Community Health Midterm

Legislation (law) and Regulation

Legislation is law that comes from the legislative branches of federal, state, or local government. Much legislation has an effect on nursing. Regulations are specific statements of law related to defining or implanting individual pieces of legislation. Board of Nursing Nurse Practice Act

Health Policy

Is a set course of action to obtain a desired health outcome, for an individual, family, group, community, or society.

A nurse orienting to the home health role states, "I don't understand why we have to collaborate with so many other disciplines. Doesn't this conflict with the concept of nurses engaging in holistic nursing practice?" What would be the best response?

"The nurse still functions holistically; however, interdisciplinary collaboration is necessary to prevent fragmentation of care."

A school nurses primary prevention efforts do what?

- Access children and families to determine their level of knowledge about health issues - Find out whether children are at risk for preventable problems - Analyze the assessment findings - Make plans to develop teachingoplans or health promotion activities - Implement the health promotion activities - Evaluate and revise health promotion plans

The immunization/vaccination records of all children in a school, that are kept by the school nurse, must have what in them?

- Name of Student - Date of birth - Address - Telephone number - Parent'/guardians' names - Contact infrmation - Primary health care providers name, telephone number and address - All the vaccinations with teh dates the child received booster shots

A primary independent function of the parishnurses is that of personal health counseling which discusses ?

- health risk appraisals - Spiritual assessments - Plans for healthier lifestyles - Support and guidance related to numerous acute and chronic actual and potential health problems

What do demographic figures suggest about the ways in which the population of the United States is changing? Select all that apply

Approximately 12% of the U.S. population was born in a different country Hispanics are the largest minority group population Mortality for both genders in all age-groups declined.

A major portion of a construction project has collapsed. The emergency department (ED) has been notified that numerous victims are being transported to the ED. What should be the first action of the ED nurse?

Assess department for resources-staff, beds, equipment.

incidence rate calculated for a particular population for a single disease outbreak; expressed as a percentage

Attack rate

A community health nurse is working with an uninsured family with two children. The nurse assists the parents in applying for SCHIP benefits and securing an appointment for the children with a community pediatrician that participates in SCHIP. The intervention can best be described as: a. care management. b. case management. c. continuity of care. d. disease management.

B

A community is experiencing the Honeymoon phase following a disaster. Which of the following is most likely to occur in the community? A. First responders work tirelessly to save others B. Survivors share their stories C. Medical personnel experience exhaustion D. Community organizations rebuild the community

B

A nurse is using a case management plan to maximize patient care outcomes. Which of the following describes an important consideration that should be made by the nurse? a. Case management plans should be used only by nurses to manage care. b. Case management plans should be individualized for each client. c. Case managements plans provide additional expense to the client and family. d. Case management plans focus on the natural progression of the disease.

B

A case manager implements a primary prevention activity. Which of the following actions would the nurse most likely complete? a. Advocating for the client whose values conflict with those of the medical service provider b. Collaborating between nursing and occupational health personnel c. Educating a group regarding community services that are available if ever needed d. Resolving conflict between a primary care clinic and a tertiary health care facility

C

A community health nurse has invited several agencies in the community to a meeting to discuss the disaster plan for the community. Which of the following best describes the purpose of this meeting? A. To increase stability in the community B. To improve overall community functioning C. To manage response to disasters in the community D. To enhance communication among agencies in the community

C

A nurse is assessing persons arriving at a shelter following a disaster. Which of the following would be the first action the nurse should take? A. Limit the amount of equipment and medications brought into the shelter. B. Determine if the person has a psychological condition requiring special attention. C. Assess if this type of facility is appropriate for the person. D. Provide medical care for persons as if they were in a hospital.

C

What is the purpose of the National Response Framework? A. Create a new branch of government that deals with bioterrorism B. Establish a way for the Red Cross to carry out its mission C. Develop a nationwide all-hazards approach to domestic incident management D. Extend presidential power to act quickly upon weapons of mass destruction

C

Which of the following Medicaid clients would most likely receive case management? a. An elderly person b. A person receiving rehabilitation following an injury c. A person who has a high-cost chronic disease d. A person with acute illness

C

Which of the following older adults is most in need of psychological support? A. The older adult who keeps asking if loans will be available for him to rebuild B. The older adult who keeps asking if he can go back home yet C. The older adult who keeps lamenting the loss of his family photos D. The older adult who keeps talking about how expensive his home theater was and how he will never be able to afford to replace it

C

number of deaths in given year from all causes, divided by midyear population

Crude death rate

Which of the following best describes the goal or priority of the nurse advocate? a. To gain organizational and governmental support for the promotion of nursing objectives b. To improve community service needs identified by research findings c. To integrate evidence-based practice guidelines in the provision of community nursing service d. To promote the client's rights and self-determination

D

Federal Non-Health Agencies

Department of Defense Department of Labor Department of Agriculture Department of Justice

Measures burden of disease

Disability adjusted life years

Research demonstrates that exercise is important for general wellness and weight control. How might the school nurse use this information to implement primary prevention?

Drafting policy for increases in noncompetitive physical activity programs

It is the job of the school nurse to teach teenagers about the dangers of all?

Drugs

The school health nurse is interested in promoting safety in the high school population. In planning safety education for this age group and their parents, the nurse would recognize the need to address which developmental risk factor for adolescents?

Feelings of immortality related to perception of being invulnerable to risks that affect others

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

Gonorrhea is not a reportable condition.

Public protection:

Government has authority to protect the public's health; CDC, state health departments, Supreme Court rulings

The nurse has completed a summative evaluation of a program designed to decrease obesity in school-aged children, of the following statements, which best represents summative evaluation?

Has obesity in school-aged children decreased

The eight parts of the CDC school health program are:

Health Education Physical Education Health services Nutrition services Counseling and psychological and social services Healthy school environment Health promotion for staff Family and community involvement

What is the preferred public health approach to avoid premature deaths in America?

Influencing Americans' lifestyle behavior choices

Executive

U.S. Department of Health and Human Services (USDHHS) Enforces

Feminists

Women and men who hold a worldview advocating economic, social , and political atatus for women that is equivalent to that of men.

Numbers of years lost when death occurs before one's life expectancy. Subtract person's age at death from life expectancy

Years of potential life lost

The state board of nursing can write regulations to clarify in a more concrete manner what the nurse practice act allows and requires. What type of effect do these regulations have on the individual nurse?

Major, since these rules and regulations have the effect of law and must be obeyed

Ethical decision making

Making decisions within an orderly framework that considers context, ethical approaches, client values, and professional obligations.

Which of the following statements are accurate descriptions of current social and economic trends in the United States? Select all that apply.

Many families are seeing decreases in family income Massive and unexpected social and economic changes have occurred.

Summaries of records of major life events including birth, death, marriage, and divorce. Published by National Center for Health Statistics under the CDC

Monthly Vital Statistics Report

Code of ethics

Moral standards that specify a professions values, goals, and obligations

Most reliable measure of population health status

Mortality statistics

infectious diseases in which health officials request or require reporting; can become epidemics

Notifiable disease

a blank treatment

Placebo

What are some diseases responsible for the fall of classical civilizations of Greece and Rome?

Plague, yellow fever, cholera

Can be used to calculate incubation period - period of time between exposure to an infectious agent and onset of symptoms

Single epidemic curves

Public health nursing is a specialty because: a.It has a distinct focus and scope of practice. b.It must be done by a registered nurse with a master's degree. c.It is focused on disadvantaged citizens. d.It performs interventions at the acute care level.

a. It has a distinct focus and scope of practice.

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? 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

A widely recognized chemical health hazard in health care environments is which of the following? a. Burn-out b. Latex allergy c. Radiation d. Viruses

b

An occupational health nurse is working with the manager to change the assignment of an employee from working with heavy metal to using machinery to assist with loading and unloading boxes at the truck dock. Which of the following best explains the rationale for this change? a. To prevent injury b. To limit disability c. To provide primary prevention d. To provide tertiary prevention

b

An occupational health nurse periodically conducts spirometry testing of employees who work around hazardous gases. Which of the following levels of prevention is being implemented? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Tertiary care prevention

b

During a recent heat advisory, baggage handlers at the local airport were placed on a 1-hour shift rotation. This work-health interaction demonstrates the theoretical application of which of the following? a. Aggregate populations b. Epidemiologic model c. Host risk factor d. Occupational exposure

b

Following the attacks of 9/11, a nurse practitioner in a family clinic used opportunities at the clinic staff meetings to speak about her own feelings of loss and guilt. This strategy indicates that the nurse was aware of what phenomenon related to disasters? a. Anxiety b. Effects of stress on individuals c. Sense of urgency d. Scapegoating and blaming

b

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? a. Prospective study b. Experimental study b. Cross-sectional study c. Retrospective study

b. Experimental study

How can the school nurse help prevent violent actions by children/students?

by teaching teachers and students the six characteristics that point out a student who is at risk to commit drastic violent acts and by providing follow up on children/students who need help.

In the school setting school nurses must carry out what skills often?

catheterizations, suctioning, gastrostomy feedings, and other skills in schools

refers to a group exposed to a common noxious influence such as the release of noxious gases (e.g., ricin in the Japanese subway system several years ago and more recently in a water system in the United States)

common source

holistic health centers

comprehensive health teams that include family and clergy and encourage personal responsibility for health and preventive health practices

The nurse who conducts vision screenings on children in the school setting is practicing _____ nursing practice. a.Community-oriented b.Public health c.Community health d.Community-based

d. Community-based

if there is a persistent (usual) presence with a low to moderate number of cases of the disease or event. The endemic levels of a disease or an event in a population provide the baseline for establishing a public health pr

endemic

means that the occurrence of a disease within an area is clearly in excess of expected levels (endemic) for a given time period.

epidemic

The parish nurse partners with the wellness committee and volunteers to plan programs and consider health-related concerns withing what?

faith communiies

pastoral care staff

faith community leaders including clergy, nurses, and educational and youth ministry staff

PL 93-112 Section 504 of the Rehabilitation Act of 1973

federal law requiring services for persons with handicaps

The goal of the AAP standards/recommendations for school nurses is?

for children to obtain complete health care in the schools

Getting what information to the parents of the children is often a challenge for teh school nurse?

health promotion

in a population implies a highly prevalent problem that is commonly acquired early in life. The prevalence of this problem decreases as age increases

holoendemic

Parish nurses carry out their practice in groups or individually and make visits to?

homes, hospitals and nursing homes

Persons assulted with physical and emotional illness and brokenness that are able to call upon their faith beliefs and religious traditons are better able to do what?

increase their coping skills and realize spiritual growth

In the early 1900's school nurses did screenings for what in school children?

infectious diseases

Additional legal concerns for the parish nurse are?

institutional contractual agreements Records manaagement release of infromation volunteer liability

a good example of a process in place to detect morbidity data is

national program of cancer registries

refers to the epidemic spread of the problem over several countries or continents (e.g., severe acute respiratory syndro

pandemic

institutional model

parish nurse arrangement in a larger partnership undr contract with hospitals, medical centers, long-term care facilities, or educational institutions

congreational model

parish nurse arrangement in an individual community of aith in which the nurs is accountable to the congregation and its governing body

do-not-resuscitate (DNR) orders

physcians orders to not medically intervene when deathis about to occur

individualized education plans (IEPs)

plans to decide educational accommodations for disabled children

healing

strengthening the inner spiritual connectedness and choosing healthy lifestyles

School Nurses assess school playgrounds for equipment safety on what basis?

the U.S. consumer Product Safety Commission guidelines

Legal resources for the arish nurse or faith community nurse include:

the faith community's legal consultant the faith community's national position statements statements of the HMA and IPNRC

15. A nurse is assessing the status of a communitys health. Which of the following will the nurse examine? a. Community awareness b. Health facilities c. Health care manpower d. Vital statistics

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

PL 105-17 Individuals With Disabilities Education Act (IDEA)

educational services that must be provided for disabled children from birth through age 22

foodborne botulism in Alaska.

endemic

How often should a crisis plan be updated?

every year

congregants

people who gather as part of faith community of the congregation of a church

consultant

someone who provides professional advice, services, or infromation

problems are those with an irregular pattern with occasional cases found at irregular intervals.

sporadic

polity

the policy, governances, expectations, and mission of a specific faith community

Ethical dilemmas in schools are related to?

women's health care and religious beliefs of the students or nurses

The family of a client diagnosed with terminal cancer has been informed the client is not expected to live more than 2 months. Which statement made by a family member indicates to the nurse that the family understands the client's prognosis?

"Hospice nurses are going to help care for him to make him more comfortable."

Why learn about government?

- Community nurses must be especially aware of the impact of government, law, and health policy on nursing, health, and the communities in which they practice. - Knowing how government, law, and political action have changed over time is necessary to understand how the health care system has been shaped by these factors. - Nurses are advocates for the health of the population.

30. 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

Government Health Care Functions

- Direct services: - Financing - Information - Policy setting - Public protection

What does the State say?

- Every state has its own board - State tells the nurses what they can do

What are the three branches of the government?

- Executive - Legislative - Judicial

When dealing with IEPs the nurses responsibilities include?

- Havinginformation about the child's medications to be given during school hours - Knowing if the child needs any therapy during the school day,, such as physical or occupational therapy - Knowing if the child has hearing or vision problem - asking the teacher to seat the child in best place in the classroom so the child can better see or hear the teacher

Children seek out a school nurse for what different needs?

- Headaches - Stomaches - Diarrhea - Anxiety over being separated from the parents - cuts, bruises, or other injuries

At least how many different staff memebers must be identified as responsible for determining if emergency care is needed?

2

Which of these public health nurse applicants is the least qualified for a position of case manager in a rural county?

A 34-year-old who will be moving from a large city

A child came to school coughing almost constantly. The next day, six other children in the same school room were coughing. What type of outbreak is this?

A common source outbreak

Health care costs are influenced by factors related to demographic changes, new technology, resource intensity, and: A. chronic illness. B. market practices. C. nursing shortages. D. professional competition.

A. chronic illness.

12. A nurse who is explaining to a client why it is important to take medication states, The medication takes a couple of weeks to be effective, but then you should feel better. When the client is next seen, no medication has been purchased. Which of the following is the most likely explanation? a. The nurse emphasized that eventually the client would feel better, but the client needed to feel better immediately so didnt bother with the drug. b. The medication required a trip to the pharmacy, and the client just hadnt had time to obtain the drug yet. c. The medication was too expensive for the clients family. d. The client really hadnt understood why the medication was important.

ANS: A Although any of the answers given is possible, if we look closely at what the nurse stated, there may have been a cultural disconnect based on time orientation. Many nurses are future oriented, whereas many families may place greater value on quality of life and view present time as being more important. When nurses discuss health promotion and disease prevention strategies with persons from a present orientation, they should focus on the immediate benefits these clients would gain rather than emphasizing future outcomes.

11. A city has announced its plans to build a city dump near a community of poor and predominantly African-American citizens. Which of the following principles would the nurse be using when vocalizing opposition for this plan? a. Environmental justice b. Equal rights c. Primary prevention d. Risk protection

ANS: A Environmental justice is the goal of campaigns seeking to improve the unequal burden of environmental risks borne by impoverished and minority communities. The Environmental Justice Act would be used in support of the nurses position.

An occupational health nurse maintains a log of injuries from contaminated sharps because of the: a. Bloodborne Pathogen Standard b. Occupational Safety and Health Administration (OSHA) c. Department of Labor (DOL) d. Department of Defense (DOD)

ANS: A OSHA is part of the Department of Labor. The Bloodborne Pathogen Standard became effective in 2002.

A nurse discusses with legislators the importance of passing legislation to ban smoking in all public places. This demonstrates the nurses involvement in: a. Policy b. Politics c. Law d. Health policy

ANS: A Politics is the art of influencing others to accept a specific course of action. Therefore political activities are used to arrive at a course of action (the policy).

The agency most heavily involved with the health and welfare concerns of United States citizens is the: a. Unites States Department of Health and Human Services (DHHS) b. Public Health Service c. Health Resources and Services Administration d. World Health Organization

ANS: A The DHHS is the agency most heavily involved with the health and welfare of United States citizens. It touches more lives than any other federal agency.

Congress's legal base for actions in health care include (select all that apply): a. Providing for the general welfare b. Raising funds to support research c. Regulating commerce among the states d. Providing spending power

ANS: A, B, C, D The legal base for actions in health care includes providing for the general welfare, regulating commerce among the states, providing spending power, and raising funds to support the military.

3. A nurse is assessing potential environmental health risks in the community. Which of the following would be the first step that the nurse should take? a. Conduct health risk assessments of randomly selected individuals b. Perform a windshield survey c. Review facility permits and consumer confidence reports d. Survey community members

ANS: B Conducting a windshield survey is a useful first step to understanding potential environmental health risks. This provides first-hand information about the community and areas of concern that must be investigated.

5. A nurse is using the technique of motivational interviewing when working with a client. Which of the following statements by the client indicates the client is ready to make the change? a. I should change. b. I am willing to change. c. Its important to change. d. I want to change.

ANS: B Motivational interviewing uses the term change talk to refer to statements by the client that he or she is motivated and willing to make change. An easy to use mnemonic is DARN-CAT which refers to desire, ability, reason, need, activation, commitment, and taking steps. I am willing to change demonstrates activation, a client who is ready, prepared, and willing to make the change. The other statements refer to the client who is preparing to make the change, but not yet ready to implement the change.

Which of the following groups is pressuring clinicians the most to use evidence-based practice (EBP)? a. Administrators b. Insurance companies c. Nurses d. Physicians

ANS: B Much of the pressure to use evidence-based practice comes from third-party payers and is a response to the need to contain costs and reduce legal liability.

A doctoral prepared nurse (PhD) at a university wants to submit a grant to study the impact of a nursing activity on patient outcomes. From which federal agency could this nurse potentially seek funding? a. Centers for Disease Control and Prevention (CDC) b. National Institute of Nursing Research (NINR) c. Department of Health and Human Services (DHHS) d. World Health Organization (WHO)

ANS: B NINR funds the development of the knowledge base of nursing and promotion of nursing services in health care.

When planning, delivering, and financing responsibility for programs is shifted from the federal level to the state level, it is called: a. Evolution b. Devolution c. Block granting d. State administration

ANS: B The process of shifting the responsibility for planning, delivering, and financing programs from the federal level to the states is called devolution. This was a major effort during the Reagan administration.

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

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

Incidence rate in important in the study of

Acute diseases

used to make comparisons of relative risks across groups and over time when groups differ in age structure

Age-adjusted rates

Virtue ethics

Asks "What kind of person should I be?" and purports that people should be allowed to flourish as human beings.

5. A key characteristic of faith community nursing services is to facilitate collaborative health ministries in the faith communities by: embracing individuals across the life span. respecting diverse traditions of faith. requiring statements of faith. using a Judeo-Christian theological framework.

B The faith community nurse incorporates faith and health and employs the nursing process in providing services to the faith community as well as to the community served by the faith community. Facilitating collaborative health ministries in the faith communities is an important component of the practice. While the curricula of faith community nursing practice stem from a Judeo-Christian theological framework, parish nursing respects diverse traditions of faith communities and encourages adaptation of the programs to these faith traditions. DIF: Cognitive Level: Knowledge REF: Pages 540-541

Ethic of care

Belief in the morality of responsibility in relationships that emphasize connection and caring.

Ethics

Branch of philosophy that includes both a body of knowledge about the moral lif and a process of reflection for determining hat persons ought to do or be, regarding this life.

The 2 staff members who are identified as responsible to determine if emergency care is needed should be educated by whom in what?

By teh School Nurse in first aid techniques

Of the following educational objectives, which example best meets all necessary criteria for a well-written objective?

By the end of the class, 80% of children in the course will correctly identify two vegetables on a page of food pictures

Which of the following organizations would direct nurses' response to a county-wide disaster? A. American Red Cross B. Centers for Disease Control and Prevention C. Emergency Management Agency D. The local public health department

C

If a small business employer desires to control company benefit expenditures by turning health care decision-making control over to the employees, the insurance reform effort that best addresses the shifting of responsibility, knowledge, and decision-making involvement to the individual receiving the care would be: A. health spending accounts (HSA). B. managed care. C. medical savings account (MSA). D. prospective payment.

C. medical savings account (MSA).

The 1989 changes to Medicaid required states to provide care for children younger than 6 years and to pregnant women under 133% of the poverty level. These changes also ensured adequate access to qualified providers by: A. adding coverage for the medically indigent. B. reimbursing early periodic screening, diagnosis, and treatment (EPSDT) for those younger than 21 years. C. reimbursing pediatric and family nurse practitioners. D. reimbursing skilled and intermediate nursing home care.

C. reimbursing pediatric and family nurse practitioners.

Measures death rate for a specific disease

Cause-specific mortality rate

Information

Centers for Disease Control and prevention (CDC)

Prevalence rate is useful in the study of

Chronic diseases

Based on research, what is the best way to increase the number of persons who come to their screening test appointments?

Client reminders via telephone, e-mail, or mail

Group of people who share important demographic characteristics

Cohort

classified by exposure to one or more risk factors and observed to determine rate of disease development

Cohort studies

After World War II, as the number of chldren with communicable diseases decreased due to immunizations and antibiotic use, the School Nurses turned their attention to screening children for what?

Common Health problems, vision and hearing,

A school health nurse plans to use evidence-based practice (EBP) to guide the development of health education programs most likely to increase retention of learning in elementary school children. What may be the best way to use EBP in this situation?

Compare and contrast randomized clinical trials related to learning in elementary school children.

Rates allow for

Comparison of outbreaks at different times or in different places

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

Cases were exposes to a common source over time

Continuous source epidemic curve

Epidemiologists are concerned with

Course of disease in a population

Measures referring to the total population; they are not specific to any age groups or disease categories.

Crude rates

A health care provider is concerned about the high number of clients with type 2 diabetes mellitus who have poor glucose control. What would be the best reference for the provider to implement evidence-based practice (EBP) in the management of this problem?

Current research findings

A case manager is concerned that some of the clients at the neighborhood clinic are getting fewer services because of their financial situations. The case manager is confronting the ethical principle of: a. justice. b. veracity. c. deontology. d. beneficence.

D

A nurse is employed by the American Red Cross and is frequently assigned to fly to a disaster zone. Which of the following should the nurse's family members have readily available? A. Gloves, mask, and other personal protective equipment B. A copy of the nurse's professional license C. A 5-day supply of water D. A disaster/emergency plan

D

A nurse learns about a huge disaster a few states away. Which of the following actions by the nurse would be most helpful in this situation? A. Contributing funds to any charity that is assisting the victims B. Driving over to the area and volunteering to assist C. Sending clothes and food to the area for distribution D. Training to become a Red Cross disaster volunteer

D

6. The future of school nursing is very strong and will be further enhanced by the future trend in which of the following? Development of an HIV/AIDS health curriculum Enhanced use of picture boards Improving the air quality of school buildings Telehealth and telecounseling

D The amount of health care being given in the schools is increasing. In the future, school nursing will use telehealth and telecounseling to teach health education. School nurses will use the Internet to work with children and parents. The school nurse is responsible for keeping up with the latest changes in health care and health practice so that the health of children in the schools can be enhanced by new trends in health care. DIF: Cognitive Level: Knowledge REF: Page 581

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

Describe epidemics with respect to person, place, and time

Descriptive studies

What is the most crucial aspect in minimizing the damage from a bio-terrorism attack?

