Community Health - NCLEX - with explanations

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

A,B,C,D,E

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. DIF: Cognitive Level: Understand (Comprehension) REF: p. 104

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

A home health nurse is discussing portals of entry with a group of newly hired assistive personnel. Which of the following are portals of entry the nurse should discuss? Select all that apply A. Respiratory secretions B. Skin C. Genitourinary tract D. Saliva E. Mucous membranes

B, C, and E; a and D are portals of exits

It is important that nurses understand the nontraditional healing practices of their clients because: a. folk practices are usually ineffective. b. nurses can refer clients to the appropriate local folk healers. c. safe, effective nontraditional healing methods can be blended with Western medicine. d. the nurse must understand them to help the client give them up.

c. safe, effective nontraditional healing methods can be blended with Western medicine. Nurses need to understand the nontraditional healing practices that their clients use. Many of these treatments have proven effective and can be blended with traditional Western medicine. The key is to know what practices are being used so that the blending can be knowledgeably done. DIF: Cognitive Level: Application REF: Page 71

A community-level intervention designed to increase the sense of belonging among older community residents at risk for social isolation was implemented by opening a senior center every other Wednesday at a local church that provided lunch and social programs. At the end of 6 months, the attendees were surveyed to determine their experience with the program, barriers to attendance, expansion of their social networks, and involvement in other community activities. This survey allowed the community health nurse to _______ the program and design program improvements. A) Evaluate the effectiveness of. B) Assess the expansion needs of. C) Identify problems with D) Implement the expansion of.

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 nurse's position. DIF: Cognitive Level: Apply (Application) REF: p. 104

7. The school health nurse has enlisted the assistance of high school role models in the areas of sports and scholarship to provide an antidrug presentation to their peers. Which of the following levels of prevention is being implemented? a. Primary b. Secondary c. Tertiary d. Both primary and secondary

ANS: A Primary prevention interventions by the school nurse include educating children and adolescents about the effects of drugs. In preventing use, students are taught by the school nurse to stay away from drugs such as marijuana, cocaine, crack, heroin, and alcohol. DIF: Cognitive Level: Apply (Application) REF: p. 572

17. Which of the following is the leading cause of children being absent from school because of a chronic illness? a. Allergies b. Asthma c. Diabetes d. Upper respiratory infections

ANS: B Asthma is the leading cause of children being absent from school because of a chronic illness. URIs are an acute problem, not a chronic one. DIF: Cognitive Level: Remember (Knowledge) REF: p. 578

1. Which of the following is the underlying science or area of study on which public health is based? a. Biostatistics b. Epidemiology c. Medicine d. Social sciences

ANS: B Public health uses biostatistics in its practice. It is not a branch of medicine; it is an organized community approach designed to prevent disease, promote health, and protect populations. It works across many disciplines and is based on the scientific core of epidemiology. DIF: Cognitive Level: Remember (Knowledge) REF: p. 524

3. A school health nurse is requested by the board of education to assist in choosing new playground equipment for an elementary school that meets safety standards. Which of the following best describes the nurse's role in this scenario? a. Case manager b. Consultant c. Counselor d. Health educator

ANS: B The school nurse is the person best able to provide health information to school administrators, teachers, and parent-teacher groups. 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 nurse also can recommend changes in the school's policies or ask community organizations to help make the children's schools healthier places. DIF: Cognitive Level: Apply (Application) REF: p. 570

6. 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

ANS: C Telehealth is an organized health care delivery approach to triage and to provide advice, counseling, and referral for a client's health problem using phones or computers with cameras. The client is usually in the home, and the nurse is at an office, health care facility, or phone bank location. DIF: Cognitive Level: Apply (Application) REF: p. 235

11. A public health nurse found that out of the 70 people who ate the potato salad at a school picnic, 63 developed symptoms of food poisoning. Which of the following best describes the attack rate? a. 63% b. 70% c. 90% d. 100%

ANS: C The attack rate is the proportion of persons exposed to an agent who develop the disease. Because 63 of the 70 persons became ill, the attack rate is 63:70, or 90%. DIF: Cognitive Level: Apply (Application) REF: p. 158

27. A principal comments to the school nurse that it seems there are a lot more problems with asthma among the students than there were before the school was remodeled a couple of years ago. The nurse investigates the principal's observation by reviewing all the school records to determine visits to the health office because of asthma by week and month for the past 5 years. Which of the following best describes the type of study the nurse is conducting? a. Descriptive epidemiological study b. Ecological study c. Prospective cohort study d. Retrospective cohort study

ANS: D Retrospective cohort studies rely on existing records to define a cohort that is classified as having been exposed or unexposed at some time in the past. In this case, the issue is whether there is some health risk in the new building addition that is increasing frequency of visits to the school nurse because of asthma. DIF: Cognitive Level: Apply (Application) REF: p. 168

5. Several small communities have applied for grant funding from the state department of health to help decrease their teenage pregnancy rate. Which of the following communities should the nurse suggest receive funding first? a. Community A—with 23 single teenage pregnancies in a city of 500 b. Community B—with 45 single teenage pregnancies in a city of 1000 c. Community C—with 90 single teenage pregnancies in a city of 2000 d. Community D—with 90 single teenage pregnancies in a city of 1500

ANS: D Without doing any actual math, it should be fairly obvious that 23:500, 45:1000, and 90:2000 are all about the same proportion but that 90:1500 is a larger proportion. Doing the math, the pregnancy rates of A, B, and C are 45-46:1000, whereas the rate in Community D is 60:1000. DIF: Cognitive Level: Analyze (Analysis) REF: p. 156

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

A client comes to the local clinic with acute symptoms of fever, nausea, lack of appetite, malaise, and abdominal discomfort. During the course of the assessment, the nurse determines that the client is a health care aide working at a daycare center. These facts are important because: A) Acute hepatitis B is self-limiting. B) Hepatitis A outbreaks commonly occur in facilities where staff change diapers. C) Hepatitis C is a "silent stalker." D) Individuals with chronic liver disease are at greater risk for hepatitis A.

A community-oriented nurse seeks to implement evidence-based practice (EBP) in the community clinic's programs. The best model for the nurse to apply is: A) Action research and review. B) Community development. C) Community research utilization. D) EBP.

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

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

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

An occupational health nurse practitioner's physical assessment of a factory worker identifies an acute-onset pruritic dermatitis extending over the face, hands, neck, and forearms. The nurse's priorities should be to: A) Contact factory senior management, educate workers about their exposure, and clean the area. B) Contact the Occupational Safety and Health Administration immediately and remove the offending chemical in the work environment. C) Immediately evacuate the worker's nearby workspace and treat the worker and other exposed workers. D) Treat the client and obtain a comprehensive exposure history; if an onsite environmental exposure is suspected as the cause, screen other at-risk workers and ensure that the environmental risk is identified and eliminated.

Campaigns to decrease the inequitable burden of environmental risks on the poor and people of color in the United States strive to apply the ethical principle of: A) Societal justice. B) Nonmaleficence. C) Compliance and enforcement of the Environmental Protection Agency Regulatory Act. D) Environmental justice.

A nurse is developing a community health education program for a group of clients who have a new diagnosis of diabetes mellitus. Which of the following learning strategies should the nurse include for clients who are auditory learners? A. Showing informational videos B. Providing equipment to practice hands-on skills C. Supplying outlines for note-taking D. Facilitating small group discussions

D; A and C are for visual learners; B is for tactile-kinesthetic learners

The Clean Air Act of 1970 was amended in 1990 to meet unaddressed or insufficiently addressed problems that included which of the following? (Select all that apply.) a. Addressing acid rain b. Addressing excessive noise and heat or cold extremes c. Addressing ground-level ozone d. Addressing stratospheric ozone depletion e. Tracking 75,000 industrial chemicals

a. Addressing acid rain c. Addressing ground-level ozone d. Addressing stratospheric ozone depletion The Clean Air Act of 1970 regulates air emissions from area, stationary, and mobile sources and authorized the EPA to establish National Ambient Air Quality Standards (NAAQS) to protect public health and the environment. The 1990 amendments to the Clean Air Act intended to meet unaddressed or insufficiently addressed problems, such as acid rain, ground-level ozone, stratospheric ozone depletion, and air toxins. The Occupational Safety and Health Act (OSHA) establishes guidelines for addressing excessive noise, heat, or cold extremes and industrial chemical use in the workplace. DIF: Cognitive Level: Knowledge REF: Page 103

3. The outpatient health care data show a notable increase in asthma over the numbers treated the previous year. Which of the following actions should the public health nurse take first? (Select all that apply.) a. Analyze educational health programs offered to the public last year. b. Congratulate the public health staff on the success of their asthma awareness program. c. Determine whether there are any other data sources that might confirm or dispute the apparent increase in asthma. d. Review data with the outpatient clinic staff such as confirming repeat visits versus newly diagnosed cases.

ANS: C, D Before drawing any conclusions, further data should be sought, including confirmation of the current data and their meaning. Data can be inaccurate or collected differently than in the past. What might have led to an increase? Are there other valid sources that might have relevant data? Should surveillance specific to asthma be established? DIF: Cognitive Level: Analyze (Analysis) REF: p. 268

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 nurse's 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 community's 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. DIF: Cognitive Level: Apply (Application) REF: pp. 93-94

3. 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.

ANS: D A particularly challenging problem is the fragmenting of services, which can result in overuse, underuse, gaps in care, and miscommunication. DIF: Cognitive Level: Understand (Comprehension) REF: pp. 233-234

7. Which of the following best describes the primary reason life spans have notably lengthened over the past 100 years? a. Advances in hospital care and procedures b. Advances in medicine and medical research c. Advances in nursing practice d. Advances in public health

ANS: D A person born today can expect to live 30 years longer than someone born in 1900. Medical care accounts for 5 years of that increase, but public health is responsible for the additional 25 years, through prevention efforts brought about by changes in social policies, community actions, and individual and group behavior changes. DIF: Cognitive Level: Understand (Comprehension) REF: p. 525

6. Between 2000 and 2005, 1000 of 10,000 young women ages 17 to 20 years at a university tested positive for a sexually transmitted infection (STI). Of the 1000 diagnosed STIs, 300 were gonorrhea and 500 were chlamydia. Which of the following statements best summarizes these findings? a. The proportion of cases of gonorrhea to all STIs was 300:1300. b. The proportion of cases of gonorrhea to chlamydia was 300:500. c. The proportion of cases of gonorrhea to all STIs was 50%. d. The proportion of STIs to the total population was 100:1000.

ANS: D A proportion is a ratio in which the denominator includes the numerator. If the proportion is small, we can express the number per 1000. The answer of 300:1300 adds the total of the numerator to the denominator, which is unnecessary because the gonorrhea cases were already included in the denominator. In the answer of 300:500, the ratio comparing gonorrhea to chlamydia does not meet the epidemiological definition of proportion (i.e., the denominator must contain the numerator). Although proportions may be expressed as percentages, in the answer of 50% the percentage reflects the number of gonorrhea cases to all STIs, which doesn't summarize the total STI problem. The answer of 100:1000 correctly summarizes that 1000 of 10,000 (or 100:1000) young women had the problem. DIF: Cognitive Level: Analyze (Analysis) REF: p. 156

29. A teacher recommends that surveys to obtain data on drug use be given to high school students when they meet for various school organizations. Which of the following best describes why the nurse would reject this suggestion? a. This method of data collection would result in classification bias. b. This method of data collection would result in confounding bias. c. This method of data collection would result in personal bias. d. This method of data collection would result in selection bias.

ANS: D Any study is subject to bias resulting from selective choice. There may be a difference between students who choose to belong to an organization and students who choose not to join an organization. Selection bias occurs when selection procedures are not representative of the population as a whole. In this instance, the goal is to determine drug use of all students at the school. If only students who join school organizations are selected, those who do not join organizations will not be represented. DIF: Cognitive Level: Apply (Application) REF: p. 170

12. A public health nurse has reviewed the objectives of Healthy People 2020. Which of the following should be the focus for programming in the community related to communicable diseases? a. Encouraging community members to engage in healthy behaviors b. Identifying high-risk sexual behaviors among community members c. Monitoring the sexual activity of adolescents d. Providing information about the hazards of multiple sexual partners

ANS: D Healthy People 2020 lists communicable disease as an area of focus including levels of human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), and sexually transmitted infections. One method to reduce the risk of acquiring a communicable disease is by the public health nurse providing information on the hazards of multiple sexual partners and street drug use. DIF: Cognitive Level: Analyze (Analysis) REF: p. 530

2. A nurse is employed at the state department of public health. Which of the following is a fundamental principle guiding his practice? a. Decisions are made at the federal level, disseminated at the state level, and carried out at the community level. b. Health of populations is only as good as the health of individuals that live and work in the community. c. Oversight of community health departments is the most important function. d. The interaction of the local-state-federal partnership is critical to success.

ANS: D In the United States, the local-state-federal partnership includes federal agencies, the state and territorial public health agencies, and the local public health agencies. Their effective interaction is critical to the effective use of both financial and personnel resources to address the health of populations. Nurses working in all of these agencies work together to identify, develop, and implement interventions that will improve and maintain the nation's health. DIF: Cognitive Level: Apply (Application) REF: p. 524

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. DIF: Cognitive Level: Analyze (Analysis) REF: p. 94

10. 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

ANS: D In today's practice, the nurse advocate makes the client's rights the priority. Thus, the goal of advocacy is to promote self-determination in a constituency or client group. DIF: Cognitive Level: Understand (Comprehension) REF: p. 239

10. Which aspect of a biological agent is probably the most frightening to those exposed? a. Infectivity b. Invasiveness c. Pathogenicity d. Virulence

ANS: D Infectivity refers to the capacity of an agent to enter a susceptible host and produce infection or disease. Invasiveness is the ability of an agent to get into a susceptible host. Pathogenicity measures the proportion of infected people who develop the disease. Virulence refers to the proportion of people with clinical disease who become severely ill or die. It is assumed people could cope with illness but possible death is truly frightening for most. DIF: Cognitive Level: Understand (Comprehension) REF: p. 272

3. A rural public health nurse is spending time reviewing death certificates. Which of the following best explains the purpose of this activity? a. To ensure that local causes of death are consistent with national causes of death b. To confirm that no local health problems are beginning c. To evaluate effectiveness of health promotion programs d. To obtain mortality data for the local area

ANS: D Mortality data are often the only source of health-related data available for small geographic areas. Vital statistics reports such as death certificates are reviewed. Useful information also comes from administrative data such as discharge reports and billing records. DIF: Cognitive Level: Apply (Application) REF: p. 268

11. A case manager advocates for a client by helping an insurer understand the client's needs and desires and by helping the client understand programs and benefits offered by the insurer. What role is the nurse? a. Arbitrator b. Counselor c. Mediator d. Negotiator

ANS: D Negotiating is a strategic process used to move conflicting parties toward an outcome. Parties must see the possibility of achieving an agreement and the costs of not achieving an agreement. Mediating is the process of assisting parties to understand each other's concerns and to determine their conclusion of the issues. The mediator has no authority to decide, whereas an arbitrator is legally allowed to suggest an appropriate outcome. DIF: Cognitive Level: Apply (Application) REF: pp. 236, 242

5. Which of the following best explains why school nurses are involved in helping teachers with the task of teaching children how to practice problem solving, communication, and other life skills? a. Teacher shortages have required nurses to be increasingly involved in teaching life skills. b. Because so many nurses want to be employed in schools, this responsibility was assumed to increase employment opportunities. c. States are requiring nurses to screen and to teach life skills. d. Nurses have been enlisted in this role to help reduce risk factors for future health problems in school children.

ANS: D School health nurses were originally involved in this capacity in 1987 after the CDC began funding schools for HIV-prevention education programs. This program was so successful that it was expanded to include programs to teach children prevention of other chronic illnesses caused in part by risk factors such as poor diet, lack of exercise, and smoking. The schools are actively involved in helping the children practice problem solving, communication, and other life skills so that they can reduce their risk factors for health problems. DIF: Cognitive Level: Understand (Comprehension) REF: p. 571

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. DIF: Cognitive Level: Apply (Application) REF: p. 103

13. Which of the following is a core competency required of public health nurses? a. Knowledge in the use of high-technology diagnostics b. Knowledge of the implementation of electronic medical records c. Skill in the physical assessment of complex clients d. Skill in developing policy and planning programs

ANS: D The core public health competencies are divided into the following eight domains: (1) analytic assessment skills; (2) basic public health sciences skills; (3) cultural competency skills; (4) communication skills; (5) community dimensions of practice skills; (6) financial planning and management skills; (7) leadership and systems thinking skills; (8) policy development/program planning skills. The other competencies listed are better suited for tertiary facilities such as hospitals. DIF: Cognitive Level: Understand (Comprehension) REF: p. 529

A community health nurse is educating the public on the agents of bioterrorism. Which of the following are Category A biological agents? Select all that apply A. Hantavirus B. Typhus C. Plague D.Tularemia E. Botulism

C, D, and E; Hantavirus is a category C; Typhus is a category B

15. A nurse is examining the various factors that lead to disease and suggests several areas where nurses could intervene to reduce future incidence of disease. Which of the following models would the nurse most likely use? a. Epidemiologic triangle b. Health promotion c. Levels of prevention d. Web of causality

ANS: D The web of causality model recognizes the complex interrelationships of many factors interacting to increase or decrease the risk for disease. Causal relationships (one thing or event causing another) are often more complex than the epidemiologic triangle conveys. With all the various antecedents identified, the nurse can then decide in which areas interventions are possible. DIF: Cognitive Level: Apply (Application) REF: p. 160

10. A community health nurse is trying to decrease the incidence of emerging infections caused by drug-resistant organisms. Which of the following actions would be most appropriate for the nurse to implement? a. Lobby for increased use of antibiotics in the treatment and prevention of communicable diseases. b. Notify the Centers for Disease Control regarding any unusual signs and symptoms related to a communicable illness. c. Reinforce the importance of receiving vaccinations according to recommended schedules. d. Teach parents that antibiotics should not be used for treatment of viral infections or for prevention of bacterial infections.

ANS: D The widespread, often inappropriate, use of antimicrobial drugs has resulted in loss of effectiveness for some infections. Clients and health care providers are responsible for the inappropriate use of antibiotics. The nurse can influence this trend by objecting to inappropriate use of antibiotics by providers and by educating individuals, families, health care providers, and the community about the dangers of misuse and overuse of antibiotics. DIF: Cognitive Level: Apply (Application) REF: p. 528

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. DIF: Cognitive Level: Apply (Application) REF: p. 92

19. A nurse has only a regular blood pressure cuff when conducting a health screening for all of the residents of a community. Which of the following may be lacking when obtaining blood pressure readings? a. Reliability b. Sensitivity c. Specificity d. Validity

ANS: D Validity is the accuracy of a test or measurement, or how closely it measures what it claims to measure. With only one regular BP cuff, the nurse cannot obtain accurate measurements on those who are extremely obese or extremely thin. A thigh cuff and a pediatric cuff would allow the nurse to obtain accurate—that is, valid—measurements. DIF: Cognitive Level: Apply (Application) REF: p. 162

A college health nurse is working with students, faculty, and staff to improve environmental air quality. To address the primary cause of air pollution on campus, the nurse plans a precautionary intervention. Which of the following interventions best demonstrates an appropriate approach? A) Encourage the use of electric cars and scooters on campus. B) Increase the use of bicycles, foot-powered scooters, rollerblades, and walking as the primary mode of transportation on campus. C) Make the entire campus a no-smoking zone. D) Establish a policy to reduce electricity consumption in university buildings by raising the thermostat to 78 degrees in the summer and lowering the thermostat to 70 degrees in the winter.

A community health nurse manager has integrated exposure history elements into the assessment practices of the health department that are relevant to the urban industrial community served. This strategy indicates that the nurse manager is aware of the relationship between: A) Community strengths and weaknesses. B) Environment and human health/disease. C) Toxicology studies conducted by the Environmental Protection Agency and the environment. D) Federal and state environmental regulations.

A nurse is assigned to teach clients sexually transmitted disease (STD) prevention information. The nurse updates her teaching plan to incorporate new guidelines from the Centers from Disease Control and Prevention (CDC). She includes which of the following as updated information during her next teaching session? A) Always use spermicides with condoms to reduce the risk of contracting chlamydia or gonorrhea. B) Condoms can be effective in preventing infections transmitted by fluids from mucosal surfaces but are not always effective in preventing infections transmitted by skin-to-skin contact. C) Condoms should not be used during oral sex, because they are not effective in preventing transmission of infection. D) When genital ulcers are present, condoms should be used to prevent the spread of infection.

