely encounter? (Select all that apply.) a. There is no one with whom to collaborate or exchange ideas. b. There will be no physician available to tell the nurse what needs to be done. c. No feedback can be obtained from others. d. The nurse may only be able to offer services supported by federal funds. e. The nurse will have to raise local funds to support the department. f. There will not be any epidemiologists or sanitarians to help

A, D, F Many smaller local health departments do not have the economic base to employ other professional public health providers, such as physicians, epidemiologists, sanitarians, and nutritionists at the local level. The lack of additional onsite public health providers poses two problems. First, the ability to collaborate with others about potential or actual public health problems is decreased or nonexistent. Second, the ranges of services provided are less comprehensive. Often, these small facilities can only offer federally funded programs with few locally funded services. The nurse should be able to think independently to determine what needs to be done and should be able to work without physician direction. Feedback can be obtained from the population that the nurse is serving. Local, state and federal funds may all support the services that the nurse is providing. It is unlikely that the nurse will need to raise funds to support the work of the department; there should be local funding available for this nurse's position.

A nurse always reviewed the medications taken by elderly clients on each home visit. Which of the following best explains the rationale for the nurse's action? (Select all that apply.) a. Age-related changes and polypharmacy make elderly clients vulnerable to drug interactions and dangerous adverse reactions. b. Elderly clients are known to sue if medications taken do not make them feel better, and lawsuits are to be avoided, if possible. c. Folk or herbal medicines are often the same as the generic medications prescribed by health care providers, so elderly often have overdoses. d. Older adults are known to consume many over-the-counter medications, as well as folk or herbal remedies. e. The elderly are known to be particularly noncompliant with pharmaceutical prescriptions. f. With the high prevalence of chronic diseases, elderly clients are taking a large number of medications.

A, D, F The high prevalence of chronic diseases in the elderly population causes this group to use a large number of medications. Older adults consume slightly more than one third of all prescription drugs and spend billions annually on medications. Older adults also consume many over-the-counter medications, as well as "folk" or herbal remedies which are not typically prescribed by health care providers. The elderly population is vulnerable to the effects of drugs because of normal aging changes and age-related differences in pharmacokinetics and pharmacodynamics. Polypharmacy may also make older adults vulnerable to drug interactions and dangerous adverse reactions. It is unlikely that elderly clients will seek legal action if a medication does not make them feel better. The elderly are not known to be any more noncompliant with taking medications than the other segments of the population.

Which of the following best describes the strengths of the American health care system? (Select all that apply.) a. Offering the availability and use of technological advances in equipment and procedures b. Having the ability to overcome concerns regarding access and rationing c. Providing the highest quality of life among any industrialized nation d. Having the lowest maternal and infant mortality rate among industrialized nations e. Leading the world in laboratory and clinical research f. Creating the best patient care outcomes

A, E The United States leads the world in laboratory and clinical research. The United States also exceeds other industrialized countries in the availability and use of technological advances. We do not rank near the top in length of life or patient care outcomes, although we spend far more on health care than other industrialized nations. We are just beginning to confront the issues of access and rationing.

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

A. "Abusers don't stop unless intervention occurs. I have to report it." It is a common myth that abusers will stop the abuse on their own. Professional intervention is required to break the cycle of abuse. The only way to effectively begin breaking the cycle of abuse is to report the incident. The nurse has a professional responsibility to report the abuse, just as the physician does. Documenting the information in the medical record will not initiate stopping the cycle of abuse

In a college health course, the question arose as to when a woman needs to see her health care provider for a Pap smear. Which of the following would be the most appropriate response by the nurse? a. "After you begin having intercourse or reach age 21, whichever is sooner" b. "Before having sexual intercourse, when you go to obtain your birth control" c. "If your periods change at all, go to see your health care provider." d. "If you have a vaginal discharge that's unusual, go right in for a Pap smear."

A. "After you begin having intercourse or reach age 21, whichever is sooner" Current guidelines recommend cervical cancer screening to begin approximately 3 years after a woman begins having vaginal intercourse, but no later than 21 years of age. So it will be important for the woman to have a Pap smear after beginning to have intercourse, or by the age of 21. It is not necessary to obtain a Pap smear before having sexual intercourse. A Pap smear may not be necessary for a change in periods or unusual vaginal discharge, these may be signs of other problems that will not be diagnosed through a Pap smear.

A nurse was creating an ecomap for a family, which consisted of a 3-year-old girl, an 8-year-old boy, and their mother. Which of the following questions would be useful for the nurse to ask? a. "Are you involved with any groups or resources in the community?" b. "Can you tell me about your extended family wherever they live?" c. "Have you thought about what would happen if you needed help?" d. "What were the causes of death for your older family members?"

A. "Are you involved with any groups or resources in the community?" The ecomap is another classic tool that is used to depict a family's linkages to their suprasystems. The nurse can note people, institutions, and agencies significant to the family with some notations as to the nature of the ties that exist. Knowing what resources the family is currently able to assess will help the nurse know what resources to suggest to the family

A young mother was very proud because she had been taking her 9-month-old with her to various garage sales where she had purchased a lot of toys for very little money. Which of the following would be the most appropriate response by the nurse? a. "Be sure there are no small pieces as young children can easily choke." b. "Fantastic. Saving money on toys will allow you to buy more fresh fruits and vegetables." c. "Toddlers love new toys; they will help with cognitive development." d. "You are doing an excellent job of giving your child lots of stimulation with new playthings."

A. "Be sure there are no small pieces as young children can easily choke." Infants and young children are at great risk for accidental injuries. The leading cause of injury death for children under the age of 1 year is accidental suffocation due to choking or strangulation. Thus, it is important for the nurse to talk with the young mother about the dangers of toys with small pieces. Safety of the infant should be the primary concern of the nurse in this situation. Saving money on toys will not necessarily allow the young mother to be able to purchase more fruits and vegetables. The infant is nine-months old and would not be considered a toddler yet. It is not apparent in this situation if the toys are age appropriate for the infant or would provide the appropriate amount of stimulation for a child at this developmental level.

When the school health nurse suggested the school health clinic include sexual counseling and free condoms if requested, an angry woman yelled, "Why do I care if some girls have no morals and sleep around?" Which of the following would be the most appropriate response by the nurse? a. "Because taxpayers spend billions each year for teenage moms and their babies." b. "Because your son may have to pay child support to that girl for the next 18 years!" c. "I understand your point of view, but since some parents don't teach their children morals, the school has to help." d. "We all should care for our neighbors and our neighbors' children."

A. "Because taxpayers spend billions each year for teenage moms and their babies." Preventing pregnancy among teenagers can reduce the dropout rate, welfare dependency, low birth weight, and infant mortality. According to an analysis by the National Campaign to Prevent Teen Pregnancy, the estimated cost of teen childbearing in the United States cost taxpayers (federal, state, and local) is at least $109 billion.

A nurse asked of a family, "Could each of you tell me what you typically do during the week?" Which of the following would the nurse most likely say to follow up such an open-ended question? a. "Could you tell me about what you do at your job?" b. "Do you believe those choices are the best use of your free time?" c. "How do you feel about those activities?" d. "Is there anything you would like to do differently?"

A. "Could you tell me about what you do at your job?" Both of these questions pertain to data collection for the family health tree. The family health tree can be used in planning positive familial influences on risk factors such as diet, exercise, coping with stress, or pressure to have a physical examination.

In the supermarket checkout, a young woman complained to her friend, "Old people think we taxpayers should pay for them to be in a nursing home. Seems like a waste of money." Which of the following would be the most appropriate response by the nurse? a. "Did you know more than 90% of all the elderly live in their own homes while fewer than 5% live in care facilities?" b. "Those old people built our society; we owe it to them to support them now." c. "Would it be better to put each person to sleep when they reach a certain age such as 80 years?" d. "You know, you'll get old someday too. Won't you want someone to take care of you when you can't anymore?"

A. "Did you know more than 90% of all the elderly live in their own homes while fewer than 5% live in care facilities?" In 2009, 93% of Medicare enrollees aged 65 years and over resided in traditional community settings. Three percent resided in community housing with at least one service available, and approximately 4% resided in long-term-care facilities. The other responses do not support a therapeutic response by the nurse in this situation.

"My health problems are too much to handle," said an elderly woman at her annual clinical checkup. "What's most important for me to do?" Which of the following would be the most appropriate response by the nurse? a. "Focus on eating properly and staying active." b. "Get the shingles immunization along with your flu shot this year." c. "Keep active mentally—do you do crossword puzzles or Sudoku puzzles?" d. "Stay involved with others. Do you ever go to the senior citizens center?"

A. "Focus on eating properly and staying active." Health care professionals must inform and educate elders about the benefits of health care screenings and examinations, physical activity and fitness, and good nutrition. As the woman was already getting an annual checkup, the nurse should stress nutrition and exercise.

A woman said, "I've never been retired before. I didn't plan it but it's OK. I'm still doing what I used to do otherwise; I go to church, make quilts for charity, and babysit my grandkids. Do you think I should be trying to find another job for a few years?" Which of the following would be the most appropriate response by the nurse? a. "For lots of people, retirement, even if unplanned, is much like life has always been." b. "It's okay to slow down at your age; why look for problems?" c. "You really need to get out of your house more and be more active, even if you don't get paid at the position." d. "Without a job, you really don't have an identity. Have you been to the unemployment office?"

A. "For lots of people, retirement, even if unplanned, is much like life has always been." The continuity theory of aging suggests that a person continues through life in a similar fashion as in previous years. Because the woman stated she is doing what she has previously done, and has not suggested any particular problems other than concern that what she is doing is acceptable behavior, she should be supported. The statement that best supports her decision states that retirement life is much like life has always been. The other statements do not support her current satisfaction with her activities in her life.

A nurse is going to visit a client who needs assistance with personal hygiene and feeding. Which of the following suggestions should be made to the family? a. "I'll teach you how to care for your family member to keep him comfortable or, if you can afford it, you can employ an aide." b. "It's important that he try to take care of himself and, if he can't or won't, he'll have to deal with the consequences." c. "Reimbursement is available for a nurse to come to the house each day if you would like this assistance." d. "You can always have your family member readmitted to the hospital for care."

A. "I'll teach you how to care for your family member to keep him comfortable or, if you can afford it, you can employ an aide." The only thing the nurse can do if the care needed is maintenance and assistance with activities of daily living is suggest a home health aide if the family can afford it, or teach the family how to help the client. Currently, most reimbursement for nursing services is based on the patient's need for skilled nursing. On each patient visit, the nurse must document that the care provided is of a skilled nature that requires the knowledge and assessment skills of a nurse and must verify that the patient or a family member could not provide the same level of care.

A nurse is on the treadmill exercising, when the woman next to her says, "You're a nurse. Explain to me how the scale says I've lost weight, but my waist and tummy just keep getting larger." Which of the following would be the most appropriate response by the nurse? a. "I'm concerned. You need to see your health care provider to follow up on this." b. "Muscle weighs more than fat so you're creating muscle while losing fat, but it takes a while for the body to redistribute the weight." c. "Tell me what you've been eating in the last week or so." d. "You're running so you're strengthening your legs and thighs, but to lose around your tummy, you have to exercise your abdominal muscles."

A. "I'm concerned. You need to see your health care provider to follow up on this." The most common sign of ovarian cancer is abdominal enlargement. A woman may complain that her skirts and slacks are getting tighter in the waist. Because ovarian cancer is a silent cancer that causes more deaths than any other pelvic malignancy, the woman needs to see her health care provider immediately for transvaginal ultrasonography and a blood test (CA-125). Thus, it is important to refer the woman to a healthcare provider and not try to minimize or rationalize the symptoms that she has reported.

Which of the following best describes a carve-out service? a. A particular service that is offered only by a designated provider or group. b. A particular procedure that receives limited reimbursement. c. A particular treatment is not allowed within a particular diagnosis. d. A particular prescription drug that is only available to those with certain conditions.

A. A particular service that is offered only by a designated provider or group. Carve-out services might be designated for those who need the services the least. A carve-out service (for example, mental health care) is provided within a standard benefit package but delivered exclusively by a designated provider or group. The other definitions do not correctly describe a carve-out service.

A man came for follow-up care to the free clinic, explaining that he had applied for a job based on his education and years of previous work experience, but, being in a wheelchair, he was turned down. Which of the following responses would be most appropriate for the nurse? a. "If you know you can do the job, go to the free legal aid clinic for assistance. The employer may not know the law." b. "No one would want to hire a handicapped person, so you can continue to come here for free care." c. "Because it can be expensive to obtain the necessary equipment to help you do that job, the employer has every right to refuse to hire you." d. "The law says, if a handicapped person applies, he or she has to get hired even if an able-bodied person also applies."

A. "If you know you can do the job, go to the free legal aid clinic for assistance. The employer may not know the law." The Americans with Disabilities Act (ADA) became law in 1990. This landmark civil rights legislation prohibits discrimination toward people with disabilities in everyday activities. The ADA guarantees equal opportunities for people with disabilities related to employment, transportation, public accommodations, public services, and telecommunications. A qualified individual with a disability must meet legitimate skill, experience, education, or other requirements of an employment position. The person must be able to perform the essential functions of the job.

A young son was so physically fidgety that his mother was seriously embarrassed by his inability to be quiet and involved in the interview. Which of the following comments by the nurse would be the most helpful? a. "Isn't it marvelous how much energy your son has?" b. "Is there something your son could be doing for you that would use some of that energy?" c. "Is your son always so fidgety? Have you discussed his behavior with his pediatrician?" d. "Why don't you let your son go to his room until we're finished?"

A. "Isn't it marvelous how much energy your son has?" Sending the son to his room might be seen as punitive and would remove him from being informed about interventions planned and decisions made. A compliment reinforces family strengths and tends to further progress toward open trusting relationships. The comment took a flaw (physically fidgeting) and reframed it as an asset (high energy)

A principal called the school nurse into his office and asked, "Will this student be able to attend our school?" after handing over the medical record of a severely handicapped prospective student. Which of the following would be the most appropriate response by the nurse? a. "Legally all students have a right to public education in the least restrictive environment possible, so let me think how we can manage." b. "The student clearly won't be comfortable here; other students can be so cruel. Let me talk to the student's family." c. "There are schools that specialize in the care of the severely handicapped. Let me get in touch to see if one of those schools has the needed resources." d. "This student is so handicapped there is no way to manage the needed care; the family needs a home schooling teacher."

A. "Legally all students have a right to public education in the least restrictive environment possible, so let me think how we can manage." In 1976, Public Law 99-142 was enacted, giving all students, including those who are severely handicapped, the right to public education in the least restrictive environment possible, regardless of mental or physical disabilities. The Education for All Handicapped Children Act of 1973 and the subsequent Individuals with Disabilities Education Act of 1990 enhanced the opportunities for children previously served in acute care and long-term care settings to have access to public education

"I don't understand," a woman said. "I know I'm eligible for Medicare part A and it's free. Part B isn't free. When will I ever use it?" Which of the following would be the most appropriate response by the nurse? a. "Part A is only for hospital bills. Most care is given on an outpatient basis. Part B pays a large portion of those costs." b. "Part A is a benefit because you paid into Social Security for more than 10 years. In comparison, part B is optional if you want that additional insurance." c. "Part B is easy to pay for; they take the cost out of your Social Security check each month." d. "Researchers have found that people don't waste health care resources if they have to pay a bit for them."

A. "Part A is only for hospital bills. Most care is given on an outpatient basis. Part B pays a large portion of those costs." All the responses are true, although the woman may not care about research findings. Further, she may well prefer the money from her Social Security benefit to be paid to her rather than go for additional insurance. However, the reason the woman needs to know why she should pay for part B is that so much care today is given on an outpatient basis, including diagnostic procedures, physicals, speech and occupational therapy, ambulances, durable medical equipment, and some home health care services.

A nurse is called by her sister, who tells her how wonderful it is that she knows the exact date her baby is coming because her doctor scheduled her for a C-section before his vacation. Which of the following would be the most appropriate response by the nurse? a. "A C-section is major surgery. Do you remember what the doctor shared were the risks for yourself and your baby?" b. "How marvelous to know the date; I'll plan to visit you in the hospital." c. "I'm so pleased. I know exactly when I'm going to be an aunt." d. "Why not wait until after your doctor comes back from his vacation?"

A. A C-section is major surgery. Do you remember what the doctor shared were the risks for yourself and your baby?" C-section involves the risks of any major surgery such as hemorrhage, infection, damage to adjacent structures, as well as risks associated with anesthesia. Long-term sequelae for women include pelvic pain, along with formation of adhesions and placental abnormalities that lead to complications in subsequent pregnancies. Risks to the neonate include higher incidence of persistent pulmonary hypertension and respiratory diseases. C-sections are not shown to improve outcomes for either mother or baby. Women should be made aware of the risks involved with interventions associated with birth and educated on how to best select their place of birth. The role of the nurse is to educate her sister that this is a major surgery and remind her of the risks involved. The other responses do not consider the importance of education needed for the client in this situation.

Which of the following is consistent with the American Academy of Pediatrics (AAP) recommendations for breastfeeding? a. A mother combines breastfeeding with the introduction of complementary foods until the infant is 1 year old b. A mother supplements breastfeeding with formula when then infant is 4 months old c. A mother stops breastfeeding her infant after introducing solid foods d. A mother asks her employer to allow her to bring her infant to work so that she may breastfeed

A. A mother combines breastfeeding with the introduction of complementary foods until the infant is 1 year old The AAP recommends exclusive breastfeeding for about the first six months of a baby's life, followed by breastfeeding in combination with the introduction of complementary foods until at least 12 months of age, and continuation of breastfeeding for as long as mutually desired by mother and baby.

Which of the following actions has been most effective in reducing HIV infections in some countries? a. ABC campaign b. Free HIV immunizations c. Religious leaders stressing abstinence or faithfulness in monogamous marriages d. Public health workers distributing free condoms

A. ABC campaign Substantial reductions in HIV seroprevalence occurred after several countries deployed "ABC" (Abstinence, Be faithful, Condom use) strategies. There is not an immunization available to prevent HIV. The ABC strategy involves use of all three strategies, not just abstinence or condom use.

A nurse established a new parent support group where new parents meet to share problems and solutions. After about 3 months, fewer people were attending. Which of the following actions should the nurse take next? a. Accept that the new parents may now be comfortable in their role and no longer need a support group b. Bring in outside experts to give presentations on specific infancy development issues c. Change the format of the group meetings to include more time for socialization d. Suggest an ongoing educational program on infant and child development to renew interest in attending the group

A. Accept that the new parents may now be comfortable in their role and no longer need a support group It is also important to remember that groups usually have an anticipated "life expectancy." After the needs of the groups are met through education or support, there may no longer be a need for a particular support group. The FCN should document the history of the group and move forward toward new goals.

Which of the following describes what has been identified by public health experts as the number one priority in rural areas? a. Access to health care b. Access to education c. Access to telecommunications d. Access to better-paying employment opportunities

A. Access to health care Bolin and Gamm (2003) reported that access to health care was the number one priority identified by the majority (73%) of rural health care leaders. Although access to education, telecommunications, and well-paying employment are important, they have not been identified as the number one priority in rural areas.

Which of the following concerns can a nurse as a citizen help address? a. Advocating for removal of environmental and social barriers to needed services b. Continuing to engage in political action to increase funding for care for the handicapped c. Recognizing that it is better to offer to help than to wait for a person with handicaps to have to ask for assistance d. Needing to not stare or ask personal questions of a person with a disability

A. Advocating for removal of environmental and social barriers to needed services In the National Agenda for the Prevention of Disabilities model, disability occurs when a person's physical or mental limitations, in interaction with physical and social barriers in the environment, prevent the person from taking equal part in the normal life of the community. Confronting environmental and social barriers to needed services can frustrate and exhaust many people with disabilities and their families. The nurse—as a citizen and a concerned professional—can advocate for removal of such barriers. This issue is the most important for the nurse to address, allowing the nurse to partner with clients and families affected by disabilities to remedy barriers that negatively affect quality of life for this population.

Which of the following is the most commonly used drug among children and adolescents in the United States? a. Alcohol b. Marijuana c. Methamphetamine d. Cocaine e. Steroids

A. Alcohol All 50 states and the District of Columbia have outlawed the sale of alcohol to anyone under the age of 21 years, yet it is still the most commonly used drug among children and adolescents. Marijuana is the most commonly used illicit drug in the United States. The use of other illegal drugs in high school students includes cocaine (6.8%), inhalants (11.4%), heroin (2.9%), methamphetamine, (3.8%) and steroids (3.6%)

Who should create a disaster plan including emergency supplies and where to meet in case of an emergency? a. All families b. All government officials c. All public health employees d. Members of Congress and the Supreme Court

A. All families The American Red Cross publishes many pamphlets and educational materials to help individuals, families, neighborhoods, schools, and businesses prepare for potential disasters. The key actions it recommends are: (1) identify potential disaster events, (2) create a disaster plan for sheltering in place or for evacuation, (3) assemble a disaster supplies kit, and (4) practice and maintain the plan. The disaster plan should include an emergency communications plan, a predetermined meeting place for family members or significant others, and plans for care of pets in the event that evacuation is required.

Which of the following is the basis for any American citizen to feel comfortable expressing an opinion on a political issue? a. Amendments to the Constitution b. Articles of the Constitution of the United States c. Declaration of Independence d. Gettysburg Address

A. Amendments to the Constitution Amendments to the Constitution, later known as the Bill of Rights, were added after the original Articles of the Constitution were ratified. These amendments protect individuals' rights and freedoms. The Declaration of Independence announced the freedom of America from the British Empire. The Gettysburg Address was a speech given by President Abraham Lincoln following the Civil War.

A nurse is employed by the state nursing association to serve as a lobbyist. Which of the following would be the most crucial task to achieve? a. Be seen as a reliable and credible source of accurate information b. Convince colleagues in nursing to join their local nursing organization and write to encourage legislators to vote according to nurses' goals c. Offer to make large donations to the legislator who can forward nursing's agenda d. Visit every single legislator so the nurse is recognized in this role

A. Be seen as a reliable and credible source of accurate information An individual who establishes a reputation as a reliable and accurate resource as a lobbyist has substantial influence. Certainly, it is also useful to convince colleagues to join nursing organizations and write legislators or contribute to campaigns of legislators supportive of nursing goals. Legislators rely on lobbyists to educate them on issues. The official must trust the lobbyists to give accurate (though predictably biased) information, which is timely and up to date.

An elderly gentleman was shoveling his snow when you arrived for a home visit. You notice that when he comes inside he is very pale, is shivering, and seems a bit confused. His skin is very cold when you touch it. Which of the following actions would be most appropriate for the nurse to take first? a. Apply warm moist towels to his head, neck, chest, and groin b. Give him hot coffee with sugar to drink c. Have him get in a tub of very hot water immediately d. Call 911

A. Apply warm moist towels to his head, neck, chest, and groin Initial management is to prevent further loss of heat. Rewarming of the core temperature at a safe, slow rate is important to avoid lethal side effects. The reason for rewarming the core first is to prevent vasodilation that would place the individual in ventricular fibrillation. Measures that can be taken are: (1) remove the individual from the cold area as soon as possible; (2) add more clothing, especially to the head (e.g., use a hat or scarf); (3) provide a warm sweetened drink (no coffee or tea); and (4) apply mild heat to the head, neck, chest, and groin areas using hot water bottles or warm moist towels. Medical help is imperative, and hospitalization may be needed depending on the stage of hypothermia.

A school nurse has identified that there has been an increase in sexually transmitted infections (STIs) among the adolescents attending the school. Which of the following interventions should be completed by the nurse? a. Arrange for the health department to come to the school to give information and treatment on a confidential basis b. Encourage the athletic coaches to distribute condoms in such a way that a boy can obtain them in private c. Have English teachers assign stories about the problems that result from adolescent pregnancy d. Have the bus drivers put a comic book about sexuality, STIs, and preventive measures on each seat

A. Arrange for the health department to come to the school to give information and treatment on a confidential basis Barriers to health care such as lack of transportation, concerns about confidentiality, and lack of access to preventive health services contribute to a high prevalence of STIs among teens. Having a free clinic in the school removes some of the barriers.

Which of the following is the leading cause of disability in the United States? a. Arthritis b. Car accident c. Falls d. Heart disease

A. Arthritis Arthritis is the leading cause of disability in the United States. Car accidents, falls, and heart disease are not among the leading causes of disability in the United States.

Which of the following statements best describes why nurses should contribute whenever possible to their state nursing association political action committee (PAC)? a. As PACs are a reality of political life, nursing needs to be heard. b. Contributing money may result in a future political appointment. c. Only money really has any influence on legislative votes. d. PACs are being used to increase nursing salaries and working conditions.

A. As PACs are a reality of political life, nursing needs to be heard. Because PACs are a reality of political life, nurses need to recognize their power and support those that are committed to electing candidates sympathetic to health care issues. The contribution of money will support the current nursing practice initiatives which will change as nursing practice changes. These contributions will most likely not have any relationship to a future political appointment. Legislative votes are influenced by a variety of factors and are not limited only to money.

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

A. Ask about and educate regarding IPV IPV, formerly known as domestic violence, is a pattern of coercive behaviors perpetrated by someone who is or was in an intimate relationship with the victim, such as a spouse, ex-spouse, boyfriend or girlfriend, ex-boyfriend or ex-girlfriend, or date. These behaviors may include battering resulting in physical injury, psychological abuse, and sexual assault that contributes to progressive social isolation and intimidation of the victim. Abuse is typically repetitive and often escalates in frequency and severity. IPV crosses all ethnic, racial, socioeconomic, and educational lines. About 30% of women and 1% of men report experiencing physical forms of IPV at some point in their lives. Thus, the nurse must assess for IPV.

A woman was in the emergency department with a bruised and broken leg. She explained that she had accidentally opened the car door on a trip and the door had blown back on her leg. Her husband was very attentive, constantly asking the nurse to make his wife more comfortable. Which of the following actions should be taken by the nurse? a. Ask the husband to step out of the room while you get a urine specimen, and, after he leaves, ask the woman, "Have you ever been deliberately hurt by someone?" b. Call x-ray immediately, and prepare for the leg to have a cast applied. c. Put ice bags on the area until the leg can be repaired. d. Try to get an additional pain medication order from the physician.

A. Ask the husband to step out of the room while you get a urine specimen, and, after he leaves, ask the woman, "Have you ever been deliberately hurt by someone?" Abuse of women is often explained as accidental injury. Approximately 6% of visits made by women to emergency departments are for injuries that result from physical battering by their husbands, former husbands, boyfriends, or lovers. It is important for the nurse to understand the state laws related to reporting known or suspected domestic violence. The AMA and ANA advocate that all women should be assessed for intimate partner violence. Questions should be posed privately, in nonjudgmental specific terms (i.e., "Do you feel safe?" "Have you ever been hit, punched, slapped, or kicked?") with follow-up questions if the woman responds "yes." In this situation, with a questionable explanation for the injury and an overly attentive husband, it would be important to complete this assessment. This invention would be more important than calling for x-ray, applying ice, or administering additional pain medication.

For which of the following groups is homicide the leading cause of death in the United States? a. Black males aged 15 to 34 years b. Black children aged 1 to 14 years c. White children aged 1 to 14 years d. White males aged 15 to 34 years

A. Black males 15-34 yo For black males aged 15 to 34 years, homicide is the leading cause of death. Homicide is the second leading cause of death among black males aged 1 to 4 and 10 to 14 years, compared with white males, where homicide is the third leading cause of death in ages 15 to 29 years.

On the basis of what a faith community nurse (FCN) believed was best practice, she wanted to share various methods of dealing with infertility. However, the tradition of the church was that childbirth was in the hands of God and it was inappropriate to use artificial means of becoming pregnant. Which of the following actions should be taken by the nurse? a. Ask to be excused from the situation if a couple wants to obtain information inconsistent with the church's teaching b. Follow the teaching of the church and keep quiet; there are worse fates in life than infertility c. Suggest that a client consider adoption and suggest an appropriate adoption agency d. Tell the client all the various methods used in cases of infertility

A. Ask to be excused from the situation if a couple wants to obtain information inconsistent with the church's teaching The FCN's roles include understanding the scope of practice for parish nurses related to ethical practice and the values and beliefs of the community served. The nurse must understand his or her own beliefs and values that are in conflict with the faith community's beliefs. It is necessary that the parish nurse know when to seek help, when to refer, and when to remove himself or herself from the ethical decision-making process.

Which of the following best describes what was done by large industrial giants to stop the constant increase in their costs for health insurance for their employees? a. Assembled their own health care programs b. Established health promotion programs that employees were required to attend c. Signed only certain providers to give care at a reduced rate in exchange for so many new patients d. Suggested that employees seek only the most necessary services

A. Assembled their own health care programs Large industrial giants, such as Kaiser Permanente, decided to assemble their own health care programs. They built hospitals, hired physicians, and provided health care services to their employees. In an effort to market this concept, the phrase health maintenance organization was created. These organizations were designed to provide comprehensive care to employees. As these large health care programs were established, enrollees had limited freedom of choice. Preventive care was covered and encouraged, but care was somewhat restricted, and care providers were encouraged to reduce costs by providing only the most necessary services.

Which of the following is the best use of the nurse's time while en route to the client's home? a. Assess the surrounding neighborhood and the exterior of the client's home b. Begin the client record using a computer or oral recording device c. Look for appropriate places to obtain food, fuel, or rest stops for the nurse d. Consider if another home health agency would be closer to the client's home

A. Assess the surrounding neighborhood and the exterior of the client's home An environmental assessment begins as the nurse leaves the agency en route to the client's home. The nurse should make specific observations. It would not be appropriate to use a computer or oral recording device while driving. Although the nurse should be conducting an environmental assessment, the nurse should be considering the needs of the client during this assessment and not his/her own needs. The nurse would not want to refer the client to another agency if the client has already selected this agency.

Which of the following statements best describes the message that public health leaders are trying to emphasize to the public? a. Assume responsibility for your own health by choosing healthy behaviors b. Have a primary physician and get yearly checkups c. Obtain immunizations and screenings when they are offered d. Support legislative efforts to improve our medical care system

A. Assume responsibility for your own health by choosing healthy behaviors Although there are many public health messages in the media, from quitting smoking to getting a checkup, the primary message currently being emphasized by public health, as well as all the media coverage of the constantly increasing cost for health care, is for each person to take responsibility for his or her own health through choosing healthy lifestyle behaviors. Supporting legislative efforts is not as important as the need for individuals to take responsiblity for their own health.

The school nurse only had the resources for one education program for all the schools' teachers and support staff. Which of the following topics would be the most important to address in this program? a. Asthma b. Diabetes c. Epilepsy d. Measles and mumps

A. Asthma In 2011, 9.6 % of children under the age of 18 had asthma, occurring most often among poor (13.5%) and non-Hispanic black children (17%). Asthma is one of the most common chronic childhood conditions, causing more than 4.6 million people to miss more than 1 day of school or work (CDC, 2011d). Because asthma is so prevalent, it is recommended that school-based support exists. Actions undertaken by some schools across the country include immediate access to asthma medications, development and implementation of asthma action plans, and student and staff education on asthma. Because of the severity and prevalence of asthma, this is the most important topic to address and should be addressed instead of diabetes, epilepsy, or measles and mumps

A nurse was trying to decrease the amount of respiratory illness in the community. Which of the following approaches should be used by the nurse? a. Attend each farmworkers' meeting and listen to how they perceive and discuss their problems b. Offer to teach the farmers' spouses how to protect their families, such as having the farmer shower and change clothes before coming into the house c. Suggest the community work together to obtain a community college so farmworkers could be educated for other employment opportunities d. Teach children in the school system the importance of seeking employment in cities rather than staying on the farm

A. Attend each farmworkers' meeting and listen to how they perceive and discuss their problems Using informal networks in the community is essential. The involvement of informal networks and local leaders in planning health interventions is crucial. To be able to do that, the nurse must first listen to how the community perceives its problems.

Why are health care providers concerned over such social issues as mass transit, clean power, and the farming industry? a. Because air pollutants are contributors to asthma and other health problems. b. Clean power would reduce the pollution that results from burning of high-sulfur coal. c. Manure runoff from industrial farming is polluting water and killing fish throughout the United States. d. Mass transit would remove the problem of so many Americans being killed or injured by drunken or impaired drivers

A. Because air pollutants are contributors to asthma and other health problems. All three (mass transit, clean power, and industry) emit air pollutants, which result in smog, the most common outdoor air pollutant in the United States. Atmospheric pollutants cause or contribute to asthma, allergic reactions, bronchitis, lung cancer, chronic respiratory disease, and death. They also harm animals and plants. The most inclusive answer refers to air pollutants, although certainly, the others are true in society today.

The current school year is now over, and the school health nurse spends time summarizing the records of all the children who had come into the school health office during the past school year. Which of the following best explains the rationale for this action? a. Because analysis can help establish priorities for future health programs b. Because annual reports are expected by the school board c. Because it's very personally rewarding to see all the help one has given throughout the year d. Because the nurse has to justify the school health office budget for each year

A. Because analysis can help establish priorities for future health programs Community health nurses (CHNs) are employed in ambulatory care centers, occupational health and school sites, housing complexes, day care programs, residential treatment and substance abuse programs, and other official and nonofficial agencies. At each of these sites, CHNs meet families and can assess and intervene at the family and community levels The challenge is to focus not only on individual students but extend practice to the whole school community of children. Fiscal constraints hold the nurse accountable for the best delegation of scarce resources. In times of limited budgets, the school health nurse, on the basis of the most frequent problems presented in the office, can draw conclusions as to what are the major health needs of children in the community. On the basis of those conclusions, health programs can be planned to maximize health promotion and disease prevention in the school.

Which of the following best describes why nurses are increasingly becoming case managers when social workers have historically been so successful in the role? a. Because of the need for ongoing patient assessment. b. Because of a shortage of licensed social workers. c. Nurses seek such roles as being easier than direct clinical care. d. Social workers expect higher salaries than nurses in the same role.

A. Because of the need for ongoing patient assessment Traditionally, case managers were social workers. Client health care needs became more complex, the need for ongoing patient assessment has emerged, and available resources have become more numerous and diverse. Therefore, nurses have become case managers. There is not a shortage of licensed social workers to fill these roles or a salary issue with social workers being in these roles. These roles are different than direct clinical care, but may not be considered to be an easier role for the nurse.

When does disaster management begin? a. Before a disaster occurs b. Immediately after the disaster c. Throughout the disaster period d. When the disaster begins

A. Before a disaster occurs When one is aware of the types and characteristics of disasters, the question then becomes: What can be done to prevent, prepare for, respond to, and recover from disasters? Disaster management requires an interdisciplinary, collaborative team effort and involves a network of agencies and individuals to develop a disaster plan that covers the multiple elements necessary for an effective plan. Communities can respond more quickly, more effectively, and with less confusion if the efforts needed in the event of a disaster have been anticipated and plans for meeting them have been identified. The results of planning are that more lives are saved and less property is damaged. Planning ensures that resources are available and that roles and responsibilities of all personnel and agencies, both official and unofficial, are delineated.

Which of the following realities would cause difficult ethical conflicts for a faith community nurse? a. Best clinical practice may suggest behaviors contrary to the faith community's values and beliefs. b. Individuals might pressure the nurse to make medical decisions for them. c. Persons do not always follow the nurse's advice as to appropriate actions. d. Some political maneuvers within the faith community have implications for the nurse's practice.

A. Best clinical practice may suggest behaviors contrary to the faith community's values and beliefs. The nurse must understand the policies and beliefs of the congregation related to specific health issues. Church doctrine may guide members to adopt values and beliefs that are in conflict with current health care recommendations, such as issues of homosexuality, infertility, birth control, or sex education for youth. The parish nurse must understand that the politics of working within the faith system require acceptance of individual and system values and beliefs.

Which of the following has been a common result in countries with a severe HIV/AIDS epidemic? a. Birth rate is high, but life expectancy is only 35 to 40 years. b. Free clinics have begun distributing condoms to stop the spread. c. International aid has begun to lower the infection rates. d. Missionaries are establishing orphanages within their churches.

A. Birth rate is high, but life expectancy is only 35 to 40 years. In countries severely affected by the HIV/AIDS epidemic, life expectancy has dropped to 35 to 40 years. In these countries, the working age population has dwindled while the birth rate has risen. International aid, orphanages, and condom distribution may be present in these countries; however, the main problem is that the birth rate is high and life expectancy is short.