Detecting an increase in people with similar signs and symptoms

A nurse who works for a hospital in employee health notes that several nurses from one unit have missed work after contracting a communicable disease from a patient. In this scenario, the host is which of the following?

Each sick nurse

Each state has....

Each state has a Board of Nursing created by legislation called the Nurse Practice Act - Approves schools of nursing; sets educational requirements - Examination and licensure of RNs and LPNs - Defines professional practice and legal titles - Outlines Scope of Practice

Deontolgy

Ethical theory that bases moral obligation on duty and claims that actions are obligatory irrespective of the good or bad consequences that they produce.

What is the relationship between ethics and a community health nursing practice?

Ethics is constantly involved in nurses' clinical decisions

Number of years of healthy life expected, on average, in a given population or region of the world

Health adjusted life expectancy

Of the four main factors that affect health, which is the least important?

Health care system

HP 2010

Healthy People 2010 focused on a vision of healthy people living in healthy communities

HP 2020

Healthy People 2020 has four overarching goals.

Concepts of epidemiology date back to

Hippocrates, 300 B.C.

A committee of health care professionals would like to establish a countywide program to improve Hispanic immigrant access to culturally competent health care services. Which person might be most helpful as a key informant?

Hispanic community leader

A 90-yearl old client expresses a wish to die at home after being told that an esophageal stricture prevents swallowing. The client refuses a feeding tube. The family fully supports this decision. What would be the most appropriate resource for the nurse to call?

Hospice care

A nurse is investigating bacteria that have caused a health problem in the community. Only some of the people exposed to the bacteria have become ill. What could account for this?

Host factors

Values

Ideas f life, customs, and way sof behaving that members of a society regard as desireable.

What are some types of morbidity rates?

Incidence rate, attack rate, prevalence rate

Which action would be most helpful for the nurse executive to implement evidence-based practice at a community nursing center that serves a large Cuban immigrant population?

Include Cuban immigrants from the community on the center's advisory board

In what way is nursing in the community more challenging than nursing in an acute care setting?

It is more challenging to control the environment in the community

A man says, "I just can't get myself to leave the house and go for a 30-minute walk each day. I wish I could think of some way to motivate myself." An effective measure by the nurse would be to suggest that the man:

Join a group that walks early each morning

Judicial and Common Law

Judicial law is based on court or jury decisions. Case law is the opinions of the court

Feminist ethics

Knowledge and critique of classical ethical theories developed by men and women; entails knowledge about the social, cultural, political, economic, environmental, and professional contexts that insidiously and overtly oppress women as individuals, or within a family, group, community, or society.

How does the government inadvertently encourage low-income persons to use emergency departments as their primary care provider?

Legally, emergency departments must see clients even if clients can't pay.

Average number of years a person from a specific cohort is projected to live from a given point in time

Life expectancy

What single factor is most closely correlated with poor health?

Low socioeconomic status

Public health nurses have been activated to open a shelter due to an approaching hurricane. What most important items should families be encouraged to take to the emergency shelter?

Medication and vital records

______ _________ are often the only source of health-related data available for small geographic areas.

Mortality Data

Birth, deaths, and diseases are reported to the CDC via

National Electronic Telecommunications System

What are some National Health Surveys?

National Health Interview Survey, National Health and Nutrition Examination Survey, and Behavioral Risk Factor Surveillance System, National Health Care Survey

Deontology

Nurses may conclude that the ation is right or wrong in itself, regardless of the aomunt of good that might come from it. Adhereing to moral rules or duty rather than to the consequences of the actions.

The Nurse's Role in the Policy Process

Nurses need to be involved in the policy process & understanding the importance of involvement in nursing to the clients they save

investigator observes natural course of events, noting exposed vs. unexposed and disease development

Observational studies

This year 600 of 8000 young women ages 17 to 20 years at a university health center tested positive for a sexually transmitted infection (STI). What does this finding represent?

Prevalence

number of new and old cases in a given period of time, divided by total number in that population

Prevalence rate

Cases are from multiple sources of exposure

Propagated epidemic curve

A nurse wants to help keep the community environment safe. What is the best action he can take?

Reduce, reuse, and recycle.

Persons often point out that smokers choose to light their cigarettes, alcoholics lift the glass to their mouths, and drug addicts inject or ingest their drugs. Why, then, don't nurses simply focus on helping persons who engage in poor health behaviors to behave appropriately?

Society must offer healthy choices, offer support, and practice helpful policies.

A nurse noted that of 18 children in a day care center room, 5 became ill. What might be a host factor for some becoming ill and some not becoming ill?

Some of the children were from very low socioeconomic families

Measure morbidity and mortality for particular populations or diseases

Specific rates

A school nurses required level of education depends on what?

State laws

What is the law in relation to clinical practice by nursing students?

Students are expected to meet the same standard of care as the professional nurse

Politics

The art of influencing others to accept a specific course of action

Beneficience

The ethical tenet that the physician has a responsibility to act in the patient's best interest. Doing good.

Which hospital employees are most at risk for being exposed to and possibly developing active drug-resistant TB?

The housekeeping staff

Utilitarianism

The theory, proposed by Jeremy Bentham in the late 1700s, that government actions are useful only if they promote the greatest good for the greatest number of people.

Priciplism

The use of the four ethical principles of autonomy, non maleficence,beneficence, and justice, which provide a framework for one to weigh and balance the benefits and burdens of treating a specific patient in order to do what is in the patient's best interest

Government Health Functions

The variety and range of functions of governmental agencies have had a major impact on the practice of nursing. - Funding, in particular, has shaped roles and tasks of population centered nurses.

Direct Services

Veteran Administration (VA)

An employee in a laboratory drops a flask, resulting in a chemical splash into the employee's eyes, which in turn results in burns to the eyes. Which of the following would be considered the agent? a. The chemical b. The employee c. The flask d. The laboratory

a

Which of the following groups should the occupational health nurse devote the most time to regarding education and follow-up evaluation? a. New workers employed less than 1 year b. Older workers with chronic illnesses c. Older workers with diminished hearing d. Women in their childbearing years

a

full-service school-based health centers (FSSBHCs)

a federal program providing comprehensive health care at a site within a school to all including social services, day care, and job training may provide social services, day care, job training, educational counseling, medical and nursing care, mental health counseling and dental care

American Academy of Pediatrics (AAP)

a professional organization for pediatricians that sets policy statements for child health

direct caregiver

a role of a nurse giving health care to the ill or injured

health educator

a role of a nurse in providing instruction on heealth topics

Collecting data and monitoring the health status of the population defines which of the core public health functions? a.Assessment b.Prevention c.Assurance d.Policy development

a. Assessment

Judicial

- enforcement - Police power

: Cognitive Level: Knowledge REF: p. 571 (Table 30-1)

...

A public health nurse found that out of the 70 people who ate the potato salad at the school picnic, 60 developed symptoms of food poisoning. What is the attack rate?

90%

When does disaster management begin? A. Before the disaster occurs B. During the disaster C. Immediately following the disaster D. During the recovery period

A

Which of the following is the best way to increase the number of persons who come to their screening test appointments? a. Reminding clients via telephone, e-mail, or mail b. Emphasizing long life and happy family when conditions are caught early and treated successfully c. Pointing out how inexpensive and convenient screening tests are d. Stressing the dangerousness of the condition if not caught early

ANS: A Client reminders and recalls via mail, telephone, or e-mail—or a combination of these strategies—are effective in increasing compliance with screening activities such as those for colorectal and breast cancer.

A nurse is familiar with evidence-based practice (EBP) and wants to implement it into the care of clients. Which of the following would present the biggest challenge? a. Assessing one's current practice and accessing evidence-based resources b. Convincing administration that EBP is beneficial c. Distinguishing EBP from practice based on old standards d. Showing clients that EBP will improve their health outcomes

ANS: A The first step toward implementing evidence-based practice in nursing is recognizing the current status of one's own practice and believing that care based on the best evidence will lead to improved client outcomes. The challenge for the clinician is how to access the evidence and integrate it into practice, thus moving beyond practice based solely on experience, tradition, or ritual.

When a school nurse reports suspected child abuse, there is a breach of confidentiality. This breach is allowed because of: a. Civil immunity b. Sovereign immunity c. Nurse practice act d. Respondeat superior

ANS: A The law mandates that a health professional breach patient confidentiality norms to protect someone who may be in a helpless or vulnerable position.

Nurses are available to provide health services for women and children due to the provisions of the: a. Sheppard-Towner Act b. Public Protection of Maternity and Infancy program c. Early Periodic Screening and Developmental Testing (EPSDT) program d. Women, Infants, and Children (WIC) program

ANS: A This act also offered well-child and child-development services, provided adequate hospital services and facilities for women and children, and provided grants-in-aid for establishing maternal and child welfare programs.

7. The nurse gives a very informative and engaging presentation and then gives everyone in the audience a handout that outlines the presentation. Later, the nurse discovers that many of the handouts were thrown away before the audience left the building. Which of the following educational principles has the nurse forgotten? a. Audiences expect PowerPoint or video presentations, not lectures. b. Many Americans do not have a high reading level. c. People want photographs and images, not wordy outlines. d. The nurse gave them too much information too fast for them to want to cope with it all.

ANS: B Although visual images are certainly helpful, this does not explain why the handouts were discarded. Most health information is printed at a tenth-grade reading levelyet the average U.S. adult reads at the eighth-grade level and 40% of adults over age 65 read below the fifth-grade level. If people cannot read or understand the material, they discard it.

6. Which of the following statements about children and environmental hazards is correct? a. The prevalence of autism is directly related to the increase in environmental toxins. b. Children are more susceptible to environmental toxins because of their smaller size. c. The prevalence of asthma among children has been decreasing. d. Children are more susceptible to cancer if they have a family history of the disease.

ANS: B Because of the smaller size of children, they are exposed to higher doses of pesticide residues in the foods they eat and drink. Autism has increased 1000% since the mid-1980s. However, there is not a direct link to environmental toxins discussed in the text. The prevalence of asthma is at an all time high. Only about 5% of all cancers are strongly associated with heredity.

States have certain continuing education requirements for persons to renew a nursing license. This type of law is called: a. Constitutional law b. Legislation and regulation c. Judicial and common law d. Police power

ANS: B Licensing is regulated by each states nurse practice act as a function of the board of nursing.

After finding several studies related to the clinical problem, a nurse knows the studies must be evaluated. Which of the following characteristics should be present in the literature? a. Federally supported multiagency clinical studies b. Multiple high-quality studies with large sample sizes and consistent findings c. Research studies done by multidisciplinary teams in multiple settings d. Controlled clinical trials

ANS: B The Agency for Healthcare Research and Quality (AHRQ) reviewed 40 systems used to evaluate the quality of studies and strength of evidence. The report identified three domains for evaluating systems that grade the strength of evidence: quality, quantity, and consistency. The quality of a study refers to the extent to which bias is minimized. Quantity refers to the number of studies, the magnitude of the effect, and the sample size. Consistency refers to studies that have similar findings, using similar and different study designs.

3. Which of the following strategies should be used when providing educational programs for children? (Select all that apply.) a. Emphasize how to build learning from previous experiences. b. Use simple words to enhance understanding. c. Use objects to help increase their attention. d. Emphasize the importance of the long-term consequences.

ANS: B, C When providing educational programs for children, the nurse should use more concrete examples and word choices; use objects or devices to increase attention; incorporate repetitive behaviors into games to help with knowledge retention and acquiring new skills.

When writing to a legislator to advocate for funds to support advanced practice nursing education, a nurse should remember to (select all that apply): a. Limit the letter to one page in length. b. Identify oneself as a nurse. c. Provide only factual information. d. Share personal knowledge about the issue.

ANS: B, D When writing to a legislator, the letter should be a maximum of two pages in length and opinions should be expressed. Additionally, the nurse should identify oneself as a nurse and share knowledge about the issue.

A nurse is interested in census data. Which federal departments website would be a good place to start? a. Department of Labor b. United States Immunization Survey c. Commerce Department d. World Health Organization

ANS: C The Commerce Department handles the United States Census and population estimates and projections.

The Office of Homeland Security has a mission to rebuild the crumbling public health infrastructures of each state and provide: a. Vaccines for smallpox, anthrax, and plague b. Regulation of nuclear weapons c. Surveillance of bioterrorism threats d. Regulation of foreign nurses entering the United States

ANS: C The DHHS and the new federal agency, the Office of Homeland Security, have provided funds to address serious bioterrorism threats to the people of the United States.

A nurse is found to be negligent. Because of the doctrine of respondeat superior, the one responsible for that negligence is the: a. Administrator b. Nurses immediate supervisor c. Nurses employer d. Nurse

ANS: C The doctrine of respondeat superior says that when a nurse is employed and functioning within the scope of that job, the one responsible for that negligence is the nurses employer.

A nurse would like to propose legislation requiring all schools to employ a registered nurse. The first step taken in the legislative process would be: a. Introducing the bill to the legislature b. Moving the bill to the other house c. Developing the policy option into a bill d. Hearings, testimony, and lobbying

ANS: C The first step in the legislative process is developing the policy option into a bill. This is then followed by introducing the bill to the legislature; hearings, testimony, and lobbying; and the bill moving to the other house.

A nurse believes additional funding is necessary to support a home-delivered meal program for the elderly. The best way to share these ideas with a legislator is to: a. Send an e-mail. b. Write a formal letter. c. Attend a town hall meeting. d. Schedule a face-to-face visit.

ANS: D Face-to-face visits with legislators are viewed as the most effective means of communication.

Virtues

Acquired traits of character that dispose humans to act in accord with their natural good.

What should a nurse caring for clients of another culture be sure to do?

Alter personal nonverbal behaviors to reflect the cultural norms of the client.

Professional Negligence (malpractice)

An act (or a failure to act) that leads to injury of a client

The crisis plan should include what?

An administrative policy made either for entire school district or for individual schools in the district. The names of persons on the crisis team\ The superintendent of the school district The school nurse the guidance counselor the school psychologist or social worker police or school security clery from community Parents

Principlism

Approach to problem solving in bioethics that uses the principles of respect for autonomy, beneficence, nonmaleficence, and justice as the basis for organization and analysis

Which of the following best defines a disaster? A. Any event that results in multiple deaths B. Devastation that cannot be relieved without assistance C. Devastation that covers a broad geographical area D. When the event results in multiple injuries and deaths as well as property damage

B

Which of the following best describes countries that bear the greatest burden of disasters? A. Arid regions that are prone to drought B. Developing countries with limited resources C. Industrialized countries with much to lose D. Water-boundary regions that are prone to floods and hurricanes

B

When does disaster management begin?

Before the disaster occurs

A nurse states, "The best way to treat a client from another country is to care for them the same way we would want to be cared for. After all, we are all humans with the same wants and needs." What does this statement reflect in relation to culture?

Blindness

The school nurse should have what necessary equipment?

Full oxygen tanks w/oxygen masks of different kinds, and splints Cervical spine collars in different sizes sterile dressings

Which of the following are evidence that the U.S. health care system is in crisis? Select all that apply.

Full-time employees may not have health insurance as a benefit. Long work hours and provider fatigue are a major factor in medical errors.

the number of new health-related events or cases of a disease divided by the total number in the population at risk

Incidence rate

Public health advocacy

Intended to reduce death or disability in groups of people and that is not confined to clinical settings.

Emergence of bioethics

Late 1960s

Ethical issues

Moral challenges facing the nursing profession.

One lost year of healthy life

One DALY

outbreak over wide geographic area

Pandemic

What is a useful first step in assessing potential environmental health risks in a community?

Performing a windshield survey

Policy setting

Primary Function

Life expectancy increased dramatically during the twentieth century, primarily because of:

Sanitation and other public health activities

What level of prevention is the school nurses largest responsibility?

Secondary Prevention

Designation of money

The designation of money for specific needs has led to special and more narrowly focused nursing roles (i.e., emergency preparedness, school nursing, and family planning). - Categorical programs/funding

Consequentialism

The right action is the one that produces the gretest amount of good or the least amount of harm in any given situation

HP throughout 1990s

Throughout the 1990s states used Healthy People 2000 objectives to identify emerging public health issues.

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.

Moral distress

Uncomfortable state of self when one is unable to act ethically.

Whats critical for better health policy for the nation?

Understanding how these factors have influenced the current and future roles for nurses and the public health system is critical for better health policy for the nation.

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

Unethical and racist treatment of uninformed subjects

What is the dominant issue in ethical debate around an issue such as continuing or withdrawing treatment in acute health care?

Upholding ethical principles

A nurse in community health in California has been working with a 6-year-old child that was rescued from a mudslide. The nurse will observe the child for which of the following stress effects? Select all that apply. a. Bed-wetting episodes b. Desire to return to school c. Fantasies of denial d. Increased playfulness with peers e. Thumb sucking

ace

health ministries

activities and programs in faith comunities directed at improving the health and well-being of individuals, families, and comunities across the life span

neighborhood nurse

also known as block nurse, the nurse responds to a defined community or locality

Which of the following best describes the mission of OSHA? a. To create an inspection system to avoid preventable loss of life b. To ensure safe and healthful working conditions c. To establish rules for employee safety d. To share factory illness and injury rates with the public

b

Which of the following statements best describes how workers' compensation legislation has changed employer behavior? a. Employers have improved safety of working conditions because safety data is now public information. b. Companies have improved safety of working conditions because worker's compensation insurance premiums are now based on previous claims. c. Employers were legally required to implement safety changes. d. Companies have become more involved in the legislative process.

b

28. 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

Population-focused practice focuses on defining the problems or needs of and implementing solutions for: a.Individuals b.Aggregates c.Communities d.Geographical regions

b. Aggregates

Public health practitioners prepared at the graduate level should be able to: a.Teach public and community health nursing b.Assess and intervene successfully at the aggregate level c.Diagnose and treat disease and have prescriptive authority d.Run for political office as experts in public health policy

b. Assess and intervene successfully at the aggregate level

is the intentional release of hazardous chemicals into the environment for the purpose of harming or killing

chemical terroism

tertiary prevention

continued long-term health care

Since 2002 school nurses have been directly responsible for what nursing care?

direct care health education counseling case management community outreach

School Nurses give care to children as?

direct caregivers, educators, counselors , consultants, and case managers.

faith communities

distinct groups of people acknowledging specific faith traditions and gathering in churches, cathedrals, synagogues or mosques

high cholera in asians and pacific islanders

hyerendemic

parish nurses

nurses who respond to health and wellness needs within the faith context of populations of faith communities and are partners with the church in fulfilling the mission of the health ministry

emergency plan

procedures to effectively give care in a crisis situation

Standard Precations

procedures to prevent exposure to blood-borne diseases

National Association of School Nurses (NASN)

professional organization for school nurses that sets standards and guidelines for them

does not have a common source and spreads gradually from person to person over more than one incubation period, such as the spread of tuberculosis from one person to another.

propagated outbreaks

Constitutional Law

provides overall guidance for selected practice situations

Partnerships

relationships between individuals, groups, or organizations in which the parties are working together to achieve a joint goal; often used synonymously with coalitions and alliances, although partnerships usually have focused goals such as jointly provideing a specific program; involve shared power

Distributive justice

requires that different treatment of individuals not be based on arbitrary characteristics

crisis teams

school staff designated to deal with crises at school

Secondary prevention in School Nursing

screening and providing health care that involves screening children for illnesses and providing direct nursing care

All cases were exposed at same point in time

Point source epidemic curve

those susceptible to particular disease or condition

Population at risk

A father confides to the parish nurse that his wife has been really hurting their 3-year-old daughter. The nurse examines the daughter and finds evidence of physical abuse. In the parish nurse role, what will the nurse do first?

Report the findings to child protective services

A family shared their concerns, including sexual issues, in strictest confidence with a faith community nurse. When the nurse returned to the church office, the pastor asked why the family wanted to see her. What should be the nurse's response?

"The family had some issues they wanted to discuss in confidence, which I will keep in confidence."

Public Health

"the science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community effort" - C. Winslow

As a liaion between resources in teh faith community and the local community the parish nurse's responsibilities include:

- Helpng clients know what resources are available to solve their problems - Helping individuals and families match the appropriate resource to their problems - Linking clients ith the appropriate services

What responibities dose the school nurse have when dealing with homebound children?

- Being the liaison between the child's teacher, physician, school administrators, and parents regarding the child's needs - Helping individuals make up the child's IEP in a way that dosn't remove necessary learning form the plan - Allowing the child to go to school when possible Coordinating the child's health care needs and classes

As with other community health situations, the parish nurse along with the client does what?

- Identifies parameters of ethical concerns - Plans ahead with clients to consider health options in making ethical decisions - Supports clients in their journey to choose alternatives that will strengthen coping skills - Allows the client to grow stronger in faith and health - Considers teh "virtue ethics, such as careing, forgiveness and compassions, in their decision making"

Financing

- National Institute of Nursing Research (NINR) - Centers for Medicare and Medicaid (CMS)

The school nurse focuses on what areas of promary prevention?

- Preventing childhood injuries - Preventing substance abuse behaviors - Reducing the risk of teh development of chronic diseases - Monitoring the immunization status of children

State and Local Health Departments

- Programs vary depending on funding, public commitment and interest, and access to other resources - Coordinating efforts between health departments and other county/city departments is necessary.

In regards to lice and nits what are teh school nurses responsibilities?

- Teach children, parents, and teachers how to prevent lice and treat cases of infestations - Teach parent how to completely treat the child with the anti-lice medications - Teach parents to remove all nits from the head with fine toothed comb - Teach parents to wash all bed linens and clothing

The AAP stated that school nurses should ensure:

- That children get the health care they need, including emergency care in the school - That the nurse keeps track of the state-required vaccinations that children have received - That the nurse carries out the required screening of the children based on state law - that children wit health problems are able to learn in teh classroom

Trends and Shifts in Governmental Roles

- Wars, economic instability, and political differences between parties all shaped the government's role. - History of creation of government agencies and acts for health - Health Insurance Portability and Accountability Act - State Child Health Improvement Act - Public Health Threats and Emergencies Act - Patient Protection and Affordable Care Act

Legislative

- oversight of regulations and laws through the senate and house of representatives - Committees: Aging, Nutrition, Environment, Health, Education, Appropriations - Makes laws

What is the best action for a school nurse to do if a adolescent in school threatens to commit suicide?

- remove the student from the school situation immediately - notify the parents while assessing the students risk - refer the child or teenager to crisis intervention or mental health services

Nurses should do what to aid in Suicide Prevention efforts in adolescents:

. Lead educational programs within the schools to emphazise coping strategies and stress management techniques for children and adolescents who have problems and to teah about the risks - Teach faculty members to look for the risk factors - Help organize a peer assistance program tohelp teenagers cope with school stresses

What six characteristics may point out a student who may be thinking of comminting an act of violence agnist their school?