A nurse teaches an asthmatic client to recognize and avoid exposure to asthma triggers and assists the client's family in implementing specific protection strategies in the home, such as removing carpets and avoiding pets. This nurse's activities can best be described as: A) Comprehensive assessment. B) Primary prevention. C) Secondary prevention. D) Treatment intervention.

A public health nurse in the local health department assists the community in identifying the health need priorities and the services that can best meet these needs in a cost-effective manner. This is an example of the tertiary prevention public health nursing function of: A) Case finding. B) Case management. C) Collaboration. D) Provision of direct services.

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

Community-oriented nurses use evidence-based practice (EBP) most effectively when they: A) Base care on nationally accepted clinical guidelines, informing clients and community groups that the accepted standards of care need to be universally applied. B) Base care on nationally accepted clinical guidelines, involve clients in individual care decisions, and include community input when applying evidence in practice. C) Make client care decisions using the latest nursing research findings. D) Work with physicians to design client care guidelines for community clinics.

Many behaviors place any individual-regardless of age, gender, ethnicity, or other characteristics-at greater risk for sexually transmitted diseases (STDs). The nurse should include primary prevention interventions in all client encounters through the discussion of: A) Partner notification. B) Safer sex. C) Standard precautions. D) STD testing.

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.

Randomized controlled trials are often inappropriate for evaluating many public health interventions. The most common approach to establishing evidence in public health is the use of: A) Blinded studies. B) Case-control studies. C) Expert opinion. D) Research synthesis.

The Superfund Amendments and Reauthorization Act (SARA) increased the involvement of the states and their citizens in the cleanup of toxic waste sites and stressed the importance of permanent remedies and innovative treatment technologies. Another important aspect of this federal legislation was that it: A) Provided for the appointment of state emergency response commissions. B) Increased focus on the human health problems related to hazardous waste sites. C) Established a new safety standard of reasonable certainty of no harm that is to be applied to all pesticides used on food. D) Reduced the amount of pollution by mandating cost-effective changes in production, operation, and raw materials use.

The community planning board's evaluation of a community intervention (child immunization campaign) carried out by the health department determined that some progress was made toward the desired outcome (target rate of childhood immunization), but the degree of progress achieved was not sufficient to offset the initial effort in terms of cost and time to launch the campaign. The community determined that the rate gain was not adequate when compared with that achieved through similar initiatives in other communities, which obtained better results by using more efficient strategies. The budget for this program was cut. This community decision best exemplifies which statement about evaluation? A) Evaluation should start in the planning phase of the nursing process. B) Evaluation can have unintended consequences. C) Effectiveness is the only true measure of worthiness. D) The power to design, judge, or institute change is important.

The monitoring and public reporting of air quality in a local community to assist individuals with asthma or other respiratory conditions best illustrates the application of: A) Compliance and enforcement. B) Environmental epidemiology. C) Secondary prevention. D) Toxicology.

The public health nurse ensures that a local community coalition for improving school lunches takes the time to listen to each stakeholder's view, develops a common validated language for discussing the initiative, and shares the credit for the success of the initiative. The public health nurse is adhering to the principles of: A) Collaboration. B) Partnership. C) Public health care. D) Public health nursing.

The public health nurse serves as a bridge between at-risk populations and the community's health care resources. This role is based on the nurse's responsibility to: A) Collect and analyze data on public health programs. B) Ensure that all populations have access to affordable, quality health care. C) Monitor and assess critical health status indicators. D) Provide evidence-based use of resources.

When a public health nurse uses evidence-based interventions to evaluate the effectiveness, accessibility, and quality of population-based services within the community, the nurse is addressing the core public health function of: A) Assessment. B) Assurance. C) Policy development. D) Research.

A community health nurse is developing strategies to prevent or improve mental health issues in the local area. In which of the following situations is the nurse implementing a tertiary prevention strategy? A. Providing support programs for new patients B. Screening a client whose spouse recently died for suicide risk C. Teaching a client who has schizophrenia about medication interactions D. Discussing stress reduction techniques with employees at an industrial site

C; A and D are primary; B is a secondary prevention strategy

A school nurse is scheduling visits with a physical therapist for a child who has cerebral palsy. In which of the following roles is the nurse functioning? A. Direct caregiver B. Consultant C. Case manager D. Counselor

C; the nurse is functioning in the role of a case manager. As a case manager, the nurse coordinates comprehensive services for students with complex health needs. As a direct caregiver, a nurse provides illness or injury care to children at school. As a consultant, a nurse provides information to families, administrators, teachers, and parent-teacher groups to encourage decisions that promote the health of students. As a counselor, a nurse develops a trusting relationship with students and provides support on issues affecting their lives.

Case fatality from breast cancer has decreased in recent years, although the incidence of breast cancer has increased. Descriptive epidemiology would use the component of time to explain this change in terms of: A) Cyclical patterns. B) Even-related clusters. C) Point epidemic. D) Secular trends.

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.

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

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

The intervention used to influence the knowledge, attitudes, values, beliefs, behaviors, and practices of the population of interest is referred to as: A) Advocacy. B) Coalition building. C) Consultation. D) Social marketing.

When applying the nursing process to environmental health, the nurse would: A) Conduct an assessment focused on the client's presenting problem. B) Coordinate interventions with the primary care provider of record. C) Examine criteria that are limited to the client's immediate responses. D) Include outcome measures that involve mitigation and elimination of the contributing factors.

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

A nurse is caring for a client who is experiencing alcohol withdrawal. Which of the following findings is a manifestation of withdrawal? A. Decreased blood pressure B. Diaphoresis C. Pin-point pupils D. Bradycardia

B; increased blood pressure, dilated pupils, and tachycardia are also manifestations of alcohol withdrawal

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.

BCE

Collaboration is an intervention that would be located where in the Intervention Wheel? A) Red wedge at the individual/family level of practice. B) Blue wedge at the community level of practice. C) Orange wedge at the community level of practice. D) Green wedge at the systems level of practice.

Examples of the application of evidence-based practice (EBP) to improve public health nursing can be found in research projects designed to test the effectiveness of public health nursing interventions related to the core functions and essential services of public health. These projects are associated with: A) Agency on Healthcare Research and Quality. B) Cochrane Database of Systematic Reviews. C) The Intervention Wheel. D) U.S. Preventive Services Task Force.

Rapid changes in public health are providing a challenge to public health nurses because there is neither time nor staff to provide nurses with the on-the-job training needed to acquire the core public health competencies required of the public health nurse. This resulted in revisions to the American Nurses Association (ANA)'s Scope and Standards of Public Health Nursing Practice in 2005 that established: A) Core public health functions as the competency framework. B) Minnesota Department of Health's intervention wheel as the practice competencies. C) Standards for baccalaureate- and master's-prepared public health nurses. D) Quad Council principles as the primary framework for practice.

State public health agency responsibilities include: A) Conducting community health assessments. B) Enforcing public health codes. C) Monitoring health status. D) Providing expertise that facilitates evidence-based practice.

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

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.

When nurses work with communities, "best practices"-the application of the best available evidence to improve practice-must also be: A) Accessible and diverse. B) Competent and compliant. C) Culturally and financially appropriate. D) Reasonable and deliverable in a timely fashion.

Which action by the community-oriented nurse best illustrates a partnership for health? A) Assisting a school nurse in conducting vision screening of elementary school children. B) Developing a volunteer program for teaching parenting skills. C) Helping a group of citizens concerned about potential environmental hazards collect relevant health data and develop needed interventions. D) Informing a neighborhood council that smoking is its major community health problem.

Which of the following article titles include(s) an example of epidemiologic distribution and determinants (select all that apply)? A) Can Operating Room Nurses Measurably Reduce Patient Anxiety? B) Characteristics of Patients Newly Diagnosed with Tuberculosis C) Comparison of Postinsecticide Exposure Incidence of Atopic Dermatitis in Migrant Farmworkers and Land-Owning Farmers in Southwestern Utah D) Postpartum Nurses' Reaction to Rotating Shifts Compared with Assigned Stable Shift

A case management nurse at an acute care facility is conducting an initial visit with the client to identify needs prior to discharge home. After developing a working relationship with the client the nurse is engaging in the referral process. which of the following should be the first action by the nurse? A. monitor the client's satisfaction with the referral. B. Provide client information to for referral agencies. C. Review available resources with the client. D. Identify referrals that the client needs.

D; identifying the clients needs then allows the nurse and client to focus on specific needs for moving forward in the referral process

A community health nurse is developing an education program on substance use disorders for a group of adolescents. Which of the following should the nurse include when discussing nicotine and smoking? A. Smoking is the fifth-most preventable cause of death in the U.S. B. Nicotine is a central nervous system depressant. C. Withdrawal effects from smoking are minimal D. Tolerance to nicotine develops quickly.

D; smoking is first most preventable cause of death, not fifth; nicotine is a central nervous stimulant, not depressant; withdrawal effects are substantial not minimal

A nurse is planning a community health program. Which of the following should the nurse include as part of the evaluation plan? A. Determine availability of resources to initiate the plan. B. Gain approval for the program from local leaders. C. Establish a timeline for implementation of interventions. D. Compare program impact to similar programs.

D; this comparison assists with determining the efficiency of the program.

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.

A rural community health nurse has made sure that male and female lay advisors are involved in the health department's migrant worker outreach program. The nurse believes this intervention strategy is important because the nurse knows that such individuals can be: A) People who are influential in approving or vetoing new ideas. B) Medical professionals within the migrant community. C) Natural healers within their community. D) Translators to help overcome language barriers.

A school nurse notes that 60 children have missed days of high school because of pertussis this past year and this rate has been relatively constant for the past 5 years. The nurse plans to work with the community to increase awareness of the seriousness of this disease for children younger than 6 months of age and to raise and maintain the immunization rates, because in this community the pertussis is: A) Endemic. B) Epidemic. C) Pandemic. D) Sporadic.

A woman comes to the community health center complaining of increasing lower abdominal pain, fever, and abnormal menses for several months. During the assessment, the client indicates that she is aware that her husband has had multiple sex partners in the past two years. Appropriate intervention by the nurse would be to: A) Arrange to have the client referred for medical evaluation for pelvic inflammatory disease (PID) and appropriate intervention and treatment. B) Contact the health department to confirm the spouse's diagnosis of Chlamydia infection to determine the client's exposure, give the client antibiotics, and have her return to the clinic if symptoms worsen. C) Provide sexually transmitted disease (STD) prevention and treatment education and refer the client to the health department for STD screening for gonorrhea and/or Chlamydia infection. D) Supply the client with nonsteroidal antiinflammatory drugs and caution her to call the after-hours call doctor if her symptoms worsen.

Although the definitions of evidence-based practice (EBP) in the literature vary widely, their common thread across all health care disciplines is: A) Application of the best available evidence to improve practice. B) Definition of what counts as evidence. C) Reliance on principles of pathophysiology. D) Method of transforming research into practice.

An American takes a long-awaited vacation in sunny Mexico, spending days on the beach eating fresh raspberries from a nearby vendor and drinking bottled water. The tourist may be altering: A) Agent-host-environment interaction. B) Circadian rhythms. C) Herd immunity. D) Host resistance.

Community health nurses conducting health education among populations vulnerable to HIV infection should explain the natural history of the infection, including the fact that HIV infection may go undetected during the primary infection stage because: A) Antibody test results are typically negative. B) Antibody production by the immune system increases. C) Incubation period is prolonged. D) Symptoms include myalgias, sore throats, and rash.

If the community is where nurses practice and apply the nursing process, and the community is the client in that practice, then nurses will want to analyze and synthesize information about: A) Boundaries, parts, and dynamic processes of the client community. B) Community health status and structure. C) Community problems and problem correlates. D) Role of the nurse and lay advisors in the community partnership.

Public health nurses are challenged to respond to public health-related trends of the twenty-first century, which include: A) Racial, ethnic, and economic health disparities; rise of drug-resistant pathogens; unequal access to health care; and violence. B) Violence, availability of health care for all, and increasing life expectancy. C) Health disparities, access issues, and adequate mental health program funding. D) Rise of drug-resistant organisms, increased life expectancy, societal violence, and more effective disease surveillance.

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

The World Health Organization (WHO) developed the Five Keys to Safer Food campaign in 2001 to address the problem of foodborne and waterborne diarrheal diseases worldwide. This campaign emphasizes which of the following practices? A) Keep clean, separate raw and cooked, cook thoroughly. B) Never use raw, always cook, buy better. C) Wash, cut, cook, and throw away. D) Wash, cover, and always refrigerate.

The clients most at risk of reactivation of latent infections of tuberculosis (TB) are: A) Immunocompromised persons, substance abusers, and those with diabetes. B) Individuals previously treated for TB. C) Long-term cigarette smokers. D) Persons with new-onset asthma or emphysema.

The community practice nurse is preparing to initiate a community partnership with a neighborhood watch association to address teenager street vandalism. The nurse is evaluating the community health dimension of process and seeks to determine the community's: A) Commitment to prioritizing and solving health problems. B) Crime rate and school absenteeism rate. C) Educational level. D) Local client-to-provider ratio.

The federal-state-local partnership teams with other organizations to develop and implement responses to identified public health concerns because: A) Community health is a shared responsibility. B) Health objectives are defined nationally. C) Population health is the responsibility of the government. D) Public health trends focus on bioterrorism.

The public health nurse applies knowledge in working with a local school board coalition to develop a helmet safety campaign in the middle and high schools. This best exemplifies which aspect of public health? A) Core competency. B) Core function. C) Nursing role. D) Standard of practice.

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.

Today, an evidence-based nursing practice can best be defined as which of the following? A) Approach to the integration of the best research available, nursing expertise, and the preferences/values of the clients served. B) Concept developed by acute care nurses to ensure the quality of care of hospitalized clients and to challenge managed-care decisions. C) Concept developed in the early twentieth century to help nurses document the scientific basis of their nursing practice. D) Framework supporting the use of traditional research as the only basis for making clinical decisions in practice.

When a nurse evaluates the completeness and accuracy of information made available to community residents regarding the impact of rezoning of land parcels for industrial use, the nurse can best be described as: A) Advocating for ethical choices. B) Communicating risk. C) Controlling environmental damage. D) Volunteering for service on state boards.

When a situation exists in which there is potential contact with blood or body fluids, health care workers must always perform hand hygiene and wear gloves, masks, protective clothing, and other indicated personal protective barriers. The underlying reason for requiring these practices, known as universal precautions, is that: A) Blood and body fluids of all clients need to be handled as if they were infected. B) Effective infection control surveillance programs are in place. C) Health care settings are reservoirs of infection. D) Health care workers do not effectively use hand hygiene.

When confirmed cases of the mumps, a vaccine-preventable disease, emerged on college campuses in fall 2006, public health nurses conducted outreach at campuses and collaborated with student health officials to increase the number of students with full immunization compliance. This is an example of: A) Community-level practice. B) Family-level practice. C) Individual-level practice. D) Systems-level practice.

A nurse is preparing an educational program on cultural perspectives in nursing. The nurse should include that which of the following are influenced by an individual's culture? Select all that apply A. Nutritional practices B. Family structure C. Health care interactions D. Biological variations E. Views about illness

A, B, C, and E; biological variations are physical, biological and physiological differences between races, and are not influenced by the beliefs, values, and attitudes of an individual.

A community health nurse is revising the agency's nursing protocols to incorporate current evidence-based practice (EBP) clinical practice guidelines. Common barriers to EBP implementation that could be faced include which of the following (select all that apply)? A) Disempowerment of nurses in their ability to make clinical decisions. B) Experienced nurses' challenging of the need to change long-accepted practices. C) Lack of knowledge of how to conduct a systematic review of the research literature. D) Unwillingness of clients to accept changes in familiar agency programs. E) Urban agency setting with restricted computer resources.

A,B,D,E

A nurse is advocating for local leaders to place a newly approved community health clinic in an area of the city that has fewer resources than other areas. The nurse is advocating for the leaders to uphold which of the following ethical principles? A. Distributive justice B. Fidelity C. Respect for autonomy D. Veracity

A; distributive justice is the fair distribution of benefits and burden in society. Fidelity involves keeping commitments and following through with promises. Autonomy which is supporting the rights of individuals to determine and pursue personal healthcare goals. Veracity is the concept of telling the truth.

A nurse is conducting a community assessment. Which of the following data collection methods is the nurse using when having direct conversations with individual members of the community? A. Key informant interviews B. Participant observation C. Focus groups D. Health surveys

A; informant interviews are direct conversations with individual community members for the purpose of obtaining ideas and opinions.

A nurse at an urban community health agency is developing an education program for city leaders about homelessness. Which of the following should the nurse include as the fastest-growing segment of the homeless population? A. Families with children B. Adolescent runaways C. Intimate partner abuse victims D. Older adults

A; others are not

A nurse is using the I PREPARE mnemonic to assess a client's potential environmental exposures. Which of the following is an appropriate question for the nurse to ask to assess for "A" in the mnemonic? A. "What do you like to do for fun?" B. "What year was your residence built?" C. "What jobs have you had in the past?" D. "What industries are near where you live?"

A; the "A" represents activities. B would be for "R" which represents residence; C would be for "P" which represents past work; D would be for "E" which represents environmental concerns.

7. A child came to school coughing almost constantly. The next day, six other children in the same school room were coughing. Which of the following types of outbreak would the nurse suspect? a. Common source b. Mixed c. Propagated d. Intermittent

ANS: A A common source outbreak refers to a group exposed to a common noxious influence, in this case, the ill child who was attending school. The cause of the illness being spread is obvious. DIF: Cognitive Level: Apply (Application) REF: p. 272

12. A school nurse is administering medications at the school. Which of the following guidelines should be followed? a. A current drug reference should be available in case information is needed b. The nurse should administer medications brought in from home by the child c. Medications cannot be administered without a physician order d. Narcotics and controlled substances should be kept in a locked cabinet

ANS: A A current drug reference should always be available so that it can be consulted for information. DIF: Cognitive Level: Apply (Application) REF: pp. 575-576

24. 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, which of the following is the most likely explanation for a single neighborhood having such a different pattern of illness? a. A cultural or ethnic concentration in the neighborhood b. The geographical location of the neighborhood within the city c. A statistical fluke without meaning d. The time of year the different statistics were collected throughout the city

ANS: A Although any explanation is possible, the most probable reason is that there is a cultural or ethnic concentration in that particular neighborhood that has a different lifestyle pattern, resulting in different health outcomes. DIF: Cognitive Level: Apply (Application) REF: p. 165

6. A nurse at a migrant clinic assists clients with completing the application process to receive supplemental food assistance. Which of the following roles of the nurse is being used? a. Advocate b. Case manager c. Outreach worker d. Primary caregiver

ANS: A As an advocate, the nurse collects, monitors, and analyzes data and discusses with the client which services are needed and whether the client is an individual, a family, or a group. DIF: Cognitive Level: Apply (Application) REF: p. 530

25. Two women seem to agree on almost everything from favorite music to favorite media stars to the best way to prepare a meal. Which of the following best explains this similarity in the two women? a. They are both members of the same birth cohort. b. They are close friends. c. They attended the same school. d. They both go the same church.

ANS: A Being close friends is probably the result of the similarity rather than the cause. However, being born at about the same time would mean both women have lived through similar social events and media occurrences and therefore would have much in common. Going to the same school or the same church, depending on the size of the institutions, might not result in any personal interaction whatsoever. DIF: Cognitive Level: Analyze (Analysis) REF: p. 167

5. Which of the following best explains why every client doesn't receive care from a case manager? a. Case management time is demanding; thus it is restricted to complex cases. b. Many health agencies do not employ case managers. c. Most clients would not benefit from case management. d. Most nurses do not know how to function as case managers.

ANS: A Case management can be labor intensive, time consuming, and costly. Because of the increasing number of clients with complex problems in nurses' caseloads, the intensity and duration of activities required to support the case management function may soon exceed the demands that the direct caregiver can meet. DIF: Cognitive Level: Understand (Comprehension) REF: p. 235

8. A nurse noted that of 18 children in a day care center room, 5 became ill. Which of the following best describes a host factor that may be associated with this illness and who became ill? a. Some of the children were from very low socioeconomic families. b. Some of the children slept during rest time while others only rested. c. The bacterial cause of the illness was easily removed by hand washing. d. The day care center room was much warmer on three sides in comparison to the side with the floor to ceiling windows.

ANS: A Factors that must be considered as causes of outbreak are categorized as agents, hosts, and environmental factors. Host factors may be age, sex, race, socioeconomic status, genetics, and lifestyle choices. The cause of the illness is an agent factor, and the difference in temperature in the room is an environmental factor. DIF: Cognitive Level: Apply (Application) REF: p. 272

23. The mother of a high school student newly diagnosed with a condition that will require special health care services is concerned that the student will be required to be home-schooled away from the friends he has developed. Which of the following would be the most appropriate response by the school nurse? a. "Federal legislation requires that the school make provisions for those with various challenges, so your child will be able to remain in school as long as he is able." b. "I realize that this will be a difficult adjustment, but home-schooling has improved over recent decades and the Internet will allow your child to connect with friends." c. "Whether your child can remain in school will depend on state funding for those with disabilities. You might want to contact your congressman on this issue." d. "Your child may remain in school as long as he can manage the course requirements and doesn't flunk out."