An ambulance medic reported a client was on the way with a traumatic brain injury (TBI). Which of the following symptoms would the nurse expect this client to display? a. Blurred vision and a headache b. Hypotension and tachycardia c. Irregular heart rate d. Fecal incontinence

A. Blurred vision and a headache TBI symptoms may be mild, moderate, or severe. Symptoms of mild TBI include headache, confusion, light-headedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, and a change in sleep patterns or thinking. Moderate or severe TBI may demonstrate the same symptoms as mild TBI plus a headache that gets worse or does not go away, repeated vomiting or nausea, convulsions or seizures, an inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the extremities, loss of coordination, and increased confusion, restlessness, or agitation. The other symptoms are not indicative of TBI.

A nurse has been working as a case manager for the past 6 months and would like to become certified. Which of the following organizations should the nurse pursue certification through? a. Case Management Society of America (CMSA) b. American Nurses Credentialing Center (ANCC) c. American Nurses' Association (ANA) d. Centers for Medicare and Medicaid (CMS)

A. CMSA The only organization that offers a certification that this nurse is qualified to obtain is the Certified Case Manager (CCM) through the CMSA. The ANCC certification requires that the nurse has completed a minimum of 2000 clinical practice hours in case management nursing within the past year. Having worked only 6 months as a case manager, the nurse would not meet this minimum criterion. The ANA and CMS do not offer certification for case managers.

Which of the following groups would most need adult day care services? a. Caregivers who work all day b. Elderly who are bored staying home alone c. Elderly in whom Alzheimer's has been diagnosed d. Older men who want an opportunity to meet older women e. Older women who want to engage in arts and crafts activities

A. Caregivers who work all day Adult day care provides a safe and supportive environment during the day for adults who cannot or choose not to stay alone. This service is often needed by caregivers who work during regular hours or need respite.

Which of the following nongovernment organizations (NGOs) is active in improving health on a global scale? a. Carter Center b. Centers for Disease Control and Prevention (CDC) c. Pan American Health Organization d. UNICEF

A. Carter Center Collaborating with the United Nations are NGOs such as the Carter Center. The CDC is a governmental agency. The Pan American Health Organization is an international public health agency. UNICEF is an international agency.

Which of the following is the most common reason for visual impairment in older adults? a. Cataracts b. Glaucoma c. Macular degeneration d. Presbyopia

A. Cataracts Among older adults, the three most common pathological eye conditions are cataracts, macular degeneration, and glaucoma. Cataracts are the leading cause, as well as the most reversible cause, of visual impairment in older adults. A cataract is a clouding of the normally clear lens of the eye. Age is the single greatest risk factor for cataracts. By age 65 years, some degree of lens clouding has developed in half of all Americans, although it may not impair vision. Presbyopia, loss of elasticity of the lens of the eye causing difficulty with near vision, generally occurs in the 40s.

Which of the following is a fairly recent surprise regarding infectious diseases in the United States? a. Cervical cancer and coronary artery disease may be caused by infectious agents. b. Epidemics such as the H1N1 flu continue to occur. c. Mortality caused by infectious diseases continues to rise. d. Some infectious diseases remain endemic in our society.

A. Cervical cancer and coronary artery disease may be caused by infectious agents. Recent scientific discoveries on the infectious etiology of stomach ulcers, coronary artery disease, and cervical cancer, for example, suggest that infectious agents may be responsible for more morbidity and mortality than previously recognized. Mortality caused by infectious diseases has decreased. Endemic refers to a disease that is regularly found among people in a certain area. In our society today, there are no endemic infectious diseases. Advances in public health and health care have made it easier to control infectious diseases such as H1N1 flu

Which of the following best describes how hospitals initially coped when Medicare reimbursement became based on diagnosis-related groups (DRGs)? a. Charged more for patients whose care was paid by insurance b. Decreased nursing staff to cut labor costs c. Lobbied politicians to increase Medicare reimbursement to reflect actual costs d. Refused to accept Medicare patients

A. Charged more for patients whose care was paid by insurance Hospitals developed cost shifting to supplement losses caused by Medicare funding. Because private insurance reimbursements were cost based, hospitals included the loss in their total costs; therefore private insurance paid for covering care to both their enrollees and Medicare patients. The implementation of DRGs did not cause hospitals to decrease nursing staff, lobby politicians to increase Medicare reimbursement, or refuse to accept Medicare patients.

Which of the following groups makes up about 30% of the world's population? a. Children b. Elderly c. Teenaged adolescents d. Caucasians

A. Children According to the World Health Organization, in 2007, 30% of the world population consisted of children and 8% of the population were over age 60. The percentage of teenaged adolescents and Caucasians is not reported in the text.

Which of the following is the most common sexually transmitted disease (STD)? a. Chlamydia b. Gonorrhea c. HIV d. Syphilis

A. Chlamydia In 2007, the Centers for Disease Control and Prevention reported that the most common STD was Chlamydia trachomatis infection, followed by gonorrhea. The spread of HIV and syphilis are also of concern, but these rates are not as high as they are for chlamydia and gonorrhea.

Which of the following actions would be the least expensive approach to treating chronic diseases? a. Choose healthy lifestyle behaviors to retain health b. Continue media campaigns encouraging early detection and treatment c. Encourage patients to seek care at a local neighborhood health clinic d. Suggest self-therapies that have been demonstrated to be effective

A. Choose healthy lifestyle behaviors to retain health The five leading causes of death and illness can be positively affected by changes in lifestyle. Healthy lifestyles can modify or even prevent most chronic illnesses. Seeking care at a neighborhood health clinic, producing media campaigns, and engaging in self-therapies are all more expensive approaches to treating chronic diseases than choosing healthy lifestyle behaviors.

Which of the following do terrorists hope to accomplish by causing mass destruction and violence toward innocent persons going about their daily lives? a. Create fear to intimidate and coerce to accomplish a political goal b. Encourage others with similar beliefs to join them and their cause c. Obtain publicity for themselves and their goals d. Obtain increased negotiating power and respect

A. Create fear to intimidate and coerce to accomplish a political goal The U.S. Code of Federal Regulations defines terrorism as "the unlawful use of force and violence against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in furtherance of political or social objectives."

A researcher is examining potential risk factors in comparison with disease at a specific time through collecting data regarding current exercise, sleep patterns, and current health status among 12-year-olds. Which of the following research studies would be most appropriate? a. Cross-sectional study b. Prospective study c. Retrospective study d. True experiment

A. Cross-sectional study By definition, a cross-sectional study examines relationships between potential causal factors and disease at a specific time. A prospective study monitors a group of disease-free individuals to determine if and when disease occurs. A retrospective study compares individuals with a particular condition or disease with those who do not have the disease. A true experiment involves both an experimental group who receives an intervention and a control group who does not receive an intervention.

Which of the following compositional factors influences rural health needs? a. Demographics of the people living in an area b. Local environment c. The geography of the area d. The political and social institutions in the community

A. Demographics of the people living in an area There is a growing emphasis on the distinction between context, which is defined by the characteristics of places of residence, and composition, which is the collective health effects that result from a concentration of persons with certain characteristics. Problems in rural areas are compositional when they derive from individual characteristics of groups of people residing in rural settings. Examples of compositional sources of health disparities include such characteristics as age, education, income, ethnicity, and health behaviors. The environment, geography, and political and social institutions are considered to be characteristics of place.

Which of the following insights is being stressed by advocacy groups regarding persons with disabilities today? a. Disability results when physical and social barriers in the environment prevent a person from taking equal part in community life. b. Handicapped persons have as much right to social support as nonhandicapped persons. c. It is recognized that an individual may be limited by an environmental barrier in society. d. Impairment is a result of society's reaction more than mental or physical condition.

A. Disability results when physical and social barriers in the environment prevent a person from taking equal part in community life. Nearly all definitions identify an individual as disabled on the basis of a physical or mental impairment that limits the person's ability to perform an important activity. The complementary possibility—that the individual is limited by a barrier in society or the environment—is never considered. Advocacy groups are stressing that environment and the reactions of others are as crucial as the actual physical or mental limitation.

Which of the following strategies should be used to lower the risk of malaria among the world's population? a. Distribute insecticide-treated nets and antimalarial medications b. Educate people to keep their windows closed at night c. Spray neighborhoods with insecticides to kill any mosquitoes present d. Spread DDT on bodies of water to prevent larva growth

A. Distribute insecticide-treated nets and antimalarial medications Effective low-cost strategies are available for malaria's prevention, treatment, and control, including insecticide-treated nets and new-generation medications such as artemisinin-based combination therapies. It would be very dangerous to spray neighborhoods with insecticides, which also contaminate food. DDT has been banned in the United States for many years because of its long-term harmful effects on the environment, including food animals. Keeping the windows closed at night is not going to prevent the threat that occurs during other times of the day.

Who primarily provides care for military personnel, their families, and veterans, as well as Native Americans? a. Federal government b. Local health departments c. Regional health districts d. State health departments

A. Federal govt. The federal government is responsible for the health care of specified populations including military personnel, their families, and veterans. The federal government also is responsible for health care for Native Americans. Local health departments and state health departments are not the primary provider of care for these populations. Regional health districts are not used to provide care for these populations.

Which of the following theoretical approaches would be most useful to the nurse who wants to improve patient-provider communication and address the gap between what providers discuss and what families want to know about? a. Ecological framework b. Network therapy theory c. The Kentucky Partnership model d. Transaction model

A. Ecological framework The ecological framework is a blend of systems and developmental theory with an individual's understanding of his or her environment. Kogan and others investigated parent-health care provider discussions of family and community health risks during well-child examinations, as well as the gaps in issues discussed by the practitioner and the information the parent desired. The results indicate the need for better communication and education between health care providers and clients.

A school health nurse was concerned about the diagnosed eating disorders of three high school students. A nutrition and body image program was planned. Which of the following classes should receive the program first? a. Elementary school grades 4, 5, and 6 b. Grades 7, 8, and 9 c. High school grades 10, 11, and 12 d. Kindergarten students

A. Elementary school grades 4-6 It is imperative that the school nurse recognize the association between feelings of inadequacy (e.g., low self-esteem, anger, anxiety, and depression) and unhealthy eating practices in adolescents and young people. These self-perceptions begin early in life; therefore education and counseling must begin in elementary school. This program would be offered too early for kindergarten students and too late for grades 7 through 12. Thus, the priority population would be the elementary school children

Everyone in a high school was very upset over the fact that one of the students had shot and killed another student. The nurse decided this was an appropriate time to establish a program to help prevent violence. Which of the following groups of students should receive the program first? a. Elementary school grades 4, 5, and 6 b. Grades 7, 8, and 9 c. High school grades 10, 11, and 12 d. The students who knew the victim and his assailant

A. Elementary school, grades 4,5,6 Violence prevention programs should begin in elementary schools. Children who exhibit aggressive behavior in elementary school are more likely to exhibit antisocial and violent behavior as adolescents and adults. Programs should teach stress management, conflict and anger resolution, and personal and self-esteem development. This program would be offered too late for children in grades 7 through 12, and should be offered to a larger audience than only those who knew the victim and assailant. Thus, the priority population would be the elementary school children

Which of the following best explains why companies do not build work places in rural areas where people are anxious to find full-time employment? a. Employers need highly educated and skilled employees. b. Managers do not want to be transferred into a rural area where they will not fit in and will not be comfortable. c. Rural persons do not work as hard as urban dwellers. d. Smells emanating from farms are unacceptable to persons working inside.

A. Employers need highly educated and skilled employees. Counties that have a low-wage economy have difficulty providing the infrastructure needed to provide education for low-wage families. They therefore have difficulty attracting new employers who might contribute to the economic development of a rural area but need a more highly educated workforce. Rural workers are known for their strong work ethic, but they may not have the educational skills that are necessary. Smells from farms is not a typical reason as to why companies do not build in rural areas.

A man has been off work because of a recent illness. Which of the following would be the most useful action for the employer to take to support this man? a. Encourage the man to return to work as soon as possible, possibly at something less physically demanding b. Reassure the man that he may have as much time off as he needs c. Share the man's need with other employees so that they may donate unused or unneeded sick time to him d. Suggest that other male employees visit the man at his home to help keep his spirits up and demonstrate he is not forgotten

A. Encourage the man to return to work as soon as possible, possibly at something less physically demanding Time away from work because of occupational injuries should be kept to a minimum. Males should be encouraged to return to work in an altered capacity rather than remaining away from work until the injury is completely healed. Employment keeps the man active during the day and also gives opportunity for socialization. Because the man should be encouraged to return to work, it would not be appropriate to request additional sick time from other employees or suggest that other employees visit him at home.

A woman with two young children is debating if she should try to work using child care or stay at home and care for her children. Based on the current trends, which decision is she most likely to make? a. Enter the work force b. Invite a relative to live with them to care for the children c. Negotiate with her husband so he stays home with the children d. Stay home with the children

A. Enter the work force Sixty-two percent of women with young children (younger than 6 years) work outside the home. Thus, it is most likely the woman will enter the workforce based on current trends. A working woman is less likely to have a spouse or partner to help with the home and children. Even when a spouse or partner is present, the burdens of housework and child care usually fall more heavily on women, regardless of ethnicity.

A daughter tells the nurse that her mother is frequently confused, but what is really upsetting is that she is incontinent during the night. "All I do is watch her and wash sheets," the daughter says. Which of the following suggestions should the nurse provide to the daughter? a. Explain about respite care or the need to ask other family members to help so the daughter can have some time off b. It's time to have her mother go into a nursing home where they can give her the care she needs. c. Refer the daughter to Adult Protective Services so responsibility for her mother's care may be assumed by an agency prepared for such tasks d. Teach the daughter how to establish a toileting routine for the mother to help control the incontinence

A. Explain about respite care or the need to ask other family members to help so the daughter can have some time off The best approach—because the daughter is willing to share her feelings with you—is to see whether there is anyone else in the family to help so the daughter can be less overwhelmed. If the mother has Alzheimer's, any number of resources are available for respite for the caregiver, support groups for both client and family, and day care facilities for the client. Adult Protective Services assists in cases of abuse. The daughter is stressed and may become an abuser if assistance is not found. A toileting routine would probably not be successful during the night. Although a nursing home is possible, many families cannot afford such care or do not want a family member sent there.

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

A. First get out of there, then call the campus police and report what was heard The text talks about date rape drugs including ketamine. The first priority is to keep oneself safe, so leaving would be prudent. Ideally, the police will allow the report to be made without sharing who reported the potential problem. Doing nothing, talking to the men, and watching young women at the party will not protect the females at the party from unknowingly consuming the ketamine.

Which of the following best describes the problem with the viewing disability based on the Nagi model? a. Functional limitations are used to determine if an individual is disabled. b. Functional limitations are not easily objectified and measured. c. The model does not distinguish between genetic limitations and limitations imposed by injury or illness. d. Persons are or are not limited according to choices they make.

A. Functional limitations are used to determine if an individual is disabled. The Nagi model uses functional limitations, which have been defined and are measureable, to determine whether an individual is disabled. However, the current paradigm considers the environmental barriers and the perspectives of the onlooker when considering if an individual is disabled. Thus, the other options do not address the limitation of using only functional limitations.

Which of the following statements best describes why the incidence and prevalence of gonorrhea is unknown? a. Gonorrhea is not a reportable condition. b. Gonorrhea can vary in how long the infection remains in the body. c. Gonorrhea can be cured with antibiotics, so people do not remain infected. d. People are ashamed to admit they have gonorrhea.

A. Gonorrhea is not a reportable condition. Morbidity rates (incidence and prevalence rates) are not available for many conditions because surveillance of many chronic diseases is not widely conducted. Furthermore, morbidity rates may be subject to underreporting when they are available. In other words, there is no responsibility to report cases of most diseases, including gonorrhea. Information is only available related to conditions where care providers are required to report that specific condition or where those affected die and mortality data are available.

A man, who looked about 45 years old, gave a cashier at a grocery store the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) vouchers for some of the food he had just selected. Which of the following conclusions can be drawn from this scenario? a. He had a teenage daughter who was pregnant or with a young child. b. He met the requirement for Aid to Dependent Families. c. He really knew how to beat the welfare system. d. He was handicapped, although his handicap was not immediately apparent.

A. He had a teenage daughter who was pregnant or with a young child. WIC provides federal grants to states for the purpose of serving nutritionally at-risk, low-income pregnant and postpartum women and their children up to five years of age. WIC programs provide highly nutritious foods, nutrition education and counseling, and screening and referral to needed services. To be eligible, women and children must meet income guidelines established by each state, and a health professional must determine they are at "nutritional risk." Women and children who participate in Medicaid, the Food Stamp program, or the Temporary Assistance for Needy Families program are automatically income eligible for WIC. This man would not be eligible for WIC assistance himself because this program is for women and children.

Which of the following conclusions can be drawn from reviewing how health care costs are spread over a person's lifetime? a. Health care expenditures increase with age. b. Premature newborns incur more costs than other children from birth through adulthood. c. The majority of cost is incurred during middle age when chronic diseases strike. d. Persons aged 85 years and above spend the most money on health care.

A. Health care expenditures increase with age. Expenditures increase with age. About one third of costs are incurred during middle age; half during the senior years; and, for those older than 85 years, one third of their lifetime costs occurs during their last year of life.

The local stream was full of trash. The Boy Scouts had a cleanup day so they could again canoe on the stream. Which of the following actions should be taken by nurses in the local community? a. Hold a dialogue with community members about the problem and its effects b. Fight for stronger "do not trash" laws and harsher penalties c. Lecture community organizations about the value of safe water for recreation d. Put all personal trash in appropriate trash receptacles

A. Hold a dialogue with community members about the problem and its effects An important nursing goal is to help people learn from their own experiences and analyze the world with an intention to change it. It is essential that those affected participate in the process of identifying and working to solve environmental problems. The nurse's role is to ask critical questions and help groups reflect on the environmental realities of their lives. The only way for the nurse to promote this involvement is through a dialogue with the community members.

Which of the following symptoms would the faith community nurse (FCN) expect to see when caring for a client with the diagnosis of spiritual distress? a. Hopelessness, isolation, and loneliness b. Intense need for prayer and support c. Loss of faith d. Withdrawal from stress and the environment

A. Hopelessness, isolation, and loneliness FCNs provide nursing interventions related to the nursing diagnosis as connected to spiritual distress (e.g., loneliness, isolation, and hopelessness).

Which of the following statements best describes an effect of the Welfare Reform Act of 1996? a. Individuals who were required to obtain employment lost their health coverage. b. Many were happy to be off the government dole and self-supporting. c. Persons sought and obtained employment that often included insurance benefits. d. The food stamp program decreased in size.

A. Individuals who were required to obtain employment lost their health coverage. The law decreased the number of people on welfare and forced many individuals to take low-paying jobs, many of which did not offer health insurance. Many individuals, particularly women and children, subsequently lost Medicaid coverage.

As a concerned citizen and professional, a nurse encourages the local senators and representatives to support expansion of health clinics for the poverty stricken. Which of the following locations is in most desperate need? a. Rural areas where migrant and seasonal farmworkers (MSFW) labor b. Inner city poverty-stricken neighborhoods c. Near elderly low-income housing units d. Inside high schools in poverty-stricken neighborhoods

A. Rural areas where migrant and seasonal farmworkers (MSFW) labor In general, MSFW may have the poorest health of any aggregate in the United States and the least access to affordable health care. Thus, a location that serves this population would be most important.

Which of the following best explains why an employer would care about the health needs of local children? a. The children are the employer's future workforce. b. The employer needs positive media coverage and no scandals. c. The community will provide greater support to employers that have family-based policies. d. Staying home to take care of sick children will impact the productivity of the workplace.

A. The children are the employer's future workforce. Business and industry have an enormous stake in the health of the nation's children. A strong, productive workforce is ensured only when the health, social, and educational needs of the next generation of workers are met. Furthermore, health risks cost employers in lost productivity and increased health care costs. Avoiding scandal and negative media coverage would not be a reason why employers would care about the health needs of the local children. The community does not provide greater support to businesses that have family-based policies. Although, businesses want to keep their employees at work instead of at home taking care of ill children, businesses are concerned with more than just the children of their employees. All children in the local community are a concern for employers as these are the future workforce.

The case manager gave the client a list of eight possible sources for the equipment needed for care after discharge. Which of the following best describes why the nurse did not just tell the client the best source for the equipment? a. The client has a right to select providers of needed resources. b. The nurse did not know which source was the best resource. c. The client must make a decision independently. d. The nurse did not care which source is chosen.

A. The client has a right to select providers of needed resources. Ethical issues for case managers include the client's right to select providers of resources. As a practical matter, nurses usually offer several choices so there is no suggestion of misconduct in pushing a particular provider.

Which of the following ethical issues is often a concern to a faith community nurse (FCN)? a. The client's right to confidentiality if a client repents and confesses sin to the nurse b. Following the Health Insurance Portability and Accountability Act (HIPAA) requirements c. The nurse's legal responsibility to the faith community leader d. Setting up appropriate medical records of care given in case of a later legal suit

A. The client's right to confidentiality if a client repents and confesses sin to the nurse Confidentiality issues have the potential to be problematic in a church community. Church members can ask how someone is doing. Another church member would respond with whatever they have heard. The FCN cannot respond in an equally open way but must maintain confidentiality. In the role of health minister, the parish nurse may receive private and sensitive information. Congregation members should not relate information in the form of confession or repentance; however, the connection with the church ministry team may put the nurse in a position to hear this type of sensitive information. The nurse must protect the client's right to confidentiality. The nurse should share confidential information with other church ministry leaders (or prayer groups) only when given permission by the client. FCN programs within faith communities generally are not required to follow HIPAA guidelines related to medical records and confidentiality because churches are not in the category of identified health care providers.

Which of the following best describes when case management is implemented for hospitalized patients? a. Immediately on admission b. Immediately on discharge c. When a nurse recognizes the need and makes the appropriate referral d. When the patient is assigned a case manager

A. immediately on admission Health care coordination begins on the patient's admission or shortly thereafter and continues after discharge.

A nurse overheard an adult woman, shaking her head in exasperation as she said, "Dad, you're being unreasonable. It's not safe!" Which of the following is the most likely reason for this argument? a. The dad wants to keep driving. b. The dad wants to keep cooking his own meals. c. The dad wants to keep taking care of himself each day without assistance. d. The dad wants to marry some young woman who may just want his money.

A. The dad wants to keep driving One of the quality-of-life factors that is important to seniors is the ability to drive. Many older adults depend on driving in order to maintain independence and personal mobility. Age related declines in vision, hearing, and other abilities as well as certain medical conditions and medications can affect driving skills. Thus, safety is a concern for any elderly driver. This safety concern outweighs the other concerns of cooking one's own meals, providing self-care, and marrying a younger woman.

Which of the following best describes the purpose of case management from the client's perspective? a. To help clients navigate a complex, fragmented, confusing health care system to obtain appropriate care b. To help clients recognize that health care resources are limited and must be used wisely c. To help clients understand their varied health problems and the best approach to maintain their health d. To help clients obtain whatever care they need or desire

A. To help clients navigate a complex, fragmented, confusing health care system to obtain appropriate care Client-centered case management assists the patient through a fragmented and often confusing health care delivery system and to achieve specific client-centered goals. Systems-centered case management recognizes that health care resources are finite. Helping clients understand their health problems is a responsibility of health education, not case management.

A nurse had shared a great deal of information with a new client. Time had passed, but the nurse had more to share and was energetically doing so. Which of the following should the nurse use as a guide to determine when to stop teaching and plan the next visit? a. After about an hour b. Depends on what other visits the nurse had scheduled that day c. When the client or family members start fidgeting d. When the client begins to look tired e. When the client demonstrates symptoms of sensory overload

A. after about an hour The average visit should not exceed 1 hour. The client receives a great deal of information during that hour, and the nurse collects a great deal of information. Most clients are tired at the end of a 1-hour visit and often cannot retain additional information.

What was the poverty guideline for a family of four in mainland United States in 2013? a. Below $23,550 b. Below $25,250 c. Below $28,550 d. Below $32,250

A. below 23,500 A four-person household must make less than $23,550 to be considered under the poverty guideline according to the U.S. Department of Health and Human Services.

Which of the following is a biological explanation for gender differences in health status? a. Influence of hormones b. Different treatment by parents c. Random differences in genetic inheritance d. Social expectations of appropriate gender behavior

A. different tx by parents Random differences are random and do not have a systematic effect. Although parents do indeed treat male and female babies differently, that is an environmental effect, not a biological one. Similarly, social expectations are a sociological explanation, not a biological one. Several biological factors influence sex differences in mortality and morbidity rates, including genetics, effects of sex hormones, and physiological differences. Biological advantages for females may also exist later in life because estrogen protects against heart disease. Some evidence supports the hypothesis that men's higher testosterone levels contribute to men's lower high-density lipoprotein levels.

Which gender has higher morbidity rates with a higher prevalence of chronic diseases that cause disability and limitation of activities? a. Females b. Males c. No difference between genders in chronic health problems d. Prevalence of chronic diseases varies strongly by individuals more than gender.

A. females A chronic condition is a condition that persists for at least 3 months or belongs to a group of conditions classified as chronic regardless of time of onset. In general, women have higher morbidity rates than men. Women are more likely than men to have a higher prevalence of chronic diseases that cause disability and limitation of activities but do not lead to death.

27. What may help the nurse be effective in helping clients change their behavior?

Counseling through the Ask, Advise, Assess, Assist, and Arrange approach Ask, Advise, Assess, Assist, and Arrange is the five A's approach to counseling as seen, for example, in smoking cessation programs.

2. Which of these can be found in both the Health Belief Model and Pender's Health Promotion Model? Select all that apply.

Cues to action Demographics Perceived barriers Perceived benefits A review of the tables will show that only the HBM includes both perceived severity and perceived susceptibility. All other factors are found in both models.

4. Which two groups does critical theoretical perspective say should be held responsible for many of the illnesses of Americans today? Select the best two answers.

All manufacturers of products that increase morbidity and mortality, Any corporation whose processes result in environmental carcinogens Although all the answers could be correct, the two inclusive responses are manufacturers of products that increase morbidity and mortality or whose processes result in environmental carcinogens. Choosing just one industry will not change the overall social recognition of the broader problem.

1. Which factors have a profound, if sometimes unrecognized, impact on one's health? Select all that apply.

Adequate resources to allow easy access to health services, Interpersonal relationships with family and friends, Local, state, and national policies, Physical neighborhood where one works and lives Health is affected by biology. Behaviors, social environment, physical environment, policies, and access to quality health care are all factors that affect health. The number and quality of health care providers is not relevant if one does not have access to them because of lack of insurance or financial resources. Understanding the need for healthy lifestyle choices is important, but knowledge alone is not adequate to change behavior.

10. What must a nurse do to be successful in addition to the typical assessment, diagnosing, and planning directly related to the intervention project?

Advocate for community empowerment throughout the process An essential component is to have a strong level of community involvement. The nurse is responsible for advocating for client empowerment throughout the process. Attention to community involvement and empowerment helps ensure that the outcomes reflect the community's needs and will be accepted.

28. The lack of certain B vitamins can result in pellagra. Where would a nutritional deficiency fit in the agent-host-environment model?

Agent factor Nutritional deficiencies are included under agent factors. Although too much of an agent can cause disease (such as obesity related to diabetes), so can too little of an agent.

13. As Healthy People 2020 suggests, by thinking and acting strategically, what will be the most effective way to improve the health and well-being of American citizens?

Addressing the root causes of health problems The chapter emphasizes the need to go beyond individual lifestyle behaviors to the social, economic, political, and value-laden processes of daily life that affect health.

12. A nurse assessed carefully and created a comprehensive intervention plan including primary, secondary, and tertiary care for individuals and families. What crucial factor might the nurse have overlooked?

Are there adequate resources for such a project? The nurse must validate the practicality of any planned intervention, in other words, determine whether there are adequate resources to implement it.

10. What led to the creation of the Health Belief Model (HBM)?

Attempting to understand why people did not flock to free health care The HBM was created to explain why people did or did not participate in health education programs to prevent or detect disease, even when the programs were free.

3. Of what can the American health care system be especially proud? Select all that apply.

Availability and use of technological advances in equipment and procedures, Laboratory and clinical research The United States leads the world in laboratory and clinical research. The United States also exceeds other industrialized countries in the availability and use of technological advances. We do not rank near the top in length of life or patient care outcomes, although we spend far more on health care than other industrialized nations. We are just beginning to confront the issues of access and rationing.

Which of the following best describes the goals of nursing case management regardless of setting? (Select all that apply.) a. Ensure that all clients have a case manager b. Contain costs and control use of services c. Decrease duplication and fragmentation d. Enhance client's quality of life e. Focus on avoiding hospitalization or institutionalization f. Maintain routine communication channels

B, C, D Case management programs aim to provide a service delivery approach to ensure the following: cost-effective care, alternatives to institutionalization, access to care, coordinated services, and patient's improved functional capacity (Lyon, 1993). Not all clients need case managers if they have adequate financial resources and can navigate the health care system. Although hospitalization can often be avoided, in acute cases hospitalization would be the most appropriate use of resources

Which of the following best describes how eligibility for Medicaid services is determined? (Select all that apply.) a. Anyone over age 65 years who is eligible for Social Security benefits may apply for Medicaid. b. Baseline eligibility is established by the federal government, but states may be more lenient. c. Children in low-income families are eligible for free care. d. Eligibility depends on family size and total family income. e. Federal government establishes eligibility and gives funds to the states in reimbursement for this care. f. State government establishes guidelines for whether to participate and who will be covered.

B, C, D Medicaid provides universal health care coverage for the indigent and children. Eligibility is dependent on the size and income of the family. The federal government sets baseline eligibility requirements. State governments who wish to provide care to more citizens can lower the eligibility requirements. The federal government mandates covered services, but state governments may provide more services.

Which of the following statements best describes what happened to health care providers during the Great Depression? a. The amount of charity care greatly increased. b. Both hospitals and physicians went bankrupt. c. Government funding was legislated to assist those in need. d. Public health greatly expanded to care for those in need.

B. Both hospitals and physicians went bankrupt. With 25% of the population out of work, the number of patients capable of paying their medical bills was reduced. Because public financing was limited, hospitals, physicians, and other providers went bankrupt. Because hospitals and physicians were going bankrupt, there was no way to increase charity care or services for those in need.

Which of the following describe a problem with the U.S. water quality today? (Select all that apply.) a. Companies demand high reimbursement when asked to stop dumping heavy metals into local water sources. b. Many aquifers are contaminated with pesticides and fertilizers. c. More than 45 million Americans drink untreated water. d. Sediment from construction, agriculture, and deforestation is often present. e. Underground water, if contaminated, cannot be cleansed. f. Water-related diseases (cholera, typhoid, dysentery) frequently occur.

B, C, D, E More than 45 million Americans obtain water from private wells, which have no treatment or monitoring guidelines. Water quality problems include dosing reservoirs with chemicals to reduce algae, contaminating aquifers with pesticides and fertilizers, and leaching lead from water pipes. Underground water cannot be cleansed. Companies demand high reimbursement when asked to stop dumping heavy metals into local water sources and the frequent occurrence of water-related diseases (cholera, typhoid, dysentery) are not current problems with the water quality in the United States.

Which of the following best describes the effects of Medicare and Medicaid? (Select all that apply.) a. All persons who were temporarily disabled now receive free care. b. A previously unseen rise in demand for services occurred. c. Many persons previously without access now receive health care. d. Medicare reimbursement rates became the standard for all insurance carriers. e. Indemnity insurance plans were offered. f. Public health education was now financed.

B, C, D, E The enactment of Medicare and Medicaid created an unprecedented demand for services, and many persons without access to health care were now able to receive care using an indemnity insurance plan. Medicare reimbursement rates generally became the standard for all insurance carriers. These plans did not provide services for the temporarily disabled or change financing for public health education.

Which of the following statements best describes a notable change of the Omnibus Budget Reconciliation Act? (Select all that apply.) a. Legislated a funding increase for RN staffing b. Changed from process evaluation to outcome evaluation when evaluating care c. Established guidelines for the use of restraints d. Created health maintenance organizations nationwide e. Added prescription drug benefits for Medicaid recipients f. Required all states to review certificates of need before agencies could expand

B, C, E The Budget Reconciliation Act influenced funding and set up guidelines and regulations about several issues including a move from process to outcome evaluation, use of restraints, and prescription drugs for Medicaid recipients. The Health Maintenance Organization Act of 1973 established health maintenance organizations. The National Health Planning and Resources Act of 1974 required health care facilities to obtain prior approval from the state for expansion in the form of a certificate of need. The Nurse Training Act in 1964 provided funds for nursing school construction and loans and scholarships for full-time study.

Which of the following best describes why home health care has continued to grow until very recently? (Select all that apply.) a. Consumers prefer home care, so they will personally pay for it. b. Demographics—there are more elderly persons in U.S. society. c. Home care does not cost much more than institutional care. d. Insurance companies are encouraging home care. e. Medicare is encouraging home care rather than institutional care. f. Physicians prefer to visit clients in their homes rather than institutions.

B, D, E Home care is less expensive than institutionalized care. Physicians rarely make home visits. Consumers cannot usually afford to personally pay for home care. The rapid growth of the home health market reflects the increasing proportion of people aged 65 years and older; the lower average cost of home health care compared with institutional costs; active insurer support; and Medicare promotion of home health care as an alternative to institutionalization.

Which activities would be a responsibility of local health departments? (Select all that apply.) a. Ensuring quality of nursing education programs b. Determining the safety of residents' wells c. Establishing requirements for professionals to maintain their licensure d. Providing free health screenings e. Providing health education programs on proper nutrition f. Inspecting restaurants

B, D, E, F Local health departments are responsible for the health needs of their constituents. Community health services include surveillance and immunizations, as well as health education programs. Environmental health services on the local level include inspection of food processing plants and restaurants and control of waste, air, and noise and water pollution. Local health departments protect the environment through such activities as inspecting wells and public swimming pools. Ensuring quality of nursing education programs and continuing competence of health professions are both state functions.

Which of the following best describes the new national health goals as seen in Healthy People 2020? (Select all that apply.) a. Achieve a plan for universal basic health care for citizens b. Create social and physical environments that promote good health c. Eliminate health disparities d. Eliminate preventable disease, disability, injury, and premature death e. Achieve health equity f. Promote healthy behaviors at every stage of life

B, D, F Building on previous iterations, the updated 2020 version has four "over-arching goals" for 2020: (1) attain high quality, longer lives free of preventable disease, disability, injury, and premature death; (2) achieve health equity, eliminate disparities, and improve the health of all age groups; (3) create social and physical environments that promote good health for all; and (4) promote quality of life, health development, and health behaviors across all life stages. Achieving a plan for universal basic health care for citizens, eliminating health care disparities, and achieving health equity are not seen as national health goals in Healthy People 2020.

A nurse is unable to be actively involved in attending meetings at the state level. Which of the following actions would be most useful for the nurse? a. Asking students to remain informed regarding proposed legislation b. Communicating, with rationales, her stand on proposed legislation to legislators c. Remaining uninvolved so incorrect information is not inadvertently given d. Writing letters to the local newspaper asking nurses to become involved

B. Communicating, with rationales, her stand on proposed legislation to legislators Grassroots cooperation can influence decisions. A high number of communications from individual constituents via e-mail, telephone, or postal mail have great influence.

Which of the following are factors that have led to the decrease in mortality of some cancers? (Select all that apply.) a. An increase in mortality rate among other cancers b. Early detection through emphasis on routine screening c. Fewer sexual partners with emphasis on monogamy d. An increased awareness of influence of lifestyle choices e. Legislation such as the Clean Air Act f. A decrease in tobacco use and smoking among women

B, D, F The good news is that healthy lifestyle changes and early detection and intervention have contributed to the decrease in mortality rates from some cancers. For example, the death rate for colorectal cancer has been decreasing for the past 15 years because of early detection and treatment (American Cancer Society, 2011). Lung cancer deaths are beginning to show a slight decline that parallels a decreased incidence of smoking by women over the age of 18 years. Certain health choices may reduce an individual's risk of cancer. Women could reduce their risk for cancer by never smoking or by quitting if they already use tobacco products. Eating a nutritious, plant-focused, high-fiber diet, along with adopting a physically active lifestyle and maintaining a healthy body weight protect against both heart disease and many cancers.