1. venting: having mood swings 2. Vocalizing: threatening others 3. Vandalizing: damaging property 4. Victimizing: seeign himself or herself as a victim 5. Vying: belonging to gangs 6. Viewing: witnessing the abuse of others

International Organization

1945- United Nations (UN): human rights, world peace, international security, promoting economic and social advancement 1946- World Health Organization (WHO): highest possible health for all World Health Assembly (WHA): the WHO's policy making body (not enforcement)

: Cognitive Level: Knowledge REF: p. 566 (How To box) 26. Hospital-based acute care nurses engage in extensive patient education. Why would the home health nurse essentially repeat the same information? a. Clients find it difficult to learn in the midst of the stress of the acute care setting and often don't remember what the hospital nurse taught. b. Hearing something from a different person, using different words and examples, can help ensure that learning is retained. c. Home health nurses often don't know what hospital-based nurses have already taught. d. Learning depends on receiving information more than once.

: A Although all of the responses are potentially true, the bottom line is that clients may find it difficult to learn while they are hospitalized. Consequently, home care nurses should communicate clearly with discharge planners about the therapeutic plan and medication regimens, as well as what clients have been taught about self-care and symptoms that should be reported to the physician. The nurse should share this same information again, unless the client clearly demonstrates having the knowledge and skills being reviewed.

: Cognitive Level: Application REF: p. 570 17. Which comment below was most likely stated by a home health nurse? a. "Every time I see a client, it costs $80." b. "Health care costs are killing our economy." c. "I can't believe how much clients are charged for things." d. "Medicaid costs are such a large portion of our state's budget."

: A Nurses in many settings are not directly exposed to the financial aspects of health care, although as citizens they should be aware of the overall effects of high health care costs. In home health, nurses must be cost-conscious so that they can accurately explain to clients what Medicare will or will not cover and discuss other financial concerns. In addition, home care nurses must be knowledgeable about which medical supplies are covered.

: Cognitive Level: Knowledge REF: pp. 569-570 16. The board of directors is examining various submitted reports concerning its home health agency. Which report represents an example of benchmarking? a. A report by the administrator regarding how the home health agency's performance compares with that of other local and national home health agencies b. A report by the chief financial officer regarding a cost-benefit analysis related to technological advances c. A report by the chief nursing officer regarding client outcomes d. A report by the medical director regarding implementation of evidence-based practice into standards of care

: A Performance improvement programs are based on measurable data, including benchmarking, which means comparing oneself with national standards and guidelines and with other agencies.

: Cognitive Level: Knowledge REF: p. 568 14. A nurse orienting to the home health role states, "I don't understand why we have to collaborate with so many other disciplines. Doesn't this conflict with the concept of nurses engaging in holistic nursing practice?" What would be the best response? a. "The nurse still functions holistically; however, interdisciplinary collaboration is necessary to prevent fragmentation of care." b. "Holistic nursing is a concept applied to care in tertiary facilities, such as hospitals, where materials are centrally located in one facility. In home health, this is not possible." c. "Even though home health nursing is not as holistic as other nursing in community health roles, each discipline contributes to client needs from its special knowledge base." d. "Yes, it does create conflict, but Medicare mandates interdisciplinary collaboration."

: A The responsibilities and functions of other health professions in home care are dictated by Medicare regulations, professional organizations, and state licensing boards. Many of these services can be provided on a consulting basis. The plan of care should be implemented and reinforced by all involved disciplines. Therefore interdisciplinary collaboration is required in the home health setting. Such collaboration does not conflict with the concept of holism. Holism does not require that the home health nurse provide all direct care service. Rather, holistic care means the nurse considers the physical, emotional, social, economic, and spiritual needs of the client(s).

: Cognitive Level: Application REF: p. 569 (Box 30-1) 23. What is a primary requirement for a client to be eligible for home health nursing and Medicare reimbursement of services? a. Must be homebound b. Must be living in a medically underserved area c. Must be indigent d. Must be insured or eligible for Medicare or Medicaid

: A To receive home health services, clients must be homebound. Although home health care is less expensive than hospitalization, it remains much more costly than a traditional visit to a clinic; therefore those who are not homebound would be expected to receive care at a clinic.

: Cognitive Level: Knowledge REF: p. 565 (How To box) 25. Home health nurses uphold universal precautions with all clients. Which practice in the home is most crucial? a. Continuing to use good handwashing procedures b. Obtaining a puncture-resistant container for family to use for needles c. Putting all contaminated material directly into a trash bag d. Washing all surfaces with disinfectant

: A Universal precautions mean that all blood and body fluids are treated as potentially infectious, especially since many infections are subclinical. The nurse would use extreme care to prevent injuries when handling needles, scalpels, and razors and discard needles and syringes in puncture-resistant containers; use protective coverings if contact with blood and body fluids is expected; put materials contaminated with body fluids in double polyethylene garbage bags; and tell the family to be sure to use detergent in warm water to clean kitchen counters, dishes, and laundry and household disinfectant when cleaning the bathrooms. However, the single most important practice in preventing infections is careful handwashing before and after client care, touching food, or using the bathroom.

: Cognitive Level: Knowledge REF: p. 566 13. What should be the minimum requirement for a nurse to be prepared for home health nursing? a. An RN license and a baccalaureate degree in a health-related field b. A baccalaureate degree in nursing and RN licensure c. An associate's degree in nursing and RN licensure d. Eligibility for certification as a home health nurse

: B A baccalaureate degree in nursing should be the minimum requirement for entry into professional practice in any community health setting.

1. What is the most essential difference between home health care and acute client care? a. Acute client care is individualized for the client and family. b. Home health care is provided in the client's environment. c. Reimbursement for home health care varies from that of care provided in institutions. d. The focus of acute client care is on community health.

: B Home health differs from other areas of health care in that health care providers practice in the client's environment. All nurses give individualized care to clients.

: Cognitive Level: Knowledge REF: p. 561 2. A nurse has just received word that Medicaid will reimburse for care provided to a homeless man with schizophrenia who is afraid to come to the clinic to receive health care. How would this type of nursing service be best classified? a. Community-oriented nursing b. Home health nursing c. Hospice nursing d. Private duty nursing

: B Home health nursing is provided in the client's environment, regardless of where that may be. "Home" may be a house, apartment, trailer, boarding house, shelter, car, makeshift shelter under a bridge, or cardboard box.

: Cognitive Level: Knowledge REF: p. 564 8. What is a potential advantage of hospital-based home health agencies over other types of home care agencies? a. Administration and management benefits are gained from the expertise of two boards of experts. b. Continuity of care is enhanced. c. Health promotion and illness prevention concerns take precedence over acute care and rehabilitation. d. They are eligible for tax exemptions through affiliated agencies.

: B Hospital-based agencies emerged in response to the recognized need for continuity of care from the acute care setting.

: Cognitive Level: Knowledge REF: p. 563 5. In the agency, one of the nurses spent all available time visiting a group of persons with mental health problems who were trying to remain functional in the community. What type of assignment did this nurse have? a. Home-based primary care b. Population-focused home care c. Proprietary home care d. Transitional care

: B Population-focused home care is directed toward the needs of specific groups of people, including those with high-risk health needs such as mental health problems, cardiovascular disease, or diabetes; families with infants or young children; and older adults. Such care commonly includes structured regular visits with assessment protocols, focused health education, counseling, and health-related support and coaching.

: Cognitive Level: Synthesis REF: Entire chapter 22. A nurse completes a self-assessment of performance as part of the home health nurse's annual evaluation. What term best describes this activity? a. Collaboration b. Quality of care c. Performance appraisal d. Resource utilization

: C As part of a performance appraisal, the home health nurse evaluates his or her own nursing practice in relation to professional practice standards, scientific evidence, and relevant statutes, rules, and regulations.

: Cognitive Level: Application REF: p. 566 11. What would be the best approach for a home health nurse to help a client who has right-sided paresis secondary to a stroke? a. Arrange for private duty nurses to assist the client with daily needs. b. Assist the client with activities of daily living. c. Teach the client to participate in self-care activities. d. Teach the family how to care for the client.

: C Because home health care is often intermittent, and because a reliance on others is not always possible over the long term, a primary objective for the nurse is to facilitate self-care so that clients may remain in their home. This allows clients to have some control over their life and can help prevent hopelessness and a loss of self-esteem. Although assistance may be needed, such assistance should come after helping clients to help themselves.

: Cognitive Level: Synthesis REF: Entire chapter 21. A home health nurse asks a client with arthritis to attend a demonstration in which an assistive device is used to put on shoes. Which phase of the nursing process is the nurse's current focus? a. Outcome identification b. Planning c. Implementation d. Evaluation

: C Implementation is the phase in which the home health nurse implements the interventions identified in the plan of care. If the client is able to use the device, the process can progress to evaluation, in which the nurse will assess the usefulness of the device when incorporated into the client's activities of daily living.

: Cognitive Level: Knowledge REF: p. 565 10. What is the primary reason that meeting the needs of a dying child and his or her family is more challenging for most nurses than meeting the needs of a dying adult? a. Children don't understand what it means to die. b. A child's death is harder for anyone to accept. c. Nurses themselves are often parents. d. Families are not prepared to deal with death.

: C It is true that families are rarely prepared to deal with death. It is also true that children have only a limited understanding of dying. However, the main reason that the needs of the dying child and family are so challenging for most nurses is the fact that many nurses are parents themselves and can relate to the shock of a child dying before the parent.

: Cognitive Level: Knowledge REF: p. 563 7. Which type of home health agency continues to emphasize health promotion and illness prevention? a. Combination agencies b. Hospital-based agencies c. Official agencies d. Proprietary agencies

: C Official or public agencies include those agencies operated by the state, county, city, or other local government units, such as health departments. Nurses employed in these settings provide well-child clinics, immunizations, health education programs, and home visits for preventive health care. Consequently, they include a focus on health promotion and illness prevention as well as giving direct care.

: Cognitive Level: Knowledge REF: p. 562 4. Historically, home care nurses were social reformers, living in immigrant communities, developing needed programs, and providing necessary services from health education to care for the sick. What led to the current emphasis on caring for acutely ill clients expected to improve and the increased demands for extensive documentation? a. Advances in medical technology and pharmacology b. Constantly increasing lawsuits for substandard care c. Introduction of Medicare d. Social Security Act of the 1930s

: C The combination of preventive services and illness care followed the introduction of Medicare in 1966. The Medicare program emphasized care for more acutely ill people rather than illness prevention and health promotion. The 1997 federal Balanced Budget Act, which implemented the prospective payment system in home care, increased pressure to care for clients with acute illnesses that were likely to improve.

: Cognitive Level: Knowledge REF: p. 564 9. What is the primary focus of hospice care? a. Curing or controlling the client's chronic disease b. Decreasing the waste of acute care (hospital) resources c. Providing palliative care to maintain comfort until death d. Teaching the client and family how to care for themselves

: C The primary goal of hospice care is to help maintain the client's dignity and comfort. Alleviating pain; encouraging the client, family, and friends to communicate with each other about essential sensitive issues; and coordinating care to ensure a comfortable, peaceful death all contribute to palliative care.

: Cognitive Level: Knowledge REF: p. 573 20. When meeting with a client and family, the home health nurse says, "We have discussed your health problems and limitations. Now tell me what level of health and function you hope to achieve." In which phase of the nursing process is the nurse engaging? a. Assessment b. Diagnosis c. Outcome identification d. Planning

: C When discussing health problems and limitations, the nurse was gathering a history as part of the assessment phase. This allowed formulation of a nursing diagnosis. By steering the conversation toward goals, the nurse is now able to work with the client to mutually identify outcomes.

: Cognitive Level: Knowledge REF: p. 563 (Briefly Noted box) MULTIPLE RESPONSE 1. Since national accreditation may soon become a requirement for licensure of home health agencies, what might be examined during the accreditation process? Select all that apply. a. Cost of each service rendered b. Credentials of each employee c. Organizational structure d. Outcomes of care e. Process of care f. Referral processes

: C, D, E Both The Joint Commission (TJC) and the Community Health Accreditation Program (CHAP) of the National League for Nursing (NLN) look at the organizational structure through which care is delivered, the process of care through home visits, and the outcomes of client care, focusing on improved health status. Performance improvement must be ongoing in the agency. It is assumed the credentials of each employee were confirmed before employment.

: Cognitive Level: Knowledge REF: p. 570 2. A family is concerned about the medical bills of their father, age 63, who is unemployed and has almost no savings. Which of the following statements by the nurse accurately explain how Medicaid and Medicare would work in this family's situation? Select all that apply. a. "All your father's medical bills will be paid by whichever program is appropriate." b. "Choose any physician and just show them your Medicare or Medicaid card." c. "Your father must be homebound to qualify for Medicare assistance but less so for Medicaid." d. "Medicare is a federally funded program, but Medicaid is administered by your state." e. "Only care toward improvement is paid for by Medicare, but Medicaid may help with maintaining your father's current health." f. "Until he reaches age 65, your father is not eligible for Medicare, but since he has no job or savings, he may be eligible for Medicaid."

: C, D, E, F Many physicians will not accept a client on Medicare or Medicaid because of the low reimbursement rates. A deduction from Social Security is made for Medicare premiums, and clients are still responsible for deductibles and copays, so it is misleading to tell the family that all their father's medical bills will be paid. Medicare, for those age 65 and over or disabled, is a federal insurance program administered by the Social Security Administration, whereas Medicaid, based on a client's lack of financial resources, is a federal and state assistance program administered by the state. Medicare will only pay for home health care by skilled professionals while the client is homebound, whereas Medicaid does not necessarily require homebound status and may reimburse for home health aides and other nonskilled supportive services.

: Cognitive Level: Knowledge REF: p. 572 19. What do community-based nurses typically use to organize, sort, and document pertinent client data? a. NANDA b. NIC NOC c. Nursing Diagnosis Taxonomy d. The Omaha System

: D Although all four are recognized nursing taxonomies, in community health, especially home nursing, the Omaha System is typically used. This system was developed by a visiting nurses association in Omaha and based on home nursing documentation needs. The Omaha System is most relevant to home health nursing and is most typically used by home health nurses.

: Cognitive Level: Knowledge REF: p. 561 3. A hospital nurse wants to know why home health nurses often take more time with assessment than nurses do in the hospital. What is an adequate explanation for this? a. Home care assessment includes not only the client but the supplies and equipment the family may have available for use. b. The home environment is less organized and equipped for the nurse's use. c. Family members must also be assessed for possible problems that could interfere with the primary client's recovery. d. To be effective, the home health nurse must earn the family's trust and work in partnership with them.

: D Although all the responses contain some truth, the primary reason that assessment may take longer for the home health nurse is because when working in a client's home, the nurse is a guest. To be effective, the nurse must earn the trust of the family and establish a partnership with client and family.

: Cognitive Level: Application REF: p. 566 12. Which client over 65 years of age meets the criteria for Medicare reimbursement for home health nursing? a. The client who needs assistance with bathing and meal preparation b. The client who needs assistance with house cleaning and meal preparation c. The client who needs sitter services because she wanders from home and becomes lost d. The client whose family members need to learn how to care for his wound

: D Because the nursing service must be considered "skilled," custodial services alone (e.g., sitter services and assistance with ADLs) are not sufficient cause for Medicare reimbursement.

: Cognitive Level: Application REF: p. 568 15. When must the home health nurse be certain to document required Outcome and Assessment Information Set (OASIS-B1) data? a. Before any episode of hospitalization b. After each home health visit c. For all incidences of error or mistake in care d. On first admission to home health care

: D OASIS-B1 data are measured and reported to CMS (1) on admission to home health care, (2) after an episode of hospitalization, (3) at the time of recertification, and (4) on discharge from care or death at home. Data are submitted by each agency to a national databank, and agencies receive both results and comparisons with similar agencies to determine areas needing improvement. The data reported from OASIS determine the payment received by the home health agency for the client's total episode of care.

: Cognitive Level: Knowledge REF: p. 571 (Table 30-1) 24. A family member asks a home health nurse to explain the concept of hospice care. What would the nurse need to include as the fundamental underlying philosophy of hospice? a. Enabling the client to die at home b. Ensuring that the client's living will is upheld c. Placing experts in the position of power of attorney d. Providing comfort measures before death

: D The hospice philosophy of care means providing comfort measures to an individual before death. Death may occur in the individual's home, in a hospital setting, or in an uncontrolled setting such as the community.

: Cognitive Level: Application REF: p. 571 18. One outcome of the incentives and pressures for cost control and improved health outcomes has been: a. Expansion in alternative health care agencies b. Improvements in client teaching materials c. Public pressure to improve health professionals' education d. Development and increased use of telehealth technology

: D The incentives and pressures for cost control and improved health outcomes have increased the development and use of telehealth technology in home care. Simultaneously, technologies have been simplified and their reliability increased, facilitating their safe use in the home.

: Cognitive Level: Knowledge REF: p. 563 6. A new client has just been released from the hospital after intensive treatment for multiple injuries after a motorcycle accident. What type of care will he probably receive? a. Home-based primary care b. Population-focused home care c. Proprietary home care d. Transitional care

: D Transitional care programs in the home are designed for populations who have complex or high-risk health problems and are making a transition from one level of care to another. Assessment, planning, teaching, making referrals, and following up on referrals foster independence and self-care. Besides intensive teaching about self-care, telephone calls help ensure that the client understands and is able to implement instruction.

A nurse coordinating care for undocumented minority workers with a high incidence of tuberculosis (TB) conducts a presentation before the local community health board to focus attention on the magnitude of the problem and its potential impact on the local community. The presentation stimulates the community to explore innovative solutions to increase screening for and treatment of TB cases. This scenario is an example of the relationship between: a. advocacy and case management. b. advocacy and continuity of care. c. care management and case management. d. care management and continuity of care.

A

A nurse is attempting to minimize damage following a bioterrorism attack in the community. Which of the following would be the most crucial aspect for the nurse to consider? A. Detecting an increase in people with similar signs and symptoms B. Identifying typical chemical or biological agents C. Identifying factors that put people at risk D. Recognizing areas of vulnerability within an area

A

A nurse is focused on mitigation of disasters at the international level. Which of the following activities would the nurse most likely complete? A. Provide community educational programs and training on how to prepare for disasters. B. Request donations be sent to the affected area. C. Develop a notification procedure to be used by the international disaster relief office. D. Recruit volunteers to be a part of the disaster team that will travel to the afflicted area.

A

A nurse is working with a community during the preparedness stage of disaster management. Which of the following events would the nurse anticipate occurring? A. Heightened inspection and increased security in the community B. Incorporation of provision of pets into local disaster plans C. Purchase of personal protective equipment for all citizens D. Assembly of disaster kits for the home, workplace, and car

A

A nurse, after working two weeks at the site of the largest natural disaster to hit the United States, returns home. Which of the following behaviors would suggest the nurse needs professional assistance? A. The nurse becomes angry when family members quit listening to her ongoing stories about the disaster and the problems there. B. The nurse gives a presentation at the local college about the disaster and describes how health professionals were able to assist the victims who were injured. C. The nurse is moody and feels family demands are not really as important as the other members of her family think they are. D. The nurse is very exhausted and asks to have 3 personal days off from employment responsibilities.

A

Which of the following levels of prevention is being used by a nurse who is helping to develop a community-wide disaster management plan? A. Primary prevention B. Secondary prevention C. Tertiary prevention D. All prevention levels

A

1. A unique characteristic of the standards of practice for school nurses is which of the following? Alignment with the American Academy of Pediatrics (AAP) guidelines for providing health care to students Requirement of bachelor's degrees in nursing and special certification in school nursing Restriction on delegation of care to other school personnel Use of research findings in the practice of school nursing

A In general, the National Association of School Nurses (NASN) standards align with those developed by the American Academy of Pediatrics (AAP) regarding giving health care to students in the schools. The AAP developed its own ideas about how nurses function in schools based on its assessment of school children's health needs. These guidelines are very similar to those written by the NASN. Additionally, the AAP recommends that the nurse be the head of a health care team that includes a physician (preferably a pediatrician), school counselors, the school psychologist, and members of the school staff including the administrators and teachers. DIF: Cognitive Level: Comprehension REF: Page 569

3. As congregations realize the need for care and care for one another, their individual and corporate relationships with their Creator often are enhanced, thereby increasing their resilience for future crisis situations. The characteristic of faith community nursing philosophy that best endorses this principle is that faith community nurse services: Emphasize strengths of individuals, families, and communities Focus on the faith community and its ministry Focus on the centrality of the spiritual dimension Consider health, spiritual health, and healing as an ongoing dynamic process

A Parish nurse services emphasize strengths of individuals, families, and communities. Parish nurses endorse this characteristic in their practice. As congregations realize the need for care and care for one another, their individual and corporate relationships with their Creator often are enhanced. This provides additional coping strengths for future crisis situations within the family and community. DIF: Cognitive Level: Application REF: Page 540

2. The faith community nurse role arose out of the challenges faced by families to succeed in meeting the demands of young children, teens, and aging parents as well as which of the following challenges? Inadequate training for caregivers Increased hospital length of stay Lack of consumer demand for health care decisions involvement Society's lack of accountability for health care decision making

A The beginning of the parish nurse movement coincided with shortening hospital stays, increasing demands on caregivers, inadequate training of caregivers, and family challenges to meet the needs of young children, teens, and aging parents. Parish nurse services were one way to coordinate care and foster continuity of care. The parish nurse services emphasized health promotion and disease prevention and provided the benefits of holistic care through the supportive faith community. DIF: Cognitive Level: Application REF: Page 539

7. A school district in the Midwest has included health education, physical education, health services, nutrition services, and counseling, psychological, and social services as components of the student health services. Additionally, the district has integrated family/community involvement, staff health promotion, and a commitment to a healthy school environment in its program design. This school district has adopted the school health service program scope of which of the following? CDC's Federal School Health Program Healthy Schools, Healthy Communities program Healthy People 2020 School-linked program

A The federal government, through the coordination of the CDC, has developed the Federal School Health Program. The plan includes eight parts: health education; physical education; health services; nutrition services; counseling, psychological, and social services; healthy school environment; health promotion for staff; and family/community involvement. DIF: Cognitive Level: Application REF: Pages 570-571

2. A second-grade child with cerebral palsy receives services from a physical therapist and occupational therapist during the child's academic day. The school nurse sets up the schedule to ensure that the therapists' visits do not unnecessarily affect the child's academic day negatively. This role of the school nurse is best described as which of the following? Case manager Counselor Consultant Direct caregiver

A The school nurse is expected to function as a case manager, helping to coordinate the health care for children with complex health problems. This may include the child who is disabled or chronically ill, who may be seen by a physical therapist, an occupational therapist, a speech therapist, or another health care provider during the school day. The nurse sets up the schedule for the child's visits so that those appointments do not unnecessarily have a negative effect on the child's academic day. Direct caregiver is the traditional role of the school nurse where immediate nursing care is provided. As a consultant, the school nurse can provide professional information about proposed changes in the school environment and their effect on the health of the children. The school nurse as counselor occurs when children go to the nurse to share important health information. DIF: Cognitive Level: Application REF: Page 570

9. The school nurse at the intermediate level arranges for a presentation by the trauma educator at the local regional medical center. Bicycle and helmet safety will be the primary topic at the school's open house. This is an example of which of the following school nurse roles? Community outreach Counselor Consultant Case manager

A When participating in community outreach, nurses can be involved in community health fairs, reaching others about influenza immunization programs, promoting health education fairs, and coordinating with local charities to provide education to the schools. As a consultant, the school nurse can provide professional information about proposed changes in the school environment and their effect on the health of the children. The school nurse is expected to function as a case manager, helping to coordinate the health care for children with complex health problems. The school nurse as counselor is available to students who need to discuss confidential health matters. DIF: Cognitive Level: Application REF: Page 570

What may be an unexpected side effect of having community members participate as full partners in creating change to improve community health?