ANS: A Federal legislation specifies that children cannot be excluded from schools because of a disability. The school must provide health services that each child needs. Legislation further requires the school district's committee on the disabled to develop individualized education plans (IEPs) for children. DIF: Cognitive Level: Apply (Application) REF: p. 563

24. A group of nursing students are scheduled to present a program on healthy hearts to various community groups, with a daycare center being the first location. What of the following advice should be given to them by their instructor? a. Base the program on the audience's development and maturity. b. Bring (borrow if necessary) a model of the heart to help explain its functioning. c. Focus on entertaining the learners. d. Have lots of handouts to reinforce the lesson.

ANS: A For younger learners, it is important to keep the lesson to no more than 10 minutes in length; to use plenty of examples, pictures, and stuffed animals in the talk; and to remember the developmental stage of the children when teaching them. DIF: Cognitive Level: Apply (Application) REF: p. 573

9. A nurse would like to implement a primary prevention effort to decrease the leading cause of death among children and teenagers. Which of the following actions would the nurse most likely take? a. Educate students about injury prevention measures b. Provide free condoms to sexually active students c. Screen for signs and symptoms of cancer d. Invite a guest speaker to talk about living with HIV

ANS: A Injuries are the leading cause of death in children and teenagers; therefore, prevention measures should focus on injury prevention. Because the question asks for primary prevention efforts, the intervention must occur before injury. Common interventions by the school nurse include educational programs reminding children to use their seatbelts or bicycle helmets to prevent injuries. Other classes can be on crossing the street, water safety, and fire safety. DIF: Cognitive Level: Apply (Application) REF: p. 573

14. Which of the following factors is causing nursing to change so quickly? a. Economic issues b. Increases in medical and nursing knowledge c. Legislative issues d. Technology changes

ANS: A More than any other single factor, the driving force behind nursing changes is the economy and the increase in managed care to decrease or control health care costs in the United States. DIF: Cognitive Level: Understand (Comprehension) REF: p. 533

9. Which of the following best describes the role of nursing in community health? a. Application of nursing and public health theory in promoting, preserving, and maintaining health of individuals, families, or communities b. Health care provision offered in primary and secondary institutions or in the client's home c. Provision of health care services in institutions located in the community but outside the hospital d. Use of the nursing process and evidence-based practice to meet Healthy People 2020 objectives for community health improvement

ANS: A Nursing practice in community health 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 practice is health of individuals, families, and groups. Care is provided within the context of preventing disease and disability and promoting and protecting the health of the community as a whole. DIF: Cognitive Level: Understand (Comprehension) REF: p. 526

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. DIF: Cognitive Level: Apply (Application) REF: p. 100

15. A school nurse suggests to teachers that they have a session on coping strategies and stress management techniques. The nurse also sets up a peer counseling program. Which of the following is the school nurse most likely trying to prevent? a. Adolescent suicides b. Bullying c. Obesity d. Teenagers engaging in violence

ANS: A Suicide is the third leading cause of death in teenagers. To reduce the incidence of suicide in teenagers, the nurse can emphasize coping strategies and stress management techniques and organize a peer assistance program to help teenagers cope with school stresses. DIF: Cognitive Level: Apply (Application) REF: p. 577

23. The administration at a local medical center examines the trends in health problems when developing long-range plans for staffing and space allocation. Which of the following sources of information would be most helpful? a. Local data drawn from a professional survey in the city b. The National Health Interview Survey c. The National Hospital Discharge Survey d. The state's vital statistics

ANS: A The National Health Interview Survey and the National Hospital Discharge Survey both provide information on the health status and behaviors of the national population. For many studies, however, the only way to obtain the needed information is to collect the required data in a study specifically designed to investigate a particular question. DIF: Cognitive Level: Apply (Application) REF: p. 163

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. DIF: Cognitive Level: Apply (Application) REF: p. 97

14. A nurse is examining all of the various factors which can lead to disease. Which of the following models would the nurse most likely use? a. Epidemiologic triangle b. Health promotion c. Levels of prevention d. Natural history of disease

ANS: A The epidemiologic triangle categorizes factors as agent, host, or environment. The model encourages the health care provider to examine all the influences that lead to increased risk. Levels of prevention are actions taken to improve health outcomes. Health promotion addresses health improvement, not the risk for disease. DIF: Cognitive Level: Apply (Application) REF: pp. 159-160

20. A pregnant teen asks the school nurse to provide information on abortion and a list of health care providers who offer such services. If the school nurse has very strong personal beliefs against abortion, which of the following actions should be taken by the nurse? a. Call in another nurse to care for this client. b. Explain, from the nurse's perspective, all the reasons that abortion should be made illegal. c. Offer the student a combination of oral contraceptives to induce spontaneous abortion. d. Provide information on alternatives to abortion and give the client information on adoption agencies.

ANS: A This creates an ethical dilemma for the nurse. If the nurse feels so strongly that he or she cannot work with the situation, another school nurse should be called for help or the student should be referred to other health providers who can provide the care the student needs. DIF: Cognitive Level: Apply (Application) REF: pp. 580-581

9. In January, a nurse is listening to colleagues talk about the increase in depressed patients asking for help from their physicians recently. The incidence of complaints of depression was higher in the last month than in the previous 3 months. Based on this data, which of the following would be the next step for the nurse to take? a. No further action is necessary because depression is known to worsen during the shorter darker days of winter. b. No further action is necessary because this short-term increase may just be a statistical error or even just a mistaken impression by the involved nurses. c. Action should be taken because there must be some cause for this noted increase. d. Action should be taken because this increase may the beginning of an epidemic and should be investigated.

ANS: A Typically, any unusual increase in incidence should be investigated. But in the majority of cases the increased incidence occurs naturally and/or is predictable when compared with the consistent patterns of previous outbreaks. Many illnesses are seasonal. Seasonal affective disorder (depression) often worsens during the shorter periods of daylight in the winter. DIF: Cognitive Level: Analyze (Analysis) REF: p. 272

3. The public health administrator is in the process of hiring a new public health nurse. Which of the following statements made by an applicant would most likely result in the applicant not being hired? a. "I like to be the only person working on a project because individuals in teams have their own ideas and plans and the resulting debate slows progress." b. "I prefer to work in teams because no single person has too much responsibility because the burden is shared." c. "Teamwork is better than work done by individuals because teamwork incorporates different perspectives." d. "Whether teamwork is better than work done by individuals depends on the nature of the work being performed."

ANS: A Working in collaborative partnerships is an essential role of public health nursing. Partnerships and collaboration among groups are much more powerful in making change than the individual client and nurse working alone. Part of the reason is that multiple perspectives are examined in the process of coming to the best solution. DIF: Cognitive Level: Apply (Application) REF: p. 524

1. Which of the following activities are included in the Centers for Disease Control and Prevention's school health program? (Select all that apply.) a. Ensuring a healthy school environment b. Assisting teachers with education related to health c. Encouraging nutritious school meals d. Giving immunizations to students, staff, teachers, and their families

ANS: A, B, C The federal government, through the coordination of the Centers for Disease Control and Prevention, developed a plan that school health programs should follow, including health education, physical education, health services, nutrition services, counseling, psychological and social services, healthy school environment, health promotion for staff, and family/community involvement. Unfortunately schools cannot afford to give immunizations to everyone who might want such a benefit. Education in areas other than health is the responsibility of the teachers, not the nurse. DIF: Cognitive Level: Remember (Knowledge) REF: pp. 570-571

1. Which of the following is the primary goal of case management? (Select all that apply.) a. To ensure that care coordination occurs across the continuum b. To emphasize evidence-based clinical decision making c. To manage resource use and control expenses d. To stress the advantages and benefits of community-based care

ANS: A, B, C The goals in case management are to reduce institutional care while maintaining quality processes and satisfactory outcomes; manage resource use through protocols, evidence-based decision making, guideline use, and disease-management programs; and control expenses by managing care processes and outcomes. DIF: Cognitive Level: Understand (Comprehension) REF: p. 233

2. A case manager is concerned about his exposure to possible lawsuits. Which of the following are appropriate actions to take to minimize this risk? (Select all that apply.) a. Assure clients they can appeal any decision. b. Carefully document client involvement and reasons for decisions. c. Share client information with the other involved providers and agencies. d. Confirm credentials and capabilities of providers or agencies to give care.

ANS: A, B, D Elements that reduce risk exposure include clear documentation of the extent of participation in decision making and reasons for decisions; records demonstrating accurate and complete information on interactions and outcomes; use of reasonable care in selecting referral sources—which may include confirming credentials and capabilities of providers and agencies; maintaining good communication with clients; and informing clients of their rights of appeal. In compliance with HIPAA, no nurse is allowed to share information with others without written consent of the client. DIF: Cognitive Level: Apply (Application) REF: p. 243

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. DIF: Cognitive Level: Remember (Knowledge) REF: pp. 94-95

5. A school nurse describes to teachers the characteristics of an adolescent who may be thinking about drastic violence. Which of the following behaviors would suggest the adolescent was having such problems? (Select all that apply.) a. Being a gang member b. Damaging property c. Leaving the scene if another student is being bullied or hurt d. Mood swings

ANS: A, B, D Six characteristics that can help identify a student who may be thinking about drastic violence are (1) Venting: having mood swings; (2) Vocalizing: threatening others; (3) Vandalizing: damaging property; (4) Victimizing: seeing himself or herself as a victim; (5) Vying: belonging to gangs; and (6) Viewing: witnessing the abuse of others. By helping to identify students who might be considering school violence, help may be obtained and violent actions may be prevented. DIF: Cognitive Level: Apply (Application) REF: p. 577

1. A nurse is employed by a state public health department. Which of the following functions would most likely be completed by this agency? (Select all that apply.) a. Delegating power to engage in certain activities such as quarantine b. Enforcing laws and regulations that protect public health c. Filing birth and death certificates whenever these occur within the state d. Monitoring health status of citizens within its geographic boundaries

ANS: A, B, D State public health agencies are responsible for monitoring health status and enforcing laws and regulations that protect and improve the public's health. These agencies receive funding from federal agencies for the implementation of public health interventions such as the maternal and child health programs. State agencies distribute federal and state funds to the local public health agencies to implement programs and provide oversight and consultation for local public health agencies. State health agencies also delegate some public health powers, such as the power to quarantine, to local health officers. Local departments file birth and death certificates and often ask for volunteers to assist. DIF: Cognitive Level: Apply (Application) REF: p. 524

1. Which of the following explains why contagious infections are becoming a central focus of public health? (Select all that apply.) a. Americans are fearful of terrorists using biological agents. b. Awareness of human susceptibility to animal diseases has been publicized. c. Drug-resistant strains of "old" diseases have evolved. d. Media coverage exaggerates the dangers of exposure to crowds.

ANS: A, C New infectious diseases and new forms of old diseases, such as drug-resistant strains of TB, have emphasized the dangers of infectious diseases. Potential threats from terrorist use of infectious agents have also emphasized infectious diseases. DIF: Cognitive Level: Understand (Comprehension) REF: p. 154

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. DIF: Cognitive Level: Apply (Application) REF: p. 104

4. A nurse believes a new mouth care procedure (MCP) is causing more mouth problems than it is helping to avoid. Which of the following must be present for the nurse to go to administration with confidence that the new mouth care procedure (MCP) is causing problems? (Select all that apply.) a. A plausible explanation of how the new MCP could cause harm b. A strong feeling that the MCP is the cause c. Consistently seeing mouth inflammation in many of the patients who have received the MCP d. Documentation from patient records that mouth inflammation in clients did not occur until after the new procedure was implemented

ANS: A, C, D Strength of association is suggested by the fact that patients who did not receive the MCP and patients seen on the floor before the new MCP did not have problems, whereas patients who received the new MCP are having problems. Seeing the problems in many of the patients suggests a consistency. The fact that those who had the procedure more often have worse problems suggests a dose-response relationship. A plausible explanation of how the new procedure could cause harm enhances the biological risk. Feelings alone are not convincing. A study should be set up to confirm or dispute the nurse's hypothesis. Although one would hope that previous testing would have been done before the product was released to market, the product could be safe for healthy persons but a risky process for those with compromised immunity or those who are under stress. DIF: Cognitive Level: Analyze (Analysis) REF: p. 171

2. Which of the following activities are addressed by most public health departments on the federal, state, and local levels? (Select all that apply.) a. Collecting and analyzing various health statistics b. Fining or terminating business at any facility that engages in unsafe commercial practices c. Identifying and planning for high-risk populations d. Planning for and responding to emergencies

ANS: A, C, D The majority of local, state, and federal public health agencies engage in collecting and analyzing vital statistics, providing health education and information, receiving reports about and investigating and controlling communicable diseases, protecting the environment to reduce the risk to health, providing some health services to particular populations at risk, planning for and responding to natural and human-made disasters and emergencies, identifying public health problems for at-risk and high-risk populations, conducting community assessments to identify community assets and gaps, and partnering with other organizations to develop and implement responses to identified public health concerns. DIF: Cognitive Level: Understand (Comprehension) REF: p. 525

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. DIF: Cognitive Level: Understand (Comprehension) REF: p. 102

4. Which of the following supplies or equipment should a nurse have available in the school health office? (Select all that apply.) a. Cervical spine collars b. Complete emergency kit that fulfills American Hospital Association requirements c. Epinephrine autoinjector kit d. Material for splints

ANS: A, C, D The school nurse needs much equipment to deal with emergencies in the school. Basic necessary equipment includes full oxygen tanks with oxygen masks of different kinds, splints, cervical spine collars, sterile dressings, and an epinephrine autoinjector kit in case a child goes into anaphylactic shock after exposure to an allergen. A hospital-oriented emergency kit would become quickly outdated (medications) and extremely expensive. DIF: Cognitive Level: Understand (Comprehension) REF: p. 575

3. A new student's parents had not yet submitted an immunization record, although the nurse had sent a reminder home with the student twice. Which of the following actions should be taken by the nurse to keep the child in school? (Select all that apply.) a. Call the parents or mail another reminder. b. Report the problem to the teacher and the principal. c. Send the child home with a note saying the child cannot return until the immunization record is received. d. Suggest to the parents that if they don't have health care insurance, they may qualify for programs that provide immunizations free.

ANS: A, D There are many problems with children not being immunized or having incomplete vaccination records, especially in families who have moved many times or who may not have a regular physician. The parents may have no idea whether the child has received the required shots. Families may also be without health care insurance to pay for the immunizations, or they may have insurance that does not pay for preventive care. In these cases, they may lack the resources to pay for the immunizations themselves. Therefore, the nurse's role is to be sure parents are aware of the problem, to help them obtain the records if they have been misplaced, and to suggest ways to obtain the injections without charge, even if there is no obvious evidence that lack of funds is the problem. Telling the teacher or principal won't resolve the problem and it is illegal, immoral, and unprofessional to enter false information in a student's record. DIF: Cognitive Level: Apply (Application) REF: p. 574

7. 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.

ANS: B Adaptation of the case management care plan to each client's characteristics is a crucial skill for standardizing the process and outcome of care. It links multiple provider interventions to client responses and offers reasonable predictions to clients about health outcomes. Institutions report that sharing case management plans with clients empowers the clients to assume responsibility for monitoring and adhering to the plan of care. DIF: Cognitive Level: Apply (Application) REF: p. 237

16. A disaster has occurred in the community. Which of the following actions should be taken by the school nurse? a. Continue activities as much as possible as if nothing had happened b. Continue to assess for shock and stress c. Help teachers discuss the disaster with their class d. Maintain school routines and activities

ANS: B After a disaster, the school nurse has many responsibilities—for instance, continuing to assess the school community for the presence of shock and stress; encouraging parents to minimize how much their children view the disaster coverage on TV; providing grief counseling; continuing to communicate with the children, parents, and school personnel; and following up with assessment of children for anxiety, depression, regression, and posttraumatic stress disorder. DIF: Cognitive Level: Apply (Application) REF: pp. 577-578

15. A nurse is implementing a primary prevention activity to decrease the incidence of communicable disease. Which of the following actions is the nurse most likely taking? a. Identifying and treating clients in a sexually transmitted disease clinic b. Partnering with schoolteachers to teach and observe hand washing techniques in elementary school children c. Providing case management services that link clients with communicable diseases to health care and community support services d. Performing directly observed therapy (DOT) for clients with active tuberculosis

ANS: B An example of primary prevention is to educate daycare centers, schools, and the general community about the importance of hand hygiene to prevent transmission of communicable diseases. DIF: Cognitive Level: Analyze (Analysis) REF: p. 527

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. DIF: Cognitive Level: Understand (Comprehension) REF: pp. 99-100

10. The school nurse has arranged for volunteers to help check each child's hearing and vision. Any child that the volunteers feel did not "pass" will be sent to the nurse for follow-up. The nurse will then send a note to the parents that a physician should be seen. Which of the following levels of prevention is being implemented? a. Primary b. Secondary c. Tertiary d. Both primary and secondary

ANS: B Because secondary prevention involves caring for children when they need health care, this is the largest responsibility for the school nurse. This includes caring for ill or injured students and school employees. It also involves screening and assessing children and referral to appropriate health agencies or providers. DIF: Cognitive Level: Apply (Application) REF: p. 574

4. 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

ANS: B Case management competency requires the following knowledge and skills: knowledge of community resources and financing methods; written and oral communication and documentation skills; negotiation and conflict-resolution skills; critical-thinking processes to identify and prioritize problems from the provider and client views; and identification of best resources for the desired outcomes. Because communities are unique, someone new to the area will lack knowledge of community resources and financing methods. There is nothing in the descriptions of the other public health nurses that indicates a lack of current knowledge or skills. DIF: Cognitive Level: Apply (Application) REF: pp. 233-234

2. 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

ANS: B Case management practice is complex because of the coordinating activities of multiple providers, payers, and settings throughout a client's continuum of care. DIF: Cognitive Level: Understand (Comprehension) REF: p. 233

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. DIF: Cognitive Level: Apply (Application) REF: p. 94

12. A nurse reviews with the client what the client can expect during the next 3 days, as well as how the client should expect to feel each of those days. The client laughs and says, "You've got my care all mapped out." Which of the following tools is the nurse using to determine what will happen when? a. Care planning b. Critical pathway c. Demand management d. Use management

ANS: B Critical paths are tools that name activities to be used in a timely sequence to achieve desired outcomes for care with measureable outcomes. Use management attempts to redirect care and monitors the appropriate use of provider care and treatment services. Demand management seeks to control use by providing clients with correct information to empower themselves to make healthy choices, to use healthy and health-seeking behaviors to improve their health status, and to make fewer demands on the health care system. DIF: Cognitive Level: Apply (Application) REF: p. 233

11. A nurse is considering applying for a public health nurse position at a local health department. Which of the following minimum levels of educational preparation should the nurse have obtained? a. Associate degree in nursing b. Baccalaureate degree in nursing c. Master of science degree in nursing d. Training as a licensed practical nurse

ANS: B Educational preparation of nurses in community health should be at least a baccalaureate degree. Those registered nurses who have associate degrees are encouraged to seek further degrees because of the increasing complexity of better care delivery in public health. A master's degree would be even more useful, but for many, advanced education may not be feasible. DIF: Cognitive Level: Apply (Application) REF: p. 529

2. A nurse is employed as a nurse epidemiologist. Which of the following activities would most likely be completed by the nurse? a. Eliciting the health history of a client presenting with an illness b. Evaluating the number of clients presenting with similar diseases c. Performing a physical examination of an ill client d. Providing treatment and health education to a client with a disease

ANS: B Epidemiology differs from clinical medicine, which focuses on the diagnosis and treatment of disease in individuals. Epidemiology monitors the health of the population. DIF: Cognitive Level: Apply (Application) REF: p. 151

1. A nurse is using analytic epidemiology when conducting a research project. Which of the following projects is the nurse most likely completing? a. Reviewing communicable disease statistics b. Determining factors contributing to childhood obesity c. Analyzing locations where family violence is increasing d. Documenting population characteristics for healthy older citizens

ANS: B Epidemiology refers not only to infectious epidemics but also to other health-related events. Analytic epidemiology looks at the etiology (origins or causes) of disease. DIF: Cognitive Level: Analyze (Analysis) REF: p. 151

7. The nursing staff has attempted to screen the entire African-American population in the community for diabetes. Which of the following would provide immediate verification of the success of the nursing staff's efforts? a. An epidemic of diabetes will be recognized. b. The incidence of diabetes will increase in the community. c. The prevalence of diabetes will decrease in the community. d. The risk for diabetes in the community will increase.