Because of county need, a school nurse was transferred from a new suburban school to a large inner-city school in an older low-income neighborhood. Which of the following changes in role should be anticipated by the nurse? (Select all that apply.) a. An increased absentee rate because of infectious diseases b. Cooperating with the school meal program to be sure fruits and vegetables and other healthy choices are included c. Regularly checking each child for visible signs of child abuse d. Emphasizing to parents that their child cannot attend school until immunizations are done e. Need for lead poisoning screening and education f. Screening for head lice several times a year

B, E Because cheap food is often high in portion size and sugar and fat, school may be the only place where children have the opportunity to eat fruits, vegetables, and protein choices. Thus, it will be important to make sure these choices are included in the school lunch program. Because old neighborhoods often have lead pipes and old lead paint, lead screening is crucial in older neighborhoods, particularly low-income neighborhoods where parents have fewer resources and are often in aged housing. Stereotypes such as "only poor people get head lice" abound. Head lice do not respect socioeconomic class, so such screening might be done in any school. Similarly, child abuse occurs among families of all social economic classes. Free immunizations are available, so this is probably not as big a problem as stereotypes about the poor might suggest. Indeed it is usually in wealthier neighborhoods that parents are concerned about mercury poisoning and try to avoid having their children immunized. There is unlikely an increased absentee rate because of infectious disease, as these are not seen at an increased incidence in suburban versus urban neighborhoods.

Which of the following best describes how the Continuum of Care (CoC) concept determines the number of homeless? (Select all that apply.) a. By asking local police departments to visit areas where the homeless hide and report the number of people found there each March b. By conducting a point-in-time (PIT) homeless persons count every other January c. By making an educated guess based on anecdotal data d. By completing a statistical analysis of the Census Bureau data e. By reporting the number of homeless persons who use emergency shelters or transitional housing during the year f. By sending CoC personnel into the community to try to find hidden homeless

B, E CoCs are local systems responsible for providing a range of housing and related services that meet the U.S. Department of Housing and Urban Development guidelines for persons experiencing homelessness. CoCs conduct PIT counts of homeless persons on one night in January of every other year. In addition, CoCs are required to report the number of homeless persons who use emergency shelters or transitional housing throughout each federal fiscal year.

Which of the following statements best describes an unfortunate consequence of using diagnosis-related groups (DRGs) to determine reimbursement? (Select all that apply.) a. Insurance companies had to greatly increase their funding from employers. b. The incentive was to undertreat and underuse health resources. c. Health care providers had to accept losses for each patient treated. d. Health care providers learned to cheat the system. e. Health care providers refused to accept more patients whose reimbursement was based on DRGs. f. High quality of care was no longer assured.

B, F Because costs were contained by both the federal programs and insurance companies, the providers had a strong incentive to undertreat and underuse health resources. The public feared that the quality of care being provided was less to keep costs as low as possible.

Which single action has been most influential in changing men's health behaviors? a. Establishing well-man clinics during evening hours b. Legislative action c. Peer-reviewed journals such as the American Journal of Men's Health d. Running men's health ads during sports events e. The male consumer movement: seen in The National Organization for Changing Men

B, legislative action Health behaviors associated with the greatest change in a positive direction have been those influenced by legislative action (e.g., seat belt use, use of smoke detectors, and drunk driving laws). Well clinics, peer-reviewed journals, and the male consumer movement have not had as much influence on men's health behavior as legislative action.

A nurse completed the health assessment but needed to use the elderly woman's bathroom. The nurse noticed perineal pads under the sink. Which of the following questions would the nurse most likely ask the woman? a. "Can you tell me why you need to have perineal pads?" b. "Do you know how to do Kegel exercises to help control your urine?" c. "Does another woman live with you or visit often?" d. "Why do you have perineal pads? Are you bleeding down there?"

B. "Do you know how to do Kegel exercises to help control your urine?" Because the woman did not mention incontinence, it may be assumed to be very embarrassing. Therefore, the nurse should matter-of-factly address urine control problems by suggesting a self-help intervention of Kegel exercises. It may be assumed that the nurse, having completed a health assessment, would know about bleeding, as well as frequent visitors or family nearby.

Which of the following describes a dimension of the social determinants of health (SDH) defined within Healthy People 2020? a. Employment b. Education c. Gender d. Income

B. Education Five broad dimensions of SDH are defined within Healthy People 2020 as: (a) Economic Stability, (b) Education, (c) Social and Community Context, (d) Health and Health Care, and (e) Neighborhood and Built Environment. Each of these dimensions includes key issues that identify more specific factors (U.S. Department Health and Human Services Healthy People 2020, 2013). Employment, gender, and income are not addressed as dimensions of the social determinants of health within Healthy People 2020.

A mother explained that she had just dropped her 3-year-old off at her own mother's so she could come in for the required examination for her new job. She excitedly shared her hopes that she would be able to afford a used car rather than having to ride a bus all the time. Which of the following would be the most appropriate response by the nurse? a. "I'm sure the exam won't show any problems. I'm so excited for you." b. "Don't forget to buy a child's seat when you get your car." c. "How do you think your child will adapt to you being at work all day?" d. "It's fantastic that you have a new job in this rough economy. Will your mother be able to continue to babysit?"

B. "Don't forget to buy a child's seat when you get your car." Motor vehicle injuries are the leading cause of death for children over the age of 1 year in the United States. Many injuries occur because adults fail to secure children in car seats in the back seat of the vehicle or to insist that older children buckle up. The most important step that a parent can take to ensure a child's safety in a motor vehicle is to correctly secure him or her into a car seat, or seat belt when the child is older, for each ride. Safety of the toddler should be the primary concern for the nurse in this situation. The nurse should focus on the safety of the child in the response. Telling the mother that the exam will not show any problems provides false reassurance to the mother, as problems may be detected. Asking if the woman's mother will continue to babysit or how the child will adapt to the mother being at work are not relevant as this is a required examination for her new job.

"I don't want to listen to another lecture on safe sex. Just give me my antibiotic and let me leave," said a defiant client. Which of the following would be the best response by the nurse? a. "As you wish. But can you tell me why you still engage in unprotected sex?" b. "Gonorrhea is becoming resistant to antibiotics. It's becoming difficult to treat you, and permanent damage to your body is occurring." c. "Our policy requires that we review how to protect yourself even if you have heard the information before." d. "These recurrent infections are damaging you inside; please consider using condoms."

B. "Gonorrhea is becoming resistant to antibiotics. It's becoming difficult to treat you, and permanent damage to your body is occurring." Gonorrhea is becoming resistant to all our current drugs. The Centers for Disease Control and Prevention has had to change its treatment guidelines. Also, persons with gonorrhea often have other sexually transmitted diseases (STDs) as well. This person has heard the lectures on safe sex and is not changing personal behavior. Upholding policy or appealing to the person's better emotions is probably ineffective. Many people have become complacent about STDs. The nurse is obligated to warn the patient that the infections are becoming resistant to pharmaceutical treatment.

A nurse asked a family if they'd work with her to create a family genogram. The mother asked, "Why would you want to know so much about our family?" Which of the following would be the most appropriate response by the nurse? a. "A genogram helps you see how some problems run in families. Your children will need to know this." b. "If you're willing to share, we can discuss family history and possibly some hereditary health issues." c. "Please be assured you don't have to answer any question you don't want to answer." d. "Why would you want to keep your family members secret? Is there some problem?"

B. "If you're willing to share, we can discuss family history and possibly some hereditary health issues." A genogram is an excellent opening to the discussion of family history and possible hereditary health problems. It may also point to a need for health education. Some families may be sensitive to the sharing of such information, but obviously any patient can answer with however much or little he or she wishes to share

The 7-year-old boy's hands were badly burnt; it was suspected that his mother had forced his hands into boiling hot water after she caught him masturbating. The staff did not want the mother to be allowed near the boy. Which of the following statements would be made by the nurse to encourage the staff to interact more objectively with the mother? a. "If we won't let the mom near, who does the child have for support at this painful time?" b. "Most abusers were themselves abused as children and need help to learn how to be a more effective parent." c. "The child may feel responsible; we have to let the mother fix their relationship." d. "We need to encourage the mother to continue parenting him or the boy will become a ward of the state."

B. "Most abusers were themselves abused as children and need help to learn how to be a more effective parent." Most child maltreatment occurs within the family. Risk factors for child maltreatment include but are not limited to special needs children (children with disabilities, mental retardation, or chronic illness), children less than 4 years of age, family history of violence, substance abuse, poverty, and social isolation. Thus, it is most important that the staff provide support to the mother. The purpose of allowing the mother with the child is not for additional support for the child or mother, rather the recognition that the mother may have a history of abuse as well and needs assistance to change the patterns of behavior that have been learned through her own life experience

A nurse came limping into work with a huge cast on her right leg and asked to have an assignment for a week or two that did not require driving. The nurse said, "I never realized how difficult it is to get some places without two good legs. Now I know how persons with disabilities must feel!" Which of the following would be the most appropriate response from the nursing supervisor? a. "I'm sure you'll be even more understanding and supportive now." b. "Not really; you'll be out of that cast in a few weeks." c. "What a great opportunity to attend some support groups for people with disabilities and share with us which ones are most helpful." d. "Why don't you just take some sick leave rather than try to work with that leg cast?"

B. "Not really; you'll be out of that cast in a few weeks." Those who have a temporary disability have a very different experience than those who are permanently disabled. Although they may experience frustrations, they view it as a temporary problem and a temporary setback. The other responses address this temporary disability as if it is similar to a permanent disability, which it clearly is not.

Which of the following questions is crucial to ask very early in a family interview? a. "Do you see any way this problem could have been avoided—so future problems could be prevented?" b. "What do you all, as a family hope to achieve during your time with me?" c. "What would you like me to do for you today?" d. "Would you like to know my perception of what our goals together should be?"

B. "What do you all, as a family hope to achieve during your time with me?" Therapeutic questions are key questions that the nurse uses to facilitate the interview. One important basic theme is to determine the family's expectations of the interview or home visit.

A mother was concerned about her child dying of some childhood disease, because that is how some of her siblings died before her family came to the United States. Which of the following would be the most appropriate response by the nurse? a. "You should see your doctor immediately if you ever think your child is ill." b. "Your child has been immunized, so the biggest danger is from accidents." c. "You have made sure your child has all the right immunizations so you can quit worrying." d. "You're right to be concerned, since susceptibility runs in families."

B. "Your child has been immunized, so the biggest danger is from accidents." Childhood is generally a healthy time of life. The incidence of childhood disease has decreased because the majority of children receive a full complement of immunizations during infancy and toddlerhood. The leading threat to children's health is accidental injury and exposure to environmental toxins, abuse, and violence.

Which of the following best describes what is meant by cohabitation? a. A living arrangement in which one adult is employed and the other is unemployed b. A living arrangement in which an unmarried couple in a long-term relationship lives together c. A living arrangement between two members of the same sex d. A living arrangement between two single mothers with children

B. A living arrangement in which an unmarried couple in a long-term relationship lives together The most comprehensive definition of cohabitation is a living arrangement in which an unmarried couple live together in a long-term relationship that resembles a marriage. One of the key aspects of this definition is the long-term relationship which is not mentioned in the other definitions.

Which of the following best describes why so many Americans continue to engage in unhealthy behaviors? a. Americans are not knowledgeable on how to change their behavior. b. Americans believe that most illnesses can be cured with insurance footing the bill. c. Health is not a concern to most Americans. d. Most Americans do not know which behaviors are unhealthy.

B. Americans believe that most illnesses can be cured with insurance footing the bill. Society sees insurance as an economic shield protecting against all disease and illness. The belief in cure rather than prevention, combined with this financial safety net, encourages society to become a passive participant in health care. The pervasive societal thought is "I don't have to worry; I have insurance." Americans are aware of which behaviors are unhealthy, have knowledge on how to change their behavior, and are concerned about health, but insurance has allowed them to take a passive approach to health.

Which of the following statements best describes how a disaster is the same as or different from an emergency? a. A disaster is personal, whereas an emergency is communitywide. b. An emergency is personal, whereas a disaster is communitywide. c. Both emergencies and disasters are devastating. d. Both emergencies and disasters are failures resulting in extensive insurance claims.

B. An emergency is personal, whereas a disaster is communitywide. A disaster is any event that causes a level of destruction, death, or injury that affects the abilities of the community to respond to the incident using available resources. Emergencies differ from disasters in that the agency, community, family, or individual can manage an emergency using their own resources. However, a disaster event may be beyond the ability of the community to respond to and recover from the incident using its own resources. Disasters frequently require assistance from outside the immediate community. The type of emergency or disaster will determine the level of devastation or need for extensive insurance claims to be filed.

In a particular community, the rate of new cases of diabetes and the rate of new cases of flu during the month of January were precisely the same. Which disease would have the higher prevalence rate? a. As an acute condition, flu would have the higher prevalence rate. b. As a chronic condition, diabetes would have the higher prevalence rate. c. Flu would have the higher prevalence rate because people can get flu several times in one season. d. Flu would have the higher prevalence rate because it is so contagious.

B. As a chronic condition, diabetes would have a higher prevalence rate Diabetes would have the higher prevalence rate because it is a long-term chronic condition that typically does not decrease. Although flu might have a higher incidence rate of new cases, because flu is typically of short duration, the prevalence rate would remain low. Flu is contagious, which could increase the incidence rate but not the prevalence rate.

Which of the following best describes how a community will know whether its disaster plan is adequate? a. After a disaster occurs and reports of deaths and injuries are fairly accurate b. By following practice drills involving various feasible scenarios as an initial step of planning c. When federal experts have reviewed and approved the plan d. When state officials have reviewed and approved the plan

B. By following practice drills involving various feasible scenarios as an initial step of planning For a plan to be effective, it must be tested by having different disaster scenario drills. The more times realistic scenarios are created to test the plan in actual practice sessions, and not just tabletop or paper drills, the more problems with the plan will be identified and solutions for those problems can be found. Without practice drills, plans may have many unrecognized faults and, as a result, many more individuals may be harmed and communities damaged when an actual disaster occurs.

As a nurse and a citizen, what is the nurse's additional responsibility in relation to disasters? a. Assume the nurse will be asked to volunteer to assist the American Red Cross with helping care for disaster victims b. Be aware if there is an unusual increase in the number of people seeking care with similar symptoms c. Expect and plan for the possibility of being called to report to work for additional work efforts in caring for the sick and injured d. Expect to be a role model in preparing for and reacting to a disaster

B. Be aware if there is an unusual increase in the number of people seeking care with similar symptoms As a nurse, one is expected to be informed regarding the Guidelines for Early Detection for Biochemical Terrorist Incidents, including noting if there is a sudden increase in a particular disease, an unusual number of persons seeking care with similar complaints, clusters of patients from a single location, or a person presenting with an uncommon disease.

A nurse is completing a first assessment interview with a family after entering the family's apartment for the first time. Which of the following would be crucial for the nurse to remember? a. Analyze the power relationships before focusing on needed information b. Be on best behavior with manners and courtesy, starting with a self-introduction c. Determine as soon as possible who makes decisions within the family d. Evaluate the safety of the immediate environment for self and the family

B. Be on best behavior with manners and courtesy, starting with a self-introduction Manners are common social behaviors that set the tone for the interview and begin the development of a therapeutic relationship. The nurse introduces himself or herself by name and title and always addresses the client and family members by name (i.e., Mr., Mrs., or Ms., unless otherwise directed by client).

Which of the following best describes why health care institutions are unhappy beyond the fact that they are not receiving the previous high reimbursement for procedures from Medicaid or Medicare? a. Because clients are well informed and know they do not really have to pay their hospital bills b. Because insurance companies and other third-party payers copy Medicaid's approach to holding down costs c. Because it is harder to continue giving charity care when less reimbursement is received from the federal government d. Because recent legislation has required that all reimbursement be based on quality performance measures

B. Because insurance companies and other third-party payers copy Medicaid's approach to holding down costs Although publication of quality measures is occurring, this is gradually being implemented. The Centers for Medicare and Medicaid (CMS) has established a value-based purchasing program for hospitals that was launched in 2013. The program links Medicare payments to quality performance on common, high-cost conditions such as cardiac, surgical, and pneumonia care. Thus, all reimbursement is not being linked to these quality measures. However, whatever the federal government does to hold down costs is usually quickly copied by insurance and other third-party payers.

A school nurse at a high school suggests that all students have an educational unit on newborn care in their required health class. Which of the following provides the best rationale for this suggestion? a. Because all adults should be knowledgeable in basic child care b. Because the first year of life is the most hazardous until old age c. To help convince students not to engage in sexual intercourse d. To demonstrate the incredible responsibilities in parenthood

B. Because the first year of life is the most hazardous until old age The first year of life is the most hazardous until the age of 65 years. Many parents, often out of ignorance, do intentional acts that were not meant to injure or kill the child. Many new parents feel unprepared to care for a newborn and lack knowledge of normal growth and development. Newborn education would not help convince adolescents not to engage in sexual intercourse. Although this education may show the responsibilities associated with parenthood and is important for all adults to have, the purpose of the education is to prevent injuries and accidents among the infant population.

Which of the following best describes why grandparents would be the primary caregivers for their grandchildren? a. Because they fell in love with the newborn and wanted that small person to be a part of their lives b. Because the parents were drug abusers or in the prison system c. Raising a grandchild is easier because grandparents have already been experienced parents d. Raising a child gives purpose to life for the grandparents

B. Because the parents were drug abusers or in the prison system Many older adults are faced with raising their grandchildren, often without the presence of the grandchildren's parents. Reasons include neglect related to parental substance abuse, abandonment, emotional and physical abuse, parental death, mental and physical illness, incarceration, teen pregnancy, and grandparents' assisting adult children who work or attend school.

The local nursing association and the local medical association disagreed vehemently on advanced practice nursing reimbursement. Which of the following best describes why the two groups agreed to join a coalition to send representatives to testify on a particular bill? a. Although there was disagreement, both groups agreed to behave politely and professionally. b. Both associations had formed a coalition to collaborate on a bill that would benefit patients. c. Because the legislators had asked both groups to appear, the groups did not have a choice. d. The two groups were sharing costs and expenses, but their testimony would give opposing viewpoints.

B. Both associations had formed a coalition to collaborate on a bill that would benefit patients. When two or more groups join to maximize resources, increasing their influence and improving their chances of success in achieving a common goal, it is a coalition. Professional groups often form coalitions to advance their shared interests.

A community health nurse determined exactly how many cases of a particular disease were currently occurring in the community. Which of the following actions should the nurse take before determining what interventions should be planned? a. Analyze whether the disease was a priority to the nurse's agency b. Compare the current rate with the previous rate of disease c. Determine what resources are available to intervene d. Share the findings with the public health agency leadership

B. Compare the current rate with the previous rate of disease No conclusions can really be drawn from just knowing a number. Only by converting that count to a rate and then comparing the rate with the previous rate, or with the rate in the broader environment or a similar community nearby, can any conclusions be drawn as to whether there is a problem or intervention needed. Once the rate has been calculated, the nurse will be able to share the findings with leadership, determine the resources available to intervene if necessary, and determine if the disease is a priority.

Which of the following is the most effective way to determine if Healthy People 2020 is improving the health of Americans? a. Availability of relatable data on total population's health problems b. Comprehensive and systematically collected surveillance data on the health status of various population groups c. Increased financing to allow ongoing collation of information d. Willingness of individuals to share health information with the federal government

B. Comprehensive and systematically collected surveillance data on the health status of various population groups Effectiveness of Healthy People 2020 depends on the availability of reliable baseline and continuing data to characterize health problems and evaluate goal achievement. Surveillance is crucial. Without surveillance data, there is no relatable data available. Increased financing will not assist in determining if the health of Americans is improving. Although it is important for individuals to be willing to share health information so that data collection can be completed, individual health information alone will not be an effective determinant of the health of Americans.

Every day a child came into the school nurse's office with vague complaints, but sometimes it seemed to the nurse that the child just wanted to talk and be listened to for a while. Unfortunately, the child took up almost 15 minutes of the nurse's very busy day. Which of the following actions should be taken by the nurse? a. Ask a staff person to talk with the child so the nurse could complete required tasks b. Continue to listen while assessing for possible underlying problems c. Refer the child to a private physician for follow-up on the constant physical symptoms the child presented d. Talk to the teacher about not letting the child leave the classroom unless obvious symptoms (fever, vomiting) of illness were present

B. Continue to listen while assessing for possible underlying problems The nurse or teacher may be the only stable adult in the child's life who will listen without being judgmental. Therefore, one of the most important roles of the school nurse is to act as counselor and confidante. Children may come to the school nurse with various vague complaints, such as recurrent stomachaches, headaches, or sexually promiscuous behavior, and the nurse must look beyond the initial complaint to identify underlying problems.

How does critical theory differ from other nursing theories such as the health belief model or Orem's self-care deficit theory? a. Critical theory can be used by professionals other than nurses. b. Critical theory focuses on oppression and facilitates group action. c. Critical theory is not directly related to health promotion. d. Critical theory confronts changing an individual's beliefs.

B. Critical theory focuses on oppression and facilitates group action. Critical theory is an approach that raises questions about oppressive situations, involves community members in the definition and solution of problems, and facilitates group interventions. The other two theories focus more on individual beliefs and choice of action.

Which of the following statements best describes the significance of the Health Plan Effectiveness Data and Information Set (HEDIS)? a. Data are publicized so consumers can make informed decisions about where to go for care. b. Data are used to measure performance in the accreditation of managed care organizations (MCOs). c. Obvious improvement in the provision of health care has resulted from requiring health care providers to collect and analyze such data. d. Physicians and other health care providers can publicize the data to market their services to new clients.

B. Data are used to measure performance in the accreditation of managed care organizations (MCOs). The National Committee for Quality Assurance accredits MCOs and uses HEDIS to measure performance and consumer satisfaction. Some outcome data are available to informed consumers on the Web, but the data are not widely available. To date, these efforts have not been successful to ensure quality care. Errors continue to be high and patients continue to be dissatisfied.

Which of the following would be one of the first steps in attempting to control a disease? a. Create an appropriate screening test for widespread use b. Define what the disease looks like in confirmed or probable cases c. Determine the disease's portal of entry and portal of exit d. Measure the extent of its spread geographically

B. Define what the disease looks like in confirmed or probable cases Standardized definitions of diseases are necessary for public health monitoring and surveillance across all levels of government. Diseases are defined and classified according to confirmed cases, probable cases, laboratory-confirmed cases, clinically compatible cases, epidemiologically linked cases, genetic typing, and clinical case definition. Once defined, disease occurrence can be compared across time, populations, and geographic areas; and appropriate control efforts can be implemented

Which of the following is one of the most frequent health complaints of school-aged children? a. Anxiety over grades b. Dental caries c. Headaches in response to stress d. Stomachaches

B. Dental caries One of the most frequent complaints of school-aged children is dental caries. Causes include poor oral hygiene, lack of fluoridated water, and lack of funds or insurance for dental care. Half of children aged 12 to 15 years will have dental caries. Approximately 75% of those between the ages of 12 and 19 years have had tooth decay. Dental caries occur as a more frequent complaint than anxiety over grades, headaches in response to stress, and stomachaches

Which of the following federal agencies is responsible for the Women, Infants, and Children (WIC) program, food stamps, and school-based nutrition programs? a. Aid to Dependent Children Department b. Department of Agriculture c. Department of Education d. Department of Health and Human Services

B. Department of Agriculture The Department of Agriculture administers the inspection of meat and milk, and provides funds for the WIC program (supplemental nutrition), the food stamp program, and the school-based nutrition program. The Aid to Dependent Children is a program, not a department, that provided financial assistance to families with limited financial resources. The Department of Education administers and coordinates resources related to education. The Department of Health and Human Services is responsible for protecting the health of all Americans.

An epidemiologist has written a summary of a food poisoning outbreak, including its cause and ways to prevent it from occurring in the future. Which of the following best describes what has been done? a. Analytic epidemiology b. Descriptive epidemiology c. Prospective cohort study d. Retrospective cross-sectional survey

B. Descriptive epidemiology There are two principal types of epidemiology: (1) analytic epidemiology and (2) descriptive epidemiology. Descriptive epidemiology describes the amount and distribution of disease, which may suggest possible causes. These causes can then be confirmed or corrected through more advanced methods of research.

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

B. Discuss respite care and other stress relief measures with the daughter Working with victims of elder abuse, the nurse must establish rapport and trust. The nurse should remember that competent adults have the right to make decisions about their own care, including staying in an abusive situation. The nurse should support the family in examining potential respite care options and support groups for the elderly woman and her caregivers

For which of the following would a screening test be most appropriate? a. Disease A, which must be caught early because society punishes those known to have the disease b. Disease B, which can be controlled if caught early in the disease process c. Disease C, which people need to know whether they have contracted, even though there is no treatment for the disease d. Disease D, because people may want to use that information in family planning

B. Disease B, which can be controlled if caught early in the disease process It is extremely useful to the individuals concerned and society if screening can lead to early diagnosis and successful control of the disease process. There is no point in doing a screening if there is no treatment or if there is a known risk of social stigma and discrimination if it becomes known that the person has the disease. Discussion and disagreement continue as to whether genetic information should be used in family planning.

school nurse is trying to determine health trends when making plans for health programming in the school for the upcoming school year. Which of the following would be the most appropriate action for the nurse to take? a. Conduct a survey in the community b. Do an online search of groups that might collect and analyze such data c. Examine records in the school health office to determine trends d. Interview local health officials regarding problems beginning to occur

B. Do an online search of groups that might collect and analyze such data The federal, state, and local governments and many national organizations collect and analyze data to track the well-being of children and adolescents. For example, the U.S. Department of Health and Human Services (USDHHS) generates a yearly report, Child Health USA, on more than 50 indicators of the well-being of America's children and youth. Such data are readily accessible online. A number of key indicators are tracked on a regular basis by the federal statistical system so that trends are revealed. State and local data also are used to track the well-being of children. The most efficient use of the nurse's time would be to use data that already exists rather than trying to create new data. This could be done by performing an online search for existing data. Once the existing data is collected, the nurse may then need to look specifically at the data at the school or create new data to examine new or existing problems.

Which of the following is the greatest single cause of absenteeism from school and work among young women? a. A child's illness b. Dysmenorrhea c. Mental health disorders d. Upper respiratory tract infection

B. Dysmenorrhea Dysmenorrhea is the greatest single cause of absenteeism from school and work among young women and causes the loss of approximately 140 million working hours annually; therefore the economic influence of this condition is significant. A child's illness, mental health disorders, and upper respiratory tract infections do not cause as many days of absenteeism as dysmenorrhea.

A middle-aged woman was obese and being treated for hypertension; and her blood tests showed elevated triglycerides and low high-density lipoprotein (HDL). Besides recommending physical activity, which of the following nutritional guidance should be provided by the nurse? a. Buy a good diet book, and follow its advice. b. Eat fish and seafood such as salmon, halibut, tuna, and scallops at least three times a week. c. Use olive oil when you cook, especially if you are frying food. d. You have to lose weight, so stop all desserts and eat nothing but salads for 2 weeks.

B. Eat fish and seafood such as salmon, halibut, tuna, and scallops at least three times a week. Metabolic syndrome is a group of risk factors that have been linked to an increased risk of cardiovascular events. These factors include abdominal obesity (waist circumference greater than 35 inches in women), dyslipidemia (elevated triglycerides and low HDL), insulin resistance, and elevated blood pressure. The underlying etiology of metabolic syndrome is related to the combination of inactivity, obesity, and genetics. Nutritional advice should focus on weight loss, use of olive oil (but do not fry foods), and eating fish and seafood such as salmon, halibut, tuna, and scallops at least three times a week to increase omega-3 intake.

On the basis of findings related to elevated blood levels of cholesterol, a researcher wanted to determine whether a new drug would notably lower the blood levels of cholesterol in otherwise healthy persons. Which of the following studies would the researcher most likely use? a. Cross-sectional study b. Experimental study c. Prospective study d. Retrospective study

B. Experimental study Experimental design is used to test treatment and prevention strategies. Subjects are randomly assigned to the experimental group to obtain the new drug while the control group receives a placebo or alternative. The changes in blood cholesterol level would then be measured. A cross-sectional study examines relationships between potential causal factors and disease at a specific time. A prospective study monitors a group of disease-free individuals to determine if and when disease occurs. A retrospective study compares individuals with a particular condition or disease with those who do not have the disease.

A student had been absent 4 days out of the last 3 weeks. When the school nurse asked what was wrong, the student replied, "Headaches" in a rather angry tone. The student had previously been heard to complain that school was boring and it was hard to concentrate on such dumb stuff. Which of the following actions would be most appropriate for the nurse to take next? a. Emphasize the importance of completing school for lifelong success b. Express concern that the student was under a lot of stress and offer to help if possible c. Meet with the student's parents to discuss the headaches and the school absences d. Refer the student to a neurologist for a workup to see what is causing the headaches

B. Express concern that the student was under a lot of stress and offer to help if possible Warning signs of stress include angry or hostile feelings, inability to concentrate, increased boredom, frequent headaches or other ailments, and inconsistent school attendance.

Which of the following conclusions can be drawn concerning efforts to decrease environmental pollution? a. The Environmental Protection Agency (EPA) sets priorities for environmental problems and funds action. b. Federal policies have been weakened, and enforcement lacks funding. c. Federal recycling mandates have decreased waste products. d. Legislation is increasingly being passed to force companies to lower toxic waste emissions.

B. Federal policies have been weakened, and enforcement lacks funding. Legislation in the 1970s was aimed toward a comprehensive national environmental policy. The momentum slowed in the 1980s, with policies being reversed and regulation losing its funding. This trend has continued. The EPA sets rules but lacks resources to accomplish the goals. There are no federal mandates for recycling, but local communities have made great strides in this area.

A woman vows to quit smoking and drinking immediately upon the surprising news that she is 2 months pregnant. Which of the following concerns would the nurse have for this woman? a. Those with whom she shares living quarters might smoke or drink. b. Fetal damage may already have occurred. c. Peers may encourage her to resume old habits, and peer pressure is very strong. d. She won't be able to keep her vow.

B. Fetal damage may already have occurred The fetus can suffer damage very early in pregnancy, even before a woman knows she is pregnant.

"Do you have any advice?" a young woman asked. "I'm eating lunch with my dad but he can't hear and he won't wear his hearing aid." Which of the following suggestions should be made by the nurse? a. Encourage your dad to wear his hearing aid—if only for you b. Find a very quiet place with good lighting and very little background noise for lunch c. Repeat yourself several times using exactly the same words and gestures d. Talk very loudly while facing him directly

B. Find a very quiet place with good lighting and very little background noise for lunch Suggestions include to find a quiet place to talk to help reduce background noise, especially in restaurants and social gatherings; stand in good lighting and use facial expressions or gestures to give clues; face the person and talk clearly; speak a little more loudly than normal, but do not shout; and repeat yourself if necessary, using different words.

Which of the following actions should the home health nurse take to get in touch with a client if the client apparently has no telephone? a. Determine whether the client has family members in the area who might be able to get in touch with the client to ask the client to call the agency b. Go to the client's address and discuss making a home visit with the client c. Send a formal letter asking the client to call the agency for an appointment d. Tell the referral source you cannot accept referrals without usable telephone numbers, so this client was not visited

B. Go to the client's address and discuss making a home visit with the client Not all clients have a telephone. If that is the case, the nurse should check the referral for a telephone number where messages can be left. It is also worthwhile to contact the health care provider who made the referral to see whether the telephone number was omitted unintentionally. If the client does not have a telephone, the nurse may choose to make a drop-in visit. This type of visit consists of an unannounced visit to the client's home, during which the nurse explains the purpose of the referral, receives the client's permission for the visit, and appoints a time for a future visit with the client. The client may agree to the first visit while the nurse is there. It may be very difficult to determine if the client has family members in the area to relay information to the client. Sending a formal letter would not get to the client who needs services in a timely manner.

A city that depended on tourist dollars had feedback that tourists were saying they were never returning because of the constant mosquito bites. Which of the following actions should be taken by the city? a. Do not have any tourist events at dawn or dusk. b. Have everyone in town search for and remove any standing stagnant water. c. Give free bug repellent to each tourist. d. Tell tourists to avoid wearing bright colors.

B. Have everyone in town search for and remove any standing stagnant water. Knowing the reservoirs for infectious agents is important, because, in some cases, transmission can be controlled by eliminating the reservoir, such as eliminating the standing water where mosquitoes breed. The other interventions, not having events at dusk or dawn, providing bug repellent, and wearing bright colors are ways the tourists can cope with the mosquitos that are present, but they do not eliminate the breeding and presence of the mosquitos.

Which of the following best describes a current trend related to health care services? a. Nonprofit organizations are assuming responsibilities for service from for-profit organizations. b. Health care organizations are offering services low in cost and higher in reimbursement. c. Ways to minimize reimbursement using current procedural terminology (CPT) codes have been created. d. Postponing computerized medical record programs increases profitability.

B. Health care organizations are offering services low in cost and higher in reimbursement. There is a national shift from nonprofit health care to for-profit health care as large for-profit organizations take over smaller community organizations. Because emphasis is on profit, mechanisms of achieving higher reimbursement have been developed. Coding of the patient's illness from the CPT codes results in an increase in reimbursement. Use of computerized medical record programs almost ensures that service can be reimbursed at the highest rate possible. This has changed health care practices to the use of services that are low in cost and higher in reimbursement. High-cost services are limited or not offered.

Which of the following aspects of a developed country would be most worthwhile to be copied by a developing country? a. Education of health care professions b. Health care reform policies to improve health care delivery c. Advanced technology with its miracle interventions and cures d. Our approach to rationing health care

B. Health care reform policies to improve health care delivery Although transferring specialized medical technologies from developed to developing countries may not always be appropriate, developing countries are currently learning from health care reform policies and the technological revolution in developed countries. The health care reform policies will improve healthcare delivery and be more helpful than changing the education of health care professionals. There is not a rationing approach to health care services in the United States that could be used by other countries.

Based on theory, which of the following are men most likely to do when they become ill? a. Ask their female partner what action might be helpful b. Ignore symptoms or refuse to see them as symptoms of illness and act tough c. See their physician as soon as possible d. Talk to other men about what would be the best actio

B. Ignore symptoms or refuse to see them as symptoms of illness and act tough Boys are socialized to ignore symptoms and "toughen up." Men may be aware of being ill, but they make a conscious decision not to seek health care to avoid being labeled as "sick." Brown and Bond suggest that men lack somatic awareness and are less likely to interpret symptoms as indicators of illness. Because of this ignorance and lack of recognition that a problem exists, they are not likely to ask others what action to take or to see a physician for the problem.

Which of the following statements best describes how firearm injuries are different in rural areas as compared with urban areas? a. In rural areas, firearm deaths occur more frequently because of purposeful, rather than accidental, shooting. b. In rural areas, firearm injuries occur more frequently in the home. c. In rural areas, firearm injuries occur more frequently during official hunting season, whereas the frequency does not vary in urban areas. d. In rural areas, firearm injuries are more frequently fatal than in urban areas.

B. In rural areas, firearm injuries occur more frequently in the home. In rural counties, nonfatal firearm injuries occur most often at home compared with urban counties, where injuries occur most often in the streets.

One child in a kindergarten room had a slight fever and did not eat lunch. Otherwise, the child seemed OK. Three days later, several children were absent from kindergarten. Which of the following best describes what happened? a. Another nursery school was offering the same child care at a much lower price. b. Infectious diseases can be contagious before any diagnostic symptoms occur. c. No way to tell; there are many reasons why parents keep children home. d. Parents chose to protect their children from the child with a fever, so they kept their children home for a few days.

B. Infectious diseases can be contagious before any diagnostic symptoms occur. Frequently, the communicable period begins before symptoms are present. The communicable period, or communicability, follows latency and begins with shedding of the agent. The incubation period is the time from invasion to the time when disease symptoms first appear. Thus, even if parents kept their children away from the child with the fever, this could possibly be ineffective because their children may have already been exposed before the child exhibited symptoms. It is unlikely that the children suddenly changed schools. Although, there may be many reasons why parents keep their children home from school, in this situation there is a specific reason that can be identified

Which of the following suggestions was made by the Health Professions Education report? a. Expand efforts to increase enrollment in nursing education programs. b. Interdisciplinary teams should use informatics to provide patient-centered care. c. Primary care should be emphasized over education for specialty practice. d. All health professions should be required to communicate and collaborate in patient education.

B. Interdisciplinary teams should use informatics to provide patient-centered care. The Health Professions Education report concluded there were five core competencies—provide patient-centered care, work in interdisciplinary teams, employ evidence-based practice, apply quality improvement, and use informatics. The expansion of enrollment in nursing programs, emphasis in primary care education, and emphasis on patient education were not suggestions made through this report.