A change in the distribution or redistribution of power and influence.

Statistics clearly demonstrate that there are significantly more cases of a disease in one particular neighborhood than in all the rest of the city. Assuming all else is the same, what is the most likely explanation for a single neighborhood having such a different pattern of illness?

A cultural or ethnic concentration in the neighborhood

The nursing educator, who is offering a course on preparing for motherhood, asks the women taking her class to identify what they wish to learn and to write their own learning objectives. What is this method of gaining commitment called?

A learning contract

2. A community health nurse is beginning to work with a newly assigned community. Which of the following would be appropriate actions for the nurse to take to help ensure acceptance? (Select all that apply.) a. Asking those with whom the nurse interacts in the course of daily living their perception of the community (e.g., clerks in grocery stores or pharmacies) b. Attending community events such as festivals or fairs and interacting with participants c. Becoming involved in and contributing to volunteer community organizations d. Completing a comprehensive physical assessment on nearby neighbors

A, B a. Asking those with whom the nurse interacts in the course of daily living their perception of the community (e.g., clerks in grocery stores or pharmacies) b. Attending community events such as festivals or fairs and interacting with participants Gaining entry or acceptance into the community is perhaps the biggest challenge in assessment. The nurse is usually an outsider and often represents an established health care system that is neither known nor trusted by community members, who may therefore react with indifference or even active hostility. Entry into the community is critical. Often the nurse can gain entry by taking part in community events, visiting people in formal leadership positions, and clarifying community members perceptions of health needs. While an activity such as volunteering is a positive action, it is not the most efficient way to become involved in the wider community.

5. Which of the following activities are considered to be part of the core competencies for public health professionals? (Select all that apply.) a. Defining variables relevant to current public health problems b. Obtaining and interpreting information regarding risks and benefits to the community c. Implementing nursing care and subsequent evaluation outcomes d. Maintaining public health departments throughout the United States

A, B a. Defining variables relevant to current public health problems b. Obtaining and interpreting information regarding risks and benefits to the community Eleven core competencies for the nurse and other health providers working in the community have been defined by the Council on Linkages Between Academia and Public Health Practice. Defining variables relevant to current public health problems and obtaining and interpreting information regarding risks and benefits to the community are two of the eleven core competencies.

3. A nurse is deciding which alternative interventions should be implemented. Which of the following factors must be considered by the nurse when making this decision? (Select all that apply.) a. The expected effect or outcome of each possible intervention b. How interested others are in helping in any particular intervention c. The nurses own interest in implementing each intervention d. The likelihood that the intervention will resolve the problem

A, B, D a. The expected effect or outcome of each possible intervention b. How interested others are in helping in any particular intervention d. The likelihood that the intervention will resolve the problem The nurse can list each possible intervention and then consider the resources or barriers to that particular intervention, the expected effect of each choice, the likelihood that the activity will help meet the objective and resolve the problem, whether others can be educated to implement the intervention, and the change process necessary to complete the objective.

10. Secondary prevention activities are the largest responsibility of the school nurse and may include which of the following? (Select all that apply.) Establishing an emergency plan when a child or staff member needs immediate care Giving medications to children during the school day Participating in developing an individual education plan (IEP) for students with long-term health needs Screening for vision, hearing, height and weight, oral health, TB, and scoliosis Teaching standard precautions to all staff

A, B, D, E Secondary prevention involves caring for children when they need care and is the largest responsibility of the school nurse. It may include such activities as caring for ill or injured children or staff (including the development of an emergency plan and appropriate training of staff in standard precautions, first aid, and relevant emergency procedures); screening and assessing children; making appropriate referrals; giving medications; identifying abuse and neglect; communicating with health care providers; preventing suicide and violence; and responding to disasters. DIF: Cognitive Level: Application REF: Pages 574-575

1. A community health nurse encourages members of the community to partner and assist in creating health programs. Which of the following best describes the rationale for this action? (Select all that apply.) a. Partnering results in increased effectiveness b. Involving community members results in contributions of time and money into the program c. Having many partners results in increased publicity for the program d. Participating in planning results in having a vested interest in the outcome

A, D a. Partnering results in increased effectiveness d. Participating in planning results in having a vested interest in the outcome Although partners do indeed contribute time and effort in participation, the primary reason community partnership is crucial is that community members and professionals who are active participants in a collaborative decision-making process have a vested interest in the success of efforts to improve the health of their community. The significance and effectiveness of partnership in improving community health are supported by a growing body of literature.

A community-oriented nurse has identified obesity as a problem in the middle school. The next step in a population-focused practice is to make information available about the health of the middle school students. This describes the core public health function of: a. assessment. b. assurance. c. policy development. d. research.

ANS: A Assessment is a core function of public health and refers to systematically collecting data concerning the population, monitoring the population's health status, and making information available on the health of the community. In a community-oriented approach, a nurse would apply both nursing and public health theory. In this case, assessment would be the first step from the perspective of both theories. Because the practice is population focused and community oriented, it would involve the assessment of the community subpopulation of middle school children and the impact of obesity on their overall health status.

A nurse planning a smoking cessation clinic for adolescents in the local middle schools and high schools is providing: a. community-oriented care. b. community-based care. c. secondary care. d. tertiary care.

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

A community-oriented nurse conducts home visits to new parents to assess the health status of the infant, the parent-child relationship, the parents' knowledge regarding the care of the infant, and the need for health department and social services referrals to support the needs of the new parents and the infant. This can best be described as an example of: a. clinical community health practice. b. community-based practice. c. population-focused practice. d. public health nursing.

ANS: A Community-oriented nurses who provide direct care services to individuals, families, or groups are engaging in a clinically oriented practice even when they apply concepts of population-focused, community-oriented strategies along with their direct care clinical strategies.

16. For a bedridden Muslim patient, the nurse rearranges the room and moves the bed so that it faces toward Mecca for the patients daily prayers. Which of the following is the nurse demonstrating through these actions? a. Accommodation b. Awareness c. Brokering d. Imposition

ANS: A Cultural accommodation involves including aspects of the patients religious beliefs and/or folk practices in the traditional health care system to implement essential treatment plans. For this patient, daily prayer in the tradition of Islam is importantfrom the patients perspective, possibly more important than medical treatment.

4. A nurse is caring for a client of another culture. Which of the following actions would be most appropriate for the nurse to take? a. Alter personal nonverbal behaviors to reflect the cultural norms of the client. b. Keep all behaviors culturally neutral to avoid misinterpretation. c. Rely on friendly gestures to communicate caring for the client. d. Avoid any pretense of prejudice by treating the client in the same way as any other client.

ANS: A Cultural competence in nursing includes adoption of culturally congruent behaviors. Culturally skillful nurses use appropriate touch during conversation, modify the physical distance between themselves and others, and use strategies to avoid cultural misunderstandings while meeting mutually agreed-upon goals. Nurses who strive to be culturally competent respect people from other cultures and value diversity, which helps them to provide more responsive care.

15. At a local hospital, postpartum care policy requires that nurses observe the mother during infant care to assess the mothers ability to care for the new baby and to promote bonding. A new mother expresses concern that in her country, all infant care is provided by other family members so that the mother can rest and recover. Which of the following actions would be taken by a culturally competent nurse? a. Allow family members to provide the newborns care and assess the mothers knowledge of child care through discussion. b. Reinforce the importance of bonding and that all good mothers gladly assume these responsibilities. c. Explain that the process of postpartum recovery does not require this much rest and require that she provide infant care. d. State that she must abide by hospital policy because documentation of the mothers ability to give the infant care is required for discharge.

ANS: A Culturally competent nursing care focuses on the specific patient, reflects the patients individual beliefs and values, and is provided with sensitivity.

9. A nurse says, Im not going to change the way I practice nursing based on where the client is from, because research shows that Western health care technology and research is best. Which of the following is being demonstrated by the nurses statement? a. Ethnocentrism b. Prejudice c. Racism d. Stereotyping

ANS: A Ethnocentrism, a type of cultural prejudice at the cultural population level, is the belief that ones own group determines the standards for behavior by which all other groups are to be judged. For example, some American nurses and providers may think, The way we do it is the only right way to provide this care.

15. A nurse established an ongoing group meeting of teenagers with diabetes. In the early stages, the nurse was very directive in arranging location, providing low-carbohydrate drinks and snacks, steering the discussion, and trying to meet all the teenagers needs. After the group had been meeting for about 3 months, the nurse noticed that the group members no longer simply accepted everything the nurse suggested. Instead, the teenagers began making decisions themselves, and eventually, the nurse no longer controlled the group. Which of the following most likely happened to cause this shift? a. The group became cohesive enough to share leadership tasks. b. Teenagers dont like feeling dependent on adults with power. c. Teenagers often rebel against adult authority. d. The nurse was overwhelmed and lost control of task process.

ANS: A In the beginning, the nurse used an authoritarian style because the nurse was responsible for the group direction. However, as the group matured, continuing an authoritarian style would have resulted in low morale and lack of cohesion. After a group is well established, nurses may best facilitate leadership by relinquishing central control and encouraging group members themselves to determine the norms for their group.

1. Which of the following best describes most Americans attitude toward immigrants? a. Ambivalence because there are no clear solutions about how to address their needs b. Strongly negative because immigrants take jobs that native-born Americans could have instead c. Strongly positive because immigrants bring useful job skills and often join previous family members already in the United States d. Strong opposition to further immigration because of the increasing population in the United States

ANS: A Most Americans are ambivalent about immigration, recognizing both the positive and negative aspects involved and realizing that it is a complex issue that has no clear solutions.

19. When teaching a nutrition class to a student group with a large Hispanic population, the school nurse incorporates foods such as salsa and other healthy dishes familiar to Hispanic students into the presentation. Which of the following best describes the action taken by the nurse? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Both primary and secondary prevention

ANS: A Primary prevention involves activities such as health teaching to prevent a problem from occurring.

7. Which of the following actions represents the use of secondary prevention to reduce environmental health risks? a. Collecting blood specimens from preschool children to check for lead levels b. Meeting with local government officials to request that the city clean up a hazardous vacant lot c. Referring a child with toxic lead levels to a neurologist d. Teaching parents of a 2-year-old about the dangers of lead-based paint in older homes

ANS: A Secondary prevention refers to actions such as surveillance and screening, which are undertaken so that problems may be detected at early stages.

8. Which of the following statements regarding the Health Belief Model is accurate? a. Cues to action are an important component of the model. b. Multiple methods of education should be used when implementing this model. c. The first stage experienced in this model is the pre-contemplation stage. d. To successfully implement this model, ongoing maintenance of the behavior must be considered.

ANS: A The Health Belief Model includes six components that attempt to answer the question of what motivates an individual to do something. These components are perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. The pre-contemplation stage is part of the Transtheoretical Model. Maintenance is part of the Precaution Adoption Process Model.

4. A community citizen reports to the public health nurse that the city water in one neighborhood has had an unusual taste for the past few months. Which of the following actions should the nurse take first? a. Check the most recent consumer confidence report. b. Consult the Centers for Disease Control and Prevention. c. Notify the Environmental Protection Agency (EPA). d. Place a call to the poison control center.

ANS: A The consumer confidence report (also known as the right-to-know report) reports the condition of drinking water. Because this is only one citizen, whose sense of taste may be affected by many conditions, it would not be appropriate to overreact by calling in governmental agencies first. Even so, in case one needed to contact an authority, it would be appropriate to start with local governmental agencies such as the city water department rather than federal agencies.

The state public health agency has received multiple complaints regarding the availability of elder transportation services to a specific county senior center. The state agency assigns a public health nurse to work with the community to evaluate its program for elder transportation services to publicly sponsored eldercare programs. The public health core function applied is: a. assurance. b. policy development. c. primary prevention. d. public transportation.

ANS: A The public health core function of assurance focuses on the responsibility of public health agencies to be sure that activities are appropriately carried out to meet public health goals and plans. This involves making sure that essential community-oriented health services are available and accessible, especially to vulnerable populations who would otherwise not receive necessary services. Assurance also includes assisting communities to implement and evaluate plans and practices.

10. When evaluating an educational program, the nurse discovers that only 25% of community members met the learning objectives. Which of the following parts of the program should be improved? a. Educator b. Content c. Learners d. Objectives

ANS: A Ultimately, the educator is responsible for the success or failure of the educational process and the development of learner knowledge, skills, and abilities. The educator determines how content can be tailored to the learner. The educator determines the objectives. If evaluation reveals that the learning objectives are not being met, the nurse must determine why the instruction is not effective. The educator is responsible for presenting the material creatively and meaningfully in new ways to increase learner retention and ability to apply the new knowledge.

16. A group of teenagers with diabetes become upset and angry because they cannot agree on whether or not to have meetings during summer vacation. Which of the following should the nurse do to be effective in helping the teenagers resolve the conflict? a. Admit that it is difficult for everyone to agree on everything; then ask whether the group can try to decide how to agree on the issue. b. Assume adult authority and announce that meetings will be suspended until fall. c. Recognize that most of the teenagers want to have the meetings, but two are being stubborn; ask the two deviant members to leave the group. d. Suggest that the group avoid discussing it further but rather think about it over the next week and try to discuss the situation more rationally next week.

ANS: A When you respond to conflict by avoiding (suggesting that they avoid further discussion), forcing with power (assuming adult authority), capitulating, or excluding some members (asking the deviant members to leave), the behavior fails to satisfy the concerns of those involved. Open communication and recognition that conflict is inevitable may allow the group to focus on a procedure for fairly resolving the conflict.

The relationship between nursing practice, health policy, and politics can best be described as nursing: A. advocacy. B. policy process. C. process. D. profession.

ANS: A Advocacy begins with the art of influencing others (politics) to adopt a specific course of action (policy) to solve a societal problem and is accomplished by building relationships with appropriate policy makers—the individuals or groups that determine a specific course of action to be followed by a government or institution to achieve a desired end (policy outcome). This can be done in many ways. Types of advocacy include actions on behalf of clients served by nursing, especially vulnerable populations; activities of the nursing profession itself; work to develop needed health policies or revise existing policies; and actions related to the community.

Staff members have agreed to implement evidence-based practice; they have chosen a specific problem and searched the literature. The group has selected the interventions that seem the easiest to implement. Which of the following actions would the staff take next? a. Assess the quality of the evidence in the literature. b. Decide how best to orient the staff and community to the proposed changes. c. Eliminate all nursing interventions that are not evidence based. d. Choose another specific problem for the next literature search.

ANS: A After the group has chosen the topic and evaluated the literature for approaches that seem feasible, specific interventions are chosen. The quality of the evidence must be assessed before recommending specific changes or writing a protocol to resolve the problem. Grading the strength of evidence or determining the quality, quantity, and consistency of research studies must be done before making recommendations for practice.

One effect of the use of block grants was a: a. Reduction of federal expenditures b. Decreased ability of states to spend money on programming c. Guaranteed continuation of programs with demonstrated effectiveness d. Shift from hospital-based to community-based nursing care

ANS: A Block grants enabled financial responsibility to shift from the federal level to the state level, thereby reducing expenditures.

The state orders a person newly diagnosed with tuberculosis to be quarantined. What type of law allows the state to do this? a. Constitutional b. Common c. Judicial d. State

ANS: A Constitutional law provides overall guidance for selected practice situations.

When a local health department provides a hypertension screening to all individuals, which general category of health care functions is being used? a. Direct services b. Financing c. Information d. Policy setting

ANS: A Direct services are actions that provide health care directly to individuals.

A nurse implements an education program that incorporates computer games to reinforce learning for a group of older adults. Although the research demonstrates evidence of improved retention of this information, the nurse experiences exactly the opposite with this group. Which of the following is the most likely cause of such poor outcomes? a. Failure to consider client and setting differences b. Inadequate incorporation of evidence into practice c. Inferior quality of the available research evidence d. Lack of skills when evaluating the evidence

ANS: A EBP cannot be applied as a universal remedy without attention to client differences. When EBP is applied at the community level, best evidence may point to a solution that is not sensitive to cultural issues and distinctions and thus may not be acceptable to the community. For example, computer games may be excellent for younger groups but are often poorly suited for older Americans who may face challenges with learning new technology.

It is important that nurses are involved in health policy because: a. Government and policy have a large impact on nursing and health. b. Policy affects nursing values as set forth by Florence Nightingale. c. Political science is a course of study that parallels nursing. d. Nurses must interpret laws to fit their practice.

ANS: A Nurses should be advocates for the health of the population. In order to do this, nurse professionals must have a working knowledge of government, health care law, the policy process, and the political forces that are shaping the future of health care.

Several community-oriented nurses want to explore the problem of obesity in school-age children and assess their community school district's health status related to that problem. When gathering information at a national level, they would begin with the: A. Centers for Disease Control and Prevention. B. Centers for Medicaid and Medicare Services. C. Health Resources and Services Administration. D. National Institute of Nursing Research.

ANS: A The Centers for Disease Control and Prevention serve as the national focus for development and application of measures to advance disease prevention and control, environmental health, and health promotion, and for educational activities designed to improve the health of the people of the United States. The mission of the Centers for Disease Control and Prevention is to promote health and quality of life by preventing and controlling disease, injury, and disability.

A member of the military receives health care services through which department? a. Defense b. Labor c. Agriculture d. Justice

ANS: A The Department of Defense delivers health care to members of the military, including their dependents and survivors, and to retired members and their families.

2. A nurse recognizes that although a patient speaks English, the patient is from a culture with which the nurse is unfamiliar. Therefore, a cultural assessment should be attempted. Which of the following questions should the nurse ask? (Select all that apply.) a.Can you tell me where your family is from? b.Do you practice a particular religious faith? c.Have you ever been in an American hospital before? d.Is there anything special we need to know about your food preferences?

ANS: A, B In a brief cultural assessment, nurses ask clients about their ethnic background, religious preference, family patterns, cultural values, language, education, politics and health practices. Nurses want to also ask about the clients perception of the health issue and what caused it and how it should be treated as well as the results they expect from the care they get. Such basic data help nurses understand the client from the clients point of view and recognize what is unique about the person, thus avoiding stereotyping.

4. A patient tells a nurse, I know all about this already. I read about it on the Internet. The patient then summarizes what he has learned. Because some of this information seems incorrect, what questions would be effective for the nurse to ask? (Select all that apply.) a. Were you able find what you wanted easily on the website? b. Did the website say when the information was updated? c. Did the website state who was responsible for the information? d. Did you enjoy reading the material on the website?

ANS: A, B, C To assess the quality of information, the nurse should attempt to find information about the authors, the purpose of the site (to share information or sell a product?), any available editorial reviews, the date of the material, the design of the site (easy to navigate? well organized?), etc.

State and federal statutes and regulations affect the health care specialties of home health and hospice practice. A primary motivator for nurses to become knowledgeable about these statutes and regulations is their impact on nursing practice in which of the areas below? (Select all that apply.) A. Documentation of client status and progress B. Documentation of services C. Living wills and advance directives D. Resident's rights in long-term care facilities E. Right to death with dignity

ANS: A, B, C, D, E State laws specify licensure and certification requirements for home health care and hospice agencies. Compliance with these laws is directly linked to the method of payment for the services. For example, a service must be provided by a licensed and state-certified agency to obtain payment from Medicare. Federal regulations implementing Medicare and Medicaid programs have an enormous effect on much of nursing practice, including documentation practices and recording of visits, client care, status, and progress. Other laws focus on issues such as the right to death with dignity, the rights of residents in long-term care facilities, definitions of death and death pronouncement, and the use of living wills and advance directives.

2. Which of the following are the major sources of air pollution in the United States? (Select all that apply.) a. Burning of fossil fuels b. Waste incineration c. Industrial plants d. Motor vehicles

ANS: A, B, D Motor vehicles are the greatest single source of air pollution in the United States. The burning of fossil fuels (diesel, industrial boilers, and power plants) and waste incineration are two other major contributors.

The Centers for Disease Control and Prevention accomplishes its mission by (select all that apply): a. Implementing prevention strategies b. Detecting and investigating health problems c. Dictating world health policy d. Fostering safe and healthful environments

ANS: A, B, D The Centers for Disease Control and Prevention implements prevention strategies, detects and investigates health problems, and fosters safe and healthful environments.

4. Which of the following strategies would a nurse expect to be implemented by a typical state environmental agency? (Select all that apply.) a. Acting, through unannounced inspections, to ensure compliance b. Writing permits that help limit toxic hazards c. Monitoring hazardous substances to uphold established standards d. Obtaining and analyzing samples to confirm compliance

ANS: A, C, D The organization and approach to environmental protection vary somewhat among states, but the common essential strategies of prevention and control via the permitting process, establishment of environmental standards, and monitoring, as well as compliance and enforcement, are found in every state.

1. A nurse has been making ongoing visits to a preschool to help the staff teach the children important skills, such as brushing their teeth after meals. Now the nurse is scheduled to teach carbohydrate counting to adults newly diagnosed with diabetes. Which of the following actions will the nurse need to take when teaching this population? (Select all that apply.) a. Appeal to the need for autonomy and choice. b. Emphasize that anyone with diabetes must know this information. c. Explain how to cope with being a guest at a dinner. d. Recognize that this audience will depend on the instructor to set goals for learning.

ANS: A, C For this audience, the best approach will be to use adult experiences and practical problems as learning motivatorsfor instance, appealing to adults sense of autonomy and choice, basing examples on practical adult situations such as cooking meals or eating in restaurants, and discussing how clients can cope with possibly awkward situations such as being a guest at dinner but having diet restrictions.

1. An undocumented immigrant comes to a physicians office to receive care. Which of the following services can the client receive? (Select all that apply.) a. Treatment for tuberculosis b. Treatment for Type 2 diabetes c. Immunization for polio d.Physical examination

ANS: A, C Undocumented immigrants or illegal aliens are individuals who have crossed a border into the United States illegally or whose legal permission to stay in the United States has expired. They are eligible only for emergency medical services, immunizations, treatment for the symptoms of communicable diseases, and access to school lunches.