ANS: B If the screening has been successful, more diabetes will be diagnosed and, hopefully, treated. Thus, the incidence of new cases will increase. Overall, prevalence will also increase, but that is not one of the answer options. DIF: Cognitive Level: Analyze (Analysis) REF: p. 156

14. The case manager explains to two disagreeing parties that coming to an agreement will save personnel costs for both of them. Which of the following terms best describes this action? a. Assertiveness b. Collaboration c. Cooperation d. Compromising

ANS: B In collaborating, an individual attempts to work with others toward solutions that satisfy the needs of both parties. DIF: Cognitive Level: Apply (Application) REF: p. 242

21. Which of the following is most important for school nurses to master in order to prepare for health care delivery in the future? a. Complementary and alternative therapies such as acupuncture b. Computer and technology use c. Psychoanalytical techniques d. Self-defense techniques

ANS: B 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. DIF: Cognitive Level: Understand (Comprehension) REF: p. 581

8. In a particular community, several high school students were diagnosed with diabetes mellitus Type 2 during the annual high school health fair. Over the next few years, the nursing staff developed and implemented educational programs about the risk factors for diabetes mellitus Type 2 and proper nutrition. Which of the following would be most useful for the nurses to use to determine if they are having any impact? a. The epidemic of diabetes in the high school is gradually ending. b. The incidence of diabetes is slowly decreasing during screening events. c. The prevalence of diabetes is slowly decreasing during screening events. d. The risk for diabetes is slowly increasing over time.

ANS: B Incidence rates and incidence proportions are the measure of choice to study etiology because incidence is affected only by factors related to the risk of developing disease and not to survival or cure. Prevalence is a fairly stable number over time, but incidence reacts more quickly to changes in risk factors or intervention programs. If the educational programs are having the desired impact, the incidence of diabetes being diagnosed will decrease in future screenings. DIF: Cognitive Level: Analyze (Analysis) REF: p. 157

13. Which of the following statistics is used by countries to compare the success of their health care systems? a. Attack rate b. Infant mortality rate c. Cause-specific morbidity rate d. Cause-specific mortality rate

ANS: B Infant mortality is used around the world as an indicator of overall health and availability of health care services. DIF: Cognitive Level: Understand (Comprehension) REF: p. 159

4. Which of the following types of surveillance is being used when case reports are routinely sent to local health departments by health care providers and laboratories, where the data are then summarized and forwarded to those responsible for monitoring such reports? a. Active surveillance b. Passive surveillance c. Sentinel surveillance d. Special surveillance

ANS: B It is passive surveillance when case reports are sent to local health departments by health care providers or laboratories. The case reports are summarized and forwarded to the state health department, national government, or organizations responsible for monitoring the problem, such as the CDC. In active surveillance, the health department nurse may begin a search for cases through contacts to determine the magnitude of the problem. Sentinel surveillance involves looking for trends. Special surveillance is developed when a particular type of data is sought. DIF: Cognitive Level: Understand (Comprehension) REF: p. 269

18. A nurse is working at a local health department. Which of the following would most likely be completed by this agency? a. Enforcement of laws and regulations related to public health nationwide b. Filing of a certificate for any birth or death in a community c. Providing experts in various specialties to answer questions and respond as needed d. Surveying the state's public health needs

ANS: B Local public health agencies provide and disseminate health information, provide leadership in health planning, provide essential public health and environmental services, analyze statistics on births to monitor community health status, and file a certificate for every birth or death in the community. DIF: Cognitive Level: Apply (Application) REF: p. 524

3. Which of the following actions by Florence Nightingale demonstrates her role as an epidemiologist? a. She convinced other women to join her in giving nursing care to all the soldiers. b. She demonstrated that a safer environment resulted in decreased mortality rate. c. She obtained safe water and better food supplies and fought the lice and rats. d. She met with each soldier each evening to say goodnight, thereby giving psychological support.

ANS: B Nightingale examined the relationship between the environment and the recovery of the soldiers. Using simple epidemiological measures, she was able to show that improving environmental conditions and adding nursing care decreased the mortality rates of the soldiers. Nightingale used statistics to document decreased mortality rates when the environmental factors were improved. DIF: Cognitive Level: Apply (Application) REF: p. 153

2. A nurse attends a conference to learn more about public health surveillance. Why is it so important that the nurse be knowledgeable about this topic? a. Because nurses are employed in public health agencies b. Because nurses are often the first to recognize and respond to a problem c. Because nurses are responsible for ensuring that action is taken when necessary d. Because nurses are typically the ones to interact with the public and the media

ANS: B Nurses are often in the forefront of responses to be made in the surveillance process whether working in a small rural agency or a large urban agency; within the health department, school, or urgent care center; or on the telephone performing triage services during a disaster. It is the nurse who sees the event first. DIF: Cognitive Level: Apply (Application) REF: p. 268

6. Which of the following best describes services that are offered at a school-based health center? a. Employee care at a discounted cost at the school b. Care to others in the community c. Sex education, birth control, family planning, and care throughout pregnancy d. Referral and networking with other health care services in the community

ANS: B School-based health centers give care not only to students but also to other persons in the community. They may provide social services, daycare, job training, and educational counseling in addition to the medical and nursing care, mental health counseling, and dental care seen in smaller school-based centers. DIF: Cognitive Level: Understand (Comprehension) REF: p. 571

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. DIF: Cognitive Level: Remember (Knowledge) REF: p. 93

12. A man is diagnosed with prostate cancer. Which of the following data should the nurse know to answer the man when he asks, "What are the chances I'll survive this thing?" a. Attack rate b. Case fatality rate c. Cause-specific morbidity rate d. Crude mortality rate

ANS: B The case fatality rate (CFR) is the proportion of persons diagnosed with a particular disorder (i.e., cases) who die within a specified period. The CFR is considered an estimate of the risk for death within that period for a person newly diagnosed with the disease. Persons diagnosed with a particular disease often want to know the probability of surviving. The CFR provides that information. DIF: Cognitive Level: Apply (Application) REF: p. 159

15. A nurse is using the problem identification phase of the case management process. To which of the following phases of the nursing process does this correspond? a. Assessment phase b. Diagnosis phase c. Planning phase d. Implementation phase

ANS: B The diagnosis phase of the nursing process is analogous to identification of the problem in the case management process. It is during this phase that the case manager determines conclusions based on the assessment. DIF: Cognitive Level: Apply (Application) REF: p. 235

13. An upset mother calls the school nurse and says, "How dare you say my child has lice? My child is clean and I keep a clean house! You've obviously made an error." Which of the following would be the best response by the nurse? a. "I'm sorry you're upset, but your child cannot return to school until this problem is addressed." b. "Most lice are found in clean hair. Children often share combs. Let me tell you how to fix the problem." c. "You may have been traveling. Lice are often found in motels." d. "I'm sure you're correct; one of my volunteers probably made an error. I'll recheck."

ANS: B The nurse must reassure the mother that no insult was intended; in fact, lice are most often found on middle-class children with clean hair. Lice travel easily when children share items such as combs or other property in school. Lice are not life-threatening, and the necessary shampoo and other items to treat lice are widely available over the counter. DIF: Cognitive Level: Apply (Application) REF: p. 576

6. Several children were hospitalized for severe vomiting and diarrhea. Which of the following best explains why the nurse would continue to pursue the cause of the illness even after the children have been discharged from the hospital? a. So that the children's families know the public health department cared about them b. So that action could be taken to avoid any such future episodes c. Because the children's parents need to know whom to sue for their medical expenses d. To confirm that the symptoms were due to an infectious disease

ANS: B The objectives of an investigation are to control and prevent disease or death by identifying factors that contribute to the occurrence and implementing measures to prevent occurrences. In this case the nurse wanted to make sure children did not become ill again when it could be avoided. DIF: Cognitive Level: Apply (Application) REF: p. 271

22. A woman is sitting in a corner of the clinical waiting room, crying audibly. The nurse asks, "What's wrong? Can I help?" The woman responds, "They just told me I have a positive mammogram and I need to see my doctor for follow-up tests. I know I'm going to die of cancer. How can I tell my family?" Which of the following information does the nurse need to know in order to help the woman cope with this finding? a. The negative predictive value of mammography b. The positive predictive value of mammography c. The reliability of mammography d. The validity of mammography

ANS: B The positive predictive value is the proportion of persons with a positive test who actually have the disease, interpreted as the probability that an individual with a positive test has the disease. DIF: Cognitive Level: Apply (Application) REF: p. 163

8. Which of the following best describes the primary reason that school health nurses spend so much time on educational programs that teach children the importance of water and fire safety, using a seatbelt in the car, and wearing a helmet when biking or skateboarding? a. Because children won't know if someone doesn't tell them b. Because injuries are the leading cause of death in children and most injuries are preventable c. Because it is a dangerous world and someone has to warn children about the dangers d. Because teaching is easy and more fun than passing out bandages and documenting care

ANS: B The school nurse, as the trusted person at school, is able to quickly give information to help prevent injuries from occurring, since most injuries are preventable. Injuries are the leading cause of death in children and teenagers. DIF: Cognitive Level: Understand (Comprehension) REF: p. 573

16. A public health nurse traces sexual contacts of clients with sexually transmitted diseases for screening and treatment. Which of the following levels of prevention is being implemented? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Secondary and tertiary prevention

ANS: B Tracing individuals exposed to a client with a sexually transmitted disease is secondary prevention because the nurse is attempting to find those exposed and screen them. Once the exposed persons have been located, screening is another secondary prevention activity. DIF: Cognitive Level: Apply (Application) REF: p. 527

4. At the annual community health fair, the school health nurse displays a science booth that examines the hazards of ineffective hand washing. Which of the following best describes the nurse's role in this scenario? a. Consultant b. Community outreach c. Counselor d. Researcher

ANS: B When participating in community outreach, nurses reach out to residents in the community. One common way this occurs is when nurses are involved in activities such as community health fairs or festivals in the schools. DIF: Cognitive Level: Apply (Application) REF: p. 570

1. Which of the following describes the purpose of surveillance systems today? (Select all that apply.) a. To obtain data used to fight for increased budgets from taxpayers b. To evaluate the effectiveness of public health programs c. To monitor and reduce the incidence of chronic diseases d. To note and help prevent occupational exposure and diseases

ANS: B, C, D Although surveillance was initially devoted to monitoring and reducing the spread of infectious diseases, it is now used to monitor and reduce chronic diseases and injuries, as well as environmental and occupational exposures. With tight budgets, public health workers must know which programs should be developed and continued based on the most commonly occurring public health problems. Evaluation of the effectiveness of programs requires valid and reliable data. DIF: Cognitive Level: Understand (Comprehension) REF: p. 267

3. What did events after September 11, 2001, clearly demonstrate? (Select all that apply.) a. A strong public health structure ready to respond effectively to a crisis b. Public health's need for additional funding and resources c. The unrecognized importance of nurses in lowering health care costs d. Lack of adequate vaccines to meet community's needs

ANS: B, C, D The anthrax exposures after 9/11 alerted policymakers to the weakening public health infrastructure required to respond to bioterrorism events. Unprecedented influenza, tetanus, and childhood vaccine shortages and emerging infections competed with bioterrorism activities for resources. The general public was not informed about how immunizations by nurses improved health and lowered health care cost. For public health services to receive adequate funding, it is necessary for the public and the government to be aware of the benefits provided to a community by nurses. DIF: Cognitive Level: Understand (Comprehension) REF: p. 526

2. A nurse is concerned about the high incidence of STDs in the community college population and sets up a special STD screening. Which of the following groups of students would be encouraged to attend? (Select all that apply.) a. Sexually active students currently receiving treatment for an STD b. Sexually active students who had been screened the previous year c. Students who claimed to not be sexually active and do not plan to become sexually active d. Students who are sexually active but never "go all the way"

ANS: B, C, D Those already diagnosed with the problem are not at risk, because they already have the condition and are no longer at risk for developing it. DIF: Cognitive Level: Analyze (Analysis) REF: p. 156

2. A public health department becomes aware of an impending health problem before any problem is reported to the agency. Which of the following has most likely occurred within the community? (Select all that apply.) a. Doctors are feeling rushed as they interact with each patient. b. Emergency departments are notably busier than usual. c. Nurses are calling in ill to the local hospital. d. Pharmacists are discussing the increase in medication purchases.

ANS: B, D Doctors feeling rushed and nurses calling in ill are not unusual events. Syndronic surveillance systems were developed to monitor illness syndromes or events, as seen in such indirect measures as increased numbers of medication purchases, trips to physicians or emergency departments, orders for cultures or x-rays, and rising levels of school or work absenteeism. These may indicate that an epidemic is developing. DIF: Cognitive Level: Analyze (Analysis) REF: p. 271

6. A child has multiple disabilities, and caring for the child has been both expensive and time consuming for the school. Once the child turns 16, which of the following actions should be taken by the nurse? (Select all that apply.) a. As an adult, the child is no longer eligible for school services without charge. b. The school must continue to provide needed appropriate education for the child. c. The school can exclude the child from any extra special activities. d. The school should prepare an updated individualized education plan.

ANS: B, D Educational services must be offered by the schools for all disabled children from birth through age 22 years. Children cannot be excluded from activities because of a disability. The school must always develop an individualized education plan for each child and update it at appropriate intervals. Turning 16 does not make a child an adult. DIF: Cognitive Level: Apply (Application) REF: p. 568

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 audience—namely, those at risk or worried about the risk—can 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. DIF: Cognitive Level: Apply (Application) REF: pp. 101-102

2. Which of the following best explains why the federal government is beginning to fund school-based health centers? (Select all that apply.) a. These centers help young children avoid becoming addicted to drugs while still in elementary school. b. Attendance and learning are higher in schools with health clinics. c. These centers help keep children in school longer by distributing birth control and thus avoiding pregnancies. d. Many children have no other source of health care services.

ANS: B, D The U.S. government began funding school-based health centers essentially because many school children may not receive health care services otherwise. These are family-centered, community-based clinics run within the schools. Certainly, avoiding pregnancy and drug addiction are among the goals of school-based health centers, but these are not reasons the government began funding them. DIF: Cognitive Level: Understand (Comprehension) REF: p. 571

3. A nurse is planning to host a health screening at a large urban mall. Which of the following variables will help the nurse determine which screenings should be included? (Select all that apply.) a. Adequate space for persons to lie down after testing until side effects are reduced b. Health problems for which the specific population is at risk c. Whether adequate privacy can be obtained for the invasive or embarrassing procedures d. Whether health care providers are available to follow up on any positive screening results

ANS: B, D The screening tests should be reliable, valid, fast, and inexpensive. They should have few side effects, be minimally invasive, and be capable of detecting enough new cases to warrant the effort and expense. Results should be known immediately. No tests should be used that have negative side effects, are invasive, or cause embarrassment. Ethically, nurses should not screen for any problem unless they can refer those with positive results to a source for follow-up testing and treatment. DIF: Cognitive Level: Analyze (Analysis) REF: pp. 161-162

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 can't afford that—furthermore, 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. DIF: Cognitive Level: Apply (Application) REF: pp. 100-101

17. A community mental health nurse is implementing a tertiary prevention activity. Which of the following interventions is most likely being completed? a. Disseminating information about mental health to community organizations b. Partnering with school health nurses for early identification of children who have evidence of mental health problems c. Providing case management services that link clients with serious mental illnesses to mental health and community support services d. Screening high-risk clients for the presence of mental disorders

ANS: C An example of tertiary prevention is the provision of case management services that link clients identified with serious mental illnesses to mental health and community support services. DIF: Cognitive Level: Apply (Application) REF: p. 527

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. DIF: Cognitive Level: Apply (Application) REF: p. 95

16. A nurse is completing a case management advocacy activity which corresponds to the implementation phase of the nursing process. Which of the following activities would the nurse most likely use? a. Asking the client what is most important b. Seeking appropriate referrals for the client c. Assuring the client that his wishes will be supported d. Determining the order in which actions will occur

ANS: C Assuring the client is a component of the advocacy process that corresponds to the implementation phase. Asking the client what is most important is a way to illuminate values, which occurs in the assessment phase. Seeking appropriate referrals for the client occurs in the assessment phase. Determining the order in which actions will occur is a prioritization of action, which occurs in the planning phase. DIF: Cognitive Level: Apply (Application) REF: p. 235

21. Persons in an auditorium may have been exposed to a disease. If they are infected, it is crucial that they receive immediate treatment and not take the disease home to their families. Which of the following characteristics would be most important to consider when selecting the screening test to be used? a. The negative predictive value b. The positive predictive value c. The sensitivity of the test d. The specificity of the test

ANS: C Because it is most important to identify every case, the sensitivity of the test is crucial. High sensitivity is needed when early treatment is important and when identification of every case is important. DIF: Cognitive Level: Apply (Application) REF: p. 162

9. 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). Which of the following terms best describes this data? a. An epidemic b. Incidence c. Prevalence d. Risk

ANS: C Because we do not have baseline data, we have no way to conclude that this is an epidemic with higher-than-normal results from the screening. Incidence refers to new cases, whereas prevalence means all cases. We don't know whether the finding represents the first time a woman was told she had an STI or whether she had previously been diagnosed with the problem. Therefore, we can't say whether these are new cases (incidence), but the results do represent all cases (prevalence). Risk is the probability of developing an STI, but no risk factors are discussed. DIF: Cognitive Level: Apply (Application) REF: p. 157

1. 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

ANS: C Case management, in contrast to the definition of care management, involves activities implemented with individual clients in the system. DIF: Cognitive Level: Remember (Knowledge) REF: p. 233

1. A nurse considered copying last month's surveillance report and changing the date because the number of occurrences per month had not noticeably changed. Which of the following best explains why the nurse should continue to spend time collecting and reporting data that is always nearly the same? a. Because such data are legally required b. Because it is still part of the nurse's responsibilities, even if it is a waste of time c. To determine a local baseline rate and immediately notice any change d. To determine differences among communities in need for state assistance

ANS: C Disease surveillance helps establish baseline (endemic) rates of disease occurrence and patterns of spread. Surveillance makes it possible to initiate a rapid response to an outbreak of a disease or event that can cause a health problem. DIF: Cognitive Level: Apply (Application) REF: pp. 267-268

8. Which of the following best describes how public health nurses (PHNs) differed from other health care professions in the early twentieth century? a. PHNs contributed without receiving any salary for doing so. b. PHNs created new settings where health care could be given. c. PHNs gave care to powerless groups. d. PHNs worked outside any organized health care system.

ANS: C During this period, public health nurses worked with populations and in settings that were not of interest to other health care disciplines or groups. Much public health service was delivered to the poor and to women and children, who did not have political power or voice. DIF: Cognitive Level: Understand (Comprehension) REF: p. 525

16. Which of the following actions would a nurse take to reduce the high incidence of coronary artery disease (CAD) in a community? a. Introduction of a heart-healthy curriculum beginning in the first grade, presentations on diet and exercise for the community at large, and special education sessions for high-risk populations b. Provision of online activities related to prevention of cardiac disease, smoking reduction programs, and blood pressure screenings c. Distribution of handouts, including age-appropriate games, self-assessments, and education on heart-healthy lifestyles; availability of community screenings for hyperlipidemia in persons age 35 and older; and walking programs for those affected with CAD d. Enrollment of clients with CAD into cardiac rehabilitation programs, routine evaluation of effectiveness of CAD treatment regimens, and participation in clinical trials that evaluate interventions for those diagnosed with CAD

ANS: C Education in schools, the community, and high-risk populations focuses only on primary prevention activities. Online activities focus only on primary and secondary prevention. Efforts focused only on those who already have CAD are not primary prevention. Distributing handouts includes all three levels of prevention to target all members of the population. Targeting all members of the population and implementing all levels of prevention increase the likelihood of positive outcomes for the community as a whole. DIF: Cognitive Level: Analyze (Analysis) REF: p. 160

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. DIF: Cognitive Level: Apply (Application) REF: p. 100

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 nurse's 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. DIF: Cognitive Level: Analyze (Analysis) REF: pp. 97-98

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 client's needs. DIF: Cognitive Level: Analyze (Analysis) REF: p. 94

10. A nursing staff has successfully screened for diabetes in the community. Which of the following might best persuade the health board to increase funding for diabetic clinics in this community? a. An epidemic of diabetes is now recognized and must be addressed. b. The incidence of diabetes is now higher than previously recognized in the community. c. The prevalence of diabetes is now higher than previously recognized in the community. d. The risk for diabetes in the community could decrease if funding is received.