Which of the following best describes why a nurse would ask about the meals of all family members, rather than focus on a nutritional history for the post-myocardial infarction patient? a. It is assumed that all family members eat the same food at the same time each day. b. Lifestyle choices among family members are usually consistent. c. Many parents eat whatever their children don't rather than throw away good food, so the nurse should know what the children eat. d. The nurse was afraid to assume that whoever cooked would only prepare one meal for everyone to share.

B. Lifestyle choices among family members are usually consistent. The family remains the focus because families experience similar risk factors (i.e., physiological, behavioral, and environmental). Family health practices influence lifestyle habits among family members. Consequently, although family members may or may not eat together, they will have a tendency to make similar choices.

A nurse was considering self-employment by starting a home health managed care agency. Which of the following risks is the nurse taking, particularly in the beginning? a. Because the nurse is a newcomer, most patient referrals may go to other, more long-term agencies. b. Managed care agencies assume the risk of providing all needed care within the amount budgeted. c. Most clients would not know the nurse and therefore would be unaware of the nurse's agency. d. Other nurses may envy the successful nurse and withdraw their friendship and support.

B. Managed care agencies assume the risk of providing all needed care within the amount budgeted. Managed care agencies contract with payers, such as insurance companies, to provide specified services to the enrolled clients at a predetermined price. Managed care agencies receive payment before offering services and are responsible for taking the financial risk of providing care to patients within the budgeted allotment. The nurse will not need to worry about patient referrals or personally knowing the clients before referral as this home care agency is part of a managed care group that has enrolled clients that need services. Envy from other nurses is not a risk faced by the nurse starting this business endeavor.

A female coach walks into your office and shares that one student concerns her. The student will not change into her gym clothes and does not seem to "move right." Which of the following actions would be most appropriate for the nurse to take next? a. Call the student into your office and discuss the importance of physical education to one's health b. Meet with the student and ask directly about sexual or physical abuse c. Offer to attend the next physical education class and talk to the student d. Point out how female adolescents are very concerned over body image and are usually embarrassed by their own lack of perfection, and suggest the coach be more understanding

B. Meet the student and ask directly about sexual or physical abuse Adolescents being physically or sexually abused may have symptoms that include changes in behavior; difficulty in walking, sitting, or other movements; and refusing to change into gym attire or participate in physical activities. It would not be appropriate to minimize the situation, call the student out in front of the class, or have a conversation about the importance of physical education. Rather, the nurse should address the potential signs and symptoms that have been displayed by this student.

A nurse needed to help a child who was not behaving consistently with the requirements of the new preschool program that began that fall. Which of the following actions would be most appropriate for the nurse to perform? a. Meet with the child each day to let the child have a safe play environment without the regular program frustrations b. Meet with the child's parents to discuss how their parenting may need to change to help improve their child's behavior at school c. Meet with the child's teacher to brainstorm ways to help the child cope with school requirements d. Point out to the child that if behavior doesn't improve, the child won't be able to play with all the other children at the school

B. Meet with the child's parents to discuss how their parenting may need to change to help improve their child's behavior at school The teacher can be assumed to be an expert in dealing with small children. If the problem is defined as a child not behaving within expectations, the most effective approach would be to discuss with the parents how to help the child. Systems theory provides direction in understanding how health care providers can expand family capacity by changing parenting and therefore changing child behaviors.

Which of the following statements best explains why men are sicker on hospital admission than women? a. Men do not have access to care. b. Men do not seek treatment until they are very ill. c. Men have chronic conditions more than women. d. Men have more acute illnesses than women.

B. Men do not seek treatment until they are very ill. Males continue to delay medical treatment, resulting in men being sicker when they do seek health care. Because they are sicker, they require more intensive medical care. The main reason that they are sicker does not relate to the increased or decreased incidence of acute or chronic illness or lack of access to care, the delayed time in seeking treatment is what results in them being sicker at the time of hospital admission.

Which of the following issues exists from communities using solid waste landfills to dispose of trash from private residences? a. Landfills are too wasteful, as solid waste can be burned to produce energy. b. Methane gas may move through the soil to cause fire or explosions nearby. c. There is an ongoing need to purchase more land as landfills eventually fill up. d. People do not use landfills but dump their garbage anywhere they will not be seen.

B. Methane gas may move through the soil to cause fire or explosions nearby. Solid waste landfills accumulate methane gas, a by-product of decomposing organic wastes. Without proper venting, this volatile gas can move through soil and cause fires and explosions in nearby areas. Waste incineration is not the best solution because it causes particulate air pollution. Illegal dumping of garbage and purchasing additional land for more landfills are concerns related to the disposal of trash from private residents, but methane gas explosions is of primary concern.

Which of the following facts is noteworthy about adolescent males who are driving without a license in the countryside? a. Most had driver's education classes but have not yet earned the money to pay for their driver's license test. b. Most were Hispanic or black from a rural area. c. Most were practiced in driving large farm machinery and were just going from one section of the farm to another section. d. Most were practicing their driving skills with their parent in the car

B. Most were Hispanic or black from a rural area Researchers studied the prevalence of unlicensed teenaged drivers compared with licensed drivers and found that they were more likely black or Hispanic and live in rural areas. There is not any research in the text that supports that the other responses are accurate

A nurse is caring for a woman, who has just found out she is pregnant. The woman begins crying and says, "But I'm not trying to get pregnant!" Should this response by the woman be concerning to the nurse? a. No, because women may not consciously be aware of an unconscious desire to be a mother b. No, because about half of all pregnancies in the United States are unintended c. No, because she admitted having unprotected sexual intercourse d. Yes, because pregnancy can usually be avoided by appropriate precautions

B. No, because about half of all pregnancies in the United States are unintended This response should not surprise the nurse because approximately half of pregnancies in the United States are unintended. Thus, it is important that women have good preconception health throughout their reproductive years to help ensure optimal fetal health and development should pregnancy occur.

It has been learned that a particular industry has vastly polluted the surrounding neighborhood. Which of the following actions would most likely be taken by those living in the neighborhood? a. Band together to shut the industry down b. Nothing, because of family ties and cost of relocation c. Immediately move to a different neighborhood d. Seek legal reimbursement for the hazard exposure

B. Nothing, because of family ties and cost of relocation. Residents may be unwilling to disrupt family ties and cultural roots to start over elsewhere, or they may be unable to afford to move. Residents are revictimized by the difficulty in obtaining compensation. Attempting to shut the industry down, seeking reimbursement for the hazard exposure, and immediately moving to a different neighborhood are all costly interventions and in most cases cannot be easily accomplished by most residents.

Which of the following agencies should develop a community disaster plan, have emergency drills to test the plan, and determine the proper response? a. Federal Emergency Management Agency (FEMA) b. Office of Emergency Management c. State Disaster Office d. The National Disaster Relief Agency

B. Office of Emergency Management The local Office of Emergency Management involves representatives from all official and unofficial agencies in developing the community disaster plan; developing scenarios to test the plan through drills; and assessing the scope, intensity, and number of casualties (once an incident has occurred) to initiate the proper response. The mission of the FEMA is to support citizens and first responders to ensure that, as a nation, everyone works together to build, sustain and improve the capacity to prepare for, protect against, respond to, recover from and mitigate all hazards. There is no specific government agency called the State Disaster Office or the National Disaster Relief Agency.

Which of the following best describes what physicians did to compete with new competition from health maintenance organizations (HMOs)? a. Accepted employment directly under the insurance company b. Organized preferred provider organizations (PPOs) to negotiate with insurance companies c. Created private practices with colleagues within hospital medical complexes d. Decided to strike and refused to work in the new HMOs

B. Organized preferred provider organizations (PPOs) to negotiate with insurance companies In an effort to compete with HMOs, physicians and hospitals organized the independent practice model, which provided services to enrollees of one insurance company. This model evolved into the PPO, which offered services at a reduced rate in exchange for a guaranteed increase in consumers. Physicians did not become directly employed by insurance companies, set up private practices with colleagues, or decide to strike in order to compete with the HMOs.

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

B. Provide information regarding safe shelters and sources of support Working with victims of intimate partner violence (IPV) requires the nurse to establish rapport and trust; deal with issues of confidentiality honestly; provide current information regarding shelters and sources of support; and recognize and accept that clients may "choose" to stay in an abusive relationship. Because the nurse wants to establish rapport and trust, it would not be in the best interest of building this relationship if the nurse insist that she go to a safe shelter (rather the nurse should provide her the necessary information) or inform the woman she may be killed (rather the nurse should recognize and accept that the client may "choose" to stay in an abusive relationship). Additionally, the nurse should recognize that even if the assault is reported, it may be denied by the woman and will not result in an arrest of the perpetrator

A nurse suggests to the students that they attend the local district nurses' association meeting, where the nurse is an officer. Which of the following provides the best rationale for this action? a. Meeting outside the clinical area allows for more effective informal learning based on discussion and interaction. b. Role models are typically the major influence on nurses choosing to become politically active. c. Students are often given extra credit from their instructor for such community involvement. d. Such groups want students to attend their meetings to encourage them to join and to accept a committee responsibility.

B. Role models are typically the major influence on nurses choosing to become politically active. Professional groups do not usually accept students into membership (especially since many students may want a different specialty practice). Nurses most often identify positive role models as the major influence that assisted them to become politically active. Therefore, mentorship at the student level up to the expert level is important. Providing extra credit should not be the motivator for students to learn from these role models. The learning that occurs is a formal learning process related to learning more about political advocacy and something that is difficult to demonstrate in a classroom environment.

Which of the following actions should be taken during a biological attack? a. Close doors and windows and turn off all ventilation b. Seek medical attention if you become sick c. Develop a family emergency plan d. Keep a written record of everything that you have eaten

B. Seek medical attention if you become sick During a biological attack one should: move away quickly; wash with soap and water; contact authorities; listen to the media for official instructions; and seek medical attention if you become sick. If a chemical attack were occurring, the first action would be to close doors and windows. In the case of a biological attack, one should move quickly away from the area. A family emergency plan should be developed well in advance of a biological attack. Unless directed by the authorities, it should not be necessary in any type of an attack to keep a written record of everything that is eaten.

A family agreed to bring all the children in to the clinic at one time to begin to catch up on the children's immunizations, but they didn't keep their appointment. Which of the following conclusions by the nurse would be most accurate? a. Obtaining immunizations might have been the nurse's goal, not the family's. b. Some barrier or restraint interfered with the family's ability to come. c. The family had other, more important priorities. d. The nurse didn't adequately emphasize the importance of obtaining immunizations.

B. Some barrier or restraint interfered with the family's ability to come. Families most frequently served by the community health nurse are disadvantaged in that they are unable to buy health care from the private sector. However, constraints to obtaining needed health and social services are well documented and may come from characteristics of health and social services rather than individual family limitations. The nurse should note those constraints that prevent full use of the resource such as hours of service, distance and transportation, availability of interpreters, and criteria for receiving services

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

B. The dad In approximately 65% to 90% of abusive head trauma cases, also known as shaken baby syndrome, the father or the mother's boyfriend is the perpetrator

When making a home visit, a nurse is usually expected to focus attention on the ill family member. But whom would the nurse possibly focus on instead? a. The children who are being affected by the stress of the situation b. The ill family member's primary caregiver c. The spouse of the ill family member d. The neighbors of the family who may be able to help

B. The ill family member's primary caregiver Changes in family patterns, fears, emotional responses, and expectations of individual family members can be assessed in the family interview. Special needs of the primary caretaker (i.e., often the spouse, daughter, or daughter-in-law) must be assessed

Which of the following best explains the purpose of the Outcome and Assessment Information Set (OASIS)? a. To analyze the cost-effectiveness of health agencies b. To evaluate and improve clinical performance quality c. To measure and publicize hospital data on outcomes such as death rates d. To survey patient satisfaction with care received from health agencies

B. To evaluate and improve clinical performance quality OASIS is a data set that measures outcomes of adult home care patients to monitor outcome-based quality improvement. These items are used to monitor outcomes, plan patient care, provide reports on patient characteristics for each agency, and evaluate and improve clinical performance. The use of OASIS is mandatory for all Medicare and Medicaid patients receiving skilled care. The primary purpose of OASIS is not to analyze the cost-effectiveness of health agencies. This data set does not publicize hospital data or survey patient satisfaction of care from the health agencies.

In which of the following circumstances would it be more helpful to use the wheel model of epidemiology than the epidemiological triangle model? a. When factors outside the triangle model are involved b. When there are multiple causes for a chronic disease c. When research has not yet determined the exact cause d. When trying to explain the situation to a lay person

B. When there are multiple causes for a chronic disease The epidemiological triangle model of agent-host-environment is very useful, especially with single-cause infectious diseases. However, with the multiple factors involved in chronic diseases, the wheel model is more useful in analyzing and identifying the multiple variables.

Which of the following problems depends on the responses of other people and therefore cannot be measured? a. Disability b. Handicap c. Impairment d. Injury

B. handicap In comparing these concepts, an impairment affects a human organ on a micro level; disability affects a person on an individual level; and a handicap involves society on a macro level of analysis. Table 21-1 points out that both impairment and disability may be objective and measurable, whereas handicap is neither, because it is an experience related to the responses of other people.

Which of the following actions would improve a man's probability of obtaining health screenings and health-promoting education? a. Being active in organized sports b. Joining the military c. Seeking an andrology specialist physician d. Working for an employer that requires employees to have an annual physical exam

B. joining the military The medical specialty of andrology is considered too narrow. Many private insurance companies will reimburse for illness but not preventive care, such as education or health promotion activities. Men are socialized to view health as a resource that enables the body to work. Therefore good health practices and preventive care are sometimes available in large industries or organized sports (sports medicine). The most complete care is currently offered by the military.

Which of the following groups has the highest poverty rate in the United States? a. Married couples with several children b. Single female heads of household c. Single male heads of household d. Two adults cohabitating when one is unemployed

B. single female heads of household Women heads of households and their children are the poorest aggregate in the United States. This phenomenon is labeled "the feminization of poverty." In 2005, the poverty rate for single female heads of household was 36.9% compared to 17.6% for men. Thus, married and cohabitating adults are not the group that has the highest poverty rate in the United States.

The forces for the proposed bill are roughly as persuasive, powerful, and well financed as the forces against the proposed bill. Which of the following describes the most likely outcome? a. The bill will be debated through a public hearing. b. The bill will fail. c. The bill will pass. d. The bill will remain in the legislature until one side or the other has a majority of votes.

B. the bill will fail It is far easier to defeat a bill than get one passed; therefore, the opposition always has the advantage.

5. What or who determines eligibility for Medicaid to pay for health care? Select all that apply.

Baseline eligibility is established by the federal government, but states may be more lenient. Children in low-income families are eligible for free care. Eligibility depends on family size and total family income. Medicaid provides universal health care coverage for the indigent and children. Eligibility is dependent on the size and income of the family. The federal government sets baseline eligibility requirements. State governments who wish to provide care to more citizens can lower the eligibility requirements. The federal government mandates covered services, but state governments may provide more services.

5. Which suggestions would be helpful for effective teaching? Select all that apply.

Be encouraging and give positive feedback for helpful comments, Review and summarize the key points at periodic intervals Incorporate demonstrations, illustrations, and real-life examples The nurse must determine what the client wants to know, not what the nurse believes the client needs to know. The nurse should not go into excess detail but focus on a few concepts or key points, that is, stick with the essentials; use clear and concise language while avoiding technical terms; encourage participants by use of questions related to their life experiences; use demonstrations and real-life examples to illustrate major points and summarize the key points to help the audience retain the material.

2. Historically, what were among the first measures large communities began to undertake to ensure community health?

Building safe sewage disposal systems In classical times, large cities grew, and elaborate drainage systems were constructed.

Which of the following nurses fought to have American nursing controlled by nurses rather than physicians? a. Clara Barton b. Florence Nightingale c. Lavinia Dock d. Lillian Wald

C Lavinia Dock was a political activist who waged a campaign for legislation to allow nurses to control the nursing profession. Florence Nightingale was the first nurse to exert political pressure on a government. Clara Barton was responsible for organizing relief efforts during the U.S. Civil War. Lillian Wald was the driving force behind the federal government's development of the Children's Bureau in 1912.

A school nurse brought a young boy back into a private office and asked him to remove his shirt. Fresh welts across his back were seen. Which of the following would most likely cause the nurse to be concerned about the parents? (Select all that apply.) a. The child had a tendency to act out frequently and really did "ask for it." b. The parents did not like their own child and had trouble hiding that fact. c. The parents were dealing with a lot of stress and lacked support. d. The parents were themselves abused as children. e. The parents may be substance abusers. f. The parents probably did not have health insurance for the boy.

C, D, E Most often, the perpetrators of maltreatment are parents and victims themselves from a cycle of abuse. The two dominant characteristics of abusive parents include a history of substance abuse and abuse from their own parents. They may be stressed by poverty, illness, or disability, and they may lack social support systems or coping skills. In cases of abuse, it is unlikely that the child "asked for it". Because of a possible past history of abuse or substance abuse, parents may be more likely to abuse their own children, it would not be because they do not like their own child. Not having health insurance for the boy would not play a role in whether he was being abused.

Which of the following actions would public health professionals want to use as primary prevention against widespread community violence? (Select all that apply.) a. Women seen in emergency departments should be asked about abuse b. Courses for prisoners about avoiding violence and resolving conflict c. Classes on parenting and supportive follow-up for new parents d. Courses on anger management and conflict resolution e. Community media campaigns to decrease acceptance of violence f. Home visits to elderly clients should include screening for elder abuse

C, D, E The goal of primary prevention is to stop violence, abuse, or neglect before it occurs. Education plays a major part in primary prevention and may include parenting and family wellness, and anger management or conflict resolution. Professionals should increase their awareness of violence, identification of cases, and provision of early treatment. The nurse can work in or with the community to educate citizens about the problem of violence, potential causes of violence, and available community services. Screening is secondary prevention, and courses for those already known to be violent are tertiary prevention

Which of the following best describes why earthquakes would be more frightening than floods to many people, even though both can cause extensive damage? (Select all that apply.) a. Death rate and scope are higher in earthquakes. b. There is a higher frequency of earthquakes. c. Imminence of earthquakes is unknown. d. It is not possible to prevent an earthquake. e. The intensity of earthquakes is higher. f. The predictability of earthquakes is lower.

C, D, F Death rate, intensity, and frequency depend on location and other factors. Hawaii, for example, has frequent earthquakes with little damage resulting. However, earthquakes cannot be predicted or prevented, whereas flooding can usually be predicted and most communities have taken steps to avoid or at least lessen the damage from floods. The frequency or intensity of earthquakes is not higher than that of flooding

Which of the following advantages do women have in relation to health screenings? (Select all that apply.) a. As the weaker sex, women are expected to be ill and see physicians more often. b. Employers often require health screening of their employees. c. Health care departments focus on maternal and child health. d. Women enjoy socialization during visits to health care providers. e. Women have more health screenings because of the need for birth control or physician visits related to childbearing. f. Women have more leisure time and can more easily see their health care providers.

C, E Maternal and child health is a major focus of many health departments, and there is not a medical or nursing specialty within a health department that routinely exists to specifically address men's health. Routine reproductive health screening has been expanded to include some general screening, such as testing blood pressure and urine and blood for chronic problems. Men do not have routine reproductive health checkups that include screening, which would detect other health problems at an early stage. Women see physicians more often because of the need for physicians related to childbearing, not because they enjoy the socialization with health care providers or have more time to complete these visits. Employers may require health screening of their employees, both male and female. Women enjoy socialization during visits to health care providers.

Which of the following best explains why the Vaccine Adverse Event Reporting System (VAERS) was originally legislated? (Select all that apply.) a. To ensure that data are used to educate health care professionals on proper vaccine administration b. To conduct media campaigns to help convince parents to bring their children in to receive appropriate immunizations c. To determine whether changes should be made in procedures or biological agents d. To illustrate, using actual data, that vaccines are widely given to healthy people with almost no side effects e. To monitor actual and potential vaccine-related problems. To provide assistance to families who experience a vaccine-related injury

C, E No drug is perfectly safe or effective. The VAERS allows for the monitoring of actual and potential vaccine-related problems. Changes are made on the basis of the collected data. For example, whole cell pertussis vaccine was changed to an acellular pertussis vaccine because of adverse side effects. To monitor actual and potential vaccine-related problems, health care providers must report specific postvaccination "adverse events" to the VAERS. The National Vaccine Injury Compensation Program reviews all VAERS reports and provides assistance for individuals and families who experience a vaccine-related injury, including disability and death. The VAERS does not provide education to health care professionals on proper vaccine administration or conduct media campaigns to help convince parents to bring their children in to receive appropriate immunizations. Vaccines can produce a variety of responses, both positive and negative. Thus, side effects can occur in healthy people

Which of the following disorders is experienced at a higher rate by homeless adults when compared with the general population? (Select all that apply.) a. Hepatitis b. Diabetes c. Asthma d. HIV/AIDS e. Hypertension f. Alcoholism

C, E, F Chronic disorders experienced at higher rates than in the general population include hypertension; musculoskeletal disorder; gastrointestinal problems; respiratory problems (asthma, chronic bronchitis, emphysema); neurological disorders, including seizures; and poor dentition. Like physical health problems, serious mental illnesses and minor emotional problems occur more frequently among the homeless population than in the general population. High rates of alcohol and drug use exacerbate the existing acute and chronic physical and mental health problems. The rates of hepatitis, diabetes, and HIV/AIDS are not seen at a higher rate among the homeless adult population

Which of the following would be good rules to use when interacting with a person with disabilities? (Select all that apply.) a. Apologize for slips of the tongue such as saying "Do you see?" to a blind person b. Be friendly to guide dogs, including petting them and offering to get them fresh water c. Notice similarities between yourself and the person with a disability d. Take hold of a blind person's arm to assist them in dangerous situations, such as crossing a busy street e. Volunteer the most recent research findings related to the person's disability f. With someone who is blind, announce who you are and why you are there when you enter the room

C, F Rules include do not offer expert advice or assistance based on what you think the person needs or can do; do not grab the arm of a person who is blind but let the person take your arm so the person does not lose his or her balance; do not pet a working dog; do seek out similarities and shared interests; do inform the person who is present; say goodbye when leaving; and treat the person very much like an able-bodied person.

The new principal stopped the school nurse in the hall and said, "I need to get oriented here. We seem to have a lot of handicapped children. Please make me a copy of their medical records so I can be prepared to meet with the parents if they come in." Which of the following is the most appropriate response by the nurse? a. "I'd be happy to help you get oriented to our students. I'll prepare a summary of our special students' needs and problems for you." b. "I'm so happy to hear of your interest; I'll get those records to you immediately." c. "I'm glad you're interested. Student health records are confidential, but I'll give you a schoolwide overview without any identifying data." d. "Let me check our school board policies regarding sharing of information and get back to you."

C. "I'm glad you're interested. Student health records are confidential, but I'll give you a schoolwide overview without any identifying data." The Family Educational Rights and Privacy Act, a strong privacy protection act, protects student education records, including the health records. Student health records should be afforded the same level of confidentiality as that given to clients and patients in other settings

A community health clinic put a tax levy on the ballot. An angry man asks a nurse, "How can you ask me to pay taxes to buy immunizations for parents who do not want to pay for their kids to get their shots?" Which of the following is the most appropriate response by the nurse? a. "Don't you think ethically we should help if we can?" b. "For many of us, our faith says we have to treat our neighbor as ourselves." c. "Only by getting almost everyone immunized can we prevent epidemics that can hurt us all." d. "The law requires childhood immunizations, and, if parents can't afford it, you and I will have to help pay."

C. "Only by getting almost everyone immunized can we prevent epidemics that can hurt us all." Herd immunity is a state in which those not immune to an infectious agent will be protected if a certain proportion (generally considered to be 80%) of the population has been vaccinated or is otherwise immune. If most persons are immune, it will be difficult for an infectious disease to spread.

A 36-year-old woman had diabetes diagnosed at a free health-screening program at a large employer. Which of the following should be emphasized by the nurse when helping the woman make an appointment at the diabetic clinic for follow-up testing and treatment? a. "Bring a food diary of everything you've eaten for one week with you to the appointment to help with future meal planning." b. "It's really not that hard to learn how to inject insulin, and it really doesn't hurt." c. "Please encourage all your family members, including your parents, to be tested for diabetes as well." d. "They'll teach you how to manage your meals and medications to stay healthy."

C. "Please encourage all your family members, including your parents, to be tested for diabetes as well." Although the nurse might make any of these comments, it is particularly important that the rest of the family also get tested. Any problem that affects one or more family members probably affects other family members and the family as a whole. Commonalities in risk factors and diseases shared by family members can lead to case finding within the family. Because families often choose similar foods and engage in similar lifestyle behaviors, they all are at similar risk for problems such as diabetes. The earlier the diagnosis and treatment, the more likely it is that secondary problems can be avoided.

A mother was very proud that she had cut back smoking from two packs a day, which she had smoked for years, to only half a pack a day. Which of the following would be the most appropriate response by the nurse? a. "I wish all smoking moms could see your example!" b. "I'm so proud of you. You're down to only 25% of what you used to smoke!" c. "That must have been difficult, but you're probably still getting nicotine, so it's important you quit entirely." d. "Your baby will really appreciate your efforts at quitting, especially if you do not resume after the baby is born."

C. "That must have been difficult, but you're probably still getting nicotine, so it's important you quit entirely." Quitting is best. Merely reducing cigarette use during pregnancy may not be enough to benefit the fetus because women who cut back tend to inhale more deeply or take more puffs to get an equivalent amount of nicotine. The nurse's response must be supportive and recognize the mother's efforts but also continue to encourage total quitting.

A nurse has just been told by a friend that her physician has recommended a hysterectomy for fibroids in her womb. Which of the following would be the most appropriate response by the nurse? a. "Hysterectomies are the most common surgical procedure done on women; you'll be fine." b. "Tell your doctor to remove your ovaries as well so you will never have to worry about ovarian cancer." c. "There are other alternatives. Why don't you seek a second opinion just to be sure a hysterectomy is best for you?" d. "Uterine fibroids are very common so don't feel badly; you've already had your children, so there's no reason to keep your uterus."

C. "There are other alternatives. Why don't you seek a second opinion just to be sure a hysterectomy is best for you?" Hysterectomy is the second most frequently performed major surgical procedure among women of reproductive age, after C-section. The most common reason for hysterectomy is uterine fibroids. Optional procedures are becoming available to women. Myomectomy, or removing only the tumors with repair of the uterus, uterine artery ablation, and the use of a gonadotropin-releasing hormone to shrink the tumors can decrease the need for hysterectomy, but women may not know about these alternatives. Community health nurses function as advocates for women and can provide health education programs related to alternatives to hysterectomy, indications for hysterectomy, and oophorectomy, and information regarding the type of surgical approach and the purpose of a second opinion. Second opinions and higher levels of education tend to decrease the rate of hysterectomies. Thus, it is important that the nurse first encourage the friend to seek a second opinion rather than encouraging the procedure or ovary removal.

A hospice patient is taking rather strong narcotics with good pain control, but today the patient's family tells the nurse that the client does not want to become addicted. Which of the following is the best response by the nurse? a. "But you're dying, what difference will it make if you become addicted?" b. "You can try not to take so much so frequently if you are concerned." c. "You may develop tolerance but you can't be addicted when you're using the medication for pain control." d. "You need strong narcotics to control your pain; we want to keep you comfortable." e. "We'll keep you comfortable using some nonnarcotic drugs if that is what you prefer."

C. "You may develop tolerance but you can't be addicted when you're using the medication for pain control." The key to successful pain control for the terminally ill is to convince patients to take their medications on a regular basis. Many patients, especially the elderly, are afraid of becoming "junkies" or "druggies" and want to delay using pain medication until they "get really bad." Many people believe that using these medications signals "the end of the line," and they are amazed to learn that patients do well while receiving this drug for months, even years, before death occurs. Almost every family must learn that addiction is not the same as tolerance and that their physicians will not "cut off their supply if they take too much."

A man stated, "I used to work out at the exercise room at work, but now that I'm retired I sit and watch TV. My wife keeps nagging me to do something. What do you think I should be doing at my age?" Which of the following would be the most appropriate response by the nurse? a. "I think you should try to please your wife. What is it she wants you to do?" b. "It's okay to slow down at your age; why look for problems?" c. "You should try to exercise just as you did before. Is there a YMCA or club nearby?" d. "You've worked all your life; you have a right to rest now."

C. "You should try to exercise just as you did before. Is there a YMCA or club nearby?" The activity theory posits that activity is necessary to maintain life satisfaction and a positive self-concept. Physical activity is beneficial for the health of people of all ages, including older adults. Therefore, because the man has previously been physically active, he should continue to be physically active to maintain satisfaction with his life.

A newspaper published an article stating that the athletic banquet at the local high school had approximately 1000 family members in attendance. Exactly 650 persons became ill within 24 hours, complaining of severe diarrhea, vomiting, and cramping. Which of the following best describes the attack rate? a. 650 persons b. 1000 persons c. 650:1000 d. 6.5%

C. 650:1000 Rates are calculated by the number of people with the problem over the number exposed to the problem. In this case, 650 persons out of the 1000 at the banquet complained of illness. Although this rate could be presented as an attack rate of 65%, 6.5% is incorrect.

Which of the following individuals is most likely to be the victim of violent crime? a. A 10-year-old white female b. A 15-year-old black female c. A 15-year -old black male d. A10-year-old white male

C. A 15-year -old black male Black males are the racial group most likely to be victimized. Violence is more likely to occur with an adolescent than a child.

A nurse is making the first home visit to a recently discharged elderly client. Which of the following should the nurse most likely expect to find? a. A client who is unhappy with the disorganization of the house b. A client who will expect the nurse to do everything now that the nurse is at his or her house c. A client who may well have hearing or vision problems or both d. A client who is upset with being discharged while still so ill and having to take on problems at home

C. A client who may well have hearing or vision problems or both Visual and hearing impairment are among the most common age-related conditions affecting the elderly population. The prevalence of vision impairment in individuals over the age of 65 years is: 17% of individuals 65 to 74 report some form of vision impairment and 26% of individuals over the age of 75 report some form of vision impairment. A study by physicians at Johns Hopkins University in Baltimore, MD, found hearing loss prevalence in patients 70 years and older to be 60%. Thus, the nurse should be anticipating the needs of the client rather than being concerned about the potential factors that the client may be upset about.

Which of the following persons will have the most difficulty in obtaining adequate support services to find a long-term home? a. An alcoholic homeless person b. A homeless person who has a limited support system and is unemployed c. A homeless person who has a mental illness and is an alcoholic d. A mentally ill homeless person

C. A homeless person who has a mental illness and is an alcoholic For a sizable proportion of the homeless, severe mental illness exists along with the problems of alcohol or other types of substance use. Like physical health problems, serious mental illnesses and minor emotional problems occur more frequently among the homeless population than in the general population. High rates of alcohol and drug use exacerbate the existing acute and chronic physical and mental health problems. These coexisting problems can make it harder to assist the homeless person.

A hospital is going to start a care management program. Which of the following groups of clients would most likely be selected to first receive such services? a. Clients who represent the most common diagnosis group to be admitted b. Clients who request such services from their local hospital c. Clients with chronic illnesses d. Clients with the least education

C. Clients with chronic illness The overall goal of care management is to improve the coordination of services provided to clients who are enrolled in a care management program. Examples of groups of people who may be served by care management services include the elderly, children from low-income families who receive Medicaid services, and groups of people with chronic illnesses. The other groups do not represent groups who are typically enrolled in a care management program.

Two brothers played with their cousin. One brother later became quite ill, whereas the other did not. Which of the following provides the best explanation for this occurrence? a. Difference in length of time exposed b. Difference in how actively the children played c. Difference in genetic inheritance between the two brothers d. Difference in lifestyle between the two brothers

C. Difference in genetic inheritance between the two brothers Assuming the two brothers lived in the same household, the environment and the agent or infectious organisms are the same. The only difference could be between the two brothers themselves and their genetic inheritance.

A school nurse is trying to decrease the effects of an incredible health crisis attacking school children. Which of the following actions would be most appropriate for the nurse to take? a. Arrange for booster shots to maximize immunization protection against childhood infectious diseases b. Arrange for swine flu and regular flu shots each year c. Establish recreational programs that encourage physical exercise each day d. For those whose parents give permission, teach adolescents about the need for abstinence or "safe sex"

C. Establish recreational programs that encourage physical exercise each day Childhood obesity has become a health crisis in the United States. Obesity has more than doubled in children and tripled in adolescents over the past 30 years. An estimated one-third of children are overweight or obese. Children who are overweight are more likely to develop cardiovascular disease, diabetes, bone and joint disease, sleep apnea, and face social discrimination which can lead to poor self-esteem and depression. Nurses can design and implement nutrition, healthy eating, and physical activities policies and standards in schools in order to address this health crisis. Immunizing against infectious diseases and the flu and teaching about the need for abstinence or "safe sex" does not address the obesity, which has become a health crisis throughout the United States.

Which of the following types of behaviors would a nurse expect to see when a disaster first strikes a community? a. A sense of all being okay and that one can rebuild and go on b. Anger and despair that help being offered is insufficient, slow, and inadequate c. Everyone trying to help strangers, as well as their neighbors, survive. d. People involved sharing their stories and reliving what occurred.

C. Everyone trying to help strangers, as well as their neighbors, survive. The classic four phases of a community's reaction to a disaster are the heroic phase, honeymoon phase, disillusionment phase, and reconstruction phase. During the heroic phase, nearly everyone feels the need to rush to help people survive the disaster.

Which of the following best describes the importance of discovering all of the variables that may be involved in creating a disease state in some persons? a. People want an explanation of why they are ill. b. Knowing causes helps obtain funds for research to try to create a cure. c. Finding variables that are susceptible to prevention or early intervention is important. d. It is important to educate communities on how to avoid any risk factors.

C. Finding variables that are susceptible to prevention or early intervention is important. Identifying risk factors is critical to creating or discovering specific prevention and intervention approaches that reduce chronic disease morbidity and mortality. Because some risk factors cannot be avoided, knowing other risk factors involved allows for more possibilities of preventing the problem. These variables need to be identified first so that health care providers are able to provide an explanation to persons as to why they are ill, obtain funding for research for the problem, and educate the community about the avoidance of the known risk factors.

Which of the following best describes why all citizens should care about young people joining gangs? a. Gangs are beginning to be seen in suburban areas. b. Gangs are responsible for destroying lives and property in inner cities. c. Gangs commit as much as 90% of all crime in some communities. d. Gangs help give the young person protection, respect, and sense of belonging.

C. Gangs commit as much as 90% of all crime in some communities It is estimated that gangs are responsible for approximately 48% of all crime and up to 90% in some areas. These crimes include illegal alien smuggling, armed robbery, assault, auto theft, drug and weapon trafficking, identity theft, and murder. Gangs exist throughout the country, in urban and suburban areas. Destruction of lives and property is not the major reason why citizens should be concerned with gangs. Although gangs do give young persons protection, respect, and sense of belonging, the major concern would be the amount of crime that is associated with gangs.

Each evening, a newly disabled man becomes angry when his wife, just home from her new full-time job, does not have dinner on the table at 6 PM. Which of the following actions would be most appropriate for the nurse to take? a. Allow the wife to express her frustration and anger to you b. Explain to the husband that he is going to have to begin learning how to cook c. Help all family members recognize that long-time roles are being changed and change is uncomfortable for everyone d. Suggest to the children who are old enough that they prepare some simple meals during the week with the mother doing the fancy cooking only on weekends

C. Help all family members recognize that long-time roles are being changed and change is uncomfortable for everyone Roles refer to established patterns of behavior for a family. It takes other family members to keep a person in a particular role. Traditional roles are being challenged and are evolving with economic changes. Formal roles may come into conflict with roles set by family members. The husband has major life changes to which to adjust, as do all the other family members. His anger is a symptom of the painfulness of major life changes. The nurse can help the family members recognize the problem in preparation for addressing the issues.

Which of the following groups of children is at the highest risk to have poor health? a. African American children living in a suburb b. Asian children living in an outer urban area c. Hispanic children living in the inner city d. White children living in a rural area

C. Hispanic children living in the inner city Significant disparities persist in health status of white children versus children of color. However, children living in suburban areas and most outer urban areas experience superior access to health services compared with children living in rural areas and inner cities, especially if they are poor.