A nurse has decided to increase the evidence base of current nursing practice in an agency. Which of the following describes a barrier that could be encountered by the nurse? (Select all that apply.) a. Colleagues who don't know how to search the literature or critique research b. Dedication to the history and tradition of the agency c. Little or no research published in the clinical area of concern d. Several meta-analyses in the literature with inconsistent results

ANS: A, C Barriers to evidence-based practice exist when the following are limited or lacking: time, access to journal articles, search skills, critical appraisal skills, and an understanding of research terminology. Other barriers include miscommunication about the process; inferior or unavailable research or other evidence; unwillingness of organizations to fund research or make decisions based on evidence; and concern that evidence-based practice will decrease emphasis on individual client needs or the nurse's clinical decisions.

5. Which of the following actions would a nurse take when serving as an advocate for the community? (Select all that apply.) a. Asking questions related to health implications at policy meetings b. Calling the local health department to report problems at the hospital c. Serving as a source of information at public meetings d. Volunteering to serve on health-related committees

ANS: A, C, D Advocacy roles of the community-oriented nurse include attending policy meetings to obtain health-related information, holding public meetings (or serving on panels at meetings) to provide health-related information, serving on health-related committees, and informing local media about environmental hazards in the community.

2. Which of the following characteristics must a learner possess to successfully master psychomotor learning? (Select all that apply.) a. The necessary ability to perform the skill b. An open mind to learning the new skill c. A sensory image of how to perform the skill d. Opportunities to practice the skill

ANS: A, C, D Psychomotor learning is dependent on the learners meeting the following three conditions: having the necessary ability including both cognitive and psychomotor ability, having a sensory image of how to carry out the skill, having opportunities to practice the new skill.

6. A community health nurse has been recently hired to work in an unfamiliar community. Which of the following persons would be effective key informants for the nurse? (Select all that apply.) a. Communitys immigrant group activist b. Federal senators and representatives c. Health board members d. Local politicians such as the town mayor

ANS: A, D a. Communitys immigrant group activist d. Local politicians such as the town mayor Informant interviews, which consist of directed talks with selected members of a community about community members or groups and events, are basic to effective data collection. Talking to key informants is a critical part of the community assessment. Key informants are not always those who have a formal title or position. Key informants often have an informal role within the community. Examples of informal key informants would include a member of a minority group who is listened to by other members of the group, a church leader, and a parent who is active and vocal about the school health curriculum.

14. A Buddhist patient enters the hospital for diagnostic testing just before lunch time. The nurse tells the aide to give a meal tray to the new patient, because no tests will be done until later that evening. The aide gives the patient a meal of Salisbury steak, bread, green beans, and potatoes with brown gravy. The patient eats nothing but a slice of bread and the green beans. Which of the following considerations was omitted by the nurse? a. The patient should not be served any food until a physicians order is obtained. b. The patients Buddhist faith probably requires a vegetarian diet. c. The patient may be too frightened about the tests to want to eat very much. d. The patient may have diabetes or be allergic to some foods.

ANS: B Although it is always wise to check with a patient before sending in food, the meal given to this patient was offensive. Most Buddhists are vegetarians and dont eat meat.

10. Which of the following best describes the purpose of local health departments making unannounced inspections of local restaurants? a. To enforce local laws and regulations b. To ensure compliance c. To provide exposure to oversight d. To monitor employee safety

ANS: B Ensuring compliance refers to the process of making certain that permitting requirements are met. Although this activity may be seen as a type of monitoring, the question asks for the purpose, which is to ensure compliance. Enforcement involves penalties such as fines or facility closure.

4. A nurse planned a presentation about the latest trends in disaster planning for the senior nursing students at the local college. However, when the nurse began to share the information, the students were talking to one another and essentially ignoring the nurse. Which of the following actions should be taken by the nurse? a. Ask the students why they are being so rude. b. Explain why the information is crucial to their current clinical practice. c. Nothing; let the instructor of the course handle the problem. d. Tell a joke to get the students attention.

ANS: B Before learning can take place, you need to gain the learners attention. One way to do this is by convincing the learner that the information about to be presented is important and beneficial to them personally.

3. A nurse wishes to develop cultural competence. Which of the following actions should the nurse take first? a. Complete a survey of all the various ethnicities represented in the nurses community. b. Consider how the nurses own personal beliefs and decisions are reflective of his or her culture. c. Invite a family from another culture to join the nurse for an event. d. Study the beliefs and traditions of persons living in other cultures.

ANS: B Cultural awareness requires self-examination and an in-depth exploration of ones own beliefs and values as they influence behavior.

10. A nurse states, The best way to treat a client from another country is to care for them the same way we would want to be cared for. After all, we are all humans with the same wants and needs. What does this statement reflect in relation to culture? a. Awareness b. Blindness c. Knowledge d. Preservation

ANS: B Cultural blindness is the tendency to ignore differences between cultures and to act as if they do not exist. People from different cultures may have different expectations, wants, and needs.

2. A nurse is about to despair. Earlier in the week, she carefully taught a patient from a different culture exactly how much medication to take and emphasized the importance of taking the correct amount. However, the patient is back in the hospital today with symptoms of an overdose, although the patient denies taking more than the label indicated. Which of the following is the most likely explanation? a. The patient was taking more mediation in the hope of getting well faster. b. The patient was also taking folk medicines that had many of the same effects and perhaps some of the same ingredients as the prescribed medication. c. The patient truly did not understand and thought the dose being taken was correct. d. The patient had a unique response to the medication and should have a smaller dose ordered.

ANS: B For fear of disapproval, a person may not tell the nurse that he or she is using folk medicine as well as Western medication. The two medicines may have cumulative effects that could be dangerous to the client. Nurses who lack cultural knowledge may develop feelings of inadequacy and helplessness because they are often unable to effectively help their clients.

2. A nurse wants to find information about environmental threats that are present in the community. Which of the following would be the best source of data for the nurse? a. CINAHL b. National Library of Medicine c. State health department d. Closest local library

ANS: B Technology helps us understand environmental threats. The National Library of Medicine (NLM) databases are user-friendly and accessible on the Internet. The NLM website provides access to medical databases such as PubMed and GratefulMed, which can be searched for possible environmental linkages to illnesses using key terms.

Nurses should consider opportunities for population-focused practice that result from the rapid transformation of health care delivery from a medical model to a health promotion/disease prevention model. An example of such opportunity is: a. operator of a nurse practitioner-run urgent care center in a major retail location. b. director of clinical services spanning inpatient and community-based settings that provide a wide range of services to the populations seen by the system. c. clinical director of a home health agency. d. school nurse position in the local high school.

ANS: B The new focus on populations, coupled with the integration of acute, chronic, and primary care occurring in some health care systems, is likely to create new roles for individuals, including nurses, who will span inpatient and community-based settings and focus on providing a wide range of services to the populations served by the system. Such a role might be director of client care services for the health care system, who has administrative responsibility for a large program area. There will be a demand for individuals who can design programs of preventive and clinical services to be offered to targeted subpopulations and for those who can implement such programs.

A school nurse is developing a primary prevention strategy for school-aged children. Which of the following interventions would the nurse most likely implement? a. Developing individualized exercise programs for overweight children b. Drafting policy for increases in noncompetitive physical activity programs c. Monitoring body mass index in children to identify elevations before they become difficult to manage d. Notifying parents and/or guardians of their child's height-weight scale in comparison with national norms

ANS: B At the primary prevention level, campaigns to support regular exercise, greater emphasis on school-based physical education programs, and environmental and policy initiatives to create or enhance places for physical activity in communities can make significant contributions to improving the lifestyle of sedentary children. Exercise programs are an example of tertiary prevention. Monitoring BMI in children is an example of secondary prevention. Notifying parents of their children's height-weight scale increases family awareness but does not meet the definition of a preventive measure.

A health care provider is concerned about the high number of clients with type 2 diabetes mellitus who have poor glucose control. What would be the best reference for the provider to implement evidence-based practice (EBP) in the management of this problem? a. Published protocols b. Current research findings c. Opinions of colleagues d. Nursing journals

ANS: B EBP in community-oriented nursing challenges nurses to integrate outcomes of the best evidence into their clinical practice. Current research findings will explicate evidence of most successful interventions. (Randomized clinical trials are the gold standard of research for EBP.) Protocols and opinions often reflect tradition rather than the most current scientific evidence. Although many nursing journals are peer reviewed, many are not and, even if peer reviewed, many are not research based or focused on scientific evidence. Similarly, information from the Internet may or may not be reliable, because the goal of many websites is to sell products rather than to serve as an unbiased source. Determining when the website was last updated would also be helpful in evaluating the site's usefulness.

A public health nurse (PHN) has identified a need to make amendments to an existing law concerning the tuberculosis health assessment of individuals sentenced to serve jail terms on weekends only because of the gap in treatment accountability and potential health risk to the free-living community. To draw attention to this concern, the nurse has several paths to follow, but the amendment of any existing laws would ultimately be decided by which of the following? A. Executive branch of government B. Legislative branch of government C. Local representative D. Senate hearings

ANS: B Each of the government branches at the federal level, in most states, and at the local level plays an important role in developing and implementing health law and public policy. Concerned citizens have many avenues for addressing issues related to needed laws and regulations as well as existing laws and regulations. However, each branch of government has a separate and important function. The legislative branch identifies problems and proposes, debates, passes, and modifies laws to address identified needs.

The levels of government responsible for carrying out the five government health care functions of direct services, financing, information, policy setting, and public protection are: A. federal and state. B. federal, state, and local. C. all, but primarily state and local. D. all, but primarily federal and state.

ANS: B Federal, state, and local governments are responsible for carrying out the five core government health care functions. All levels of government provide direct services, but the targeted populations may vary; for example, at the federal level, the focus is on the members and dependents of the military, whereas the states focus on childhood immunizations. The federal government provides funding for health care education and research. The states provide maternal-child health care services through state-level funding for the poor or near poor. Local governments/organizations provide health care services through funding for free clinics that serve the uninsured. All branches and levels of government collect vital statistics and census data, and conduct health surveys. Governments, agencies, and organizations at all levels make health policy. Functions that protect the public, such as monitoring air and water and regulating food, drug, or animal transportation, are carried out at all levels. Affirmation of a woman's right to reproductive privacy occurred at the federal level (Supreme Court). Requiring vaccinations for school entry occurs at the state level.

Needle stick legislation clarified the role of employers to: a. Use Universal Precautions when dealing with all patients. b. Select safer needle devices as they became available. c. Provide needle disposal boxes. d. Incinerate all infectious waste including needles.

ANS: B Health care facilities by law have to select safer needle devices and involve employees in identifying and choosing the devices.

Health policy can best be defined as a set course of action to: A. administer public health care programs at the federal level for disaster preparedness, response, and recovery. B. obtain a desired health outcome for an individual, family, group, community, or society. C. support publicly funded health care programs at the local, state, and national levels. D. support health care development and research to improve the health status of citizens.

ANS: B Health policy is a set course of action to obtain a desired health outcome, either for individuals, families, groups, communities, or societies. Policies are made not only by governments but also by institutions such as a health department or other health agency, a family, or a professional organization. Politics plays a role in the development of such policies. Politics is found in families, professional and employing agencies, and governments. Therefore, political activities are used to arrive at a course of action (the policy). Policy is a settled course of action to be followed by a government or institution to obtain a desired end.

The health policy-making body of the World Health Organization (WHO) released a policy statement on nursing and midwifery in 2013. The important fact for nurses to understand about WHO policy statements is that such statements: A. apply only to underdeveloped countries. B. are guides for in-country initiatives and priorities. C. carry the weight of international law. D. provide mandates for in-country legislatures.

ANS: B In 1946, the WHO was created through a United Nations initiative as a special autonomous organization. The WHO provides services worldwide to promote health, cooperates with member countries in promoting their health efforts, coordinates collaborative activities between countries, and disseminates information on biomedical research and vital international statistics. The World Health Assembly (WHA) is the policy-making arm of the WHO and meets annually. The WHA's health policy work provides policy options for many countries of the world in their development of in-country initiatives and priorities. Although WHA policy statements are very important everywhere, they are guides and not law.

One of the main purposes of the Patient Protection and Affordable Care Act was to: a. Create a government-funded insurance program for all Americans. b. Make health insurance affordable for the middle class and small businesses. c. Decrease the rates of chronic disease in the United States. d. Increase the funding for public health agencies.

ANS: B One of the main purposes of this legislation was to make health insurance affordable for middle class families and small businesses with one of the largest tax cuts for health care in history: reducing premiums and out-of-pocket costs. This act does not create a government-funded insurance program nor does it increase funding for public health agencies.

A school health nurse plans to use evidence-based practice (EBP) to guide the development of health education programs most likely to increase retention of learning in elementary schoolchildren. Which of the following would be the best way to use EBP in this situation? a. Ask other school health nurses what they included in their own education programs. b. Compare and contrast randomized clinical trials related to learning in elementary schoolchildren. c. Develop a series of games to accompany the programs developed to promote health. d. Seek out and examine health education programs for elementary school children on the Internet.

ANS: B Randomized clinical trials are the gold standard of evidence gathering in EBP.

A community health nurse is determining the best way to address an outbreak of a new infectious disease using evidence-based practice. Which of the following actions would the nurse most likely take? a. Review policies and procedures b. Review outcomes of clinical trials c. Review several nursing textbooks d. Review reputable sites on the Internet

ANS: B Research findings, knowledge from basic science, clinical knowledge, and expert opinion should be considered sources of evidence for EBP. The problem with nursing textbooks is that many are not grounded in evidence-based practice, because the concept is relatively new to the United States (as mentioned in the section of the chapter on historical perspectives of EBP). Scanning the Internet for ideas is helpful only if evidence-based practice sites are accessed, and most Internet sites are not EBP sites.

If a nurse researcher wants to get information on the occurrence of an internationally important disease, where would be a good place to seek this information? a. The United Nations website b. The World Health Organization (WHO) website c. The World Bank website d. The World Health Assembly website

ANS: B The WHO publishes day-to-day information about international occurrence of disease, injury, and death.

The United States Department of Health and Human Services (DHHS) is part of which branch of the government? a. Judicial b. Executive c. Legislative d. Health

ANS: B The executive branch includes regulatory departments, one of which is the United States DHHS.

A busy school health nurse concerned over the rising incidence of obesity wants to implement evidence-based practice (EBP) but faces barriers because of time constraints. Which of the following actions should the nurse take first? a. Identify students who are obese so that they may be closely monitored for weight control success or failure. b. Evaluate best practices to determine those that have the highest success rates for weight control in children. c. Schedule physician appointments for obese children. d. Develop an obesity management program for children whose body mass index exceeds normal.

ANS: B The first step of the seven-step EBP process is step zero, which involves a curiosity about the interventions that are being applied; this is not described in any of the topic descriptors. Step one requires asking questions in a "PICOT" format; this is not described in any of the topic descriptors. Step two involves searching for the best evidence to answer the question. This is done through evaluating best practices.

disease that occurs regularly in a population as a matter of course

Endemic

The occupational health nurse is preparing to administer a purified protein derivative (PPD) tuberculin skin test to an employee. Before administration, the nurse should take which actions?

Ensure that the employee has not had a positive test result in the past

unexpectedly large number of cases of an illness, specific health-related behavior or event, in a particular population

Epidemic

3. A nurse wants to use the principles of risk and outrage to improve an environmental hazard in the community. To accomplish this, which of the following actions would be taken by the nurse? (Select all that apply.) a. Advertise in the media throughout the entire surrounding area. b. Communicate the correct information in a timely fashion. c. Share all the data found on the community assessment. d. Talk to those affected or those worried about the situation.

ANS: B, D Sharing all the data would be overwhelming, and much of the data might not be relevant. Using epidemiological statistics would not be meaningful to those without the education or experience to be able to draw an appropriate conclusion. Instead, the correct information must be given in a language the audiencenamely, those at risk or worried about the riskcan understand. Use the communication channels the neighborhood residents use and meet at a common meeting place for the community. It is wasteful of resources to advertise in media throughout a wider region or to meet at a central regional facility when only community residents will be interested or involved.

9. A nurse wants to help keep the community environment safe. Which of the following is the most appropriate action for the nurse to take? a. Conserve water by bathing less often. b. Downsize to a smaller living space. c. Reduce, reuse, and recycle. d. Replace all his appliances with new energy-efficient ones.

ANS: C All citizens can engage in minimizing their impact on the environment by reducing, reusing, and recycling. Although it would be nice to replace all appliances for energy-efficient newer models, most people cant afford thatfurthermore, it is an environmental issue to discard the used models. Similarly, downsizing to a smaller living space could help the environment, because the nurse would use less energy, but again, not everyone can afford all the expenses involved in moving. On the other hand, all persons can reduce, reuse, and recycle the individual products they currently consume.

18. A 40-year-old Bosnian, Muslim woman who does not speak English presents to a community health center in obvious pain. She requests a female health care provider. Through physical gestures, the woman indicates that the pain is originating in either the pelvic or genital region. Which of the following interpreters would be the most appropriate in this situation? a. A Bosnian male who is certified as a medical interpreter b. A female from the clients community c. A female who does not know the client d. The clients 20-year-old daughter

ANS: C Although having experience in medical interpretation is important, in many cultures it is inappropriate to have a male interpreter for females. This client has specifically requested a female provider; therefore, one might anticipate that the client will not be as forthcoming with a male interpreter. Regardless of certification and ability, the interpreter cannot interpret information the client may withhold because she feels it inappropriate to discuss private matters in front of a male. This client may also feel it inappropriate to have private matters interpreted by her daughter (especially if they are of a sexual nature or if they involve infidelity). Additionally, to avoid a breach of confidentiality, the nurse should avoid using an interpreter from the same community as the client.

12. A nurse is completing a basic health assessment. Which of the following questions should be asked by an environmentally aware nurse? a. Is anyone else in your family having these symptoms? b. Can you tell me about your house or apartment? c. What jobs have you held longest? d. Where do you live?

ANS: C An exposure history should identify current and past exposures, have a preliminary goal of reducing or eliminating current exposures, and have a long-term goal of reducing adverse health effects. The I PREPARE mnemonic consigns the important questions to categories that can be easily remembered. Asking about previous employment helps to answer the P of past work.

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

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

7. Mexican immigrants who take metamizole (Mexican aspirin) for pain may experience life-threatening agranulocytosis. Which of the following actions would be taken by a nurse who employs cultural repatterning? a. Complete a cultural assessment to identify any other dangerous medications that the client may be taking. b. Put this into perspective by considering that many drugs used in the United States cause agranulocytosis. c. Explain the harmful effects of metamizole and recommend an alternative medication for pain. d. Recognize that taking metamizole is common among persons living in Mexico and accept this as a cultural tradition.

ANS: C Cultural repatterning means that the nurse works with clients to help them reorder, change, or modify their cultural practices when the practice is harmful to them.

8. An occupational health nurse at a local factory is using primary prevention strategies to reduce the environmental health risks among the employees. Which of the following activities would the nurse most likely implement? a. Checking radiation detectors to monitor for unsafe levels of radiation exposure b. Irrigating the eyes of an employee who has had a chemical splash to the face c. Teaching new employees who will work outdoors about the signs and symptoms of heat-related illness d. Using spirometry to rule out obstructive or restrictive lung disease for workers who will be wearing mask respirators

ANS: C Education is a primary preventive strategy. When examining the sources of environmental health risks in communities and planning intervention strategies, it is important to apply the basic principles of disease prevention.

6. A nurse uses lecturing as the primary method of educating clients. Which part of the education process is missing? a. Evaluation b. Experience c. Participation d. Understanding

ANS: C Educators should include participation. (This is one of the six principles of education.) Merely sitting and listening to someone lecture are not as effective as discussion, even when the presentation is stimulating, interesting, and dynamic.

5. A nurse who works at the local hospital asks a public health nurse what might be causing her hands to become very sore and sensitive. Which of the following statements would be the most appropriate response by the public health nurse? a. Ask the staff in employee health if there have been any other complaints. b. Call the local health department about any recent problems at the hospital. c. Check the material safety data sheet on any chemicals you have used recently. d. See the nurses health care provider for a complete work-up.

ANS: C Employees have the right to know about hazardous chemicals with which they work. Employers must maintain a list of all hazardous chemicals used on the premises, along with a material safety data sheet that addresses health risks related to these chemicals, as well as information about safe use and handling.

15. A nurse practitioner has established a mobile clinic to vaccinate noninstitutionalized adults against influenza. Which of the following phases of the nursing process is being implemented? a. Assessment b. Planning c. Intervention d. Evaluation

ANS: C Giving immunizations is an intervention that will increase the number of people who will be vaccinated. Intervention includes coordinating medical, nursing, and public health actions to meet the clients needs.

Graphic display of the cases of disease according to the time or date of onset of symptoms

Epidemic curves

11. A man says, I just cant get myself to leave the house and go for a 30-minute walk each day. I wish I could think of some way to motivate myself. Which of the following would be the best action for the nurse to take? a. Establish a written contract between him and his employer that states walking is required each day. b. Recognize the reasons why 30 minutes of walking each day is one of the best health promotion activities he can choose. c. Join a group that walks early each morning. d. Set up rewards for himself, such as a nice snack after he gets back from walking.

ANS: C Health behavior is influenced by the groups to which people belong. Having someone else to walk with is an effective way to maintain the behavior.

3. A nurse is providing an educational program about testicular self-examination (TSE). Which of the following would be the best learning objective for this program? a. Each participant will state why TSE is important and explain how to do it. b. Each participant will describe how to do TSE and discuss the dangers of testicular cancer. c. 90% of the men will correctly demonstrate testicular self-examination. d. 100% of the men will do a testicular examination correctly on a model.

ANS: C If the goal is to learn TSE, the best goal is for the person to be able to do TSE correctly. Being able to state why it is important is a helpful first step, as is practice on a model, but to be sure the person can really do the procedure, you need to allow practice time and feedback until the person can demonstrate the procedure properly.

14. The leader of an Alzheimers support group surveys the members of the group to determine the best time for the group to meet. Which of the following norms is being supported through this action? a. Group norms b. Task norms c. Maintenance norms d. Reality norms

ANS: C Maintenance norms create group pressure to affirm members and maintain their comfort. Maintenance behaviors include identifying the social and psychological tensions of members and taking steps to support those members at high-stress times. Maintenance norms often refer to things such as scheduling meetings at convenient times and in an accessible and comfortable space.

13. A client is crying softly and saying, What did I do to deserve this punishment, Lord? Which of the following responses by the nurse would be the most appropriate? a. God doesnt punish people. Youre sick just because of bad luck. b. I can call the hospital chaplain to help you talk about these feelings c. What can I do to be helpful to you right now? d. Would you like to confess your sins and repent so this illness will go away?

ANS: C Some clients may view their illness as punishment for misdeeds and may have difficulty accepting care from nurses who do not share their beliefs. Because the nurse may not be a member of the clients religious faith group, an open-ended response showing caring is the most appropriate statement.