ANS: C If more people are now being diagnosed with diabetes and need support, more ongoing services will be needed for this population. Incidence may go up and down, but prevalence is a fairly stable number. DIF: Cognitive Level: Apply (Application) REF: p. 157

2. Which of the following statements best explains why many school nurses are not able to ensure that all children receive needed health care in the schools? a. There is a shortage of baccalaureate-prepared nurses with national school health nurse certification. b. Most nurses prefer to be employed in hospitals giving direct care. c. Most school districts are unable to afford a nurse in every school. d. School districts and taxpayers see no need for nurses in schools.

ANS: C In Healthy People 2020, objective ECBP-5 states that there should be one nurse for every 750 children in each school (U.S. Department of Health and Human Services, 2010). Most schools have not achieved this objective. In 2006, approximately 40% of the nation's schools met that standard. The new objective is that 44.7% of the country's elementary, middle, junior high, and senior high schools have this many nurses by 2020 (U.S. Department of Health and Human Services, 2010). Having fewer nurses in the schools means that the nurses are expected to perform many different functions. It is therefore possible that they are unable to provide the amount of comprehensive care that the students need (Croghan, 2009). DIF: Cognitive Level: Understand (Comprehension) REF: p. 569

5. In which of the following situations would the nurse most likely use active surveillance? a. A newspaper wants to know the incidence of asthma in the community. b. A real-time ongoing communication channel is established to monitor a particular symptom. c. Several children become ill with GI upset at one local school. d. The nurse is asked to report the incidence of a specific nonreportable common problem in the community.

ANS: C In active surveillance, the nurse may begin a search for cases to determine the magnitude of the problem (how widespread it is). An example would be when several school children become ill after eating lunch in the cafeteria or at the local hot dog stand, in which case, active surveillance would be used to investigate the possibility of food poisoning. DIF: Cognitive Level: Apply (Application) REF: p. 269

4. Which of the following statements describes how nursing in the community is more challenging than nursing in an acute care setting? a. There is limited access to information useful to the nurse in giving care in the community. b. More paperwork and forms are required when giving care in the home. c. It is more challenging to control the environment in the community. d. Specialization isn't possible in the community setting.

ANS: C In the community, nurses often use epidemiology, since the factors that affect the individual, family, and population group cannot be as easily controlled as in acute care settings. It is essentially impossible to control the environment in the community. DIF: Cognitive Level: Understand (Comprehension) REF: p. 154

18. A nurse advises a client with osteoporosis to have three servings of milk or dairy products daily. Which of the following levels of prevention is being used by the nurse? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Treatment, but not prevention

ANS: C Interventions that prevent worsening of a condition are tertiary prevention activities. In this instance, the client already has a health problem (osteoporosis). By advising adequate dairy intake, the nurse aims to ensure that enough calcium is available to limit worsening of the osteoporosis. DIF: Cognitive Level: Apply (Application) REF: p. 161

8. A client spends a great deal of his time on the Internet or reading articles related to diabetes and its long-term effects. One day the client asks why the nurse has not suggested a life care plan. Which of the following would be the best response by the nurse? a. "Life care plans are only for young persons who are newly diagnosed." b. "Life care plans are primarily used to determine long-term financial needs for legal reasons." c. "You are receiving appropriate care for your diabetes without serious side effects, so a life care plan isn't really appropriate." d. "I was waiting for you to express interest in having a life care plan."

ANS: C Life care plans are typically used for clients experiencing catastrophic illness or adverse events resulting from professional malpractice. Others who benefit from life care planning are those who have sustained injury when younger and whose care requirements have changed as a result of aging. DIF: Cognitive Level: Apply (Application) REF: pp. 237-238

5. Which of the following agencies are responsible for implementing and enforcing local, state, and federal public health codes and ordinances and providing essential public health programs to a community? a. Community health clinics b. Federal health agencies c. Local health agencies d. State health agencies

ANS: C Local public health agencies are the agencies responsible for implementing and enforcing local, state, and federal public health codes and ordinances and providing essential public health programs to a community. DIF: Cognitive Level: Understand (Comprehension) REF: pp. 524-525

19. A school nurse has developed a special class for pregnant teens to teach them everything from anticipated body changes to methods for managing common pregnancy-associated problems. The classes also allow the nurse to be in close frequent contact with the students to monitor their health status. Which of the following levels of prevention is being used by the nurse? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Both primary and secondary prevention

ANS: C Many teenage girls who are pregnant attend school; therefore, the school nurse may provide ongoing care to the mother. Although this may appear to be secondary prevention, it is tertiary prevention because adolescent pregnancies are considered to be high risk. DIF: Cognitive Level: Apply (Application) REF: p. 580

13. A nurse, client, family, and other care providers meet to discuss what will be the best approach to use to continue care. Which of the following best describes why the nurse suggests changing the goal from obtaining appropriate long-term care placement to ensuring that the client's convalescence is beneficial and safe? a. To consider all possible consequences of long-term care placement b. To encourage the group to review the client outcomes in the different settings c. To expand the goal so that different solutions can be generated and considered d. To help the group focus on the critical aspects the client's family considered most important

ANS: C One problem with seeking solutions is stating the problem in such a narrow fashion that only one possible outcome is acceptable. To avoid this, the nurse may restate the problem. By expanding the goal, different solutions can be generated. Clients and advocates may feel limited in their options if they generate solutions before completely analyzing the problems, needs, desires, and consequences. DIF: Cognitive Level: Apply (Application) REF: p. 241

20. A nurse is administering a tuberculosis skin test to a client who has AIDS. Which of the following results should the nurse anticipate when using this screening test? a. Decreased positive predictive value b. Decreased reliability c. Decreased sensitivity d. Decreased specificity

ANS: C Persons with immune deficiencies may have a negative tuberculosis skin test even though they are infected. Sensitivity is the extent to which a test identifies those individuals who have the condition being examined. AIDS is an acquired immune deficiency; thus, clients with AIDS may have a false-negative response to TB skin tests; that is, they have the disease but the test is not sensitive enough to detect infection in these individuals. Therefore, there is decreased sensitivity with those clients. DIF: Cognitive Level: Analyze (Analysis) REF: p. 162

17. 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

ANS: C Primary prevention involves the use of the information exchange process to increase the client's understanding of how to use the health care system. Primary prevention occurs at a point before illness or problem exists. In the remaining options, the client has a problem for which interventions have been employed. DIF: Cognitive Level: Apply (Application) REF: p. 241

26. A nurse reports that in comparison to all the children in a particular school, the children who are members of the Cub Scouts have 0.3 risk for obesity before entering the sixth grade. Which of the following recommendations would the nurse make to the new parents of two boys who had just moved into this school's neighborhood? a. Discourage the parents from enrolling their sons in Cub Scouts because of the risk. b. Don't say anything about Cub Scouts, because it isn't relevant to nursing care. c. Encourage the parents to enroll their sons in Cub Scouts. d. Share the finding and let the parents draw whatever conclusions they feel appropriate.

ANS: C Relative risk is an estimation of the risk of acquiring a problem for those who are exposed compared with those who are unexposed. As the risk for obesity is less for those that are members of Cub Scouts, joining the group is protective and reduces the incidence among members. DIF: Cognitive Level: Analyze (Analysis) REF: pp. 167-168

1. According to the American Academy of Pediatrics, which of the following activities are expectations for a school health nurse? a. Ensuring that children with health problems are accepted by their peers b. Driving children home if parents can't pick them up c. Giving emergency care in the school or during school events d. Giving medications as needed if children are ill

ANS: C School nursing responsibilities include making sure that children get the health care they need, including emergency care in the school; keeping track of the state-required vaccinations that children have received; carrying out the required screening of the children based on state law; and ensuring that children with health problems are able to learn in the classroom. The nurse cannot convince children to accept other children as peers, although certainly efforts should be made. HIPAA would not allow individual examples of health problems to be shared, other than providing group statistics. DIF: Cognitive Level: Understand (Comprehension) REF: p. 569

17. A school nurse wants to decrease the incidence of obesity in elementary school children. Which of the following describes a secondary prevention intervention that the nurse could implement? a. Giving a presentation on the importance of exercise and physical fitness b. Designing a game in which students select healthy food choices c. Weighing students to identify those who are overweight d. Putting students on a diet if they weigh greater than 20% of their ideal weight

ANS: C Secondary prevention refers to interventions that increase the probability that a person with a condition will have the condition diagnosed early. Health screenings are the mainstay of secondary prevention. Weighing students and assessing whether the weight is higher than recommended will allow for early intervention so that obesity may be avoided. DIF: Cognitive Level: Apply (Application) REF: pp. 160-161

9. 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

ANS: C Some states, through their Medicaid programs, are developing disease management programs for high-cost chronic diseases among their populations, such as asthma and diabetes. DIF: Cognitive Level: Understand (Comprehension) REF: pp. 237-238

18. A school nurse is demonstrating the use of a peak flow meter to help children with chronic asthma recognize when they need to use a rescue inhaler. Which of the following levels of prevention is being used by the nurse? a. Primary b. Secondary c. Tertiary d. Both primary and secondary

ANS: C Tertiary prevention includes caring for children with long-term health needs, including asthma and disabling conditions. The nurse is teaching disease management (i.e., when to use an inhaler). DIF: Cognitive Level: Apply (Application) REF: p. 578

11. Which of the following would be the best way for the school nurse to fulfill his or her responsibilities in an emergency situation? a. Tell all staff to call 911 if the nurse is not in the building. b. Arrange to always be available, even if only by phone. c. Create and share an emergency plan with all teachers and staff. d. Wear a pager so that the nurse can come as soon as humanly possible.

ANS: C The American Health Association recommends that the school nurse create an emergency plan with at least two different staff members identified and responsible for implementing the plan if the nurse is not in the building at the time of the emergency. The plan would include when to call 911 and how to get a child to the hospital via ambulance if needed. DIF: Cognitive Level: Understand (Comprehension) REF: pp. 574-575

4. Which of the following federal agencies is most influential in public health activities? a. The Agency for Healthcare, Research, and Quality b. Centers for Disease Control and Prevention c. Department of Health and Human Services d. Food and Drug Administration

ANS: C The U.S. Department of Health and Human Services (USDHHS) and the Environmental Protection Agency (EPA) are the federal agencies that most influence public health activities at the state and local levels. The Agency for Healthcare, Research, and Quality, the Centers for Disease Control and Prevention, and the Food and Drug Administration are all pieces of the broader USDHHS. DIF: Cognitive Level: Remember (Knowledge) REF: p. 524

30. A nurse is investigating a bacterial illness that has caused a health problem in the community. Only some of the people exposed to the bacteria have become ill. Which of the following factors best explains why this would have happened? a. Chemical agent factors b. Environmental factors c. Host factors d. Physical agent factors

ANS: C The epidemiologic triangle includes the agent, host, and environment. The bacteria were the agent so chemical and physical agents are not relevant. The environment was apparently the same for everyone, since all were exposed to the bacteria. Therefore, only differences in host factors can explain why some became ill and some were able to fight off the bacterial infestation. DIF: Cognitive Level: Apply (Application) REF: p. 160

28. Which of the following types of study should the nurse researcher choose if the goal is to identify the long-term benefits and risks of a particular nursing intervention for senior citizens living in the community? a. Cross-sectional study b. Ecologic study c. Clinical trial d. Retrospective analysis

ANS: C The goal of a clinical trial is to evaluate the effectiveness of an intervention. Clinical trials are generally the best way to show causality. DIF: Cognitive Level: Apply (Application) REF: p. 170

22. The principal of a school was upset over a rumor that one of the children had engaged in a violent activity that injured a younger sibling. The principal asked the nurse who the children were so that the involved teachers could both support the injured child and guard other children from the violent child. Which of the following would be the best response by the nurse? a. "I'll get the names to you and the involved teachers immediately." b. "Let me get the parents' consent, and then I'll get you the names." c. "Rumors are often inaccurate; let me follow up and see what happened and what needs to be done." d. "Why don't we coordinate a school-wide program on preventing accidents instead?"

ANS: C The school nurse is responsible for maintaining school health office policies, including privacy and safety of health records. The nurse must follow the HIPAA privacy rules while also ensuring the safety of children at school. When a rumor is involved, it is always wise to check its accuracy. If a child was indeed hurt, the nurse needs to make sure both children involved receive (or have already received) appropriate care. The question about having a school-wide program may be appropriate, but this behavior was apparently purposeful, not accidental. DIF: Cognitive Level: Apply (Application) REF: p. 569

What was the initial impact of African-American nurses working in the public health setting? (Select all that apply.) a. African-American nurses in the South were paid less than their white counterparts. b. African-American nurses held supervisory roles. c. Public health nursing certificate and graduate education programs were segregated in the South. d. Nursing education for southern nurses was provided through free educational grants. e. Study outside the South for southern nurses was difficult to afford and study leaves from the workplace were rarely granted.

a. African-American nurses in the South were paid less than their white counterparts. c. Public health nursing certificate and graduate education programs were segregated in the South. e. Study outside the South for southern nurses was difficult to afford and study leaves from the workplace were rarely granted. African-American nurses seeking to work in public health nursing faced many challenges. Nursing education was absolutely segregated in the South until at least the 1960s, and elsewhere was also generally segregated or rationed until the mid-twentieth century. Even public health nursing certificate and graduate education programs were segregated in the South; study outside the South for southern nurses was difficult to afford and study leaves from the workplace were rarely granted. The situation improved somewhat in 1936, when collaboration between the United States Public Health Service and the Medical College of Virginia (Richmond) established a certificate program in public health nursing for African-American nurses for which the federal government paid nurses' tuition. Discrimination continued during nurses' employment: African-American nurses in the American South were paid lower salaries than their white counterparts for the same work. In 1930, only 6 African-American nurses held supervisory positions in public health nursing organizations. DIF: Cognitive Level: Knowledge REF: Page 22

Which of the following factors have had an impact on the complex relationship among nursing practice, health policy, and politics? (Select all that apply.) a. Categorical funding b. Death penalty c. Head Start d. Health fairs e. Statutory authority for the profession

a. Categorical funding c. Head Start e. Statutory authority for the profession Constitutional law, judicial and common law, legislation, regulation, and funding mandates are the key factors of health policy and politics that affect nursing practice in a complex relationship: · Categorical funding, designating funding for specific needs, has led to the special and more narrowly shaped nursing roles and tasks in community-oriented nursing (e.g., home health care, school nursing, and family planning). Government funds assigned to specific programs or purposes cannot be used to support other services. This factor has restricted the broader development of a public and community-oriented nursing role to meet unanticipated needs since funding drives programming, which drives services, which drives roles. · School health legislation establishes a minimum of services that must be provided to children in public and private schools. Examples of such federally legislated programs that affect nursing practice in the schools and with families are Head Start, early diagnostic screening programs, nutritional programs, services for the handicapped, and special education. · Despite the broad nature and varied roles of nurses in practice, two legal arenas are most applicable to nurse practice situations. The first is the statutory authority for the profession and its scope of practice, and the second is professional negligence or malpractice. The issue of scope of practice involves defining nursing, setting its credentials, and then distinguishing between the practices of nurses, physicians, and other health care providers. The issue is of particular importance to community-oriented nurses who traditionally practiced with much autonomy. DIF: Cognitive Level: Knowledge REF: Pages 118, 119

Several community-oriented nurses want to explore the problem of obesity in school-age children and assess their community school district 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 (CDC). b. Centers for Medicare and Medicaid Services (CMS). c. Health Resources and Services Administration (HRSA). d. National Institute of Nursing Research (NINR).

a. Centers for Disease Control and Prevention (CDC). The Centers for Disease Control and Prevention (CDC) serves as the national focus for developing and applying disease prevention and control, environmental health, and health promotion and education activities designed to improve the health of the people of the United States. The Centers for Medicare and Medicaid Services (CMS) administer Medicare and Medicaid accounts and guide payment policy and delivery rules for services for the poor, elderly, disabled, and unemployed. HRSA has been a long-standing contributor to the improved health status of Americans through the programs of services and health professions education that it funds. The NINR is the focal point of the nation's nursing research activities. DIF: Cognitive Level: Application REF: Page 115

Which of the following factors assisted such community-oriented nursing pioneers as Lillian Wald to develop approaches and programs to solve the health care and social problems of the late 1800s? (Select all that apply.) a. Community health's focus on teaching and prevention b. Establishment of settlement houses c. Establishment of the Town and Country Nursing Services in large cities d. Lack of public interest in limiting disease e. Middle and upper class fear of diseases

a. Community health's focus on teaching and prevention b. Establishment of settlement houses e. Middle and upper class fear of diseases In the 1890s the public was interested in limiting disease among all classes of people, partly for religious reasons, partly for charity, but also because the middle and upper classes were afraid of the diseases that seemed to be brought in by the large communities of European immigrants. Nurses began to establish settlement houses and neighborhood centers, which became hubs for health care and social welfare programs. From the beginning, community health nursing practice included teaching and prevention. Community-oriented interventions led to improved sanitation, economic improvements, and better nutrition. These interventions were credited with reducing the incidence of acute communicable diseases. Pioneers in public health nursing, such as Lillian Wald, took advantage of the public's concern and existing practice models to solve health care and social problems that reduced the incidence of acute communicable diseases in immigrant communities. DIF: Cognitive Level: Application REF: Page 18

A nurse exclaims proudly to other nurses at the agency, "The care I provide is the same for everyone. I treat everyone the same." In fact, this nurse is demonstrating what inhibitor to developing cultural competence? a. Cultural blindness b. Cultural competence c. Cultural conflict d. Culture shock

a. Cultural blindness Cultural blindness is the tendency to ignore all differences among cultures and to act as though the differences do not exist and to treat all people the same when, in truth, each person is different. Cultural competence in nurses is a combination of culturally congruent behaviors, practice attitudes, and policies that allow nurses to work effectively in cross-cultural situations. Cultural conflict is a perceived threat that may arise from a misunderstanding of expectations between clients and nurses when either group is not aware of cultural differences. Cultural shock is the feeling of helplessness, discomfort, and disorientation experienced by an individual attempting to understand or effectively adapt to another cultural group that differs in practices, values, and beliefs. DIF: Cognitive Level: Knowledge REF: Page 79

A nurse in community health that administers a local WIC program for women, infants, and children is participating in a federal-state collaborative program that receives oversight from the: a. Department of Agriculture (DOA). b. Department of Defense (DOD). c. Department of Health and Human Services (DHHS). d. Department of Labor (DOL).

a. Department of Agriculture (DOA). The Department of Agriculture is involved in health care primarily through administering the Food and Nutrition Service, which oversees a variety of food assistance activities in collaboration with state and local government welfare agencies to provide food stamps to needy persons to increase their food purchasing power, as well as school breakfast and lunch programs, grants to states for nutrition education training, and WIC, a supplemental food program for women, infants, and children. The Department of Defense provides health care for members of the military and their dependents. The Department of Health and Human Services maintains primary responsibility for the health of the American people. Agencies within the Department of Labor develop safety and health standards and ensure compliance. DIF: Cognitive Level: Application REF: Pages 43-44

Which of the following statements accurately reflects the current status of nursing in community health? a. Each type of nurse is needed in today's communities. b. Community health serves only clients with chronic conditions. c. Comprehensive reform of health care is required. d. People no longer believe they can protect themselves.

a. Each type of nurse is needed in today's communities. Many nurses work in the community. Some bring a public health population-based approach and have as their goal preventing illness and protecting health. Other nurses have a community-oriented approach and deal primarily with the health care of individuals, families, and groups in the community. Still other nurses bring a community-based approach that focuses on "illness care" of individuals and families in the community. Each type of nurse is needed in today's communities. The latter two groups are growing and will continue to do so, because so much health care is being provided in community rather than inpatient settings. What is necessary is the extension of public health services to prevent illness, promote health, and protect the public. Without this extension a large gap would exist in the design of a comprehensive program for health care. DIF: Cognitive Level: Application REF: Page 28

In the United States, the current system of the local government's responsibility for providing care for the disenfranchised emerged from: a. Elizabethan Poor Law b. Florence Nightingale c. Public Health Service (PHS) d. Federal Emergency Relief Administration (FERA)

a. Elizabethan Poor Law Colonial Americans established systems of care for the sick, poor, aged, mentally ill, and dependent based on the model of the Elizabethan Poor Law. Early county or township government was responsible for the care of all dependent residents, and they were strict about caring for their own residents. In 1918 the U.S. Public Health Service (USPHS) established a division of public health nursing to work in the war effort. The Federal Emergency Relief Administration (FERA) was established during the depression to support nurse employment through increased grants-in-aid for state programs of home medical care. DIF: Cognitive Level: Knowledge REF: Pages 15-16

The historical nursing figure who contributed to establishing the foundation for current community health and nursing in community health by working in military field hospitals using a population-based approach that improved nursing care and environmental conditions was: a. Florence Nightingale. b. Frances Root. c. Lillian Wald. d. Mary Breckinridge.