Where is youth violence most likely to occur? a. At home b. At recreational facilities c. In inner city schools d. In fast-food facilities where young adults are employed

C. In inner city schools Youth-related violence is more concentrated in minority communities and inner cities, causing a disproportionate burden on these communities. Children are often not taught peaceful ways of resolving differences and learn by default from what they observe on television and in movies. Consequently, schools have become a common site for

Which of the following statements best describes what tobacco companies have done to counter their losses resulting from U.S. efforts to decrease smoking tobacco? a. Begun advertising in more subtle ways such as sponsoring sports programs or building and naming large sport arenas b. Bought off more restrictions on tobacco through the tobacco settlement funds, which gave a large amount of money to each state c. Increased international exports and targeted children d. Rapidly decreased their tobacco components and focused on other products

C. Increased international exports and targeted children Tobacco control and secondhand smoke policies have been implemented at various political levels in the United States and abroad. To continue their profits, the tobacco industry has targeted youth and dramatically increased international exports. The tobacco industry has not begun to focus on other products, changed to more subtle advertising, or bought off more restrictions on tobacco as ways to counter their losses.

Which of the following statements supports why it is believed that the risks of various employment positions are inaccurate? a. Companies refuse to share employee injury information. b. Because factories reimburse employees directly, the injury is not reported. c. Individuals assume it is a personal problem, not an employment issue. d. Most employment positions do not have known risks.

C. Individuals assume it is a personal problem, not an employment issue. Statistics do not reflect unreported health problems. Collective problems related to employment or occupation are often perceived as individualized injuries, and no one "connects the dots." Companies are willing to share employee injury information and recognize the risks of employment, but the information may be inaccurate because of the perception of individualized injuries.

Which of the following best describes the health care services that are provided by philanthropic groups? a. Direct care to patients with problems related to the group's primary interest area b. Legislative lobbying for increased funding for their special interests c. Informational and research activities d. Special services such as housing, transportation, or appearance aids

C. Informational and research activities Philanthropic funding, whose services are typically research or disease oriented, pays a limited amount of health care. Services are limited to the specific disease or population of interest. Informational and research activities constitute the majority of services provided, although some give direct care or meet ancillary needs such as housing, transportation, or wigs. Legislative lobbying and special services are not the primary health care services provided by philanthropic groups.

What was the importance of the Lalonde Report, which proposed the "health field concept" in 1974? a. It first called attention to the growing problem of air pollution. b. It first emphasized the importance of basic hand washing. c. It first emphasized influence of lifestyle and environment. d. It was the first report that suggested a link between smoking and lung cancer.

C. It first emphasized influence of lifestyle and environment. This report emphasized lifestyle and environment as determinants of health outside the traditional medical sphere. It became the basis for rethinking new paradigms for health care delivery. The report signaled the early beginnings of a health care paradigm shift from the traditional medical model to a more holistic system-environment perspective. The report did not call attention to the problem of air pollution, emphasize the importance of basic hand washing, or suggest a link between smoking and lung cancer.

Which of the following best describes why infant mortality rate is used as an international comparison of a country's health status? a. Every country, regardless of other priorities, focuses on care of infants and their mothers. b. It is easy to obtain and compare such data. c. It reflects medical care quality and access and public health practice. d. The World Health Organization requires these data be reported to them each year.

C. It reflects medical care quality and access and public health practice It is an important marker because it is related to several factors, including maternal health, medical care quality and access, socioeconomic conditions, and public health practices. Infant mortality reflects the health and welfare of an entire community and is used as a broad indicator of health care and health status.

Which of the following statements best describes how the Centers for Disease Control and Prevention (CDC) differs from its many peer agencies? a. It focuses primarily on prevention. b. It is a uniquely American approach to problem resolution. c. It responds to health emergencies. d. It uses years of experience as the basis for its actions.

C. It responds to health emergencies The CDC applies research and findings to improve people's daily lives and responds to health emergencies—something that distinguishes the CDC from many of its peer agencies. Other peer agencies of the CDC also are involved in focusing on primary prevention, using an American approach to problem resolution, and using years of experience as the basis for action.

Which of the following best describes why the numbers of children seen by the school health nurse is increasing? a. Higher expectations for performance by parents and school administrators b. Increasing school enrollments c. Lack of another source of regular health care d. Overcrowding within the community

C. Lack of another source of regular health care Increasing numbers of children are being seen in the school setting because they lack a source of regular medical care.

Which of the following best describes a major difference between women who have always had shelter and women who have been homeless? a. Educational opportunities and attainment b. History of gender relationships (marriages, divorces) c. Level of involvement with physical and/or sexual abuse d. Skills necessary for paid employment

C. Level of involvement with physical and/or sexual abuse In the 1990s, research clearly documented the extraordinary histories of violence, from childhood through adulthood, among women experiencing homelessness. High numbers of homeless women report histories of foster placement as children and exposure to violence as both children and adults. This research has not documented the differences in educational opportunities, gender relationships, and skills necessary for paid employment.

A school nurse was asked to see Lisa, a student in the fourth grade who was rumored to be living in a car with her mother. Which of the following would most likely have caused the teacher to become concerned? a. Lisa is not always respectful of the teacher. b. Lisa has not been doing her homework. c. Lisa may be developmentally delayed. d. Lisa may have behaved in a sexually inappropriate manner.

C. Lisa may be developmentally delayed. Homeless children have higher rates of physical, mental health and behavior, and educational problems than children in the general population. All children are not always respectful and do not always have their homework done and may act out behaviors seen on television.

Which of the following statements best describes what has happened to air quality since the United States outlawed the use of chlorofluorocarbons, halons, and carbon tetrachloride? a. Air quality immediately improved. b. Air quality is slowly improving. c. Little change occurred because these chemicals remain in the atmosphere. d. Nothing has happened because other countries worldwide continue to extensively use these products.

C. Little change occured because these chemicals remain in the atmosphere. These chemicals, which were in widespread use, remain in the atmosphere. Thus, air quality has not improved. This is a global concern and is being addressed worldwide by the World Health Organization.

Who is responsible for ensuring the safety and welfare of communities? a. Federal government b. Federal Emergency Management Agency c. Local government d. State government

C. Local govt The local government is responsible for the safety and welfare of its citizens. Emergencies and disaster incidents are handled at the lowest possible organizational and jurisdictional level.

What is meant by discriminatory land use? a. Backlash against companies that do not protect the environment b. Daily insults to people who live in a particular community c. Locating industrial hazards in low-income communities d. Political recognition that companies support a safe environment

C. Locating industrial hazards in the low-income communities Discriminatory land use ensures that many impoverished and marginalized groups, especially people of color, live in close proximity to industrial contamination. Members of these communities are at risk for illness and injury. The other responses do not correctly define discriminatory land use.

Which of the following statements best describes why the federal government is unable to do whatever politicians currently in power want? a. The citizens would rise up in rebellion if actions were outrageous. b. The lack of funds to implement actions are seen as unreasonable by a majority of voters. c. Only the actions authorized by the Constitution are legitimate. d. The states would rebel and withdraw from the union.

C. Only the actions authorized by the Constitution are legitimate The federal government is a government of limited powers, which means that, for a federal action to be legitimate, it must be authorized. Only those actions that are within the scope of the Constitution, the supreme law of the land, are authorized. Power of the states and citizens is limited under the overall umbrella of the federal government. Funding is also controlled through the powers of the federal government.

When considering the benefits for the recipients, which is more beneficial: Medicaid or private insurance? a. Private insurance, because it is accepted by all providers, whereas Medicaid is not b. Private insurance, because it gives its beneficiaries more benefits than Medicaid gives c. Medicaid, because it includes early and periodic screening, diagnosis, and treatment services d. Medicaid, because it is available for all children

C. Medicaid, because it includes early and periodic screening, diagnosis, and treatment services Through the Early Periodic Screening, Diagnosis, and Treatment program, a child covered by Medicaid can receive a range of health and health-related services beginning in infancy. The program is designed to ensure availability and accessibility of health care resources and to help Medicaid recipients and their parents effectively use these resources. The program's services far exceed those usually covered by private insurance. Private insurance may not be accepted by all providers, as many insurance plans may limit the providers that can be seen under a certain insurance plan. Medicaid is not available for all children, only those from low-income families.

Which of the following best explains why some community health nurses find nursing models inappropriate for use in their clinical practice? a. Models are almost always based on meeting the needs of individuals, not groups. b. Models are too theoretical and not realistic. c. Models, developed for the middle class, do not fit low-income families. d. Models taught in nursing school are not remembered by nurses in practice

C. Models, developed for the middle class, do not fit low-income families. Because many models were developed for the middle class, they may not be useful to community health nurses working with low-income families.

A nurse is employed by the state public health department. Which of the following activities would she most likely complete? a. Set up a flu shot clinic at a neighborhood church b. Lobby for health care reform to cover more preventive services c. Monitor the incidence of influenza in the state d. Serve as a volunteer for a state legislator's campaign

C. Monitor the incidence of influenza in the state One of the state health care functions is assessment of health needs based on statewide data collection. This could be done by monitoring the incidence of influenza in the state. Setting up a flu shot clinic would most likely be done at the local level, while lobbying for health care reform would most likely be done at the federal level. Serving as a volunteer for a campaign may be something a nurse would do, but would not be specifically related to employment by the state public health department.

Why do some researchers believe data regarding health behaviors may be inaccurate in relation to men? a. Men are not socialized to tell the truth when interviewed. b. Men do not know when they are ill. c. Most of the data are collected about and from women. d. Most of the data are collected by women.

C. Most of the data are collected about and from women. Males are less likely than females to participate in the data collection process. Women are often solicited in health surveys to report the health behavior of men. As proxies, they have a tendency to underreport behavior. Men may not want to participate and will make light of health problems. Males may conceal or suppress pain in an effort to appear strong. Men believe that they are telling the truth, as they may be less willing to talk, may not recall health problems, and may lack a health vocabulary. There is nothing to suggest that the data is collected by women and that this causes a problem with inaccuracies.

Which of the following legislation marked the first entry of the federal government into school health? a. The Drug-Free Schools and Community Act b. The Education for the Handicapped Act c. The National School Lunch Program d. The Safe and Drug Free Schools and Communities Act

C. National School Lunch Program The federal government did not get involved with school health until the passage of the National School Lunch Program in 1946. The School Breakfast Program was implemented 30 years later. The Drug-Free Schools and Community Act was implemented in 1986 to fight substance abuse through education and was expanded in 1994 to include violence prevention measures. The Education for the Handicapped Act in 1975 mandated that all children, regardless of disabilities, have access to educational services. The Safe and Drug Free Schools and Communities Act supports programs that focus on prevention of school violence and illegal use of alcohol, tobacco, and drugs

Which of the following best describes a model that demonstrates the progression of disease from prepathogenesis through disease outcome? a. Epidemiological model b. Ecosocial model c. Natural history model d. Wheel model

C. Natural history model The natural history of disease model explains disease from prepathogenesis through resolution of the disease process. The epidemiological model involves the epidemiological triangle: agent, host, and environment. The ecosocial model emphasizes the role of evoloving macro-level socio-environmental factors to understand health and illness. The wheel model subscribes to multiple-causation rather than single-causation disease theory, and is more useful in analyzing complex chronic conditions and identifying factors that are amendable to intervention.

In a nationwide survey, which of the following was identified by school health nurses as the most crucial research priority for their specialty? a. Emergency preparedness b. Health education c. Obesity and nutrition d. Role of the school health nurse

C. Obesity and nutrition Gordon and Barry surveyed 263 school nurses in 2006 to identify what the nurses believed to be the top research priorities for the specialty. The first most crucial response was obesity/nutrition—nutrition and weight-loss counseling programs, eating disorders, obesity in children and teens, and importance of exercise

Which of the following are particularly prevalent in rural areas (more so than in urban areas) of the South? a. Falls and motor vehicle accidents b. Less use of seatbelts and more drinking of alcohol c. Obesity and sedentary lifestyle d. Suicide and homicide

C. Obesity and sedentary lifestyle Rural residents in the southern states are more likely to be obese, smoke more heavily if they do smoke, use smokeless tobacco, and engage in sedentary lifestyles. Rates of motor vehicle accidents and suicide are higher in rural areas, although not necessarily the South. Additionally, there is a decreased use of seatbelts and increased use of alcohol in rural areas; however, the textbook mentions that these rates are higher in the rural West than in the rural South. The rates of falls and homicide are not addressed in the textbook.

A family has recently learned that their child will be permanently disabled. The parents do not deny the disability, but do not fully realize its impact. Which of the following levels of adjustment are the parents experiencing? a. Self-actualization b. Normalization c. Ostrich phase d. Special designation

C. Ostrich phase Ulrich and Bauer (2003) propose that the adjustment to disability experience occurs in four levels as parents gradually become aware of the impact of their child's disability. These levels include: (1) the ostrich phase, where parents do not deny a disability, but do not fully realize its impact; (2) special designation, when parents begin to realize their child has a special need and seek help; (3) normalization, when parents try to make the differences between their child and children without disabilities less apparent, and may actually request a decrease in services; and (4) self-actualization, when parents do not view being different as better or worse, just different, and support their child in learning about his or her disability, along with how to be a self-advocate.

Which of the following is the major assumption of Albrecht's conceptual model? a. Nurses are the only appropriate case managers for home health patients. b. Quality is best measured by using data from assessments, interventions, and outcomes. c. Patient outcomes depend primarily on the education and experience of the nurse. d. The most important outcome measure is the cost-effectiveness of the care given

C. Patient outcomes depend primarily on the education and experience of the nurse. An underlying premise of Albrecht's conceptual model is that professional satisfaction and effective patient outcomes depend on the education and experience of the home health nurse. Within the Albrecht nursing model, the three major elements for measuring the quality of home health care patient outcomes include structural, process, and outcome elements. Although nurses are usually the case managers, Medicare pays for skilled services, including occupational therapy and physical therapy. If nursing is not involved, the skilled professional would be the case manager.

Which of the following led to school nurses moving beyond the role of screening, assessment, intervention, and exclusion of children for communicable diseases? a. A communicable disease outbreak, which led to the requirement that all children be vaccinated against common infectious diseases b. Federal legislation, which required immunizations for communicable diseases c. Political movements such as temperance, which led schools to educate about the effects of alcohol and tobacco d. The need for inspecting schools to identify children who were ill and exclude them until they were no longer infectious

C. Political movements such as temperance, which led schools to educate about the effects of alcohol and tobacco The federal government was not involved in school health because education and health are responsibilities of the state government. The first citywide vaccination program—against smallpox—was in the 1870s before school nurses were first employed in 1902. Other issues beyond treatment for minor problems quickly became part of school nurse school practice. In the early part of the twentieth century, the temperance movement led schools to teach about the effects of alcohol and tobacco

Which of the following best explains why cancer rates increase as people get older? a. Better prevention programs are available for cardiac disease, so cardiac disease rates are decreasing, making cancer rates increase. b. It is harder to screen for cancer than for other fatal diseases, so the rates are increasing because of the inability to detect the cancer at an early stage. c. Poor lifestyle choices, environmental exposures, and increased life expectancy have all caused cancer rates to increase. d. Other causes of death are decreasing, so it appears that cancer rates are increasing.

C. Poor lifestyle choices, environmental exposures, and increased life expectancy have all caused cancer rates to increase. Cancer rates appear to be increasing for a number of reasons, including lifestyle choices (smoking, diet, sun exposure); increasing exposure to environmental carcinogens; and age. There has not been a significant decrease of cardiac disease or other causes of death. Screening programs exist to detect cancers early and more cancers are detected at earlier stages.

A researcher wanted to engage in the best possible research design to obtain reliable information about the possible cause(s) of a disease. Which of the following designs would the researcher choose? a. Cross-sectional study b. Descriptive study c. Prospective study d. Retrospective study

C. Prospective study (longitudinal) The most advantageous research design, because it obtains more reliable information and can more easily establish a stronger temporal relationship between presumed causal factors and their effects, is a longitudinal cohort prospective study. A cross-sectional study examines relationships between potential causal factors and disease at a specific time. A descriptive study focuses on the amount and distribution of health and health problems within a population. A prospective study monitors a group of disease-free individuals to determine if and when disease occurs. A retrospective study compares individuals with a particular condition or disease with those who do not have the disease.

Which of the following best describes a conclusion of the report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care? a. Disparities are found only in particular disease categories. b. Lack of access in some neighborhoods is a primary cause of inequities. c. Provider bias and stereotyping contribute to inequalities. d. Physiological racial and ethnic differences lead to disparities in outcomes.

C. Provider bias and stereotyping contribute to inequalities. The report observed that bias and stereotyping on the part of heath care providers might contribute to differences in care. The report did not address disparities among particular disease categories, lack of access, or physiological racial and ethnic differences.

A health care provider has charged more than a managed care organization (MCO) typically pays for a procedure. Which of the following would most likely be the result? a. Provider may be removed from the MCO's list of approved providers. b. The MCO will re-examine the payment for that procedure. c. Provider would get the typical payment instead of what was charged. d. The MCO would be forced to increase its typical payment for that procedure.

C. Provider would get the typical payment instead of what was charged. MCOs may deny reimbursement to health care providers who exceed the expected costs. Therefore, at least on the first occasion, the most probable result would be that the provider gets the listed payment, not what the provider charged.

5. What was the first government step in trying to stop constantly rising costs?

Payment reimbursement was based on diagnosis and client characteristics rather than on treatment given. The first efforts to control costs were made by the federal government when Medicare hospital reimbursement was based on a prospective payment system. Payment would be based on a classification system that identified costs according to diagnosis and client characteristics.

A case of severe acute respiratory syndrome (SARS) was diagnosed immediately on signs of illness at a tourist site in China. Which of the following actions should be taken to protect the badly needed income from tourist dollars? a. Close the airports and refuse to let the tourists in the area leave b. Begin to immunize everyone in the immediate area with protective vaccine as soon as possible c. Quarantine the ill person and use isolation techniques when providing care d. Screen everyone in the area by requiring a blood and urine sample

C. Quarantine the ill person and use isolation techniques when providing care Quarantine is an enforced isolation or restriction of movement of those who have been exposed to an infectious agent during the incubation period; this is another method of controlling the reservoir. Quarantine was used effectively during the outbreak of SARS in 2003, when some hospitals required that their staff exposed to SARS patients remain at the hospital until proved to be symptom free at the end of the incubation period. Immunization and screening would not protect the population from exposure to this infectious disease. It is likely that others besides tourists could be exposed or infected by this disease, thus, closing airports would be ineffective in controlling the spread of the disease.

The faith community nurse (FCN) finds the faith community's needs overwhelming. Which of the following best describes how the nurse can best meet the community's many needs? a. Discover appropriate resources already existing in the community b. Help the community members meet their own needs independently of the nurse or other assistance c. Recruit, train, and direct volunteers to implement needed programs d. Suggest the faith community recruit more parish nurses to help

C. Recruit, train, and direct volunteers to implement needed programs It would be fantastic if existing resources already in the community could meet the needs of the faith community within which the FCN is working, but that would be extremely unlikely. The role of coordinator of volunteers includes recruiting, training, and directing volunteers to work with the FCN program or health ministry. The nurse may work with other nurses and lay people within the congregation. The FCN program may encompass all programs related to the health of the church community.

Which of the following is a major barrier to a nurse caring for the family as a whole? a. Families often don't want to know what is wrong with their loved one. b. Nurses don't know how to care for families. c. Reimbursement is paid only for services given to an individual. d. The family often isn't available when the nurse is giving care.

C. Reimbursement is paid only for services given to an individual. As a result of the current era of cost containment, constraints on the community health nurse will increase. Reimbursement is almost entirely calculated for services rendered to the individual and thus is a major constraint toward moving toward planning care for the family as a unit.

Which of the following types of maps is crucial to be included in any disaster plan? a. Communication map showing telephone wires and cell phone towers b. Geographic map showing, for example, roads, highways, and train routes c. Resource map showing potential resources in persons and supplies d. Response maps showing sites of first responders, such as fire stations and police stations

C. Resource map showing potential resources in persons and supplies A resource map is a geographic map that outlines the resources that would be available in or near the area affected by a potential disaster (e.g., potential shelter sites, potential medical sources, and location of equipment that might be needed)

A researcher, interested in the onset of early menses, compared the life experiences and history of 1000 14-year-old girls, half of whom had monthly periods and half of whom did not, to determine what variables might be observed. Which of the following would be the most appropriate categorization of this study? a. Cross-sectional study b. Prospective study c. Retrospective study d. True experiment

C. Retrospective study When a study looks at individuals with a particular condition in comparison with those who do not have the disease, based on their exposures to various life situations, it is a retrospective study; that is, the study requires participants to look back at previous experiences. A cross-sectional study examines relationships between potential causal factors and disease at a specific time. A prospective study monitors a group of disease-free individuals to determine if and when disease occurs. A true experiment involves both an experimental group who receives an intervention and a control group who does not receive an intervention.

Which of the following best explains why there are so few hospitals in rural areas? a. Few nurses and physicians enjoy the rural lifestyle. b. Historically, hospitals began in large urban areas and have slowly expanded outward but have not yet reached all rural areas. c. Rural areas have very low population density. d. Rural residents do not trust hospitals, preferring to receive care from neighbors and friends

C. Rural areas have very low population density. Although 75% of U.S. counties are classified as rural, they contain only 20% of the U.S. population. The population density is too low to support a large hospital. There are providers available to serve the population and residents are accepting of health care services, but not as many services are needed because of the lower population density.

Which of the following is the best definition of economics? a. Assets that can be traded for different assets b. Income and outgo of monies c. Science of allocation of resources d. Study of goods, services, talents, and transportation

C. Science of allocation of resources Economics represents the science of allocation of resources. Resources are goods or services. The other definitions do not fully describe economics.

A new school nurse was concerned about being accepted, as the previous nurse had been at the school for more than 20 years. Which of the following would be the best approach for the nurse to take? a. Do the best job possible of revising policies and approaches to reflect current information and trends b. Put all the nurse's credentials (degrees, certifications) in an obvious spot in the health office c. Set up workshops on exercise, nutrition, and weight management and perhaps ongoing blood pressure screenings for school staff d. Spend time with each student, making sure the students all think she is very helpful

C. Set up workshops on exercise, nutrition, and weight management and perhaps ongoing blood pressure screenings for school staff The school nurse can assist the faculty and staff by giving workshops on exercise and nutrition, screening for increased blood pressure, and establishing weight management programs.

Which of the following best describes how Lillian Wald helped encourage the idea of school nurses in the schools? a. She brought political pressure to bear on school boards through her political action movement. b. She persuaded very wealthy women to convince their husbands to fund such positions. c. She demonstrated that school nurses decreased absenteeism by 50%. d. She used volunteer nurses until school boards were persuaded to fund such positions.

C. She demonstrated that school nurses decreased absenteeism by 50% In 1902, New York City hired the first nurses to help inspect children, educate families, and ensure follow-up treatment. Within a few years, the renowned nurse Lillian Wald was able to show that the presence of school nurses could reduce absenteeism by 50%

Which of the following factors are most likely to contribute to homelessness? a. Domestic violence and substance abuse b. Scarcity of support systems and recent job loss c. Shortage of affordable housing and insufficient income d. Substance abuse and serious mental illness

C. Shortage of affordable housing and insufficient income The text addresses three broad factors: (1) shortage of affordable housing, (2) insufficient income, and (3) scarcity of supportive services as societal conditions that contribute to homelessness rather than cause homelessness. Domestic abuse, substance abuse, and serious mental illness are not identified as the broad factor contributing to homelessness.

Which of the following best describes how Migrant Health Centers (MHCs) under the Migrant Health Program are often different from other clinics? a. Care is restricted to those who can document that they are employed in agriculture. b. They are much better funded than typical rural clinics. c. Staff are typically bilingual and bicultural. d. They welcome illegal immigrants to receive care.

C. Staff are typically bilingual and bicultural. The MHCs and the Migrant Health Program provide comprehensive nursing and medical care and support services to migrant and seasonal farm workers and their families from many countries in Latin America and the Caribbean. Bilingual, bicultural health personnel, including lay outreach workers, use culturally appropriate protocols for providing primary care, preventive health care, transportation, dental care, pharmaceuticals, and environmental health. The funding at the MHC may not be any different than other rural clinics. Their primary purpose is not to provide care to illegal immigrants, rather to migrant and seasonal workers.

Which of the following research studies would determine the attributable risk of a sedentary lifestyle in cardiac disease? a. Measuring all cases of cardiac problems in a specific community b. Comparing the number of persons with cardiac disease among athletes with the number among nonathletes in a community c. Subtracting the rate of cardiac disease among athletes from the rate of cardiac disease among nonathletes d. Calculating the relative risk and then subtracting the attack rate to determine the attributable risk

C. Subtracting the rate of cardiac disease among athletes from the rate of cardiac disease among nonathletes Attributable risk is determined by subtracting the rate of disease among nonexposed individuals (such as athletes) from the rate of disease among those exposed (the individuals with a sedentary lifestyle).

A nurse would like to influence an internal private health policy. Which of the following actions should the nurse take? a. Build or join a private entrepreneurial practice to provide lower cost services to underserved groups b. Participate in public discussions regarding quality and managed care c. Support nursing research done that demonstrates positive clinical and economic outcomes d. Write managed care organizations to request that nurses receive reimbursement for health services to clients

C. Support nursing research done that demonstrates positive clinical and economic outcomes Internal nursing action is from within the agency, such as holding an important management position. Nurses can support and use nursing research that demonstrates positive clinical and economic outcomes. Such action also serves to validate the importance of nursing within the health system. External strategies can include participation in discussions regarding aspects of care or seeking employment in entrepreneurial practices.

Although it was uncomfortable, a home health nurse finally learned to discuss finances with the client and family on the very first visit. Visits had to be reimbursed. Now that she is working for a different agency, funding was no longer such a concern. Which of the following offers the best explanation for this change? a. Because the nurse was an unpaid volunteer professional, visits made by that nurse had no cost to the agency. b. Only clients of high socioeconomic class were admitted for care, so the agency was always immediately reimbursed for care rendered. c. Taxpayers fund official (i.e., public) home health agencies for care not reimbursed by third parties. d. The new agency has a large foundation that funds its activities from investment profits.

C. Taxpayers fund official (i.e., public) home health agencies for care not reimbursed by third parties. Taxpayers fund official (i.e., public) home health agencies, but they also receive reimbursement from third-party payers such as Medicare, Medicaid, and private insurance companies. This additional taxpayer funding eliminates the stressor as to who will be paying for the nursing visits for both the client and the home health agency. The nurse is not working as an unpaid professional volunteer for this agency. The clients served by the official agency are not likely of a high socioeconomic class and the agency most likely does not have a large foundation to assist with paying for services that are provided.

Using a public health perspective, which of the following has responsibility for a child's health? a. The child's family b. The businesses in the community c. The entire community d. The school system

C. The entire community Child health is affected by many factors; therefore, the responsibility for improving children's health rests with the entire community. This responsibility begins with parents and includes health care professionals, community groups, businesses, and the public sector. When a child gets older, he or she can be responsible for practicing healthy behaviors and obtaining proper health care.

Which of the following has been determined to be a major variable in transmission of sexually transmitted infections? a. The pathogenesis of the involved agents b. The susceptibility of the host c. The environment in which the hosts live d. The amount of sex education provided in the schools

C. The environment in which the hosts live The researchers concluded that ecosocial or contextual conditions strongly enhance sexually transmitted infection risk by increasing sexual risk behaviors and likelihood of exposure to infection. Thus, the environment has been determined to be a more important variable in sexually transmitted infections than the pathogenesis, susceptibility, and the amount of sex education provided.

The male home health nurse parked his marked car in preparation for visiting the next client when a young female walked over to the car and asked him if he would like to have some fun. Which of the following provides the best explanation for this behavior? a. The girl was skipping school and wanted money for entertainment. b. The male nurse was extremely young and attractive and looked like he had money. c. The girl may have hoped a nurse would give her enough money to eat. d. Young girls often engage in thrilling, if high-risk, behaviors.

C. The girl may have hoped a nurse would give her enough money to eat. Homeless youth experience sexually-transmitted diseases, physical and sexual abuse, skin disorders, anemia, drug and alcohol abuse, and unintentional injuries at higher rates than in the general population. Depression, suicidal ideation, and disorders of behavior, personality, or thought also occur at higher rates among homeless. Family disruption, school failures, prostitution or "survival sex," and involvement with the legal system indicate that homeless social health is severely compromised. Thus, it is most likely that the girl is hoping that the nurse would provide her enough money to eat.

Which of the following best describes the history of the State Child Health Improvement Act (SCHIP) of 1997? a. The law included goals and programs but no funding to achieve them. b. The law received extensive support by both Republicans and Democrats. c. The law was extended, not renewed by the Bush administration, and then renewed by the Obama administration. d. The law was passed by the majority of states but not by the federal government.

C. The law was extended, not renewed by the Bush administration, and then renewed by the Obama administration. The law was extended several times, and then it was not renewed by the Bush administration. In January 2009, the law was renewed again by the Obama administration.

A nurse was a volunteer in a faith community when a police officer asked for specific information related to a member's behavior and mental health. The faith community nurse (FCN) told the police officer, "I'm a part-time volunteer; I'm not paid. Besides, I have client-professional privileges so I can't share information with you." Which of the following will most likely be the outcome of this encounter? a. The Health Insurance Portability and Accountability Act (HIPAA) will require the nurse to maintain confidentiality. b. The matter will be referred to the faith community leader for resolution. c. The nurse is still accountable and has no legal right not to disclose information requested by a legal authority. d. The police officer will have to accept the nurse's refusal to share information.

C. The nurse is still accountable and has no legal right not to disclose information requested by a legal authority. Volunteers in a church are held to the same degree of accountability as are paid employees. Ministers, both ordained and nonordained, may be required to disclose confidential information in court. FCNs, as nonordained ministers, do not have client-professional privilege. Thus, HIPAA does not apply as the information has been requested by a police officer and there is not client-professional privilege involved. The faith community leader is not able to offer a resolution to this problem as client-professional privilege does not exist in this situation. Because there is not client-professional privilege, the police officer does not need to accept the nurse's refusal to share information.

In addition to factual data such as name, address, and diagnosis, which of the following information is crucial to the nurse when a referral is received? a. The amount of reimbursement the agency will receive for a visit b. The family's reaction to the suggestion that a nurse visit in their home c. The purpose of the referral for a home visit d. The patient's agreement with the home visit referral

C. The purpose of the referral for a home visit The nurse prepares for the home visit by reviewing the referral form including the purpose of the visit, the geographic residence of the family, and any other pertinent information.

When trying to determine whether the swine flu outbreak was getting worse, which of the following rates should be carefully observed? a. The crude death rate b. The age-specific death rate c. The swine flu incidence rate d. The swine flu prevalence rate

C. The swine flu incidence rate The incidence rate of new cases would be most useful for detecting short-term acute disease changes, because the swine flu duration is usually relatively short.

Which of the following statements best describes how working on a farm is different from working in a factory? a. Factories have more dangerous dust than farming dust. b. Farm chemicals are more immediately fatal than most industrial chemicals. c. The worksite and the home are the same. d. Workers on farms, unlike those in factories, can bring dangerous substances home on their clothing, which expose their families.

C. The worksite and the home are the same. Farming is unusual because the home and the worksite are the same. Several types of farming activities are associated with higher-than-expected occurrences of acute and chronic respiratory conditions. Individuals with long-term exposure to grain dusts, such as grain elevator workers and dairy workers, have diminished respiratory function and increased frequency of respiratory symptoms. Occupational asthma and more exotic fungal or toxic gas-related conditions occur in higher frequency in agricultural than nonagricultural populations. Exposure risks to children and spouses may be heightened when farmers wear contaminated clothing and boots into the home, but the same can happen in several industries.

Which of the following should be included when the nurse writes a proposed treatment plan for a home health client? a. Outline of specific client goals with measurable outcomes b. Specific nursing interventions to treat identified client problems c. Type of services needed and frequency of visits by each discipline d. Typical nursing care plan information from assessment to evaluation

C. Type of services needed and frequency of visits by each discipline There are differences between the treatment plan and the nursing care plan. The plan of treatment includes the type of home health services received, the projected frequency of visits by each discipline, and the necessary interventions. The nursing care plan addresses specific nursing interventions designed to treat the patient's actual or potential problems and includes identified goals with measurable outcomes.

Which of the following groups of people is most likely to experience homelessness? a. Those who have a supportive family b. Those who have recently become unemployed c. Those who have substance abuse problems d. Those who frequently change jobs

C. Those who have substance abuse problems Some people experiencing homelessness have individual characteristics that, in interaction with the structural conditions of a shortage of affordable housing and insufficient income, perpetuate their homeless conditions. Supportive services for these people are deficient in quality and quantity. Some people need services to work and earn money. They are able to function in the workforce, whereas others need services to maintain their housing status. Included in this latter group are people whose serious chronic mental health and/or substance abuse problems preclude their functioning in the workforce and whose behaviors interfere frequently with their ability to obtain housing stability. People in this group need income assistance and comprehensive and accessible behavioral and physical health care.

Which of the following statements best describes how a family can meet the needs of society? a. By living and existing in the wider community b. By meeting the needs of the individual family members c. Through procreation and socialization d. Through productivity seen in employment positions

C. Through procreation and socialization The family fulfills two important purposes. The first is to meet the needs of society, and the second is to meet the needs of individual family members. The family meets the needs of society through procreation and socialization of family members.

Which of the following best describes when faith communities first began to be involved with health and healing? a. In 1998, when parish nursing was first officially recognized b. In the time of Jesus and similar religious leaders of the early years AD c. Throughout history, faith communities provided basic health care d. When parish nursing began in the Lutheran Church in the 1980s

C. Throughout history, faith communities provided basic health care The majority of the world's populations belong to organized faith communities. All of these religions have traditions and rituals related to health and healing. Throughout history, religious communities have provided care for the indigent and disenfranchised, meeting basic human needs of food and clothing and basic health care. Thus, parish nursing began before time of Jesus. The Old Testament discusses Shalom, or God's desire for health and wholeness for the Earth and its people.

Which of the following best describes what happens when persons who work full-time and receive the typical minimum wage seek an apartment? a. Few clean and decent low-rent apartments exist. b. People do not like to rent to low-income persons. c. To afford housing, they need a job that pays at least three times minimum wage. d. There are not many trailer parks near their employment.

C. To afford housing, they need a job that pays at least three times minimum wage. In many areas of the country, wages needed to afford housing are three to five times higher than the federal minimum wage of $7.25 per hour.

Which of the following statements best describes why nurses should be knowledgeable about health care funding? a. To be able to be an effective employee for insurance companies b. To be knowledgeable when media asks for opinions on some new legislation c. To better serve as patient advocates in policy making for funding that provides appropriate care for the greatest good d. To know how to write nursing notes that reflect higher reimbursement possibilities

C. To better serve as patient advocates in policy making for funding that provides appropriate care for the greatest good Increasing knowledge of health care funding and policy making will empower nurses to advocate for the type of funding that provides appropriate care to obtain the greatest good. Nurses need to use their political power. Nurses must advocate for health promotion disease prevention funding. Although these skills are helpful when working for insurance companies, talking to the media, and writing nurses notes, the primary reason why nurses need this knowledge is to engage in the role as a patient advocate.

Which of the following best describes why clinical areas are so careful to ensure sanitization of surfaces and equipment between each patient? a. To avoid direct patient-to-patient transmission of infection b. To provide a clean environment for clients and staff c. To decrease transmission by fomites d. To decrease transmission by vectors

C. To decrease transmission of fomites Indirect transmission is the spread of infection through a vehicle of transmission outside the host. These may be contaminated fomites or vectors. Fomites can be any inanimate object, material, or substance that acts as a transport agent for a microbe (e.g., water, a telephone, or a contaminated tissue).

Which of the following best explains why all family members should want their aged relatives to have a living will? a. To confirm that the attorney is serving as guardian and family members do not have to be responsible b. To fulfill the federal Patient Self-Determination Act requirements c. To help family members know what their loved one does or does not want if he or she becomes incapacitated d. To keep physicians from writing a do-not-resuscitate order

C. To help family members know what their loved one does or does not want if he or she becomes incapacitated Living wills are legal documents whose purpose is to allow individuals to specify what type of medical treatment they would or would not want if they became incapacitated or had an irreversible terminal illness. Living wills can direct physicians to withhold life-sustaining procedures and can assist family members in making decisions when they are unable to consult a comatose or medically incompetent relative. The purpose of a living will is not to appoint an attorney as a guardian. The Patient Self-Determination Act requires health care facilities that receive Medicare and Medicaid funds to ask patients on admission if they possess an advance directive; it does not require that patients complete one.