1. A member of a community weight-loss group has maintained a healthy weight for 2 years through healthy eating and daily exercise. Which of the following steps of the affective domain is this participant demonstrating? a. Analysis b. Application c. Evaluation d. Knowledge

ANS: C Steps in the affective domain have the learner doing the following in this sequence: (1) knowledge: receives the information; (2) comprehension: responds to what is being taught; (3) application: values the information; (4) analysis: makes sense of the information; (5) synthesis: organizes the information; (6) evaluation: adopts behaviors consistent with the new values. In this example, the individual has adopted the behavior and this has resulted in the ability to maintain the value of a healthy weight.

2. A nurse just finished teaching breast self-examination to a large group of women at a professional conference. During the session, she distributed literature and used culturally appropriate visual aids. However, the session was not as effective as it could have been. Which of the following was the most important thing omitted by the nurse? a. Time for audience members to ask questions and clarify the information b. Explanation of why culturally appropriate images are more acceptable c. Opportunity for the women to practice what they learned d. Use of simple language instead of printed material

ANS: C The learner must have opportunities to practice the new skills being learned. Provide practice sessions during the program because many people may not have the time, facilities, motivation, and/or support to practice at home what they have learned.

17. A nurse gives detailed information on how to apply for Medicaid to a new mother who moved to the United States from Russia about 10 years ago. The nurses next client is an African-American mother of newborn twins who worked until the children were born. The nurse knows the woman is eligible to maintain her insurance after her employment was lost and does not discuss insurance options at all. Which of the following errors is being made by the nurse? a. Covert intentional prejudice b. Covert unintentional prejudice c. Overt intentional prejudice d. Overt unintentional prejudice

ANS: C The nurse may have assumed that the African-American mother knew the available resources and could negotiate for assistance on her own and that the immigrant Russian woman had no experience negotiating government programs and thus needed the nurse to advocate for her and inform her of the programs available to her. The nurse, not knowing the health-seeking behaviors of either client, stereotyped both women and intentionally used her informational power to help one client while denying assistance to the other client.

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

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

A nursing administrator wants to develop a work environment conducive to the implementation of evidence-based practice (EBP). Which of the following actions would best achieve this goal? a. Conducting market research to determine customer satisfaction with EBP b. Eliciting opinions from nurses on how EBP will affect workload c. Purchasing computers and Internet access for use by employees d. Sending staff to conferences related to incorporation of EBP into practice

ANS: C A lack of computers and Internet access can create a barrier to implementation of EBP in community-based nursing agencies. If these are provided, nurses can quickly access current evidence-based findings and recommendations.

A nurse executive is implementing evidence-based practice at a community nursing center that serves a large Cuban immigrant population. Which of the following actions would be the most helpful for the nurse? a. Review clinical policies with cultural competency experts from the local university. b. Conduct weekly staff meetings to discuss which methods work best when helping immigrants. c. Invite Cuban immigrants from the community to serve on the center's advisory board. d. Send personnel to conferences and seminars that focus on treating Hispanic immigrants.

ANS: C Although all of these options are good, to determine whether practice is serving the needs of the population, the nurse will need to consult the population served. This means that evidence should be applied with input from the community. For example, decisions related to the services to be offered in a nurse-managed clinic should be made with input from the clinic's advisory board, which should include community leaders and consumers of the clinic's services. Cuban immigrant needs may not be the same as

Nurses working in hospice and home care settings need to be knowledgeable of health policy to: a. Provide safe nursing care. b. Prevent elder abuse. c. Receive payment for the services provided. d. Influence future legislation.

ANS: C Although nurses should be involved in influencing future legislation by contacting their legislators, the best response is that nurses need to be knowledgeable of the current health policies needed so that payment can be received for services that are providing.

Investigations carried out when disease or death occurs in unexpected or unacceptable numbers, consisted of descriptive and analytic studies

Epidemiologic studies

Americans with Disabilities Act (ADA)

an act passed in 1990 that mandated that individuals with mental and physical disabilities be brought into the mainstream of American Life

The branch of medical science concerned with the incidence, distribution, and control of diseases that are prevalent among a population at a special time and are produced by some special causes not generally present in the affected locality. Population medicine

Epidemiology

While researching various health care services that are provided in prisons, a nursing student learns that these services: a. Are funded by the Department of Defense b. Focus on health promotion interventions c. Must be provided at an adequate level d. Are available to those diagnosed with a chronic illness

ANS: C Health care services for prisoners are required at an adequate level for all incarcerated individuals. This is administered by the Department of Justice. Prisoners will receive health care services when diagnosed with chronic illnesses as well as acute illnesses.

A PHN employed by the state's department of health is working on a team to develop local health policy. The nurse recognizes that policy development focuses on the level of the larger society and adopts strategies that require political actions such as lobbying and testifying. The reason that action in the policy arena comes most easily and naturally to nurses is the fact that the policy process is very similar to which of the following? A. Citizen action committee B. Nursing diagnosis C. Nursing process D. Socratic method

ANS: C Health policy is simply the process of turning health problems into workable action solutions. Thus, the policy process is very similar to the nursing process, but the focus is on the level of the larger society and the adoption of these strategies requires political action. The policy process includes statement of a health care problem, statement of the policy options to address the problem, adoption of a particular policy option, implementation of the policy product, and evaluation of the policy's intended and unintended consequences in solving the original health problem.

When a nurse is sued for malpractice and goes to court, which type of law is being used? a. Constitutional b. Common c. Judicial d. Institutional

ANS: C Judicial law is based on court or jury decisions.

The practices of physicians, nurses, and other health care providers are differentiated by the: a. Health Resource and Services Administration (HRSA) b. State board of nursing c. Scope of practice d. United States Department of Health and Human Services

ANS: C Scope of practice involves defining nursing, setting its credentials, and then distinguishing between the practices of nurses, physicians, and other health care providers.

Nursing practice is governed by: A. boards of nursing established by the U.S. Department of Health and Human Services. B. nurse practice acts promulgated by federal and state legislative boards. C. nurse practice acts promulgated by state legislatures and operationalized by the state boards of nursing. D. nurse practice acts promulgated by the states in conformity with broad federal guidelines.

ANS: C State legislatures enact laws that establish boards of nursing. The functions of the board are described by the nurse practice act of each state. The boards of nursing license nurses, oversee training programs, and interpret and enforce statutory law.

A nurse says, "I'm not going to change the way I practice nursing based on where the client is from, because research shows that Western health care technology and research is best." What is such a belief called?

Ethnocentrism

A nurse seeks the best resource that provides a broad vision of the goals and objectives of many health care stakeholders in our nation and identifies the current national health policy for the United States. The best source for such information would be the: A. American Public Health Association's guidelines. B. website of the Centers for Disease Control and Prevention. C. Healthy People initiatives. D. Pan American Health Organization's mission statement.

ANS: C The Healthy People initiatives began in 1979 with subsequent updates and revisions across multiple decades. Healthy People 2020 builds on earlier versions to identify a national health agenda to attain quality, longer lives free of preventable diseases, disability, injury, and premature death; achieving health equity, eliminating health disparities and improving health for all groups; creating social environments that promote good health for all; and promoting quality of life, healthy development, and healthy behaviors across all life stages.

The first major federal government action relating to health was the: a. Passage of the Social Security Act b. Creation of the National Institutes of Health (NIH) c. Creation of the Public Health Service (PHS) d. Creation of Medicare and Medicaid

ANS: C The PHS was created in 1798.

Which branch of the government interprets the states rights to grant abortions? a. Executive branch b. Legislative branch c. Judicial branch d. Federal branch

ANS: C The judicial branch interprets laws and their meaning, as in its ongoing interpretation of states rights to define access to reproductive health services for citizens of the states.

The Law (federal or state) and Health Care

Constitutional Law Legislation (law) and Regulation - Board of Nursing - Nurse Practice Act Judicial and Common Law

A nurse was the first on the scene of a disaster and saw people with injuries ranging from minor to serious. Some of those with minor injuries were helping others. Which of the following injured persons would the nurse assist first? A. Those with life-threatening head and chest injuries B. Those who have life-threatening abdominal injuries C. Those who have serious injuries of limbs D. Those who are hurt but still mobile and functioning

B

After a house fire, a 4-year-old child begins sucking his thumb and wetting his bed. Which of the following would be the most appropriate action for the nurse to take? A. Explain to the child that it is important to be strong and not act like a baby. B. Explain to the family that this behavior is a normal reaction to disaster. C. Recommend admission for inpatient psychological counseling. D. Recommend behavior therapy as a means to overcome regression.

B

1. A public health nurse is assisting the community in dealing with the effects of lead paint poisoning. Which of the following activities would the nurse most likely complete? (Select all that apply.) a. Administering medications to those with signs of lead poisoning b. Assessing community members for any health problems c. Setting up a blood screening program with the local health department d. Encouraging local landlords to improve the condition of their housing

ANS: C, D The nurses role is to understand the roles of each respective agency and organization, know the public health laws, and work with the community to coordinate services to address the communitys needs. Other needed interventions include organizing a blood-lead screening program through the local health department, educating local health providers to encourage them to systematically test children for lead poisoning, and working with local landlords to improve the condition of their housing stock.

12. A nurse is meeting to discuss problems and solutions with a group of teenagers who have been newly diagnosed with diabetes. One teenager states, My mom found this particular brand of popcorn that has only 15 carbohydrates in the whole giant bag. Which of the following best describes the group purpose that is being served by the teenagers statement? a. Maintenance function of encouraging everyone to continue the discussion b. Maintenance function of helping everyone feel comfortable talking about food c. Task function of resolving problems about what to nibble during movies d. Task function of sharing information and resources

ANS: D A task function is anything a member does that deliberately contributes to the groups purpose. Members with task-directed abilities are attractive to the group. These traits include strong problem-solving skills, access to material resources, and skills in directing. The teenagers statement shared information about a good resource for the group.

13. A nurse invited all the teenagers who were newly diagnosed with diabetes to a group meeting to discuss issues they all had in common. One teenager replied, I dont know if I want to share all the problems Im having with strangers. Which of the following is the best nurse response? a. Don't share anything with anyone until youre comfortable doing so. b. I can understand what you are saying. c. No one will require you to do anything you dont want to do. d. The purpose of the group is to have a safe place to share problems with others who may be having similar problems.

ANS: D All the responses are empathetic and supportive. However, during the first phase, potential participants do not know whether they can trust one another. The primary task of the leader at this point is to clarify the purpose. Even though a statement such as Dont share anything until youre comfortable is supportive, the response explaining that the purpose is to have a safe place both recognizes what was said and clarifies the purpose of the group.

A public health nurse leader is encountering barriers when trying to shift the public health agency's efforts to a population-focused practice. The reasons peers are not supportive of the proposed shift to a population focus are most likely related to: a. agency colleagues' push for nurses to focus on population initiatives. b. costs associated with staff training and revision of documents. c. lack of support from the agency's funding sources. d. opinions that nursing should focus on the provision of direct client care and services.

ANS: D Barriers to implementing population-focused care include lack of understanding of the public health nurse role and its relationship to other roles in nursing, such as direct care and services; workplace role socialization that determines what roles are appropriate and inappropriate or accessible and inaccessible for nurses; and lack of comprehensive training at the graduate level in the disciplines basic to public health such as epidemiology, biostatistics, community development, service administration, and policy formation.

11. A family from Mexico comes to the public health department. No one in the family speaks English, and nobody at the health department speaks Spanish. Which of the following actions should be taken by the nurse? a. Attempt communication using an English-Spanish phrase book. b. Call the local hospital and arrange a referral. c. Emphatically state, No hablo Espaol (I dont speak Spanish). d. Obtain an interpreter to translate.

ANS: D Communication with the client or family is required for a careful assessment. When nurses do not speak or understand the clients language, they should obtain an interpreter. The nurse must use strategies that will allow effective communication with the client. The client has the right to receive effective care, to judge whether the care was appropriate, and to follow up with appropriate action if the expected care was not received.

6. The nurse practitioner (NP) discovered that an immigrant client is not taking the penicillin prescribed because his illness is hot and he believes that penicillin, a hot medicine, will not provide balance. Which of the following terms best describes the action taken by the NP when the clients prescription is changed to a different yet equally effective antibiotic? a. Cultural awareness b. Cultural brokering c. Cultural knowledge d. Cultural skill

ANS: D Cultural skill involves the provision of care that is beneficial, safe, and satisfying to the client. The medication change allows the client to retain his cultural beliefs and also satisfies the nurse practitioners need to prescribe an effective antibiotic.

5. A male nurse had a habit of sitting with the lower part of one leg resting over the knee of his opposite leg when collecting a clients history. He stopped doing this around Muslim clients after being told that Muslims were offended when he exposed the sole of his foot (shoe) to their face. Which of the following was exhibited by the nurse when he changed his behavior? a. Cultural accommodation b. Cultural imposition c. Cultural repatterning d. Cultural skill

ANS: D Cultural skill is the effective integration of cultural knowledge and awareness to meet client needsin this case, the clients need to not be offended by having the bottom of the nurses foot or shoe in view of the clients face. The nurse using cultural skill makes sure nonverbal communication techniques take into consideration the clients use of body language and space. Cultural accommodation involves negotiation with clients to include aspects of their folk practices with the traditional health care system to implement essential treatment plans. Cultural imposition is the process of imposing ones values on others. Cultural repatterning is working with clients to make changes in their health practices if cultural behaviors are harmful or decrease their well-being.

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

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

14. The nurse is examining blood lead levels in school-age children 1 year after a community-wide education intervention. Which of the following phases of the nursing process is being implemented? a. Assessment b. Diagnosis c. Intervention d. Evaluation

ANS: D In this instance, the nurse is evaluating the results of the intervention to determine whether goals were reached. If you chose assessment, understand that this would have been done earlier in the process because assessment was needed to determine that a problem existed and that interventions were needed.

9. A nurse is planning an educational program about cardiovascular disease. Which of the following would be the optimal time for the nurse to elicit feedback from program participants? a. At the beginning of the program b. At the program midpoint c. Immediately following program completion d. Throughout the program

ANS: D Not only should learners receive feedback, but the educator should also elicit feedback from learners throughout the educational process. On the basis of the feedback that the educator receives from learners, the implementation and presentation of the educational program can be modified.

8. A health care worker tells a nurse, It does no good to try to teach those Medicaid clients about nutrition because they will just eat what they want to no matter how much we teach them. Which of the following is being demonstrated by this statement? a. Cultural imposition b. Ethnocentrism c. Racism d. Stereotyping

ANS: D Stereotyping occurs when someone attributes certain beliefs and behaviors about a group to an individual without giving adequate attention to individual differences. In this instance, the health care worker makes the assumption that clients with low incomes are not educable. The health care worker is guilty of making another assumption as well: noncompliance among other Medicaid clients the worker has known may have been related to an inability to afford nutritious food.

13. A high school student considering a job in the restaurant industry after graduation asks a nurse about workplace safety issues. Which of the following acts would the nurse most likely discuss with the student? a. Chemical Safety Information, Site Security, and Fuels Regulatory Act b. Comprehensive Environmental Response, Compensation, and Liability Act c. Food Quality Protection Act d. Occupational Safety and Health Act

ANS: D The Occupational Safety and Health Act (OSHA) was passed to ensure worker and workplace safety in all employment settings, including restaurants. Others may contribute to safety but do not have the full oversight of OSHA.

1. A nurse wants to have a better understanding of the physiological effects of selected chemicals. Which of the following individuals would provide the most useful information to the nurse? a. Chemist b. Epidemiologist c. Pharmacologist d. Toxicologist

ANS: D Toxicology is the basic science that studies the health effects associated with chemical exposures. The other specialists would probably be able to provide some information, but the toxicologist would most likely provide information related to physiological processes.

The nurse has been reading everything she can find on a particular clinical problem, using both the closest medical library and the Internet. Which of the following would be the most helpful source? a. A journal with a whole issue devoted to research on that clinical problem b. A randomized controlled clinical trial related to that clinical problem c. A researcher who has built a career on studying that clinical problem d. A systematic review related to the clinical problem

ANS: D A systematic review is an approach to identifying, appraising, and synthesizing research evidence to evaluate and interpret all available research that is relevant to a particular research question. Systematic reviews can be accessed from most databases. Systematic reviews require more rigor and contain less opinion of the author than typical reviews of the literature.

A nurse manager wants to facilitate incorporation of evidence-based practice (EBP) in the clinical setting. Which of the following would be the best strategy to accomplish this goal? a. Eliminate all protocols and standards that are not evidence based b. Encourage group reflection on the ideals and expectations of nursing care c. Refer agency nurses to Internet sources of research findings d. Support nurses using practice-oriented research findings in decision making

ANS: D EBP demands changes. It requires incorporating more practice-oriented research and more collaboration between clinicians and researchers. Emphasis should be on decision making using the varied sources of evidence. The environment and climate must be supportive in order to implement EBP.

A goal of the Division of Nursing is to: a. Enhance nursing competence in providing high-tech skills b. Apply disease prevention, environmental health, and health promotion concepts c. Provide scholarships for advanced nursing education d. Enhance racial and ethnic diversity in the nursing workforce

ANS: D One of the Division of Nursing goals is to enhance racial and ethnic diversity and cultural competency in the nursing workforce. The other statements apply to other agencies or are false.

Action taken to protect the health, safety, and welfare of citizens, such as requiring immunizations of children before admission to school, is called what kind of power? a. Executive b. Legislative c. Judicial d. Police

ANS: D Police power is state power concerning health care. This power allows states to act to protect the health, safety, and welfare of their citizens.

The federal government provides for the protection of the publics health by: a. Interpreting decisions related to womens right to privacy b. Setting up immunization clinics for smallpox vaccine c. Regulating nursing at the state level d. Monitoring the influx of disease at the borders

ANS: D The United States Constitution gives the federal government the authority to provide for the protection of the publics health. By monitoring the influx of disease at the borders the publics health is being protected.

A group of teenagers with diabetes is arguing over whether to have meetings during summer vacation. Which response, by the nurse, represents an understanding of group dynamics?

Admit that it is difficult for everyone to agree on everything; then ask whether the group can try to decide how to agree on the issue and ask whether group members think there are other issues involved.

10. Nurses are reclaiming their tradition of healing and affirming the independent functions of nursing. A heritage of health and healing can also be found in the foundations of faith communities through activities such as: (select all that apply) holding grief groups. providing meals to families in crisis. sponsoring health fairs. visiting the homebound. volunteering in community AIDS care groups.

All the above The earliest accounts of concern for others stem from communities of faith. In the roots of many faith communities are concerns for justice, mercy, and the need for spiritual and physical healing. An important aspect of living one's spirituality and religion is being a part of a community of faith from birth to death, throughout illness and wellness. Individuals who encounter physical and emotional illness and brokenness and who are able to call upon their faith and religious traditions can increase coping and realize spiritual growth. This increases resilience. Faith communities established health ministries to support congregations and communities in achieving this objective. DIF: Cognitive Level: Application REF: Page 536

What two things should be kept by the school nurse or other school offical that is responsible for ensuring emergency care is provided for a sick or injured child?

An injury or illness log and Procedures on notifying parents about the emergency that include what was done for the child, where the child is, and what is required

Aimed at testing hypotheses about relationships between health problems and possible risk factors

Analytic studies

Consequentialism

Approach whereby the right action is the one that produces the greatest amount of good or the least amount of evil in a given situation.

On the second day after a disaster, a male colleague tells the nurse he has a splitting headache. The nurse notes the colleague is feeling irritable and having difficulty focusing. Which of the following actions should the nurse take in response to the complaint of headache? A. Explain that the headache and problems focusing are probably the result of worry, so he should concentrate on the work at hand and deal with emotions later. B. Explain that he is experiencing signs and symptoms of psychological stress and recommend that he take some time off for a break. C. Explain to the worker that this is a common problem when multitasking under pressure and suggest that he focus on one task at a time. D. Suspect dehydration and encourage the worker to drink more fluids.

B

The local hospital, health department, and university together planned and implemented a mock casualty drill, with the university's theater and nursing students playing the injured victims. After the drill, which of the following would the nursing students most likely complete? A. Volunteer as leaders in the next casualty drill B. Evaluate the drill and offer recommendations for more effectiveness in the future C. Recognize how to respond to a real disaster in the future D. Write a report on their actions and how they felt during the drill

B

Which of the following best describes why planning care for an individual is so challenging in today's health care system? a. Because today's clients have high expectations of the health care system b. Because multiple providers, payers, and settings have to be coordinated c. Because of the new high technology constantly being created and used for client treatment d. Because so many different health care providers are in the acute care setting today

B

Which of the following public health nurse applicants is the least qualified for a position of case manager in a rural county? a. A 24-year-old who has a master's degree in public health b. A 34-year-old who will be moving from a large city c. A 44-year-old who was born and raised in the community d. A 54-year-old who, until recently, was a member of the community's school board

B

7. Communities of faith strive to be caring communities and strongly value the fellowship among members. The faith community nurse recognizes that sharing concerns with pastoral staff and fellow congregants gains valuable support to promote optimal healing. The ethical issue of concern in this matter is: group rights. individual rights. statements of faith. virtue ethics.

B Confidentiality is of the utmost importance in parish nursing practice. An individual's right to privacy is an ethical issue. The nurse values client confidentiality while delicately assisting the client and client's family to "share" concerns with pastoral staff and fellow congregants. This sharing gains valuable support to promote optimal healing. The nurse is often the staff member who helps the family to the stage of acceptance of a health concern. How much to share and when to share a concern is indeed a private affair and a part of the important journey of healing. DIF: Cognitive Level: Application REF: Page 543

4. An effective program strategy for health promotion efforts guided by the Healthy People 2020 framework that can be used by the faith community is establishing: food pantries. health fairs. statements of faith. volunteer training.

B Health fairs are effective strategies for health promotion efforts guided by the Healthy People 2020 framework. These and similar activities promote increased health of the entire community, and they include persons of all ages, encourage enthusiasm, offer fellowship and leisure, and reduce duplication of effort. DIF: Cognitive Level: Knowledge REF: Page 544

4. At the end of each school term, the school nurse schedules an equipment safety assessment of each school playground in the district. The school nurse uses the guidelines of the U.S. Consumer Protection Safety Commission and prepares a report of the findings for the school board for planning purposes. This intervention by the school nurse is an example of which of the following? Community outreach Primary prevention Secondary prevention Tertiary prevention

B Injuries are the leading cause of death in children and teenagers. The school nurse educates children, teachers, and parents about preventing injuries. School nurses also provide information on how to prevent playground injuries. They assess school playgrounds for equipment safety on the basis of the U.S. Consumer Product Safety Commission guidelines. DIF: Cognitive Level: Application REF: Page 573

8. An urban school-based clinic is located in a school district where many of the children lack health insurance. The school nurse continues to provide screening, assessment, first aid, and record keeping but can refer students who require additional services to the nurse practitioners that staff the school-based health center (SBHC) on the school grounds. The SBHC is federally funded under which of the following? CDC's Federal School Health Program The Affordable Care Act Healthy People 2010 School-linked program

B School-based health centers are family-centered, community-based clinics run within schools under a federally funded program. These clinics give expanded health services, including mental health and dental care, in addition to the more traditional health care services. The Affordable Care Act of 2010 appropriated $200 million to improve and expand services at SBHC. They can vary in size, hours, and days of operation, or administrative model (i.e., school clinic, health center, school-linked program). They are successful because they focus on bringing health care services to children in a community school location and are coordinated with the school health program. DIF: Cognitive Level: Knowledge REF: Page 571

8. To ensure the success of a faith community's health ministry program, the parish nurse must ensure that the wellness committee addresses issues of: experiential preparation. financing and fundraising. referrals. retired professionals.