a. Florence Nightingale. During the Crimean War (1854-1856), the British military established hospitals for sick and wounded soldiers in Scutari in Asia Minor. The care of the soldiers was poor, with cramped quarters, poor sanitation, lice and rats, not enough food, and inadequate medical supplies. When the British public demanded improved conditions, Florence Nightingale asked to work in Scutari. Because of her wealth, social and political connections, and knowledge of hospitals, the government sent her with a contingent of ladies, hired nurses, and hired servants to Scutari. Using simple epidemiology measures, she documented decreased mortality rates from the beginning of the war to the end of the war. Florence Nightingale progressively improved the soldiers' health using a population-based approach that improved both environmental conditions and nursing care. DIF: Cognitive Level: Knowledge REF: Page 17

What are some of the effects of technology in the area of home health care? (Select all that apply.) a. High technology equipment increases expense. b. Technology decreases legal liability. c. Technology has the potential for increased privacy. d. Technology quickly becomes outdated when newer developments occur. e. There is inconsistent quality of resources available on the Internet.

a. High technology equipment increases expense. d. Technology quickly becomes outdated when newer developments occur. Cost is the most significant negative aspect of advanced health care technology. The more high-technology equipment and computer programs become available, the more they are used. High-technology equipment is expensive, quickly becomes outdated when newer developments occur, and often requires highly trained personnel. There are other drawbacks to new technology, particularly in the area of home health care. These include increased legal liability, the potential for decreased privacy, too much reliance on technological advances, and the inconsistent quality of resources available on the Internet and other places. DIF: Cognitive Level: Knowledge REF: Page 36

What are some examples of programs which may be provided at the local health department level? (Select all that apply.) a. Immunization clinics b. Health education c. Family planning services d. Licensing of health care professionals e. Quality and safety data

a. Immunization clinics b. Health education c. Family planning services Some examples of programs that may be offered by local health departments include immunization clinics, health education, and family planning. The range of services varies considerably depending on the size of the area served and the resources available to fund programs. Licensing of health care professionals is conducted at the state level and quality and safety data is typically provided by federal entities. DIF: Cognitive Level: Application REF: Page 45 (Box 3-5)

Implementing a community-level program, such as walking for exercise, to assist citizens in improving health behaviors is an example of which level of prevention? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Disease promotion

a. Primary prevention Implementation of a community level program like walking for exercise to assist citizens in improving health behaviors related to lifestyle is an example of primary prevention at the public health level. Implementation of a family-planning program to prevent unintended pregnancies for young couples who attend the local community health center is a secondary prevention activity. An example of tertiary prevention at the public health level is the self-management asthma program for children with chronic asthma to reduce their need for hospitalization. These examples are not disease promotion measures. DIF: Cognitive Level: Application REF: Page 44

When a community health nurse evaluates the completeness and accuracy of information made available to community residents regarding the impact of rezoning land parcels for industrial use, the nurse is: a. advocating for ethical choices. b. communicating risk. c. controlling environmental damage. d. volunteering for service on state boards.

a. advocating for ethical choices. Understanding ethics is essential for nurses making their own choices, in describing issues and options within groups, and in advocating for ethical choices. Ethical issues likely to arise in environmental health decisions are the following: · Who has access to information and when? · How complete and accurate is the available information? · Who is included in the decision making and when? · What and whose values and priorities are given weight in decisions? · How are short-term and long-term consequences considered? DIF: Cognitive Level: Knowledge REF: Page 102

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 public health core function of: a. assessment. b. assurance. c. policy development. d. research.

a. assessment. The three public health core functions are assessment, policy development, and assurance. Assessment is systematic data collection on the population, monitoring the population's health status, and making information available about the health of the community. Policy development refers to efforts to develop policies that support the health of the population, including using a scientific knowledge base to make policy decisions. Assurance is making sure that essential community-oriented health services are available. These services might include providing essential personal health services for those who would otherwise not receive them. Assurance also includes making sure that a competent public health and personal health care workforce is available. DIF: Cognitive Level: Knowledge REF: Page 4

The ethical question, "Are persons assigned to develop community knowledge adequately prepared to collect data on groups and populations?" is based on an ethical tenet that supports the community-oriented core function of: a. assessment. b. assurance. c. policy development. d. compliance.

a. assessment. Assessment is systematic data collecting about the population, monitoring of the population's health status, and making information available about the health of the community. Competency related to knowledge development, analysis, and dissemination is important because the research, measurement, and analysis techniques used to gather information about groups and populations usually differ from techniques used to assess individuals. Policy development and assurance are core functions that use ethical decision making in community-oriented health services. DIF: Cognitive Level: Knowledge REF: Page 60

A state 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 elder care programs. The public health core function applied is: a. assurance. b. policy development. c. primary prevention. d. public transportation.

a. assurance. 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 role requires skill in assessment, investigative functions, collaboration, consultation, and cooperation. Assurance also includes assisting communities to implement and evaluate plans and projects. Policy development refers to efforts to develop policies that support the health of the population, including using a scientific knowledge base to make policy decisions. Primary prevention does not focus on provision of services and a part of assurance is assisting communities to obtain necessary services such as transportation. DIF: Cognitive Level: Application REF: Page 4

A community-based hospice nurse has an Asian male client with terminal stage cancer. The client complains that he is in continuous pain and receives no relief from the codeine prescribed by his primary care practitioner (PCP). The nurse contacts the client's PCP to discuss replacing the prescription of codeine with another pain-reducing non-codeine-based drug. The nurse is demonstrating knowledge of the cultural organizing factor of: a. biological variance. b. communication. c. space. d. time perception.

a. biological variance. Biological variations are the physical, biological, and physiological differences that exist and distinguish one racial group from another. They occur in areas of growth and development, skin color, enzymatic differences, and susceptibility to disease. Research findings suggest that sensitivity to codeine varies with ethnic background, and that Asian men experience significantly weaker effects from the drug than do European men. Asian men are missing an enzyme called CYP2D6 that allows the body to metabolize codeine into morphine, which is responsible for the pain relief provided by codeine. When an individual is missing the enzyme, no amount of codeine will lessen the pain, and other pain-reducing chemicals should be explored. The cultural organizing factors associated with communication, space and time perception are not related to this situation. DIF: Cognitive Level: Application REF: Page 84

Virtue ethics is distinctly different from moral justification via theories or principles because the emphasis of virtue ethics is practical reasoning applied to: a. character development. b. consequentialism. c. distributive justice. d. egalitarianism.

a. character development. The goal of virtue ethics, one of the oldest ethical theories, is to enable persons to flourish as human beings. According to Aristotle, virtues are acquired excellent traits of character that dispose humans to act in accord with their natural good. Examples of virtue ethics include benevolence, compassion, discernment, trustworthiness, integrity, and conscientiousness. Consequentialism is the action that produces the greatest amount of good or the least amount of harm in a given situation. Distributive or social justice refers to the allocation of benefits and burdens to members of society. Egalitarianism is the view that everyone is entitled to equal rights and equal treatment in society. DIF: Cognitive Level: Application REF: Page 58

A school nurse teaches three middle school students with asthma conditions techniques to minimize their incidence of bronchial spasms. This is an application of: a. community-based nursing. b. community-oriented nursing. c. institutional nursing. d. public health nursing.

a. community-based nursing. The goal of community-based nursing (CBN) is to manage acute or chronic conditions while promoting self-care among individuals and families. In CBN the nursing care is family centered, which means that the nurse works to improve the competencies of families to enable them to take better care of themselves. The nurse pays particular attention to the uniqueness of each family and works to plan the most useful interventions. Nurses practicing in the community and many staff public health nurses focus on providing direct care services, including health education, to persons or families outside of institutional settings, either in the home or in a clinic. DIF: Cognitive Level: Knowledge REF: Pages 10-11

A nurse in a clinic that provides direct care services to clients with tuberculosis would be classified as practicing: a. community-based nursing. b. community-oriented nursing. c. institutional nursing. d. public health nursing.

a. community-based nursing. The nurse practicing as a community-based nurse is more likely to give direct care to people than are nurses who practice from a community-oriented framework. A community-oriented framework includes community-oriented nursing and public health nursing. Institutional nursing care is generally delivered in a hospital or nursing home setting. DIF: Cognitive Level: Knowledge REF: Page 11

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.

a. community-oriented care. Community-oriented nurses emphasize health protection, maintenance, and promotion and disease prevention, as well as self-reliance among clients. Regardless of whether the client is a person, a family, or a group, the goal is to promote health through education about prevailing health problems, proper nutrition, beneficial forms of exercise, and environmental factors such as safe food, water, air, and buildings. Community-based care is nursing care that is provided in a setting. A smoking cessation clinic is an example of primary prevention, not secondary or tertiary. DIF: Cognitive Level: Application REF: Page 2

Nurses in community health who understand the basis of their own behaviors and how those behaviors help or hinder the delivery of competent care to persons from cultures other than their own are demonstrating the cultural competence development process construct of: a. cultural awareness. b. cultural desire. c. cultural encounter. d. cultural skill.

a. cultural awareness. The five constructs that explain the process of developing cultural competence are cultural awareness, cultural knowledge, cultural skill, cultural encounter, and cultural desire. Cultural awareness is self-examination and in-depth exploration of one's own beliefs and values as they influence behavior. Nurses who are receptive to learning about cultural dimensions understand the basis of their own behaviors and how they help or hinder the delivery of competent care, and nurses who recognize that health is expressed differently across cultures have developed cultural awareness. Cultural desire refers to the nurse's intrinsic motivation to provide culturally competent care. Cultural encounter is the process that permits nurses to seek opportunities to engage in cross-cultural interactions. Cultural skill refers to the effective integration of cultural awareness and cultural knowledge to obtain relevant cultural data and meet the needs of culturally diverse clients. DIF: Cognitive Level: Knowledge REF: Page 75

A nurse overhears the doctor saying, "Let's not give him codeine; he is Asian." The nurse reflects on the comment and determines that the: (select all that apply) a. doctor is culturally competent. b. doctor is prejudiced. c. doctor should have called an interpreter. d. doctor's ability to assess pain based on culture may be limited. e. doctor is planning care based on racial enzymatic differences.

a. doctor is culturally competent. e. doctor is planning care based on racial enzymatic differences. Biological variations distinguish one racial group from another. They occur in areas of growth and development, skin color, enzymatic differences, and susceptibility to disease. Research findings suggest that sensitivity to codeine varies with ethnic background. Asian men experience significantly weaker effects from drug use than do European men. Asian men are missing an enzyme called CYP2D6 that allows the body to metabolize codeine into morphine, which is responsible for the pain relief provided by codeine. When an individual is missing the enzyme, no amount of codeine will lessen the pain, and other pain-reducing medicines should be explored. DIF: Cognitive Level: Application REF: Page 84

A nurse who speaks only English has just gotten a new client for an intake interview. The client is a refugee who has very limited English proficiency (LEP). The nurse should: a. get an interpreter. b. see whether another nurse, more comfortable with refugees, will work with the client. c. see what helpful information is on the Internet. d. try to communicate with hand gestures.

a. get an interpreter. When nurses do not speak or understand the language, they should obtain an interpreter. The amount of accommodation that an agency must provide is guided by the proportion of people using the service overall as compared with those who need special assistance. Depending on the volume of clients who cannot speak English, agencies may be required to have all of their written materials translated and regularly use interpreters or have only portions of the materials translated. Health care agencies are responsible for effectively communicating with their clients. When an interpreter is not available to translate, the client may view this behavior as unacceptable and bring legal action against the agency. DIF: Cognitive Level: Application REF: Pages 82-83

The term "instructive district nursing" was coined in the nineteenth century to describe the relationship of nursing to: a. health education. b. home health care. c. settlement houses. d. visiting nurse services. In 1886 in Boston, two women, to improve their chances of gaining financial support for their cause, coined the term "instructive district nursing" to emphasize the relationship of nursing to health education. Other nurses established settlement houses and neighborhood centers, which became hubs for health care and social welfare programs. Home health and visiting nursing evolved at a later time. DIF: Cognitive Level: Knowledge REF: Page 18

a. health education. In 1886 in Boston, two women, to improve their chances of gaining financial support for their cause, coined the term "instructive district nursing" to emphasize the relationship of nursing to health education. Other nurses established settlement houses and neighborhood centers, which became hubs for health care and social welfare programs. Home health and visiting nursing evolved at a later time. DIF: Cognitive Level: Knowledge REF: Page 18

In a federally funded preschool program such as Head Start, nursing services that include conducting developmental-level screening for cognitive and psychomotor development of individual children would most likely be considered community-oriented nursing care when: a. individual results are compared with established standards for children of the same age group. b. program characteristics are assessed for their effectiveness in making the school population healthier. c. referral is provided for a child identified with delayed psychomotor development. d. treatment is initiated for a child with an identified learning disability.

a. individual results are compared with established standards for children of the same age group. Within federally funded programs for preschool children, from a community-oriented nursing care perspective, nursing services could be provided to individual children by conducting developmental-level screening tests to evaluate each child's level of cognitive and psychomotor development in comparison with established standards for children of the same age. This is population-focused service. A community-based nurse may deliver illness care or direct services to individual children. A public health nurse may assess the program's ability to achieve the overall goal of making its population of children healthier by evaluating the characteristics of the facility, program, and environment for their effectiveness in achieving the goal. DIF: Cognitive Level: Knowledge REF: Page 10

Ethical decision making is conducted in a generic framework. One step of ethical decision making is to place an ethical issue or dilemma within a meaningful context. The rationale for this step is: a. multiple factors affect the formulation and justification of ethical issues and dilemmas. b. the nature of ethical issues and dilemmas determines the specific ethical approach used. c. people cannot make sound ethical decisions if they cannot identify ethical issues and dilemmas. d. professional persons cannot avoid choice and action in applied ethics.

a. multiple factors affect the formulation and justification of ethical issues and dilemmas. The historical, sociological, cultural, psychological, economic, political, communal, environmental, and demographic contexts affect the way ethical issues and dilemmas are formulated and justified. The nature of ethical issues and dilemmas determines the specific ethical approach used when appropriate approaches are considered. The identification process assists people with making sound decisions. Professionals use ethical decision making to make decisions and take action. DIF: Cognitive Level: Comprehension REF: Page 54 (Table 4-1)

Provision 3 of the Code of Ethics for Nurses states, "The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient." In applying this provision to practice, the public health nurse understands that: a. patient means the recipient of nursing care. b. the profession's integrity is at stake. c. rights of the individual supersede. d. this applies only to nursing in community health.

a. patient means the recipient of nursing care. In the Code of Ethics for Nurses, Provision 3, the term patient means the recipient of nursing care, whether an individual, family, group, or community. In nursing, the emphasis is on professional standards, active involvement in nursing, and the integrity of the profession. All nurses have a responsibility to meet these obligations. Provision 1 of the Code of Ethics addresses primarily the individual but acknowledges that there are times when public health considerations override individual rights. Provisions 2 and 3 and their interpretive statements are pertinent to nurses in community health and to public health nurses. DIF: Cognitive Level: Application REF: Page 62

When applying the nursing process to environmental health, the community health nurse would examine criteria that include the immediate and long-term responses of the client to the planned interventions. Another important factor to consider in the evaluation process would be: a. recidivism of the problem for the client. b. consideration of community policy and laws. c. relationship between the disease and the environmental factors. d. coordination of actions to meet the client's needs.

a. recidivism of the problem for the client.

Which of the following statements best explains the need for geologists, meteorologists, and chemists on the multidisciplinary team in environmental health? a. sciences explain how pollutants travel in air, water, and soil. b. Earth sciences help us understand the strength of the association between exposures and health effects in human populations. c. Earth scientists study the negative effects of chemical exposure. d. Earth scientists work with the community to coordinate services to meet the community's needs.

a. sciences explain how pollutants travel in air, water, and soil. Toxicology is the basic science that studies the health effects associated with chemical exposure. Epidemiology, an applied use in environmental health, helps us understand the strength of association between exposures and health effects in human populations. Environmental epidemiology is the study of the effect on human health of physical, chemical, and biological factors in the external environment. To understand how and when humans may be exposed to hazardous chemicals, radiation, and biochemical contaminants, earth sciences are used to help explain how pollutants travel in air, water, and soil. Therefore environmental health requires a multidisciplinary approach to assess and decrease environmental health risks. This may involve geologists, meteorologists, chemists, food safety specialists, sanitarians, radiation specialists, industrial hygienists, housing inspectors, clinical specialists, laboratory workers, and/or remediation specialists. This may also involve interagency cooperation (i.e., health department, department of environmental protection, housing department, public/private laboratories, tertiary care facilities, department of agriculture, transportation department). DIF: Cognitive Level: Comprehension REF: Pages 92, 93-94

A nurse demonstrates cultural competence by using statements such as: a. "I know how you feel." b. "Tell me about your health care beliefs." c. "Let me show you the way you should do this." d. "You can do things in a more modern way now."

b. "Tell me about your health care beliefs." Cultural competence includes acknowledging the fundamental differences in the ways clients and families respond to illness and treatment from one's own response or a more generalizable Western health care response. Culturally competent nursing care is grounded in the following four principles: 1. Care is designed for the specific client. 2. Care is based on the uniqueness of the person's culture and includes cultural norms and values. ("Tell me about your health care beliefs.") 3. Care includes self-empowerment strategies to facilitate client decision making in health behavior. 4. Care is provided with sensitivity and is based on the cultural uniqueness of clients. DIF: Cognitive Level: Application REF: Page 74

Congress-supported categorical funding has produced what negative effect on the delivery of health care services? a. Beginning of 2-year associate's degree programs in nursing. b. A reduction in comprehensive community health programs c. End of insurance company support for visiting nurses. d. Rise in hospital-based care.

b. A reduction in comprehensive community health programs The shift in Congress to categorical funding provides federal money for priority diseases or groups rather than for a comprehensive community health program. Thus local health departments design programs to fit the funding priorities. This has included maternal and child health services and crippled children (1935), venereal disease control (1938), tuberculosis (1944), mental health (1947), industrial hygiene (1947), and dental health (1947). This type of funding pattern continues today. DIF: Cognitive Level: Knowledge REF: Page 23

When final health care-related regulations are published, they often lead to changes in practice. After a period of draft review, public comment/hearing, further study if necessary, and then final redrafting, the regulations at both federal and state levels carry the weight of law and are published in the: a. ANA Code of Conduct. b. Code of Regulations. c. Patient Safety Act of 1997. d. Interstate Nurse Licensure Compact.

b. Code of Regulations. Revisions made to proposed regulations are based on public comment and public hearing. Depending on the amount and content of the public reaction, final regulations are prepared, or the area and issues are studied further. Final regulations are published in the Code of Regulations at the state and federal level and carry the force of law. When regulations become effective, health care practice is changed to conform to the new regulations. Monitoring administrative regulations is essential for the professional nurse, who can influence regulations by attending the hearings, providing comments, testifying, and engaging in lobbying aimed at individuals involved in the writing of the regulations. Concrete written suggestions for revision submitted to these individuals are frequently persuasive and must be acknowledged by government in publishing the final rules. DIF: Cognitive Level: Knowledge REF: Page 125

A community-based HIV/AIDS clinic would be concerned about which aspects of the Public Health Code of Ethics? (Select all that apply.) a. Autonomy of the professional b. Confidentiality when possible c. Funding d. Promoting advocacy for disenfranchised persons e. Respecting only community rights

b. Confidentiality when possible d. Promoting advocacy for disenfranchised persons The 12 principles of the Public Health Code of Ethics incorporate the ethical tenets of preventing harm; doing no harm; promoting good; respecting both individual and community rights; respecting autonomy, diversity, and confidentiality when possible; ensuring professional competency; trustworthiness; and promoting advocacy for disenfranchised persons within the community. DIF: Cognitive Level: Application REF: Page 62

Nurses should review which of the following reports to determine what pollutants have been found in the drinking water of a community? a. Point source report b. Consumer confidence report c. Material Safety Data Sheet d. Environmental standards report

b. Consumer confidence report When a community is provided drinking water by a water supplier (as opposed to individual wells), the water provider is responsible for testing the water according to EPA standards. The results of the testing must be reported to those who purchase the water, in the form of a consumer confidence report (CCR). Nurses should review consumer confidence reports, sometimes referred to as right-to-know reports, to learn what pollutants have been found in the drinking water. Pollution sources are characterized as point sources. A point-source pollutant is released into the environment from a single site, such as a smoke stack, a hazardous waste site, or an effluent pipe into a waterway. Environmental standards are reviewed at the community level. Material Safety Data Sheets provide information about the chemical makeup, the health risks, and any special guidance on safe use and handling of chemicals in the workplace. DIF: Cognitive Level: Knowledge REF: Page 97