Which of the following best describes the purpose of the Vulnerability Index? a. To identify those most at risk of becoming homeless b. To determine the underlying cause of homelessness among vulnerable populations c. To identify and prioritize the need for housing among the homeless d. To determine what resources should be provided for vulnerable populations

C. To identify and prioritize the need for housing among the homeless Homeless service providers, concerned about the high risk for mortality among "street" homeless population constructed the Vulnerability Index, a screening tool for identifying and prioritizing the need for housing.

24. How might all the changes resulting from attempts to control costs be summarized?

Conflict between providers, patients, employer, and insurance plans raged. All these changes resulted in conflicts among providers, patients, employers, and the insurance plans, particularly when services deemed necessary by the consumer and provider were denied insurance coverage. Everyone blamed everyone else.

Which of the following questions would be a good opening to address health concerns with a male client? a. "How do you know when you are ill?" b. "What sort of health problems or illnesses do you have?" c. "What are your usual physical activities?" d. "What would your wife say about your health?"

C. What are your usual physical activities? The text suggests to ask a man about how he spends his leisure time, what he is doing to take care of himself, and what his usual physical activities are. Thus, asking about his physical activities would be the most appropriate question. Asking how he knows when he is ill, the sorts of illnesses he experiences, or what his wife says about his health would not be a good opening to the conversation.

Which of the following is the most useful way to discuss aging? a. By divisions—young-old, middle-old, old-old, and elite-old b. Chronological age c. Functional age d. Number of chronic comorbidities

C. functional age Functional age refers to functioning and the ability to perform activities of daily living, such as bathing and grooming, and instrumental activities of daily living, such as cooking and shopping. This definition of aging is a better measure of age than chronological age. After all, most older adults are more concerned with their functional ability than their chronological age. Assisting older adults to remain independent and functional is a major focus of nursing care.

A female client develops a fungal vaginal infection after being treated with antibiotics for strep throat. Which of the following components of the epidemiological triangle is primarily responsible? a. Agent b. Environment c. Host d. Interaction of agent and environment

C. host Infectious diseases are the result of interaction among the human host, an infectious agent, and the environment, which surrounds the human host and where transmission is occurring. This interaction is pictured in the epidemiological triad of agent, host, and environment also discussed in Chapter 5. The antibiotic therapy eliminated a specific pathological agent, but it also may alter the balance of normally occurring organisms in the woman's body, which caused a change in the vaginal environment, allowing normally present fungi to proliferate, resulting in a yeast infection

A family will most likely lose their primary nighttime residence within the next week. Which of the following terms best describes their situation in relation to homelessness? a. Homeless under other federal statutes b. Literally homeless c. Imminent risk of homelessness d. Fleeing/attempting to flee domestic violence (DV)

C. imminent risk of homelessness The U.S. Department of Housing and Urban Development has issued regulations that summarized the statutory definitions in four descriptive categories. These four categories with their respective definitions include: Literally homeless: Individuals and families who lack a fixed, regular, and adequate nighttime residence, including a subset for individuals who resided in an emergency shelter or a place not meant for human habitation and who are exiting an institution where he or she temporarily resided; Imminent risk of homeless: Individuals and families who will imminently lose their primary nighttime residence; Homeless under other federal statutes: Unaccompanied youth and families with children and youth who are defined as homeless under other federal statutes who do not otherwise qualify as homeless under this definition; and Fleeing/attempting to flee DV: Individuals and families who are fleeing, or are attempting to flee, DV, dating violence, sexual assault, stalking, or other dangerous or life-threatening conditions that relate to violence against the individual or a family member.

2. What did Florence Nightingale suggest is one of the most fundamental nursing principles?

Constantly engage in health teaching. Although Nightingale would probably agree with each of the listed suggestions, she emphasized that health teaching is one of the most fundamental nursing principles.

Which of the following best describes how the government controls conditions that individuals cannot? a. Appeals to the common sense and good nature of the citizens b. Establishes social mores that enable groups to control individuals' behaviors c. Passes and enforces law d. Uses fear reinforced by police power

C. passes and enforces laws Government regulates conditions that individuals cannot control and provides individual protection through a population-wide focus. These tasks are accomplished through passage and enforcement of laws. These laws control individuals' behaviors, which may lead to the establishment of social mores and common sense related to the laws that have been established.

Which of the following groups is especially at risk for sexually transmitted diseases (STDs)? a. Recently divorced adults b. Single young women between 19 and 24 years of age c. Teenaged girls d. Young males between the ages of 15 and 19 years

C. teenage girls Teenaged girls in particular may be more susceptible to STDs because they have fewer protective antibodies to STDs and a cervix that is biologically immature. Of the estimated 20 million cases of STDs occurring each year in the United States, almost half of them are in persons aged 15 to 24 years. Women are at higher risk for contracting STDs than men because they have anatomical differences that enhance transmission of disease and make diagnosis difficult. The population of recently divorced adults does not address the increased incidence seen among females and the young adult/adolescent population

The president was sent a bill that he did not really like, but he would have been unpopular if he vetoed it, so he did nothing. Which of the following best describes what will happen to the bill? a. The bill is dead. b. The bill returns to both houses to see if enough votes can be obtained to pass the bill even without the president signing the bill. c. The bill becomes law. d. The bill sits there until the president signs it or vetoes it.

C. the bill becomes a law A bill that has been passed by the legislature goes to the president. The president may sign it so it becomes law; however, if he neither signs nor vetoes it, the bill becomes law by default.

3. In what way(s) would a nurse, who uses the critical theoretical perspective in practice, respond when a patient suggests that the physician should prescribe a widely advertised medication for tension and anxiety? Select all that apply.

Can you tell me what is going on in your life right now?, What have you tried in the past to relieve tension and anxiety? The best answer is to ask what is going on the client's life at that moment because situational stresses often occur to everyone. Next, asking what previously has been effective in relieving the symptoms may suggest more appropriate actions than medication. Although generics would be less expensive than brand-name medication, medication should not be the first approach to resolving a symptom before even examining why the symptom is occurring.

20. A nurse who works on the surgical unit at the local hospital was asked by the home health unit to make a home visit to a patient who had been discharged the previous day and to give follow-up care (for overload pay). What kind of nursing would this nurse be doing?

Community-based nursing The nurse is caring for a patient in the home. Community-based nursing is nursing somewhere in the community. As the nurse is not focusing on the health of the community but on an individual, it is not community or public health nursing. It is not acute care hospital nursing because the nurse is seeing the patient in his or her home.

21. Healthy People 2020 establishes goals for improving the health of all Americans. What is most necessary to determine whether Americans' health is improving?

Comprehensive and systematically collected surveillance data on the health status of various population groups Effectiveness of Healthy People 2020 depends on the availability of reliable baseline and continuing data to characterize health problems and evaluate goal achievement. Surveillance is crucial.

Which of the following are the responsibilities of the Centers for Disease Control and Prevention (CDC) in relation to disasters? (Select all that apply.) a. Contacting family members with up-to-date information regarding victims and their condition b. Coordinating local services to prevent duplication and fragmentation c. Delivering first aid and arranging for prescription medications that were lost to be replaced d. Detecting disease outbreaks, their cause, and risk factors, and implementing interventions for control e. Ensuring that drinking water, food, shelter, and medical care are available to victims f. Setting up safe and comfortable disaster shelters (emergency housing) for families

D, E After the rescue of survivors has been accomplished, the Department of Health and Human Services (HHS), the CDC—which is responsible to the HHS—steps in to ensure that clean drinking water, food, shelter, and medical care are available for those affected. Preparedness includes vigilance and reporting of suspicious illnesses (e.g., signs and symptoms of biological agents, food-borne diseases, and communicable diseases) in the community by physicians and nurses in local health care facilities or private offices and clinics. Public health officials then have the responsibility of detecting outbreaks, determining the cause of illness, identifying the risk factors for the population, implementing interventions to control the outbreak, and informing the public of the health risks and preventive measures that need to be taken. Many of the other choices are actually services offered by the American Red Cross

Which of the following were among the outcomes of the 1979 report Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention? (Select all that apply.) a. A national committee was established to have hearings and study the problem further. b. Increased funds were allocated for health planning and health care. c. Many of the recommendations were adopted on the federal level. d. The Health Objectives Planning Act of 1990 was passed. e. The federal government began to identify and monitor national health care goals. f. The president addressed the American people about the need for health care reform.

D, E The federal government began to take a direct approach in identifying and monitoring national health care goals after the Surgeon General's report. The Healthy Objectives Planning Act of 1990 was passed. Healthy People 2000, Healthy People 2010, and Healthy People 2020 are continuing the efforts. The establishment of a national committee, increased funding for health planning and health care, adoption of recommendations at the federal level, and the need for health care reform were not outcomes of the 1979 report.

Which of the following interventions would be appropriate for a faith community nurse who bases care on the CIRCLE Model of Spiritual Care? (Select all that apply.) a. Giving a mini sermon based on the specific client problem b. Listening and showing respect without any actual intervention c. Suggesting to the client what would be an appropriate response to the situation d. Showing love and empathy toward the client and the situation e. Calling the client by name during the conversation f. Allowing time for prayer during the client interaction

D, E, F Faith community nurses should avoid giving sermons or preaching religion to clients. Listening without any intervention is not possible, because listening in and of itself can be therapeutic. Clients retain their autonomy so nurses can give information but cannot suggest to clients what their decision should be. Appropriate emotional interventions include working with feelings, showing love, and using appropriate touch and empathy. Calling a patient by name is part of showing caring during the interaction. Intuition includes allowing time for prayer and sacrament and supports and encourages religious activities

Which of the following best explains why a community health nurse would choose to emphasize women's health? (Select all that apply.) a. Different nurses prefer different specialties. b. It is currently politically correct to verbalize support for female issues. c. Many women's groups are lobbying for more programs. d. Many factors resulting in illness and death in women are preventable. e. Knowledge deficits prevent women from assuming responsibility for their own health. f. Women face barriers in accessing health care.

D, E, F Many factors that lead to death and illness among women are preventable or avoidable. Knowledge deficits related to health promotion and disease prevention activities prevent women of all educational and socioeconomic levels from assuming responsibility for their own health and well-being. A significant number of women and their families face tremendous barriers in gaining access to health care. Although different nurses select different specialties, this does not explain why a nurse would choose women's health. Because women face tremendous barriers in addressing female issues, it is important that nurses provide political support for these issues because of their professional commitment, not because it is the politically correct action to take.

A parent at a school says to the school nurse, "I can't keep that plate thing straight. What is the bottom line about nutritious eating today?" Which of the following is the most appropriate response by the nurse? a. "Avoid processed foods, and eat fresh fruits and vegetables." b. "Eat lots of protein, fruits, and vegetables, and don't worry about the other rules." c. "Let me get you a copy of the Department of Agriculture plate that you can keep on your refrigerator for easy reference." d. "Balance your plate with half of a plate of fruits and vegetables, and a quarter of a plate of both proteins and grains."

D. "Balance your plate with half of a plate of fruits and vegetables, and a quarter of a plate of both proteins and grains." The "My Plate" approach encourages persons to be mindful of the foods they eat in terms of both portion size and proportion to other foods. One half of the plate should consist of fruits and vegetables, one quarter each for meats/proteins and grains, preferably whole grains. Recommendations also include decreased sodium and sugary foods. Thus, there are additional considerations to keep in mind in addition to avoiding processed foods and eating fresh fruits and vegetables. Giving the parent a copy of the plate does not help educate the parent about the "My Plate" approach.

A nurse states that he or she does not want to become involved in politics because of family, school, work, and other commitments. Which of the following would be the best reply to this statement? a. "Good for you. We should all stay out of such dirty game playing!" b. "I am sorry to hear that but I do understand." c. "It doesn't matter; politics have nothing to do with nursing practice." d. "It won't take much time to join ANA and pay dues so their lobbyist can represent you."

D. "It won't take much time to join ANA and pay dues so their lobbyist can represent you." Some of the nursing organizations have full-time lobbyists who work in Congress, including the American Nurses Association (ANA). These lobbyists help represent the interests of nurses and society. Politics play a major role in nursing practice and nurses should be encouraged to participate in organizations, even if it is through paying dues, so that their voice can be represented.

A woman confides in the nurse that she and her husband want to become parents as soon as possible. Which of the following statements would be the best reply from the nurse? a. "Ask some young parents if you can babysit for a while to get in practice." b. "Can you afford to become parents with all the items a baby will need?" c. "Consider whether you are really ready to become parents." d. "Start living as healthy a lifestyle as possible right now."

D. "Start living as health a lifestyle as possible right now." Adopting a healthy lifestyle and obtaining regular medical care before becoming pregnant can help to ensure a healthy pregnancy. Questioning the woman's statement would not be a therapeutic response from the nurse, rather the nurse should reply by providing support and education for the woman.

A son explained to the home health nurse that since his mother died, his father did not seem to have any interest in life and had even told his son he was considering suicide. Which of the following would be the most appropriate response by the nurse? a. "If he really wants to kill himself, he will, and there really isn't anything you can do to stop him." b. "If you talk to him about it, you're strengthening the idea." c. "People who talk about suicide rarely do it, so don't worry." d. "Suicide is a serious concern; let's talk to his doctor about what you've noticed."

D. "Suicide is a serious concern; let's talk to his doctor about what you've noticed." Suicide is a serious health concern related to the elderly, who account for 18% of all suicides. Elder suicide is associated with depression, chronic illness, physical impairment, unrelieved pain, financial stress, loss and grief, social isolation, and alcoholism. Warning signs to watch for in the elderly are loss of interest in things or activities that are usually found enjoyable; cutting back from social interactions, self-care, and grooming activities; not following medical regimens (e.g., going off diets, not taking prescriptions); experiencing or expecting a significant personal loss (e.g., death of spouse or friend); feeling hopeless or worthless; putting affairs in order; giving things away; making changes in will; and stockpiling medications or obtaining other lethal means for committing suicide. The most significant warning sign is any expression of intent. Because the father is at high risk for suicide, the son must discuss the problem with the father's physician so that care can be obtained.

A nurse is explaining why migrant farmworkers experience cultural barriers when trying to receive care. Which of the following would the nurse include in this explanation? a. "As illegal immigrants, they are not eligible for tax-paid health care." b. "Families who travel in isolation seeking agricultural work do not mix with their employers or other members of the community." c. "Mexicans who speak primarily Spanish and cannot understand English." d. "Usually perceived as outsiders, they are from many countries and cultures."

D. "Usually perceived as outsiders, they are from many countries and cultures." Cultural, linguistic, economic, and mobility barriers all contribute to the nature and magnitude of health problems observed in farmworkers. Cultural and linguistic barriers are the most overt because many of the communities where farmworkers work consider them outsiders. A common misconception among U.S. health care providers is that these farmworkers are from Mexico, with Spanish as their primary language. Farmworkers originate from many communities in Mexico, the Caribbean, and Central and South America, and they may speak English, the language of their home country, or several languages

A mother says to the nurse, "I know I should be feeling an empty nest sadness now that our youngest has left for college—but mainly I'm dying to turn his room into my craft room. Do you think that's normal for a mom? I really do love my kids." Which of the following would be the most appropriate response by the nurse? a. "Hmm, that is unusual. Would you like me to make an appointment with a psychologist for you?" b. "Maybe you've always wanted to be an artist and now you can, so enjoy the feeling—and the room!" c. "You're probably trying to put a positive spin on the situation to keep feelings of sadness at bay." d. "Very normal; you've launched your family and now you can devote attention to your own life and preferences—such as crafts." e. "Would you like to talk about how you feel?"

D. "Very normal; you've launched your family and now you can devote attention to your own life and preferences—such as crafts." To assess the family, the community health nurse must comprehend developmental phases and the struggles that families experience while going through them. The mother is recognizing the stage of launching family that occurs when the youngest child leaves home. The development requirement of this stage of life includes establishment of independent identities for parents—such as focusing on becoming a crafts person.

A nurse is explaining case management to a client. Which of the following statements would be the most appropriate for the nurse to make? a. "We assess, plan, facilitate, and advocate to save money as much as possible." b. "We coordinate your care so you obtain needed services without incurring undue costs." c. "We seek the lowest cost provider to give you what care is necessary." d. "We collaborate with you to coordinate your care for the best outcome."

D. "We collaborate with you to coordinate your care for the best outcome." There is no single definition of case management. But it is a collaborative process to meet an individual's health needs through communication and available resources to promote quality cost-effective outcomes. The response "with you" shows a collaborative approach to coordinating care for the best outcome.

"I want to get pregnant as soon as possible now that I'm married," a 43-year-old female says to the nurse. Which of the following would be the most appropriate response by the nurse? a. "Having a child will certainly cement your new marriage and give it a focus." b. "It's understandable that your 'biological clock is ticking' and time is running out." c. "You're right, once you hit menopause you won't be able to have a child." d. "We will help you, but you need to know that there are more risks for you at your age."

D. "We will help you, but you need to know that there are more risks for you at your age." An additional risk factor, regardless of race, is advancing age. Women aged 40 years and older have over three times the risk of dying of a pregnancy-related cause as women aged 30 to 39 years. Intrinsic maternal factors, such as increasing frequency of hypertension and a greater likelihood of uterine hemorrhage, help explain this increase in the mortality rate. The other responses are not therapeutic responses by the nurse. It is important for the nurse to educate the woman that there can be more risks associated with becoming pregnant after age 40

A young man rolled his wheelchair up the ramp into the clinic to the desk where the intake nurse greeted him. After welcoming him to the clinic, which of the following should be the initial question asked by the nurse? a. "Are you a vet home from the war?" b. "Can I help you into the treatment room to see the nurse practitioner?" c. "Do you have any family with you to help today?" d. "What brings you to the clinic today?"

D. "What brings you to the clinic today?" The client should be asked what is needed just as any other client would be. A veteran would more probably be at a Veterans Affairs (VA) clinic, and there is nothing in the statement to imply that the clinic is part of the VA medical system. Because the man made it into the clinic, it is doubtful he would need help into the treatment room. Not all persons live with families. The handicap may be unrelated to why he is at the clinic. He may be ill or merely need immunization or other health promotion activity.

The nurse has started to complete a family health tree. Which of the following questions would be most helpful as the nurse works with the family to promote their health? a. "Can you tell me the cause of death of your older relatives back several generations?" b. "Do you know of any chronic health problems any of your relatives or their spouses have had?" c. "What concerns do you have about your family's health?" d. "What do your family members do to keep in shape and handle stress?"

D. "What do your family members do to keep in shape and handle stress?" The family health tree is based on the genogram of the current generations—that is, parents, their children, and their own parents. Spouses and past generations aren't included. The family health tree provides a mechanism for recording the family's medical and health histories. The nurse should note causes of death of deceased family members, genetically linked diseases, and lifestyle-related risk factors (i.e., by asking what family members do to "handle stress" and "keep in shape"). The family health tree can be used in planning positive familial influences on risk factors such as diet, exercise, coping with stress, or pressure to have a physical examination

A man had been in an extended-care facility for five weeks and was now home. His wife tells the nurse, "He's trying to take up where he left off but we've adapted to not having him home. He keeps thinking things will be just as they were when he left, but they aren't." Which of the following would be the most appropriate response by the nurse? a. "Are the changes making him uncomfortable or are the rest of you uncomfortable?" b. "Do you want me to talk to him and try to explain?" c. "How can we make things as they were before he left?" d. "You all adapted to running the house without him; it will be challenging now to adapt back."

D. "You all adapted to running the house without him; it will be challenging now to adapt back." Family functional assessment, or how family members behave toward one another, is divided into two categories. The first is instrumental functioning, which refers to routine activities of daily living. This area takes on important meaning for the family when one member of the family becomes ill or disabled and changes were made. When the family member is better, the family must again adapt to changes, even if the change is to return to the original mode of functioning. It will help the family to be able to recognize the problem; labeling it makes it more manageable.

Which of the following best describes why hate crimes involving violence are often considered worse than other crimes involving violence? a. Because hate crimes cannot be avoided because one cannot change one's race or religious or sexual orientation b. Because hate crimes often are committed by groups rather than individuals c. Because more damage is typically done in a hate crime than in a typical assault and battery d. Because the crime is personal, attacking the victim's identity

D. Because the crime is personal, attacking the victim's identity Hate crimes are crimes based on an individual's race, sexual orientation, religious beliefs, ethnic background, or national origin. Hate crimes may include rape, sexual or physical assault, harassment, attacks on homes or on places of worship, and vandalism. Because hate crimes attack an individual's identity, the emotional effects are compounded.

Which of the following 66-year-old clients who needs skilled nursing care would be eligible for home health care reimbursement by Medicare? a. A client who always worked for the state and enjoys going to the neighborhood coffee shop on a daily basis b. A client who needs his wounds cared for every day, including weekends, and needs the nurse to visit at 8 AM every day c. A client who is a loner and has no one to assist him except for the home care agency d. A client who is homebound and has a very strong support system e. A client who is an illegal immigrant who has lived in the United States for 25 years but begged the nurse not to tell

D. A client who is homebound and has a very strong support system Medicare pays for short-term, skilled health care on a part-time or intermittent-care basis for persons aged 65 years or older who are eligible under Title XVIII of the Social Security Act. If family and caregiver support is available in the home to care for the patient between nurse visits, the patient is eligible.

Which of the following best describes what happened after the Medicare Modernization Act of 2003 was enacted? a. Additional restrictions in coverage were imposed. b. Experimental treatments were approved for reimbursement. c. Reimbursement procedures became more efficient. d. A prescription drug benefit was added.

D. A prescription drug benefit was added. The Medicare Modernization Act of 2003 provides seniors and people living with disabilities with some prescription drug benefit coverage, as well as more choices and better benefits. The act did not impose additional restrictions to coverage, approve experimental treatments, or provide efficiency with reimbursement procedures.

Which of the following individuals would be described as being "doubled up"? a. An individual who has two chronic conditions b. An individual who has recently been released from prison c. An individual who maintains two jobs to avoid being homeless d. An individual who is forced to live with friends

D. An individual who is forced to live with friends An individual may be considered to be homeless if that person is "doubled up," a term that refers to a situation where individuals are unable to maintain their housing situation and are forced to stay with a series of friends and/or extended family members. The other responses do not accurately describe being "doubled up"

Which of the following best describes the typical perpetrator of homicide? a. A person trying to engage in rape with the woman fighting back b. A person who wanted money and she refused to give it to him c. A stranger d. An intimate partner

D. An intimate partner Over 50% of the victims were killed by someone they knew. Notably 37% of female murder victims are killed by an intimate partner. Thus, the typical perpetrator would be an intimate partner. It would be less likely to be a stranger, someone who wanted money, or someone trying to engage in rap

Which of the following best describes how the faith community nurse, as a health educator, decides which educational programs to offer the faith community? a. Based on feedback from the local public health department nursing professionals b. Based on what will help implement the Healthy People 2020 goals c. Based on what is consistent with the health laws of scripture or holy books d. Based on the health status and needs of faith community members

D. Based on the health status and needs of faith community members Although any response could be the basis of a program, the program should address the needs of the local faith community. Educational efforts are planned on the basis of the church community's priorities consistent with Healthy People 2020 objectives. Because the faith community membership includes people across the life span, church-based educational programs can address all 10 major health indicators. Early in the development of a parish nurse program, and periodically thereafter, the parish nurse should assess the health status and needs of the congregation members to determine educational priorities

Which of the following best describes the documentation that the nurse should expect to complete during the home visit? a. Creation of a carefully laid out nursing care plan for future visits b. Documentation of assessment data and care given demonstrating the nurse's effectiveness c. Necessary documentation will depend on the agency policies and forms d. Completed Medicare forms per the Health Care Financing Administration (HCFA) regulations for reimbursement

D. Completed Medicare forms per the Health Care Financing Administration (HCFA) regulations for reimbursement Home health nurses often identify documentation as a frustration. Medicare holds a prominent position as a home health care payer; therefore, the HCFA's regulations determine the home health industry's documentation. Correct and accurate completion of required Medicare forms is the key to reimbursement. The forms require documentation of the nurse's care given.

An individual has been terminated from his job and has lost his health insurance. Which of the following federal laws allows him to continue his insurance benefits for a specified period of time? a. Health Insurance Portability and Accountability Act of 1996 (HIPAA) b. Family Support Act of 1988 c. Health Maintenance Organization Act of 1973 (HMO) d. Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)

D. Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) An important requirement of COBRA focuses on the problem of the loss of insurance when a person loses his or her job. With the growing number of unemployed, COBRA is even more important. Employers who terminate an employee must continue benefits for the employee and dependents for a specified period of time if the employee had health benefits before the termination. HIPPA offers protections for patient privacy and confidentiality. The Family Support Act expanded coverage for poor women and children and required states to extend Medicaid coverage for 12 months to families who have increased earnings but are no longer receiving cash assistance. The HMO Act provides grants for HMO development.

A school had tried very hard to uphold the requirement for all children to be vaccinated. However, state law allowed parents to exempt their child if they had a religious reason for refusal. Two children have been diagnosed with chickenpox. Which of the following will be the most likely result? a. Adults as well as children in the neighborhood will get chickenpox. b. All the children who played with the two sick children will probably get chickenpox. c. All the unimmunized children will probably come down with chickenpox. d. Few children will get chickenpox because of herd immunity.

D. Few children will get chickenpox because of herd immunity. Herd immunity is a state in which those not immune to an infectious agent will be protected if a certain proportion (generally considered to be 80%) of the population has been vaccinated or is otherwise immune. Because most children in the school are immune, it will be difficult for the chickenpox to spread

Which of the following actions should be taken by a small community group who hopes to accomplish goals against a large powerful corporation? a. Appeal to the chief executive officer's conscience b. Ask the corporation's employees to encourage change c. Begin legal action to force the corporation to change d. Form coalitions with other groups that have similar goals

D. Form coalitions with other groups that have similar goals. Brainstorm about all possible groups that might have a stake in the outcome of the issue. Nurses can help make connections with larger, more powerful organizations.

Which of the following reports state that nurses should practice to the full extent of their education and training? a. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care b. Keeping Patients Safe: Transforming the Work Environment c. Priority Areas for National Action d. The Future of Nursing

D. Future of Nursing The Future of Nursing report contains four key messages. One of the key messages is that nurses should practice to the full extent of their education and training. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care addresses potential causes of disparities in health care. Keeping Patients Safe: Transforming the Work Environment addresses critical quality and safety issues with a particular focus on nursing care and nurses, and examines these issues from the perspective of the work environment. Priority Areas for National Action identified 19 priority areas that should be addressed to improve quality.

A wife explained to the nurse that her husband was becoming awfully forgetful, and now he's started getting lost on the way home from the golf club. She's scared he may be getting Alzheimer's disease. Which of the following would be most appropriate action for the nurse to take? a. Ask the husband to explain why he thinks he got lost coming home b. Explain that all elderly persons get a little forgetful and not to worry c. Ask the husband to count backwards by 7 from 100 d. Hand the husband pencil and paper and ask him to draw a clock

D. Hand the husband pencil and paper and ask him to draw a clock Clients with Alzheimer's disease are unable to draw a normal clock. As a test for Alzheimer's disease, clock drawing had a sensitivity of 86.7% and a specificity of 92.7%. The clock drawing test is an easily administered, low-cost screening tool, which is useful. This should be the first action taken by the nurse to screen the client for Alzheimer's disease and take appropriate action as necessary.

Which of the following nursing actions would be the most helpful to the community's long-term health? a. Careful assessment, diagnosis, planning, and giving care to individual patients and their families b. Dialogue with community members concerning what health issues are of importance in that community c. Focusing on family health through school-based neighborhood clinics d. Helping the community create political change through organization, use of media, legislative lobbying, and mass demonstrations

D. Helping the community create political change through organization, use of media, legislative lobbying, and mass demonstrations The ultimate goal is liberating people from health-damaging environmental conditions by using collective actions. Mechanisms have included strategic organization, litigation, public hearing testimony, letter-writing campaigns, legislative lobbying, and mass demonstrations. Helping the community create political change through organization, use of media, legislative lobbying, and mass demonstrations shows how collective action can be applied. The other interventions do not demonstrate the use of collective action.

A nurse shared information with a family concerning a community resource, including a brochure with telephone number. The family agreed to follow up. Which of the following demonstrates to the nurse that the family wants to use those resources? a. If the agency calls the nurse to share that they will be offering services to the family b. If the family always agrees with the nurse's suggestions c. If the family asks the nurse to please call and set up the service d. If the family calls and sets up the service

D. If the family calls and sets up the service Under the Health Insurance Portability and Accountability Act, it is doubtful any agency would suddenly call to share such information with the nurse. If the family always agrees with the nurse's suggestion, it may be cultural rather than actual interest in the suggestion. Although the family may prefer the nurse do all the work of calling and setting up services, they may do so simply because they are not really that interested and they can always cancel later. However, if the family calls and sets up the service, it demonstrates commitment to the plan to use those resources.

Which of the following statements best explains how infectious diseases are different from any other health problem? a. Infectious diseases are easier to treat by using pharmaceuticals. b. Infectious diseases are more prevalent now than in the past. c. Infectious diseases are acute illnesses that catch clients unprepared. d. Infectious diseases have the potential to spread, creating a community emergency.

D. Infectious diseases have the potential to spread, creating a community emergency. Because of their potential to spread and cause communitywide or worldwide emergencies, infectious diseases require organized, public efforts for their prevention and control. Most human diseases (e.g., cancer or diabetes) can be classified as personal health problems. Individuals with a personal health problem can be treated by the health care system one person at a time. By contrast, infectious diseases are categorized as public or community health problems

Which of the following best describes the Tuskegee Syphilis Study? a. It provided excellence in research design. b. It used an extensive subject base leading to confirmed conclusions. c. It developed information about the causes and treatment of syphilis. d. It implemented unethical and racist treatment of uninformed subjects.

D. It implemented unethical and racist treatment of uninformed subjects As treatment was knowingly withheld over many years resulting in incredible harm to the subjects and their families, public outrage over unethical, racist, and discriminatory behavior of the researchers continues today.

Which of the following statements best describes how the American Red Cross (ARC) is different from the Federal Emergency Management Agency (FEMA) or the National Incident Management System? a. Funding includes only voluntary contributions. b. It emphasizes being prepared for emergencies, not just reacting to them. c. It has only volunteers as staff. d. It is a nongovernmental volunteer agency.

D. It is a nongovernmental volunteer agency. The ARC is not a governmental agency. The ARC, however, is chartered by Congress to provide disaster relief. It works in partnership with FEMA, the Department of Health and Human Services, the Centers for Disease Control and Prevention, and other federal agencies to provide and manage needed services. The ARC receives federal money as well as voluntary contributions. The ARC has both paid and volunteer staff. All of these agencies focus on preparation for disasters (not emergencies) as well as reacting after they occur

A male client reports that he is unable to change his health behaviors and adopt a healthier lifestyle. Which of the following is the most likely reason for his difficulty? a. Lack of financial resources b. Lack of transportation c. Lack of programs d. Lack of motivation

D. Lack of motivation Two nurse researchers (Dallas & Neville, 2012), conducted a study to describe the health education and health screening practices of older men living in an area of New Zealand and the perceived barriers and benefits of healthy lifestyle choices. Of those men who did report barriers, the most common reason was lack of motivation (12%), followed by lack of knowledge related to availability of programs and screenings (8%). Reported external barriers included: lack of programs, associated costs, and transportation challenges.

Which of the following best describes a major problem faced by the U. S. health care system? a. Inadequate number of licensed professional caregivers b. Lack of sufficient clinics to serve all communities and neighborhoods c. Ongoing increase in infections, such as nosocomial infections d. Large number of underinsured and uninsured citizens

D. Large number of underinsured and uninsured citizens Although the health care reform legislation of 2010 should significantly reduce the number of uninsured individuals, it is estimated that following full implementation in 2017, there will still be about 13 million people without any health care coverage and many with inadequate coverage. Thus, universal health coverage remains an important question. Considering there will still be a large number of underinsured and uninsured citizens, the consideration of an inadequate number of providers or clinics may not be an issue if citizens are unable to access care. The lack of health insurance is a greater concern at this time than the increase of infections among Americans.

Which of the following was the result of the passage of the American Recovery and Reinvestment Act of 2009? a. A few employers accepted the extra funds and employed more people with disabilities (PWDs). b. Large numbers of employers accepted the extra funds and employed more PWDs. c. Employers still refused to employ PWDs. d. Little change has occurred.

D. Little change has occurred. Employers willing to hire PWDs may receive monies provided through the American Recovery and Reinvestment Act (2009). However, little improvement in employment levels has been seen.

Which of the following statements is correct? a. Males are more likely to have colorectal testing than females. b. Males are more likely to receive dental care than females. c. Males are more likely to have routine physicals than females. d. Males are more likely to be eligible for primary care services than females

D. Males are more likely to be eligible for primary care services than females Men do not engage in these health protective behaviors at the same frequency as females (Brown and Bond, 2008). Most men do not have routine checkups. National health surveys indicate that women overall are more likely than men to have visits to various healthcare providers (NCHS, 2011). Men are twice as likely to report no usual source of care although eligibility for primary care in males exceeds that for females (Lynch, 2008). Men tend to have fewer dental health care visits (56.2) versus women (58.9) (NCHS, 2011, p. 319). Additionally, men have lower rates of use of colorectal testing and procedures (men, 54.7, women, 55.1).

Which of the following strategies should a nurse use to remember what should be included in a health history? a. Always use a preprinted form b. Depend on education to learn this c. Depend on experience to know what to ask d. Memorize the I PREPARE mnemonic e. Memorize the I HEALTH mnemonic

D. Memorize the I PREPARE mnemoic The I PREPARE environmental exposure history mnemonic is a quick reference for primary care providers. I—Investigate Potential Exposures P—Present Work R—Residence E—Environmental Concerns P—Past Work A—Activities R—Referrals and Resources E—Educate This tool will help the nurse remember what to ask to determine environmental factors relevant to health.

How does participatory action research differ from other research methods? a. Participatory action research does not use a control group. b. Participatory action research does not require randomization. c. Participatory action research is not based on a predetermined hypothesis. d. Participatory action research poses solutions to the problem.

D. Participatory action research poses solutions to the problem Participatory action research calls for nurses, community members, and other resource people to work together in identifying health problems, designing the studies, collecting and analyzing the data, disseminating the results, and posing solutions to the problems. The research process (use of control groups, randomization, and using a predetermined hypothesis) is part of participatory action research.

During an outbreak in the hospital, all staff members were given immunoglobulin if they were not already immune to the disease. Which of the following types of immunity will the staff who received the immunoglobulin have? a. Active immunity b. Long-lasting immunity c. Natural immunity d. Passive immunity

D. Passive immunity Passive immunity is the temporary resistance that has been donated to the host through transfusions of plasma proteins, immunoglobulins, or antitoxins, or transplacentally from mother to neonate. Passive immunity lasts only as long as these substances remain in the bloodstream. Active immunity is when the body produces its own antibodies against an antigen, from either infection with the pathogen or introduction of the pathogen in a vaccine

Which of the following has been confirmed by research regarding the relationship between religion, spirituality, and health? a. Essentially, religion gives persons a sense of hope. b. Faith communities help by praying for ill persons during services. c. Healthy persons have a tendency to be active within their faith communities. d. Persons who attend services have decreased anxiety, depression, and stress.

D. Persons who attend services have decreased anxiety, depression, and stress. Individuals who reported intrinsic religion (internalized or regularly practiced) and regular attendance at a religious service reported decreased stress. In 147 studies, it was found that there was an inverse relationship between religiosity and depression. The authors found evidence in another 49 studies that indicated people who practiced religious coping had lower levels of anxiety, depression, and stress and coped more positively with many chronic diseases.

Which of the following problems was the Ticket to Work and Work Incentives Improvement Act (TWWIIA) designed to address? a. Employers trying to avoid hiring persons with disabilities b. Employers resenting being forced to hire persons with disabilities c. Persons with disabilities not being able to receive on-the-job training d. Persons with disabilities not seeking employment for fear of losing their health care and other governmental supports

D. Persons with disabilities not seeking employment for fear of losing their health care and other governmental supports Typically, people with disabilities could qualify for such benefits as health care, income assistance programs, and personal care attendant services only if they chose not to work. To address employment and benefit issues for persons with disabilities, in December 1999, the TWWIIA was signed into law. The TWWIIA reduced people with disabilities' disincentives to work by increasing access to vocational services and provided new methods for retaining health insurance after returning to work.