B The faith community nurse is called on to partner with potential supporters in finding funds. The nurse is accountable for money spent and for fundraising, whether the position is salaried or voluntary. Educational and promotional materials, equipment, travel time, continuing education, and malpractice insurance are selected areas that must be included in a budget of the parish nurse. If these materials are not budget items, services may be limited. The nurse must communicate the importance of these areas and the associated funding to the faith community and the wellness committee to ensure the success of any program. DIF: Cognitive Level: Comprehension REF: Page 544

3. A middle school student approaches the school nurse and asks, "Can I speak with you about something important?" The school nurse responds affirmatively but should also state which of the following? "Anything you tell me will be kept private and confidential." "If anything you tell me indicates that someone is in danger, the parents and school officials must be told." "It may be best for me to set up an appointment with the school counselor." "You can always speak to me if you are in trouble or when you need someone to talk to."

B The school nurse may be the person whom children trust to tell important secrets about their health. The school nurse has a reputation as being a trustworthy person to whom the children can go if they are in trouble or when they need to talk to someone. Nurses in this situation should tell the children that if anything they reveal points out that someone is in danger, the parents and school officials must be told. DIF: Cognitive Level: Application REF: Page 570

9. Which of the following dimensions is an essential component of parish nursing? Assertiveness Compassion Organizational skills Fiscal responsibility

B The spiritual dimension is central to the practice of parish nursing. Nursing embodies the physical, psychological, social, and spiritual dimensions of clients into professional practice. Although parish nursing includes all four, it focuses on intentional and compassionate care, which stems from the spiritual dimension of all humankind. DIF: Cognitive Level: Comprehension REF: Page 540

4. A nurse wants to determine whether health problems have been improved and interventions have been appropriate and successful over a period of time. Which of the following data should the nurse examine? (Select all that apply.) a. Changes in staffing patterns and assignments in the health agency b. Demographic data c. Education and school statistics d. Environmental factors

B, D b. Demographic data d. Environmental factors To see the outcomes of chosen interventions, the nurse would examine changes in demographics, socioeconomic factors, environmental factors, health status, and/or use of health services.

The primary reasons for delay, difficulty, or failure to access care include which of the following factors? (Select all that apply.) A. The increase in safety net providers B. Inability to afford health care and a variety of insurance-related reasons C. Lack of transportation D. Refusal of services by providers E. Resolved nursing shortage

B. Inability to afford health care and a variety of insurance-related reasons C. Lack of transportation D. Refusal of services by providers

The concept of managed care is most often associated with processes such as utilization management, disease prevention, health promotion, wellness, and: A. ambulatory payment classes (APCs). B. consumer education. C. retrospective payment. D. third-party payer.

B. consumer education.

The aging population is expected to affect health services more than will any other demographic factor. Another demographic population factor that affects health care costs can be related to: A. consumer demand. B. illnesses such as AIDS. C. marketing practices for new drugs. D. technology advancement.

B. illnesses such as AIDS.

Of the four major factors that affect health care—personal behavior/lifestyle, environmental factors (physical, social, economic), human biology, and the health care system—medical services are said to have the least effect. Yet, the U.S. health care system remains reactionary with high-cost, high-technology, and disease-specific "sickness care." This statement supports the need for increased investment in: A. managed care. B. primary prevention. C. secondary prevention. D. tertiary prevention.

B. primary prevention.

When health care providers in the community refuse to accept Medicare clients, this implies reduced access to care, potential decreases in acceptable quality of services offered, and a form of health care rationing. Health care rationing becomes a public health and nursing issue because: A. Medicare reimbursement needs to be higher. B. proactive primary prevention orientation is cost effective. C. public health systems and nurses must ensure that essential clinical services are available. D. sufficient resources are available in the public health system to meet the unmet need.

B. proactive primary prevention orientation is cost effective.

Which of the following disasters would implementation of disaster medical assistance teams (DMATs) (Select all that apply.) A. Disaster that covers a broad geographical area B. Disaster that is beyond the coping capabilities of the affected state C. Disaster that may result in substantial health and medical problems D. Disaster that may cause a large number of deaths and/or injuries

BCD

A community health nurse involved in care management would most likely: a. develop, conduct, and evaluate health teaching programs in primary care. b. manage the staff at a free clinic. c. monitor the health status, resources, and outcomes for an aggregate. d. provide immunizations to migrant workers.

C

The nurse suggests use of telehealth to assess how a client is progressing. Which of the following resources must be available for continuing care to be implemented? a. A physician who is willing to use wireless prescriptions and plans of care b. Family permission for the nurse to make home visits c. Long-distance telephone service or a computer with Internet access d. Willingness of the caregiver to drive the client to the nearest clinic

C

Which of the following best describes case management? a. A tool of health maintenance organizations b. Targeted toward a specific segment of the population c. Implemented with individual clients d. Used to monitor the health status, resources, and outcomes for an aggregate

C (Case management, in contrast to the definition of care management, involves activities implemented with individual clients in the system.)

Since 1998, nurse practitioners (NPs) and clinical nurse specialists (CNSs) are reimbursed by Medicare Part B at a rate that is what percent of physician rates for the same service? A. 50% B. 70% C. 85% D. 95%

C. 85%

A useful way to distinguish between Medicare Part A and Medicare Part B is to recognize that: (select all that apply) A. Part A covers outpatient hospital care. B. Part B covers limited skilled nursing care. C. Part A is hospital insurance. D. Part B is noninstitutional care insurance. E. Part B is a voluntary supplemental program.

C. Part A is hospital insurance. D. Part B is noninstitutional care insurance. E. Part B is a voluntary supplemental program.

the percentage of cases of a particular disease that result in death

Case fatality rate

Compares those with disease to those without but with similar background and/or with prior exposure to certain risk factors

Case-control study

A physician refuses to order pain medication for a drug addict who has been severely injured in a car accident. When reminded by nurses that pain medication has not been ordered, the physician merely replies that the patient's suffering from the pain of his injuries will build character and that the addicted patient needs to get off drugs. What ethical theory is the physician using (or misusing)?

Consequentialism

number of live births in given year, divided by midyear population

Crude birth rate

Which of the following best describes the primary problem that can result from health care today being given by many different care providers? a. Clients are not sure which provider to see first. b. Health care providers have to make referrals to other providers. c. Clients sometimes are not sure who their primary provider is. d. Overuse, underuse, or gaps in care may result.

D

Advocacy

Set of actions undertaken on behalf of another whle supporting the other's right to self-determination; activities for the purpose of protecting the rights of others while ssupporting the clients responsibility for self-determination; involving informing, supporting, and affirming a clients self-determination in health care decisions.

1. An academic medical center and a local senior living complex employ a parish nurse. The faith community nurse also holds a faculty position at the university's school of nursing. This nurse is practicing a type of parish nursing known as the: advanced practice model. clinical specialty model. congregation-based model. institution-based model.

D In an institution-based model of faith community nursing, which includes greater collaboration and partnership, the nurse may be in contractual relationships with hospitals, medical centers, long-term care facilities, or educational institutions. DIF: Cognitive Level: Application REF: Page 537

6. An example of the use of the nursing process within a faith community nursing practice is the: contractual agreement. evidence of a mature faith. polity of the faith community. use of health appraisals.

D The parish nurse uses the nursing process for assessment, program planning, and evaluation. An example of an assessment intervention would be the use of health risk appraisals, spiritual assessments, and other assessment tools to provide personal health counseling. DIF: Cognitive Level: Knowledge REF: Page 545

5. A child with severe macular degeneration and some hearing loss will be attending the third grade in a local school. A tertiary prevention intervention the school nurse should perform would be which of the following? Assess the child's language skills, motor abilities, and social abilities. Ensure that a telephone is available for calling emergency personnel or parents. Lead educational programs to address coping strategies and stress management techniques. Meet with the assigned teachers to discuss classroom seating to enhance the child's learning experience.

D The school nurse gives nursing care related to tertiary prevention when working with children who have long-term or chronic illnesses or with special needs. This may include participation in the development of an individual education plan (IEP); identification of medication, therapy needs, and/or physical, auditory, or visual limitations; and interventions to ensure the appropriate placement of the child in the classroom environment or physical accommodations required, which enhances the child's learning experience. DIF: Cognitive Level: Application REF: Page 578

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

A community health nurse drives through her assigned community before visiting the community groups scheduled for the day. She then drives through the community again that evening before going home. From a community nursing perspective, what might be the nurse's reason for driving through the community twice in the same day?

Driving through twice allows the nurse to see the community when many residents are at work or at school and then again when most are at home.

In which of the following activities is the nurse acting in the role of a nurse epidemiologist?

Evaluating the number of clients presenting with similar diseases

investigator allocates exposure and follows development of disease

Experimental studies

What are the 3 types of surveys?

Health interviews, clinical tests, and survey of place where people received medical care

HP 1989

Healthy People 2000 became a national effort. Stakeholders represented federal, state, and local agencies; advocacy groups; academia; and other health organizations.

The nurse gives a very informative and engaging presentation and then gives everyone in the audience a handout that outlines the presentation. Later, the nurse discovers that many of the handouts were thrown away before the audience left the building. What might the nurse have forgotten?

Many Americans do not have a high reading level.

Reports outbreaks of disease, environmental hazards, unusual case, and other public health problems. Reports morbidity and mortality data by state and region. Prepared by CDC from state health departments.

Morbidity and Mortality Weekly Report

Authorized continuing survey of amount, distribution, and effects of illness and disability in the US

National Health Survey Act of 1956

types of cancers found in a state and the locations of the cancer risks and health problems in the state.

National program of cancer registries

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.

Data can be used to

Prevent disease outbreaks or determine effectiveness of prevention effort

Percentage of overall mortality in a population that is attributable to a particular cause

Proportionate mortality ratio

Number of events in a given population over a given period of time or given point in time

Rates

Legal Issues Affecting Health Care Practices

School and Family Health (immunizations, school physicals, reproductive rights, child protection) Occupational health (OSHA and DEC) Home Care and Hospice (insurance coverage) Correctional Health (basic health services are usually NOT comprehensive nor preventive)

Data collected by someone else, possibly for another purpose

Secondary data

In what way could Florence Nightingale be considered an epidemiologist?

She demonstrated that a safer environment resulted in decreased mortality rate.

Who is responsible for determining the scope of practice for registered nurses?

State legislators

Summary of statistics on social, political, and economic organization of the US, published annually by the Bureau of Census

Statistical Abstract of the US

What are some sources of standardized data?

Statistical Abstract of the US, Monthly Vital Statistics Report, and Morbidity and Mortality Weekly Report

HP 1979

Surgeon General issued a report that began a 20-year focus on promoting health and preventing disease for all Americans

What would be the best approach for a home health nurse to help a client who has right-sided paresis secondary to a stroke?

Teach the client to participate in self-care activities

researcher

a role of a nurse to investigate phenomena related to health

counsler

a role of a nurse when mental health support is provided

The AAP recommends that the nurse be what member of the health team that includes a physician, school counselor, school psychologist, members of the school staff including the administrator, and teachers?

The head of the health team

If a child is in a wheelchair or uses crutches, then the school building itself needs to be alteed toallow the chid access and use of the schoo facilities, who is responsible for tellig the school administrators about these special needs if changes need to be made?

The school nurse

Community Outreach

a role of a nurse whogivescare outside one defined setting

A nurse wants to have a greater understanding of the physiological effects of selected chemicals. From whom would the nurse be most likely to find useful information?

Toxicologist

Enumeration of the population, taken every 10 years, gathers data on race, age, income, employment, education, dwelling type

U.S. Census

Federal Health Agencies

U.S. Dept. of Health and Human Services (USDHHS) Health Resources and Service Administration (HRSA) Division of Nursing Centers for Disease Control and Prevention (CDC: prevention and control of disease, injury and disability National Institutes of Health (NIH): biomedical research National Institute of Nursing Research (NINR) Agency for Healthcare Research and Quality (AHRQ) Centers for Medicare and Medicaid Services (CMS)

A nurse makes the suggestion that the 2-week shift rotations should be set up so that the next rotation in shifts is later rather than earlier. Which of the following is the nurse attempting to prevent through this suggestion? a. Anxiety, depression, and exhaustion b. Family turmoil c. Physical illnesses d. Sleeping disorders

a

A nurse who works for a hospital in employee health notes that several nurses from one unit have missed work after contracting a communicable disease from a patient. Which of the following best describes the host factor? a. Each sick nurse b. The communicable disease c. The hospital d. The patient

a

A recent news article reported the death of a 60-year-old road construction worker on a day with a posted heat advisory. An occupational health nurse would recognize the additional host factors that contributed to this fatality as which of the following? a. Age and work practices b. Gender and lifestyle c. Health status and age d. Work practices and health status

a

The greatest risk for experiencing work-related accidents with subsequent injuries is to which of the following? a. New workers with less than 1 year of experience on the current job b. Older workers with 2 years of experience on the job c. Women over 50 years of age with 3 years of experience on the current job d. Workers with safe, low-level exposure on the job

a

Which of the following hospital employees are most at risk for being exposed to and possibly developing active drug-resistant TB? a. Housekeeping staff b. Medical staff c. Nursing staff d. Ward clerks

a

Which of the following is a unique characteristic of the role of the occupational health nurse? a. Adapts to the needs of the agency and specific groups of workers b. Works as a solo clinician and/or independent contractor c. Is interdisciplinary in nature d. Specializes in health promotion and education

a

Bioethics

a branch of ethics that applies the knowledge and processes of ethics to the examination of ethical problems in health care.

Centers for Disease Control and Prevention (CDC)

a branch of the U.S. public health service whose primary responsibility is to propose, coordinate and evaluate changes in the surveillance of disease in the U.S.

parish nursing

a community-based and population-focused professional nursing practice with faith communities to promote whole person health to its parishioners, usually focused on primary prevention

School based health centers (SBHCs)

a federal program providing health care, dental care and mental health care to children and families in schools

Safe Kids Campaign

a federal program to provide education to children about safety

School Health Policies and Programs Study 2000 (SHPPS 2000)

a federal study of CDC-funded school health program run by community health agency

wellness committee

a health cabinet supporting healthy spiritually fulfilling lives; made up of a nurse and members of the congregation

parish nurse coordinator

a parish nurse who has completed a certificate program designed to develope the nurse as a coordinator of a parish nursing service

Case Manager

a school nurse who performs a number of general activities concerning health problems of the children

Policy

a settled course of action to be followed by a government or institution to obtain a desired end

31. What kind of 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 a. Description of commonalities among those who became ill, b. Depiction of the possible pathogen, d. Portrayal of the geographic area where people became ill

33. 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. 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 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, d. The more of variable A present, the sicker the person becomes.

32. 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. 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 a. It decreases the focus on the individual person., c. It emphasizes the role of complex political and economic context, f. Its use suggests possible public policy interventions.

5. A nurse has invited community members to participate as full partners in creating changes to improve the health of the community. Which of the following may be an unexpected consequence of this action? a. A change in the distribution or redistribution of power and influence b. An increase in awareness of the importance of health c. Continued ongoing interest in community health activities d. Improved family functioning and involvement in health activities

a. A change in the distribution or redistribution of power and influence Partnership is the informed, flexible, and negotiated distribution and redistribution of power among all participants in the processes of change for improved community health. Such changes may be unexpected by those in formal power positions in the community.

The nurse manager who makes sure that the staff members who work in a local clinic are competent is demonstrating the public health core function of: a.Assurance b.Assessment c.Prevention d.Policy development

a. Assurance

One of the primary focuses of improving the health of the American people in the twenty-first century is to address: a.Bioterrorism and global health threats b.Delivery of individual care and hygiene c.The need for increased hospital and acute care d.Chronic disease and disability management

a. Bioterrorism and global health threats

The purpose of public health core functions is to: a. Clarify the role of the government in fulfilling the mission of public health. b. Ensure the safety of populations in receiving quality health care. c. Provide community-based individualized care to every person in the United States. d. Unite public and private providers of care in a comprehensive approach to providing health care.

a. Clarify the role of the government in fulfilling the mission of public health.

The nurse investigating environmental health problems caused by contaminated ground water is best described as practicing: a.Community-oriented nursing b.Community-based nursing c.Policy development d.Tertiary care

a. Community-oriented nursing

22. Which kind of study would be most helpful in (or 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? a. Cross-sectional study b. Prospective study c. Retrospective study d. True experiment

a. Cross-sectional study

The public health workforce should demonstrate competency in which of the following competency categories? a.Financial planning and management b.Workforce needs assessment c.Acute care services d.Curriculum development

a. Financial planning and management

Which statement about community health nursing practice is correct? a.It focuses on the delivery of personal health services to individuals and families. b.It provides care to protect the health of the community as a whole. c.It emphasizes the setting where care is provided for clients and families. d.It requires a baccalaureate preparation for practice.

a. It focuses on the delivery of personal health services to individuals and families.

Proposed changes to the health care delivery system in the United States will: a.Provide new opportunities for public health specialists. b.Result in isolated care being provided to individuals. c.Emphasize specialty care. d.Increase the utilization of acute care services.

a. Provide new opportunities for public health specialists.

The number and proportion of persons aged 25 or older with less than a high school education is an example of: a.Sociodemographic characteristics b.Health status c.Health risk factors d.Health care resource consumption

a. Sociodemographic characteristics

Which is an example of an aggregate or population? a.Students in a county school system b.Christians around the world c.A patient in the intensive care unit at the local hospital d.People who play cards together once a week at private homes

a. Students in a county school system

Which of the following are considered barriers to public health nursing? Select all that apply. a.The mindset that the only role for the nurse is at the bedside. b.The structures within which nurses work and the process of role socialization within those structures. c.Few nurses receive graduate-level preparation in the concepts and strategies of the disciplines basic to public health. d.The number of job opportunities in the area has been steadily declining.

a. The mindset that the only role for the nurse is at the bedside. b. The structures within which nurses work and the process of role socialization within those structures. c. Few nurses receive graduate-level preparation in the concepts and strategies of the disciplines basic to public health.

Implementing quality performance standards in public health is important because: a. They are used to guide improvement in the public health system. b. They rigidly control public health. c. Administrators will not monitor public health at the local level, but instead at the national level. d. They can be used as hiring guidelines for nurses.

a. They are used to guide improvement in the public health system.

7. A nurse just accepted a position in community health and has been assigned to a neighborhood very close to where she lives. Which of the following best describes the rationale for this assignment? a. To allow participant observation by the nurse b. To ensure that the nurse would care about her intervention outcomes c. To maximize convenience and minimize commuting time for the nurse d. To save gasoline in these difficult economic times

a. To allow participant observation by the nurse Such an assignment allows for participant observation or the deliberate sharing in the life of a community. If the nurse lives in the community, activities such as participating in clinical organizations and church life and reading the newspaper give the nurse observations of the communitys life.

Which of the following is an example of the mission of public health according to the Institute of Medicine? a.Tracking avian flu outbreaks and doing surveillance in the United States b.Providing a flu shot for an elderly person at the health department c.Keeping track of alternative therapies in use in the United States d.Keeping snake antivenom at the Centers for Disease Control and Prevention in Atlanta

a. Tracking avian flu outbreaks and doing surveillance in the United States

An example of a community health nursing practice is: a.Administrating a flu shot to a client in a physician's office b.Conducting a flu shot clinic at a community center c.Performing a client assessment in a hospital d.Providing supervision of staff in a rehabilitation center

a.Administrating a flu shot to a client in a physician's office

Which of the following describes how occupational health nursing differs from other nursing specialties (Select all that apply.) a. It is autonomous, because the occupational nurse works independently. b. The major focus is on the environment. c. Nurses focus on health promotion and disease prevention. d. Nursing care is given in the community.

ab

An occupational health nurse should be aware of which of the following trends in the marketplace (Select all that apply.) a. A majority of new jobs will be in service-oriented employment. b. Employees will often have compressed work weeks, shift work, and reduced job security. c. A majority of positions will still be held by males. d. Many employees will be older and suffer chronic health problems.

abd

An effective industrial disaster plan is a written plan that is shared with all who will be involved, such as the internal first responders, external community-based emergency personnel (transportation, fire, EMS, hospitals), and other key resources in the community. Another factor that influences the effectiveness of an industrial disaster plan is which of the following? a. Addressing activities for work areas that are at greater risk b. Conducting a response agency worksite walk-through c. Testing with a biannual drill d. Training specific employees for fire brigade procedures

b

Four months after the disaster of 9/11 at the Pentagon, a local EMS worker complained of extreme exhaustion. The veteran EMS worker also stated that the pace of work at the squad was too slow. The occupational health nurse that is assessing the EMS worker recognizes the symptoms of: a. anger. b. delayed stress reaction. c. inability to concentrate. d. insomnia.

b

In health care facilities and clinical laboratories, the occupational health nurse needs to be aware of the worker groups that are at risk for exposure to biological agents. Besides the health care workers, worker groups at risk for exposure to biological infectious agents may include which of the following? a. Clerical staff b. Maintenance personnel c. Receptionists d. Chaplains

b

Nurses often participate on field assessment teams (surveillance) during a disaster response. These assessments are crucial to best help: a. encourage good intentions of those giving aid. b. match available resources to the population's emergency needs. c. separate casualties and allocate treatment. d. provide compassion and dignity.

b

The occupational health nurse continually reminds employees to wear their safety goggles and ear plugs. Which of the following levels of prevention is being implemented? a. Both secondary and tertiary prevention b. Primary prevention c. Secondary prevention d. Tertiary prevention

b

The recovery phase of a disaster can take a very long time. Nurses need to be aware that despite effective disaster preparedness and response efforts: a. environmental hazards are minimal. b. individuals must ultimately recover on their own. c. the government provides economic support. d. religious organizations must bear the burden of the community.

b

The necessary basic preparation for public health nursing is a(n) _____ in nursing. a.Associate's degree b.Baccalaureate degree c.Master's degree d.PhD

b. Baccalaureate degree

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? 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 the higher prevalence rate

The nurse who compares the rate of teenage pregnancy in various areas of the city is practicing the public health core function of: a.Assurance b.Assessment c.Prevention d.Policy development

b. Assessment

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? 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

To better address emerging public health issues, a public health nurse enrolls in a course addressing which content area? a.Leadership b.Ethics c.Communication d.Finance

b. Ethics

13. A nurse is assessing a communitys openness to change. Which of the following variables indicate that the community is ready? a. Commitment to current processes and policies b. High social-economic status in the community as a whole c. Long history of dependence on the community health agency and its staff d. Minimal level of social participation by community members

b. High social-economic status in the community as a whole Not all communities are open to change. Ability to change is often related to the extent to which a community focuses on traditional norms. The more traditional the community, the less likely it is to change. The ability to change is often directly related to higher socioeconomic status; a perceived need for change; the presence of liberal, scientific, and democratic values; and a high level of social participation by community residents.