The historical figure whose work in providing care to poor people, primary prevention, and environmental health established that individual as nursing's first moral leader and community-oriented nurse was: a. Sister Mary Augustine. b. Florence Nightingale. c. William Rathbone. d. Lillian Wald.

b. Florence Nightingale. Modern nursing has a rich heritage of ethics and morality, beginning with Florence Nightingale (1820-1910). The morals and values she gave to nursing have endured. She was passionate about the need to provide care to poor people and also about the importance of a sanitary environment, as seen in her work with soldiers in the Crimean War (1854-1856). Because of her commitment to poor individuals in communities, her championing of primary prevention, and her work to show that healthy environments saved soldiers' lives, she is seen as nursing's first moral leader and community-oriented nurse. Sister Mary Augustine, William Rathbone, and Lillian Wald are not known as nursing's first moral leader. DIF: Cognitive Level: Comprehension REF: Page 53

Primary care refers to personal health care for the most common needs of members of a community. Which of the following statements also differentiates primary care from primary health care? (Select all that apply.) a. Primary care consists of a multidisciplinary team. b. Primary care is provided within the context of family and community. c. Primary care encourages self-care and self-management. d. Primary care provides first-contact, continuous, comprehensive, and coordinated care. Primary care provides preventive, curative, and rehabilitative services.

b. Primary care is provided within the context of family and community. d. Primary care provides first-contact, continuous, comprehensive, and coordinated care. Primary care refers to personal health care that provides first-contact and continuous, comprehensive, and coordinated care. The providing of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with clients, and practicing in the context of family and community. Primary health care is defined more broadly than is primary care. Primary health care is "essential care" made universally accessible to individuals and families in a community with the full participation of the community and provided at a cost that the community/county can afford. The primary health care workforce is a multidisciplinary team that includes providers from multiple disciplines, community outreach workers, allied health professionals, translators, and community members themselves. DIF: Cognitive Level: Knowledge REF: Page 48; Box 3-1 on page 34

A nurse who questions whether a particular activity in her job description is within her scope of practice would look to which government jurisdiction or agency to seek the clarification? a. Federal system b. State system c. Department of Labor d. U.S. Department of Health and Human Services

b. State system Every state has a board of examiners of nurses. The board may be in the department of licensing board of the health department or in an administrative agency of the governor's office. Created by legislation known as a state practice act, the examiners' board is made up of nurses and consumers and, in a few states, other providers and/or administrators. The functions of the board are described in the practice act of each state and generally include licensing and examination of registered nurses and licensed practical nurses; approval of schools of nursing in the state; revocation, suspension, and denial of licenses; and writing of regulations about nursing practice and education. The Department of Labor, the Department of Health and Human Services, and other federal agencies are not responsible for licensure at the state level. DIF: Cognitive Level: Application REF: Page 44

Jennifer is a nurse in a family medicine clinic. Today she is assessing Jose, a 4-year-old who is being seen for an earache. The type of nursing Jennifer practices is: a. community-oriented nursing. b. community-based nursing. c. public health nursing. d. tertiary health nursing.

b. community-based nursing. In community-based nursing, the nurse focuses on "illness care" of individuals and families across the life span. The aim is to manage acute and chronic health conditions in the community, and the practice is family-centered illness care. Community-based nursing is not a specialty in nursing but, rather, a philosophy that guides care in all nursing specialties. Community-oriented nursing has as its primary focus the health care either of the community or populations as in public health nursing (PHN) or of individuals, families, and groups in a community. DIF: Cognitive Level: Knowledge REF: Page 2

The monitoring and public reporting of air quality in a local community to alert individuals with asthma or other respiratory conditions would illustrate: a. compliance and enforcement. b. environmental epidemiology. c. secondary prevention. d. toxicology. Incorrect

b. environmental epidemiology. By examining specific populations or communities exposed to different ambient environments, environmental epidemiology seeks to clarify the relationship between physical, chemical, and biological factors and human health. Toxicology is the study of health effects associated with chemical exposures. Secondary prevention and compliance and enforcement are not associated with monitoring and public reporting. DIF: Cognitive Level: Knowledge REF: Page 93

A mother brings her child to the nurse's office a few days before the first day of class for the new school year. The mother wants the child to begin school but says, "I'm going to take care of the immunizations tomorrow." The most important action the nurse should take is to: a. conduct a physical exam to determine whether the child is healthy. b. explain to the parent that all required immunizations must be given before the child will be allowed to enter school. c. let the child begin school but ensure that the school keeps the child separated from the other children. d. make sure the child does have an appointment for tomorrow.

b. explain to the parent that all required immunizations must be given before the child will be allowed to enter school. Community-oriented nursing practice interacts with many legal aspects of nursing in community health. Nurses employed by health departments or boards of education may deliver school and family health nursing, a specialty area of practice with its own legal aspects. School health legislation establishes a minimum of services that must be provided to children in public and private schools. Children must have immunizations against certain communicable diseases before entering school. DIF: Cognitive Level: Application REF: Pages 120-121

Mary Breckinridge established the Frontier Nursing Service (FNS) in 1925. One of Breckinridge's primary contributions to health care in the United States was: a. the Federal Emergency Relief Administration (FERA). b. introduction of the first nurse-midwives. c. the nursing process. d. occupational health nursing.

b. introduction of the first nurse-midwives. The unique pioneering spirit of the Frontier Nursing Service (FNS) influenced the development of public health programs to improve the health care of the rural and often inaccessible populations in the Appalachian sections of southeastern Kentucky. FNS nurses were trained in nursing, public health, and midwifery. Breckinridge, the founder of the FNS, introduced the first nurse-midwives into the United States. DIF: Cognitive Level: Knowledge REF: Pages 21-22

Public health nursing is a specialty with a distinct focus and scope of practice and requires a special knowledge base different from other specialty areas of nursing. A public health nurse would first be interested in: a. drug treatments for diabetes. b. populations with the highest rate of diabetes. c. educational materials for individuals with diabetes. d. new technology for diabetic care.

b. populations with the highest rate of diabetes. The primary focus that has differentiated public health nursing from other specialties has been the emphasis on the population rather than on individuals or families. The primary goal of public health—the prevention of disease and disability—is achieved by ensuring that conditions exist in which people can remain healthy. Diabetes care and educational materials are provided to individuals and families by a nurse in the community or institutional setting. DIF: Cognitive Level: Knowledge REF: Pages 4-5

Politics is simply described as: a. the ability to fund a special project. b. the art of influencing others. c. business conducted in the senate. d. interaction between the policymakers and the public.

b. the art of influencing others. 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). Law is a system of privileges and processes by which people solve problems based on a set of established rules. Policies are made not only by governments but also by institutions such as a health department or other health care agency, a family, or a professional organization. Politics are associated with funding, business conducted in the senate, and interaction between policymakers and the public but these are not the correct definition of the term. DIF: Cognitive Level: Knowledge REF: Page 110

A public health nurse has identified the need to make amendments in an existing law concerning the TB health assessment of individuals sentenced to serve jail terms on weekends only, based on the current criminal justice system practices and potential health risk to the free-living community. To raise this concern, the nurse has several paths to follow, but the amendment of any existing laws would ultimately be decided by: a. the executive branch of the government. b. the legislative branch of the government. c. local representatives. d. senate hearings.

b. the legislative branch of the government. Each of the government branches at the federal, state, and local levels plays an important role in developing and implementing health law and public policy. Concerned citizens have many avenues to address issues related to required laws and regulations as well as existing laws and regulations. However, each branch of government has separate and important functions. The legislative branch identifies problems, proposes debates, and passes and modifies laws to address identified problems. DIF: Cognitive Level: Comprehension REF: Page 110

The public health nurse deals with the examination of a community setting to determine the community's health status. Which of the following activities should be considered in the assessment phase? (Select all that apply.) a. Assisting communities to implement and evaluate plans and projects b. Building constituencies to work with the community c. Collecting, analyzing, and disseminating information d. Evaluating the social, economic, and environmental characteristics of the population e. Questioning the availability of health services to the community

c. Collecting, analyzing, and disseminating information d. Evaluating the social, economic, and environmental characteristics of the population e. Questioning the availability of health services to the community The core public health function of assessment includes the following: · Engaging in activities that involve the collection, analysis, and dissemination of information on both the health and health-relevant aspects of a community or specific population · Questioning, for example, whether the health services of the community are available to the population and are adequate to address needs · Monitoring the health status of the community or population and the services provided over time · Evaluating the social, economic, environmental, and lifestyle characteristics and practices of a population as well as the health services and capability available within the community to support good health for the population DIF: Cognitive Level: Knowledge REF: Page 8

What are some of the benefits of an electronic medical record in the public health setting? (Select all that apply.) a. Timely billing and financial reimbursement for services provided b. Improved public reporting of medication errors c. Coordination of referrals and facilitation of chronic disease management d. Improvement of quality measurement and monitoring e. Incorporation of protocol reminders for prevention, screening, and management of chronic disease

c. Coordination of referrals and facilitation of chronic disease management d. Improvement of quality measurement and monitoring e. Incorporation of protocol reminders for prevention, screening, and management of chronic disease The electronic medical record (EMR), a form of electronic health record, helps with ensuring patient safety and quality care. The availability of an EMR system allows the embedding of reminders so that the clinician can have access to practice guidelines at the very point of care for patients. Some additional benefits in public health, and these are some of the uses health centers make of such records, include the following: · 24-hour availability of records with downloaded laboratory results and up-to-date assessments · Coordination of referrals and facilitation of interprofessional care in chronic disease management · Incorporation of protocol reminders for prevention, screening, and management of chronic disease · Improvement of quality measurement and monitoring · Increased client safety and decline in medication errors DIF: Cognitive Level: Knowledge REF: Page 37

A Public Health Service nurse working for the Indian Health Service is working with a client diagnosed with cancer. The client uses sweat lodges to "cure the disease." The nurse understands that within the culture, disease is often perceived as disharmony with other forces, and clients may look to hot or cold treatments to resolve or cure a cancerous condition. The nurse is integrating her knowledge of the cultural organizing factor of: a. biological variations. b. communication. c. environmental control. d. space.

c. environmental control. Environmental control refers to the relationships between humans and nature. Cultures that view a human harmony with nature may perceive illness as a disharmony with other forces and believe that medicine can only relieve the symptoms rather than cure the disease. They would use the mind-body-spirit connection to heal from within. Such cultures look to naturalistic solutions such as herbs, hot and cold treatments, or acupuncture to resolve or cure a cancerous condition. Biological variations are the physical, biological, and physiological differences that exist and distinguish one racial group from another. Communication and space are not cultural factors associated with this scenario. DIF: Cognitive Level: Application REF: Pages 83-84

The community health nurse asks a client, "Have you ever been exposed to any radiation or chemical liquids, dust, mists, or fumes?" The nurse is conducting an: a. environmental advocacy activity. b. environmental compliance activity. c. environmental health assessment. d. environmental risk communication.

c. environmental health assessment. The key questions in an environmental health assessment should cover present and past conditions in work, home, and community environments. In an assessment of environmental exposures, the environment can be divided into functional locations such as home, school, workplace, and community. Nurses can act in the best interest of public health, and use their abilities as educators, advocates, and communicators to affect public policy, laws, and regulations that protect public health. Nurses can serve as a resource for state and federal legislators and their staff. DIF: Cognitive Level: Application REF: Page 94

A community-oriented nurse is interested in studying the hospital discharge data for facilities that typically provide services to members of the community where the nurse practices. The nurse accesses the National Hospital Discharge Survey database of the Department of Health and Human Services (DHHS) to identify data at national, regional, and local levels for comparison purposes. The government health care function being used by the nurse is: a. direct services. b. financing. c. information. d. policy setting.

c. information. The federal, state, and local governments carry out four health care functions, which fall into the general categories of direct services, financing, information, and policy setting. Collecting vital statistics, including mortality and morbidity data, gathering census data, and conducting health care status surveys are government functions that relate to the role of the government to provide information. The National Hospital Discharge Survey is a national data source on the health status of the U.S. population from the federal government, Department of Health and Human Services. Direct services may be provided to individuals or groups. Financing refers to government payment for health care services. Policy decisions about health care are made at all levels and within all branches of government. DIF: Cognitive Level: Application REF: Page 113

Community-oriented nursing in the twenty-first century has been influenced by historical events and government initiatives that support the approach of: a. caring for the disenfranchised. b. illness care. c. keeping the public healthy. d. preventing acute illness.

c. keeping the public healthy. The Healthy People program, recent disasters and acts of terrorism, and most recently the Patient Protection and Affordable Care Act of 2010 have brought renewed emphasis on prevention to public and community health nursing. During the late twentieth and early twenty-first century, challenges have continued to trigger growth and change in nursing in the community. Nurses continue to care for the vulnerable populations, provide illness care, and prevent acute illness while delivering care that is safe and high in quality. DIF: Cognitive Level: Application REF: Pages 27-28

The Food Quality Protection Act of 1996 increased the protection of infants and children from pesticide exposure from multiple sources by establishing a new health-based standard of reasonable certainty of "no harm" that: a. considers the cumulative impacts of all pesticides that may share a common mechanism of action. b. establishes a 15-year renewal process for all pesticides. c. prohibits taking into account economic considerations when children are at risk. d. uses an additional tenfold margin of safety when there are adequate data indicating developmental risks.

c. prohibits taking into account economic considerations when children are at risk. The Food Quality Protection Act of 1996 added new provisions related to protection of infants and children from pesticide exposure from multiple sources. The law established a health-based standard of reasonable certainty of "no harm" that prohibits taking into account economic considerations when children are at risk. Other safeguards under the FQPA include the use of an additional tenfold margin of safety when there are adequate data to assess prenatal and postnatal developmental risks, a 15-year renewal process for all pesticides to ensure that they have up-to-date scientific evaluations over time, and a cumulative impact consideration. DIF: Cognitive Level: Knowledge REF: Page 99

In 1902 Lillian Wald introduced the concept of school nursing to address the problem of student absenteeism by: a. enforcing the Department of Health's rules and regulations. b. excluding infectious children from the school environment. c. providing and obtaining medical treatment for absent students. d. providing shoes and clothing for absent students.

c. providing and obtaining medical treatment for absent students. In New York City in 1897, school medical examination focused on excluding infectious children from school. By 1902, more than 20% of children might be absent from school on any given day because no one was focused on providing or obtaining medical treatment so that absent children could return to school. Lillian Wald introduced an English innovation by providing nurses for schools. The first school nurses made home visits to teach parents and provide follow-up care to children absent from schools. DIF: Cognitive Level: Knowledge REF: Page 19

A nurse in community health that speaks out in a public hearing in support of changes to existing requirements for reporting any long-term effects of structural or organizational changes within the community's health care organizations would be demonstrating: a. legislative action. b. health policy. c. regulatory action. d. regulatory monitoring.

c. regulatory action. The regulatory process, although it may not be as visible as the legislative process, can also be used to shape laws and dramatically affect health policy. Because regulations flow from legislation, they have the force of law. The legislative process begins with ideas (policy options) that are developed into bills. At each level of government, the executive branch can and, in most cases, must prepare regulations for implementing policy and new programs. These regulations are detailed, and they establish, fix, and control standards and criteria for carrying out certain laws. DIF: Cognitive Level: Application REF: Page 124

A nurse in community health may have state-granted personal immunity for particular practice areas such as giving immunizations. If the state legislature has granted personal immunity to nurses employed by public agencies to cover all aspects of their practice, the legal theory that applies is: a. case law. b. respondeat superior. c. sovereign immunity. d. worker's right to know.

c. sovereign immunity. In some states, the legislature has granted personal immunity to nurses employed by public agencies to cover all aspects of their practice under the legal theory of sovereign immunity. Respondeat superior occurs when a nurse is directed to carry out a particular function and the employer becomes responsible for negligence, along with the individual nurse. Case law and the worker's right to know are not associated with the granting of personal immunity to nurses. DIF: Cognitive Level: Knowledge REF: Page 120

Parents can expect their children to be immunized for communicable diseases before entering kindergarten in the local school system because: a. primary care clinics focus on prevention. b. primary care clinics maintain adequate supplies of immunization. c. the public health system has mandates for immunization. d. the public health system provides good access to immunization clinics.

c. the public health system has mandates for immunization. Although the goal of the public health system is to ensure that the health of the community is protected, promoted, and ensured, overlap exists between this system and the primary care system. The overlap comes from the primary care system, which provides health promotion and disease prevention, and through the public health system, which provides personal primary care services for those who cannot afford to receive care elsewhere. The public health system is mandated through laws that are developed at the national, state, and local levels. Examples of public health laws instituted to protect the community are laws mandating immunization for all children entering kindergarten or laws requiring the constant monitoring of the local water supply to make sure that it meets set standards. DIF: Cognitive Level: Application REF: Page 40

The community-oriented nursing care function of policy development is supported by the ethical tenet of: a. competency. b. do no harm. c. what is ethical is also good policy. d. to each person a fair share.

c. what is ethical is also good policy. Policy development refers to the need to provide leadership in developing polices that support the health of the population, including the use of a scientific knowledge base in making decisions about policy. What is ethical should be the sole foundational pillar upon which community-oriented nursing is based. Moral leadership is critical to policy development because it is the highest human standard and therefore should result in ethical health care policies. Competency and do no harm refer to the assessment function of public health nursing. "To each person a fair share" applies to the assurance function of public health. DIF: Cognitive Level: Knowledge REF: Page 60

A public health nurse employed by the Department of Health is working on a team developing local health policy. The nurse recognizes which of the following about policy development? a. It is based on Socratic method. b. It is important that the policy has been approved by the American Nurses Association. c. It is primarily up to politicians to plan for health care. d. It is very similar to the nursing process.

d. It is very similar to the nursing process. 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 strategies require political action. The policy process includes the following: · Statement of a health care problem · Statement of policy options to address the health problem · Adoption of a particular policy option · Implementation of the policy product · Evaluation of the policy's intended and unintended consequences in solving the original health problem DIF: Cognitive Level: Application REF: Page 121

The federal act that grants authority to the Environmental Protection Agency (EPA) which controls the generation, transportation, treatment, storage, and disposal of hazardous waste and ultimately called for the phaseout of land disposal of hazardous waste under a later amendment was the: a. Emergency Planning and Community Right-to-Know Act (EPCRA). b. National Environmental Policy Act (NEPA). c. Pollution Prevention Act (PPA). d. Resource Conservation and Recovery Act (RCRA).

d. Resource Conservation and Recovery Act (RCRA). The Resource Conservation and Recovery Act (RCRA) gave the EPA the authority to control the generation, transportation, treatment, storage, and disposal of hazardous waste. The 1984 federal Hazardous and Solid Waste Amendment to this act required phasing out land disposal of hazardous waste. The NEPA established the Environmental Protection Agency (EPA) and a national policy for the environment and provides for the establishment of a Council on Environmental Policy. The EPCRA was enacted to help local communities protect public health safety and the environment from chemical hazards. The PPA focused industry, government, and public attention on reduction of the amount of pollution through cost-effective changes in production, operation, and use of raw materials. DIF: Cognitive Level: Knowledge REF: Page 103

A nurse works in a free clinic for uninsured low-wage employees in the community. The free clinic setting operates in a primary health care (PHC) strategy. The nurse would most likely focus on: a. Incidence of the disease. b. Physician orders for the individual. c. Pathophysiology of the disease. d. Self-care/management.

d. Self-care/management. Primary health care (PHC) is generally defined more broadly than is primary care. It includes a comprehensive range of services including public health; prevention; and diagnostic, therapeutic, and rehabilitative services. PHC is essential care made universally accessible to individuals and families in a community. Health care is made available to them with their full participation and is provided at a cost that the community and county can afford. PHC encourages self-care and self-management in health and the social welfare of daily life. PHC does not provide a focus on incidence of disease, pathophysiology of disease, or individual orders for care. DIF: Cognitive Level: Application REF: Page 39

The federal agency most responsible for improving the health status of the American people is the: a. Office of Health Preparedness. b. Office of Global Affairs. c. Food and Drug Administration. d. U.S. Department of Health and Human Services.

d. U.S. Department of Health and Human Services. The U.S. Department of Health and Human Services (USDHHS) is the federal agency most heavily involved with the health and welfare concerns of U.S. citizens. The department includes the Office of the Secretary, 11 agencies, and a program support center. It is charged with regulating health care and overseeing the health status of America. Newer areas in the HHS are the Office of Public Health Preparedness, the Center for Faith-Based and Community Initiatives, and the Office of Global Affairs. The Office of Public Health Preparedness was added to assist the nation and states to prepare for bioterrorism after September 11, 2001. DIF: Cognitive Level: Knowledge REF: Page 40