Which of the following best describes a flaw of indemnity plans? a. Blue Cross and Blue Shield had a great idea, but they went bankrupt. b. Cost sharing was expected of Blue Cross and Blue Shield enrollees. c. Enrollees could not choose their provider or manage their own care. d. Plans lacked any incentives to contain costs.

D. Plans lacked any incentives to contain costs. Indemnity plans paid all the costs of covered services provided to the enrollee. The enrollee enjoyed free choice of provider and services. They preserve the enrollee's right of choice and allow the person to manage his or her own health care. These plans lack incentives for cost containment. Today, cost-sharing efforts (e.g., copayments, deductibles) help contain costs. Blue Cross and Blue Shield continue to be a provider of health insurance.

Which of the following best describes how the local government is provided authority? a. Through the ability to tax local residents to meet local needs b. Through the people themselves who band together to create the community c. Power delegated from the federal level to the local level d. Power delegated from the states

D. Power delegated from the states States may delegate powers to the local government. Which powers they delegate vary widely from state to state. The federal government does not directly delegate power to the local level, this occurs through state government. Taxation and creation of a community do not provide the local government with authority.

Which of the following best describes how the government was successful at containing costs? a. The original legislation for Medicare and Medicaid had built-in cost controls. b. Certificate-of-need requirements restricted provider overtreatment. c. Utilization review determined appropriateness of care. d. Prospective payments were based on diagnosis-related groups (DRGs). e. Peer standard review organizations were effective watchdogs.

D. Prospective payments were based on diagnosis-related groups (DRGs). Prospective payment based on DRGs proved to be effective. The cost reduction that resulted gave rise to the managed care revolution as providers searched for the most cost-effective mechanism of care provision. Various efforts from, for example, certificate-of-need, peer review, and utilization review were not effective.

Which of the following is the leading cause of lung cancer among nonsmokers? a. Secondhand smoke b. Living near a nuclear power plant c. Exposure to pesticides d. Radon gas

D. Radon gas Radon exposure is the leading cause of lung cancer among nonsmokers in the United States. It is estimated that radon causes an estimated 21,000 lung cancer deaths every year.

Which of the following statements best describes the relationship between the environment and health? a. Because of the large number of variables involved, the relationship between environment and health cannot be researched. b. Because the environment has such long-term effects on health, research findings are not yet available. c. Research shows that a healthy environment has limited impact on one's health. d. Research shows that a healthy environment increases quality of life and years of healthy living.

D. Research shows that a healthy environment increases quality of life and years of healthy living. A healthy environment increases quality of life and years of healthy living. Accumulated evidence shows that the environmental changes of the past few decades have profoundly influenced the status of public health. Globally, environmental factors contribute to nearly 25% of all deaths and increase disease burden (World Health Organization, 2006). The safety, beauty, and life-sustaining capacity of the physical environment are unquestionably of global consequence.

Which of the following differences is found in parish nursing in a rural area as opposed to parish nursing in an urban area? a. Rural parish nurses are less likely to be involved in case management or care coordination than their urban counterparts. b. Rural residents are more grateful for the nurse's assistance because there are so few health resources in rural areas. c. Rural residents are typically less committed to traditional values or a strong religious faith. d. Rural residents may discuss health concerns with the nurse wherever they meet, whether in church or the local market.

D. Rural residents may discuss health concerns with the nurse wherever they meet, whether in church or the local market. In urban settings, contact with parishioners was primarily at the church, whereas contacts in rural settings were most often in the home, on the phone, or in other community-based settings.

A nurse saw there was a need for a hospice facility in a rural area, because so many of the residents were quite elderly and death was common. Which of the following best explains why the community would not immediately see the wisdom of the nurse's suggestion? a. Change is always difficult; the nurse just needs to keep reinforcing the need for such a facility. b. The nurse did not tell residents how much their taxes would need to go up to support such a facility. c. Residents were fearful of confronting death in such an open way. d. Rural residents prefer to use their informal social support networks when help is needed.

D. Rural residents prefer to use their informal social support networks when help is needed. Limited availability and accessibility of formal health care resources in rural areas combined with self-reliance and self-help traits of rural residents have resulted in the development of strong rural community informal care and social support networks. Rural residents are more apt to entrust care to established informal networks than to new formal care systems. It is unlikely that creation of such a facility would impact their taxes. The nurse needs to partner with the community to implement the change process while building upon the community's strengths, beliefs, and values systems.

"Stand up straight, mom," a young woman said to an older woman in the grocery store checkout line. Which of the following would be the most appropriate action by the nurse who is standing next to them in line? a. Do nothing; the nurse is not expected to act as a nurse when not at work. b. Say to the older woman, "You need to start treating that osteoporosis." c. Say, "Older women who don't get much calcium, vitamin D, or exercise can often have trouble standing up straight. Keep reminding yourselves." d. Say, "You both may have some problems. Have you both ever been checked for osteoporosis?"

D. Say, "You both may have some problems. Have you both ever been checked for osteoporosis?" It is assumed that students will know that symptoms of osteoporosis include loss of height, low back pain, neck pain, and stooped posture. These are late symptoms, and there is no cure for osteoporosis. But screening needs to be done so both of these women can be informed, especially of the risk of fractures with this condition.

When a person was brought into the clinic in a wheelchair, the new nurse asked the patient if he felt a need for a priest. Which of the following best explains why the nurse would ask about spiritual health during the intake assessment? a. All patients have spiritual as well as physical needs. b. Medical personnel have to collaborate with religious leaders. c. People reach out for spiritual care when they have suddenly become ill. d. Some people perceive disabilities as punishment for sin.

D. Some people perceive disabilities as punishment for sin. There are four models for viewing disability including: (1) the medical model, (2) the rehabilitation model, (3) the socially constructed disability model, and (4) the moral model, which connects disability with sin and shame. The nurse apparently perceived disability as a result of sin not yet repented.

An earthquake has hit and buildings are knocked down; people are injured and crying for help. Looters have already started grabbing essential resources. Which of the following actions should the community take first? a. Send in ambulances to transport injured persons to medical facilities b. Send in media personnel to share the event and begin efforts to obtain donations for the injured c. Send in medical personnel to administer first aid and triage the injured d. Send in law officials to secure the area and ensure the safety of the victims

D. Send in law officials to secure the area and ensure the safety of the victims Before search and rescue should begin, safety must be considered. In some instances, if a criminal action is suspected, law officials will be among the first to respond to secure the area and possibly gather evidence. While the area is being checked and then cleared of potential threats, a staging area can be set up at or near the site of the incident to direct onsite activities. Search and rescue of victims can begin once clearance is given, a disaster triage area is established, and an emergency treatment area is set up to provide first aid until transportation for victims to hospitals or health care facilities for treatment can be coordinated.

Which of the following best describes how health care professionals are involved in the problem of homelessness? a. Homeless persons make everyone uncomfortable when they beg for handouts. b. Homeless persons often live in emergency departments and clinics. c. Poverty leads to crimes, and health care professionals can be attacked and robbed outside health care facilities. d. Serious illnesses or disability creates high medical bills, which may lead to homelessness

D. Serious illnesses or disability creates high medical bills, which may lead to homelessness In 2011, of households with an annual income less than $25,000, 25.4% had no health insurance. Lack of health insurance is a significant factor in creating homelessness. A serious illness or disability can lead to a downward spiral as a result of job loss, use of savings to pay for care, and inability to pay rent.

Which of the following best describes why it is so difficult to change the paradigm of health care from disease orientation to promoting health orientation? a. The belief exists that those without insurance could obtain insurance if they worked hard enough. b. People find it difficult to agree on what the ideal paradigm should be. c. People realize the media have exaggerated the problems that result from lack of insurance. d. Serious reallocation of resources would have to occur.

D. Serious reallocation of resources would have to occur. A shift in the paradigm would necessitate a substantial reallocation of resources because the vast majority of health spending is currently directed to medical care and biomedical research and reflects a viewpoint of health care as a commodity. The allocation of resources has the most influence on creating a paradigm shift. Individual opinions and the use of media do not play as great of role as where resources are spent.

Which of the following are the most frequent problems suffered by the chronically homeless? a. Chronic conditions such as hypertension, bronchitis, and emphysema b. HIV/AIDS and other sexually transmitted diseases, tuberculosis, and hepatitis C c. Respiratory infections, trauma, and skin disorders d. Severe mental illness and substance abuse disorders

D. Severe mental illness and substance abuse disorders Chronically homeless people may well have many physical conditions, but the primary problems that lead to their homelessness are severe mental illness and substance use disorders.

A new faith community nurse (FCN) met with a client who was dying. The client asked the FCN to pray for her out loud. The FCN had an active prayer life, but privately—not out loud relating to someone else. Which of the following would be the best response by the nurse? a. Deliberately misunderstand the request and promise to pray for the client when you are at home each evening b. Look for a religious book nearby, open it, and hope there is something there the nurse can use c. Offer to share the client's request with the faith community's leader, as well as ask the faith community to pray for the client d. Share a traditional prayer that the nurse had previously memorized for personal use

D. Share a traditional prayer that the nurse had previously memorized for personal use It is good to offer to pray for the client and to ask the faith community's leader and the faith community to pray for the client. But the request was immediate, so the best response is to use the faith's traditional prayers, which the parish nurse has memorized. If nothing comes to mind, the FCN can use a book of the faith to find a prayer that is suitable. A guideline to follow is to keep the prayer simple and offer the request to the client's higher power.

A wife, who had just come home after major abdominal surgery, explained to the home health nurse that she was really worried about her husband. He had not been sleeping well or eating well, seemed to have no energy, and did not seem to enjoy anything including activities he used to love. Which of the following suggestions should the nurse give to the client? a. Ask what medications the husband is taking, because many medications can affect mood b. Explain her husband has probably been worried sick about her and the surgery, and she should reassure him frequently that she is OK c. Point out that many people get sad during the winter months and he should be fine when spring arrives, but in the meantime put full-spectrum light bulbs in all the household lamps d. Share that her husband seems depressed and that they should see his doctor immediately

D. Share that her husband seems depressed and that they should see his doctor immediately Depressed people may experience several or all of the following symptoms: changes in appetite or weight, changes in sleep patterns, restlessness, loss of energy, feelings of worthlessness or guilt, and repeated thoughts of death or suicide. If any of these symptoms exist, the client should be referred to a physician for diagnosis. A physician can only make a diagnosis of clinical depression in the presence of five or more of the symptoms mentioned above.

Which of the following is the primary source of income for elderly Americans? a. Employment income b. Pensions c. Savings d. Social Security

D. Social security Aggregate income for the population aged 65 years and over comes largely from four sources: (1) Social Security provides 37%, (2) earnings account for 30%, (3) pensions provide 19%, and (4) asset income accounts for 11%.

If most students have no intention of ever leaving their local community, which of the following languages should be chosen as the required foreign language in high school? a. French, as it is a very romantic language b. German, because many of the students' names are German c. Latin, as it is the basis for many other languages d. Spanish, to improve employment opportunities

D. Spanish, to improve employment opportunities By 2050, Hispanic children as a percentage of the population are expected to grow to 39%, up from 24% in 2011. The percentage of children who are Hispanic has increased faster than that of any other racial or ethnic group. More immigrants speak Spanish, and care providers need to give culturally appropriate care. Speaking Spanish would be helpful. Because of these reasons, it would be most appropriate for Spanish to be selected as the required foreign language. Speaking French, German, or Latin would not be as practical as being able to speak Spanish.

Which of the following best describes the approach to health care used by states? a. Federal funding encourages experimentation in creating new programs. b. Insurance regulations concerning reimbursement cross state lines. c. Information about successful programs is known to legislators. d. States frequently develop new programs as federal funds become available to pay for them.

D. States frequently develop new programs as federal funds become available to pay for them. Many state and local government programs were developed on the basis of availability of federal funds. Funds are accompanied by regulations, which apply to all recipients. These have served to standardize health policy. Federal funding is limited, thus there is limited opportunity for experimentation. Legislators must be involved in ongoing education in order to keep up to date on what is happening with programs that have been implemented. Insurance regulations are monitored by individual states so reimbursement concerns are unable to cross state lines.

Which of the following best describes the effect of President Clinton's Advisory Commission on Consumer Protection and Quality in the Health Care Industry report (1999)? a. Created improvement in both physician and nurse educational programs b. Demonstrated the incredible influence on health care made by the insurance industry c. Increased national interest in improving health care and seeking reform d. Stimulated the Institute of Medicine to explore quality in more depth

D. Stimulated the Institute of Medicine to explore quality in more depth The report had a major impact in that it stimulated a series of more in-depth explorations of the health care delivery system, which resulted in a series of reports developed by the Institute of Medicine called the Quality Chasm Series. These reports then caused several other movements within the health care system.

The daily patrons of a local town restaurant became ill with nausea, vomiting, and diarrhea. Without knowing the cause, which of the following actions should be taken immediately to help avoid future problems? a. Establish a series of cooking classes for all citizens b. Have a citywide campaign to cover your mouth when sneezing c. Use bleach to clean the entire restaurant d. Strongly emphasize the importance of proper hand washing to staff

D. Strongly emphasize the importance of proper hand washing to staff Agents leave the human host through a portal of exit and invade through a portal of entry. Portals of exit include respiratory secretions, vaginal secretions, semen, saliva, lesion exudates, blood, and feces. Portals of entry are associated with the portal of exit and include the respiratory passages, mucous membranes, skin and blood vessels, oral cavity, and the placenta. Because it was food poisoning of some sort, until the cause is known, it can be assumed to probably be a fecal-oral transmission. Thus, the interventions of cooking classes, covering your mouth when sneezing, and using bleach to clean the entire restaurant would be ineffective. Therefore, staff need to again be reminded of the importance of careful hand washing after using the facilities

Which of the following would be the best example of service learning? a. Student nurses collecting gloves and coats to distribute to the homeless b. Student nurses distributing food on plates at a "feed the hungry" site c. Student nurses employed as nursing assistants for minimum wage on the weekends d. Student nurses volunteering at the free clinic doing health assessments

D. Student nurses volunteering at the free clinic doing health assessments Service learning is a teaching and learning strategy that integrates meaningful community service with instruction and reflection to enrich the learning experience, teach civic responsibility, and strengthen communities. Volunteering at a free clinic to perform health assessments is the best example of how this definition can be applied. Collecting gloves and coats and distributing food, while allowing the student to volunteer, does not allow the student to apply materials learned in the classroom. Student employment cannot be considered volunteering of services to the community.

A young woman is panic-stricken. She had not realized how much she was drinking, and she thinks she had unprotected sex with several men last night. She is petrified and wants an HIV test immediately. Which of the following actions should be taken by the nurse? a. Give her a strong lengthy lecture about the dangers of alcohol b. Administer the HIV test c. Provide a physical examination, testing for all sexually transmitted diseases (STDs) d. Suggest she be treated immediately to be safe

D. Suggest she be treated immediately to be safe The young woman should be aware that treating HIV exposure with HIV medications has been shown to decrease the incidence of seroconversion and HIV infection. Thus, she should be treated immediately to be safe. HIV infection is usually determined by the HIV antibody test, most commonly the enzyme-linked immunosorbent assay. False-negative findings may occur, especially before the body produces antibodies after exposure. So a negative reading on an HIV test now would not negate starting the HIV medications. Giving her a strong lecture about the dangers of alcohol will not change that she was possibly exposed to HIV. Although it would be appropriate to provide an examination and test for all STDs, it is still most important that she receive HIV medications

Which of the following best describes the problem with the Section 8 housing program? a. Direct access to an apartment in a public housing facility is faster and easier. b. Most renters prefer the program to make direct payment to apartment owners willing to rent to them. c. Section 8 housing is essentially slum housing, and no one wants to live there. d. Supply is vastly less than the demand.

D. Supply is vastly less than the demand. Although these programs are intended to alleviate housing problems for low-income renters, the demand for these assisted housing programs has far exceeded the supply. Section 8 housing does not provide direct access to an apartment in a public housing facility or provide payment directly from the program to apartment owners. Section 8 housing provides affordable housing through the U.S. Department of Housing and Urban Development, and is not slum housing.

Which of the following is most effective in helping males choose healthier lifestyle behaviors? a. Educational programs that include both threat and reward b. Involvement in team sports at school or at work c. Physician prescription for a specific behavior change d. Support from a female family member concerned about the man's well-being

D. Support from a female family member concerned about the man's well-being Cheatham reported that several studies showed males to be more likely to change health behaviors when these changes were suggested and supported by female family members whom they believed were concerned about the well-being of the man. Thus, female support is more important than educational programming, being part of a team, or a physician prescription.

Which of the following best describes a proposed strategy to address the lack of health care professionals in rural communities? a. Advertise that there are more men than women in many rural areas to attract female nurses who want to be wives and mothers b. Offer free housing and office space to a professional who will come to live in the community c. Pay extremely high salaries to professionals willing to relocate d. Support local students obtaining an education while continuing to live at home

D. Support local students obtaining an education while continuing to live at home A solution proposed for the shortage of health care providers is for rural communities to "grow their own." A rural community, a group of small communities, or a county could support local students attending college and recruit students currently attending professional schools. The students make a commitment to work in the community in return for monetary support for their educations.

Which of the following best describes the primary conclusion of the report To Err Is Human: Building a Safer Health System? a. Hospital staffing must be improved to focus on safety rather than cost containment. b. Quality of care and medical error are not easily defined. c. Patients must recognize that care providers are human and errors will occasionally be made. d. System failures are resulting in an incredible amount of harm from medical errors.

D. System failures are resulting in an incredible amount of harm from medical errors. The first key message from this report was the emphasis on the incredible magnitude of harm resulting from medical errors, which are largely due to system problems, not individual failure. Error reporting programs are needed as health care systems are encouraged to focus on error reduction. The report clearly states that there is no one answer to solving this problem. Errors are directly related to outcomes, which is a significant concern in quality improvement efforts.

A school nurse is conducting a program with high school students about adolescent sexuality. Which of the following information would the school nurse most likely include? a. Abstinence is the only way to avoid pregnancy and sexually transmitted diseases. b. Resources are available for assisting teenage parents with, for example, maternity clothing and baby needs. c. There are many sources of free or very-low-cost birth control measures. d. Teenage mothers are less likely to complete high school and often remain single and live in poverty. e. Abortion is dangerous, is illegal in most areas, and can result in lifelong sterility.

D. Teenage mothers are less likely to complete high school and often remain single and live in poverty. Although the nurse might want to include information on abstinence and birth control, it is important to convey the reality of teenage pregnancy. Adolescent fathers can confront a lifetime of paying child support. Teen mothers are less likely to complete high school and are more likely to be single parents and live in poverty

Everyone is talking about the disaster that has been widely seen on the news programs. Which of the following suggestions would be most appropriate for the nurse to make at this time? a. That this opportunity should be used to discuss how to be brave in a crisis. b. That programs in collaborative problem solving should be created for students and staff. c. That the staff should reassure students that such a disaster would not occur here. d. That the school should develop an emergency management plan.

D. That the school should develop an emergency management plan. Every school is encouraged to develop an emergency management plan. In fact, many states mandate that schools develop plans to address the potential threat of another terrorist attack or a natural or man-made disaster. It would not be appropriate for the nurse to discuss bravery, student safety should come before bravery. Collaborative problem solving will not help the students be safer should this type of a crisis arise at the school. It is not appropriate to provide the students with reassurance as it is impossible to prevent all of these disasters, rather the school must develop an emergency plan so that they are prepared if this would happen at their school

Which of the following U.S. agencies is responsible for overseeing the actions of protecting against, responding to, recovering from, and preventing the effects of disaster? a. American Red Cross (ARC) b. The Department of Homeland Security (DHS) c. Federal Emergency Management Agency (FEMA) d. The National Incident Management System (NIMS)

D. The National Incident Management System (NIMS) Because of the recognition of the need to be prepared, programs have been created to address the national, state, and local management of disasters. President George W. Bush established the NIMS in 2004. The NIMS provides a systematic, proactive approach for all levels of government and nongovernmental agencies to work seamlessly to prevent, protect against, respond to, recover from, and prevent the effects of disasters (Federal Emergency Management Agency, 2012). The ARC is not a governmental agency. It is chartered by Congress to provide disaster relief. It works in partnership with FEMA, DHS, the Centers for Disease Control and Prevention, and other local, state, and federal agencies to provide and manage needed services. The DHS was established to realign the existing agencies, groups, and organizations into a single department, focusing on protecting the American people and their homeland. The mission of the FEMA is to support citizens and first responders to ensure that, as a nation, everyone works together to build, sustain, and improve the capacity to prepare for, protect against, respond to, recover from, and mitigate all hazards.

Which of the following statements best describes a major event that occurred in the 1960s that affected health care? a. The amount of charity care by health care providers greatly increased. b. Hospitals began to voluntarily pay taxes to the communities where they were located. c. Legislation greatly expanded funds available to train physicians, nurses, and other health care providers. d. The Social Security Act was amended to create Medicare and Medicaid legislation.

D. The Social Security Act was amended to create Medicare and Medicaid legislation. The popularity and benefits of employer-provided insurance plans were recognized, as was the reality that some segments of society were being neglected. The 1960s, with a pervasive thrust for social justice, presented the opportunity to move toward universal health care coverage. Titles XVIII and XIX of the Social Security Act created Medicare and Medicaid, respectively. There was no increase in funding for training of health care providers, voluntary payment of taxes by hospitals, and an increase in the amount of charity care provided in the 1960s.

A community health nurse suggested that a group of nursing students perform a diabetic screening at a location where groups of people meet. Which of the following sites would be best for the screening? a. The senior citizens center, which always welcomes students back b. The shopping mall where many young adults go to save money c. The YWCA/YMCA down the street d. The Weight Losers group meeting at the church

D. The Weight Losers group meeting at the church Adults who are obese and meeting at a group such as "Weight Losers" probably have not previously been screened for diabetes. If the senior citizen center always welcomes students back, they have clearly had screenings there before. Hence, even though older adults are at risk, it would be better to choose a different group. Young adults and those working out at a YMCA are not particularly at high risk.

A client needed a great deal of care. During a morning visit, the nurse shared information with the client's caregiver and demonstrated technical procedures. Which of the following is most important for the nurse to assess? a. Client response to the procedures b. How the client thought the goals were being achieved c. If the client and the caregiver retained all the information the nurse gave d. The skill and comfort level of the client's caregiver

D. The skill and comfort level of the client's caregiver The home health nurse spends much of the visit assessing the skills of the caregiver. The home health nurse instructs the caregiver in the correct procedures for providing care and in recognizing the signs and symptoms of problems that must be reported to the health care provider. The goal of the home health nurse's instruction is to provide the caregiver with the skills necessary to care for the patient successfully in the home without intervention of the nurse. Information not retained can be repeated.

Which of the following has the largest influence on the case manager's role? a. Criteria of the program for accepting clients b. Location of the program c. Population served by the program d. The specific program that employs the case manager

D. The specific program that employs the case manager The individual case manger's role will vary depending on the specific program's services. The criteria of program acceptance, location, and population served by the program will not have as large an influence on the case manager's role as do the specific services of the program.

Which of the following best describes the advantage of the web of causation model in comparison with the epidemiological triangle model? a. The web of causation model is easier to understand and use. b. The web of causation model is more widely known and publicized. c. The web of causation model is more recent and current. d. The web of causation model shows the relationships among variables.

D. The web of causation model shows the relationships among variables. Although it is a more recently created model, the web of causation model is more useful because it illustrates the complexity of relationships among causable variables. It is not easier to understand and use as it has more variables than the three (agent, host, and environment) in the epidemiological model.

Record data demonstrated that there were a very large number of children in the school district whose insurance plan was the Children's Health Insurance Program (CHIP). Which of the following conclusions would be accurate for the nurse to make? a. There are a large number of parents who know how to abuse government programs. b. There are a large number of homeless families. c. There are a large number of unemployed poverty-stricken families. d. There are a large number of working, low-income parents.

D. There are a large number of working, low-income parents CHIP has greatly increased access to health care for many low-income children. The majority of these children live in families with working, low-income parents.

Which of the following best explains why home health care agencies that are part of national chains are doing better in the competitive marketplace than individually owned agencies? a. There is better media coverage and a nationally known "name" recognized by prospective clients. b. They are able to offer lower quality care using less well-prepared caregivers to ensure maximum profit. c. The chief executive officer usually has extensive experience and makes wise decisions. d. There are lower administrative costs and easier negotiating when buying in bulk.

D. There are lower administrative costs and easier negotiating when buying in bulk. Agencies within chains have a financial advantage over single agencies. The chains have lower administrative costs because a larger single corporate structure provides many services. For example, a multiagency corporation has greater purchasing power for supplies and equipment because they purchase a larger volume. A single corporate office can provide administrative services such as payroll and employee benefits for all chain employees, thereby reducing duplication of these services. It is unlikely that they are doing better because they receive better media coverage, offer less quality care, or have a more experienced chief executive officer.

Who first created the idea of a continuum of care, which later evolved into the term "case management"? a. Florence Nightingale, when she engaged in activities such as writing letters for the wounded. b. Lillian Wald, who created health education programs for the whole community. c. Social workers, who function as discharge planners, use the term. d. Those who coordinated services for discharged psychiatric patients after World War II (WWII) used the term.

D. Those who coordinated services for discharged psychiatric patients after World War II (WWII) used the term. The concept of continuum of care originated after WWII to describe the long-term services required for discharged psychiatric patients. The term "case management" first appeared in social welfare literature during the early 1970s. Nightingale, Wald, and social workers were not involved in the creation of the idea of the continuum of care.

Why did employers decide to offer health insurance as an employee benefit? a. Hospitals and physicians quit offering charity care to those who could not pay. b. Society was focused on not having to pay for doctor visits and other needed health benefits. c. Teachers were role models for unions to demand insurance as a benefit. d. To obtain and retain the limited number of persons available to work when government rules prohibited raising wages, insurance was offered.

D. To obtain and retain the limited number of persons available to work when government rules prohibited raising wages, insurance was offered. The idea of paying a small fee for guaranteed health care to have sickness cured was very popular. Health care providers liked knowing they would receive payment for their services. During World War II, faced with a limited workforce and governmental restrictions on wages, employers began to see health insurance as a means of supplying workers' benefits without granting a wage increase. Teachers were not demanding insurance as a benefit. Hospitals and physicians continued to provide charity care as they were able. Society understood that they needed to pay for health services; however, businesses realized that providing insurance was a way to keep their needed workforce.

Which of the following offers the best explanation as to why it is important for low-income women to seek prenatal care? a. To provide the extra support from a nurse who listens b. To begin the process of obtaining hospital care for delivery for a reduced cost c. To have time to begin healthy behaviors to ensure a healthy infant d. To obtain referrals for other helpful services

D. To obtain referrals for other helpful services. Comprehensive prenatal care is particularly important for low-income women. It can help them obtain other services such as the Special Supplemental Food Program for Women, Infants, and Children program, food stamps, smoking cessation, housing, child care, job training, substance abuse treatment, and domestic violence counseling. Ideally, healthy behaviors should begin before the woman becomes pregnant. Prenatal care would not assure obtaining reduced costs for hospital care at the time of delivery. Although nurses do provide support by listening, the most important resource that nurse can provide is referral for other community resources.

Which of the following is the primary factor in how a hospice nurse makes decisions while giving care in the client's home, surrounded by the client's family? a. To allow the patient a comfortable, pain-free death b. To assure the caregiver and the whole family that they are not hastening the client's death by anything they do to keep the client comfortable c. To encourage the family to grieve and confront the reality of the client being terminal d. To prevent a decline in the caregiver's health

D. To prevent a decline in the caregiver's health Although the nurse tries to do everything possible for the client, the caregiver, and the whole family, the nurse must prevent a decline in the caregiver's health. Although the dying patient is the focus of all skilled nursing care, the experienced home care nurse knows that a careful assessment of the caregiver's mental and physical health is important. The spouse, lover, children, friends, and neighbors who have made the commitment to stay until the end need the nurse's time and attention as much as, if not more than, the patient. Although the patient's wishes are important, all decisions regarding care are made considering the health of the caregivers. Encouragement of the family to grieve and confront the reality of the client being terminal would not be a primary factor in how the nurse makes decisions.

Which of the following best describes the mission of the U.S. Department of Homeland Security (DHS)? a. To consolidate all existing agencies, groups, and organizations into a single department b. To distribute federal financial aid to disaster-stricken areas c. To enable appropriate response to assist a state having a disaster d. To protect against and respond to threats and hazards to the nation

D. To protect against and respond to threats and hazards to the nation The mission of DHS is to: (1) lead the unified national effort to secure America, (2) prevent and deter terrorist attacks, and (3) protect against and respond to threats and hazards to the nation. This agency was created to realign the existing agencies, groups, and organizations into a single department, focusing on protecting the American people and their homeland, but this is not the mission of the agency. The Federal Emergency Management Agency distributes federal financial aid to disaster-stricken areas and is responsible to enable the appropriate response to assist a state having a disaster

Which of the following best describes why large employers would decide to self-insure? a. To claim to offer more benefits to employees b. To have more control over health care providers c. To be more effective at keeping employees happy d. To reduce administrative costs charged by insurance companies

D. To reduce administrative costs charged by insurance companies Some organizations have decided to self-insure their employees. This reduces the administrative cost of insurance. Self-insurance does not claim to offer more benefits to employees, allow for more control over health care providers, or do a better job at keeping employees happy.

A school nurse was responsible for five schools. To give students required medications during the day, the school nurse teaches a particular office staff member in each school exactly what to give to whom and when, and they practice until both are comfortable. Which of the following remains as the nurse's responsibility in relation to the administration of medications? a. To begin teaching a second person at each school because the original staff member might occasionally not be available to give the medications b. To confirm with each student that they do not mind obtaining their medication from the staff person assigned to the task c. To continue to evaluate the comfort level of the staff person in completing the task d. To systematically continue with assessment, diagnosis, goal setting, and evaluation of student health needs

D. To systematically continue with assessment, diagnosis, goal setting, and evaluation of student health needs Not every school has a full-time nurse available on site. Often a nurse is assigned to three or four schools, resulting in delegation of certain tasks to unlicensed personnel. Each state's nurse practice act stipulates which procedures may be delegated. The responsibility for assessment, diagnosis, goal setting, and evaluation may never be delegated. When tasks are delegated, the nurse must provide appropriate education, written procedures, and ongoing supervision and evaluation of the caregivers

According to the U. S. Department of Commerce, which of the following rules must be followed by makers of toy guns? a. Darts from toy guns must be made of materials that will not penetrate skin. b. Toy guns cannot contain parts made of lead or lead-based paint. c. Reflective paint must be used on toy guns. d. Toy guns must be distinguishable from real guns.

D. Toy guns must be distinguishable from real guns The U.S. Department of Commerce requires toy guns to be distinguished from real guns. In many cases, the toy industry has established voluntary safety standards to minimize risk of injury. There is not specific legislation from the U.S. Department of Commerce that outlines the materials that must be used in darts of toy guns or banning the use of reflective or lead-based paint or lead products.

Which of the following is the first step in preventing further spread of a particular sexually transmitted disease (STD)? a. Have a citywide free screening program in all high schools and colleges b. Provide public education about safe sex from abstinence to monogamous relationships c. Require all public facilities to sanitize all restrooms with a stronger, more effective agent d. Treat each infected person with the appropriate pharmaceutical agent

D. Treat each infected person with the appropriate pharmaceutical agent Antiinfective drugs, such as antibiotics, antivirals, antiretrovirals, and antimalarials, play important roles in controlling infectious diseases. Not only do they permit recovery of the infected person, but they also play a major role in preventing transmission of the pathogens to another. The first step in preventing transmission of tuberculosis and syphilis is to treat the infected person with antibiotics. Because the question asks about further spread, infection in a person has been diagnosed, so education is needed, but it is too late for that person. Adults not in school also are infected with STDs. A stronger, more effective sanitizing agent would not be the most effective strategy to prevent spread of STDs

Which of the following statements is true concerning tuberculosis (TB) infections in the United States? a. Subclinical cases of TB can occur in patients who fight off the infection and thus are not a danger to themselves or others. b. TB can be cured by a 6-month period of treatment with INH. c. TB can only be caused by the Mycobacterium bovis bacillus. d. Under certain conditions, susceptible hosts may be infected by the TB bacillus.

D. Under certain conditions, susceptible hosts may be infected by the TB bacillus The principle of multicausation emphasizes that an infectious agent alone is not sufficient to cause disease; the agent must be transmitted within a conducive environment to a susceptible host. Mycobacterium tuberculosis kills cells. M. tuberculosis has low infectivity, low pathogenicity, but high virulence if untreated

A nurse needed to do a quick assessment of a client's lifestyle behaviors to counsel appropriately. Which of the following strategies would be the easiest way to determine the elderly woman's nutritional status? a. Ask the woman to keep a food diary for 2 weeks and bring it to the clinic b. Have the clinic dietitian interview the woman about her eating habits c. Quiz the woman verbally as to her usual meals during the day d. Use the DETERMINE mnemonic

D. Use the DETERMINE mnemonic All the responses are good approaches. However, the nurse should take a broad view of what assets or barriers are involved in relation to nutrition. A nutrition checklist, described by the mnemonic DETERMINE, reviews warning signs and risk factors of poor nutritional health. (See Table 19-2 in the textbook for more information).

A patient walks into a community clinic complaining of severe intestinal cramps and diarrhea. Which of the following actions can be taken to protect the staff at the clinic? a. Refuse to see anyone that sick as clinics have a different mission than secondary and tertiary care of the obviously ill b. Send the patient immediately to the closest hospital emergency department c. Treat the patient with broad-spectrum antibiotics and lots of fluids d. Use universal precautions with all patients regardless of the situation

D. Use universal precautions with all patients regardless of the situation In the late 1980s, the Centers for Disease Control and Prevention (CDC) developed a set of guidelines, called universal precautions, to prevent transmission of diseases found in blood and other body fluids. These guidelines were developed because infected people may be asymptomatic and have no knowledge of their conditions; therefore, health care workers must assume that all patients are infectious and protect themselves. Refusing to treat the patient, sending the patient to an emergency department, or treating the patient with antibiotics and fluids would not be appropriate measures to protect the staff.

Which of the following best describes how the United Nations (UN) is able to implement its decisions? a. Asking for funding from all member nations to obtain appropriate resources b. Through five permanent members of its security council c. Sending military units to developing countries d. Using its moral authority and world opinion

D. Using its moral authority and world opinion Regardless of size, wealth, or political system, all member nations have an equal vote in the decision-making process. UN decisions reflect world opinion and the moral authority of the community of its 192 nations. The UN does not ask for funding from all member nations, as some of the nations do not have additional funds to provide to the UN. The security council is unable to implement decisions without support from all of the member nations. It is not feasible for the UN to send military units to developing countries to implement their decisions.

The mother confided in the nurse, "I don't think my child is improving." Which of the following statements would be the best response by the nurse? a. "My assessment shows your child is improving." b. "The children seem to be playing with and accepting your child." c. "The teacher reported to me that your child is doing much better." d. "What is causing your concern?"

D. What is causing your concern? Nurses should pay attention, particularly when parents intuitively whisper, "Something is not right." A well-meaning health care provider may attempt to reassure a concerned mother. However, this kind of response may create silence and delay further questions by the parent. Rather than decrease parental concern, it may increase anxiety. The nurse can serve as an intermediary, working among the family and the health care team, to address parental concerns and client goals.

Some of the medical staff thought an abused woman deserved what she got when she told them she was not going to a safe house following discharge from the emergency department. Which of the following information should the nurse stress to the medical staff? a. When the woman leaves the emergency department, her abuser will most likely be arrested. b. The woman probably feels fearful and helpless and, until her life is clearly threatened, nothing will probably change. c. The woman needs additional reinforcement that she would be safer in a domestic violence shelter. d. When a woman attempts to leave the situation, it is often when the abuser kills her.

D. When a woman attempts to leave the situation, it is often when the abuser kills her. The most dangerous time for the victim is when the victim leaves or attempts to leave the relationship, because it is seen as an erosion of the abuser's control. The victim is more likely to be killed at this time than at any other time in the relationship. It is unlikely the abuser will be arrested, even following this incident of violence. Because the woman is fearful for her life and recognizes the dangers that occur with leaving, she most likely will not leave the relationship. Additional education about the domestic violence shelter will most likely not change her mind to leave the situation

Which of the following best describes what happens when a health care organization receives federal funding for a special health care need? a. Other groups see the project and write grants wanting similar projects in their geographic area. b. Participants continue to demand the services so local funding has to be readjusted to continue the care. c. Research is done to demonstrate whether or not the intervention was successful and should be replicated. d. When funds cease, so does the health care; therefore, continuity is lacking.