A key opportunity for public health nurses to improve population-focused care is by: a.Assuming traditional nursing roles b.Influencing public health policy c.Conducting community assessments d.Specializing in community-based nursing practice

b. Influencing public health policy

11. Which of the following objectives is most appropriate for the development of a community-oriented nursing care plan? a. All monitored patients will receive abortive therapy for lethal dysrhythmias within 3 minutes of dysrhythmia recognition. b. Of mothers receiving nutrition counseling, 80% will identify five sources of calcium by the end of class. c. 95% of children will be immunized by 1 year of age. d. There will be a 25% reduction in health disparities by 2015.

b. Of mothers receiving nutrition counseling, 80% will identify five sources of calcium by the end of class. Objectives must be precise, behaviorally stated, and measurable. Treatment in an acute care setting is not part of a community-oriented care plan. The objective that 95% of children will be immunized by 1 year does not precisely state which children (in a county? in the country?) and does not state which immunizations. (Some are not appropriate to give to children who are only 1 year old.) A 25% reduction by 2015 is a goal, not an objective. Only the option about mothers receiving nutrition counseling represents a specific, measureable behavior as an objective.

14. A nurse is working toward an objective to Increase to at least 90% the proportion of all pregnant women who receive first trimester prenatal care. During which of the following phases of the nursing process would determination of the objective occur? a. Assessment phase b. Planning phase c. Implementation phase d. Evaluation phase

b. Planning phase Evaluation begins in the planning phase, when goals and measurable objectives are established and goal-attaining activities are identified.

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? a. Cross-sectional study b. Prospective study c. Retrospective study d. True experiment

b. Prospective study

The term community-based nursing care is applied when implementing which nursing intervention? a. Assessing the health needs of a defined community b. Providing care to families in a community c.Promoting the health of an entire community d.Investigating environmental health problems in a community

b. Providing care to families in a community

20. 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

Population-based preventive programs launched in the 1970s are responsible for increased: a.Use of tobacco b.Use of automobile safety restraints c.Incidence of hypertension d.Incidence of obesity

b. Use of automobile safety restraints

3. When would the wheel model of epidemiology be more helpful 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

An occupational health nurse wants to know the NAICS code of a prospective employer. Which of the following best explains why the nurse would be interested in this information (Select all that apply.) a. To assess how others have rated the company in relation to employment there b. To compare the prospective employer's injury rate with similar employers' rates c. To learn more about the usual processes and products of the company as well as typical hazards d. To learn how employees feel about the employer

bc

Changes in the workforce will pose new challenges to protecting worker health and safety. Which of the following trends will influence business strategies to increase health status, employment longevity, and satisfaction of workers? Select all that apply. a. Expanded younger workforce b. Female workforce increasing c. Increase in minority workers d. Job shifts to manufacturing e. More racially diverse workforce

bce

Which of the following statements accurately describe the stress reaction phases a community may experience during a disaster response? Select all that apply. a. Disillusionment and reconstruction is most associated with response efforts. b. During the Heroic phase, there is overwhelming need for people to do whatever they can to help others survive the disaster. c. In the Honeymoon phase, survivors may be rejoicing in that their lives and the lives of loved ones have been spared. d. Disillusionment is the longest phase in the stress reaction process. e. The Disillusionment phase occurs after time elapses and people begin to notice that additional help and reinforcement may not be immediately forthcoming.

bce

Which of the following are the primary reasons that employers have increasingly focused on ensuring a healthy and safe environment for workers (Select all that apply.) a. To fulfill their ethical and moral responsibility b. To avoid the cost of liability suits, workers' compensation, etc. c. To maintain good public relations d. To meet legislated standards and avoid significant penalties for noncompliance

bd

the deliberate release of viruses, bacteria, or other germs (agents) used to cause illness or death in people, animals, or plants

biological terrorism

A nurse keeps ongoing documentation of all the clients seen at the community health clinic. The nurse enters the demographic data and the primary diagnoses into the computer to have a comprehensive perspective of the clinic's clients. Which of the following best explains why the nurse is collecting this data? a. This data will be useful in a research study the nurse is conducting. b. This data will provide evidence of clinic resources being wasted on minor health problems. c. This data will help identify patterns in the risk factors associated with a particular subgroup. d. This data can be used to show trends that can be included in the next grant proposal for further funding.

c

An occupational health nurse is removing a foreign body from a patient's eye. Which of the following levels of prevention is being implemented? a. Injury prevention b. Primary prevention c. Secondary prevention d. Tertiary prevention

c

In which of the following settings have nurses most often reported being the victims of violence, especially by patients and their families? a. Acute care inpatient settings b. Community clinics and physicians' offices c. Emergency departments and psychiatric units d. In homes during home health visits

c

The occupational health nurse is aware that several employees from the accounting/finance departments are complaining about exhaustion, anxiety, and heartburn and notes an increase in absenteeism for these departments. On further exploration, the nurse learns that a new chief financial officer (CFO) has been in place for 1 month. The new CFO is demanding higher productivity and turnaround with expectations of working overtime and weekends to "get the job done" ahead of deadlines. The occupational health nurse, using the epidemiologic model, recognizes this as a psychological agent that can best be described as which of the following? a. Employment conditions b. Nonfatal violence c. Organizational culture d. Shift work

c

Which of the following interventions regarding worker safety would be the least effective? a. Using job rotation and workplace monitoring b. Designing equipment so that employee exposure to hazards is minimized c. Having employees use safety measures and personal protective equipment d. Designing the environment to encourage employees to follow workplace procedures

c

Which of the following would most likely be one of the first steps taken in employer disaster planning? a. All employees are invited to attend sessions on disaster planning. b. Employers stress the importance of disaster drills and encourage active participation. c. Exhaustive inventory of chemicals and industrial hazards is completed. d. Written disaster plans are distributed to each employee and each worksite.

c

34. 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 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.

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? a. 650 persons b. 1000 persons c. 650:1000 d. 6.5%

c. 650:1000

10. A new nurse is overwhelmed with the needs of the community. Which of the following should be the first priority of the nurse? a. A problem that affects the most disadvantaged residents in the community b. A problem that is very easy and inexpensive to address c. A problem that is of high concern to the community d. A problem in an area in which the nurse has a great deal of expertise

c. A problem that is of high concern to the community Choice of priority must depend on the communitys awareness of the problemand their motivation to improve it. Other bases for choosing include determining which individuals would be most affected, what benefits to the community would result, what might happen if the problem is not resolved, how much it might cost to address the problem, and how much support for or opposition to the problem seem likely based on community values and priorities.

Making sure that essential community-oriented health services are available defines which of the core public health functions? a.Policy development b.Assessment c.Assurance d.Scientific knowledge-based care

c. Assurance

Providing for the availability of essential personal health services for people who would otherwise not receive health care defines which public health core function? a.Assessment b.Prevention c.Assurance d.Policy development

c. Assurance

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? a. Cross-sectional study b. Descriptive study c. Prospective study d. Retrospective study

c. Prospective study

Which of the following statements is true with regard to a population focus in public health nursing? a.Priority is given to the highest risk population. b.Direct caregiving is limited to preventive measures, such as administration of immunizations. c.Attention is given to the population or community as a whole, regardless of whether they do or do not access the health care system. d.Only populations outside institutional settings are considered.

c. Attention is given to the population or community as a whole, regardless of whether they do or do not access the health care system.

A population is best defined as a: a.High-risk group b.School or institutional setting c.Collection of individuals who share at least one common characteristic d.Geographical location within a community

c. Collection of individuals who share at least one common characteristic

Which is an example of the primary goal of public health? a.Ensuring that a newly diagnosed 40-year-old hypertensive man takes his medication b.Finding home care for a 70-year-old client recuperating from a hip replacement c.Conducting an infant car seat safety check d.Contacting a local hospice to admit a terminally ill 60-year-old woman

c. Conducting an infant car seat safety check

2. Two brothers played with their cousin. One brother later became quite ill, whereas the other did not. How can this be explained? 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

The threat of bioterrorism has the potential to: a.Dissolve community-based programs. b.Cause the health care system to collapse. c.Divert funds from other public safety health care programs. d.Increase the need for shelters.

c. Divert funds from other public safety health care programs

8. A community health nurse drives through her assigned community before visiting the community groups scheduled for the day. She then drives through the community again that evening before going home. Which of the following best describes the nurses reason for driving through the community twice in the same day? a. On the second trip, the nurse can carefully confirm the results of the first assessment. b. Repeating the experience ensures that the nurse absorbed all the relevant details. c. Driving through twice allows the nurse to see the community when many residents are at work or at school and then again when most are at home. d. When leaving in the evening, the nurse has more time to write down the results of the earlier assessment.

c. Driving through twice allows the nurse to see the community when many residents are at work or at school and then again when most are at home. When doing a windshield survey as part of community assessment, the nurse should observe two times: once during the day when people are at work and children are at school and a second time in the evening after work is done and school is out. Rather than continually stopping to write down her findings, the nurse could use public transportation or ride in a car with another nurse driving for more efficient documentation of her findings.

The public health nurse analyzes data related to the number and type of United States Environmental Protection agency air quality standards that a community failed to meet. This data is an example of using which community health profile indicator? a.Sociodemographic characteristics b.Health status c.Health risk factor d.Functional status

c. Health risk factor

Which of the following statements about public health is accurate? a.Prevention of early deaths can be more effectively accomplished by medical treatment than by public health approaches. b.Expenditures and resources for public health have increased in recent years. c.Historically, gains in the health of populations have been related largely to changes in safety, sanitation, and personal behavior. d.Reform of the medical insurance system is the single change needed to improve the health of Americans.

c. Historically, gains in the health of populations have been related largely to changes in safety, sanitation, and personal behavior.

4. A nurse is focusing on the process dimension of a communitys health. Which of the following interventions will the nurse most likely implement? a. Assessing the health care services available in a community b. Establishing screening programs to diagnosis diseases as early as possible so treatment can begin c. Implementing health promotion activities such as education programs d. Planning for new programs to be developed based on identified needs

c. Implementing health promotion activities such as education programs When the emphasis is on the process dimensionusually the level of intervention of the nurse in community healththe best strategy is usually health promotion, such as various primary prevention strategies.

The public health nurse must participate in the essential services of public health. These include: a.Monitoring health status by completing a community assessment b.Diagnosing and investigating health problems in the world c.Informing, educating, and empowering people about health issues d.Working in law enforcement to regulate health and ensure safety

c. Informing, educating, and empowering people about health issues

A public health staff nurse who has a clear understanding of population-focused practice: a.Is frustrated providing care to individuals b.Would rather perform population-focused interventions c.Is able to improve the effectiveness of care provided d.Is considered a public health nurse specialist

c. Is able to improve the effectiveness of care provided

16. What is the name for the model that demonstrates the progression of disease from pre pathogenesis through disease outcome? a. Epidemiological model b. Ecosocial model c. Natural history model d. Wheel model

c. Natural history model

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? a. Cross-sectional study b. Prospective study c. Retrospective study d. True experiment

c. Retrospective study

26. Which research design would a researcher with limited time and funds probably choose? a. Cross-sectional study b. Prospective study c. Retrospective study d. True experiment

c. Retrospective study

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

c. Secondary prevention

2. A nurse is practicing in the community but also has the community as the target of practice. Which of the following best describes the activities of this nurse? a. Providing care to an active caseload of 50 families in the neighborhood b. Inviting all the parents of asthmatic children in the school to meet together for mutual support c. Sharing assessment findings and health goals with every community group that will listen d. Writing articles for the local newspaper highlighting the various programs and services of the local health department

c. Sharing assessment findings and health goals with every community group that will listen Although it is not possible to know the nurses goals from the nurses behavior, giving care to select groups does not represent the whole community. Publicizing services increases knowledge but doesnt necessarily help eligible clients access care. Meeting with all interested community groups is the only way to keep the focus on the community rather than on individuals.

14. Which research study 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 non athletes

A public health nurse provides a clinic for HIV-positive citizens in the community. This is an example of: a.Primary prevention b.Secondary prevention c.Tertiary prevention d.Policy making

c. Tertiary prevention

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?

c. The environment in which the young adults lived

9. In trying to determine whether the swine flu outbreak was getting worse, what rate 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

Which of the following explains why some occupational health specialists are very concerned about chemicals in the workplace (Select all that apply.) a. All chemicals are inherently dangerous to humans. b. Chemicals are often used when natural substances are equally effective. c. Effects of chemicals can be cumulative. d. Interactions of chemicals are typically unknown.

cd

A nurse educator who teaches at the local community college takes the time to read and understand her community's disaster plans and participates in community mock disasters as a leader of the triage team. The best description of the nurse's activities would be: a. ARC disaster training. b. community preparedness. c. personal preparedness. d. professional preparedness.

d

A nurse is completing a health history on a client during a routine physical exam. Which of the following questions, which is often omitted, should be asked by the nurse? a. "How is your family doing" b. "What problems have you been having" c. "What health concerns do you have today" d. "Where do you work and what do you do there"

d

A nurse is interviewing a person who has stated on her entry health form that she is retired. Which of the following is the most crucial question for the nurse to ask? a. "Have you had any problems since leaving your employment" b. "How do you spend your time now" c. "What has retirement been like for you" d. "Where were you previously employed and what did you do there"

d

An occupational health nurse sees the various injuries and diseases that persons can acquire from employment. Which of the following recommendations would the nurse most likely provide about safety in the workplace? a. Find employment in physical labor; at least your body will be in good condition. b. Professional positions are the safest choice for employment. c. White collar positions provide the least risk for injury. d. There is no "safe" occupation or profession.

d

As the single occupational health employee at a company, a nurse is busy with safety programs and first aid when employees are hurt. However, the nurse still finds time to walk through the entire facility once a day. Which of the following best explains the rationale for this action by the nurse? a. To document employee efficiency and effectiveness at their jobs b. To look for evidence of personal protective equipment being torn or destroyed c. To observe whether employees are taking their rest periods as scheduled and drinking adequate fluids during the day d. To observe effectiveness of safety education and equipment

d

In the event of a disaster, shelters are generally the responsibility of which of the following entities? a. Centers for Disease Control & Prevention (CDC) b. Federal Emergency Management Agency (FEMA) c. Public Health Service (PHS) d. Red Cross chapter

d

The difference between the Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH) can best be described as which of the following? a. NIOSH enforces workplace safety, and OSHA educates about occupational injury and illness prevention. b. NIOSH monitors work-related injury/illness incidence, prevalence, and prevention, and OSHA governs financial compensation under Workers' Compensation. c. OSHA is part of the Department of Labor, and NIOSH is part of the National Institutes of Health. d. OSHA sets the workplace safety standards, and NIOSH examines potential hazards of new work technologies and practices.

d

The major factor that has increased Florida's vulnerability to natural disasters in recent decades has been: a. El Niño. b. geography. c. trade winds. d. urbanization.

d

The occupational health nurse makes certain all employees have and know how to use personal protective equipment (PPE). Which of the following factors will most likely determine how effective the PPE is in keeping employees safe? a. Comfort level of the PPE b. Effectiveness of the nurse's teaching c. Knowledge level of the employee d. Psychosocial norms of the setting

d

The occupational health nurse suggests that an employee work only half-days for three weeks and then return to full-time employment. Which of the following best describes the rationale for this suggestion? a. To provide an example to other employees to ensure future cooperation with safety measures b. To enforce an economic penalty for not obeying nurse's instructions regarding safety measures c. To ensure that all employees keep their positions during an economic downturn d. To continue employment and income with limited duty as a rehabilitation effort after an injury

d

To maintain effective disaster preparedness, nurses working in the community can play a critical role in providing an updated record of: a. immunizations. b. active tuberculosis (TB) cases. c. WIC enrollees. d. vulnerable populations.

d

Which of the following is the most common disabling condition when measured by days away from work? a. Bruises b. Cuts and lacerations c. Mental illnesses d. Sprains and strains

d

Which of the following is the primary reason that large companies are becoming more involved in their employees' personal health and well-being? a. It is an ethical and moral responsibility. b. It improves public relations within the community. c. It allows managers to better understand their employees. d. It provides a cost savings to the company.

d

1. Which of the following is the best brief definition of community? a. A geographic area or political division under common leadership b. A group sharing a common bond such as a profession or occupation c. A group working together to confront a common problem d. A social group with common goals within a geographic area

d. A social group with common goals within a geographic area According to WHO, A community is a social group determined by geographic boundaries and/or common values and interests. Its members know and interact with one another. It functions within a particular social structure and exhibits and creates norms, values and social institutions. The correct answer includes aspects of people, place, and function or aims.

Public health nurses who develop and implement local public health policies through partnerships with agencies, organizations, and consumers within the community are using which core public health function? a.Assessment b.Prevention c.Assurance d.Policy development

d. Policy development

3. Persons often point out that smokers choose to light their cigarettes, alcoholics lift the glass to their mouth, and drug addicts inject or ingest their drugs. Which of the following statements best describes why nurses dont simply focus on helping persons who engage in poor health behaviors to behave appropriately? a. Addicts dont have the willpower to change their behavior. b. It is too rewarding to continue the behavior for a person to be able to change. c. Laws and policies must reward good healthy behaviors and punish unhealthy behaviors to help individuals recognize the importance of change. d. Society must offer healthy choices, offer support, and practice helpful policies.

d. Society must offer healthy choices, offer support, and practice helpful policies. Change for the benefit of the community client often must occur at several levels, ranging from the individual to society as a whole. Lifestyle-induced health problems cannot be solved simply by asking or encouraging individuals to choose health-promoting habits. Society also must provide healthy choices. Most individuals cannot change their habits alone; they require the support of family members, friends, community health care systems, and relevant social policies.

12. During which of the following activities is the nurse in community health acting as a partner in change? a. Administering vaccinations to preschoolers b. Analyzing community problems to determine the best interventions c. Establishing an elder-care center for older adults living with family members who work d. Teaching anger management skills to a group of teens in a halfway house

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

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? 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

5. What is 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.

6. During the assessment phase, the nurse compiles and interprets available data and draws conclusions as to the communitys strengths and concerns. Which of the following best describes why the nurse would also conduct interviews with key informants? a. To ensure that others agree with the nurses plans for interventions b. To confirm the nurses initial findings and conclusions c. To encourage community partners to feel they own the data d. To generate nonstatistical data such as values, beliefs, and perceived needs

d. To generate nonstatistical data such as values, beliefs, and perceived needs Data generation is the process of developing data that do not already exist, through interaction with community members, individuals, families, or groups. Such information might include the communitys knowledge and beliefs, values and sentiments, and goals and perceived needs. Such data are collected by interviews and observation.

9. Before beginning to survey the community to assess its health needs and strengths, the nurse reviews various documents, including local statistical data and the minutes of the previous meeting of the health care agency. Which of the following best explains why the nurse would start with this activity? a. To avoid confronting the community until the nurse is thoroughly oriented b. To become familiar with previous goals and priorities of the agency c. To help get a better understanding of the assigned community d. To save time and effort and perhaps have new insights

d. To save time and effort and perhaps have new insights Although the nurse might review materials for any of these reasons, the nurse uses previously gathered data because it saves time and effort. Many sources of data are readily available and useful for secondary analysis.

16. A nurse is assessing the structure of a communitys health. Which of the following data will the nurse examine? a. Health facilities and their staffing patterns b. Health risk profiles of selected aggregates c. Statistics of morbidity and mortality in comparison with similar communities d. Treatment and service use patterns from local health agencies and care providers

d. Treatment and service use patterns from local health agencies and care providers Community health, when viewed from the structure of the community, is usually defined in terms of community characteristics, as well as services and resources. Indicators used to measure community health services and resources include service use patterns, treatment data from various health agencies, and provider/client ratios

13. Which group should be used for determining 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 and 45 years old in the community

cases may be exposed over a period of days or weeks, as in the recent food poisonings at a restaurant chain throughout the United States as a result of the restaurant's purchase of contaminated green onions.

intermittent or continous source

Data also come from ________ _____________ s and administrative data such as ________ ________ ________ ________

death certificates discharge reports billing records

Nonmaleficence

duty to do no harm

Primary prevention in School Nursing

health promotion and education; provides health promotion and education to prevent childhood injuries and substance abuse

there is a persistently (usually) high number of cases.

hyperendemic

Parish nursing includes the physical, psychological, social and spiritual dimensions of its clients into its practiice however it focuses on what aspect of nursing care?

intentional and compassionate care which stems from the spiritual dimension of all humankind

Scope of Practice

involves defining nursing, setting its credentials, and then distinguishing between the practices of nurses, physicians, and other health care providers. Nurse Practice Act Licensure

The parish nurse is required to be :

knowledgeable about lines of authority and channels of communication in the congregation and in the colaborative institutions well acquainted with the personnel committees of the congregation An advocate for well-being to highlight justice issues in local and national legislation A contributor of information to policymakers about the implications for health and well-being for the parish and the local and global communities An active participant in political activities that contribute to spiritual growth and healthy functioning

public health surveillance can be used to facilitate the following (CDC, 2014): • Estimate the _________ of a problem (disease or event) • Determine the _______ __________ of an illness or symptoms • Portray the _______ _________ of a disease • Detect ______ and define a _________ • Generate __________ and stimulate _________ • Evaluate ________ _________ • Monitor changes in ___________ __________ • Detect __________ in health practices • Facilitate _____________

magnitude geographic distribution natural distribution epidemics problem hypothesis research control measures infections agents changes planning

s "when a victim of a common source epidemic has person-to-person contact with others and spreads the disease, further propagating the health problem"

mixed outbreak

a epidemic is often called a

outbreak

all persons exposed become ill at the same time, during one incubation period.

point source

Ethical dilemmas

puzzling moral problems in which a person, group, or community can envision morally justified reasons for both taking and not taking a certain course of action (e.g., how to allocate limited resources to two equally needy populations)

Response to bioterrorism or large-scale infectious disease outbreak may require the use of emergency public health measures such as:

quarantine, isolation, closing public places, seizing property, mandatory vaccination, travel restrictions, disposal of the decreased

Parish nursing services emphasize on what?

srengths of individuals, families, and communities

ways to protect HCP from exposure

standard precautions , disposable non sterile gowns and gloves with hand washing following removal and use of a face shield.

Clinicians, health care agencies, and laboratories report cases to

state health departments

The nurse must personally and professionallly abide by the parameters of the nurse practice act of the jurisdiction and maintain an active license of whhat?

the state

The revised scope of standards of the Faith Community Nursing: Scope and Standards of Practice describes?

the who, what, where, when, why, and how of te practice of faith community nursing

holistic care

understanding the body, mind and spirit relationship of persons in an enviornment that is always changing

When dose a school nurse give tertiary prevention care?

when working with children/students who have long-term or chronic illnesses or when working with children with special needs