Caring and the ethic of care is a core value of nursing in community health. This ethical view was developed in the mid-1980s and early 1990s in response to the technical advances in health care science and the desire of nurses to: a. apply gender-related voices to moral judgment. b. apply principles of utilitarianism. c. differentiate distributive justice from beneficence. d. differentiate nursing practice from medical practice.

d. differentiate nursing practice from medical practice. The view of caring and the ethic of care that emerged in the mid-1980s and early 1990s was a response to the technological advances of science and the desire of nurses to differentiate nursing practice from medical practice. It is closely interrelated with feminist ethics. Caring and the ethic of care are core values of public health nursing. These concepts are not associated with utilitarianism or the differentiation between distributive justice and beneficence. DIF: Cognitive Level: Knowledge REF: Page 58

In caring for a young adult from West Africa, the community nurse is introduced to another individual who is referred to as "auntie." A culturally competent nurse who is aware of the basic organizing factor of culture related to social organization would: a. assess the competence of the "auntie" to care for the young adult. b. assume that the "auntie" is related to one of the young adult's parents. c. declare that the young adult is capable of making personal health decisions. d. find out who is considered to be a member of the family.

d. find out who is considered to be a member of the family. Social organization is one of the basic organizing factors related to cultures. It refers to the way in which a cultural group structures itself around family to carry out roles and functions. In some cultures, family may include people who are not actually related to one another. The nurse should find out who is considered to be in the family, who the key decision makers are, and if the needs of the family supersede those of the individuals in the family. Nurses should advocate for the individual, so that when families make decisions, the individual's needs are also considered. DIF: Cognitive Level: Application REF: Page 83

When applying the nursing process to environmental health, the community health nurse would: a. conduct a focused assessment on the presenting problem. b. coordinate interventions with the physician only. c. examine criteria that include only the client's immediate response. d. include outcome measures that mitigate and eliminate the environmental factors.

d. include outcome measures that mitigate and eliminate the environmental factors. If the community health nurse suspects that a client's health problem is being influenced by environmental factors, the nurse should follow the nursing process and note the environmental aspects of the problem in every step of the nursing process. For instance, in goal setting, the nurse would include outcome measures that mitigate and eliminate the environmental factors. DIF: Cognitive Level: Application REF: Page 94

In applying Ethical Principles for Effective Advocacy, the ethical principle that empowers the client (groups or communities) to make knowledgeable decisions is: a. act impartially and offer frank, independent advice. b. act in accordance with the client's wishes and instructions. c. act in the client's best interest. d. keep the client properly informed.

d. keep the client properly informed. The Ethical Principles for Effective Advocacy identifies six ethical principles for effective advocacy: 1. Act in the client's best interest. 2. Act in accordance with the client's wishes and instructions. 3. Keep the client properly informed. 4. Carry out instructions with diligence and competence. 5. Act impartially and offer frank, independent advice. 6. Maintain client confidentiality. By following the third principle, "Keep the client properly informed," the client is empowered to make knowledgeable decisions. DIF: Cognitive Level: Application REF: Page 64

The most significant commonalities between the ANA's Scope and Standards of Public Health Nursing Practice and the Public Health Code of Ethics assert that advocacy is conducted in the: a. assertiveness arena. b. education arena. c. litigation arena. d. policy arena.

d. policy arena. The ANA's Code of Ethics for Nurses states, "The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient," whereas the Public Health Code of Ethics states, "Public health should advocate and work for the empowerment of disenfranchised community members, aiming to ensure that the basic resources and conditions necessary for health are accessible to all." The Code of Ethics for Nurses (American Nurses Association, 2001) emphasizes political action as the mechanism to effect social justice and reform regarding homelessness, violence, and stigmatization. There are commonalities between the Code of Ethics for Nurses and the Code of Ethics for Public Health. Both codes provide general ethical principles and approaches that are enduring and dynamic. DIF: Cognitive Level: Application REF: Pages 61-63

A nurse in community health seeks to determine whether the visit with an older adult Asian woman is successful. The nurse has not encountered many clients from this culture. An effective way to judge whether a cultural encounter has been effective would include the nurse's sense that the visit was successful, the nurse and client experience little or no stress, and: a. the client says "thank you." b. the client nods frequently. c. the client's family does not complain. d. tasks are done efficiently.

d. tasks are done efficiently. Having cultural competence is not the same thing as being an expert on the culture of a group that is different from one's own. Nurses can develop cultural competence by reading about, taking courses on, and discussing different cultures within multicultural settings. A successful encounter may be judged on the basis of the following four aspects: 1. The nurse feels successful about the relationship with the client. 2. The client feels that interactions are warm, cordial, respectful, and cooperative. 3. Tasks are done efficiently. 4. The nurse and client experience little or no stress. DIF: Cognitive Level: Application REF: Page 77

In a community clinic that screens and treats individuals for cardiovascular disorders, the nurse practicing public health/population-focused nursing would most likely ascertain: a. a holistic treatment plan. b. a specific clinical diagnosis. c. individual dietary interventions for cardiovascular disorders. d. the prevalence rate of cardiovascular disorders among various groups.

d. the prevalence rate of cardiovascular disorders among various groups. A public health nurse in a community clinic engaged in population-focused practice would ask the following questions: · What is the prevalence rate of the diagnosis or condition among various age, race, and gender groups? · Which subpopulations have the highest rates of untreated diagnosis or condition? · What programs could reduce the problem of untreated diagnosis/condition and decrease the risk for further morbidity and mortality? Public health nurses are typically concerned with more than one subpopulation, and they often deal with the health of the entire community. Assessment, one of the public health core functions, is a logical first step in examining a community setting to determine its health status. DIF: Cognitive Level: Knowledge REF: Pages 7-8

A occupational health nurse is consulting with senior management of a local industrial facility. When discussing work-related illness and injury, the nurse should include which of the following as physical agents? Select all that apply) A. Noise B. Age C. Lighting D. Viruses E. Stress

A and C

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.

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.

A newly hired nurse occupational health nurse at an industrial facility performing an initial workplace assessment. Which of the following should the nurse determine when conducting a work site survey? A. Work practices of employees B. Past exposure to specific agents C. Past jobs of individual employees D. Length of time working in current role

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

A nurse manager at a community agency is developing an orientation program for newly hired nurses. When discussing the differences between community-based and community-oriented nursing, which of these are community-based nursing? Select all that apply A. A home health nurse performing wound care for a client who is immobile. B. An occupational health nurse providing classes on body mechanics at a local industrial plant. C. A school nurse teaching a student who has asthma about medications D. A parish nurse teaching a class on low-sodium cooking techniques. E. A mental health nurse discussing stress management techniques with a support group.

A and C; the other three are community-oriented nursing, which involves health care of individuals, families, and groups to improve the collective health of the community. Community-based nursing involves the management of acute and chronic conditions in a community setting.

A nurse at a community clinic is conducting a well-child visit with a preschool age child. The nurse should identify which of the following as a manifestation of child neglect? Select all that apply A. Underweight B. Healing spiral fracture of the arm C. Genital irritation D. Burns on the palms of the hands E. Poor hygiene

A and E; spiral fracture is physical abuse; genial irritation is sexual abuse; burns on the palms is physical abuse

A nurse is collecting data to identify health needs in the local community. Which of the following are examples of secondary data the nurse should review? Select all that apply A. Birth statistics B. Previous health survey results C. Windshield survey D. Community forum E. Health records

A, B, and E; C and D are methods of collecting direct data.

A nurse is preparing to conduct a windshield survey. Which of the following data should the nurse collect as a component of this assessment? Select all that apply A. Ethnicity of a community B. Individuals who hold power within the community C. Natural community boundaries D. Prevalence of disease E. Presence of public protection

A, C, and E; B as a participant observer; D through morbidity rates of the community

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

A,B,C,D

The role of the nurse who wants to become more active in environmental health could include which of the following (select all that apply)? A) Assessing farmworkers for pesticide exposure and providing pesticide risk education. B) Conducting epidemiologic investigations as a public health nurse. C) Developing corporate policy to protect workers from unsafe levels of toxic agents. D) Organizing the local community to encourage landlords to remove lead-based paint. E) Working as a skilled risk communicator for a local chemical manufacturer.

A,B,C,D,E

The Quad Council of Public Health Nursing identified eight principles that distinguish the public health nursing specialty from other nursing specialties, including which of the following (select all that apply)? A) Collaboration with other professions, organizations, and entities. B) Optimal use of available resources. C) Population-based unit of care. D) Primary obligation to work for the good of individuals and families. E) Engagement with clients as an equal partner.

A,B,C,E

Emerging infectious diseases may arise as a result of factors operating singly or in combination, and these factors may include which of the following (select all that apply)? A) Environmental changes. B) Host behavior. C) Improved surveillance. D) Microbial adaptation. E) Public health infrastructure deterioration.

A,B,D,E

A client diagnosed with human papillomavirus (HPV) infection states, "I'm not concerned, I know the warts disappear after a while." The nurse should counsel the client regarding which of the following? Select all that apply. A) Link between HPV and cervical cancer. B) Status of HPV infection as a reportable disease. C) Need to eliminate the warts. D) Serious complications of HPV infection for men. E) Lack of cure for HPV infection.

A,C,E

A nurse is working with a client who has it systemic lupus erythematossus and recently lost her health insurance. Which of the following is an appropriate action by the nurse in the implementation phase of the case management process? A. Coordinating services to meet the clients needs B. Comparing outcomes with original goals C. Determining the clients financial constraints D. Clarifying roles of interprofessional team members

A; B is appropriate in the evaluation phase; C is appropriate in the assessment phase; D is appropriate in the planning phase of the case management process.

A nurse developing a community health program is determining barriers to community resource referrals. Which of the following is an example of a resource barrier? A. Costs associated with services B. Decreased motivation C. Inadequate knowledge of resources D. Lack of transportation

A; B, C, and D are all examples of client barriers to community referrals.

14. A school nurse listens as one student talks about another student being upset because his father frequently spanks him with a leather belt that leaves big marks on the student's back. But the student begs the nurse not to tell anyone because he promised the friend that the information would never be shared. Which of the following actions should be taken by the nurse? a. Ask the student if abuse has occurred. b. Call in the named student and ask him to remove his shirt. c. Discuss the conversation with the student's parents. d. Notify the legal authorities.

ANS: D When the nurse identifies a child who may be abused or who receives information from someone else that a child may have been abused, the nurse must contact the appropriate legal authorities and the school's principal. Asking the student about the abuse will not always elicit a truthful answer, because children will protect their parents. A confidential file should be made about the incident; however, the nurse should let the government authorities, usually the state or county child protection department, look into the suspected case. In all cases, the child should be protected from harm, and those who have no right to know that child abuse or neglect is suspected should not be given any information. DIF: Cognitive Level: Apply (Application) REF: p. 576

A 6-year-old is brought to the emergency department with a full-body rash and fever. During the nursing assessment, which of the following findings would be most relevant to recognizing the case as potential smallpox rather than varicella? A) Fever has responded to acetaminophen, and the child is playful when temperature is not elevated. B) Fever of 101° F was present for several days before the rash appeared. C) Low-grade fever (100° F or less) has been present ever since the rash became obvious. D) Rash is primarily on the trunk of the body.

A community-oriented nurse introduces a community partnership group to the Healthy People 2020 information access objective to use electronic personal health management tools. This is an example of: A) Meta-analysis of research evidence. B) Primary prevention using evidence-based practice (EBP). C) Secondary prevention using EBP. D) Tertiary prevention using EBP.

In an effort to address West Nile virus, a community increased livestock immunization, began a vector control program, and initiated a community campaign to eliminate standing water reservoirs. This best exemplifies communicable disease control through: A) Health education. B) Multisystem approach. C) Improved public health infrastructure. D) Reduction of environmental hazards.

A nurse is interviewing for a position at the local health department. When preparing for the interview, the nurse should find that which of the following are responsibilities of this agency? Select all that apply A. Managing the Women, Infants, and Children programs B. Providing education to achieve community health goals C. Coordinating directives from state personnel D. Reporting communicable diseases to the CDC. E. Licensing of registered nurses

B and C; A and D are responsibilities of state departments; E is the responsibility of the state boards of nursing.

A nurse is creating partnerships to address health needs within the community. The nurse should be aware that which of the following characteristics must exist for partnerships to be successful? Select all that apply A. A leading partner with decision-making authority. B. Flexibility among partners when considering new ideas. C. Adherence of partners to ethical principles. D. Varying goals for the different partners. E. Willingness of partners to negotiate roles.

B,C,and E; shared power must exist for a partnership to be successful; shared goals must exist for a partnership to be successful

A school nurse is planning health promotion and disease prevention activities for the upcoming school year. In which of the following situations is the nurse planning a secondary prevention strategy? A. Placing posters with images of appropriate hand hygiene near restrooms B. Routinely checking students for pediculosis throughout the school year C. Implementing age-appropriate injury prevention programs for each grade level D. Working with a dietician to determine carbohydrate counts for students who have diabetes mellitus

B; A and C are primary prevention; D is tertiary

A newly hired public health nurse is familiarizing himself with the levels of disaster management. Which of the following actions is a component of disaster prevention? A. Outlining specific roles of community agencies B. Identifying community vulnerabilities C. Prioritizing care of individuals D. Providing stress counseling

B; A is a component of disaster preparedness; C is a component of disaster response; D is a component of disaster recovery

A Nurse is reviewing the various roles of a community health nurse. Which of the following is an example of a nurse functioning as a consultant? A. Advocating for federal funding of local health screening programs. B. Updating state officials about health needs of the local community. C. Facilitating a discussion of a clients ongoing needs with an interprofessional team. D. Performing health screenings for high blood pressure at a local health fair.

B; A is a nurse functioning as a charge agent; C is an example of a case manager; D is an example of a nurse functioning as a caregiver

A community health nurse is determining available and needed supplies in the event of a bioterrorism attack. The nurse should be aware that community members exposed to anthrax will need access to which of the following medications? A. Metronidazole (Flagyl) B. Ciproflaxacin (Cipro) C. Zanamivir (Relenza) D. Fluconazole (Diflucan)

B; Metronidazole is used for trichomoniasis, skin infections, and septicemia; zanamivir is used to treat influenza; fluconazole is used to treat candidiasis

A nurse is completing a needs assessment and beginning analysis of data. Which of the following actions should the nurse take first? A. Determine health patterns within collected data. B. Compile collected data into a database. C. Ensure data collection is complete. D. Identify health needs of the local community.

B; in order to adequately and appropriately analyze collected data the nurse must first compile collected data into a database.

A nurse is conducting health screenings at a statewide health fair and identifies several clients who require referral to a provider. Which of the following statements by a client indicates a barrier to accessing home health care? A. "I don't drive, and my son is only available to take me places in the mornings." B. "I can't take off during the day and the local after-hours clinic is no longer in operation." C. "Only one doctor in my town is a designated provider by my health maintenance organization." D. "I would like to schedule an appointment with the local doctor in my town who speaks Spanish and English."

B; inconvenient hours make scheduling a follow-up appointment challenging and indicates a barrier to accessing health care for this client.

A nurse is caring for a client who is from a different culture than himself. When beginning the cultural assessment, which of the following actions should the nurse take first? A. Determine the client's perception of his current health issues. B. Gather data about the client's cultural beliefs. C. Determine how the client's culture may impact the effectiveness of nursing actions D. Gather information about previous client interactions with the healthcare system.

B; the nurse's first action when beginning a cultural assessment is to collect self-identifying data about the client, including specific information about how the client's cultural influence family structure, food patterns, religious preferences, and health practices.

A client newly diagnosed with human papillomavirus (HPV) infection, herpes simplex virus 2 (HSV-2) infection, and syphilis asks, "Okay, so how do I get rid of all this stuff?" In developing a plan of care, the nurse recognizes that it is essential to address: A) Correct use of condoms to prevent transmission of all sexually transmitted diseases (STDs). B) Cures for each of the STDs identified. C) Risk of skin-to-skin contact in transmitting the identified STDs. D) Safety of sexual contact in the absence of lesions.

A local health department in the Midwest reports cases of certain diseases to the state health department for inclusion in the National Notifiable Diseases Surveillance System (NNDSS). From the perspective of community-level disease monitoring, which of the following 3-year trends in incidence rates for hepatitis A would be of local, state, and national interest? A) 1998 = 2/100,000; 1999 = 3/100,000; 2000 = 1/100,000 B) 1998 = 4/100,000; 1999 = 8/100,000; 2000 = 6/100,000 C) 1998 = 12/100,000; 1999 = 8/100,000; 2000 = 31/100,000 D) 1998 = 16/100,000; 1999 = 24/100,000; 2000 = 9/100,000

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.

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

After consulting with the health department director, a public health nurse collaborates with a housing advocate service and legal counsel on behalf of the nurse's clients who live in substandard housing under fear of eviction. The nurse is applying the _______ component of the nursing process to a _______ level of practice. A) Evaluation + systems. B) Assessment + community. C) Implementation + systems. D) Diagnosis + community.

Although infectious disease epidemics are still the major cause of death worldwide, they have subsided in the United States because of improvements in nutrition and sanitation, the discovery of antibiotics, and the development of vaccines. Infectious diseases have not vanished, however, and remain a continuing cause of concern. Healthy People 2020 has a number of objectives aimed at reducing these illnesses because of the morbidity, mortality, and costs associated with infectious diseases. One such costly disease trend related to an increase in the performance of invasive diagnostic and surgical procedures, the use of broad-spectrum antibiotics, and treatment with immunosuppressive drugs is the rise of: A) Escherichia coli 0157:H7. B) Multisyndrome effect. C) Hospital acquired infections. D) Severe acute respiratory syndrome.

An example of secondary prevention of infectious disease is: A) Malaria chemoprophylaxis. B) Pneumocystis carinii pneumonia chemoprophylaxis for people with AIDS. C) Quarantine. D) Restaurant inspections.

If the two major goals of Healthy People 2020 are to be achieved, collaboration is essential for public health nursing practice, and collaboration with existing groups at the local level is encouraged for which of the following reasons? A) The federal government is ultimately responsible for the health status of the nation. B) The public demands that the government protect the people. C) Public health departments do not have the resources to accomplish these goals independently. D) State health agencies must take a universal approach to achieving objectives.

A nurse is preparing an education program on disease transmission for employees at a local day care facility. When discussing the epidemiological triangle, the nurse should include which of the following as agents? Select all that apply A. Resource availability B. Ethnicity C. Toxins D. Bacteria E. Altered immunity

C and D; resource availability as an environmental factor; ethnicity as a host factor; altered immunity as a host factor.

A community health nurse is implementing health programs with several populations in the local area. In which of the following situations is the nurse using primary preventions? A. Performing a home safety check at a client's home B. Teaching healthy nutrition to clients who have hypertension C. Providing influenza immunizations to employees at a local preschool D. Implementing a program to notify individuals exposed to a communicable disease.

C; A and D are secondary prevention; B is tertiary prevention

A nurse is preparing a community health program on communicable diseases. When discussing modes of transmission, the nurse should include which of the following as an airborne illness? A. Cholera B. Malaria C. Influenza D. Salmonellosis

C; cholera is a waterborne illness; malaria is a vector-borne illness; salmonellosis is a foodborne illness

A nurse identifies higher-than-normal levels of lead when screening a 3-year-old child. The nurse works with the local health department to put together a team to address the environmental issues responsible for the child's abnormal lead level. Team members should include the following specialists: A) Epidemiologist, pediatric specialist, and sanitarian. B) Laboratory specialist, contractor whose bid for lead reduction work is the lowest, and public health lead reduction specialist. C) Public health sanitarian, pediatric generalist, and plumbing inspector. D) Specially trained housing inspector, pediatric specialist, lead-based paint intervention team, and laboratory specialists to test the child's home and the surrounding neighborhood.

A nurse is talking to a client who asks for additional information about hospice. Which of the following is an appropriate statement by the nurse? A. "Clients who require skilled nursing care at home quality for hospice care." B. "One function of hospice is to provide teaching to clients about life-sustaining measures." C. " Hospice assists clients to develop the skills needed to care for themselves independently." D. "A component of hospice care is to control the client's symptoms."

A population-level tertiary prevention intervention typically carried out by nurses caring for those with communicable disease in the community is: A) HIV test results counseling. B) Needle exchange. C) Partner notification. D) Instruction in standard precautions.

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.

A school nurse is teaching a class of sophomores about the relationship between the risk of sexually transmitted disease (STD) and risk-taking behaviors. A key point to include is: A) All STDs are easily preventable with consistent condom use. B) Once a young woman is pregnant, she is no longer at risk for most STDs. C) STDs are most likely to be transmitted during a student's initial sexual encounter. D) Use of alcohol and drugs makes a student more likely to make decisions that result in exposure to and infection with STDs.

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