D. When funds cease, so does the health care; therefore, continuity is lacking. When the funding is no longer provided, the programs cease, which results in lack of continuity of care. Research may be done related to the program, other programs may be developed because of the current program that is being implemented, and participants may encourage local funding to continue. However, the most likely outcome is that the program will end when the funding ends, so there is no continuity in the services that are provided.

When would the National Guard become involved in a disaster? a. When the Federal Emergency Management Agency requests such assistance b. When the local government requests help keeping order in the community c. When the president has declared the area a national disaster d. When the state has been asked to help an overwhelmed community

D. When the state has been asked to help an overwhelmed community When a disaster overwhelms the local community's resources, then the state's department or office of emergency management is called for assistance. Before an event, state officials provide technical support for prevention, preparedness, response, and recovery. State officials are on scene at disaster events to facilitate coordination of state resources and to disseminate information. In some cases, the National Guard may be called in to aid the community

A mother was debating whether or not to take her son to the clinic. His temperature was 104° F and rising so she gave him acetaminophen (Tylenol). Which of the following will most likely be the deciding factor in the mother's decision? a. Whether or not the child is crying b. Whether or not the fever goes down after the Tylenol c. Whether or not the child seems to be getting better d. Whether or not the child is covered under insurance

D. Whether or not the child is covered under insurance The ability to pay for health care greatly influences whether a parent takes a child to see a health care provider. Having health insurance would be the most important deciding factor in this situation, more important than if the child is crying, if the fever goes down, or if the child seems to be getting better.

Which of the following best describes the aftermath of the deinstitutionalization of mentally ill patients into the community during the 1970s? a. Community health centers were created and gave care to such clients. b. Families were eager to accept their family members back home. c. Many mentally ill clients without social skills ended up in nursing homes. d. Without follow-up care, many clients were readmitted to care.

D. Without follow-up care, many clients were readmitted to care. Several problems resulted from deinstitutionalization of mentally ill patients, because there was no follow-up or monitoring. Many were readmitted to state hospitals. Many ended up homeless or in prison facilities, not in nursing homes or with their family members at home. Community health centers were created to provide care to these patients, but the deinstitutionalized were unable to meet their basic needs and receive proper follow-up and health care monitoring. Thus, they were readmitted to care.

A school nurse is developing a health education program for third grade students about how to play safely. Which of the following provides the best rationale for this nursing action? a. The kids were playing chicken in front of the school buses each day. b. The students are at the age when they begin to engage in risky behaviors. c. Toys can have unexpected hazards from lead paint to small swallowable parts. d. Without proper head protection, many sports can lead to traumatic brain injury (TBI).

D. Without proper head protection, many sports can lead to traumatic brain injury (TBI). Head injury from cycling and other wheeled sports, such as skateboarding, is a leading cause of child death and disability. Without proper head protection, a fall from as little as two feet can cause TBI. The use of helmets and proper protective equipment can substantially reduce the risk of injuries. Adolescents are the population who begin to engage in risky behaviors. As third graders, these children are not typically at risk for swallowing small parts from toys. Although the education may provide information about why it is not safe to play chicken in front of the school buses, this is a behavior that should be stopped by the rules and regulations that are in place at the school.

Which of the following groups should be used to determine the community's pregnancy rate? a. All persons between 15 and 45 years old in the community b. The total population of the community c. The total population of women in the community d. Women between 15 and 45 years old in the community

D. Women between 15-45 years old in the community Although pregnancy is not specifically addressed, the text stresses that only those susceptible to a particular condition should be considered in the denominator. In the case of pregnancy, only women of childbearing age are susceptible.

Which of the following best explains why lung cancer kills more women than breast cancer? a. Early detection and cure of breast cancer has lowered the death rate. b. Pap smears lead to early detection and often the cure of uterine cancers, hence avoiding breast metastasis. c. There is no accepted treatment for lung cancer. d. Women have begun smoking.

D. Women have begun smoking Lung cancer is responsible for more deaths yearly in U.S. women than breast, ovarian, and uterine cancers combined. The increase in the incidence of lung cancer in women is due primarily to an increase in their tobacco use. Eighty-five percent to 90% of all clients in whom lung cancer develops have a history of cigarette smoking. The incidence of breast cancer continues to increase, and is the most common cancer among women, but it is not responsible for as many deaths as lung cancer. Pap smears are used as a screening tool for early detection of cervical cancer. There is accepted medical treatment for lung cancer, and it is similar for both men and women with the disease

Which of the following provides the best explanation for the importance of the "Go Red" and "The Heart Truth" campaigns? a. Because heart disease is so prevalent, we all need to know the usual symptoms so we may seek help quickly. b. Few people are aware of how to prevent chronic diseases such as cancer. c. We need to increase awareness of the genetic component in chronic disease. d. Women have different symptoms and require different treatment than men.

D. Women have different symptoms and require different treatment than men. After the age of 65 years, women are twice as likely to die because of heart disease as men. Women have higher rates of complications after revascularization procedures and higher rates of death after myocardial infarction. This phenomenon exists because women display different symptoms of heart disease and are managed differently than men. In 2002, the American Heart Association launched the "Go Red" campaign for women and "The Heart Truth" program for health care providers. Both programs are designed to educate about the unique features of women and heart disease. These campaigns address heart disease and do not include information about other chronic diseases such as cancer. Heart disease is caused by both lifestyle choices and genetic factors, thus education needs to be provided related to both of these aspects

Which of the following events caused attention that has resulted in the current emphasis on women's health? a. Hillary Clinton and Sarah Palin's comments during the presidential race b. Political correctness, including addressing the rights of women c. New research studies that are focusing on women d. Women's movement from the 1970s

D. Women's movement from the 1970s Beginning in the 1970s, the women's movement called for the reform of systems affecting women's health. The current emphasis began before the presidential races that involved Hillary Clinton and Sarah Palin. The women's movement has caused there to be new research studies that focus on women. Additionally, political correctness addressing the rights of women has occurred because of the women's movement.

A nurse is using an upstream intervention when working with the homeless population. Which of the following public health interventions will the nurse most likely use? a. Case management b. Outreach c. Surveillance d. Community organizing

D. community organizing Although nurses may use all interventions at all three levels, community/public health nurses working more upstream, at the system level, employ collaboration, coalition building, community organizing, advocacy, social marketing, and policy development and enforcement. In contrast, community/public health nurses—working downstream with individuals, families, or groups—use surveillance, disease and other health event investigation, outreach, screening, case finding referral and follow-up, case management, delegated functions, health teaching, counseling, and consultation.

Which of the following aspects of health care could be learned by a developing country from a developed country? a. Acceptance of illness or disease as a learning experience b. Effective ways to treat chronic disease c. Use of healthy behaviors to prevent illness d. Delivery of primary health care

D. delivery of primary health care Likewise, developed countries have much to learn about low-technology initiatives such as oral rehydration therapy for the treatment of diarrhea and the delivery of primary health care as defined by the World Health Organization. The other behaviors such as acceptance of disease, effective ways of treating chronic disease, and use of healthy behaviors to prevent illness would most likely be passed on from developed countries to developing countries.

Which of the following is one of the biggest threats faced by developing countries that are trying to grow economically and make a better life for their citizens? a. Lack of education and knowledge b. Political unrest c. Environmental hazards d. Large population

D. large population Large populations create pressure. In developing countries, famine, trade problems, and war may occur. Malnutrition, disease, or death may result. The poor suffer excess mortality and morbidity. Quality of life is less. Overcrowding leads to pollution, stress, disease, and violence. Each of these challenges represents a major barrier to economic growth. Thus, the large population can cause there to be problems with lack of education, political unrest, and environmental hazards.

Which health care provider organization is seeing an increase in the demand for their services? a. Physician practice b. Hospice service c. Hospitals d. Long-term care facilities

D. long term care facilities Hospital stays have shortened and patients who are admitted are more acutely ill and require more intensive care. Consequently, decreased hospital stays result in more home care admissions and more discharges to long-term care facilities for short-term recovery and rehabilitation. Hospice services and physician practices have not been as impacted as greatly by this shift in where care is provided.

Which of the following represents the largest group of homeless adults? a. Minorities b. Disabled c. Females d. Males

D. males Among all sheltered homeless adults, approximately 63% were men; 37% were women. Men were overrepresented compared with the general population. The sheltered homeless population is younger than the general population. Most homeless adults were between 31 and 61years of age; 22.1% were less than 18 years of age; and 3% were older than 62. In the general population, 16% were over age of 62. Minorities comprised 60% of the total sheltered population. More sheltered homeless people had disabilities than did members of the general population: 38.1% versus 15%.

Which of the following best describes who has the authority to act in every area except those specifically mentioned in the Constitution? a. Any individual citizen b. Federal government c. Local government d. State government

D. state govt Any powers not delegated to the federal government are reserved for the states. Thus, individual citizens, the federal government, and local governments are excluded.

Most of a country's citizens have died from malnutrition or as the result of violence. Which of the following conclusions can be drawn? a. Their country has a problem with an adequate water supply for agriculture. b. They live in a country where weather interferes with food crops. c. They live in a developed country involved in a war. d. They live in a developing country.

D. they live in a developing country Infections, malnutrition, and violence are the primary causes of mortality in developing countries. Cardiovascular disease, cancer, respiratory disease, stroke, violence, and traumatic injury are the primary causes of mortality in a developed country. The problem of malnutrition is broader than examining the environment associated with growing the country's food supply.

Which of the following best explains why many people decide to move to large urban areas? a. To be eligible for social aid b. To be with friends c. To join family who are already there d. To seek employment

D. to seek employment As the world population grows, a global trend toward urbanization occurs; people live closer together and migrate to urban areas for employment. Thus, most people are choosing to move into these urban areas for employment. Being closer to friends and family or being eligible for aid may also occur with the move to the urban area, but it is not the main reason why people are deciding to move.

Which of the following is the most frequent cause of farm fatalities and nonfatal injuries? a. Manure pits (methane poison) b. Power take-off augers c. Storage silos d. Tractors e. Very old and barely functioning trucks

D. tractors Agricultural machinery is the most common cause of fatalities and nonfatal injuries of U.S. agricultural workers, including on-farm fatalities among youth under 20 years of age (CDC, NIOSH Program, 2012). Tractor-related accidents, especially rollovers, are the most frequent causes of farm accidents and account for more than one fourth of farm fatalities.

From which of the following causes are rural residents twice as likely to die from in comparison with urban residents? a. Chronic diseases, especially cardiac problems and cancers b. Diabetes from the higher incidence of obesity c. Respiratory diseases (from pesticides and herbicides) d. Unintentional injuries

D. unintentional injuries Residents of rural areas are nearly twice as likely to die of unintentional injuries, including motor vehicle accidents, when compared with their urban counterparts. The rates of chronic diseases, diabetes, and respiratory diseases are more similar to that of urban residents.

5. What were important events related to health care during the Reagan administration in the 1980s? Select all that apply.

Decrease in both federal control and federal funding, Implementation of Medicare funding based on diagnosis-related groups, Suggestions to shift costs and reduce costs The Reagan administration encouraged competition. Emphasis was on cost shifting and cost reduction with greater state power, less centralization, and less national control. The Omnibus Budget Reconciliation Act of 1981 reduced federal funding, which also decreased federal planning efforts. The federal government recommended eliminating planning agencies. Cost shifting and cost reduction were emphasized.

3. What might be an appropriate indicator for determining what an aggregate's needs are? Select all that apply.

Demand for services as seen in the behaviors of the chosen aggregate members, Experts' determination of what is needed in the situation, Obvious health disparities between the advantaged and disadvantaged populations, Verbalized expression of need from the chosen aggregate There are four types of needs to be assessed: expressed need as seen in behavior; normative need or the need determined by expert health professionals; perceived need expressed by the aggregate including wants and preferences; and, finally, relative need, which is the gap showing health disparities between the advantaged and disadvantaged populations.

1. What is it called when an epidemiologist writes a summary of a food poisoning outbreak, from cause to plans, for prevention in the future?

Descriptive epidemiology There are two principal types of epidemiology, analytic epidemiology and descriptive epidemiology. Descriptive epidemiology describes the amount and distribution of disease, which may suggest possible causes. These causes can then be confirmed or corrected through more advanced methods of research.

9. A nurse assessed an aggregate, determined the priority health needs, and decided what intervention to offer. What may determine whether the nurse's intervention will be successful?

Determination of the aggregate's perspective of the need for the intervention Interventions are seldom successful unless the aggregate has input into determination of need, its priority, and appropriateness of the intervention.

2. What did insurance companies do to decrease their constantly increasing costs? Select all that apply.

Did not cover any illnesses that were diagnosed before the person (or his or her employer) purchased insurance Limited coverage to only certain services, eliminating any that were experimental, nontraditional, or too costly Only care requested by the patient's primary physician was eligible for reimbursement. Required preapproval before expensive services were used Whenever possible, ceased coverage on any person who used an exorbitant number of services Insurance companies attempted to reduce unnecessary utilization by limiting coverage for certain services and people. Restrictions such as the establishment of a gatekeeper that requires preauthorization, limited coverage for preexisting illnesses, and exclusion of participants whose use was deemed exorbitant were instituted. Such restrictions increased resentment and resistance and were not very successful.

2. Two brothers played with their cousin. One brother later became quite ill, whereas the other did not. How can this be explained?

Difference in genetic inheritance between the two brothers Assuming the two brothers lived in the same household, the environment and the agent or infectious organism are the same. The only difference could be between the two brothers themselves and their genetic inheritance.

Which of the following best explains why the name of parish nursing was changed to faith community nursing by the American Nurses Association (ANA)? a. To allow nurses to use the title "congregational nurse" or "church nurse" rather than "parish nurse" b. To allow nurses who were not religious to accept practice positions c. To decrease the emphasis on the church d. To emphasize the community setting of the specialty e. To reflect the diversity now found in the specialty

E. To reflect the diversity now found in the specialty The ANA revised the standards in 2005, providing a clearer definition of the practice, including advanced nursing practice and changing the name of the specialty from parish nurse to faith community nurse. While acknowledging the importance of the Judeo-Christian basis of the practice, the authors believed the change better reflected the diversity now found in the specialty.

Which of the following definitions of family would be the most useful for the nurse practicing in the community? a. A group of persons with shared convictions b. A social unit interacting with the larger society c. People descended from a common ancestor d. Persons related either by blood or by legal contract (marriage) e. Whoever the family says is in their family

E. Whoever the family says is in their family Although some believe even these definitions are too narrow, the widest definitions are "the members of the family are self-defined" and "the family is who they say they are."

A woman stumbled into the rural health clinic and explained that she had an incredible headache. She was sweating and began vomiting into the wastebasket by the intake nurse's desk. Which of the following diagnoses should be anticipated by the nurse? a. Acute adult panic disorder b. Acute alcohol intoxication c. Acute appendicitis d. Acute meningitis e. Acute pesticide poisoning

E. acute pesticide poisoning Signs and symptoms of acute pesticide poisoning are fairly clear, and most health providers in rural communities would recognize them. Common symptoms include headache, dizziness, diaphoresis, nausea, and vomiting. If left untreated, those affected may experience a progression of symptoms including dyspnea, bronchospasm, and muscle twitching. Deaths are relatively uncommon, but they do occur. The nurse is reminded that not all farm laborers are men. The symptoms that are being displayed are not typical of acute panic disorder, acute alcohol intoxication, acute appendicitis, or acute meningitis

1. How does having a broader, aggregate focus approach to care help an individual nurse and client improve that client's outcomes? Select all that apply.

Empowers both nurse and client to make decisions based on both individual and community goals, needs, and priorities, Encourages the nurse to allocate time for population-focused preventive efforts Having a broader focus will help both nurse and patient make appropriate decisions. Unfortunately, it cannot ensure that others will help. Ideally it will help both parties recognize that health problems are not just an individual's responsibility but often a result of environmental, sociopolitical, and economic factors as well. Encouraging the nurse to allocate time for population-focused health promotion efforts will also help the nurse's individual clients over the long term.

5. What actions have been effective in reducing problems related to alcohol use? Select all that apply.

Enforcement of ban on sales of alcohol to minors Increased taxes on alcoholic beverages The prevalence of underage drinking declined significantly when states enacted the minimum legal drinking age of 21 years. The states with more stringent drinking laws have a lower prevalence of binge drinking. Enforcement of the legal drinking age, as well as enforcement of bans on sales of alcohol to minors, helps prevent underage drinking, as have increased excise taxes on alcoholic beverages.

2. What historically have been public health nurses' two most important priorities? Select all that apply.

Engaging in political activity to improve living conditions, Working with the community to confront health issues and poverty Neither administering bedside clinical nursing nor teaching family members to deliver care in the home has adequately addressed the true determinants of health and disease. The early public health nurses resolved that collective political activity should focus on improving social and environmental conditions such as poverty.

27. On the basis of findings related to elevated blood levels of cholesterol, a researcher wanted to determine whether a new drug would notably lower the blood levels of cholesterol in otherwise healthy persons. What kind of study would the researcher probably choose?

Experimental study Experimental design is used to test treatment and prevention strategies. Subjects are randomly assigned to the experimental group to obtain the new drug while the control group receives a placebo or alternative. The changes in blood cholesterol level would then be measured.

25. Why is it believed that states will increasingly monitor and report on quality and cost of health care?

Failure of Congress to act to reduce health care costs forced states to assume responsibility. When Congress rejected Clinton's plan for health care in 1994, the federal government withdrew from active health planning. Most states have become very involved in various aspects of health care planning as state funding from the federal government decreased and state budgets are not increasing. States are forced to determine priorities for the resources available.

3. Why do folk healers continue to be consulted by many people, including well-educated American citizens? Select all reasons that apply.

Folk healers are often effective., Folk healers integrate religion and medicine., Folk healers often use social interventions involving the whole family, as well as friends and neighbors. Folk healers offer repeated success, as many of their medicines are effective; their healing practices are socially cohesive, often including family and neighbors; and folk healers often integrate religion and morality with medicine.

15. What is the primary reason that so many Americans are obese?

For many people, caloric intake is more than needed for their physical activity. Although many factors have led to obesity in American society—including cultural pressures, increased portion sizes in restaurants (portion distortion), offers of more food at a reduced price ("super-size"), and a perceived lack of time to cook nutritious inexpensive foods—the primary cause remains the consumption of more calories than needed for physical activity. With computers and television as recreational choices, Americans are as a group sedentary rather than physically active.

24. What has research concluded about the view of nurses as seen in novels over the past 100 years?

For the past 50 years, nurses were primarily viewed as promiscuous women. Nurses were strong independent women in novels until the 1960s and 1970s when they were presented very negatively as promiscuous "bed hoppers."

15. What would be the purpose of a nurse starting to collect evaluation data when a major heath project has only been in process for short period of time?

Formative evaluation allows the nurse to make changes if needed. Evaluation includes reflecting on each previous stage to determine strengths and weaknesses. Process evaluation, also called formative evaluation, would allow one to change the project while it is being implemented. This reality (being able to change while in process) is not discussed in the textbook.

17. The Carnegie Commission appointed Abraham Flexner to evaluate medical schools on the basis of the German model. What was the overall result of his report?

Funding was withdrawn from weak medical schools. The Flexner Report outlined shortcomings of weak schools that were not built on the German model of a scientific base. Funding was withdrawn such that scientifically inadequate medical schools closed. Physicians now emerged who had been taught the germ theory of disease.

5. What is the nurse's first task when dealing with an aggregate as client?

Gaining access into the aggregate Once the nurse has chosen the target aggregate (which would not be possible without also knowing the aggregate's meeting place or geographic location), the nurse must gain entry into the group. It can be assumed that the nurse is knowledgeable about personal strengths and preferences and what resources are available to function.

21. Which task is most crucial for the community health nurse to do very well?

Give testimony regarding proposed state health legislation Public health's core functions are assurance, assessment, and policy development. Giving testimony regarding legislation directly reflects policy development, which would have a wider impact than the other options, which are more local and narrow in focus.

2. What is it called when a 50-year-old woman comes to the clinic for her first screening mammogram?

Health protection Health protection is used to detect disease in its early state or maximize health within the constraints of disease. Unfortunately, screening will not prevent disease. Screenings are secondary health promotion—not primary health promotion.

1. What are the leading health indicators found in Healthy People 2020? Select all that apply.

Health systems issues, Individual behaviors, Physical and social environmental factors Ten leading health indicators are identified in Healthy People 2020, including individual behaviors, physical and social environmental factors, and health systems issues.

20. What was successful in helping people become educated on healthful living in nineteenth-century England?

Health visitors joined nurses in providing care in the homes. Health pamphlets alone had little effect, so health-visiting services enlisted home visitors to distribute health information to the poor. Eventually, although Nightingale thought district nurses should be the health teachers, district nurses provided care for the sick while the health visitor provided health information in the home.

5. What were the chief factors that led to the creation and growth of Blue Cross hospital insurance? Select all that apply.

Hospitals banded together, and their leaders encouraged such plans, It was an employer alternative to increasing employee pay compensation. Physicians later sought insurance plans, but originally only hospitals created insurance plans based on American Medical Association (AMA) leadership encouragement. During World War II increasing salaries was not an option, so offering health insurance helped ensure employee retention. Although government-supported health plans were suggested as early as the 1930s, politicians were not seriously discussing government-supported care.

28. What is the primary concern both historically and today for many people when they become ill?

How can they afford to take time off from work and lose pay to be ill? This question assumes students are aware of current social reality related to illness, health insurance, and employment realities. Historically, the greatest health concerns were lost wages associated with sickness. Today many employment positions do not offer health insurance. In addition, many employment positions do not have sick leave; if you are not at work, you do not get paid.

3. What variables are missing from both the HBM and HPM models? Select all that apply.

Ignoring the impact of being socially and politically disenfranchised Inaccessibility of health services Omitting the influence of social, structural, and physical environmental factors The models are very useful in relation to changing individual behaviors, but they do not address the complex relationships among social, structural, and physical factors in the environment such as lack of social support systems or inaccessible health services. Changes are needed to improve care for socially and politically disenfranchised groups. Knowledge is always within a social context and is always bound to power relationships. A nurse cannot assign power and control to an individual. The individual must take on power, although perhaps with the nurse's guidance.

26. What is one approach the textbook suggests to improve the functioning of local and national health planning?

Increase nursing involvement The textbook suggests increased nursing involvement as one method of strengthening local and national health planning. Nurses can assess aggregates, identify health needs, and perform planning, intervention, and evaluation. Health would improve if nurses reemphasized the larger aggregate and shared their insights with planning groups.

26. Which factor is most responsible for differences in an individual's health?

Individual's education and income Factors that contribute to wide variations in health disparities are education, income, and occupation.

10. What is the advantage of using Nancy Milio's approach to caring for a client?

It encourages nurses to assess the personal and societal resources of the client. As the model focuses on sociopolitical and environmental constraints to a client's free choice, it also encourages assessment of such constraints, as well as suggesting alternative avenues to helping the patient obtain needed care. Milio encourages the practice of nursing from a broad understanding of health and illness.

2. From a community health nurse's perspective, what are the major problems with the health belief model? Select all that apply.

It ignores the need to reduce health system barriers to action, The choice and the burden for acting are entirely with the client. A major problem with this model is that the burden for taking action is totally with the client. The model requires health professionals to assume responsibility for modifying the client's perceptions so they recognize the need to act. Although the line between persuading and educating is a fine one, nurses are responsible for education. Persuasion may border on coercion. Further, the model assumes that all responsibility is personal, ignoring barriers in the health care system, which may make it difficult for an individual to take appropriate action.

4. Which factors are necessary to assume there might be a cause-effect relationship between a particular variable A and a specific illness? Select all that apply.

It is easy to understand how the variable A could lead to the illness, Research studies consistently demonstrate a relationship between variable A and the illness, The more of variable A present, the sicker the person becomes. There are six criteria for assuming possible causation including strength of the association, dose-response relationship, temporarily correct relationship, biological plausibility, consistency among studies, and specificity. Only the "easy-to-understand," consistent research studies and the increased dose leading to increased illness are consistent with those six criteria.

23. How is "health literacy" operationally defined in the United States?

Knowing how to access and use information to make health decisions Literacy as a whole is typically defined as being able to read and write at the fifth-grade level. Health literacy, however, is defined as being able to access, understand, and use information to make health decisions. Only the latter type of literacy empowers clients to best act on their own behalf.

15. What characteristics of the nurse are crucial to success when nursing in the community?

Listening and showing respect Rather than nursing to the community, to be successful the nurse must work with the community. Listening, being patient, providing accurate information, and respecting the experiences of community members are essential for success.

15. What is the most crucial skill for a nurse teaching diabetic self-care in a small group?

Listening carefully to understand participants' issues Listening is the first phase and is essential to understanding the issues.

14. How do public health efforts differ from medical efforts in improving the health of our citizens?

Medical care providers focus on disease diagnosis and management, whereas public health care providers focus on health promotion and disease prevention. Medical care providers are restricted by insurance and government regulations. Providers may also be employed in government such as veterans administration facilities. However, medical care providers primarily focus on diagnosis and treatment of disease, whereas public health care providers try to promote health and prevent disease. Although medical care providers primarily focus on individuals and public health care providers primarily focus on aggregates, their practice is not limited to only individuals or only aggregates.

8. Because people respond to incentives, how has having health insurance affected lifestyle behaviors?

Medications and medical treatment are relied on for cure. Funding for behavioral changes is limited, inadequate, or unavailable. Weight loss programs or smoking cessation programs are not reimbursable treatment regimens, although more expensive pharmaceutical interventions are reimbursable. Therefore, it is financially wise not to worry until illness strikes because illness care is reimbursable, whereas preventive health care is not.

22. A new public health nurse carefully assessed all the local mortality and morbidity data in preparation for making appropriate planning suggestions at a meeting next week. What other action is crucial before the nurse can feel prepared?

Meet members of the community to determine their culture and values Community health nurses must work with the community. It is essential to assess an aggregate's needs and resources and identify its values.

7. A community health nurse determined that the number one priority was to help families in which one member had diabetes. Which decision would be best to maximize services to persons with diabetes?

Meet with the diabetic organization to see how the public health department can augment what it is offering. The nurse should augment existing resources or create a new service rather than duplicate what is already available to the aggregate. It is assumed that if the nurse has concluded that diabetic issues are the number one priority, there is no pressing need to ask specific questions of friends with diabetes.

2. What is the reason nurses are encouraged to get involved in discussions about our health care system?

Nurses are the largest group of health care providers. As the largest group of health care providers, nurses are informed about the current health care system and all the problems that result from people not seeking care until they are desperately ill. Nurses, as the American Nurses Association (ANA) emphasizes, usually believe that health care is a right, not a privilege. Therefore nurses, whose work is central to our current health care delivery system, can also be instrumental in working politically to create a health care delivery system that will meet health needs. While nurses are in several current TV series and are employed both inside and outside of hospitals, physicians and other health care providers are as well. Nurses are often managers, but managers often have other backgrounds, such as business administration.

1. What were the major concepts recognized through the 1950s that Lillian Wald emphasized as nursing responsibilities? Select all that apply.

Nurses should help the local community mobilize to solve their local problems, Nurses should improve environmental conditions that foster disease, Nurses should always treat the poor and vulnerable. Lillian Wald's concepts included mobilizing communities to solve local problems, treating the poor, and improving the environmental conditions that foster disease. The idea that anyone working outside the hospital is a community health nurse is very recent. Nurses serving as primary care providers is also a relatively recent trend. Clients do not join agencies; rather, agencies serve clients.

1. What did Lillian Wald suggest in regard to giving care to individuals and families?

Nurses should recognize the larger social and economic forces that the family cannot control. Wald emphasized that one could not understand an individual without understanding the family, and the family is in the grip of larger social and economic forces that they cannot control.

13. What must be created before establishing the evaluation plan to determine the success (or lack of) for a health project?

Observable and measurable objectives Goals are generally what is desired, while observable and measurable objectives are used to determine whether or not the goal was achieved and whether the project was successful.

22. What did physicians do to compete with new competition from health maintenance organizations (HMOs)?

Organized preferred provider organizations (PPOs) to negotiate with insurance companies In an effort to compete with HMOs, physicians and hospitals organized the independent practice model, which provided services to enrollees of one insurance company. This model evolved into the PPO, which offered services at a reduced rate in exchange for a guaranteed increase in consumers.

1. What is the primary reason that Americans are so concerned about health care?

Our national health care costs keep increasing. Although politicians and media do continue to discuss our health care system and people worry about the uninsured, the primary reason for the focus on health care is the constantly increasing costs, which cannot be sustained. Families worry they cannot afford care; politicians and media discuss the problem, as easy answers seem elusive

10. Which groups of persons are more likely to engage in health-oriented lifestyle behaviors?

People with higher socioeconomic and education attainment Resistance to behavior change remains high among minorities and those of lower socioeconomic status and lower educational levels. Interest in health education, health promotion, and behavioral change has increased, particularly among those of higher socioeconomic and education attainment.

14. During a health history, the client looked confused and said, "But everybody drinks, like at parties and such. How much drinking do you think is too much?" How should the nurse respond?

Per day, no more than one drink for women and two drinks for men. Because most Americans drink alcohol, it is probably not effective to teach total abstinence. Alcohol in moderation is not a specific answer to the client's question. The Dietary Guidelines suggest no more than one drink for women and two drinks for men per day, which is a specific response to the client's question.

11. Which factor is the main determinant of behavior within the Health Belief Model?

Perceived benefits of engaging in healthy behaviors Although all the factors are included in the model, the factor of perceived benefits was found to be the most powerful predictive element within the model, whereas perceived severity of the health threat had the lowest value.

12. What is a factor found in the Health Belief Model (HBM) that is not a factor in Pender's Health Promotion Model (HPM)?

Personal threat as motivator Pender's Health Promotion Model is a competence or approach-oriented model and, unlike the HBM, does not rely on personal threat as a motivating factor. Both attempt to explain behavior, based on individual perceptions, and both include self-efficacy as a factor. (Although the HBM did not originally have this concept, it was added in the revised model.)

1. With what tool(s) did Florence Nightingale create change? Select all that apply.

Political advocacy, Publication of treated soldiers' death rate change from 42% to 2%, Use of statistics to demonstrate the effectiveness of her interventions Nightingale focused on the aggregate of British soldiers and used graphically depicted statistics and other data to demonstrate effectiveness of her interventions, which allowed her to become a political advocate on behalf of the soldiers.

23. Why are high-risk and vulnerable subpopulations identified by public health nurses before deciding on appropriate interventions?

Populations are not homogeneous, and resources are limited. Populations are not all the same. The needs of subpopulations must be assessed. The high-risk and vulnerable subpopulations must be identified early. Those individuals who do not receive service early become very expensive high-cost users later.

27. How might providers legally improve their profit under the current reimbursement process?

Practice very conservatively to earn an incentive payment by delivering care for less cost than allocated As a reward for conservative medical practices, health care providers may receive a specified amount of money or a percentage of the agreed reimbursement if services are delivered below the limit set by the third-party payer.

23. A researcher, interested in the onset of early menses, compared the life experiences and history of 1000 14-year-old girls, half of whom had monthly periods and half of whom did not, to determine what variables might be observed. How would this study be categorized?

Retrospective study When a study looks at individuals with a particular condition in comparison with those who do not have the disease, based on their exposures to various life situations, it is a retrospective study; that is, the study requires participants to look back at previous experiences.

8. A student's assignment was to determine the needs of a selected aggregate. Eight percent of the aggregate have diabetes. How should the student determine whether that should be a priority?

Review the literature to determine the national and state diabetic rate A rate by itself is meaningless unless compared with previous trends (although the instructor or the head of the local public health department may or may not know that particular piece of information) or with state or national norms. The easiest way to find those norms would be to check the literature to determine the typical incidence in a similar environment or community. The literature review could include research reports and statistics that will help determine whether this finding represents a priority for this aggregate.

19. A community health nurse is overwhelmed with all that needs to be done in one day. Which task could most easily be postponed?

Reviewing the most recent hospital patient data collected by the local college of nursing All of the tasks are related to assessing needs, implementing new care options, or evaluating health outcomes measures in the community except reviewing hospital patient data. Hospital patient data may be helpful but not directly related to the agency's ability to promote primary health and prevent disease.

12. How did Nightingale respond to some powerful leaders challenging her suggestions for reform of health care beyond the military war arena?

She conveyed her statistical data in more detail and depth and shared it with political leaders. Nightingale felt very strongly about the unnecessary loss of life and shared her findings widely. When prominent male leaders challenged her conclusions, she rewrote her report in more depth and redistributed it to members of Parliament and military leaders.

3. What conclusion can be drawn from examining where nurses are employed?

There is an increased emphasis on community-based health care. MCOs are employing nurses in many capacities. While hospitals are closing and acute care is increasingly found in central medical centers, an equal trend may be seen in an increase in neighborhood-based practice centers. While positions are cut in most industries, health care is recognized as an area where growth in employment is expected. However, nurses are increasingly employed in community settings as opposed to hospitals. This change reflects the move toward community-based care rather than hospital-based tertiary care. To help decrease the continued rise in health care costs, the increased emphasis is on disease prevention rather than high-cost treatment.

13. Why would a public health nurse want to know about morbidity and mortality statistics on the local, state, and national level?

To be able to observe the community's statistics over time and compare the community with other communities Although being informed is always preferred and nurses often do have to justify budgets, data are needed to compare the local community with itself over time and with other communities so that problems may be recognized and action taken to confront health issues. The first step is always to recognize problems as they develop.

29. Why should nurses be knowledgeable about health care funding?

To better serve as patient advocates in policy making for funding that provides appropriate care for the greatest good Increasing knowledge of health care funding and policy making will empower nurses to advocate for the type of funding that provides appropriate care to obtain the greatest good. Nurses need to utilize their political power. Nurses must advocate for health promotion disease prevention funding.

5. The nurse working with a client to change behavior to maximize health asked the client to bring his family to the next visit. Why would the nurse want the family to come with the client?

To evaluate whether the family members approve of the proposed changes Under the Theory of Reasoned Action, it is assumed that all behavior is determined by intentions, which are determined by attitude toward the behavior and the norms associated with the behavior. That in turn is determined by whether or not important persons approve or disapprove of the behavior.

4. Why is it so important to discover all the variables that may be involved in creating a disease state in some persons?

To find variables susceptible to prevention or early intervention. Identifying risk factors is critical to creating or discovering specific prevention and intervention approaches that reduce chronic disease morbidity and mortality. Because some risk factors cannot be avoided, knowing other risk factors involved allows for more possibilities of preventing the problem.

13. What is the primary purpose of both the HBM and HPM models?

To help explain why individuals do or do not engage in health actions The models are meant to provide an organizing framework to explain why individuals engage in health actions. Therefore, they are also useful in assessing patients' motivations and explaining their behavior.

19. A very busy day was planned at a community health fair. Why would a nurse spend time greeting and meeting each new person who walked in?

To immediately establish a friendly relationship and a level of trust The core of health education is the therapeutic and healing relationship between the nurse and clients. Inclusion and trust must be established before creating change. The nurse enhances inclusion by greeting clients on arrival in a warm fashion.

18. What was the primary purpose of the Heart Disease, Cancer, and Stroke Amendments of 1965?

To increase the availability of high technology in health care Its purpose was to make the latest technology for the diagnosis and treatment of heart disease, cancer, stroke, and related diseases available to community health care providers through the establishment of regional cooperative arrangements.

4. Why did employers decide to offer health insurance as an employee benefit?

To obtain and retain the limited number of persons available to work when government rules forbid raising wages, insurance was offered. The idea of paying a small fee for guaranteed health care to have sickness cured was very popular. Health care providers liked knowing they would receive payment for their services. During World War II, faced with a limited workforce and governmental restrictions on wages, employers began to see health insurance as a means of supplying workers' benefits without granting a wage increase.

Which of the following best describes the most crucial step in policy formation? a. Convincing both political parties and independents to support the proposed policy b. Defining the issue and placing it on the agenda for possible action c. Determining who has vested interest in what aspects of the policy d. Trying to simplify the proposed legislation so the public will support it

b. Defining the issue and placing it on the agenda for possible action How an issue is defined determines what the possible approaches to resolution might be. With all the demands on legislators' time, it is difficult for an issue to be seen as important enough to have action taken. Defining the issue as crucially important and worthy of a place on the agenda for possible action is the most critical step.